February 26, 2025 • 27 mins
Step into an insightful conversation with Dr. Scott Geiger, a distinguished plastic surgeon whose career uniquely blends military and medical experiences. From his early days flying jets in the Navy to rebuilding lives through reconstructive surgery, Scott shares stories that illustrate the profound influence that physical transformation can have on self-esteem and overall happiness. With a focus on both cosmetic enhancements and essential reconstructions, we delve into the world of plastic surgery, discussing key procedures, common patient experiences, and their impact on emotional well-being.
As we navigate the conversation, Dr. Geiger addresses the vital role self-image plays in personal happiness, especially in today’s selfie-driven culture. He discusses how the pressures of social media can skew perceptions of beauty and explores strategies to help patients set realistic expectations. We also touch upon the increasing acceptance of plastic surgery among men, revealing a shift in societal norms that encourages open discussions about body enhancement.
Throughout this episode, you’ll learn how surgical procedures can lead to life-altering changes, restoring confidence and promising new beginnings. Whether you're curious about the possibilities of plastic surgery or are simply interested in hearing compelling stories from the medical field, this episode offers valuable insights and inspiration. Don't miss your chance to benefit from Dr. Geiger's expertise and discover how embracing your own journey toward self-improvement can lead to empowered living. Be sure to subscribe, share with friends, and leave us your thoughts on this enlightening discussion.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Doc Discussions.
I'm Jason Edwards and this isthe world's best medical podcast
, in my opinion.
I'm here with my good friend,dr Scott Geiger.
Scott's a plastic surgeon hereat St Luke's.
Scott, how you doing, buddy?
Speaker 2 (00:11):
Hey, doing wonderful.
Thanks for having me on today.
Appreciate it, Jay.
You bet, man you bet.
Speaker 1 (00:15):
Now kind of take me from the start.
Where are you from originally?
Speaker 2 (00:19):
Oh gosh, yes, so originally born out in Arizona.
So originally born out inArizona, so born and raised in
Arizona, moved over to kind ofsmall town Illinois for a little
bit, did all my training herein St Louis.
I was a SLU guy, so down in StLouis, u SLU undergrad, slu med
school.
Then I decided to join the Navyand go do some cool fun stuff
which was phenomenal.
So I joined the Navy.
(00:40):
They paid for my medical school.
Where were you stationed at?
First?
I started off in San Diego.
So Naval Medical Center SanDiego is out there, largest
naval medical facility in theworld.
It is phenomenal, Is thatBalboa Balboa?
You got it, yeah Good, and didmy surgery intern there.
And then I decided to go dosome adventurous stuff.
So I went to flight school andlearned to fly jets and
(01:02):
helicopters and aerospacemedicine, a lot about safety and
aviation and personal factors,all that sort of stuff.
Speaker 1 (01:10):
And that's in Pensacola.
Is that where the Navy doestheir?
Speaker 2 (01:12):
That was in Pensacola , correct yeah?
So, home of the Blue Angels,yeah, down in Pensacola.
So a little stint down there.
And then so what did you fly?
Were you a pilot?
We did pilot, we did.
So I was not a pilot but we hadflight time.
So we got to learn to fly thefixed wing, you know, your
regular airplanes and jets.
And then we get to learn to flyrotaries, the helicopters kind
of a half a syllabus for both,so we can understand what the
(01:35):
pilots go through, all theirstressors, and what it's like to
do that in those situationskind of get in their head, cause
our job was to keep the pilotssafe, make sure they were safe
to fly, and the air crew and allthat stuff.
Speaker 1 (01:46):
Yeah.
Speaker 2 (01:47):
Yes, we got a lot of flight time, flew a lot of cool
aircraft.
Speaker 1 (01:50):
Did you ever break the speed of sound?
Yes, absolutely.
How was it?
Speaker 2 (01:56):
Don't quite know.
I mean kind of you do yourlittle thing.
I would say everything wasawesome in it the pulling the Gs
back of an F-18, on and offaircraft carrier, the helicopter
stuff was phenomenal.
It's just, it's everything,it's like every little kid's
dream man, it was great.
Speaker 1 (02:14):
And did you have a mustache at the time, or were
you just clean shaven?
No, no mustache, you had to beclean shaven.
Speaker 2 (02:18):
This was during, you know, all the rack, fallujah
wars, all that sort of stuff, sothere's always business.
Everybody's got to be kind ofclean shaven in case there's gas
mask stuff.
I mean, even though we were inthe States, but yeah, you got to
keep it, keep it clean.
Speaker 1 (02:30):
That's amazing man.
Yeah Well, thank you for yourservice to our country for sure.
Absolutely.
And so did you have the glasses, did you have the oh?
Speaker 2 (02:37):
absolutely Navy issued.
Uh, aviator glasses for sure,yes, and the jacket, the bomber
jacket too.
Yes, Um and so, and so youfound your way to uh St.
Speaker 1 (02:52):
Luke's here in Chesterfield, missouri.
You got it, yes, and and so youknow, um, plastic surgery kind
of covers a lot of things, andfor the people who don't know, I
mean, it's very hard to becomea plastic surgeon.
They only take the very best ofthe best and, um, and you know,
I know a few people whoactually trained with you and
that's what they said and that'sbeen my experience too.
Um, you, uh, you and I interactwith patients who have breast
(03:15):
cancer when you doreconstructions and you do a
wonderful job and I think it'sit's so important for the
patient's mental health to getthat optimal cosmetic outcome.
But what other procedures doyou do?
What are the common proceduresyou do?
Speaker 2 (03:28):
Well, kind of like you mentioned, plastic surgery
is super broad.
It's basically head-to-toecancer, trauma and cosmetic
reconstruction.
So basically we go everywherewe can be up in the head and
rearranging the skull for acranial vault, remodeling to
facelift, neck lift, nose jobs,ears down to the breasts, all
(03:52):
the belly stuff, massive weightloss, patients, a lot of excess
skin, thighs, arms, you know,lower extremity reconstruction,
traumatic accident.
The orthopedic surgeons have to, you know, do all their work
and get plates and screws andsometimes we need to move
muscles around the body to kindof help cover that so things can
heal yeah same thing in thechest.
Someone has a you know a heartsurgery and they have some wound
problems because they're pretty, that's pretty intense stuff
(04:12):
and they can get pretty sick andsometimes we've got to come in
and help out and cover the heartand make sure we can help
things move along and get themhealed up.
Speaker 1 (04:19):
So get some good closure pretty neat, yeah, and
and actually we treat keloidssometimes too scar.
Scar tissue.
They excise it and treat it.
Speaker 2 (04:26):
Overaggressive scarring.
Yeah, that's right.
Speaker 1 (04:28):
Yeah, and so which procedures would you say like
are your three most commonprocedures that you do?
Speaker 2 (04:36):
Absolutely so.
Without a doubt, my top two isgoing to be, you know, breast
lifts and reductions, let's sayso, shrinking up the size of the
breast a little more perky,managing.
You know, breast lifts andreductions, let's say so, uh,
shrinking up the size of thebreast a little more perky,
managing.
You know, excess weight, back,neck, shoulder pain, all that
sort of stuff, Uh, and thentummy tucks, any kind of the
body contouring.
So, so we work a lot with uh,the bariatric surgeons you know
(04:58):
down at De Pere and all aroundtown people you know Ozempic
craze going on right now, whichis phenomenal Everybody losing
all that weight, yeah.
Well, you're left with a lot ofskin afterwards and and that's
not fun you want to kind of showthose results that you've
worked so hard for.
So we take off a lot of skin.
So that's probably number two,yeah, and then probably breast
cancer.
Reconstruction is probably mythird most common thing.
Speaker 1 (05:20):
You know a couple of things um, breast reductions, um
, cosmetically, are look great,I mean.
I mean I think I think that'sone thing people probably may
not realize.
Um, and the other thing I willsay is, you know, with my
experience in patients who'vehad cosmetic surgery, I think,
(05:42):
um, if they feel better abouttheir way, they look that kind
of bleeds into other parts oftheir lives where they start
eating a little bit betterbecause they say you know what
I'm looking better, you knowwhat, maybe I will take care of
it, and it kind of has thisripple effect that I always see.
But I think patients don'tanticipate.
Have you had some experiencewith that?
Speaker 2 (06:02):
You nailed it.
It is something like a breastreduction is the patient
satisfaction is through the roof.
It's like 97, 98% satisfaction.
It is so happy.
We hear all the time man, youchanged my life, I got my life
back.
Yeah, I didn't realize I was inpain all the time and this
isn't hyperbole.
Speaker 1 (06:22):
I mean, I've seen it with my own eyes because if you
have really large breasts itmakes you look like you're
overweight.
Correct, yeah and so, but butyou know people start buying
clothes and and you know thatfit a little bit better and it
it just has an outsized impact.
Speaker 2 (06:41):
I think, yeah Well, and like you said, with the
health stuff, when the breastgets smaller you may notice your
belly a little bit more orsomething.
And you say, well, you know,I'm going to continue to eat a
little bit better.
It has a whole bunch ofdownstream just positive effects
.
It's great.
Speaker 1 (06:56):
I'm reading this book called happiness hypothesis by
Dr Jonathan hate, and he'swritten a couple of books that
that I thought were pretty good,but one of the things that it
wasn't him, other people haveshown but he references in the
book that it's actually hard tospend money on things that make
your life better.
Um, you, you will be happy inthe short term, but then you
kind of go back to your setpoint of happiness, whether it's
(07:18):
seven out of ten or whatever.
Um, plastic surgery is actuallyone thing that they found
scientifically that you canspend money on that actually
makes your life better in thelong run.
Speaker 2 (07:27):
For, for for reasons like that, you know, I think I
see that every day, but Ihaven't seen it put.
You know, pen to paper, that'sgood.
It's good to have, like, somevalidation.
I just heard.
Speaker 1 (07:37):
I was driving to work listening to the book on tape
when I heard that and I justlaughed.
Speaker 2 (07:47):
I said, yeah, like I'll buy that.
Yeah, I think that is probablywhat you know.
Everybody wants jobsatisfaction and make sure
you're doing the right thing andI think it's really easy for my
particular job to every day.
It's high fives I feel great, II look great, I feel so much
better.
You changed my life.
It's positive, positive,positive and that's a great
reinforcement and it just makesus love what we do and want to
do it more and help everybody.
(08:07):
Yeah, and you know there'scertain times you deal a lot
with cancers and you have a lotmore of you're saving lives, but
there's a lot more sad momentsand that's tough.
No doubt I'm fortunate to be alittle more on the positive side
all the time, which is good.
Speaker 1 (08:22):
Yeah, yeah, you know, some people they have a job,
some people have, they have acareer, and some people they
have a calling and it and it, it, yeah.
I would imagine that you walkthrough the day feeling like,
hey, I'm making a positivedifference in this world.
Speaker 2 (08:33):
Yeah, and you are for sure.
Speaker 1 (08:35):
Um, now, breast augmentation also has a high
rate of satisfaction.
What I read was 94% um ofpatients are satisfied.
Um, do you see kind of asimilar thing?
Speaker 2 (08:45):
Oh, uh, absolutely, I would say absolutely, yes.
Uh, let's see here, from thebreast augmentation, most people
think about it and think aboutit and think about it, you know,
finally kind of take, take theleap of faith, uh, go through it
now.
Nowadays it's not nearly asscary or like guesswork.
I say, yeah, um, a lot of ushave 3D imaging softwares where
(09:09):
we can take photos of thepatient, and then it's kind of
like weird science where you,you know, we plug in the
computer, all right, let's putthis little implant in and then
kind of see what it looks likeand you can watch it on yourself
, you know on a screen, and kindof see those changes and sort
of get a, you know aforeshadowing of hey what's this
?
really going to look like yeah,and then trying on size and
stuff.
So I think, through all that wecan nail it pretty close almost
(09:33):
every single time.
So the you know near universalhey, I'm happy with this thing.
Yeah, I would totally agreewith that.
Speaker 1 (09:39):
Yeah, yeah, that's.
And you know anotherobservation I can make.
I treat a lot of patients withbreast cancer.
Yeah, I would say probably 1%of women love their breasts.
That's my guess Now probably 85are going to say I feel okay
about my breasts, they're fine,but I would say 1%, just I love
(10:02):
my breasts.
Is that about?
Speaker 2 (10:05):
what you'd notice.
You know, I would say yeah,it's like pre.
You know surgical patients, alot of women, and you ask them
questions about their breastsbeforehand in our you know our
medical interviews.
We're doing with them and samething.
They're like I don't know, Idon't ever look at them.
Speaker 1 (10:19):
Yeah, kind of ambivalent, right, you do run
across that a lot, yeah, and so,yeah, that's cool.
And now do you ever do anysurgeries on men?
Surgeries on men Do you have?
Which procedures would you sayyou perform on men, the most Men
?
Speaker 2 (10:31):
So kind of like the whole specialty is becoming more
and more accepted.
You know, I think 20 years agoplastic surgery was like still a
big secret.
You didn't want anybody to knowabout it.
It was a very hush, hush, youknow, kind of thing.
And in recovery, now we're inthe selfie generation and the
self-promotion generation andmore acceptance of everything,
(10:52):
and so that brings in a lot moremen who normally wouldn't.
So a lot of men coming in forBotox, for fillers, for brow
lifts, face lifts we do a lot ofmen.
Tummy tucks Same thing.
Massive weight loss.
You know women have a muchhigher rate of one abdominal
contouring because ofchildbearing and muscle
(11:12):
stretching and all thatabdominal wall stuff.
We need to kind of help them,help get them back to where they
were, you know, at one point intime.
But a lot of men, a lot ofweight loss, they want to kind
of get back to looking healthyand fit because they've worked
so hard.
They are healthy and fit.
You just can't see it.
Speaker 1 (11:27):
And just the last place underneath all that skin
place it comes off is in thebelly a lot of times, and so
it's probably more sociallyacceptable for a man to have a
belly.
If I have a gut, I don't feelthat bad walking around with it
sometimes, which happens in thewintertime, you're going to gain
(11:49):
a little weight and it's justpart of the deal.
And then the.
So the technology that you weretalking about, that kind of
gives people an idea of whatthey're going to look like in
the future.
Is that an AI-based thing, oris it just a computer-based
thing?
Or does AI have a role?
In plastic surgery.
Speaker 2 (12:07):
There is probably some stuff in the works and I
think our particular program hassome that they're working on,
but it's more of a not quiteinto the, the, the new ai realm,
where it's figuring everythingout, it's still more of a
between photoshop and ai,exactly somewhere blending those
magics?
Speaker 1 (12:24):
yeah, yeah it's.
You know, that's all the crazeai.
It's going to fix everything.
We'll see it might but we'llsee.
And then what's like a recoverytime, let's say for like a
breast augmentation.
Speaker 2 (12:38):
Sure, it's actually pretty quick.
All right, so you could have abreast augmentation and,
depending on where we put things, but I mean you could easily go
to lunch the next day with somefriends and be pretty
comfortable.
Okay, a little sore, a littletight.
Variables are going to be howbig of an implant or how much of
an augment you go.
The more stretch on yourtissues, the little more
(12:59):
uncomfortable you'll be.
But for the vast majority ofpeople it's about a week of
downtime.
You're feeling sore, tight.
Most women describe I just feeltight tightness in my chest,
like a stretch.
Women describe.
I just feel I feel tighttightness in my chest like a
stretch, more so than pain, um,but it's, but it's very well
managed.
It's not a not a lot.
Now we need you to not do toomuch activity, so we don't go
bench press, you know?
(13:19):
Yeah, exactly, let's hold off onthe pushups and the bench press
for a little while.
But, uh, but uh, the recoveryis really not too bad.
Probably about a week to 10days of taking it easy, and by a
month you're pretty much doingeverything you want to do, yeah.
Speaker 1 (13:32):
What about people who overdo it?
You know this body.
Dysmorphic syndrome is thatsomething you see very often?
Or dysmorphic disorder?
I guess Sure.
Speaker 2 (13:41):
Yeah, statistically it's about 7% to maybe 11% or
12% of patients that come into aplastic surgery office in some
sort of you know variance, Iguess you know somewhere around
there and it is.
We definitely see people thatcome in.
I wouldn't say an addiction atall, but but it's kind of like a
snowball effect to where Iguess I'm kind of jumping to a
(14:03):
different little thing.
There are some people that, hey, I've got some, I lost a lot of
weight, so let's treat thisarea first, and then I'm going
to plan it.
We kind of decide some stagesto do it in.
You can't do it all at once, alittle too much for your body,
right?
So we'll break it down.
So it's kind of pre-planned.
There are some people that comein that their mind is telling
(14:24):
them something looks a certainway and we don't really see it.
So we try to hold their handand let them know.
I know you're feeling this, butI'm going to tell you the vast
majority of people aren't seeingwhat you're seeing, and it's
okay.
Now here's what we can do.
But we can also not do that andwe'll kind of try to guide them
.
It's glaringly obvious, but youcan tell when something is not
(14:48):
as bad as they think it is, andour job is to help guide them
through that.
Speaker 1 (14:50):
Yeah, yeah, I.
I think all human, we all,every one of us has distortions
in our thinking and, and youknow, and sometimes you can just
kind of take it a little toofar at or or a lot too far um,
but, but um and so, yeah, it'skind of a, it's kind of a
nuanced thing, I would assume.
Um, and then what do you thinklike the Instagram and the face
(15:14):
chats and all that's the socialmedia stuff?
How do you think that playsinto like plastic surgery?
Are you seeing some interplaythere?
Speaker 2 (15:23):
Yeah, well, it's well from that.
In particular, I would say onething that we get so many people
that come in that are worriedabout their like the neck.
These days, and I think it'smore because we're a selfie
generation, we're on our phones,we're doing things A lot of
people will take their selfiepicture up high so it pulls
(15:45):
their you know their chin up alittle bit so they don't have
that little gap.
You know, any of us look down.
We all got extra skinunderneath the chin and a little
fullness, and everybody triesto find their way to hide that
and look the best.
So that's, I would say, a muchmore common thing we see now,
probably related to always beingon the phone would be one thing
, and then, two, the filtersunfortunately kind of misguide
(16:06):
everybody on what true beauty isand what the real population is
.
So we do get a little skewed onthinking man, everybody looks
this good, why do I not lookthat good?
Speaker 1 (16:15):
Yeah, there's like a selection bias, right.
Speaker 2 (16:17):
Correct and that's that's gotta get to.
And that's probably one of themost negative aspects of that is
just not realizing that, likeyou said, everybody's got some
flaws and there's some there'ssome beauty in that and some
asymmetries, um, and just tryingto figure out what's what's
really a problem for you andwhat?
Can we really fix versusunrealistic filter type?
You know Snapchat expectations.
Speaker 1 (16:38):
Are you, are you familiar with this Fox eye?
This, uh, it's like.
It's like an upturning of theuh, the outer, uh canvas of the
eye.
It's, uh, I don't know, it'slike a a thing.
Uh, I saw I would assume thereis.
Speaker 2 (16:53):
There's probably a technical name for that, yeah
some famous celebrities willkeep names out that do those, I
think, a lot of times.
The particular fox eye I'm notfamiliar with, but I'm assuming
it's probably some sort ofthread, okay, sometimes a little
suture, with some barbs on itthat can easily be threaded
through the tissue, just througha little needle hole, so it's
not like a major surgery.
Speaker 1 (17:13):
Okay, got you.
Speaker 2 (17:14):
Dissolvable suture lasts six months to a year and a
half or something like that,where they can pull some tissue
tight quickly in an office andthen redo it.
Speaker 1 (17:23):
Redo it yeah.
Speaker 2 (17:23):
It'll hold and pull tight and then it'll slowly
relax over time.
Speaker 1 (17:26):
So when the FAD passes you can kind of get back
to baseline, kind of a quick wayto do something.
Speaker 2 (17:31):
It can be good.
There's a lot of bad that comeswith it too.
Speak with your medicalprofessional before diving into
that.
Yeah, we're doctors, but we'renot your doctors.
Speaker 1 (17:41):
So don't take anything we say as gospel as far
as medical advice.
And then I've read about 30% ofbreast implants require a
revision within 10 years.
Is that old data or is that?
Speaker 2 (17:56):
relevant.
I think that's more on the olddata.
Let's say so.
There is, you know, big picturesaline implants and silicone
implants.
And you know for a while not togo way deep into the weeds, but
silicone implants were pulledoff the market from 1992 to 2006
as we studied them to make sure, hey, are these causing health
problems?
We can't find a correlationwith health problems.
(18:17):
We still have ongoing studiesto try and figure that stuff out
, because we don't want to doanything wrong and fortunately
we can't find it related toanything wrong.
Speaker 1 (18:25):
And silicone's a relatively inert element.
Speaker 2 (18:28):
Yeah, and the body sees it, walls it off, says I
can't eat you up, I'm going towall you off into a capsule or a
scar ball and that's what holdsit in place and and we like
that, that's what holds thatimplant there and it kind of
forgets about it.
Yeah, during that period oftime when it was kind of off the
market in America, the rest ofthe world kept using it.
But we used a lot of salineimplants still a silicone shell,
but we used a lot of salineimplants yeah, still a silicone
(18:49):
shell, but we can fill them withsalt water.
They didn't last quite as long,8 to 13 years maybe, on average
.
They can slowly leak, they canjust pop and then just kind of
deflate real quickly.
But a very safe implant, youknow, when it's leaking because
the breast gets smaller or itjust goes flat, you know, but
they didn't last quite so long.
And then the implants beforethat, the old silicone implants,
(19:11):
very thin shells, very kind of,you know, kind of oily sorry,
thin oily silicone in there,just because the characteristic
of the physics of that implantjust didn't last as long.
Now we're light years ahead ofthat.
We're in our you know, fifth,sixth generation of implants,
much better technology.
Silicone is a lot stronger.
It's a solid gel.
(19:31):
It's bonded well to the shell,so we're lasting.
I mean 25, 35 years now.
I can anticipate that man-madedevice, it can you know be
quicker than that, but for thevast majority of people they're
going to last a really long timenow, which is which is great so
, and we again can't find anyhealth risks truly associated
with them.
Still looking into that to tryand figure that all out.
Speaker 1 (19:54):
Yeah, and just you know, just of course you want to
do the studies and followpeople over time, but just it
makes sense that a relativelyinert element like silicone the
body is just not going to have alot of reaction to Correct
Should be safe.
Speaker 2 (20:08):
Yeah, I would say the .
You know it's probably about sohalf percent per year rupture
risk.
So, whereas before, at 10 years, got to do something with it, I
mean at least.
Now I mean we're talking maybe5% of them, yeah, and half
percent you're going to be trulyruptured.
Now there's other reasons why.
You know, size change, lifegoes on, body changes.
I lost weight.
(20:28):
We need to do somethingbeforehand yeah sure.
But.
Speaker 1 (20:31):
But yeah, and is that a spontaneous rupture or is it
due to trauma or car wreck, orboth?
Kind of Probably a little bitof all the above, yeah, yeah,
you'd think if you ran a lot, or?
Something like that.
It probably increases your riska touch.
I don't know, I don't know, Imean they're pretty robust.
Speaker 2 (20:46):
I mean, we put them to the test in the office to
show patients that these arepretty strong and they can take
a beating which is nice, and soyeah, of course, the Ozempic and
the GLP-1 medications.
Speaker 1 (20:57):
people are losing a lot of weight.
Can you talk about what goesinto the plastic surgery side of
treating those patients?
Sure, so you know.
Speaker 2 (21:06):
The first thing is we want to make sure you're a good
candidate for that surgery.
You've just lost a lot ofweight and whether you're not
eating as much or you'reexercising more, less calories,
whatever but we want to makesure you lose that weight.
Or you've had bariatric surgery, let's say you're taking in
less food and you lose a rapidamount of weight pretty quickly.
Well, your body's kind of inthis breakdown sort of phase.
(21:30):
We don't want to jump rightinto surgery and start making
incisions and cuts and sewingthings together because you
don't really have the proteinstores to heal correctly or heal
strongly and get nice, good,thin scars and stuff.
We don't want you to fall apart.
So most people let's say, if youhad bariatric surgery, you're
going to lose a lot of weight inthat first year and then it's
going to taper off and we wantyou to kind of stabilize for
(21:51):
about six months, get thoseprotein stores back up, and then
we can start working on stagingtaking off.
You know what area bugs you themost.
Is it your belly that bugs youthe most, or your back, or your
arms or your thighs?
And figuring out combinationsof things that are going to work
well together so you canrecover and still move and get
up and be pretty functional.
(22:11):
And it's skin that you'reremoving right A lot of skin and
subcutaneous.
Speaker 1 (22:14):
Skin and fat.
Yeah, yeah.
Speaker 2 (22:15):
And then in the case of a belly, in case of women
with childbearing and whatnot,we're going to tighten those
muscles as well, but the vastmajority of it is skin and fat
that's left over that we got toremove.
Speaker 1 (22:26):
Yeah.
Speaker 2 (22:26):
For a combination of techniques.
So there's say gosh, we allknow, you know that lower, back
and flanks, you can work out allyou want and have a six pack,
but there's still guys at thegym with, like you know, you get
that bulge down there with atight shirt.
Speaker 1 (22:45):
Yeah.
Speaker 2 (22:46):
So we're there to help out with that.
That's okay.
Um, with that massive it'susually you've man, you've
burned through all that.
Uh, you don't have a lot of fatstores left, it's just loose
skin.
And we just got to take up gobsof skin and figure out the best
ways to hide those scars.
Is most as inconspicuous aspossible, hide them in clothing
and yeah, I've seen them in themedial thighs with some of my
(23:07):
patients and you know you andlike if I'm doing like a guy and
exam on somebody, I can see it,but other than that you'd never
see it.
Yeah, over the years we've gotsmarter and smarter and our
placement of things has gotbetter, even probably.
The arms is probably your mostvisible area to do a cosmetic
(23:27):
surgery the upper arm.
The upper arms, yeah, if you'vegot the saggy kind of bat wings
hanging down.
But we put those scars lowenough and kind of back enough
that for the vast majority ofyour arm and body positions
you're never going to see thosescars because they're kind of
tucked in on your side.
Maybe if you, you know, raiseyour arm way up in the air,
people will notice them.
But once they faded, they'refaded pretty well.
(23:48):
It's awesome, yeah.
Speaker 1 (23:49):
And you actually rarely raise your arm up in the
air.
Yeah, I mean yeah, we're not.
Speaker 2 (23:53):
We're not in school anymore, yeah, yeah.
So that's a, that's great andwith that one, like all these
things, it gives people theirlife back.
A lot of people with, like thearms, I can't find shirts that
fit.
I can't.
You know it.
It depends on every piece ofclothing choice.
Is my arms aren't going to fitin that.
Speaker 1 (24:09):
Yeah.
Speaker 2 (24:10):
And so when you get to that point, the scar is
easily an easy trade-off to getrid of that Cause.
Your confidence is up, yourclothing choices are up and most
people don't care anymore.
They've got uh, they're sohappy with that contour, it's
just they got their life back.
Speaker 1 (24:24):
Yeah, I recently read that the more self-conscious
you are, the higher your rate ofdepression is.
So like, so, literally like themore you're thinking about
yourself, the more depressedyou're going to be.
And I believe that you knowthat, checked out when I read it
, and you know if you're worriedabout a part of your body that
you think is very visible, Imean you're going to be kind of
focused on yourself a lot andthat's not good for the mind,
(24:47):
and so if you're trying tooptimize your quality of life, I
mean it makes a lot of sense toget those things taken care of.
Speaker 2 (24:53):
Yeah, I think, uh, the old thought maybe of being
vain or, you know, doing it forselfish reasons and stuff, just
like you said, it's not reallythat.
It really gives you positivityand confidence back, which
travels over to your job and tothe way you interact with other
people and the activities you do, which changes your lifestyle,
which keeps you healthier.
(25:13):
It's it's a great little kindof connected circle a balance of
life.
Speaker 1 (25:18):
I agree a hundred percent.
I think most people would bevery surprised and shocked and I
think in some ways, you know,like the Overton window of
plastic surgery has shifted in agood direction, where it's more
acceptable, you're notconsidered to be totally vain to
do it.
And then the last thing do youdo ab implants?
(25:39):
Have you ever done the abimplants?
Speaker 2 (25:41):
I don't do any ab implants, let's say, but we do
do some sculpting on there, ifwe're doing some liposuction on
the abdomen where we can kind ofsculpt in some kind of I don't
want to say fake abs, but it'ssort of a subtraction thing you
leave a little more fat whereyou want the abs to be and you
kind of sculpt the lines outaround there and you can give
(26:01):
the illusion of a nice littlesix pack by doing a little bit
of sculpting, do you dodiscounts for, like fellow
radiation oncologists?
Yeah, absolutely All right,let's do it.
Man Game on.
Speaker 1 (26:11):
All right, scott hey, thanks so much, buddy, I
appreciate you.
Welcome to Doc Discussions.
I'm Jason Edwards and this isthe world's best medical podcast
, in my opinion.
I'm here with my good friend,dr Scott Geiger.
Scott's a plastic surgeon hereat St Luke's.
Scott, how you doing, buddy?
Speaker 2 (00:11):
Hey, doing wonderful.
Thanks for having me on today.
Appreciate it, Jay.
You bet, man you bet.
Speaker 1 (00:15):
Now kind of take me from the start.
Where are you from originally?
Speaker 2 (00:19):
Oh gosh, yes, so originally born out in Arizona.
So originally born out inArizona, so born and raised in
Arizona, moved over to kind ofsmall town Illinois for a little
bit, did all my training herein St Louis.
I was a SLU guy, so down in StLouis, u SLU undergrad, slu med
school.
Then I decided to join the Navyand go do some cool fun stuff
which was phenomenal.
So I joined the Navy.
(00:40):
They paid for my medical school.
Where were you stationed at?
First?
I started off in San Diego.
So Naval Medical Center SanDiego is out there, largest
naval medical facility in theworld.
It is phenomenal, Is thatBalboa Balboa?
You got it, yeah Good, and didmy surgery intern there.
And then I decided to go dosome adventurous stuff.
So I went to flight school andlearned to fly jets and
(01:02):
helicopters and aerospacemedicine, a lot about safety and
aviation and personal factors,all that sort of stuff.
Speaker 1 (01:10):
And that's in Pensacola.
Is that where the Navy doestheir?
Speaker 2 (01:12):
That was in Pensacola , correct yeah?
So, home of the Blue Angels,yeah, down in Pensacola.
So a little stint down there.
And then so what did you fly?
Were you a pilot?
We did pilot, we did.
So I was not a pilot but we hadflight time.
So we got to learn to fly thefixed wing, you know, your
regular airplanes and jets.
And then we get to learn to flyrotaries, the helicopters kind
of a half a syllabus for both,so we can understand what the
(01:35):
pilots go through, all theirstressors, and what it's like to
do that in those situationskind of get in their head, cause
our job was to keep the pilotssafe, make sure they were safe
to fly, and the air crew and allthat stuff.
Speaker 1 (01:46):
Yeah.
Speaker 2 (01:47):
Yes, we got a lot of flight time, flew a lot of cool
aircraft.
Speaker 1 (01:50):
Did you ever break the speed of sound?
Yes, absolutely.
How was it?
Speaker 2 (01:56):
Don't quite know.
I mean kind of you do yourlittle thing.
I would say everything wasawesome in it the pulling the Gs
back of an F-18, on and offaircraft carrier, the helicopter
stuff was phenomenal.
It's just, it's everything,it's like every little kid's
dream man, it was great.
Speaker 1 (02:14):
And did you have a mustache at the time, or were
you just clean shaven?
No, no mustache, you had to beclean shaven.
Speaker 2 (02:18):
This was during, you know, all the rack, fallujah
wars, all that sort of stuff, sothere's always business.
Everybody's got to be kind ofclean shaven in case there's gas
mask stuff.
I mean, even though we were inthe States, but yeah, you got to
keep it, keep it clean.
Speaker 1 (02:30):
That's amazing man.
Yeah Well, thank you for yourservice to our country for sure.
Absolutely.
And so did you have the glasses, did you have the oh?
Speaker 2 (02:37):
absolutely Navy issued.
Uh, aviator glasses for sure,yes, and the jacket, the bomber
jacket too.
Yes, Um and so, and so youfound your way to uh St.
Speaker 1 (02:52):
Luke's here in Chesterfield, missouri.
You got it, yes, and and so youknow, um, plastic surgery kind
of covers a lot of things, andfor the people who don't know, I
mean, it's very hard to becomea plastic surgeon.
They only take the very best ofthe best and, um, and you know,
I know a few people whoactually trained with you and
that's what they said and that'sbeen my experience too.
Um, you, uh, you and I interactwith patients who have breast
(03:15):
cancer when you doreconstructions and you do a
wonderful job and I think it'sit's so important for the
patient's mental health to getthat optimal cosmetic outcome.
But what other procedures doyou do?
What are the common proceduresyou do?
Speaker 2 (03:28):
Well, kind of like you mentioned, plastic surgery
is super broad.
It's basically head-to-toecancer, trauma and cosmetic
reconstruction.
So basically we go everywherewe can be up in the head and
rearranging the skull for acranial vault, remodeling to
facelift, neck lift, nose jobs,ears down to the breasts, all
(03:52):
the belly stuff, massive weightloss, patients, a lot of excess
skin, thighs, arms, you know,lower extremity reconstruction,
traumatic accident.
The orthopedic surgeons have to, you know, do all their work
and get plates and screws andsometimes we need to move
muscles around the body to kindof help cover that so things can
heal yeah same thing in thechest.
Someone has a you know a heartsurgery and they have some wound
problems because they're pretty, that's pretty intense stuff
(04:12):
and they can get pretty sick andsometimes we've got to come in
and help out and cover the heartand make sure we can help
things move along and get themhealed up.
Speaker 1 (04:19):
So get some good closure pretty neat, yeah, and
and actually we treat keloidssometimes too scar.
Scar tissue.
They excise it and treat it.
Speaker 2 (04:26):
Overaggressive scarring.
Yeah, that's right.
Speaker 1 (04:28):
Yeah, and so which procedures would you say like
are your three most commonprocedures that you do?
Speaker 2 (04:36):
Absolutely so.
Without a doubt, my top two isgoing to be, you know, breast
lifts and reductions, let's sayso, shrinking up the size of the
breast a little more perky,managing.
You know, breast lifts andreductions, let's say so, uh,
shrinking up the size of thebreast a little more perky,
managing.
You know, excess weight, back,neck, shoulder pain, all that
sort of stuff, Uh, and thentummy tucks, any kind of the
body contouring.
So, so we work a lot with uh,the bariatric surgeons you know
(04:58):
down at De Pere and all aroundtown people you know Ozempic
craze going on right now, whichis phenomenal Everybody losing
all that weight, yeah.
Well, you're left with a lot ofskin afterwards and and that's
not fun you want to kind of showthose results that you've
worked so hard for.
So we take off a lot of skin.
So that's probably number two,yeah, and then probably breast
cancer.
Reconstruction is probably mythird most common thing.
Speaker 1 (05:20):
You know a couple of things um, breast reductions, um
, cosmetically, are look great,I mean.
I mean I think I think that'sone thing people probably may
not realize.
Um, and the other thing I willsay is, you know, with my
experience in patients who'vehad cosmetic surgery, I think,
(05:42):
um, if they feel better abouttheir way, they look that kind
of bleeds into other parts oftheir lives where they start
eating a little bit betterbecause they say you know what
I'm looking better, you knowwhat, maybe I will take care of
it, and it kind of has thisripple effect that I always see.
But I think patients don'tanticipate.
Have you had some experiencewith that?
Speaker 2 (06:02):
You nailed it.
It is something like a breastreduction is the patient
satisfaction is through the roof.
It's like 97, 98% satisfaction.
It is so happy.
We hear all the time man, youchanged my life, I got my life
back.
Yeah, I didn't realize I was inpain all the time and this
isn't hyperbole.
Speaker 1 (06:22):
I mean, I've seen it with my own eyes because if you
have really large breasts itmakes you look like you're
overweight.
Correct, yeah and so, but butyou know people start buying
clothes and and you know thatfit a little bit better and it
it just has an outsized impact.
Speaker 2 (06:41):
I think, yeah Well, and like you said, with the
health stuff, when the breastgets smaller you may notice your
belly a little bit more orsomething.
And you say, well, you know,I'm going to continue to eat a
little bit better.
It has a whole bunch ofdownstream just positive effects
.
It's great.
Speaker 1 (06:56):
I'm reading this book called happiness hypothesis by
Dr Jonathan hate, and he'swritten a couple of books that
that I thought were pretty good,but one of the things that it
wasn't him, other people haveshown but he references in the
book that it's actually hard tospend money on things that make
your life better.
Um, you, you will be happy inthe short term, but then you
kind of go back to your setpoint of happiness, whether it's
(07:18):
seven out of ten or whatever.
Um, plastic surgery is actuallyone thing that they found
scientifically that you canspend money on that actually
makes your life better in thelong run.
Speaker 2 (07:27):
For, for for reasons like that, you know, I think I
see that every day, but Ihaven't seen it put.
You know, pen to paper, that'sgood.
It's good to have, like, somevalidation.
I just heard.
Speaker 1 (07:37):
I was driving to work listening to the book on tape
when I heard that and I justlaughed.
Speaker 2 (07:47):
I said, yeah, like I'll buy that.
Yeah, I think that is probablywhat you know.
Everybody wants jobsatisfaction and make sure
you're doing the right thing andI think it's really easy for my
particular job to every day.
It's high fives I feel great, II look great, I feel so much
better.
You changed my life.
It's positive, positive,positive and that's a great
reinforcement and it just makesus love what we do and want to
do it more and help everybody.
(08:07):
Yeah, and you know there'scertain times you deal a lot
with cancers and you have a lotmore of you're saving lives, but
there's a lot more sad momentsand that's tough.
No doubt I'm fortunate to be alittle more on the positive side
all the time, which is good.
Speaker 1 (08:22):
Yeah, yeah, you know, some people they have a job,
some people have, they have acareer, and some people they
have a calling and it and it, it, yeah.
I would imagine that you walkthrough the day feeling like,
hey, I'm making a positivedifference in this world.
Speaker 2 (08:33):
Yeah, and you are for sure.
Speaker 1 (08:35):
Um, now, breast augmentation also has a high
rate of satisfaction.
What I read was 94% um ofpatients are satisfied.
Um, do you see kind of asimilar thing?
Speaker 2 (08:45):
Oh, uh, absolutely, I would say absolutely, yes.
Uh, let's see here, from thebreast augmentation, most people
think about it and think aboutit and think about it, you know,
finally kind of take, take theleap of faith, uh, go through it
now.
Nowadays it's not nearly asscary or like guesswork.
I say, yeah, um, a lot of ushave 3D imaging softwares where
(09:09):
we can take photos of thepatient, and then it's kind of
like weird science where you,you know, we plug in the
computer, all right, let's putthis little implant in and then
kind of see what it looks likeand you can watch it on yourself
, you know on a screen, and kindof see those changes and sort
of get a, you know aforeshadowing of hey what's this
?
really going to look like yeah,and then trying on size and
stuff.
So I think, through all that wecan nail it pretty close almost
(09:33):
every single time.
So the you know near universalhey, I'm happy with this thing.
Yeah, I would totally agreewith that.
Speaker 1 (09:39):
Yeah, yeah, that's.
And you know anotherobservation I can make.
I treat a lot of patients withbreast cancer.
Yeah, I would say probably 1%of women love their breasts.
That's my guess Now probably 85are going to say I feel okay
about my breasts, they're fine,but I would say 1%, just I love
(10:02):
my breasts.
Is that about?
Speaker 2 (10:05):
what you'd notice.
You know, I would say yeah,it's like pre.
You know surgical patients, alot of women, and you ask them
questions about their breastsbeforehand in our you know our
medical interviews.
We're doing with them and samething.
They're like I don't know, Idon't ever look at them.
Speaker 1 (10:19):
Yeah, kind of ambivalent, right, you do run
across that a lot, yeah, and so,yeah, that's cool.
And now do you ever do anysurgeries on men?
Surgeries on men Do you have?
Which procedures would you sayyou perform on men, the most Men
?
Speaker 2 (10:31):
So kind of like the whole specialty is becoming more
and more accepted.
You know, I think 20 years agoplastic surgery was like still a
big secret.
You didn't want anybody to knowabout it.
It was a very hush, hush, youknow, kind of thing.
And in recovery, now we're inthe selfie generation and the
self-promotion generation andmore acceptance of everything,
(10:52):
and so that brings in a lot moremen who normally wouldn't.
So a lot of men coming in forBotox, for fillers, for brow
lifts, face lifts we do a lot ofmen.
Tummy tucks Same thing.
Massive weight loss.
You know women have a muchhigher rate of one abdominal
contouring because ofchildbearing and muscle
(11:12):
stretching and all thatabdominal wall stuff.
We need to kind of help them,help get them back to where they
were, you know, at one point intime.
But a lot of men, a lot ofweight loss, they want to kind
of get back to looking healthyand fit because they've worked
so hard.
They are healthy and fit.
You just can't see it.
Speaker 1 (11:27):
And just the last place underneath all that skin
place it comes off is in thebelly a lot of times, and so
it's probably more sociallyacceptable for a man to have a
belly.
If I have a gut, I don't feelthat bad walking around with it
sometimes, which happens in thewintertime, you're going to gain
(11:49):
a little weight and it's justpart of the deal.
And then the.
So the technology that you weretalking about, that kind of
gives people an idea of whatthey're going to look like in
the future.
Is that an AI-based thing, oris it just a computer-based
thing?
Or does AI have a role?
In plastic surgery.
Speaker 2 (12:07):
There is probably some stuff in the works and I
think our particular program hassome that they're working on,
but it's more of a not quiteinto the, the, the new ai realm,
where it's figuring everythingout, it's still more of a
between photoshop and ai,exactly somewhere blending those
magics?
Speaker 1 (12:24):
yeah, yeah it's.
You know, that's all the crazeai.
It's going to fix everything.
We'll see it might but we'llsee.
And then what's like a recoverytime, let's say for like a
breast augmentation.
Speaker 2 (12:38):
Sure, it's actually pretty quick.
All right, so you could have abreast augmentation and,
depending on where we put things, but I mean you could easily go
to lunch the next day with somefriends and be pretty
comfortable.
Okay, a little sore, a littletight.
Variables are going to be howbig of an implant or how much of
an augment you go.
The more stretch on yourtissues, the little more
(12:59):
uncomfortable you'll be.
But for the vast majority ofpeople it's about a week of
downtime.
You're feeling sore, tight.
Most women describe I just feeltight tightness in my chest,
like a stretch.
Women describe.
I just feel I feel tighttightness in my chest like a
stretch, more so than pain, um,but it's, but it's very well
managed.
It's not a not a lot.
Now we need you to not do toomuch activity, so we don't go
bench press, you know?
(13:19):
Yeah, exactly, let's hold off onthe pushups and the bench press
for a little while.
But, uh, but uh, the recoveryis really not too bad.
Probably about a week to 10days of taking it easy, and by a
month you're pretty much doingeverything you want to do, yeah.
Speaker 1 (13:32):
What about people who overdo it?
You know this body.
Dysmorphic syndrome is thatsomething you see very often?
Or dysmorphic disorder?
I guess Sure.
Speaker 2 (13:41):
Yeah, statistically it's about 7% to maybe 11% or
12% of patients that come into aplastic surgery office in some
sort of you know variance, Iguess you know somewhere around
there and it is.
We definitely see people thatcome in.
I wouldn't say an addiction atall, but but it's kind of like a
snowball effect to where Iguess I'm kind of jumping to a
(14:03):
different little thing.
There are some people that, hey, I've got some, I lost a lot of
weight, so let's treat thisarea first, and then I'm going
to plan it.
We kind of decide some stagesto do it in.
You can't do it all at once, alittle too much for your body,
right?
So we'll break it down.
So it's kind of pre-planned.
There are some people that comein that their mind is telling
(14:24):
them something looks a certainway and we don't really see it.
So we try to hold their handand let them know.
I know you're feeling this, butI'm going to tell you the vast
majority of people aren't seeingwhat you're seeing, and it's
okay.
Now here's what we can do.
But we can also not do that andwe'll kind of try to guide them
.
It's glaringly obvious, but youcan tell when something is not
(14:48):
as bad as they think it is, andour job is to help guide them
through that.
Speaker 1 (14:50):
Yeah, yeah, I.
I think all human, we all,every one of us has distortions
in our thinking and, and youknow, and sometimes you can just
kind of take it a little toofar at or or a lot too far um,
but, but um and so, yeah, it'skind of a, it's kind of a
nuanced thing, I would assume.
Um, and then what do you thinklike the Instagram and the face
(15:14):
chats and all that's the socialmedia stuff?
How do you think that playsinto like plastic surgery?
Are you seeing some interplaythere?
Speaker 2 (15:23):
Yeah, well, it's well from that.
In particular, I would say onething that we get so many people
that come in that are worriedabout their like the neck.
These days, and I think it'smore because we're a selfie
generation, we're on our phones,we're doing things A lot of
people will take their selfiepicture up high so it pulls
(15:45):
their you know their chin up alittle bit so they don't have
that little gap.
You know, any of us look down.
We all got extra skinunderneath the chin and a little
fullness, and everybody triesto find their way to hide that
and look the best.
So that's, I would say, a muchmore common thing we see now,
probably related to always beingon the phone would be one thing
, and then, two, the filtersunfortunately kind of misguide
(16:06):
everybody on what true beauty isand what the real population is
.
So we do get a little skewed onthinking man, everybody looks
this good, why do I not lookthat good?
Speaker 1 (16:15):
Yeah, there's like a selection bias, right.
Speaker 2 (16:17):
Correct and that's that's gotta get to.
And that's probably one of themost negative aspects of that is
just not realizing that, likeyou said, everybody's got some
flaws and there's some there'ssome beauty in that and some
asymmetries, um, and just tryingto figure out what's what's
really a problem for you andwhat?
Can we really fix versusunrealistic filter type?
You know Snapchat expectations.
Speaker 1 (16:38):
Are you, are you familiar with this Fox eye?
This, uh, it's like.
It's like an upturning of theuh, the outer, uh canvas of the
eye.
It's, uh, I don't know, it'slike a a thing.
Uh, I saw I would assume thereis.
Speaker 2 (16:53):
There's probably a technical name for that, yeah
some famous celebrities willkeep names out that do those, I
think, a lot of times.
The particular fox eye I'm notfamiliar with, but I'm assuming
it's probably some sort ofthread, okay, sometimes a little
suture, with some barbs on itthat can easily be threaded
through the tissue, just througha little needle hole, so it's
not like a major surgery.
Speaker 1 (17:13):
Okay, got you.
Speaker 2 (17:14):
Dissolvable suture lasts six months to a year and a
half or something like that,where they can pull some tissue
tight quickly in an office andthen redo it.
Speaker 1 (17:23):
Redo it yeah.
Speaker 2 (17:23):
It'll hold and pull tight and then it'll slowly
relax over time.
Speaker 1 (17:26):
So when the FAD passes you can kind of get back
to baseline, kind of a quick wayto do something.
Speaker 2 (17:31):
It can be good.
There's a lot of bad that comeswith it too.
Speak with your medicalprofessional before diving into
that.
Yeah, we're doctors, but we'renot your doctors.
Speaker 1 (17:41):
So don't take anything we say as gospel as far
as medical advice.
And then I've read about 30% ofbreast implants require a
revision within 10 years.
Is that old data or is that?
Speaker 2 (17:56):
relevant.
I think that's more on the olddata.
Let's say so.
There is, you know, big picturesaline implants and silicone
implants.
And you know for a while not togo way deep into the weeds, but
silicone implants were pulledoff the market from 1992 to 2006
as we studied them to make sure, hey, are these causing health
problems?
We can't find a correlationwith health problems.
(18:17):
We still have ongoing studiesto try and figure that stuff out
, because we don't want to doanything wrong and fortunately
we can't find it related toanything wrong.
Speaker 1 (18:25):
And silicone's a relatively inert element.
Speaker 2 (18:28):
Yeah, and the body sees it, walls it off, says I
can't eat you up, I'm going towall you off into a capsule or a
scar ball and that's what holdsit in place and and we like
that, that's what holds thatimplant there and it kind of
forgets about it.
Yeah, during that period oftime when it was kind of off the
market in America, the rest ofthe world kept using it.
But we used a lot of salineimplants still a silicone shell,
but we used a lot of salineimplants yeah, still a silicone
(18:49):
shell, but we can fill them withsalt water.
They didn't last quite as long,8 to 13 years maybe, on average
.
They can slowly leak, they canjust pop and then just kind of
deflate real quickly.
But a very safe implant, youknow, when it's leaking because
the breast gets smaller or itjust goes flat, you know, but
they didn't last quite so long.
And then the implants beforethat, the old silicone implants,
(19:11):
very thin shells, very kind of,you know, kind of oily sorry,
thin oily silicone in there,just because the characteristic
of the physics of that implantjust didn't last as long.
Now we're light years ahead ofthat.
We're in our you know, fifth,sixth generation of implants,
much better technology.
Silicone is a lot stronger.
It's a solid gel.
(19:31):
It's bonded well to the shell,so we're lasting.
I mean 25, 35 years now.
I can anticipate that man-madedevice, it can you know be
quicker than that, but for thevast majority of people they're
going to last a really long timenow, which is which is great so
, and we again can't find anyhealth risks truly associated
with them.
Still looking into that to tryand figure that all out.
Speaker 1 (19:54):
Yeah, and just you know, just of course you want to
do the studies and followpeople over time, but just it
makes sense that a relativelyinert element like silicone the
body is just not going to have alot of reaction to Correct
Should be safe.
Speaker 2 (20:08):
Yeah, I would say the .
You know it's probably about sohalf percent per year rupture
risk.
So, whereas before, at 10 years, got to do something with it, I
mean at least.
Now I mean we're talking maybe5% of them, yeah, and half
percent you're going to be trulyruptured.
Now there's other reasons why.
You know, size change, lifegoes on, body changes.
I lost weight.
(20:28):
We need to do somethingbeforehand yeah sure.
But.
Speaker 1 (20:31):
But yeah, and is that a spontaneous rupture or is it
due to trauma or car wreck, orboth?
Kind of Probably a little bitof all the above, yeah, yeah,
you'd think if you ran a lot, or?
Something like that.
It probably increases your riska touch.
I don't know, I don't know, Imean they're pretty robust.
Speaker 2 (20:46):
I mean, we put them to the test in the office to
show patients that these arepretty strong and they can take
a beating which is nice, and soyeah, of course, the Ozempic and
the GLP-1 medications.
Speaker 1 (20:57):
people are losing a lot of weight.
Can you talk about what goesinto the plastic surgery side of
treating those patients?
Sure, so you know.
Speaker 2 (21:06):
The first thing is we want to make sure you're a good
candidate for that surgery.
You've just lost a lot ofweight and whether you're not
eating as much or you'reexercising more, less calories,
whatever but we want to makesure you lose that weight.
Or you've had bariatric surgery, let's say you're taking in
less food and you lose a rapidamount of weight pretty quickly.
Well, your body's kind of inthis breakdown sort of phase.
(21:30):
We don't want to jump rightinto surgery and start making
incisions and cuts and sewingthings together because you
don't really have the proteinstores to heal correctly or heal
strongly and get nice, good,thin scars and stuff.
We don't want you to fall apart.
So most people let's say, if youhad bariatric surgery, you're
going to lose a lot of weight inthat first year and then it's
going to taper off and we wantyou to kind of stabilize for
(21:51):
about six months, get thoseprotein stores back up, and then
we can start working on stagingtaking off.
You know what area bugs you themost.
Is it your belly that bugs youthe most, or your back, or your
arms or your thighs?
And figuring out combinationsof things that are going to work
well together so you canrecover and still move and get
up and be pretty functional.
(22:11):
And it's skin that you'reremoving right A lot of skin and
subcutaneous.
Speaker 1 (22:14):
Skin and fat.
Yeah, yeah.
Speaker 2 (22:15):
And then in the case of a belly, in case of women
with childbearing and whatnot,we're going to tighten those
muscles as well, but the vastmajority of it is skin and fat
that's left over that we got toremove.
Speaker 1 (22:26):
Yeah.
Speaker 2 (22:26):
For a combination of techniques.
So there's say gosh, we allknow, you know that lower, back
and flanks, you can work out allyou want and have a six pack,
but there's still guys at thegym with, like you know, you get
that bulge down there with atight shirt.
Speaker 1 (22:45):
Yeah.
Speaker 2 (22:46):
So we're there to help out with that.
That's okay.
Um, with that massive it'susually you've man, you've
burned through all that.
Uh, you don't have a lot of fatstores left, it's just loose
skin.
And we just got to take up gobsof skin and figure out the best
ways to hide those scars.
Is most as inconspicuous aspossible, hide them in clothing
and yeah, I've seen them in themedial thighs with some of my
(23:07):
patients and you know you andlike if I'm doing like a guy and
exam on somebody, I can see it,but other than that you'd never
see it.
Yeah, over the years we've gotsmarter and smarter and our
placement of things has gotbetter, even probably.
The arms is probably your mostvisible area to do a cosmetic
(23:27):
surgery the upper arm.
The upper arms, yeah, if you'vegot the saggy kind of bat wings
hanging down.
But we put those scars lowenough and kind of back enough
that for the vast majority ofyour arm and body positions
you're never going to see thosescars because they're kind of
tucked in on your side.
Maybe if you, you know, raiseyour arm way up in the air,
people will notice them.
But once they faded, they'refaded pretty well.
(23:48):
It's awesome, yeah.
Speaker 1 (23:49):
And you actually rarely raise your arm up in the
air.
Yeah, I mean yeah, we're not.
Speaker 2 (23:53):
We're not in school anymore, yeah, yeah.
So that's a, that's great andwith that one, like all these
things, it gives people theirlife back.
A lot of people with, like thearms, I can't find shirts that
fit.
I can't.
You know it.
It depends on every piece ofclothing choice.
Is my arms aren't going to fitin that.
Speaker 1 (24:09):
Yeah.
Speaker 2 (24:10):
And so when you get to that point, the scar is
easily an easy trade-off to getrid of that Cause.
Your confidence is up, yourclothing choices are up and most
people don't care anymore.
They've got uh, they're sohappy with that contour, it's
just they got their life back.
Speaker 1 (24:24):
Yeah, I recently read that the more self-conscious
you are, the higher your rate ofdepression is.
So like, so, literally like themore you're thinking about
yourself, the more depressedyou're going to be.
And I believe that you knowthat, checked out when I read it
, and you know if you're worriedabout a part of your body that
you think is very visible, Imean you're going to be kind of
focused on yourself a lot andthat's not good for the mind,
(24:47):
and so if you're trying tooptimize your quality of life, I
mean it makes a lot of sense toget those things taken care of.
Speaker 2 (24:53):
Yeah, I think, uh, the old thought maybe of being
vain or, you know, doing it forselfish reasons and stuff, just
like you said, it's not reallythat.
It really gives you positivityand confidence back, which
travels over to your job and tothe way you interact with other
people and the activities you do, which changes your lifestyle,
which keeps you healthier.
(25:13):
It's it's a great little kindof connected circle a balance of
life.
Speaker 1 (25:18):
I agree a hundred percent.
I think most people would bevery surprised and shocked and I
think in some ways, you know,like the Overton window of
plastic surgery has shifted in agood direction, where it's more
acceptable, you're notconsidered to be totally vain to
do it.
And then the last thing do youdo ab implants?
(25:39):
Have you ever done the abimplants?
Speaker 2 (25:41):
I don't do any ab implants, let's say, but we do
do some sculpting on there, ifwe're doing some liposuction on
the abdomen where we can kind ofsculpt in some kind of I don't
want to say fake abs, but it'ssort of a subtraction thing you
leave a little more fat whereyou want the abs to be and you
kind of sculpt the lines outaround there and you can give
(26:01):
the illusion of a nice littlesix pack by doing a little bit
of sculpting, do you dodiscounts for, like fellow
radiation oncologists?
Yeah, absolutely All right,let's do it.
Man Game on.
Speaker 1 (26:11):
All right, scott hey, thanks so much, buddy, I
appreciate you.
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