Latest / The Dr. Randi Show / The Red-Carpet Facelift, Filler Fatigue, and Flawless Recovery — Dr. Sam Rizk

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The Red-Carpet Facelift, Filler Fatigue, and Flawless Recovery — Dr. Sam Rizk · The Dr. Randi Show

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The views expressed in this podcast are for informational
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purposes only and do not constitute medical advice.
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This episode of the Doctor Randy Show is proudly sponsored by New
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Now let's get into the episode. Hello everyone, and welcome to
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the Doctor Randy Show, the podcast where innovation,
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aesthetics, lifestyle and medicine intersect with the
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people shaping what's next. Every week we bring you the
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conversations that define the future.
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Today we have a very special guest.
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He is the surgeon behind some of the most talked about faces on
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the red carpet. He is known for transformations
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so seamless even the cameras can't catch them, and he is the
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surgeon recognized for the shortest recovery time in
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plastic surgery. Please welcome Doctor Sam Rizk.
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How are you? Nice to meet you.
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So great to have you here today. We're excited to jump in and
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start talking about your buzzing career.
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We've been hearing about you all over.
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So excited to talk about it today.
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So welcome to the show. You have built one of the
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busiest and most talked about practices in the country.
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What does a typical day look like to you right now?
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I usually get up in the morning, work out, exercise, have coffee,
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have a little mini breakfast and then start with the usually a
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big case like a facelift, eye lift, brow lift and then I see
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patients after. At the end of the day.
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I only do one surgery per day. Oh, that's just.
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One a day. We're a boutique, high caliber
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practice. We don't believe in rushing or
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doing too many cases in one day well.
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That sounds smart, so that one case gets all of your attention.
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All the attention exactly like 1 artwork.
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That's right. Well, Speaking of artwork, in
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the preparation for this podcast, I did a lot of research
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and read that you trained as a sculptor.
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How does that background help in the way you operate today?
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Since I was a kid, I used to be interested in art and sculpting.
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My first sculpture was Shakespeare's Globe Theatre.
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When I was 8 years old, I did an exact replica of Shakespeare's
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Globe Theatre in balsa wood. So I've been doing that my whole
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life, even before plastic surgery.
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And you know, surgery is a continuum, and particularly
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plastic surgery. It's all art, which is why I
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only do one big case a day. It sounds like the sculpting set
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you up for success with surgery. That's phenomenal.
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I've never heard of that before. So for a little background for
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our audience. So every career has a turning
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point, right? What would you say was the
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moment that put you on the map of 1 of New York's most sought
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after surgeons? I have done a lot of celebrities
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throughout my whole career and you know what's interesting
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about celebrities is they do talk amongst themselves.
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They may not necessarily go public, but there is a short
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list in Hollywood about who does what and so forth.
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What would you say, you know, talking about celebrities and
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the turning point in your career, what would you say is
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the riskiest case that you've ever agreed to take on?
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And what made you say yes? I've taken on a lot of difficult
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cases in my career. As you know, I'm also a head and
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neck surgeon, so my comfort zone in the deeper layers of the face
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is very high because I'm able to navigate the deeper layers with
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ease. So knowing that I've had a very
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difficult case referred to me by a plastic surgeon and she was a
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cardiac surgeon at University of Alabama, had facelifts before
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and had severe necrosis that occurred from a permanent
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filler. And she also had nerve damage
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and I was able to get her looking amazing by removing
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those deep fillers that were near her nerve and also do a
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facelift at the same time or a vision facelift.
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I do a lot of revisions in my practice and 50% of my
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surgeries, whether facelifts or rhinoplasties, are revisions.
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One of the things I wanted to focus on for a minute is your
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rapid recovery technique. People are going in for deep
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plane facelifts and we're hearing stories of recovery that
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takes weeks, if not months, and, you know, pain and discomfort.
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But people that are listening may not know.
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What makes your approach different and what are the key
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innovations that allow you to shorten the recovery time so
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much? Since 2005, I stopped using
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drains and I start using tissue sealants, which I learned about
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the tissue sealant from being a head neck surgery fellow at
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Sloan Kettering. So we used to use it in cancer
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surgery, but also it's being used in open heart surgery
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around blood vessels. So the problem with a drain is
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it doesn't always function. It can malfunction, it can
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introduce infection, it's painful, and you have these two
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form bodies in your face for days.
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So I start using the tissue glue and I noticed that significant
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reduction in bruising and I published the first article in
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our medical journal on the advantage of tissue glue in
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reducing bruising and the incidence of hematoma.
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I published that in 2008. So since that publication of
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that about 3000 facelifts without drains with less
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bruising as swelling and a less incidence of hematoma.
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And I think universally, with very few exceptions, patients do
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notice that. They do notice that when I post
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a video of my patients early on, they usually look a lot less
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swollen and bruised than they typically expect.
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And one thing that I also read is that you share your
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techniques publicly, your training other physicians, other
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plastic surgeons on a regular basis and that you're very open
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to sharing your technique, which is interesting because some of
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the doctors that we interview on the show, they will not share
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anything that they have, right? They consider that proprietary
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and they don't want to share it. So I love that you are sharing
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that. Tell us a little bit about that.
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So I think a doctor that does not share his technique is doing
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a disservice to our community. There should be nothing
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proprietary about what we do. We innovate, we improve the
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outcomes of patients because ultimately that's what's
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important. It's not about me, it's about
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the patient. It's about getting the best
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outcomes. And I welcome a lot of surgeons
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to use my technique, which is why I get invited to national
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conferences that I do live surgeries demonstrating this
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technique. And any surgeon that holds on to
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their own knowledge is not doing a service to patients, and
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they're not doing a service to our community.
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And they probably have some insecurity issues.
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Just because I watched Michael Jordan do something doesn't mean
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I can be a basketball player. So just because they see me
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doing live surgery, they should learn the techniques and try to
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do it, it doesn't mean they could actually do it.
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And I think it's wonderful that you're sharing your techniques
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with the world. And I agree with you, this is
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medical. This is not proprietary
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information. And it does help to push the
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entire industry forward by you sharing that information.
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You know, whenever I see these named lifts by surgeon and they
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have it trademarked, I look at these surgeons, some of them,
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and they've never gone to a conference and they never teach.
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So all that trade marking and all that secret of information,
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if it's not shared at a national conference where other experts
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can critique what I'm doing, then it's not real useful.
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Science, you know, you have to separate love from science.
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Science is something you share with other experts at a national
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conference. I love that.
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So I'm going to dive into a few hot topics with you.
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One of the topics that is very hot right now is the fact that
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facelifts used to be for women in their 60s, and now we're
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seeing people starting late 30s, early 40s.
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What do you think is driving this shift and what are your
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thoughts on that? Well, it's twofold. 1 I feel
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like the GLP peptide medications have caused drastic weight loss
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in younger patients and once that skin sags and the muscle
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sags, there is no other way to fix that except to cut it out,
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hence A facelift. So that's one big thing.
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The other big thing is are we seeing a lot of people melting
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their fillers? But remember those are patients
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in their early 40s that have used fillers for probably 10
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plus years. So that skin has been expanded.
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When you deflate the balloon during the 40s, it's not going
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to shrink back. So between melting fillers,
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that's a big trend the past four or five years, massive weight
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loss in your 40s, that skin is not going to shrink.
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But you have to understand, I tell patients who will come in
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early on, if there's not enough loose skin, I can't do your
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surgery and I turn them away. So not every young person is a
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surgical facelift candidate and we have to make that
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distinction. We have to have rules, we have
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to have morals and we have to have guidelines as to what is a
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surgical patient candidate. Now, a lot of patients want to
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look younger, in their mid 40s, and they want to look like they
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haven't been touched. And the best way to achieve that
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is with a facelift. So back to the topic of filler,
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you coined the idea of filler fatigue.
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And what does that look like when someone has kind of hit the
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wall and they know it's time for surgery?
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So I get a lot of patients who have, you know, they get
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referred to me by dermatologists.
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So the derms have been managing them for years with fillers, but
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then they reach a point where it's not going to fix the
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effects of gravity. But also these patients, many of
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them have also tried non invasive, non surgical
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treatments like Altera, Softwave, Thermage, They've
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already been through that route, Elacor.
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So they want to see meaningful results.
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They want to see a major meaningful outcome, have an
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excellent relationship with many dermatologists and we talk about
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this all the time. There's also a role for fillers,
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so if fillers are done properly and they're being used to fill
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dents and not lift necessarily, then there's a great role for
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them. But in order for you to achieve
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a lift with fillers, you'd have to use so much filler in the
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cheeks, and over time it just doesn't look right.
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If you're using gobs and gobs and syringes of filler to try to
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improve the jowl, you'd have to use so much of it, and over time
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both the patient and the dermatologist lose track of what
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the patient used to look like. And then we see that puffer fish
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face, right? Where it creeps up on you, it
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doesn't happen overnight, it doesn't happen in six months.
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It's like eyesight fatigue, both for the patient and their
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provider. So over time, both provider and
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patient kind of lose track of what the patient used to look
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like. I know I'm guilty.
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Many years ago, maybe 5 or 6 years ago, I had way too much
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filler in my face and don't realize it until suddenly it's
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there and you're like, what did I do?
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And then we have to reverse it. But I think we're all guilty of
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it. We're like, oh, a little bit
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looks good, why not put more? But you're right, I think
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there's a wall that we hit where it's time for the surgery.
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So let's talk about celebrities. Obviously, I'm not going to ask
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you who, what, where, why, when, but I was told that 13 of your
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patients were on the 2025 Oscars red carpet.
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That's a huge amount. And when you know that your work
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is going to be seen under the high def cameras and the harsh
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lights, how do you design results that look natural
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instead of surgical? So when I do any patient,
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whether celebrity or non celebrity, there are certain
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criteria are used for surgery that achieves a very natural
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outcome #1 is the direction of lifts.
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You cannot lift horizontal, you have to lift vertically for a
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facelift #2 you have to go deep enough because we're not relying
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on stretching the skin like older lifts.
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So the deeper you go, as in a deep plain facelift, the more
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natural it looks, the more you go away from the skin blood
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vessels, the less you're destroying the blood supply to
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the skin and the smoother the outcome.
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So that's number two. Number 3 is when you look or
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when I look at a face, I'm trying to create harmony.
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So I cannot have eyelids that look 50 if the face looks 30.
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If I lift vertically, I can't have bunching near the brow, so
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sometimes the temporal brown needs to be lifted up.
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So there's a lot of tweaking procedures during the facelift
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that are very, very important with ancillary procedures to
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make everything look like they belong together.
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So we as surgeons or as artists, we notice harmony, but we notice
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this harmony much more. So if something is not
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harmonious, as in bunching near the eyes from doing a facelift,
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that can look worse than anything else.
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So we avoid things that are disharmony.
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We want the eyes, we want the brow, we want the face to belong
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together in the same age bracket.
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That's how you get a natural outcome.
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And that's what I do for my patients.
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So back to the topic of the revision work that you're doing.
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What, if you don't mind me asking, because I think this is
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something that's interesting to others and our viewers and
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listeners. What are the most common
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mistakes that you are fixing from other surgeons?
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Number one would be something that was done in the wrong
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vector. You get that pulled fake
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appearance. 2A facelift that dropped too quickly because the
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deeper layers were not addressed and they look stretched. 3 Doing
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a facelift and not addressing a volume, a deep volume deficit. 4
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getting bunching around the eyes because a facelift was done, but
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a a temporal brow or a partial brow was not done.
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So there's too much bunching here, and when the patient
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smiles, they look very fake. What percentage of your work is
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revision work? Revision facelifts account for
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50% of my facelift surgery. I think that will make everyone
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listening just kind of think twice about who they're going to
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for their facelift surgery, right?
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You want to go to a face expert, You want to go to somebody who's
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comfortable, who only specializes in certain
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procedures. You don't want to go to somebody
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who's a Jack of all trades. I couldn't agree more in fact I
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say this a lot on the show but even for my filler I go to a
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facial plastic surgeon because there's nobody that knows the
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face better than that so couldn't agree I.
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Have a lot of colleagues who are general plastic surgeons as
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well, and they're excellent surgeons.
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It's just you have to do enough. You have to specialize in
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something. You can't be diverting your
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whole practice into doing. You know, a boob lift one day,
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abdominoplasty the next day, and then doing just one facelift a
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week. You can't be an occasional
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facelift surgeon. You have to have volume.
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You have to be doing at least three to four facelifts per
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week. So revision rhinoplasty is
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considered to be one of the most difficult surgeries in plastic
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surgery When a patient comes to you.
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And I've witnessed this a lot. I mean, I have friends that get
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their noses done and then, you know, three months later,
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they're still complaining. This isn't what I thought it was
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going to look like. How do you handle that when they
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come to you after their first disappointing result?
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What is your process for deciding?
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If you're going to first of all, you have to decide if the
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patient is really do they want an outcome that is like an
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Instagram filtered picture? If that's what they desire,
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they're never going to get it because that knows that's so
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small on Instagram is a non functioning nose, the patient
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will not be able to breathe. So there are limitations in what
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can be done. Now, if there are collapses from
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an overdone nose, if there's a saddle nose, a scoop nose,
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breathing issues, major asymmetries, things like that,
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then that's a different story and that can be improved.
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But you're already dealing with somebody who's been burnt, so
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their psyche have to deal with that as well.
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You're dealing with a difficult psyche and you have to separate
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the patients who have body dysmorphia from those who
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actually could benefit from a revision.
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So let's talk about now how your global presence.
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There are patients flying in from all over the world to see
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you. How do you manage the pre op and
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post op when they're not in New York for that long?
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I have an excellent nursing team that corresponds with them and
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Facetimes the patients and asks them to do certain things that
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we need preoperatively. Blood work, Shermer's test for
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eyelid surgery, things that we require before they come here.
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And I get patients from all over the world, the Middle East,
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Europe, South America. What I always do is in addition
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to me Facetiming and doing a Zoom consultation, I always meet
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the patients the day before in person and examine them so that
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can either confirm what we're doing or sometimes I may decide
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that I want to remove a procedure or add a procedure so
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that in person evaluation the day before the surgery is very
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important. That brings me to my next
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question that I was going to ask you.
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You've really seen it all. Not every patient should go
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under the knife. How do you decide when to shut
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it down and how do you deliver the I'm not doing this message?
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And how does that go over? You know, sometimes I
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unfortunately have to deliver that message to revision
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patients or primary patients whom I feel I can't improve or
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would not benefit from surgery. Just last week I saw a 35 year
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old that came to me for her facelift and she had come to me
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a year earlier. I said no.
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She ended up doing it with somebody else.
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She had very poor scarring and she came in and her scars are
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bad. I told her there wasn't enough
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to do if you do surgery when you're not ready.
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She's going to end up with consequences and she didn't
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listen to me, She did it with somebody else.
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Or you know, this has happened with rhinoplasty as well, where
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I tell them I don't think that you should do your nose and they
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end up doing it with somebody else and then they end up with a
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problem. So 2 out of 10 patients I feel
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are not good candidates for surgery.
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That's my general 20% rejection rate.
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I had a patient that flew in from Australia for her nose and
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I told her I can't help you, your skin is too thick, you're
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not going to get a good result with your tip.
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She was so upset she ended up writing a bad review that I
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refused her surgery. I'm OK with those bad reviews.
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I'm happy to receive those bad reviews because she'll be a lot
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more unhappy if she had done the surgery.
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Well, that means that you walk the talk, you believe what you
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say, and you're willing to stand by that.
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Which is great because I agree 35 is very young for facelift,
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but like you say, some people are not going to feel good about
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themselves no matter what. Just last night I logged into
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Instagram and saw someone I had not seen in a long time and I
21:36
knew they had a very extreme facelift because they were
21:39
barely recognizable. And I don't think that's our
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goal right? I thought to myself, am I sure
21:44
this is the person? I had to check the name and
21:46
everything because that's how different the person looked and
21:48
I don't think that's really supposed to be the goal.
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Goal is to achieve and refresh the face.
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I do things that makes you look refreshed and untouched by a
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surgeon. There's a caveat to that.
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There's a small percentage of patients that I do for facelifts
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that want to look different. They didn't like the way they
22:08
looked even when they were 20. They may have a major imbalance
22:12
like a lack of a chin or a very, very low brow.
22:16
They want to look different and more beautiful.
22:19
And in those cases, there is an aspect to the facelift that is
22:22
done to beautify and create balance.
22:26
And they may look different, but that's a combination of
22:31
balancing because let's say they never had a jawline even when
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they're teens and they want a jawline and they don't mind if
22:39
they look different. So that's a different kind of
22:42
face that we do to. Sum up this section of the
22:45
podcast. You have seen it all.
22:47
What is the most shocking request you've ever received?
22:51
Well, I mean somebody coming out of jail who wanted to look
22:54
completely different, like unrecognizable as them.
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What did you do? I just declined.
23:01
That's probably something not to get tangled up in, right?
23:04
Right. But interesting and entertaining
23:07
nonetheless. The stats that I read are that
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you've logged more than 3000 facelifts and 6000
23:14
rhinoplasties. Is that correct?
23:17
It's about 4000 facelifts now. Wow, OK. 7500 Rhinophasics
23:22
close. Wow, wow.
23:24
So what does that level, that volume of surgery teach you that
23:30
a textbook never can? And then how do you share that
23:33
with the young surgeons? You know, this is over a 25 year
23:37
period and I see from doing that many cases an evolution in my
23:43
approach. It's changed.
23:45
We're doing more extensive, deeper work in the neck.
23:50
We're doing more aggressive neck surgery to try to give a more
23:54
lasting outcome. So over the years my results
23:58
have improved because I'm constantly trying to change
24:02
them. I'm never doing the same thing
24:04
year after year, particularly in facelift and rhinoplasty.
24:08
You know, there's always new things that we're doing with
24:11
brow lifts. We're doing more endoscopic brow
24:13
lifts, minimally invasive brow lifts.
24:16
Our fixation techniques have changed.
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I used to use stitches in the past ten years.
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I'm using endotines. They're a little bit better and
24:26
longer lasting than a suture. So what you're sharing with the
24:31
new surgeons is that they shouldn't just settle into what
24:35
they're doing, constantly getting better, improving,
24:38
trying new techniques is the way to go, right?
24:41
You have to feel uncomfortable, and it's important to feel
24:45
uncomfortable in what you're doing so you can improve.
24:48
There's a certain level of underlying anxiety or
24:51
discomfort, which means you're improving.
24:53
If you're too comfortable, that means you're not improving.
24:56
Agreed. Agreed.
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So looking back on your career, if you could do one thing
25:01
differently, what would it be? I wish I had done more shorter
25:07
scar facelifts early on in my career because I start
25:11
progressing towards shorter scars in the mid 2000s and I
25:15
think shorter scar facelifts with the incisions being limited
25:19
a little bit can work very well. Can you explain what that is for
25:23
the audience? So traditionally you could do a
25:25
deep plane with a longer scar or a shorter scar.
25:29
Now a short scar doesn't stop here, it still goes up and down.
25:33
But now I'm modifying my incisions even behind the ear to
25:38
push it in a certain more vertical vector.
25:40
So my incision behind the ear is smaller and the one of the
25:44
temple is shorter. But early on in my career I had
25:48
a longer incision in the temple and a longer incision behind the
25:52
ear. That's the way I was trained.
25:54
And then I progressed to removing less skin and doing
25:58
shorter incisions. Not a short scar, but a shorter
26:02
incision because I was able to do more with the deeper work,
26:06
the deep plane and. What is the single innovation or
26:10
technique you're most excited about right now?
26:13
My entry point in the deep plane, which I first
26:17
demonstrated it in the Baker Gordon Symposium in February of
26:21
this year. That was a live surgery I did,
26:24
and I demonstrated a novel entry point that allows lifting the
26:30
face without cabling the sutures.
26:34
So when you don't cable sutures, when you attach tissue end to
26:38
end, it lasts longer and it avoids a pulled appearance.
26:43
So I enter higher up and allow the lift to be performed with
26:48
less cabling. I get more of a lift with less
26:51
cabling. I think that's one of my biggest
26:53
innovations in the deeper plane facelift.
26:55
And Dr. Aston, Doctor Rourke, Doctor Susan noticed the lack of
27:01
cabling in my technique and that was a big deal that they enjoyed
27:04
seeing that part. As we wrap things up here, when
27:08
you look ahead 10 years, what do you think will define the future
27:13
of plastic surgery? What do you see as the next
27:15
steps, the next innovations that are coming?
27:18
I think we're going to be doing shorter scars, deeper work, more
27:24
things to create a rapid recovery.
27:25
In addition to tissue glues, hyperbaric oxygen, there is
27:29
going to be more lasers that will expedite the recovery.
27:33
I think that's going to be very, very big in the future.
27:36
I also think regenerative medicine, stem cells will be a
27:40
big part of what we do in the future.
27:42
Agreed. I think the shift that we're
27:44
seeing right now with that has just gotten started, right.
27:47
I'm hoping that we soon have a pill for aging like they created
27:52
for GLP. One for weight loss where, you
27:56
know, within 10 years we could just take a pill and it turns
27:59
back the clock 20 years. Now that would be phenomenal.
28:02
But hey, they said it could never be done with weight loss,
28:05
but here it is. Let's see what they come up with
28:07
next. Well, anything else that you'd
28:10
like to share with the audience, Dr. Risk?
28:11
You've been an amazing guest and shared so much with us.
28:15
Well, thank you so much for inviting me.
28:16
I think we covered a lot of ground here and good luck and
28:19
let me know how it goes. Absolutely.
28:22
Well, thank you so much for. Joining us.
28:24
You've been a great guest. This is it for this episode of
28:28
The Doctor Randy Show. Thanks for listening and I'll
28:31
see you again next week. Doctor Randy Boyet holds a PhD
28:35
and is a recognized leader in the aesthetics and medical
28:37
industry. She is not a licensed medical
28:40
doctor. All commentary and product
28:42
recommendations are based on industry expertise and are
28:45
provided for informational purposes only.