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- [00:06]
A
Hi, guys. Welcome back to another episode of the Blondest podcast. I am your host, Savannah Boda. I have my dear friend here today. Again, because you guys loved our episode so much, we have a lot of questions, so we're get into it. Have you had any, like, revelations or any new thoughts or new quotes to share with us since you've seen me seven days ago? I don't even think it's been that long.
- [00:30]
B
Yeah, it's been a very short period of time. Those things kind of just come to my brain while we're talking. So maybe I'll come up with something, but I don't have anything on the top of my mind right now.
- [00:39]
A
Amazing. I love it. All right, so our first question for you tonight. Let's see here. We'll start with the most common one that we have on here is, are you single?
- [00:51]
B
Oh, that's funny. No, I am happily married. I have been with my wife total of probably about 17 years.
- [00:59]
A
Amazing.
- [01:00]
B
And we've been married for 15 years.
- [01:02]
A
Aww. So when you know, you know.
- [01:04]
B
That's right. I met her after the first year of medical school. And I don't know if everybody remembers it, but Fireside pies on Henderson.
- [01:13]
A
Yes.
- [01:14]
B
And the porch. She was having dinner at the porch. I was having dinner at Fireside. We were connected by a common friend, and then we went wakeboarding the entire next day.
- [01:23]
A
Awesome. And you knew.
- [01:24]
B
That's what sealed the deal.
- [01:25]
A
Aw, that's amazing. And you have four kids.
- [01:28]
B
We have four kids. 12 year old, 10 year old, 7 year old, and a 4 year old.
- [01:33]
A
I know. Our babies are, like, so close in age.
- [01:35]
B
That's right.
- [01:36]
A
Yeah.
- [01:36]
B
Archer and Cyrus.
- [01:37]
A
Yeah. I love that. That's amazing. So true love does exist.
- [01:40]
B
It sure does. Yep. It's great.
- [01:43]
A
I want to know, have you ever done surgery on her? Is that, like, allowed?
- [01:46]
B
I have. It's. It's. I would say that it's not great practice. It's kind of. It's discussed and it's kind of frowned upon. But easy little things are not really that big.
- [01:58]
A
Like doing, like, a bluff or like a little.
- [02:00]
B
Exactly. I think the problem is you don't have objectivity when you're. When there's a problem that arises.
- [02:06]
A
Mm. You're like, save them. Even though.
- [02:08]
B
Right. You panic. You're. You're the husband or the, you know, the father, the brother, whatever that patient is to you. You're more emotional rather than the doctor that thinks objectively in. In times of emergency. So that's. I think that's why they. They kind of frown upon that.
- [02:24]
A
But at least. It's like plastics is like, least amount of, like, life or death. Like, it makes sense if you're like, trauma, you know, trauma surgeon. And then like, that's true. Someone got in, like, a car accident.
- [02:36]
B
The chances of something really bad happens in our line of work is very rare.
- [02:39]
A
Yeah. You have to be, like, really bad at what you're doing or the patient's, like, in really bad health.
- [02:43]
B
Or you're. Exactly. You have to choose your patients improperly. Yeah. And that's. I mean, honestly, that's pretty easy to do. We don't have a lot of people with severe medical problems that walk into our office in the midd. That you see something, that's what your training's for. You just say, I'm sorry.
- [02:56]
A
Would you ever put implants in someone that was like, 80.
- [03:00]
Years old?
- [03:02]
B
I don't have a pure objection to operating on people because of their age. It would have to be more because of what their energy was if they were. If they came in bouncing off the walls, super energetic and intellectually sharp, then they're good, then they're fine. And they don't have, you know, they're not ridden with medical problems. I would say that's totally fine. Age by itself is not a contraindication to do surgery.
- [03:24]
A
It's just like your cognitive decline or like how aware you are.
- [03:28]
B
Yeah. That kind of brings a story to mind. There was a lady who came in. She was on a couple of sort of psychiatric meds that were not necessarily like a stop sign for doing surgery, but.
- [03:42]
We probably should have asked more questions. Towards the preoperative visit, it came out that she had dementia and that she was on a lot of medications that were kind of helping her cognitive status. And when you get general anesthesia, you can have cognitive decline.
- [03:58]
A
Oh, wow.
- [03:59]
B
You can. You can send some of those patients into spiral if they're already like, Alzheimer's, Parkinson's, you know, all kinds of different causes of dementia. So we're glad that we discovered that. That's amazing because in person, when you're talking to her, she was very.
- [04:15]
A
You wouldn't know she's with it.
- [04:16]
B
Yeah.
- [04:17]
A
That's wild.
- [04:18]
B
But that was, you know, that was held up by her meds, and she was doing very well. And patients don't know that.
- [04:23]
A
Yeah. When you don't know that you're not doing well because you're on meds. Right.
- [04:27]
B
That's right. Yeah. They also just don't know that that's an important thing. To avoid. Right.
- [04:32]
A
Wow, that's interesting.
- [04:34]
B
There is a contraindication to doing surgery into the younger years. That, that is where age plays more of a role.
- [04:41]
A
Like young children, like not children, but like someone that say they turn 18 and like, because we live in Dallas, let's be real. I remember when I was in high school, like many girls, their high school graduation gift was tits.
- [04:52]
B
Yeah. Breast implants for high school. That's a little bit creepy, but that's okay.
- [04:56]
A
I know. It's literally, you've heard it.
- [04:59]
B
That's who's paying for the boobs. Right.
- [05:01]
A
The dad. Right.
- [05:02]
B
That's kind of strange.
- [05:03]
A
I know. I wanted a reduction. I was like, I'm asking to get mine taken out, not get them in. But I was like, no, you can pay for that when you have your own money.
- [05:09]
B
Yeah. I mean, I would say 18 is probably, you know, that's when you become an adult. By societal standard, I would say that's probably the, the lower limit of where you should be doing breast augmentation. There are some other surgeries. You also have to be careful that you don't operate on a body part that is still in development.
- [05:27]
A
Yeah. When do your breasts stop developing?
- [05:31]
B
Probably 15, 16, 17.
- [05:34]
A
So that's what you got.
- [05:34]
B
It's different for everybody. But you don't want to like say a 14 year old comes in and wants a breast reduction or a breast augmentation. Like, absolutely not.
- [05:45]
The breast is still developing and you can cause long term problems with the scarring and everything that's introduced by surgery. Wow. So that's really important too.
- [05:54]
A
That is really important.
- [05:55]
B
That's not really relevant for practice though. Like that almost never. I would say that never happens. I would say the more common thing is facial surgery, especially with young kids with craniofacial anomalies. You have to study the different phases of skeletal maturity of the craniofacial skeleton. It's part of our training. And you know, like you can't operate on certain parts of the face until it's done because you will stunt growth.
- [06:21]
A
That's crazy.
- [06:22]
B
Cleft lip and cleft palate are the best examples of that.
- [06:25]
A
Wow.
- [06:26]
B
So when you do a cleft lip repair, you're. You're doing that for oral competence and for speech at a young age.
- [06:32]
A
Yeah.
- [06:33]
B
But if you, the data shows that if you do a cleft lip repair or a cleft palate repair at a young age, it will also stunt maturity of the patient's mid face.
- [06:44]
A
Wow. So it's like kind of a lose Lose ish situation.
- [06:49]
B
It's really tough when you see patients come in from developing countries that don't have access to medical care. They'll be well into their teens or twenties when they get their cleft repair. And those patients actually look the best.
- [07:03]
A
Wow.
- [07:03]
B
But they usually have speech problems. Sometimes they have.
- [07:07]
Problems eating and they have malnutrition because they can't form that same suck reflex. And the things that you take for.
- [07:14]
A
Granted, what does that happen from. Like to get a cleft.
- [07:17]
B
Cleft palate. Oh, gosh. That's an embryogenesis thing.
- [07:21]
A
Is this more common in certain cultures? In certain areas of the world, it is.
- [07:26]
B
Certain races are more predisposed to having clefts.
- [07:33]
It's a problem with the fusion of your palatal shelves. This is getting nerdy.
- [07:37]
A
Yeah. I'm very curious because I feel like you don't hear about a lot of cases in America.
- [07:42]
B
You don't.
- [07:43]
A
It's more like more foreign countries. Right.
- [07:46]
B
I forget the incidence. I would say it's most common in African, American and Asian countries. You don't see it in Caucasian people as much.
- [07:55]
A
You think it's because of the nutrients they're getting?
- [07:58]
B
I think it's purely genetic, really.
- [08:00]
A
Okay.
- [08:00]
B
I think it's genetic.
- [08:01]
A
That's wild.
- [08:03]
B
I don't know that they've actually identified a gene, but it follows, you know, Mendelian characteristics.
- [08:11]
A
Yeah, that makes sense.
- [08:12]
B
Passed down by genetics.
- [08:13]
A
I had no idea that operating on it younger could cause a delay.
- [08:17]
B
Right. Yeah. You shouldn't operate on something without knowing the, you know, the time at which it's sort of mature.
- [08:23]
A
So when you go become a plastic surgeon, you have to learn everything, every single thing that you can do with plastics.
- [08:29]
B
Yep. We are, I would say we are anatomist first before we are surgeons.
- [08:35]
A
And then you get to, like, kind of see what you're best at and like the most.
- [08:37]
B
That's right. Yep. When you. When you go through a hospital, surgeons are so sub specialized based on the organ system or the part of the body that they work on. Plastic surgeons, because we operate all over the body, have to be pretty well versed in just about all of. All of the anatomy.
- [08:54]
A
That's crazy.
- [08:55]
B
There are a few areas where we don't really delve into, like intracranial stuff. That's not really ever an issue.
- [08:59]
A
Yeah.
- [09:00]
B
But the majority of the human body, you have to be very well versed on otherwise. We talked about it last time. Surgical hesitance is rooted in anatomical ignorance.
- [09:12]
A
Yeah, that's so true. That's crazy. Wow, that's so interesting to know. So if someone lost a finger, would that be considered a plastic surgery repair? Because you'd want to get a finger that looks like your finger that's more like a static. But also you need a finger.
- [09:29]
B
It's very tough. It's very tough and.
- [09:34]
Somewhat unnecessary to reconstruct a finger that's been lost.
- [09:37]
A
Yeah.
- [09:38]
B
But we do what's called replantation. So if you come in after an injury that takes off your finger within a few hours, then the success rate of us replanting, putting the finger back on is actually pretty good.
- [09:52]
A
Wow.
- [09:52]
B
It depends on the skill level of the surgeon and the number of operations he's done. But you get under a microscope and you basically sew the tiny little blood vessels and the tiny little nerves together with a very small piece of suture.
- [10:04]
A
That's amazing.
- [10:05]
B
Yeah, it's very cool. What can be done.
- [10:07]
A
And now they're growing, like body parts in labs, which is crazy.
- [10:10]
B
They are growing tissue. There's a certain. There's. There's a thing called polarity with tissue. If you think of, like, cutting a piece of skin off your body and set it on the table, the top.
- [10:20]
A
Never thought about that.
- [10:21]
B
But the top of the skin is different than the bottom of the skin, so it has polarity.
- [10:26]
A
Okay.
- [10:27]
B
If you took your liver and put it on the table, it doesn't matter which way you put it. Your liver is the same. It's homogeneous all the way through. So the. The homogeneous or the tissues without polarities have been grown successfully. And it also helps, you know, with things like liver transplant. Yeah.
- [10:45]
A
More candidates, more people that are able to get access. That's amazing. Wow. I always wanted to know why you might not know this. Cause you're not a veterinarian. But why do lizards grow body parts back? What do they have so special about them that they can grow their tail back?
- [11:02]
B
Gosh, that's a good question.
- [11:03]
A
Or like some animals, like, they're able to do that.
- [11:04]
B
I would imagine that there's just sort of a growth center that the whole, like, losing your tail thing and it flipping around is a distraction so you can get away from the predator. And then I would imagine that there's just a growth center.
- [11:15]
A
That's crazy.
- [11:16]
B
Stem is a bunch of collection of stem cells, or who knows, right there in the stub.
- [11:19]
A
We should harvest that, make a skincare product.
- [11:21]
B
That's a good call.
- [11:22]
A
Kind of like lizard tail.
- [11:23]
B
That's a lot of the regenerative products that are available for plastic surgeons to Use in wound care actually originate from stem cell derived body parts.
- [11:32]
A
Wow.
- [11:34]
B
You see all kinds of stuff. Animal products, you see.
- [11:36]
A
Yeah.
- [11:37]
B
Foreskin, foreskin, fetal foreskin.
- [11:39]
A
I'm sure Cyrus is in a serum somewhere because they're like, do you want to keep the. They're going to charge me to keep his foreskin.
- [11:44]
B
Do you know that they do that? Yeah.
- [11:46]
A
I was like, why am I have to pay money to keep my child's, like, foreskin?
- [11:50]
B
Were you at the time Osiris was delivered four years ago?
- [11:53]
A
So, yeah.
- [11:54]
B
So did they offer you to leave the umbilical cord attached for longer? So more of the umbilical. Not only the blood supply, but the stem cells could circulate into Cyrus's body. I think that's really thoughtful.
- [12:07]
A
I do too.
- [12:08]
B
That's really cool.
- [12:09]
A
So the least they could do after cutting seven layers of muscle, Right? I know when you do a tummy tuck, it's not seven layers, right? No. Because you only cut.
- [12:16]
B
We don't cut any muscle on a tummy tuck.
- [12:18]
A
I didn't know that.
- [12:19]
B
Now, occasionally, the one exception is if we do a hernia repair. Okay, that's different. That's not a standard tummy tuck. But if we do a hernia repair, then we're repairing the muscle and you're, you know, there's a connection between the outside and the inside of the abdomen.
- [12:31]
A
That's crazy.
- [12:32]
B
But no, with a tummy tuck, you're superficial. You're under the skin, you're gliding along the muscle.
- [12:37]
A
So whenever I decided to do that, you're like, my next. We'll see if I have more children. I hope I do.
- [12:43]
Yeah. That won't be as bad, right?
- [12:45]
B
Wasn't that one of the questions on whether or not you had a tummy tuck?
- [12:48]
A
Yes, that is one of the questions is if I had a tummy Tucker. If I had stomach lipo. Did not.
- [12:53]
B
Nope. I can verify that.
- [12:54]
A
I know he thought he did. That was my, my. One of my favorite, other than you calling me an angel, was when I came back after surgery for my post op, after my reduction. You're like, did we do a tummy tuck? You look great. And it was just you motivated me to feel good about myself, you know, having all that extra, like, boob.
- [13:12]
B
It's just all hard work, hard work and fitness and eating right. That's all you. That's all you. You did it the hard way.
- [13:19]
A
It is hard. But, you know, I think, like I said in the last podcast, it makes it so much easier when you start to get that little bit of confidence back, it really just like, catapults you in every aspect of your life to want to be better. And I think, you know, a lot of times you want to, like, you know, get healthy, lose weight before you get surgery. But I think if you can get to, like, a good place and then get the surgery and then, like, continually, like, go down that journey, it's a good thing.
- [13:45]
B
No doubt.
- [13:46]
A
Yeah.
- [13:47]
B
The things that cannot be addressed with weight loss and, you know, fitness, healthy lifestyle, eating. Right. Are skin laxity and the muscle.
- [13:56]
A
Yeah.
- [13:57]
B
When the muscle has been separated, exercise will strengthen the muscle. And you can flex your muscle and you can probably have a very firm, strong abdomen. But when you have an anatomic separation, your core will never be.
- [14:09]
A
Are you talking about fat in between your muscle?
- [14:11]
B
Oh, sorry. So the muscles. No, there's something called diastasis recti.
- [14:14]
A
That's with pregnancy. Do I have that right?
- [14:17]
B
If you've had a baby, it's likely. Yeah. In fact, it's 100%.
- [14:22]
A
You're like. You definitely do. What happens?
- [14:25]
B
So the growing baby expands your stomach, your abdomen, in kind of a radial fashion, and the muscles quite literally separate in the midline. It's not a hole. The fascia is what it's called. The connective tissue between the two muscle bellies will stretch. And when your muscles are stretched, you deliver the baby, the muscles go back down. But that connective tissue is not elastic, so it's not going to come back. It won't regain its.
- [14:53]
A
So you have to sew it back together.
- [14:55]
B
Right. So if you think about it, like, there's a straight piece of connective tissue between your rectus muscles. When you suture them back together, that fascia is kind of like right underneath. So there's like a tiny little pocket underneath erectus muscles. So you just bury that stretched fascia when you repair the muscles together.
- [15:14]
A
But if you're gonna have more kids, you should wait until after. Cause it's just gonna keep happening.
- [15:17]
B
Absolutely.
- [15:19]
A
And what is the risk if you don't do it?
- [15:21]
B
Absolutely.
- [15:22]
A
Really? Does it make your abs look weird? Like, what's. Like, the. What is the reason why you would want to even get it fixed? Can you, like. Does it look weird?
- [15:32]
B
You mean after. After you finish having kids?
- [15:34]
A
Yeah. Like, why do people, like. Is it, like a health risk?
- [15:37]
B
There's no.
- [15:37]
A
There's.
- [15:38]
B
Why would you get it repaired? There's. Well, there's. There's functional anesthetic reasons. So you're. When you have ab separation, you have a little Pooch.
- [15:48]
A
Okay.
- [15:48]
B
You don't. You're blessed. You're, you know, you. You're able to amazing, you know, regain your. Your strong abdomen. But maybe baby two, baby three, you.
- [15:56]
A
Start to lose it more. So you just feel puffy, you're pudgy, or. Because it's not like.
- [16:00]
B
It's just when you. When you totally relax your. Your belly, it will just. It will kind of form a little pooch because you don't have muscular competence anymore.
- [16:07]
A
That's so sad. And you can't get it back by working out a lot.
- [16:10]
B
No. You'll strengthen the muscles, but you cannot. You cannot reestablish that central connection that you have.
- [16:16]
A
That is wild. That's crazy.
- [16:18]
B
Only tummy tuck can do that. So the muscle repair and the skin, those are the two things that you can't exercise back into shape.
- [16:25]
A
Wow, that's so interesting. Okay, that's good to know. I definitely never thought that I had that.
- [16:31]
B
The muscle repair probably provides more functional improvement than people realize, too.
- [16:37]
A
They feel stronger, like, they have more of a balance, and they feel like their core is tighter.
- [16:41]
B
I've heard crazy things. You know, people have said that their back pain improves. Not only do they feel stronger, but like, it actually provides, you know.
- [16:50]
A solution for ailments everywhere in their. Else in their body. It's crazy. There was actually one woman who dealt with urinary incontinence, and we fixed her rectus muscles, and I promise you, her urinary incontinence went away.
- [17:02]
A
That's crazy. That's amazing. Yeah. I mean, that makes a huge difference.
- [17:06]
B
Everything's connected.
- [17:08]
A
Body's crazy.
- [17:09]
B
The funnier feedback that we've gotten is, you know, I sing better in the shower and in the car.
- [17:14]
A
Aww. Maybe that's what I need to be a good singer.
- [17:18]
B
Just a rectus repair, Literally, I would.
- [17:19]
A
Do it for that. That would be the reason. Okay, one of the biggest questions here is how do you know what size implant to do when someone wants to get their boobs done?
- [17:30]
B
We size breast implants based on three large things. So the first one is your goals.
- [17:38]
We'll start with cup size. Cup size is kind of a moving target. You don't ever want to make cup size your first priority. You want to make the aesthetic of the breast. You know, what are you going for? And concept photos are always really helpful. So we ask, what's your desired concept?
- [17:53]
A
Which I was. So I'm the worst patient. He's like, what are your info photos? I was like, I have none. I trust You.
- [17:58]
B
But that's all right. A lot of times. That's why we'll flip through the website.
- [18:02]
A
Yeah.
- [18:03]
B
And when you come in for a consult, we'll flip through our photos, our before and after results, because it's kind of hard to show. You get on the Internet and you start looking at girls in bikinis. You see girls in different poses. It's not standardized. It's kind of hard to say. You also don't know what size implants these girls have. So in before and after photos in the office, we can say which of these kind of resonate with you. What's your look? And we know everything about these patients, so it's easy for us to say, okay, this girl has this.
- [18:35]
The second thing. The second big thing that we look at is your overall height. We try to. And your body size. We try to fit the implant proportionately speaking, to your body. You don't want to use an implant that's either too small or too big. You can put the same implant on a hundred different people, and you get a hundred different results.
- [18:56]
A
Wow. It's crazy.
- [18:57]
B
It is. And so body frame, your. Your rib cage, your overall height, your width plays a big role.
- [19:05]
A
Reminds me, I saw a TikTok that got sent to me a lot. Do breast implants glow in the dark? Did you see this?
- [19:10]
B
I did.
- [19:11]
A
Is it true? I haven't tried it yet.
- [19:13]
B
No, that's. That's. I think that's AI you do that's doing that.
- [19:16]
A
Okay.
- [19:16]
B
Yeah. There was like, a tiny little blip where that. People were showing results of that, and I think they'll either. They're either placing a little LED strip underneath their implant or AI is creating the image.
- [19:27]
A
So it's not real.
- [19:28]
B
I don't believe it's real.
- [19:29]
A
So my boobs are not going to lead me home.
- [19:32]
B
That would be funny, though. Like, imagine stealing the remote and turning it on when somebody doesn't want it on.
- [19:36]
A
That's exactly. Like. That would be great. Or be like, I can just see at night. That's hilarious.
- [19:42]
B
The third way that we use to size implants is on your breast measurements.
- [19:45]
A
Okay.
- [19:46]
B
You have to match the implant width to your breast width within about a centimeter.
- [19:51]
A
Wow.
- [19:52]
B
If you go too wide, then you'll get that Baywatch look with a lot of side boob. It will also stress the architecture of your breast. You don't want to do that because it reduces longevity.
- [20:05]
And you don't want to go too narrow because then it looks like a little tennis ball inside your breast. You have to match the implant width to your breast width.
- [20:11]
A
Why do some women, when they get breast implants, they just completely social distance.
- [20:17]
B
A lot of times that's because of their anatomy. If you have a wide gap between your breast already, you can't expect implants to do much to fix that.
- [20:27]
A
Yeah, it's easier, I feel like, when you have like real breasts because they're looser and they're not as firm so that you can kind of like maneuver them to like push them to make more cleavage. Sure.
- [20:37]
B
Yeah. So you can do that with clothing and you'll still be able to do that. Once you have implants, you can, you can kind of push them up, push them together. The other thing is, if you go submuscular with the implant, the muscle inserts onto the pectoralis or onto the sternum. And when the sternum where. Where the muscle inserts on the sternum dictates how far that implant can travel medially. So that's, that's an anatomic thing.
- [21:00]
A
Interesting. Okay. And you told me too, if there's. There's certain things you can do post implant to make sure like they don't start shifting.
- [21:08]
B
Sure. So exercise restrictions early on are really important. Anything that is either very strong or very repetitive on your pec muscles, Push ups, inverted yoga poses where your hands are on the ground, Burpees, Crossfit style workouts.
- [21:27]
A
Don't do that.
- [21:28]
B
There's a lot of.
- [21:29]
A
She'll never see me do a burpee.
- [21:31]
B
There's a lot of exercises that women don't really engage in.
- [21:33]
A
Yeah.
- [21:34]
B
Like, you know, bench press, push ups, pec deck, Things like that that guys know very well. That's not really relevant advice. I would say that the more common thing that women do that can cause separation of their implants early on are like the Pilates moves, the inverted yoga poses. I try to keep my patients from doing that for probably about three months after breast August. You want those implants to be surrounded by mature scar tissue.
- [22:03]
A
Yeah.
- [22:03]
B
Really solidify. Get a foundation of scar underneath them before you really start pushing it.
- [22:07]
A
That's true. I know. Cause I was trying to do my emsculpt and I was like, you felt it? Oh. Immediately I was like, yeah. No.
- [22:12]
B
How do you like emsculpt?
- [22:13]
A
I love emsculpt.
- [22:15]
B
Pretty cool, right?
- [22:15]
A
It's amazing. I think it's one of those things, like, because I did it when I was a little bit bigger too. And like, I think it was really good for especially like post pregnancy, like to help me get Some like, core strength back and then also too. I felt like it helped me with my pelvic health as well. But now that I'm thinner, I think, like, you know, it's made a big difference. Like, it's really, really helped tighten and then also just keep my abs looking good when I, like, I'm busy and not able to have different. You know, we have different seasons of life where I might be traveling a shit ton that month and I'm not on my normal, like, workout schedule. So it kind of helps keep me looking good.
- [22:53]
B
How many sit ups do you think? One Emsculpt treatment.
- [22:56]
A
I heard it was 20,000.
- [22:58]
B
It's incredible, right? Should we describe what emsculpt is for people who don't know?
- [23:02]
A
Yes. Well, I don't do. I don't.
- [23:05]
B
I can describe it.
- [23:06]
A
You can do it. I'm like, I just get it done.
- [23:08]
B
So it's a technology made by a company called BTL that delivers electromagnetic energy through a paddle through your skin and through your clothing. You don't have to strip down for this.
- [23:23]
Down through the skin and into the muscle. And it stimulates the muscle stronger than you can flex it. It's absolutely.
- [23:30]
A
Whoever did that is probably just like the smartest human came up with this.
- [23:36]
B
When you start a patient on a treatment, and treatments are usually about 30 minutes and obviously, I mean, you can't expect results from the gym one time. So you have to do it, you know, multiple weeks, months, in order to see results. But when you, when you start a patient on it, you have to start them low because the treatment scares them.
- [23:54]
A
I loved it.
- [23:55]
B
It's really cool, right? Yeah.
- [23:57]
A
I never, I'm. I'm always at a hundred. I'm like, ramp it up. And I don't think it's like, can.
- [24:01]
B
You imagine just jumping on there and just going to a hundred to begin with?
- [24:04]
A
Yeah, but that's just. I'm crazy.
- [24:05]
B
I mean, it's an intense experience.
- [24:07]
A
I don't know. I felt like it was. And people say that and they're like, oh, it hurts. Or like, I never felt that really, but I have a really high pain tolerance.
- [24:16]
B
Yeah, that's impressive. You know, I jumped on there and it was. I mean, I was sweating on that thing.
- [24:21]
A
No way.
- [24:21]
B
It was. It was intense.
- [24:22]
A
Well, you're a man. Not to be mean.
- [24:25]
B
I know dudes don't handle.
- [24:26]
A
But it's like how a period. I think, you know, being a woman going through like contractions and like labor, like, that's nothing. And like period cramps. M school just can't hold a candle to that.
- [24:35]
B
I've got some thoughts on that. When you. When you look at that. Cause we've always wondered, why are guys. We're supposed to be tough and manly, right?
- [24:42]
A
Yeah.
- [24:43]
B
Why are guys.
- [24:45]
Such pansies when it comes to pain? Elective pain. And I think it's because men associate pain with something wrong.
- [24:56]
Name another time that a man experiences pain in a good way. They don't, you don't. But women. And the best example would be childbirth. Associate pain with good things, like having your baby. It's a happy time.
- [25:11]
A
Yeah. And when you get your period and you're in pain, you're like, didn't get pregnant. You're not trying to get pregnant, so you're kind of happy. You're like, okay, good. Yeah, this fucking sucks. But at least you know I'm not having an unwanted pregnancy right now.
- [25:23]
B
Sure.
- [25:23]
A
Yeah.
- [25:24]
B
So there's some positive things. So I think women associate pain with good in general. And I think that's why they can tolerate, you know, some. Some elective pain when it comes to crazy esthetic treatments.
- [25:34]
A
That makes. That would make a lot of sense. I see it.
- [25:37]
B
My brain starts to wander.
- [25:39]
A
I like, that's how I am. I'm always like everywhere at the same time.
- [25:43]
B
Nobody sculpt is very cool. I definitely recommend it for people who haven't tried it.
- [25:47]
A
Yeah.
- [25:48]
B
The rep is just a totally awesome guy.
- [25:50]
A
Yeah, it's great. I know I need to come start seeing you guys soon. Okay. Two questions about internal bras and Galaflex. What? I mean, I know for me, when I had that one surgery to get the reduction that kept getting canceled with a different doctor. And then I ended up coming to you, he wanted to do Galaflex on me. And that was at the time of your breast reduction?
- [26:13]
B
Okay.
- [26:14]
A
Yeah, that was like his treatment plan for me. But then remember it kept getting canceled because the COVID the snowpocalypse and the pregnancy. And then I ended up having my son and then seeing you after and we didn't do an internal bra. We. Which. Okay, that brings me to a follow up question. If I had done a reduction with an internal bra, could I still have done implants now?
- [26:34]
B
Yes. Okay, you could have. But your breast reduction went really well, right?
- [26:38]
A
Oh, yeah, I didn't need it. But why do people do that?
- [26:41]
B
Yeah. So it's a, it's a technique or a product that is meant to reinforce soft tissue. That's the whole point. And I think the routine use of Galaflex or soft tissue reinforcement products are probably not totally indicated because they do have complication profiles.
- [27:00]
A
Because it's pig, right? It's pig skin.
- [27:02]
B
There is a pig skin product.
- [27:04]
A
Okay.
- [27:05]
B
There is also.
- [27:07]
A synthetic product called Galiflex. There's an old one called Siri that we don't really use anymore. It was too complicated, had too many problems. But galaflex is poly 4 hydroxybutyrate. Say that 4 times fast.
- [27:20]
A
Sounds fun.
- [27:22]
B
It is a product that is rigid and it's not stretchy. And it's meant to be placed into a surgical plane to help support a big implant or a lifted breast that you're trying to keep up, that you don't believe the tissue by itself is going to be able to keep it up by itself.
- [27:40]
A
So you do it with people with more skin laxity or someone who doesn't really have thick skin.
- [27:46]
B
That's right. The problem that I find with using it routinely is, number one, it's another foreign body. Foreign bodies can get infected. They can become malpositioned. Galaflex in particular, it can fold unfavorably. So if it folds unfavorably, it's like a screen material. It's kind of hard to describe otherwise.
- [28:09]
A
That makes sense.
- [28:10]
B
It's like a screen material. And when you place that into somebody's breast, your breast is supposed to be soft and you don't like, ripply. You don't want to feel the edge of a piece of mesh in there. So that's why I disagree with the routine use of it. Now, if you see a patient who has very weak soft tissue, has an unfavorable chest shape where the implants are going to want to lateralize or descend because of some strange anatomy with their ribs, or if somebody has multiple failed operations where the implant keeps dropping or.
- [28:43]
A
What does it mean to have an implant drop?
- [28:46]
B
It means that the implant. So the implant is supposed to be bound by your inframammary fold where your breast meets your abdomen. And if the implant drops below that or stretches that, can you see it.
- [28:56]
A
Start going into their tummy like it was past the scar tissue.
- [28:59]
B
There's two ways that it happens. It will either descend past that ligament and the ligament will disconnect from your chest. And that's what we call a double bubble. Or it will stretch out the lower pole of your breast and. And it will descend with regard to your nipple. And that's what we just call bottoming out, where that actually stretches the lower pole of your breast. The Galliflex, the Stratases, the pigskins of the world, are all meant to prevent that from happening. But in. There's a lot of techniques to prevent that, prevent that, and to. And to fix that.
- [29:31]
A
What's the most common reason why that happens other than, like, not having good breast tissue or too big of an implant? Like, working out?
- [29:38]
B
You just nailed it. That's why.
- [29:40]
A
That's what happens. So it won't happen, like, five years down the line. And I'm like, let's say I'm on a really bumpy boat ride. I'm not gonna lose a tit.
- [29:50]
B
No, it's not like acute force can do it. I mean, I'm sure it could, but it's more just chronic wear and tear. And you nailed it when you said an implant that's too big. So a responsible surgeon will counsel a patient on the proper implant for their tissue and for their body. If you overwhelm the breast pocket and the breast anatomy with either an implant that's too wide or an implant that's just overall volumetrically too large, then you're gonna have problems.
- [30:21]
A
That makes sense.
- [30:22]
B
So it's almost like the routine use of these products is almost in order to allow a surgeon to do things that you probably shouldn't be doing.
- [30:31]
A
Mm.
- [30:31]
B
The best way to have really, really big breast implants is to have two surgeries.
- [30:36]
A
Damn.
- [30:37]
B
You place a smaller implant that's indicated for your tissues, and then what your body eventually does is it surrounds it with scar tissue. Once that scar tissue layer is mature, that's like putting a foundation underneath a house. And now, after six months or so, you can come back, you can take the implant out, and you can put a bigger implant on. And now that implant is resting on the scar tissue and not on your native tissue, and you're not. The complications can still occur, but it's less so when you have that scar tissue introduced.
- [31:07]
A
Damn. I did not know that.
- [31:08]
B
It's like your own body's Galaflex.
- [31:11]
A
That's crazy. So that's, like, the more ethical way to do it or.
- [31:15]
B
No, I wouldn't necessarily bring ethics into it. It's not. It doesn't seem like I would just say that.
- [31:19]
A
That's technique.
- [31:20]
B
It's a technique thing. Surgeons. Surgeons will kind of operate within their comfort level. In my practice, I just find that to be valuable in a salvage manner rather than for routine use.
- [31:32]
A
So you really don't use it often unless you have to.
- [31:34]
B
That's right.
- [31:35]
A
Okay. Okay. That's good to know. All right. A lot of people are Very curious about Gal Flex. A lot of questions about that. Okay, next one is fat transfer to breast versus implants.
- [31:50]
B
Fat transfer to the breast.
- [31:53]
Peaked in popularity around.
- [31:56]
2018-2020. You saw a lot of people posting about it. You saw a lot of people doing it, and then it fell out of favorability almost as quickly as it gained popularity.
- [32:08]
I did it a few times and I did not like any of them.
- [32:13]
A
Yeah.
- [32:14]
B
A lot of times you find a patient that doesn't want implants and you're trying very hard to figure out a solution so you can offer them something. And fat grafting. Kind of checked that box for a while. But now my rhetoric has changed. I say if you don't want implants, it's probably not a good idea to try anything else that's going to augment your breast.
- [32:31]
A
Yeah.
- [32:32]
B
The two big reasons are.
- [32:35]
Fat tissue ages whether or not you graft it or if it's just native in your body. So you're not changing anything about the aging quality of your breasts. And implant will not age like, like your breast will. Your. An implant will keep its form stability and it will keep its, its structure and its shape forever. As long as it doesn't rupture. Fat will not. Fat just makes your existing breast larger and it will still be subject to the aging process. Descending, gravity, sagging.
- [33:04]
A
Yeah.
- [33:05]
B
The other, the, the second reason that I don't prefer fat is it does not give you the shape, the structure that breast implant look that people want.
- [33:15]
A
Yeah.
- [33:16]
B
And there's honestly nothing that can.
- [33:19]
A
Yeah, it's.
- [33:19]
B
It's just a breast implant.
- [33:21]
A
Do you think in the future years we'll have a different option instead of implants?
- [33:26]
B
Maybe.
- [33:27]
A
I wonder what they'll do.
- [33:29]
B
Yeah, that's hard to say.
- [33:32]
I would imagine that probably will have something to do with sort of regenerative possibilities. Like there's, there's a lot of products where you can inject the skin substructure or the matrix into your, into your body and then allows your body to regenerate fat cells and, and fill it in with its own. Its own tissue.
- [33:55]
A
Crazy. That'll be cool. That's crazy. Okay, next one we have here. Okay. Anesthesia and SSRIs. Can they have an interaction? I can tell you I'm on Zoloft, so no. Right.
- [34:10]
B
I have not found SSRIs in particular to be problematic. I don't. Like I said last time, I don't think you can necessarily make encompassing statements about everything in medicine. But largely, SSRIs are safe and do not interact with anesthetic agents.
- [34:26]
A
That's good.
- [34:27]
B
There are some other categories of antidepressants and.
- [34:33]
Anti anxiety medications that would. So it's always a good idea to ask your doctor and make sure that your medications do not interact with each other or with anesthesia agents.
- [34:44]
A
What is the difference between a mini tummy tuck and a full tummy tuck?
- [34:50]
B
So the components of a full tummy tuck include what we talked about.
- [34:53]
A
Right.
- [34:54]
B
What we talked about. Skin below the muscle. Sorry, Skin below the belly button. Skin above the belly button, your muscle repair, and typically some liposuction.
- [35:04]
A
Okay.
- [35:05]
B
A mini tummy tuck only addresses the skin below your belly button.
- [35:09]
A
Okay.
- [35:10]
B
You can do liposuction with it. But from a standpoint of the changes that you're making to the abdomen, in an anatomical sense, you're only putting the skin below the belly button on stretch.
- [35:21]
A
Yeah.
- [35:22]
B
And it is a. I think it's an operation that should be only indicated for patients that have a small fold of skin below their belly button that drives them crazy or a unfavorable scar from a C section from some other abdominal operation.
- [35:40]
A
Interesting. My question, is it possible to ever pull someone's stomach so tight that they get stretch marks after a tummy tuck?
- [35:47]
B
I haven't seen that. I guess that's possible. I have not seen stretch marks induced.
- [35:52]
A
Because, like, from breast implants. Like, if you stretch the skin too much, like, I'm sure not you, but like people that are putting those types of surgeons that put too large of implants.
- [36:00]
B
You know, again, I haven't. I haven't seen implants cause stretch marks.
- [36:06]
A
Amazing.
- [36:07]
B
I've seen. I mean, I've seen weight gain cause stretch marks. I've seen muscle hypertrophy. Like, when you see these bodybuilders, they've got these stretch marks in their pecs.
- [36:16]
A
Yeah.
- [36:16]
B
And in their. In their buttocks because they're just so. Their muscles are so large and, you know, they stretch the skin.
- [36:22]
A
Yeah.
- [36:24]
B
I've seen it from breastfeeding. I've seen it from pregnancy. You get stretch marks and stria in the abdomen. I have not seen cosmetic surgery. When you put the skin on stretch can worsen stretch marks temporarily. So when the skin gets swollen, stretch marks look awful. But as the swelling goes down, you find those stretch marks to look better over time.
- [36:42]
A
That's amazing. Okay. I was curious about that.
- [36:45]
B
So a traditional tummy tuck is much more powerful. It makes a longer scar. But in my opinion, if you're okay with a scar in general, then it's justified to Go forward with the full tummy tuck. The skin above your belly button is not touched by a mini tummy tuck. And that's, that's not to be taken, you know, sort of trivially because when you do a mini tummy tuck and kind of pitch it with the same sort of, oh, this is just going to give you a minor version of a, of a full tummy tuck. It really doesn't. It's a very, very weak operation.
- [37:16]
A
That's good to know. Good. All right, next one we have is why do people get fat after they get breast implants? This is what people told me.
- [37:28]
B
I haven't really noticed that, to be honest. I don't think breast implants necessarily make you fat.
- [37:34]
A
Yeah, a little bit of body dysmorphia maybe. I mean, when I came out of surgery, but that was because I was constipated from the hydros. I like, was like, oh, are you.
- [37:43]
B
Talking about weight gain immediately post op?
- [37:45]
A
I don't know. She says, why do a lot of people get fat with breast implants? And then the other one is, why do a lot of people that get, get breast implants end up gaining weight?
- [37:54]
B
You know, I don't, I don't know. That's, that doesn't seem to be.
- [38:00]
It's not something that I've really noticed in my patients and it's not something that I would say that is necessarily connected.
- [38:06]
A
I wanted to know, just so I know for me, how much do each of my implants, what would they weigh? So like, let's say before surgery I was 106. I'm going to be like 108.
- [38:17]
B
No, they're not a pound a piece. I'd probably say they're, you know, maybe a third of a pound.
- [38:21]
A
Okay. So basically if I, I gained 2 pounds water.
- [38:27]
B
So saline implant has a density of one. So you're like 1 cc would be 1 milligram.
- [38:34]
A
Okay.
- [38:35]
B
So a 300 cc breast implant that's saline would weigh 300 milligrams and it's a, that's about a third of a pound.
- [38:45]
A
Interesting. Okay, that's good to know. Okay, this is probably like very controversial and you do not have to answer this, but I was just thinking about it. Is there any studies that indicate people are more prone to breast cancer with implants or less likely to get breast cancer when they have implants? Or is it really just. It happens, it happens. It's, you know, one of those things.
- [39:04]
B
There has been no connection between breast cancer and breast implants. There have been malignancies reported. Not breast cancer malignancies, but lymphoma, actually. And some very rare reports of skin cancers actually reported in the scar tissue surrounding a breast implant. But. And we can cover those. But no, breast cancer has not been associated with breast augmentation.
- [39:27]
A
It's good to know.
- [39:28]
B
Yeah. It does not change.
- [39:32]
I can't say that it necessarily reduces your risk either, though.
- [39:35]
A
Yeah. Good to know. Okay, that brings me to our next big one. Is breast implant illness actually that common? That's the only thing stopping me from getting implants.
- [39:47]
B
So I'll say breast implant illness is real. I do think that it exists. I do not think that it exists in the commonality that social media will have you believe. I think it's a very popular buzzword and it gets a lot of engagement, but I do not think that as many women suffer from breast implant illness as social media would have you believe. Yeah, I know this because I have seen a lot of patients that thought they had the implant illness. They had all the symptoms, the rashes, the fatigue, the joint pain, the brain fog, and they go get their implants removed, and then they come see me maybe a year or two later and their symptoms haven't changed and they want their implants back, and they find out that there's a new medication. They started. They developed an allergy to dairy, or they were stressed out because of a boss at work or something like that. There's so many reasons that our bodies are showing these symptoms. We live in an industrialized society. We put so many processed materials into our body that it's kind of silly to be honest, to blame an inert substance like silicone.
- [40:53]
A
Yeah. When we're eating hot Cheetos, I'm being very careful.
- [40:57]
B
Exactly. And we wonder. We know. We don't sleep. We pump our body full of stimulants in the morning and then depressants at night. We're eating a ton of sugar. I would actually say that sugar is probably the most lethal substance on the planet Earth.
- [41:13]
A
I know.
- [41:14]
B
If you look at heart disease, obesity, metabolic syndrome.
- [41:16]
A
Well, that's why so many people that are on GLP1s are helping with blood sugar in general. It's improving, like, so much more than just weight loss. Like, it's helping a lot of, like, PCOS and just so many different things. And it's.
- [41:31]
B
PCOS is actually a disease of insulin sensitivity.
- [41:35]
A
Wow.
- [41:36]
B
People don't realize that, but it is. It is a disease of insulin insensitivity. So when. When you have an issue with your body, a lot Of a lot of times you go into a physician's office and they. They give you a medication for your diabetes, or if you're PCOS and they're not looking at holistic picture there. And.
- [42:00]
Everything'S connected physiologically, anatomically, everything's connected. So if you see somebody that's manifesting with PCOS symptoms, I think it's a very easy thing to just say, let's put you on, you know, a typical medication that's going to help you with PCOS and not look at the patient holistically.
- [42:18]
A
Like, what's your lifestyle, what's your diet?
- [42:20]
B
What's your proper advice? Would probably say, let's try to lose a little bit of weight. Let's now it's a little bit easier. In the days of GLP1s, we have Ozempics and Wegovies and Manjaros that we can put these people on. And you're right, the weight loss is triggering an improvement with pcos and with diabetes, with addiction, problems with. Even with cognitive disorders, there's all kinds of crazy improvements that people are seen.
- [42:46]
A
Wow.
- [42:46]
B
And I think metabolic syndrome is probably at the basis for all of those issues.
- [42:51]
A
That's wild.
- [42:52]
B
Yep. So taking care of your body, eating right, exercising every single day, staying active, staying connected. We are social beings. It's really important. Avoiding the substances, too much caffeine, especially in the afternoon.
- [43:10]
Smoking, drinking, drugs, all.
- [43:12]
A
The things, all the fun stuff.
- [43:13]
B
If you can avoid the fun stuff.
- [43:16]
Then you will. I mean, it's all about moderation, right?
- [43:18]
A
Yeah. That's why I don't like drinking, because it literally, like, it makes me puffy. Like, my face swells, like, double the size the next day. Like, even if I have one drink, I'm. And I don't even get. Like, I don't party drink like that. But, like, if I have a drink, I look puffy the next day.
- [43:33]
B
No doubt. Because it's a poison. I mean, you're poisoning your body. If you look at the way that alcohol is metabolized by your body, it releases a molecule or a substance byproduct by your liver called acetaldehyde. And acetaldehyde is a toxin. It creates scar.
- [43:48]
A
I think the Mormons are onto something.
- [43:50]
B
No doubt. There's no doubt in my mind. The old teaching in medicine was that a single or two drinks a day, depending on if you're male or female, is actually healthy. From a heart standpoint. A glass, you know, have you heard that a glass of wine a day is actually a healthy habit?
- [44:07]
A
Is that A lie.
- [44:08]
B
I think that's a lie. I think we are transitioning away from that. I think alcohol is a poison just like anything else. And if you can minimize that, it's amazing the effects that you will.
- [44:19]
A
People drop weight like that when they stop drinking too.
- [44:21]
B
That's right. People drink more calories than they eat.
- [44:24]
A
I'm so glad I never got into drinking like that. I always would just throw up.
- [44:28]
B
The younger generations are stepping away from alcohol and you see a major uptick in non alcoholic drinks. Have you seen some TV commercials for like Heineken 0 or some of the non alcoholic beers?
- [44:42]
A
Just drink a Coke.
- [44:44]
B
I think there's a social impetus to have a beer in your hand or have a glass of wine. If you're that chick at the party that's like trying to be cool and you're drinking a Coke while everybody else is drinking beer or wine or vodka or whatever it is, you're that chick with a diet Coke in her hand and it's like, she's not fun.
- [45:01]
A
I'm not fun.
- [45:02]
B
So I think there's a, you know, sort of a social pressure to have what looks like an alcoholic drink in your hand, but you don't have to be drinking. I think it, I think it checks the box.
- [45:11]
A
That's awesome. So that's gonna be probably. That's a good business to invest in.
- [45:16]
B
I think so. Yes. No doubt.
- [45:17]
A
That's amazing. Okay, we have. Someone says they want a mini tummy tuck, but they don't want to touch the belly button. Think just muscle repair and a small amount of skin excised.
- [45:30]
B
Yeah. So the problem with the mini tummy tuck, again is that you cannot repair the muscle adequately because the dissection only. So your, your belly button is a point of tether.
- [45:40]
A
How do you not get the belly button to look weird? Yours don't, but there's some out there that it's like, it looks like a.
- [45:46]
B
You mean after a traditional tummy tuck.
- [45:49]
A
How do you make your belly button not look like that?
- [45:52]
B
It's my trade secret. I can't. I can't tell. Yeah.
- [45:57]
There'S just a lot of attention. I spent a lot of time looking at what anatomical features. Yes. Make it a good looking body.
- [46:03]
A
It's like a belly button looker. Your wife, you and your wife are at the beach, are like, I'm not looking at their body, I'm looking at their belly button. Babe, don't worry.
- [46:09]
B
That's right. She's like, you're doing your market research, aren't you? And I was like, yes, honey.
- [46:14]
So if you look at, if you look at the features of a good looking belly button and we need to get back to the mini tummy tuck question. But you have to.
- [46:22]
A
Dad, giveaway. You know, a lot of women, you would not know they had a tummy tuck until they pushed the belly button.
- [46:27]
B
That's exactly right. The belly button is a giveaway. Or a high scar. If you can see a high scar, obviously it's a, you know, it's a dead giveaway. You also lose some dimension to your abdomen. And that's why. So I do a technique called the drainless tummy tuck where you stitch the skin back down to the muscle. And we're very intentional about where that skin is placed. I can stitch definition back into your abs, back into your stomach. It's wonderful. So the features of a good looking belly button, you see a line of definition between your abs leading up to the belly button. Going top down, you see a little hood over the belly button. If you can establish it, this isn't the reality for everybody. But if you can establish a little bit of depth to the belly button, that really helps cause it establishes a little shadow. And if you have a tiny little shadow in your belly button, that's aesthetically.
- [47:13]
A
Pleasing, innies or outies look better tummy tuck wise.
- [47:16]
B
Oh, innies for sure.
- [47:18]
A
Okay.
- [47:18]
B
Outies are a umbilical hernia.
- [47:22]
A
No way. So that's how you get them.
- [47:25]
B
It's either genetic or it's from a procedure. It's acquired during some time in your life.
- [47:32]
Umbilical hernia is just a little opening between.
- [47:35]
A
So it's not that they cut the umbilical cord weird from your baby?
- [47:39]
B
No, it's actually where the umbilical cord enters into your abdomen because that's the source of nutrients when you're a baby. So when the umbilical cord. It's just the anatomy and how you developed, um, it's not, it's not how they clipped the belly button or, sorry, the umbilical cord.
- [47:53]
A
Interesting.
- [47:55]
B
So with a mini tummy tuck, the belly button is attached, is where the skin is attached to the muscle. So you can't physically, unless you release the belly button, you can't go above it up to where the, I mean, the muscle goes from your sternum all the way down to your pubic bone. So on a mini tummy tuck, you can't repair the muscle just below the belly button.
- [48:16]
A
Yeah.
- [48:17]
B
If you do that, then you'll have this fullness above your belly button that looks really Bad. And I've seen it, and it's unfortunate. Some people do this, but they'll tighten the muscles just where they can see them.
- [48:26]
A
And you're pudgy up here, and then.
- [48:28]
B
You'Ve got this, you know, this laxity and this fullness above.
- [48:30]
A
Like a reverse muffin top.
- [48:32]
B
Yeah, kind of. Yeah, exactly.
- [48:34]
A
Crazy, huh?
- [48:36]
B
So a mini tummy tuck is skin only. You only can affect the skin, and it's only for those people that have that tiny little fold of skin or a bad scar. Now, there is a tummy tuck operation called a hybrid tummy tuck, where instead of making an incision around the belly button and releasing the skin and pulling it down, you actually release the belly button from the muscle.
- [48:59]
A
Cut it off.
- [49:01]
B
Yeah. And it's connected to the skin. So the skin and the belly button come up together, and you're able to now dissect all the way up to the sternum. And now you can do a full muscle repair.
- [49:12]
A
Damn.
- [49:12]
B
But you're kind of in. There's some downsides to that, and I'll get to that. But you are now recreating a dissection that's normal for a traditional tummy tuck. The bad side, or the bad part of that is if you. If the belly button comes up with the skin. Now you've oriented the skin, you've put a. The belly button is not connected to it. So if you pull the skin down.
- [49:36]
A
Too much, you have a low belly button.
- [49:38]
B
Your belly button's like, down in your crotch, and it. It looks really weird.
- [49:42]
A
I bet.
- [49:43]
B
So you can move the skin Maybe.
- [49:45]
A
Yeah, that's what I was going to know. Like, if you have, like, a lot of skin with a traditional tummy tuck, how do you not lose the belly button? Like, how's it not go to your vagina?
- [49:52]
B
Yeah, because the. The belly button is incised around. The belly button stays down on the muscle.
- [49:57]
A
Oh. So keep it there.
- [49:58]
B
When you release the skin, there's a hole in it for. In the belly button stays down. So then you.
- [50:03]
A
Oh, so you're cutting around the belly button.
- [50:05]
B
That's right.
- [50:06]
A
Interesting.
- [50:06]
B
So the skin is stretched down and the hole from the belly button travels past the incision so you can cut it out.
- [50:12]
A
Okay. So like, if I ever got a tummy tuck, then, like, my moles that are up here will now be down here.
- [50:17]
B
Way down. Yeah.
- [50:18]
A
What? That's crazy.
- [50:20]
B
Yep. In fact, that whole. That whole, like, sort of mole or freckle remapping is kind of a fun game. I bet it shows the magnitude of the change. It's really cool if you have, like, a little, you know, a birthmark or, you know, freckle in your upper abdomen. And after the tummy tuck, everything's healed. Your tummy's flat. Looking great.
- [50:39]
A
Vagina.
- [50:39]
B
And your mole is down now, like in your left lower quadrant. It looks awesome. And it's.
- [50:44]
A
Let's talk about ozempic vagina. Are people doing surgeries for that now? Because, like, a labiaplasty, that's just labia.
- [50:52]
B
Right.
- [50:52]
A
Like, for people that are starting to talk about that kind of stuff, like, what do you do?
- [50:59]
B
Ozempic. And all these GLP1s are creating so many.
- [51:04]
A
Your Ozempic face. Ozempic vagina issues with the human body.
- [51:07]
B
Right. And it's good. I'm always a proponent of weight loss, and I think it's very good. But you lose mass everywhere. People are losing lean mass, they're losing.
- [51:16]
A
That's the issue is when you're on the wrong. It takes your muscle.
- [51:19]
B
That's right. They are coming out with a medication that is supposedly going to preserve lean mass.
- [51:25]
A
Is that the one that starts with an R. Retatride.
- [51:28]
B
Retatrutide.
- [51:29]
A
That's it.
- [51:30]
B
Correct.
- [51:30]
A
Yeah, I heard of that.
- [51:31]
B
Yeah. It's an injectable. It's in phase three FDA trials right now. I think they're looking at late 2026 coming to market.
- [51:42]
A
Damn.
- [51:43]
B
So when you lose mass that you don't want to lose, it's. I mean, it's a pretty simple aesthetic operation. You just replace that with fat grafting. Now, the trick is, if somebody's lost a bunch of weight with ozempic, they don't have fat. So you have to have. You have to have a reasonable amount of fat.
- [52:02]
A
You can't donate fat.
- [52:04]
B
I wish.
- [52:05]
A
You really can't. Like, even if it's like a family.
- [52:07]
B
Member.
- [52:09]
I guess the only.
- [52:11]
Example that you could donate fat is it a perfect genetic identical. Like an identical twin. So I'm an identical twin. I don't know if you knew that.
- [52:20]
A
Lucky I did know that.
- [52:21]
B
But if I ever wanted to donate.
- [52:23]
A
Fat to my brother, give him a little bbl.
- [52:25]
B
Yeah. I don't think I'll ever find an opportunity to do that. But you could if you wanted to.
- [52:30]
A
Dang. That is so crazy. Wow.
- [52:34]
B
So ozympic vagina probably refers mostly to your labia majora, which is not typically addressed in a labioplasty.
- [52:41]
A
So you have to put fat. Like, to put.
- [52:43]
B
That's right. You just plump it back up.
- [52:45]
A
Could you Put filler there.
- [52:47]
B
You can, but I don't think you're gonna see the magnitude of change that people want.
- [52:51]
A
Yeah. Because you need, like, a lot, Right. That's so wild.
- [52:55]
B
Do you remember a few years ago when camel toes kind of started to try to make a comeback? I don't even know if it was a comeback.
- [53:03]
A
No, they just.
- [53:04]
B
They just. They just.
- [53:05]
A
They were just there.
- [53:05]
B
Became kind of like a trending thing.
- [53:07]
A
Yeah.
- [53:08]
B
Where people were showing their camel toes on purpose.
- [53:10]
A
Yeah.
- [53:11]
B
We had a patient come in and wanted augmentation of her labia majora with filler, and we talked to her for a little bit. We should. Are you sure you want this? I mean, so filler is reversible.
- [53:22]
A
Yeah.
- [53:23]
B
So. And we.
- [53:24]
A
Having my vagina probably would have been worse than Olivia Plasti, to be honest.
- [53:29]
B
Yeah. There's. There's some things that you. That you do, and there's some things that you don't, but I was happy to see that trend go away.
- [53:37]
A
Yeah. That's wild. I just know that they're doing, like, screw talks. Have you heard of this?
- [53:43]
B
I. Again, I think that's probably something that people talk about, but it's not really. I've never seen somebody inject Botox into their scrotum.
- [53:51]
A
They do.
- [53:52]
B
Have you seen it happen?
- [53:53]
A
Yes.
- [53:54]
B
Really?
- [53:54]
A
Yeah. There's a guy in New York that does it and he does whole talks to relax your whole.
- [53:59]
B
Yeah, I've heard that.
- [54:00]
A
Good for, like, the gay community, which is great.
- [54:02]
B
So I've seen, um. I've seen Botox help when you're. When your anus is injured.
- [54:09]
A
Really?
- [54:09]
B
Uh, if you have an anal fissure or something like that. This is a weird topic, but it's okay.
- [54:13]
A
No, I love it.
- [54:13]
B
But it's open. Your anal sphincter is a. Is a muscle and it can be. If it's relaxed, then it will have a better time healing.
- [54:20]
A
Aww.
- [54:21]
B
So that's so sweet. I think. I think Botox is probably indicated for that.
- [54:26]
A
Wow.
- [54:27]
B
I have not really seen it used successfully for Scrotox, but that's a fun topic to talk about at the time.
- [54:31]
A
I love that. And then now they're doing penis filler, and that's a lucrative market. Like this guy, like 20k for a peen. Seriously, he's putting sculpture in there.
- [54:40]
B
A friend of mine has a male only aesthetic practice up in Frisco.
- [54:44]
A
Yeah.
- [54:44]
B
And he's doing. I think he's doing a fair amount of what they call phalloplasty.
- [54:50]
A
That makes it longer, girthier, I think.
- [54:53]
B
It'S more about the diameter. Yeah. I think they can fat graft, they can put filler.
- [54:58]
Yep.
- [55:00]
A
That's pretty crazy. I mean, it's not. I mean, I just like cut my vagina open. So it's like actually not that crazy.
- [55:05]
B
Sure. I mean, surgical enhancements of any body part is possible.
- [55:11]
A
Wild though. I've heard it's there. Is it true this is not even about genitals, but that you can make someone taller? Like men will get, like, also possible really.
- [55:21]
B
So there's surgical and non surgical ways to increase your height. As we age, we lose a little bit of height because of joint collapse.
- [55:31]
A
Yeah.
- [55:31]
B
Um, so, you know, staying hydrated and staying flexible. And if you've been on one of those inversion machines that stretch, stretch your spine.
- [55:40]
A
Yeah.
- [55:41]
B
Those things can add, you know, an inch or like maybe half an inch to your height.
- [55:46]
A
What?
- [55:47]
B
And if you want any significant improvement in your height, there are operations that will actually break the your bones and your legs, your femur and your tibia. And.
- [56:00]
It'S called distraction. Osteogenesis is the term for it. But you basically put these expandable braces on your legs and at a turn of 1 millimeter per day, you can distract or lengthen the leg. And if the leg is broken, it will stretch one millimeter a day. And the idea is that all the soft tissue, the nerves, the blood vessels, the skin, the muscle is stretching very slowly. So it's not. And you're not inducing injury to it, but the bone regenerates at a very slow rate and you can gain three inches.
- [56:34]
A
No fucking way.
- [56:35]
B
Yeah. I wouldn't say it's a mainstream operation.
- [56:39]
A
Is it super expensive and painful? I bet it's painful.
- [56:41]
B
Extremely painful. It's extremely expensive.
- [56:44]
A
It's like you'd only do that if you're a guy and you're like 5 4. You're like really got to be 5 7. Sure.
- [56:49]
B
Or, you know, it's, it's. I would say it's more indicated for people with like leg length discrepancies. You know, you had some sort of operation. We talked about operating on something before. It's mature, skeleton mature. If you had an operation on your leg when you were five.
- [57:00]
A
Okay.
- [57:01]
B
And your leg didn't grow the length of your other one.
- [57:03]
A
Oh, so you want to.
- [57:05]
B
Then you're, you know, you're putting spacers in your shoes then that's typically what it's used for. But I mean, just like anything else, people are applying that technique to aesthetics.
- [57:14]
A
That's wild.
- [57:16]
B
So I Probably wouldn't say that it's warranted in. Somebody who's 6 foot wants to be 6, 3. It's probably better for someone who's 5, 4 and wants to be 5, 8.
- [57:24]
A
Yeah, I'd get it. Short kings have a hard time.
- [57:28]
B
That's right.
- [57:28]
A
They do. Short kings need love, too. That's so interesting to me. Okay. Wow. I didn't know people did that.
- [57:37]
B
I'm not sure. I. I'm not sure if there's a practice in America that does that.
- [57:42]
A
Yeah, I feel like it's kind of.
- [57:43]
B
Like I haven't looked at it specifically, but I think that's an international thing.
- [57:46]
A
Wow.
- [57:46]
B
You gotta fly to Turkey and come back. Come back in your six, three.
- [57:50]
A
There you go. Okay. Someone was.
- [57:52]
B
You know, one of my concerns with that is.
- [57:53]
A
What?
- [57:54]
B
You don't lengthen your arms.
- [57:55]
A
Oh, no. So like a T. Rex.
- [57:58]
B
So. So homeboy's got, like, really long legs, and he. You know, you can't put his hand in his pockets anymore. He can't tie his shoes.
- [58:03]
A
Poor thing. That's so sad. Poor guy. Yeah. That's not great. Okay. They want to know if you ever said no to a client wanting surgery. Sure. All day.
- [58:13]
B
Yep.
- [58:14]
A
Yeah.
- [58:15]
B
Yeah, that's. That's a tough thing to do. Patients, they. They make the decision that they're ready, and they kind of automatically assume that they're a candidate for certain things. A lot of times we find an alternative for them to keep them happy. Because a flat no to somebody is not what people want to hear.
- [58:34]
A
Yeah.
- [58:35]
B
And you know that we try to avoid doing that, but sometimes you can't get around that. And it's just about establishing rapport with a patient, making sure that they understand that it's in their best interest. But I can promise you that if you move forward with an operation that you don't feel good about, it will come back and bite you.
- [58:54]
A
I'm sure. I mean, I felt that before our clients that I'm like, okay, they're not the right fit for my practice. And I'm like, oh, I'll give them a shot. And they always end up being the ones that don't work out. Your intuition. You always know. I think that's a really big thing.
- [59:08]
B
I wish I had better Spidey sense sometimes, because sometimes you don't.
- [59:13]
A
Got you.
- [59:13]
B
You don't. You don't scope them out. You don't always see the red flags.
- [59:16]
A
Yeah. And it's hard. Cause sometimes it's the ones that you think are gonna be like, they're like so chill. And then like post treatment or post surgery, you're like, oh my God. They're not as.
- [59:27]
B
You know, you go through a career of sort of developing all of your repertoire of red flags and, you know, sort of alarm signals going off and then once you feel like you've got it, you retire.
- [59:39]
A
Yeah. Oh, my gosh. I have one girl saying she's flying to come get a consult with you.
- [59:44]
B
Let's go. We do a lot of out of 10.
- [59:46]
A
I mean, he's the best. Guys, I'm telling you. Like surgery, your skin and your hair, I think are the three things that you just got to be really careful with who you see.
- [59:55]
B
I totally agree.
- [59:56]
A
Because you can bleach all your hair off. That's going to take what, nine years to grow back? That happened to me. It like took me years to get my hair back. Your skin, someone can up your face very quickly. And then surgery out of all of them, like you don't want to go to the cheapest or the closest option.
- [60:10]
B
You asked me for a quote. I've got a quote.
- [60:12]
A
Yes.
- [60:13]
B
Don't save money on your esthetician, your surgeon, or your parachute.
- [60:17]
A
There you go. I like that. That's a good one.
- [60:21]
B
You never know when you're gonna need it.
- [60:22]
A
That's so true. Someone wants to know exactly what brand is best for implants and what did you use for me and why did you pick the brand you picked?
- [60:32]
B
Gosh, these are insightful questions. So there's a lot that goes into deciding which brand.
- [60:36]
A
Is it a really competitive market with breast implants or is there three top dogs?
- [60:42]
B
Oh, I mean, there's only one, two, three, four implant companies in America available right now.
- [60:48]
A
Is it hard to get FDA approved?
- [60:50]
B
It is. There's a big threshold to getting into the implant market.
- [60:53]
A
Like a monopoly.
- [60:55]
B
I wouldn't say it's. I mean, there's healthy competition between the three companies or four companies. There's one Allergan kind of occupies the majority of the market, but they don't control the entire market. There's options.
- [61:06]
A
So I wouldn't have like different brands underneath them because I'm sure they like, they've bought out other implant companies. So, like they have different types. Right.
- [61:15]
B
They. I'm not aware of them buying any companies, but they have several different implant styles and, and options available.
- [61:24]
A
Okay.
- [61:26]
B
Allergan is the 800 pound gorilla. They are owned by a company called Abbvie Multi billion dollar pharmaceutical company. Allergan represents some ophthalmology products as well. As the majority of aesthetic. I think it's the only revenue stream that Abbvie has in the aesthetics realm.
- [61:46]
A
Wow.
- [61:46]
B
And I mean, Botox alone is a billion dollar revenue stream. It's huge.
- [61:50]
A
Huge.
- [61:52]
B
So the four implant companies, the biggest, I would say, is Allergan. The second biggest would be Mentor.
- [62:00]
And they're owned by Johnson and Johnson. There's another company called Sientra.
- [62:06]
A
I've heard of that.
- [62:06]
B
Sientra is a very good implant.
- [62:11]
The company went through some restructuring and had some issues. A little bit of drama on the corporate side with Sientra, and they're still recovering. I really like their implant, but their companies, I feel like I remember you.
- [62:25]
A
Talking about a lot.
- [62:27]
B
Yeah.
- [62:27]
A
Back in the day.
- [62:28]
B
I really like Sientra's implant.
- [62:29]
A
Yeah.
- [62:31]
B
And then there's a new implant called Motiva.
- [62:33]
A
Yes.
- [62:34]
B
Have you heard about this?
- [62:35]
A
Yes. Yeah. Yeah.
- [62:36]
B
So Motiva is very aggressively marketing right now. They're trying to gain market share. It is a implant that's been around in non American countries, in Europe primarily for a very long time, for about 15 years. And it was introduced, I believe, in September of 2024 to the US market. It's new, so it's pretty new.
- [62:55]
A
Yeah.
- [62:56]
B
When you hold the implant in your hand.
- [62:59]
It'S a very cool implant to hold.
- [63:00]
A
Yeah.
- [63:01]
B
It's kind of different. It's got a silky texture to it, and it's what they call it ergonomic, but it's kind of a. It's a little bit more of a squishy sort of stress ball feel to the implant.
- [63:13]
A
Yeah.
- [63:15]
B
And just holding the implant will sell you the implant. It's a good feeling implant.
- [63:19]
A
Yeah. That's what the doctor wanted to put in me.
- [63:23]
B
Oh, Motiva, really? Okay. I don't think there's anything necessarily bad about it. I just think that you're taking some.
- [63:29]
A
Unknown risks because it's so new.
- [63:31]
B
So new. Exactly. We don't have the data. And you want to test an implant, bring it to the US Market.
- [63:37]
A
Yeah. See how it does. I don't want to be the test one. We do put Allergan in me.
- [63:42]
B
Yep. Exactly.
- [63:43]
A
Yeah.
- [63:44]
B
So how do we choose Allergan? Allergan, number one, is a very solid company. They back their product. So it's only. What is it a pair of implants cost? I mean, a thousand bucks. Fourteen, depending on the practice and the volume they do. It's somewhere between 1,000 and $1,500 for a pair of implants. Well, we're not talking about a $90,000 BMW.
- [64:05]
A
Yeah.
- [64:06]
B
So the warranty is not that important if you're. If you're in a practice where a surgeon is going to take care of you. I wouldn't say the warranty is necessarily a. A make or break kind of decision, but it helps. And Allergan's going nowhere. They're a billion dollar company, and the warranty's as good as the company is.
- [64:24]
A
Yeah.
- [64:25]
B
If you apply that same philosophy to Sientra, for instance. Sientra is having a lot of difficulties. They just went through corporate restructuring about a year ago, and they were purchased by another esthetic conglomerate called Tiger Esthetics.
- [64:39]
A
I've never heard of Tiger Esthetics.
- [64:41]
B
They own. They own a bunch of different brands. Really. And Sientra is now their. Their representation in the breast implant market.
- [64:49]
A
Damn.
- [64:49]
B
But Sientra, for a long time was. Was having struggles, and people had some concerns regarding their warranty. Because if you're not a company, then you're. You don't have a warranty.
- [64:58]
A
Yeah.
- [64:59]
B
So that has caused us to migrate a little bit away from Sientra and more towards, you know, the solid, you know.
- [65:07]
A
Yeah. One you can trust.
- [65:08]
B
Allergan.
- [65:09]
A
Yeah.
- [65:11]
B
When you compare the performance of Allergan and Sientra implants to Mentor, for instance, the data and the personal experience of a lot of practices that use Mentor primarily show that Mentor has a lot more complications, and we tend to avoid it.
- [65:28]
A
I've never heard of Mentor. I've heard of Santra, and I've heard of Motiva and of course, Allergan.
- [65:34]
B
But one of the reasons, I think, is because J and J bought Mentor. Gosh, I don't know how many years ago. It's been a decade.
- [65:43]
And JJ has so many revenue streams, and they're so huge. I think they just kind of put it on the back burner. And Mentor doesn't really. They don't really compete for market share anymore.
- [65:53]
A
That sucks.
- [65:54]
B
It is.
- [65:55]
A
They murdered it.
- [65:56]
B
Yeah. They bought the brand and sabotaged it.
- [65:59]
A
That's crazy.
- [66:01]
B
Mentor is a relatively formless implant. It's a loosey goosey implant, and it gives you a very soft breast. But in my opinion, an implant is there to give your breast shape and form stability to your breast. It's not meant to be firm, but it's meant to be stable, and it's meant to shape your breast. You don't want your breast to be wiggly, giggly.
- [66:23]
A
Yeah, exactly. I would be pissed. Thanks for not doing that. You're welcome.
- [66:28]
B
You can feel the difference when you hold a mentor implant versus an Allergan implant.
- [66:34]
A
That's wild. Okay, so at your practice, you have allergan, you have motiva. You don't have motiva, do you?
- [66:39]
B
We offer it. I don't ever like to be a first adopter. So we're letting the community vet the implant. I wanna watch, want to watch it for a little while and see if anybody has issues. So we talked about the other types of cancers associated with breast implants. Breast cancer is not, but lymphoma is. And there's, like I said, there's a couple of skin cancers that have been discovered around an implant. So scary those cancers. Primarily lymphomas, it's called anaplastic large cell lymphoma. ALCL was primarily discovered around textured surface implants. Now, the gradient with which the texture occurred, so the more aggressive textured surface implants had more cancers associated with them.
- [67:25]
A
Damn. Why would you want a textured implant?
- [67:28]
B
Good question. So the textured implant grips onto the tissue like Velcro.
- [67:35]
A
Okay.
- [67:35]
B
So the, the thought is that it reduces implant malposition and where you put.
- [67:40]
A
The implant sliding away.
- [67:41]
B
That's right.
- [67:42]
A
That makes sense.
- [67:43]
B
It does.
- [67:43]
A
I'd rather slip side away than have risk of skin cancer.
- [67:48]
B
I agree with you. If you do the surgery properly and you choose the implant correctly, your implant malposition rates are pretty low.
- [67:54]
A
So it's kind of like good for like, people that are newer doing it and they like, want to make sure they're. The teddies are staying where they're supposed to stay. Textured is better.
- [68:01]
B
There's, there's all kinds of issues that you have with textured implants too, though. They've, they've really fallen out of favor. And the reason I bring this up is because Motiva has a micro textured surface. They call it nanotexture silk texture. If you look at the depth on a microscope, it's 4 microns deep. When you look at some of the old school textured implants, they were hundreds of microns deep. So.
- [68:25]
The aggressiveness with which a Motiva implant is textured is a lot less than the old school textured implants that we saw on the market. With all the problems when you see a new product on the market. And what I'm saying is if there's an absence of problems, that doesn't mean that the implant is without complication and that there's no risk there. It just means that it hasn't been used enough.
- [68:51]
A
Yeah. So you want to give us some.
- [68:53]
B
Time I want to watch it smart. Right.
- [68:56]
A
That's what good surgeons do. I love that. That's amazing. That's how I am with new skincare stuff, too, because, you know, you have a big name as well, and, like, if you put your name on something and then something comes out, it's a hard place to be. And I've been there with skinc, and thankfully, it's topical. It's not something in someone's body. But, like, yeah, it's like you have to do your due diligence, you see?
- [69:18]
B
You see, in your industry, just as much in mine. You see, practices will jump on the bandwagon quickly to get advantage, take advantage of market hype.
- [69:27]
A
Yep. Like, I saw that a lot with, like, the salmon sparing, and I didn't hop on that because I was, like, I was. I was really waiting.
- [69:33]
B
Silly, right? I don't even. I mean, honestly, I didn't even look into that. What was the hype regarding regenerative, like, exosomes?
- [69:41]
A
Good. The people are injecting it, but then people are getting, like, granulomas. People were getting a lot of issues.
- [69:47]
B
Right.
- [69:48]
A
From injecting it.
- [69:49]
B
What do you think about pdgf?
- [69:51]
A
I hear really good things, and I've heard people love it for hair topical use. Well, injecting it.
- [69:59]
B
They're injecting it. I've. I've seen a lot of controversy regarding systemic use of pdgf.
- [70:06]
A
Wow.
- [70:06]
B
But I think topical and maybe local injection is probably a little bit different. Yeah, I think that's. That's another product that kind of has to be vetted.
- [70:14]
A
It's just crazy, all the stuff they're coming out with these days.
- [70:17]
B
Right.
- [70:18]
A
Every day there's something new. That's the whole thing that I heard the arguments on exosomes is like, you know, are they going to. If you put it on something that's cancerous, you don't know it's cancer. Is it going to elevate, you know, cancer?
- [70:32]
B
There's a big concern for that. Yeah, that's a concern with the peptide market.
- [70:37]
A
Yeah.
- [70:38]
B
Exosomes, stem cells, like injecting peptides, Right?
- [70:42]
A
No, tell me, because I'm on a lot of peptides.
- [70:46]
B
There's a lot of different indications for these peptides. And in this wellness revival.
- [70:53]
A
Yeah. They're not heavily watched. It's so easy to get them. It's literally easier than it was to get weed in high school.
- [71:00]
B
You're probably right.
- [71:01]
A
It is. They're so easy.
- [71:04]
B
The peptide stimulates growth hor. I mean, certain peptides stimulate growth Hormones and alter hormone levels.
- [71:11]
A
What's the one that people are doing? There's a specific one that people are doing for the growth hormone. What's it called?
- [71:16]
B
Sermorelin?
- [71:17]
A
Yes.
- [71:17]
B
Or Tessamorelin.
- [71:18]
A
Yeah, I'm not doing that one. But I've heard about this and that's why I'm not doing it.
- [71:22]
B
And NAD is another one that doesn't necessarily stimulate growth hormone. But you do it or you don't.
- [71:27]
A
I hate nad.
- [71:28]
B
Yeah. I would caution people to just be careful because you nailed it. If you have an occult malignancy, meaning a cancer that you don't know about, when you stimulate cells sort of indiscriminately in your body, those cancer cells are going to be stimulated too. And that's the last thing you want. So anything that stimulates growth hormone is going to stimulate an occult malignancy. Now there's thoughtful ways to do these treatments. Temporary use of a peptide or a growth hormone stimulant is probably not going to elevate your cancer risk. But if you're on it for a very long time, you know, key the Lance Armstrong's of the world, where these people are taking growth hormones, they're blood doping, they're doing testosterone, they're doing all kinds of sort of, you know, under the table performance stimulant kind of drugs.
- [72:27]
A
Yeah.
- [72:27]
B
You get things like testicular cancer and it stimulates cells non specifically so it will cause long term use, will cause stimuli or stimulus of the cancer cells.
- [72:40]
A
Wow.
- [72:42]
B
Nad. I don't even know if people realize what NAD is. Have you heard of ATP?
- [72:49]
ATP is adenosine triphosphate.
- [72:53]
It's a form of cellular energy.
- [72:55]
A
Yeah.
- [72:57]
I was like, I feel like this is taking me back to high school science.
- [73:01]
B
Yeah, exactly. Yeah. You remember from chemistry and biology, ATP is the fuel for a cell.
- [73:08]
A
Yes.
- [73:09]
B
NAD is a precursor to ATP.
- [73:11]
A
Okay.
- [73:13]
B
So when you give somebody NAD and you sort of charge up their ATP synthesis with that nad, you are delivering cellular energy to again non specifically to all the cells in your body.
- [73:29]
A
Wow.
- [73:30]
B
So it's not necessarily a hormone problem, but it's a cellular energy and stimulus kind of problem.
- [73:36]
A
That's crazy.
- [73:38]
B
So I again like to be a slow adopter. I like to watch it. I let the community kind of vet. I think the wellness space is here to stay for sure.
- [73:49]
A
And it's only going to get bigger.
- [73:50]
B
It is. And I love the fact that people are practicing preventative healthcare.
- [73:54]
A
Yeah.
- [73:55]
B
That is so much more important.
- [73:58]
A
Yeah.
- [73:59]
B
Have you read a book called Outlive by Peter attia no. Oh, my gosh. This is the Wellness Bible.
- [74:07]
A
I'm writing this down.
- [74:08]
B
It is an amazing book.
- [74:09]
A
You gave me a good organizer earlier. Now he's giving me the Wellness Bible. What's it called? Outlive.
- [74:15]
B
It's called Outlive?
- [74:16]
A
Yeah. I think the biohacking is. It's amazing. But I think there are sides to it where people are doing too much.
- [74:22]
B
It can get a little hokey. You gotta be careful.
- [74:24]
A
Yeah.
- [74:25]
B
I always kind of look at, number one, the training of whoever's promoting all these things. Training's not everything. If you do a lot of something, you're not necessarily an authority because of your training. You should become an authority because of your experience.
- [74:40]
A
Yeah.
- [74:41]
B
And because you do something a lot.
- [74:44]
When you start selling things that you say add some sort of benefit, if that benefit is not obvious and they have to sort of justify it with a podcast or something like that, I say that. That. That bias destroys credibility immediately.
- [75:02]
A
Yeah.
- [75:04]
B
So Peter Attia is a concierge medicine doctor. I think he's in California. He has this theory. He calls it Medicine 3.0.
- [75:15]
A
Wow.
- [75:16]
B
Medicine 2.0 is what we're living in right now.
- [75:21]
We don't focus on preventative health care.
- [75:23]
A
No. We only start taking care of ourselves when there's a problem.
- [75:27]
B
Right.
- [75:27]
A
Yeah.
- [75:28]
B
And that's how the medical field has adopted or has adapted to our needs. So if you have a medical problem, let's say diabetes or high blood pressure, you go to the doctor and they prescribe a medication. They bill for it, they collect for it. Doctor's happy, patient's happy. You come back in three months, let's see how you're doing. That's fine. And patients do really well with that. But patient, like, our mortality is climbing our nation from a standpoint of infant mortality, heart disease, cancers.
- [75:58]
A
Yeah.
- [75:59]
B
There's so many different metrics that are measured. The United States is one of the worst performers in the world.
- [76:04]
A
That's so sad.
- [76:05]
B
And we also spend an ungodly amount of dollars on health care.
- [76:09]
A
Yeah.
- [76:10]
B
So I don't. I don't like to say that it's a corrupt system, but I think it's a broken system.
- [76:14]
A
Yeah.
- [76:15]
B
And if we can.
- [76:15]
A
I think they're trying to kill us.
- [76:17]
B
You do?
- [76:17]
A
Yes.
- [76:18]
B
You think that's a. You got a conspiracy theory?
- [76:20]
A
Oh, 1000%. I think not. I don't think everyone's trying to kill us. I think the majority, they don't care. And it's, you know, I think it's.
- [76:28]
B
More lack of care. I Think it's the end result of a capitalist society. Yeah, I think everybody's trying to make money and they are cheaper, quicker, faster.
- [76:39]
A
How can we do it?
- [76:40]
B
And they're allowing certain complications, risks, downsides to occur in the interest of profits.
- [76:46]
A
And just like the natural old American way where, you know, you go to the farmer's market and go get your tomatoes and your milk and take it home and cook dinner. It's just like everything's so ultra processed and like, you know, people cut corners and you can't control everything that's happening in these factories.
- [77:03]
B
There's a downside to it all.
- [77:04]
A
You know, it's just mass produced stuff that, you know, it's not as natural and as simplistic as it used to be. And I think the more complex, it's hard for our bodies to break down, that kind of stuff.
- [77:15]
B
Right.
- [77:15]
A
You know, so that's kind of my. It's hard.
- [77:19]
B
So medicine 3.0 that Peter Attia talks about is studying the way to prevent disease. And he doesn't want you to live a long time. Not only a long time. I say he wants you to live well for a long time. If you're 90 years old, tell me.
- [77:38]
A
If I'm decrepit at that point, please don't keep me alive.
- [77:41]
B
If you're decrepit for the last third of your life, you haven't really won that battle, right?
- [77:45]
A
No.
- [77:47]
B
If you make it to 90 years old and you're sprinting off the cliff and you fall to your death, that's the way to go.
- [77:53]
A
Yeah, I agree.
- [77:54]
B
You want to be energetic and vibrant and thriving all the way up until the time that you die. And that's what his mission is. And that's all in preventative health care.
- [78:05]
A
That's how I said, the second I start being a burden and can't take care of myself, let me go, please.
- [78:15]
B
So I think that would be a good book for everybody to read. It's just a. And I listen to books. I don't really have the time or the household that is amenable to reading because we've got little kids running around. But.
- [78:29]
Having that as a constant source, just playing in the background, or if you're a reader, I cannot recommend it enough. It's just such an awesome.
- [78:39]
A
Can you talk about blue zones and stuff in it?
- [78:41]
B
He doesn't refer to blue. He might, but it is very. It's very similar to blue zones.
- [78:45]
A
I think that's so interesting. You know, one of the things I started researching recently is people that don't have acne, have a lot of high fiber in their diets.
- [78:55]
B
Okay.
- [78:55]
A
Yep.
- [78:56]
B
Like the culture one that taught me that really that skin is often your gut due to what you put in your body.
- [79:04]
A
1000%.
- [79:05]
B
Skin disease is often more of a manifestation of gut problems.
- [79:09]
A
1000%. Yep. Constipation can lead to skin problems. If you're not going regularly, you're not having healthy poop. Like there's so much that goes into it. And then real fiber is so important. Probiotics and fiber are like two of the biggest things you can do if you have acne. I mean you can do all the topical products all day long. But I mean if you're not having good gut health and you know you have an imbalance, it's going to show up in your skin because you're not detoxifying, you're not, if you're not pooping, you're not, you're not flushing your system.
- [79:37]
B
Sure.
- [79:37]
A
And all that sitting there and festering.
- [79:40]
B
So fiber, a healthy gut microbiome are the two biggest things that.
- [79:44]
A
And then I would say stress levels. Cortisol is huge because it increases your sebum and increases your inflammation. And people that have stressful work environments drink a lot of energy drinks. Pre workout are just on stimulants. A lot of people on Adderall, recreational use of cocaine, like things like that. Really anything that raises that. Cortisol and sugar is a huge one too.
- [80:08]
B
Right. Cortisol is a hard hormone to control. I think stress is self induced. And you tell somebody to lead a low stress life, like go out there, get them, soldier. It's really difficult to do. It's really difficult.
- [80:24]
A
And I'm a high stress person, so I get it. It's hard.
- [80:27]
B
Have you noticed sleep hygiene to play a role in skin health?
- [80:32]
A
Yes, definitely. Especially when it comes to under eye circles, which is huge. And then also redness in the skin, acne and all over aging. If you're not sleeping and shitting, you're not gonna have good skin.
- [80:46]
B
I'm gonna write that down.
- [80:47]
A
Yeah. You wanna be no stress, lots of shitting and lots of sleeping. That's what you gotta do.
- [80:52]
B
You know, it's all connected. Physiology. Physiology is all connected 1000%. Your body is working and functioning properly and in a healthy way. You don't manifest disease.
- [81:02]
A
Yeah. So it's like just all over win, you know. And I think what I've loved the most is the clients that come to me for acne especially. Like it's really a lifestyle Change that we do, and they improve in every aspect of their lives. Like, they look better physically, their hair gets healthier, and they feel better and they're happier. So they come in just thinking it's just the acne. And we end up, you know, really addressing multiple things.
- [81:28]
B
That's unreal.
- [81:29]
A
Yeah.
- [81:29]
B
You change in people's lives, not just their skin.
- [81:31]
A
Yeah. It's really, honestly, one of my favorite things to see.
- [81:35]
B
You know, Julie, my office manager, gets mad at me sometimes because I will go down a rabbit hole and just start talking to patients about this stuff.
- [81:41]
A
Yeah.
- [81:41]
B
And she's like, dude, you're about an hour behind. You need to quit talking all this doctor stuff. You gotta. You gotta focus on this.
- [81:46]
A
I'm sorry. I like my clients. What do I have to say?
- [81:49]
B
It's. It's addicting. Especially if you have somebody who's, like, really engaged and listening to the things. I mean, I love to.
- [81:56]
A
It's hard to find.
- [81:56]
B
Discuss this stuff.
- [81:58]
A
A lot of doctors are in and out. They're like, you know, so that's amazing. That's one of the things, actually, one of my clients and dear friends who also helps me organize my house in spa is getting something done with you and something I said. I was like, you just. You really care, you know, and you can tell, and that makes a difference. And it's not just, like, with me or, like, your influencer, like, you know, bigger clients. Like, you're like that with everybody. And I think that's a true show of character, because a lot of people will put on a show for the right person, you know, but they're not like that with everyone. And that's not true about you. You truly are who you are with everyone.
- [82:36]
B
I appreciate that. Yeah, I definitely do that on purpose. And we've built a practice full of really good people.
- [82:43]
A
You have a good team, and I have a really good team. So it takes a lot for me to say that, but you have a really good team.
- [82:48]
B
Yep.
- [82:49]
A
And it's hard to find. It really is. And I think a lot of things that I've learned is, like, I don't know if you've ever gone somewhere and you, like, absolutely love, you know, your provider or your hairdresser, or you love, you know, the food at a restaurant, but, like, the people working there just ruin it for you, you know, or make you feel uncomfortable or, like, you shouldn't be there. Like, it can ruin your practice. It can ruin your business. You know, you can have the best product in the world, the best service, the Best food, whatever it is. And if the people.
- [83:17]
B
The experience can really ruin it.
- [83:20]
A
100.
- [83:20]
B
We remind each other all the time that we're in the service industry, and customer service is everything.
- [83:25]
A
Yeah. Which is like, something I think we lost since COVID Like, I swear now when I go somewhere, I'm like, I feel bad asking for, like, a fork or, like, a water. They look at you like, I just, like, cursed their mother's name or, like, just, like, ran over their dog or their husband. I'm like, I'm so sorry for asking for a towel. Like, my bad. Yeah.
- [83:42]
B
You know, it's kind of a shame sometimes is when somebody has a really positive experience with their surgery or with their skincare.
- [83:48]
A
Yeah.
- [83:49]
B
They'll go on Google or on Yelp or something and write a nice review, and they'll say, savannah Boda is so wonderful. She's so great. And they forget to mention the staff.
- [83:58]
A
Yeah.
- [83:58]
B
And so much of what you and I do is dependent upon our staff and the hard work that a lot of times goes unnoticed. That shouldn't.
- [84:11]
A
I agree.
- [84:12]
B
And it's great to get compliments on Google reviews and things like that, but it's also nice when you see one of the staff members working hard, mention them. And we've seen that in some of our recent reviews, and it's really special.
- [84:26]
A
Yeah. That's my favorite thing to get. I'm like, I don't care if they think, like, oh, you could race again. I'm like, yeah, yeah, yeah. They're like, sierra was so amazing. And I'm like, yes.
- [84:34]
B
Yeah.
- [84:34]
A
I love that, you know, because it's just. It means a lot, and it takes a lot to find good people.
- [84:40]
B
It does.
- [84:40]
A
And I think, especially in this industry, it's really hard to have a good team. And I speak about this a lot at conferences, actually, because I think that's what differentiates your practice and mine from a lot of other practices in the area, is you don't have a bunch of fake people working for you. And that's hard. When you are in the aesthetics industry, it breeds a lot of people that are in it for the wrong reasons and people that look down upon you or think they're better than you or, you know, just kind of have this demeanor. And I think when you break down that barrier and you're like, no, like, we're really here to help people. It's not about being superficial. It's not about, you know, hiring the prettiest girls to set up front. Even though my girls are gorgeous and have Good souls. But a lot of people, they just want this certain look, and they don't care about the hearts of the people they're hiring. And I've always told my girls, I can teach them. I mean, again, all the stuff that they're doing, it is hard work, but it's teachable. If you've never shipped a day in your life, I can teach you how to do that. It might take you some time. And yes, I could hire Someone with 8 years experience in shipping, but I can teach someone to ship. I can't teach them to be a good person. I can't teach them to care. I can't teach them to have integrity. I can't teach them to be loyal.
- [85:49]
B
You're absolutely right.
- [85:50]
A
So I hire for character. I always have. These past three years, that's what made the change in my practice. And I haven't lost an employee since I started hiring off character, not what's on their resume of how many job titles they've had in the industry.
- [86:06]
B
No matter how long you've been in the industry, if you're a good person and you're intelligent, you're able to focus on the things that matter. We can teach you the plastic surgery, we can teach you how to answer the phones and talk to patients and ship products and all that stuff. But you cannot teach somebody how to treat a person when they walk in the door or when there's an issue and somebody with a larger than life personality comes in and they're pissed off and they're trying to figure out who to blame. That's sometimes a very difficult position to be in as a staff member. And you can't teach that.
- [86:43]
A
No, you can't.
- [86:44]
B
There's a level of patience, there's a level of competence that is inherent in somebody. Yeah. And if you can find those people, you got to put golden handcuffs on them because they're. You can't. You can't let them go.
- [86:56]
A
You're not going anywhere. You're dying with me. Like, I will pay whatever it takes. I agree. Yeah. And you can tell that with your team, like, they truly love what they do and they're truly, genuinely kind humans. Like, it's not fake. And I think that's so important in a plastic surgery's office and especially, you know, in the aesthetics industry in general. Having real people when we're doing things that are different and, you know, taboo, it makes it feel safe and it makes it feel down to earth, and it makes you feel like you belong, you know? And I think that's a really hard thing to do.
- [87:30]
B
It sure is. So you were telling me before this podcast started that you guys have hired a bunch of people and moved into this larger space.
- [87:38]
A
Yeah.
- [87:39]
B
You guys are growing fast.
- [87:40]
A
Yeah.
- [87:40]
B
That's incredible. How many providers do you have underneath you now?
- [87:43]
A
So I have me and Lauren. Just two. Just me and her for now. So just one. But we're adding more as we go. But right now I'm really just trying to show her the reins and, you know, teach her everything I've ever learned.
- [87:57]
B
That's really great.
- [87:58]
A
Yeah.
- [87:59]
B
Um, I. I think that it is possible to grow too fast.
- [88:02]
A
Yeah.
- [88:02]
B
So you have to. You have to grow organically, and you have to make sure that the person that you're delegating to maintains your style and your culture.
- [88:11]
A
Yeah. Then I want to pour into her, give her all of the clients and really foster her growth and make sure her books are filled and she has a good hold on who she is as a provider and just feels confident and comfortable before I introduce having someone else in the picture. I don't like juggling. I'm very 100% loyal person, and I promised her that.
- [88:34]
B
How long have you been in practice?
- [88:36]
A
Oh, God. So including when I was in my salon suite. Eight years.
- [88:42]
B
And you've been doing everything.
- [88:45]
A
Yeah.
- [88:45]
B
For eight years?
- [88:47]
A
Yeah.
- [88:48]
B
That's unreal. From. From the outside looking in, you look like you're at a five provider kind of practice.
- [88:53]
A
That's so sweet. My favorite is when people call and they're like, your call center. And I'm like, our call center. I'm like, that's Sierra and Alyssa.
- [89:00]
B
Am I calling the Texas location?
- [89:01]
A
I'm like, that's just us. It's so funny. Like, your warehouse hasn't shipped out. My warehouse is our front desk.
- [89:07]
B
Oh, that's so funny. But I mean, it's true, though. The perception of your practice is this behemoth.
- [89:14]
A
Yeah.
- [89:14]
B
And it's incredible the amount of productivity that you guys have.
- [89:17]
A
Thank you.
- [89:18]
B
In what was a very small footprint, but now is growing and deservedly so.
- [89:24]
A
Thank you. It's exciting. It's nerve wracking. I never, you know, I think my favorite quote is, like, one day you're so good at what you do. You end up, like, not being able to do what you love because now you have to manage people, you know, and it's like, I think that's been the hardest part is I miss being in the treatment room. But there's, you know, before I can get back to that, I have to set A lot of systems in place and, you know, kind of like I was telling you earlier, we're restructuring a lot. People think, you know, SBA is just getting, like a new blowout, you know, and just a different look, but the same company. But we're really restructuring from the deepest core of our identity. Because I've never had time to do that. Like, I've just been building and, you know, if I'm not working, no one's getting paid. So how am I supposed to be physically working on clients and then working on the back end of the business simultaneously? And that's where Tyler really has come in and helped this past, like, year and a half.
- [90:15]
B
You guys sell a lot of products.
- [90:16]
A
Yes.
- [90:18]
B
Do you guys derive most of your sales from online sales or this past.
- [90:21]
A
Year, since I haven't. I've not worked this past year. Yes, but usually it's like, pretty. Like, I'd say 60% online and like 40% in clinic.
- [90:30]
B
What platform do you guys use to sell products?
- [90:32]
A
Instagram.
- [90:33]
B
Really?
- [90:33]
A
People are always shocked to know we don't run ads. We have a horrible SEO. Like, our SEO is so bad. It's, like, comical. Like, people are, like, shocked when they see how bad it is. And it's because I got.
- [90:43]
B
It's all your name, it's all word of mouth.
- [90:45]
A
I got scammed when I was 20 running a business, and this guy was like, oh, I'll build this, like, custom website for you for, you know, $30,000. And I was like, oh, my God, this can be amazing. He's like, you don't want those, like, templates like everyone else. Like, you're Savannah Boda. Like, you deserve this badass, custom built out, cryptic coded website. And I'm like, yeah, of course I do. But then you have to pay me, you know, $5,000 a month to, like, update anything or run anything for you because you don't know how to code. And so basically you're in handcuffs and like, stuck with me if you want your website to work after you paid $30,000. So, you know, I've made so many mistakes in business.
- [91:23]
But I've learned so much from them. But that if I can give any advice, I got bamboozled. Like, he knew what to say to me. Like, he really knew what to say to me to get me to be like, yeah, that sounds great. But then in my head now or back then, you know, it would have been so much better to just have a basic shopify or square operated website where I could go in just something very update Items. I mean, we'd have to wait weeks. Like we'd have products like, waiting to start promoting where, like, we can't even talk about these because they're not on the website yet. And we have to wait for this man to like do everything and then do it wrong and then fix it and then still do it wrong and then do it again.
- [91:59]
B
Right.
- [92:00]
A
So that's how we've been for the past like eight years is like just really trying to restructure all of like the dumb decisions that I made. Which they worked. I mean, we did great.
- [92:11]
B
They're not dumb decisions. They're, they're molding you as a businesswoman and they're molding you as a provider and you learn more from your mistakes than you do from your successes. And it's, it's important to make those mistakes if you don't.
- [92:23]
A
And it's even honestly more impressive that we had such a, we have such a shit website and we still do that. Good. I'm like, imagine how we're going to do with this new website. It's going to be great.
- [92:32]
B
It's going to be great.
- [92:33]
A
But yeah, I learned a lot and it's amazing. And how long you've been in practice now? What, five years?
- [92:38]
B
I've been in practice for your own practice. 2017 was technically my first year of practice.
- [92:44]
A
Oh, wow.
- [92:45]
B
So we're just rounded the corner on our eighth year.
- [92:47]
A
But this location that you're at, how long have you been there?
- [92:50]
B
We've been there for five years.
- [92:52]
A
Yeah.
- [92:52]
B
Yeah, since 2020 was when we, we started building out that space.
- [92:57]
A
You think you'll open another location?
- [92:59]
B
Gosh, you know, I was just talking to my buddy about that this morning.
- [93:04]
I don't know. I don't want to make a decision that's going to degrade the culture or the brand. It's hard because ultimately when you're present or when I'm present, the culture is maintained and they can't be in two places at once. Yeah, you're right. They need their leader and the culture is a top down concept. And if you're not there to maintain that, then it tends to start to degrade over time.
- [93:32]
A
Yeah.
- [93:33]
B
And so with that in mind, I've contemplated just growing vertically rather than horizontally.
- [93:40]
A
Yeah.
- [93:40]
B
And expanding my, my existing footprint will probably need a bigger space because we're kind of busting at the seams now.
- [93:47]
A
Yeah, you will need a couple more hours.
- [93:50]
B
Yep, exactly.
- [93:51]
A
Would you ever bring someone, another surgeon onto your practice with you?
- [93:54]
B
That's, that's Another thing that I've contemplated.
- [93:58]
The. One of the issues with bringing another surgeon is train your kids.
- [94:02]
A
That's starting young.
- [94:03]
B
It's a culture disruptor. Because it's another. It's another alpha.
- [94:05]
A
Yeah.
- [94:06]
B
And.
- [94:08]
I prefer to keep everything to myself for right now.
- [94:13]
A
Yeah. Do your boys. Do you think, especially the older one, do you think he wants to do this?
- [94:18]
B
Yeah. He's actually indicated interest. He's the only one that's of age now where he can actually discuss his career interest. The other kids want to be firefighters and astronauts.
- [94:29]
A
Yeah, of course.
- [94:30]
B
And kid stuff.
- [94:31]
A
Good stuff.
- [94:31]
B
But my 12 year old, August is his name. Has indicated that he's interested in becoming a plastic surgeon.
- [94:37]
A
That's so sweet.
- [94:38]
B
I said, long road, brother.
- [94:39]
A
You're like, get up and get ready.
- [94:41]
B
That's right. Buckle down.
- [94:42]
A
Did it ever gross you out or did you always know you wanted to be like a surgeon?
- [94:45]
B
Never once grew? Yeah, it grossed me out.
- [94:47]
A
I loved it even from, like a young age. From a young age, did your parents think you could be a serial killer because you were, like, so cool with, like, blood and guts back then?
- [94:55]
B
I'm sure that thought probably crossed their mind. They never communicated that to me, but I'm sure it crossed their mind, like.
- [95:00]
A
You had way too much fun, like dissecting a frog.
- [95:03]
B
I was, it was just. It was an interest. It was never pathologic or like, I wasn't really ever crazy about it, but it was definitely something that. I was definitely the one leading the dissection.
- [95:13]
A
Yeah.
- [95:13]
B
And very.
- [95:14]
A
It felt like natural to you?
- [95:15]
B
Very into it, for sure.
- [95:16]
A
That's amazing. And your brother does not do. He's not a doctor. What does he do?
- [95:20]
B
My brother is a home builder.
- [95:21]
A
No way. So you guys both work with your hands?
- [95:23]
B
My brother and my sister. I've got a younger sister. She is also a home builder. They work for the same company. It's a family company. My dad and mom started the company. Gosh, 40 years ago.
- [95:35]
A
That's crazy.
- [95:35]
B
45. Yeah, 40 years ago.
- [95:37]
A
You just have to have them build you your practice then.
- [95:40]
B
Well, they've helped a lot.
- [95:41]
A
Yeah.
- [95:41]
B
My, My brother, my sister, and my. My wife and my dad all helped me finish out the. The practice.
- [95:48]
A
That's amazing.
- [95:49]
B
Yeah.
- [95:50]
A
I love that.
- [95:51]
B
It's a family operation.
- [95:52]
A
It's a family operation. That's wonderful.
- [95:54]
B
Yeah. Recently we built out the operating room, which has given us a lot of control and.
- [96:01]
A lot of ability to deliver the same culture and level of customer service.
- [96:06]
A
I like that so much more than being at the hospital.
- [96:09]
B
That's right. You had both experiences. Yeah. So you were at the Baylor surgery center and then you were at my office.
- [96:16]
A
Thousand times better at your office.
- [96:18]
B
Really?
- [96:19]
A
Except when I could smell the chicken and I hadn't ate since midnight.
- [96:23]
B
And I was like, the girls were fixing lunch while you were.
- [96:26]
A
And then the vet was like, this is so fucked.
- [96:29]
B
I'm sorry about that.
- [96:30]
A
No, it's so funny. No, I was like, this smells so good. What are they eating? And they're like, they had the air fryer going. They were like. I was like, that smells great.
- [96:37]
B
Torture.
- [96:38]
A
It was. It really was. Yeah.
- [96:41]
B
But our surgery center allows us to deliver one skill very, very well. Surgery centers, hospitals are more of jack of all trades. You see staff that are used to working in all kinds of different rooms, whether it be ent, ortho, ophthalmology, general surgery. Our team only operates on cosmetic patients.
- [97:00]
A
Wow.
- [97:01]
B
That's the only thing we do.
- [97:02]
A
That's amazing. And I feel like it's way more sterile too because you're not having so.
- [97:05]
B
Many people that plays a role too. Yeah. I've never looked at that from an office based or versus commercial surgery center to see if infection rates change. But we certainly don't have some of the issues like multi drug resistant organisms and contamination, cross contamination from dirty cases to clean cases. That certainly happens in bigger incidents, more controlled environment there. It certainly is.
- [97:32]
A
I love it. No, I think it's the best thing you did.
- [97:35]
B
It's been great. It's about a year and some changes.
- [97:38]
A
What was the first one you did? Remember when I still had like a little bit of that bra. Fat bulge and you're like, come on in.
- [97:44]
B
Yeah.
- [97:45]
A
And a little bit of lipo. Yeah.
- [97:46]
B
You were awake for that, right?
- [97:47]
A
Yeah.
- [97:48]
B
Oh, man. How was it?
- [97:49]
A
It was not bad actually at all.
- [97:51]
B
I was chilling that you were the whole time patient in the, in the operating room, but we had not gotten our accreditation for general anesthesia yet.
- [98:04]
A
That's crazy. Yeah. So I wasn't the first to go under. I was the first awake.
- [98:08]
B
You were. You were the patient number one for the, for the surgery center.
- [98:11]
A
That's so sweet.
- [98:12]
B
Yeah. Before. Before it was accredited.
- [98:14]
A
That's awesome. How hard is it to get it accredited?
- [98:17]
B
It's a pain in the ass.
- [98:19]
A
How long did it take?
- [98:19]
B
Like, which is a good thing, right? I mean, you want, you want a surgery center to have a lot of regulatory jump through.
- [98:24]
A
Have been a while. If you said it's been a year. And like I did that a year after my sons it probably took, like two years to get them to.
- [98:30]
B
It took us from the standpoint of conceptual phase all the way to where we got accredited, probably a solid two years.
- [98:36]
A
Wow.
- [98:36]
B
A lot of thinking, a lot of planning, a lot of implementing meeting trades on the job. You know, piping med gas through the walls, getting all the valves correct, getting the med gas room.
- [98:46]
A
How do you even go about that? You just. To hire someone that has, like, built ORs.
- [98:50]
B
There are surgery center specific trades, and the only one that's really important is the med gas plumber.
- [98:56]
A
Okay.
- [98:56]
B
Everything else is the same. Electrician, sheetrock guy, the flooring guy. There are things that we have to do, like certain types of seamless flooring that you have to put into an OR to reduce infection risk and all that. But the only real specific trade that you need is a med gas plumber.
- [99:13]
A
So they pump anything in the air to make it a sterile room?
- [99:16]
B
No, but there are pressure differentials. So you always want positive pressure in an operating room, because when a door opens, you don't want air to come into the room. You want air to flow out of the room.
- [99:25]
A
That makes sense.
- [99:26]
B
So if you have more AC inflow and no air return in the operating room, the. When the door opens, the air will flow out the door rather than in the door.
- [99:35]
A
And, like, you want it to be cold?
- [99:38]
B
Generally, yes. For sterility, I think the new guidelines are 70 degrees.
- [99:43]
A
That's not cold.
- [99:45]
B
It's. It's colder, but it's not that cold here.
- [99:48]
A
Yeah.
- [99:50]
B
The.
- [99:53]
Operating room gets kind of. Kind of hot, too. When you're operating. You got all the machines, you got a lot of people in there. You got the overhead lights, which are, you know, hot, creating a lot of heat. So the. The. A good AC system is important.
- [100:06]
A
That's amazing.
- [100:06]
B
We'll crank that baby down to 65 sometimes. Yeah. Rock on.
- [100:09]
A
That's so fun.
- [100:10]
B
Put the music on.
- [100:11]
A
That's amazing.
- [100:12]
B
Do you think more anesthesiologist is in? Like, they're, you know, as they should.
- [100:15]
A
I loved him, by the way. He was great. So I have to tell this story because it's actually really. Did you. Did you know about this?
- [100:22]
B
I don't think so.
- [100:23]
A
Dr. Gold is his name?
- [100:24]
B
Yeah, Dr. Gold. Andrew Gold.
- [100:25]
A
Poor guy.
- [100:25]
B
We love that guy. Oh, my God, he's so good.
- [100:28]
A
So, like, you came in, you're like, you know, you're like, okay, final little things like talking about, you know, getting ready to go. And I was like, can we do my labiaplasty? And you're like, yes. And you looked at it. You're like, let's do it. It's good you left the room. And I was like, you know what? This is the last time I'm ever.
- [100:40]
B
Gonna see I did hear this.
- [100:42]
A
My vagina like this. And so I'm like, spread open. And, like, the door. So where he's sitting is like, where the door is liter. So I'm like, taking a picture of my vagina, and he walks straight in. And he's like, I am so sorry. And I'm like, this is like.
- [100:55]
B
That is hysterical.
- [100:56]
A
The most embarrassing. I'm like, you're about to see that My. My vagina anyway. But, like, I'm not going to be awake.
- [101:02]
B
That is absolutely hysterical.
- [101:03]
A
I was like, I'm not sending it to anyone. It's for me.
- [101:06]
B
Did he turn around and walk out or.
- [101:07]
A
Oh, no. I was like, I'm so sorry. You know, he was so. He was like. And I was like, yeah.
- [101:13]
B
I mean, he just wants to take your vital signs, talk to you by nature.
- [101:16]
A
I was like, of course. That second, I was. And I literally looked at my assistant, Maria, and I was like, no one's gonna come in here. Like, he just came in here. Like, it's gonna take a minute for someone to come in. Immediate bam.
- [101:25]
B
Right.
- [101:25]
A
I know. I mean, that's what happens when it's the one, one, one patient. You know, care.
- [101:30]
B
When you're in a plastic surgery office, you. You run into things. Humility has to go out the window, and you run into things that, you know, you don't normally see.
- [101:37]
A
It's so funny. That's one of my. He, like, went home that night and was like, yeah.
- [101:43]
Oh, my God.
- [101:44]
B
Questioning his spirit choice.
- [101:45]
A
Yeah, he was like, I can't believe I walked in on that.
- [101:48]
B
He probably felt bad for you. I'm sure that was embarrassing.
- [101:50]
A
No, I think. I think that's what. Yeah, he was like. He was like, this poor girl.
- [101:55]
B
That's so funny.
- [101:56]
A
Oh, my God.
- [101:56]
B
Yeah. You run into occasional situations like that, but you just roll with it.
- [102:00]
A
You just roll with it.
- [102:01]
B
That's right.
- [102:01]
A
Have you ever had a client or a patient wake up?
- [102:06]
B
You know, there's a perception of wakefulness during surgery, but no, I can't say that. We've got really good anesthesiologists.
- [102:14]
A
Yeah, I was out.
- [102:15]
B
These are total Jedis. They are so good at what they do.
- [102:18]
A
That's so crazy.
- [102:20]
B
I mean, we're. From the standpoint of anesthesia, we're pretty easy.
- [102:25]
A
He's so tall, too. I wonder if he's had a leg extension surgery or an anesthesiologist. He's so tall. What is he, like, 6? 5?
- [102:34]
B
I think you're talking about Rob Lyon. Who was your anesthesiologist?
- [102:37]
A
I swear it was Dr. Gold.
- [102:38]
B
Was it Dr. Gold was. Doctor. Dr. Gold is about my height. He's probably. Rob Lyon is 6 5.
- [102:45]
A
Maybe that was him. I don't know. I just know someone called me for, like, a clearance, and it was. I believe his name was Dr. Gold.
- [102:51]
B
I believe it was Rob Lyon. That's. That's who did your anesthesia. Tall guy with long gray hair.
- [102:55]
A
Yes.
- [102:55]
B
Yep, that's Rob Lyon.
- [102:57]
A
That's who saw me.
- [102:58]
B
I'm sorry. I'd forgotten. It was not Gold. It was Rob, but Gold.
- [103:01]
A
That's why I got confused because Gold called me about, like.
- [103:03]
B
He's like a serious lion's fantastic too. He's one of my favorites. The dude is just so much fun.
- [103:08]
A
That's awesome. So they work fully for you.
- [103:09]
B
I love that. It was a contract out that walked in on you.
- [103:11]
A
Yes.
- [103:11]
B
That's even better.
- [103:12]
A
It's even better. I know. I was like this huge, tall man with long gray hair. I'm like, oh, my God, I'm so embarrassed.
- [103:19]
B
Yeah, that's absurd.
- [103:20]
A
He probably. Cause I'm like, sending this to people. I'm like, it's just for memories.
- [103:24]
B
We operate with a group of. Probably the group itself. Huda has 20 anesthesiologists, and we see a rotation on a regular basis, probably about five to six of them.
- [103:36]
A
Okay, that's good.
- [103:37]
B
And they are some of the best anesthesia providers that I've worked with.
- [103:40]
A
That's awesome.
- [103:41]
B
They are only MDs and DOs. We don't work with any CRNAs. And I think that from a standpoint of training, liability, and just.
- [103:51]
A
Yeah. If.
- [103:53]
B
If the. You don't hire the pilot to fly the plane, you hire the pilot to troubleshoot the plane when it's having problems, Right?
- [103:59]
A
Yeah.
- [104:00]
B
Otherwise the autopilot can. Can fly through the air.
- [104:02]
A
Yeah.
- [104:04]
B
So having that. That comfort level with. With a very solidly trained.
- [104:09]
Good anesthesiologist really, really makes my job a lot easier.
- [104:12]
A
I bought a. Yeah, no, he was great.
- [104:15]
B
You saw the pinnacle of it, man. They're just awesome.
- [104:17]
A
They're awesome. No, it was like the easiest surgery. I mean, the smoothest experience. And yeah, I couldn't be happier. I think that's, like, the biggest thing is you kind of get those jitters, you know? I was like, why am I more Scared to be asleep and get surgery than I was, like, jumping in the water with, like, a bunch of bull sharks. But I think right before, you know, you just kind of get that, like, you know, like. Oh. I think it's more of, like the just knowing you're not going to feel it, but just, like, thinking about yourself getting cut. It was like a hard thing to think about.
- [104:46]
B
It's a big deal.
- [104:47]
A
You can't think about it.
- [104:49]
B
You know, we just. When I go into patients, they're nervous, they'll say they're nervous and sometimes they'll try to break the ice. But you. The line that I tell them is just let the lizard take over.
- [104:59]
A
Yeah.
- [104:59]
B
You got to turn your brain off. You've made all the decisions, you've done all the thinking.
- [105:02]
A
Yeah. I just need to, like, chill.
- [105:04]
B
You're in a good place. You're with good people. You just need to, you know, let us do the markings, sign the consent form, and let's go.
- [105:11]
A
Okay, I have to ask, has anyone ever been, like, on the table about to go under anesthesia and gotten up and like, no, I don't want to.
- [105:17]
B
Do it on the table.
- [105:19]
A
Yeah, like, on the table.
- [105:20]
B
I've never seen somebody, like, back out of surgery that late. People have changed the plans last minute. Yes.
- [105:26]
A
Oh, wow.
- [105:26]
B
And that's not favorable. Sometimes you proceed, sometimes you don't.
- [105:30]
A
I feel like you can't do that because it's like, it's always your gut instinct and what you decided. Like, if you make a game time decision, it's usually not going to be what they want.
- [105:36]
B
Right.
- [105:36]
A
You know what I mean? Like, they're going to regret it and be like, why the fuck did I switch up last minute?
- [105:40]
B
Yep. That, you know, sometimes puts the team in a difficult position because you always have to follow the patient's prompt.
- [105:46]
A
Yeah.
- [105:46]
B
You always have to do what the patient wants.
- [105:49]
Doing something against the patient's consent is always bad.
- [105:52]
A
Yeah.
- [105:53]
B
So it's.
- [105:54]
A
I want to know how do you use your judgment when. Okay, so like, let's say you told me where to do three tens. Right. And then you get on the table, you put three tens in me, and they look like shit. Do you have a tattoo on your flag?
- [106:06]
B
I do.
- [106:07]
A
What is that?
- [106:08]
B
This is a tattoo that says twin. I got this when I was 18.
- [106:11]
A
With your twin?
- [106:12]
B
Yeah.
- [106:12]
A
That's so sweet.
- [106:13]
B
My brother and I both have it.
- [106:14]
A
Aw. I just noticed. I did not know. I would not peg you for a tattoo, man, but that makes sense because it's like, very wholesome yeah. An innocent little 18 year old tattoo.
- [106:22]
B
That's right.
- [106:22]
A
I love it.
- [106:23]
B
I'll never get rid of it.
- [106:24]
A
That's amazing. Yeah. So you put it in and it looks horrible. I mean, obviously you pick your surgeon because you want to trust their judgment.
- [106:33]
Is it hard to do that when.
- [106:34]
B
You'Re like, we had this discussion. But we always try to maintain a certain level of flexibility because I know that you're wanting a certain look. And if the 310 doesn't necessarily give you that look, I ask you for a little bit of laterality on. Let me change the implant size to get you what you want. We're not here to give you an implant size. We're here to give you a result.
- [106:54]
A
Yeah. That was what really stuck with me because I was really stuck on the size. And you're like, you're not gonna be happy. Like, if we go that small, then you're right.
- [107:02]
B
A lot of times the first implant that we decide on in the consult is the one that we end up going with.
- [107:08]
A
Yeah.
- [107:08]
B
You do this enough, you kind of know what an implant's gonna do for somebody. Every once in a while, I'm humbled by what I see in the operating room. And for that reason, I always, you know, ask the patient if it's okay.
- [107:19]
A
To change, make that judgment call.
- [107:21]
B
If, if there's a big change, then I will often call, you know, their husband, their, their mom, whoever dropped them off with surgery. And I'll say, hey, listen, this is what we found.
- [107:30]
A
Yeah.
- [107:31]
B
And this is what we need to do. And almost always they say, do what you need to do. This is, you know, you're in control here. And she's, she's, she's giving you the green light, the consent, the green light to do it.
- [107:43]
A
That's amazing.
- [107:43]
B
Yeah. And uniformly that ends up going well.
- [107:47]
A
Yeah. No, I couldn't be.
- [107:48]
B
When you make, when you make a decision based on the aesthetics rather than the actual ccs, it bodes well for the patient and the doctor.
- [107:56]
A
I think people get just really hung up on the number.
- [107:58]
B
They do. Yep.
- [108:00]
A
Which doesn't really matter.
- [108:04]
How much less do you think, like how they are now? Because we just did another post op yesterday to check. Do you think they're going to stay this. As big as they are, do you think they're going to go down a bit?
- [108:13]
B
They're going to change a little bit in terms of their shape. You'll as the implants kind of what they call drop and fluff, they'll. They'll kind of Descend and expand that lower pole tissue. As the swelling goes down, you'll notice that they'll fill out the lower pole a little bit more, and you'll lose a little bit of the upper pole roundness. I know you do like them up there, but for somebody in good shape and not a whole lot of breast tissue on top of your. On top of your implant, you're not going to see much change from the. From the volume standpoint, this is. This is pretty much where you're gonna stay.
- [108:46]
A
Yay. That's wonderful. Okay, and we see if there's any last questions. I feel like we've been talking for, like, two hours. We always do. People love this, though. They really have such good questions.
- [108:57]
B
It's easy to talk about. It's.
- [109:00]
A
We both love what we do, and it's like.
- [109:01]
B
It's a fun topic.
- [109:02]
A
It's a fun topic. It really is. Okay, someone wants to know. Lymphatic after.
- [109:09]
Surgery, when can you get it done? Lymphatic drainage massage.
- [109:13]
B
So in terms of timing, you can get it done as soon as you're off the table. The one exception is breast surgery. I don't. I don't like my breast patients to get lymphatic massage because it can affect your postoperative outcome, your implant position. So the way lymphatic massage works is.
- [109:33]
When you do surgery, you injure lymphatic vessels, and the lymphatic vessels are what migrate the swelling and the tissue fluid away from that surgery site and back to your lymph nodes. And when the surgery cuts those lymphatic vessels, they're paralyzed, they're interrupted, they can't go, they can't flow. So the lymphatic masseuse will massage those lymphatics away from the surgical site and over to healthy lymphatic basins where that fluid can drain. And I think it's. I think it's good post op. I think it's good just in. Just in general health, healthy lymphatic flow is very important.
- [110:12]
A
Yeah.
- [110:12]
B
And I'm happy to see that lymphatic massages are becoming more mainstream.
- [110:16]
A
You guys gotta get them in your office.
- [110:18]
B
We don't do them in the office. We have, you know, a kind of a rolodex of masseuses that we send patients to.
- [110:25]
A
That's amazing. Okay, so when can I be cleared for that?
- [110:28]
B
I mean, if you do a lymphatic massage other than your breast, you're cleared now.
- [110:32]
A
Okay, so I can do it.
- [110:33]
B
You can do it.
- [110:34]
A
Amazing. Okay. Any closing thoughts?
- [110:39]
B
Well, this has been really great. I always love doing Q and A's because it provokes conversation that otherwise you don't think about. And you've got some really thoughtful followers asking some really insightful questions.
- [110:49]
A
They're amazing.
- [110:50]
B
Yeah, it's been good.
- [110:51]
A
They've been so good. I know.
- [110:53]
B
If you're. If your people want to see more, we can. We can certainly do this again.
- [110:57]
A
This is really, really important. This is a good one. Difference between under and over the muscle implants. Why do one over the other?
- [111:06]
B
Um, under the muscles, probably a little bit better. That's what we did. That's what we did.
- [111:10]
A
Yeah.
- [111:11]
B
I'm not gonna say it's all the time better. Um, it's just. It's just better most of the time. Uh, the reason is when you put the muscle over the implant, complications go down. And what we're talking about is submuscular stability of the implant pocket and keeping the implant where you want it to be. Yeah, and that's more natural, too. Natural appearance of the. Of the breast.
- [111:33]
A
They look a little bit more fake when they're on top, right?
- [111:36]
B
That's right, because it's all about soft tissue coverage. If you add that muscle to the upper pole, it kind of pushes down on the implant a little bit, and it gives you a sloping upper pole rather than it stuck on, you know, very fake, artificial look to your breast.
- [111:48]
A
Okay. Amazing. That was a good, easy answer, but, yeah. No. People want you back on here. They love you.
- [111:53]
B
Let's do it.
- [111:54]
A
I'm always available to get people to fly. Come. See you.
- [111:57]
B
I feel like I've taken Tyler's spot.
- [111:58]
A
I know, I know.
- [112:00]
B
Where's Tyler?
- [112:00]
A
We're beefing these days and. I'm kidding. We're actually getting along great. He was working late tonight.
- [112:04]
B
He's probably tired of moving you.
- [112:06]
A
Yeah, he is. He really is. He's like. He's so sick of my shit, so he gets to deal with me now.
- [112:11]
B
Cool. Always happy to do that. This has been great, Savannah.
- [112:13]
A
Thank you so much. And thank you guys again. Remember your. What's your Instagram?
- [112:17]
B
Dr. Philip Dawa.
- [112:18]
A
Okay. Used to be the real Dr. Phil.
- [112:20]
B
That's my hashtag. Yeah, you can probably find me that way.
- [112:22]
A
I love that. That's amazing. All right, guys, we'll see you next Monday. Thank you.