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Understanding Plastic Surgery and Wellness After Weight Loss with Dr. Stacey June and Dr. Prashant Soni · Building the Best You

• 0:04
  SPEAKER_02: Welcome to Building the Best You, a destination for you to reimagine what is possible in your life and then create it.
• 0:17
  SPEAKER_02: Welcome to the show, everybody.
• 0:19
  SPEAKER_02: I'm your host, Gene Collins, and today we have two doctors joining us.
• 0:23
  SPEAKER_02: I love when we get to have people from the medical profession on.
• 0:26
  SPEAKER_02: So we have Dr.
• 0:26
  SPEAKER_02: June and Dr.
• 0:27
  SPEAKER_02: Sony on, and we are going to talk about cosmetic surgery.
• 0:32
  SPEAKER_02: And in particular, we're going to talk about how this relates to people that have massive amounts of weight loss, which is a very timely subject.
• 0:40
  SPEAKER_02: There are a lot of people on GLP ones right now.
• 0:42
  SPEAKER_02: And this becomes a really big problem when you go on GLP ones and you lose a hundred plus pounds.
• 0:48
  SPEAKER_02: There's a lot of body left over.
• 0:51
  SPEAKER_02: So I was really excited when they were brought to me because this is what they specialize in helping people when that happens to them.
• 0:57
  SPEAKER_02: So, doctors, welcome to the show.
• 1:00
  SPEAKER_04: Thank you.
• 1:00
  SPEAKER_04: Good to be here.
• 1:01
  SPEAKER_00: Thank you, Gene, for having us.
• 1:03
  SPEAKER_02: It is a pleasure.
• 1:04
  SPEAKER_02: So you guys live locally and work locally to me.
• 1:07
  SPEAKER_02: So just so everyone has some grounding references to where you are.
• 1:11
  SPEAKER_02: You guys work for a company called Advanced Specialty Care, and you have offices in, hopefully I'll get this correct, Ridgefield, Danbury, and Norwalk are the three in Connecticut.
• 1:21
  SPEAKER_02: Those are the three places that the two of you work.
• 1:22
  SPEAKER_02: Am I correct?
• 1:23
  SPEAKER_04: Correct.
• 1:24
  SPEAKER_04: Yes.
• 1:24
  SPEAKER_02: That is correct.
• 1:25
  SPEAKER_02: Okay.
• 1:25
  SPEAKER_02: Just want to make sure.
• 1:26
  SPEAKER_02: But I've had lots of doctors come on, actually, that are in the New York area that have people fly to them from other parts of the country.
• 1:33
  SPEAKER_02: So we don't want to exclude everyone else.
• 1:35
  SPEAKER_02: People often fly to where we are because our medical care is so great.
• 1:39
  SPEAKER_02: But we're also going to talk about things that people can learn about and apply wherever their geography is as well.
• 1:44
  SPEAKER_02: So I thank you for the time to not only share what you do here locally, but also share your expertise.
• 1:49
  SPEAKER_02: That's really greatly appreciated.
• 1:51
  SPEAKER_02: All right.
• 1:52
  SPEAKER_02: So before we dig into it, I'd love to know a little bit about each of you personally and what your specialties are.
• 1:57
  SPEAKER_02: You are both a little bit unique and have a little bit different backgrounds.
• 2:00
  SPEAKER_02: So I'm going to start, Dr.
• 2:01
  SPEAKER_02: June, I'm going to start with you.
• 2:02
  SPEAKER_02: If you would mind giving a little bit of background about how you got to be where you are in your career journey and the specialty that you're in now.
• 2:12
  SPEAKER_00: Sure.
• 2:12
  SPEAKER_00: So I am uh originally from Long Island and I did most of my undergrad and even medical school and residency in the New York area.
• 2:22
  SPEAKER_00: I did practice in Pennsylvania for a little while and I joined advanced specialty care moving to Connecticut about seven years ago at this point, kind of bringing me closer to home.
• 2:32
  SPEAKER_00: I kind of fell in love with plastics as I went through.
• 2:36
  SPEAKER_00: I uh learned about the different specialties in surgery and really found that plastics kind of brought together that natural art and um really helped define all of my desires and specialties uh in one thing.
• 2:53
  SPEAKER_00: We're constantly working on different parts of the body and and it's really fun.
• 2:57
  SPEAKER_00: It's really interesting.
• 2:58
  SPEAKER_02: Ooh, I love that.
• 2:59
  SPEAKER_02: Do you specialize in certain body parts or is all is the whole body fair game?
• 3:05
  SPEAKER_00: The whole body is fair game.
• 3:07
  SPEAKER_00: I definitely uh do tend to favor a little bit more of the uh body contouring from breast to abdomen, but from scalp to toes, I can find something I can do for you.
• 3:21
  SPEAKER_01: Yeah.
• 3:22
  SPEAKER_02: Do you help patients of all ages, or is this only adults?
• 3:26
  SPEAKER_02: I understand for weight loss it's probably adults, but I would assume in plastic surgery, you might sometimes help children that have a need for that after a trauma.
• 3:35
  SPEAKER_00: Absolutely.
• 3:36
  SPEAKER_00: There is probably a narrower field in pediatrics that we're comfortable with.
• 3:41
  SPEAKER_00: We're not necessarily in our practice at advanced specialty care dealing with clef lips and palates.
• 3:47
  SPEAKER_00: But yeah, I mean, and there is are some patients, you know, even in their early teens with breast complications or abnormal growing that need our services as well.
• 3:57
  SPEAKER_00: So we absolutely uh do uh manage some uh complications and problems in pediatric populations.
• 4:04
  SPEAKER_02: Okay, good to know.
• 4:05
  SPEAKER_02: Thank you.
• 4:06
  SPEAKER_00: All right, Dr.
• 4:06
  SPEAKER_02: Sony, I'd love to know a little bit about you.
• 4:10
  SPEAKER_04: So, not so different.
• 4:11
  SPEAKER_04: I'm a pretty homegrown here.
• 4:12
  SPEAKER_04: I grew up in Westchester.
• 4:13
  SPEAKER_04: And but my my training kind of I bounced around a little bit.
• 4:16
  SPEAKER_04: So I went to college in New York City, things like that, but then eventually did general surgery and found my way out into Utah to do my plastics residency.
• 4:25
  SPEAKER_04: And then the intention was always to kind of come back home.
• 4:27
  SPEAKER_04: So I spent some time in New York City doing some cosmetic specialty training, and in 2006 ended up joining this practice, and I've been here ever since.
• 4:35
  SPEAKER_04: And uh it's kind of the community kind of practice that I was hoping to have.
• 4:39
  SPEAKER_04: I kind of got into it more specifically right from the get-go, um, rather than evolving into that realization.
• 4:46
  SPEAKER_04: I I was always an artist, and then when I went to college, I was an arts and humanities major, and I wanted to be an artist and a painter and a writer and all those things.
• 4:55
  SPEAKER_04: And then you get to college and you realize you may not be as good as you think you are.
• 4:59
  SPEAKER_04: So I was I was looking for avenues to kind of parlay my artistic ability into something that I could do.
• 5:05
  SPEAKER_04: And plastic surgery kind of seemed like that avenue, and it kind of fulfilled that niche for me.
• 5:11
  SPEAKER_04: And then that's how I kind of got here.
• 5:13
  SPEAKER_02: Ooh, and I love that because you both talked about that, and I would have never thought of that, but it is definitely, I can see how it is a creative, it's definitely a creative field, yet also has a pretty cool science element to it as well.
• 5:27
  SPEAKER_02: So it's kind of like a nice balance of both both sides of the brain, both the left and the right side of the brain.
• 5:32
  SPEAKER_02: Do you specialize in any particular body part or the whole body is game for you too?
• 5:37
  SPEAKER_04: So if I were to take a general area, I would say cosmetic surgery spans from top to bottom.
• 5:42
  SPEAKER_04: I mean, probably the only thing I don't do is like hair transplants, for example.
• 5:46
  SPEAKER_04: But, you know, when it comes to facelifts, eyelid lifts, things like that, and also all the body contouring procedures.
• 5:52
  SPEAKER_04: If you said what tends to my main focus, it has evolved, right?
• 5:58
  SPEAKER_04: I mean, uh, when I was uh earlier in my practice, I did a lot of body contouring, and bariatric surgery was a big part of that because we had a very thriving bariatric surgery practice in the in the area.
• 6:08
  SPEAKER_04: And but we're community surgeons, so we basically find that we're there to service what the community needs.
• 6:14
  SPEAKER_04: And as my patient population has aged, I find I'm doing a lot more facelifts and things like that.
• 6:19
  SPEAKER_04: These are people who know us, have known us for decades sometimes.
• 6:22
  SPEAKER_04: And they once they were kids and we were operating on them, and now they're teenagers and having kids and we're doing tummy tucks on them because they're done having children.
• 6:29
  SPEAKER_04: So it's it's constantly an evolving thing.
• 6:33
  SPEAKER_02: Yeah.
• 6:33
  SPEAKER_02: Yeah.
• 6:34
  SPEAKER_02: I love that.
• 6:35
  SPEAKER_02: And I would think as technology evolves and as needs, needs evolve, right?
• 6:39
  SPEAKER_02: So the gastric bypass surgery that was fairly common around here wasn't as common across the entire country, but was common here.
• 6:46
  SPEAKER_02: And GLP1s were definitely a little more common around here in the beginning and now have become more widely popular.
• 6:54
  SPEAKER_02: What type of increase are you seeing in clients coming to you specifically because they've lost so much weight and now they don't like how they actually look, even though they like how they feel because they're thinner?
• 7:06
  SPEAKER_00: Yeah, I mean, I think that it really bothers them.
• 7:11
  SPEAKER_00: There are some people who feel it more as an aging in their face.
• 7:15
  SPEAKER_00: There are other uh people who, you know, are very upset about the change in shape and loss of volume in their breasts.
• 7:21
  SPEAKER_00: And there are a lot of patients who are having problems with rashes from an overhanging apron of tissue on their abdomen, some people from extra skin on their arms to their thighs.
• 7:30
  SPEAKER_00: It's it's different per patient.
• 7:32
  SPEAKER_00: And sometimes it's all.
• 7:34
  SPEAKER_00: Sometimes you need a little bit of everything.
• 7:36
  SPEAKER_02: Yeah.
• 7:37
  SPEAKER_02: So can we talk about face for a minute?
• 7:39
  SPEAKER_02: Because I feel like that is, I see it on social media all the time.
• 7:43
  SPEAKER_02: Like, oh, they have the GLP1 face.
• 7:45
  SPEAKER_02: That's how I know they've been on GLP ones.
• 7:47
  SPEAKER_02: It's sort of people tend, and I'm gonna have you correct me if I'm wrong about this, but I see that people tend to get, you know, almost gone, like super thin, and their face changes.
• 7:58
  SPEAKER_02: And I've noticed in the people that I know who have been on it, it's almost like they've lost a level of elasticity in their skin that they used to have before.
• 8:07
  SPEAKER_02: And I may be wrong about that, might just might not be what really happens, but it's what I'm physically seeing.
• 8:12
  SPEAKER_02: So I would love to hear from you what are some of the things that do happen to people's faces as a result of GLP1s where they would come to you for some help.
• 8:21
  SPEAKER_04: Yeah, I can comment on that because I see this a lot.
• 8:25
  SPEAKER_04: So what is happening is there there is that Ozempic face that's the moniker that's been thrown at it.
• 8:31
  SPEAKER_04: But I guess many people don't understand what is going on.
• 8:34
  SPEAKER_04: It's not just that you're losing weight and perhaps you're overdoing it.
• 8:38
  SPEAKER_04: It's not really that.
• 8:39
  SPEAKER_04: There are two sides to the GLP coin.
• 8:41
  SPEAKER_04: The the beauty of it is that yes, it does make you lose weight, but it also seems to help your body target deep fat pockets.
• 8:49
  SPEAKER_04: So in the abdomen, that's the typical visceral fat, the fat that coats our organs that is highly associated with cardiovascular disease and diabetes and things like that.
• 8:59
  SPEAKER_04: I mean, we've seen, and Stacy, I'm sure, can second this, we've seen people who will diet and their arms and legs get skinny, but their abdomens are still very taut and distended, even though they don't have a lot of skin to pinch off their abdomen.
• 9:11
  SPEAKER_04: That's because that deeper visceral fat just isn't, they aren't able to target it through all the stuff they're doing.
• 9:16
  SPEAKER_04: GLPs are great at that.
• 9:18
  SPEAKER_04: They seem to find a new mechanism to target that.
• 9:21
  SPEAKER_04: But there's an equivalent to that visceral fat on our face.
• 9:25
  SPEAKER_04: And there's there are multiple fat layers in our face.
• 9:27
  SPEAKER_04: So there's the fat associated with the skin, and there's the fat that actually coats our nerves and coats our muscles of our jaw and things like that.
• 9:35
  SPEAKER_04: And people typically don't lose that, and they maintain that through even teenage years into adulthood.
• 9:42
  SPEAKER_04: And those things tend to neither grow or shrink.
• 9:45
  SPEAKER_04: But one of the downsides, it seems to me, is that these GLPs are making that become a fat source.
• 9:51
  SPEAKER_04: And so the calories that are being expended, they're starting to target that as well.
• 9:55
  SPEAKER_04: So you start seeing that gaunt face and the sunken eyes.
• 9:58
  SPEAKER_04: And that is something that can't necessarily just be lifted away because you're you're you're losing a certain kind of substrate to work with.
• 10:06
  SPEAKER_04: So some of the techniques that we're doing now in facial rejuvenation, we've had to adapt with that and we have to find new ways to kind of uh adjust for that.
• 10:14
  SPEAKER_04: Because uh you can't just lift away everything that that is a problem.
• 10:19
  SPEAKER_04: Sometimes you have to add, and that's kind of become part of the paradigm now.
• 10:23
  SPEAKER_02: Yeah.
• 10:24
  SPEAKER_02: So, Dr.
• 10:24
  SPEAKER_02: Gene, I would love to hear your experience too with that.
• 10:27
  SPEAKER_00: Yeah, I 100% support all of that.
• 10:30
  SPEAKER_00: I do not think that this is exclusive just to semiglutides.
• 10:35
  SPEAKER_00: I mean, anybody who's lost a lot of weight is gonna see that uh change in their face.
• 10:41
  SPEAKER_00: It's just, I think, more highlighted now that we're seeing so much weight loss with the GLP ones.
• 10:47
  SPEAKER_00: And um, and really fat in the face is youthful.
• 10:50
  SPEAKER_00: And when we lose that, it's not just the hanginess, it ages us.
• 10:56
  SPEAKER_00: So I I definitely agree with Dr.
• 10:58
  SPEAKER_00: Sony.
• 10:59
  SPEAKER_00: It's not just a face and necklift.
• 11:01
  SPEAKER_00: We have to give volume back and in a natural way.
• 11:04
  SPEAKER_00: And sometimes it's hard for patients who've lost a ton of weight to hear that we want to add volume back.
• 11:10
  SPEAKER_00: Um, but we we do.
• 11:11
  SPEAKER_00: We need that to re-establish that more useful um contour.
• 11:15
  SPEAKER_00: Yeah.
• 11:16
  SPEAKER_02: Yeah.
• 11:17
  SPEAKER_02: So dare I ask, how do you add volume back?
• 11:21
  SPEAKER_04: Well, it it it differs from person to person, certainly, and age to age.
• 11:26
  SPEAKER_04: If you have someone coming in who's relatively on the young side of things, and you're seeing that with GLPs, it's not just people who are in their 40s, 50s, you're seeing people who are in their 20s doing it now.
• 11:35
  SPEAKER_04: And those people generally they have such good skin elasticity that they're that we're not dealing with a lot of skin excess.
• 11:40
  SPEAKER_04: And uh my favorite thing is to use the tissue, the fillers that you commonly hear about, the juvenerms, the restilins, things like that.
• 11:48
  SPEAKER_04: There's a whole cornucopia of these things out there, and I guess all of us have our preferences, and it it's not so much the product that matters, it's how you use it.
• 11:56
  SPEAKER_04: It's much like a set of paints.
• 11:58
  SPEAKER_04: You can give it to a five-year-old and they don't know how to make something beautiful out of it.
• 12:02
  SPEAKER_04: Um, so it's the same thing.
• 12:03
  SPEAKER_04: So I would never say there's one necessarily way to do it or one particular filler.
• 12:08
  SPEAKER_04: But between fillers and Botox, and you're comfortable, and as a patient's comfortable with the maintenance aspect of it, then that becomes a great, great first-line modality for people.
• 12:19
  SPEAKER_04: But as we're getting on to age ranges where people are needing lifts and and eyelid lifts or facelifts and neck lifts, then we do have incredible tools to help use your own fat to inject uh to like in a very long-term way augment where the fat has been lost.
• 12:35
  SPEAKER_04: And there are techniques that have evolved over the say the past, say, eight to ten years that make it really quite permanent.
• 12:43
  SPEAKER_04: And once again, it's it's all in the eye of the beholder.
• 12:46
  SPEAKER_04: It's nothing inherently right about just doing it, it has to be done properly, and that takes the artistic eye to do it.
• 12:53
  SPEAKER_04: But if you if it's done, you have these tools in your in your in your bag to use.
• 12:57
  SPEAKER_04: But it depends on the person their age uh as well.
• 13:00
  SPEAKER_02: Yeah.
• 13:01
  SPEAKER_01: Okay.
• 13:01
  SPEAKER_02: That's really cool.
• 13:02
  SPEAKER_02: Who would have known?
• 13:04
  SPEAKER_02: So I'm just curious if someone's listening to this and they're thinking, ooh, okay, I I'm not sure I'm happy with how my face looks right now, whether that be because of severe weight loss or age or whatever, or you know, it would be so nice to get rid of these wrinkles under our neck.
• 13:19
  SPEAKER_02: What does the consumer journey look like if they reach out and come to your practice?
• 13:24
  SPEAKER_02: How does that work?
• 13:25
  SPEAKER_00: So when a patient reaches out to our office, they are usually assigned what we call a consultation with um one, either Dr.
• 13:32
  SPEAKER_00: Sony, I or one of our other colleagues.
• 13:35
  SPEAKER_00: And it really is a like a bit of a meet and greet where we can really discuss what their issues are.
• 13:41
  SPEAKER_00: Again, I feel like I can sometimes do things to make any part look better, but if that's not the patient's main focus, why are we wasting our time and money, right?
• 13:50
  SPEAKER_00: So you really want to talk to the patients, um, ask them what their concerns are, what their issues are.
• 13:55
  SPEAKER_00: You need to evaluate their tissues.
• 13:56
  SPEAKER_00: You need to see them and touch them sometimes, and really come up with a plan together.
• 14:01
  SPEAKER_00: And I often give my patients multiple options.
• 14:04
  SPEAKER_00: You know, I love playing around with facial fillers, especially the deeper restoring ones that we put along cheekbones and jaw lines to kind of give us that lift again.
• 14:15
  SPEAKER_00: But sometimes patients need too much of it, and I'd never want to make somebody look unnatural.
• 14:20
  SPEAKER_00: So, yeah, it's a different plan for everybody, but we can talk about non-surgical injections, we can talk about the surgical procedures, where scars go.
• 14:29
  SPEAKER_00: I can get a mirror and show them how things would lie.
• 14:33
  SPEAKER_00: And I think you really need that hands-on, face-to-face consultation with a patient before you can really come up with any plans.
• 14:41
  SPEAKER_04: I would say to just to second some of those thoughts, a lot of the consultation is spent addressing misinformation that's out there as well.
• 14:52
  SPEAKER_04: Um, we can't help it.
• 14:53
  SPEAKER_04: I'm I'm just I'm just like everybody else.
• 14:55
  SPEAKER_04: I'll go home and doom scroll a little bit, and that's how I kind of get a lot of great ideas and some things that are just so off-key.
• 15:02
  SPEAKER_04: But in our particular field, patients do come pretty educated now, but it's kind of a mixed bag of some of it that's completely one track, and there there isn't uh a hammer that hits every nail for every particular person.
• 15:14
  SPEAKER_04: And neither do we claim, and I think Stacy would would would say the same, we don't claim to be experts in every element or facet of the rejuvenation process, right?
• 15:24
  SPEAKER_04: So sometimes people will come in and they truly don't need what I can offer.
• 15:28
  SPEAKER_04: And usually I will find an avenue or a know of avenues to refer them.
• 15:32
  SPEAKER_04: Very often they just need excellent skin care.
• 15:35
  SPEAKER_04: Sometimes, and then I'll refer them to one of our dermatologists in our practice.
• 15:38
  SPEAKER_04: Uh sometimes they'll need a particular type of laser, and we may have it, we may not.
• 15:42
  SPEAKER_04: And but I know the the other people who who do those types of things.
• 15:47
  SPEAKER_04: I guess that's the benefit of being in a community where you kind of everyone knows each other.
• 15:51
  SPEAKER_04: All the doctors kind of uh know where the resources lay.
• 15:55
  SPEAKER_04: So that's part of it too.
• 15:56
  SPEAKER_04: And so I mean, a consultation can take an hour or more sometimes.
• 16:00
  SPEAKER_04: And sometimes patients coming out saying, well, thanks, I don't need your surgery, but I know where to go next.
• 16:04
  SPEAKER_04: So that's that's a big part of the whole process too.
• 16:08
  SPEAKER_01: Yeah.
• 16:08
  SPEAKER_01: Yeah.
• 16:09
  SPEAKER_01: Education is big.
• 16:11
  SPEAKER_00: And just to add, I think what's also super unique about our practice at advanced specialty care is that we have a lot of these other specialties to come join in.
• 16:20
  SPEAKER_00: Like we do have dermatologists that we work with who can absolutely help with um other medical problems, whether it be acne or rhization, documenting rashes for patients who are trying to get certain procedures covered by insurance.
• 16:32
  SPEAKER_00: So it's really nice to have uh that internal referral program as well.
• 16:37
  SPEAKER_00: When, again, something is beyond what I would do as a plastic surgeon, I can help guide them still to get to their goal.
• 16:44
  SPEAKER_02: Yeah, which is important.
• 16:45
  SPEAKER_02: When you go to your website, you guys offer just a massive amount of services, I will say.
• 16:50
  SPEAKER_02: So we're gonna link it in the show notes because your offices do a lot of different things and you are just two doctors from a very large practice, which is also very cool.
• 16:58
  SPEAKER_02: So, do people come to you and are you ever faced with the situation of I don't know that I feel comfortable as a plastic surgeon doing what they want me to do?
• 17:11
  SPEAKER_02: Does that ever happen?
• 18:01
  SPEAKER_00: I would say yes, but not as frequently as you would think.
• 18:05
  SPEAKER_00: I perhaps if we were, I don't know, in LA or something, but I do feel that most patients around this area aren't asking for a ridiculous amount of filler or Botox that would be unsafe or unnatural.
• 18:20
  SPEAKER_00: I will not do an unsafe procedure.
• 18:23
  SPEAKER_00: Um, but some people do like their lips a little fuller than I like their lips, and um, something like that is not nearly as dangerous, just not my cup of tea.
• 18:34
  SPEAKER_00: Right.
• 18:36
  SPEAKER_02: Dr.
• 18:36
  SPEAKER_02: Sony, how about you?
• 18:38
  SPEAKER_04: I I mean I've had some real doozies come my way over the years, and these are typically people who have already seen or had multiple surgeries before, and they're they are perhaps chasing a result that isn't a a realistic result.
• 18:52
  SPEAKER_04: And there's a certain amount of experience to kind of decipher if if that's the thing you can deliver.
• 18:58
  SPEAKER_04: So I don't think I have ever said that the person comes in and is just a crazy unrealistic thing.
• 19:05
  SPEAKER_04: The question is their nuances, and I I tell people that what you're trying to achieve for your given weight, your given uh health isn't realistic at this moment.
• 19:14
  SPEAKER_04: So very often it's not uh the answer is not no, is often just not yet.
• 19:19
  SPEAKER_04: That tends to be the more realistic thing that happens.
• 19:23
  SPEAKER_01: Yeah.
• 19:23
  SPEAKER_01: Okay.
• 19:24
  SPEAKER_02: And do people ever come in and want you to make them thinner, but yet haven't done any of the work to try to make their bodies thinner?
• 19:35
  SPEAKER_02: Is is that still continuing where everyone's like, I'm just gonna have surgery to get rid of all that extra fat instead of having to go for a walk?
• 19:41
  SPEAKER_00: Absolutely.
• 19:42
  SPEAKER_00: I still have patients who are coming in and they think a liposuction is like a total body weight loss procedure, and it's not.
• 19:48
  SPEAKER_00: And you do have to re-educate sometimes about working on more focused areas.
• 19:53
  SPEAKER_00: Uh, but the answer isn't always just no.
• 19:55
  SPEAKER_00: I mean, sometimes, you know, uh an abdominal plasty might actually be able to get a patient more comfortable where they can exercise better and start to.
• 20:06
  SPEAKER_00: So I don't think it's ever completely black or white.
• 20:08
  SPEAKER_00: Uh, but yes, very often we have to kind of re-educate on what the what our abilities actually are when they're asking those things.
• 20:18
  SPEAKER_04: I can point out a very typical scenario that she she's probably thinking in her head too, is that people want to exercise, they want to get into a healthy lifestyle, but they may have like triple D G cup breasts.
• 20:32
  SPEAKER_04: And it's just not practical, it's just not possible.
• 20:35
  SPEAKER_04: They're miserable, they're uncomfortable.
• 20:37
  SPEAKER_04: So, I mean, uh thousands of breast reductions have been done just so that they can get a launching pad off into that lifestyle.
• 20:44
  SPEAKER_04: And that really is what it's for, and it works.
• 20:46
  SPEAKER_04: I mean, I've seen that I've seen that manifest itself a lot of times.
• 20:49
  SPEAKER_04: Um yeah, downstream they may lose a lot more weight, and then they may think, okay, I need to have a tummy tuck now or something.
• 20:55
  SPEAKER_04: But that's where they've always hoped and envisioned themselves.
• 20:58
  SPEAKER_04: But you need to do something to kind of uh grease the wheels for that.
• 21:01
  SPEAKER_04: And that's so that's that's the the system.
• 21:04
  SPEAKER_02: Yeah, I can definitely see that.
• 21:06
  SPEAKER_02: Yes.
• 21:06
  SPEAKER_02: And being someone who is very flat-chested, I can't imagine how difficult it is to exercise for some women who just have very large breasts and that has to just be really uncomfortable to move.
• 21:16
  SPEAKER_02: And I think people like that are incredibly grateful that doctors like you exist that can help them to get to something that allows them to be able to move more comfortably and not have back pain and everything that goes along with all of that.
• 21:28
  SPEAKER_04: Very true.
• 21:30
  SPEAKER_02: So if someone is watching or listening and they think this is interesting, but I don't live near Connecticut.
• 21:39
  SPEAKER_02: How do you suggest someone goes about doing some research about people that might be in their location?
• 21:46
  SPEAKER_02: Because I have a feeling it's like any medical profession, not all doctors, quite honestly, are created equal.
• 21:53
  SPEAKER_02: And that is just the reality of life.
• 21:56
  SPEAKER_02: So how does someone go about trying to find what might be the right doctor for them?
• 22:03
  SPEAKER_00: I think there's a couple of different avenues.
• 22:05
  SPEAKER_00: If you're looking uh for specifically skin reduction procedures after massive weight loss, sometimes it is helpful to go through your primary care physician because often we need documentation of pain and rashes and support before proceeding.
• 22:25
  SPEAKER_00: And so I'm sure they'll know good physicians in the community and success stories.
• 22:30
  SPEAKER_00: But you can also just you mostly want to make sure you're finding a board certified plastic and reconstructive surgeon.
• 22:38
  SPEAKER_00: You really don't want to be with not specialized or bird certified care.
• 22:43
  SPEAKER_01: Yeah.
• 22:44
  SPEAKER_00: Okay.
• 22:45
  SPEAKER_04: I'll add one caveat to that.
• 22:46
  SPEAKER_04: It is Is very misleading that you'll see people who say I'm board certified, I'm a birth certified surgeon, just like a genera generic statement.
• 22:56
  SPEAKER_04: And they're not technically lying, but what they're not like making clear is what they're board certified in, right?
• 23:03
  SPEAKER_04: And there are no state laws or federal laws mandating that a plastic surgeon has to be the one doing your plastic surgery.
• 23:11
  SPEAKER_04: In fact, I mean you very often will find family practitioners, radiologists doing all sorts of surgeries.
• 23:18
  SPEAKER_04: Very often, though, what you'll find is hospitals and surgical centers won't give privileges to those people who unless they have the appropriate specialty uh credentials.
• 23:28
  SPEAKER_04: So if you are looking around, what you want to ask is, are you board certified in plastic surgery?
• 23:35
  SPEAKER_04: And are do you have credentials at the local hospital?
• 23:38
  SPEAKER_04: Because if you don't, that's a big red flag.
• 23:42
  SPEAKER_04: Because no surgery is without its own risks and some attendant complications that come with it.
• 23:47
  SPEAKER_04: You need to be a member of a particular hospital so you can address those concerns.
• 23:51
  SPEAKER_04: And a hospital has very strict uh you know restrictions on who they let in on staff.
• 23:57
  SPEAKER_04: So if you can if you can sift through a lot of things, if you just ask those pertinent questions, are you board certified in plastic surgery and do you have credentials at the local hospital?
• 24:06
  SPEAKER_04: And if you hit those, at least you're on the right track and you're talking to the right people.
• 24:09
  SPEAKER_02: That's so good to know.
• 24:10
  SPEAKER_02: Because I would not even think to ask about the surgery perspective because I'm thinking of you guys as surgery, and I'm like, everything I'm assuming is just outpatient, and why would that matter?
• 24:19
  SPEAKER_02: But that is a really important point and a way to distinguish, you know, one practitioner from another.
• 24:26
  SPEAKER_02: How do you encourage people, even within a practice?
• 24:29
  SPEAKER_02: How how do people pick, you know, Dr.
• 24:32
  SPEAKER_02: Sony over Dr.
• 24:33
  SPEAKER_02: June or over any of the other doctors in the practice?
• 24:35
  SPEAKER_02: Like, how does that happen?
• 24:37
  SPEAKER_00: Uh I think a lot of it is referrals.
• 24:40
  SPEAKER_00: So obviously, if a patient has a wonderful experience with me, they're gonna recommend it to their friends to come see me.
• 24:46
  SPEAKER_00: But uh there is a lot of overlap in our care.
• 24:49
  SPEAKER_00: And very often, you know, Dr.
• 24:52
  SPEAKER_00: Sony has to take care of one of my patients at times if I'm unavailable.
• 24:56
  SPEAKER_00: And uh that's the nice thing about our practice is that we have three board-certified plastic surgeons, and you will be taken care of by all three of us.
• 25:04
  SPEAKER_00: But yes, there's definitely some patients who just walk in asking for the next appointment and they get any one of us.
• 25:11
  SPEAKER_00: Uh, but I do think a lot of it is that um family-friend referral program for sure.
• 25:17
  SPEAKER_03: Yeah.
• 25:17
  SPEAKER_00: And that's the best type of referral, honestly.
• 25:19
  SPEAKER_00: Oh, of course.
• 25:20
  SPEAKER_00: That's absolutely referring happy patients.
• 25:23
  SPEAKER_02: A hundred percent.
• 25:24
  SPEAKER_02: Yes.
• 25:25
  SPEAKER_02: Yes.
• 25:26
  SPEAKER_02: All right.
• 25:26
  SPEAKER_02: So back to weight loss for a second.
• 25:28
  SPEAKER_02: As you were talking, I'm wondering, does someone I'm kind of thinking about someone who's losing a massive amount of weight.
• 25:36
  SPEAKER_02: Do they have to have maintained that baseline of wherever they are now?
• 25:41
  SPEAKER_02: Let's say they've lost a hundred pounds.
• 25:43
  SPEAKER_02: Do they have to have maintained that hundred pounds for a certain period of time before you would suggest they are a good candidate for some type of plastic surgery?
• 25:53
  SPEAKER_02: And I ask this because, you know, ebb and flow, up and down, up and down.
• 25:57
  SPEAKER_02: And then I don't know what happens to your body if you go and you tuck and you lift and then you gain 40 pounds back.
• 26:04
  SPEAKER_02: I'm not sure what happened.
• 26:06
  SPEAKER_02: So I would love to know in your experience how you handle that.
• 26:09
  SPEAKER_04: I would say it depends on how long I've known the patient, right?
• 26:12
  SPEAKER_04: There's some patients I've I've known for years who I've kind of been on that journey with them already.
• 26:17
  SPEAKER_04: So I kind of already have a sense of confidence in their motivation and and stuff like that.
• 26:23
  SPEAKER_04: So I'm not going to make them wait a year if they've hit their goal.
• 26:26
  SPEAKER_04: But my main concern is to make sure that they're healthy.
• 26:30
  SPEAKER_04: And so very often I will have them go see their primary care doctor and get blood tests and things.
• 26:35
  SPEAKER_04: The rapid rate at which people are losing weight does concern me because it it kind of supersedes anything I've ever seen before.
• 26:43
  SPEAKER_04: So I do wonder if their protein levels are good, if their calcium levels are good, or things like that.
• 26:48
  SPEAKER_04: But if I'm meeting a patient for the first time, I mean, usually I'm seeing that they've done it under a kind of a guided process.
• 26:55
  SPEAKER_04: So whether they're at a metabolic clinic or their primary care doctor is helping them, something like that, or a naturopath is helping them.
• 27:01
  SPEAKER_04: I mean, those are all viable and reputable sources.
• 27:06
  SPEAKER_04: And if they uh usually come with some information in their chart, I'm pretty comfortable moving forward when the patient feels that the time in their life is ready, they can dedicate time to recuperation.
• 27:15
  SPEAKER_04: That tends to be the rate limiting step.
• 27:17
  SPEAKER_00: Yeah, I think that um sometimes you hear that textbook answer of you need to be plateaued for three months before being considered for surgery.
• 27:25
  SPEAKER_00: And while I do think it's nice for patients to have gotten close to their goal, we're human beings and you're gonna fluctuate, you're gonna go up, you're gonna go down.
• 27:36
  SPEAKER_00: You just wanna be near where you're at.
• 27:37
  SPEAKER_00: Like I don't want to necessarily start doing surgery when you started a GLP one a month ago.
• 27:43
  SPEAKER_00: You know, I want to see where you get with it.
• 27:45
  SPEAKER_00: But I don't, I feel like patients don't always need to be at the ideal body weight in order to have surgery.
• 27:50
  SPEAKER_00: They just need to be healthy and at somewhere they think they can maintain.
• 27:54
  SPEAKER_00: And yeah, and I think that GLP1s, for like the first time ever in my career, I've seen that patients are actually able to maintain.
• 28:04
  SPEAKER_00: I feel like in the past, I've had patients just kind of get down to as much as they can before surgery and then they just rebound.
• 28:12
  SPEAKER_00: But GLP ones are allowing for that maintenance and stability.
• 28:16
  SPEAKER_00: And and sometimes you will even lose more weight after the surgery because again, we've now taken another, you know, five pounds of breast tissue off of you and you can move better.
• 28:27
  SPEAKER_00: So yeah, it's it's definitely a a journey and there's not one straight answer, but it's it's nice to be stable, but not ideal.
• 28:36
  SPEAKER_04: Body weight.
• 28:38
  SPEAKER_04: What's amazing is I have not to date seen anyone who's been on GLPs and found a happy particular brand of it and gotten to their goal who's come off of it.
• 28:47
  SPEAKER_04: People are titrating down and they're reaching these microdosing levels.
• 28:52
  SPEAKER_04: Right.
• 28:53
  SPEAKER_04: Where and these things, they they work on a psychological level too.
• 28:57
  SPEAKER_04: I mean, these these people are not craving things.
• 29:00
  SPEAKER_04: Yeah.
• 29:01
  SPEAKER_04: Uh their energy levels are better and they're getting other ancillary benefits like their arthritis is going away, their their chronic fatigue is going away.
• 29:08
  SPEAKER_04: There, there's no uh urgency for these people to stop completely.
• 29:12
  SPEAKER_04: So I think as long as they have this ability to microdose, they're gonna maintain.
• 29:17
  SPEAKER_04: That's that's been my feeling on it.
• 29:19
  SPEAKER_02: Yeah.
• 29:19
  SPEAKER_02: Well, and I also think you mentioned something about people doing it under the guise of medical care.
• 29:24
  SPEAKER_02: And I think there's a huge difference when you do that because every every doctor that I've spoken to about this topic says, you know, that you do need to do things.
• 29:33
  SPEAKER_02: You don't just take the pill or do the shot.
• 29:36
  SPEAKER_02: It's like, yes, you need to work on muscle.
• 29:38
  SPEAKER_02: You really need to work on building up your muscles so you don't lose muscle mass.
• 29:42
  SPEAKER_02: You do need to change the way you eat.
• 29:43
  SPEAKER_02: You do still need to move.
• 29:44
  SPEAKER_02: You it's not just take a pill and not change anything about your lifestyle.
• 29:48
  SPEAKER_02: So I do think it's incredibly important that someone is doing it with some medical care so that they are held accountable for checking all of the boxes.
• 29:58
  SPEAKER_04: Very true.
• 29:58
  SPEAKER_04: Very true.
• 29:59
  SPEAKER_04: Sarcopenia is like one of the new um bylines that people are talking about with this loss of muscle mass.
• 30:04
  SPEAKER_04: And yeah, they need to be watched for these kinds of things.
• 30:07
  SPEAKER_04: But when they do, they're very successful.
• 30:09
  SPEAKER_02: Yeah, right.
• 30:10
  SPEAKER_02: Well, and as women, as we get older, like we lose that naturally anyway.
• 30:14
  SPEAKER_02: So you need to be like, that's just nature and time is not helping you out in that front anyway.
• 30:19
  SPEAKER_02: So you have to be doing those types of things.
• 30:21
  SPEAKER_02: It's just part of life.
• 30:23
  SPEAKER_02: What happens after someone has surgery?
• 30:25
  SPEAKER_02: Now I know it depends on what the surgery is, but what's a typical recovery period for someone who, let's say, is in because they've lost a lot of weight and they want to remove some of the excess skin and fat that they have left?
• 30:40
  SPEAKER_00: Yes, it does vary dependent on the operation that we're doing.
• 30:45
  SPEAKER_00: I think a uh blanketed number sometimes is six weeks before returning to exercise and heavy lifting.
• 30:54
  SPEAKER_00: Uh, but that definitely varies per surgery.
• 30:56
  SPEAKER_00: And sometimes you're getting back into regular life sooner than that.
• 30:59
  SPEAKER_00: And sometimes you have complications and it's stretched out a little bit.
• 31:02
  SPEAKER_00: So it it really depends on the surgery and the patient.
• 31:05
  SPEAKER_00: But um, I do tend to, you know, micromanage my patients a little bit after surgery.
• 31:11
  SPEAKER_00: So nobody's left wondering what to do next.
• 31:14
  SPEAKER_00: I um I do oversee them and over-guide them and let them know now you can start doing X or Z.
• 31:20
  SPEAKER_00: Yeah.
• 31:21
  SPEAKER_00: So yeah, it's it's all under very strict guidance.
• 31:24
  SPEAKER_00: And uh and it's not the same number for every patient because every patient heals differently.
• 31:28
  SPEAKER_00: And every patient has different um expectations on like what regular life is.
• 31:34
  SPEAKER_00: Some people are just trying to get back to a desk job, and some people are trying to get back to a job with a lot of heavy lifting.
• 31:40
  SPEAKER_00: So it it really varies.
• 31:42
  SPEAKER_02: Yeah.
• 31:43
  SPEAKER_02: How do you guys stay on top of the technology?
• 31:46
  SPEAKER_02: Because I would think as much as technology is changing in every other facet of our life, I would think in the world of plastic and cosmetic surgery, it's changing constantly.
• 31:56
  SPEAKER_02: So how do you stay on top of all of that?
• 31:58
  SPEAKER_04: Well, I would say that plastic surgery tends to be more anecdotal, personal, experience-driven type of advancements.
• 32:08
  SPEAKER_04: We're not so heavily into um technology and computer gizmos.
• 32:13
  SPEAKER_04: There's not a lot of that in plastic surgery.
• 32:15
  SPEAKER_04: It really is kind of an extended art field in that sense.
• 32:19
  SPEAKER_04: I mean, there's a 99% of what we do, we do with a scalpel and a little forcep.
• 32:24
  SPEAKER_04: And it really is just that simple.
• 32:26
  SPEAKER_04: Um, I won't call it simple, but it really is just that uh those are the tools of the trade.
• 32:32
  SPEAKER_04: Where we tend to make advancements um is based on the techniques.
• 32:38
  SPEAKER_04: That's where it is.
• 32:40
  SPEAKER_04: And there are people who take chances and pioneer certain things, and there are a lot of things that are tried and fail just by trial and error, and people do realize that.
• 32:48
  SPEAKER_04: So we have our journals, we have our conferences every year, and we have certain people who are heralded as innovators all across the world, and we we follow that and we meet with them and we talk with them.
• 33:00
  SPEAKER_04: And then I can tell you I've learned a lot from Stacy and my other partner, and vice versa.
• 33:06
  SPEAKER_04: When you when you have that kind of collegiality among a field, it's easy to pick up the new techniques.
• 33:13
  SPEAKER_04: So I can tell you for sure the things I do with my facelifts now, I didn't do maybe eight years ago.
• 33:18
  SPEAKER_04: They've improved the longevity of it, the, and especially with some of the things we're talking about, the changes in the the patient population, the techniques are changing very fast with them as well.
• 33:28
  SPEAKER_04: So that that that's how we do, I think we do it.
• 33:30
  SPEAKER_04: Yeah.
• 33:31
  SPEAKER_00: 100% agree with all of that.
• 33:33
  SPEAKER_00: In addition, I find that we're there's a lot of trendy things sometimes, or like popular things you might see on the internet.
• 33:44
  SPEAKER_00: Like there is, we're not gonna be the first ones to jump on that kind of thing.
• 33:48
  SPEAKER_00: We're gonna wanna see the results.
• 33:50
  SPEAKER_00: We're gonna wanna see how it does.
• 33:52
  SPEAKER_00: We need we're scientists at the end of the day.
• 33:54
  SPEAKER_00: So we're not just gonna be trying new things without something to support it or back it up.
• 34:00
  SPEAKER_00: But it is changing, absolutely.
• 34:02
  SPEAKER_00: I mean, uh when I was training, uh people weren't transferring fat to other parts of the body.
• 34:08
  SPEAKER_00: Like that seemed unusual and weird or even dangerous, or especially like in a breast cancer patient, like to transfer fat, what are you gonna do?
• 34:15
  SPEAKER_00: So it's completely safe now, and we do it all the time.
• 34:19
  SPEAKER_00: But you need to be, you know, um learning these new techniques and and and using them.
• 34:24
  SPEAKER_00: Uh, but you need the research there.
• 34:26
  SPEAKER_02: Yeah.
• 34:27
  SPEAKER_02: Yeah.
• 34:27
  SPEAKER_02: Oh, that's good.
• 34:29
  SPEAKER_02: All right, before we run out of time, I just have a couple more questions.
• 34:31
  SPEAKER_02: So I am curious because I always see when I see someone who's gone and let's say they've had a facelift or a neck lift, and I think for myself, I think I don't know if I would know where to stop because I feel like, oh, you talk here and then you need to talk here, or then I don't like this, or then I don't like that.
• 34:51
  SPEAKER_02: How do you deal with?
• 34:53
  SPEAKER_02: I am sure I'm not the only person who would enter your office and have that concern.
• 34:56
  SPEAKER_02: Where do I stop?
• 34:58
  SPEAKER_02: So how do you help patients or people in general who are concerned of even starting because they're afraid they won't know how to stop?
• 35:04
  SPEAKER_04: Well, I think A, you have to have a rapport with your patients so they could trust your opinion.
• 35:10
  SPEAKER_04: Um I I have no inhibitions in telling people that there's a certain limit to where are the benefits or the diminishing return of benefits based on what you're trying to trying to do surgically.
• 35:21
  SPEAKER_04: And that's usually in my case enough.
• 35:24
  SPEAKER_04: Um I don't think that I have patients who necessarily come in and say, I I've done my facelift, I want to have another one in two years, in three years.
• 35:31
  SPEAKER_04: I don't find that is the case.
• 35:33
  SPEAKER_04: Well, what is totally reasonable is kind of what you just touched on.
• 35:36
  SPEAKER_04: My face looks better, but now I wish my arms kind of matched my face.
• 35:40
  SPEAKER_04: Or I I did my breast lift, but now I s I I kind of feel like I want to do my tummy or my thighs.
• 35:47
  SPEAKER_04: That's all reasonable.
• 35:48
  SPEAKER_04: I mean, and and um I mean, why shouldn't someone be able to improve themselves if the avenue exists?
• 35:53
  SPEAKER_04: So there's no judgment there at all.
• 35:55
  SPEAKER_04: I mean, the the main question is is there if their expectations match what's uh possible?
• 36:00
  SPEAKER_04: And then they need to look at the photos that we have of our patients that we've done.
• 36:04
  SPEAKER_04: I mean, that is the biggest differentiator between the surgeons.
• 36:08
  SPEAKER_04: You know, certain results are capable in certain people's hands and not the other.
• 36:13
  SPEAKER_04: And you need to look through different doctors, different surgeons, different practices, look at the photos and see if someone's matching your ideal.
• 36:20
  SPEAKER_04: If you hit all those check boxes, then yeah, there's no restriction.
• 36:23
  unknown: Okay.
• 36:24
  SPEAKER_00: Yeah, when we talk about like um, is plastic surgery addictive?
• 36:28
  SPEAKER_00: You know, I don't think that we're necessarily seeing what Dr.
• 36:32
  SPEAKER_00: Sony said where we're we want to do the same spot over and over again.
• 36:36
  SPEAKER_00: It's more exactly what he just said.
• 36:38
  SPEAKER_00: You made this body part look better.
• 36:40
  SPEAKER_00: Now what about this body part?
• 36:42
  SPEAKER_00: And as long as their goals are reasonable, like there's absolutely no, I mean, you know, you don't want to do a surgery that's too long or dangerous, but breaking these up into several procedures throughout the years as their desires change, um, yeah, and it's nice when you see how much one body part has been improved and it's giving you the confidence to want to explore other areas of your body is completely natural.
• 37:08
  SPEAKER_02: Yeah.
• 37:08
  SPEAKER_02: I would think it's really nice to see someone's self-confidence and just the way they enter a room, I would think probably really changes, especially if there's a body part that's really been bothering them potentially for decades that they haven't liked about themselves when they look in the mirror or how they feel in clothes.
• 37:23
  SPEAKER_02: And I would think it's really empowering to be able to gift that to someone through your work and see how they actually really blossom and change as a human being as a result of that procedure.
• 37:34
  SPEAKER_04: Yeah, I think that's why we do this.
• 37:35
  SPEAKER_04: I mean, that's the that's a rewarding part of it.
• 37:37
  SPEAKER_04: Um maybe one of the few fields of medicine where you get to see that that immediate impact.
• 37:42
  SPEAKER_04: And it's great.
• 37:44
  SPEAKER_02: Yeah.
• 37:44
  SPEAKER_02: Oh, I love that.
• 37:45
  SPEAKER_02: All right.
• 37:45
  SPEAKER_02: So before we run out of time, did I miss anything for each of you?
• 37:48
  SPEAKER_02: Is there anything else that I didn't ask that you want to make sure we cover?
• 37:52
  SPEAKER_02: So I will start with you.
• 37:53
  SPEAKER_02: Dr.
• 37:53
  SPEAKER_02: June, did we miss anything?
• 37:55
  SPEAKER_00: I'm not sure if you want to talk at all about whether insurance covers any type of these procedures after massive weight loss.
• 38:02
  SPEAKER_00: Yep.
• 38:03
  SPEAKER_00: Because uh insurance companies don't cover a lot.
• 38:07
  SPEAKER_01: Right.
• 38:08
  SPEAKER_00: There are some procedures that we can sometimes uh help get covered, whether it be um excessive skin around the eye that's interfering with their vision.
• 38:18
  SPEAKER_00: Sometimes an upper lip leproblast can be covered.
• 38:21
  SPEAKER_00: If you still do have very large pendulous breasts, sometimes a breast reduction would get covered, but not necessarily a breast lift.
• 38:29
  SPEAKER_00: And then when it comes to the abdomen, sometimes if there's an overhanging pannis down to their thighs or a big apron of tissue with rashes, insurance might pay for part of their tummy tack called a paniculectomy.
• 38:43
  SPEAKER_00: But I do think patients do need to be prepared when they come in that just because their weight loss was achieved with medication that may or may not be covered by their insurance company doesn't necessarily mean that this skin removal will also be covered.
• 39:02
  SPEAKER_02: Thank you for touching on that.
• 39:03
  SPEAKER_02: Because I would have assumed the answer was flat out no, not on anything.
• 39:06
  SPEAKER_02: So it is nice to know there are a few caveat exceptions, but I would think in general, insurance is not is not a fan of this.
• 39:13
  SPEAKER_02: So thank you for bringing that up.
• 39:15
  SPEAKER_02: Dr.
• 39:15
  SPEAKER_02: Sony, anything that I missed?
• 39:17
  SPEAKER_04: Um perhaps just one safety reminder that it goes under the radar a lot that these GLP meds are are great, but people do have to be very upfront about telling us that they're and uh their other medical providers that they're on them, because it can be an afterthought.
• 39:33
  SPEAKER_04: It's a natural tendency to think it's something I'm doing for myself.
• 39:35
  SPEAKER_04: It's not really medical in nature, or it's not something really worth mentioning.
• 39:40
  SPEAKER_04: But it's important because you can't even have surgery under anesthesia unless you follow certain protocols for that, to make it safe to do surgery and have general anesthesia if you're on these GLP agonists.
• 39:52
  SPEAKER_04: So these kinds of things are important.
• 39:54
  SPEAKER_04: And we we've now developed a good format for treating people with that.
• 39:59
  SPEAKER_04: But even the anesthesiologists who, quite frankly, are meeting often just for like a few minutes before you go into surgery, these are things that really matter to them because it's their job to get you safe through the anesthetic process.
• 40:11
  SPEAKER_04: And if the if you tell them and you're upfront about it, things get done great.
• 40:15
  SPEAKER_04: It's great.
• 40:16
  SPEAKER_02: Yeah.
• 40:16
  SPEAKER_02: And it's not fair to them.
• 40:18
  SPEAKER_02: It's not fair to put them in the position where they don't know the whole picture of what's going on entirely within your whole body.
• 40:24
  SPEAKER_02: So it's yeah, that's a great point.
• 40:26
  SPEAKER_02: I'm so glad you mentioned that.
• 40:27
  SPEAKER_02: So before I I don't want to forget to mention that your office so kindly offered a code to our listeners of 20% off their consultation with either of you if they use the code BESTU and they have to schedule it by the end of November.
• 40:39
  SPEAKER_02: So I'm gonna put that in the show notes, but I wanted to put that out there and I thank you very much for offering that code to people.
• 40:44
  SPEAKER_02: I will make sure it's in the show notes.
• 40:46
  SPEAKER_02: I will post on social media as well.
• 40:48
  SPEAKER_02: So if people are interested in getting a consultation, definitely, you know, take your office up on that kind offer to discount a consultation.
• 40:54
  SPEAKER_02: So thank you for that.
• 40:56
  SPEAKER_02: So, Dr.
• 40:57
  SPEAKER_02: June, Dr.
• 40:57
  SPEAKER_02: Sony, thank you so much for joining me.
• 40:59
  SPEAKER_02: I know you guys are so busy.
• 41:00
  SPEAKER_02: Your schedule is crazy.
• 41:02
  SPEAKER_02: So I really appreciate you carving out an hour on a Friday for us to be able to talk and to educate all of us.
• 41:08
  SPEAKER_02: And I think you've just opened, you've opened my eyes to what exists in the plastic surgery realm and the cosmetic surgery realm and the different ways that you can help people, whether it be because we're aging or because we're losing weight, or we're just honestly just not quite happy with our bodies.
• 41:23
  SPEAKER_02: So I feel like I personally feel it's a little more normalized by having this discussion.
• 41:28
  SPEAKER_02: So I thank you for that because I find I'm not I'm not the exception when it comes to my listeners.
• 41:32
  SPEAKER_02: So I thank you both for your time and we'll definitely stay connected and we'll post this on all the social media channels to get the word out.
• 41:38
  SPEAKER_02: So thank you for your time.
• 41:39
  SPEAKER_02: Thank you, Gene.
• 41:40
  SPEAKER_04: Thanks, Jean.
• 41:40
  SPEAKER_04: Appreciate it.
• 41:42
  SPEAKER_02: Thank you for joining us for this week's episode of Building the Best You.
• 41:46
  SPEAKER_02: If you are ready to take a deeper dive into transforming your life, check out my Empowerment Fundamentals course on my website, houseofgermar.com.
• 41:55
  SPEAKER_02: Thank you, and I will see you next week with another inspiring guest.