April 2, 2024 • 31 mins
In an age where social media inundates us with images of flawless beauty, it's becoming increasingly challenging to discern reality from illusion.
Many of us rely on these images when considering cosmetic treatments or selecting a doctor, but how can we trust what we see?
Our guest this week is Dr. Michel J Reilly, a double board-certified head & neck and facial plastic surgeon. He addresses the alarming trend of subtle editing in before and after photos, which may not accurately portray the outcomes of surgical procedures. Dr. Reilly shares insights gleaned from his extensive experience, offering invaluable guidance on how to navigate the sea of plastic surgery imagery flooding our social media feeds.
Studies, such as one by Vaca et al., have revealed that a staggering 97% of top before-and-after Instagram posts associated with plastic surgery hashtags showcase visually enhanced results. This raises important questions about authenticity and transparency in the industry.
In this episode, we explore strategies for decoding these images. We discuss how factors like lighting, facial expressions, head positioning, makeup, and hairstyle differences can significantly impact our perception of surgical results. By gaining insights into these nuances, listeners can become more discerning consumers of cosmetic imagery and make informed decisions about their aesthetic journeys.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
This is the Art Beauty podcast where weare always reaching for truth in beauty.
Remember, the people in the brands onthe show are not paying to be here.
So we get to havethose tough conversations
because you deserve to be informedso you can make the best choices
for yourself.
With that said, I'm your host,Amber Melton.
Today, my fabulous co-host is Dr.
Michael Riley.
(00:21):
He is a double boardcertified facial plastic surgeon
practicing out of Washington, D.C.
It is such an honorto have you here today.
Welcome to the show.
Thank you so much for having me.
I can't wait to chat with you.
So I just got to give usa little bit of a shout out
because we have a great show today.
We're going to be talkingabout social media
(00:43):
and how people can tweak images.
Now, maybe not a big dealif your mom's doing it, if your sister,
your brother, but it can be a big dealwhen plastic surgeons are doing it.
So Dr.
Riley is here to talk to us abouthow we can kind of decode those images.
We were going to showsome really wild ones out there.
(01:04):
You sent me a bunch.And then we both realize.
These are not ours.
I don't want to get sued.
So, Doctor, I love it.
You were like,
I'm actually going to use some of your ownphotos to kind of highlight things
to be looking out for.
So I just want to say,before we even get started,
you've been one of my favorite guestsever.
Just was taking a half hour to kind ofgo through and greet the week on the spot.
(01:28):
So thank you so much.
And you were like the technical supportbecause that's not my forte.
So thank you so muchfor getting those photos together.
And yeah, I think it's actually probablyeven more authentic.
Our conversation, because some of thesemistakes are mistakes I've made in my own,
you know, pre and post ops and tryingto, you know, get content developed
and then realizing later that maybeI was doing things unintentionally
(01:49):
or some maybeeven intentionally subconsciously
to make my post-ups look better.
But thankfullythat's been brought to light.
More recently,
there have been a couple of good articlestalking about just like how manipulated
plastic surgery images are and, you know,self-reflection is a good thing to do.
So it certainly made me turnand say what's what?
What's going on with my pre and post upphotos? Are they authentic?
(02:12):
And I really stand by theseand you and I can kind of tease
through some of the ways that I feel like,yes, I can.
And maybe the ways that in the pastI was being less authentic
with the pre and post ups.
You know, like I said, not intentionally,but but they're they're.
Listen, I'm going to I'm going toyou know, first of all, I love honesty.
I love when people come, you know,listen to my own career.
(02:33):
Certainly when filters came out,I was like, this is great.
You know, we've discussed this.
They now work on QVC.
QVC is totally based on authenticity.
If we're going to show a beforeand after on air,
my before has to beshot in that studio that day.
And the after has to be, you
know, is being done livebecause they certainly pride themselves on
(02:56):
on having that authenticityand developing that trust with consumers.
Well, I love that.
I mean, honestly,
that's like you can see thathow that could become an industry standard
and not exactly that because obviouslyyou can't do surgery and recover from it
and have your post-op phototaken on the same day.
But the more and more criteriawe put together as like
this is what's an acceptable before andafter photo, the you know, the stronger
(03:20):
everything will be then everyone'scomparing the same apples to apples.
And no, I actually think that's very noveland pioneering to QVC to do that.
You know, it's great.
And and listen, you've probably seen it
not just talkingabout other plastic surgeons,
but I've been at many brand presentations
and they will show those beforeand afters.
And it's laughable when you seethe techniques that are being used.
(03:43):
And it's like, look, we trim this person'sneck and in the first one they're like,
but on the second one they're out to hearand it's like, okay, okay.
And that's even better.
When the productis something like a skin care product
or like a topical or some sort of,for instance, like a radiofrequency device
where there isn't like a clear cutor something that you actually did
(04:05):
because then you're just like, well,that's within the realm of,
you know, we call it the margin of error.
I mean, if you take two pictures
of the same person, you're goingto get two different results, you know, so
yeah,no, some of those are really atrocious.
And and but there areso this is something you may not know.
There are really there are standard
photographic measuresin facial plastic surgery photos.
(04:28):
So for the face specifically, you know,we have specific views that we take,
but we also have very specific
orientation of the face.
So it's called the Frankforthorizontal plane.
It's how every photo of the faceis supposed to be taken.
And it is the idea behindthat wasn't well-intended,
which is let's make surewe're comparing apples, apples
(04:48):
and get the photostaken at the same angle,
because you can imaginemy neck looks a lot different
from down herethan it does from right here.
And so if that in
the Frankfort horizontal plane,just to be to dork out for a second
and tell you other industries insidescoop it's when the the lower
part of the orbit so the orbital rim righthere, the very bony part of the eye
has to line up on a horizontal planewith the top of the ear canal.
(05:10):
So like when I'm in, patients in my officeall the time are wondering
what am I doing?
But I kind of grab their, you know, headand help them tilt and reposition.
But I'm always trying to get that
top of the ear canal to line up withthe bottom of the orbital rim right there.
So that then I know the afteris going to look the exact same.
So there is that that's been you know,we're trying.
You know, you are tryingand I and I don't want to diverge too much
(05:32):
but there are also great apps right nowthat help people at home
take I forget the name of it,but there's one that will kind of help
you make sure that your face is measuredso that you can kind of track progress.
And it's a great idea.
You know, to make sure that your face
is in the same place,to make sure that lighting is similar.
But it's tough. It's really tough.
(05:52):
So you have agreed to share
some of your own photos of thingsthat we should be looking out for.
I wish we could have used some of them.
I mean, some of them that you sent mewere just laughable.
But we're going to play it safe here.
So I'm going to actually try toshare these now.
All right.
And we
can kind of talk through thingsthat we should be looking for.
(06:14):
Sure, I promise.
Consumers are comparingplastic surgery photos.
I'm going to preface this
by saying that we just quicklygrabbed these off of my Instagram.
As you know, you're more thanwelcome to go look for yourself.
None of these have been doctored.
It's which is Mike Riley, M.D.
But the photo that we wanted to highlight,which was like my
my just said, go to my most recent post-opphoto that's on there,
(06:36):
is because I use very, very controlledcircumstances to take my photos.
Now, the one thing that I cannot controlfor sometimes is the actual lighting
that's coming infrom the windows in the office
where I do the photosbecause it's not a complete darkroom.
So even this which was taken in thiswith the same camera, in the same
in the same exact location
and the same
in front of the same background,you can see
there's like a little bit of a dark edgeon the left side of the post-op photo.
(06:59):
But in general, this is how a preand post op photo should look.
You shouldthe background should look the same.
You know, the amount of makeupshould really look the same.
So specifically, you know, like herlipsticks is the same.
I will say like even in this onebecause you cannot control for everything.
Looks like she has eyeliner onin her second photo.
Yeah.
Having didn't have in the prepand this photo, by the way,
what we're looking atis a lower left for a plaster result.
(07:21):
So the bag is on her left side wherethere's like kind of that deep crease
and then the visible bag,that's the photo.
That's what that was done.
That was what that iswhat was done surgically.
And that's kind of what we're looking for,looking at after surgery.
So this is generally what you want to see.
Even, you know, thethe size of the head is the same.
We always whenever I'm doing the preand post ups, my assistant doesn't.
(07:41):
But I always say,you know, drag it on top of the other one.
So it's really like lined up.
Everything should be the same size you canimagine for a rhinoplasty or something.
The size really make a big differenceif the head is smaller afterwards,
the nose is going to be smaller too,which might give you might give you
a, you know, a boost in one directionor the other.
So this is a well-matched photo.
This is what you want to see in youryour doctors before and after photos.
(08:03):
You don't want to see some dramaticmakeover where, you know, the patient was,
you know, having
just rolled out of bed on the leftand then on the right side,
they were getting ready to go to the Metgala.
Like,that's not the look that we're going for.
So so that this is you know,that's the background.
If you want to go to, like the next one,I can kind of start
we can start going throughsome of the errors
that I've made over the yearswith my before and after photos.
(08:24):
So now this is onewhere this is a really good, funny story.
This woman is beautiful and wonderfuland she has been so gracious
to share her photosbecause this photo actually was published
on the Today Show when I was on that showlike ten years ago, talking about a
study I did about how
people are perceived differentlyafter a facial plastic surgery.
(08:45):
And Hoda, I'll never forget,you know, I was nervous.
I was pretty, pretty young doctorat the time and she was like, well,
I think she looks better in theafter photo because she had a blowout.
And the second photoand I was like, my gosh, you know?
And I said, Well, you know, yeah,you know, she did her hair
does look better, but, you know,she also had this, that and other thing.
So she sobut the hairstyle was the point of that.
And it was and it was interestingbecause it was her immediate and she's a
(09:06):
she's a real journalist like she was like,I'm not into the chase
because there is this, you know,bias factor that I think a lot of people
inherently, like we discussed earlier,you'll see it in certain photos.
You're like,why are they even trying to look at it
like this is fromthis is the same, you know, a comparison.
But like in this case,this is just how she happened
to look the daythe day she came in for post-op.
(09:27):
And frankly, part of it was becauseshe was really happy with the result.
And I think she was gettinga little more dolled up
after surgery than she was before surgery.
But so that's that's an important thing.
If you if you go to someone's Instagramlike mine and you see a trend of like
every single post photo,they're in full makeup
and their hair is blown out, then I mean,there are doctors practices who do that.
They they do a whole make up thing rightbefore they take their post-op photos
(09:51):
because they're trying to make themlook as good as possible.
Well,you're not comparing apples to apples.
So that's that's like a good example of,you know, be
be aware that it's,I think, a trend that maybe you would see.
And and by the way, one of the things
that got us talking aboutthis was the study
that was done showed thatmost people want to see dramatic changes.
So the top performing plastic surgeryInstagram
(10:13):
profiles, they're 97% of themare altering their photos
in some way or they're or they're they're,you know, manipulating their photos
to be more positive after surgerythan they are before surgery.
So that's because that gets engagement.
I mean, that's why they're top becausethey're like, people love that change.
So so this is one where I'mjust like this.
We mainly showed this just to sayhairstyle can make a difference, you know?
(10:35):
Yeah. Little bitmore makeup in the post-op photo, too.
So those are,
you know, those are definitely thingsthat are not comparing directly.
What about the nextone? What do you have there?
I get there.
Okay. Okay.
So this is another I mean, my patientsfirst of all, I love my patients.
Secondly,anyone who's been willing to share
their photos is extra specialbecause it's you know, it's hard.
(10:57):
If you had plastic surgery to begin with,
that was usuallybecause you didn't like something.
So people are willing to share that.
I just have to give a hugethank you to my patients.
You talk to that?
Yeah. And celebrate and support you.
100% and,and you know and, and they're amazing.
And look at this photo.
I mean, it looks like incredible.
I did do a neck lift on this patient. She.
(11:18):
She's lovely.
This was a photo taken years later,she came back to see me
and she was here for other reasons.And I was like, let's get a post up.
And I'm like, my God,this is like the best result ever.
And then we started talkingand I was like,
she had lost a little bit of weightafter the surgery.
So her, her whole composition had changed.
I'm not claiming full creditfor this result with just my surgery.
(11:39):
If you lose weight
and you have
any bit of heaviness in your neck, it'sprobably going to get a little bit better.
Now, the contours. Great. So I was okay.
I got the skin treated, but there's nothere's no there's no sagging skin there.
But I'm not taking full creditfor the entire result.
So and, you know, it's like,how much do you disclose in a photo
like, well, this was five years laterand the patient lost £20. Most doctors
(12:01):
aren't including that in their beforeand after are kind of details.
So so we probably all seenthat before, too, where the patient,
her, him or herself has had a favorablecosmetic change or intervention.
And then
the pictures benefit as as a result,maybe they've been working out whatever.
You know, I see that a lot,especially with body makeovers,
(12:22):
whether it's liposuction,the mommy makeover, you know,
and I'm sure some of that is that onceyou have gotten rid of some of that
excess fat, that excess skin, maybe you'rea little bit more inclined to work out.
But things to be aware of,
you know, and I've always said this, that,listen, I've had plastic surgery myself.
You really need to
(12:45):
sort of manage expectations.
Yes. And you want to be with a surgeon
who'sgoing to help you manage expectations. So.
Okay, so this is something good, but butto your credit, the profiles are the same.
You know, she's wearingrelatively the same amount of makeup
and the backgrounds are the same. So,yeah, yeah, yeah.
Good job.I wasn't trying to trick anybody.
I will say, do you remember?
(13:06):
I don't know if you would remember this,but when I was a kid, you know, I'd be
watching TV and there'd be these ads for,I don't know what they were like.
Maybe like GNC, vitamins or protein powderor like those AB crunchers.
And the before and after photoswould be like some guy in his garage,
you know, like thisbig like, you know, over overweight
(13:27):
body thatthat was not he was not caring for.
And then the after photo
was like taken in front of a mirrorwith all the light shining on it.
And so this has been going on
not just in the facial plastic surgeryrealm or plastic surgery realm.
It's basically
before and after is throughout timepeople have been figuring this out. So.
I mean, I love TV magic.
Listen, the differencebetween like pulling your pants,
like letting your pants, you know,if you were in spandex and letting that
(13:50):
fat roll, you know, hangover versuspulling them up.
I know all about that.
All right.
This is a good one because, you know,
this doesn't have any sort of professionallooking background.
And part of thatis because this is not a cosmetic patient.
This is a young man had actually had
some injuries and
(14:10):
his smile was not functioningproperly on the right side. So
we ended up replanting his muscle, whichhad gotten evolved in the right cheek.
And that's why he now has likethe matching tip on the after photo.
But I thought this was a good one
because, you know, on the left side,you've got the trees in the background.
In my office, we're showing in the showingthe background
(14:31):
on the right side,there's many blinds behind there.
So that inherentlyis going to change the lighting.
And then on top of that,it's just distract ding.
You know, it's really like, so if this wasa cosmetic photo, you would be on major.
No, no.
Why are you first of all,why don't you ever act together
enough to be taking the cosmetic beforeand after photo?
That would be one kind of red flag to me.
And then secondly,even if you weren't using a,
(14:53):
you know, a professional blue background,why is it that they're different
backgrounds and you'll seeweird shadows in people's photos,
You'll see the color is just not right.
But this one was pretty glaringwhen we were looking quickly
to my instrument, like, yeah,that's a good one.
Like,if someone did that for a cosmetic photo,
you would be wanting to,you know, put your alarm bells up.
Yeah, man, I really do
(15:13):
wish we could have just gone and donea deep dive on other people's Instagram.
But again, thank you for being so willingto use your own photos as an example.
Okay, here's here's here's the lot.
Here's one where I think the lightingwe might have this one.
And is there one more about there
maybe not this this onewhere the lighting is just not right.
And my excuse here because she'srelatively recent like I knew better.
(15:37):
You know, she's lined up properly.
Everything is properly positionedand scaled.
But I have two offices.
One of them is my office,my main practice at Georgetown University,
and the other one is my privatepractice office in McLean, Virginia,
about 20 minutes away from here.
And I have the same cameraand have the same flashes,
but the rooms are very differentthan I take the photos in.
(15:58):
And sometimes the lighting is just Ican I get the lighting match?
And this is a good example of likewhat is happening with the lighting here.
I mean, her eyeslook totally different colors.
Obviously the backgroundsare totally different color.
She's beautiful.
In both pictures,the post up is on the right where
we've refined her nose, her nasaltip a little bit,
but she almost looks a little washed outin the right side of picture.
So if this was one,this would be a good example.
(16:20):
If someone was showingyou like, wow, look what
I did for her skin color.
Yeah. Isn't it amazing how how.
Great. Skin looks? It's like,wait a minute.
No, that's just a has anyone like a flashjust flashed on her skin.
That's why it looks so clearand and homogeneous on the second one.
I mean, she has nearly flawless skin
in the left side, too,so she would be a bad example of that.
(16:40):
But you can imagine if someone has roughskin,
throw a flash on it, and then suddenlythey look clean in the site after photo
and like, no, that was because of that,that, you know, lotion.
They rubbed on them for themselvesfor four weeks.
Probably not.
So that's anotherthat's the lighting example
I think we were allto come up with on the fly.
So, you know, I'm
going to stop this nowand kind of go back to our conversation
(17:02):
for us regular consumers at home,
you know, these are great thingsto look for consistent backgrounds,
consistentangles, lighting, to be aware of
why do you think it isthat more doctors aren't
that doctors are a little bit,
I don't want to say deceitful, but maybenot as transparent as they should be.
(17:24):
Yeah, And this is probably athis is a great question
because it's almost like every inevery industry, there's going to be
somebody who's really not doing it right.
I mean, I think I cannot believethat the brilliance of the people
that I'm surrounded by in my fieldI mean my colleagues
in facial plastic surgery and headneck surgery.
I mean, they are some of the brightestpeople I've ever known
(17:45):
and most dedicated to their patients.
You know, they really, really careabout doing the right thing.
So the problem is,you know, you're seeing the 1% extreme
like we just talked about, the top1% of Instagram accounts.
Well, that's like basically theyou know, they're off the bell curve.
These are the people who are kind of likenot falling within the realm of normal.
So I don't necessarily know that it's
(18:06):
pervasive
in a way that's ubiquitous acrossplastic surgeons.
I just think that they're, of course,like in any industry, there are people
who are going to be manipulativeand maybe not not fully truth telling.
And I think that's been amplifiedby social media because they have a place
to put their content and it's not like
(18:27):
it has to be believable.
So now it's just aboutis it engaging or not?
So the more dramaticthe result, the more engaging it is,
the more likes you get because thenit gets pushed to other people's pages.
So they're getting rewarded for thesethe dramatic nature of the results,
which is what our human brainloves to see.
And and so yeah, so again, I don'tI think those some of those doctors
are just genuinely being deceitful.
(18:48):
You know, peoplechase their dreams in different ways.
And this is
this is one way where it seems likeit's probably being chased by some people.
But I don't think it's necessarily aproblem with physicians or like the whole
the whole of plastic surgeryrather than, you know, maybe
a warning bell, like,let's not let this become normal because
(19:09):
it does not instills trust.
I mean, one of the mostyou just said you've had surgery yourself.
One of the most important things,probably the most important thing
with the surgeon patientrelationship is trust.
You have to have trust.
So if you look at someone's Instagramand you don't believe it and you know
that there's like a a history of that,you can tell, okay, they just do this.
Well, that's not very trust inducing.
(19:31):
So where's your radar onon the trust factor?
I think that's important.
And I think most of us know thatbecause, you know, you can
if you shoot up to the moon,you're going to get shot down.
But if you you know, if you're if you'rea good plastic surgeon who does good work,
who's truthful and honest, that'swhat gives you the longevity to survive
and to have the meaningful relationshipswith patients that were.
(19:51):
That is why I went into it, I think bymost people might go into this job.
Here's an interesting thought, too,because, you know, you said earlier before
and I'd like you to restate thatstatistic, that
what was it about the the percentage of.
Yeah.
So the top this was not my study.
This was I think I was saying it right.
Vodka or vigor VCA at all.
(20:13):
They did a study basically looking at thetop performing plastic surgery accounts.
So basically the accountswith the most followers and they found
that 97% of those accounts had evidencethat they were using tactics
to manipulate the post-op photosthat were lighting angles, makeup.
(20:33):
Those are the three main ones, digital.
But digital alteration,like you and I were looking at a couple
photos earlierwhere people had actually clearly,
like just completely blurred outall irregularities in their in the skin.
So those are the things that are beingused by the top performing accounts.
So which means that like that, theyou know, the consumers,
(20:53):
the people viewing them like that are most
drawn to those types of images.
And then these sortsof set up expectations that are not real.
Like if that'swhat you're seeing all the time, then
you're like, Well, that's whatI should get if I have my plastic surgery.
And and that is why I'm kind of you and Iare here to do to educate people.
(21:16):
That is a disservice to everyone.
I mean, there's nothing worsein than my cosmetic patient.
I've you know, I've done a lot of surgeryand been a doctor for 20
to a little 21 years now. But
one of the
worst things is a dissatisfiedor disappointed patient,
and you're just kind of setting people upfor dissatisfaction
(21:37):
when you are not settingtheir expectations properly.
And I think that's what one of the risks
of social media photosand all these altered images is.
You know,
I guess the thing that surprises methe most, right, is is sure, I guess
it's good to,
you know,when you're scrolling on Instagram
and you're like, wow,that's an incredible before and after.
However, I most of the peoplethat I've talked to in that I know,
(22:00):
it seems like when they goto have any sort of work done,
they're like,I don't want anybody to know.
I want it to look as natural as possible.
Now there's two schools of thought, right?I know.
And the making of you know.
You can. Say that, right?
So like on the West Coast,people want to look done.
It's a badge of honor.
But here on the East Coast, most peoplethat I know are like, I want to do this.
(22:22):
And I don't want I just I want to better,but I don't want to look done.
So it's interesting to me
that those you know, I guess the photos
that are getting the most attentionare the ones that clearly
have been manipulated and look like a moreof a drastic before and after
when I think in reality most peoplekind of want subtle but better.
(22:42):
That's a really tough onebecause I think there is a little bit
of discourse or like dissonancewith that concept because
I think that'smaybe one of the harder lines to walk
as a surgeon is that people saythey don't want anyone to notice, but
they do want people, but they also wantto look like nothing happened.
So it's almost like just that.
(23:02):
That inand of itself is a bit unrealistic,
but it's a really comment,really, really comment.
Like, I want to look just likeI look now, but it's like 20% better.
But I don't want anyone to no notice.
It's like, well, that is notyou know, those things are not possible.
So I think there is and you'reabsolutely right that on the East Coast
I do my training, my fellowshiptraining at UCLA
(23:23):
out in Los Angelesand but I've been on the East Coast
for most of my professional career,aside from that.
So in Washington, D.C.,I think it might be even
a little more conservative than New Yorkand people really don't like anyone
to know anything about whatthey've had done or cosmetic work.
And it's really different in L.A.,where it's almost like
(23:45):
people are trying to look done.
Some people,
not everyone, but there's a little bitmore of an acceptance of like, okay, yeah,
I had this, this really expensive,like nice facelift.
I look like I'm, you know,really different than I did before.
And I'm proud of itbecause it's part of the culture.
So it is there are these micro culturesthat are different in different areas.
(24:05):
Yeah, for sure.
You know,
and I know I know this isn't surgical,but I heard once
here's like an interesting tipand tell me if this is right.
You know, going back to this ideaof before and afters
that the timing also matters. Right?
So we had somebody on here who didlip injections and she was like, you know,
(24:25):
if you if I was looking for a lip injectorsomewhere,
I would ask them to give me your before,give me your you're
right after, which is a lot of the timeswhen people aren't going to come back.
But she's like,
if you can, you should ask them forthe ones that are a couple of weeks later
when the lips have settled,when they've actually like got into that
is that the same thing with plasticsurgeon is is it good to know about
(24:48):
like time differences.
Yeah, Yeah, definitely.
That's one thingwe didn't really talk about,
but I did talk about it in my PsychologyToday blog,
which I think is how we startedthis conversation initially,
which is that there isthis trend with some people to do.
We call them on the table afterswhere you're doing a post up photo.
It's particularly popular with rhinoplastywhere you do the pre-op photo.
(25:11):
Like while they're on the table,you do the post-op photo and the risk of
that is that that has nothing, you know,not nothing to do with the final result.
But that's clearly not the final result.
When you are done operating onsomeone that is there's been zero healing.
That's happened at that point.
You can I've done it,you know, thousands of times.
I can tell you when you do a rhinoplasty,you can basically push the nose
into whatever shapeyou want it to right on the table
(25:33):
that doesn't meanthat it's going to heal that way.
So so that's a timing question.
Now, the other side of that is also truethat you need to really wait
a period of timebefore you have a final result.
Rhinoplasty is another good example.
We kind of historically talk about a year.
I think it's probably reallyhonestly longer than that.
I mean, if you really waitfor the full healing
after rhinoplasty, it'sprobably a year and a half or two years.
(25:53):
But that is notI mean, my patients are great.
Like most of them will come backfor one year, but not everyone does.
You know, some people come for their their
I usually do like one week, one month,three months in a year for my rhinoplasty.
Some people will come out of a monthor maybe they
they me they come for the three monththey're thrilled. Yeah.
No they're not going to come back.They're not going to come back.
So I got to grab that photobefore I never see them again.
(26:15):
Sure.
And and so, you know, but
but just being full disclosureabout that, like, this photo was taken at,
you know, a week or and you can see thisby the way, and pre and post up photos
so you know someone has like bruisingstill they had a facelift in their videos
and I'm like okaywell that was very recent.
If you can see
yellow or purple on their neck,then that's within the last 2 to 3 weeks.
(26:37):
That's not a final result.
I mean, I'll be just,you know, so I had a breast lift.
I've talked about it on this podcast and
and a small implantput inches to retain the size.
And right afterwards it looked likesomebody had stuck to coconuts, literally.
And I was like, now, first of all,my surgeon was like, I'm not the guy.
(26:57):
If you want big whatever.
My whole thing is very natural,very subtle.
But that first. Thatwhen you have that, you're like, what?
I was like, Well,I want my money back, you know?
But I had done enough research to knowthat it takes time to fall and to settle.
It could not be happier.
I love my surgeon,he added. He's on the podcast.
But but,
but knowing these thingsand kind of going in and knowing this,
(27:20):
you know, everybody who gets lip
injections goes home and freaks outbecause your lips blow out.
I always tell people,if you go get any sort of facial filler
and you love the way it looks,the next day, you didn't get enough.
Exactly. Exactly.
Becauseand then the flipside is true, though,
because people are not willing to toleratethose,
(27:41):
you know, like that week of theof the really fluffed face sometimes.
So you got to kind of do it slowly.
But I agree. Yes, absolutely.
Like you could manipulate,I imagine you do your before and after.
yeah.
This was right afterward like, well,of course you're you're really small
in the way those fillers work, by the way,is they pull fluid in with them.
So all the fillers are hydrophilic,meaning they the water loves them.
(28:03):
And so so whenever you get a fillerinjected,
you know,the filler syringes are pretty small.
One CC of fluid, which is in whatwhat's the most it's really tiny.
So how do you get all this volumefrom one?
CC It's because there's fluidgetting pulled in there with it
and there's more happeningin the immediate period and then it
starts to settle out. So
gosh,I feel like I could talk to you forever.
I love thatyou were talking nerdy with us,
(28:27):
you know, So
with these things said it, you know,to any of the medical companies out there,
I know that,you know, the Visio camera is pretty
there's a camera to kind of measure sundamage and wrinkles.
I'm surprised that no other companyhas come out with sort of a standardized
camera setup.
(28:49):
But are there are
there are.
And you'll see themI mean, these are the people
who are not manipulating their photoslike they're
which isI think is probably most most surgeons.
I think most of the good ones are doingreally controlled before and afters.
And there are a couple systems that are
you know, were do that very well.
(29:09):
They really control the lightingand they controlled the angles.
It's a little hardsometimes it's actually getting better.
One of my colleagues
has a new software that's availablewhich you can actually access
and acquire the images over the phonefrom your iPhone.
Like you can take the photofrom all these different angles,
and because it's essentiallya three dimensional structure,
(29:31):
then it doesn't really matterwhat you're doing where you're
putting their head becauseit's going to be able to be reoriented
and the before and afters.
And so so, yes, you are pointing out
something that I think is is knownand is definitely,
you know, an issuethat needs to be continued.
(29:51):
So but in the meantime,I have to commend you on,
you know, like I said, being brave enoughto kind of show some of the older photos,
to show things that,you know, for us to be on the lookout.
Your work is beautiful.
I will say that is so.
And I just appreciate you coming on.
Look, at the end of the day,it's important to trust your surgeon.
You know,
I think that many surgeons out thereand I'd like to say most surgeons out
(30:15):
there want the best resultsfor their patients.
They want to show this.
Maybe they're not trying to be deceitful,but if you as
a consumer can be educatedand know things to look for,
certainly going to be helpful.
Definitely.
And what I'm going to look for
after watching your beautiful facefor the last hour is a new ring light
(30:36):
because your area of your lightis so nice.
It's adjustable variable.
The newer I'll send you, I'mgoing to send you this link.
Sent me the link.
I'll send you the link.
Amazon Newer.
I gotcha in Doctor Riley.
If people want to come and see you,if they're in the D.C.
area, or
maybe if they just want to travel to you,what's the best way to reach out to you
and find you? Sure.
(30:56):
So my website is Reilly,which is REILLY F P.S.
like facial plastic surgeon dotcom and there's a contact form on there.
You fill it inand we'll we'll call you the next day.
Amazing. Thank you so much.
And of course I will haveall of his information in the show notes.
Don't even worry if you missed that.
I want to thank you so muchfor being with us today.
And then, of course, at home, if you havequestions you want me to pass on to Dr.
(31:19):
Reilly If you're curiousabout some of this stuff,
you can always reach out to meat Hello at Art Beauty podcast dot com..
You can find us on Facebook, Instagram andright here on YouTube @ArtBeautypodcast.
And as always,we will see you next Tuesday,
hopefully feeling a little bit smarterand better able to decode
some of those photos on Instagram by
(31:47):
Right.
This is the Art Beauty podcast where weare always reaching for truth in beauty.
Remember, the people in the brands onthe show are not paying to be here.
So we get to havethose tough conversations
because you deserve to be informedso you can make the best choices
for yourself.
With that said, I'm your host,Amber Melton.
Today, my fabulous co-host is Dr.
Michael Riley.
(00:21):
He is a double boardcertified facial plastic surgeon
practicing out of Washington, D.C.
It is such an honorto have you here today.
Welcome to the show.
Thank you so much for having me.
I can't wait to chat with you.
So I just got to give usa little bit of a shout out
because we have a great show today.
We're going to be talkingabout social media
(00:43):
and how people can tweak images.
Now, maybe not a big dealif your mom's doing it, if your sister,
your brother, but it can be a big dealwhen plastic surgeons are doing it.
So Dr.
Riley is here to talk to us abouthow we can kind of decode those images.
We were going to showsome really wild ones out there.
(01:04):
You sent me a bunch.And then we both realize.
These are not ours.
I don't want to get sued.
So, Doctor, I love it.
You were like,
I'm actually going to use some of your ownphotos to kind of highlight things
to be looking out for.
So I just want to say,before we even get started,
you've been one of my favorite guestsever.
Just was taking a half hour to kind ofgo through and greet the week on the spot.
(01:28):
So thank you so much.
And you were like the technical supportbecause that's not my forte.
So thank you so muchfor getting those photos together.
And yeah, I think it's actually probablyeven more authentic.
Our conversation, because some of thesemistakes are mistakes I've made in my own,
you know, pre and post ops and tryingto, you know, get content developed
and then realizing later that maybeI was doing things unintentionally
(01:49):
or some maybeeven intentionally subconsciously
to make my post-ups look better.
But thankfullythat's been brought to light.
More recently,
there have been a couple of good articlestalking about just like how manipulated
plastic surgery images are and, you know,self-reflection is a good thing to do.
So it certainly made me turnand say what's what?
What's going on with my pre and post upphotos? Are they authentic?
(02:12):
And I really stand by theseand you and I can kind of tease
through some of the ways that I feel like,yes, I can.
And maybe the ways that in the pastI was being less authentic
with the pre and post ups.
You know, like I said, not intentionally,but but they're they're.
Listen, I'm going to I'm going toyou know, first of all, I love honesty.
I love when people come, you know,listen to my own career.
(02:33):
Certainly when filters came out,I was like, this is great.
You know, we've discussed this.
They now work on QVC.
QVC is totally based on authenticity.
If we're going to show a beforeand after on air,
my before has to beshot in that studio that day.
And the after has to be, you
know, is being done livebecause they certainly pride themselves on
(02:56):
on having that authenticityand developing that trust with consumers.
Well, I love that.
I mean, honestly,
that's like you can see thathow that could become an industry standard
and not exactly that because obviouslyyou can't do surgery and recover from it
and have your post-op phototaken on the same day.
But the more and more criteriawe put together as like
this is what's an acceptable before andafter photo, the you know, the stronger
(03:20):
everything will be then everyone'scomparing the same apples to apples.
And no, I actually think that's very noveland pioneering to QVC to do that.
You know, it's great.
And and listen, you've probably seen it
not just talkingabout other plastic surgeons,
but I've been at many brand presentations
and they will show those beforeand afters.
And it's laughable when you seethe techniques that are being used.
(03:43):
And it's like, look, we trim this person'sneck and in the first one they're like,
but on the second one they're out to hearand it's like, okay, okay.
And that's even better.
When the productis something like a skin care product
or like a topical or some sort of,for instance, like a radiofrequency device
where there isn't like a clear cutor something that you actually did
(04:05):
because then you're just like, well,that's within the realm of,
you know, we call it the margin of error.
I mean, if you take two pictures
of the same person, you're goingto get two different results, you know, so
yeah,no, some of those are really atrocious.
And and but there areso this is something you may not know.
There are really there are standard
photographic measuresin facial plastic surgery photos.
(04:28):
So for the face specifically, you know,we have specific views that we take,
but we also have very specific
orientation of the face.
So it's called the Frankforthorizontal plane.
It's how every photo of the faceis supposed to be taken.
And it is the idea behindthat wasn't well-intended,
which is let's make surewe're comparing apples, apples
(04:48):
and get the photostaken at the same angle,
because you can imaginemy neck looks a lot different
from down herethan it does from right here.
And so if that in
the Frankfort horizontal plane,just to be to dork out for a second
and tell you other industries insidescoop it's when the the lower
part of the orbit so the orbital rim righthere, the very bony part of the eye
has to line up on a horizontal planewith the top of the ear canal.
(05:10):
So like when I'm in, patients in my officeall the time are wondering
what am I doing?
But I kind of grab their, you know, headand help them tilt and reposition.
But I'm always trying to get that
top of the ear canal to line up withthe bottom of the orbital rim right there.
So that then I know the afteris going to look the exact same.
So there is that that's been you know,we're trying.
You know, you are tryingand I and I don't want to diverge too much
(05:32):
but there are also great apps right nowthat help people at home
take I forget the name of it,but there's one that will kind of help
you make sure that your face is measuredso that you can kind of track progress.
And it's a great idea.
You know, to make sure that your face
is in the same place,to make sure that lighting is similar.
But it's tough. It's really tough.
(05:52):
So you have agreed to share
some of your own photos of thingsthat we should be looking out for.
I wish we could have used some of them.
I mean, some of them that you sent mewere just laughable.
But we're going to play it safe here.
So I'm going to actually try toshare these now.
All right.
And we
can kind of talk through thingsthat we should be looking for.
(06:14):
Sure, I promise.
Consumers are comparingplastic surgery photos.
I'm going to preface this
by saying that we just quicklygrabbed these off of my Instagram.
As you know, you're more thanwelcome to go look for yourself.
None of these have been doctored.
It's which is Mike Riley, M.D.
But the photo that we wanted to highlight,which was like my
my just said, go to my most recent post-opphoto that's on there,
(06:36):
is because I use very, very controlledcircumstances to take my photos.
Now, the one thing that I cannot controlfor sometimes is the actual lighting
that's coming infrom the windows in the office
where I do the photosbecause it's not a complete darkroom.
So even this which was taken in thiswith the same camera, in the same
in the same exact location
and the same
in front of the same background,you can see
there's like a little bit of a dark edgeon the left side of the post-op photo.
(06:59):
But in general, this is how a preand post op photo should look.
You shouldthe background should look the same.
You know, the amount of makeupshould really look the same.
So specifically, you know, like herlipsticks is the same.
I will say like even in this onebecause you cannot control for everything.
Looks like she has eyeliner onin her second photo.
Yeah.
Having didn't have in the prepand this photo, by the way,
what we're looking atis a lower left for a plaster result.
(07:21):
So the bag is on her left side wherethere's like kind of that deep crease
and then the visible bag,that's the photo.
That's what that was done.
That was what that iswhat was done surgically.
And that's kind of what we're looking for,looking at after surgery.
So this is generally what you want to see.
Even, you know, thethe size of the head is the same.
We always whenever I'm doing the preand post ups, my assistant doesn't.
(07:41):
But I always say,you know, drag it on top of the other one.
So it's really like lined up.
Everything should be the same size you canimagine for a rhinoplasty or something.
The size really make a big differenceif the head is smaller afterwards,
the nose is going to be smaller too,which might give you might give you
a, you know, a boost in one directionor the other.
So this is a well-matched photo.
This is what you want to see in youryour doctors before and after photos.
(08:03):
You don't want to see some dramaticmakeover where, you know, the patient was,
you know, having
just rolled out of bed on the leftand then on the right side,
they were getting ready to go to the Metgala.
Like,that's not the look that we're going for.
So so that this is you know,that's the background.
If you want to go to, like the next one,I can kind of start
we can start going throughsome of the errors
that I've made over the yearswith my before and after photos.
(08:24):
So now this is onewhere this is a really good, funny story.
This woman is beautiful and wonderfuland she has been so gracious
to share her photosbecause this photo actually was published
on the Today Show when I was on that showlike ten years ago, talking about a
study I did about how
people are perceived differentlyafter a facial plastic surgery.
(08:45):
And Hoda, I'll never forget,you know, I was nervous.
I was pretty, pretty young doctorat the time and she was like, well,
I think she looks better in theafter photo because she had a blowout.
And the second photoand I was like, my gosh, you know?
And I said, Well, you know, yeah,you know, she did her hair
does look better, but, you know,she also had this, that and other thing.
So she sobut the hairstyle was the point of that.
And it was and it was interestingbecause it was her immediate and she's a
(09:06):
she's a real journalist like she was like,I'm not into the chase
because there is this, you know,bias factor that I think a lot of people
inherently, like we discussed earlier,you'll see it in certain photos.
You're like,why are they even trying to look at it
like this is fromthis is the same, you know, a comparison.
But like in this case,this is just how she happened
to look the daythe day she came in for post-op.
(09:27):
And frankly, part of it was becauseshe was really happy with the result.
And I think she was gettinga little more dolled up
after surgery than she was before surgery.
But so that's that's an important thing.
If you if you go to someone's Instagramlike mine and you see a trend of like
every single post photo,they're in full makeup
and their hair is blown out, then I mean,there are doctors practices who do that.
They they do a whole make up thing rightbefore they take their post-op photos
(09:51):
because they're trying to make themlook as good as possible.
Well,you're not comparing apples to apples.
So that's that's like a good example of,you know, be
be aware that it's,I think, a trend that maybe you would see.
And and by the way, one of the things
that got us talking aboutthis was the study
that was done showed thatmost people want to see dramatic changes.
So the top performing plastic surgeryInstagram
(10:13):
profiles, they're 97% of themare altering their photos
in some way or they're or they're they're,you know, manipulating their photos
to be more positive after surgerythan they are before surgery.
So that's because that gets engagement.
I mean, that's why they're top becausethey're like, people love that change.
So so this is one where I'mjust like this.
We mainly showed this just to sayhairstyle can make a difference, you know?
(10:35):
Yeah. Little bitmore makeup in the post-op photo, too.
So those are,
you know, those are definitely thingsthat are not comparing directly.
What about the nextone? What do you have there?
I get there.
Okay. Okay.
So this is another I mean, my patientsfirst of all, I love my patients.
Secondly,anyone who's been willing to share
their photos is extra specialbecause it's you know, it's hard.
(10:57):
If you had plastic surgery to begin with,
that was usuallybecause you didn't like something.
So people are willing to share that.
I just have to give a hugethank you to my patients.
You talk to that?
Yeah. And celebrate and support you.
100% and,and you know and, and they're amazing.
And look at this photo.
I mean, it looks like incredible.
I did do a neck lift on this patient. She.
(11:18):
She's lovely.
This was a photo taken years later,she came back to see me
and she was here for other reasons.And I was like, let's get a post up.
And I'm like, my God,this is like the best result ever.
And then we started talkingand I was like,
she had lost a little bit of weightafter the surgery.
So her, her whole composition had changed.
I'm not claiming full creditfor this result with just my surgery.
(11:39):
If you lose weight
and you have
any bit of heaviness in your neck, it'sprobably going to get a little bit better.
Now, the contours. Great. So I was okay.
I got the skin treated, but there's nothere's no there's no sagging skin there.
But I'm not taking full creditfor the entire result.
So and, you know, it's like,how much do you disclose in a photo
like, well, this was five years laterand the patient lost £20. Most doctors
(12:01):
aren't including that in their beforeand after are kind of details.
So so we probably all seenthat before, too, where the patient,
her, him or herself has had a favorablecosmetic change or intervention.
And then
the pictures benefit as as a result,maybe they've been working out whatever.
You know, I see that a lot,especially with body makeovers,
(12:22):
whether it's liposuction,the mommy makeover, you know,
and I'm sure some of that is that onceyou have gotten rid of some of that
excess fat, that excess skin, maybe you'rea little bit more inclined to work out.
But things to be aware of,
you know, and I've always said this, that,listen, I've had plastic surgery myself.
You really need to
(12:45):
sort of manage expectations.
Yes. And you want to be with a surgeon
who'sgoing to help you manage expectations. So.
Okay, so this is something good, but butto your credit, the profiles are the same.
You know, she's wearingrelatively the same amount of makeup
and the backgrounds are the same. So,yeah, yeah, yeah.
Good job.I wasn't trying to trick anybody.
I will say, do you remember?
(13:06):
I don't know if you would remember this,but when I was a kid, you know, I'd be
watching TV and there'd be these ads for,I don't know what they were like.
Maybe like GNC, vitamins or protein powderor like those AB crunchers.
And the before and after photoswould be like some guy in his garage,
you know, like thisbig like, you know, over overweight
(13:27):
body thatthat was not he was not caring for.
And then the after photo
was like taken in front of a mirrorwith all the light shining on it.
And so this has been going on
not just in the facial plastic surgeryrealm or plastic surgery realm.
It's basically
before and after is throughout timepeople have been figuring this out. So.
I mean, I love TV magic.
Listen, the differencebetween like pulling your pants,
like letting your pants, you know,if you were in spandex and letting that
(13:50):
fat roll, you know, hangover versuspulling them up.
I know all about that.
All right.
This is a good one because, you know,
this doesn't have any sort of professionallooking background.
And part of thatis because this is not a cosmetic patient.
This is a young man had actually had
some injuries and
(14:10):
his smile was not functioningproperly on the right side. So
we ended up replanting his muscle, whichhad gotten evolved in the right cheek.
And that's why he now has likethe matching tip on the after photo.
But I thought this was a good one
because, you know, on the left side,you've got the trees in the background.
In my office, we're showing in the showingthe background
(14:31):
on the right side,there's many blinds behind there.
So that inherentlyis going to change the lighting.
And then on top of that,it's just distract ding.
You know, it's really like, so if this wasa cosmetic photo, you would be on major.
No, no.
Why are you first of all,why don't you ever act together
enough to be taking the cosmetic beforeand after photo?
That would be one kind of red flag to me.
And then secondly,even if you weren't using a,
(14:53):
you know, a professional blue background,why is it that they're different
backgrounds and you'll seeweird shadows in people's photos,
You'll see the color is just not right.
But this one was pretty glaringwhen we were looking quickly
to my instrument, like, yeah,that's a good one.
Like,if someone did that for a cosmetic photo,
you would be wanting to,you know, put your alarm bells up.
Yeah, man, I really do
(15:13):
wish we could have just gone and donea deep dive on other people's Instagram.
But again, thank you for being so willingto use your own photos as an example.
Okay, here's here's here's the lot.
Here's one where I think the lightingwe might have this one.
And is there one more about there
maybe not this this onewhere the lighting is just not right.
And my excuse here because she'srelatively recent like I knew better.
(15:37):
You know, she's lined up properly.
Everything is properly positionedand scaled.
But I have two offices.
One of them is my office,my main practice at Georgetown University,
and the other one is my privatepractice office in McLean, Virginia,
about 20 minutes away from here.
And I have the same cameraand have the same flashes,
but the rooms are very differentthan I take the photos in.
(15:58):
And sometimes the lighting is just Ican I get the lighting match?
And this is a good example of likewhat is happening with the lighting here.
I mean, her eyeslook totally different colors.
Obviously the backgroundsare totally different color.
She's beautiful.
In both pictures,the post up is on the right where
we've refined her nose, her nasaltip a little bit,
but she almost looks a little washed outin the right side of picture.
So if this was one,this would be a good example.
(16:20):
If someone was showingyou like, wow, look what
I did for her skin color.
Yeah. Isn't it amazing how how.
Great. Skin looks? It's like,wait a minute.
No, that's just a has anyone like a flashjust flashed on her skin.
That's why it looks so clearand and homogeneous on the second one.
I mean, she has nearly flawless skin
in the left side, too,so she would be a bad example of that.
(16:40):
But you can imagine if someone has roughskin,
throw a flash on it, and then suddenlythey look clean in the site after photo
and like, no, that was because of that,that, you know, lotion.
They rubbed on them for themselvesfor four weeks.
Probably not.
So that's anotherthat's the lighting example
I think we were allto come up with on the fly.
So, you know, I'm
going to stop this nowand kind of go back to our conversation
(17:02):
for us regular consumers at home,
you know, these are great thingsto look for consistent backgrounds,
consistentangles, lighting, to be aware of
why do you think it isthat more doctors aren't
that doctors are a little bit,
I don't want to say deceitful, but maybenot as transparent as they should be.
(17:24):
Yeah, And this is probably athis is a great question
because it's almost like every inevery industry, there's going to be
somebody who's really not doing it right.
I mean, I think I cannot believethat the brilliance of the people
that I'm surrounded by in my fieldI mean my colleagues
in facial plastic surgery and headneck surgery.
I mean, they are some of the brightestpeople I've ever known
(17:45):
and most dedicated to their patients.
You know, they really, really careabout doing the right thing.
So the problem is,you know, you're seeing the 1% extreme
like we just talked about, the top1% of Instagram accounts.
Well, that's like basically theyou know, they're off the bell curve.
These are the people who are kind of likenot falling within the realm of normal.
So I don't necessarily know that it's
(18:06):
pervasive
in a way that's ubiquitous acrossplastic surgeons.
I just think that they're, of course,like in any industry, there are people
who are going to be manipulativeand maybe not not fully truth telling.
And I think that's been amplifiedby social media because they have a place
to put their content and it's not like
(18:27):
it has to be believable.
So now it's just aboutis it engaging or not?
So the more dramaticthe result, the more engaging it is,
the more likes you get because thenit gets pushed to other people's pages.
So they're getting rewarded for thesethe dramatic nature of the results,
which is what our human brainloves to see.
And and so yeah, so again, I don'tI think those some of those doctors
are just genuinely being deceitful.
(18:48):
You know, peoplechase their dreams in different ways.
And this is
this is one way where it seems likeit's probably being chased by some people.
But I don't think it's necessarily aproblem with physicians or like the whole
the whole of plastic surgeryrather than, you know, maybe
a warning bell, like,let's not let this become normal because
(19:09):
it does not instills trust.
I mean, one of the mostyou just said you've had surgery yourself.
One of the most important things,probably the most important thing
with the surgeon patientrelationship is trust.
You have to have trust.
So if you look at someone's Instagramand you don't believe it and you know
that there's like a a history of that,you can tell, okay, they just do this.
Well, that's not very trust inducing.
(19:31):
So where's your radar onon the trust factor?
I think that's important.
And I think most of us know thatbecause, you know, you can
if you shoot up to the moon,you're going to get shot down.
But if you you know, if you're if you'rea good plastic surgeon who does good work,
who's truthful and honest, that'swhat gives you the longevity to survive
and to have the meaningful relationshipswith patients that were.
(19:51):
That is why I went into it, I think bymost people might go into this job.
Here's an interesting thought, too,because, you know, you said earlier before
and I'd like you to restate thatstatistic, that
what was it about the the percentage of.
Yeah.
So the top this was not my study.
This was I think I was saying it right.
Vodka or vigor VCA at all.
(20:13):
They did a study basically looking at thetop performing plastic surgery accounts.
So basically the accountswith the most followers and they found
that 97% of those accounts had evidencethat they were using tactics
to manipulate the post-op photosthat were lighting angles, makeup.
(20:33):
Those are the three main ones, digital.
But digital alteration,like you and I were looking at a couple
photos earlierwhere people had actually clearly,
like just completely blurred outall irregularities in their in the skin.
So those are the things that are beingused by the top performing accounts.
So which means that like that, theyou know, the consumers,
(20:53):
the people viewing them like that are most
drawn to those types of images.
And then these sortsof set up expectations that are not real.
Like if that'swhat you're seeing all the time, then
you're like, Well, that's whatI should get if I have my plastic surgery.
And and that is why I'm kind of you and Iare here to do to educate people.
(21:16):
That is a disservice to everyone.
I mean, there's nothing worsein than my cosmetic patient.
I've you know, I've done a lot of surgeryand been a doctor for 20
to a little 21 years now. But
one of the
worst things is a dissatisfiedor disappointed patient,
and you're just kind of setting people upfor dissatisfaction
(21:37):
when you are not settingtheir expectations properly.
And I think that's what one of the risks
of social media photosand all these altered images is.
You know,
I guess the thing that surprises methe most, right, is is sure, I guess
it's good to,
you know,when you're scrolling on Instagram
and you're like, wow,that's an incredible before and after.
However, I most of the peoplethat I've talked to in that I know,
(22:00):
it seems like when they goto have any sort of work done,
they're like,I don't want anybody to know.
I want it to look as natural as possible.
Now there's two schools of thought, right?I know.
And the making of you know.
You can. Say that, right?
So like on the West Coast,people want to look done.
It's a badge of honor.
But here on the East Coast, most peoplethat I know are like, I want to do this.
(22:22):
And I don't want I just I want to better,but I don't want to look done.
So it's interesting to me
that those you know, I guess the photos
that are getting the most attentionare the ones that clearly
have been manipulated and look like a moreof a drastic before and after
when I think in reality most peoplekind of want subtle but better.
(22:42):
That's a really tough onebecause I think there is a little bit
of discourse or like dissonancewith that concept because
I think that'smaybe one of the harder lines to walk
as a surgeon is that people saythey don't want anyone to notice, but
they do want people, but they also wantto look like nothing happened.
So it's almost like just that.
(23:02):
That inand of itself is a bit unrealistic,
but it's a really comment,really, really comment.
Like, I want to look just likeI look now, but it's like 20% better.
But I don't want anyone to no notice.
It's like, well, that is notyou know, those things are not possible.
So I think there is and you'reabsolutely right that on the East Coast
I do my training, my fellowshiptraining at UCLA
(23:23):
out in Los Angelesand but I've been on the East Coast
for most of my professional career,aside from that.
So in Washington, D.C.,I think it might be even
a little more conservative than New Yorkand people really don't like anyone
to know anything about whatthey've had done or cosmetic work.
And it's really different in L.A.,where it's almost like
(23:45):
people are trying to look done.
Some people,
not everyone, but there's a little bitmore of an acceptance of like, okay, yeah,
I had this, this really expensive,like nice facelift.
I look like I'm, you know,really different than I did before.
And I'm proud of itbecause it's part of the culture.
So it is there are these micro culturesthat are different in different areas.
(24:05):
Yeah, for sure.
You know,
and I know I know this isn't surgical,but I heard once
here's like an interesting tipand tell me if this is right.
You know, going back to this ideaof before and afters
that the timing also matters. Right?
So we had somebody on here who didlip injections and she was like, you know,
(24:25):
if you if I was looking for a lip injectorsomewhere,
I would ask them to give me your before,give me your you're
right after, which is a lot of the timeswhen people aren't going to come back.
But she's like,
if you can, you should ask them forthe ones that are a couple of weeks later
when the lips have settled,when they've actually like got into that
is that the same thing with plasticsurgeon is is it good to know about
(24:48):
like time differences.
Yeah, Yeah, definitely.
That's one thingwe didn't really talk about,
but I did talk about it in my PsychologyToday blog,
which I think is how we startedthis conversation initially,
which is that there isthis trend with some people to do.
We call them on the table afterswhere you're doing a post up photo.
It's particularly popular with rhinoplastywhere you do the pre-op photo.
(25:11):
Like while they're on the table,you do the post-op photo and the risk of
that is that that has nothing, you know,not nothing to do with the final result.
But that's clearly not the final result.
When you are done operating onsomeone that is there's been zero healing.
That's happened at that point.
You can I've done it,you know, thousands of times.
I can tell you when you do a rhinoplasty,you can basically push the nose
into whatever shapeyou want it to right on the table
(25:33):
that doesn't meanthat it's going to heal that way.
So so that's a timing question.
Now, the other side of that is also truethat you need to really wait
a period of timebefore you have a final result.
Rhinoplasty is another good example.
We kind of historically talk about a year.
I think it's probably reallyhonestly longer than that.
I mean, if you really waitfor the full healing
after rhinoplasty, it'sprobably a year and a half or two years.
(25:53):
But that is notI mean, my patients are great.
Like most of them will come backfor one year, but not everyone does.
You know, some people come for their their
I usually do like one week, one month,three months in a year for my rhinoplasty.
Some people will come out of a monthor maybe they
they me they come for the three monththey're thrilled. Yeah.
No they're not going to come back.They're not going to come back.
So I got to grab that photobefore I never see them again.
(26:15):
Sure.
And and so, you know, but
but just being full disclosureabout that, like, this photo was taken at,
you know, a week or and you can see thisby the way, and pre and post up photos
so you know someone has like bruisingstill they had a facelift in their videos
and I'm like okaywell that was very recent.
If you can see
yellow or purple on their neck,then that's within the last 2 to 3 weeks.
(26:37):
That's not a final result.
I mean, I'll be just,you know, so I had a breast lift.
I've talked about it on this podcast and
and a small implantput inches to retain the size.
And right afterwards it looked likesomebody had stuck to coconuts, literally.
And I was like, now, first of all,my surgeon was like, I'm not the guy.
(26:57):
If you want big whatever.
My whole thing is very natural,very subtle.
But that first. Thatwhen you have that, you're like, what?
I was like, Well,I want my money back, you know?
But I had done enough research to knowthat it takes time to fall and to settle.
It could not be happier.
I love my surgeon,he added. He's on the podcast.
But but,
but knowing these thingsand kind of going in and knowing this,
(27:20):
you know, everybody who gets lip
injections goes home and freaks outbecause your lips blow out.
I always tell people,if you go get any sort of facial filler
and you love the way it looks,the next day, you didn't get enough.
Exactly. Exactly.
Becauseand then the flipside is true, though,
because people are not willing to toleratethose,
(27:41):
you know, like that week of theof the really fluffed face sometimes.
So you got to kind of do it slowly.
But I agree. Yes, absolutely.
Like you could manipulate,I imagine you do your before and after.
yeah.
This was right afterward like, well,of course you're you're really small
in the way those fillers work, by the way,is they pull fluid in with them.
So all the fillers are hydrophilic,meaning they the water loves them.
(28:03):
And so so whenever you get a fillerinjected,
you know,the filler syringes are pretty small.
One CC of fluid, which is in whatwhat's the most it's really tiny.
So how do you get all this volumefrom one?
CC It's because there's fluidgetting pulled in there with it
and there's more happeningin the immediate period and then it
starts to settle out. So
gosh,I feel like I could talk to you forever.
I love thatyou were talking nerdy with us,
(28:27):
you know, So
with these things said it, you know,to any of the medical companies out there,
I know that,you know, the Visio camera is pretty
there's a camera to kind of measure sundamage and wrinkles.
I'm surprised that no other companyhas come out with sort of a standardized
camera setup.
(28:49):
But are there are
there are.
And you'll see themI mean, these are the people
who are not manipulating their photoslike they're
which isI think is probably most most surgeons.
I think most of the good ones are doingreally controlled before and afters.
And there are a couple systems that are
you know, were do that very well.
(29:09):
They really control the lightingand they controlled the angles.
It's a little hardsometimes it's actually getting better.
One of my colleagues
has a new software that's availablewhich you can actually access
and acquire the images over the phonefrom your iPhone.
Like you can take the photofrom all these different angles,
and because it's essentiallya three dimensional structure,
(29:31):
then it doesn't really matterwhat you're doing where you're
putting their head becauseit's going to be able to be reoriented
and the before and afters.
And so so, yes, you are pointing out
something that I think is is knownand is definitely,
you know, an issuethat needs to be continued.
(29:51):
So but in the meantime,I have to commend you on,
you know, like I said, being brave enoughto kind of show some of the older photos,
to show things that,you know, for us to be on the lookout.
Your work is beautiful.
I will say that is so.
And I just appreciate you coming on.
Look, at the end of the day,it's important to trust your surgeon.
You know,
I think that many surgeons out thereand I'd like to say most surgeons out
(30:15):
there want the best resultsfor their patients.
They want to show this.
Maybe they're not trying to be deceitful,but if you as
a consumer can be educatedand know things to look for,
certainly going to be helpful.
Definitely.
And what I'm going to look for
after watching your beautiful facefor the last hour is a new ring light
(30:36):
because your area of your lightis so nice.
It's adjustable variable.
The newer I'll send you, I'mgoing to send you this link.
Sent me the link.
I'll send you the link.
Amazon Newer.
I gotcha in Doctor Riley.
If people want to come and see you,if they're in the D.C.
area, or
maybe if they just want to travel to you,what's the best way to reach out to you
and find you? Sure.
(30:56):
So my website is Reilly,which is REILLY F P.S.
like facial plastic surgeon dotcom and there's a contact form on there.
You fill it inand we'll we'll call you the next day.
Amazing. Thank you so much.
And of course I will haveall of his information in the show notes.
Don't even worry if you missed that.
I want to thank you so muchfor being with us today.
And then, of course, at home, if you havequestions you want me to pass on to Dr.
(31:19):
Reilly If you're curiousabout some of this stuff,
you can always reach out to meat Hello at Art Beauty podcast dot com..
You can find us on Facebook, Instagram andright here on YouTube @ArtBeautypodcast.
And as always,we will see you next Tuesday,
hopefully feeling a little bit smarterand better able to decode
some of those photos on Instagram by
(31:47):
Right.
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