April 20, 2026 • 24 mins
Dr. Dubrow and Dr. Schwartz call out popular procedures for being unnecessary, risky or just plain bad.
From buccal fat and gland shaving, they explain what actually works and what's best left alone.
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Speaker 1 (00:04):
Okay, we're back to part two between us doctors. I'm
doctor Terry debro and you are.
Speaker 2 (00:10):
I'm doctor Robert Schwartz, my buddy.
Speaker 1 (00:13):
Too crazy wild and crazy boards certified plastic surgeons. Okay,
we have some really actually I think, very good and
relevant and useful listener questions. Okay, so when we go ahead,
we talked about the Leanne Rhimes deep Jaw release video
that's gone viral. Okay, don't do it. It's a scam
(00:35):
to give me a break.
Speaker 2 (00:37):
And it's dangerous. Yeah, more than anything else, it's really
really danagerous.
Speaker 1 (00:42):
Okay. Do you think Marco Robbie's slimmer face is more
likely from buckle fat removal or weight loss for mozambic
or just normal aging? So have you seen a recently,
I mean extraordinarily beautiful woman obviously, you know, genetically gifted
and a very good actress too. Obviously I have noticed.
I did look at that. I did look at that.
(01:05):
So I don't think Margot Robbie has had buckle fat removal,
which is a procedure. By the way, it takes like
twenty minutes. You make incisions on the inside of the
upper part of the mouth, right across from the second molar,
and you dissect into this compartment of the face that
has this sort of little extra pad of fat that's
below the muscle, you know, that's on the other side
(01:26):
of the muscle, the deeper side, and it can make
your face if it's round, thinner. And I think we
both agree that it's rarely indicated in patients only in
very specific situations. Should you even consider it in a
young patient because you may pay for it later when
you look much older. So how often do you do
(01:48):
buckle fat decision?
Speaker 2 (01:50):
Very rarely. Yeah, I get people coming forward and I
usually talk them out of it, right, Yeah, I usually
talk them out of it. It's just that's one of
those things. I don't have an object. That's not one
of those things that I'll go like, oh, never do this.
But it's not on my you know, a list. I
think it's it's mildly effective at best. And frankly, you
(02:12):
got to think about some of these procedures long term,
because fat in your face is a valuable commodity as
you get older, right, and you don't just want to
like wantonly remove it. It's a bad idea.
Speaker 1 (02:24):
So my first five years when I came out. It
was the hottest procedure. We did it on everybody. Every
guy wanted it gave them more of a terminator kind
of jawline and a little bit yeah.
Speaker 2 (02:35):
I mean, it really creates that little hollow below your cheek.
Speaker 1 (02:37):
It can and now, of course, like everything else, we've
learned when it's a good idea and when it's really
not a good idea. And I think it's someone like
a Christy Tiagan who has a very round face that
it can be useful. Particularly she's sort of over forty,
so we sort of know what she's going to look
like in the future. I think that's pretty safe. But
(02:59):
I think if you do it in sort of a
Margot Robbie situation, it's probably a really bad idea. I doubt.
I actually don't think she's had. My suspicion is that
she's just a little thinner, you know, I think actresses,
I mean, you know, I talked about this, We talked
about this ozempic anarex anorexy ozempica thing where you know,
we're basically able to shut off her appetites now using
(03:20):
these GLP one drugs. And I just think some people
are just taking a little too far and maybe maybe
maybe she's just a little thin right now. And that's
not to say that Margot Robbie's on a GLP one.
I doubt it, but who knows.
Speaker 2 (03:33):
Yeah, I don't look. I think she looks a little
leaner overall. And buckle fat doesn't do that. Bubble fat
removes a little bit of fat from a very specific area.
It doesn't make you look it doesn't make your face
look thinner overall. It doesn't do that.
Speaker 1 (03:45):
So a deep plan necklift with sub mandibular land shaving.
So the submandibular gland it's located sort of halfway between
the tip of the chin and the angle of the
jaw back there, okay, and it's it's just below the
bone and it can bulge a little bit. And there
(04:06):
are some well known surgeons who actually get in there
and they have a device and they they shave it up.
Some guys actually remove it. They take it out of
a capsule and they cut it up, and I you know,
you can get The main side effect, of course, is
zero stomia. Right is the dry mouth if you bugger
it up too much, because.
Speaker 2 (04:27):
It's really called a syalys eel where you get a
fluid pocket of saliva in your neck, that's right, or
or major nerve injury that can paralyze part of your face.
Speaker 1 (04:39):
Right. So there are some surgeons though, who get in
there and they use a shaving device and they take
sort of the outer edges of it off. I think
I think it's rarely indicated. I think it's you know,
the risk outweigh the benefits. I know there's a couple
of guys out there who are well known to do
it routinely, and and I have seen because I always
(05:02):
see everybody's mess ups. So I get to see they're
old records and they charge. They probably some of those
guys who do it routinely charge you know, eighty five
ninety thousand for a procedure that probably takes four minutes
on each turn.
Speaker 2 (05:14):
Eighty five ninety thousand just for that.
Speaker 1 (05:16):
Yeah. Yeah, it's an addisle. Yeah yeah, and uh nice.
I think mostly it's probably not a good idea in
my opinion. Now, that's the thing about plastic surgery. I'm caring.
I want to hear your opinion. Plus surgery, you get
ten good plastic surgeons, you're going to get seven different
kinds of opinions. What do you think about it?
Speaker 2 (05:40):
I think I always look at these things from a
risk benefit perspective, and so I think, with very very
rare exceptions, the difference you're going to get in your
result of the facelift in terms of how overall much
younger or better the patient looks. I think anything you
(06:01):
do to the sub mandibular gland, no matter how aggressive,
it's at best the sprinkles on the frosting on the cake,
it's definitely not the cake.
Speaker 1 (06:11):
Right.
Speaker 2 (06:12):
And if it were a completely benign procedure that we
all do, you know, take off a little bit of
the submanadbuta it is not that. Though it is a potent,
it is a procedure that is going to add little
to your result, if anything, and is exposing you to
some pretty significant risks. And so for me, that's a
bad idea. Okay, just a bad idea. Why are we
(06:33):
going to add potential significant risks to a procedure for
very little better?
Speaker 1 (06:38):
Okay, So if we were doing a smasher pass, it
would be a pass. If you noticed this thing that
they're doing an Instagram smasher pass, Okay, you pass? Okay.
I watched the whiskers podcast. Have you ever seen the
Whiskers podcasts.
Speaker 2 (06:49):
We have very different feed I know it's.
Speaker 1 (06:51):
These two AI cats because I love cats that are
talking to each other, and one atisode. I know in
one episode they show they go, okay, guys, it's okay,
time for a smasher pass. And they show this cat
you know, sitting there and they go, ooh, I would
(07:12):
throw her out of bed for eating crackers. That's a smash.
They show another one.
Speaker 2 (07:16):
Yeah, I think that's what they're referring to in smash
or pass. I don't think they're referring to your submandibular glass.
Speaker 1 (07:21):
And then then oother ones again, they show another cat
licking its butt and when one goes, okay, okay, that's
the thing we do. But it's still a smash.
Speaker 2 (07:31):
We so have to get you off.
Speaker 1 (07:33):
I know, I really I recommend you.
Speaker 3 (07:36):
What are you doing with your time? You're watching talking
cat videos talking about licking their buttoles. This is what
you are doing. Whatever amount of lifetime we have left,
you're doing this.
Speaker 1 (07:54):
Really, it's what I'm into, Okay, two own all right,
all right, no, no, no, I'm into AI generated cats
licking their babbles. Okay, that's my thing.
Speaker 2 (08:06):
All right, all right, all right, I guess okay, fair enough,
that's the hobby.
Speaker 4 (08:18):
Hey, hey you yeah, you you're sitting there wondering what
podcast do I want to listen to? Are you thinking yourself?
So many podcasts? Which one do I want to pick?
We can answer that for you. Listen if you want to. No,
we're not saying listen if you want to. We're saying
that's the podcast. Listen if you want to. We talk
about everything you're gonna want to hear, your favorite celebrities,
pop culture, what to watch on TV, what music to
(08:40):
listen to, what games to play, what clothes to wear,
where to go, what to do. It's called listen if
you want to, you say something.
Speaker 3 (08:47):
You're doing so good, keep going.
Speaker 1 (08:49):
And keep going.
Speaker 5 (08:50):
Okay, guys, Listen if you want to. Is available on
the iHeartRadio.
Speaker 6 (08:54):
App, Apple Podcasts or wherever you listen to podcasts.
Speaker 1 (08:58):
Let's talk about fat transfer to the bread US. Very interesting. Okay,
So what we're talking about is there's essentially two ways
to do a breast augmentation right now. There actually there
may be more because there's no other things like alo clay,
and you can inject other kinds of injectibles. But then
you know, okay, run.
Speaker 2 (09:15):
It wallow Clay is processed fat.
Speaker 1 (09:17):
If I remember it's cadaver fat, cadaver fat, Yeah, okay,
it's better. Yeah, I know, all right, so.
Speaker 2 (09:23):
Weird how it's how much more appealing it sounds when
you call it Alo Clay's are calling it fat from
a dead person? I know, right, good, Hey, nice job
marketing team on the renaming.
Speaker 1 (09:36):
Right way to go. But what are we going to
call this some dude dead dudes fat that we're putting
in people's press.
Speaker 2 (09:41):
Yeah, I know, fat fat into corpse.
Speaker 1 (09:44):
So no, I've got the idea. It's called it. By
the way, it's it's weirdly similar to the way they
named drugs. I mean, who thought of turzeppetite or moncharo?
How about way to hold on Moonjaro.
Speaker 2 (10:00):
They basically took Killimunjaro and took the kill out, which
was a good move.
Speaker 1 (10:04):
Where did zep bound come from? Who thinks of the
zep bound?
Speaker 2 (10:09):
But by the way, look at look at just look
at the way they name our implants. Right, The softer
allergan implant is the responsive implant, right, and the firmer
one is the soft touch.
Speaker 1 (10:23):
Yes, okay, how does that make right? Yeah?
Speaker 2 (10:25):
Well done? Boys, Yeah, well done?
Speaker 1 (10:27):
I know.
Speaker 2 (10:27):
Or what about the people who named I don't mean
to call this, but what about the people who named Zeman?
Speaker 1 (10:33):
Yeah, that's it's one of the botoxes Zman.
Speaker 7 (10:36):
Suriously, really seriously, because when I first heard that, when
I was like in my fifties, I'm not proud of this.
Speaker 2 (10:47):
I still would.
Speaker 1 (10:50):
Yeah really, okay, that's.
Speaker 2 (10:52):
What you're putting in your face.
Speaker 1 (10:54):
So currently the two ways and people are combining them.
By the way to make your breast larger is either
to use, of course, a breast implant, it's been around
since the seventies, and or adding fat from sort of
like a bbl of the breast fat transfer to the breast. Okay,
and that is an acceptable way theoretically of adding some
(11:15):
volume to your breast. Now, what's interesting is when we
were young plastic surgeons, the dermatologists were doing that, and
we ragged on them to no end. We thought that's
so dangerous, and then, of course, thirty years later, it's
now an accepted procedure in plastics. What you see a
(11:36):
lot with fat transfer, which I think is really sort
of doesn't make sense for me, people who've had multiple
previous operations have a lot of scarring. We'll go to
a doctor and the doctor will do liposuction from somewhere
and inject it into that scarred up breast. Well, think
about that. I mean, you're basically taking a potted plant
from one soil bed and putting it, digging it up
(11:59):
and put into another, depending upon how well irrigated the
other soil bed get, you know, and whether it's a
good environment for it to live and take. And if
you injected into a breast that's had multiple previous operations
and a lot of scarring, what are the chances it's
going to get its own independent blood supply and live low.
And if it doesn't, I mean, if you're lucky and
it doesn't, it just gets absorbed. If you're unlucky and
(12:22):
it doesn't get its own blood supply and absorb it
can turn into what we call fat necrosis or oil
cysts and be painful or granuloma's foreign body directions or worse.
Speaker 2 (12:32):
Right, Well, I think you hit the nail on the
head with your soil analogy, because literally what you're doing
in that case is you're taking some sort of tropical
plant from Florida and tried to plant it in Arizona.
Speaker 1 (12:44):
That's a good and it's not.
Speaker 2 (12:46):
It's not going to work. I was the first person
to do that procedure in Dallas really, so after it
was you know, basically we got the ok that, oh yeah, no,
it doesn't get mistaken for cancer. So I have a
fair amount of experience doing this and it's an okay
procedure at best. And so when someone comes to me
(13:09):
for a breast augmentation, they want to know should they
do fat or breast implants? The answer is never fat.
And the problem isn't because it's so risky. It's because
it's so minimally effective, and there's a number of problems
with it. The first is you can only put so
much fat in the average female breast because you have
to put the fat in as little micro droplets or
(13:30):
it doesn't survive. You can't just go and squirt a
big amount of fat in there. It just dies and
it creates the problems you just talked about. So you
can't do that. So there's only so many places you
can put it.
Speaker 1 (13:40):
When is it useful for small augmentations at best?
Speaker 2 (13:45):
It's used in my book it's useful for a patient
who comes in primarily for lipos suction and is of
the feeling that, hey, instead of wasting the fat, let's
get what we can in my breasts out of this fat. Okay,
but got no issue with that. That's a great use
of it. You'll get something, Okay. But here, I don't
think I've ever done one where you can't tell the
difference afterwards.
Speaker 1 (14:05):
Right. But here in Beverly Hills, the people who are
trying to market their practice are doing combo platters. Now
that's the big thing. Do a breast implant? Do a
breast implant take fat from the stomach and inject it
at the same time. I think it's not the greatest
idea because you're lifting up the breast tissue radically reducing
the blood supply to create a pocket.
Speaker 2 (14:25):
Yeah, compressing the breast tissue at the same time, right.
Speaker 1 (14:28):
And compressing it. And then just as you're sort of
waiting for it to re establish its blood supply, which
it will increase its blood supply as it's healing, you're
now putting a vascular demand on it by asking it
to give fat transferred into it its own independent blood supply.
Speaker 2 (14:44):
I think it's a mistake in addition to whatever risks
there are of the breast implant.
Speaker 1 (14:48):
Okay, yeah, I call sham. Okay, so pass mostly on
fat transfer, pass on combination implants and fat transfer, and okay.
Speaker 2 (15:01):
So I would say pass, I would say, I would
say smash on fat transfer in the right patient. Okay,
nothing wrong with it. I would say, pass on implants
plus fat transfer. I can find no convincing argument that
I've ever seen, or results that anyone has ever shown
that would suggest to me that's a good idea.
Speaker 1 (15:19):
Okay, do surgeons take lung lunch breaks or pee while
we have lung operations. So let's say you're doing a
five hour operation. You're doing a breast augmentation, at breastlift
and at tummy tuck. How long will that take you?
Five five and a half something like that.
Speaker 2 (15:35):
You're talking about a breast dog, a breastlift, and a
tummy talk. Yeah wait what.
Speaker 1 (15:39):
Master PETSI, tommy tuck og Master PEXI tummy tuck.
Speaker 2 (15:43):
Yeah, probably about five hours.
Speaker 1 (15:44):
Okay, So five hours. So that's you know, and it's
gruss you're crossing. It's your second case. You're going from
ten to two thirty it's crossing past lunch. What do
you typically do? Do you take a break, do you pee?
What do you do?
Speaker 2 (15:59):
I would rarely do either, so I would certainly not
break for lunch. But I think it's acceptable to itself.
Speaker 1 (16:08):
But I think it's I think.
Speaker 2 (16:09):
It's acceptable to it's to step out and look, it's
acceptable step out and p Obviously I'm not quite at
that stage that I need to go that often, so
usually I try to remember to go before we get
in the car or whatever. So you know, it's generally
it just doesn't happen. I don't like hydrate heavily on
the morning of serge okay, so that's rarely an issue.
(16:29):
But I don't see anything wrong with it. Nor do
I think there's anything wrong with stepping out and like
having a protein bar or protein shake, but like no
a half hour lunch, clocking out and clocking No.
Speaker 1 (16:40):
It's not so. Having said that, I would I surmont.
I think that most surgeons, when they do an operation,
even as long as seven to eight hours, never scrub out,
never eat anything, and never pee. Wouldn't you agree with that?
Speaker 2 (16:56):
Yeah, I'll say this. There's a lot of operations that
you're doing Okay. Operations in plastic surgery run that long
is because people are doing multiple right right, and very
often when that's happening, there's some point where you need
to reprep and rate.
Speaker 1 (17:10):
Then you have a natural break, and then there's a
natural break because you have to scrub back in, you know.
Speaker 2 (17:14):
While the nurses are doing that, where I could step
out and go to the bathroom or have a little
snack or something. But if it's just we're going continuously
and there's an extraneous reason why I should do that,
very rarely, I think think it's wrong as long as
it's limited in scope.
Speaker 1 (17:30):
I think in the nearly thirty years that I've been
doing this, I think I've probably scrubbed out from an operation,
any operation, maybe twice con And what's weird is you're
so focused and so into it that you would literally
never have to pee. But the moment, it's the weirdest thing,
(17:51):
isn't it. The moment you take your gown off. It's
all of a sudden you.
Speaker 2 (17:55):
Go, oh, bladder reflex or whatever it is. I don't
know what it is. Yeah, no, Look, honestly, the anesthesiologist.
Speaker 1 (18:08):
Sometimes does that, but you know, yes, they do it.
Speaker 2 (18:12):
They're not serge. And by the way, when they when
when they come back from that, please tell me you
relentlessly mock them for it.
Speaker 1 (18:18):
I said, it must be nice. They said, did you
bring a new playlist? Just let's face it, they're they're anethesiologist.
Last DJs?
Speaker 2 (18:26):
Was that? Was that very satisfying for you? Remember to
wash your head?
Speaker 1 (18:30):
Did you have a little sneak? Do you have a sneak?
Do you feel better?
Speaker 3 (18:35):
Now?
Speaker 2 (18:36):
Feel better? Now?
Speaker 1 (18:37):
It's still be I still hear the beep, beep beep.
You're good. Don't worry about it.
Speaker 2 (18:42):
By the way, nothing happened in your absence.
Speaker 1 (18:45):
I watched the.
Speaker 5 (18:46):
Screen No Bachelorette season, No problem. Hey, it's Ben Higgins and.
Speaker 6 (18:59):
Ash Like from the almost famous podcast Even on the
fate of Bachelor Nation is a giant question mark. We're
not going anywhere because the Bachelor Universe has expanded.
Speaker 5 (19:10):
We're still bringing you great reality TV show recaps that
your favorite Bachelor Nation alum are a part of interviews
with your favorite cast members. News and did we mention
our very own Ashley is a cast member of Bravo's
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(19:33):
our podcast can give you.
Speaker 6 (19:35):
Listen to Almost Famous on the iHeartRadio app, Apple podcasts
or wherever you listen to podcasts.
Speaker 1 (19:42):
What is the best way to remove a scar? And
of course the answer is it depends, right.
Speaker 2 (19:49):
Yeah, it really depends. So if we were talking about
it depends why we're removing the scar, right, Let's see,
let's say it's least or thickened or way you cut
it out? And Rea, Yeah, sometimes you inject some steroid
at the same time you do that.
Speaker 1 (20:03):
What about if it's a flat scar that just could
be better, like too wide, too wide, irregular something. Some
areas of it are slightly you know, you're.
Speaker 2 (20:14):
Basically essentially what you're doing is you're recreating the wound
and closing it better.
Speaker 1 (20:17):
Right, But there is a role for PRP micro needling,
I mean, I you know, and some laser. It's a thing,
and it's a big thing here in Beverly Hills. Lots
of PRP microneedling and laser and actually, you know it
can remodel the scar. I know what you're thinking, let's
eat because we're surgeons, give me a break. Let's just
cut it out, give me ten minutes and restart block
(20:39):
and it'll be better. Right.
Speaker 2 (20:41):
I think those things are better. I don't. I don't
discount that there that they have a role. I think
the role is limited, and I think they tend to
be more effective when the issue with the scar is
either the color of the scar or the texture of
the scar. Is it not going to fix a pale
wide scar, It's not going to fix the hypertrophixed car.
Speaker 1 (20:58):
I think if the scar to do that, if the
scars red and you put pressure on it with your
fingers and the red as goes away, it can be
very helpful to do an ipl intense pulse light treatment
to try to get the circulating blood in the superficial
vessels to get out of there, and that can be
very helpful.
Speaker 2 (21:18):
Is it ever a good that case it will fade
and shrink the scar?
Speaker 1 (21:21):
Yeah? Is it ever a good idea to have plastic
surgery outside of the US?
Speaker 2 (21:28):
Okay, so the way most people do it? No?
Speaker 1 (21:32):
Yeah, I think.
Speaker 2 (21:33):
Look, are there good plastic surgeons all around the world,
no doubt. Yes. Are those the people that are marketing
to you who are in say Mexico or Turkey or whatever, right, No, right, No,
they are excellent plastic surgeons in Mexico. They're in you know,
places like Mexico City at major hospitals, and by the way,
(21:55):
they're probably just as expensive as American surgeons.
Speaker 1 (21:58):
Yeah. The problem. The problem is if you come back
here and with a complication, nobody wants to touch you. No,
you're kind of that's your your WIT's in there, I think, I.
Speaker 2 (22:08):
Think, look, look, it's it's it's not necessarily a great
idea to fly in the ideally in the weeks following
plastic surgery or any surgery. Yeah, there's a heightened risk
of a flight, and particularly an overseas flight, right, and
if you're going to the best people in these places
for the most part, your savings are not going to
(22:28):
be that compelling. But that's not who's.
Speaker 1 (22:31):
Marketing, that's true. So not a good.
Speaker 2 (22:33):
Idea't know what you're getting.
Speaker 1 (22:34):
Except for maybe a hair transplant. In Turkey, they seem
to really got that wired. They can, they do a
good job, and it costs next to nothing, and they
put you in a hotel room. I've seen this on internet.
It's pretty amazing. I think, yeah, yeah, yeah, Still, you know, look,
I think medical tourism. You're you're you're a pass, not
a smash for that.
Speaker 2 (22:56):
I look, I'm a pass just because I think it's
hard to evaluate how good doctor is here. It's hard
enough to do. It's hard. I mean, we had a
whole discussion about how hard it is to, you know,
choose a good plastic surgeon. And when someone asked me, oh,
who's a good roomatologist for me to go to? No,
I have no idea. It's hard enough to fiure out
who a good doctor is here, try and figure it
out in some other contract.
Speaker 1 (23:17):
Agree, Well, we have many more listener questions that we'll answer.
Maybe we'll answer them next time, but we've run out
of time. That has always was so fun, so fun,
and I would recommend you, if you haven't watched the
Whiskers podcast to see two AI generated cats talking to
each other. It's hilarious and very cute.
Speaker 2 (23:38):
I feel like we have very different uses for you
and I. Yeah, I know, do agree to disagree. I
am not watching the Whiskers except now I'm going to
get the Whiskers podcast. Oh if your phone is listening,
thank you. Yeah, that was your plan all along.
Speaker 1 (23:51):
Yeah, yeah, so I think And next time on between
us doctors. I think we're going to talk about something
even more shocking and interesting than we have even in
the last two and this has been very good and helpful.
I hope you all enjoyed it, and we will see
you next time.
Okay, we're back to part two between us doctors. I'm
doctor Terry debro and you are.
Speaker 2 (00:10):
I'm doctor Robert Schwartz, my buddy.
Speaker 1 (00:13):
Too crazy wild and crazy boards certified plastic surgeons. Okay,
we have some really actually I think, very good and
relevant and useful listener questions. Okay, so when we go ahead,
we talked about the Leanne Rhimes deep Jaw release video
that's gone viral. Okay, don't do it. It's a scam
(00:35):
to give me a break.
Speaker 2 (00:37):
And it's dangerous. Yeah, more than anything else, it's really
really danagerous.
Speaker 1 (00:42):
Okay. Do you think Marco Robbie's slimmer face is more
likely from buckle fat removal or weight loss for mozambic
or just normal aging? So have you seen a recently,
I mean extraordinarily beautiful woman obviously, you know, genetically gifted
and a very good actress too. Obviously I have noticed.
I did look at that. I did look at that.
(01:05):
So I don't think Margot Robbie has had buckle fat removal,
which is a procedure. By the way, it takes like
twenty minutes. You make incisions on the inside of the
upper part of the mouth, right across from the second molar,
and you dissect into this compartment of the face that
has this sort of little extra pad of fat that's
below the muscle, you know, that's on the other side
(01:26):
of the muscle, the deeper side, and it can make
your face if it's round, thinner. And I think we
both agree that it's rarely indicated in patients only in
very specific situations. Should you even consider it in a
young patient because you may pay for it later when
you look much older. So how often do you do
(01:48):
buckle fat decision?
Speaker 2 (01:50):
Very rarely. Yeah, I get people coming forward and I
usually talk them out of it, right, Yeah, I usually
talk them out of it. It's just that's one of
those things. I don't have an object. That's not one
of those things that I'll go like, oh, never do this.
But it's not on my you know, a list. I
think it's it's mildly effective at best. And frankly, you
(02:12):
got to think about some of these procedures long term,
because fat in your face is a valuable commodity as
you get older, right, and you don't just want to
like wantonly remove it. It's a bad idea.
Speaker 1 (02:24):
So my first five years when I came out. It
was the hottest procedure. We did it on everybody. Every
guy wanted it gave them more of a terminator kind
of jawline and a little bit yeah.
Speaker 2 (02:35):
I mean, it really creates that little hollow below your cheek.
Speaker 1 (02:37):
It can and now, of course, like everything else, we've
learned when it's a good idea and when it's really
not a good idea. And I think it's someone like
a Christy Tiagan who has a very round face that
it can be useful. Particularly she's sort of over forty,
so we sort of know what she's going to look
like in the future. I think that's pretty safe. But
(02:59):
I think if you do it in sort of a
Margot Robbie situation, it's probably a really bad idea. I doubt.
I actually don't think she's had. My suspicion is that
she's just a little thinner, you know, I think actresses,
I mean, you know, I talked about this, We talked
about this ozempic anarex anorexy ozempica thing where you know,
we're basically able to shut off her appetites now using
(03:20):
these GLP one drugs. And I just think some people
are just taking a little too far and maybe maybe
maybe she's just a little thin right now. And that's
not to say that Margot Robbie's on a GLP one.
I doubt it, but who knows.
Speaker 2 (03:33):
Yeah, I don't look. I think she looks a little
leaner overall. And buckle fat doesn't do that. Bubble fat
removes a little bit of fat from a very specific area.
It doesn't make you look it doesn't make your face
look thinner overall. It doesn't do that.
Speaker 1 (03:45):
So a deep plan necklift with sub mandibular land shaving.
So the submandibular gland it's located sort of halfway between
the tip of the chin and the angle of the
jaw back there, okay, and it's it's just below the
bone and it can bulge a little bit. And there
(04:06):
are some well known surgeons who actually get in there
and they have a device and they they shave it up.
Some guys actually remove it. They take it out of
a capsule and they cut it up, and I you know,
you can get The main side effect, of course, is
zero stomia. Right is the dry mouth if you bugger
it up too much, because.
Speaker 2 (04:27):
It's really called a syalys eel where you get a
fluid pocket of saliva in your neck, that's right, or
or major nerve injury that can paralyze part of your face.
Speaker 1 (04:39):
Right. So there are some surgeons though, who get in
there and they use a shaving device and they take
sort of the outer edges of it off. I think
I think it's rarely indicated. I think it's you know,
the risk outweigh the benefits. I know there's a couple
of guys out there who are well known to do
it routinely, and and I have seen because I always
(05:02):
see everybody's mess ups. So I get to see they're
old records and they charge. They probably some of those
guys who do it routinely charge you know, eighty five
ninety thousand for a procedure that probably takes four minutes
on each turn.
Speaker 2 (05:14):
Eighty five ninety thousand just for that.
Speaker 1 (05:16):
Yeah. Yeah, it's an addisle. Yeah yeah, and uh nice.
I think mostly it's probably not a good idea in
my opinion. Now, that's the thing about plastic surgery. I'm caring.
I want to hear your opinion. Plus surgery, you get
ten good plastic surgeons, you're going to get seven different
kinds of opinions. What do you think about it?
Speaker 2 (05:40):
I think I always look at these things from a
risk benefit perspective, and so I think, with very very
rare exceptions, the difference you're going to get in your
result of the facelift in terms of how overall much
younger or better the patient looks. I think anything you
(06:01):
do to the sub mandibular gland, no matter how aggressive,
it's at best the sprinkles on the frosting on the cake,
it's definitely not the cake.
Speaker 1 (06:11):
Right.
Speaker 2 (06:12):
And if it were a completely benign procedure that we
all do, you know, take off a little bit of
the submanadbuta it is not that. Though it is a potent,
it is a procedure that is going to add little
to your result, if anything, and is exposing you to
some pretty significant risks. And so for me, that's a
bad idea. Okay, just a bad idea. Why are we
(06:33):
going to add potential significant risks to a procedure for
very little better?
Speaker 1 (06:38):
Okay, So if we were doing a smasher pass, it
would be a pass. If you noticed this thing that
they're doing an Instagram smasher pass, Okay, you pass? Okay.
I watched the whiskers podcast. Have you ever seen the
Whiskers podcasts.
Speaker 2 (06:49):
We have very different feed I know it's.
Speaker 1 (06:51):
These two AI cats because I love cats that are
talking to each other, and one atisode. I know in
one episode they show they go, okay, guys, it's okay,
time for a smasher pass. And they show this cat
you know, sitting there and they go, ooh, I would
(07:12):
throw her out of bed for eating crackers. That's a smash.
They show another one.
Speaker 2 (07:16):
Yeah, I think that's what they're referring to in smash
or pass. I don't think they're referring to your submandibular glass.
Speaker 1 (07:21):
And then then oother ones again, they show another cat
licking its butt and when one goes, okay, okay, that's
the thing we do. But it's still a smash.
Speaker 2 (07:31):
We so have to get you off.
Speaker 1 (07:33):
I know, I really I recommend you.
Speaker 3 (07:36):
What are you doing with your time? You're watching talking
cat videos talking about licking their buttoles. This is what
you are doing. Whatever amount of lifetime we have left,
you're doing this.
Speaker 1 (07:54):
Really, it's what I'm into, Okay, two own all right,
all right, no, no, no, I'm into AI generated cats
licking their babbles. Okay, that's my thing.
Speaker 2 (08:06):
All right, all right, all right, I guess okay, fair enough,
that's the hobby.
Speaker 4 (08:18):
Hey, hey you yeah, you you're sitting there wondering what
podcast do I want to listen to? Are you thinking yourself?
So many podcasts? Which one do I want to pick?
We can answer that for you. Listen if you want to. No,
we're not saying listen if you want to. We're saying
that's the podcast. Listen if you want to. We talk
about everything you're gonna want to hear, your favorite celebrities,
pop culture, what to watch on TV, what music to
(08:40):
listen to, what games to play, what clothes to wear,
where to go, what to do. It's called listen if
you want to, you say something.
Speaker 3 (08:47):
You're doing so good, keep going.
Speaker 1 (08:49):
And keep going.
Speaker 5 (08:50):
Okay, guys, Listen if you want to. Is available on
the iHeartRadio.
Speaker 6 (08:54):
App, Apple Podcasts or wherever you listen to podcasts.
Speaker 1 (08:58):
Let's talk about fat transfer to the bread US. Very interesting. Okay,
So what we're talking about is there's essentially two ways
to do a breast augmentation right now. There actually there
may be more because there's no other things like alo clay,
and you can inject other kinds of injectibles. But then
you know, okay, run.
Speaker 2 (09:15):
It wallow Clay is processed fat.
Speaker 1 (09:17):
If I remember it's cadaver fat, cadaver fat, Yeah, okay,
it's better. Yeah, I know, all right, so.
Speaker 2 (09:23):
Weird how it's how much more appealing it sounds when
you call it Alo Clay's are calling it fat from
a dead person? I know, right, good, Hey, nice job
marketing team on the renaming.
Speaker 1 (09:36):
Right way to go. But what are we going to
call this some dude dead dudes fat that we're putting
in people's press.
Speaker 2 (09:41):
Yeah, I know, fat fat into corpse.
Speaker 1 (09:44):
So no, I've got the idea. It's called it. By
the way, it's it's weirdly similar to the way they
named drugs. I mean, who thought of turzeppetite or moncharo?
How about way to hold on Moonjaro.
Speaker 2 (10:00):
They basically took Killimunjaro and took the kill out, which
was a good move.
Speaker 1 (10:04):
Where did zep bound come from? Who thinks of the
zep bound?
Speaker 2 (10:09):
But by the way, look at look at just look
at the way they name our implants. Right, The softer
allergan implant is the responsive implant, right, and the firmer
one is the soft touch.
Speaker 1 (10:23):
Yes, okay, how does that make right? Yeah?
Speaker 2 (10:25):
Well done? Boys, Yeah, well done?
Speaker 1 (10:27):
I know.
Speaker 2 (10:27):
Or what about the people who named I don't mean
to call this, but what about the people who named Zeman?
Speaker 1 (10:33):
Yeah, that's it's one of the botoxes Zman.
Speaker 7 (10:36):
Suriously, really seriously, because when I first heard that, when
I was like in my fifties, I'm not proud of this.
Speaker 2 (10:47):
I still would.
Speaker 1 (10:50):
Yeah really, okay, that's.
Speaker 2 (10:52):
What you're putting in your face.
Speaker 1 (10:54):
So currently the two ways and people are combining them.
By the way to make your breast larger is either
to use, of course, a breast implant, it's been around
since the seventies, and or adding fat from sort of
like a bbl of the breast fat transfer to the breast. Okay,
and that is an acceptable way theoretically of adding some
(11:15):
volume to your breast. Now, what's interesting is when we
were young plastic surgeons, the dermatologists were doing that, and
we ragged on them to no end. We thought that's
so dangerous, and then, of course, thirty years later, it's
now an accepted procedure in plastics. What you see a
(11:36):
lot with fat transfer, which I think is really sort
of doesn't make sense for me, people who've had multiple
previous operations have a lot of scarring. We'll go to
a doctor and the doctor will do liposuction from somewhere
and inject it into that scarred up breast. Well, think
about that. I mean, you're basically taking a potted plant
from one soil bed and putting it, digging it up
(11:59):
and put into another, depending upon how well irrigated the
other soil bed get, you know, and whether it's a
good environment for it to live and take. And if
you injected into a breast that's had multiple previous operations
and a lot of scarring, what are the chances it's
going to get its own independent blood supply and live low.
And if it doesn't, I mean, if you're lucky and
it doesn't, it just gets absorbed. If you're unlucky and
(12:22):
it doesn't get its own blood supply and absorb it
can turn into what we call fat necrosis or oil
cysts and be painful or granuloma's foreign body directions or worse.
Speaker 2 (12:32):
Right, Well, I think you hit the nail on the
head with your soil analogy, because literally what you're doing
in that case is you're taking some sort of tropical
plant from Florida and tried to plant it in Arizona.
Speaker 1 (12:44):
That's a good and it's not.
Speaker 2 (12:46):
It's not going to work. I was the first person
to do that procedure in Dallas really, so after it
was you know, basically we got the ok that, oh yeah, no,
it doesn't get mistaken for cancer. So I have a
fair amount of experience doing this and it's an okay
procedure at best. And so when someone comes to me
(13:09):
for a breast augmentation, they want to know should they
do fat or breast implants? The answer is never fat.
And the problem isn't because it's so risky. It's because
it's so minimally effective, and there's a number of problems
with it. The first is you can only put so
much fat in the average female breast because you have
to put the fat in as little micro droplets or
(13:30):
it doesn't survive. You can't just go and squirt a
big amount of fat in there. It just dies and
it creates the problems you just talked about. So you
can't do that. So there's only so many places you
can put it.
Speaker 1 (13:40):
When is it useful for small augmentations at best?
Speaker 2 (13:45):
It's used in my book it's useful for a patient
who comes in primarily for lipos suction and is of
the feeling that, hey, instead of wasting the fat, let's
get what we can in my breasts out of this fat. Okay,
but got no issue with that. That's a great use
of it. You'll get something, Okay. But here, I don't
think I've ever done one where you can't tell the
difference afterwards.
Speaker 1 (14:05):
Right. But here in Beverly Hills, the people who are
trying to market their practice are doing combo platters. Now
that's the big thing. Do a breast implant? Do a
breast implant take fat from the stomach and inject it
at the same time. I think it's not the greatest
idea because you're lifting up the breast tissue radically reducing
the blood supply to create a pocket.
Speaker 2 (14:25):
Yeah, compressing the breast tissue at the same time, right.
Speaker 1 (14:28):
And compressing it. And then just as you're sort of
waiting for it to re establish its blood supply, which
it will increase its blood supply as it's healing, you're
now putting a vascular demand on it by asking it
to give fat transferred into it its own independent blood supply.
Speaker 2 (14:44):
I think it's a mistake in addition to whatever risks
there are of the breast implant.
Speaker 1 (14:48):
Okay, yeah, I call sham. Okay, so pass mostly on
fat transfer, pass on combination implants and fat transfer, and okay.
Speaker 2 (15:01):
So I would say pass, I would say, I would
say smash on fat transfer in the right patient. Okay,
nothing wrong with it. I would say, pass on implants
plus fat transfer. I can find no convincing argument that
I've ever seen, or results that anyone has ever shown
that would suggest to me that's a good idea.
Speaker 1 (15:19):
Okay, do surgeons take lung lunch breaks or pee while
we have lung operations. So let's say you're doing a
five hour operation. You're doing a breast augmentation, at breastlift
and at tummy tuck. How long will that take you?
Five five and a half something like that.
Speaker 2 (15:35):
You're talking about a breast dog, a breastlift, and a
tummy talk. Yeah wait what.
Speaker 1 (15:39):
Master PETSI, tommy tuck og Master PEXI tummy tuck.
Speaker 2 (15:43):
Yeah, probably about five hours.
Speaker 1 (15:44):
Okay, So five hours. So that's you know, and it's
gruss you're crossing. It's your second case. You're going from
ten to two thirty it's crossing past lunch. What do
you typically do? Do you take a break, do you pee?
What do you do?
Speaker 2 (15:59):
I would rarely do either, so I would certainly not
break for lunch. But I think it's acceptable to itself.
Speaker 1 (16:08):
But I think it's I think.
Speaker 2 (16:09):
It's acceptable to it's to step out and look, it's
acceptable step out and p Obviously I'm not quite at
that stage that I need to go that often, so
usually I try to remember to go before we get
in the car or whatever. So you know, it's generally
it just doesn't happen. I don't like hydrate heavily on
the morning of serge okay, so that's rarely an issue.
(16:29):
But I don't see anything wrong with it. Nor do
I think there's anything wrong with stepping out and like
having a protein bar or protein shake, but like no
a half hour lunch, clocking out and clocking No.
Speaker 1 (16:40):
It's not so. Having said that, I would I surmont.
I think that most surgeons, when they do an operation,
even as long as seven to eight hours, never scrub out,
never eat anything, and never pee. Wouldn't you agree with that?
Speaker 2 (16:56):
Yeah, I'll say this. There's a lot of operations that
you're doing Okay. Operations in plastic surgery run that long
is because people are doing multiple right right, and very
often when that's happening, there's some point where you need
to reprep and rate.
Speaker 1 (17:10):
Then you have a natural break, and then there's a
natural break because you have to scrub back in, you know.
Speaker 2 (17:14):
While the nurses are doing that, where I could step
out and go to the bathroom or have a little
snack or something. But if it's just we're going continuously
and there's an extraneous reason why I should do that,
very rarely, I think think it's wrong as long as
it's limited in scope.
Speaker 1 (17:30):
I think in the nearly thirty years that I've been
doing this, I think I've probably scrubbed out from an operation,
any operation, maybe twice con And what's weird is you're
so focused and so into it that you would literally
never have to pee. But the moment, it's the weirdest thing,
(17:51):
isn't it. The moment you take your gown off. It's
all of a sudden you.
Speaker 2 (17:55):
Go, oh, bladder reflex or whatever it is. I don't
know what it is. Yeah, no, Look, honestly, the anesthesiologist.
Speaker 1 (18:08):
Sometimes does that, but you know, yes, they do it.
Speaker 2 (18:12):
They're not serge. And by the way, when they when
when they come back from that, please tell me you
relentlessly mock them for it.
Speaker 1 (18:18):
I said, it must be nice. They said, did you
bring a new playlist? Just let's face it, they're they're anethesiologist.
Last DJs?
Speaker 2 (18:26):
Was that? Was that very satisfying for you? Remember to
wash your head?
Speaker 1 (18:30):
Did you have a little sneak? Do you have a sneak?
Do you feel better?
Speaker 3 (18:35):
Now?
Speaker 2 (18:36):
Feel better? Now?
Speaker 1 (18:37):
It's still be I still hear the beep, beep beep.
You're good. Don't worry about it.
Speaker 2 (18:42):
By the way, nothing happened in your absence.
Speaker 1 (18:45):
I watched the.
Speaker 5 (18:46):
Screen No Bachelorette season, No problem. Hey, it's Ben Higgins and.
Speaker 6 (18:59):
Ash Like from the almost famous podcast Even on the
fate of Bachelor Nation is a giant question mark. We're
not going anywhere because the Bachelor Universe has expanded.
Speaker 5 (19:10):
We're still bringing you great reality TV show recaps that
your favorite Bachelor Nation alum are a part of interviews
with your favorite cast members. News and did we mention
our very own Ashley is a cast member of Bravo's
The Real Housewives of Rhode Island. We're breaking down every
episode in giving you the behind the scenes details only
(19:33):
our podcast can give you.
Speaker 6 (19:35):
Listen to Almost Famous on the iHeartRadio app, Apple podcasts
or wherever you listen to podcasts.
Speaker 1 (19:42):
What is the best way to remove a scar? And
of course the answer is it depends, right.
Speaker 2 (19:49):
Yeah, it really depends. So if we were talking about
it depends why we're removing the scar, right, Let's see,
let's say it's least or thickened or way you cut
it out? And Rea, Yeah, sometimes you inject some steroid
at the same time you do that.
Speaker 1 (20:03):
What about if it's a flat scar that just could
be better, like too wide, too wide, irregular something. Some
areas of it are slightly you know, you're.
Speaker 2 (20:14):
Basically essentially what you're doing is you're recreating the wound
and closing it better.
Speaker 1 (20:17):
Right, But there is a role for PRP micro needling,
I mean, I you know, and some laser. It's a thing,
and it's a big thing here in Beverly Hills. Lots
of PRP microneedling and laser and actually, you know it
can remodel the scar. I know what you're thinking, let's
eat because we're surgeons, give me a break. Let's just
cut it out, give me ten minutes and restart block
(20:39):
and it'll be better. Right.
Speaker 2 (20:41):
I think those things are better. I don't. I don't
discount that there that they have a role. I think
the role is limited, and I think they tend to
be more effective when the issue with the scar is
either the color of the scar or the texture of
the scar. Is it not going to fix a pale
wide scar, It's not going to fix the hypertrophixed car.
Speaker 1 (20:58):
I think if the scar to do that, if the
scars red and you put pressure on it with your
fingers and the red as goes away, it can be
very helpful to do an ipl intense pulse light treatment
to try to get the circulating blood in the superficial
vessels to get out of there, and that can be
very helpful.
Speaker 2 (21:18):
Is it ever a good that case it will fade
and shrink the scar?
Speaker 1 (21:21):
Yeah? Is it ever a good idea to have plastic
surgery outside of the US?
Speaker 2 (21:28):
Okay, so the way most people do it? No?
Speaker 1 (21:32):
Yeah, I think.
Speaker 2 (21:33):
Look, are there good plastic surgeons all around the world,
no doubt. Yes. Are those the people that are marketing
to you who are in say Mexico or Turkey or whatever, right, No, right, No,
they are excellent plastic surgeons in Mexico. They're in you know,
places like Mexico City at major hospitals, and by the way,
(21:55):
they're probably just as expensive as American surgeons.
Speaker 1 (21:58):
Yeah. The problem. The problem is if you come back
here and with a complication, nobody wants to touch you. No,
you're kind of that's your your WIT's in there, I think, I.
Speaker 2 (22:08):
Think, look, look, it's it's it's not necessarily a great
idea to fly in the ideally in the weeks following
plastic surgery or any surgery. Yeah, there's a heightened risk
of a flight, and particularly an overseas flight, right, and
if you're going to the best people in these places
for the most part, your savings are not going to
(22:28):
be that compelling. But that's not who's.
Speaker 1 (22:31):
Marketing, that's true. So not a good.
Speaker 2 (22:33):
Idea't know what you're getting.
Speaker 1 (22:34):
Except for maybe a hair transplant. In Turkey, they seem
to really got that wired. They can, they do a
good job, and it costs next to nothing, and they
put you in a hotel room. I've seen this on internet.
It's pretty amazing. I think, yeah, yeah, yeah, Still, you know, look,
I think medical tourism. You're you're you're a pass, not
a smash for that.
Speaker 2 (22:56):
I look, I'm a pass just because I think it's
hard to evaluate how good doctor is here. It's hard
enough to do. It's hard. I mean, we had a
whole discussion about how hard it is to, you know,
choose a good plastic surgeon. And when someone asked me, oh,
who's a good roomatologist for me to go to? No,
I have no idea. It's hard enough to fiure out
who a good doctor is here, try and figure it
out in some other contract.
Speaker 1 (23:17):
Agree, Well, we have many more listener questions that we'll answer.
Maybe we'll answer them next time, but we've run out
of time. That has always was so fun, so fun,
and I would recommend you, if you haven't watched the
Whiskers podcast to see two AI generated cats talking to
each other. It's hilarious and very cute.
Speaker 2 (23:38):
I feel like we have very different uses for you
and I. Yeah, I know, do agree to disagree. I
am not watching the Whiskers except now I'm going to
get the Whiskers podcast. Oh if your phone is listening,
thank you. Yeah, that was your plan all along.
Speaker 1 (23:51):
Yeah, yeah, so I think And next time on between
us doctors. I think we're going to talk about something
even more shocking and interesting than we have even in
the last two and this has been very good and helpful.
I hope you all enjoyed it, and we will see
you next time.
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