Lessons From a Lifetime in Plastic Surgery With Dr. Garth Fisher

Episode Transcript
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Speaker 1 (00:06):
Welcome to another episode of Plastic Surgery. I'm censored. I'm
your host, Doctor Roddy Raban, and every week I tell
you I'm super excited about our guests, but no week
more than this week. Am I excited about our guest
because it's not only a world renowned celebrity plastic surgeon,
but a very very dear friend and my mentor, Garth Fisher.
So you guys better listen up because this is going

(00:29):
to be a fantastic episode. I've dragged his ass in
here on the weekend. He's got many other things to do,
and I'm grateful that he's here.

Speaker 2 (00:37):
So Garth, welcome to the show. Thank you for having me.
It's an honor to be here. You've been your biggest fan.
And I love your coffee cup. Yes that's right.

Speaker 1 (00:45):
Advertising at all times. We got a logo behind a
logo here.

Speaker 2 (00:48):
It's like rolls rice in reverse, but it's uh, they
look good going backwards or forwards? Got it?

Speaker 1 (00:54):
You?

Speaker 2 (00:54):
I love it?

Speaker 1 (00:55):
So you know you and I did an episode during
COVID and we did it via and you were sweet
to be on and I felt like there's so many
things we didn't talk about. Number one Secondly, I think
so much has happened since COVID in the area of
plastic surgery, and I obviously I consider you one of
the foremost experts, and just having an opportunity to chat

(01:18):
with you in general is really great. So I'm gonna
tell everybody a little again about our background, so everybody
knows our connections. So for those of you who don't know,
let's just back up, back up a little bit. So
Garth Fisher would be akin to Michael Jordan. I can
say that because but it's accurate, and he would be
the Michael Jordan, the goat of plastic surgeons. I would

(01:41):
consider myself the Kobe Bryant, but that goes neither here
nor there. But Garth has You've been in practice now
thirty five years, right, thirty five years, and of the
many accolades you've had, obviously you were the cornerstone of
extreme makeovers. Not that that necessarily was made you famous,

(02:01):
but obviously you were famous that allowed you to be
in that. But that's definitely something people would recognize you.
I think you were the godfather of the transition from
plastic surgery for rich and famous to oh wow, I'm
a regular person, Oh, I can have plastic surgery. Because
it was extreme makeover that really brought plastic surgery to

(02:25):
the public, and you could see military wives and regular
folks having surgery and the transformations that were possible and
their backstories. And I think that you are responsible for
that transition. I know you and I talked about it
all the time. Initially that was met with a lot
of resistance, right.

Speaker 2 (02:45):
Only in this plastic surgery society areas.

Speaker 1 (02:49):
Right, So that's where it kind of got you going.
But you have so many other you work with Hugh
Hefner and all the playmates. You and the Kardashians have
been friends, family friends for years. There's so many things
about your practice that is special and unique. But I remember,
I'm just to put a story together. I remember graduating.

(03:11):
Now I've been in practice. This would be my twenty
first year, and I remember graduating and I was like,
I went to USA. I was a local resident. So
I was lucky enough that I did my training in
the city in which it has the most plastic surgeons.
And I did something a little unusual, and it's like
one of my rotations. One of my rotations, I instead
of going to go do something which I felt was

(03:33):
not very helpful. I created my own mini quiet secret rotation.
I would write down all the people in Beverly Hills
that I thought were reputable or noteworthy, and then I
would call their offices and I'd be like, Hi, how
you doing.

Speaker 2 (03:46):
My name is Roddy Raban.

Speaker 1 (03:47):
I'm a resident US, and I was wondering if I
could come and watch doctor X, Doctor Y, Doctor Z.
It was either sure, it was like click, hello, hello, click.
So I remember doing that, and I actually still have
this chart on my in my library where I had
a little calendar. It was prior to any iPhone crap,

(04:07):
and I was writing down all these people and I
one of the offices that I were to visit was
doctor Fisher. I'd heard amazing things about you, and a
shout out to Bonnie, who is your sally to me,
which is your right hand maybe arguably you're right and
left hand person who runs your office. And I remember her, sweet,
sweet as can be. I called, and you would have

(04:28):
thought she, of all people, would have been the click
right and she said, yeah, how can I help you?
I said, Hi, I'm you know, I'm ready, RoboN I'm
a resident here at USC locally, and I was wondering
if I could come in and shadow doctor Fisher and
the oar just waiting for the click. I'm just waiting
for the hell no or whatever. And she's like, well,
he's really busy, and you know he's already have like

(04:49):
twelve doctors coming to see him. Let me see how about.
I was flabbergas, I'll take it. Yeah, And I was like,
is she going to call me back and tell me
it was just a and so at any rate, she
was very kind, you were very gracious. I ended up
spending six weeks. I remember it vividly. Every day I'd
come back like a cat. You know, you feed the

(05:10):
cat once you own it, It's coming back every day.
And I hung out and before I knew it, I
was asking for space in your office. You were generous
at the time. You said sure. You were very gracious.
You said, yeah, there's just some little room in my office,
and you let me office share with you for several years.
And that's sort of actually the foundation of my early

(05:33):
training because as much as I love my training at USC,
let's be honest, most of our cosmetic training occurs after
our residencies because most residencies are free flaps, burns, gunshots, mandibles, pediatrics, craniofacial.
You're not learning, you know, rhinoplasty, the correct way to

(05:54):
do a breast dog, et cetera. You learn it sort
of out in the field, and if you're lucky, which
I was, I was just I mean, I was just
in the o R with you all the time, and
I was taking notes and I was paying attention, and
I learned, I would say, almost majority of the things
that I currently know from you, I've obviously modified them
since then. But that is how our relationship started. And

(06:16):
then at some point I left the nest. I didn't
go very far because I fell out of the nest
and I'm next door now.

Speaker 2 (06:22):
I'm actually a block over the egg and rolled a.

Speaker 1 (06:27):
Couple down the So that's our connection and what I've
admired about you, and I'm I have to set the
story for those of you who like guard who don't
know because you've been under a rock. What I admired
about you is that you have probably the highest end practice,
meaning you're taking care of incredibly all the A listers,
but you haven't cut any corners. And that's what's unique,

(06:51):
because what ends up happening. Is there's this inverse relationship
that inevitably happens. As you get busier, busier, richer, more famous,
you start getting lazier cutting corners, don't have to do
as much, hire more staff. And the younger you are,
the more involved you are, and the more hands on
you are, the more you care, and it kind of
shifts and you are because I've I've operated, I've had

(07:14):
the luxury of operating with you in the last couple
of years. And it's still it's really remarkable. You're still
in there. You still sit them up, you still give
a shit, You still like, give me the scissors, I
got to take the suiture out. Yeah, that doesn't look right.
Something is not. You still care. And even though everyone
out there is thinking, well, of course he does.

Speaker 2 (07:34):
He's a doctor.

Speaker 1 (07:34):
You have no idea when you've thrown a ball through
a who eight hundred and forty seven thousand times to
maintain that same level of enthusiasm and accuracy and discipline.
It's not that.

Speaker 2 (07:48):
Easy's passion and focus and being happy with what you do. Yeah,
and it's clear to me.

Speaker 1 (07:53):
So that's the background. So let's dive right in.

Speaker 2 (07:55):
First of all, and.

Speaker 1 (07:59):
What I asked you last time, so I'll ask you again,
is I take care of a variety of patients, and
I find that a certain subset of patients, a small
subset of patients, take up ninety percent of my energy.
In other words, most patients come and go, they're sweet,
they're grateful, great outcomes, but a small subset of people
are very high maintenance. I'm not high maintenance. Two or

(08:22):
three patients a month suck up ninety percent of my energy.
And then every once in a while I have a
reflection like, wow, Gar's been doing this for thirty five
years and most of his patients are high maintenance. So
since your practice tends to be a lot of high
maintenance patients, either well to do or celebrities, what has

(08:43):
been the how do you manage the nature of their personalities?
Because you know, not to say that you have to
be wealthy to be high maintenance, but you got to
admit that the higher up the echelon you get, the
more you expect and the more you demand.

Speaker 2 (08:58):
Would you agree, well, not necessarily. I mean there's some
people that you wouldn't say are high up and upper echelon,
and they demand a lot too. And I think if
you know we were patients, we would demand a lot
all because we're OCD and you know, everybody wants perfection.
I don't think anybody comes to the office says, you know,
if you do an okay job, I'm happy, because that's
not what we want. But you know, first of all,

(09:21):
I want to go back and say that one of
the one of the things I regret the most. If
there was had been an opportunity, I wish that you
and I had stayed in the same office because I
love being with you, and I think you're so talented.
And when you came in, it was like, Wow, of
course this guy's first in his class. He's got all
these stronger letters recommendation. You were great with people, engaging,
I mean, you articulate, and I thought you were very honest,

(09:44):
and today I think you're even more honest that I
thought even then, which is a big thing for me.
But you're fantastic surgeon, So that that would have been
a lot great That would have been a great thing
for me. And as you know, irefer a lot of
people to yes, and we're grateful for that, and I'm
grateful for all the patients that have come to me.
And we've been very fortunate over the career that we've
been very fortunate. We don't ever need any patients, so

(10:04):
it's not been a problem for us. But the really
important thing is having that relationship with that person that
you're taking care of, that it's such an honor that
they would come to you and let you put them
to sleep and cut them open and do things. And
when you sit down and just think about that moment,
it's like, you know, if this was your daughter, your
family member, It's like, Wow, they're allowing me to do this.

(10:26):
I better do a good job. I want to do
a good job because the happiest part of our day,
you know, people think, oh, they're going to the bank. No,
the happiest part of our day is when the patient
comes in and they're so happy. Oh yeah, and they're
so confident, and they change you actually change your life,
you know. And so that's what drives me. The worse
I see a problem, the more I want to make
it better. And after doing this for a long time,

(10:50):
you learn about patients. You get better at things the
more you do them. Sure, and I'm able to see
the patient that might not be the right fit for me,
might not be the right fit for them. I think
there's two things that are really important in plastic surgery.
One is you've got to be really good at what
you do, and that's all about you focusing, learning, trying,

(11:12):
putting in the effort, putting in the time, dedicating, and
being authentic and true to yourself that you want to
have the best result possible. You want to make a
hundred of these tests, just like it was a medical school.
And you know, everybody who's a doctor did good in school.
They're smart, they probably had straight a's, they did this,
they did that. But in plastic turigy it's a little different.
There's an artistic component of that too, which I think

(11:32):
is a lot missing. But the two things important are
number one, you got to do a good job. Second
thing is you've got to be very very honest with patients.
And I think that the problems really mostly are handled
before the surgery. Sure, because I think at this point
in my life, I can look at somebody, I can say, well,
I'm gonna knock this out of the park. It's gonna
be a home run. And I'll look at somebody and
I'll say I can't help them. And I'm not going

(11:53):
to say I'm gon hit the out of the park,
go ahead to good schedule, obvious, say look, I doubt
I can do this, and I don't think this is
going to end up being like this the promise. People
don't remember that when you tell them that, they don't.
They don't hear that. And I can give you the
story if I can, of course, And this is the
typical story. I had a girl come in that had
very very thin skin and she wanted her implants changed
out for other ones. I said, you know, you got

(12:14):
thin skin, you're going bigger, You're you're going to have rippling. Sure,
you know every implant's got ripples pretty much, and so
I said you got rippling. She says, I don't want ripley.
I said, well, you're going to have rippling because you're
going bigger your skins. Then this is what I showed her,
the ripples, and this is what's going to happen. She said, well,
I don't want rippling. I said, it's going to happen.
So I went on and talked about all the other complications,
which you're very open about, and I said, she says, okay,

(12:36):
I'm ready to schedule. I said, okay. She says, as
long as I don't have ripley yes, I said, I register.
I said, I've filled you four times. You got rippling.
She said, well I don't want that. So I went
straight over to bank. I says, it's not the right
patient for us because I don't want to deal with that.
You know, patients, you want them to be happy. I
heard Roethluman and Llard. He's a long time ago. He said,
my job is not to make patients happy. And I

(12:58):
was listening to that was not it doesn't sound right
to me. My job is to make people happy. And
if they aren't happy, they're going to make damn sure
you're not happy either. So you know, be honest with them,
do a really good job. You know, take care of them.
They'll take care of you. And and you're just trying
to build two trees. One of these one is the
tree of experience. You start off as a stump. You're

(13:22):
just trying to learn how to grow, how do you
make how do you sew up something? How do you
where do you put an incision? You know, as you
get this tree, that's just this beautiful tree of experience
you've grown this long branch. Well, I've done thousands of these.
I know what to do. I know which way to turn,
which way to do this, which way to do that,
what not to do? And you you build this tree

(13:43):
of experience. The other tree is patient referrals. You get
a tree of like this one likes me, she's going
to send too. This one likes me, she's going to
send to this one doesn't like me, she's got to
turn away ten. And so you have to build this tree.
And those are two things I think you focus on.
And you know this could go into a lot of
this is your this is your no.

Speaker 1 (14:01):
No.

Speaker 2 (14:01):
I think this is also very but this is your interview.
But I would say that the problem with I think
young people today, young surgeons actually is you know, people
come to me for my results and my experience, and
I feel like they feel like communicate. Well, I've got
plenty of people out there that I wish I'd done
a better job or it just didn't happen. I'm not

(14:22):
perfect either, but I've learned a lot. And I think
that what happens with some of the younger guys is
if you get a big aquayem and put a lot
of guppies in there, and you know, a fish food
you put on this and they all scramble over there
and eat, eat, eat, eat eat. You put a little
bit over here, they go over there and eat eat.
It's like, here's this new technology, new technology. Yeah, you

(14:45):
and margally all this stuff, and they don't learn how
to build the tree. There's just this branch, this branch,
this branch, and somebody the ten year experience is going
to be better doing something for ten years and something
they've done three different every three years they change. I
think that's kaya. No, Actually, you and I talk about it.
I mean, I mean part of the reason.

Speaker 1 (15:00):
We've sustained a relationship, starting a relationship is one thing
like oh, this kid was in my office, he was
a good kid, whatever. But I would say that you
and I are closer today with me not in your office,
than we ever were before. And that's just we see
eye to eye. We are similar in that regard. You're
not like, oh, you know, he was a guy that

(15:20):
I mentored, so what I mentor hundreds of people. And
the reason is that on aside from all the other
eras that we have similarities. Our view of plastic surgery
is very much the same. And it's not because you
were my mentor. It just turned out that way. Number One,
I've been in a thousand consults with you, my consults
and your consults. If we videotape them and put them together,

(15:41):
we're like, that's uncanny, because it's about transparency. I'm not
here to shamboozoo you. I'm not here to sell you.
I'm here to just tell you the truth. The truth
is your anatomy is great. I'll do the same thing.
For example, I see a patient I want to do
a breast dog. I open up and I say, oh,
you're gonna have a great outcome. You have great anatomy.
You're breasturficing forward, your folds are the same, you don't

(16:02):
have some weird chest abnormality, and you are a beacup
and you want to be a full bee home run
unless you' and I screwed up. Whereas somebody else's like, okay,
well we can make it better. But you do recognize
that you have this incredible odd rib cage, right, And
so we're the same in our transparency. I think patients
immediately recognize that, oh wow, this person's honest. At the

(16:25):
end of the day, the goal is for us to
make people happy, not just it's it's a self fulfilling prophecy.
Like it's not just because I'm so benevolent and I
want you to be happy. When you're happy, you're you're
you're good to the practice. It's like we're both going
to the same destination. Yeah, yeah, I don't. I don't
want you unhappy. It's going to be and and and

(16:47):
the and the last is we know our limits. So
that's the you know. In other words, if I see
a patient and I'm like, it's nothing, like it's just
not something I can do, or it's a bad idea,
or you should just all around stay clear of this.

Speaker 2 (16:59):
Just don't do it.

Speaker 1 (17:00):
Not only do I not do it, just don't have
anyone do it. And I actually think it's kind of
that notion is the more you the more you surrender
to it, the more it gives to you. And I
think the reality is akin to your analogy of the
guppy metaphor, it's that, you know, because we live in
an competitive landscape, there is this notion, it's completely a

(17:25):
false notion that there isn't enough oxygen and therefore I
need to grab everything I can get my hands on,
even though it's probably not going to be a good outcome.
I got it's feast or fabine and it's odd. But
despite there being a thousand plastic surgeons, there's still plenty
of patients. We live in the Mecca. You just need

(17:46):
to pick and choose which pitch to swing at so
that you have a good batting average as opposed to
every goddamn swing that comes by. I'm gonna take a
york at this one. I don't know when they're gonna
throw me another ball, and so I think that that
may I think that's true. We're also similar in our
friend well well.

Speaker 2 (18:04):
Not to mention, plastic surgery is very difficult to do
and there's a lot of variables, so it's you know,
it's not just the surgery, but we don't follow them
for two or three years, and what happens someone fall down, infection, smoking, whatever,
elastic skin. But I just want to say that, but
keep going.

Speaker 1 (18:18):
With yeah, you're saying no, And I think and I
think the other area that we are similar in is
in our frustrations. So we're similar in the way we
practice medicine. We are similar in the way we approach
the patient. We are also similar in the things that
we in the way we see our profession, right, I
am in many ways. I've never been more enamored with

(18:39):
plastic surgery. I love what I do. I feel super
lucky that I get to do such.

Speaker 2 (18:44):
Cool shit every day.

Speaker 1 (18:45):
I have great respect or reverence for what I do.
I never take it lightly. I never like another nose.
Patients always ask me, doctor, von is my nose easy?
I'm like, oh, hell no, no knows has ever will
ever be easy. Every one of them is fucking hard.

(19:06):
So I have that reverence at the same time, I'm
frustrated by all the nonsense, all the noise, all the marketing.
So in your mind, what are some of the most
common things that you've seen, because we you and I
talk about it. Well, you've been there, done that, right,
It's kind of like bell bottoms are in again. Bell
bottoms the hell hell bell bottoms in? Well, they're in again.

(19:28):
Because there's very few new inventions. What are some of
the things you see that are going on now just
globally that you're like, uh, I think this is a fad.
This is going to come and go up. I think
this is a fad. I think this is going to
come and go well.

Speaker 2 (19:40):
I think a lot of this requires a lot of
patience and it's cyclical. And when I first started practice,
I remember going into that office for the first couple
of years like, Wow, how can I be better? Anything new?
I wanted to try because I thought that was the
best thing to try. And you know, I had to
build my tree yet as a little stump, just trying
to get water and sunlight and grow the right direction

(20:03):
with the aspirations of trying to be the best and
we all want one hundred on. Our tests were not
any different. But I was lucky to train with Bruce Knell,
who I think still is the best face of surgeon
ever lived. And he gave me some points that every
time I listen to those back in my mind he
was right and he would tell me Garth and I
could give a lot of stories on the show, but

(20:24):
you probably have time. But some of the things he
told me says, never go to a medical meeting and
learn anything. If you really want to learn something, find
some new trust, go spend time with him, ask questions.
That's how you're going to learn. Yeah, you just go
to the medical meeting. And I witnessed this. I saw
firsthand what happened. Everybody's crawling on top of themselves trying
to be relevant and have a new paper or whatever,

(20:46):
and God bless those people. But I just I've never
gone and looked at it in that way as far
as trying to learn from somebody. So he told me
that and other things he's told me. But I just
think that when you look at you know, people that
come into the office have been interviewed I don't know
how many times, and they come in they ask what's

(21:07):
doing plastic surgery? They always ask what's TV? Because they love,
they want, they love trends.

Speaker 1 (21:13):
In twenty twenty.

Speaker 2 (21:14):
Six, I think we should embrace new technology. The problem
is is that they should be asking what works, what's
time testing, what's the best. Because let's take breast implants
for example. I was very, very lucky. I start off
with smooth silicone implants. They've never been taken off the market.
Every five years or so, they get improved. I've learned
the behavioral that you know, all the characteristics of that implant, weaknesses, drinks,

(21:37):
you know. I've modified, modified, modified, modified, modified for thirty
five years my technique. But during that period of time,
there's been eleven different implants that came in, new and shiny,
let's advertise they use these. Five years later they're gone.
And it's like, I'm glad I didn't jump on those
different branches because you know, I don't want to. I
don't want my patients to be guinea pigs. I want

(21:59):
them to the news technology, but I want to have
it tested for a long time before I tried, because medical,
you know, we can sit here and design and can't
open earn your office, and you know tomorrow we'll say
this works great, let's sell it. But medical procedures it
takes five six years to see what happens with healing
and complications, and it takes a lot of a lot
of time. So just because something's brand new and shiny,

(22:21):
it's uh, you know. And I saw when that transitioned.
I was in John Williams's office, who I can say
operate on Marilyn Roe and Nancy Reagan. It was a
great thing. And used to they would bring the lasers
in and they'd say, John, we try this for three
months and tell us what you think. We spend half
million dollars on this laser. He tried for three months,
and he would say, you know, it's not that great.
Oh okay, we'll take it back, and they'd take it

(22:41):
back and spend another couple hundred thousand dollars, bring it
back three months later, try this, and he would take
it back. He'd say, you know, after three or four months,
he'd say it's not great, you know. And so it
was at that time in the nineties, these laser companies
they said, hell with doctor Williams. You know what we're
going to do. We're gonna get some pictures. Let's call

(23:02):
it the red laser. We're gonna get some pictures. We're
going to put in Cosmopolitan market director. They direct to
patients and next thing you know, the patients are calling
John William's office and you have that red laser. No, no, no, hey,
we've had thirty calls a day. Isn't that that rate
or laser? We say it was no good, yep, Well
we better get it now because we can make some money.

(23:23):
So they had to order it now, the same one
they didn't like, and that was when they turned the
corner and technology went straight to consumer. Correct. They get
some doctors, they pay the doctors to get behind it,
which you know.

Speaker 1 (23:35):
You and I've talked about about being ethical.

Speaker 2 (23:38):
I got you got to see who's really motivated and
who's you know, where's this where's this advertising coming from?
So you know, I still believe that the most important
thing is a connection that we have with patients. Trust
is the most important currency in any relationship, whether it's business,
whether it's patients, whether it's you know, your family relationships.
And I think that you know, patients have to try

(24:00):
trust us. God, I've got so many stories of things
almost did I found out it was a bad idea.
They're really great stories too, But I wait, I'm patient.

Speaker 1 (24:08):
Yeah. So I think that you and I in regards
to technology, you're quite similar. I think there is an
incredibly refined balance between not embracing technology right right, I
use navigation. I'm not going to get an I'm not
going to get an almanac or whatever it's called and
go look around. At the same time, I'm not going

(24:30):
to be the one. And when I say I'm not
the one, I mean my patients are not the one
who are going to be the testing grounds, right, Because
if we just look at like the SMP, there's historical data, right,
you can look at the SMP and be like, it's
done twelve percent. For if you look at the number
of technologies, devices procedures that have come out every year,

(24:51):
there's probably two hundred, and if you look five years later,
there's probably four. So not because I said so, but
ninety six percent of technologies over ten years disappear. So
that means that ninety six percent of the things that
I did to patients today I wouldn't do. And I
have an obligation.

Speaker 2 (25:09):
Exactly to the patient to withhold.

Speaker 1 (25:14):
I have a responsibility to patients to withhold that technology
from them until I feel that it's right for them.
As you said, what incentivizes people. For me, what incentivizes
people is this technology. Oh man, this is going to
rocket on this patient. It's going to be great. Alternatively,

(25:34):
what incentivizes people is like, well, shit, I could sell
twelve of these. You see the difference. One is fiscally driven,
one is clinically driven, and so, thank the Lord, don't
I've never been driven by I don't get me wrong.
I have seven classic cars. I like money and I
like to spend it, but it never motivated me.

Speaker 2 (25:52):
And that helps.

Speaker 1 (25:53):
And the reality is that we're busy enough that we're
never feeling the sense that, oh my god, if I don't.

Speaker 2 (25:58):
Do this whatever, but.

Speaker 1 (26:01):
Patient direct direct to patient, direct to patient advertising or
consumer advertising is to kiss a death. You bypass the doctors,
you go and advertise to the patients. Now is not
only do you have doctors promoting it, you have, my god,
you have celebrities and influencers doing it. And so as

(26:22):
a result, you create is very, very, in my opinion,
dangerous environment for patients because they'll call your office to
call my office. Hey, doctor Fisher, are you doing the
newest implant in the newest technique using this device. No,
we don't do that right now. We're not sure that
that's the right thing to do. Great click, and then
they just call the next guy. Oh yeah, of course

(26:44):
we think it's the best thing. Since I spread boom,
they go and do it. So you can only protect
who you can protect. That being said, I want to
shift to something because I know that amongst one of
the things I tried to do is emulate my practice
around yours in that one of the things that I
really like about my practice, which I consider a very

(27:04):
unique aspect, is that I'm excellent at a lot of
things literally on Monday, I'll do nose jobs.

Speaker 2 (27:10):
Your talented surgeon, Ah, your talented surgery I do Monday,
I do No's job.

Speaker 1 (27:14):
Wednesday I do circumferenceial body lift, and Friday I am doing islands,
whatever the case is. So I don't need to be
an oculoplastic specialist to only do eelids every day. I
don't need to be a rhinoplasti specialist.

Speaker 2 (27:24):
So I do a lot of Thus, I could have
shaved three years off my residency if I decide I
would be an oculoplastic.

Speaker 1 (27:29):
Yeah, and just all day long. All you're gonna do
is iselid iselid islid. I know every nuance of island. Yeah,
but you've trained for like forty years. That's all you're
doing is elid. Yeah, it's all I do. I just
do islands because I'm an eyelet specialist. Okay, what about
the no, no, no, just the islands. So that shifts
me into the things that you have. Obviously you do
a lot of different things. One of the areas that

(27:50):
you really have pushed the envelope, and that's the graces
of Bruce Kneal, is the area of facelift. So facelift
have just talk about exploded. I mean, I don't even
know what another word besides exploded is. So in the
last few years, do to all the right things in
the right places. Facelifts have gone one thousandfold higher.

Speaker 2 (28:13):
So what are they?

Speaker 1 (28:14):
Number One? Celebrities have finally stopped denying things. It's now
slowly becoming a badge of honor. So not all of them,
but a lot of them are ad meeting it. Of
course Chris being at the helm of that, but prior
to her, other ones have said, Hey, I had this done,
I have that done. So that helps a lot. Two
Younger and younger and younger patients are getting it, meaning

(28:38):
whereas before you would do it in your fifties and sixties,
now you're doing it in your mid forties. So there's
a discussion about that and how the results look more natural, Well, yeah,
because she's forty five. And then the whole idea of
marketing and social media and how every doctor has I
have the Laski lift.

Speaker 2 (28:56):
Have you seen my new Laski lifts.

Speaker 1 (28:58):
It's Bruce Canal's surgery, but instead of putting the stitch
in a vertical direction.

Speaker 2 (29:03):
I got the last ki two left. Oh jumped on
top of you.

Speaker 1 (29:06):
I got point three point zeros coming out. So you
trained under a guy who really studied the mechanics of it.
What I find fascinating is because I'm I'm I'm a
I'm a student, a real student of classic surgery. So
I watched the slow evolution of everyone's Mickey mouse procedures,

(29:30):
and they keep modifying it, and they're ending up back
where Bruce Canal started.

Speaker 2 (29:34):
So oh, wait a minute. So there's a Baker Gordon
course just on Faceliss in Florida. And because Bruce said
don't go, I just never went. And my friend to Martin,
who I respect, and we trained with with Bruce pretty
much the same time. And so it was the sixtieth year.
I finally went this year. I didn't go every year,
but I went this year. I've gotten other things. But

(29:57):
when I got there, I listened to the whole weekend
and I came up the same conclusion. They were all saying, Yeah,
it's best left Bruce Canels what I've been doing. I
didn't need to come here for all the meetings. Yeah right,
it's fun to be in Miami, but it's a good
meeting and a bunch of good guys and good surgeons.
But I haven't missed anything at all. But you know,
like you said, I think FACIFS is just an area

(30:17):
where there's such an explosion of marketing. And the marketing
they're pouring old wine and new bottles, they're renaming it.
And you know you've got to separate the marketing. But
how can patients separate the poor patients?

Speaker 1 (30:29):
So you and I, you and I are sitting amongst
colleagues and like, where's your smass entry point? Do you delaminate?

Speaker 2 (30:35):
Where is your suture?

Speaker 1 (30:36):
Are you going through here? How much do you open?
Do you extend it?

Speaker 2 (30:39):
Is it?

Speaker 1 (30:39):
Do you do application? Do you take out glan? But
the patient is just hearing the last get two point zero?

Speaker 2 (30:44):
No, that's the problem. And so if we're sitting here
with a group of doctors, I know you're a great surgeon,
you got good hands. The two things, okay, how do
you choose your doctor? Unfortunately, the two most important things
in a surgeon patients are not aware of That is
their judgment in their hands. For sure, you could be

(31:06):
the smartest guy on this planet and have bad hands,
bad judgment. You're a terrible surgeon. Correct, Okay, So We're
sitting a bunch of doctors here. Whatever technique you use,
I say, he's practiced, he's good at it. Don't worry
about the name. He's going to give you a good
result because he's you know this guy. I wouldn't have
him plunging my toilet because I've seen his hands. I

(31:29):
don't care what he's doing.

Speaker 1 (31:30):
Don't go there.

Speaker 2 (31:31):
So, but it's hard for patients. I mean, I'm frustrated myself.
I mean, I take my car to the shop. I want,
you know, new tires. I get this call. Of course
I'm getting this call. I've lived long enough to know
I'm getting this call. Yeah, you need tires, you need
new tires. You know, all your brake pads. You gotta
get realized breake pads. I want to see that breake pad.
I want to measure that pad. But in evidently I'm like, ah,

(31:51):
put the brake pads of h Yeah, well they know.
So patients are like this. They just hear the marketing.
They're on chat, GPT, they're on Google, they're doing whatever
they can. But you know, a patient does not have
the ability to know what we know, so they can't
see through that. That's why marketing wins a lot of times,
and all these facelifts are named so many different names,
which I get it. I name mine too. I look,

(32:13):
I know how to market with the best of them.
But you know, in reality, when you look at facelifts,
everything has a little bit of a stretch back. You
don't put your hand your foot on the thing and
pulled as hard as you can because you want to
look natural. One decisions to heal, and so there's always
a little stretch back after three months. That's predictable. You're
never going to have it exactly as tie as it
was to day of surgery breastlifts either. But really there's

(32:36):
I think you can't say there's three types of facelifts,
because there's many types of facelifts. But there's if you
really want to talk about deep plane lifts, and that's
forget deep plane and smass. Just forget that for a minute. Okay,
deep plane. There's three types of facelifts. There's skin lifts,
which you don't want.

Speaker 1 (32:54):
Old fashion lift up the skin, skin cut the excess sod.

Speaker 2 (32:58):
It dentists are doing though you know you could. You know,
if you do it underloath surges, Okay, then you want
the deep plane lift. The real deep plane lift is
sub periostile, and there was sub period.

Speaker 1 (33:09):
It was that Sam Hamra and those back.

Speaker 2 (33:12):
In the nineties. They're just going underneath the bone, right
on top of the bone, underneath the periostitin and doing that.
Then in between there's the smass. Okay, have you got
the skin, a little fat smass, which is the sub
muscle or epenuotic system, and that's connected all these muscles.
And underneath that is between that and the bone, there's
nerves and muscles. Okay, that's smass. If you go underneath that,

(33:35):
that's the deep plane. Sure, that's the deep plane. Now
Hammer called it the deep plane because of the way
he did it. But the way I was taught, I'm
releasing maler ligaments, submandibular ligments, you know, I'm looking. I'm
releasing all those ligments too. And when you get to
the neck, there's a deep plane when there's muscles and
glands and you know, so when people say deep planes

(33:56):
better on smass, what type of smass? You can do
a high spass you can enter, but mediately you can
do a spas ectomy. You can do a spassed acting.
There's so many different ways to deal with it. There's
no way that patients can really understand. And I would
tell you that the person who's a good surgeon with
good hands, good judgment, who's been doing his procedure no
matter what it is, for you know, a long time,

(34:18):
he's very confident do it that way. It doesn't mean that,
you know, he's worse than somebody with a better name,
you know that has a different name. And then there's
all the ancillary stuff. There's fat crafting, there's lasers, there's appeals.
You do them before after surgery. There's a lot of
stuff that goes on to this, and then once you
do your magnificent procedure, you have to wait, and you
have to wait. What about the patient? You know what,

(34:39):
I want to go to the ball game, I want
to go swimming. I fell down, I did this, I
did that. I can infection, I'm smoking, I got high.
Whatever they do, and they come back three months later
and you evaluate them and then you know, you sort
everything out if there's something to sort out. But there's
just a lot of variables involved, and I know, you know,
it's hard as a consumer to really understand.

Speaker 1 (35:00):
I think I think that it was always hard for
a consumer to grasp the complexity of plastic surgery, but
the landscape today is a thousand times more stretched, treacherous,
and the land minds are much.

Speaker 2 (35:13):
More in that.

Speaker 1 (35:17):
In certain certain areas, facelifts being one of them, we've
really really done a disservice by allowing doctors to keep
coming up with Mickey Mouse names of things. I understand
the basic principles, I am or I'm not manipulating the smass,
I am or not manipulating this, that the other.

Speaker 2 (35:38):
That then the newest name of the best picture wins.

Speaker 1 (35:40):
Yeah, of course, of course it's it's it's insane to me,
which then takes me something to fascinate.

Speaker 2 (35:45):
I don't want to interrupt you because you're on your thing, but.

Speaker 1 (35:47):
No, no, I'm not into anything. I'm just I'm trying
to get as much out of you as I can
before you turn into a pumpkin. So what That then
takes me to the fusion plane and the husion plane,
which maybe not affect you because you're sort of you're
sort of outside the hurricane, but I'm in the hurricane,

(36:08):
which is social media. You're sort of outside the hurricane.
You kind of your practice came built, and then you're
sort of outside the hurricane. You are affected, you recognize
that there's some bad weather around you, but you're not
in the hurricane. I am in the hurricane by nature
of the years i've been out, like it or not,
I'm sort of in this milieu and I can fuck it.

Speaker 2 (36:27):
I'm not gonna pay.

Speaker 1 (36:27):
Attention, which would just be suicide. Or I can play
in the hurricane according to my personality and my principles.
So once you're in the hurricane, you are at the
mercy of before and after photos and all these things.
So let's take, for example, and I know you know
the genders, you know the Kardashians and Chris. This is
a perfect example. So Chris has her facelift. She obviously

(36:50):
had her facelift originally done by you. She decided to
have a second one, no problem, as she should fifteen
years or so, goes by. That's about a long ay.
You're older, you've changed, you've gained weight, you've lost weight,
about right, she goes she's actually got great structure for
it because she's got super high cheek bones and a
good jawline.

Speaker 2 (37:08):
That's right.

Speaker 1 (37:08):
I mean, my gardener can get a good result.

Speaker 2 (37:11):
It's beautiful.

Speaker 1 (37:12):
Right, she's got everything she needs to have. She goes
and gets a facelift.

Speaker 2 (37:16):
Right.

Speaker 1 (37:17):
This guy, whoever it is, a levine, happened to be
at the right place at the right time. That's all
that was. He's a good surgeon. I don't know him,
I don't care. He does as you said, he executes
a surgery. He does a good job. Whatever technique he uses,
it works. Because she came out.

Speaker 2 (37:33):
She looks great. She now what.

Speaker 1 (37:39):
Broke the internet? I mean literally broke the internet was
her initial reveal, And in my opinion, the reveal broke
the internet because it just was an unrealistic reality of
what happened. Number One, she was in the honeymoon stage.
Everyone who does surgery knows what that honeymoon stage is.
In surgeries that require tightness for a good outcome, there's

(38:02):
a honeymoon stage. Breastlifts and facelifts are two where the
tighter it is, the better it looks. And so you're swollen,
you're six weeks out, six weeks to two months, you're
in a sort of a nice place. You're not early
where you look weird and you're bruised, and your skar
and you're not so late. So she's first of all
in that phase. So that's one deception because she's swollen.

(38:26):
And two she has perfect skin. And while she lives
a stunning woman, she's seventy. She's a seventy year old woman.
And we in plastic surgery know that facelifts and browlifts
and eyelids and nose jobs don't change skin quality. And
she has a spectacular reveal and she looks great, but
in my opinion, it's not an actual, true, accurate reveal.

(38:50):
And of course three months goes by and she's a
human being and it relaxes and does what all of
them do, and she's still oh she's still seventy.

Speaker 2 (38:58):
What do you know?

Speaker 1 (38:59):
And now, of course she doesn't look as snatched as
say one of the younger women who are forty. And
it broke the internet again. It's like, what the fuck?
She had a great outcome, it relaxed a little bit.
I don't know about his technique, and it didn't fall
apart or fail. I just think this, it's just so

(39:23):
much bad information revolving around these things, and it's like, what,
I actually, if this lavin guy couldn't It's comical because
he literally was at the right place at the wrong
time and he just got hit by mac truck.

Speaker 2 (39:35):
It's crazy.

Speaker 1 (39:39):
Anyways. I only bring that up because not so much
that I care about the comments about Chris Jenner's facelift,
because it doesn't really matter to me, but just how
within a matter of six months, look at all the
information that's come in and out about this facelift, and
how I don't know, I just I find it very fascinating.

Speaker 2 (39:59):
Well, the standard that first picture, when I saw that,
I thought, you know, she's a beautiful woman no matter
where you see her, and she could walk in here
right now. You see. Wow, it's a really pretty woman.
And and when I saw that first picture, I was like, wow,
it looks really he did a great job. And I
understand the questions about, you know, things but skin quality
and things like that, but he did a great job.

(40:19):
I was like, Wow, I'd like to have a result
like that myself. Yeah, I would love to be able
to do that. But I was happy for her. And
you know, face off, no matter who you do them on,
they're going to look different, as you say, because there's
relaxation of the tissues and you know, I don't know
the you know what what all is going into that,
but you know, I I think I think all those

(40:39):
girls look fantastic, and you know, it's it's it's it's
a it's a great uh, it's a great roll with
a bar. It's yeah, it's a great bar. You know,
if if I had fifty daughters they looked like them,
I'd be like, you got a beautiful family.

Speaker 1 (40:58):
Yeah, yeah, yeah, for sure.

Speaker 2 (40:59):
No, they definitely have done a lot from plastic surgery
and prosticated They're really very educated about this stuff. They're
smart people anyway. So but I think that's what you're
saying is it's unpredictable. Afterwards, there's tissue quality that that
settles and relaxes, that almost makes it look more natural,
you know, instead of thirty, you look forty instead of thirty.

Speaker 1 (41:19):
I mean, I mean, I just think that they're putting
way too much weight on this particular scenario, and I
think it's just actually quite accurate. She's a celebrity, she
gums out, she does her reveal, she looks spectacular, she's
a human being, she's seventy. It relaxes a little bit,
and all of a sudden it's like the pendulum swung
one hundred and eighty.

Speaker 2 (41:35):
It's not the surgeon's fault.

Speaker 1 (41:36):
Like, I don't think he did something worse. I don't
think he did anything where it's like a botch or
oh my god, the cable broke.

Speaker 2 (41:43):
Yeah, no, there's no cable broke.

Speaker 1 (41:45):
Then that switches to so faces and all the sort
of excitement about faces. What are your thoughts about sort
of I have my opinions on it, this age of
faces now.

Speaker 2 (41:56):
So okay, I got great opinions on that.

Speaker 1 (41:58):
Yeah, so tell me, like what you're feeling on younger
and younger, what's too young? Tell me that what ageism?

Speaker 2 (42:06):
So? Age is very different for different people. I remember
an extreme makeover. I thought, God, I can't believe I'm
doing a facelift on a lady who's thirty eight years old.
She was on the docks in Florida. Her name was Tammy.
I can see that because you're on TV. Your skin
looked like hell yeah. I think she's working on boats
every day in the middle of the sun. And she

(42:27):
had a spectacular result. We did a facelift, eyes and
everything on her. But then I look at somebody's getting
a facelift. I had some contact my office thirty two
years old, want to face and I said, no, you know,
the longer you wait, the more dramatic the results going.
To be sure, there's people out there, their friends are
dragging them in. You got to do it and then
there before after picture spectacular. Some people are forty five
and they want to skip over that period of aging

(42:49):
and they do it earlier. But you know, I think
it's a case by case basis. I'm not into doing
face of preventive face of su preemptive striking. Yeah, that
doesn't make sense. I think it's terrible, and I think that.
What I tell patients is you got to pick the
right time to do the right procedure, and it's going
to last you whatever, ten fifteen years. Bruce used to say,

(43:09):
they say, how long is my facelift going to last?
He would say nine years, three months, two weeks and
two days. That's what he would tell them. Yeah, yeah,
it was quite a care. Yeah, but he would say that.
But you know, I think you each procedure you do. Afterwards,
there's scar tissue, there's more unpredictable planes, there's it's harder
to get a result. The most sustaining best faceliff you

(43:31):
do is going to be the first one, so that's
the one you should do, right. So I think that
you have to take people on a case by case basis,
and you know, if there's somebody that wants to do
it in their forties, you know, people eat differently. Some
start with an asy, be a full start with the neck,
and it's all tied together. So I just I used

(43:52):
to tell people there's an analogy. There's a bank, a river,
and a bank. On this bank, you don't need a
facecift on this bank, you really do, And everybody would
tell you in the river, it's like you're not really
there yet. And that's when you there's those transitional things
like botox and pillars and things like that. And you know,
I still do that. I'm really into natural results, and

(44:12):
so I mean, we see everybody, but I'm sure like you.
You're a very ethical doctor, and you're very straightforward. And
one of the things I respect about you the most,
not only how good yours, is you're very honest with
your patients.

Speaker 1 (44:23):
Yeah, I mean, I want them to do well, and
I think sometimes they're shamboozled. I kind of looked at
my I look at my patients, I swear to God
like my own children, because they come in and they're
asking for something and they wouldn't be asking for it
unless somebody misled them. They didn't just you.

Speaker 2 (44:37):
Tell them no, They just go to the next person
says yes.

Speaker 1 (44:40):
But I am I say no in such a way
you know me, I'm aggressive?

Speaker 2 (44:43):
Yeah, yeah, yeah, yeah, you're aggressive. You're not aggressive, but
you sound aggressive, so you know me.

Speaker 1 (44:49):
I make sure to scare the beajami's out of them
so they don't do it because I know they're going
to get shambooso. I don't just go, hey, you know what,
this isn't for me. I don't think you're right. I'm like,
if you do this, you're going to get in necrosis
and you probably won't move your face. But hey, what
am I?

Speaker 2 (45:01):
You know?

Speaker 1 (45:01):
I purposely do that because I don't want them getting shamboozled.
So my current philosophy of facelifts in aging is globally.
This is one of the few times that I think
social media celebrities have done good overall for plastic surgery.
And let me elaborate. I do think that the reason

(45:22):
why we have so many patients who didn't want to
get facelifts. Is because when you show up and you're
sixty eight and you have shitty skin, really lax tissue,
you have a super super neck, saggy neck, and you
go get a facelift, not because of the surgeon's misdoing,
but because these tissues are so dynamic and stretchy you

(45:44):
can get when swept. You can move in a plane
that wasn't intended. You can pull too hard, so you
get a lot of dramatic results. Dramatic is good, Dramatic
is bad. So you're working on a less ideal patient
when you start doing facelifts. As aging starts to present,
aging doesn't present at sixty eight. Aging has arrived. Aging

(46:08):
presents usually around your early forties. You get a little marionetting,
a little jowy, and a little bit mostly right, I'm generalizing,
and I think that when a patient has the signs,
you can't do it. When the sign Hey, you know
what I want to facelift. Okay, you don't have any jows,
you have no marionetting, you have no mid face loss,
and you have no neck banding. Yeah I know, but

(46:29):
I don't want to have any other things, so I
want to that's the craziest thing I've ever heard. You're
doing something that isn't it hasn't even arrived. But once
you start presenting, and let's say you're forty seven and
you have great tissue your forty seven and you have
the mid face sag and you have the jowling and
you look okay, but you don't look like you did
when you were thirty five, and you do an appropriate

(46:52):
facelift in that person, that's a home run. And that
is one of the few times that I'm I'm an
agreeance or or I'm happy that patients have shifted and
that I'm getting younger patients and I'm getting a patience
in their forty seven and forty eight or forty six
who are appropriate candidates because those are better candidates and

(47:15):
I can get better results because they've I say to them,
I say, wait, I have four nieces. I've done all
four of their noses. One was at fifteen, one was
at sixteen, one was at eighteen, one was at twenty four.
No one even blinkedn eyelash. I operated on a fifteen
year old. I rearranged her face.

Speaker 2 (47:30):
That's fair.

Speaker 1 (47:30):
Yeah, yeah, forty seven year old once a tiny facelift
in removal, like facelift already, so it was more of
a social acceptance or not. And I like that we
move that dial because I do think an appropriately appropriate
forty seven year old will look better than an appropriate

(47:51):
sixty eight year old, at least that's my opinion, So
I do like to shift. The problem with that is that,
like anything, there is potentially no floor. So now you
have thirty seven, thirty six year old on social media
getting like Ponytail Psycho cat lift face lifts, and.

Speaker 2 (48:09):
Because there is no guardian they're getting there's no guardian,
there's nobody. There's no either. Twenty one year old. This
was fifteen twenty years ago, a twenty one year old
little Saudi Arabian princess. She came to my office. She says,
I want to facelift. I said why. She just look
see yeah, like you move your finger yet she can

(48:31):
put you can move, I said, I said, you don't
need a facelift. Find a two or three year old
in your family and see if it's just the same thing. Anyway,
she ended up coming back five years later. Somebody did
her facelift for her, got a lot of money. She
had the worst car. She said, can you fix these scars?
I said, no, there's not enough skin. Now it's easier
to stay out of trouble and get out of trouble.

(48:51):
So it's uh, you know, you just have to do
the right thing. Crazy.

Speaker 1 (48:55):
I had a celebrity come to me. She was a Latino,
very famous celebrity, very fat, very full face. She wanted
a facelift. She was in her early forties. I said,
I can't. There's no laxity here, there's nothing to pull
on your face. I and get it. You don't like
the shape of your face, go lose a shit ton
of weight. She with scars, the thickest scars.

Speaker 2 (49:14):
She came back with her hair down. She used to
wear ponytails.

Speaker 1 (49:17):
It's sad she since passed for unfortunate reasons. But and
she's like, can you fix this? No, I can't fix it.
And it wasn't the typical post curricular scar. It was
all pre auricular and it was the same thing. And
so I don't know. Generally speaking, the shift is good.
I want to talk to you quickly about another shift,

(49:38):
because these are two areas where I think you are
you know, not only are you amazing in all of them,
but these are is this implant phenomenon? Okay, so when
you started out plastic surgery, where were people putting in
the implant majority?

Speaker 2 (49:52):
Uh? You know what. When I I I'm lucky to
have so much experience, and I really enjoy what I do,
I hate that I have so much experience. Yeah, yeah,
you know better. But you know, when I first started,
people were there's a lot of different implants out there.
There were the mimim plants that didn't have capsule contracts,

(50:13):
little texture ips. Well, there was a misty gold. They
had these gold implants. If you put five implants on
a counter, that's what you did back in the day,
and they all look clear. This one had gold flakes
in it. And somebody came in, which one you want?
They say, I want those gold flake implants. Once you
put them in, you can't tell what's in. You can't see.

(50:34):
But they were great sellers. Right, So I've seen all
of them. But they were putting them either underneath the muscle,
which all bulged up like this the book's pointing down,
or they're going on top of the muscle, and so
it's either on top or below. And then this doctor
that showed me is on my Instagram. You showed me
how to do a partially I've interpreined. Oh, yes, his

(50:56):
breast looks so good. I watched him, I said, God,
I just watched him release muscle and make that little
pocket down there, and those breast looks so beautiful. I said,
that's what I want to learn how to do. And
he started me. And back in the day, it was
half under the muscle, half on top, half undern eighth
half on top, half under. You know, this is what's
what we called it. Yeah, half half, yeah, half hat.

(51:18):
That's I just that's always what I call it. And
then I don't know, ten years ago they start calling
it dual bill plane, whatever you want. You call it
whatever you want. But I've modified that every time, and
I've learned a lot, you know, I just doing all
the porn stars, all the planets. The bigger the implant,
the better they look. But then I was like, shit,
it's like a wheelbarrow going over the hill. You know,
the more you put in it, the board's going to

(51:38):
go and you can't control it sactly. So I've learned
my lessons I got I've done, you know, I don't
know tens and tens of thousands of implants now, but
I I they were usually on top or below, and
so I still feel like the dual plane as they
call it now, or half under half on top, which
was kind of a name that I gave it because
I didn't know about dual plane. I still think that's

(52:01):
the best way to do it. And you know, everybody
can be different. I've done them on top, I've done
them below, I've done them every way you can do them,
and I think every patient is a little different. I
think implants, uh, you know, I like what. I'm comfortable
with what I've learned. Yeah, you have mastered your mastered
my implant. And like I say, I'm sure there's people
have seen my problems out there and I've seen yours too,

(52:25):
not you, but yeah, I know you referred to. I've
seen them all, they've seen mine. We're not perfect, you
know I I you know, so Michael Jordan missed a
lot of free throws. I've missed my share too. Yes,
I'm not Michael jordd so fair enough.

Speaker 1 (52:38):
So why I bring this up is because, as I
mentioned to you, with trends and shifts and marketing, I
don't have any problem with clinicians making conclusions on their
owns and choosing things for their patients based on their
clinical acuum, their judgment, and their education. I have an
issue with, as you do, with industry pushing or peddling
their products and their procedures and utilizing the vulnerability of

(53:06):
you know, or the the vulnerability of patients, and sort
of the unscrupulousness of certain physicians. So that's what I
have a problem with, so real popular now just so
as you, as you and I have talked about it.
So we went from basically completely under the muscle to
dual plane, which is of course the way I do it,
partly because that's how you train me, but one hundred

(53:29):
percent because it's the one that gives the best outcome.
In other words, if if I learned it from you
and it was shitty, I would have stopped doing it.
There's a lot of things that I do differently today
that I did ten years ago, but.

Speaker 2 (53:40):
That's not one of them.

Speaker 1 (53:41):
And now we're back and above the muscle. And so
this above the muscle thing I find very fascinating because
it's easy for the doctor, it's easy for the patient.

Speaker 2 (53:50):
It's the easiest way to do it right.

Speaker 1 (53:51):
The problem with it is the issues associated with the
takes time, same.

Speaker 2 (53:56):
Issues as they were before, right they abandoned.

Speaker 1 (53:58):
It takes time to show and we have historical data
which shows a lot of those things right. In other words, Oh,
what's their issue with bell bottoms? Oh you trip on
them with your boots. I don't need to do it
now to know that I'm gonna trip on them with
my boots because in the seventies people used to trip
on them with their boots. Nothing's changed. It's still a
bell bottom. Okay, no about now we're making the bell

(54:20):
bottoms with corduroid and before it was gene material. It
doesn't matter. It's a bell bottom. So anyway, I know
there's a huge shift above the muscle. And listen our practice,
you know we we people call and say do you
do this? Do you do That's it? We do everything,
and we do do everything, and that we want you
to come in and be educated, and then we will
educate you as to why we think you need a

(54:43):
B or C. And only then will you then be
able to decide if really CE, do you do C? Yes,
we do CE. Come on in and then after you
meet with a doctor who you believe to be knowledgeable.
If it turns out that B is ideal for you,
well then you're a fool if you do C. Well,
but that's what I on Instagram. You know, TikTok said,
see is the right way to do it? Yeah, but

(55:03):
that's not what your your body, your presentation suggests.

Speaker 2 (55:08):
So I think you have to trust your doctor. I
mean I've I can't think of a time as many
flights that I've made. No matter what I read, what
I thought, what my opinion was, I've never gone up
to the cockpit and told the pilot flight a thirty
six thousand feet that's what I think is the best.
I just you know, do it. This is your job.
You're gonna so I don't like people. I want them

(55:29):
to be educated. Come in with I'll answer all your questions,
but the end, I'm going to do it the way
I know is the best way for you to have
a good result. And I'm not going to have you
directing you know how I make my spaghetti because this
is why people come to me because they like how
this is. So you know, I'm not telling you not
to educate yourself, but I'm just saying that that education
sometimes leads you down the wrong road. And I'll give

(55:51):
people options. I'll tell them what's gonna happen, what's not
gonna happen, and that's all we can do. Yeah, you know,
it's funny. We it's interesting after them.

Speaker 1 (55:57):
The more years you're in practice, the more analogies you
have for metaphors, so to speak. And I always tell
people I'm not your uber driver. I'm not here to
take you to your destination. So you don't get in
say hey, take me here. That's not how this works.
I'm going to educate you, and I'm gonna tell you
what I think you should do, and if you want
to do other than what I tell you, I won't
do it.

Speaker 2 (56:15):
But at least you know.

Speaker 1 (56:16):
So it's true in that nature, a good clinician will
always stand firm, irrespective of whether they lose or they
lose a patient or not. And you know, I'm sure
I've lost a ton of patients who wanted No, it's
not it's great because I don't want to have anything
to do with it. It's gonna end up being a
shitty oucome, I don't want to party.

Speaker 2 (56:34):
I got to tell you twenty five years ago. I
had a patient coming to my office. Is a great story,
and everybody wanted this patient to be their patient, and
I did too. I was like, wow, I can't believe
I got this person in my office. And I looked
at her breast and she says, I said, you need
a breast left. You didn't need an anchor left. She said, well,
you know she don't want any scars. Yeah, of course
I've heard this. She went to two doctors before they said, oh,

(56:55):
we can do it with this little circular scar. Yeah. Sure.
I say, it's not going to work. And she says, well,
that two of them said they could do it. I
made a mistake. I said I could do it too,
so I wonder as my patient. So I did it.
I knew it was the wrong thing to do. You
were in practice for years. I knew it was the
wrong thing to do. I still did it because I
wasn't thinking right and I knew it was bad when

(57:17):
I was doing it. And she came back afterwards, She
came back and afterwards it was terrible. I said I
should have done what I knew I should have done.
I'm sorry, just let me do it I need to
do went back in did the anchry left look spectacular.
Ever since then, I will not ever let it patient.

Speaker 1 (57:33):
I push and that and that comes with that comes
with wisdom, and that like, for example, give you an example.
Everything you tell me, I can parallel. I saw a
lady in my office last week. She wanted a chinnog.
I do a lot of chinnogs. I teach the course.
All these things. I learned chinnog's on my own, literally
by making the errors. And I remember very vividly a
patient that was an Asian patient who comes in with

(57:55):
a white chin. Everything about it was like, no, don't
do this surgery on this patient. And I was like, oh,
I can do this. I can crush this. And I
did the case and i'd heard before and after I
have it, you could see the dismay in her eyes,
like she was so unhappy because and then after that
I learned my lesson. I was three years out and
I teach. When I teach the course, I have her

(58:16):
photo in the in the lecture. I'm like, you see
this patient, You see how sad she looks here and
post off. Don't do that. This is what to avoid.

Speaker 3 (58:24):
So I you know you should to take your picture
at the same time. See, I said, you were yeah,
she made Oh my, I had to take the thing out.
I said, I'm sorry, I'll take it out for you.
No problem, Thank god, it's a reversible procedure.

Speaker 1 (58:35):
So I do, I do understand that, and I think
that that you know, I hope for the people listening
and you hear this fun, this fun banter between the
two of us. But I think that you want to
And the thing is, I don't even know how to
tell patients. The last podcast I did is with a
clinician that I took care of who had a catastrophic
I mean catastrophic complication from another doctor in which she

(58:58):
was abandoned, and she and I went over the whole
story and then we could not have found one way
for a patient to have avoided that because she went
to a board certified plastic surgeon in Beverly Hills. No flags,
no nothing. At the end, he just left her hanging.
And so I want to always try to leave the
podcast with an articulation of take this nugget home. But

(59:20):
what you want to do is find someone that you
believe is genuinely you has your best interest at heart,
is a transparent and honest surgeon. But as Garth said,
the problem is the two parts that probably matter most
is judgment and hands, or you'll never know.

Speaker 2 (59:41):
I mean, I guess, can you imagine a smart doctor,
he's got great judgment. Yeah, who's got cerebral palsy? Well,
they can operate, you can. And some people are like that. Oh,
I mean they don't get they don't get weeded out
going through the process because they made hundreds oh.

Speaker 1 (59:59):
Nothing, they do research. I mean I remember. Actually the
funny thing is I remember in our residency program. As
it's ironic for people to understand this, residency programs gets
funding based on their the global research funding that they have.
So you want md PhDs and really research driven residents

(01:00:20):
in your program because they pump out papers papers then
make your program more prestigious. So it has nothing zero
zero zero. Like I actually couldn't write a paper for
the life of me. Even with chat GPT, I probably
could still write it. But I can operate circles around
ninety percent of the people that I was in programs with.
But the thing is, it's unfortunate there is.

Speaker 2 (01:00:43):
It's these are just don't know and they don't understand.
I know a doctor who writes a lot of papers.
Is a great surgeon, a great guy? You know what?
A lot of these people are writing papers. They're writing
papers because aren't good surgeons. But I don't know. It's
it's when I look back at my residency, the people

(01:01:06):
that train me, there's only one that I would let
operate on me today. The other two, the other two
professors there were professors for reasons they were and you know,
God bless their souls. And there's a I respect and
I admire all these people for doing what they do.
But I've written papers, I've lectured, I've done all this time.
I just still enjoy it. I don't like it. I
like to operate. That's where I like to be. If
you if you want if you want somebody to write

(01:01:27):
a paper, if you want to steer committee, if you
want somebody to do a lecture, then there's a lot
of people out there that God bless them. If you
want spy in the operating room, that that's where he
lives and results, I say that's you. O.

Speaker 1 (01:01:38):
Yeah, yeah, I know, I one hundred percent agree with
you that that I actually enjoy the art of operating. Actually,
one of the things I remember about you is that
you were the columnist while you are the most yourself
while operating. Now that I know you very well, I've
seen comfortable. I've seen you in a million I've seen
you in the clinic with patients.

Speaker 2 (01:01:58):
I've seen you.

Speaker 1 (01:01:58):
You're great everywhere. But where I would say you're the
most yourself is operating because it's the air. It's when
you're having fun. It's actually enjoyable, enjoyable.

Speaker 2 (01:02:07):
It's the most comfortable part of my day.

Speaker 1 (01:02:09):
Yeah, because he is part of my days of sleep.
So you don't how many communication you just get to
do the art part. It's fantastic. So last and a
final part. Okay, so you are in you've been in practice.
I'm in twenty one thirty five years.

Speaker 2 (01:02:23):
So you came into my office in two thousand and five.

Speaker 1 (01:02:26):
Two thousand and six, two thousand and six.

Speaker 2 (01:02:28):
Okay, yeah, so.

Speaker 1 (01:02:30):
You have God willing another ten years let's say, well
plus or minus whatever. So these are the final ten years, right,
because it's the downhill.

Speaker 2 (01:02:38):
It depends totally on my daughter's career because she told
me I could be in our band. So she hits itabay,
so maybe you go sooner if she gets it big
next year. I'll ret next year and I'm gonna be
uh on her stage with a you know, mustache and tattoos,
and you're gonna be what you're playing the drum. I'm
gonna play some percussion instrument. I'm gonna be on tour
on the stage, and that's what I'll be doing.

Speaker 1 (01:02:58):
I see you with a thimble.

Speaker 2 (01:03:00):
It could be nothing, but I'm going to be on
that stage with it. And I'm going to tour the
world because that sounds fun. Okay, I agree with you.

Speaker 1 (01:03:06):
But let's say your daughter's career takes a little longer.
She will she will actually become incredibly successful.

Speaker 2 (01:03:13):
What is it?

Speaker 1 (01:03:13):
What do you what do you envision or what do
you hope these last ten years will be like? And
I and what that I mean?

Speaker 2 (01:03:21):
I know you have the perfect practice, And how much
space you give me? I got a.

Speaker 1 (01:03:24):
Whole eighteen hundred square if you got there and I
got a room with your name on it, Okay, well
we'll see that would be actually ironic because it's kind
of like start in circle, like the full circle of life.
But what do you? What do you? What do you?
What do you want these last ten years? If you
could just draw it out. I want this, I want that.
What do you hope these last ten years do?

Speaker 2 (01:03:43):
First of all, already I've designed my life. I'm very
fortunate and blessed by God to have an amazing wife.
I got a great family, I got a great practice.
I've accomplished everything in my life that I could possibly want.
I was living in a ten x twelve foot room
for thirteen years and didn't have a dad when I
was nine years old, and I I had poor as
I could be, and I only wanted to make one
hundred thousand dollars a year and have a family. And

(01:04:05):
I've got everything I need. If I was given two
billion dollars today, I would I'd probably get that billionaire's tax.
I'd be bad. But if I was given a bunch
of money today, I would still come back to work
and operate tomorrow. Just like a guy that's rich as hell.
I was given a billion dollars, he's still got to
go golfing the next day, because that's what it's like.
For me. It's more of a hobby, but I really

(01:04:26):
enjoy it. And I've designed my life to take three
months off a year.

Speaker 1 (01:04:30):
Yeah, I noticed that you've done a very good job
in the last few years to spend more time with
my friend time that I.

Speaker 2 (01:04:38):
Like the way my life is now, and I enjoy
family time. I am so lucky that my wife went
to school for surgical first assistance. Yes, I know I've
operated with He's very very very loved and needed and
respected in the operating room helping out with everybody, and
so I've been fortunate in that. And uh, I don't know,

(01:05:01):
I just I don't know that more more of the same.
I'd go out to deep dinner with you more often
that I would like.

Speaker 1 (01:05:07):
So I love that, And that says everything it needs
to say. Because most people, when you ask them what
do they hope, they start to modify things right, And
you think to yourself, well, why do you need to
wait to do the modification if you really ask them,
and it's like, I guess I could do that now.
And the fact that you can say, well, no, I
kind of just keep doing what I'm doing is is

(01:05:29):
Actually it's a wonderful. It's a testament that you are
you've you've over the because it wasn't like that, right,
there was a period of time you were doing the
naked true if you were there all the time because
I'm you know, as I said, I've in many ways.

Speaker 2 (01:05:41):
Mirrored my practice towards yours.

Speaker 1 (01:05:43):
And I remember a period of time because when I
joined your practice, you were around my age.

Speaker 2 (01:05:49):
Yeah, and I had more testosterone. Yeah, but I've slowed down, right.

Speaker 1 (01:05:52):
But the reality is that when I yes that, I
know when I'm meant joined. When I joined your practice,
you were my age, and I remember you when I
was when I was starting, and you were you were driven,
you were focused, not that you're not, but you were
more in the trenches. And now you've slowly and gradually,
due to success and age and time or whatever, you've

(01:06:14):
done more so I definitely know that you've modified your
life as the years have gone by, which is good
on you, because what's what's the point of all this?

Speaker 2 (01:06:23):
If you don't go on a vacation, If you do not,
oh you got to you got to enjoy your life.
And during that extreme makeover time, the naked truth, and
I was doing all that, I was going to bed
three in the morning and waking up at six in
the morning. It was just like my residency. I was
just driven in so many different directions, doing things that
I thought were best for my practice, best for my
family and me, and it paid off. It did pay off.

(01:06:47):
And I tell young guys that I said, look, you know,
I had so many business cards I was handing out
at the beginning. Everywhere I would go, I'd say, here,
I'm doctor Fisher, and you know, I'm expecting a call.
Of course I wouldn't, but the mad or do you
would have my card waiting, you know. And I was
passing on so many cards. And you just got to
work tirelessly at your craft and building that those two trees.

(01:07:08):
So so now what's going to be for you? As
you're heading in the right direction you always have been,
as you know, you're designing your life the way you
want to do. You know where you're weaving it out,
don't I don't have any more goals, to be honest
with you, that's probably so, but no.

Speaker 1 (01:07:22):
Just to keep you know, you know, just as a
closure what people ask me, you know, what is your
what would you hope would happen? And I tell this
because I walk with my cousin every Saturday. It's sort
of a therapeutic, you know, exercise routine. And I say
to them every Saturday, like clockwork, if I could have
exactly what I have right now, right now, if you

(01:07:43):
could guarantee me that I would have this for the
next twenty years, I'd be the happiest guy.

Speaker 2 (01:07:47):
You will because you're that good of a guy, a surgeon,
you know. And I'll tell you every time I've blown
out a candle in the last five to ten years,
I always wish for everybody's health and happiness. Yeah, it's lie.
My my family and my wife, my daughter's, my staff,
my friends, my patients are all happy. That's fair. God
bless amen, amen on that.

Speaker 1 (01:08:06):
Yeah, all right, guys, you got a very small glimpse
you could tell that probably he and I could go
for probably twenty four hours straight sharing back and forth stories,
because really, a medical practice is an endless book of stories.
It's a weaving tapestry of patient after patient after patient,
and so it is a real blessing to be able

(01:08:28):
to do that. So at any rate, that wraps up
a fantastic episode of plastic surgery and censor as always.
You know, I have two partying requests. One is, if
you like our show, go write something nice. Everyone reads
the reviews from the people who put this show together,
and it makes everyone feel good. And the last is
if you can share this show with those are that
you love. You never know who's about to have a
surgery and would have benefited from the information. Okay, Garth,

(01:08:52):
I appreciate you very much.

Speaker 2 (01:08:53):
I know your time is precious. Great to see you
again as always.

Speaker 1 (01:08:56):
And we will have you on again and again and again.
All Right, guys, that's a that's a wrap on plastic
surgery and censor.

Speaker 2 (01:09:04):
Mm hmm.

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Lessons From a Lifetime in Plastic Surgery With Dr. Garth Fisher

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