Let's Be Honest with Kristin Cavallari - All Implants Are Silicone

Episode Date: June 18, 2024

Join Nashville's best plastic surgeon Dr. Jacob Unger and I as we go in-depth about facelifts, all the different types of boobs jobs, BBLs and mommy makeovers, labia reconstructive surgery, what procedure hurts the most, and Hollywood's current surgery obsession. Plus, the Hollywood surgery he thinks isn't worth the hype and the next big trend in plastic surgery. A word from our sponsors:LMNT - Get a free Sample Pack with any drink mix at DrinkLMNT.com/HONEST. And if your an LMNT INSIDER, you have first access to LMNT Sparkling - a bold, 16-ounce can of sparkling electrolyte water.SKIMS - hop SKIMS T-Shirt shop at SKIMS.com. Now available in sizes XXS - 4X. If you haven't yet, be sure to let them know I sent you! After you place your order, select "podcast" in the survey and select my show in the dropdown menu that follows. Smartwater - Life's full of choices. Smartwater is a simple one. Visit drinksmartwater.com to learn more.Bon Charge - Go to boncharge.com and use code HONEST to save 15% off my favorite Red Light Face Mask and other wellness products.Rhoback - Use code "HONEST" on Rhoback.com for a generous 20% off your order through the end of this week.Hero Bread - Keep the carbs out of summer without compromising flavor with Hero Bread. Get 10% off your order at hero.co and use code HONEST at checkoutProduced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The following podcast is a Dear Media production. This is Let's Be Honest with Kristen Cavallari, a podcast all about getting real and open on everything from sex, relationships, reality TV, wellness, family, and so much more. And just a fair warning, there will probably be some oversharing. Welcome in to Let's Be Honest. I'm your host, Kristen Cavallari, and I have Nashville's number one plastic surgeon at my house, Dr. Unger. Thank you for being here. Thank you so much for having me. This is such a treat. This is going to be a good episode because we're not going to hold back. And I know that plastic

surgery is such a hot topic for so many people. People have a lot of questions about this stuff. So we're just going to dig into it all. Absolutely. Let's do it. Is it true? Well, I always thought it was true that plastic surgeons specialized in one thing. Like I know a lot of plastic surgeons do everything, but aren't a lot of people known for like noses or boobs, but you're good at everything you do. Like literally everything. That's sweet of you. It honestly changes based on geographic area. So, you know, New York, LA, and now more so in Nashville, as markets kind of mature, we find that people tend to try to get known for one thing to try to build a practice there. I see. I mean, if you have good training and most

of the training in the US is good, you should get well trained really across our field. Okay. And then you tend to find what you like to do. And so, yeah, you know, I have things that I definitely do a lot more of and things I do less and less. What are your favorite things to do? So I do a lot of breast surgery, a lot of like mommy makeover type stuff, breast and tummies, and then a lot of facelifts. Those are kind of the two boats that I play in mainly. Okay. There's so much I want to say. In my head, I think what makes the most sense is instead of going like the Botox filler route, doing a facelift. What age do you recommend doing a facelift at? So loaded question, but I actually agree with you. And there is a role for small

things because sometimes we only need small touches and tweaks and that makes sense. But as you continue to age, aging is really two things, right? Facial aging, it's volume loss. You lose fat in your face as, as you age, the thinner you are, the faster you'll see that might see some of like your heavier friends that look a little younger as they get older. Right. And then of course, tissue falls. Right. And so once you start to see that change, the best time to do it is really as it's beginning to bother you. Okay. Because your tissue is stronger. The change is more subtle. It's a longer lasting result. Okay. And so you can kind of maintain yourself in a more natural, harmonious way if you do it on the younger side. Right. Because that's like

Hollywood secret is people getting facelifts before it's too late or not too late, but before it's noticeable. Before it's crazy noticeable. Yeah, exactly. Totally. And then do you just do one facelift or is that something that you have to do multiples of as you age? Right. So let's say I start at age 45. So listen, you know what? What I always say is that a facelift is permanent in that the improvements you get are going to be there forever.

Now, that doesn't mean that you stop aging, right? So things will continue to move. But when you're 60, you'll look a lot better if you had a facelift at 50 than if you didn't. Okay, right. But there might be enough new sagging and volume loss that you'll want to do something again, right? And so, people… That's like my boobs. All of a sudden, I'm like, why are my boobs sagging again? You know, gravity's pretty tough to beat. I mean, it's… Yeah, really, that's a tough one. So, you know, it's a totally Hollywood secret. And the people from, you know, that kind of group that I get to see from time to time, I have performed third and fourth facelifts on people who aren't that old because they've just maintained.

They've just kind of looked great forever. Right. They never seem to age, right? What's the recovery like on a facelift? Because it scares the shit out of me. Oh, well, it shouldn't because it doesn't hurt me at all. So what I like to say about a facelift, it's really, it's a longer, delicate, tedious procedure,

but there's very little blood loss. And the recovery is pretty easy. You don't use your face for much, right? So your arms and legs work just fine. Yeah. My patients are up and moving the day of surgery. I want you, you know, going to the bathroom and walking around the house immediately. And this is a full facelift.

Full facelift. Okay. Full deal. Okay. And the swelling and bruising is really minimal. And the pain is really minimal. It's probably the least painful big surgery we do. Really?

Yeah. I thought when you did the lower, like you can't even open up your mouth for a while. Well, I don't want you to like chomp a steak that night. Okay. Because all the musculature in your neck and the, you know, a really good facelift or a facelift that's going to last is done on what's called the deep plane or the deeper layers of the face. Because pulling on the skin, like what you did in the nineties, giving that like, you know, smushed back look. So you're like pulling on the muscle. It's all the muscle.

It's all the deep stuff. Okay. Whoa. Oh, so back in the day, they only touched the skin. Yeah. In the old days. Oh, wow. Like those silly pictures you think about from like socialite to New York in the 80s.

Yeah. Like super pullback face. Whoa. Because we didn't quite understand what was really happening. So now you have to cut the skin, of course, to access everything. But the skin, a little skin comes out because the deep face is moving back up, but that is not the point of the surgery. It's all the deep stuff. And so you move all of that back and then it just lies in a nice, natural, more tight position. So it's the muscles that you're really pulling on.

So you don't want to chomp a lot or like do a podcast that day. Maybe wait a day. Maybe a week. Because you want to let all that stuff kind of heal into its new position before you overly stretch the muscles. Okay. That makes sense. So you're literally sewing the muscle. Yeah. And then where are the scars for a facelift? So super hidden, right? They tend to go, you know, to some extent around, they change for each person. So for me, I really try to individualize everything, including where the deep tissue goes, where the skin goes. But in general, it goes around the ear, usually behind this part of the ear, the tragus. Oh, inside of the ear.

Right on the inside here. Oh, wow. Oh, my ears are cleaning. Yeah. And then around the ear lobe. Okay. And then the crease behind the ear here. Wow.

And then like along the hairline or into the hair a little bit here. Oh, wow. So that's for lower. And so a lower facelift allows you to access the jawline and neck. And then a quote unquote full facelift really just means that incision goes around the ear and that gives you full access to the whole cheek. Okay. If you think about, you know, the forehead or the eyebrows, that's a brow lift or a forehead lift. Oh, that's not considered a facelift. No. Yeah. Oh, okay. So a facelift is or the eyebrows. Yeah. That's, that's a brow lift or a forehead lift. Oh, that's

not considered a facelift. No. So, yeah. Oh, okay. So a facelift is just the lower. Yeah. The facelift is kind of the mid face and the jawline and the neck. Oh, I see. Technically speaking. Okay. So the, right. So this is, you're going to be a doctor by then. I know this is so informative. I'm learning so much. So if you want to raise your eyebrows, that is a brow lift specifically. And those scars are up here, right? Correct. And there's a handful of different techniques, of course. But in general, it's a small incision buried in the hair that allows you to get a little lift. You know, again, what you want to do is get the tail of the brow up like that pretty elegant shape. Nobody wants to be super surprised. You don't want to pull in the middle. Again, the 90s

overdone quite a bit. And now it's really all migrated to kind of just that lateral or that side temple region. Interesting. And then what about the eyelid surgery that everyone's doing right now? That's really popular in Hollywood. Yeah, for sure. So what is that? So the technical term is a blepharoplasty. We have fancy words for everything. But so the brow is kind of the stabilizing. That's the footprint of the eyelid, right? Because you think about the brow skin that kind of blend into this. So part one,

make sure the brow is in the right position. If it is already, then you're fine. If it's a little low, it might need to be lifted. Okay. And then the extra skin and possibly a little bit of fatty tissue that pooches out around the eyelid. Yeah. You make a little incision in the natural little crease, cut out a little skin, little muscle, sew it up. Oh, my God. It gives me the heebie-jeebies. I do these awake all the time. No.

It takes 25 minutes. No. People go drive themselves home. Awake? Well, I don't want them to drive. Yeah, awake. Like watching it happen? Well, you can't.

It's on the top of your eyelid. I mean, I got LASIK eye surgery and that about put me out. Okay, no, but that's your eyeball. We don't offer eye balls. Yeah, but just like if I'm like my eye was open, I was me out. Okay, no, but that's your eyeball. We don't offer eye balls. Yeah, but just like the fact that my eye was open. No, so your eyes are closed for it. Okay. I mean, I tell stories.

It's like a whole thing. You got a comedy show. Wait, that is wild. And then you can do underneath too, right? Yeah, and then there's a lower buffer plaster, a lower eyelid surgery. Okay. Which is usually a little different because what tends to happen here, you know, those deep circles and those lines, that's really where you start to see facial aging, right? And so as your cheek, which is not

happening on you because you're perfect, but as your cheek falls down and the fat in this part of your face starts to fade away, the bone becomes like more visible and you get that circles and those creases. So I like to take a little bit of your own natural fat, add it back in to this area. Oh, cool. Wow. And then sometimes there's like the puffiness here. Yeah. That's from a relaxation of the eyelid itself, like just stretching out just like the neck stretches.

Oh, wow. And so that's, you go inside of the eyelid. Now you're going to get freaked out. You go inside of the eyelid and pluck a little bit of the fat out from around the eyeball. It helps smooth that back out. Holy shit. So there's no scars. And then usually for most people these days, unless you have lots and lots of extra skin, from around the eyeball. It helps smooth that back out. Holy shit. So there's no scars. And

then usually for most people these days, unless you have lots and lots of extra skin, you don't even cut skin out here. You might do a laser. You might do radiofrequency. You might go needling. Okay, yeah. You might do a chemical peel. Something to just kind of smooth that skin out and improve the tone and texture. Wow. I didn't realize so much went into that. Yeah. Lower lids are more complicated than upper lids as a general rule. And like, so when can everyone go back to work after these procedures? Well, it kind of runs the gamut, right? So if you do your upper eyes, like I say, if you come in, you can come in.

I do those in the office. If that's all you're having done, people go back to work. If you have a desk job, might work from home the next day. That's it? Oh yeah. There's no downtime. Whoa. No, I don't want you doing push-ups or headstands, right?

For a little while. Yeah. You might get some bruising because it's very delicate skin. Okay. Stitches are out by day five. Wow. And so, and with a facelift, well, let's say you do the whole thing, right? But you're young and you have good tissue.

The older you get, the kind of more swelling you get because your skin's not very strong, right? It can't press back against the body's natural tendency to swell. Yeah. So for most people, and we'll get to the average age in a minute. I know we're all dying to hear. But for most people, I say you're restaurant ready, meaning you could go out to dinner with girlfriends or whatever in like, you know, a reasonably lit restaurant

and no one can tell at two weeks. Oh, wow. But how long does it take for it to be 100% the swelling? So camera ready? Yeah. Six weeks. Okay. But I mean, that's not bad. I mean, the scars are hard to see. And I always show people on my phone, I pick the consult or the post-ops that came in from that day to show them not like the best ever. Just this is what it looks like at six weeks for my patient from six weeks ago. Every time. You can't see them. I mean, they're gone in two weeks. Yeah. You really can't. I mean, I know a few people who, well, I would imagine you do. Yeah. I know a few men who have

had facelifts. I love doing male facelifts. Do you? I think they're more common than people think, right? They should get more. I mean, yeah, you know, they are. I'd say it's in my practice, it's probably the number one surgery I do on. Oh, interesting. Okay. Let's talk about Boncharge. Boncharge is a holistic wellness brand with a huge range of evidence-based products to optimize your life in every way. Founded on science and inspired by nature, all Bon Charge products adopt ancestral ways of living in our modern day world. Their extensive range of premium wellness products

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a bold 16 ounce can of sparkling electrolyte water. And then, okay, let's talk about boobs. Let's talk about it. Okay. And everyone's going to ask. Big fan. Big, big fan of boobs. You did not do my boobs.

However, when I redo them, I'm coming to you. I've seen two pairs of your boobs and they're both phenomenal because they look natural. They just look perfect. So explain the different types of boob jobs that you can have because there are quite a few. Oh, for sure. And again, for me, and I guess part of what I'm known for, one is natural results that are designed to kind of fit your body and fit your frame and work with what your natural anatomy allows for.

Yeah. And then two, you really have to tailor the surgery to each patient's needs, right? And so a youthful breast, just like a youthful tummy or youthful face, is making sure the skin envelope matches kind of the deeper tissue, right? And so a youthful breast, just like a youthful tummy or youthful face, is making sure the skin envelope matches kind of the deeper tissue, right? If you have too much skin and not a lot of boob, then that's like a saggy, hangy, like not filled, not taught, not youthful shape. Which is when you need a lift, right? Correct. Yeah. Right. So see, you are a doctor. Because I had one. I'm okay to say that. So, you know, we want to make sure everything is balanced in the right position.

We want to make sure there's enough volume. So there's a couple of ways to get volume back into the breast. There's fat grafting and there's breast implants. Fat grafting. You just take your own fat and put them in your boobs? What? And it looks great. It feels great.

It's smooth. It's all the things. It's all the things. It's wonderful. But it's really more adjunctive. meaning that can help from contouring and shaping. You can't build what we call core volume. It's kind of like sand on a sandhill, right? I see.

You can't just squirt a bunch in there. If that worked that way, we would never use implants. Okay. Right. But to give real shape and kind of give a new projecting breast, you know, after children, a lot of times people have no breast tissue left. It's gone. I remember bending over just like loose skin and I was like, Oh God. Uh, you know, listen, it's, it happens to everybody. Right. And so if you want to recreate some volume and make sure that it's obviously when you place a breast implant, you

know exactly what you're getting. Fat is a little bit, a little more delicate and there's a little bit more nuance to it, but it's a lovely way to kind of improve shape and contour. But real volume is an implant. And then of course, there are multiple types of lifts. I do probably six or seven different approaches depending on what's going on. Okay. What are this? I only know, like I know I've got like the one scar down, but then I know there's also the anchor underneath. What's the difference between those two? Why do one over the other? Well, so it kind of depends on where the nipple is positioned, how low on the breast it is,

how high on the breast it is, how much extra skin there is in both directions. This way and this way. Right. Right. And so if there's too much skin from, you know, your neck down to the bottom of your breast, if you just, this is, we're getting into geometry, but if you take the breast and just narrow it in this way, it's still going to be too long of a breast. So you can use the fold and tuck in that skin and shorten the breast that direction.

Do you take the nipple and like literally put it in a new spot? You do, but it doesn't come off. Oh, okay. People think like the nipple comes off and you stick it back on like a sticker. Okay. That would be insane. That actually is a thing that can be done, but it's not done very commonly. That's so wild.

And you do that with extremely large breasted women. I mean, you're talking about watermelon. Like a reduction that are so large. Because you have to keep the blood supply and the nerve supply alive to the nipple. Right. You need to cut around it. That's why there's always a scar all the way around. Yeah. So it can be loose within the tissue and move it and then sew it into new spots.

You have to make sure blood flow, like the roads need to be connected from the heart on their pathway to the nipple. And so you have to keep it connected in some way and there's a multitude of ways to do that. And that's why we have anatomy. You know, I say what we do is art bounded by science and anatomy. So I have to, I can't just draw whatever picture I want. Unfortunately, I have to use, you know, what the body will allow me to do to do that. So depending on how far the nipple has to move, how much extra skin there is, the scar pattern changes. Okay. That makes sense. It's tailored. Yeah. And what kind of implants do you like? Are you saline?

Are you silicone? Yeah. So that's a great shape. Like, aren't there like the teardrop shape? There were. So not in the US, they're essentially gone. So I almost got them. And my doctor was like, they can shift. And if they shift, it looks fucking crazy.

So thank God I didn't get them. Yeah. So I was really fortunate. I did a lot of research years ago on those implants. I worked in Europe for a little while where they had those implants 10 years before we had them. Yeah. So I was really fortunate. I did a lot of research years ago on those implants. I worked in Europe for a little while where they had those implants 10 years before we had them. Oh. So I got to see the 10 year out problems. So, and they were moving. Is that what it was? They can shift a lot. They can, they can give what's called a double capsule.

What does that mean? It means, so scar tissue naturally forms on our breast implant. Yep. Just like it does around the knee, artificial knee or a pacemaker. Yep. The body just puts scar tissue around any foreign body. Yeah. It's not a problem. It's just natural. But because the shaped implants had to stay right where you put them, so they're kind of sandpapery.

Okay. So it's called texture. And texture is essentially gone in the US for a variety of reasons. If that texture was stuck under the muscle and then you do something super active, it could kind of tear like Velcro. Oh, wow. And cause there to be a fluid collection and then a new layer of scar. So you have two capsules. Dang. And we saw that a lot as time would go on. And what does that look like? Like externally? Yeah. Can you tell? If the fluid collects, it can get swollen. Because I feel like the tops of mine are really swollen. Like, I feel like it's like scar tissue, though.

Do you think? It could be. Yeah. Yeah. You know, I mean, and so that scar tissue can become a problem. Yeah. If it's something called capsular contracture, which I think all women need to know about. I talk about it in 100% of my consults.

Yeah. It's the most common complication of breast implant surgery. It's not dangerous. That won't harm your health. But it's where that scar tissue gets irritated. And then it kind of gets extra thick and extra tight. It makes your breasts hard. I mean, they're not hard, but like they're like puffy at the top.

And I feel like if I really massage it out, then they'll like lay better. I know. Maybe I'll have to look. After the video. Yeah. But is there truth to, because like back in the day, wasn't the whole thing like you had to get your boobs redone every 10 years? I still don't know the answer to that. Is that true? No. It isn't. And that's a beautiful thing. So saline silicone, number one, everyone should know that all implants are silicone. Okay. But the difference between the two is whether there's salt water inside or silicone gel inside. Oh. Okay.

In the old days, in the olden days, you know, 90s and early 2000s, the shell or the covering, the sack, was thin and tended to break more easily. Saline tended to break more easily because they have more ripples and wrinkles because it's just water inside. Got it. The silicone gels, the old version was kind of like shampoo. So if it broke and you left it alone, it could leak.

Okay. Right, yeah. And again, that leaking could cause some local tissue damage even and it'd certainly be kind of messy. Yeah. So because of the data we have, we say we should just change them in 10 years,

try to head that off, make sure the rupture rate was lower. Okay. But the silicone implants that most people use nowadays, they're gummy bears. Have you heard of that term? Yeah, I have. So it's like a cohesive gel or basically a solid gel. So if it's split, it doesn't like seep out. I think that's what I have. You can cut it in half and just sits there. Okay. Yeah. So in those implants, you don't need to be as concerned. And the rupture rate is much, much lower. Because the reason they would break, it's called a shell fold failure. That would be full.

I know, I'm getting so technical. I don't know how to not. I'm trying to be normal, I promise. When that circle folds over and it kind of rubs on itself back and forth, like after a decade, it could like crack, right? Okay, right.. But now since they're firmer, they don't tend to have those, those issues. Got it. And so they tend to not break. Okay. So the advice I give my patients is, you know, we're going to check you. I'm going to follow you forever. I'm your doctor forever. If there's a difference or a change or something we need to evaluate, you know, the, the FDA has

some recommendations on monitoring for MRIs or ultrasounds. We can do all of that. But if there's no changes and there's no problems, you don't have to just go swap them out like an oil change. Okay. That's nice. Yeah. I mean, again, because mine are seven years old and I do all of a sudden, I'm like, you know, they aren't laying how they used to. So I guess if it's more like just a cosmetic. Right. And so here's what I tell most of my patients. Aging is a bitch. Yeah. Implants have gotten so good.

Yeah. That the reason why you're going to want surgery is probably not because of your implants. It's because of gravity. Yeah. And skin changes. Yeah. No. What was nice, cute, and tight is no longer not as cute and as tight.

Yeah. And so you're not going to leave old implants in, obviously, if it's been 15 years. We're not going to be like, leave those old things. We'll just cut around it. We'll get you some freshies. Yeah. Yeah. Fresh so you're not going to leave old implants in. Obviously, if it's been 15 years, we're not going to be like, leave those old things. We'll just cut around it. We'll get you some freshies. Yeah. Yeah. Freshies. Some freshies. Okay. Yeah. I love that. That's my new tagline. Come in for some freshies. We'll get you some freshies here at Dr. Unger's. Okay. What are, okay. So the top surgeries you do, you said facelifts and like a mommy makeover. Yes. So mommy makeover is boobs and tummy tuck, right? And then a lot of times people will take their fat and put it in their butt too,

BBLs. How common are those? I think it depends on your practice. I mean, so a mommy makeover in my mind, it's really just restoring your own natural shapes and giving you back, you know, the sexiness that you deserve and helping to fix things or put things back in the place that you can't do on your own, right? You can't exercise away extra skin. You can't exercise your abdominal muscles all the way back together if they're really wide. Oh, so do you, you like fix abs? Like you like sew them back together if they've split? Oh, interesting. And that's because when you get pregnant, you know, the rectus, right? The central ab muscles, your six pack, split apart. And they don't usually quite

get back. They never do. No. Oh, interesting. Oh, I didn't know that. Yeah. And so, you know, a lot of moms have like low back pain all the time and feel like bloated after meals and you can do Pilates till you're blue in the face. And listen, some people are super lucky and they come all the way back together. Most people don't get that lucky. Yeah. And so you can repair that muscle wall. And all of a sudden, you have your core back. Oh, wow. You do a plank.

It feels good. You know, that sense that women have, like their guts falling out when they're upset. Yeah. That goes away because you put everything back together. Wow. Oh, my gosh. And sometimes people have, you know, extra fullness on their sides and they have extra fullness on their hips.

Whatever it is, it's really an all-encompassing term to allow you to do multiple different procedures to give you back what you're looking for. And so BBLs is something you can do, right? Yeah. And for me, that is, it's a smaller subset. I do, you know, again, with my aesthetic, it's a little more athletic. It's kind of softer, more natural. So call it a skinny BBL or athletic BBL. It's really just taking some of

the fat that we suction out to help get the right shapes and contours in the tummy and maybe the backside and then using it to help fill in kind of the hip dips or just to create a little bit more shape and contour. Okay. Just, just a touch, but the recovery on the BBL is pretty intense, right? Cause you can't sit on your butt for like two months. It's pretty annoying. How do people function? Like what? Both six weeks. Oh, okay. And you know, when there's a will, there like two months. It's pretty annoying. How do people function? Like what? Well, it's six weeks. Oh, okay. And you know, when there's a will, there's a way.

Yeah, I guess. You can sit on your hamstrings on a stool. Okay. We have these little like pillows to help and little setups in your bed. Damn. It is the one kind of difference maker for me. Like when we're talking about the recovery

and then if someone wants to talk about that, I do take pause like, okay, things just got a little bit more annoying. It doesn't necessarily hurt more. It's just there are less positions you can safely be in, especially if you had a tummy tuck and your breast under your stomach. It's a lot. So if you're like just getting like some huge butt down in Miami, then you just like sleep on like your stomach, like a starfish for six weeks.

Just laid out for six weeks. I mean, how do you go to the bathroom? Well, I'm like, everything still works normally. I need to know the logistics. Everything still works. How do you sit on the toilet? Yeah, you're allowed to sit for like a second. Okay. Yeah. I mean, what I really warn people about is I don't want you getting on a super long flight on like a hard chair and sitting on all that fat. I don't want you driving your car for a long period of time. Okay, right.

If you think about the way you actually sit though in a chair, you sit on your sits bones, right? Those are just the bottom of your pelvis. That's not where you're adding fat because you don't want like a dumpy butt. Oh, I see. Right. So it's more of the top, more of the sides. So it's more like side compression or sitting back against something for long periods of time that you don't want to do. Okay. That makes sense. All right. Noted. I could use a BBL, but I don't think I'd ever do it. I'm just going to keep doing my squats. I think you're okay. Yeah. Just keep squatting it out. Yeah. I try really hard for that little bit. What about labia reconstructive surgery? Do you do that? I do.

Yeah. Do you? Yeah. What's the recovery like on that? It's super easy. It's actually shocking. So what do you do for that? So, you know, again, it kind of runs the gamut, right, of needs. I don't do like vaginal reconstruction. Well, what's the difference? Good question. So the inner portion of the vagina, kind of the vaginal opening or the introitus, that can be stretched out. You can have tearing during childbirth, things like that.

That's kind of sewing the actual pelvic floor back together. That's more functional. I leave that to OBGYNs and reconstructive gynecologists. But a labiaplasty, which is typically refers to, it can be, you know, the outer lips or the inner lips, mostly the inner lips. And, you know, there are a lot of issues that come up over time. It can be from childbirth. It needs to be natural.

It can be very uncomfortable to ride a bicycle or if they're extremely long, ride a bicycle or ride a horse in our neighborhood, right? Yeah. Or uncomfortable in yoga pants. Yeah. Pain with intercourse. Oh, wow. So essentially, it's a fairly straightforward procedure.

You know, the hard part of really everything we do or what really matters is kind of, my opinion, the aesthetic eye of the surgeon, whether it's facial shape or, you know, any contour. You want to just remove some of the excess m whether it's facial shape or any contour, you want to just remove some of the excess mucosa. It's just like mucosa inside of your mouth. And you just do it in a couple of different layers and remove it so that- Is it like a cut? Like an actual cut? Yeah. Yeah. You trim it away and then you sew it up in a couple of layers to make sure that you don't take too much out because then you can have vaginal dryness and a bunch of other problems.

But you remove enough that it alleviates the symptoms. And there's no harm, no downside to that. Like we don't need all that skin, I guess. No. But again, you can overdo it and then there's a problem, right? Because it's protective and it helps, you know, maintain a moist environment and all these important things. But people that come to me for it anyway, it's typically, it's a functional issue or a sexual issue and there's just kind of too much. It can be stretched out from a variety of reasons, like you said, like childbirth. So you're just trying to clean it up a little bit,

just like a little extra skin. And how is the recovery on that? You know, I don't really do it commonly alone. It's typically in conjunction with a mommy makeover or something. And so it's such a small procedure. People literally don't complain at all. Really? I guess if you've had a kid, you're like, that's right. So like a little spray post going to the bathroom, some cool packs. It seems like after having a baby. It's completely healed. It's mucosa,

meaning inside the mouth. It's super vascular. It heals incredibly quickly. Within a week, the stitches are all dissolved. It's gone. You can't see anything. They're just done. You have to wait a little while to have sex. Six weeks. So it's like having a baby. Yeah. Wow. It's so interesting. You really do it all, Dr. O'Gara. Look at you. Okay. What is the hardest recovery and then the easiest recovery out of everything? That we've spoken about? Well, no, unless you have something else that you want to tell us. Hardest, most involved recovery is going to be mommy makeover, an involved one with a tummy tuck. Obviously, BBL adds an extra layer of difficulty on there. What we tell most of our patients is the liposuction

is what really hurts the most. So suctioning out all those areas, they're just like bruised and beat up. That's very precise from a contour standpoint, but liposuction works with suction and basically, you know, a metal tube that we use in areas of suction off that. Yeah. So it's kind of like beat me up pretty good. Right. So it's never super, super painful, but it definitely hurts for everybody. Yeah.

And tummy tucks are uncomfortable because you're bent over. Yeah. And probably the easiest recovery from a major surgery standpoint is a facelift. Really? Yeah. And breast surgery, if it's revision, I do a lot of revision. You know, you say, you know, what are you known for? So I have the opportunity to lecture around the world that like all these meetings with plastic surgeons and we all, all these plastic surgeons hang out together and do lots of boring

stuff. And so what I usually am asked to speak on for those is breast revision surgery, meaning secondary or third or 10th breast surgeries, fixing problems, complications. Some of those can be really complicated, but they're pretty easy to recover from because there's typically already a pocket where the implant was and you're really just cutting out some skin and fat. Yeah. I actually, I had my boobs done twice because I got them done after I breastfed Jackson, my second, and then I got pregnant with Saylor. Right. And then, so as soon as I was done breastfeeding Saylor, I was like, I'm just going to redo them and just because they look awful again because I breastfed with them. And the second time was so easy.

Yeah. I mean, it was such a breeze. See, that's the perfect example. Yeah, it really. And I remember Carmen Electra actually said this to me years ago, but she was like, oh, you've never done your boobs. She's like each time because I think I had seen her right before I was about to do them the first time.

She's like, each time is so much easier. She's like each time. Cause I think I had seen her right before I was about to do them the first time. She was like, each time is so much easier. That's an amazing quote. Yeah. Thanks Carmen. Let's talk about rowback. The best way to describe rowback is best fit, best feel. They recently launched a new women's line and comfortable would be an understatement. If you like being comfortable while still looking cute when out and about during the day, Roback is for you. Let me tell you about their active dress, which is actually my new favorite. It's made with their signature GTG technology, which allows you to keep your dress on when you're on the go and you got to go. The fabric is

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I know. I was going to text you yesterday. This is one question. Well, there's people who come to you and you can make some really meaningful impacts people's lives. And then there's people like from training that show up on the door. Those stories are pretty interesting. I've had to reattach a couple of penises. No. Come on. What do you mean? And hands. Those are interesting

too. No. Someone shows up with their penis in their hand and they're like, what happened? Usually it's on ice. We did three of them where I trained. No. What happened? That's not a good day. Yeah. You know, there have been a variety of reasons.

Okay. So they just come off and then you can, but it's microsurgery. So we, you know, we use microscopes and plastic surgery. We're trained to do reconstruction, rebuild all parts of the body. And then aesthetics comes out of finding the prettiest form in rebuilding function. That's our basis. And so you go into the microscope. You put all the tubes back together, all the blood vessels.

You get some help from urology, for sure, from the urethra standpoint. You rebuild everything. And they're able to get erections before they leave the hospital. No way. That is wild. I had no idea. Yeah. So that's pretty interesting. That's very cool. Quite literally saving someone's life. Yeah. And then, you know, I also do a lot of, and I used to do quite a bit more,

but a lot of breast cancer reconstruction and that's super meaningful. You know, it's obviously a huge problem in the United States for whatever reason. So one in seven women get it. I see women younger than my wife with breast cancer all the time. It's crazy. And to be able to, you know, of course, everyone's worried about saving their life first and their children and everything else and as they should be. And of course, but then to be able to give someone back their sense of femininity and allow them to feel whole and complete and, you know, sometimes, you know, aesthetically look even as good or better than they did beforehand is super meaningful. And it feels like a nice thing to be able to do for someone for sure.

Absolutely. Yeah. That's really nice. Have you had patients who just don't like their results? And what do you do? What do you do? It's tough. We talk about this in our meetings all the time, right? And it runs the spectrum. I'm fortunate that it's not common for there to be a lot of big issues, right? However, it doesn't prevent somebody from not liking the results. One of the running lines amongst plastic surgeons is some of our happiest patients have the worst results aesthetically, and some of our least happy patients have the best results. And that's a state of mind, and it could be a problem with explanation and education. So you have to have a lot of empathy.

You have to be really patient. I mean, my approach is, you know, I always want my patients to be happy end of the day as much as I can possibly make that happen any way, shape, or form, right. And so you work through it, you talk through it. Sometimes there's a small adjustment. That's easy. You know, okay. Things stretched out on your right breast a little more than your left breast. We can go and remove a little bit more tissue and make it match better. Or your right cheek, he feels a little flatter than your left cheek. Maybe we can add a little bit more volume into that side or something along those lines, you know, simpler fixes that we both see the real hard part if you, you know, is when patients are really displeased with something and there is no objective issue.

Right. Okay. Yeah. Or not, not much of one. Right. And so then you're kind of stuck. So like, I'm happy to do anything for you, but, but I, there's nothing, I don't really have a solution for this particular problem. Well, like the eyelid surgery, that changes the way people look. I mean, it really does. And I know someone in LA who she had it done and she hates, she hates the way she looks, but it's like one of those things where it's not like anything the plastic surgeon did change the way she looks. But I would argue without knowing anything about this case. So there are different ways to do eyelid surgery. So there are some even more aggressive things that I didn't mention. What changes the shape of your eye is if you cut the

corner of the eye where the eyelid attaches to the bone and move it. So I don't do that at all. So it's called acanthoplasty. Again, fancy word. But if you start to change the shape of the eye, you need to talk to the patient beforehand to explain what you're doing because that can, you know, that's a real difference. Well, it's like, I've seen a lot of like where it really opens up your eyelid. Does that make sense? So it almost looks like your eyelid is, or is that for hooded eyes? Yeah.

And so it like, so if you over is that for hooded eyes? Yeah. Yeah. And so it like, it looks bigger. Yeah, it looks bigger. Right. So that won't change the actual shape of your lid position, but the upper lid will be further back and you'll see more what's called upper lid show. Yeah. I mean, that's kind of a desired goal. Now, if you over, if you cut out too much, then it might look too open and too hollow.

And that might be a technical error. That's a hard thing to fix. That would be tough to do something like that. And then you hate the way you look. It's not an easy profession. Jeez, yeah, that would not be good. We take beautiful people and we try to cut them open and then make them feel that they're more beautiful afterwards. So it's not like, not a lot of room for error in the field. No, I know that is tough. Have you ever had someone come to you and you've had to say that you won't do something just because they do so much? Yeah. That's my favorite thing to say. Really? Oh yeah. Because people just go overboard, right? Yeah. And

you know, that, that's kind of the key, right? You need to recognize, you need to stay true to your own aesthetic and you want to do the right thing by your patients, right? There's still, it's still medical care end of the day. And sometimes people ask for things that aren't good for them or are not really appropriate or. Like what? Like what's the craziest thing someone's asked you for that you're like, I just can't do

that. You know, in nose surgery, like in rhinoplasty, they're like, I need my nose to be smaller. And they have like an extremely, like it's already an undersized juvenile appearing nose. People have kind of lost the horizon. It's super common with like filler patients, right? They're like, I need more because they think they want more volume. They're already chipmunks, you know? So. So you say no to even the filler and stuff too. Oh yeah. Yeah. Oh my gosh. Right. You do to even the filler and stuff too oh yeah yeah oh my gosh right you do botox and filler and on in the office i mean i do very little of that but you know we we all everyone in my office we all hew to a conservative like elegant aesthetic and we want to give people

you know what they need and and honestly what i find people end up will end up being on your page if you spend the time to educate and explain, right? That makes sense. People think they want, you know, really common when it comes to boobs. My girlfriend has X CCs. I want that. Oh, yeah. Well, your girlfriend's six feet tall.

You know, you're five feet tall. So, like, you would look ridiculous with that. That doesn't fit you. And you're like, oh, I get it. People always ask me what CCs I have. I don't even know. But I'm always like, it doesn't matter. You have to do it to your body. I'm, like, oh, I get it. People always ask me what CCs I have. I don't even know, but I'm always like, it doesn't matter. You have to do it to your body.

I'm like tiny. You're going to want bigger ones than I have. Trust me. Yeah. All that matters that it looks good in your figure, in your frame and fits your body. Right. The number, the number doesn't matter. Do you find that with your boob patients, when they come back to do them again, do they always want to go a hair bigger though?

Or no? Not always. Not always. So again, I, I hue pretty conservatively. I always try to use the least amount of volume to give the desired result. So if you want to be bigger, that can still be, you know, on the fuller side of what fits for you. But I want you to have, you know, a super long lasting result, the less weight and pressure there is, the longer lasting it's going to be. Your tissue is not being taxed and stretched as much. So I would say in my practice, because I spend a lot of time going over things, there are very rarely requests for like size, like real changes. On the rare occasion that does happen, they usually want to be a little bit bigger,

especially because I start smaller. So do you kind of encourage patients to go a little bit smaller maybe sometimes than they come in? Well, it's really funny. Again, we all kind of end up with our certain type of patient based on our prior patients. And so women, the typical path is they come in like, I want to be really small and cute and perky and model-esque. I'm like, cool, no problem. Like, oh wait, I don't want to be too small. I want to make sure. I was like, yeah, I know. I know you're paying for surgery.

You want to make sure you can tell. You don't want to be huge. It's like, it's a little dance we go through. And it's the first time for them. It's like the 10,000th time for me. I'm like, yes, I know how this ends. I'll hit the button. I'll keep playing the speech.

But, you know, you do want to understand what people are looking for, what they're thinking about. You know, cup sizing as you know is like fake. It depends where you go. It's such a joke. But I do let people kind of walk me through what they think because different cup sizes mean different things from like an American standard

standpoint. So we can usually with enough time really arrive at a place where we both feel good about it. It tends to work out pretty well. What's a surgery that is just not worth the hype? Surgery not worth the hype? I mean, listen.

You know, everything has like a trend. Like, yeah. Okay, fine. Focal fat was a trend. Like, what's the- How about like the- So we talked about brow lift earlier. We didn't get super into it.

Yeah. But there was this massive Hollywood trend, right? Where everyone was getting like this fox eye thing. Their like brows like touching their hairline or something absurd girls like in their 20s yeah not worth the hype no bad idea that's just like a facelift specifically or like a brow yeah temp or like a temple lift right so you're so either with stitches that come all the way down to the brow or cutting the skin out inside your hairline, pulling super hard and trying to overly aggressively elevate the brow. Okay. Yeah. I didn't come in back down and like, and that might go out of style. So don't do things that they're trendy that are trending. Okay. So what's like the next big trend in plastic surgery?

Like what's something that we don't even know about yet that everyone's doing like Google fat had its moment, right? Is that kind of like gone? Not gone, but like. I mean, listen, I'm not on TikTok, but I think it's like not as trending on it anymore. So listen, the Buccal fat pad removal. Yeah, it's fine. It's fine. I was like, should I just go with the other pronunciation? I'm actually kind of happy. I don't even know what the fuck it's called. Yeah. So Buccal fat, but that's a little like egg yolk fat sack that's inside the cheek. Oh, it's a sac that you take out?

Yeah. It's like a little pad. It's like a little circle. It kind of looks like a yolk. It's this little enclosed fat pad. It's between the muscles of mastication or the muscles of chewing in your mouth. Okay. So, it's there for a reason.

Yeah. Oh, yeah. Everyone is like super snatched, super sculpted looks. I think that… So, I think the trend, I think that, so I think the trend, if you will, is away from the old trend. Super defined liposuction, super defined face shape, kind of overdone, overly sculpted. People are finally, the pendulum is swinging back towards a natural aesthetic. So when I do liposuction, you know, high def lipo, which I,

I learned from my friends in South America. They're the experts on it. I've seen everything they do. This is like the full body sculpting that they do. Yeah, like the crazy contouring the abs and the everything. Oh my God. I always, my line was always like, I'm going to do, I want you to have some shadowing and curve, right? But I call it soft def.

Okay. Like soft to definition liposuction. Yeah. That is now becoming what everyone is going for. Okay. Because that overly defined look might be great in an Instagram picture that's one inch square, you know,

down the beach. Yeah. But you see these people in real life and they look like there's like scars all over themselves. It doesn't look good.

Crazy. Yeah. I'm sure you've seen tons of it in LA. Yeah, in LA. Well, everyone was doing that full body sculpting for a while.

Right. And I actually know someone who had a crazy scar along their whole stomach and it got infected and it was like a whole thing. And so just like, I don't know, some of this stuff just seems so intense. Yeah. You know, you always want to, you know, there's some interesting ideas out there, but it's usually good to kind of find a middle ground and get the results in the shape you're looking

for. I mean, you know, you don't need to have saggy eyebrows, but you just want to get them rebalanced, right? I mean, brow lift results, in my opinion, should never be like shocking. It should always be just stabilized and pretty and just in the right spot. Same thing with body contouring. Same thing with cheek highlighting. Same thing with buccal fat. And the problem with this…

Cheek highlighting? What? Yeah, you know, like back grafting or adding volume to the cheeks or contouring underneath. And so the reason why this buccal fat thing is such a problem is because fat in your face that we've talked about dissolves as we eat.

Yeah. So the buccal fat pad is no different. So all these kids, these like, you know, 20-year-old girls are going and trying to get super snatched faces

and they're plucking this pocket of fat out of their face when it's nice and full and they're young and then they get older and then they look gaunt and hollow like a skeleton. Yeah. And that fat isn't coming back. Yeah. You don't want to take fat out of your face. You're going to want that. Right. Yeah. That's what everyone is saying on TikTok. Like stay away from it because of that reason. Now there are some people that have just like in the lower

eyelid, it can be a little poochy or prolapse or sticking out, especially in a facelift patient who's not a kid. Right. And so I will, you know, a couple of times a year, there's someone that has just too much fullness. You can take part of it out in a 50 year old. Okay. And that's reasonable because that much more stable out of the aging has gone on and you're trying to create a little bit of a softer, better contour. Okay. But yeah, the, the overdone 20 year old taking it all out thing is a bad call. No, it's crazy. Wait, what is the average age for a facelift? Yeah. So the average age in my practice is like late 40s. Okay. For a full facelift. What's the youngest person you've ever done a facelift on? 30. Yeah, I was going to say. There's rumors of a certain actress who looks really good. I'm

not going to say it though, but that she started getting facelifts at age 30. Yeah. I would say the 30-year-olds that I've done full facelifts on have had massive weight loss. Oh. So, you know, you'd be super full and then you kind of lose a lot of volume and everything's hanging low. So, it's almost reconstructive in a way. That makes sense. Now, I will have done plenty of neck lifts or lower facelifts on women and men in their early 30s. In the early 30s. Yeah. Just to get ahead of it. Well, that's kind of the end of the age where you can just address the neck.

Because once you get into your 40s, the cheeks are starting to sag too. So if you're 32 and you have a little bit of fullness and you don't want to do something minor and there's a little bit of hangy skin. If it's tight and you're 20, you can do a little suctioning right oh the lipo right there okay yeah and it'll snap back but if your skin's already getting a little lax right we got to match that skin and the deep tissue yeah and so you're better off taking the muscle again it's the most natural look it's a little more involved okay yeah expensive it's a little longer how much is like a that neck facelift it's a great more involved. It's a little more expensive. It's a little longer. How much is like a face lift? Do you not want to say? Well, expensive. Yeah. It's, you know, nothing's cheap. You don't want to get a discount. Yeah. Discount on facial surgery is probably not your best move. I don't really keep tabs on it.

Honestly. That's like, I tried to. The office does it. Yeah. I try to like keep what I do, like focus on like what I want, like what the patient needs. And then like the financial aspect can be handled by the office side. Yeah. I try to like keep what I do like focused on like what I want, like what the patient needs and then like the financial aspect can be handled by the office side. Yeah. It's a very awkward thing, right? Well, yeah. You want to like be, I just want to like do the best thing for the patient. It's kind of like my art is my art.

I'm the artist. I don't know the numbers. I don't know. I don't know the numbers. But it's a lot. But I do know it's a lot. Great. I'll start saving up now.

Okay. So what's one thing that we're all sleeping on? What's one thing that we should all be getting done? Like even if it's a laser. Yeah. Okay. Okay. Honestly, I'll take you a step further back than that.

The one thing we all need to be doing, okay, and all the dermatologists should like this, sunscreen is one, but that's boring. I just got killed for saying I don't wear it. I know. I know. Let's just say something else. I don't know if we can be friends anymore. Okay.

Okay. Sunscreen. Listen, you need to, the sun destroys the structure of your skin. Nevermind skin cancer, right? That's a problem. Yeah. But you need to, so fine. The step above sunscreen, which is the protective aspect.

One of the true kind of fountains of youth is things that help increase cellular turnover in the face. Okay. So like retinol, retin-A, retinol gas. Retinoid. Exactly. Yeah. Okay. And so using these creams every day, right,

which is actually super trendy for like young people. They're probably overdoing it at super young ages. But you want to encourage your skin to build new collagen, maintain elastin, remove that top layer of dead skin. Okay, yeah. And so these products that are, they're irritants, but they actually have been proven with very good science to really keep your skin pretty and fresh and young.

And that is going to only benefit you. Okay, yeah. That makes sense. Good skincare, medical grade. Yeah. There's all these fancy creams at Saks and, you know, Neiman Marcus. Most of those things have very little active ingredients and cost a lot more than just the stuff

you can get at your dermatologist, your plastic surgeon's office. Okay, yeah. Cell turnover. I know it is true. Great advice. Okay, tell everyone where they can find you, where they can book their facelifts.

So yeah, I'm Jacob Unger. I'm in Nashville. I'm in Hillsborough Village. My practice is called Nashville Plastic Surgery Institute. Instagram. Oh, Instagram, yeah. Dr. Jacob Unger,

drjacobunger on Instagram. I guess that's it. I guess that's it. That's the address. That's, you know, there's a website. It's your home address. If you like a home address. Here, here.

I actually live here with Kristen every other week. Oh my God. We're super close. Thank you so much. I just learned a lot. So I think obviously everyone's going to be. Well, let me just say, and you may cut this,

but let me just say that you are such a sweet person. I feel very fortunate to have you as a friend. You're one of the most humble and kind people I've ever gotten to know. And so thank you very much for having me. Thank you. I'm not cutting that.