Latest / The Dr. Randi Show / The Facelift Phenomenon — Dr. Jacob Steiger

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The Facelift Phenomenon — Dr. Jacob Steiger · The Dr. Randi Show

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Now let's get into the episode. Hello everyone.
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We have a very special guest today, Doctor Jacob Steiger.
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He is the chief surgeon at Steiger Facial Plastic Surgery
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and we are thrilled to have him here today.
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He is not only a long term friend and colleague of mine,
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but he also is in charge of this face and making sure it stays
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looking fresh. So excited to have you on today,
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Mr. Steiger, Welcome. Excited to be here, thanks for
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having me. So I'd love for you to tell our
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listeners and viewers a little bit about your background.
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It's so impressive. You didn't just take one route
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to education or study and expertise.
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You went several routes and really learned everything and
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became the expert. So if you don't mind, tell us a
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little bit about that. Well, I'm a homegrown Florida
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boy. I'm one of the few Miami Beach
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boys. I was born down in the South
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Florida and actually stayed here, did one of those honors 6
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year medical programs, the baby doc programs at University of
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Miami. And then after that I went to
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the University of Pennsylvania, did my surgery internship there.
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I had neck surgery residency. I was there for a little bit of
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five years. Then I went on to the University
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of Michigan in Ann Arbor and I did my fellowship in the facial
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cosmetic surgery, facial plastic surgery with some wonderful
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mentors. It was a great journey and then
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I decided to come back to Florida if I moved down here and
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started my practice in Boca Raton, FL and Delray.
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Actually I started in Delray, which is just north of us and
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you know, did a couple moves and here we are in Boca.
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We have a great office and kind of had a vision.
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I had a dream as far as what I wanted.
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And so we have a center with an operating room, big office,
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basically everything in one. Yeah, a one stop shop if you
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will. So I'm very proud of that, proud
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of the technology we have. We are proud of the team that
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we've built here over the last 1718 years.
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That's really, you've seen the team.
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Most of the people that work with me have been with me
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forever since the beginning. I'm proud of that because
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they're all family and our patients, our family, we really
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treat them that way. So that's kind of the path we
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took. It was not the typical path
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where you join a group or a place.
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I just on the shingle and did my thing and it fortunately worked
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out. It sure did.
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And as I understand, Doctor Stegger, you're like triple
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board certified or something. Is that correct?
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Yeah. So I'm board certified in
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Otorhinolaryngology, had a neck surgery and I'm board certified
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in facial plastic and reconstructive surgery.
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So I have the board certifications and those are the
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big boards that I'm certified and I'm very proud of that as.
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Well, it shows the commitment to excellence and the training and
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yes, it works. I knew you before had this
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amazing center and then I've grown with you and watched you
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grow and it's been amazing to see.
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And now I trust my face to you on a regular basis and feel
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great about that and receive a lot of compliments about how
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natural my face looks even at 54, how we keep it real.
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I appreciate that. But what's been amazing for me
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to watch, you know, as I come in quarterly to your office, we are
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treated like family. There's nothing that we, you
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know, if we call or ask a question or there's never, it's
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never feels like it's too much for anybody.
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It's an amazing feeling and we really do feel like family.
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I've referred probably hundreds of patients over the years
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because of that feeling. Something I get to listen to
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when I'm in the waiting room, you know, for a little bit
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waiting for you is the phone's ringing off the hook.
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The people requesting to come in for a consultation and you have
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built an amazing following in order to have a consultation
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with you for a facelift is a six month wait.
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People are waiting those six months because of the expertise
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that you deliver. As a facial plastic surgeon,
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this is really interesting listening to me.
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We recently had Doctor Patrick Byrne on Head of the Facial
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Plastic Academy as Doctor Byrne also hit upon this, that going
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to a facial plastic for your face, there's nothing better
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than that, right? Then if you're going to somebody
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who has worked on the body all year and maybe only did a few
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facelifts, no, we want to go to somebody who really specializes
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in that. And as you're talking to us, you
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literally just wrapped up a facelift just a few minutes ago,
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right? So this is your craft, your
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expertise, and people are waiting for those consultations.
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They are waiting in line to have a consultation to have a Steiger
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facelift. So tell us about what that
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means. What's involved in a Steiger
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facelift? I appreciate all the kind of
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words. I'm always a little humbled by
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that, so thank you. A couple things, like you said,
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this is what I do day in, day out.
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I agree with everything you said.
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I think going to a physician, a facial blast surgeon or a
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plastic surgeon that does only body or only boobs or only
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bellies or in my case only faces, that's important.
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This is what I eat, breathe and sleep.
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I do this every day, really seven days a week.
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When I go home at night, I'm not just shutting down and I'm
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thinking about it. I'm looking at articles, I'm
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looking at do things, trying to see anything interesting out
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there. So it really is something that I
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eat, breathe and sleep as a physician, that's really
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important to me as a consumer. I would be really important to
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me to go to somebody that like that, that's not only does
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something but is very passionate, loves what they do.
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And and and really it's my wife is a dentist and we always talk
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about the separation between our lives and our work lives, like
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our personalized. It really is unfortunately or
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fortunately, we are what we are and it's it's 24/7 as far as our
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careers and you know, so there's no separation of personal life
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versus work life. It's just one continuum.
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As a physician, I think that's very important, but as a
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consumer, it's very important because everybody would want
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somebody who's taking care of him to be the pro at that.
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So that being said, you know, I think, you know, like you
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mentioned, I just got out of a facelift.
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I did 2 today and with some other stuff, you know, we call
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facelift. Facelift is really the procedure
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designed to lift the hanging cheeks, the hanging jowl, the
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hanging neck, fixing what quote UN quote gravity has done
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through the years. We have eyelid surgery.
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We do eyebrow lifts or we do lasers.
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Usually in my practice being here in sunny South Florida,
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most patients, I would say 90% that I do facelifts on get a
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laser as well, some kind of resurfacing laser to treat the
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skin, to treat little fine lines and wrinkles.
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We call it facial rejuvenation being maybe having a facelift,
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having your eyes on, having a brow lift.
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And like you mentioned, the facelift itself is the procedure
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designed to lift the hanging cheeks, gels and neck, which
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sack. As we get older, you asked me
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earlier what is special about how I do a facelift or what is
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the technique? And I I think it's important
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question because, you know, as time has gone on, Facebooks have
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evolved significantly. Facebooks have gone through the
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whole day 67 to 80 years ago where they would just make
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incisions around the ear and pull the skin, tighten the skin.
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But it's in the 50s and 60s and 70s it was very taboo.
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I was like the face of really was the famous surgeons who did
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certain Johns Hopkins and they would go into their private
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clinics on the side and do that time by they're doing facelifts,
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right? It was a very, that's not real
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medicine, if you will, But as time has gone on, it became more
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accepted, became more popular. There was a demand for it.
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It was safe. A lot of the technology back
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then was new types of stitches. How could we make things tighter
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and tighter and tighter? Obviously, that's not the way to
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go because we got to that 70s and 80s that, you know, winds
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tunnel windswept. In the 70s or 80s, they started
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doing what's called the muscle layer facelift.
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The muscle layer is really a layman's term for something
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called the smash. The smash stands for superficial
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muscular aponeurotic system. It's a, unlike A fascial, it is
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a fascial tissue layer that wraps our whole face 360° on the
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top of our head down to our clavicles.
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And most serves, what they would do when they do that kind of
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face stuff is they would lift the skin there, then they would
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find that smash layer and they would tighten the smash layer.
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So they really made all the tension that's on that layer.
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And then they were, they would still tighten the skin, but they
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didn't have to go as tight on the skin.
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And you know, basically for the next 20-30 years, that's the way
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face lifts were done. And there's many variations.
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Patients on a smash facelift. As that got more popular and
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facelift look better, faces became more and more popular.
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And then we realized this is in the, in the early 2000s, late
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mid to late 90s. There's a couple, there's a
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surgeon who, you know, talked about this, but it really wasn't
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done in between like 2000 and 5:00-ish to 2010 ish.
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We talked about what's called AD plane phase, and then the D
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plane face was predicated on the knowledge that our face, just
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like our shoulders and our elbows and our knees, we have
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ligaments that hold up our faces, OK?
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And these ligaments, right? As we get older, that's what's
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actually satin. So we pull the skin and we pull
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the smash layer. We're basically stretching or
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tethering those ligaments of the face.
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That's what's giving us the lip, these facial retaining
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ligaments. So the idea was if we can
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release these ligaments and restore them, we can get a
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better facelift and it would still look very natural.
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So that's where this deep plane faces came in.
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We realized that coming more forward, lifting the ligaments
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and at first they started doing something called an extended
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smash face, that this was even in the 90s.
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They were going further into the muscle layer and releasing some
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of the ligaments. And that's we had more
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experience with this. Like when I started doing the
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deep plain phases on 2007, we figured out how to release all
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the retaining ligaments to release the cheeks, the jowl
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ligaments and then down in the neck area.
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In doing so, you're treating the problem at the 'cause you're not
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pulling the skin, which then pulls the muscle and pulls the
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ligament. You're not just pulling the
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muscle and pulls the ligaments. We're directly lifting the
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ligaments. And it just makes sense, you
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know, Like from my early days of doing this, it just made sense
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to me. It's like, why?
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You know, why would you do it any other way really?
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You're treating the problem at the cost.
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If the cause is A, then you fix A.
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You don't go from B to A or from C to B to AI.
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Learned a lot from my patients. I was explaining this to a
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patient of mine a week and a half ago and she said, you know,
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that makes sense, Doctor Steiger.
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She goes, it's kind of like if you have a pant that doesn't fit
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you and you put a belt on that pants, right?
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That's like this fast facelift. But the deep plant facelift
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sounds like you're going to the tailor and you're fixing the
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pant to fit you perfectly. I caught this conversation
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probably 10 times a day when I see consultations all year long
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for the last 18 years, and I never put it that way.
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So I thought that was a pretty cool way to put it.
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If you're really like tailoring the pant, you're not just
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putting a patch on it or a belt on it, You're taking the pant
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and you're fitting it to the person.
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So we're bringing the face, the ligaments back to where they
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belong. We're restoring them to the
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original position, shortening them and sewing them back to
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where they belong. And that's the beauty of D plane
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Facebook. And that gives you not just, you
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know, the other thing about facelifts in the past is they've
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never addressed the cheek, the mid face area.
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They really addressed the jowl and they addressed the neck.
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And that could work well, especially for a first time face
11:41
lift. But we've seen these people that
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when people have had multiple facelifts, they're lifting you
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laterally, they keep lifting you more and more laterally.
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And then the cheek falls and this is tight.
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So you get that kind of sweep look that people have, right?
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And it's not a good look. It looks, it's a telltale of a
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face lift. It says you had a face.
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So the beat of the D plane faces is we lift the cheeks up, the
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jowls up in the neck and we're doing this in a vertical vector.
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It's the natural path of the aging.
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When you pull back, you're pulling in a non natural path.
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When you pull vertically, because we don't age laterally,
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we age more vertically, not straight vertically, but more or
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less in a vertical plane or vertical vector.
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So the D plane addresses that issue as well.
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It's amazing for a first time facelift and to me only way to
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do a facelift in general for me, but but to do a second or third
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or face of it's totally safe, it's totally effective and it
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can make it look more natural, right because it addresses your
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mid face as well. The technique has worked
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amazingly well to create that frenzy of people waiting six
12:46
months just to talk to you. Congratulations to you on that.
12:49
That's. Well, the thing about the thing
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about the D plant phase of this, even six years ago, I was kind
12:54
of like the crazy person doing this Facebook.
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There were pockets of us around the country doing it.
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This is pre 2020, pre COVID. Then a lot of people got big on
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Instagram and they started really showing the effects of
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the so it became popular. It became consumers, you know,
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people who are looking for a face that saw what it is.
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You know, I'm very much a word of mouth kind of doctor, like
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people hear about me through other people, not as much
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through social media. You know, I'm not like a big
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social media person, which is just a different venue.
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I'm, I'm kind of busy. I, I really credit social media
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and some of my colleagues. It's such an amazing job
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educating people to the difference.
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And then the consumer started to demand, it's the patient
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starting to demand it. So, you know, it's much harder
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to do. It's much more technical.
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You have to really know what you're doing to do the to do a
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proper deplane thing, not a partial, like a real true full
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release of the ligaments and restoration, which is what the
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definition of a true deep lane face of this.
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People still do partial releases and whatnot, but to do it, you
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have to really know what you're doing.
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You have to really learn about it.
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Understanding the anatomy, the nerves, the muscles, the deep
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tissues, the deep structures of the face.
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It pushed doctors to do that because they're comfortable
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doing it the other way. So I think it's great.
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It's a true power of the people, People understanding and
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learning about things. That's what's special about the
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deep lane face. Do I do a true deep lane face of
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full releases ligaments and restoring them back full mid
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face relief full cheek was for the majority of people.
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We don't live in a world of absolutes.
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There's always unique circumstances that that's what's
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done. As far as face of surgery, at
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this point, there's really nothing better.
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So how many of these facelifts would you say you've done?
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So a question I've probably done over 3000.
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I would say I do about, you know, between 250 to 300 a year.
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You know, so good bit. I do a lot of surgery.
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I operate three days a week. So I've done quite a bit of them
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And and so a lot of experience. I've learned a lot from my
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patients. It's a patient today who came
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in, she goes doc, you must have put like 40-50 stitches in my
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face. I looked at her.
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I go maybe 340 or 350 stitches in your face.
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It's a lot of suturing, it's a lot of work and there's a lot of
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little nuances that you pick up. This will heal better if you do
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it this way. The scar will look better if we
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move it this way. Just fine tunes that come with
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years of experience and managing people so that not only it's an
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amazing result, but they feel quicker and they heal better.
15:17
They can get back to their normal lives faster, and that's
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something that's gotten better with time and with experience.
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So on that topic, something I'm always amazed by, you know,
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we're talking about 350 sutures and a surgery that takes many
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hours, right? Several of my friends have had a
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facelift in your hands and the consensus is that they are not
15:42
in pain afterwards. And this one fact is shocking to
15:48
me because people are afraid of the pain of a facelift.
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So tell me about that. Yeah, people never believe it,
15:56
but faces really are not painful surgeries.
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There are some surgeries that I do that are uncomfortable that
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we give people pain pills for, but faces is not that surgery.
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As a general rule, we don't prescribe like narcotics after
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face of surgery. We use things like Celebrex,
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which is an anti-inflammatory that's safe to take after
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surgery. Tylenol, we like you know, kind
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of Valium, something that calm people down a little bit,
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relieve some tension. It's not a painful surgery.
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Most people would say that it's a little uncomfortable,
16:24
especially the first night we use, you know, when I do a face,
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if I don't use drains, A lot of doctors do use drains.
16:30
I don't use drains. I actually feel that using
16:34
drains is worse for your healing.
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I'm sure I can get a room of five surgeons and we can have an
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argument about that. This is coming from the years of
16:41
experience because I started off using drains and we stopped.
16:44
We do other things like give special medications the way we
16:47
do our bandages. It's all tailored to to kind of
16:50
heal as fast as we can be, not painful, you know, be
16:54
comfortable. So the first night people feel
16:56
tight and uncomfortable in the neck only because there's a
16:59
bandage around you and you swell a lot the first night.
17:01
So generally people use the word uncomfortable.
17:05
The neck feels tight, you know, most people doesn't bother at
17:08
all. Some people, you know, kind of a
17:10
bit more discomfort that's few and far between.
17:12
And then after that it's really just swelling.
17:15
It's the way you look. And I tell people you're going
17:17
to look horrible the first two days.
17:19
Not the first day, it's really the second day.
17:22
That's when swelling peaks. And every day after that, you
17:25
look and feel better and better, better and surprising, you know,
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surprising at a week, really, it's unheard of to have pain.
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In fact, if someone calls us, you know, 5-6 days out of
17:34
surgery, one of the first questions we asked them if
17:36
they're worried about something, are you in pain?
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Because if they're in pain, that's actually more 'cause for
17:41
concern then if something is wrong, like could be, you know,
17:45
whatever it might be. So if there so pain, is that
17:47
unusual? And if someone says, yeah, I'm
17:49
in a lot of pain, come right to the office, we need to take a
17:51
look because that's not a normal.
17:52
That is the exception, not the rule.
17:55
The rule is like you just said, it's just not a painful surgery.
17:58
It really is not. I think that's mostly in your
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hands though, because I will tell you I have friends who've
18:03
had facelifts in other places in the country and by other
18:07
doctors, and they are in pain, right?
18:08
So whatever it is that you're doing, it works.
18:11
And like I said, it makes sense, right?
18:12
All my tailoring, like we spoke about, is focused on that deep
18:16
layer. I'm fixing those ligaments.
18:18
I'm restoring. So there's no pulling, there's
18:20
no tension on the skin, there's no tension on the muscle.
18:23
And that's what hurts. People say I'm worried about the
18:25
pain of a deep plane. Sounds scary, right?
18:27
Deep plane. Whoa, you know, it sounds like a
18:29
big, but reality is when you're doing a smash face up, it's more
18:33
tension, There's more pulling that's more uncomfortable.
18:36
When I did smash face that's I found people to be a lot more
18:38
uncomfortable that we needed narcotics for those surgery with
18:42
a deep lane face up, because you're in the deeper layer,
18:44
you're at the source, you don't have that pain.
18:46
You're right, that's 100% true. I tell people when they come in,
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I'm like, you want to talk about the F word, the facelift.
18:52
People think of it as the F word when they think about the old
18:54
style, the pull, the tight, the pain.
18:56
That is just not the case. And when you're doing the neck,
19:00
you also use that deep plane technique.
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Yeah. So, so when you do a deep plane
19:04
face, like technically that that includes them, we say I call a
19:08
deep plane face slash necklace because the necklace portion
19:11
when we treat the neck, what bothers people about the neck?
19:14
The hanging obviously and the bands that people have, right?
19:18
So the bands is made-up of a muscle called the platysma
19:22
muscle. And when we do the neck, we make
19:24
a small decision under the chin and tighten up the platysma
19:27
muscle. It's called a platysmoplasty.
19:29
So we're tightening out that muscle.
19:30
We're creating this kind of like sling here.
19:33
That muscle is part of that fascial tissue layer, the smash
19:37
layer, actually at the face. So when we come back here and go
19:40
into the smash and then into the deep plane, we're lifting
19:44
everything back. And this sling that this muscle
19:46
creates lifts everything up together.
19:49
We don't age in 2 dimensions. We age in three dimensions,
19:53
number one. Number two, we don't, we're not
19:54
just aging in our like we don't just age in our jowls.
19:57
We don't just age in our neck. It's the cheek jowls and neck
19:59
all that fall together. So the best way to do it is to
20:02
restore aging at its cause at what basically time has done,
20:07
what time is done to your body. And we're lifting all those
20:10
areas back together. We're not doing a partial thing.
20:12
We're lifting everything up together.
20:13
So it always includes your cheek, jowls and neck.
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And the neck is usually what bothers most people.
20:18
Why do you have to do my face lifting?
20:19
The neck bothers me because it all stems from the face.
20:22
The 1st place to fall is your cheeks.
20:25
Then your jowl comes. That's in your early 40s late
20:28
30s people cheeks start to fall. Then as you go into your 40s,
20:32
mid to late 40s and jowl start to sag and the neck starts to
20:35
fall into your 50s and that's progressively worse with time.
20:39
So that's kind of the idea. So the neck comes with it.
20:42
Now you mentioned a deep neck lift.
20:44
It's definitely separate from a deep playing face and neck lift.
20:47
Deep playing face and neck lift is fixing the ligaments.
20:49
But what's been more popular in the past several years is deep
20:54
neck surgery or deep neck contouring is basically where we
20:57
going under that platysma muscle.
21:00
Some people just have bulky necks and sometimes when you do
21:03
facelift, there's these. We have glands on the side of
21:06
our necks. The the Sal is a submandibular
21:08
glands. Salivary glands as we get older
21:11
really start to become tardic. They sag, right?
21:14
That's one thing that happens. The other thing that happens is
21:16
we lose bone along our drawings and some people more than others
21:20
in these situations, we would do a face if then they still have
21:22
some gland, you could still see some fullness there and
21:25
something that's certainly a little bit more higher octane
21:28
for some people who don't like the idea of it.
21:30
Some people like, I love the idea of it.
21:32
We can't take all the glands out.
21:33
You do need some of the glands out safe to take them all out
21:36
either, but we partially remove a trim part of that gland to
21:40
give you a better neck contour. And that's something we call a
21:43
deep neck lift or deep neck contouring that's become, that's
21:47
becoming more popular, that's kind of more cutting edge, if
21:50
you will. When we talk about face of
21:51
surgery and neck surgery, that's like the next.
21:54
This is something, you know, we're always learning.
21:57
We're learning from our patients, we're learning from
21:58
our colleagues, we're learning, you know, from ourselves.
22:01
And this is something that, you know, to me over the past year
22:04
or so, we've been doing this deep neck contouring and about
22:07
2025% of patients now. And it does give a very nice
22:11
result. We were getting amazing results
22:13
before. And this is just that extra
22:14
icing on the cake. And this is only if you need it,
22:16
not ever needs it. And we don't want to do things
22:18
unnecessarily. So when you do something, you do
22:21
it because it's necessary. Yes, absolutely.
22:24
So you're doing faces, noses, eyes, ears.
22:28
I see all the pictures, I see the results.
22:30
It looks amazing. My own husband had surgery with
22:33
you on his eyes and it was so funny because I'm a nervous
22:38
personality. The morning of his surgery, he's
22:40
leaving to go have the surgery with you.
22:42
I said are you nervous? And he said, no, I said, why are
22:45
you not nervous? Because, you know, that's just
22:47
our natural setting. You're, you're leaving for
22:49
surgery. And he said, I'm going to the
22:52
guy who's done this like 10,000 times, why would I be nervous?
22:56
He knows exactly what he's doing.
22:57
And I was like, wow, you know, I wish we could all get into that
23:00
mindset. But he did come home 0 pain.
23:03
I mean, I live with a man, so 0 pain.
23:06
The only thing that was annoying for him was that he couldn't
23:08
wear his contact lenses for a couple days.
23:10
But other than that, zero pain. And he was healed up in just a
23:13
few days. Eyelid surgery is a great
23:15
surgery. I tell people that eyelid
23:17
surgery is the gateway drug to plastic surgery.
23:20
It's relatively a quick surgery. It's a very quick healing.
23:24
We let people go back to full activities once the stitches
23:27
come out and it looks amazing right away.
23:29
There's very little downtime for most eyelid surgery, you know,
23:33
85% of them. And so especially when you just
23:36
do the lower eyes, you just, you know, maybe repositioning the
23:39
fat or moving a little fat, whatever it needs to be done.
23:41
It just a super quick surgery, like immediately, like you wake
23:44
up from surgery, look in the mirror like I can't believe how
23:46
good this looks right away. So I tell people little faces
23:50
aren't that easy. There's a little bit more of a
23:52
recovery time, but that's why we say gateway drug.
23:54
People see think, oh, all classic surgery is this easy.
23:57
I'm going to do, I'm going to do everything right.
23:59
So islet surgery is amazing. I love doing islet surgery for
24:01
that reason. I think it's very gratifying.
24:04
And all some other surgery you can do awake under local, like
24:06
upper eyelids. We do under local anesthesia.
24:08
We don't put people to sleep for that.
24:10
The lowers I usually put people to sleep because I do it through
24:13
the inside of the lid. It's an advanced technique.
24:15
It's a scarless technique. There's no skin incisions.
24:18
So we do it all from the inside and it's awesome.
24:21
I mean, I actually want mine done.
24:23
I need mine done. Maybe I just need some sleep,
24:25
but I I would like my lower eyes done maybe soon.
24:28
Who would you trust to that right to?
24:30
Be determined. So that's right, like you said
24:32
it surgeons are actually probably the most difficult
24:35
because we have our way. We love to do it.
24:37
We feel that our way is the best way.
24:39
And so I, you know, we'll see. So obviously you've reached a
24:45
pinnacle in your career as a trusted surgeon and people are
24:49
seeking out your services all over the country.
24:51
What do you think is coming next in plastic surgery?
24:55
If you were to predict in five years?
24:57
I see you working endlessly. I see you, you know, on
25:00
Saturdays and Sundays, even working with your patients and
25:03
making sure everybody's comfortable.
25:05
What do you see as the next disruptor in facial plastic
25:09
surgery? Or what are your predictions in
25:12
the next 5 years of what's going to happen?
25:14
One thing that's been very popular of late, and I would say
25:18
the past two years or so, you know, we talked about the
25:21
buzzword is regenerative medicine, right?
25:23
Regenerative medicine, if people talk about stem cells or growth
25:27
factors from stem cells like exosomes are different, you
25:31
know, type of fibroblast derived growth factors or fibroblast
25:34
derived stem cells, you know, so the idea of regenerative
25:38
medicine has been around for a while and I think it's getting
25:41
more advanced. We do use exosomes quite a bit.
25:44
We use them with all of our lasers.
25:46
And, and I think, you know, compared to, you know, I've
25:48
tried everything. I've tried PRP, PRP is we took
25:51
your own blood and we tried to purify the growth factors from
25:54
your own blood. And we find that that did not
25:57
work that well. We, we did quite a bit of it.
25:59
I did a study on it years ago and then exosomes came out,
26:02
especially with lasers, we see healing so much quicker and
26:06
better. So regenerative medicine,
26:07
there's something to look out for.
26:08
You got to be careful any types of things new, and it's a great
26:12
buzzword. Regenerative medicine, it sounds
26:14
sexy. It's like we're going to use
26:15
stem cells as a very sexy word as well.
26:18
But unfortunately, you got to kind of separate the wheat from
26:20
the chaff and see what it's good for and what it's not.
26:23
But that's what we're figuring out now.
26:25
I could tell you that exosomes, for example, were very expensive
26:28
in the beginning. It's not inexpensive now, but it
26:31
was very expensive early on. I had some patients who were
26:33
like, listen, I want these exosomes.
26:35
One patient specifically says she want, she demanded the
26:37
exosomes. I was like, I'll get them for
26:38
you. And you know, I think it was it
26:40
was very I I forgot a few $1000 for one little thing.
26:44
I use it on her for her laser. And then after her facelift, the
26:47
days, then I said, gosh, it looks really good for eight
26:49
days. I looked at my laser settings
26:51
like, yeah, it's typical laser. So for the next about 6 to 8
26:56
months, we we offered as an option for people and I would
26:59
say the quarter of the people took it up and we look back and
27:02
saw that the people who did it definitely got much quicker
27:06
healing and then actually look at the results if they were
27:08
better. But healing wise, we saw a huge
27:11
difference. After eight months, we were able
27:13
to buy it in huge bulk and prices came down.
27:16
It became more popular and we do it on all of our lasers unless
27:18
someone doesn't want it for some reason.
27:20
We do all of our lasers reasons, exercise and that's just helping
27:23
people heal quicker, heal better, maybe get better results
27:26
as well. So I think that's something to
27:28
lookout for. I think also you have to lookout
27:30
for the hocus pocus, the snake oil type part of it.
27:33
I'm very, I like to, as you know, keep it real.
27:36
I don't believe in the BS of it. There's a lot, unfortunately out
27:39
there because, you know, cosmetic surgery and cosmetic
27:43
procedures and cosmetics have been around since before
27:46
Cleopatra, right? So there's all kinds of, you
27:48
know, things out there. My job is to kind of help people
27:51
navigate the waters of what it is.
27:53
You can read about a million things and you can convince
27:56
yourself, I need this. I'm like, well, why do you think
27:58
you need it? Because I read this, this, and
27:59
this, you know, and my job is to help people separate that.
28:03
And I take that very seriously. Overall, I think regenerative
28:06
medicine is something to certainly look out for, but
28:09
research is getting better and better, and we've been doing
28:11
supplements with surgery like bromelain or arnica.
28:14
There are certain things that may or may not help with getting
28:17
people optimized for healing with nutrition is something that
28:21
we talked about with our patients.
28:23
These tweaks can not only make our results maybe better, but
28:26
also make people heal better and quicker so they don't have to
28:29
take as much time off or they don't have as much downtime in
28:31
their life, which is great. That's one thing that's pretty
28:34
important, something to look out for now and within the next five
28:38
years. I'm glad you brought up
28:40
exosomes. The last time I was at your
28:42
office, which was probably only a couple of weeks ago, I heard
28:46
we need the exosomes in room 3. We need the exosomes in room 1.
28:49
And I was like, wow, they really are diving into that.
28:52
So I'm glad that we're having the chance to talk about it.
28:55
Exosomes are everywhere from in the clinic, like what you're
28:58
doing to buying it on the shelves.
29:01
And they're telling us to put it on our skin and it's going to be
29:03
better. So there's all kinds of opinions
29:05
out there. I think just like the weight
29:07
loss medications that made a, I feel like we're going to learn
29:11
more about exosomes or we're going to understand where
29:14
they're really are. Are they helping us if we're
29:16
using it at home? Do you use any that you send
29:18
patients home with at all? Yeah, we do have a product that
29:21
we send people home with. The way I do it, I use exosomes
29:24
with all my my ablative laser procedures.
29:27
So an ablative laser, the lasers, it's actually like
29:29
ablating the skin and peeling or like drilling a hole.
29:32
Let's call it the skin, right? Going to the deeper layers of
29:35
skin and creating a peel the superficial skin and creating a
29:39
in response to the deeper skin, you're creating a peel using
29:42
heat and laser wavelengths in order to peel the skin.
29:46
So when you put exosomes and we use very strong and different
29:50
concentrations you can get of exosomes.
29:52
And so we're using the most concentrated version of exosomes
29:54
and we're playing it right when I'm like literally I put it on
29:57
myself, on the patient, right when I'm done with the laser,
30:00
the first thing I do, those channels are open, right?
30:02
The deep channels into the skin are open.
30:04
So we're laying those exosomes. Exosomes are basically growth
30:08
factors. They're not the so that's the
30:10
misconception. People say, oh, I'm putting stem
30:12
cells on your face. You're not putting stem cells on
30:14
someone's face. You're putting the medium that
30:17
the stem cells basically extract or excrete.
30:20
So it's basically that milieu, that environment around.
30:23
So the signals, basically you're adding these signals to your
30:26
body saying, hey, heal, you know, heal better, stimulate the
30:30
lasers doing that the effect, right.
30:33
And then this is kind of saying, OK, now heal better or bring in
30:37
those cells that'll heal this quicker or better.
30:39
And that's kind of the cytokines the all the signaling pathway.
30:42
So it's basically supercharging your healing pathway.
30:46
That's the theory behind why it's working in those areas.
30:50
I have, I've only tried the at home but I'm excited to see so
30:53
maybe next time we do a CO2 I'll try the exosomes with you.
30:57
Yeah, it works great at home. We put them on a week after
31:00
surgery. We have people use an at home
31:02
type product before we have very concentrated ones for in the
31:06
operating room which comes sterile and and that one we also
31:10
saw a difference between you know the healing.
31:12
So again, we're we always are fine tuning things to get people
31:17
better results, quicker healing and we want to make sure it's
31:20
it's effective. We don't want to do something
31:22
unless it's absolutely necessary.
31:23
Yeah, absolutely. So when talking to the audience
31:27
out there, those who are afraid of surgery, one of the things
31:30
Doctor Byrne said to us the other day, that sweet spot age
31:34
right now for the facelift, the most common age right now is 54,
31:38
right? So just happens I'm 54 so you
31:41
know. But a sweet spot age.
31:43
I could tell you when I started 2000 and seven 2008, I was
31:46
seeing mainly mid 60s to 70 was the age and that's gotten much
31:52
lower with time because I think the word is out.
31:56
People want faceless, but it's not the F word anymore.
31:59
Social media, people's friends are doing it and you know, we're
32:03
seeing people in their 40s do faces. 50s is, I think 50s is
32:07
the sweet spot. Early 50s, perimenopausal,
32:10
menopausal time is when a woman just goes through.
32:12
When we talk about women now, men do Facelets as well.
32:16
I will tell you about 20 to 25% of my business is male facelift.
32:20
So that's something we do every single week here.
32:23
As far as women, around the time of menopause is when women
32:26
really notice things changing. Laxity of the ligaments gets
32:30
more extreme, if you will. And women a lot of times will
32:33
tell me, gosh, I feel like during menopause, I aged, you
32:37
know, five years and three months and it's all those skin
32:40
changes, ligament changes, muscle changes.
32:42
When that's usually in the 50 to 55 age group.
32:46
There are acceptance. I have colleagues, you know,
32:48
that are doing facelifts and that people in their 30s.
32:51
I am not that person. I believe you do a face when
32:54
it's necessary. I don't believe in preventative
32:56
surgery. I think I've done young
32:58
facelifts, but it was people with premature aging for various
33:01
reasons. But that's few and far between.
33:04
We do have patients call the office about women in their 30s
33:07
wanting facelifts. Our staff, our front desk, our
33:10
concierge will tell them that you're welcome to come for a
33:12
console. Doctor Steiger very rarely will
33:14
do facelifts on someone that young because he just doesn't
33:18
believe in it. And it's true because I believe
33:19
in treating the problem at the cost.
33:22
Remember we talked about the ligaments were falling.
33:24
Your ligaments really haven't fallen enough in your 30s to
33:28
warrant surgery. So I would say 45, you know,
33:33
sometimes, but 50 plus is kind of the most common.
33:37
And I think that the fear becomes less listening to you
33:41
talk or seeing the results. But you're right.
33:43
I'm seeing a trend on social media, this thing called
33:45
ponytail lift. And these women are like 30-5
33:49
years old or even younger and showing this lift where they
33:53
lift up their eyes or whatnot. So, you know, God bless them and
33:56
you know, if they want to die into surgery at that age.
33:58
But it does seem early to start. It's early, you know, like I
34:02
said, it's about, you know, is that a long lasting effective
34:05
way to do surgery? Part of it goes to what we
34:07
talked about very early, people having what they call filler
34:10
fatigue. They're sick of fillers, worried
34:12
about fillers because they've seen bad things from fillers.
34:15
That doesn't mean that fillers are bad.
34:17
Fillers are not bad. Fillers are great in the right
34:19
person, in the right time for the right reason.
34:22
So, you know, everything is putting the puzzle together the
34:25
right way, understanding the aging process, understanding
34:28
what's happening, You know, ponytail, there's all kinds of
34:31
buzzwords and something that sounds sexy to people and that's
34:34
more marketing. Let's not true procedure, but
34:37
yeah, we do see that. I always tell people I treat you
34:40
like I would treat my own wife or my own family member.
34:43
I will tell you what I would have done to me if I was in your
34:45
shoes. I would do it.
34:46
Then I'll tell you not to do it. That's just the golden rule.
34:48
Treat others as you would want to be treated.
34:51
So just in closing, one last question.
34:54
As an expert facial plastic surgeon, I know you do utilize a
34:59
few devices in the office. What are your favorite?
35:03
What do you think works doesn't work and we'd love your expert
35:06
opinion on that as we close. OK, well that's what the SO
35:10
devices for us, devices that help us in surgery like tools we
35:13
use. Oh no.
35:14
I think it's anti aping like the energy based devices or yes.
35:19
There's a lot of devices out there.
35:20
We love you do surgery for the right reason, you do fillers for
35:23
the Razor, and we love our CO2 laser.
35:26
We love our lighter lasers as well.
35:28
We have devices like soft wave and soft wave is ultrasound
35:32
based technology, you know, not analogous to what all therapy, a
35:37
little bit different technologically the way it
35:40
works. So we like software for the
35:41
right people. We actually like all therapy for
35:43
the right person as well. It really is about tailoring the
35:47
treatment. These are tools.
35:48
It's like telling me, hey, you give me a knife, OK, I can do a
35:52
face lift on you, I can do your eyes, or I could do a nose job
35:55
on you. You give a knife to the surgeon
35:57
across the street, he'll take a gallbladder out with it.
35:59
It's a tool. It's a means to an end, right?
36:02
So you need to use that tool the right way, the right method.
36:05
It gives us optionality. So I love like you mentioned, 30
36:09
year old, like the 5060 year olds, you know, some of these
36:14
devices don't work as they work. They don't work as well on
36:17
they're not there may be a single or double in that age
36:20
group because they need something a little bit more
36:22
powerful. But in the 30s, that's a home
36:24
run for a lot of people, you know.
36:26
So I love these devices like that.
36:28
The consumer and the industry is pushing harder and harder to get
36:31
better technology in our hands. Every company knows I'm a buyer
36:35
of good technology, but it's got to work.
36:37
You know, that's what happened when old therapy first came out.
36:40
They told me it could lift my brows.
36:42
I was always followed by my brows.
36:43
So I told the Rep, do my brows, if it works, I'll buy the
36:46
machine. She goes, well, it takes three
36:48
months. I'm like, OK, I'll have to wait
36:49
three months. So she did the procedure on me
36:51
and then three months later she called me.
36:52
She goes, hey Steiger, she goes, what's with your brows?
36:55
And I said, I looked at them and I said, you know, I didn't even
36:57
fiddle with my brows. I was like, wow, it works.
36:59
So I said I was the most expensive therapy.
37:02
I think my old therapy broth cost me $150,000 for my free
37:06
treatment that they gave me. But it worked well and so I
37:09
bought it. I'm very much into, like I
37:11
mentioned, always separating the wheat from the chat, you know
37:13
what's good and then using it for the right person.
37:15
And so we're very honest about it too.
37:18
Like we don't promise a facelift with what software.
37:21
It gives nice results, it gives beautiful results, but it's not
37:24
a facelift. So people need to understand
37:26
that we don't have that yet. Maybe 10 years or maybe we'll
37:30
have machines that can target the ligament.
37:32
We'll see. We're working on stuff.
37:34
I can tell you I'm always doing new things with different parts.
37:37
We have different aesthetic things that bother people and
37:40
we're working on different types of of non surgical things to
37:43
help with that as well. So, so it's exciting and there's
37:46
a lot of demand for this. We have a lot of people willing
37:49
to help us, help them get better if you will.
37:51
So they're willing to try, you know, devices, these machines,
37:55
and like I said earlier, like this is a learning process.
37:58
I, I still use devices that I used 20 years ago and not all of
38:02
them, most, most of them not, but some of them, like the
38:04
fractionate CO2 laser, I've had different lasers that try to
38:07
supplant that. Nothing's been better through
38:09
the years, but newer technology comes out that phases out other
38:12
things and that's more common. So that's as far as that.
38:17
And then, you know, if you want to talk about any other devices,
38:20
you know, we have devices that help us with procedures and
38:23
tools like with nose jobs, for example.
38:25
We're not breaking the bones like we used to be in the old
38:28
days with in many patients, we can use ultrasound waves,
38:31
ultrasonic rhinoplasty they call it, but it's really using a
38:34
device called the Piezotome, which uses ultrasound to cut the
38:38
bone. I have a video of this online
38:40
somewhere where I do it on an egg and it cuts away the egg
38:42
shell and leaves the membrane underneath totally intact.
38:45
So this is a device, we're using rhinoplasty, and it allows us
38:48
less bruising, less discomfort, getting people healed quicker,
38:53
healed better. People call the office and say I
38:55
want the ultrasonic like it's some kind of procedure.
38:58
The ultrasonic rhinoplasty is a tool that I use.
39:01
So it's still more important who the surgeon is.
39:04
The fact that they use it can help people heal better and
39:06
quicker. But first and foremost, who's
39:09
doing it, how they're doing it? And then it doesn't always
39:12
automatically make average surgeon an amazing surgeon,
39:15
right? It helps people get quicker,
39:18
feeling better results, more reliable results.
39:21
Well, I know that we can count on you to stay on the cutting
39:24
edge of anything that's new. I love that you don't head first
39:28
into exosomes and all of these new tools and you have other
39:31
equipment there. Not everybody that comes into
39:34
Steiger's office is getting surgery.
39:36
You are super honest with people and tell them what they need,
39:38
what they don't need, and what works for them.
39:40
I've watched it for many years. So excited that you took some
39:43
time to join us today. Thank you so much for taking the
39:46
time. I'm sure you're tired, been
39:48
hungry and been operating all day.
39:50
Thank you so much for joining us and we hope to have you back
39:52
again in the future. When something new comes on the
39:55
scene, we'll reach out to have you back on.
39:57
Awesome. Thanks for having me, I
39:59
appreciate it. I'll see you soon.
40:01
Absolutely. Thanks so much.
40:03
Doctor Randy Boyett holds a PhD and is a recognized leader in
40:06
the aesthetics and medical industry.
40:08
She is not a licensed medical doctor.
40:11
All commentary and product recommendations are based on
40:14
industry expertise and are provided for informational
40:17
purposes only.