Latest / Scalpel and Skin / Are Eyelid Procedures Worth It? Blepharoplasty, Fillers, Botox & Laser | EP 07

Transcript

Are Eyelid Procedures Worth It? Blepharoplasty, Fillers, Botox & Laser | EP 07 · Scalpel and Skin

• 0:00
  SPEAKER_00: People come in, they're like, I'm not tired.
• 0:02
  SPEAKER_00: Why does everybody think I'm tired all the time?
• 0:04
  SPEAKER_00: I don't like the way I look.
• 0:05
  SPEAKER_01: People don't understand that the fat loss makes them look more tired.
• 0:11
  SPEAKER_01: If you rub your eyes a lot, I can tell of saying you rub your eyes, and they're like, yes, how did you know?
• 0:17
  SPEAKER_01: It's because they get increased pigmentation under their eyes.
• 0:20
  SPEAKER_00: The question then becomes is an upper bleferplasty worth it?
• 0:24
  SPEAKER_01: I can't wait to get mine done.
• 0:25
  SPEAKER_00: Yeah, I can't wait to cut on you.
• 0:40
  SPEAKER_00: Hi, everybody.
• 0:40
  SPEAKER_00: Dr.
• 0:41
  SPEAKER_00: Labraska, board certified plastic surgeon here with my sister.
• 0:44
  SPEAKER_00: Missed it because she's the dermatology P.
• 0:46
  SPEAKER_00: I just get it out of the way.
• 0:47
  SPEAKER_00: Let's go.
• 0:49
  SPEAKER_00: Those of you just listening.
• 0:50
  SPEAKER_00: She did the peace sign that she's trying to make her thing.
• 0:53
  SPEAKER_00: It's exhausting.
• 0:54
  SPEAKER_00: I hate it.
• 0:55
  SPEAKER_00: I'm stuck with it.
• 0:56
  SPEAKER_00: She's my sister.
• 0:56
  SPEAKER_00: I uh I I I can't get rid of her.
• 0:59
  SPEAKER_00: So today, I love you.
• 1:02
  SPEAKER_00: You're my sister.
• 1:03
  SPEAKER_00: It is what it is.
• 1:04
  SPEAKER_00: So, how you been doing?
• 1:05
  SPEAKER_01: What's up?
• 1:06
  SPEAKER_01: Oh, good.
• 1:06
  SPEAKER_01: I'm ready for back to school.
• 1:08
  SPEAKER_00: Yeah.
• 1:09
  SPEAKER_00: Okay.
• 1:09
  SPEAKER_01: I'm ready for my children to go back to school.
• 1:11
  SPEAKER_00: So, what grades are we in now?
• 1:14
  SPEAKER_01: Solidarity to all of the working parents out there.
• 1:18
  SPEAKER_01: They moms, I know the moms know what I'm saying.
• 1:20
  SPEAKER_01: We love kids, but we want them to go to school now.
• 1:23
  SPEAKER_00: I have two nephews, and uh they are in what we're we're going to fourth grade and first grade, right?
• 1:32
  SPEAKER_00: And uh uh I love them very much.
• 1:35
  SPEAKER_00: Uh they are very much hell raisers.
• 1:38
  SPEAKER_00: And um Dad calls it karma.
• 1:41
  SPEAKER_00: Yeah, well, you were a little bit of a pain in the ass too, whenever you were a kid.
• 1:45
  SPEAKER_00: Uh did we ever talk about that time whenever you were two years old and uh we got a call from so we lived uh on a it was a essentially a pond, right?
• 1:57
  SPEAKER_00: And on the other side of the pond, so like three or four hundred feet away, someone called our house because my sister was on the roof.
• 2:09
  SPEAKER_00: She was like two, maybe one, you know.
• 2:13
  SPEAKER_00: She was not three yet.
• 2:14
  SPEAKER_00: And she was out on the roof.
• 2:16
  SPEAKER_00: She shouldn't have been on the roof walking around on the roof by herself.
• 2:20
  SPEAKER_01: And they were like, Do you know where your daughter is?
• 2:22
  SPEAKER_01: Do you know that your daughter's on the roof right now?
• 2:26
  SPEAKER_00: So karma.
• 2:28
  SPEAKER_01: You know, it's I'm not even, I this is not even a joke.
• 2:31
  SPEAKER_01: This is not a joke.
• 2:33
  SPEAKER_01: One hour ago, my nine-year-old climbed out onto the roof because he threw his his like squeeze.
• 2:40
  SPEAKER_01: You know, the kids are all into these squeezy things, yeah.
• 2:43
  SPEAKER_01: These like sensory things.
• 2:45
  SPEAKER_01: And he threw it onto the roof, I guess, just to see what would happen.
• 2:50
  SPEAKER_01: And I said, Don't go out on the roof and get it.
• 2:54
  SPEAKER_01: I'll handle it.
• 2:55
  SPEAKER_01: Just give me five minutes.
• 2:58
  SPEAKER_01: And two minutes later, he came down with a squishy thing.
• 3:01
  SPEAKER_00: Out on the roof.
• 3:02
  SPEAKER_01: Karma.
• 3:02
  SPEAKER_01: That's that's what that's what dad says.
• 3:04
  SPEAKER_01: Karma.
• 3:06
  SPEAKER_00: Yeah, I mean, you were bad, and you know, and and your kids are imperfect.
• 3:12
  SPEAKER_01: That's that's a that's a really very sweet uncle way of putting it.
• 3:20
  unknown: I love them.
• 3:21
  SPEAKER_00: Um my kids are going to a sophomore at University of Pittsburgh, my son, Algie, and uh my daughter.
• 3:28
  SPEAKER_00: Yeah, go pit.
• 3:29
  SPEAKER_00: That's right.
• 3:30
  SPEAKER_00: And my daughter is, she's a junior in high school this year, and uh she is uh She's your karma.
• 3:36
  SPEAKER_00: She's loving life.
• 3:38
  SPEAKER_00: You know, she just she has a I when I grow up, you know, I want to be like her.
• 3:41
  SPEAKER_00: Today I thought maybe we'd talk a little bit about eyelid rejuvenation and I the entire upper eye, upper one-third of the face rejuvenation.
• 3:51
  SPEAKER_00: And, you know, and that is like so many different things.
• 3:54
  SPEAKER_00: There's there's so many different things that that are involved with that.
• 3:58
  SPEAKER_00: And and it really, it's super fun.
• 4:01
  SPEAKER_00: People come in, they're like, I'm not tired.
• 4:03
  SPEAKER_00: Why does everybody think I'm tired all the time?
• 4:06
  SPEAKER_00: I I just I I don't like the way I look.
• 4:08
  SPEAKER_00: I I I hate that people say those things and and I feel good.
• 4:12
  SPEAKER_00: I work out four days a week and I, you know, uh wear sunglasses, like whatever.
• 4:17
  SPEAKER_00: And and uh folks are just they just hate to be told they look tired or or feel like they look tired.
• 4:23
  SPEAKER_01: So what's one of the most common things?
• 4:26
  SPEAKER_01: People come in and they say, I just I feel like I look tired all the time, but they don't know why.
• 4:30
  SPEAKER_01: They just know that they're looking tired.
• 4:32
  SPEAKER_00: Right.
• 4:33
  SPEAKER_00: Especially in men, it's the first thing that that ages a man is eyes, his eyelids.
• 4:40
  SPEAKER_00: And uh, and I do a ton of blephoplasty, which is an eyelid lift in men.
• 4:46
  SPEAKER_00: I do many more in women, but compared to other male plastic surgeries, I do eyelid is above and beyond number one, and you know, it's more than number two, number three, and probably number four combined.
• 4:59
  SPEAKER_00: I've done a bunch of my friends because we're all about that age now, too.
• 5:03
  SPEAKER_00: And and they're like, Els, why, you know, why do I look tired?
• 5:06
  SPEAKER_00: I get I can you you had your eyelids done.
• 5:09
  SPEAKER_00: Can you can you do my eyelids?
• 5:10
  SPEAKER_00: I had mine done too, and I love it.
• 5:12
  SPEAKER_00: It's been over six years, so it's so good.
• 5:14
  SPEAKER_01: I can't wait to get mine done.
• 5:16
  SPEAKER_00: Yeah, I can't wait to cut on you.
• 5:18
  SPEAKER_00: I can't wait to cut on you.
• 5:19
  SPEAKER_00: Five to ten years.
• 5:20
  SPEAKER_00: Yeah.
• 5:20
  SPEAKER_00: Yeah.
• 5:20
  SPEAKER_00: So there's a you know, a lot of stuff.
• 5:22
  SPEAKER_00: What do you see?
• 5:23
  SPEAKER_00: When do you see it first?
• 5:25
  SPEAKER_01: I would say the vast majority of my patients are women.
• 5:28
  SPEAKER_01: I would say most women are coming in saying they're starting to look more tired.
• 5:34
  SPEAKER_01: I would say late 30s to early 40s is is really when I I think those those changes start to occur.
• 5:43
  SPEAKER_01: That's when they start to lose some of that, some of that fat under the eyes.
• 5:48
  SPEAKER_01: And people don't they they don't understand that the the fat loss makes makes them can can make them look more tired, but it's not necessarily that they're more tired.
• 5:59
  SPEAKER_01: It's just that all of the they yeah, all of the fat that was covering the the vasculature and the vessels under there before is now smaller.
• 6:09
  SPEAKER_00: Tired eyes could come from so many different things.
• 6:11
  SPEAKER_00: It could come from the skin, it could come from the fat, it come from the brow position, the eyelid position, volume, like you said.
• 6:18
  SPEAKER_00: It can come from you know other things as well.
• 6:20
  SPEAKER_01: And the skin, yeah, right.
• 6:23
  SPEAKER_01: Skin pigmentation, especially people, a lot of people don't realize this.
• 6:27
  SPEAKER_01: If you rub your eyes a lot, I can tell.
• 6:29
  SPEAKER_01: I will be able to tell.
• 6:31
  SPEAKER_01: I have a 100% success rate of saying you rub your eyes and they're like, Yes, how did you know?
• 6:38
  SPEAKER_01: It's because they get increased pigmentation under their eyes.
• 6:42
  SPEAKER_00: You know, it even comes from bone, because we get bone resorption uh as well over time, and and uh and and that's a big thing as well.
• 6:50
  SPEAKER_01: So the eye socket actually changes shape.
• 6:54
  SPEAKER_01: So it goes from being shaped more like a golf ball, or I'm sorry, more like an almond to more like a golf ball as we get older.
• 7:02
  SPEAKER_00: Right.
• 7:02
  SPEAKER_00: You know, the eye, it's it's it's the one where patients they're most likely to ask for kind of the right goal, but the wrong procedure.
• 7:10
  SPEAKER_00: They come in and they want they just know they look, you know, not as not like they want to, but they're going to, but they ask uh they ask for the wrong thing, but with the right goal in mind, eyelid rejuvenation.
• 7:25
  SPEAKER_00: You know, so let's let's jump right in and let's talk surgery because that's what I do most of all.
• 7:31
  SPEAKER_00: And and an upper eyelid lift is the procedure that I've done most of all.
• 7:36
  SPEAKER_00: I've done about 3,000 of these.
• 7:39
  SPEAKER_00: And it's just because I I've worked for, I worked with an eyelid group.
• 7:45
  SPEAKER_00: I'm sorry, an uh optoma uh optometry and ophthalmology group for like more than 10 years.
• 7:51
  SPEAKER_00: We're we're buds, we're partners, and I get all of their stuff.
• 7:54
  SPEAKER_00: And so hundreds of eyelid surgeries every year.
• 7:57
  SPEAKER_00: Just last week, I I think I did, I did eight in one week.
• 8:01
  SPEAKER_00: Or I'm sorry, I did eight on one day.
• 8:04
  SPEAKER_01: Eight on one day.
• 8:05
  SPEAKER_00: In one day, yeah.
• 8:06
  SPEAKER_00: Yeah, that the most I've ever done is like 12 or 14.
• 8:10
  SPEAKER_01: In a day.
• 8:11
  SPEAKER_00: In a day.
• 8:11
  SPEAKER_00: Yeah.
• 8:11
  SPEAKER_00: I mean, it only takes me, listen, my team is amazing.
• 8:15
  SPEAKER_00: I've done a ton of them.
• 8:17
  SPEAKER_00: You know, it only takes me about 20 minutes.
• 8:19
  SPEAKER_00: That's not a that's not a brag, and that's not me like like cutting corners and stuff like that.
• 8:24
  SPEAKER_00: It's just so routine that, you know, we just all the time.
• 8:27
  SPEAKER_00: We just do it all the time.
• 8:28
  SPEAKER_00: And, you know, it is what it is.
• 8:30
  SPEAKER_00: You know, when I do an an upper blepheroplasty, an upper eyelid lift, what I tell patients, you know, my kids.
• 8:36
  SPEAKER_01: People know what that is.
• 8:37
  SPEAKER_01: What what tell like you say an eyelid lift?
• 8:40
  SPEAKER_01: What are you doing?
• 8:41
  SPEAKER_00: So what I tell folks whenever I'm just kind of running over the like the quick overview is I make a cut in the lead crease, I tug in the extra skin and remove it, do a little inside work, make it look nice, and then I run a stitch that goes from the inside to the outside of the eye.
• 8:55
  SPEAKER_00: And I leave what's called a pullout stitch where there's a knot on the inside of the eye and a knot on the outside.
• 9:01
  SPEAKER_00: And then we just cut one of those knots and slide it out a week later, and it it leaves um it just absolutely beautiful and it's very easy and not painful at all.
• 9:10
  SPEAKER_01: Yeah, I've taken those stitches out for you before.
• 9:13
  SPEAKER_00: Yeah, you have.
• 9:13
  SPEAKER_00: That's right.
• 9:14
  SPEAKER_00: Yeah.
• 9:14
  SPEAKER_00: But some of the inside work is uh it can be multiple different things.
• 9:20
  SPEAKER_00: One of the things it can be is actual little bit of a droopy eye or a little bit of a lazy eye.
• 9:25
  SPEAKER_00: Like think Sydney Sweeney.
• 9:27
  SPEAKER_00: Sydney Sweeney's a beautiful girl, but she's got what we call a little bit of eyelid toisus.
• 9:31
  SPEAKER_00: It gives her those kind of sleepy eyes.
• 9:34
  SPEAKER_01: It works for her, though.
• 9:36
  SPEAKER_00: Yeah, it works for well, it works for her because kind of the everything else is in is is nice.
• 9:40
  SPEAKER_01: Um she's like in her late 20s.
• 9:43
  SPEAKER_01: Yeah, right.
• 9:45
  SPEAKER_00: Yeah, in 10 years, she'll she'll want uh what's called a little tosis repair that'll make her eyes pop a little bit more.
• 9:51
  SPEAKER_00: For right now, it works for her.
• 9:52
  SPEAKER_00: But uh, that's one of the things that that I do a lot of.
• 9:56
  SPEAKER_00: Um, and what that does, that's a muscle issue where a mu typically a muscle becomes loose, and what we do is we tighten it back up on the inside without getting too technical.
• 10:07
  SPEAKER_00: You tighten up a muscle on the inside to make the eye open a little bit better.
• 10:11
  SPEAKER_00: Uh the other thing that's very common is uh either fat removal or fat repositioning.
• 10:16
  SPEAKER_00: On the upper eyelids, we have two little fat pockets, one on the inside, kind of one in the middle there.
• 10:21
  SPEAKER_00: And then on the outer aspect, there's a it's called a lacrimal gland.
• 10:25
  SPEAKER_00: It's where your tears come from.
• 10:26
  SPEAKER_00: When you cry, they go that way and then they go over, wash over your eye, and they drain down um through a little tear duct there that and then it goes into your nose, and that's why your nose runs while you cry.
• 10:38
  SPEAKER_01: So can though there's um I I've seen some things, this is kind of trending on social media right now, where it ha like it happened to Bradley Cooper, they take too much of the fat and then they look really hollowed out, right?
• 10:52
  SPEAKER_00: You're absolutely right.
• 10:53
  SPEAKER_00: So as folks get into their, you know, 60s, 70s, 80s, 50s, even, they there's a there's fat that descends and a lot of it needs, some of it anyway, needs to be removed.
• 11:07
  SPEAKER_00: Like very handsome, thin guys in their 30s and 40s don't really need that.
• 11:13
  SPEAKER_00: If anything, we do we we burn the little fat pads a little bit to to shrink them down a little bit.
• 11:18
  SPEAKER_00: We but we don't uh want to over-resect the eyelids there.
• 11:22
  SPEAKER_00: Um fat equals youth.
• 11:24
  SPEAKER_00: Yeah, right, right.
• 11:26
  SPEAKER_00: We fat uh at having a little bit of fat in there makes them look very, very nice.
• 11:31
  SPEAKER_00: Having no fat in there and no bueno.
• 11:34
  SPEAKER_01: But you can do it where you just take the skin, right?
• 11:38
  SPEAKER_00: Yeah, you can, yeah.
• 11:39
  SPEAKER_00: So someone like you, for example, you know, if you wanted to get rid of a little tiny extra skin you did and and you threatened me because I'm your brother, I would be.
• 11:50
  SPEAKER_01: Get rid of my eyelid skin.
• 11:52
  SPEAKER_00: Yeah, right.
• 11:52
  SPEAKER_00: You know, I may do that just for you.
• 11:54
  SPEAKER_00: I'd just be like, all right, shut up, I'll do it.
• 11:56
  SPEAKER_00: And, you know, and and trim a little bit of eyelid skin for you.
• 11:59
  SPEAKER_00: You know, but there's there's so much more to that uh as well, too.
• 12:03
  SPEAKER_00: One of the other bigger things is brow descent.
• 12:06
  SPEAKER_00: So your brows kind of sink and they often sink laterally.
• 12:10
  SPEAKER_00: The older brow lifting techniques were way super aggressive, where we'd make a cut from the top of your ear on one side all the way across over your head and over connected on the other side.
• 12:23
  SPEAKER_00: And we would kind of peel down your face a little bit, and that's called a coronal brow lift.
• 12:28
  SPEAKER_00: It's really gone by the wayside.
• 12:30
  SPEAKER_00: It was it was a lot.
• 12:31
  SPEAKER_00: And then we did endoscopic brow lift, and that was that's nice and it's effective, but sometimes it uh becomes a little bit uneven and and such.
• 12:41
  SPEAKER_00: And so we've we've really kind of trended more to a lateral brow lift.
• 12:44
  SPEAKER_00: It's a very powerful procedure, works really, really nice, and it's not super duper aggressive compared to the older brow technique.
• 12:52
  SPEAKER_01: Where's the cut in the hairline?
• 12:54
  SPEAKER_00: Yeah, uh yeah, so it's in the kind of in the lateral temporal hairline.
• 12:59
  SPEAKER_00: So if you if you're you know, if you look at your your forehead on in a mirror, it's gonna be in the hairline, kind of off to the side, maybe kind of like when you rub your temples when your kids are driving in and yats and you a little bit above where you typically do that.
• 13:14
  SPEAKER_00: Right, yeah.
• 13:14
  SPEAKER_00: A little bit like maybe an inch uh or so or half an inch above where you kind of rub there in the hairline.
• 13:20
  SPEAKER_00: That's that's where you'd make those cuts, and then you uh do some dissection and and and bring it up there a lot.
• 13:25
  SPEAKER_01: So that's so I'm thinking of Bella Hadid.
• 13:29
  SPEAKER_01: You don't even know who that is, do you?
• 13:30
  SPEAKER_00: I know who that is.
• 13:31
  SPEAKER_00: I I I figured out there's she's got a sister.
• 13:33
  SPEAKER_00: Um Gigi, yes.
• 13:35
  SPEAKER_00: Gigi Hadid, yes.
• 13:37
  SPEAKER_01: She has this very sharp high lateral brow, which she did not have as a teenager.
• 13:44
  SPEAKER_01: I mean, it's clearly surgical.
• 13:46
  SPEAKER_01: It's beautiful, she was stunning.
• 13:47
  SPEAKER_01: She's stunningly beautiful.
• 13:49
  SPEAKER_01: Yeah.
• 13:50
  SPEAKER_01: Um, but what's do you have an age cutoff where you'll say that?
• 13:54
  SPEAKER_01: So I don't know.
• 13:55
  SPEAKER_00: So some of them are doing that fox eye thing, right?
• 14:00
  SPEAKER_00: Yeah.
• 14:00
  SPEAKER_00: And that was a few years ago.
• 14:02
  SPEAKER_00: And and that was uh a slightly different procedure where we would uh pull the lateral canthus.
• 14:09
  SPEAKER_00: So there's a tendon that connects um our eye ball to our eye socket, and they would um either tighten that or cut it and pull it up and change the actual shape of the eye.
• 14:22
  SPEAKER_00: I I don't jive with that shit.
• 14:23
  SPEAKER_00: I think it's dumb.
• 14:25
  SPEAKER_00: And like you really have to be a true master to not mess that up every other time.
• 14:31
  SPEAKER_00: Um you know, and and patience it's just no bueno.
• 14:36
  SPEAKER_00: I I just I don't do weird shit, right?
• 14:39
  SPEAKER_00: And and that's really up there in the weird shit category, right?
• 14:43
  SPEAKER_01: You could just as an alternative do four units of Botox.
• 14:47
  SPEAKER_01: Look at that.
• 14:47
  SPEAKER_01: You have a brow lift.
• 14:49
  SPEAKER_00: That's a good option, right?
• 14:50
  SPEAKER_00: Yeah, yeah, do like a regular brow lift, blefroplasty, do some Botox.
• 14:54
  SPEAKER_00: It's fine.
• 14:55
  SPEAKER_00: Yes.
• 14:56
  SPEAKER_00: Let's see, what else can we talk about?
• 14:57
  SPEAKER_00: It a lot of people say an upper blyfroplasty is like a really easy procedure.
• 15:02
  SPEAKER_00: And it is.
• 15:03
  SPEAKER_00: It is a really easy procedure when you've done 3,000 of them.
• 15:07
  SPEAKER_00: But while I trained uh at Henry Ford, uh, one of the plastic surgeons there, he was amazing.
• 15:12
  SPEAKER_00: He would do these crazy, you know, 15-hour cases that were reconstructive.
• 15:17
  SPEAKER_00: He could do some incredible, amazing uh reconstructive work, but then he would do eyelids and he would stress about it.
• 15:24
  SPEAKER_00: And uh, you know, but that's just yeah, yeah.
• 15:27
  SPEAKER_02: He just didn't do them a lot.
• 15:28
  SPEAKER_00: He just didn't do them a lot.
• 15:30
  SPEAKER_00: And it was like he hated it.
• 15:31
  SPEAKER_00: We all have our thing that we hate.
• 15:33
  SPEAKER_02: Yeah.
• 15:33
  SPEAKER_00: And so that was his thing that he hated.
• 15:34
  SPEAKER_00: He would love to, he'd rather do a 12-hour uh reconstruction where we would take bone out of the leg and put it in the jaw instead of doing like a 20-minute eyelid case.
• 15:46
  SPEAKER_00: I'm he was wonderfully taught me a lot of really great stuff.
• 15:50
  SPEAKER_00: His name is Ken Mokwin, M-O-Q-U-I-N.
• 15:53
  SPEAKER_00: So he taught me a lot of stuff and I appreciate what he did.
• 15:55
  SPEAKER_01: Some people just get the ick over eye stuff.
• 15:58
  SPEAKER_01: You know, if you're watching, you know, like if you're watching a horror movie and there's a weird eye scene.
• 16:03
  SPEAKER_00: I don't know why I'm going to like they push the eyeball in or whatever.
• 16:07
  SPEAKER_00: Yeah, that curses me out too.
• 16:09
  SPEAKER_01: Game of Thrones.
• 16:10
  SPEAKER_01: Yeah.
• 16:10
  SPEAKER_01: I get it.
• 16:11
  SPEAKER_01: People get weird about eye stuff.
• 16:12
  SPEAKER_01: Well, so what's the downtime look like?
• 16:14
  SPEAKER_01: That's gonna be a question a lot of people have.
• 16:17
  SPEAKER_00: Very easy.
• 16:18
  SPEAKER_00: So I when I had mine done, I went back to work the next day.
• 16:22
  SPEAKER_00: I didn't do any surgery for a few days.
• 16:24
  SPEAKER_00: It was over COVID, but like who did your up a week, a week at most.
• 16:28
  SPEAKER_00: Dr.
• 16:29
  SPEAKER_00: uh Craig Oser in Pittsburgh.
• 16:31
  SPEAKER_01: Yeah, he's here in Pittsburgh.
• 16:32
  SPEAKER_00: Yeah, right.
• 16:33
  SPEAKER_00: And uh so we went, we trained it in uh Detroit together, and he was a couple years ahead of me, and we were just bitching over COVID and they're like, Yeah, I need a bluff.
• 16:42
  SPEAKER_00: He's like, I need one too.
• 16:43
  SPEAKER_00: So we went up and and we did each other's blef for plastic on the same day.
• 16:47
  SPEAKER_01: You did it on the same day, but same day, yeah, yeah.
• 16:50
  SPEAKER_01: Who went who went first?
• 16:51
  SPEAKER_00: I think I went first.
• 16:52
  SPEAKER_00: Yeah, I went first, and then I did his second.
• 16:55
  SPEAKER_01: That's really funny.
• 16:56
  SPEAKER_01: That would have been great content.
• 16:59
  SPEAKER_01: It would have been.
• 17:00
  SPEAKER_00: I guess it would have been, yeah, you know, it was a different time back then.
• 17:03
  SPEAKER_01: Different time.
• 17:04
  SPEAKER_00: Uh it was only six years ago, but it was it was a different time.
• 17:07
  SPEAKER_00: So, you know, the the question then becomes is isn't upper blepherplasty worth it?
• 17:13
  SPEAKER_00: And and the answer is absolutely a big yes when excess upper eyelid skin is is the problem.
• 17:21
  SPEAKER_00: It's high impact for a really short, relatively focused operation.
• 17:27
  SPEAKER_00: Uh, it's not worth it if the actual problem is in the brow and not in the eyelid itself.
• 17:34
  SPEAKER_00: You know, it's absolutely worth it when you're actually treating an eyelid problem.
• 17:38
  SPEAKER_00: Simple as that.
• 17:39
  SPEAKER_01: Sign me up.
• 17:41
  SPEAKER_00: Someday, absolutely, yes.
• 17:43
  SPEAKER_00: So I guess let's talk about lower balefryplasy as well.
• 17:46
  SPEAKER_00: So we you can do an upper eyelid lift.
• 17:48
  SPEAKER_00: Now let's do a lower eyelid lift.
• 17:50
  SPEAKER_00: So lower eyelid lift, it's a little bit of a trickier procedure.
• 17:54
  SPEAKER_00: Lots of different things uh go on, but it you know, it typically becomes lower eyelid bags.
• 18:00
  SPEAKER_00: Uh, you know, fat sticks out, loose skin.
• 18:04
  SPEAKER_00: Um, they be the the tear trough is kind of the area where the the bags separate from the the cheek there.
• 18:11
  SPEAKER_00: Yeah, and there's a lot of stuff.
• 18:12
  SPEAKER_01: And you would do you so you can do it when people have that little bit of fat pad herniation where the fat sticking out.
• 18:19
  SPEAKER_01: Yeah.
• 18:19
  SPEAKER_01: But you would also maybe do it if they just have a lot of skin redundancy, right?
• 18:24
  SPEAKER_00: Yeah.
• 18:24
  SPEAKER_00: So, you know, there it it's different for different people.
• 18:27
  SPEAKER_00: And you really, you know, when it comes to lower eyelids, you really need to someone who go to someone who does a ton of these.
• 18:33
  SPEAKER_00: I've done, I don't know, 500 to a thousand of these.
• 18:36
  SPEAKER_00: I I did two last week.
• 18:38
  SPEAKER_00: And so it it matters what you're looking at.
• 18:41
  SPEAKER_00: So if someone has just some like loose skin that or kind of wrinkly skin that Botox doesn't really fix, then you can just do like a very simple skin pinch blephroplasty.
• 18:52
  SPEAKER_00: That's an office procedure.
• 18:54
  SPEAKER_00: It takes 20 minutes.
• 18:55
  SPEAKER_00: It it's very high yield, you know, for the right patient.
• 18:58
  SPEAKER_00: Um the incision under directly like two no two millimeters under the eyelashes of the lower lids.
• 19:07
  SPEAKER_00: And when it's a woman and and she wears little is it m mascara?
• 19:10
  SPEAKER_00: Is that what you wear?
• 19:11
  SPEAKER_01: Concealer, I would say.
• 19:13
  SPEAKER_00: The little things on the eyelid, little bla black stuff on the eyelashes.
• 19:16
  SPEAKER_01: What's that's mascara?
• 19:18
  SPEAKER_00: Yeah, see, yeah.
• 19:18
  SPEAKER_00: You wear a little bit of that, or like whatever else, and and you can't see that at all.
• 19:22
  SPEAKER_01: This oring this.
• 19:25
  SPEAKER_00: I made a little face like a little like uh thing from the Addams family.
• 19:30
  SPEAKER_00: That was it.
• 19:31
  SPEAKER_00: That was an it handle.
• 19:33
  SPEAKER_00: No, no, thing.
• 19:34
  SPEAKER_01: Thing, yeah.
• 19:36
  SPEAKER_01: It it had the hair, right?
• 19:38
  SPEAKER_01: The hair over top.
• 19:41
  SPEAKER_01: Right?
• 19:42
  SPEAKER_01: There was a guy on there.
• 19:43
  SPEAKER_01: Yeah, yeah, cousin it.
• 19:44
  SPEAKER_00: Yes, it was cousin it.
• 19:45
  SPEAKER_01: Cousin it.
• 19:46
  SPEAKER_01: Yes, cousin it.
• 19:47
  SPEAKER_00: So with that, with the lower eyelid bags, the you know, we talked about the skin there.
• 19:53
  SPEAKER_00: Sometimes you have to remove skin.
• 19:56
  SPEAKER_00: A lot of times you have to remove some of the fat and reposition some of the other fat.
• 20:01
  SPEAKER_00: There are there are a couple of guys that almost never remove fat, but I always tend to, in my patients, I always feel like my patients are old, a little older, and need to have a little bit of fat removed and other fat reposition and put back in the in in a good place.
• 20:17
  SPEAKER_00: And then I take a little bit of skin.
• 20:19
  SPEAKER_00: Some people do, instead of taking skin, if there's not a lot, you can do a little chemical peel there.
• 20:23
  SPEAKER_00: That works really nice.
• 20:24
  SPEAKER_00: Laser also works really nice if you have access to laser.
• 20:27
  SPEAKER_00: Yeah, really, really nice.
• 20:28
  SPEAKER_01: So, what about when you take the fat pat out?
• 20:30
  SPEAKER_01: Because a lot of people really need that, and there's not a lot I can do with that.
• 20:34
  SPEAKER_00: Right.
• 20:35
  SPEAKER_00: So, in the, we talked about fat in the upper eyelid.
• 20:38
  SPEAKER_00: In the lower eyelid, you have three fat pockets.
• 20:41
  SPEAKER_00: You have one closest to the nose, uh, one kind of in the middle, and then there's a little ligament there, and then there's a lateral kind of on the outside.
• 20:50
  SPEAKER_00: You know, for me, for example, I have my left lateral, uh, my fat lateral lower fat pad uh is kind of perniating out.
• 20:59
  SPEAKER_00: I've got I'm keeping an eye on it.
• 21:01
  SPEAKER_00: You know, maybe in five years or three years or whatever, I'll go and get it dealt with.
• 21:05
  SPEAKER_00: The rest are in pretty good position.
• 21:07
  SPEAKER_00: You've done over the years, you've given me a little bit of filler under there, and it's worked really well.
• 21:12
  SPEAKER_00: It's been nice to kind of conceal.
• 21:14
  SPEAKER_00: It's been a few years.
• 21:15
  SPEAKER_00: I think it's pretty much dissolved.
• 21:18
  SPEAKER_00: Yeah, it's probably pretty long time.
• 21:19
  SPEAKER_00: Four years.
• 21:20
  SPEAKER_01: I don't think we've done anything in three or four years.
• 21:23
  SPEAKER_00: Right before we opened the the year before we opened Skin Lab, so 2023.
• 21:28
  SPEAKER_00: Three years.
• 21:28
  SPEAKER_00: Yeah.
• 21:28
  SPEAKER_00: So three, three and a half years.
• 21:30
  SPEAKER_00: We yeah, we uh you did a little bit of mine, I did a little bit of yours.
• 21:33
  SPEAKER_00: You know, it's really nice.
• 21:34
  SPEAKER_00: It's in the right patient in a very small amount.
• 21:37
  SPEAKER_00: It's it's very nice.
• 21:38
  SPEAKER_00: It can be very powerful.
• 21:39
  SPEAKER_01: So you're basically just concealing it though.
• 21:42
  SPEAKER_01: Yeah, yeah.
• 21:42
  SPEAKER_01: You know, you're kind of filling the volume around it.
• 21:45
  SPEAKER_00: You were in your late 30s, I was in my late 40s.
• 21:47
  SPEAKER_00: Uh it's just a you know, a nice little tweak.
• 21:50
  SPEAKER_00: So whenever I go and I do a lower bleproplasty, I make an incision in the conjunctival.
• 21:55
  SPEAKER_00: What the hell does that mean?
• 21:56
  SPEAKER_00: So basically, I'm over top of your head and I pull your eye.
• 22:00
  SPEAKER_00: Eyelid away from your eyeball.
• 22:02
  SPEAKER_00: Yeah.
• 22:03
  SPEAKER_00: She's making a gross face.
• 22:04
  SPEAKER_00: And I make a little cut in there, and that gives me really nice access to the fat.
• 22:10
  SPEAKER_00: And then you just you can remove a little bit of fat there, and then you can reposition it, make sure it goes in a really nice aesthetic place.
• 22:17
  SPEAKER_00: Yeah, but you're not a surgeon, so you know, it's the stuff like that's gonna gross you out because you're a little wussy.
• 22:24
  SPEAKER_01: I get I think I just discovered I'm one of the weird eye people.
• 22:27
  SPEAKER_01: Just as you were going into detail about that, I just became a you know gross at my eye thing person.
• 22:33
  SPEAKER_00: Yeah, and and the you know, the thing about the lower eyelids is you really have to give support to the to whatever's left behind.
• 22:40
  SPEAKER_00: Sometimes that involves some additional sutures to tighten that lower eyelid, what's left over, because you don't want it to kind of hang outward and and get like a little bit of so Simon Cowell, is that the is that the American idol guess?
• 22:54
  SPEAKER_01: Yeah, Simon Cow, yeah.
• 22:55
  SPEAKER_00: Yeah, so he got some bad Botox, but but what it did is it kind of showed his lower eyelid, it showed the white under his eyeball.
• 23:04
  SPEAKER_00: And uh that's certainly not attractive.
• 23:07
  SPEAKER_01: And so that way you don't think that was a surgical issue that he had?
• 23:12
  SPEAKER_01: I mean, because it's it's really hard to cause that.
• 23:15
  SPEAKER_00: I can't remember.
• 23:17
  SPEAKER_00: It's been a few years.
• 23:18
  SPEAKER_00: I probably should have researched that if I was gonna bring him up, but I I can't remember.
• 23:21
  SPEAKER_00: Did we think it was surgical or did we think it was I think he's had a lot of stuff done.
• 23:26
  SPEAKER_01: I think I'm not looking at a picture at him right now, but I definitely think there's been some surgical stuff, some non-invasive stuff.
• 23:34
  SPEAKER_00: I just remember a picture from a few years ago.
• 23:36
  SPEAKER_00: I I I can't remember.
• 23:37
  SPEAKER_00: So, but anyway, that uh what happened to him can I don't know that if it did happen from a blephyroplessy, but it a lower blefroplasty, but it can.
• 23:46
  SPEAKER_00: And we want to tighten that lower eyelid to make sure that doesn't happen.
• 23:49
  SPEAKER_00: Also, a very easy procedure for someone who's done a ton of them.
• 23:52
  SPEAKER_00: It takes me more than 20 minutes.
• 23:54
  SPEAKER_00: It takes me, I don't know, it takes what it takes.
• 23:56
  SPEAKER_00: 45 minutes can take longer if you know if it's harder.
• 24:00
  SPEAKER_00: But you know, we we certainly don't cut corners on it.
• 24:03
  SPEAKER_00: And uh so that yeah.
• 24:04
  SPEAKER_01: And they're always under general anesthesia, probably, right?
• 24:07
  SPEAKER_00: Not always.
• 24:08
  SPEAKER_00: No, uh-uh.
• 24:08
  SPEAKER_00: We can do it under less.
• 24:10
  SPEAKER_00: I like it under general.
• 24:11
  SPEAKER_00: It's nice because the patients are super chill, but you can do it under less than general anesthesia as well.
• 24:16
  SPEAKER_01: But they're kind of really out of it, right?
• 24:19
  SPEAKER_01: Oh, yeah, they're like snoring.
• 24:20
  SPEAKER_01: Yeah, yeah.
• 24:21
  SPEAKER_01: Snoring.
• 24:22
  SPEAKER_00: Yeah, yeah, yeah.
• 24:22
  unknown: Yeah.
• 24:22
  SPEAKER_01: Just not intubated.
• 24:24
  SPEAKER_00: Correct.
• 24:24
  SPEAKER_00: And that means under general anesthesia on a ventilator.
• 24:28
  SPEAKER_00: That's what intubated means.
• 24:29
  SPEAKER_00: So lower bleproplasty, is it worth it?
• 24:31
  SPEAKER_00: The answer is absolutely yes in the right patient.
• 24:35
  SPEAKER_00: You can have a super dramatic improvement.
• 24:37
  SPEAKER_00: It can take 10 to 15 years off of your face.
• 24:40
  SPEAKER_00: Um, it's a little bit harder than upper blephyroplasty.
• 24:44
  SPEAKER_00: So, for kind of uh newbie plastic surgeons who haven't done a lot of eyelid stuff, I would start on the upper and then go to the lower, do some easy lower ones first before you jump right in.
• 24:56
  SPEAKER_00: You know, the the most important thing isn't to make the lower eyelid look empty.
• 25:01
  SPEAKER_00: It's best to make it look younger.
• 25:03
  SPEAKER_01: It makes my job easier too.
• 25:05
  SPEAKER_00: Yeah, yeah, yeah.
• 25:07
  SPEAKER_00: Let's talk a little bit about some of the other areas, the the tear trough area.
• 25:13
  SPEAKER_00: That's an area that you treat uh pretty frequently.
• 25:15
  SPEAKER_00: So that again is the area kind of where the tears go, where they kind of roll down on the inside of the eye.
• 25:22
  SPEAKER_01: On the sort of in the inner corner of the eye is the true tear trough.
• 25:26
  SPEAKER_00: Correct.
• 25:27
  SPEAKER_00: Yep.
• 25:27
  SPEAKER_00: On the in the lower, obviously, again.
• 25:30
  SPEAKER_00: On the lower.
• 25:30
  SPEAKER_00: Um and then just a little bit lateral to that, that's where those little fat bags are.
• 25:35
  SPEAKER_00: And uh, and then we get a malar bags, which are like cheek bags, and those are those are difficult to treat.
• 25:41
  SPEAKER_00: Soons.
• 25:43
  SPEAKER_00: Yeah, festoons are malar bags.
• 25:45
  SPEAKER_00: Uh, not necessarily very common.
• 25:47
  SPEAKER_00: You can out.
• 25:49
  SPEAKER_00: Yeah, you can in the right patient.
• 25:51
  SPEAKER_00: Sometimes we try to reposition, we do a little bit of a cheek lift, and uh that's an option as well.
• 25:56
  SPEAKER_01: So those are two areas that you have to be really careful with filler.
• 26:00
  SPEAKER_01: So if you're if you have someone who has those festoons, malar edema, you you don't want to put filler in that area because filler's attracted to water, and that area is very prone to taking on water.
• 26:16
  SPEAKER_01: So oftentimes they can look worse.
• 26:18
  SPEAKER_01: And same thing with the tear trough.
• 26:20
  SPEAKER_01: The tear trough can very easily take on water.
• 26:22
  SPEAKER_01: So you have to be very careful that you're selecting the right patient to put filler in that area.
• 26:28
  SPEAKER_01: And you have to really choose the right filler product too.
• 26:32
  SPEAKER_01: Certain fillers are are more what we call hydrophilic, meaning likes to take on water versus others are less hydrophilic.
• 26:40
  SPEAKER_01: So you're gonna want to use something that is less hydrophilic.
• 26:43
  SPEAKER_00: So let's use uh name some names.
• 26:45
  SPEAKER_00: What are some of the ones that you want to use in that area?
• 26:48
  SPEAKER_00: And what are the some of the ones you would want to avoid?
• 26:51
  SPEAKER_01: There, there is literally only one product that I put in that area, and it's Restalin L.
• 26:58
  SPEAKER_01: OG Restin, the very first.
• 27:00
  SPEAKER_00: Right.
• 27:00
  SPEAKER_00: The OG Restalin is great for that.
• 27:03
  SPEAKER_01: Yes.
• 27:04
  SPEAKER_01: It is, it is very, very minimally hydrophilic.
• 27:08
  SPEAKER_01: There's a newer product out there called We'Density.
• 27:11
  SPEAKER_01: It's made by um RHA, it's part of the RHA line of fillers that I've actually seen some decent results with, but I I tend to just always default back to Restlin.
• 27:22
  SPEAKER_01: It's just it's what I've been using for so long.
• 27:26
  SPEAKER_01: And knock on wood, it's it's really never given me any issues.
• 27:31
  SPEAKER_01: Patients get beautiful results.
• 27:34
  SPEAKER_00: So, what are you doing for the lower eyelids now?
• 27:37
  SPEAKER_00: What what is your kind of go-to but run a patient through for me here?
• 27:42
  SPEAKER_00: Let's talk about it.
• 27:44
  SPEAKER_01: Yeah.
• 27:44
  SPEAKER_01: So when I'm looking, if someone comes in, say they're say they're late 30s, early 40s, like we talked about before, and they're saying that they look less tired.
• 27:54
  SPEAKER_01: I'm I'm looking at multiple things.
• 27:56
  SPEAKER_01: I'm looking at the skin.
• 27:59
  SPEAKER_01: So is the skin, does the skin need some more collagen?
• 28:03
  SPEAKER_01: Do we need to thicken up the skin a little bit?
• 28:05
  SPEAKER_01: Does the skin have pigmentation that we need to fade?
• 28:09
  SPEAKER_01: And best ways to do that, so building collagen and making the skin look a little bit thicker, healthier, improve the texture.
• 28:17
  SPEAKER_01: Or if there's pigment that we want to lighten, I will often go to laser.
• 28:23
  SPEAKER_01: Um, microneedling is another good option.
• 28:26
  SPEAKER_01: Although I'd probably only go microneedling if it's just texture.
• 28:30
  SPEAKER_01: If there's also pigmentation there, laser is going to be better because laser is going to target the pigment and the texture, the right laser.
• 28:40
  SPEAKER_01: And then I'm looking at volume.
• 28:42
  SPEAKER_01: So how much fat do they have in there?
• 28:44
  SPEAKER_01: Where is the fat sitting?
• 28:46
  SPEAKER_01: Have they lost a lot of volume?
• 28:48
  SPEAKER_01: Do they have fat pad herniation like we talked about with your patients, where the fat's kind of sticking out and coming forward?
• 28:55
  SPEAKER_01: Do they have fastoons like we talked about?
• 28:58
  SPEAKER_01: Um, do we need to replace some of that volume?
• 29:01
  SPEAKER_01: Would it benefit to replace some of that volume or would it cause more problems?
• 29:06
  SPEAKER_01: And if it would benefit them, then I am thinking about things like filler.
• 29:11
  SPEAKER_01: I'm also looking at um, we talked about how the bone changes.
• 29:16
  SPEAKER_01: So how much how much structural support do they need?
• 29:19
  SPEAKER_01: Have has has their eye, the eye can sort of look and appear and become more deep set with age.
• 29:27
  SPEAKER_01: So if they do need a lot of structural support, that's that's something that filler could potentially help in in a someone who's skilled with filler and and knows what they're doing.
• 29:38
  SPEAKER_01: But it's a very, it is a very advanced area to treat.
• 29:42
  SPEAKER_01: So if if I'm getting filler under the eyes, for those of you listening, make sure you're going to someone who has done it many, many times.
• 29:51
  SPEAKER_01: I mean, I've filled thousands of tear troughs.
• 29:55
  SPEAKER_01: So that's that's a higher risk area for sure with filler.
• 29:59
  SPEAKER_01: And then another really great treatment for skin quality, but also adding just a little bit of volume because it because it helps to thicken up the skin, is PRF injections or PRP.
• 30:13
  SPEAKER_01: Um, PRF is platelet-rich fibrin.
• 30:16
  SPEAKER_01: So that's when we draw your blood and we we spin it and separate it into the red blood cells, which we discard and the platelet-rich fibrin, which is very rich in growth factors, and then we inject that back in.
• 30:31
  SPEAKER_01: Another thing that we can do when we really do need a lot of volume support and because they've lost a lot of fat under the eyes, but maybe they're not a great candidate for filler, maybe they just don't want to do filler, is we can take that PRF and turn it into something called biofiller.
• 30:49
  SPEAKER_01: So instead of spinning it and turning it into just PRF, we take it a step further and we create this sort of thickened albumin gel that kind of takes the place of filler because it's going to add volume temporarily in that area.
• 31:09
  SPEAKER_01: And while it's sitting in there, it's going to help build collagen and elastin because you've got all those growth factors as well.
• 31:16
  SPEAKER_01: The downside to biofiller is that it's not as predictable as hyaluronic acid filler.
• 31:22
  SPEAKER_01: We don't know how long it's going to last because it comes from you.
• 31:25
  SPEAKER_01: Everyone has different quality of PRF and growth factors.
• 31:29
  SPEAKER_01: So for one person, it might last three months.
• 31:32
  SPEAKER_01: For another person, it might last a year.
• 31:35
  SPEAKER_01: But the benefit of it, no matter how long it lasts, is as long as it's sitting in there, it's building collagen and elastin.
• 31:42
  SPEAKER_01: So even once it's gone, even once that initial volume improvement is gone, the skin tends to look better and healthier and more youthful.
• 31:50
  SPEAKER_00: So where's that injected?
• 31:51
  SPEAKER_00: Is it injected into the skin?
• 31:53
  SPEAKER_00: Is it injected subdermal?
• 31:55
  SPEAKER_00: Skin.
• 31:56
  SPEAKER_00: Skin.
• 31:57
  SPEAKER_00: So the eye, yeah, the eyelid skin is so, so thin.
• 32:02
  SPEAKER_00: It is uh the the back skin can get to almost a centimeter.
• 32:06
  SPEAKER_00: So a centimeter is about 40% of an inch.
• 32:09
  SPEAKER_00: Eyelid skin is just a couple of millimeters.
• 32:12
  SPEAKER_00: It is so, so small.
• 32:13
  SPEAKER_00: Very tricky to get to get into the eyelid skin.
• 32:19
  SPEAKER_00: So again, you have to go to somebody who is a master of this.
• 32:23
  SPEAKER_00: Uh, I would say there, I would say that your run-of-the-mill, you know, uh McDonald's style med spa is is not the place to go for this.
• 32:32
  SPEAKER_00: You want to go to a plastic surgeon's office or a cosmetic dermatologist's office or to skin lab by Dr.
• 32:39
  SPEAKER_00: Labraska run by Mystica Lebraska, because you know, there's just not a lot of people with that kind of skill set and experience to do that and do it well.
• 32:50
  SPEAKER_01: You know, it's it's actually a really interesting procedure because how you process the PRF also really affects the results and the quality of the platelets.
• 33:03
  SPEAKER_01: So I went to LA twice to really perfect my technique and actually my processing, processing of the biofiller.
• 33:14
  SPEAKER_01: I went and I shadowed someone out there, a really super amazing PA.
• 33:20
  SPEAKER_01: She's a provider to the stars.
• 33:23
  SPEAKER_01: I um give her a shout out.
• 33:25
  SPEAKER_02: We love her.
• 33:26
  SPEAKER_01: Um her name is Goher Abrahamian, and her um her academy is called GoFlawless Now Academy.
• 33:32
  SPEAKER_01: So for other injectors out there listening, she's incredible.
• 33:36
  SPEAKER_01: She is a master of biofiller.
• 33:40
  SPEAKER_01: She goes, she trains all over the country.
• 33:42
  SPEAKER_01: She trains medical providers.
• 33:44
  SPEAKER_01: Biofiller is actually very popular in dentistry too.
• 33:47
  SPEAKER_01: They use it for grafting, grafting in the in the in the gums and in the um when they're doing implants, dental implants.
• 33:55
  SPEAKER_01: So they want to build tissue in that area and they use biofiller to do it.
• 34:00
  SPEAKER_01: They use they do it in a different way, they process it in a different way than we do for aesthetic purposes, but um, it's very popular in that space too.
• 34:08
  SPEAKER_01: So she's she's amazing, and that's where I learned to do it.
• 34:12
  SPEAKER_00: And um, are you doing this uh a whole lot yet?
• 34:16
  SPEAKER_00: Or just kind of you're doing a ton of it.
• 34:18
  SPEAKER_00: There you go.
• 34:18
  SPEAKER_01: I'm doing a ton of it.
• 34:19
  SPEAKER_01: I'm doing a ton of it.
• 34:20
  SPEAKER_01: Patients are really happy, and I love having an alternative to traditional filler because not everybody wants filler.
• 34:29
  SPEAKER_01: We can we can do a natural filler that comes 100% from your body.
• 34:35
  SPEAKER_01: Everything that I put back in came from you, even the the tubes themselves that we draw your blood has nothing nothing in it.
• 34:43
  SPEAKER_01: There's there's no chemicals, no additives, nothing.
• 34:46
  SPEAKER_00: Incredible.
• 34:47
  SPEAKER_00: You know, this is this is the beginning of the next phase uh of aesthetic medicine and medicine in general, really.
• 34:55
  SPEAKER_00: Uh very, very cool.
• 34:57
  SPEAKER_00: Is uh how many people in the East Coast are doing it?
• 35:00
  SPEAKER_00: Or is it done a lot now?
• 35:02
  SPEAKER_01: You know, I don't I I don't know.
• 35:04
  SPEAKER_01: Um I I know a lot of people do PRP and PRF.
• 35:09
  SPEAKER_01: I don't know how many are doing biofillers.
• 35:13
  SPEAKER_01: I I I'm not sure.
• 35:15
  SPEAKER_01: Um, but it's it's tricky.
• 35:17
  SPEAKER_01: I I mean the you you'll see, you're gonna be in the on the off in the office on Thursday, and I actually have a biofiller.
• 35:24
  SPEAKER_01: So I'll show you how I process it.
• 35:26
  SPEAKER_00: It's really doing it on me.
• 35:28
  SPEAKER_01: No, no, I have a patient.
• 35:29
  SPEAKER_01: Oh, I have a patient schedule.
• 35:30
  SPEAKER_01: What do you want some?
• 35:32
  SPEAKER_00: Yeah, of course.
• 35:34
  SPEAKER_00: Yeah.
• 35:34
  SPEAKER_01: I want some too.
• 35:36
  SPEAKER_01: I don't have anybody to do mine.
• 35:38
  SPEAKER_00: I can do yours.
• 35:39
  SPEAKER_01: You well, I'll have to, I'll do all the processing and you just have to do that.
• 35:44
  SPEAKER_00: I want you to do that for me.
• 35:45
  SPEAKER_00: I'll just inject it.
• 35:46
  SPEAKER_00: Yeah, it's you know, so we talked about a bunch of stuff.
• 35:48
  SPEAKER_00: So we talked about PRP, PRF, we talked about hyaluronic acid filler, we talked about biofiller.
• 35:55
  SPEAKER_00: We haven't really touched on on regular old-fashioned Botox and and uh neurotoxins.
• 36:01
  SPEAKER_00: And I I guess you talked about laser and you talked about microneedling.
• 36:05
  SPEAKER_00: You hit on tox a little bit.
• 36:07
  SPEAKER_00: Why when to use Botox or or uh one of the others, this port, whatever, and and when to not.
• 36:16
  SPEAKER_01: So that's so when we're when we're using Botox, we'll just say Botox, because everyone knows it is Botox.
• 36:22
  SPEAKER_01: When we're using Tox, um, we're targeting the muscle.
• 36:26
  SPEAKER_01: So if if they have if their under eye area is completely from movement of the muscles, so the orbicularis oculi is this circular muscle that goes all the way around the eyes, and it's what causes the crinkling of it, is what causes what we call the crow's feet.
• 36:47
  SPEAKER_01: So those smile lines that you get.
• 36:49
  SPEAKER_01: So if it's truly from muscle, just that little bit of wrinkling skin that you get, and some people get this little bit of we call it a jelly roll or a lower orbic roll where they smile and they get this little pop right here directly under the eye.
• 37:06
  SPEAKER_01: That is that's a Botox case.
• 37:08
  SPEAKER_01: I will say it's rarely just a muscle thing.
• 37:12
  SPEAKER_01: It's really if it's just muscle, they're they're typically young.
• 37:16
  SPEAKER_01: So they're gonna be a younger patient.
• 37:19
  SPEAKER_01: Almost everyone, though, mid-30s and beyond, is going to have some collagen loss that's going to need to be addressed with microneedling or laser.
• 37:28
  SPEAKER_01: And as they're getting a little older, they're going to have some fat loss too.
• 37:33
  SPEAKER_01: So, really, I think if you really want to tackle the under-eye area, you have to do a combination approach.
• 37:41
  SPEAKER_01: And honestly, that's what's going to make the most natural.
• 37:44
  SPEAKER_02: Yep.
• 37:45
  SPEAKER_01: You're not aging in that area for one reason.
• 37:48
  SPEAKER_01: So there's not one thing to fix it.
• 37:50
  SPEAKER_01: You have to combine treatments and techniques for the for the best results.
• 37:56
  SPEAKER_00: You know, I think the uh I think to it's important to say to look the most natural, you may need to do a bunch of different things because one thing will not necessarily make you look natural, even though it's less, right?
• 38:12
  SPEAKER_00: Where um it might not give you the best, most natural looking result.
• 38:18
  SPEAKER_00: Sometimes you need to approach different parts for different things.
• 38:21
  SPEAKER_00: If you've got um, if you've got you know fat bags, you remove them or reposition them.
• 38:28
  SPEAKER_00: And then if the skin is very crepey, you you need to add uh a biofiller or a laser for the skin, and and and if the the muscles are involved, then a little bit of Botox and all of that with the upper eyelid blephyroplasty as well, will really rejuvenate that area of your face and you will no longer look tired.
• 38:50
  SPEAKER_01: Absolutely.
• 38:51
  SPEAKER_01: It will you can shave 10 years off.
• 38:53
  SPEAKER_00: Absolutely for sure.
• 38:54
  SPEAKER_01: Okay.
• 38:54
  SPEAKER_01: And then the other thing worth mentioning, or shall I say, not worth mentioning is under eye cream.
• 39:01
  SPEAKER_01: I mean, honestly, can we just can we just skip it, guys?
• 39:06
  SPEAKER_01: Please.
• 39:07
  SPEAKER_01: Yeah, just put put your none of that.
• 39:09
  SPEAKER_01: Yep.
• 39:10
  SPEAKER_01: Put your retinol under your eyes.
• 39:11
  SPEAKER_01: That's all you need.
• 39:13
  SPEAKER_01: If you want a little extra hydration, ask me.
• 39:16
  SPEAKER_01: I'll recommend a relatively inexpensive eye cream.
• 39:19
  SPEAKER_01: But put your sunscreen under your eyes, put your retinol under your eyes at night.
• 39:23
  SPEAKER_01: Yes, you can use it on your lower eyelids every single night.
• 39:27
  SPEAKER_01: Don't get it in the on the whites of your eyes, please, but put it on the skin for sure.
• 39:32
  SPEAKER_00: The other thing we didn't really hit on was fat grafting.
• 39:35
  SPEAKER_00: Now, fat grafting is uh wonderful and it works very, very well for volume loss.
• 39:42
  SPEAKER_00: Uh so you take a little bit of fat from one area and put it in another one.
• 39:47
  SPEAKER_00: It has to be mixed up very, very into very, very fine particles.
• 39:51
  SPEAKER_00: And the techniques that we use are now better than they were 10 and 20 years or so ago.
• 39:58
  SPEAKER_00: More of the fat lives.
• 39:59
  SPEAKER_00: It's very nice.
• 40:00
  SPEAKER_00: It should be very subtle.
• 40:02
  SPEAKER_00: And you and again, you should go to somebody who does a ton of it.
• 40:04
  SPEAKER_01: You know what scares me about fat though?
• 40:06
  SPEAKER_00: Yeah.
• 40:07
  SPEAKER_01: It's you're stuck with it.
• 40:08
  SPEAKER_01: If it doesn't look good, there's nothing you can do.
• 40:12
  SPEAKER_00: Right.
• 40:12
  SPEAKER_01: So you definitely have to go to someone who does You go to someone who's a master, right?
• 40:16
  SPEAKER_00: You you just go to someone who is a master.
• 40:18
  SPEAKER_00: I um I think that it is uh very powerful in the right patient, you know, done by the right surgeon.
• 40:26
  SPEAKER_00: Absolutely.
• 40:27
  SPEAKER_00: Uh for that worth it.
• 40:29
  SPEAKER_00: If you're going to your regular plastic surgeon down the street, probably not worth it.
• 40:34
  SPEAKER_00: Probably if you have volume loss, stick to your other things like um hyaluronic acid filler and sculpture and other things like that uh would be good choices.
• 40:46
  SPEAKER_01: We don't put sculpture under the eyes.
• 40:48
  SPEAKER_01: Just I know you know that.
• 40:49
  SPEAKER_01: But you you mean in general if you have a lot of things.
• 40:52
  SPEAKER_00: Yeah, in general.
• 40:53
  SPEAKER_00: Yep, yeah.
• 40:53
  SPEAKER_00: Because you can use fat for more areas than then directly under the eye.
• 40:58
  SPEAKER_00: I don't love to do I do tear trough, and that's fine, but I don't do a ton of other fat grafting to the to the lids.
• 41:06
  SPEAKER_00: Uh there are people that put it in the upper.
• 41:08
  SPEAKER_00: Uh, I don't have that kind of that kind of nerve.
• 41:11
  SPEAKER_00: I don't do that.
• 41:12
  SPEAKER_01: I I don't blame you.
• 41:14
  SPEAKER_01: I don't blame you.
• 41:16
  SPEAKER_01: You get a fat embolus and not alive someone.
• 41:21
  SPEAKER_00: Yeah, it's not for me.
• 41:23
  SPEAKER_00: It's not for me.
• 41:24
  SPEAKER_00: Uh so okay.
• 41:25
  SPEAKER_00: So let's go over some of the procedures and are they worth it?
• 41:28
  SPEAKER_00: PRP, PRF, biofiller, lump them together.
• 41:32
  SPEAKER_00: Is it worth it?
• 41:33
  SPEAKER_00: Worth it.
• 41:34
  SPEAKER_00: Fox eyes.
• 41:35
  SPEAKER_01: Nah.
• 41:36
  SPEAKER_00: Not worth it.
• 41:37
  SPEAKER_01: Not worth it.
• 41:38
  SPEAKER_01: $300.
• 41:40
  SPEAKER_01: No, not worth it.
• 41:42
  SPEAKER_00: Not worth it.
• 41:43
  SPEAKER_00: Laser.
• 41:44
  SPEAKER_01: Worth it.
• 41:44
  SPEAKER_01: Yes.
• 41:45
  SPEAKER_00: Sun protection.
• 41:46
  SPEAKER_01: Yes.
• 41:46
  SPEAKER_01: Worse.
• 41:47
  SPEAKER_01: Kidding?
• 41:48
  SPEAKER_01: You rage baiting me.
• 41:49
  SPEAKER_00: It was rage baiting you a little bit.
• 41:51
  SPEAKER_00: Uh fat grafting, worth it if you go to the right surgeon and you're a very good patient.
• 41:56
  SPEAKER_01: I'm gonna say not.
• 41:57
  SPEAKER_01: I mean, I for what you'll pay and for the risk, honestly, I don't know.
• 42:03
  SPEAKER_01: I'm gonna say not worth it to fat grafting.
• 42:05
  SPEAKER_01: We can do so much now with non-invasive things that are so much less risky.
• 42:09
  SPEAKER_01: I'm gonna go not worth it on fat grafting.
• 42:12
  SPEAKER_00: Okay, very, very good.
• 42:13
  SPEAKER_00: Um, how about cat eye surgery or uh different from the fox eye surgery, a little bit different, but uh um not worth it.
• 42:22
  SPEAKER_00: No, you don't want you don't think I should do that.
• 42:23
  SPEAKER_00: I'm thinking I probably I'm thinking I probably won't do it.
• 42:28
  SPEAKER_00: Um some of the other things uh that were brought up.
• 42:31
  SPEAKER_00: Best age for an upper bleferplessy.
• 42:34
  SPEAKER_00: It depends on the uh it depends on the patient, but I've done in the 30s and I've done the oldest I did was 104 years old.
• 42:41
  SPEAKER_01: That was no way.
• 42:43
  SPEAKER_01: Yeah, yeah, yeah, yeah.
• 42:44
  SPEAKER_00: She did good.
• 42:45
  SPEAKER_01: She probably couldn't see, right?
• 42:46
  SPEAKER_00: She couldn't see a single thing.
• 42:48
  SPEAKER_00: And she had a toast.
• 42:49
  SPEAKER_00: She had a toasis too.
• 42:51
  SPEAKER_00: Like the one eye didn't open hardly at all.
• 42:54
  SPEAKER_01: Oh my god.
• 42:55
  SPEAKER_01: She was probably so cute.
• 42:57
  SPEAKER_00: Yeah, I just showed her the picture of anesthesia, um, and she fell asleep.
• 43:02
  SPEAKER_00: Like, you know, she we essentially did her completely awake.
• 43:06
  SPEAKER_01: Um and it was great.
• 43:09
  SPEAKER_00: Uh she did great.
• 43:10
  SPEAKER_00: So upper or lower blef, which has the biggest payoff?
• 43:13
  SPEAKER_00: The biggest payoff would be both combined together.
• 43:17
  SPEAKER_00: Um, does an upper blef hurt?
• 43:19
  SPEAKER_00: No.
• 43:19
  SPEAKER_00: When I had mine done, I took two Tylenol one time and that was it.
• 43:24
  SPEAKER_00: Uh, so that was uh that was really cool.
• 43:26
  SPEAKER_01: You're so tough.
• 43:28
  SPEAKER_00: I am tough.
• 43:29
  SPEAKER_00: I you're not a wussy like you.
• 43:32
  SPEAKER_00: Can lower lid fat bags come back?
• 43:34
  SPEAKER_00: They can.
• 43:35
  SPEAKER_00: They can come back some anyway.
• 43:36
  SPEAKER_00: They're not gonna come back quite as aggressively as as uh as they would if you hadn't done in the first place.
• 43:43
  SPEAKER_00: How about uh laser for crepey eyelids, miss?
• 43:46
  SPEAKER_00: That's you.
• 43:47
  SPEAKER_01: Yes.
• 43:47
  SPEAKER_01: Oh my god, yes.
• 43:49
  SPEAKER_01: Absolutely.
• 43:50
  SPEAKER_01: My my answer is always going to be yes if you're asking about laser.
• 43:55
  SPEAKER_00: Okay.
• 43:55
  SPEAKER_01: Yes.
• 43:56
  SPEAKER_01: Forever.
• 43:57
  SPEAKER_00: Best thing for Crow's feet.
• 43:58
  SPEAKER_01: Laser for Crow's feet?
• 44:00
  SPEAKER_01: I mean, but Botox.
• 44:02
  SPEAKER_01: Botox.
• 44:02
  SPEAKER_01: For sure.
• 44:03
  SPEAKER_00: Botox is the answer.
• 44:04
  SPEAKER_00: Yep.
• 44:06
  SPEAKER_01: So, okay.
• 44:07
  SPEAKER_01: Overall, can you hear the tornado?
• 44:10
  SPEAKER_01: Can you hear it?
• 44:11
  SPEAKER_00: Is it your children?
• 44:13
  SPEAKER_01: It's, I mean, I think that the top part of my house just blew away in in Dorothy's tornado.
• 44:22
  SPEAKER_01: I I can I can't believe you can't hear it.
• 44:25
  SPEAKER_00: No, well, you know, the microphones are really good.
• 44:27
  SPEAKER_00: They're they're just directional microphones.
• 44:30
  SPEAKER_00: So I can't hear any of it, you know.
• 44:33
  SPEAKER_01: I can't hear they're they're on their way to Oz.
• 44:37
  SPEAKER_01: That's what's going on.
• 44:38
  SPEAKER_01: I mean, I there's that's the only explanation.
• 44:41
  SPEAKER_00: Well, yeah, click your, you know, we're almost done here.
• 44:44
  SPEAKER_00: So click your your your your heels three times and say there's no place like home.
• 44:49
  SPEAKER_00: Oh, you're already home.
• 44:50
  SPEAKER_00: Never mind.
• 44:51
  SPEAKER_00: So eyelid rejuvenation, eye rejuvenation, is it worth it?
• 44:55
  SPEAKER_00: Yes.
• 44:56
  SPEAKER_01: 500% yes.
• 44:58
  SPEAKER_00: And I absolutely agree as well.
• 45:00
  SPEAKER_00: Sometimes it's surgery, sometimes it's not surgery, uh, but it's very powerful and it is one of the most high yield things that we do.
• 45:09
  SPEAKER_00: So, Mystica, we are now through seven episodes of Skin Labs, Scalpel and Skin.
• 45:16
  SPEAKER_00: And uh, so what do you think so far?
• 45:18
  SPEAKER_01: I I still, I mean, I would love to know how many people are listening.
• 45:21
  SPEAKER_01: Do you know?
• 45:22
  SPEAKER_01: Is it do we ever get to find that out?
• 45:24
  SPEAKER_00: It's like five.
• 45:25
  SPEAKER_01: Yeah.
• 45:26
  SPEAKER_00: It's like five.
• 45:26
  SPEAKER_01: We might be up to seven.
• 45:28
  SPEAKER_00: It's five, it's still five.
• 45:30
  SPEAKER_00: It's five.
• 45:32
  SPEAKER_00: So, everybody, thank you for listening.
• 45:34
  SPEAKER_00: If you made it this far, I appreciate it.
• 45:36
  SPEAKER_00: I'm Dr.
• 45:37
  SPEAKER_00: LG Labraska, board certified plastic surgeon in north of Pittsburgh, Pennsylvania, and New York City.
• 45:43
  SPEAKER_00: This is my sister, Mystica Labraska.
• 45:45
  SPEAKER_00: She is a dermatology PA of 16 years.
• 45:47
  SPEAKER_00: She is amazing with the skin, as well as I am amazing with the scalpel.
• 45:52
  SPEAKER_00: Together we'll scalpel and skin.
• 45:54
  SPEAKER_00: We're siblings, we're business partners, and somehow we still get along.
• 45:57
  SPEAKER_00: Let's go.
• 45:58
  SPEAKER_00: That's it for today's episode of Scalpel and Skin.
• 46:01
  SPEAKER_00: Follow the show wherever you listen and come find us on social media.
• 46:04
  SPEAKER_00: Send us the treatments, trends, or questions you want us to break down next.
• 46:08
  SPEAKER_00: This is Scalpel and Skin.
• 46:09
  SPEAKER_00: Let's go.