May 12, 2026 • 54 mins
What happens when the spot everyone keeps treating… should’ve been biopsied?
In this deeply personal episode of Plastic Surgery Uncensored, Dr. Rady Rahban sits down with Valerie, a vibrant 40-year-old woman whose “sun spot” was dismissed, lasered, peeled, and treated for years—before finally being diagnosed as invasive melanoma.
This conversation is equal parts shocking, educational, and incredibly important.
Valerie shares the emotional reality of hearing the words “you have melanoma,” while Dr. Rahban breaks down the dangerous misconception that skin cancer always looks obvious, raised, or alarming.
Together, they unpack:
• Why melanoma can look deceptively harmless
• The warning signs people (and even providers) can miss
• Why persistence and self-advocacy matter
• The critical role of annual dermatology checks
• What happens when skin cancer affects the face—and why reconstruction decisions matter more than most patients realize.
This episode is not fear-mongering—it’s empowerment.
Because sometimes the most dangerous diagnosis starts as the spot you were told not to worry about. And when it comes to your health, “probably nothing” should never be the end of the conversation.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
In this deeply personal episode of Plastic Surgery Uncensored, Dr. Rady Rahban sits down with Valerie, a vibrant 40-year-old woman whose “sun spot” was dismissed, lasered, peeled, and treated for years—before finally being diagnosed as invasive melanoma.
This conversation is equal parts shocking, educational, and incredibly important.
Valerie shares the emotional reality of hearing the words “you have melanoma,” while Dr. Rahban breaks down the dangerous misconception that skin cancer always looks obvious, raised, or alarming.
Together, they unpack:
• Why melanoma can look deceptively harmless
• The warning signs people (and even providers) can miss
• Why persistence and self-advocacy matter
• The critical role of annual dermatology checks
• What happens when skin cancer affects the face—and why reconstruction decisions matter more than most patients realize.
This episode is not fear-mongering—it’s empowerment.
Because sometimes the most dangerous diagnosis starts as the spot you were told not to worry about. And when it comes to your health, “probably nothing” should never be the end of the conversation.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Welcome to another episode of Plastic Surgery Uncensored. I'm your host,
doctor Rodiy Raban, and we have a fantastic episode for you.
As always, the episodes are amazing, right just because we
talk about cool shit, But the episodes get elevated when
we have the honor of having someone who joins me
to help narrate and tell their story. And you know,
(00:26):
having colleagues on is great, but having patients on is
extraordinary because it takes courage, it takes time, it takes effort,
and we're blessed to have Valerie on our show today,
and we're gonna be talking about something that you wouldn't
expect from a young lady. We're gonna be talking about
skin cancer, most notably melanoma. That's right, melano is one
of those words that gives you know, gives you the
(00:48):
fear of God, as it should. And Valerie had a
you know, so now a couple of months out from
being diagnosed, being treated and in the wake of her
melooma experience, and she was kind enough to come on
the show and together we're going to try to educate
you about sort of everything I think you need to
know about when it comes to skin cancers, both from
(01:11):
a diagnostic, from a treatment, and from an aftermath standpoint.
So welcome to the show.
Speaker 2 (01:17):
Valorie, Thanks for having me.
Speaker 1 (01:19):
So let's just back up real quick and just put
the let's put the foundation. When how are you just
turned forty? Just turned forty? So in the world of
skin cancer, that's considered young. Right when we think skin
cancer are like, oh that old gome, that old lady.
Oh they're going to be seventy. That's not true. We
(01:41):
now know that a lot of young people get skin cancer.
So you're forty, and tell me your journey when it
came to diagnosing this skin cancer. Like you're living your
life and all of a sudden, you notice what.
Speaker 3 (01:54):
So about ten years ago I had I was really
a freckly kid. And so you know, or your freckles
as you get a little bit older, as you get
into your thirties, they kind of start to turn into
sun spots. They some of them merged together and become
a little bit bigger. Some of them start popping up
out of nowhere. And I had a little sun spot
(02:15):
on my cheek and it was like a freckle that
just kind of got a little bigger. It was getting
a little bit darker, but it wasn't very dark. It
wasn't a big deal. And I had tried ipl and
nothing came from it, and then I let it go,
and then it really started to bother me.
Speaker 2 (02:36):
So then I was actively trying to get rid of it.
Speaker 3 (02:39):
And every single like medspot type place or doctor's office
or any place that I would go, it would constantly
be you know, I'd say, hey, I can't get this
dark spot to go away. And nobody ever flagged it
as something that they were worried about, but they would
always say, oh.
Speaker 2 (02:55):
Well, have you tried this, have you tried this?
Speaker 3 (02:58):
And I'd say, yes, I've tried X, y Z, and
nothing's getting rid of it. And every doctor inevitably would
be like, but you haven't tried this.
Speaker 1 (03:06):
Right, the newest, greatest.
Speaker 2 (03:08):
Yeah, exactly.
Speaker 3 (03:09):
And so I tried everything from lasers, fraxil, cosmolon, peels, everything,
and it would eventually like fade for for a couple of.
Speaker 2 (03:20):
Weeks, and then it would come right back right. And
so I.
Speaker 1 (03:23):
Were any of these people dermatologists.
Speaker 3 (03:25):
One, so I had been going to a dermatologist UCLA
for something separate. So I went in for a full
body check. But what I don't recall is if I
had makeup over it and didn't.
Speaker 1 (03:39):
But these people that you were going, which is this
is very important, none of them because what it shows
you is you just assume skin cancer this ugly, horrible,
wart looking thing. And I'm a thirty year old girl
with some sunspots and freckles. So it's it's very very
important you listen to that aspect because while I don't
want you running out and having every freckle examined, but
(04:03):
the story that she's telling you is a very common one,
which is I had this thing that I kept trying
to get rid of and it wouldn't go away.
Speaker 3 (04:10):
And you would think people that look at faces every
day would say, hey, that's alarming, but it really wasn't,
because even when I showed you the photo, you were like, wow,
this is this is crazy. This didn't seem like something
that would be that scary. So I went back to
a dermatologist that I had seen pre COVID, and he
scared me. He said, we're taking this off right now.
(04:32):
You know, I thought Beverly Hill's private practice, and you
know he's gonna care about taking it off in like
a pretty way, he'll get rid of it, and that
was my concern, was getting rid of it. I didn't
expect that we were about to do a biopsy.
Speaker 1 (04:46):
And when was that? When did you buy up SI?
Speaker 2 (04:47):
December first?
Speaker 1 (04:48):
Okay, so story. It's very important everyone listen because there
are two ways skin cancer presents, and it's usually always
the latter. One is I see this goomba on my face,
Oh my god, what is that thing that's crairy looking?
And go get a biopsy. That never happens. The reason
it never happens is skin cancers don't just wake up
(05:09):
one morning and are skin cancer. They start from totally
normal cells, and due to some exposure often sun or
radiation or whatnot, the cells change and then they gradually,
like watching grass grow, they morph and change and morph
and change, and they probably go from pre cancer normal
(05:31):
to pre cancer to cancer. And because it's so incremental,
and because it's so slow, it is always the case
that someone says it's nothing, it's just a brown spot.
And because the reality is it happens in millions of
other areas on your body. That being said, the red
flags should be bleeding, which yours didn't have, crusting scabbing,
(05:54):
which yours didn't have changes that are constantly dramatic, Like
getting bigger is one thing, but changing colors or it
used to be brown and now it's a tan, and
it was tan and it's brown, and the fact that
it just doesn't go away with any type of treatment.
Those are sort of the things. But the truth is,
even with all that, nine at ten times, you're gonna
miss it.
Speaker 3 (06:15):
And like you said, it's so incremental, and you're looking
at yourself in the mirror every single day. You know,
it's like you don't see yourself aging and every day.
But you look at photos from five years ago and
you go, oh, I looked so much younger.
Speaker 2 (06:29):
It's the same thing.
Speaker 3 (06:29):
You go, oh that spot was so much smaller, And
that's when it starts to become really concerning.
Speaker 2 (06:36):
But it's all in hindsight.
Speaker 1 (06:38):
Yeah. Sure. So the second thing you and I spoke about,
which we're going to highlight in circular is Okay, well, fuck,
if you're telling me that this thing is so gradual
and I'm going to miss it, how am I supposed
to know? And the way how you're supposed to know
is you're supposed to have a dermatologist, not a met small,
not a plastic surgeon. A dermatologist who specializes in skin
and skin care. Do an annual and you said this
(07:01):
annual skin check and what they do and what they
ought to do, and if they don't, then it's the
wrong dermatologists is map out all of your sun's spots
and that way when they see you next year, not
next week, not in twenty years, next year, they're like, ooh,
this one has changed, and I don't like it now.
I always think that they're way too aggressive, but now
(07:22):
I I don't want to say it makes sense, but
this is the nature of the beast. I think they
remove way too much shit off of people. As a result,
a lot of people have these ugly little scars all
over their body. The problem is that when you have
a patient like you who's melanoma, when you look at
it was like, you gotta be kidding me this, then
(07:44):
it tells you, fuck now, I got to take everything
off because what you're basically doing is a shotgun approach.
They're like, if I take off a thousand of these,
nine hundred and ninety seven of them are going to
be normal, but three of them are going to be abnormal.
So what do I do? Let three people get, you know,
sick and die. So I think you were right. So
(08:05):
you go and see this guy in Beverly Hills. You're like,
this thing's not going way. He's a dermatologist. He looks,
takes a good look at it, and he's like, oh,
I don't like this, which you're grateful, right because that
was the right thing for someone to do save my life.
And then he's like, we need a biopsy this yep.
So you're like, uh, okay, sure it's gonna be siny,
little tiny something. So he biopsies it.
Speaker 3 (08:24):
He does a shave biopsy, which is basically just like
shaves off a small layer of skin. And I'm thinking,
this is this is what I have to be worried about.
Speaker 2 (08:32):
Like I'm covering it up. I'm treating it so well.
I don't like go outside.
Speaker 3 (08:37):
I don't want it to get any sun because I'm like,
I need this little scar to heal up really well.
And he calls me on Thursday. Well, I called Thursday
morning because now I'm starting to get anxious and it
was taken on a Monday and Thursday morning I call him.
I'm like, hi, do you have my results. Nope, we'll
call you when we know. Doctor calls me.
Speaker 1 (08:56):
That's always a bad sign when you call and they
don't give you any uh, the doctor will call you. Fuck,
this is bad.
Speaker 3 (09:04):
So, like five minutes to five on Thursday afternoon, I
get the phone call and it's like, hey, can you
hold for the doctor?
Speaker 1 (09:12):
Yeah? Your heart drops to the ground. I'm sure, And.
Speaker 3 (09:14):
I said when you picked up, it was like, so
you just want to give me good news right yourself.
Speaker 2 (09:19):
He's like nope, he's He's like, you have melanoma.
Speaker 4 (09:23):
And I went, okay, well you just got it all right,
like it's not a big I didn't understand the gravity
of what I was getting into.
Speaker 2 (09:34):
And also you hadn't.
Speaker 1 (09:36):
Heard the word melanoma, right, like, so when they said melanoma,
you were you knew melanoma is like not good.
Speaker 3 (09:42):
For a second, I was just like, okay, melanoma, and
then my brain went to wait, that's the worst one, right, yeah,
And because the other ones all have these like crazy names,
they almost sound worse.
Speaker 1 (09:52):
So the three types of main can skin cancers are
basil cell car skin can carcinomor BC basil cell carcinoma
basil cell cancer, squay miss cell carcinoma SCCA, and melanoma.
And the reason why melanoma is by far the worst
(10:14):
is because the melanomas tend to spread the fastest and
go to places, and unlike the other ones that are
very superficially slow growing, melanoma kind of doesn't follow any
real rules. So it is very unlikely that someone were
to God forbid, die of a squay miss cell or
a basil cell, but it's not unheard of. It's rare,
(10:39):
but it's not unheard of that someone passes away from
a melanoma. So it is a diagnosis that if you get,
is definitely very.
Speaker 3 (10:46):
Concerning, absolutely, because what I've learned in this process is
once it becomes invasive, then you really start to have
a problem. Which mine was invasive, but it was stage
one A right, but it was still it meant that
this was going to be a major surgery and a
major problem when we started to get into it.
Speaker 1 (11:07):
So he calls you up, he tells you this, You're like,
oh shit, and then he says, what come back? What
does he tell you?
Speaker 3 (11:13):
He says, I am sending you over to I went
over to cedar Sinai to the Angelus Clinic. He says
he's got the top guy for melanoma, top guy on
the West coast, and that's who I'm going to go see.
And I was like, well, wait a second, can't you
just do.
Speaker 2 (11:33):
You know, I'm doing my own research. I'm like, can't
you just remove cut it out?
Speaker 3 (11:37):
Like what what do you mean? I'm going to an oncologist.
And he's like, it's past the it's past me dealing
with it had become invasive in C two and side.
Speaker 1 (11:47):
Yeah, so it's invasive, but it stays within invasive and spreads,
so yeah, I mean it's it's the least aggressive of
an invasive kind of thing. Yeah.
Speaker 2 (11:57):
Yeah.
Speaker 3 (11:57):
And so because it had gone that far, he wanted
to send me to somebody sure who was going to
be able to map work at it.
Speaker 1 (12:05):
Okay, so you go to this oncologist. I'm sure during
the longest process you're tripping, You're chatchype and grock going crazy.
Speaker 3 (12:12):
I hung up the phone and like I said, it
was like five minutes to five, and I called your office. Okay, yes, Thursday,
Thursday afternoon, which.
Speaker 1 (12:20):
Is which by the way, and we'll get onto all
of this which is incredibly unusual because that's not the normal.
Like healthcare is delivered in a certain order. Right, you
get a breast cancer diagnosis, you go to your ob
who then sends you to an oncologist, who then sends
you to a surgical oncologist who then works with a
(12:42):
plastic surgeon. We're usually the last person to be involved
because there's all these other steps. If you are knowledgeable,
if you have access to healthcare, if you are very aggressive,
you will recognize, maybe if you've done this before, you
know someone or whatever, that eventually you're need to get here.
(13:02):
And while you need to go through these steps, you
may not want to wait till you go through all
these steps to talk to the person who's eventually going
to possibly have to put things back together. So you
obviously are young, you're pretty, you're camera facing, and you
recognize that Okay, I don't know the full extent of this,
but this is not going to end well in some ways,
(13:24):
so I'm going to need to find So tell me
what you thought or read or knew that. You're like,
I need to call a classic surgeon. So tell me
how that happened. Because you're like, I have melanoma. I'm
going to call this classic surgeon, So tell me how
that went out.
Speaker 3 (13:37):
So I knew that there was going to be I
thought there was going to be mose surgery, which is
where they kind of basically take layer by layer and
test it in increments until like things we have discussed
is that sometimes they end up taking half your face.
But I found out I was going to have an excision,
and then found out the extent of it, and it's
(13:58):
going to be you know, I talked to a friend,
a friend's mom, and she's like, look, they're going to
take a golf ball sized chunk out of your face.
And so I had called here because I'm on camera
all the time for work and at the end of
the day, it's your face, yea, And so I thought
I was going to have to have you in. I
didn't realize that it was going to go the way.
Speaker 1 (14:19):
That you didn't know the steps involved, but you definitely
knew that there would be possibly, So.
Speaker 3 (14:24):
I thought it was going to have to have you
in the room when the other surgery was taking place.
Speaker 1 (14:29):
So we'll get to how I get involved in this.
So then you call us and I said to you,
I need to know what the whole looks like. First, right,
I think I saw you at the biopsy stage. Is
that what I saw you at.
Speaker 3 (14:39):
My second biopsy, which is where they went in and
took a bigger chunk and then corterized it and it was.
Speaker 2 (14:45):
Like black, right?
Speaker 1 (14:46):
And then did you have another one or that was it?
Speaker 2 (14:48):
Which it was a two biopsies, right, The.
Speaker 1 (14:50):
Second one was an excision, yes, okay, So you go
to this oncology group at CEDARS and then they decide
that you're going to get an excision, right, and who
ended up doing that excision?
Speaker 2 (15:02):
Doctor Fairies guard. So this guy is.
Speaker 1 (15:05):
He's an uncle surgeon, right, He's a surgeon that does oncology.
And with melanoma. The key to melanoma, which makes it
really much more damaging, is the margin is usually much larger.
What does that mean? So when you take out cancer,
(15:26):
any cancer, gallbladder, pancreas, stomach, skin, you want to remove
all the bad cells and then you want to remove
enough normal cells that are adjoining that you know you
got it all. What you don't want to do is
get up to it, think you got it all, and
then find out after the fact that, oh shit, we
(15:49):
left some of it. Why because it'll recur. It's just
not just basic stuff. So to get sort of a
sense of security, you want clear margins, you want I
got it. Plus I got a bunch of things that
are normal. And the question is how much normal do
you need to remove? Because remember you're removing gall bladder,
you're moving pancras, you're moving face, you're moving eyelid. You
(16:11):
don't wanna take any more than you have to. At
the same time, you don't want to leave anything you
don't have to. So every type of cancer squayme, missell
basil cell has a margin, and the cancer melanoma is
a much larger margin. Hence, when it's on your thigh
or your arm, not as scary, but when it's on
(16:33):
your face, every millimeter is expensive real estate. Just think
about it. Your whole eyelid is only two and a
half three centimeters, So if we remove an sonometer of
your eyelid, you're gonna you understand. So this guy says, Okay,
we're gonna cut it out.
Speaker 2 (16:48):
And we're gonna take five millimeter.
Speaker 1 (16:50):
We're gonna take, which, which, by the way, you got
away with murder because normally it's a centimeter it's a
ten millimeter margin. That means the margin just the healthy
stuff is two centimeters.
Speaker 2 (17:01):
I pleaded and begged.
Speaker 1 (17:04):
So so you go see this person and that at
the same time, and we're going to talk about this
because I think if God forbid any of you get
skin cancer, there are two pathways. There's a traditional pathway,
and then there's the pathway that you sorted, which is
you ran both pathways simultaneously, which is I know, I'm
gonna need to address the cancer. That's the most important thing.
(17:26):
Nothing else matters. I need to be healthy. I need
to be here. But assuming it all works out, I
need to look normal. I can't have this disfigurement of
my face. Most mows, let me back up, most skin
cancer goes as follows, Oh my god, what's this weird
thing on my arm, leg, face, whatever. Let's just stick
(17:46):
to the face for the time being, because that's where
the real estate is most expensive. What's this weird lump
I have under my nostril? Or I keep scabbing at
this thing on my nose. It's bleeding and it's irritated.
At some juncture a couple of weeks, a couple of years,
you go and see a dermatologists who says that doesn't
look normal, and they will decide that they need to
buy op see it and they take a piece of
(18:07):
it and they send it and they look at the
pathology and it comes back as one of the three
I mentioned to you, basal cell squam as, cellar melanoma.
Depending on which one it is, will then determine what
they do next. And usually with the face, the idea
is we want to remove everything we have to and
nothing more. Right, I got to remove all of it,
(18:29):
but I don't want to remove a bunch of shit
I don't need to remove because I can't afford to
do that. So there is a surgery called a mose
surgery which you were referring to, which is the most
common way that this is addressed. Because what they do
is they go in and they remove pieces at a time.
They go at that moment, sit under a microscope and
check to see what the margin is and they're like, nope,
(18:50):
I still see tumor. Then they go back and they
cut out more. Then they check nope, I need more.
And in their world, they remove everything they have to,
but no more than they need to. And you often
ninety percent of times have a much bigger hole than
you ever imagined. You go in with like and erase
your head size problem, and you come out usually with
(19:13):
a quarter and a quarter size size of a quarter
and or bigger up to a half dollar, and.
Speaker 2 (19:19):
Hold up a quarter or a half dollar to your face,
and you see just that.
Speaker 1 (19:24):
If you hold up a quarter, literally pick up a
quarter out of your pocket right now and stick it
anywhere on your face, on your cheek, on your chin,
on your nose, on your forehead, that's a lot of
tissue to be missing on your face. So then they
go to this mose surgeon who then will remove the tumor,
and in their eyes, they've cleared it. It's gone, it's done,
(19:44):
and now there's a defect, a hole, whether that's on
your cheek or your jaw, on your chin or whatever.
And then somebody, somebody has to put that hole back together.
In the past, that somebody was a plastic surgeon. Why
do I say in the past, because as time has
gone on, the moe's surgeons, ninety nine percent of them
are dermatologists, go on to, in addition to taking everything out,
(20:09):
learn to put everything back together. So they do the
excision and the reconstruction, and they do it a number
of ways, and we'll get into reconstruction, but they are
the ones doing it, so you really don't have any say.
You just show up and you just kind of go
with the flow. Now I'm not saying they're not capable,
(20:29):
but I'm saying that you don't really get to pick
and at the end of the day, a dermatologist and
a plastic surgeon, we're just different. But from a sense
of efficiency, if a dermatologist is seeing seven most cases
a day, all of whom are usually in their sixties, seventies,
and eighties, then them closing it kind of works. It's
(20:52):
good enough. If the most surgeon is really conscientious in
that they don't want to deal with the closure because
it's a lot of headache. What if I don't like it, whatever,
then someone will show up into their office. That's the
second way. Now, first way is the most surgeon takes
out the tumor closes. Second way is the most surgeon
takes out the tumor. And they have doctor Smith who's
(21:13):
sitting there closing these as he's making the holes. And
who's doctor Smith's E and t's a dermatologist, A plastic surgeon.
But one thing is for sure, you didn't pick doctor
Smith because doctor Smith was selected for you, because doctor
Smith is the one that works with doctor John and
doctor John's the dermatologist just kicked a hole out. Again,
nothing wrong with doctor Smith. He might be excellent, she
(21:34):
might be excellent. Maybe not. But one thing's for sure,
you didn't go do the homework. So it's like you
picked the guy who did the demolition of your house,
but you didn't pick the architect who built you the house.
Would you would you let the demolition guy hire the architect. No,
you hire the architect and you find a demolition guy exactly.
So the third way is the way that you chose
(21:56):
to do it, which is very uncustomary because of the
time of how this works, because now you have a
hole in your face and you're tripping, and you want
that hole closed as fast as possible. So the way
that you did it is you found someone, in this
instance me to close your defect when and if the
defect occurred, right.
Speaker 2 (22:14):
And it was.
Speaker 3 (22:16):
The least convenient way to do it, which made it
the scariest. But coming into your office and having the conversation,
I knew it was the right one. But it would
have been so much easier to just lead because essentially
I came to you with a hole in my face
and then you had to say, I have to get
you on the schedule, right.
Speaker 1 (22:34):
So what does this entail? So it's very important for
all of you understand because we're really pathwighing this for
you because when you get skin cancer, if you get
skin cancer, you don't have you're under pressure. It isn't
like I want to get a breast dog and I
have endless amount of time. I could literally do it
in five years. I can do hundreds and hundreds and
hundreds of hours of research. I would just diagnose with
(22:56):
skin cancer. I feel pressure to get going. So you're
not going to have the luxury to do that much homework.
So it's very important for you to understand this pathway
in the case that you get it, if you opt
to go the third route, which is a route that
you took, which is I want to identify the surgeon
who's closing me, because ultimately, let's be honest, once they've
taken everything out, that's the major event here. I want
(23:18):
to research and homework and who does what and whatever.
If you take the third route, which is the route
you did I or whoever you select, if you feel
they're amazing. They're not going to sit there and wait
for your dermatologists to make a hole and then they
show up and close it. They're surgeons, they're busy, they
have a whole clinic. The reason why that other method
works is because it's convenient and it works and it
(23:40):
does the job. So if you're doing a lot of
old people, which is often the case with skin cancer,
they're closing them. They're closing them, they're closing.
Speaker 3 (23:46):
And the reason I saw that that was the easier
path was because that's one surgery and you're done, you're in,
you're out, sure, And it was you're not walking around
with a hole in your face for a couple of days,
which is really hard on your psyche.
Speaker 1 (24:00):
Yeah, so the option you took was I found doctor Rabond,
I found doctor Smith, whatever, and you come to me
and say, listen, I have a melanoma here. In your instance,
it was right at the junction of your cheek and
your eyelid, And I said, you came in when you
already had it.
Speaker 2 (24:16):
I had my second biopsy, so.
Speaker 1 (24:18):
It was story you on that first time when you
had the second by.
Speaker 2 (24:21):
Yeah, and it was it looked like somebody had burned
a sar.
Speaker 1 (24:24):
So I said to you, I remember you called in
and said I have this skin cancer. I said, go
get the I need to see the defect. The reason
I need to see the defect is I want to
plan what we're doing, and I like to have dialogue
with you and planning and discussion, just like if you
wanted to get a breast dog, just like you wanted
to get a rhinoplasty. I don't want us making this
(24:44):
call like you show up and you just had the
most surgery done thirty minutes ago, and I'm like, is
it your option or better?
Speaker 3 (24:51):
Yet, I'm doing this right, which I appreciated because it
was such a conversation of you being an expert and
saying I don't know what I'm going to do to you.
Yet was the most refreshing thing that I had ever heard,
because anybody else would have said, this is what we're
going to do to you. You know, it's a one
size fits all. And you were looking at me, going
(25:14):
I have to look at the curvature of your cheek.
I have to see how you look when you smile.
I have to see like which way the lines go
when you laugh, And those things were what made me
feel so comforted because I was like, Okay, like you
said to me before I went in, I'm not going
to one hundred percent.
Speaker 2 (25:33):
This is what I think we're going to do. I
won't know until you're asleep and I play with your face.
Speaker 3 (25:37):
Yeah, And that was so that was more comforting than
anything else because I knew that you were going to
take this and look at this from an artist's perspective,
and it was like an artist going in there and
putting me back together the best possible way for me,
not oh, the best possible way for most people, right.
Speaker 1 (25:57):
And I think you the idea of it and the
reason why I like this method the most, even though
it creates inconvenience. The inconvenience is that from the time
you add the most surgery till the time I get
you in the operating room, and we do a very
good job of trying to get you in within a week,
a whole week. You can have a hole in your belly,
(26:17):
a bite in your arm for months at a time.
You don't like it, you don't want to, but nothing's
gonna happen to you. The sense of urgency we have,
oh my god, I gotta fix this is self driven.
It isn't like, oh, I'm gonna get an infection or whatever. Actually,
as a matter of fact, the longer you take to
close it, the more it closes on its own. But
we try to get you in a week because I
want to take my time, I want to explain it
(26:38):
to you, and I want to schedule it. I like
to do these cases the same way I like to
do a facelift under general anesthesia, common whatever. Most people
do this under local because they can numb up the
area and do it again. You can go to Motel six,
or you can go to the Peninsula across the way.
So it's all relative, and it's not for everyone. And
(26:58):
this isn't the approach for all comers and hot everybody.
This is a very select way to do it. So
you came in and I looked at you and I said, okay, wow,
you have it was probably more a size of a
nickel on you at that point. It's a nickel. The
guy who did it said, I'm pretty sure the margins
are clear. We were a little bit worried about that
(27:18):
because I don't want to go do this reconstruction for
him to call me back and be.
Speaker 2 (27:21):
Like fuck, and we were backed up against Christmas, right.
Speaker 1 (27:24):
I was like, oh, it's positive, so and then I
drew for you options. We call it the reconstructive ladder,
which means option one, option two, option three, option four.
There are options to everything we do. In some instances
there are multiple options that are good, they're just different.
And in some instances there's only one option that's good.
(27:46):
The rest of them are options, but they're shitty options,
but they're all options. And I have a very very
strong philosophy that patients need to know options. Even if
I know option three is by far the best option
and one and two would be a disaster, I'm still
going to tell you options one and two. Why Because
I want you to understand what you're doing. I want
(28:08):
you to know that I've thought it through, and I
want you to know that we're selecting the best option
based on you really grasping it, instead of me going
you don't know what you're doing, You know anything about this?
Why would I even explain this shit to you? I
got it right, which is old school, and I don't
like that. So you came in, and the way we
reconstruct defects or as follows one. You can leave them
(28:30):
alone and let them heal. Let's say you lived in
the Sahara and you had you were bitten by a
scorpion minus the poison part, and you had a hole
in your elbow or your forearm, and yours and a
doctor within hundreds and hundreds of miles. If you didn't
get infected, that would close on its own. That's how
brilliant our body is. It will scar in and scarf
(28:52):
in and close. That's secondary closure. It just keep closing
on its own. Very very utilitarian, terrible option when it
comes to the face.
Speaker 2 (29:00):
Absolutely okay.
Speaker 1 (29:02):
Second option is, okay, you know what, Let's just get
a piece of skin, right skin graft and take it
and place it where it was removed. The reason why
that's not a very good option in a young person
is it will be obvious from three thousand miles away
that you have a stamp, literally a circular stamp on
your face, because we're replacing beautiful, thick cheek skin with
(29:24):
skin that we borrowed from behind your neck or in
front of your ear or wherever, and it never is
a match. So we call that a stamp. It looks
like a postage stamp, and it works in certain people
because they're old or whatever. The next option, which is
almost never the case because if there's if that's the option,
then they wouldn't be with me, is to close it primarily,
(29:46):
which means just so it closed. And when you close things,
it creates tension, it creates lines, it creates all kinds
of things. But in your instance, it was one of
the unique cases because of the location where it was
and the laxity of your mid face, because it was
in just the right place that it's kind of like
where we do facelifts. It was a reasonable option. And
(30:08):
the last and by far the most popular way to
do this is rearranging tissue. We call that tissue adjacent
transfer or flaps, where we borrow from Paul and pay
Peter and rearrange things. Super sophisticated and cool, and I
would say that's the overwhelming majority. But in your instance,
you had that unique opportunity. I drew them all out.
Speaker 3 (30:27):
For you, right right, absolutely, so you drew them over
the scar, like next to the scar, you drew what
tissue what I would have to do, and then on
the other side of my cheek, the part that wasn't
touched with anything with melanoma, the part that was still normal.
You drew what the scar would look like and where
(30:47):
it would be placed based on those three different options
that you gave me, So we had the first one
that you drew, I believe is the one that we
went with, right.
Speaker 1 (30:55):
Which is a linear closure, which usually you can't do right.
Usually you can't just take a circle and close it
as a line. What happens you First of all, you
can't close a circle of the line without extending it right.
It gets longer, and then you have to take the
extra tissue out on both sides of it, so you
can close this as a football like an ellipse. But
yours was just the right place where it could actually
(31:17):
work pretty good, right.
Speaker 3 (31:18):
And the other two options were the flaps that we
were just talking about, and they left two very different
types of scars. So the one that we went with
is just a straight line, and then there was an
option for a flap that made like a little y
correct and then there was one that instead of the
line going down my face, it went up. But the
(31:39):
reason that along with all of the other reasons The
reason that we chose this one was because it went.
Speaker 1 (31:44):
With the curvature, right, And that's the idea that, like
what I said to you, is when you're asleep, I'm
going to start pulling and pushing on your skin, which
I can do while you're awake, and see where the
skin wants to go, where the natural fold creases are,
where which one of these all very reasonable options would
(32:07):
lead to the least conspicuous scar. And as a result,
I needed you to trust me. That's just how this works. Yes,
we talked about yes, this that the other. At the end,
I said, listen, I'm gonna go in there and do
my very best and you have to be like, okay,
doctor Bonn, I trust you, right, And you did a
great job, I will say, which I expected. You were
very emotional about this process. Yeah, I have a hole
(32:29):
in my face, but there is emotional because I'm a
young girl and I'm young, and there's emotional. I just
have skin cancer and I'm an older woman. Steaks get
higher as you get younger. Right, if you're a twenty
five year old man or woman, your face is going
to have a different value to you than when you're
an eighty year old person. It that's just the way
(32:50):
that it is.
Speaker 3 (32:51):
And outside of my face being my entire job and
career and I had to be on camera four weeks
post everything, outside of all.
Speaker 2 (33:01):
Of that, you had discussed with me.
Speaker 3 (33:03):
Well, the benefit of most people that they get skin
cancer when they're older, at least their skin is thinner.
Speaker 2 (33:09):
So even though it.
Speaker 3 (33:10):
Takes a little bit longer to heal, it usually heals
up a little bit better. So the challenge with me
was that I still had so much elasticity, and.
Speaker 1 (33:19):
So that is exactly true. So we're going to talk
about scars in general, because no scar is more important
than the scar in your face, whether it's a face
if a nose job, or mose surgery. But scars are
very very interesting because we're all chasing scars to make
them minimal and there's one hundred variations and that's why
no one has a solution. But we know some facts.
And one of the interesting facts is that people think
(33:40):
that the younger you are, the better your scar. That's
not true. The younger you are, the more collagen you have,
the more collagen you have, the thicker your scar, because
the better you're healing. And in the world of healing,
healing when you ask the cells what's healing, more scar
(34:01):
equals better. So children, Asians, African Americans, thick, oily Latinos
make thicker scars than white, old, dry, freckly people because
their body doesn't have as much collagen. Ironically, in the
cosmetic world, the thinner, shittier scar is the better scar.
And so that's issue number one. Secondly, location, eyelids, beautiful,
(34:26):
cheeks not so beautiful. Why eyelids are just static, They're
just laying there and the skin is paper. Cheeks are moving,
they're curved, and they're very thick. So these things all
play into effect. And at the end of the day,
we don't get to pick. We didn't get to pick
where this thing was. So fast forward we do the
(34:48):
surgery and as I said, you were very emotional about it,
and that's why I'm proud of you for being here.
At first, you were like, I don't want anyone or know.
You were very like traumatized as you would exc and
little by little you've come to terms with it, which
is the normal way to process things. And you've kind
of gotten past that state of anxiety and panic and whatever,
(35:10):
partly because mostly because it's done, and you can see
yourself and you don't look like a monster, and oh
my god, well it's not perfect, it's healing. It's okay,
this is good. We're good. And partly because you now
are experienced, Like you get the news your husband cheated
on you, it's shocking, and then after a year you're like,
fuck that asshole, right, so so so one of the
(35:34):
things that people don't understand is that there's a process.
It's a process, just like anything else, and you cannot
accelerate this process. So where we are now is in
the post stop phase. Right, you're three months out. You're
still wearing tape. Why because I like tape, and tape
flattens a scar, and we're to talk about it. The
number one most important thing. There are two things that
(35:56):
make up ninety nine percent of your scar. Two things.
One is you as a person. You biologically make good
scars and your sister biologically makes thick scars. That's your
contribution to healing. Zero you can do about it. You
just are That guy over there got a z it.
Now he's got a kiloid. That woman over there had
(36:17):
a facelift and you can't even see it. That's number one.
The second, the controllable element is how is this being closed?
And we talked about it in the previous podcast. It's
not only how's it being closed? First of all, it's
how's it being opened? How's it being prepped? So the
first thing you do when you deal with surgery is
(36:38):
you need to make sure everything that you're about to
close is cut clean with a blade, so the edges
are pristine. So that charring that you were referring to
was cottery, So you're most surgeon or the guy that
cut it out. After he cut it out, it was
bleeding and he charged it so it wouldn't bleed. I
can't close that shit. That is damage tissue. That is burnt,
(37:00):
crisp tissue, So I have to go on the outside
of it cut everything out, so I'm starting with brand
new tissue. The second is you need to release things
so there's no tension that it can move. If something
is stuck down and you're trying to pull on it
to close it and it doesn't want to come, tension
is your enemy. You don't want anything tight and tense.
(37:22):
So we need to release some tissue. Then we need
to put it back together. And the key to closure
is methodical, layered individual fine sutures under a microscope or loops,
and very very conscientious middle layer, sorry, deep layer, middle layer,
and final layer. So once you've done that and you
(37:43):
have a patient who is body is cooperative, you're ninety
percent of the way there, ninety five percent of the
way there. Everything after that is nonsense. Lasers, creams, lotions, potions,
red light therapy, this, it's all fucking nonsense. Why because
if you make shitty scars, you can do anything you want.
(38:04):
It's gonna be crap. And if I close like dog meat,
there is no cream that's gonna make that go away.
Once your scar is out and ahead, then everything you
do is fine. The reason why all these things work
and none of them work is because they don't have
anything to do with this. So if you do nothing
from here on out, you'll do great. So the question
(38:24):
you had, and you asked me earlier today, is I'm
over it. I need this to be better. What do
I do? How do I go? So the things that
I think do help are what Number one The most
important thing is a little bit of massage. Why because
massage mechanically pressure onto the scar tells the cells instead
(38:44):
of being jumpled up, all the collagen and fibrils and
alassins lay them in a uniform line. So if you
push on something long enough, the cells get signals, mechanical
signals to line up. All of you stand in a
row as opposed to all of you just standing randomly.
The problem is you can't sit there with your finger
on your face and besides your face for hours on
(39:06):
hours and ay that's where the tape comes in. The
tape is Chinese water torture. A drop of water is meaningless,
but a drop of water in the same space for
ten days at a time will burrow whole through your
body because it's repetitive, microscopic, constant, and so tape, in
my opinion, that's how it does. So we have tape.
(39:27):
There is some benefit, although not a lot of great
literature that some type of silicone is ideal. I prefer
the liquid version over the strips because the strips don't breathe,
and moisture gets trapped underneath it, and it creates irritation
and inflammation and red spots and acne and whatever. So
what I do is I use a little bit of
(39:48):
liquid silicone and then I use paper tape which breathes
that lets air in and out, and that is my
poor man's scar strips. After that, the question you asked
was can I laser this? Can I lay this? Everyone's
gung ho to a laser, and the question is, well,
what is laser going to do? So you are at
three months, so in the world of weather, you're in
(40:09):
the eye of the hurricane.
Speaker 2 (40:11):
Okay, okay.
Speaker 1 (40:12):
So the way scars work is the first six weeks
it's perfect. Why because it's all me and zero you.
You've done nothing. Your body has done jack shit. It's
just the sutures and it's thin and it's barely.
Speaker 2 (40:27):
Visible, right, and it's crazy to watch it change.
Speaker 1 (40:31):
At six weeks your body goes, oh, oh shit, I
got to do something here. And then it starts building
inflammation because that's how we heal. And it gets a
little redder and a little redder and a little redder,
and it gets a little stiffer and a little raised
and a little itchy and a little raised and a
little itchy and raised and red and it starts going
(40:53):
the opposite direction, and so you and everybody else starts tripping. Yep,
what the fuck is getting worse? I got to do something.
As you said, your scar schizophrenic, right, or you have
good days and bad days.
Speaker 2 (41:05):
Yeah, it's got multiple persons.
Speaker 1 (41:06):
Multiple personality, right. So the reason is it's healing. That
is healing, and you have to wait it out. Yeah,
and how long does that take? Six months or so? Okay,
then your body is like I'm done, I'm finished with this.
It's good. Assuming there's no infection, assuming there's no tension,
assuming all the things are good, your body eventually will
(41:27):
resign and then it'll send a whole new group of
people in. It'll send in the cleaners. We're done, buildings,
just clean up, let's get out of here. And then
your scar will start remodeling.
Speaker 3 (41:37):
So that's when your collagen, your collagen is essentially building
for six months, and then after six months is when
it starts organizing it in a better fashion.
Speaker 1 (41:46):
Correct, And then you start noticing, oh maybe maybe it's
a little better today, And then you look and you
watch grass grow. And then when you look back from
seven to nine to twelve to eighteen to twenty four months,
the scar starts getting flatter, lighter, and it keeps looking better.
So you can't That is human biology, right, So when
(42:09):
you're at three months or four months and you're annoyed
because it's starting to like that is your body healing.
You can do the things I'm mentioning to you, but
you're not gonna outescape. You're not gonna escape your biology
and you're not gonna escape the closure and your biology
and our closure is pristine. And you're in the ninety
nine percentile for that space of healing for three months,
(42:30):
you look fantastic. There are different little things we talked about,
dog ears, et cetera. And so what do lasers do?
Lasers are designed. What they say is you're gonna okay.
So there's three things that matter when it comes to
a scar, how wide it is, how raised it is,
and what color it is. Okay, So when you laser something,
(42:52):
do you make it narrower? No? No, not at all,
because the thickening of it is either shitty closure or
starting to widen because there's too.
Speaker 2 (43:01):
Much tension right because you haven't taken care of it.
Speaker 1 (43:04):
Or just or or they just put too much tension
and yanked it together. Okay, the height of it, they
think they're gonna be able to flatten it, and it's
not accurate you're not gonna laser away scar down.
Speaker 2 (43:18):
Okay, that's your body.
Speaker 1 (43:19):
It's just not gonna happen. The collagen it's creating and whatever.
And then the last thing is color. And so where
color matters is like maybe a little bit of pigment
or something like that, but by and large, your color
is red. And what is red it's blood, blood flow,
it's healing, it's it's it's it's inflamed, so lasering it.
So then what they'll do is they'll laser your scar
(43:40):
four times, and then you'll come back after twelve months
and be like, oh my god, it's so much better.
And it was going to be better anyways.
Speaker 2 (43:49):
GOTA.
Speaker 1 (43:49):
So the reason you're like, I think this worked is
because it was on its way there and now it's
getting the credit. So I don't use any of the lasers.
I think in many instances it doesn't help. In many instance,
it makes people who are pigmented pissed. And I've had
many patients who laser their scars and then they get
hyperpigmentation around it. Steroid injections disaster. Why, because you're putting
(44:15):
in a drug that eats away collagen and you think
you're gonna make it eat away just the right amount,
so it's thin, and all it does is just napalm,
and it eats the collagen of the scar surrounding tissue.
It flattens, it widens, it gets tell adjectagious, horrible. It's
because you cannot you cannot control it. It's just too aggressive, okay,
(44:37):
And then I don't really think there's anything else that
really does anything. So your question today, because you're at
your three months, is a normal one, which is I'm
getting a little agitated because you're actually feeling like there's
some possible regression and it's not true at all. It's
exactly where it's supposed to be.
Speaker 3 (44:55):
I think I'm just heading the limit of Okay, I've
been so dill gent for four months almost that so
but this, yeah.
Speaker 1 (45:06):
But this recipe calls for a sixty minute cook time,
and I don't care that you've been really good for
forty five minutes. Exactly, this turkey is raw, and so
no matter how you dice it and how no matter
how hungry you are, if you eat the turkey it
forty five minutes, you're getting salmonilla. You need to wait
sixty minutes. And this recipe of yours requires the nine
(45:28):
to twelve months minimum, at which point you'll stop being
so agitated because while it's not fully healed.
Speaker 3 (45:33):
You see the light at the end of the tunnel, right,
and then that's what the silicone does, right.
Speaker 2 (45:37):
It goes in and it organized.
Speaker 1 (45:39):
It just holagzes it and nobody knows exactly It doesn't
go in because you don't you know, it doesn't penetrate
your tissue. But the silicone, there's something about the electron
microscopes and how the cells react to it, and even
that I would say is a little bit of it's
a little bit of fools gold, okay, Right, the pressure
(45:59):
works and as a result or instances where I don't
use any silicone, and there's instances where if you literally
didn't use anything. To be honestly, I think you'll be
one hundred percent fine. We give it you because it
also keeps you preoccupied and it's something for you to
do something. And I'm okay with that, because the healing
process is physical and mental and emotional, and so you
have to heal every part of it. And there's a
(46:20):
part of it which is I participated. You know, my
son wants to be involved. So even though he's not
really cooking, we give him shit to do because he
feels like he's involved.
Speaker 3 (46:28):
Right, And I think it's you know, that helps throughout
the process of you have to learn to stop looking
at it every single day. Like those first two weeks,
you look at it every day, and or like when
it becomes uncovered, you're like, oh my gosh, like, what's
it doing today? It looks different than yesterday, especially when
you start to like wash your face off gently and
(46:50):
the scab kind of fall off and it looks totally different.
So you're looking at it every day because every day
it's changing. But once you're two weeks out, looking at
it every day driving you crazy. So it's that's what
I like about the tape is I only see it
every four days, essentially, And I.
Speaker 1 (47:07):
Think there's a huge component of that as well, which
is just trying to get your mind off of it
because at the end of the day, you've got to
just sit there and wait. Anyways, I think your story
is a good one. You were, you know, I know,
at first you were incredibly what you should have been
very private about it because you're like, what the fuck,
I don't know it? And then little by little, when
the shot had finished and you knew that you'd be okay,
you sort of have slowly started having talks because the
(47:27):
reality is that everyone's crossed that they carry is somebody else,
somebody else's to be journey And the reality is a
four year old who gets melanoma that I don't want
to say was miss the diagnosis, but maybe could have
been diagnosed sooner. And I don't think anyone did anything wrong.
It's a good story to tell because now I don't
want on the end end go and get everything removed
(47:49):
off your body, but you you if something doesn't look right,
you should have it checked. And I think now you
are ten times more vigil and it's a result of
let's say this show. Let's say four people and are
listening to like, oh fuck, I have that thing on
my back, then they're going to go and get it
checked out sooner.
Speaker 2 (48:06):
Yeah, and it's so important.
Speaker 3 (48:08):
I mean I didn't know this before, but it's so
important to go to the dermatologist once a year.
Speaker 2 (48:12):
And you learned that.
Speaker 1 (48:14):
Yeah, something that you mentioned to me which was really interesting.
Then I'll end with this is you have you have
your general practitioner, right and that general practitioner is seeing
you for your general health. And it's it's obvious when
you get sick you go to them, but usually go
to them so that you don't get sick and they
can diagnose you earlier than you would have figured it out.
So one is you want to have a dermatologist, even
(48:36):
if it's just checking your skin. And the other which
you mentioned, which was an interesting concept I hadn't thought before,
which is you use a plastic surgeon for two reasons.
One cosmesis like I want a breastdog, I want my
nose done, I want my earpinned, I want to do
my eyelids. I'm looking for a facelift. And in that
process you have ample time. You'll take your time and
(48:56):
you'll do so much you could literally take five years
to reach. But the other things that we do is
really urgent things. We do lacerations, we do burns, we
do trauma, we do skin cancer, which is not emergency,
but it's urgent. We do rupture of implants that become urgent.
So what happens then is you're under the gun. And
(49:19):
what ends up happening is you don't have the time
to do the homework you would have not done. So
one of the things you said mention to me is
it's really good to have a plastic surgeon whom you've
developed a relationship with that you can always know that
you have that when and if God forbid you your son,
whatever happens, you have already established relationships as opposed to
have to build it in about two days or three days.
(49:42):
And I thought that was very interesting and that was
a very cool thought process because we don't generally are
not considered primary guys, but since we do a lot
of urgent things, I think it's not a bad concept
to have.
Speaker 3 (49:52):
Yeah, I think it'd be good for everybody listening to this,
no matter where they are. Obviously if they're here, they.
Speaker 1 (49:57):
Yeah, sure, your local plastic surgeon.
Speaker 3 (50:00):
But like doing your research, talking to some of your friends,
having that conversation, seeing the different types of personalities, and
like maybe you have maybe you have like just a
botox appointment, you want to go in for something. Maybe
your plastic surgeon's office does that, and you can go
in go there say hey, I want to develop a
relationship with the plastic surgeon here.
Speaker 2 (50:20):
I don't know how it would work. You'd have to
tell me on your friend.
Speaker 1 (50:23):
I think that's very accurate, and I think it actually
made sense, and hence why I brought it up is
it's nice to have already established that and have that
in your back.
Speaker 3 (50:30):
Pocket if I was in a car accident or something,
or God forbid, something else happened in my face.
Speaker 2 (50:35):
Well, actually, interesting, I've got some random part.
Speaker 1 (50:38):
That's actually how most of my most surgery is done, right,
Because I'm not the guy that the most guy's gonna call,
because I'm not either him and or the guy he
uses the most surgery I do. The reconstruction is my
own patients who have come to me for other things
over the years, who then call me about their most surgery,
about their kid, who got a dog bite, about this,
about that, because they already have that relationship with me,
(50:58):
and they already trust me, and they know that that
can call me. So I thought that was really really
interesting and it's not a bad idea to consider that,
all right, So one parting you get one partings recommendation
to anyone listening. What was that? What would you like
to recommend? Ooh, that's one and only.
Speaker 2 (51:16):
One one parting recommendation. Just in general, know about this
whole journey, about this whole journey, this whole journey, what was.
Speaker 1 (51:23):
The one thing that you're like, if I could leave
you with this, and this is just the one.
Speaker 3 (51:27):
Thing I would I mean, if I could leave anybody
with anything, it would be like I said, it's great
to have a relationship with your local plastic surgeon for
those things that are urgent, but more so it would
be go to the dermatologist, get everything checked, make sure
that they are doing their due diligence.
Speaker 2 (51:46):
Using that you're going to be able to correct me
with us. Is it a dermoscopy dermoscopy?
Speaker 1 (51:51):
Yeah, They're going to look at things and the literal
really really kind of magnifying and look at things.
Speaker 3 (51:55):
And make sure that they're using that tool. Because what
I've learned is that that's super important in the part
of being able to look at everything without having to
biopsy everything on your body.
Speaker 2 (52:06):
But go if something in.
Speaker 3 (52:07):
Your gut is telling you something's not right, I would
definitely go to the doctor, get it checked out, make
sure that you're doing your due diligence. And at the
end of the day, I've had outside of this, I've
had so many other health issues. Lime disease, and what
I've learned through all of these is that you are
your own best advocate. And if you go to someone
(52:30):
and you and they say you're okay, and you still
think something's not right, it's really important to get a
second opinion follow up on things, because you are your
own best advocate. Like we said, this had been looked
at so many times by so many random people that
I had trusted that see faces every day. So it
was just out of frustration thinking this was a spot
(52:50):
that was going to be removed, that I happened to
get it looked at, and I was so lucky that
I didn't, you.
Speaker 1 (52:56):
Know, wait longer.
Speaker 2 (52:58):
Yeah, exactly, Yeah, I definitely.
Speaker 1 (53:00):
That's a very good suggestion, which is you know you
you need you need a skin health check, and if
you I think the things you said were one, you
got to get see a dermatologists regularly. And the other
is if you feel like something is being missed, keep
keep at it until you get satisfied with the outcome.
(53:23):
Because I do think that while doctors are great, they're
not infalluable, and some are great and some suck, and
so at the end of the day, you need to
rely on your own absolutely all right, well, thank you
very much for coming. As always, this is a fantastic
show because of patient's willingness to come and chat and talk.
And you know, it takes a takes a takes a
(53:44):
courage to have that conversation, so we are grateful.
Speaker 3 (53:46):
Well, thank you, and we're able to have that conversation
too and have it be a two way conversation because
you've educated me so much in the process.
Speaker 1 (53:53):
So I really agree. Yeah, of course, it's my obligation.
All right, guys, that's a rap. So two things, as
always at the end of every show. Number one, if
you love the show, please share this with other friends
and family members. For the love of God, you're not
going to know who's going to have skin cancer, so
if it's after the fact, it's kind of a moot subject,
so forward and share it. The other is, if you
like our show, which I hope you do if you're listening,
go ahead and write us a nice review. Write us
(54:16):
something nice. It helps everyone's motivation and enthusiasm to keep
putting these shows together because it does take a lot
of effort to do them. So oh guy, guys, As always,
I'm your host, Doctor Roddy Raban and We will connect
next week.
Welcome to another episode of Plastic Surgery Uncensored. I'm your host,
doctor Rodiy Raban, and we have a fantastic episode for you.
As always, the episodes are amazing, right just because we
talk about cool shit, But the episodes get elevated when
we have the honor of having someone who joins me
to help narrate and tell their story. And you know,
(00:26):
having colleagues on is great, but having patients on is
extraordinary because it takes courage, it takes time, it takes effort,
and we're blessed to have Valerie on our show today,
and we're gonna be talking about something that you wouldn't
expect from a young lady. We're gonna be talking about
skin cancer, most notably melanoma. That's right, melano is one
of those words that gives you know, gives you the
(00:48):
fear of God, as it should. And Valerie had a
you know, so now a couple of months out from
being diagnosed, being treated and in the wake of her
melooma experience, and she was kind enough to come on
the show and together we're going to try to educate
you about sort of everything I think you need to
know about when it comes to skin cancers, both from
(01:11):
a diagnostic, from a treatment, and from an aftermath standpoint.
So welcome to the show.
Speaker 2 (01:17):
Valorie, Thanks for having me.
Speaker 1 (01:19):
So let's just back up real quick and just put
the let's put the foundation. When how are you just
turned forty? Just turned forty? So in the world of
skin cancer, that's considered young. Right when we think skin
cancer are like, oh that old gome, that old lady.
Oh they're going to be seventy. That's not true. We
(01:41):
now know that a lot of young people get skin cancer.
So you're forty, and tell me your journey when it
came to diagnosing this skin cancer. Like you're living your
life and all of a sudden, you notice what.
Speaker 3 (01:54):
So about ten years ago I had I was really
a freckly kid. And so you know, or your freckles
as you get a little bit older, as you get
into your thirties, they kind of start to turn into
sun spots. They some of them merged together and become
a little bit bigger. Some of them start popping up
out of nowhere. And I had a little sun spot
(02:15):
on my cheek and it was like a freckle that
just kind of got a little bigger. It was getting
a little bit darker, but it wasn't very dark. It
wasn't a big deal. And I had tried ipl and
nothing came from it, and then I let it go,
and then it really started to bother me.
Speaker 2 (02:36):
So then I was actively trying to get rid of it.
Speaker 3 (02:39):
And every single like medspot type place or doctor's office
or any place that I would go, it would constantly
be you know, I'd say, hey, I can't get this
dark spot to go away. And nobody ever flagged it
as something that they were worried about, but they would
always say, oh.
Speaker 2 (02:55):
Well, have you tried this, have you tried this?
Speaker 3 (02:58):
And I'd say, yes, I've tried X, y Z, and
nothing's getting rid of it. And every doctor inevitably would
be like, but you haven't tried this.
Speaker 1 (03:06):
Right, the newest, greatest.
Speaker 2 (03:08):
Yeah, exactly.
Speaker 3 (03:09):
And so I tried everything from lasers, fraxil, cosmolon, peels, everything,
and it would eventually like fade for for a couple of.
Speaker 2 (03:20):
Weeks, and then it would come right back right. And
so I.
Speaker 1 (03:23):
Were any of these people dermatologists.
Speaker 3 (03:25):
One, so I had been going to a dermatologist UCLA
for something separate. So I went in for a full
body check. But what I don't recall is if I
had makeup over it and didn't.
Speaker 1 (03:39):
But these people that you were going, which is this
is very important, none of them because what it shows
you is you just assume skin cancer this ugly, horrible,
wart looking thing. And I'm a thirty year old girl
with some sunspots and freckles. So it's it's very very
important you listen to that aspect because while I don't
want you running out and having every freckle examined, but
(04:03):
the story that she's telling you is a very common one,
which is I had this thing that I kept trying
to get rid of and it wouldn't go away.
Speaker 3 (04:10):
And you would think people that look at faces every
day would say, hey, that's alarming, but it really wasn't,
because even when I showed you the photo, you were like, wow,
this is this is crazy. This didn't seem like something
that would be that scary. So I went back to
a dermatologist that I had seen pre COVID, and he
scared me. He said, we're taking this off right now.
(04:32):
You know, I thought Beverly Hill's private practice, and you
know he's gonna care about taking it off in like
a pretty way, he'll get rid of it, and that
was my concern, was getting rid of it. I didn't
expect that we were about to do a biopsy.
Speaker 1 (04:46):
And when was that? When did you buy up SI?
Speaker 2 (04:47):
December first?
Speaker 1 (04:48):
Okay, so story. It's very important everyone listen because there
are two ways skin cancer presents, and it's usually always
the latter. One is I see this goomba on my face,
Oh my god, what is that thing that's crairy looking?
And go get a biopsy. That never happens. The reason
it never happens is skin cancers don't just wake up
(05:09):
one morning and are skin cancer. They start from totally
normal cells, and due to some exposure often sun or
radiation or whatnot, the cells change and then they gradually,
like watching grass grow, they morph and change and morph
and change, and they probably go from pre cancer normal
(05:31):
to pre cancer to cancer. And because it's so incremental,
and because it's so slow, it is always the case
that someone says it's nothing, it's just a brown spot.
And because the reality is it happens in millions of
other areas on your body. That being said, the red
flags should be bleeding, which yours didn't have, crusting scabbing,
(05:54):
which yours didn't have changes that are constantly dramatic, Like
getting bigger is one thing, but changing colors or it
used to be brown and now it's a tan, and
it was tan and it's brown, and the fact that
it just doesn't go away with any type of treatment.
Those are sort of the things. But the truth is,
even with all that, nine at ten times, you're gonna
miss it.
Speaker 3 (06:15):
And like you said, it's so incremental, and you're looking
at yourself in the mirror every single day. You know,
it's like you don't see yourself aging and every day.
But you look at photos from five years ago and
you go, oh, I looked so much younger.
Speaker 2 (06:29):
It's the same thing.
Speaker 3 (06:29):
You go, oh that spot was so much smaller, And
that's when it starts to become really concerning.
Speaker 2 (06:36):
But it's all in hindsight.
Speaker 1 (06:38):
Yeah. Sure. So the second thing you and I spoke about,
which we're going to highlight in circular is Okay, well, fuck,
if you're telling me that this thing is so gradual
and I'm going to miss it, how am I supposed
to know? And the way how you're supposed to know
is you're supposed to have a dermatologist, not a met small,
not a plastic surgeon. A dermatologist who specializes in skin
and skin care. Do an annual and you said this
(07:01):
annual skin check and what they do and what they
ought to do, and if they don't, then it's the
wrong dermatologists is map out all of your sun's spots
and that way when they see you next year, not
next week, not in twenty years, next year, they're like, ooh,
this one has changed, and I don't like it now.
I always think that they're way too aggressive, but now
(07:22):
I I don't want to say it makes sense, but
this is the nature of the beast. I think they
remove way too much shit off of people. As a result,
a lot of people have these ugly little scars all
over their body. The problem is that when you have
a patient like you who's melanoma, when you look at
it was like, you gotta be kidding me this, then
(07:44):
it tells you, fuck now, I got to take everything
off because what you're basically doing is a shotgun approach.
They're like, if I take off a thousand of these,
nine hundred and ninety seven of them are going to
be normal, but three of them are going to be abnormal.
So what do I do? Let three people get, you know,
sick and die. So I think you were right. So
(08:05):
you go and see this guy in Beverly Hills. You're like,
this thing's not going way. He's a dermatologist. He looks,
takes a good look at it, and he's like, oh,
I don't like this, which you're grateful, right because that
was the right thing for someone to do save my life.
And then he's like, we need a biopsy this yep.
So you're like, uh, okay, sure it's gonna be siny,
little tiny something. So he biopsies it.
Speaker 3 (08:24):
He does a shave biopsy, which is basically just like
shaves off a small layer of skin. And I'm thinking,
this is this is what I have to be worried about.
Speaker 2 (08:32):
Like I'm covering it up. I'm treating it so well.
I don't like go outside.
Speaker 3 (08:37):
I don't want it to get any sun because I'm like,
I need this little scar to heal up really well.
And he calls me on Thursday. Well, I called Thursday
morning because now I'm starting to get anxious and it
was taken on a Monday and Thursday morning I call him.
I'm like, hi, do you have my results. Nope, we'll
call you when we know. Doctor calls me.
Speaker 1 (08:56):
That's always a bad sign when you call and they
don't give you any uh, the doctor will call you. Fuck,
this is bad.
Speaker 3 (09:04):
So, like five minutes to five on Thursday afternoon, I
get the phone call and it's like, hey, can you
hold for the doctor?
Speaker 1 (09:12):
Yeah? Your heart drops to the ground. I'm sure, And.
Speaker 3 (09:14):
I said when you picked up, it was like, so
you just want to give me good news right yourself.
Speaker 2 (09:19):
He's like nope, he's He's like, you have melanoma.
Speaker 4 (09:23):
And I went, okay, well you just got it all right,
like it's not a big I didn't understand the gravity
of what I was getting into.
Speaker 2 (09:34):
And also you hadn't.
Speaker 1 (09:36):
Heard the word melanoma, right, like, so when they said melanoma,
you were you knew melanoma is like not good.
Speaker 3 (09:42):
For a second, I was just like, okay, melanoma, and
then my brain went to wait, that's the worst one, right, yeah,
And because the other ones all have these like crazy names,
they almost sound worse.
Speaker 1 (09:52):
So the three types of main can skin cancers are
basil cell car skin can carcinomor BC basil cell carcinoma
basil cell cancer, squay miss cell carcinoma SCCA, and melanoma.
And the reason why melanoma is by far the worst
(10:14):
is because the melanomas tend to spread the fastest and
go to places, and unlike the other ones that are
very superficially slow growing, melanoma kind of doesn't follow any
real rules. So it is very unlikely that someone were
to God forbid, die of a squay miss cell or
a basil cell, but it's not unheard of. It's rare,
(10:39):
but it's not unheard of that someone passes away from
a melanoma. So it is a diagnosis that if you get,
is definitely very.
Speaker 3 (10:46):
Concerning, absolutely, because what I've learned in this process is
once it becomes invasive, then you really start to have
a problem. Which mine was invasive, but it was stage
one A right, but it was still it meant that
this was going to be a major surgery and a
major problem when we started to get into it.
Speaker 1 (11:07):
So he calls you up, he tells you this, You're like,
oh shit, and then he says, what come back? What
does he tell you?
Speaker 3 (11:13):
He says, I am sending you over to I went
over to cedar Sinai to the Angelus Clinic. He says
he's got the top guy for melanoma, top guy on
the West coast, and that's who I'm going to go see.
And I was like, well, wait a second, can't you
just do.
Speaker 2 (11:33):
You know, I'm doing my own research. I'm like, can't
you just remove cut it out?
Speaker 3 (11:37):
Like what what do you mean? I'm going to an oncologist.
And he's like, it's past the it's past me dealing
with it had become invasive in C two and side.
Speaker 1 (11:47):
Yeah, so it's invasive, but it stays within invasive and spreads,
so yeah, I mean it's it's the least aggressive of
an invasive kind of thing. Yeah.
Speaker 2 (11:57):
Yeah.
Speaker 3 (11:57):
And so because it had gone that far, he wanted
to send me to somebody sure who was going to
be able to map work at it.
Speaker 1 (12:05):
Okay, so you go to this oncologist. I'm sure during
the longest process you're tripping, You're chatchype and grock going crazy.
Speaker 3 (12:12):
I hung up the phone and like I said, it
was like five minutes to five, and I called your office. Okay, yes, Thursday,
Thursday afternoon, which.
Speaker 1 (12:20):
Is which by the way, and we'll get onto all
of this which is incredibly unusual because that's not the normal.
Like healthcare is delivered in a certain order. Right, you
get a breast cancer diagnosis, you go to your ob
who then sends you to an oncologist, who then sends
you to a surgical oncologist who then works with a
(12:42):
plastic surgeon. We're usually the last person to be involved
because there's all these other steps. If you are knowledgeable,
if you have access to healthcare, if you are very aggressive,
you will recognize, maybe if you've done this before, you
know someone or whatever, that eventually you're need to get here.
(13:02):
And while you need to go through these steps, you
may not want to wait till you go through all
these steps to talk to the person who's eventually going
to possibly have to put things back together. So you
obviously are young, you're pretty, you're camera facing, and you
recognize that Okay, I don't know the full extent of this,
but this is not going to end well in some ways,
(13:24):
so I'm going to need to find So tell me
what you thought or read or knew that. You're like,
I need to call a classic surgeon. So tell me
how that happened. Because you're like, I have melanoma. I'm
going to call this classic surgeon, So tell me how
that went out.
Speaker 3 (13:37):
So I knew that there was going to be I
thought there was going to be mose surgery, which is
where they kind of basically take layer by layer and
test it in increments until like things we have discussed
is that sometimes they end up taking half your face.
But I found out I was going to have an excision,
and then found out the extent of it, and it's
(13:58):
going to be you know, I talked to a friend,
a friend's mom, and she's like, look, they're going to
take a golf ball sized chunk out of your face.
And so I had called here because I'm on camera
all the time for work and at the end of
the day, it's your face, yea, And so I thought
I was going to have to have you in. I
didn't realize that it was going to go the way.
Speaker 1 (14:19):
That you didn't know the steps involved, but you definitely
knew that there would be possibly, So.
Speaker 3 (14:24):
I thought it was going to have to have you
in the room when the other surgery was taking place.
Speaker 1 (14:29):
So we'll get to how I get involved in this.
So then you call us and I said to you,
I need to know what the whole looks like. First, right,
I think I saw you at the biopsy stage. Is
that what I saw you at.
Speaker 3 (14:39):
My second biopsy, which is where they went in and
took a bigger chunk and then corterized it and it was.
Speaker 2 (14:45):
Like black, right?
Speaker 1 (14:46):
And then did you have another one or that was it?
Speaker 2 (14:48):
Which it was a two biopsies, right, The.
Speaker 1 (14:50):
Second one was an excision, yes, okay, So you go
to this oncology group at CEDARS and then they decide
that you're going to get an excision, right, and who
ended up doing that excision?
Speaker 2 (15:02):
Doctor Fairies guard. So this guy is.
Speaker 1 (15:05):
He's an uncle surgeon, right, He's a surgeon that does oncology.
And with melanoma. The key to melanoma, which makes it
really much more damaging, is the margin is usually much larger.
What does that mean? So when you take out cancer,
(15:26):
any cancer, gallbladder, pancreas, stomach, skin, you want to remove
all the bad cells and then you want to remove
enough normal cells that are adjoining that you know you
got it all. What you don't want to do is
get up to it, think you got it all, and
then find out after the fact that, oh shit, we
(15:49):
left some of it. Why because it'll recur. It's just
not just basic stuff. So to get sort of a
sense of security, you want clear margins, you want I
got it. Plus I got a bunch of things that
are normal. And the question is how much normal do
you need to remove? Because remember you're removing gall bladder,
you're moving pancras, you're moving face, you're moving eyelid. You
(16:11):
don't wanna take any more than you have to. At
the same time, you don't want to leave anything you
don't have to. So every type of cancer squayme, missell
basil cell has a margin, and the cancer melanoma is
a much larger margin. Hence, when it's on your thigh
or your arm, not as scary, but when it's on
(16:33):
your face, every millimeter is expensive real estate. Just think
about it. Your whole eyelid is only two and a
half three centimeters, So if we remove an sonometer of
your eyelid, you're gonna you understand. So this guy says, Okay,
we're gonna cut it out.
Speaker 2 (16:48):
And we're gonna take five millimeter.
Speaker 1 (16:50):
We're gonna take, which, which, by the way, you got
away with murder because normally it's a centimeter it's a
ten millimeter margin. That means the margin just the healthy
stuff is two centimeters.
Speaker 2 (17:01):
I pleaded and begged.
Speaker 1 (17:04):
So so you go see this person and that at
the same time, and we're going to talk about this
because I think if God forbid any of you get
skin cancer, there are two pathways. There's a traditional pathway,
and then there's the pathway that you sorted, which is
you ran both pathways simultaneously, which is I know, I'm
gonna need to address the cancer. That's the most important thing.
(17:26):
Nothing else matters. I need to be healthy. I need
to be here. But assuming it all works out, I
need to look normal. I can't have this disfigurement of
my face. Most mows, let me back up, most skin
cancer goes as follows, Oh my god, what's this weird
thing on my arm, leg, face, whatever. Let's just stick
(17:46):
to the face for the time being, because that's where
the real estate is most expensive. What's this weird lump
I have under my nostril? Or I keep scabbing at
this thing on my nose. It's bleeding and it's irritated.
At some juncture a couple of weeks, a couple of years,
you go and see a dermatologists who says that doesn't
look normal, and they will decide that they need to
buy op see it and they take a piece of
(18:07):
it and they send it and they look at the
pathology and it comes back as one of the three
I mentioned to you, basal cell squam as, cellar melanoma.
Depending on which one it is, will then determine what
they do next. And usually with the face, the idea
is we want to remove everything we have to and
nothing more. Right, I got to remove all of it,
(18:29):
but I don't want to remove a bunch of shit
I don't need to remove because I can't afford to
do that. So there is a surgery called a mose
surgery which you were referring to, which is the most
common way that this is addressed. Because what they do
is they go in and they remove pieces at a time.
They go at that moment, sit under a microscope and
check to see what the margin is and they're like, nope,
(18:50):
I still see tumor. Then they go back and they
cut out more. Then they check nope, I need more.
And in their world, they remove everything they have to,
but no more than they need to. And you often
ninety percent of times have a much bigger hole than
you ever imagined. You go in with like and erase
your head size problem, and you come out usually with
(19:13):
a quarter and a quarter size size of a quarter
and or bigger up to a half dollar, and.
Speaker 2 (19:19):
Hold up a quarter or a half dollar to your face,
and you see just that.
Speaker 1 (19:24):
If you hold up a quarter, literally pick up a
quarter out of your pocket right now and stick it
anywhere on your face, on your cheek, on your chin,
on your nose, on your forehead, that's a lot of
tissue to be missing on your face. So then they
go to this mose surgeon who then will remove the tumor,
and in their eyes, they've cleared it. It's gone, it's done,
(19:44):
and now there's a defect, a hole, whether that's on
your cheek or your jaw, on your chin or whatever.
And then somebody, somebody has to put that hole back together.
In the past, that somebody was a plastic surgeon. Why
do I say in the past, because as time has
gone on, the moe's surgeons, ninety nine percent of them
are dermatologists, go on to, in addition to taking everything out,
(20:09):
learn to put everything back together. So they do the
excision and the reconstruction, and they do it a number
of ways, and we'll get into reconstruction, but they are
the ones doing it, so you really don't have any say.
You just show up and you just kind of go
with the flow. Now I'm not saying they're not capable,
(20:29):
but I'm saying that you don't really get to pick
and at the end of the day, a dermatologist and
a plastic surgeon, we're just different. But from a sense
of efficiency, if a dermatologist is seeing seven most cases
a day, all of whom are usually in their sixties, seventies,
and eighties, then them closing it kind of works. It's
(20:52):
good enough. If the most surgeon is really conscientious in
that they don't want to deal with the closure because
it's a lot of headache. What if I don't like it, whatever,
then someone will show up into their office. That's the
second way. Now, first way is the most surgeon takes
out the tumor closes. Second way is the most surgeon
takes out the tumor. And they have doctor Smith who's
(21:13):
sitting there closing these as he's making the holes. And
who's doctor Smith's E and t's a dermatologist, A plastic surgeon.
But one thing is for sure, you didn't pick doctor
Smith because doctor Smith was selected for you, because doctor
Smith is the one that works with doctor John and
doctor John's the dermatologist just kicked a hole out. Again,
nothing wrong with doctor Smith. He might be excellent, she
(21:34):
might be excellent. Maybe not. But one thing's for sure,
you didn't go do the homework. So it's like you
picked the guy who did the demolition of your house,
but you didn't pick the architect who built you the house.
Would you would you let the demolition guy hire the architect. No,
you hire the architect and you find a demolition guy exactly.
So the third way is the way that you chose
(21:56):
to do it, which is very uncustomary because of the
time of how this works, because now you have a
hole in your face and you're tripping, and you want
that hole closed as fast as possible. So the way
that you did it is you found someone, in this
instance me to close your defect when and if the
defect occurred, right.
Speaker 2 (22:14):
And it was.
Speaker 3 (22:16):
The least convenient way to do it, which made it
the scariest. But coming into your office and having the conversation,
I knew it was the right one. But it would
have been so much easier to just lead because essentially
I came to you with a hole in my face
and then you had to say, I have to get
you on the schedule, right.
Speaker 1 (22:34):
So what does this entail? So it's very important for
all of you understand because we're really pathwighing this for
you because when you get skin cancer, if you get
skin cancer, you don't have you're under pressure. It isn't
like I want to get a breast dog and I
have endless amount of time. I could literally do it
in five years. I can do hundreds and hundreds and
hundreds of hours of research. I would just diagnose with
(22:56):
skin cancer. I feel pressure to get going. So you're
not going to have the luxury to do that much homework.
So it's very important for you to understand this pathway
in the case that you get it, if you opt
to go the third route, which is a route that
you took, which is I want to identify the surgeon
who's closing me, because ultimately, let's be honest, once they've
taken everything out, that's the major event here. I want
(23:18):
to research and homework and who does what and whatever.
If you take the third route, which is the route
you did I or whoever you select, if you feel
they're amazing. They're not going to sit there and wait
for your dermatologists to make a hole and then they
show up and close it. They're surgeons, they're busy, they
have a whole clinic. The reason why that other method
works is because it's convenient and it works and it
(23:40):
does the job. So if you're doing a lot of
old people, which is often the case with skin cancer,
they're closing them. They're closing them, they're closing.
Speaker 3 (23:46):
And the reason I saw that that was the easier
path was because that's one surgery and you're done, you're in,
you're out, sure, And it was you're not walking around
with a hole in your face for a couple of days,
which is really hard on your psyche.
Speaker 1 (24:00):
Yeah, so the option you took was I found doctor Rabond,
I found doctor Smith, whatever, and you come to me
and say, listen, I have a melanoma here. In your instance,
it was right at the junction of your cheek and
your eyelid, And I said, you came in when you
already had it.
Speaker 2 (24:16):
I had my second biopsy, so.
Speaker 1 (24:18):
It was story you on that first time when you
had the second by.
Speaker 2 (24:21):
Yeah, and it was it looked like somebody had burned
a sar.
Speaker 1 (24:24):
So I said to you, I remember you called in
and said I have this skin cancer. I said, go
get the I need to see the defect. The reason
I need to see the defect is I want to
plan what we're doing, and I like to have dialogue
with you and planning and discussion, just like if you
wanted to get a breast dog, just like you wanted
to get a rhinoplasty. I don't want us making this
(24:44):
call like you show up and you just had the
most surgery done thirty minutes ago, and I'm like, is
it your option or better?
Speaker 3 (24:51):
Yet, I'm doing this right, which I appreciated because it
was such a conversation of you being an expert and
saying I don't know what I'm going to do to you.
Yet was the most refreshing thing that I had ever heard,
because anybody else would have said, this is what we're
going to do to you. You know, it's a one
size fits all. And you were looking at me, going
(25:14):
I have to look at the curvature of your cheek.
I have to see how you look when you smile.
I have to see like which way the lines go
when you laugh, And those things were what made me
feel so comforted because I was like, Okay, like you
said to me before I went in, I'm not going
to one hundred percent.
Speaker 2 (25:33):
This is what I think we're going to do. I
won't know until you're asleep and I play with your face.
Speaker 3 (25:37):
Yeah, And that was so that was more comforting than
anything else because I knew that you were going to
take this and look at this from an artist's perspective,
and it was like an artist going in there and
putting me back together the best possible way for me,
not oh, the best possible way for most people, right.
Speaker 1 (25:57):
And I think you the idea of it and the
reason why I like this method the most, even though
it creates inconvenience. The inconvenience is that from the time
you add the most surgery till the time I get
you in the operating room, and we do a very
good job of trying to get you in within a week,
a whole week. You can have a hole in your belly,
(26:17):
a bite in your arm for months at a time.
You don't like it, you don't want to, but nothing's
gonna happen to you. The sense of urgency we have,
oh my god, I gotta fix this is self driven.
It isn't like, oh, I'm gonna get an infection or whatever. Actually,
as a matter of fact, the longer you take to
close it, the more it closes on its own. But
we try to get you in a week because I
want to take my time, I want to explain it
(26:38):
to you, and I want to schedule it. I like
to do these cases the same way I like to
do a facelift under general anesthesia, common whatever. Most people
do this under local because they can numb up the
area and do it again. You can go to Motel six,
or you can go to the Peninsula across the way.
So it's all relative, and it's not for everyone. And
(26:58):
this isn't the approach for all comers and hot everybody.
This is a very select way to do it. So
you came in and I looked at you and I said, okay, wow,
you have it was probably more a size of a
nickel on you at that point. It's a nickel. The
guy who did it said, I'm pretty sure the margins
are clear. We were a little bit worried about that
(27:18):
because I don't want to go do this reconstruction for
him to call me back and be.
Speaker 2 (27:21):
Like fuck, and we were backed up against Christmas, right.
Speaker 1 (27:24):
I was like, oh, it's positive, so and then I
drew for you options. We call it the reconstructive ladder,
which means option one, option two, option three, option four.
There are options to everything we do. In some instances
there are multiple options that are good, they're just different.
And in some instances there's only one option that's good.
(27:46):
The rest of them are options, but they're shitty options,
but they're all options. And I have a very very
strong philosophy that patients need to know options. Even if
I know option three is by far the best option
and one and two would be a disaster, I'm still
going to tell you options one and two. Why Because
I want you to understand what you're doing. I want
(28:08):
you to know that I've thought it through, and I
want you to know that we're selecting the best option
based on you really grasping it, instead of me going
you don't know what you're doing, You know anything about this?
Why would I even explain this shit to you? I
got it right, which is old school, and I don't
like that. So you came in, and the way we
reconstruct defects or as follows one. You can leave them
(28:30):
alone and let them heal. Let's say you lived in
the Sahara and you had you were bitten by a
scorpion minus the poison part, and you had a hole
in your elbow or your forearm, and yours and a
doctor within hundreds and hundreds of miles. If you didn't
get infected, that would close on its own. That's how
brilliant our body is. It will scar in and scarf
(28:52):
in and close. That's secondary closure. It just keep closing
on its own. Very very utilitarian, terrible option when it
comes to the face.
Speaker 2 (29:00):
Absolutely okay.
Speaker 1 (29:02):
Second option is, okay, you know what, Let's just get
a piece of skin, right skin graft and take it
and place it where it was removed. The reason why
that's not a very good option in a young person
is it will be obvious from three thousand miles away
that you have a stamp, literally a circular stamp on
your face, because we're replacing beautiful, thick cheek skin with
(29:24):
skin that we borrowed from behind your neck or in
front of your ear or wherever, and it never is
a match. So we call that a stamp. It looks
like a postage stamp, and it works in certain people
because they're old or whatever. The next option, which is
almost never the case because if there's if that's the option,
then they wouldn't be with me, is to close it primarily,
(29:46):
which means just so it closed. And when you close things,
it creates tension, it creates lines, it creates all kinds
of things. But in your instance, it was one of
the unique cases because of the location where it was
and the laxity of your mid face, because it was
in just the right place that it's kind of like
where we do facelifts. It was a reasonable option. And
(30:08):
the last and by far the most popular way to
do this is rearranging tissue. We call that tissue adjacent
transfer or flaps, where we borrow from Paul and pay
Peter and rearrange things. Super sophisticated and cool, and I
would say that's the overwhelming majority. But in your instance,
you had that unique opportunity. I drew them all out.
Speaker 3 (30:27):
For you, right right, absolutely, so you drew them over
the scar, like next to the scar, you drew what
tissue what I would have to do, and then on
the other side of my cheek, the part that wasn't
touched with anything with melanoma, the part that was still normal.
You drew what the scar would look like and where
(30:47):
it would be placed based on those three different options
that you gave me, So we had the first one
that you drew, I believe is the one that we
went with, right.
Speaker 1 (30:55):
Which is a linear closure, which usually you can't do right.
Usually you can't just take a circle and close it
as a line. What happens you First of all, you
can't close a circle of the line without extending it right.
It gets longer, and then you have to take the
extra tissue out on both sides of it, so you
can close this as a football like an ellipse. But
yours was just the right place where it could actually
(31:17):
work pretty good, right.
Speaker 3 (31:18):
And the other two options were the flaps that we
were just talking about, and they left two very different
types of scars. So the one that we went with
is just a straight line, and then there was an
option for a flap that made like a little y
correct and then there was one that instead of the
line going down my face, it went up. But the
(31:39):
reason that along with all of the other reasons The
reason that we chose this one was because it went.
Speaker 1 (31:44):
With the curvature, right, And that's the idea that, like
what I said to you, is when you're asleep, I'm
going to start pulling and pushing on your skin, which
I can do while you're awake, and see where the
skin wants to go, where the natural fold creases are,
where which one of these all very reasonable options would
(32:07):
lead to the least conspicuous scar. And as a result,
I needed you to trust me. That's just how this works. Yes,
we talked about yes, this that the other. At the end,
I said, listen, I'm gonna go in there and do
my very best and you have to be like, okay,
doctor Bonn, I trust you, right, And you did a
great job, I will say, which I expected. You were
very emotional about this process. Yeah, I have a hole
(32:29):
in my face, but there is emotional because I'm a
young girl and I'm young, and there's emotional. I just
have skin cancer and I'm an older woman. Steaks get
higher as you get younger. Right, if you're a twenty
five year old man or woman, your face is going
to have a different value to you than when you're
an eighty year old person. It that's just the way
(32:50):
that it is.
Speaker 3 (32:51):
And outside of my face being my entire job and
career and I had to be on camera four weeks
post everything, outside of all.
Speaker 2 (33:01):
Of that, you had discussed with me.
Speaker 3 (33:03):
Well, the benefit of most people that they get skin
cancer when they're older, at least their skin is thinner.
Speaker 2 (33:09):
So even though it.
Speaker 3 (33:10):
Takes a little bit longer to heal, it usually heals
up a little bit better. So the challenge with me
was that I still had so much elasticity, and.
Speaker 1 (33:19):
So that is exactly true. So we're going to talk
about scars in general, because no scar is more important
than the scar in your face, whether it's a face
if a nose job, or mose surgery. But scars are
very very interesting because we're all chasing scars to make
them minimal and there's one hundred variations and that's why
no one has a solution. But we know some facts.
And one of the interesting facts is that people think
(33:40):
that the younger you are, the better your scar. That's
not true. The younger you are, the more collagen you have,
the more collagen you have, the thicker your scar, because
the better you're healing. And in the world of healing,
healing when you ask the cells what's healing, more scar
(34:01):
equals better. So children, Asians, African Americans, thick, oily Latinos
make thicker scars than white, old, dry, freckly people because
their body doesn't have as much collagen. Ironically, in the
cosmetic world, the thinner, shittier scar is the better scar.
And so that's issue number one. Secondly, location, eyelids, beautiful,
(34:26):
cheeks not so beautiful. Why eyelids are just static, They're
just laying there and the skin is paper. Cheeks are moving,
they're curved, and they're very thick. So these things all
play into effect. And at the end of the day,
we don't get to pick. We didn't get to pick
where this thing was. So fast forward we do the
(34:48):
surgery and as I said, you were very emotional about it,
and that's why I'm proud of you for being here.
At first, you were like, I don't want anyone or know.
You were very like traumatized as you would exc and
little by little you've come to terms with it, which
is the normal way to process things. And you've kind
of gotten past that state of anxiety and panic and whatever,
(35:10):
partly because mostly because it's done, and you can see
yourself and you don't look like a monster, and oh
my god, well it's not perfect, it's healing. It's okay,
this is good. We're good. And partly because you now
are experienced, Like you get the news your husband cheated
on you, it's shocking, and then after a year you're like,
fuck that asshole, right, so so so one of the
(35:34):
things that people don't understand is that there's a process.
It's a process, just like anything else, and you cannot
accelerate this process. So where we are now is in
the post stop phase. Right, you're three months out. You're
still wearing tape. Why because I like tape, and tape
flattens a scar, and we're to talk about it. The
number one most important thing. There are two things that
(35:56):
make up ninety nine percent of your scar. Two things.
One is you as a person. You biologically make good
scars and your sister biologically makes thick scars. That's your
contribution to healing. Zero you can do about it. You
just are That guy over there got a z it.
Now he's got a kiloid. That woman over there had
(36:17):
a facelift and you can't even see it. That's number one.
The second, the controllable element is how is this being closed?
And we talked about it in the previous podcast. It's
not only how's it being closed? First of all, it's
how's it being opened? How's it being prepped? So the
first thing you do when you deal with surgery is
(36:38):
you need to make sure everything that you're about to
close is cut clean with a blade, so the edges
are pristine. So that charring that you were referring to
was cottery, So you're most surgeon or the guy that
cut it out. After he cut it out, it was
bleeding and he charged it so it wouldn't bleed. I
can't close that shit. That is damage tissue. That is burnt,
(37:00):
crisp tissue, So I have to go on the outside
of it cut everything out, so I'm starting with brand
new tissue. The second is you need to release things
so there's no tension that it can move. If something
is stuck down and you're trying to pull on it
to close it and it doesn't want to come, tension
is your enemy. You don't want anything tight and tense.
(37:22):
So we need to release some tissue. Then we need
to put it back together. And the key to closure
is methodical, layered individual fine sutures under a microscope or loops,
and very very conscientious middle layer, sorry, deep layer, middle layer,
and final layer. So once you've done that and you
(37:43):
have a patient who is body is cooperative, you're ninety
percent of the way there, ninety five percent of the
way there. Everything after that is nonsense. Lasers, creams, lotions, potions,
red light therapy, this, it's all fucking nonsense. Why because
if you make shitty scars, you can do anything you want.
(38:04):
It's gonna be crap. And if I close like dog meat,
there is no cream that's gonna make that go away.
Once your scar is out and ahead, then everything you
do is fine. The reason why all these things work
and none of them work is because they don't have
anything to do with this. So if you do nothing
from here on out, you'll do great. So the question
(38:24):
you had, and you asked me earlier today, is I'm
over it. I need this to be better. What do
I do? How do I go? So the things that
I think do help are what Number one The most
important thing is a little bit of massage. Why because
massage mechanically pressure onto the scar tells the cells instead
(38:44):
of being jumpled up, all the collagen and fibrils and
alassins lay them in a uniform line. So if you
push on something long enough, the cells get signals, mechanical
signals to line up. All of you stand in a
row as opposed to all of you just standing randomly.
The problem is you can't sit there with your finger
on your face and besides your face for hours on
(39:06):
hours and ay that's where the tape comes in. The
tape is Chinese water torture. A drop of water is meaningless,
but a drop of water in the same space for
ten days at a time will burrow whole through your
body because it's repetitive, microscopic, constant, and so tape, in
my opinion, that's how it does. So we have tape.
(39:27):
There is some benefit, although not a lot of great
literature that some type of silicone is ideal. I prefer
the liquid version over the strips because the strips don't breathe,
and moisture gets trapped underneath it, and it creates irritation
and inflammation and red spots and acne and whatever. So
what I do is I use a little bit of
(39:48):
liquid silicone and then I use paper tape which breathes
that lets air in and out, and that is my
poor man's scar strips. After that, the question you asked
was can I laser this? Can I lay this? Everyone's
gung ho to a laser, and the question is, well,
what is laser going to do? So you are at
three months, so in the world of weather, you're in
(40:09):
the eye of the hurricane.
Speaker 2 (40:11):
Okay, okay.
Speaker 1 (40:12):
So the way scars work is the first six weeks
it's perfect. Why because it's all me and zero you.
You've done nothing. Your body has done jack shit. It's
just the sutures and it's thin and it's barely.
Speaker 2 (40:27):
Visible, right, and it's crazy to watch it change.
Speaker 1 (40:31):
At six weeks your body goes, oh, oh shit, I
got to do something here. And then it starts building
inflammation because that's how we heal. And it gets a
little redder and a little redder and a little redder,
and it gets a little stiffer and a little raised
and a little itchy and a little raised and a
little itchy and raised and red and it starts going
(40:53):
the opposite direction, and so you and everybody else starts tripping. Yep,
what the fuck is getting worse? I got to do something.
As you said, your scar schizophrenic, right, or you have
good days and bad days.
Speaker 2 (41:05):
Yeah, it's got multiple persons.
Speaker 1 (41:06):
Multiple personality, right. So the reason is it's healing. That
is healing, and you have to wait it out. Yeah,
and how long does that take? Six months or so? Okay,
then your body is like I'm done, I'm finished with this.
It's good. Assuming there's no infection, assuming there's no tension,
assuming all the things are good, your body eventually will
(41:27):
resign and then it'll send a whole new group of
people in. It'll send in the cleaners. We're done, buildings,
just clean up, let's get out of here. And then
your scar will start remodeling.
Speaker 3 (41:37):
So that's when your collagen, your collagen is essentially building
for six months, and then after six months is when
it starts organizing it in a better fashion.
Speaker 1 (41:46):
Correct, And then you start noticing, oh maybe maybe it's
a little better today, And then you look and you
watch grass grow. And then when you look back from
seven to nine to twelve to eighteen to twenty four months,
the scar starts getting flatter, lighter, and it keeps looking better.
So you can't That is human biology, right, So when
(42:09):
you're at three months or four months and you're annoyed
because it's starting to like that is your body healing.
You can do the things I'm mentioning to you, but
you're not gonna outescape. You're not gonna escape your biology
and you're not gonna escape the closure and your biology
and our closure is pristine. And you're in the ninety
nine percentile for that space of healing for three months,
(42:30):
you look fantastic. There are different little things we talked about,
dog ears, et cetera. And so what do lasers do?
Lasers are designed. What they say is you're gonna okay.
So there's three things that matter when it comes to
a scar, how wide it is, how raised it is,
and what color it is. Okay, So when you laser something,
(42:52):
do you make it narrower? No? No, not at all,
because the thickening of it is either shitty closure or
starting to widen because there's too.
Speaker 2 (43:01):
Much tension right because you haven't taken care of it.
Speaker 1 (43:04):
Or just or or they just put too much tension
and yanked it together. Okay, the height of it, they
think they're gonna be able to flatten it, and it's
not accurate you're not gonna laser away scar down.
Speaker 2 (43:18):
Okay, that's your body.
Speaker 1 (43:19):
It's just not gonna happen. The collagen it's creating and whatever.
And then the last thing is color. And so where
color matters is like maybe a little bit of pigment
or something like that, but by and large, your color
is red. And what is red it's blood, blood flow,
it's healing, it's it's it's it's inflamed, so lasering it.
So then what they'll do is they'll laser your scar
(43:40):
four times, and then you'll come back after twelve months
and be like, oh my god, it's so much better.
And it was going to be better anyways.
Speaker 2 (43:49):
GOTA.
Speaker 1 (43:49):
So the reason you're like, I think this worked is
because it was on its way there and now it's
getting the credit. So I don't use any of the lasers.
I think in many instances it doesn't help. In many instance,
it makes people who are pigmented pissed. And I've had
many patients who laser their scars and then they get
hyperpigmentation around it. Steroid injections disaster. Why, because you're putting
(44:15):
in a drug that eats away collagen and you think
you're gonna make it eat away just the right amount,
so it's thin, and all it does is just napalm,
and it eats the collagen of the scar surrounding tissue.
It flattens, it widens, it gets tell adjectagious, horrible. It's
because you cannot you cannot control it. It's just too aggressive, okay,
(44:37):
And then I don't really think there's anything else that
really does anything. So your question today, because you're at
your three months, is a normal one, which is I'm
getting a little agitated because you're actually feeling like there's
some possible regression and it's not true at all. It's
exactly where it's supposed to be.
Speaker 3 (44:55):
I think I'm just heading the limit of Okay, I've
been so dill gent for four months almost that so
but this, yeah.
Speaker 1 (45:06):
But this recipe calls for a sixty minute cook time,
and I don't care that you've been really good for
forty five minutes. Exactly, this turkey is raw, and so
no matter how you dice it and how no matter
how hungry you are, if you eat the turkey it
forty five minutes, you're getting salmonilla. You need to wait
sixty minutes. And this recipe of yours requires the nine
(45:28):
to twelve months minimum, at which point you'll stop being
so agitated because while it's not fully healed.
Speaker 3 (45:33):
You see the light at the end of the tunnel, right,
and then that's what the silicone does, right.
Speaker 2 (45:37):
It goes in and it organized.
Speaker 1 (45:39):
It just holagzes it and nobody knows exactly It doesn't
go in because you don't you know, it doesn't penetrate
your tissue. But the silicone, there's something about the electron
microscopes and how the cells react to it, and even
that I would say is a little bit of it's
a little bit of fools gold, okay, Right, the pressure
(45:59):
works and as a result or instances where I don't
use any silicone, and there's instances where if you literally
didn't use anything. To be honestly, I think you'll be
one hundred percent fine. We give it you because it
also keeps you preoccupied and it's something for you to
do something. And I'm okay with that, because the healing
process is physical and mental and emotional, and so you
have to heal every part of it. And there's a
(46:20):
part of it which is I participated. You know, my
son wants to be involved. So even though he's not
really cooking, we give him shit to do because he
feels like he's involved.
Speaker 3 (46:28):
Right, And I think it's you know, that helps throughout
the process of you have to learn to stop looking
at it every single day. Like those first two weeks,
you look at it every day, and or like when
it becomes uncovered, you're like, oh my gosh, like, what's
it doing today? It looks different than yesterday, especially when
you start to like wash your face off gently and
(46:50):
the scab kind of fall off and it looks totally different.
So you're looking at it every day because every day
it's changing. But once you're two weeks out, looking at
it every day driving you crazy. So it's that's what
I like about the tape is I only see it
every four days, essentially, And I.
Speaker 1 (47:07):
Think there's a huge component of that as well, which
is just trying to get your mind off of it
because at the end of the day, you've got to
just sit there and wait. Anyways, I think your story
is a good one. You were, you know, I know,
at first you were incredibly what you should have been
very private about it because you're like, what the fuck,
I don't know it? And then little by little, when
the shot had finished and you knew that you'd be okay,
you sort of have slowly started having talks because the
(47:27):
reality is that everyone's crossed that they carry is somebody else,
somebody else's to be journey And the reality is a
four year old who gets melanoma that I don't want
to say was miss the diagnosis, but maybe could have
been diagnosed sooner. And I don't think anyone did anything wrong.
It's a good story to tell because now I don't
want on the end end go and get everything removed
(47:49):
off your body, but you you if something doesn't look right,
you should have it checked. And I think now you
are ten times more vigil and it's a result of
let's say this show. Let's say four people and are
listening to like, oh fuck, I have that thing on
my back, then they're going to go and get it
checked out sooner.
Speaker 2 (48:06):
Yeah, and it's so important.
Speaker 3 (48:08):
I mean I didn't know this before, but it's so
important to go to the dermatologist once a year.
Speaker 2 (48:12):
And you learned that.
Speaker 1 (48:14):
Yeah, something that you mentioned to me which was really interesting.
Then I'll end with this is you have you have
your general practitioner, right and that general practitioner is seeing
you for your general health. And it's it's obvious when
you get sick you go to them, but usually go
to them so that you don't get sick and they
can diagnose you earlier than you would have figured it out.
So one is you want to have a dermatologist, even
(48:36):
if it's just checking your skin. And the other which
you mentioned, which was an interesting concept I hadn't thought before,
which is you use a plastic surgeon for two reasons.
One cosmesis like I want a breastdog, I want my
nose done, I want my earpinned, I want to do
my eyelids. I'm looking for a facelift. And in that
process you have ample time. You'll take your time and
(48:56):
you'll do so much you could literally take five years
to reach. But the other things that we do is
really urgent things. We do lacerations, we do burns, we
do trauma, we do skin cancer, which is not emergency,
but it's urgent. We do rupture of implants that become urgent.
So what happens then is you're under the gun. And
(49:19):
what ends up happening is you don't have the time
to do the homework you would have not done. So
one of the things you said mention to me is
it's really good to have a plastic surgeon whom you've
developed a relationship with that you can always know that
you have that when and if God forbid you your son,
whatever happens, you have already established relationships as opposed to
have to build it in about two days or three days.
(49:42):
And I thought that was very interesting and that was
a very cool thought process because we don't generally are
not considered primary guys, but since we do a lot
of urgent things, I think it's not a bad concept
to have.
Speaker 3 (49:52):
Yeah, I think it'd be good for everybody listening to this,
no matter where they are. Obviously if they're here, they.
Speaker 1 (49:57):
Yeah, sure, your local plastic surgeon.
Speaker 3 (50:00):
But like doing your research, talking to some of your friends,
having that conversation, seeing the different types of personalities, and
like maybe you have maybe you have like just a
botox appointment, you want to go in for something. Maybe
your plastic surgeon's office does that, and you can go
in go there say hey, I want to develop a
relationship with the plastic surgeon here.
Speaker 2 (50:20):
I don't know how it would work. You'd have to
tell me on your friend.
Speaker 1 (50:23):
I think that's very accurate, and I think it actually
made sense, and hence why I brought it up is
it's nice to have already established that and have that
in your back.
Speaker 3 (50:30):
Pocket if I was in a car accident or something,
or God forbid, something else happened in my face.
Speaker 2 (50:35):
Well, actually, interesting, I've got some random part.
Speaker 1 (50:38):
That's actually how most of my most surgery is done, right,
Because I'm not the guy that the most guy's gonna call,
because I'm not either him and or the guy he
uses the most surgery I do. The reconstruction is my
own patients who have come to me for other things
over the years, who then call me about their most surgery,
about their kid, who got a dog bite, about this,
about that, because they already have that relationship with me,
(50:58):
and they already trust me, and they know that that
can call me. So I thought that was really really
interesting and it's not a bad idea to consider that,
all right, So one parting you get one partings recommendation
to anyone listening. What was that? What would you like
to recommend? Ooh, that's one and only.
Speaker 2 (51:16):
One one parting recommendation. Just in general, know about this
whole journey, about this whole journey, this whole journey, what was.
Speaker 1 (51:23):
The one thing that you're like, if I could leave
you with this, and this is just the one.
Speaker 3 (51:27):
Thing I would I mean, if I could leave anybody
with anything, it would be like I said, it's great
to have a relationship with your local plastic surgeon for
those things that are urgent, but more so it would
be go to the dermatologist, get everything checked, make sure
that they are doing their due diligence.
Speaker 2 (51:46):
Using that you're going to be able to correct me
with us. Is it a dermoscopy dermoscopy?
Speaker 1 (51:51):
Yeah, They're going to look at things and the literal
really really kind of magnifying and look at things.
Speaker 3 (51:55):
And make sure that they're using that tool. Because what
I've learned is that that's super important in the part
of being able to look at everything without having to
biopsy everything on your body.
Speaker 2 (52:06):
But go if something in.
Speaker 3 (52:07):
Your gut is telling you something's not right, I would
definitely go to the doctor, get it checked out, make
sure that you're doing your due diligence. And at the
end of the day, I've had outside of this, I've
had so many other health issues. Lime disease, and what
I've learned through all of these is that you are
your own best advocate. And if you go to someone
(52:30):
and you and they say you're okay, and you still
think something's not right, it's really important to get a
second opinion follow up on things, because you are your
own best advocate. Like we said, this had been looked
at so many times by so many random people that
I had trusted that see faces every day. So it
was just out of frustration thinking this was a spot
(52:50):
that was going to be removed, that I happened to
get it looked at, and I was so lucky that
I didn't, you.
Speaker 1 (52:56):
Know, wait longer.
Speaker 2 (52:58):
Yeah, exactly, Yeah, I definitely.
Speaker 1 (53:00):
That's a very good suggestion, which is you know you
you need you need a skin health check, and if
you I think the things you said were one, you
got to get see a dermatologists regularly. And the other
is if you feel like something is being missed, keep
keep at it until you get satisfied with the outcome.
(53:23):
Because I do think that while doctors are great, they're
not infalluable, and some are great and some suck, and
so at the end of the day, you need to
rely on your own absolutely all right, well, thank you
very much for coming. As always, this is a fantastic
show because of patient's willingness to come and chat and talk.
And you know, it takes a takes a takes a
(53:44):
courage to have that conversation, so we are grateful.
Speaker 3 (53:46):
Well, thank you, and we're able to have that conversation
too and have it be a two way conversation because
you've educated me so much in the process.
Speaker 1 (53:53):
So I really agree. Yeah, of course, it's my obligation.
All right, guys, that's a rap. So two things, as
always at the end of every show. Number one, if
you love the show, please share this with other friends
and family members. For the love of God, you're not
going to know who's going to have skin cancer, so
if it's after the fact, it's kind of a moot subject,
so forward and share it. The other is, if you
like our show, which I hope you do if you're listening,
go ahead and write us a nice review. Write us
(54:16):
something nice. It helps everyone's motivation and enthusiasm to keep
putting these shows together because it does take a lot
of effort to do them. So oh guy, guys, As always,
I'm your host, Doctor Roddy Raban and We will connect
next week.
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