March 16, 2026 • 22 mins
The doctors are back for a bonus episode with everything you need to know about Botox, Butt Lifts, and Nose jobs.
They talk about the safest beauty fix, and the one Dr. Schwartz refuses to do!
See omnystudio.com/listener for privacy information.
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Episode Transcript
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Speaker 1 (00:05):
So this is between us with me and doctor Robert
Schwartz best boobs in Dallas. Heather debro is doing is
off doing things with conflict and resolution. I think somewhere
with us, maybe some housewives or two. And I've got
my best friend, my favorite genius, doctor Robert Schwartz, ports
(00:27):
curified plastic surgeon from Dallas, and we're doing a bonus episode.
Speaker 2 (00:30):
We're gonna answer some banned questions.
Speaker 1 (00:32):
Okay, and let's uh, let's go through these pretty quickly
and give some really fun, interesting take home message answers. Okay,
fan question everyone, I have a dv AD sceptum.
Speaker 2 (00:44):
What do I dot plastic?
Speaker 1 (00:48):
Well, it depends you go to a doctor plastic surgeon
or your no's threats. I have a dv accept they go, great,
lie down here, let me cut you open. I mean
it depends. What does that mean to have a deva septum?
If your DVAN septum is causing significant airway obstruction?
Speaker 2 (01:02):
Okay?
Speaker 1 (01:03):
But if everybody has a devaated septum and it's like
a spine, does anybody really have a straight spine?
Speaker 2 (01:10):
Okay?
Speaker 1 (01:10):
I think if you did a cat scam on one
thousand people with no airway obstruction. Nine hundred and eighty
eight of them would have some deviation of their septum.
Speaker 2 (01:19):
So a deviated septum in.
Speaker 1 (01:20):
And of itself is not necessarily an anatomic geometric structure.
It really is what is it doing to you functionally,
So it depends, you know, go to a doctor.
Speaker 3 (01:29):
Usually or potentially cosmatically. Yeah, it may be causing a
visible outward curve of the nose, and so there's fixes
for that. Yeah, So in and of itself, it doesn't
necessarily mean anything. But I'm assuming that anyone's saying that
didn't just I don't know, take photos of their own
septum and just some they've had some symptom from that.
Speaker 1 (01:48):
Well, in the past, it was the way the plastic
surgeon could get it paid for by insurance calling it deviated.
Speaker 2 (01:55):
And then those days are long gone, yes, and now.
Speaker 1 (01:57):
People are very helpy to discuss their plastic surgery. But
it was a way that you could justify to your
friends having your rhinoplasty. Oh, my nose looks completely different
because I had a deviated septem while I was there.
Speaker 2 (02:09):
I had them take a little bit of the bump off.
Speaker 3 (02:12):
Right, Yeah, all right, yeah, those days are over.
Speaker 2 (02:16):
I know number two.
Speaker 1 (02:17):
I've been getting filler for years and now my face
looks puffy. Ah, what's happening under the skin? Do you
want to grab that one?
Speaker 3 (02:26):
Well, there's a number of things that could be happening
under the skin. The first is that depending on what
the filler is and how much has been put in,
it's not always going away, right, and so it can
build up over time. And I think I think people
talk about filler migrating. I think that's less of a
thing that it is claimed. I don't think it's that
(02:47):
easy for it to move around. But I think giant
globs of it can certainly deform your face after a while, right,
And probably large amounts of it caused some inflammatory processes
under there. Some of them are tended to do that.
Sculptra radys, those are intended to cause inflammation, right. But
so it can make changes over time.
Speaker 2 (03:06):
Very important points.
Speaker 1 (03:07):
So if your doctor goes, don't worry about it, but
put filler in.
Speaker 2 (03:11):
It all dissolves.
Speaker 1 (03:12):
Even if it's hyaluronic acid, it may not dissolve and
probably won't, And recent studies based on mmerise have shown
it probably hangs and then it attracts a lot of
water and then it can cause scarring and just as
you said, the inflammatory reaction. So your face is puffy
because you may have had too much filler, and I
would immediately less is more, and immediately if it's looking puffy,
(03:35):
go get some hyluron a dase, which is an enzyme
that dissolves it.
Speaker 2 (03:38):
Okay, I'm twenty you had.
Speaker 3 (03:40):
A hyaluronic acid filler in the first place.
Speaker 2 (03:42):
That's true. I'm twenty eight.
Speaker 1 (03:44):
Starting to see early Choweli, Am I too young to
do anything about that.
Speaker 2 (03:49):
We're seeing a lot of that.
Speaker 1 (03:50):
People wanting to come in now with the early face,
wanting early facelif surgery is everything else that you like
to tell your patients maybe to consider before a facelift
for jewling.
Speaker 3 (04:01):
I well, I would generally on someone that young, I'm
not sure that it's even aging at that point. I
think it's just your facial anatomy. And I've had a
lot of success with those things. Again, well, using filler basically,
and basically I inject some filler in front of the jaw,
a little bit behind it. It smoothed out the jow.
It essentially makes it invisible. But I think at that age,
(04:22):
unless there's something strange going on, a facelift is vastly
overkill for this.
Speaker 1 (04:27):
Yeah, twenty eight early jelling. You may just have gained
a little weight, you know, and so you might or
lost a little weight or something.
Speaker 2 (04:34):
But Mike, but I don't think the face.
Speaker 3 (04:36):
Off is the plus estata nindage yourself. Yeah, you're twenty eight.
You probably look great.
Speaker 2 (04:41):
You're not having a face ok.
Speaker 1 (04:42):
Okay, I want to breast dougmentation, but I'm scared about
what they'll look like when I'm older. Should I be
answer I think is yes, But it depends, right, You
should always be scared about any plastics or procedures going
to look like when you're older.
Speaker 2 (04:56):
Having said that, probably.
Speaker 3 (04:58):
You should just be scared of what you're look like
when you're older. Now that I'm old, if I had
known it was going to be this, I would have
been terrified a lot. There's nothing good happening.
Speaker 1 (05:10):
No, But I think, what do you think the average
age for rob What do you think the average age
for a faith a breast domentation is.
Speaker 3 (05:16):
In my practice probably thirties.
Speaker 2 (05:19):
Yeah, so I think thirty mid.
Speaker 3 (05:20):
Forties or so. But I mean all over the place.
Speaker 1 (05:22):
Yeah, so twenty eight you should be worried and that
you shouldn't go too big. Don't push the envelope too much.
Because of your twenty eight the chance that you're going
to want to have children is probably high. And then
if you go very big and then have children with
all the concomitants weight gain on top of that, then
it's going to stretch out your skinny more skin even more.
(05:44):
And then after the first child, you're not only going
to need a downsize, but you're probably going to need
an early lift, which you absolutely want to avoid because
of the scarring is associated with lyft. So I think
less is better when it comes to a breast dogment.
What do you think that the average size and ccs
you're seeing you're putting in people today around age thirty.
Speaker 3 (06:04):
In the range of about in the range of the
upper three.
Speaker 2 (06:06):
Hundreds lower four hum, What was it twenty years ago?
For me? It was four fifty to five fifty. It's
gotten smaller.
Speaker 3 (06:13):
Do you think it was this? I think it was
the same for me.
Speaker 1 (06:16):
Honest, even in Dallas where everything is bigger, best boobs.
Speaker 3 (06:22):
I've never been the guy for that. Now if I
have someone who comes in. I have a very elaborate
consultation process to figure out what size put in. But
I've never firs thought. I've never been the guy that
pushes them to go bigger.
Speaker 2 (06:35):
Either, and everything very common.
Speaker 3 (06:39):
In fact, I remember you and I sitting in a
meeting once at more than once probably where some guy
up on the stage goes, you know, whatever your patient
tells they want put in two sizes bigger. It's this
patronizing Oh the little lady doesn't know what she really means, right,
And I remember turning to him going, did he just
really say that in public?
Speaker 2 (06:58):
It's amazing, isn't it?
Speaker 3 (07:00):
It really is. So Look, I think you have a
finite amount of real estate on your chest, and if
you if you push over this, then you're just more
likely to have problems.
Speaker 1 (07:15):
Okay, what do you tell patients how long implants should last?
I remember the old days, and a lot of them
still think, oh, at ten years, I'm supposed to change
them out.
Speaker 2 (07:23):
What do you tell your patients?
Speaker 3 (07:24):
I don't tell them that anymore. I tell them, you know,
for a long time I was telling them expect that
they're going they're going to need to be changed at
some point because they league right, you know, and historic
they've been telling patients to expect tens or twenty years.
I actually think it's a little longer than that with
modern implants. So I'm closer like twelve to twenty five
or so.
Speaker 1 (07:50):
Okay, I'm forty one. I've never done botox. I think
I'm ready to try, but I'm worried. It literally says
toxin in the name of it. I'm trying not to
put toxins in my body.
Speaker 2 (08:00):
I not.
Speaker 1 (08:00):
Are there long term effects from botox? Is is it
toxic for you?
Speaker 2 (08:07):
Well?
Speaker 3 (08:07):
I mean we've been doing botox now for over twenty
five years in the society, and large amounts, so you
should all be dead. I agree, I think I think. Look,
everything is a toxin. It's all question of dosages, right, So,
you know, on the one of the saddest things you
see in an er is people who swallow a bottle
of thailanol in a suicide gesture, only to find out
(08:29):
that not only are you going to die, there's pretty
much nothing short of a liver transplant that's going to
prevent that. It's the dose, and so the amount of
dosage that you're putting in with botox is not going
to harm you unless injected in some bizarre, irrational way.
Speaker 1 (08:46):
I think botox is one of the most benign things
that a plastic surgeon or dermatologist does, and that you
almost I think it looks weird when you put too
much in, particularly.
Speaker 2 (08:55):
For a guy.
Speaker 1 (08:56):
You should have lines. Don't go for the bowling ball
head with the shiny head. But uh, I think botox
is extraordinarily safe. I will tell you that the only
problem I've had on boat with botox, and I've had
a lot of botox in my life, is that they
don't work on me anymore because I've formed antibodies to botox.
So unless I use Daxify, which is like fifth generation botox,
(09:19):
it doesn't work at all. And even Daxify doesn't really
work very well for very long on me.
Speaker 3 (09:24):
So yes, that's also getting older. Nothing everything works less.
Speaker 2 (09:29):
Yeah, that's true.
Speaker 1 (09:30):
Okay, my under eye bags make me look exhausted even
when I'm not What are my options under eye bags? Boy,
that's that's a two hour podcast right there. How can
you sort of, you know, summarize that with a couple
of sentences.
Speaker 3 (09:45):
Well, under eye aging is a very complicated Yeah, it's
very complicated anatomy and it requires a very careful diagnosis
because sometimes the problem isn't even the eyelids, it's the
upper cheeks yeap. Sometimes it's the hollow between the cheeks,
the island that makes the islands of baggie. Sometimes it's
true fat coming out of your eye sockets and yep retruding.
(10:07):
It's so the the answer could be as simple as
some filler, right. It might even be just some skin gear.
Sometimes it's literally a mid facelift to shorten the height
of the lower lids, and sometimes it's a traditional leproplasty
to tighten the skin.
Speaker 1 (10:22):
So it's so it's very individualized. It's very hard to
answer this with a simple answer. But I would say,
you know, filler in the lower iselid areas become a
lot less popular these days because of a lot of
the complications that people have realized. So if you're gonna
have we use this word we like to use called judicious.
(10:43):
If you're gonna have filler put in your lower eyelids,
have the surgeon or dermatologists do it judiciously. Less is better,
And if you got very deep hollows with very significant
pillowing in your lower eyelids. Don't maybe try to even
all that out with a lot of filler, and I can't.
Speaker 2 (11:01):
You can't. It doesn't work.
Speaker 1 (11:03):
Work, It's not gonna work, and then it's going to
cause scar you know, it can cause scarring or nodularity
and be a real problem that we've that Paul and
I have been seeing on botch So be careful with
the filler, all right. How do I know if my
surgeon is actually good or just good? At Instagram? I
think they're all good at Instagram. Okay, So instagramming in
and of itself doesn't mean deadly. Unfortunately, we're all sort
(11:25):
of influenced by Instagram because I'm like a thirteen year old.
I sproll all day long, like a mindless idiot looking
at cats. And I know I'm embarrassing.
Speaker 2 (11:40):
I mean, I know.
Speaker 3 (11:41):
It's you know where this takes me mentally?
Speaker 2 (11:43):
Yeah, I know, you know it takes me. Yeah, So
you know you look at.
Speaker 3 (11:47):
My inside at some point on this podcast, Yeah I will.
Speaker 1 (11:51):
Well, let's let's hold that for another time. But I
think Instagram, you know, is it's just the new way
to advertise your practice. You're putting your very best pictures
and what I really, by the way.
Speaker 3 (12:04):
Thinks about things about an education meeting.
Speaker 1 (12:07):
Yeah, I try not to get bugged by the plastic
surgeon sitting there in his scrubs and somebody goes.
Speaker 2 (12:14):
Hey, doctor so and so, rate this from what zero
to ten?
Speaker 1 (12:19):
That really bugs me, as if as if you can
rate it, you know, for all patients based on one
individual rating system. It's so ridiculous, you know, uh Blaffer
plus it's a six. Oh, breast augmentation, that's a nine. Well,
he's a breast of augmentation. Doctor, deep plane facelift, Oh
that's a two. Oh, you don't do deep playing, you know.
(12:39):
It's that those things take those all with a big
giant grain of salt.
Speaker 3 (12:45):
You know what, maybe actually avoid those surgeons because you
know what, it's unsurgeon like. It just is. You know,
perhaps if your surgeon does reels where he does choreograph
dance free teams with his nurses, maybe that's not a
serious enough person to be doing your surgery.
Speaker 2 (13:04):
He has a little too much free time, right, because.
Speaker 3 (13:07):
We're little too much free time.
Speaker 1 (13:09):
What is the one thing you wish every patient knew
before they walked into your office? For me, how incredibly
good looking and tall. I actually am no kidding you
know what.
Speaker 3 (13:24):
I wish that too, if they'd walk in there knowing
how incredibly tall and good looking you are. That's what
I often think. I go. Have I ever told you
about my friend Harry Debro You may know him from Bosch,
but he's also incredibly tall.
Speaker 2 (13:37):
And good despite what you see on TV face for rad.
Speaker 3 (13:41):
You're tall and very and very very good looking.
Speaker 1 (13:44):
So I think for me, I used to rue the
day that the patients would come to ARM with Google
Search knowledge, right.
Speaker 2 (13:52):
I hated that.
Speaker 1 (13:53):
I actually wish they would look at chat chept and
ask Chatchept some preliminary question because I think Chat CVT
or any of the other language learning models and thrawpicked,
Gemini and Blabba Perplection whatever not.
Speaker 2 (14:07):
Grock, Croc sarcastic.
Speaker 1 (14:09):
I love gro but it is actually very good at
giving you sort of a general informational you know, sort
of syllabus primer before you come in. I think they
I wish they knew a little bit of what Rock
or one of the other lmms is going to tell you.
Speaker 2 (14:27):
What do you what would you say?
Speaker 1 (14:28):
I don't know that I haven't How about you get
what you pay for if the plastic surgeon's too inexpensive.
Speaker 3 (14:33):
Yeah, I think, I guess, I guess along those lines,
I would wish that they would understand that when you're purchasing,
you know, whatever it is, let's say, a breast augmentation,
are facelift or whatever. It's not like you're buying a buick.
There's no such thing as a breast augmentation. It is
a rough categorization of techniques that will be done differently
(14:57):
by any surgeon that you see. And so it it's
not like going and buying a Toyota at one dealership
or the same cart another dealership. There's no way you're
getting the same thing. And so you need to form
that connection with the surgeon and the consultation you make.
You need to make sure they understand you very clearly
and have a clear target of what it is that
(15:18):
you want, and that you get a sense in your
gut that okay, we've got to figure because if you don't,
don't do it right.
Speaker 1 (15:33):
Yeah, I had a baby a year ago. My body
just doesn't feel like mine anymore. What is a mommy
make over? And is it worth it?
Speaker 2 (15:40):
What do you I mean?
Speaker 1 (15:41):
Let's say mommy makeover is typically something with the breast,
something with the tummy. It's usually either breast dougmentation plus
or minus lyft or at least a lyft and a
tummy tuck right usually suction and or a LiPo section,
which is often part and parcel of a dominoplasty.
Speaker 2 (15:58):
A tummy tuck operation.
Speaker 1 (16:00):
Yeah, I think that is one of the most worth
it procedures, depending on where you are in your stage
of life and depending what weight you're at. Okay, because
if you still really haven't lost a lot of the
baby weight, even though you may really want a mommy makeover,
you know, maybe go on a GLP one and get
get your weight down because you'll get much better results
(16:21):
closer to you, more idealized BMI, but above you know.
But I think mommy makeovers, generally speaking, are extraordinarily. We
were going to do a segment on the podcast that
we did previously about operations that are almost always worth it.
I think this is one that's almost always worth it.
Speaker 2 (16:38):
Do you agree?
Speaker 3 (16:38):
Yeah? And I think this warrant's talking about in more
detail in the future because I think what women go
through following pregnancy, there is no equivalent from them where
you start off and you have your girlish body, your
youthful body, and in the span of like a year,
it's completely transformed. Yeah, you know, we you know, we
(16:59):
lose our hair over decades. It's for a man, it's
like waking up one you know, going to bed with
the full head of hair and waking up bald in
the morning.
Speaker 2 (17:06):
It's shocking.
Speaker 1 (17:07):
What is the one thing people spend money on that
you think is completely worth it and sort of in
the same vein, and one thing that's totally overhyped? Oh
with this is a whole another two hour podcast, But
what what I think?
Speaker 2 (17:21):
Again?
Speaker 1 (17:21):
I think the Mommy makeover is completely worth it if
you're doing at the right stage of your life and
you're healthy, and you're at your pretty close to your
ideal body. Way, would you agree the Bomby makeover is brilliant?
Speaker 3 (17:32):
Right? I think the Mommy Makeover totally delivers. I think modestly,
I think, you know, on a much simpler level, breast
implants totally deliver.
Speaker 2 (17:39):
Yeah, I would agree with that.
Speaker 3 (17:40):
I think they totally deliver. Right.
Speaker 1 (17:42):
In the future, we have talked about the new kind
of breast implants and what you think about them, those
motivas because at lower rate of caps or contractor. But anyway,
and the one thing that's totally overhyped, boy, you could
you could separate that into surgical and non surgical categories.
Speaker 2 (17:57):
But the nons. It's funny.
Speaker 1 (17:58):
Even though the future UH of plastic surgery will be
non surgical energy delivery devices to tighten the skin, it's
kind of shameful. Knock, it's still not it's I think
that's the most overhyped come in I have. I just
bought spent this one hundred and seventy five thousand dollars
on this device, and I need to get my return
on investment, and it causes so much tightening without a scalpel.
Speaker 2 (18:21):
Its over hype. Would you agree with.
Speaker 3 (18:23):
That the laser Chotski djure is the most over hype thing.
It's like going back to we need to talk about
this sometimes. The first laser thing we went to together
in like the ninety end light see end light, save
that the stone light makes new collagen in your skin,
as has every bullshit device since then. If an aggregate
(18:48):
of one pound of collagen has been made worldwide, I'd.
Speaker 2 (18:52):
Be amazed by the way it was. The world's most
expensive flashlight. If that it absolute?
Speaker 1 (18:59):
In fact, you want to hear something pathetic, that's true.
The only thing I ever saw it do plus or
minus is caused some mild hyper pigmentation. It never caused
any significant tightening.
Speaker 3 (19:11):
I think it did have one benefit. I think it
really started to hone your acting skills. Walking in, they're going,
oh my god, look at you.
Speaker 2 (19:19):
This is the greatest thing ever. Right, Okay?
Speaker 1 (19:23):
And then finally, is there anything you simply won't do
a procedure you turn patients away for you know what
it is for me, right, I will not do a
Brazilian butt lift. I just don't think something that has
a risk of fatality to it for me. Okay that
even if, even if we've learned how to do it
much more favorably with a much lower risk of fatality,
(19:46):
it's just too bloody scary, you know, as a medical
legal guy who does a lot of this in a career,
to certified expert a California medical cort, I'm still seeing
and you're still seeing in the media, you know, fatalities
from the Brazilian butt lift.
Speaker 2 (19:59):
I won't touch it. I just won't. What about you?
Speaker 3 (20:03):
There are a number of things that I won't do,
and one of them has nothing to do with the
procedure itself. I don't do rhinoplastic, Okay. Reason I don't
do rhinoplast I think rhinoplasty is I don't think there's
anything wrong with the procedure. I don't do them because
I think, even in the best hands, it's an operation
that has too much unpredictability in the healing, at least
(20:26):
for me. Yeah, I want to do things where I know,
if I'm aiming for this, I might go to this,
or I might go to this. But the problem with
rhinoplasty is very often what you're trying to do is
change things by millimeters because you're dealing with the way
the body heals, an unpredictable skin tightening and unpredictable amounts
(20:46):
of scarr and all these things. Small changes, small variabilities
in the result are the difference, especially on the nose,
between a great result and one that never quite looks right.
And even in guys I know, look, I trained, you
know some of the best rhino blastis in the world, Okay,
(21:08):
and at ut Southwestern, even in their hands, there's a
an unacceptable degree of unpredictability for my taste. I don't
I just don't want to do procedures like right.
Speaker 1 (21:20):
Two millimeters of difference in nipple height. You can't see it, okay,
you can't even really measure matter, but two millimeters. We
used to have this expression, right, because we love these
sort of coined expressions in plast Thirty millimeters are miles
when it comes to rhino plastic surgery.
Speaker 3 (21:36):
Yeah, yeah, And you can't control, and you don't have control,
You don't have fine control at the level you need
fine control to hit that operation out of the park
every time. And if that's going to be the case,
I just don't want to do it.
Speaker 1 (21:48):
Okay, Yet another fascinating episode of Bonus episode with doctor
Robert Schwartz, Boob, God of Dallas, genius and my best friend.
Speaker 3 (21:59):
Thank you very much, thank you. Good
So this is between us with me and doctor Robert
Schwartz best boobs in Dallas. Heather debro is doing is
off doing things with conflict and resolution. I think somewhere
with us, maybe some housewives or two. And I've got
my best friend, my favorite genius, doctor Robert Schwartz, ports
(00:27):
curified plastic surgeon from Dallas, and we're doing a bonus episode.
Speaker 2 (00:30):
We're gonna answer some banned questions.
Speaker 1 (00:32):
Okay, and let's uh, let's go through these pretty quickly
and give some really fun, interesting take home message answers. Okay,
fan question everyone, I have a dv AD sceptum.
Speaker 2 (00:44):
What do I dot plastic?
Speaker 1 (00:48):
Well, it depends you go to a doctor plastic surgeon
or your no's threats. I have a dv accept they go, great,
lie down here, let me cut you open. I mean
it depends. What does that mean to have a deva septum?
If your DVAN septum is causing significant airway obstruction?
Speaker 2 (01:02):
Okay?
Speaker 1 (01:03):
But if everybody has a devaated septum and it's like
a spine, does anybody really have a straight spine?
Speaker 2 (01:10):
Okay?
Speaker 1 (01:10):
I think if you did a cat scam on one
thousand people with no airway obstruction. Nine hundred and eighty
eight of them would have some deviation of their septum.
Speaker 2 (01:19):
So a deviated septum in.
Speaker 1 (01:20):
And of itself is not necessarily an anatomic geometric structure.
It really is what is it doing to you functionally,
So it depends, you know, go to a doctor.
Speaker 3 (01:29):
Usually or potentially cosmatically. Yeah, it may be causing a
visible outward curve of the nose, and so there's fixes
for that. Yeah, So in and of itself, it doesn't
necessarily mean anything. But I'm assuming that anyone's saying that
didn't just I don't know, take photos of their own
septum and just some they've had some symptom from that.
Speaker 1 (01:48):
Well, in the past, it was the way the plastic
surgeon could get it paid for by insurance calling it deviated.
Speaker 2 (01:55):
And then those days are long gone, yes, and now.
Speaker 1 (01:57):
People are very helpy to discuss their plastic surgery. But
it was a way that you could justify to your
friends having your rhinoplasty. Oh, my nose looks completely different
because I had a deviated septem while I was there.
Speaker 2 (02:09):
I had them take a little bit of the bump off.
Speaker 3 (02:12):
Right, Yeah, all right, yeah, those days are over.
Speaker 2 (02:16):
I know number two.
Speaker 1 (02:17):
I've been getting filler for years and now my face
looks puffy. Ah, what's happening under the skin? Do you
want to grab that one?
Speaker 3 (02:26):
Well, there's a number of things that could be happening
under the skin. The first is that depending on what
the filler is and how much has been put in,
it's not always going away, right, and so it can
build up over time. And I think I think people
talk about filler migrating. I think that's less of a
thing that it is claimed. I don't think it's that
(02:47):
easy for it to move around. But I think giant
globs of it can certainly deform your face after a while, right,
And probably large amounts of it caused some inflammatory processes
under there. Some of them are tended to do that.
Sculptra radys, those are intended to cause inflammation, right. But
so it can make changes over time.
Speaker 2 (03:06):
Very important points.
Speaker 1 (03:07):
So if your doctor goes, don't worry about it, but
put filler in.
Speaker 2 (03:11):
It all dissolves.
Speaker 1 (03:12):
Even if it's hyaluronic acid, it may not dissolve and
probably won't, And recent studies based on mmerise have shown
it probably hangs and then it attracts a lot of
water and then it can cause scarring and just as
you said, the inflammatory reaction. So your face is puffy
because you may have had too much filler, and I
would immediately less is more, and immediately if it's looking puffy,
(03:35):
go get some hyluron a dase, which is an enzyme
that dissolves it.
Speaker 2 (03:38):
Okay, I'm twenty you had.
Speaker 3 (03:40):
A hyaluronic acid filler in the first place.
Speaker 2 (03:42):
That's true. I'm twenty eight.
Speaker 1 (03:44):
Starting to see early Choweli, Am I too young to
do anything about that.
Speaker 2 (03:49):
We're seeing a lot of that.
Speaker 1 (03:50):
People wanting to come in now with the early face,
wanting early facelif surgery is everything else that you like
to tell your patients maybe to consider before a facelift
for jewling.
Speaker 3 (04:01):
I well, I would generally on someone that young, I'm
not sure that it's even aging at that point. I
think it's just your facial anatomy. And I've had a
lot of success with those things. Again, well, using filler basically,
and basically I inject some filler in front of the jaw,
a little bit behind it. It smoothed out the jow.
It essentially makes it invisible. But I think at that age,
(04:22):
unless there's something strange going on, a facelift is vastly
overkill for this.
Speaker 1 (04:27):
Yeah, twenty eight early jelling. You may just have gained
a little weight, you know, and so you might or
lost a little weight or something.
Speaker 2 (04:34):
But Mike, but I don't think the face.
Speaker 3 (04:36):
Off is the plus estata nindage yourself. Yeah, you're twenty eight.
You probably look great.
Speaker 2 (04:41):
You're not having a face ok.
Speaker 1 (04:42):
Okay, I want to breast dougmentation, but I'm scared about
what they'll look like when I'm older. Should I be
answer I think is yes, But it depends, right, You
should always be scared about any plastics or procedures going
to look like when you're older.
Speaker 2 (04:56):
Having said that, probably.
Speaker 3 (04:58):
You should just be scared of what you're look like
when you're older. Now that I'm old, if I had
known it was going to be this, I would have
been terrified a lot. There's nothing good happening.
Speaker 1 (05:10):
No, But I think, what do you think the average
age for rob What do you think the average age
for a faith a breast domentation is.
Speaker 3 (05:16):
In my practice probably thirties.
Speaker 2 (05:19):
Yeah, so I think thirty mid.
Speaker 3 (05:20):
Forties or so. But I mean all over the place.
Speaker 1 (05:22):
Yeah, so twenty eight you should be worried and that
you shouldn't go too big. Don't push the envelope too much.
Because of your twenty eight the chance that you're going
to want to have children is probably high. And then
if you go very big and then have children with
all the concomitants weight gain on top of that, then
it's going to stretch out your skinny more skin even more.
(05:44):
And then after the first child, you're not only going
to need a downsize, but you're probably going to need
an early lift, which you absolutely want to avoid because
of the scarring is associated with lyft. So I think
less is better when it comes to a breast dogment.
What do you think that the average size and ccs
you're seeing you're putting in people today around age thirty.
Speaker 3 (06:04):
In the range of about in the range of the
upper three.
Speaker 2 (06:06):
Hundreds lower four hum, What was it twenty years ago?
For me? It was four fifty to five fifty. It's
gotten smaller.
Speaker 3 (06:13):
Do you think it was this? I think it was
the same for me.
Speaker 1 (06:16):
Honest, even in Dallas where everything is bigger, best boobs.
Speaker 3 (06:22):
I've never been the guy for that. Now if I
have someone who comes in. I have a very elaborate
consultation process to figure out what size put in. But
I've never firs thought. I've never been the guy that
pushes them to go bigger.
Speaker 2 (06:35):
Either, and everything very common.
Speaker 3 (06:39):
In fact, I remember you and I sitting in a
meeting once at more than once probably where some guy
up on the stage goes, you know, whatever your patient
tells they want put in two sizes bigger. It's this
patronizing Oh the little lady doesn't know what she really means, right,
And I remember turning to him going, did he just
really say that in public?
Speaker 2 (06:58):
It's amazing, isn't it?
Speaker 3 (07:00):
It really is. So Look, I think you have a
finite amount of real estate on your chest, and if
you if you push over this, then you're just more
likely to have problems.
Speaker 1 (07:15):
Okay, what do you tell patients how long implants should last?
I remember the old days, and a lot of them
still think, oh, at ten years, I'm supposed to change
them out.
Speaker 2 (07:23):
What do you tell your patients?
Speaker 3 (07:24):
I don't tell them that anymore. I tell them, you know,
for a long time I was telling them expect that
they're going they're going to need to be changed at
some point because they league right, you know, and historic
they've been telling patients to expect tens or twenty years.
I actually think it's a little longer than that with
modern implants. So I'm closer like twelve to twenty five
or so.
Speaker 1 (07:50):
Okay, I'm forty one. I've never done botox. I think
I'm ready to try, but I'm worried. It literally says
toxin in the name of it. I'm trying not to
put toxins in my body.
Speaker 2 (08:00):
I not.
Speaker 1 (08:00):
Are there long term effects from botox? Is is it
toxic for you?
Speaker 2 (08:07):
Well?
Speaker 3 (08:07):
I mean we've been doing botox now for over twenty
five years in the society, and large amounts, so you
should all be dead. I agree, I think I think. Look,
everything is a toxin. It's all question of dosages, right, So,
you know, on the one of the saddest things you
see in an er is people who swallow a bottle
of thailanol in a suicide gesture, only to find out
(08:29):
that not only are you going to die, there's pretty
much nothing short of a liver transplant that's going to
prevent that. It's the dose, and so the amount of
dosage that you're putting in with botox is not going
to harm you unless injected in some bizarre, irrational way.
Speaker 1 (08:46):
I think botox is one of the most benign things
that a plastic surgeon or dermatologist does, and that you
almost I think it looks weird when you put too
much in, particularly.
Speaker 2 (08:55):
For a guy.
Speaker 1 (08:56):
You should have lines. Don't go for the bowling ball
head with the shiny head. But uh, I think botox
is extraordinarily safe. I will tell you that the only
problem I've had on boat with botox, and I've had
a lot of botox in my life, is that they
don't work on me anymore because I've formed antibodies to botox.
So unless I use Daxify, which is like fifth generation botox,
(09:19):
it doesn't work at all. And even Daxify doesn't really
work very well for very long on me.
Speaker 3 (09:24):
So yes, that's also getting older. Nothing everything works less.
Speaker 2 (09:29):
Yeah, that's true.
Speaker 1 (09:30):
Okay, my under eye bags make me look exhausted even
when I'm not What are my options under eye bags? Boy,
that's that's a two hour podcast right there. How can
you sort of, you know, summarize that with a couple
of sentences.
Speaker 3 (09:45):
Well, under eye aging is a very complicated Yeah, it's
very complicated anatomy and it requires a very careful diagnosis
because sometimes the problem isn't even the eyelids, it's the
upper cheeks yeap. Sometimes it's the hollow between the cheeks,
the island that makes the islands of baggie. Sometimes it's
true fat coming out of your eye sockets and yep retruding.
(10:07):
It's so the the answer could be as simple as
some filler, right. It might even be just some skin gear.
Sometimes it's literally a mid facelift to shorten the height
of the lower lids, and sometimes it's a traditional leproplasty
to tighten the skin.
Speaker 1 (10:22):
So it's so it's very individualized. It's very hard to
answer this with a simple answer. But I would say,
you know, filler in the lower iselid areas become a
lot less popular these days because of a lot of
the complications that people have realized. So if you're gonna
have we use this word we like to use called judicious.
(10:43):
If you're gonna have filler put in your lower eyelids,
have the surgeon or dermatologists do it judiciously. Less is better,
And if you got very deep hollows with very significant
pillowing in your lower eyelids. Don't maybe try to even
all that out with a lot of filler, and I can't.
Speaker 2 (11:01):
You can't. It doesn't work.
Speaker 1 (11:03):
Work, It's not gonna work, and then it's going to
cause scar you know, it can cause scarring or nodularity
and be a real problem that we've that Paul and
I have been seeing on botch So be careful with
the filler, all right. How do I know if my
surgeon is actually good or just good? At Instagram? I
think they're all good at Instagram. Okay, So instagramming in
and of itself doesn't mean deadly. Unfortunately, we're all sort
(11:25):
of influenced by Instagram because I'm like a thirteen year old.
I sproll all day long, like a mindless idiot looking
at cats. And I know I'm embarrassing.
Speaker 2 (11:40):
I mean, I know.
Speaker 3 (11:41):
It's you know where this takes me mentally?
Speaker 2 (11:43):
Yeah, I know, you know it takes me. Yeah, So
you know you look at.
Speaker 3 (11:47):
My inside at some point on this podcast, Yeah I will.
Speaker 1 (11:51):
Well, let's let's hold that for another time. But I
think Instagram, you know, is it's just the new way
to advertise your practice. You're putting your very best pictures
and what I really, by the way.
Speaker 3 (12:04):
Thinks about things about an education meeting.
Speaker 1 (12:07):
Yeah, I try not to get bugged by the plastic
surgeon sitting there in his scrubs and somebody goes.
Speaker 2 (12:14):
Hey, doctor so and so, rate this from what zero
to ten?
Speaker 1 (12:19):
That really bugs me, as if as if you can
rate it, you know, for all patients based on one
individual rating system. It's so ridiculous, you know, uh Blaffer
plus it's a six. Oh, breast augmentation, that's a nine. Well,
he's a breast of augmentation. Doctor, deep plane facelift, Oh
that's a two. Oh, you don't do deep playing, you know.
(12:39):
It's that those things take those all with a big
giant grain of salt.
Speaker 3 (12:45):
You know what, maybe actually avoid those surgeons because you
know what, it's unsurgeon like. It just is. You know,
perhaps if your surgeon does reels where he does choreograph
dance free teams with his nurses, maybe that's not a
serious enough person to be doing your surgery.
Speaker 2 (13:04):
He has a little too much free time, right, because.
Speaker 3 (13:07):
We're little too much free time.
Speaker 1 (13:09):
What is the one thing you wish every patient knew
before they walked into your office? For me, how incredibly
good looking and tall. I actually am no kidding you
know what.
Speaker 3 (13:24):
I wish that too, if they'd walk in there knowing
how incredibly tall and good looking you are. That's what
I often think. I go. Have I ever told you
about my friend Harry Debro You may know him from Bosch,
but he's also incredibly tall.
Speaker 2 (13:37):
And good despite what you see on TV face for rad.
Speaker 3 (13:41):
You're tall and very and very very good looking.
Speaker 1 (13:44):
So I think for me, I used to rue the
day that the patients would come to ARM with Google
Search knowledge, right.
Speaker 2 (13:52):
I hated that.
Speaker 1 (13:53):
I actually wish they would look at chat chept and
ask Chatchept some preliminary question because I think Chat CVT
or any of the other language learning models and thrawpicked,
Gemini and Blabba Perplection whatever not.
Speaker 2 (14:07):
Grock, Croc sarcastic.
Speaker 1 (14:09):
I love gro but it is actually very good at
giving you sort of a general informational you know, sort
of syllabus primer before you come in. I think they
I wish they knew a little bit of what Rock
or one of the other lmms is going to tell you.
Speaker 2 (14:27):
What do you what would you say?
Speaker 1 (14:28):
I don't know that I haven't How about you get
what you pay for if the plastic surgeon's too inexpensive.
Speaker 3 (14:33):
Yeah, I think, I guess, I guess along those lines,
I would wish that they would understand that when you're purchasing,
you know, whatever it is, let's say, a breast augmentation,
are facelift or whatever. It's not like you're buying a buick.
There's no such thing as a breast augmentation. It is
a rough categorization of techniques that will be done differently
(14:57):
by any surgeon that you see. And so it it's
not like going and buying a Toyota at one dealership
or the same cart another dealership. There's no way you're
getting the same thing. And so you need to form
that connection with the surgeon and the consultation you make.
You need to make sure they understand you very clearly
and have a clear target of what it is that
(15:18):
you want, and that you get a sense in your
gut that okay, we've got to figure because if you don't,
don't do it right.
Speaker 1 (15:33):
Yeah, I had a baby a year ago. My body
just doesn't feel like mine anymore. What is a mommy
make over? And is it worth it?
Speaker 2 (15:40):
What do you I mean?
Speaker 1 (15:41):
Let's say mommy makeover is typically something with the breast,
something with the tummy. It's usually either breast dougmentation plus
or minus lyft or at least a lyft and a
tummy tuck right usually suction and or a LiPo section,
which is often part and parcel of a dominoplasty.
Speaker 2 (15:58):
A tummy tuck operation.
Speaker 1 (16:00):
Yeah, I think that is one of the most worth
it procedures, depending on where you are in your stage
of life and depending what weight you're at. Okay, because
if you still really haven't lost a lot of the
baby weight, even though you may really want a mommy makeover,
you know, maybe go on a GLP one and get
get your weight down because you'll get much better results
(16:21):
closer to you, more idealized BMI, but above you know.
But I think mommy makeovers, generally speaking, are extraordinarily. We
were going to do a segment on the podcast that
we did previously about operations that are almost always worth it.
I think this is one that's almost always worth it.
Speaker 2 (16:38):
Do you agree?
Speaker 3 (16:38):
Yeah? And I think this warrant's talking about in more
detail in the future because I think what women go
through following pregnancy, there is no equivalent from them where
you start off and you have your girlish body, your
youthful body, and in the span of like a year,
it's completely transformed. Yeah, you know, we you know, we
(16:59):
lose our hair over decades. It's for a man, it's
like waking up one you know, going to bed with
the full head of hair and waking up bald in
the morning.
Speaker 2 (17:06):
It's shocking.
Speaker 1 (17:07):
What is the one thing people spend money on that
you think is completely worth it and sort of in
the same vein, and one thing that's totally overhyped? Oh
with this is a whole another two hour podcast, But
what what I think?
Speaker 2 (17:21):
Again?
Speaker 1 (17:21):
I think the Mommy makeover is completely worth it if
you're doing at the right stage of your life and
you're healthy, and you're at your pretty close to your
ideal body. Way, would you agree the Bomby makeover is brilliant?
Speaker 3 (17:32):
Right? I think the Mommy Makeover totally delivers. I think modestly,
I think, you know, on a much simpler level, breast
implants totally deliver.
Speaker 2 (17:39):
Yeah, I would agree with that.
Speaker 3 (17:40):
I think they totally deliver. Right.
Speaker 1 (17:42):
In the future, we have talked about the new kind
of breast implants and what you think about them, those
motivas because at lower rate of caps or contractor. But anyway,
and the one thing that's totally overhyped, boy, you could
you could separate that into surgical and non surgical categories.
Speaker 2 (17:57):
But the nons. It's funny.
Speaker 1 (17:58):
Even though the future UH of plastic surgery will be
non surgical energy delivery devices to tighten the skin, it's
kind of shameful. Knock, it's still not it's I think
that's the most overhyped come in I have. I just
bought spent this one hundred and seventy five thousand dollars
on this device, and I need to get my return
on investment, and it causes so much tightening without a scalpel.
Speaker 2 (18:21):
Its over hype. Would you agree with.
Speaker 3 (18:23):
That the laser Chotski djure is the most over hype thing.
It's like going back to we need to talk about
this sometimes. The first laser thing we went to together
in like the ninety end light see end light, save
that the stone light makes new collagen in your skin,
as has every bullshit device since then. If an aggregate
(18:48):
of one pound of collagen has been made worldwide, I'd.
Speaker 2 (18:52):
Be amazed by the way it was. The world's most
expensive flashlight. If that it absolute?
Speaker 1 (18:59):
In fact, you want to hear something pathetic, that's true.
The only thing I ever saw it do plus or
minus is caused some mild hyper pigmentation. It never caused
any significant tightening.
Speaker 3 (19:11):
I think it did have one benefit. I think it
really started to hone your acting skills. Walking in, they're going,
oh my god, look at you.
Speaker 2 (19:19):
This is the greatest thing ever. Right, Okay?
Speaker 1 (19:23):
And then finally, is there anything you simply won't do
a procedure you turn patients away for you know what
it is for me, right, I will not do a
Brazilian butt lift. I just don't think something that has
a risk of fatality to it for me. Okay that
even if, even if we've learned how to do it
much more favorably with a much lower risk of fatality,
(19:46):
it's just too bloody scary, you know, as a medical
legal guy who does a lot of this in a career,
to certified expert a California medical cort, I'm still seeing
and you're still seeing in the media, you know, fatalities
from the Brazilian butt lift.
Speaker 2 (19:59):
I won't touch it. I just won't. What about you?
Speaker 3 (20:03):
There are a number of things that I won't do,
and one of them has nothing to do with the
procedure itself. I don't do rhinoplastic, Okay. Reason I don't
do rhinoplast I think rhinoplasty is I don't think there's
anything wrong with the procedure. I don't do them because
I think, even in the best hands, it's an operation
that has too much unpredictability in the healing, at least
(20:26):
for me. Yeah, I want to do things where I know,
if I'm aiming for this, I might go to this,
or I might go to this. But the problem with
rhinoplasty is very often what you're trying to do is
change things by millimeters because you're dealing with the way
the body heals, an unpredictable skin tightening and unpredictable amounts
(20:46):
of scarr and all these things. Small changes, small variabilities
in the result are the difference, especially on the nose,
between a great result and one that never quite looks right.
And even in guys I know, look, I trained, you
know some of the best rhino blastis in the world, Okay,
(21:08):
and at ut Southwestern, even in their hands, there's a
an unacceptable degree of unpredictability for my taste. I don't
I just don't want to do procedures like right.
Speaker 1 (21:20):
Two millimeters of difference in nipple height. You can't see it, okay,
you can't even really measure matter, but two millimeters. We
used to have this expression, right, because we love these
sort of coined expressions in plast Thirty millimeters are miles
when it comes to rhino plastic surgery.
Speaker 3 (21:36):
Yeah, yeah, And you can't control, and you don't have control,
You don't have fine control at the level you need
fine control to hit that operation out of the park
every time. And if that's going to be the case,
I just don't want to do it.
Speaker 1 (21:48):
Okay, Yet another fascinating episode of Bonus episode with doctor
Robert Schwartz, Boob, God of Dallas, genius and my best friend.
Speaker 3 (21:59):
Thank you very much, thank you. Good
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