Dr. Perry Discusses Various Ways of Protecting Your Skin

Episode Transcript

Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.

Speaker 2 (00:09):
Well Doctor Arthur Perry, he's one of the top plastic surgeons.
He's got offices in Manhattan, New Jersey. You know what.
He's been doing the show here on w R for
years and years and years. Very popular show and a
great plastic surgeon. Everybody has questions on this subject, so
he's the guy to ask.

Speaker 3 (00:26):
Doctor Arthur Perry, and the public wants to know.

Speaker 4 (00:28):
The public doesn't get a damn.

Speaker 5 (00:30):
And I went to his office and I said, I said,
look at my face. And he goes, yeah, look at
your face. We're going to do with your fan What
can you do with his face? I go like that,
I sai, what, I go, look at this, I'm getting old.
I said, I want to maybe you get fix it
up a little bit.

Speaker 6 (00:41):
Doctor Oz, are you there, I'm here Ark, and I
want to get a plagued you. Having worked with you
on a book and numerous other activities, you want to talk.

Speaker 5 (00:47):
To Arthur Perry, the best in plastic surgery.

Speaker 6 (00:49):
Remarkable knowledge, but also your grace at delivery content, which
is why it's been a blessing to have you on
my show so many times.

Speaker 3 (00:54):
When I was a resident at the University of Chicago,
we had a.

Speaker 6 (00:58):
Media smart as I really really gifted position. I want
to pay you the bit the highest true that I
can give to a surgeon, which is when people come
to you, they don't come for an operation, they come
for an opinion. And that's why I trust you with
my friends and relatives.

Speaker 3 (01:09):
I didn't realize we were going to get the Michael
Jordan of Plastic Surgeons nine oh two and zero.

Speaker 1 (01:13):
Bows to this guy.

Speaker 3 (01:17):
And welcome. This is Bord's certified plastic surgeon, doctor Arthur Perry.
And yes, this is what's your wrinkle right here on WOAR.
Hope you're having a great weekend. I am a little
cold out there, but we are starting with this show. Noah.
This is season twenty, season twenty twenty years, twenty long years,
Noah says on WOAR, and I'm so happy to be

(01:41):
here every Saturday evening at six o'clock. And thank you
for listening and giving me a call. The phone number
this is a call in show eight hundred. You ready
for this eight hundred three two, one zero seven ten.
I hope you wrote that down. And for those of
you listening on the straight Talk About Cosmetic Surgery podcast,
and I know there are are tens of thousands of

(02:02):
you all over the world now and thank you. Tell
your friends hit subscribe, listen every week, and you can
call the show live. Even though you can't call podcasts normally,
you can this one because we're live at six pm
on Saturday evenings in New York and welcoming your phone call.
So what is this show that we're going into twenty years.

(02:24):
This is a show about you, A show about your wrinkles,
a show about your jowls. And I know you have
them if you're over the over let's say fifty or so, right,
I almost said sixty, but most of you have little
tiny jowls at fifty. Well, this is a show about
sagging breasts and small breasts and large breasts and inverted nipples. Yeah,

(02:45):
we talk about that kind of stuff. We talk about
small lips and ears, ear lobes that hang and sag
or shrivel up as you get older. This is the
Plastic Surgery Show. I'm a board certified plastic surgeon. Host
of this show for a long time. Now. I trained
at Harvard, Cornell and the University of Chicago, bringing you
an education of decades of experience so that I can

(03:10):
answer your questions and take care of you because I'm
a real plastic surgeon. I've got an office on Park
Avenue in eighty fifth Street in Manhattan, and another office
in Somerset, New Jersey. And what I do during the
week is, yeah, I take care of people. I do facelifts,
I do islid lifts. I do noses. That's called the rhinoplasty.
I do suctioning of fat, and I inject botox and

(03:33):
inject filler and figure out how to make you look
better and younger. So give me a call tonight if
you've got a question about any of those topics eight
hundred three two one zero seven ten. And if you
do call and ask me a it's got to be
a good question, right, We're going to send you a
bottle of soft Time, the moisturizer, which is so important

(03:53):
this time. And you look at your hands right now,
you know here we are in December. Your hands. If
you're in the Northeast, all right, if you're in the
Southwest United States listening to the show. I guess you
don't have this issue, do you, But we do up here.
Your hands get chapped this time of year. You get
those little tiny cuts around your fingernails that hurt so much,

(04:14):
and your lips get chapped, and your face is warm looking. Well,
you know, it's a moist charger. That's what you need.
And it's because of the humidity in your apartment, in
your house, it's so low when you put the heat
up to warm yourself. Because it's called up here. It's
thirty something degrees in New York today. I'll get a
little bit warmer tomorrow hopefully. All right, So we're giving
away bottles of soft time. Give me a call eight

(04:36):
hundred three two one zero seven tens. So what are
we going to talk about today? Well, you know I've
been doing this a long time and I do a
lot of facelifts. In fact, last week I did a
facelift at an in on in maybe on an eighty
three year old woman. I did her eyelids. It was her,
I believe, her third facelift, the second one i've done.

(05:00):
Not quite my oldest patient for a facelift, but getting
up there, you know I've done people a little bit
older than that, but she's in such good shape past
her stress test and sailed through the facelift. So, you know,
we're going to talk today about staying safe when you're
in your golden years. And what's a golden year? You know,

(05:21):
Mike roys And says ninety is the new forty, right,
but certainly after age seventy five or so, it gets
a little dicey when you have elective cosmetic surgery. So
we're going to talk about that, who's inappropriate candidate, how
to stay safe, the things that I ask my patients
to do so that I know that they're not going

(05:42):
to have a complicator. I hope anyway that they're not
going to have a complication in surgery. So we'll talk
about that today. We're also going to talk about basil
cell carcinomas and squam mis cell carcinomas, the most common
skin cancers of the face, and why I, as a
plastic surgeon, often get involved in that. So I was
at dinner last night with someone and she told me, oh,

(06:05):
she has a basal cell carcinoma for forehead, and can
I take care of it? So we're going to talk
about that and we're also well, if we have time,
we'll see. If we have time, we're going to talk
about direct excision. This is kind of interesting, direct excision
of extra facial skin. What does that mean? Well, a

(06:26):
facelift is direct excision, right, but it's through hidden incisions. Well,
you know, it's a complex because the incisions are far
away from where we need to pull. And that's the
essence of the difficulty of a facelift and one of
the reasons it costs so much because the skill required
is enormous.

Speaker 7 (06:46):
Uh.

Speaker 3 (06:46):
But there's other ways to do this operation, and we're
going to talk about those alternative methods today on the show.
Eight hundred three to two one zero seven ten is
our phone number here at WOAR. And remember that I
do have an office. You know, people tell you, you know,
you sound like you're a guy on the radio. Are
you a real plastic surgeon? Yeah, yes, I am, and

(07:07):
every day in the office in New York and in
New Jersey. Give me a call, and we've got we've
got a regular guest on the line, a regular caller, Shelly.
What can I do for you? What's your wrinkle?

Speaker 4 (07:19):
Hi, Doctor Perry. Yeah, Well you've got a couple of
your fans down here in South Carolina, and we're sort
of older gals, and we were wondering, we've got some
we've got some problems with jowls turkey, you know, turkey
wattles and things like that, and we don't know what
to do. Uh, you never seem to talk about them.

(07:42):
What can we do about them?

Speaker 3 (07:45):
Well, the essence of a facelift is correcting those those things,
those jowls. So what is a jowl? Uh? You know,
if you're fifty, you begin to get a jowl and
you only have to look at your jawline, Shelley, if
you're how old are you?

Speaker 4 (07:58):
By the way, I'm seventy four, and some of us
are almost eity here and we're kind of worried about
about this excess chain under jow.

Speaker 3 (08:14):
Okay, so here's what a jowl is. So, So, ajowl
is not a real anatomic entity like a nose or
an ear right. You know, when you're thirty years old,
you have you've got a nice sharp jawline. You can
take your finger from your ear to your chin and
run it down your jawline and you feel the mandible
that's the jawbone, and there should not be any fat

(08:38):
skin or anything kind of hanging off of that. But
when you hit right around fifty shelly, depending on what
you do in life, so earlier, if you smoked earlier,
if you spend a lot of time in the sun, later,
if you're genetically you know, privileged, I suppose, But certainly
somewhere around fifty, everybody begins to see just a little

(09:01):
bit of a jewl. What that is is a sagging
of the skin being weighed down by a little bit
of fat and the fibrous and fatty layer of the
tissue that connects the inside of your face. So if
I made an incision in your skin. Hopefully you guys
don't do that out here, but if you, unless you're
a doctor or a veterinarian or a dentist, I suppose.

(09:24):
But if I made an incision in your skin, I
would cut through the skin, and then I'd cut through
a layer of fat, and that's called the subcutaneous fat.
This is your anatomy lesson for the day. And then
if we went further right where that jowl is, we'd
see a different type of fat, and that's the fat
that is in a the next layer, and it's a fibrous,

(09:46):
fatty layer that connects the muscles of the forehead with
the muscles of the neck, and it begins to sag
and it becomes your jowl. Now some people, some people
also have this fat in their mouth, called buckle fat.
So if you suck in your cheeks like little kids
like to do, or when you're sucking on a lollipop,
your cheeks go in and that fat is called buckle fat.

(10:09):
B U C C A L that's the name of it.
And that is that's fat that we have to be
very careful about removing because as you get older, it
naturally goes away. So you know, it's sort of interesting
with our bodies. We get fat where we don't want it,
like in our neck and our gels. We lose fat
where we do want it, which is our buckle area.

(10:32):
We lose fat. Women tend to lose fat in their breasts,
so as you get older, you tend to get smaller
brusts and saggy brusts, and so, you know, and men,
I don't know, we won't talk about men where they
gain and lose weight, but women, you know, you know
where it is, and it's it's not really where you
want it. It's like hair, you know, you lose it
on your scalp and you get it in your cheeks

(10:54):
when you're a woman. Not good, all right, But we
can't we can't fix that. But plastic surgeons can put
the fat where it's supposed to be. So with a facelift, Shelley,
I lift up the skin and I'm actually looking right
at that fat. And often because it's sagged a quarter
inch or a half an inch or sometimes even lower,
I will trim that fat directly, so I'm looking right

(11:16):
at it, and I take a scissors and I trim it,
and it usually bleeds a little bit, and I cauthorize it.
And then what we do is suspend that layer a
little bit higher. And there's lots of different ways to
do that, and I won't bore you with those techniques,
but we can put stitches in, or we can remove it,
we can do all sorts of things. But really what
we want to do is bring that jow up to

(11:38):
a higher level where it was fifteen or twenty or
thirty years ago. So that's what we do with the jow. Now,
the turkey gobbler or the turkey wattle that you mentioned
also that's completely different. That is from the thinning of
your skin as you get older. So when you're thirty
years old, your skin is at its maximum thickness and
it's all downhill from there. It is at a rate

(12:00):
of about one percent per year. We lose the integrity
of our skin, the thickness of our skin, the protein
called collagen, the elastic fibers of the skin, the high
uronic acid. It's all. It's depressing, isn't it. But we
can do something about that too, because we can certainly
thicken the skin with a good skincare program or with

(12:20):
lasers and things like that. They do thick in the skin.
And then the procedure of a facelift, which is a
very poorly named procedure. It's really a facelift, is really
a cheek lift and a neck lift. So we make
an incision in front of the ear, and I lift
up the cheek and that jow that we just talked about.
But then I make an incision underneath the chin, and

(12:42):
I'm suctioning fat in most people. Most people have fat,
although I have a lot of patients that are rail thin,
no fat whatsoever. So when I make that incision and
lift the skin off of those turkey gobbler muscles. The
platisma that's what that's called. The two bands of the neck.
When I lift that, I see them directly, and I

(13:02):
put some stitches in that stay in for six months.
I sew them together, kind of like if your jacket.
If you wore a jacket and unzipped it, the edges
of your coat or jacket kind of separate. Well, you
want to zip that up. And that's what the platisma
plasty is. It's a zipper right in the middle. It
brings those muscles together. And one of the interesting things

(13:24):
about anatomy Shelley, is that when I bring those muscles together,
you would think that they would bowstring, like a guitar
string that you tighten too much, it kind of bows.
Doesn't happen. It's actually the reverse in the neck. The
tighter I make those muscles, the more they grip the neck,
and they follow the right angle of the neck that

(13:47):
you had when you were a teenager. You know, it's
three sides of a triangle, and by the time you're
sixty it's a high pot noose. But when you're twenty,
it's the two sides of the triangle. So when we
tighten those muscles, the muscles then follow the youthful contour
of the neck, and that's not enough. Usually we need
to then lift the skin from the cheeks, lift that
extra skin, and it will follow those muscles and heal

(14:11):
to the muscle. So that's what a necklift is, and
it's part of a facelift. And that hopefully answers your
question and your friends in South Carolina.

Speaker 4 (14:20):
Okay, Oh, interesting, because we were thinking that it would
be like a sort of like making a pleat, you know,
in a in a to remove to make a pleat
in the skin and remove the excess skin.

Speaker 3 (14:34):
Well, you know something, when we come back from our break,
you know, you can listen on your radio or on
the internet. I guess, yeah, do you get the WR
signal in in South Carolina? Or are you listening on
the computer.

Speaker 4 (14:46):
No, we're listening on a group of computer computers here. Yeah.

Speaker 3 (14:51):
Okay, So so when we come back from the break,
you know, just listen on the computer and I'm going
to talk about some of the newer older they're new,
they're old. It's so you know what they say, what's
new is really you know, we forgot to read from
thirty years ago. But I'm going to talk about some
techniques that are less complicated than the facelifts that we

(15:12):
traditionally do and might be able to solve the problem
in some people, maybe not for everybody. So so thank
you for the phone call. I'm board certified plastic surgeon,
doctor Arthur Perry, host of What's Your Wrinkle, host of
Straight Talk about Cosmetic Surgery. And by the way, Shelly,
tell all your friends down there in South Carolina that
they should be listening to the podcast, and you know,

(15:34):
clicking on the podcast when they listen. Go to Apple
Podcasts or iHeart Podcasts, click on my name, click on
Straight Talk about Cosmetic Surgery, which is the name of
this podcast, and then click subscribe. It's important to me,
very important, because if no one's listening, you know, I'm
just talking to myself out there, right, So I know
that a lot of people listen to the podcast, but

(15:56):
more is better, So please tell your friends, all right, thanks, thank.

Speaker 4 (16:00):
You, thank you. Also, because we are buying your product tment,
we found them on Amazon and we've found all of
your skin.

Speaker 3 (16:09):
Products great well, thank you, and we'll talk about those
in a few minutes. Also, but we've got to take
a break. Thanks Shelley. I'm Board certified plastic surgeon, doctor
Arthur Perry, the host of this show for a long time.
Eight hundred three two one zero seven ten. Eight hundred
three two one zero seven ten. We'll be back after
these words. Did you know that your skincare may be

(16:36):
hurting you more than helping you. I'm Board certified Plastic surgeon,
doctor Arthur Perry. The foundation for looking good is clean,
healthy skin. So I've created a program that is so
simple that everyone can stay on it long enough to
see real results. It starts with an incredible skin cleaner
called clean Time. It's actually good for your skin. Protect

(16:57):
your skin with my Daytime SPF twenty in the evening,
feed your skin with my Powerhouse Nighttime Serum. Nighttime has
Vitamin CNA, antioxidants and skin brighteners. And if you like moisturizers, well,
I've created Soft Time with seramides and Vitamin D. Throw
away the bags of useless products and try doctor Perry's skincare.

(17:18):
Join the thousands of people whose skin is healthier. Use
the fifteen wor radio code on Amazon dot com for
a fifteen percent discount. That's fifteen WOR Radio when checking
out and enjoy free shipping. If you're a prime member
and don't forget to listen to my radio show right
here on WOR every Saturday evening at six pm.

Speaker 7 (17:40):
You're listening to What's your Wrinkle with Doctor Arthur Perry.
What's your wrinkle?

Speaker 3 (17:45):
Van? What is your wrinkle? What is bothering you about
your appearance? You know, as a plastic surgeon, my goal
is to help you look better and help you look normal.
You know, here we are in the year twenty finishing
up twenty twenty four. Wow, it's time moves on right Well?
You know, I started in plastic surgery. I started in

(18:07):
medical school in nineteen seventy seven. Long time ago finished
medical school. I was, I was pretty young, twenty four
in those days when I finished medical school and I
started going to plastic surgery meetings. I guess my first
one was in nineteen eighty one. And I've been reading

(18:28):
the journals since nineteen seventy seven, and boy, I'll tell
you I have seen so many changes in plastic surgery,
but nothing like what's going on now. Not in terms
of the advances in plastic surgery. They're kind of trundling
along as they have over the last thirty forty years.
But what's going on is this Internet thing, the Instagram thing,

(18:51):
the influencer thing, and the way that cosmetic surgery is
being swayed, swayed by delay and people who have access
to a microphone. That's not the radio guys, but the
Instagram people. And then what happens is you get a
group of plastic surgeons that are fairly young and and

(19:14):
fairly publicity hungry, and you know, they get the celebrities
in and they get them on Instagram, and then they
do things that are kind of funny and there's a
lot of procedures. I talk about this on the show
all the time. You know, I look at myself as
a cutting edge plastic surgeon. I do the most advanced
procedures that are available. But I do you know, I

(19:37):
listen and I watch and I think to myself, is
this a procedure, this new thing that people are doing,
is this a procedure that's better than what's out there
or safer than what's out there? And if it's not,
why are we doing it? Are we doing it just
to get headlines? So you know, unfortunately that's kind of
the field that we're in, you know, the But that's

(19:57):
what the show is all about, keeping you safe and
maybe adding a little common sense to a very very
hyped up field and getting more so, seemingly every week
or so. So we're gonna go we're gonna take a
step back in time now and talk about some facelifting
techniques that are actually fairly old, fairly old but having

(20:21):
a resurgence. So it's kind of interesting. You know, these
papers are written nineteen ninety nineteen ninety five for these
techniques that look pretty good, and then other techniques kind
of move ahead, and then thirty years later they get
revisited and someone says, wow, here's a great technique. We'll
go back in the literature, and it was described thirty

(20:43):
years ago. So a few of those techniques are pertinent
to those of you who might not want a full facelift,
let's say, and there are so many of you for
lots of reasons, whether it's you know, you're not medically
suited for a full facelift, whether or not you don't
have the finances for a full facelift, or or you

(21:04):
just don't want that kind of recovery. But Let's say
you've got really deep nasal abial folds, all right, and
we've tried filling those, but they're just so deep. They're
really deep. I mean, they're deep, and you know who
you are, So a facelift is really the answer. You know.
We would make an incision in front of the ear.
I do a short scar facelift. So I make an

(21:25):
incision coming out from the top of the ear, and
then in front of the ear goes in the ear
and I'm right around back just a short distance, and
I lift up the skin of the cheeks to nearly
the fold, and I pull on the nasal abial fold.
And sometimes we will add fat to the fold, and
sometimes we'll actually suction fat lateral to the fold. That

(21:48):
means to the side closest to the ear of the
fold and will make your nasal abial fold look better.
That's a cheek lift procedure. And then we usually combine
that with a necklift that we were talking about with
Shelley a couple of minutes ago. But let's say you
don't want that, and I try filling that fold with
filler's higaluronic acid. I'll try, and it does a reasonable job.

(22:11):
But the fold is still there. So I'll say, well,
why don't we go with something called radius, a more robust,
a thicker filler, and we'll we'll try that, and then
you know, we do the best we can. But some
folds are just really really deep and just we can't
get rid of them, and you want those gone, and
not by the way that we should get rid of them,

(22:32):
because everybody has an aso abil fold. Look at your children,
look at your grandchildren, look at the kids on the sidewalk.
If you're fifteen years old, you have an azel abial fold,
but you don't have a real deep one. But when
you're sixty and seventy and eighty, sometimes you have a
pretty deep nasal abial fold. So there are other techniques
that I have up my sleeve that are older techniques,

(22:53):
and one of those is one that we're going to
revisit tonight. It's called the direct excision of the nasal
abial fold. And you say, what is that. Well, under
local anesthesia in the office, I numb up the fold,
the fold from the corner of the nose to the
corner of the mouth, and it's almost as if there

(23:14):
was a mole or a skin cancer or something like that. There,
I take any ellipse. You know what an ellipse is.
It's that shape sort of like a football shape, an
elliptical incision I make. I remove the skin, and I
usually will move the fat, not take out fat, but
move the fat to the from the side of the fold,

(23:36):
and I tuck it into the fold also to kind
of to give it a lift the base. It's like
a fat graft, but it's not really a graft. It's
just kind of moving the fat over, not taking it
from one part of the body and putting it another.
That's what a graft is. And then I'll sew the
skin edges together without that quarter inch or sometimes even more,

(23:58):
maybe a third of an inch of skin, And boy,
is that a dramatic result. It's the direct excision of
the nasal abiel folds. Now I don't do it often,
maybe a couple times a year. It's got to be
just the right person. You have to be able to
heal a scar perfectly. Because there's going to be a
scar there. We're replacing a very deep fold with a scar,

(24:20):
but the scar is usually much better and certainly can
be covered by makeup. So the direct decision of a
nasal abiel fold is one of those techniques that is
kind of coming back. There was another paper or I've
written about it very recently and so you'll see those
and they are that is a way to kind of permanently,
without the use of wrinkle filler, reduce or remove that

(24:45):
nasal abial fold that's bothering you. So we can also
excize other areas that are really deep. So where have
I done that? Where have wrinkles been? Where I've actually
excised those. If you have really deep, really deep lines
between your brows, yeah, you know those eleven lines or
some people have those horizontal lines on the top of

(25:05):
their nose, and that's an area that we cannot fill.
Now there are people that will try and fill those,
but there are probably close to a thousand cases of
blindness now, yeah, blindness from injecting filler into that area.
That's a very dangerous area. I just gave the lecture
to the residents at Cornell and Columbia on fillers wrinkle fillers.

(25:27):
That was last week and where I'm on the faculty
at Colombian, So the residents and the medical students have
their lecture series on Monday, mornings, and I gave the lecture,
and one of the things I stressed was that we
do not want to inject gel material, which is filler,
into the area between the brows or and you know,

(25:48):
sometimes we do in the nose. But you have to
be very, very careful because those areas, the lower forehead,
the area between the brows, the upper nose very dangerous
areas because those blood bests connect with the blood vessels
that supply the eye with blood, and we can get
a little bit of filler in there, and in two
thirds of cases where there is a visual disturbance, it's

(26:11):
permanent and there's nothing you can do. And it's a
devastating thing. Never happened to me or anyone I even know,
I'll tell you, but it's in the literature and rising
in numbers. And that's why it always worries me when
a nurse or a physician's assistant or non plastic surgeon
does these procedures and they haven't operated in those areas,

(26:32):
they don't know exactly where the blood vessels are. And
all right, you know, it's a gamble. Let's try and
make it not so much for a gamble. But so
we can't inject filler in those areas now one of
the things we can do. And I was searching for
the paper tonight and I can't find it. Maybe I
thought of this or someone suggested it to me, But

(26:53):
I've been for years using something called polydioxinone. It's a
suture material and I thread it into those wrinkles between
the brows, so it's really filler, but it's a solid filler,
so it doesn't get into blood vessels in any way.
And polydioxinone, it's the material in a particular type of
stitch called PDS. And you've had it, if you've had

(27:16):
most surgery. Now we close the skin with PDS. It's
the dissolving layer. It takes six months to dissolve. I
do it in every tummy talk and every breast reduction,
every breast lift. I use this material all the time.
And one of the unique characteristics of this particular stitch
is it causes you to generate more collagen around the stitch.

(27:38):
And for you, if you're having your breasts operated on,
I'll tell you, well, you're going to feel little lumpies
that's a technical term around the stitches for six months
or eight months or so if I put it underneath
the wrinkle purposely, those lumps, which is just the generation
of collagen in a linear way when we do it

(28:00):
under a wrinkle, is something we want. So that's something
we can do also, so we can excize those wrinkles
in the what's called the globella between the brows, just
like we can excize the fold, the nasal abial fold.
So when we come back from our break, we're going
to talk about perhaps the biggest use of the direct
decision in the face, something that might be able to

(28:25):
save you a facelift. And I'll keep you on the
edge of your seat. Eight hundred and three two one
zero seven ten is the phone number here at wor
give me a call. When we come back. We'll talk
more about direct excision of skin in the face. And
I want to get into why I, as a plastic surgeon,
often help people out who have had basil cell carcinomas

(28:45):
and squam and cell carcinomas. We'll be right back. They
say that sixty is the new but while you may
feel and act fifty, the mirror doesn't lie. But that's
where plastic surgery comes in. I'm board certified plastic surgeon,

(29:08):
doctor Arthur Perry, and I love helping patients look younger
and better. If you've got sagging cheeks, jowls, and that
dreaded turkey gobbler, it might be time for a little
nip and a tuck. You look more rested and yes,
younger with my short scar facelift and the artistic injection
of wrinkle filler or a laser peel, well, that might
be just what it takes to get you looking as

(29:29):
good as you feel. Let's sit down for an hour
consultation in my new Park Avenue office. Together, we'll come
up with a plan to help you look your best.
Give me a call at eight three three Perry MD.
That's a three three p e r R Y M D.
Check me out on the web at Perryplasticsurgery dot com.
And don't forget to listen to me doctor Arthur Perry,
every Saturday evening at six pm right here on WOR.

Speaker 7 (29:53):
You're listening to what's your wrinkle with doctor Arthur Perry.
What's your wrinkle?

Speaker 3 (29:58):
And what is your We're talking all about wrinkles and
folds and sagging skin. That's what I do every single day.
I'm a board certified plastic surgeon and part time radio guy.
This is my hobby. I like to say. Some people
play golf. I do the radio thing. I like sitting
here in the home studio. I've got my co host

(30:19):
tonight hasn't said a word, Winston, not one word. He's
sitting here, but no other co host. I don't know.
You know, maybe we should interview people for the job.
All right, So eight hundred and three to two one zero
seven ten is the phone number. So what is what is?
What's the problem, let's say, of having a facelift. Well,

(30:40):
you know a lot of people just don't have the time.
You have to take a couple weeks off of work.
You can't exercise for three solid weeks. You can't lift
weights for maybe six weeks. It's a costly operation, it is.
A facelift is about a four hour procedure. I did it.
I did one this week less, I guess. I did
eyelids and face in about three. Yeah, that was a

(31:00):
good time for me this week, but usually it takes
me a little bit longer than that. But one of
the drawbacks, of course, the facelift is the cost. So
what if you've just got that turkey gobbler that Shelley
was talking about. It in the neck, just have that,
and you really don't have significant jews or don't care
about gels. So let's say you're a man, because men

(31:23):
don't have as prominent jowls, but they have that. You know,
I've got a little of it. I've got that extra
skin in the neck, you know, and maybe I'd like
to get rid of that, but I don't want to
have a facelift. And one of the problems of a
facelift in men is that scar in front of the ear,
and men don't like to wear makeup right. But also

(31:45):
a facelift will bring hair bearing bearded skin into the ear,
and men know what I'm talking about here. It is
really annoying if you've got hair already in your ear
and now you've brought facial hair into your ear. And
you can't have laser hair removal if you're in your sixties,
because that hair is for the most part white or gray.

(32:05):
We can only zap black and brown hair with laser
hair removal. So now you've got an issue. And those
are some of the reasons why facelips are not particularly
popular in men, but yet so many men have this
stuff in their neck. You know, I'm pulling on my
own the skin of the neck. So what do you do. Well,
there is a fairly simple and straightforward procedure, and that

(32:28):
is a direct excision of that skin. Now, it's not
for everyone. It's not for everyone because you're going to
have a scar that if people look real carefully, they'll
see a vertical scar going down from your chin, down
your neck and almost to your Adam's apple. That's the problem.

(32:49):
There's extra that we're taking out that extra skin. And
then I'm directly looking at those bands, you know, those
platisma bands, we talk about the Catherine Hepburn bands. I'm
directly looking at those and I do a direct platismoplasty.
It's called a corset platismo plasty because you know, like
we you know the old corsets, you know, with a lace,

(33:10):
we lace them up. That's what we're doing. We're using
two layers of stitches in that platisma muscle those bands
in the neck to bring them together to tighten that.
And then I'm suctioning the fat of the neck. Also,
there's usually almost always liposuction involved in this procedure. And
then I've removed a fair amount of skin, and it
could be a half inch wide, it could be an
inch wide of skin. The wider the skin is, the

(33:34):
longer the scar is. So that is a procedure that
can be done under local anesthesia. Now I don't recommend
straight local for most people. Most people do much better
with an anesthesiologist and a little bit of light sedation
keeps you happy, keeps me happy. They watch your blood pressure,
they watch your EKG. It's a better way to do it.

(33:55):
But technically, if you were exceedingly healthy, and if you
were already my patient and we know each other and
I know you're gonna be okay under local anesthesia, it
could be done that way because it's not a painful procedure.
And then we put stitches in and then you know,
here it's the winter here in New York, right, so
it's a perfect time to have this procedure. You put

(34:15):
a scarf around your neck and you can walk around,
you know, a day or two later. Uh, there's minimal
pain from this procedure. And but but there's bruising, Yes,
there's swelling. Yes, that's why you cover with a scarf.
And certainly there's going to be a scar and the scar, well,

(34:36):
most people heal with a pretty good scar, and a
lot of men, now you know that you've got one, two, three,
four days growth of your beard because that looks cool, right, yeah,
so that covers the scar, and uh, it's it's a
great thing for men. For women, I've done them also
that way, probably not as good a choice for a woman.

(34:57):
But if it's that or a FA or not having
a facelift, not having anything, whether it's because of medical reasons,
because let's say your cardiologists would say, well, you know,
a smaller procedure, I'll clear you for it, but not
the full facelift. You know, an hour and a half
procedure we can deal with, but not a four hour
procedure something like that. Or if it's just finances, you know,

(35:19):
we can do it also in a woman and you
can cover the scar with makeup, but you have to
be aware of these things. So you know, there was
a study that was done on a direct decision and
they looked at the risks and the complications, and almost
everybody was happy with their result. There were some revisions

(35:41):
of the scar necessary. There's minimal chance of infection, it's
not an area that has a high infection risk and bleeding. Well,
you know, men are worse patients than women, and that's
the truth. They don't pay attention to the rules. I
had one man get on a motorcycle just a few
days after tummy tuck and he bled afterwards. Of course,

(36:02):
you get on a motorcycle, you're gonna leed. After surgery.
You can't do these things. You have to listen to
your doctor. So but for the most part, UH, the
the complications, the risks are are pretty small and UH,
and it's a very very reasonable procedure. In this particular
review that was done, there were one hundred patients that

(36:24):
had direct excision of that turkey gobbler, and eight of
them had problems with the stitches kind of coming through.
That's not a real big deal. Uh. Four people had
to have some steroid injections for a visible scar. UH.
And there were no cases of bleeding in this series,
no infections, no nerve injuries. Everybody was satisfied. So you know,

(36:47):
it's an option. And UH, these direct excisions the fourth area.
You know, we talk about direct decisions on the face
of you know what we can directly remove, you know,
the nasal abial folds, and you know that skin between
the eyebrows and now the neck. And what's the last one,
the direct thing, it's the festoon. And we talked about

(37:08):
that a few weeks ago. Festu what are festoons? Festoons
are are fat collections and skin collections beneath the eyelids,
So you have your eyelid and then the bony rim
and then if you've got this collection this this almost
like a swelling underneath there. That's called the festoon. And
it's actually pretty difficult to take care of. And there

(37:29):
are many many different techniques. I've lasered those, I've used
al thera. I just used al thera on those a
couple of weeks ago. And in the old days thirty
years ago, people directly excise those, and that is coming
back into vogue because these other techniques, the lasers, the altherra,

(37:49):
those techniques, you know, they're they're successful in some people,
but they're not successful in everybody. But if we excize those,
just cut them out, well, you know they're successful and
almost everybody. But the problem is you've got a scar there.
So if you're not willing to accept a scar, hopefully
it's a good scar men, not a great idea in
this location. Women, You're you're used to putting makeup on

(38:12):
in this area, so it's just another thing to cover.
All right, We're gonna take a short break. I'm Board
certified Plastic surgeon, doctor Arthur Perry, host of What's Your Wrinkle?
Right here on wo R the phone number eight hundred
three two one zero seven ten. Eight hundred three two
one zero seven ten. We'll be back to these words.

(38:34):
Did you know that your skincare may be hurting you
more than helping you. I'm Board certified Plastic surgeon, doctor
Arthur Perry. The foundation for looking good is clean, healthy skin.
So I've created a program that is so simple that
everyone can stay on it long enough to see real results.
It starts with an incredible skin cleaner called clean Time.

(38:55):
It's actually good for your skin. Protect your skin with
my Daytime SPF twenty cream in the evening, feed your
skin with my Powerhouse Nighttime serum. Nighttime has vitamin CNA
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I've created Soft Time with seramides and Vitamin D. Throw
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(39:19):
Join the thousands of people whose skin is healthier. Use
the fifteen WOR radio code on Amazon dot com for
a fifteen percent discount. That's fifteen WOR Radio when checking out,
and enjoy free shipping if you're a prime member, and
don't forget to listen to my radio show right here
on WOR every Saturday evening at six pm. They say

(39:41):
that sixty is the new fifty. But while you may
feel and act fifty, the mirror doesn't lie. But that's
where plastic surgery comes in. I'm board certified plastic surgeon,
Doctor Arthur Perry, and I love helping patients look younger
and better. If you've got sagging cheeks, jowls, and that
dreaded turkey gobbler, it might be time for a little
nip and a tuck. You look more rested and yes, younger.

(40:03):
With my short scar facelift and the artistic injection of
wrinkle filler or a laser peel, well, that might be
just what it takes to get you looking as good
as you feel. Let's sit down for an hour consultation
in my new Park Avenue office. Together, we'll come up
with a plan to help you look your best. Give
me a call at eight three three Perry MD. That's
a three three p e R R Y M D.

(40:25):
Check me out on the web at Perry Plastic Surgery
dot com and don't forget to listen to me, doctor
Arthur Perry, every Saturday evening at six pm. Right here
on WOR.

Speaker 7 (40:35):
You're listening to What's Your Wrinkle with Doctor Arthur Perry.
What's Your Wrinkle?

Speaker 3 (40:41):
And we are back on bord sertivied plastic surgeon, Doctor
Arthur Perry, host of this show for a long, long time.
Tend to do things long. You know, I've been a
plastic surgeon for a long time. I was married for
thirty five years. I've got this radio show for twenty Yeah,
but it's a lot of fun, so stick with me
in twenty twenty five on the radio. But as important,

(41:05):
it's you know that podcast. You know you've really got
to go to straight talk about cosmetic surgery. Click on it, subscribe.
It's absolutely free. All right. So I told you earlier
in the show that I operated. I did a facelift
and I did eyelids on an eighty three year old
this past week and she did just wonderfully. It was
her third facelift. And but you know a lot of

(41:26):
people you might say, well, am I too old for
cosmetic surgery? And I had Mike Royson on a couple
of weeks ago, right, you heard Mike Roysen. Ninety is
the new forty. It's not so much your age anymore.
It is how healthy you are. And if you keep
yourself in good shape, you know, and you can you

(41:47):
can learn that more from doctor Roysen than from me.
But if you do, then you should be able to
have cosmetic surgery even in your eighties. And I have
an expanding number of patients, you know, when there's seventies
and eighties that I'm doing face lips and eyelids and
certainly filler and things like that. So here's what I

(42:07):
do to keep my patients healthy when having surgery, because
you know, I want to make sure that you do
not have a complication, because I'll tell you something, While
you don't want a complication, I don't want you to
have a complication. And what we're talking about the most
important thing, of course, is being sure that your heart
is okay and can withstand surgery, because surgery is a

(42:28):
stress and it's an uncontrolled stress you know, a controlled
stress is a stress test when you get on a treadmill.
So that's what I want you to do, and pretty
much anyone over sixty, I ask you if you're going
to have a significant surgical procedure, one that we're going
to be injecting drugs like lightycain with epinephrine. The anesthesiologist

(42:49):
is going to give you ketamine, which can raise your
blood pressure. All sorts of drugs can do things. Plus
maybe there's a little bit of bleeding or maybe you're
anxious and your blood pressure goes up. We need to
know that your heart is okay with surgery. And if
you have an exercise stress test, and I'm talking about
just getting on a treadmill and having them run an
EKG and it's usually at a cardiologist's office. If you

(43:12):
have that and pass it, the chance of you having
a problem with your heart during surgery is exceedingly low,
almost remote. So I asked my patients to do that.
So that's one. I also think that cosmetic surgery is
a team effort. It's you and me, of course, it's
our anesthesiologist, and it's your internal medicine doctor. And if

(43:35):
you're an adult, you should have an internist, not a
family doctor. Sorry, family doctor's out there. You know. Look,
if you're thirty and healthy, you can have a family doctor,
but if you're sixty or seventy, you deserve an interness.
They're the doctors for you know, adult health issues, your heart,
your lungs, liver, kidneys, things like that. You know those
important things, right. Yeah, So you get an internest and

(43:58):
your interness needs to clear you for surgery, and that
means they examine you. You go in for a history
and physical. You tell them, I tell them exactly what
you're going to be having, and they make a determination
based on your laboratory test, your physical examination, your history,
whether or not you're suitable for surgery. And if they
say no, it's no, that's it. Likewise, if you're going

(44:22):
to have your eyelids operated on, I have you see
anoph themologists before surgery. Very important. If the ofph theomologist
says no, dice, you should not have surgery, then we're
not going to operate on your eyelids. Also, I ask
you to have blood pressure well under control. I like
it under one hundred and thirty because the rate of

(44:42):
bleeding after surgery, whether it's eyelid surgery, facelook surgery, breast surgery,
tummy tucks. The rate of bleeding goes up dramatically if
your blood pressure is over one hundred and thirty, and
a lot of a lot of cardiologists will say, well,
you know you can tolerate one hundred and forty. Yeah, you,
but we have no cushion of safety if in the

(45:03):
operating room your blood pressure then decides to go up
to one hundred and sixty or one hundred and seventy.
So we really want it well controlled. I want it
under a hundred and thirty. I don't want you to
have blood thinners. You can't have open surgery if you're
on blood thinners. I'm sorry. I can do filler and
botox and things like that, but if you're on cuminin
or some of the newer things aloquist and things like that,

(45:24):
not a great idea to have surgery. And you say, well,
i'll stop it for a few days, Well, why are
you on it to begin with? You're on it because
vetro fibrillation, or on it because you had a blood
clot or something like that. Is it really worth the
risk to stop for you know, a week or two
around surgery. I don't know. I don't like that idea.

(45:45):
I also want your blood sugar to be under control.
So if you're pre diabetic, you know it's got to
be your hemoglobin A one C really should be under
six or so. If you're looking at elective cosmetic surgery,
now remember if you're going to have surgery with a
general surgeon, if you need your gallbladder operated on, if
you need your esophagus operated on, or something like that,

(46:06):
you need a heaven forbid a mess sectomy or something
of that nature, you have to accept some problems, medical
problems and higher risk. But we don't with cosmetic surgery.
We do not want to accept higher risk. We want
to keep you safe. And it's not really a fair
thing to operate on you if you've got lots of

(46:26):
medical problems. And even if you say, well, I'll accept
the risk. No, No, You know the surgeon is like
a parent in this situation. You know you wouldn't let
your kid do something silly, right, Or like an accountant.
You know your accountant is supposed to keep you from
doing something with your money that's dangerous, right, Or your
lawyer that's what the doctor, your plastic surgeon should say no.

(46:50):
And if your doctor is not willing to say no,
well what can I say? You know, I say no
all the time because I don't want to accept higher
risk for you, all right. We also want to keep
you safe in the operating room with what's called DVT
profile access. A DVT that's a blood clot in the leg,
a deep venus thrombosis. We always think about that because
you could have a normal heart surgery can go just

(47:12):
perfectly fine, and you're lying on the operating room table
for six hours and you get a clot in your
leg that goes to your lungs and that can be
even deadly. So we want to be very careful. We
want to keep surgery time down. So what does that mean?
So if you're younger, you can tolerate longer operating times,

(47:33):
but when you're older, your body doesn't tolerate it. So
this is one where there is a correlation with the
chance of a blood clot and how old you are
so and also how long you're on the operating room table.
So I try and keep if you're over seventy five,
I really try and keep surgery under four hours. So
that means sometimes saying, Okay, we're going to do a

(47:55):
facelift one day and then come back a few months
later for your eyelids and a lot of plastics are as.
We'll say, well, you know it's a little higher risk,
let's do it. You know, my attitude is it's I
want to do what's the safest for you. And if
that means, you know, losing some patience to other doctors,
will so be it. If that means that you might

(48:15):
not have your eyelids done ever, well that's the way
it goes also, but I've kept you safe. That's how
I am. Not everyone is that way, but you know
I think they should be, so we want to keep
the the time down. Also, little things like drains. You've
heard of drains being used in surgery. They're two way street.
Bacteria can go in, well you know, drainage can go out.

(48:38):
So I use them only when absolutely necessary. So tummy
tucks they're necessary. But pretty much all the operations I
do other other than that, facelifts and breastlifts and things
like that, I don't use drains. And now there's a
lot of discussion there, and your doctor may use drains,
and they're they're not wrong. There's different ways to do things.

(48:59):
And if your doctor feels more comfortable with drains, you know,
you go with the doctor and you leave the driving
to the doctor, leave the flying to the airplane pilot. Right,
But there's different ways to do things. I try and
minimize those things. So that's my formula for trying to
keep things as safe as possible. If we do all
those things. If you're clear for surgery, yeah, you can

(49:19):
even have a facelift into your eighties because, as my
good friend Mike roys And said, ninety is the new forty, right,
And if you're eighty and very healthy, chances are really
good you're going to live well into your nineties. So
that's great. So we can, but we have to be
very careful, all right on board. Certified plastic surgeon, doctor
Arthur Perry, host of What's Your Wrinkle right here on

(49:41):
wo R and So I do almost all cosmetic surgery.
My practice is ninety nine percent cosmetic surgery. I do facelifts, eyelids, rhinoplasts.
Those are nose jobs. Although that sounds so bad, doesn't it.
You know, rhinoplastic much better word. Nasalry shaping that works. Also,
I suction fat that flip a suction. I do tummy tucks,

(50:01):
I do breast surgery. I make breasts larger, I make
them smaller, I lift them, and I do all sorts
of ancillary procedures. And hardly a day goes by that
I'm not injecting filler. I love injecting filler. By the way,
there's a lot of plastic surgeons that don't like it.
I've made an art form out of it, I really have.
And I pretty much every single day I'm doing one
or two people. And I don't delegate it to a

(50:25):
junior associate. I don't delegate it to a nurse. I
do it myself and we spend our hour together and
sometimes longer. And you know, the hardest part of is
having to listen to me drone on and on, and yeah,
you're listening. If you're my patient, you know exactly what
I'm talking about. But when I'm not doing cosmetic surgery,
I do have patients for a long time. Usually it's

(50:48):
my existing patients that will call me up and say,
a dermatologist just diagnosed a basis cell carcinoma on my forehead.
What do I do? What do I do? Do? I
did it? The dermatologist did a biopsy, a little took
a little piece and it's a basil cell carcinoma. I'm scared.
What am I gonna do? And okay, so let's talk

(51:09):
a little bit about it. So, basil cell carcinomas are
the most common cancer, and some people don't even like
to call it cancers because they don't spread. There, you know,
don't be afraid if you get that diagnosis that you
have a basil cell carcinoma. There. The way I look
at them, they're nuisances as opposed to problems. And if
you've lived long enough, you know exactly what I'm talking about.

(51:30):
There are problems in life, and then there are nuisances
in life. And this is a nuisance. And so is
that siren you hear outside my upper west side window.
All right. So, so it's a nuisance, and it's a
nuisance that you have to take care of because if
you don't take care of it, if you if you
wait long enough, if you ignore it for three or
four years or so, it could be a problem. And yeah,

(51:54):
there are people that can die from basil cell carcinomas.
But those are people that neglect those for years and
years and years, and these little tiny things in their
skin become the size of a golf ball. That's not
what you want to do. And I think a sophisticated
audience that's listening to this program would never do something
like that. So let's say you are the sixty year
old woman who just had the basis sell carcinoma diagnosed

(52:17):
on your forehead. It's a little thing, it's not a
big thing. And the dermatologist says, you know, I will
do Mo's surgery and then I'll put things back together.
And the patient says, to me, what do I do?
Is that a good idea? So let's talk about that.
So what is Moe's surgery? Mo's. That's the name of
a man, by the way, doctor Mo's, So it's not
an acronym for anything. It's a guy first described this

(52:41):
technique of removing skin cancers and looking under the microscope
right away, like immediately, so you're still in the room.
The doctor takes the specimen, their technician processes it, and
in fifteen minutes he's looking under the microscope and he
looks to see what's left behind, and sometimes the doctor's

(53:03):
lucky and they got it all in one shot and
that's it. Now we just have a hole, a wound
that has to be closed. So when is it appropriate
to do to do most? Well? First of all, eighty
five percent of basil cell carcinomas occur on the face.
What do they look like? A lot of you have
had those? You know they're kind of waxy, little dots,

(53:26):
a little pearly, some some erode. They also some bleed.
If it's been there for more than a few months,
you know there's a reasonable chance it's a basil cell carcinoma.
So it's biopc first, and then the techniques are for
the most part, either that mos technique where the dermatologists
will excize it, or what's called a frozen section where
I will go into the operating room and do basically

(53:48):
the same type of thing as a mose surgeon and
do frozen sections. They tell us right away did I
get it all? And then I will close it. If
the dermatologist has done the most as a dermatologists will
want to close it, I think I'm sorry. I'm a
plastic surgeon. Plastic surgeons are the masters of making things
look as good as possible after something's been removed. So

(54:12):
I encourage my patients it's okay to have the most surgery.
Go to the mo's doctor and then walk over to
my office. We coordinate this and I will close the
wound in the office, and that's what we're going to
be doing for this woman. Sometimes it requires a flap
or a skin graft or something like that. We'll do
that over at Manhattan Iron Ear.

Speaker 6 (54:30):
Uh.

Speaker 3 (54:31):
And that way you get if you want the MOS
most is appropriate on the eyelids, I mean, I think,
and I send people to dermatologists to do the most
procedures all the time. If it's on the nose, on
the eyelids and the lips, cosmetically extremely sensitive areas, and
it's good for you to know that they will have
removed the smallest amount of skin possible and then I'll
put things back together. You get the best of both

(54:54):
both worlds. So that's how I often do it. It
has to be well coordinated between the armatologist and the
plastic surgeon. So that's the story with MOSE And if
you have those, give me a call. I'm board certified
plastic surgeon, Doctor Arthur Perry here every Saturday afternoon evening
at six pm, six to seven, But in a couple

(55:15):
of weeks we go six to six thirty. We're changing
our time. It's only going to be a half an hour.
So if you do want to call, I know everybody
you know, you call at the end of the show.
You can't. You've got a call at the beginning. If
you're interested in the products we talk about on the show,
it's Amazon now. The store is on Amazon. You can
go to doctor Perry's dot com and you click and
it brings you to Amazon. And I have people tell me, well,

(55:36):
I don't have an Amazon account. You got to have
an Amazon. Everybody has an Amazon account, right, So go
to Amazon. You can buy the products. They've got the
subscribe feature, they've got all the discounts. That's what you
want to do. If you're interested in me Perry Plastic
Surgery dot com. That's the website and the phone number
two one two seven five three eighteen twenty two one

(55:56):
two seven five three eighteen twenty give me a call.
Happy to see you and help you look better and younger.
All right, thanks Noah for great engineering. We'll see everybody
six o'clock next week, Stay warm out there in New York.
Bye bye now.

Speaker 1 (56:11):
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the ideas expressed