Latest / The Body Pod / Everything You've Wanted to Know About Facial Plastic Surgery with Dr. James Manning - Expert Insights & Techniques

Transcript

Everything You've Wanted to Know About Facial Plastic Surgery with Dr. James Manning - Expert Insights & Techniques · The Body Pod

• 0:00
  Speaker 1: Hey everyone, This is Haley and I'm Lara, and welcome
• 0:03
  Speaker 1: to the Body Pod.
• 0:10
  Speaker 2: Today we are speaking with the phenomenal doctor James Manning,
• 0:14
  Speaker 2: a leading expert in facial plastic surgery with a reputation
• 0:19
  Speaker 2: for delivering exceptional and flawless results. Doctor Manning has transformed
• 0:24
  Speaker 2: the lives and confidence of countless patients. In this episode,
• 0:28
  Speaker 2: it feels just like a one on one consultation where
• 0:32
  Speaker 2: you'll hear his insights on cutting edge techniques, personalized care,
• 0:37
  Speaker 2: and what truly sets them apart in the field.
• 0:39
  Speaker 3: You don't want to miss it. I love that when
• 0:47
  Speaker 3: we spoke that you said, you know, I really am
• 0:50
  Speaker 3: trying to take the stigma of having plastic surgery, facial
• 0:55
  Speaker 3: plastic surgery be superficial and kind of like you're this vain, yeah,
• 1:02
  Speaker 3: flashy human that does it. And I just I love
• 1:06
  Speaker 3: that that's your motto and mentality around.
• 1:09
  Speaker 4: It right now, especially there's so much hype around the
• 1:16
  Speaker 4: stigma of Utah aesthetics.
• 1:20
  Speaker 5: And yes, yes, yes.
• 1:22
  Speaker 4: Right, And I'm a girl dad, right, So I have
• 1:26
  Speaker 4: a nine year old and a five year old daughter
• 1:30
  Speaker 4: and a twenty month old daughter, and my wife is,
• 1:35
  Speaker 4: you know, a very kind of progressive thinker, which I
• 1:37
  Speaker 4: think as far as being you know, for supporting women,
• 1:42
  Speaker 4: and that wears off on me, right, And so when
• 1:48
  Speaker 4: I think about the ways that I talk about surgery
• 1:50
  Speaker 4: and the ways that I approach altering someone's face, you know,
• 1:55
  Speaker 4: you never I would never want anyone to tell my daughter,
• 1:59
  Speaker 4: you need to look this way to be beautiful. One
• 2:02
  Speaker 4: of my big pet peeves, I never use the word
• 2:05
  Speaker 4: beautiful in my posts. I never. I avoid that word
• 2:09
  Speaker 4: altogether with my patients, and I keep it very subjective
• 2:14
  Speaker 4: and use descriptive words to define what we've done. We've
• 2:17
  Speaker 4: moved this this way, We've defined the jaw line, things
• 2:20
  Speaker 4: like that, we brought down the bump. Because beauty is
• 2:24
  Speaker 4: really what I find beautiful has nothing to do with
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  Speaker 4: what a patient gets done to their face, and so
• 2:33
  Speaker 4: I just try to keep all of the you know,
• 2:37
  Speaker 4: subjective portion of that out of it and leave it
• 2:40
  Speaker 4: up to the patient to decide what best suits their features.
• 2:45
  Speaker 1: So like TikTok has a new filter that tells you
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  Speaker 1: what your dimensions are, and if you fall like into
• 2:52
  Speaker 1: the beauty category, first of all, who's signing up to
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  Speaker 1: do that? I just have I'm not even on TikTok.
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  Speaker 1: But my sister is and I she did it, and
• 3:02
  Speaker 1: I was like, who is signing up to do this?
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  Speaker 5: You know what post it?
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  Speaker 4: It's good for business, but I think it's bad for
• 3:09
  Speaker 4: our mental health. And so here's another thing, right, So,
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  Speaker 4: like you talk about the parameters, what what are these
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  Speaker 4: apps using?
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  Speaker 3: Right?
• 3:17
  Speaker 4: What are the what are the parameters of beauty? If
• 3:19
  Speaker 4: you read in the textbook, you can find descriptions, angles,
• 3:24
  Speaker 4: you can find lengths, proportions that are supposed to be
• 3:29
  Speaker 4: you know, beautiful, all those things. This has been a
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  Speaker 4: very male dominated field for a very long time. All
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  Speaker 4: these things are written by a bunch of old white dudes.
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  Speaker 6: Right yeah, or like your hair okay, so like and
• 3:43
  Speaker 6: and so take a nose for example, when I when
• 3:46
  Speaker 6: I'm talking with a patient about altering their nose with
• 3:51
  Speaker 6: a rhinoplasty, I do use those parameters that you would
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  Speaker 6: read in a textbook, but I have to preface it with, look,
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  Speaker 6: these parameters are just a starting point.
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  Speaker 4: These these are a very westernized ideal of you know
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  Speaker 4: what it should look like, And it doesn't mean it's right.
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  Speaker 4: It just is a starting point. And you can tell
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  Speaker 4: me what resonates with you because take ethnic noses for example.
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  Speaker 4: You know, like often I'm making nostrils narrower, but sometimes
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  Speaker 4: you don't want to narrow them too much, or you
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  Speaker 4: start to lose someone's ethnic identity. And that's all dependent
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  Speaker 4: on what the patient wants. So yeah, I just think
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  Speaker 4: that we have to be very careful about how we
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  Speaker 4: talk about these things, how we portray our patients, and
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  Speaker 4: to not try to ascribe a beauty to certain features
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  Speaker 4: which may go out of style in the next thirty
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  Speaker 4: or forty years.
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  Speaker 3: True, And it's not like having thinner earth thicker eyebrows.
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  Speaker 3: You can't just grow your eyebrows back and more thick.
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  Speaker 3: Once you get punch, you're under the knife, right, like
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  Speaker 3: a bigger commitment.
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  Speaker 5: It's a bigger high.
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  Speaker 4: Well, I mean, actually, yeah, I can make your eyebrows
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  Speaker 4: thicker out.
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  Speaker 5: You're right, we live it.
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  Speaker 4: But you know it doesn't mean you want you know,
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  Speaker 4: you want a timeless look. You want something that blends
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  Speaker 4: with someone's features. You want something they're not going to
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  Speaker 4: regret doing when they're thirty or forty years older than
• 5:19
  Speaker 4: they are now.
• 5:20
  Speaker 1: Okay, so what's the average age for Well, I know
• 5:25
  Speaker 1: there's the mini facelift, which I want to talk about
• 5:27
  Speaker 1: because I I have no clue. I know what a
• 5:30
  Speaker 1: facelift is, but I don't know anything about the mini.
• 5:33
  Speaker 1: So that's a great question, along with what age.
• 5:37
  Speaker 5: Is it usually like around fifty? Is there a certain age?
• 5:41
  Speaker 4: Yeah, So a mini facelift is really best cater to
• 5:45
  Speaker 4: someone who is focused primarily on joeling and does not
• 5:49
  Speaker 4: want as much out of their neck. A mini facelift
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  Speaker 4: in our practice is called a max lift. It's it
• 5:55
  Speaker 4: can be done either awake or general under general natusia,
• 5:59
  Speaker 4: the recovery is a little shorter. Well, the difference is
• 6:02
  Speaker 4: that you're not elevating the deeper layers of the face,
• 6:06
  Speaker 4: you know, so you're elevating the skin you're and then
• 6:10
  Speaker 4: you're you're suspending the muscular layer without cutting it and
• 6:13
  Speaker 4: elevating it as you wik with a deep plane facelift.
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  Speaker 4: So it's it's a nice procedure for people who don't
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  Speaker 4: have a lot of laxity, who don't have a lot
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  Speaker 4: of volume loss, who are primarily focused on jowling, and
• 6:28
  Speaker 4: who don't want a lot of downtime, who'd like to
• 6:30
  Speaker 4: be able to do it awake, and so that is
• 6:35
  Speaker 4: the main difference.
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  Speaker 3: Okay, so that's the mini facelift, But what are the
• 6:40
  Speaker 3: different options and because I know there's more than just
• 6:43
  Speaker 3: the mini in the full, what are the different options
• 6:47
  Speaker 3: that you can do for the face? Just so our
• 6:50
  Speaker 3: listeners know what there is offer being offered and me,
• 6:54
  Speaker 3: by the way.
• 6:58
  Speaker 4: The gold standard in facelifting right now is a deep
• 7:01
  Speaker 4: plane facelift. A deep plane facelift involves decisions that extend
• 7:06
  Speaker 4: around the ears, and it involves entering in under the
• 7:11
  Speaker 4: wrapping around the muscle of the of the face, the
• 7:14
  Speaker 4: move the face, and elevating that all the way out.
• 7:17
  Speaker 4: In our practice we elevate all the way to the
• 7:20
  Speaker 4: side of the nose and down to the close to
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  Speaker 4: the corner of the mouth. The key is that there
• 7:24
  Speaker 4: are attachments between that layer down to the bone here,
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  Speaker 4: down to the muscle, the wrapping around the muscle here
• 7:31
  Speaker 4: and down to the bone along the jawline, and you
• 7:34
  Speaker 4: have to divide those that in inexperienced hands is scary
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  Speaker 4: because that's where the nerves live. And that's so you know,
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  Speaker 4: people who many people claim to do a deep plane facelift,
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  Speaker 4: not everybody does it and divide, But dividing those ligaments
• 7:51
  Speaker 4: that the deeper attachments is really the definition of a
• 7:53
  Speaker 4: deep plane facelift. There are intermediate kind of facelifts that
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  Speaker 4: are not quite the max lift and not quite a
• 8:00
  Speaker 4: deep plane, called a subsmass lift, where you're lifting everything
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  Speaker 4: but not dividing those attachments, and we do that less
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  Speaker 4: because the deep plane facelift really gives you the best
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  Speaker 4: mobilization of the face. You can put the cheeks right
• 8:13
  Speaker 4: where you want them, you can put a lot of
• 8:15
  Speaker 4: tension on that deeper layer and then gently redrape the
• 8:18
  Speaker 4: skin and trim out the extra and and get a
• 8:21
  Speaker 4: lot of longevity without having people look pold or unnatural.
• 8:25
  Speaker 4: The direction of lift with that is probably you know,
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  Speaker 4: forty to sixty degrees from horizontal in this direction, and
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  Speaker 4: so you get a lot of lyft. It looks really natural,
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  Speaker 4: and it the recovery time is a good it's like
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  Speaker 4: it's still an investment. You know of a couple of
• 8:43
  Speaker 4: weeks of feeling very swollen and bruised, and you know,
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  Speaker 4: at two months looking pretty natural, at six months looking
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  Speaker 4: you know, indiscernible from on close inspection.
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  Speaker 3: And that's the deep plane.
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  Speaker 4: So that's the deep plane. Now you compare that with
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  Speaker 4: something like a sub periosteal mid face lift, which I
• 9:01
  Speaker 4: use in limited applications. That's done through an incision back
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  Speaker 4: here behind the hairline and you're elevating. It's a brow
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  Speaker 4: lift plus a face lift, and you're elevating right next
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  Speaker 4: to the bone. Actually, that's a very vertical lift, and
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  Speaker 4: your eyes look funky for months after. It's a longer recovery.
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  Speaker 4: It's a very powerful lift. I'm pretty sure that's kind
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  Speaker 4: of how the ponytail lift if you hear people talking
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  Speaker 4: about that, it's some variation of a superiosteal mid face lift.
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  Speaker 4: The reason I just don't think it's generally applicable to
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  Speaker 4: everybody because your eyes do look much different.
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  Speaker 3: So who is someone that is in for that that's
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  Speaker 3: just their desired look? Is that higher not higher poll?
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  Speaker 4: Good candidates for that are someone with severe mid face
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  Speaker 4: descent and someone who needs a lot of brow elevation,
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  Speaker 4: someone who needs a lot of vertical lift, who's not
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  Speaker 4: afraid of having a prolonged healing phase where they're going
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  Speaker 4: to feel like their eyes look altered, and another. So
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  Speaker 4: a good application for that, like a good example is
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  Speaker 4: I use that on a patient who had a facial paralysis.
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  Speaker 4: So he couldn't move the whole side of his face,
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  Speaker 4: and his eye had started to pull down because he
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  Speaker 4: had lost the muscle tone in his eyes. So he
• 10:19
  Speaker 4: was getting an exposure carotopathy, meaning like the eye was
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  Speaker 4: drying out and he was having problems maintaining the health
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  Speaker 4: of his cornea. So I actually did a unilateral sub
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  Speaker 4: periosteal midphase lift. And the reason why it works is
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  Speaker 4: is so much pull in this direction that you actually
• 10:35
  Speaker 4: move the eyelid up and support the eyelids so that
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  Speaker 4: it fixes that problem of having over tearing and drying
• 10:43
  Speaker 4: out in addition to getting them because his face was
• 10:47
  Speaker 4: very obviously like falling on one side, so he needed
• 10:50
  Speaker 4: as much vertical lift as he could get. So that's
• 10:53
  Speaker 4: one example of somebody who it makes a lot of
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  Speaker 4: sense to do a sub periosteal midphase on So.
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  Speaker 5: Like if you're on camera every week, a good idea.
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  Speaker 4: Yeah, it's just it's it's really, you know, hard to
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  Speaker 4: hide hide it. Yeah, exactly, Okay.
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  Speaker 3: So there's different options for the face. One of the
• 11:14
  Speaker 3: main questions that we got asked when we asked like
• 11:18
  Speaker 3: what people want to know from you? And this is
• 11:21
  Speaker 3: something that I feel like my friends and I talk about, Oh,
• 11:25
  Speaker 3: I don't know daily is our next. So for someone
• 11:29
  Speaker 3: who maybe isn't ready for a face left, mini or
• 11:35
  Speaker 3: full deep plane, what do you recommend for the neck?
• 11:43
  Speaker 4: Yeah, so this also gets into the question of what
• 11:48
  Speaker 4: ages are these things happening the end. The brief answer
• 11:52
  Speaker 4: to that is, I'm doing neckwork on patients in their
• 11:56
  Speaker 4: twenties all the way through sixties and seventies. Face lifts,
• 12:02
  Speaker 4: you know is a very young face would be in
• 12:06
  Speaker 4: their thirties, a lot more mini facelifts in their thirties,
• 12:10
  Speaker 4: you know, and beyond, and but the neck is really
• 12:14
  Speaker 4: that area that ends up capturing a lot young neckwork.
• 12:21
  Speaker 4: There are basically there are a couple different options. So
• 12:25
  Speaker 4: I'm going to start with the least invasive option. That
• 12:29
  Speaker 4: would be for a young patient with a lot of fullness,
• 12:33
  Speaker 4: a lot of thickness in the skin, but no skin laxity,
• 12:36
  Speaker 4: a lot of fat into the skin, you can do
• 12:39
  Speaker 4: sub mental liposuction, just LiPo section of the neck. You
• 12:42
  Speaker 4: see lots and lots of surgeons talking about sub mental
• 12:45
  Speaker 4: liposuction talking. They give it other names. You know that Gosh,
• 12:50
  Speaker 4: I can't even the newest I can't remember the newest name.
• 12:55
  Speaker 4: But they combine it with a little radio frequency sometimes
• 13:00
  Speaker 4: radio frequency tightening as well. But honestly, people are showing
• 13:05
  Speaker 4: you their best results most of the time. Sub Mental
• 13:07
  Speaker 4: liposuction has the highest probability of being underwhelmed. And that's
• 13:12
  Speaker 4: because some patients are all just fat under the skin,
• 13:16
  Speaker 4: but the majority of patients have something else going on,
• 13:20
  Speaker 4: whether it's fat under the muscle that's under the skin,
• 13:22
  Speaker 4: in large muscles under the muscle in large salivary glends,
• 13:25
  Speaker 4: and the muscle skin laxity. All those things contribute to
• 13:29
  Speaker 4: the blunting of the neck. So sub mental liposuction in isolation,
• 13:33
  Speaker 4: I'm not doing all that frequently, just because I want
• 13:36
  Speaker 4: my patients to have an experience that is this is amazing.
• 13:41
  Speaker 4: This gave me a huge difference. I don't want them
• 13:43
  Speaker 4: to say, yeah, yeah, it's nice.
• 13:45
  Speaker 3: Right.
• 13:47
  Speaker 4: So that's kind of like the least invasive thing you
• 13:51
  Speaker 4: can do for your neck. The next step up would
• 13:53
  Speaker 4: be deep neck contouring. That's what I do a lot.
• 13:56
  Speaker 4: That's kind of how I built my practice here was
• 13:58
  Speaker 4: by really coming in and focusing on deep neck contouring.
• 14:01
  Speaker 4: It's an incision under the chin, and I do liposuction.
• 14:05
  Speaker 4: But then I go in and I remove the fat
• 14:08
  Speaker 4: between the muscles that are in the neck here and
• 14:11
  Speaker 4: under the muscle, and I contour down the muscles under
• 14:14
  Speaker 4: the muscle called the digastric and sometimes I'll even take
• 14:17
  Speaker 4: out portions of the salivary glands to deepen the neck.
• 14:21
  Speaker 4: And then I tighten all that muscle like a corset.
• 14:23
  Speaker 4: And that not only removes the fullness from excess fat
• 14:28
  Speaker 4: and excess enlarged muscle, but it tightens the muscle overlying everything.
• 14:34
  Speaker 4: So it moves the angle of the neck the deepest
• 14:37
  Speaker 4: point backwards and upwards, and people get a lot more
• 14:42
  Speaker 4: out of their neck that way.
• 14:43
  Speaker 1: I know, But how do I know? Like, how would
• 14:45
  Speaker 1: you know? Is like you can tell that there's like
• 14:48
  Speaker 1: extra muscle.
• 14:50
  Speaker 4: You gotta feel it, you know, I got it. I
• 14:52
  Speaker 4: feel and I roll the skin and see how thick
• 14:54
  Speaker 4: the skin is. I feel the fat under the skin.
• 14:57
  Speaker 4: I look at the angle on your side views and really,
• 15:01
  Speaker 4: you're a good candidate for that if you don't have
• 15:04
  Speaker 4: skin laxity, okay or yeah, well, basically skin laxity. Once
• 15:10
  Speaker 4: you've decided, once you've started to develop skin laxity, you
• 15:15
  Speaker 4: can't just do deep net contouring because you're going to
• 15:17
  Speaker 4: remove everything from underneath and you're going to be like
• 15:19
  Speaker 4: a deflated bag over the top of it. You're going
• 15:21
  Speaker 4: to have extra skin that will drive. So no one's
• 15:27
  Speaker 4: wanting that, right, And so I came here, I started
• 15:30
  Speaker 4: doing a lot of deep net contouring, and then I
• 15:34
  Speaker 4: started seeing a lot of patients who wanted deep net contring.
• 15:39
  Speaker 4: They weren't ready for a face left and they were
• 15:42
  Speaker 4: in this weird in between where their face, their mid
• 15:44
  Speaker 4: face looked really good, didn't have a lot of descent,
• 15:48
  Speaker 4: their skin, you know, looked very young, but they were
• 15:51
  Speaker 4: developing jals and they were they had some necklax some
• 15:55
  Speaker 4: skin neck laxity. So then I started, yeah, they're aging
• 16:01
  Speaker 4: in their neck. So then I started working on making
• 16:05
  Speaker 4: a hybrid between a facelift and deep neck contouring. And
• 16:09
  Speaker 4: it's kind of gone a few undergone a few different
• 16:12
  Speaker 4: name changes, but right now we've landed on lower face
• 16:15
  Speaker 4: contouring as the most descriptive kind of you know name
• 16:20
  Speaker 4: for the procedure. It involves doing deep neck contouring where
• 16:23
  Speaker 4: I'm going in and I'm doing all that same work
• 16:25
  Speaker 4: that I mentioned before with the liposection and the removal
• 16:28
  Speaker 4: of the fat under the muscle and the tidening of
• 16:30
  Speaker 4: the muscle and potentially reduction of the glands. But then
• 16:34
  Speaker 4: I make a partial facelift decision up behind the ear.
• 16:38
  Speaker 4: I enter into the deeper plane under the muscle from
• 16:40
  Speaker 4: the back, just like I would from a facelift, and
• 16:44
  Speaker 4: I lift the neck from the back, and I also
• 16:48
  Speaker 4: get a little bit of lift on the face as
• 16:49
  Speaker 4: well to remove the gewling. So it's perfect for people
• 16:52
  Speaker 4: who have jowls, who have extra neck skin, who maybe
• 16:57
  Speaker 4: have a little bit of fullness under their chin. And
• 17:01
  Speaker 4: the nice thing is that when you lift all that
• 17:03
  Speaker 4: muscle from the back, that skin can be gently redraped
• 17:07
  Speaker 4: and you can trim out the excess skin from these
• 17:09
  Speaker 4: incisions back behind the ear, and you kind of it's
• 17:14
  Speaker 4: a nice bridging procedure for people that really wanted to
• 17:18
  Speaker 4: find their neck but aren't ready for the facelift. Now,
• 17:20
  Speaker 4: facelift always includes the next So that's the next step up.
• 17:23
  Speaker 4: Anyone who's starting to have falling of the face volume
• 17:27
  Speaker 4: loss in the face here in the mid face, in
• 17:29
  Speaker 4: addition to gils in the neck, the facelift is the
• 17:32
  Speaker 4: best definitive treatment for that.
• 17:36
  Speaker 1: Okay, and what's the recovery like for the full This
• 17:39
  Speaker 1: is all new to me because I only knew that
• 17:42
  Speaker 1: there was a full facelift and like obviously an eyebrow lift,
• 17:46
  Speaker 1: but all of these things you've been talking about, I
• 17:49
  Speaker 1: didn't even know there were things for the next.
• 17:51
  Speaker 4: Deep neck contouring, especially it's kind of a newer concept
• 17:54
  Speaker 4: in the last probably you know, people have been doing
• 17:58
  Speaker 4: it probably longer, but ten ten years or so, like,
• 18:01
  Speaker 4: it's really started to gain a lot of popularity and
• 18:03
  Speaker 4: now a lot of people are talking about it. But
• 18:05
  Speaker 4: so it's becoming more well known. The lower face contouring.
• 18:08
  Speaker 4: You're not really going to find anything on that out
• 18:11
  Speaker 4: there because well, maybe people are doing similar things. It's
• 18:15
  Speaker 4: not as they might call it a necklift deep deep
• 18:19
  Speaker 4: plane necklift. People have different names for their procedures that
• 18:24
  Speaker 4: they use to try to market it better, and we've
• 18:27
  Speaker 4: just decided to be very descriptive with what we call
• 18:29
  Speaker 4: this this kind of thing that you know has been
• 18:33
  Speaker 4: developed here in the practice. So yeah, sorry, I'm trying.
• 18:38
  Speaker 3: To tell us where we were going faster about recovery
• 18:41
  Speaker 3: time for the neck the neck contra time, just said,
• 18:45
  Speaker 3: what's the recovery time for that? First tell us that
• 18:47
  Speaker 3: and then the full deep plane facelift.
• 18:52
  Speaker 4: Okay, so if when you're talking, I'll maybe covered deep
• 18:56
  Speaker 4: neck contouring, lower face contouring, and facelift recovery times. So
• 19:00
  Speaker 4: deep net contouring, you wear a head wrapt for five
• 19:04
  Speaker 4: days around the clock, then for seven days at night
• 19:07
  Speaker 4: after that, and most patients will have bruising on the neck.
• 19:11
  Speaker 4: Sometimes patients will have no bruising and deep net contouring.
• 19:16
  Speaker 4: I actually have started doing it awake. I do so
• 19:18
  Speaker 4: much of it that I've gotten very comfortable with it.
• 19:21
  Speaker 4: I even removed salvary glands awake a couple of weeks ago.
• 19:25
  Speaker 4: And it's definitely not something I would recommend unless you're
• 19:29
  Speaker 4: doing a lot of it, because there are very major
• 19:33
  Speaker 4: structures that you're working around deep in the neck. And
• 19:36
  Speaker 4: I've only done it because I feel very comfortable doing it,
• 19:41
  Speaker 4: and I've done many many cases awake to be able
• 19:45
  Speaker 4: to do it safely. So that is nice because you
• 19:51
  Speaker 4: don't have the overnight you know, you don't have the
• 19:53
  Speaker 4: anesthesia and recovering from that at home, but you know,
• 19:56
  Speaker 4: like for the first twenty four hours, the other two
• 20:01
  Speaker 4: procedures have to be done with gener anesthesia you're pretty
• 20:04
  Speaker 4: bruised and swollen for the first two to four weeks,
• 20:09
  Speaker 4: you know, and then it starts to taper off after that. Generally,
• 20:13
  Speaker 4: when you're doing deeper muscular work for any of those
• 20:16
  Speaker 4: three procedures, you're going to have swelling and firmness under
• 20:19
  Speaker 4: the chin that can last a couple of months. So
• 20:23
  Speaker 4: some patients, if you're making really big changes to the neck,
• 20:26
  Speaker 4: you know they had more fullness. You're going to see
• 20:28
  Speaker 4: a big change right away. Some patients, if you're trying
• 20:31
  Speaker 4: to go from good to better, you might actually look
• 20:33
  Speaker 4: more full for the first couple months after surgery while
• 20:36
  Speaker 4: that's healing. For lower phase contouring, it's deep net contouring
• 20:41
  Speaker 4: plus the suspensions in the back, and so there's maybe
• 20:44
  Speaker 4: a little bit more bruising and swelling that you would see,
• 20:46
  Speaker 4: especially in the back portions of the neck. And then
• 20:49
  Speaker 4: you have the redness of the incisions around the ears,
• 20:51
  Speaker 4: which covers well. If you have longer hair for my
• 20:54
  Speaker 4: male patients, you know, you grow your beard out, that
• 20:56
  Speaker 4: can help cover things a little bit. Wearing hats can
• 21:00
  Speaker 4: kind of help. Sometimes you're still wearing the head wrap
• 21:04
  Speaker 4: for five days around the clock and then just at
• 21:06
  Speaker 4: night for another seven days after that. The main difference
• 21:09
  Speaker 4: in healing between the lower face contouring and the facelift
• 21:12
  Speaker 4: is that with the facelift, you are swollen and bruised
• 21:16
  Speaker 4: and you look a little bit polled, to be quite honest,
• 21:19
  Speaker 4: for the first couple of weeks up in the midface area.
• 21:23
  Speaker 4: So you know, that's that's the main difference. And to
• 21:27
  Speaker 4: be quite honest with you, the difference between a facelift
• 21:30
  Speaker 4: and lower face contouring for me is it's a lot
• 21:34
  Speaker 4: of work to do lower face. It's almost easier to
• 21:36
  Speaker 4: just do a full facelift right, But for the patients,
• 21:41
  Speaker 4: you're elevating less in the face, which I think anytime
• 21:44
  Speaker 4: you can leave tissue alone, that's a good thing, and
• 21:49
  Speaker 4: they're not going to have as much recovery in the face.
• 21:51
  Speaker 4: You know, it's a little bit less noticeable early on,
• 21:54
  Speaker 4: and so it's worth it to me to offer that,
• 21:57
  Speaker 4: even though it's a little bit more challenging to use
• 22:01
  Speaker 4: a smaller incision to do a lot of work and
• 22:03
  Speaker 4: to get the skin delay just right when you're not
• 22:07
  Speaker 4: moving the skin to the face. All those things are
• 22:08
  Speaker 4: a little bit technical, but in the end, I think
• 22:12
  Speaker 4: for a little bit less recovery time and to address
• 22:15
  Speaker 4: really the problem they're having it as opposed to just
• 22:18
  Speaker 4: kind of blanket, you know, operating on everything. I think
• 22:21
  Speaker 4: it's worth doing it.
• 22:23
  Speaker 1: Okay, So what are some non like if somebody I'm
• 22:27
  Speaker 1: totally freaked out, like I don't know if I would
• 22:29
  Speaker 1: if I could, maybe I'll change my tune in a while.
• 22:33
  Speaker 1: But for someone that's like, okay, I'm not ready for that,
• 22:37
  Speaker 1: what are some non surgical options that could at least
• 22:40
  Speaker 1: get you, you know, some kind of change or maybe
• 22:45
  Speaker 1: even just delay then if somebody's wanting that but maybe
• 22:49
  Speaker 1: delayed a few years.
• 22:50
  Speaker 4: Yeah, I'm gonna be really honest with you right now. Okay.
• 22:53
  Speaker 4: And this is not this isn't a very good business move,
• 22:56
  Speaker 4: but it's the truth. And it drives me nuts when
• 22:58
  Speaker 4: I see this kind of stuff circulating that there's not
• 23:02
  Speaker 4: once you've developed skin laxity, there is not a simple
• 23:05
  Speaker 4: fix for that. There's not a cream that will reverse that.
• 23:08
  Speaker 4: There's no neck yoga exercises. My favorite. The jaws are size.
• 23:14
  Speaker 4: I don't know if you've seen that that like whether
• 23:15
  Speaker 4: two and on the on the tennis ball thing that
• 23:18
  Speaker 4: that's that's amazing. It's awesome. If you haven't seen those videos,
• 23:22
  Speaker 4: you need to go check them out. But yeah, it
• 23:24
  Speaker 4: doesn't work. And I've tried to tighten the neck with laser.
• 23:27
  Speaker 4: I do a lot of laser resurfacing too. I'm you know,
• 23:30
  Speaker 4: I have the ability. We have the most powerful laser
• 23:33
  Speaker 4: really on the market right now, that Erbium contour terial laser,
• 23:38
  Speaker 4: And you can't put enough energy into the neck to
• 23:41
  Speaker 4: tighten it with a laser alone. You're just never going
• 23:43
  Speaker 4: to pull that laxity out. You're not going to get
• 23:45
  Speaker 4: what you want from cool sculpting most of the time.
• 23:48
  Speaker 4: Ky Bella is not going to really get you where
• 23:50
  Speaker 4: you want to be. It's not going to take care
• 23:51
  Speaker 4: of laxity certainly, and it actually causes a lot of
• 23:55
  Speaker 4: scarring when I go back and revise those necks. So
• 24:00
  Speaker 4: once you've developed the laxity, the cats out of the bag. Now,
• 24:05
  Speaker 4: if someone has not yet developed laxity, or if they're
• 24:07
  Speaker 4: in the very early stages of developing laxity, I do
• 24:11
  Speaker 4: think that things like micro needling BBL and some laser
• 24:16
  Speaker 4: treatments can help. And the reason they can help is
• 24:19
  Speaker 4: that they do increase the collagen and elasting content of
• 24:25
  Speaker 4: the skin. So if you treat the skin with sell
• 24:30
  Speaker 4: Firm or BBL and then you take a biopsy of
• 24:33
  Speaker 4: the skin and you look at it into the microscope,
• 24:35
  Speaker 4: you can see the collagen layer is definitely thicker in
• 24:39
  Speaker 4: that area. It's not a permanent phenomenon. It's not a
• 24:43
  Speaker 4: permanent result. And so for that reason, those procedures or
• 24:47
  Speaker 4: those treatments need to be done on you know, maybe
• 24:50
  Speaker 4: a yearly or bi yearly basis in order to keep
• 24:53
  Speaker 4: up with it. But those are the things that if
• 24:56
  Speaker 4: anything is going to slow down the aging process, it's
• 24:59
  Speaker 4: going to be those type of therapies. You got to
• 25:01
  Speaker 4: put a little bit of energy, you know, physical energy
• 25:04
  Speaker 4: into the skin to get that, whether it's a peel
• 25:07
  Speaker 4: or a laser or micro kneeling or BBL. But that's
• 25:12
  Speaker 4: that's probably your best bet, that combined with medical grade skincare.
• 25:18
  Speaker 4: But once that laxity is developed, there's not a simple
• 25:22
  Speaker 4: there's not a simple fix to that. And so yeah,
• 25:26
  Speaker 4: anyone that tries to tell you like that you're going
• 25:29
  Speaker 4: to have a simple, easy procedure to get rid of
• 25:31
  Speaker 4: skin laxity, you just got to really question.
• 25:36
  Speaker 3: You have to go under the knife.
• 25:37
  Speaker 1: I feel like, okay, so can you say what what
• 25:44
  Speaker 1: is BBL? Because all I'm thinking in my head is
• 25:46
  Speaker 1: Brazilian butt lift, And I know.
• 25:48
  Speaker 4: I can tell you right I want I want nothing
• 25:50
  Speaker 4: to do with a Brazilian butt lift. Okay, I'm very
• 25:53
  Speaker 4: happy working from the collarbone up. So this, this is
• 25:56
  Speaker 4: very important to kind of differentiate. So BBL is broadband light.
• 26:02
  Speaker 4: You might have heard of IPL, So it's kind of
• 26:05
  Speaker 4: a similar modality. So if you want to talk about
• 26:09
  Speaker 4: like the light based therapies, you have lasers, and you
• 26:13
  Speaker 4: have light, you know, broad spectrum light treatments. So BBL
• 26:20
  Speaker 4: is like a hot flashlight. It has all the colors
• 26:23
  Speaker 4: in it. It looks white because you have all the colors, right,
• 26:28
  Speaker 4: you run a filter. You run it through a filter
• 26:30
  Speaker 4: where it takes out everything except for specific wavelengths that
• 26:34
  Speaker 4: are focused on red or brown or deep you know, purples,
• 26:39
  Speaker 4: and those wavelengths they penetrate deep into the skin and
• 26:42
  Speaker 4: they get absorbed by the pigment or they get absorbed
• 26:44
  Speaker 4: by the blood vessels, and everything else around them does
• 26:48
  Speaker 4: not absorb that wavelength. The rest of the skin does
• 26:50
  Speaker 4: not absorb that wavelength as efficiently, so the blood vessels
• 26:54
  Speaker 4: heat up to the point that they collapse, and so
• 26:58
  Speaker 4: you can treat you know, redness roseatia spider, you know
• 27:02
  Speaker 4: little telanjectasia's little broken capillaries. You can treat pigment that's
• 27:08
  Speaker 4: deep seated in the skin age spots because you focus
• 27:12
  Speaker 4: on the brown color. The brown picks up all that
• 27:15
  Speaker 4: heat and the body then comes in and removes that
• 27:19
  Speaker 4: that pigment that has been heated up and basically destroyed
• 27:22
  Speaker 4: by the by the broadband light. So bbl's grade that
• 27:27
  Speaker 4: down time is not as is not as long as
• 27:31
  Speaker 4: what you would see with the more aggressive laser. Within
• 27:34
  Speaker 4: the realm of lasers there are A laser is one
• 27:38
  Speaker 4: wavelength of light, so rather than having all the colors,
• 27:41
  Speaker 4: you have one color, and the source can be various
• 27:45
  Speaker 4: different substances. So you've heard of CO two. That's one
• 27:48
  Speaker 4: type of source. That's a very tried and true laser.
• 27:52
  Speaker 4: I've used it before. I use primarily herbium. Now it's
• 27:56
  Speaker 4: kind of the latest and greatest, very tune. I can
• 28:00
  Speaker 4: adjust it to exactly the parameters that I want, the
• 28:03
  Speaker 4: depth and the heat and all that. So a laser
• 28:08
  Speaker 4: is one wavelength of light, and the wavelengths are all
• 28:12
  Speaker 4: lined up. So if you think about a wave in
• 28:14
  Speaker 4: the ocean, you think about another wave, they might be
• 28:16
  Speaker 4: peaking at different times. Well, a laser lines up all
• 28:19
  Speaker 4: the waves so that they're going at the same time,
• 28:22
  Speaker 4: and it's a very it's it's a very uplative or
• 28:28
  Speaker 4: very kind of destructive wavelength. Okay, so it's like it's
• 28:33
  Speaker 4: like mowing your lawn where you're just coming in with
• 28:37
  Speaker 4: the mower and you're taking off the top layers, right,
• 28:39
  Speaker 4: or like sanding down the skin. There are also settings
• 28:43
  Speaker 4: where you can set it to be more like errating
• 28:45
  Speaker 4: your lawn, where you have these columns of light that
• 28:47
  Speaker 4: are going in and that's perfractionated is what that's called.
• 28:50
  Speaker 4: And so if you see the videos of people where
• 28:52
  Speaker 4: they get a bunch of little dots that form as
• 28:54
  Speaker 4: they're a lasering, that's a perfractionated setting. So there are
• 28:58
  Speaker 4: lots of different ways that you can use these light
• 29:01
  Speaker 4: based therapies, but really it's just important to have someone
• 29:06
  Speaker 4: look at your skin and figure out how much downtime
• 29:09
  Speaker 4: can you have. What are you trying to address? Is
• 29:12
  Speaker 4: a pigment, is it texture, is it vascularity? Is it
• 29:15
  Speaker 4: all three? And then you can kind of come up
• 29:17
  Speaker 4: with a plan that uses these different tools to really
• 29:21
  Speaker 4: target what is, you know, your biggest problem, your biggest concern.
• 29:25
  Speaker 1: So what's like, what's your number one is a facelift?
• 29:28
  Speaker 1: The number one thing that you do at your clinic
• 29:32
  Speaker 1: that you get the most requests for.
• 29:34
  Speaker 4: It's really pretty spread out between facelifts, necklifts where that's
• 29:41
  Speaker 4: a deep net contouring or lower face contouring, rhinoplasts, and hair,
• 29:46
  Speaker 4: and then I do a lot of other things like
• 29:48
  Speaker 4: bleproplasts and otoplastis and things like that that get added
• 29:51
  Speaker 4: in on all these procedures and laser treatments, but it's
• 29:57
  Speaker 4: kind of evenly split between those kind of major catgories,
• 30:01
  Speaker 4: so to.
• 30:03
  Speaker 3: Go along with what we were just talking about about
• 30:06
  Speaker 3: lasers for a certain age, but then there does come
• 30:10
  Speaker 3: to the point where you should just go for the
• 30:12
  Speaker 3: bigger procedure. I I feel like people are getting facelifts
• 30:19
  Speaker 3: at a younger age now, and it makes sense to
• 30:23
  Speaker 3: me that you don't wait until it gets really bad,
• 30:28
  Speaker 3: and you do it so you kind of keep looking
• 30:32
  Speaker 3: the same and aging gracefully. So I have friends that
• 30:38
  Speaker 3: have gotten it done right before they turn fifty, like
• 30:42
  Speaker 3: right around there and so if you do a facelift
• 30:48
  Speaker 3: at that age, and do you feel like it is
• 30:50
  Speaker 3: more common that people are doing it younger?
• 30:52
  Speaker 4: Now?
• 30:53
  Speaker 3: Are we in for one face lift? Or does this
• 30:56
  Speaker 3: mean we're doing two facelifts in our life and that's
• 30:59
  Speaker 3: going to carry us through and we do one like
• 31:01
  Speaker 3: around fifty and then are we doing one again at
• 31:04
  Speaker 3: like sixty nine to seventy or like what do you how.
• 31:09
  Speaker 4: Do you see this? I think with the current trend,
• 31:15
  Speaker 4: it's getting younger and younger. I mean I have facelift
• 31:17
  Speaker 4: patients in their late thirties. I like to think of
• 31:20
  Speaker 4: it more in an anatomical sense than an age sense,
• 31:23
  Speaker 4: because some people have a lot of age and a
• 31:25
  Speaker 4: lot of laxity even in their late thirties, or a
• 31:27
  Speaker 4: lot of volume loss or a lot of volume descent
• 31:31
  Speaker 4: in the mid face. That's the main place I'm looking,
• 31:34
  Speaker 4: you know, a deep naz alabial folds. That's really what's
• 31:37
  Speaker 4: going to get better with a facelift. Is this here
• 31:39
  Speaker 4: the folds and the cheeks in addition to the jaw
• 31:43
  Speaker 4: line in the neck. But I can take care of
• 31:45
  Speaker 4: the jaw line in the neck with other procedures, So
• 31:47
  Speaker 4: I see the trend as continuing to get younger right now,
• 31:51
  Speaker 4: and I see the trend as yeah, probably having multiple
• 31:56
  Speaker 4: facelifts because if people are already thinking about it younger
• 32:00
  Speaker 4: and younger, they are going to want to stay on
• 32:03
  Speaker 4: top of it. And you know, a facelift is not
• 32:06
  Speaker 4: it doesn't last forever. You're basically rewinding the clock. And
• 32:11
  Speaker 4: the more laxity you have, the further you rewind the clock.
• 32:14
  Speaker 4: On some of my patients in their seventies with a
• 32:17
  Speaker 4: lot of laxity, a lot of volume loss. When you
• 32:20
  Speaker 4: when you lift that, you might make them look like
• 32:22
  Speaker 4: they're in their fifties again. You might get a twenty
• 32:24
  Speaker 4: year result out of that, right like where you're taking
• 32:26
  Speaker 4: them back twenty years and you continue to age at
• 32:29
  Speaker 4: the same rate. So in you know, twenty years, you
• 32:34
  Speaker 4: probably have the same amount of laxity as when you had.
• 32:36
  Speaker 4: For those patients is when you had your facelift to start, right,
• 32:40
  Speaker 4: So in younger patients, if you're not rewinding the clock
• 32:44
  Speaker 4: quite as far, they will probably still develop skin laxity.
• 32:48
  Speaker 4: They may want to keep up on that. You know,
• 32:50
  Speaker 4: say someone does it at forty, maybe they want another
• 32:52
  Speaker 4: facelift at fifty five or sixty and then maybe they
• 32:55
  Speaker 4: do another one. I don't know. I mean, we're living
• 32:57
  Speaker 4: longer and longer too, So the probability if things stay
• 33:01
  Speaker 4: on the same trajectory, you know, the probability of people
• 33:05
  Speaker 4: having multiple face lists when they start young is a
• 33:07
  Speaker 4: little bit higher. And so that you know, that's something
• 33:12
  Speaker 4: I think a lot about. And if I have a
• 33:15
  Speaker 4: young patient that's really wanting to do a facelift, sometimes
• 33:19
  Speaker 4: I'm a bad salesman. I mean sometimes I'll talk people
• 33:21
  Speaker 4: out of it. They have to like talk me into it,
• 33:24
  Speaker 4: and I try to keep the expectations. I try to
• 33:29
  Speaker 4: keep the expectations reasonable, and I try to show them
• 33:32
  Speaker 4: photos of young patients so they know, especially in the cheeks,
• 33:35
  Speaker 4: what to expect. Usually I can get you a deeper
• 33:37
  Speaker 4: neck than you know, what you've had previously. If your
• 33:40
  Speaker 4: neck is full, that is a little bit of a
• 33:44
  Speaker 4: different issue, right than someone who doesn't have any aging
• 33:47
  Speaker 4: in their cheeks, And then doing a young facelift, is
• 33:50
  Speaker 4: it really worth it? So I sometimes I slow walk
• 33:53
  Speaker 4: people and I try to really make them prove to
• 33:56
  Speaker 4: me that they are ready to do it. And when
• 33:59
  Speaker 4: I do that, my patients are really happy. The setup
• 34:03
  Speaker 4: for an unhappy patient is convincing them to do a
• 34:06
  Speaker 4: surgery for sure. Oh yeah, you know that that your
• 34:11
  Speaker 4: probability of unhappiness goes way up.
• 34:12
  Speaker 3: Okay, I have been dying to ask you this question.
• 34:16
  Speaker 3: I think sculptra is an incredible service and really does work.
• 34:24
  Speaker 3: I feel like it's helped me in a major way.
• 34:29
  Speaker 3: But I have heard that it's you should not get
• 34:33
  Speaker 3: sculpture if you want to get a facelift because it
• 34:36
  Speaker 3: makes it harder, or there's I don't know if there's
• 34:40
  Speaker 3: build up or what the situation is. But then I've
• 34:43
  Speaker 3: heard something totally different that it doesn't make a difference.
• 34:48
  Speaker 3: Do sculpture. It's going to help you look good longer,
• 34:51
  Speaker 3: and it doesn't. It shouldn't affect a facelift. So what
• 34:56
  Speaker 3: is the skinny on sculptre?
• 35:00
  Speaker 4: This is I this is awesome. We actually just did.
• 35:03
  Speaker 4: We have a surgeon's vlog that we record with the
• 35:05
  Speaker 4: three of us here in the practice. This is something
• 35:08
  Speaker 4: we've been talking a lot about, and so we have
• 35:10
  Speaker 4: actually an episode coming up on this where we talk
• 35:13
  Speaker 4: about this a little bit. But it's I'll just start
• 35:16
  Speaker 4: by saying that sculpture is one of the major advancements
• 35:19
  Speaker 4: in injectable treatments. Okay, for those who don't know, there's
• 35:23
  Speaker 4: when you're talking about fillers in the face. You have
• 35:25
  Speaker 4: highly uronic acid fillers, and then you have other stuff
• 35:28
  Speaker 4: that I don't think is like as good. You definitely
• 35:32
  Speaker 4: don't want permanent fillers in the face, right, So I
• 35:35
  Speaker 4: primarily focus on the high uronic acids and then sculpture.
• 35:39
  Speaker 4: And the difference between a high uronic acid filler and
• 35:41
  Speaker 4: sculpture is that high uronic acid is found in the body.
• 35:44
  Speaker 4: It's what's called ground substances. It gives volume to the
• 35:48
  Speaker 4: face basically, and we found a way to generate that
• 35:53
  Speaker 4: synthetically and your body generally accepts it very well. It's
• 35:56
  Speaker 4: a great filler that will last you six months to
• 35:59
  Speaker 4: a year.
• 36:00
  Speaker 3: What is that called ratio or what are the different Yeah.
• 36:04
  Speaker 4: So those would be the restall in or wrestling products.
• 36:08
  Speaker 4: The Jupiterian products are kind of the big players in
• 36:10
  Speaker 4: the in the market right now. And then sculpture is
• 36:15
  Speaker 4: actually very different in its mechanism. So what they were
• 36:19
  Speaker 4: finding is that when they were using certain types of
• 36:21
  Speaker 4: suture in the skin, that the body would create collagen
• 36:27
  Speaker 4: around that suture and you would get these little tunnels
• 36:30
  Speaker 4: of collagen, and someone had the good idea to kind
• 36:34
  Speaker 4: of take advantage of that and create an injectable that
• 36:38
  Speaker 4: was made out of that same kind of suture material,
• 36:41
  Speaker 4: and so when you inject it, your body puts its
• 36:43
  Speaker 4: own collagen around it. And the nice thing about that
• 36:46
  Speaker 4: is this is sculpture. The nice thing about that is
• 36:49
  Speaker 4: that it lasts a lot longer than traditional filler, So
• 36:54
  Speaker 4: people are getting two and three years out of their
• 36:56
  Speaker 4: sculpture treatments as opposed to six to twelve months. It
• 37:01
  Speaker 4: works slowly over time, so you inject it. I think
• 37:04
  Speaker 4: great areas to use it are like the cheeks and
• 37:06
  Speaker 4: the temple area, and you do it over a couple
• 37:10
  Speaker 4: of sessions and your body will build up over the
• 37:13
  Speaker 4: course of six to eight weeks the collagen and then
• 37:15
  Speaker 4: you can do another session and slowly build up the
• 37:19
  Speaker 4: volume that you want in the area. And then again
• 37:21
  Speaker 4: it lasts a long time. So maybe like a year ago,
• 37:26
  Speaker 4: there was a lot of buzz because some surgeons started
• 37:31
  Speaker 4: talking about sculpture as being this and even some fillers
• 37:34
  Speaker 4: as being counterproductive to facelifting surgery. And they know we're
• 37:39
  Speaker 4: saying that it just makes all the tissues stick together
• 37:42
  Speaker 4: and it scars them down and it's not worth doing.
• 37:46
  Speaker 4: And I just you know, in talking with my partners too,
• 37:51
  Speaker 4: we all agree that sculpture has never been a deal
• 37:55
  Speaker 4: breaker for getting a patient to have a very nice
• 37:58
  Speaker 4: facelift result. You know, anything that you inject, any time
• 38:03
  Speaker 4: you're passing a canula or a needle through the tissues
• 38:05
  Speaker 4: of the skin, you're going to have some build up
• 38:09
  Speaker 4: of scar tissue. And so anytime you're doing anything to
• 38:12
  Speaker 4: the skin, yeah, you're going to feel that when you're
• 38:15
  Speaker 4: trying to separate the tissues you're going to you're going
• 38:18
  Speaker 4: to be able to tell that somebody else had been
• 38:19
  Speaker 4: there before. But to scare people out of getting sculpture
• 38:22
  Speaker 4: sometimes I kind of feel like in plastic surgery, people
• 38:25
  Speaker 4: take these hot topics and they just talk about them,
• 38:29
  Speaker 4: and it generates a lot of views, and it generates
• 38:31
  Speaker 4: a lot of traffic, and sometimes at the expense of
• 38:38
  Speaker 4: somebody having a really nice procedure or a really nice
• 38:42
  Speaker 4: outcome from a treatment. You know, I think sculpture for
• 38:46
  Speaker 4: somebody who's not ready for, you know, a facelift, or
• 38:50
  Speaker 4: maybe they're not ready for fat grafting, which is a
• 38:52
  Speaker 4: permanent option instead of sculpture. It could be a nice
• 38:56
  Speaker 4: way to you know, get a nice long life asting
• 39:00
  Speaker 4: result without having to go into.
• 39:02
  Speaker 3: An air people. Yeah, they here keep doing the sculpture
• 39:05
  Speaker 3: until you're ready to go under the night.
• 39:09
  Speaker 1: Yeah, I don't even know what the sculpture is. So
• 39:11
  Speaker 1: this is all just like it's like a filler, but
• 39:14
  Speaker 1: it's not immedia.
• 39:16
  Speaker 4: No. Well, it your body builds up its own collagen
• 39:19
  Speaker 4: around the filler over the course of weeks, and so
• 39:22
  Speaker 4: you do it in kind of a series. But then
• 39:24
  Speaker 4: because it's your own body's collagen, it lasts a really
• 39:27
  Speaker 4: long time. Now, I will say this, if you think
• 39:29
  Speaker 4: that you're going to have a facelift in the next
• 39:31
  Speaker 4: three years, sculpture's probably anything less than three years. You know,
• 39:35
  Speaker 4: sculpture's probably not the right answer because it is more
• 39:38
  Speaker 4: expensive as a filler, And if you're going to do
• 39:41
  Speaker 4: that and then do a facelift or backgrafting with it,
• 39:44
  Speaker 4: you're kind of you know, it's it's not the best
• 39:47
  Speaker 4: economical use. And yeah, anytime you're in that area, it's
• 39:50
  Speaker 4: going to make it a little bit harder to do
• 39:53
  Speaker 4: the lift. But again, it doesn't preclude you from getting
• 39:55
  Speaker 4: a good lift and in the hands of experienced surgeons,
• 39:59
  Speaker 4: you're still going to have a really nice result. Even
• 40:01
  Speaker 4: if you've had sculpture in the past. Again, if you're
• 40:04
  Speaker 4: gonna if you're thinking of facelift is within the next
• 40:06
  Speaker 4: three years of your immediate future, maybe you lay off
• 40:09
  Speaker 4: the sculpture. But it's definitely not a deal breaker, and
• 40:13
  Speaker 4: it's not something that we would discourage people about.
• 40:16
  Speaker 3: Threads. Threads the same mats are basically I've never I've never.
• 40:23
  Speaker 4: Please tell me I hate threads. Okay, I hate threads.
• 40:26
  Speaker 5: I have colleagues help them.
• 40:28
  Speaker 1: I did them like three years ago and I can
• 40:31
  Speaker 1: still fill them in here. And it didn't like it
• 40:33
  Speaker 1: was not worth it at all.
• 40:34
  Speaker 4: It was the one thing where it was like any
• 40:36
  Speaker 4: lift out of it at any point.
• 40:39
  Speaker 1: It was a rip and a waste of money. That's
• 40:41
  Speaker 1: the one thing that I think a friend talked me
• 40:44
  Speaker 1: into it. When I was like, you know, in doing
• 40:47
  Speaker 1: some esthetician stuff.
• 40:49
  Speaker 5: I was like, okay, she's an easy cell.
• 40:53
  Speaker 1: She's an easy I was like, okay, sure.
• 40:57
  Speaker 5: Let's do it. And then I was like that was
• 40:58
  Speaker 5: the worst. I was like bleeding down.
• 41:00
  Speaker 4: It was terrible. Here's here's how threads work, so the
• 41:03
  Speaker 4: people know. So they're they're usually like dissolvable over time.
• 41:07
  Speaker 4: They're barbed, okay, so they have they the barbs are
• 41:11
  Speaker 4: angled away from the direction that they're being placed. So
• 41:13
  Speaker 4: you put them in, you shove them down and they
• 41:15
  Speaker 4: grab the tissue and then you pull on them and
• 41:18
  Speaker 4: then the barbs stick into the tissue to try to
• 41:20
  Speaker 4: hold everything in place. And I've never heard it. I've
• 41:25
  Speaker 4: never heard anyone like their their threads. When I operate
• 41:29
  Speaker 4: on people, threads are way more problematic than sculpture. When
• 41:32
  Speaker 4: I come across them, they're like you have to cut
• 41:36
  Speaker 4: through them, and then then you're in this position of
• 41:38
  Speaker 4: like do I take them out and traumatize the tissue
• 41:42
  Speaker 4: by pulling all those barbs through? Are they are they
• 41:45
  Speaker 4: dissolved enough to where they're not going to cause a
• 41:48
  Speaker 4: problem and you leave them in? And so threads are problematic,
• 41:52
  Speaker 4: and they're very popular because people want a non surgical option,
• 41:55
  Speaker 4: especially if you can't offer surgery. You know, if you're
• 41:58
  Speaker 4: the nice thing about our practice, don't really do threads
• 42:00
  Speaker 4: here at Utah Facial Plastics, we have a lot of
• 42:03
  Speaker 4: injectors who are phenomenal and because they have at their
• 42:08
  Speaker 4: you know, disposal, they can send people over for surgery
• 42:11
  Speaker 4: when they're in a place to where they need to lift.
• 42:14
  Speaker 4: We just, you know, it's a nice it's a very
• 42:17
  Speaker 4: kind of symbiotic relationship, and so we just don't really
• 42:20
  Speaker 4: do a lot of those types of threads. But yeah,
• 42:23
  Speaker 4: I would discourage.
• 42:24
  Speaker 5: People my money back from Jill. You talk about lucky
• 42:29
  Speaker 5: in order to do a brow.
• 42:30
  Speaker 4: Lift surgically, right, it's if you aren't more, if you
• 42:36
  Speaker 4: aren't very comfortable and a little bit more not aggressive,
• 42:39
  Speaker 4: but you've got to be thorough with your surgical elevation
• 42:41
  Speaker 4: of the brow. It's not even going to move even
• 42:44
  Speaker 4: when you operate on it. I mean, you've got to
• 42:46
  Speaker 4: release the connections down around the bone around the eye
• 42:51
  Speaker 4: completely in order to get the brow to move up
• 42:53
  Speaker 4: and put it what you want. So if if that,
• 42:56
  Speaker 4: and when I'm putting tension on the sutures that are lifting,
• 42:58
  Speaker 4: there's a lot of tension on those. So the thought
• 43:00
  Speaker 4: of getting that type of tension and getting that type
• 43:02
  Speaker 4: of lift out of a thread is just ridiculous as possible. Yeah,
• 43:07
  Speaker 4: So anybody that says that they can lift with a
• 43:10
  Speaker 4: non invasive procedure where whether it's threads or whether it
• 43:14
  Speaker 4: is injectables, is pulling the bowl over your eyes.
• 43:19
  Speaker 1: Yeah, it's like in the fitness industry when somebody thinks
• 43:21
  Speaker 1: they can just build muscle overnight and there's like a
• 43:23
  Speaker 1: magic a magic pill or something new.
• 43:27
  Speaker 5: It doesn't work that way.
• 43:29
  Speaker 3: No, I know, it doesn't. Do you usually do a
• 43:32
  Speaker 3: brow lift or headlift? Is that the same thing? Basically?
• 43:38
  Speaker 3: Do you usually do it time? Most of the time
• 43:40
  Speaker 3: we call it with everyone with a.
• 43:43
  Speaker 4: Facelift, most of the time we call it a browlift.
• 43:45
  Speaker 4: I so I will very routinely perform either an anoscopic
• 43:50
  Speaker 4: browlift or what's called a lateral suspension lateral brow suspension
• 43:55
  Speaker 4: with my face lift. The reason for that is that
• 43:58
  Speaker 4: when you lift, you still to get bunching if you're lifting,
• 44:02
  Speaker 4: but you're not lifting the brows. So some surgeons will
• 44:05
  Speaker 4: make an incision that comes all the way up like
• 44:07
  Speaker 4: this up the hairline, or they'll bring it up like this.
• 44:11
  Speaker 4: You could lose the sideburn if you do that. Also,
• 44:14
  Speaker 4: this incision looks terrible if you bring it all the
• 44:17
  Speaker 4: way up. You know, you just see that vertical segment
• 44:20
  Speaker 4: of that incision very apparently, So I like to instead
• 44:24
  Speaker 4: of bringing the incision all the way up like this,
• 44:26
  Speaker 4: I make an incision back behind the hairline, same incision
• 44:29
  Speaker 4: I make for a brow lift, and I do a
• 44:30
  Speaker 4: little lateral suspension just to pull out the laxity. Now,
• 44:34
  Speaker 4: if someone actually wants to move their brows upward, you know,
• 44:38
  Speaker 4: if they need to actually mobilize the brow, then I
• 44:41
  Speaker 4: need to do a full endoscopic brow lift where I'm
• 44:44
  Speaker 4: releasing the brow entirely from all the bony attachments around
• 44:48
  Speaker 4: the eye and suspending it superiorly.
• 44:52
  Speaker 5: What does that recovery look like?
• 44:55
  Speaker 4: So, because the incisions are behind the hair and I
• 44:58
  Speaker 4: don't cut out any hair part it and work between it,
• 45:02
  Speaker 4: the incisions hide really well. You do get when you're lifting,
• 45:06
  Speaker 4: you get so much lyft because I'm not excizing skin.
• 45:09
  Speaker 4: You do get some wrinkling and the you feel a
• 45:10
  Speaker 4: little wrinkle there of the skin that flattens over the
• 45:13
  Speaker 4: course of weeks to months, but it's hidden under the hair,
• 45:16
  Speaker 4: so no one you feel it, but you don't see it.
• 45:18
  Speaker 4: And so that is one plus of the brow lift.
• 45:22
  Speaker 4: Sometimes people will get a black eye from it because
• 45:24
  Speaker 4: you're you're working around the eye, and so you can
• 45:28
  Speaker 4: get a black eye or get swolen. But sometimes patients
• 45:31
  Speaker 4: don't have any of that, and so they look a
• 45:33
  Speaker 4: little bit too elevated for a couple of weeks, but
• 45:35
  Speaker 4: then it kind of settles, and the recovery can actually
• 45:38
  Speaker 4: be from it being presentable to the public, can actually
• 45:42
  Speaker 4: be a lot shorter than a facelift. I have a
• 45:44
  Speaker 4: lot of patients that even a week they look awesome
• 45:47
  Speaker 4: because they didn't have any bruising. But you got to
• 45:50
  Speaker 4: plan on being that person that has bruising, and if
• 45:52
  Speaker 4: that's the case, then you're talking more on the order
• 45:54
  Speaker 4: of two to three weeks before that bruising goes away.
• 45:58
  Speaker 4: And the main thing with browlift is that patients sometimes
• 46:02
  Speaker 4: will get a pretty significant headache for the first twenty
• 46:06
  Speaker 4: four hours. So I have ways to treat that, I
• 46:09
  Speaker 4: have medications that I use for that, but that can
• 46:12
  Speaker 4: be a tough portion of the recovery. So I just
• 46:16
  Speaker 4: they have my number, they call me anytime in that
• 46:18
  Speaker 4: first twenty four hours, and we get you through that
• 46:20
  Speaker 4: and now tell you a.
• 46:21
  Speaker 3: Browlift like fifty percent of the time with your facelifts
• 46:24
  Speaker 3: or I've just never even thought about that aspect of stuff.
• 46:29
  Speaker 4: I would say a full endoscopic browlift is maybe like
• 46:33
  Speaker 4: you know, thirty or forty percent of the time, and
• 46:35
  Speaker 4: then a temporal suspension suture is probably not.
• 46:39
  Speaker 3: Just like pulling from the top of the forehead and
• 46:42
  Speaker 3: just like pulling the skin up.
• 46:45
  Speaker 4: Yeah, so an endoscopic browlift is kind of a it's
• 46:52
  Speaker 4: an interesting well, this is another kind of interesting topic.
• 46:54
  Speaker 4: So the difference between an endoscopic browlift between from surgeon
• 46:58
  Speaker 4: to surgeon is that some surgeons still will use the endoscope,
• 47:02
  Speaker 4: meaning like they're looking on a camera as they're doing
• 47:06
  Speaker 4: the brow lift to elevate the brow I have done
• 47:11
  Speaker 4: a lot of these, okay, so I don't use the endoscope.
• 47:14
  Speaker 4: I don't need the endoscope to see what I need
• 47:16
  Speaker 4: to see, and I can do a lot of the
• 47:19
  Speaker 4: work very safely and by feel. In the middle portions,
• 47:22
  Speaker 4: I've never had a nerve injury there. I would use
• 47:24
  Speaker 4: it if I was going to remove the muscle here,
• 47:27
  Speaker 4: and that would be the main and really the only
• 47:30
  Speaker 4: reason I would do use the endoscope is to remove
• 47:32
  Speaker 4: the corrugators, the ones you treat with botox that make
• 47:34
  Speaker 4: the elevens. I don't like that procedure. I've seen. I've
• 47:43
  Speaker 4: seen people come to me from other surgeons with irregularities
• 47:48
  Speaker 4: in asymmetry and taking those muscles out so the brows
• 47:51
  Speaker 4: look funky, they move weirdly. It's a very hard problem
• 47:55
  Speaker 4: to fix. And the other thing is those muscles sit
• 47:57
  Speaker 4: right around the nerves that come out from your eyes,
• 47:59
  Speaker 4: and I think that those you're a lot more likely
• 48:02
  Speaker 4: to have what are called paristhiesias or numbness or weird
• 48:06
  Speaker 4: sensations in your scalp when you work on those muscles,
• 48:10
  Speaker 4: so I don't like to take them out. And that's
• 48:13
  Speaker 4: the only thing I would use the endoscope for. So
• 48:16
  Speaker 4: even though we use the term endoscopic browlift so that
• 48:20
  Speaker 4: it's kind of more applicable to what other people are
• 48:24
  Speaker 4: doing or what's being marketed, but I don't actually have
• 48:28
  Speaker 4: to use the endoscope to do the procedure to elevate
• 48:32
  Speaker 4: all the brows here and lift everything. There's a suture
• 48:35
  Speaker 4: that lifts on the lateral corners here, and then there
• 48:38
  Speaker 4: are different ways that you can suspend the middle portion
• 48:40
  Speaker 4: of the brow. Some people will use what are called
• 48:43
  Speaker 4: end of times, which is a dissolvable hook basically kind
• 48:46
  Speaker 4: of like a thread. Honestly, it goes away over the
• 48:48
  Speaker 4: course of weeks to months. I don't like them. I
• 48:50
  Speaker 4: don't use them. Some people can do suture right to
• 48:54
  Speaker 4: the bone and lift the middle. I use screws that
• 48:57
  Speaker 4: come out of a week, and that's really nice because
• 48:59
  Speaker 4: my decision and the middle portion is very very small.
• 49:02
  Speaker 4: It's only a couple millimeters, just enough to get the
• 49:04
  Speaker 4: screw through when that comes out, and patients it doesn't
• 49:08
  Speaker 4: bother patients, they hardly even notice that that's there while
• 49:11
  Speaker 4: they're healing.
• 49:11
  Speaker 3: And does that help so you don't have to get
• 49:14
  Speaker 3: as much botox. It just kind of also gives the
• 49:17
  Speaker 3: finished overall look of the facelift, so you're doing the
• 49:21
  Speaker 3: whole face in its entirety.
• 49:25
  Speaker 4: You're getting multiple things out of a brow lift, so
• 49:28
  Speaker 4: you are pulling on the skin, and when you do that,
• 49:31
  Speaker 4: you're removing some of that laxity that you're getting in
• 49:34
  Speaker 4: the foreheadlines, so your your fore headlines will look less deep.
• 49:39
  Speaker 4: You can maybe you use less botox, or it's not
• 49:43
  Speaker 4: going to prevent you from using botox right from needing
• 49:45
  Speaker 4: to use botox unless you remove the corridators. But the
• 49:48
  Speaker 4: thing is that once you've suspended it, you can use
• 49:51
  Speaker 4: a lot more botox and not drop the browse, which
• 49:54
  Speaker 4: is always a concern for people. But the thing that
• 49:56
  Speaker 4: the browlift does that's really nice, aside from you know,
• 50:01
  Speaker 4: removing or reducing the wrinkles above, is it can open
• 50:04
  Speaker 4: the upper eyelid. So you can do this test at
• 50:09
  Speaker 4: home if you are looking in the mirror, take your
• 50:12
  Speaker 4: eyebrow and lift it to the point to where you
• 50:14
  Speaker 4: think it looks aesthetically pleasing, where it matches your features,
• 50:19
  Speaker 4: and then look at what it does to your upper
• 50:21
  Speaker 4: eyelid crease. And some of that lax it in the
• 50:23
  Speaker 4: upper eyelid crease will actually be alleviated by lifting the
• 50:26
  Speaker 4: brow so that's another thing that it does. And then
• 50:29
  Speaker 4: again it removes the redundancy that you form here in
• 50:32
  Speaker 4: the temple region when you lift the face. So those
• 50:35
  Speaker 4: are all reasons why someone would want to do a
• 50:38
  Speaker 4: browlift with their facelift or in combination with any procedure
• 50:41
  Speaker 4: or on it zone.
• 50:42
  Speaker 3: Well, speaking of the eyelids, so eyelids are huge, and
• 50:45
  Speaker 3: I feel like they age people so quickly, and it's
• 50:49
  Speaker 3: something so easy to do. That's like an easy procedure
• 50:53
  Speaker 3: that makes a huge difference. So is that something that
• 50:57
  Speaker 3: you recommend to people to even and like, can you
• 51:01
  Speaker 3: look at someone and just say, you know, if you
• 51:03
  Speaker 3: get your eyelids done, you might give you a couple
• 51:05
  Speaker 3: of years before you do the facelift or.
• 51:10
  Speaker 4: Yeah, And for that reason, we do so many eyelid
• 51:12
  Speaker 4: lifts here. It's it's probably if you're looking for a procedure,
• 51:17
  Speaker 4: that's the biggest bang for your buck and the most
• 51:19
  Speaker 4: generally applicable. Almost anybody can have a blood for a plasty.
• 51:23
  Speaker 4: It's very uncommon that I'm like, there's nothing there to
• 51:26
  Speaker 4: that can be removed. You know, I can do a
• 51:31
  Speaker 4: blood for a plasty and like a half hour awake,
• 51:34
  Speaker 4: half hour to forty five minutes awake, and the sutures
• 51:38
  Speaker 4: come out of a week. But you know, when we
• 51:40
  Speaker 4: have staff they get blood for a plastis, a lot
• 51:42
  Speaker 4: of them will come back to work like the next
• 51:43
  Speaker 4: day because they don't. You know, it's not weird to
• 51:45
  Speaker 4: have someone walking around or clinic sutures in there, and
• 51:49
  Speaker 4: you take out the sutures at the week mark, often
• 51:52
  Speaker 4: people are kind of flying. You know, they're they're looking good.
• 51:55
  Speaker 4: They can cover with makeup. It's pretty indiscernible and you
• 51:58
  Speaker 4: get a nice improvement right away. So it's Bleffer plasties
• 52:03
  Speaker 4: are really really nice procedure. They go along ways. And
• 52:08
  Speaker 4: the thing about just our inner personal communication is that
• 52:12
  Speaker 4: we look at our eyes more than so you're never
• 52:15
  Speaker 4: looking at someone's ears when you're talking, right, Like, the
• 52:19
  Speaker 4: communication is in the eyes, and so when you do
• 52:23
  Speaker 4: an eyelid lift, it can be transformational. I have a
• 52:26
  Speaker 4: patient that I've put results out where I did her
• 52:29
  Speaker 4: eyes and I did some laser and people thought I
• 52:31
  Speaker 4: did a facelift because you know, the eyes are just
• 52:35
  Speaker 4: so much brighter and and everything. So I think, yeah,
• 52:39
  Speaker 4: the Bleffer plasty can be a really nice procedure. A
• 52:43
  Speaker 4: lot of people are good candidates for it, and it's
• 52:47
  Speaker 4: really is pretty straightforward and it's recovery and it's not hard.
• 52:50
  Speaker 3: To get it. Yeah, Okay, I even feel like this
• 52:53
  Speaker 3: is the perfect procedure for men, because I don't know,
• 53:01
  Speaker 3: I feel like that's a really good one for MENTU.
• 53:03
  Speaker 3: But okay, I have one last question. So this kind
• 53:08
  Speaker 3: of goes along with the recovery question. But listen, we've
• 53:13
  Speaker 3: all seen photos of what people look like right after
• 53:18
  Speaker 3: a facelift, and I think that's one of the terrifying things.
• 53:22
  Speaker 3: And to what Hay lou Is saying like, Okay, when
• 53:25
  Speaker 3: can you really go back to work? Because if you
• 53:26
  Speaker 3: are a business professional and you don't want anyone to
• 53:30
  Speaker 3: know you've had a facelift, and I know all the
• 53:33
  Speaker 3: results range. Some people bruise really badly, some people don't.
• 53:37
  Speaker 3: Some people are super swollen, some people aren't as swollen.
• 53:40
  Speaker 3: What do you think is the average of when someone
• 53:45
  Speaker 3: a business professional could go back to work if they
• 53:48
  Speaker 3: don't want anyone to know they've done it? And do
• 53:52
  Speaker 3: people freak the hell out when they wake up and
• 53:57
  Speaker 3: are texting you what have I done? I'm like panicking.
• 54:03
  Speaker 3: Is this a normal reaction?
• 54:05
  Speaker 4: Yes? I try to tell people that this is like
• 54:09
  Speaker 4: a roller coaster and when you wake up, you're going
• 54:12
  Speaker 4: to be like, what have I done? This is never
• 54:14
  Speaker 4: going to look right, and you'll have good days and
• 54:18
  Speaker 4: you'll have bad days. You'll have good hours and bad hours.
• 54:20
  Speaker 4: And my job not just in doing the surgery, but
• 54:24
  Speaker 4: I try to be an expert handholder, right, so like
• 54:28
  Speaker 4: one of the things, I feel like I'm a good surgeon.
• 54:30
  Speaker 4: I feel like I'm the best handholder that's out there,
• 54:32
  Speaker 4: and I'm the most available that I can possibly be
• 54:35
  Speaker 4: for my patients. Because if you can turn the roller
• 54:38
  Speaker 4: coaster of emotion in the post operative period to a
• 54:41
  Speaker 4: kiddie ride, you know, that's the goal. And the way
• 54:44
  Speaker 4: that I've found that you do that is by being
• 54:46
  Speaker 4: really accessible, seeing your patients a lot, especially in the
• 54:49
  Speaker 4: first couple of weeks, and by giving them expectations. And
• 54:54
  Speaker 4: so I tell them, you know, you're going to feel
• 54:55
  Speaker 4: too pold in the beginning, You're going to feel natural.
• 54:58
  Speaker 4: You're going to feel like your head is a you tip,
• 55:00
  Speaker 4: you know, just huge and swollen and bruise. You just
• 55:04
  Speaker 4: have to trust the process and it's going to look better.
• 55:07
  Speaker 4: And for my professionals, it depends on our people who
• 55:11
  Speaker 4: have you know, a lot of face time or are
• 55:14
  Speaker 4: very conscientious about people knowing that they've had it done.
• 55:18
  Speaker 4: It depends a little bit on the person. So for example,
• 55:22
  Speaker 4: if I'm operating on a seven year old patient paper
• 55:25
  Speaker 4: thin skin, lots and lots of laxity, a few medical
• 55:30
  Speaker 4: co morbidities, I know they're going to bruise more. I
• 55:33
  Speaker 4: know that they're going to be more pulled. I know
• 55:35
  Speaker 4: that they're going to have in the beginning, like when
• 55:38
  Speaker 4: you if they have deep seated wrinkles and they decide
• 55:40
  Speaker 4: not to do a laser procedure, those wrinkles are going
• 55:42
  Speaker 4: to change direction. All those things are going to be
• 55:45
  Speaker 4: a lot more noticeable for a lot longer, And so
• 55:48
  Speaker 4: we're talking more on the order of one to two
• 55:50
  Speaker 4: months before they're really going to feel very confident being seen.
• 55:54
  Speaker 4: I've had young patients where you know, I did their facelift,
• 55:59
  Speaker 4: and you know, there's one I'm thinking of that she
• 56:01
  Speaker 4: went out to dinner with her very close friends at
• 56:03
  Speaker 4: under two weeks and they couldn't tell that she had
• 56:07
  Speaker 4: had anything done. She had to wear her hair down
• 56:09
  Speaker 4: over her incision lines. But you know, she was very
• 56:13
  Speaker 4: confident to be out very much earlier on. So but
• 56:17
  Speaker 4: a safe a safe time point is probably more on
• 56:21
  Speaker 4: the order of one to two months. And if you
• 56:26
  Speaker 4: are in very you know, in situations where there's no
• 56:30
  Speaker 4: way you can get around people being up close and personal,
• 56:33
  Speaker 4: and or if you have to wear your hair up.
• 56:35
  Speaker 4: You know, my people who dance, people who are you
• 56:38
  Speaker 4: know in those scenarios like you just got to tell
• 56:40
  Speaker 4: them those incision lines you can cover them with makeup.
• 56:42
  Speaker 4: But you're probably looking at one to two months. The
• 56:45
  Speaker 4: adage from my you know, doctor Cotela always used to
• 56:48
  Speaker 4: say people, I stole some of his like lines right
• 56:51
  Speaker 4: because they were so good, So I have to give
• 56:52
  Speaker 4: him credit. He was phenomenal person, phenomenal surgeon, very good
• 56:56
  Speaker 4: at taking care of patients and making sure they had
• 56:58
  Speaker 4: expectations that are realistic. So his was you know, at
• 57:02
  Speaker 4: your very Bruis and swan for two weeks. At two months,
• 57:05
  Speaker 4: the people who know you well probably will not be
• 57:07
  Speaker 4: able to tell that you've had anything done. And at
• 57:09
  Speaker 4: six months you look at yourself and say, this could
• 57:11
  Speaker 4: have been me ten, fifteen, twenty years ago, and that
• 57:15
  Speaker 4: has been pretty tried and true in my practice. I
• 57:17
  Speaker 4: feel like that's a pretty you know, that's that's a
• 57:21
  Speaker 4: pretty realistic expectation to give patients.
• 57:26
  Speaker 5: I'm fascinating.
• 57:28
  Speaker 3: I feel like take some appointments even a couple of
• 57:33
  Speaker 3: years down the road. Oh my gosh, thank you so much.
• 57:36
  Speaker 3: I know how busy you are, I know your schedules
• 57:41
  Speaker 3: and Saint, so I appreciate you taking the time talking
• 57:44
  Speaker 3: to Haley and I and our audience. I know that
• 57:47
  Speaker 3: our listeners are going to love this information. I feel
• 57:50
  Speaker 3: like they just got the best consults with this phenomenal
• 57:55
  Speaker 3: facial classics Surgy.
• 57:56
  Speaker 5: Yeah, now they have all the answers.
• 58:00
  Speaker 4: I appreciate you having me on, and I just have
• 58:02
  Speaker 4: to put a plug for my two partners too, because
• 58:04
  Speaker 4: they're phenomenal people and if anybody ever needs someone to
• 58:09
  Speaker 4: take care of them, like, there's no one I would
• 58:11
  Speaker 4: trust more. That's the whole reason I'm here. So I
• 58:13
  Speaker 4: can't really, you know, take credit for the greatness of
• 58:16
  Speaker 4: Utah Facial Plastics. Doctor Thompson, doctor Henstam have done a
• 58:20
  Speaker 4: really good job of just having a place where people
• 58:24
  Speaker 4: can trust that they're going to be taken care of
• 58:25
  Speaker 4: and that the most important thing is their safety and
• 58:29
  Speaker 4: having a good result and a good experience. And so
• 58:31
  Speaker 4: I'm just really appreciative to be a part of that.
• 58:34
  Speaker 4: I'm very just flattered and appreciative that you guys would
• 58:37
  Speaker 4: have me on and pick my brain about things, and
• 58:40
  Speaker 4: so I'm very happy to have been here today.
• 58:43
  Speaker 5: Yeah, thank you so much.
• 58:45
  Speaker 4: You're welcome.
• 58:47
  Speaker 5: Thanks for listening.
• 58:49
  Speaker 3: If you enjoyed this episode, please consider giving us a
• 58:52
  Speaker 3: five star review and sharing the body Pod with your friends.
• 58:56
  Speaker 5: Until next time,