Well with Arielle Lorre - 114: All Things Plastic Surgery + Other Cosmetic Enhancements with Dr. Miguel Mascaró

Episode Date: June 9, 2021

In this episode I’m talking to my friend & plastic surgeon Dr. Miguel Mascaró about all things cosmetic procedures. Dr. Mascaró is A fellowship trained and Board Certified Facial Plastic & Reconstructive Surgeon, also concurrently Board Certified in Head & Neck Surgery and a specialist in cosmetic and reconstructive surgery of the face, nose, eyelids, ears, neck and scalp. In addition, he has extensive experience in non-surgical treatments of the face, neck, and scalp, including injectables and laser therapy. This is a comprehensive episode in which we discuss the biggest mistakes people make when it comes to cosmetic enhancements; how to figure out what procedures to do; current trends that will last and which trends are fading; the current climate and popularity of plastic surgery; when to do what procedures; the truth about non-invasive interventions such as botox and filler; the best procedures for common concerns like early jowling, hooded eyes and volume loss; brow lifts vs. eyelid surgery; lip lifts; the beauty of fat transfer and so much more. We also do a rapid fire Q&A at the end where he answers your most pressing plastic surgery questions.   www.Sakara.com/BLONDEFILES for 20% off your first order www.Blublox.com/BLONDE for 15% off your order www.Curology.com/blonde for a free 30 day trial, just pay for shipping and handling www.Helloned.com/BLONDE for 15% off your first one-time order, or 20% off your first subscription plus free shipping   Produced by Dear MediaSee 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. Hey, welcome to the Blond Files podcast. I'm your host, Ariel Lori, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits. I know there is so much information out there, so I'm here to help you navigate it all and live your best life. Thanks for listening.

Let's get into it. Hi, everybody. Welcome to the show. I am so excited for this one. I am talking to my friend and plastic surgeon, Dr. Miguel Mascaro, and we are talking about all things cosmetic procedures. So Dr. Mascarro is a fellowship trained and board certified facial plastic and reconstructive surgeon. Also concurrently board certified in head and neck surgery and a specialist in cosmetic and reconstructive surgery of the face, nose, eyelids, ears, neck, and scalp. In addition, he has extensive experience in non-surgical treatments of the face, neck and scalp, including injectables and laser therapy. This is a very comprehensive episode. We discuss the biggest mistakes people make when it comes to cosmetic enhancements, how to figure out what procedures to do, current trends, what trends he thinks are going to last and which ones might be kind of fading or dying down. We talk about the current climate and popularity of plastic surgery, when to do what procedures, the truth about non-invasive interventions like Botoxin filler, the best procedures for common concerns.

Like a lot of people asked about early jowling and hooded eyes and volume loss. We talk about brow lifts versus eyelid surgery. We talk about lip lifts, of course. We talk about the beauty of fat transfer and so, so much more. And then we also do a rapid fire Q&A at the end where he answers your most pressing plastic surgery questions. So I think you guys are really going to love this one. He and I have done some tweaks over the last couple years. And I just love his eye.

He is also truly the incision king. His incisions are insane. If you follow him on Instagram, you know what I'm talking about. And our goals are just very much aligned. So I always say nobody else will touch my face ever again. So anyway, I hope. you enjoy this episode with Dr. Mascarro. All right.

Hi, buddy. What's going on? It's the most professional intro ever. Yeah, yeah, exactly. Well, I mean, it's much better than our last intro, where we went off for 10 minutes before we realized we were not recording whatsoever, which was actually probably just as professional as would just happen. I totally forgot about that.

And I was going to say, if people want to get like your full. background and really learn everything about you, they can go back to that first episode that we recorded. I think it was probably almost exactly a year ago. But just to start, why don't you just tell people like where you are, what you do, what you specialize in, all of that. Sure, no problem. So my name is Miguel Mascar as you guys know from clicking on the podcast. I practice in Delray Beach, Florida. It's a small little town just north of Boker-R-R-Ontone. Everybody knows Boker-R-Otone. Everybody knows of someone that's retired in Boker-R-R-Tone. So it's a great place to practice, is plastic surgery. So I do facial plastics. I specialize in facial plastic surgery. My background is

in head and neck training and specific in facial plastics. So anything cosmetic is what I do from the neck up. I'm probably most known for lips, um, facelifts, eyelids, really just aging face procedures. That's kind of what I do. And you've been treating my aging face. And I talked about you in another podcast. A lot of people were like, who is the doctor again that you said? Is the only person that will ever touch your face again? And I was like, oh, that's Dr. Mascarro, the only person ever work with this again. Yeah. I mean, it's funny because, you know, it's all about tweaks, right? It's all little tweets. And we talk about this all the time, you know, when you text me and you're like, hey, listen, Miguel, what should we do? Like, what's the next

move? And I always tell you, slow is better because the one thing that I notice with young patients in particular is they're very eager, which is great. You know, you're very eager. You're starting to see some changes. You're starting to take care of yourself. You know, we get the crazy 20s out of our lives. And then we get into our 30s and we start thinking like, okay, I got to start taking care of myself a little bit. I can't be out all night in the sun, parting all the time. I want to start taking care of myself. So what's the next move? What's the next step? And the biggest mistake people do is they do too much at once. And then all of a sudden you start micromanaging tiny little things. You start chasing tiny little changes in your face. So you start saying like, you know what, I really don't like, you know, these little wrinkles

that I'm starting to get here. Or I don't like this bag that I'm starting to get under my eyes. And you start micro focusing on that tiny little area and you fix it. But then when you take a step back and look at the macro, you've changed your face completely. And so it's very easy to start going down these slopes that aren't necessarily in your best interest. And it's so important to make sure that you have someone that can kind of guide you along the way and take that step back and say, hey, listen, let's take a look at the mirror. Let's look, make sure that everything looks right. And what's the goal? What's the end point? What are we trying to do? Where are we trying to improve things? Where are we trying to get things better? So absolutely, you know, when when you talk about Miguel, what should we do next? My usual thing is, listen, let's slow down. Let's see what it is that we need to do, what it is that we can do to get you there. And then, you know, I'll throw some ideas out there. I'll sprinkle a couple things in there just to kind of tweak a little bit. But, you know, that's probably the biggest thing. You kind of talked me off the ledge with wanting to get a face and necklift recently. Yeah.

I think it was like kind of the pandemic got to me like it did to a lot of people, seeing yourself on Zoom, seeing yourself in pictures. I bombard you with pictures of my neck from like outtakes of when I'm looking down. And just seeing so much of that, I was like, it's time. And you said to me, if you were my sister, if you were my cousin, you know, I would tell you not to do this. And so we did a couple other things that made such a huge difference and probably put that off for quite a few years. But a lot of people asked me, how do they figure out what to do to harmonize their face and who do they listen to? And is it the right move to walk into a surgeon's

office and say, what do you think I should do? Tell me. And how do they figure that out for themselves if they don't have that person that they already trust. That's a really good question. And it's somewhat tricky, and it's something that conflicts me a lot, to be honest with you, because I do get a lot of people that come in and sit down in front of me

and say, hey, Miguel, you're the artist, you're the professional. Tell me what you want done to my face. And honestly, I feel like it's a little disrespectful. At least for me to start telling someone, oh, well, let me just rig out my Sharpie and start drawing on your face what we need to do. I think it's a little rude. I think it's a little disrespectful. I think that, especially nowadays,

with my younger patients who are getting barbed by social media and what they think they should be looking like, to all of a sudden, you know, they finally, you know, they get the, you know, they get the balls to really like go to a doctor's office, sit in front of them and then have someone sit there and point all the things that are wrong with them. Like, who am I to say what's wrong with you and what isn't? You know, the reason why it conflicts me is because at the same time, there are a lot of doctors out there who will just say anything to kind of convince you to do whatever it is that we'll get them the most money, sad to say. And I think that's an experience that a lot of people have had. You know, I mean, we joke about it all the time where the number

of patients that come in to see me who are in their 20s and 30s who've had a facelift or a necklift somewhere else. And then they say, oh, so and so did this. I, A, look the same. B, have really bad scars. See, now I have to fix what this person did to me because now it's changed is way more than one. And so once you start having that, you start realizing it's not just one doctor, it's not just two doctors, and there's three doctors. And it really is, at some point, it's, you know, doctors do get strong on. So I don't want to just say like, hey, there's a couple bad apples out there that are, you know, always just in it for the money. We also kind of live and die by the sort of social media as well.

So there's a lot of docs out there, especially older docs who are afraid of getting bad reviews, getting bad stuff. They'll do anything just to make sure that the patients remain happy. And that may not be in that patient's best interest. And so I always tell people, you know, you've got to find someone that you vibe with, that you have a good relationship with,

that's going to be honest with you, that's going to tell you no. If someone tells you no, that's a good thing. Because the one thing when we're doing a consult is, the first thing I ask you is, so tell me what is that you're thinking about blankety, blank, blank. And in my notes, you know, I have a little drawing that I'm taking notes on your face, but next to it, I'm writing your goals. And so what your goals are. And that's what we're going to be shooting for. So as soon as you come in here, you know, pop in and I'll say, okay, Ariel, so your goals were

XYZ. What did you write for my goals? I want to know. I don't think people want to know. Cute baby face, Haley Bieber. People don't, people don't want to know the DMs that. where it's onslaught. People don't remember, so there's a time difference. And so Ariel has like this time where she actually goes on the phone because she's a crazy busy. She's doing things here. She's doing things there. And so there's time that she allots herself to do social media stuff. And so usually that's when I'm like starting to go to bed, like around 10, 30, 11 p.m. at night, Eastern time. And so all of a sudden I'll just see like 10, 11, 12 DMs. And it's just like pictures, pictures, pictures, pictures. And she's like, so what do you think?

And I'm just like, no. I'm like, stop, stop, stop, stop. Or when you're doing surgery and I'm like, hello, hello. Yeah, and you're like, all right, so we're doing this, right? I know you're busy, but I need, I need attention. Or I know you're busy and no response means that we're doing it, right? You have 30 minutes to respond. And I was like, dude, I was in the OR for five hours. Anyway, we digress. We are inundated with blue light in our daily lives from what seems like every direction and I don't want to be an alarmist, but it's really not great for us. Even just picking up your phone and looking at it first thing in the morning can tell your body that it's like mid-afternoon and your hormone and your bodies can react accordingly. I bet that everybody listening can tell the difference in everything from your energy to your appetite and more on days that you wake up and get right on your phone and days that.

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I'm Kareen Eldor. Ever feel like you're playing small? Well, turn up the volume on my podcast, share a voice. Every Thursday, I sit down with the wave makers and game changers on everyone's radar. I'll be sharing inspo and takeaways based on my conversations with disruptors, visionaries, and compelling creatives about how they express themselves in their work. Prepare for tons of mic drop moments and subscribe so that you catch every soundbite. I'm fascinated by the power of feeling heard and taking up space.

and I'm amped up about sharing these conversations with you. So I'm curious, what are the trends, if any, that you've been seeing, especially in the past year I mentioned, like, I know for myself, I was able to recognize, okay, I'm seeing myself all the time. It's getting a little crazy. Granted, I did need a few little things tweaked, which we did. And that was super helpful. But I think so many people who aren't used to seeing themselves all the time,

who don't take pictures and all of that are kind of faced with, oh my God, is this really what I look like? So have you been seeing kind of the ramifications of that? And what trends have you been seeing? Yeah, it's been pretty wild. So, you know, they're, you know, they call it the zoom boom for plastic surgery. And it's a cute name. Anything that rhymes is always cute. But the interesting thing about it is you're 100% right. Is to understand why people are seeing this. You have to think back, right? So what I always joked with my older patients, because this kind of helps bring it together. My older patients always said,

Miguel, your patients are so young, why do you have so many young patients? All these young girls are crazy. They're coming in. They're getting lip fillers. They're getting lip lifts. They're doing all this surgery. It's so unnecessarily.

They're so young. They're so pretty. And I always tell them, think back to when you were growing up, when you were in your 20s and 30s. 15 years ago, you never saw a picture of yourself, except if you took a picture, printed it out,

put it in a photo album, got together with family, and then randomly went through it and said, oh, my God, I looked so good, you know, a year ago. I looked so great two years ago. Look how young I looked. Oh, my God, I looked terrible.

I can't believe I went out looking like that. Over the last 10 years, that has just sped up so much where we went into like the Facebook phase of like, okay, now we're going out with cameras at night. And so, you know, people our age remember, like, it was a big deal when you had someone that had like a little camera that you could take out at night and like, oh my God, look how small that camera is and we can upload it and we can share the pictures

a little bit more frequently. And then camera phones came out. And so now you had all these young patients. that once Instagram and Facebook really started taking out, particularly Instagram and Snap, when they took over, you're starting to be seeing themselves every single day. They're seeing themselves every single minute. They're taking hundreds of pictures. And they're like, I like this. I like this. I don't like this. Oh, wait, I can put a filter on and I can see what I could do if I did this or I didn't do this. So now take that that was happening with patients in their 20s,

even late teens, early 30s, spread it across the entire population. And so you're seeing patients in their 60s who never thought about doing any sort of plastic surgery, start calling up. You're seeing patients in their 70s who've had multiple procedures saying, I thought my face of was going to last longer. I look bad. I got to do another face left. Or, you know, I did my brows a while back. Shit, they're falling down. I got to do it again. And so we're seeing a ton of that. And part of that has to do with the focal length of the selfie picture camera. And that's something that people don't talk about enough. Focal length is super, super important. And, you know, we talk about this all the time and not to put anybody on blast,

but there's many doctors that we will both send each other pictures of. And I'll often comment, and I'm like, different lighting, different focal length. Look at the before and after. Or little things like after they're smiling before they're not, different focal length, different lighting. And so when you're focusing on these things, you realize that tiny little changes in the camera that's pointing at you

can make you look stunning or can make you look like the grim reaper. And so you have to kind of take that into account too. So, you know, Zoom Boom has created a huge increase in rhinoplasty. Why? Because the focal length of that selfie camera is super short. So unless you've got these crazy orangutan arms that you can stick your hand all the way out, your nose is going to be a little bit bigger and a little bit longer. The midface is going to get elongated.

Your face is going to look longer. And so that's why a traditional focal length for a portrait is around 100 millimeters. The selfie is about 28. So it's going to make things a little bit wider. So a basic understanding in photophysiology kind of gives you an idea that like, listen, things are a little different. And so you kind of have to explain that to patients sometimes just for them to be aware of that. But that combined with all of a sudden literally everyone and I mean everyone across the world having to do this for a whole year has left to a crazy, crazy boom in plastic surgery. What trends do you think are going to stick around for the next couple years?

And what do you think is going to die off quickly, if any? I think the thing that's going to stick around more than anything is people are going to realize that there's such a thing as overinflated. Right. And so the overinflated face, I think, is going to be gone in the next five, six, seven years. The downside of fillers is that everyone up and down the street, particularly in South Florida. Everyone up and down the street does fillers. And so when all you got a hammer, everything looks like a nail. And, you know, they'll tell you, hey, listen, I want to lift this up. Oh,

just put a little more filler. Listen, I want to plump this up. Oh, just do a little more filler. Hey, I want to look younger. Oh, you just need more filler. It doesn't look quite right. Oh, that's because you didn't do enough filler. You got to do more filler to get that result. And so I think that people are starting to realize that when you do that, you start to grow laterally as well as anteriorly. And so all of a sudden, you start looking like a big lollipop. Nobody likes to look like a lollipop walking around. So that's a lot of it. So that that overinflated face not only looks bad, but it also has some dilaterious health effects as well. So it can lead to obstruction in the lymphatic. So when you get sick, you get allergies, you pop up.

People follow me on my Instagram stories. I posted about that myself because, you know, I don't care. I have one syringe of a loom in this cheek. I have one syringe of balloon in this cheek. I have one syringe of wrestling, plain wrestling split with a little bit of lytocaine split between my two eyes. And so half and half? Yeah, half and half. And so I usually, I'm pretty, I'm bad. Like, if you look back here, actually, I'll show you, I'm not going to show the product, but I have like random product just randomly sitting back here. So as you can imagine, it's super tempting, right? I'm on constant. I'm just as liable as everybody else. I'm staring at myself on camera all day. So many times I'll just look at myself. I'm like, shit, man. I just need a little bit right here and I'll add it. And so my, I do my own. Yeah. And so. I do my own. Yeah. And so. Yeah, I know. It's bad. So my daughter just got a cold from going to preschool. Pre-school's open back up in South Florida. She goes to preschool. What happens? She's three years old. She gets a cold. Happens to every preschooler. So what happens? She comes home. She gives it to dad-da. Dad-da gets sick. Data gets a cold. All of a sudden, this eye puffed up like crazy. And so my voice was crazy. I sounded like the Marlborough man. But this cheek puffed up like crazy because the lymphatics were obstructed because I normally put a little bit more filler right here. And so that tells me that, hey, Miguel, You're about the borderline as far as getting to that lollipop stage. So the overfilled phase is going to slowly phase out because we're going to see more and more of that. We're going to see people more aware that there's options apart from that.

The other trend that I think is going to slowly go away are threads. And we're starting to see that as well. You know, threads for about three, four years. And we talked about this last year was a hot thing, was, hey, listen, you can just pop in, pop out and you're good. And in the right person, in the right situation, threads are great. let's go back to that patient I told you about that is getting that her daughter is getting married in two months or two, three months. That's a great patient for threads. That's a great patient for failure where you just need to look good for a little bit of time. You don't need much downtime.

You need to be realistic about it. And here's the thing. Threads are not something that just any Joe Schmoe down the street can do. You know, it gets sold that way. So you feel comfortable going to anybody. But it's just like anything else. You need to go to someone that knows what they're doing. otherwise they're going to be painful, they're going to look bad, or they're not going to give you any results, which is even worse, because they're incredibly expensive. So I think people are starting to see that trend a little bit, and they're starting to realize, like, listen, what I really need is the right surgical intervention. And so a little bit goes a long way. So we're starting to see younger and younger patients doing surgical interventions, but not necessarily super aggressive surgical interventions, doing the right surgical interventions. So we're seeing, particularly with facelps, for example, the 60-year-old lady that's coming for her first facelift is really a thing of the past.

Even the 50-year-old lady that's coming for her first facelift is starting to be a thing of the past. We're starting to see that more in our mid-40s and even early 40s for some of our mini-lift patients. And mini-lift means different things for different people and we can talk about that another day. But the long story of it is you need some elasticity issues to be able to pick that up. But you also want that muscle to be strong in it. And as you get younger, there's that happy medium. And everyone's a little different, right? You never treat an age.

You treat the patient. And so when things are starting to fall down, there's a patient that you can pick that up. And when it's nice and strong, it lasts longer and it looks much more natural. So that patient who's in their mid-40s, all of a sudden they look like they're in their mid-30s. And then that their build of time keeps moving. So they keep aging. But guess what? Now, by the time you get to your mid-50s, you look like you're in your mid-40s.

And so then slowly keeps getting picked up and tweaked up. up. So we're seeing that trend kind of slowly go down the path as well. We're seeing that with eyelids. We're seeing that with brow lifts as well. The complex of the eye is super important. Lips, a little trendy. I mean, I'm super biased because I do a ton of lip surgery. But the reason why I say this is kind of biased is because historically, I never used to see revision lip lips. Never. It was super rare. I mean, I would do maybe one a month. And I do. I do. do like 10 lip lifts a week. So it was rare for me to see a revision and like something bad. And over the last two years, I'm seeing many, many, many more revisions. So it's coming down to

now I'm doing like maybe two or three a week where I'm seeing just disaster lip lifts that we're having to fix. And so that was really, really bad early on. And now I'm starting to see people not doing that as much. They're slowing things down. They're kind of saying like, okay, there's about four or five different guys across the country that are really, really good at doing this. You know, there's a couple in California. There's a couple in New York. A couple in Baltimore. There's me. So let me just hold off. Let me just talk to the guy that knows what he's doing rather than going and passing through a really bad situation. So I don't want to kind of seem like the surgeon with the scalpel that thinks everything needs to be cut out. But there is that trend where we kind of saw it swing in one direction where all of a

sudden everybody thought they needed to do a little lip lift, swinging back the other way to making sure you're the right patient for it and kind of getting the best result. So oftentimes, like things like filler threads, these kind of less invasive interventions are not the right thing. And it can be beneficial to do surgery at a younger age. You were saying, but is there, is there a downside to that? I mean, I remember when we were talking about me doing like a lift and you said, I'm not there yet, what can happen if, say, somebody does get a facelift? I know You see a lot of these women in their 20s in L.A. who get facelifts at 26, 28. What are the effects of that?

So let's talk about worst case scenario from medical sampling. You know, I joked before that we take your face apart and put it back together. Yes, it's a funny thing to say, but it's also true. And so it depends on what kind of technique you do. So I like doing a deep plain face left. I actually like doing an extended deep plane face left. So it's a little more invasive. You know, when I was training, the way that we used to joke is once you get into

that deep playing, that's where the tigers play. And so when you're playing with tigers and you're riding a tiger, sometimes you get bit. And what that means is that the nerve that controls your face, you're literally right on top of it. So you have to be somewhat careful because sometimes if someone's had, especially with older patients that have had multiple surgeries, you've got to be careful because you can pull a little bit too tight or that nerve maybe a little bit weak. So guess what? You may look like you had a stroke for a little bit of time.

Now, that does come back, you know, and it does regain strength. but it's a reasonable risk that you're undergoing. And so, you know, the risk of facial nerve paralysis is there. It's small, but it's there. And so when you're talking about, I just need to do a little bit of this. Like, I'm thinking about it from, again, if you're my family member knowing what I know about the risks involved, especially if you want something that's going to last you, that's strong, you want to do a bi-limin or a high smash facelift or a deep plane facelift. You know, one of like kind of the gold standards of lifts that are really going to kind of help you out.

those are different techniques, but you can talk about a different time, but those are both very, very good techniques. You're playing with some fire. You know, you're playing with the tigers for a little bit. So, you know, that's a reasonable risk that you're running. And so like I said, Ariel, if you're my sister and God forbid something like that happened, you know, mid-30s and people look at you afterwards and they're like, you didn't even need that. You needed that other thing that we talked about that we may or may not have done. You know, that that is almost tragic in a sense. Now, the worst, to me, the worst outcome is you look the same. You know, so you go through this whole thing and first of all, you pop a ton of money down. You set your schedule apart. You know, you do the recovery. You look good for two months. And so you do need some elasticity for that to be able to be pulled up.

Again, unless you're freeing everything. And if you free everything and pull things up and you're a little bit too young, guess what? You don't have that elasticity. Things start looking weird. So then you can start changing the way your face. You can start looking a little bit like the alien. an emoji, and that's not the cutest emoji to look like. So there's different things that can happen, but to me, that's one of the worst.

And when that happens, guess what? You also get bad scars. Younger people make more collagen. More collagen and more tension leads to relaxation, which in the essence leads to a little bigger scarring. So I have a ton of patients that have come to see me for lip-lifts, for rhinos, for eyelids, and I end up having to fix their scars from their facelves, and they're 29, 30, 31. And it's crazy to me that, you know, people get talked into it.

they get these crazy bad scars. And I had a patient who was 27 from L.A. That I had to fix her necklace. Because she had a necklace two years before when she was 25. And now she had these crazy scars. And I'm just like, who told you this was a good idea? She's like, I look the same. I have these bad scars.

And basically we had to redo part of the necklace to fix the scars. And I'm just like, this is insane. Like, this is just bad. You know, because in my mind, you're getting, you're not even getting a good result from a necklace. You're basically just getting me to fix your scars. so that you can pull your hair back in a ponytail. I know the struggle of trying to find skincare products that actually work.

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So again, that's Sakara, S-A-R-A-A-R-A-com slash blonde files, B-L-O-N-D-E-F-I-L-E-S to get 20% off your first order with the code Blond Files 20. So I do want to get to listener questions, but really quick, since we're kind of talking about it, what are the best procedures in the 20s, maybe non-invasive and more invasive? Depends on what it is that's misleading. So you kind of have to look at someone's face. You have to look at where they were before and how they've been aging. And that involves also kind of exploring a little bit into how the parents look, how the parents age, because that'll get you a better idea. Because when people are 20, everyone looks pretty good. But at the mid-20s is when you start to lose that volume in your face, and you start thinking and start tinkering with with fillers

and start thinking about those things. So from a minimally invasive standpoint, we have to look at skin quality because most of us in our teens and early 20s are really, really, really bad about sun protection. So skin quality and skin treatments, very, very important, very good. So things like, you know, from the more invasive CO2, Irvium-Yag lasers to, you know, clear and brimbril, billions, IPLs, even some deeper peels like Jesners, TCAs, like medium-depth TCAs, stuff like that, they do a huge, huge, huge difference. Because the key is you're basically just getting your skin right so that you're fixing that sun damage and then getting it to get to a point where you can continue to not improve it

and turn into a porcelain doll because nobody likes that either. But just get it so that it's softened so that it doesn't look as rinkly so it doesn't look as dry so that it looks as hydrated as possible. So some of those treatments in the 20s do wonders. Botox, topic that people, some people love to do pre-a-like, I'll do a preemptive strike with Botox. Other people think it's stupid. I'm kind of torn.

I think that if someone needs it, they need it. You know, if someone comes to me and they're in their 20s and they got crazy deep lines, then do it. If some, I have patients in their 30s. I have a patient in my adjusted today. She's a good friend of mine. She's 39. She's turning 40.

She's in great shape, looks great. and the only place we ever do Botox is around the eyes and between the forehead, just because when she's working out, she's always squinting. And so those are the areas where she gets a lot of wrinkling. Forehead, she has nothing. So why are we going to put Botox in the forehead? She doesn't need it, you know? So there's those.

And then, you know, there's the younger patients who, on the other hand, have crazy deep lines here. And so you just do a little bit, just to kind of start softening them. You don't want to paralyzing you want to have expressions. You know, I used to have crazy deep lines before. And so, you know, just a little bit of Botox, just help. helps out, just softens things up. You know, so you can still move and you can still see a little bit of lines because I need a little Botox,

but, you know, it kind of gets you an idea that, you know, you can do little things that help out. More involved treatments. Yeah, they're the surgical ones that, you know, for the right person, you know, you can do. But micronealing with radio frequency, awesome, awesome, awesome treatment. I think that's probably the best advancement as far as minimally invasive treatments that work that give you a good response. And so the microneedling we've known around for ages. Microneedling, the long of it is tiny little needles get driven into the skin that causes

micro trauma in the skin, brings blood supply to the area, causes a response in the skin that causes to heal itself, dermis thickens, brings more supply to it, improves the quality. It can actually help men grow beards as well if you're doing micrnealing. So it has a lot of really, really, really good benefits. The downside, it can only do so much, right? You can only go so deep. You can only go so frequently. You can only do so much.

okay, let's add PRP. Let's add a bunch of other stuff. Okay, that adds you a tiny little bit more. But the radio frequency, what does that do? So radio frequency elicits a collagen response and stimulates an elastin response as well. So not only can it melt fat if you go deep enough. And some people are a little chubby and it helps get rid of some of that fat down here in particular. But it stimulates that tightness a little bit more. Yeah, exactly. It stimulates that tightness a little bit more. And stimulates the collagen deposition, stimulates the skin to tighten. So, We can see significant tightening once we get over about 55 degrees Celsius on the skin level. Now, the downside, because you'll be thinking like, hey, Miguel, I've heard of thermage. I've heard of all these other radio frequency treatments.

I did it. Didn't work. And you have to remember there's a difference between transcutaneous radio frequency, meaning something that just goes on your skin and the radio frequency goes through the skin layer versus something that goes in the skin. That's where the microneedling with radio frequency has a huge advantage. There's a couple great, great, great treatments out there. profound RF is a good one-time treatment. I have pixel-8, which is very similar to morphosate.

Those are great multimodal treatments that help more with cellulite and skin texture. So if you have acne scarring, for example, it's a great way of tightening the skin, improving the texture. Same thing with scars that are a little bit flattened. It just tightens up that texture really, really nice, so it feels the same, which is really, really, really nice. So the micromanating with radio frequency is something that's now in our armamentarium of treatments, which is really, really nicely.

and that's probably something that people in the early 20s are starting to do. 30s, you can go a little more involved. Then you can do something with radio frequency as well that really melts the fat, it melts the fat rather, tightens the skin under the neck. You can do a little bit up here as well. And so then at that point, what you're doing is you're thinking like almost like you're shrink wrapping that skin. The younger you are, the better you'll do.

All this is based on your immune response. So the younger you are, the stronger it is. The older you are, you'll still get some response, but it's not quite the same. same as when you're young. When you're young, it really tights things up. And it's a great in between procedure. It buys you time until you're in your early mid-40s and you need a little bit more of a pickup. So, you know, that's something that we're starting to see a trend for, especially patients that are so concerned with their jawlines with all their selfies that they're taking looking like this. That was like the main question that I got, by the way. Everybody wants to know

about like early jowling and seems to be a big problem. It's not. It's not. It's. It's nuts. And I get so many young patients that come and they're like, oh, I got these jails. And I was like, what are you talking about? Like, stop. Like, go home. You don't need it. Wait, I have to tell you something so funny because right before this, I was looking through all the questions that people sent in and typing them in and Chuck came up behind me and he's like, what are you doing? And I told him I was preparing for this. And he started looking at the questions and he was like, oh my God. I mean, And it's like, I have a bigger jowl in this side than the other side and asymmetry. And what do I do about asymmetrical lip corners?

And what do I do about one eye that's a little droopier than it? And to him, because it's not his world, he was just like, you guys are so hard on yourselves. Like, he's like, I can't even look at it. And he walked away. Yeah. It's true. It's true. I mean, there's so many patients that sit in front of me and they start picking themselves apart.

And I always tell them, I'm like, listen, the devil that says between your ears is your worst enemy. He will always be your worst enemy. and you will always be harshest on yourselves. And you kind of touch on it, the asymmetries in the face. And we have to remember that embryologically, the way that the face forms is not from the middle out, right? So, I mean, it's a bad example, but everybody has seen, you know, someone with a cleft lip or a cleft palate. And the way that the face forms is it actually is a flat plate and then it comes together in the midline. So it's not perfect twins, but rather it's like really closely, like really closely related siblings.

So when it comes together, it's going to be off a little bit on the middle. the side. And the reason why Clef's form is because they don't fuse in the midline. So one cheekbone's going to be naturally higher than the other. One eyelid socket's going to be a little bit higher. One bone is going to be a little bit higher than the other. And, you know, that's like a cheap, easy way to kind of do a party trick and tell people like, oh, that's your good face. When you see the corner of the mouth that's a little bit higher, the cheekbone that's a little bit higher, that's their good side. Yeah. So embryologically, I was smushed on my left side for a long period of time. It would appear. Yeah, you can blame your mom. Just be like, listen, mom. You should have

listening. So thanks, Mom. Yeah. And so the thing that people notice, why people notice that as we get older is because we lose volume. And so as we lose volume, you start noticing those asymmetries. When you're young and you're fluffy and puffy and really nice and chubby, you don't notice these things. It's not like these things appeared out of nowhere. These things have always been there. But as we start to lose volume, we start noticing it. And we try to correct it with fillers. But what we notice is that one syringe of filler can make you look horrible or it can make you look like you did nothing. But at the same time, 30 syringes of filler can make you look incredible or it can make you look like a complete monster. So, you know, putting things in the right place and the right type of filler, whether that's fat, whether that's, you know, the right H.A.

Or the right hydroxyapit, whatever it is, the right tool for the right job is what's going to help more than anything. You know, I'm all about that fat. That's nice. That's nice. Liquid gold. Yeah. Okay. Let me get to questions.

So first I just have to ask because so many people ask, is there a special VIP line for Blonde Files listeners? You're going to have to talk to Lauren? Why did I feel like this was going to happen? So basically, yeah, so I don't know. I'm going to talk to Lauren and see what we can do. We'll figure something. I've already made Lauren's life difficult enough. for the year.

Yeah, Lauren, anytime I'm like, hey, Ariel has a question. You can just hear the eyes rolling to the back of her head. I'm like, Jesus, what are we doing now? I'm sending her cookies, so hopefully I'll get on her good side. I'm going to eat all of them, so she's not going to get it. Okay, well, I sent you a few boxes, so some of those are for Lauren and for the other people in your office. Nice.

Just, FYI. Okay. What's your opinion on buckle fat removal? I think we talked about this. For the right person, it's a great procedure. And so you have to evaluate what someone's face looks like. Understand that as you age, you will lose volume. And so the last thing you want to do is take fat away.

When more frequent than not, we end up having to add fat back into the face, particularly in younger patients. So you want to be aware of that. And so what does that mean? Who is the right person? Well, long, skinny frame, athletic build, usually not the best candidate because it'll hollow you out. And, you know, I joke with patients that, you know, I'm like a fancy makeup artist. All we do is I play with lights and shadows.

So you have to think, do I want to create a shadow in this area? And so, yes, in some cases you do, you want to create that contour. It's nice. It looks good. And other cases, we don't. And so when you have a long skinny frame and then it's going to create a highlight here, by creating a shadow down here. It's going to create a highlight up here.

So for the people that are listening in the podcast and that aren't that aren't watching this, what I mean is there's going to be highlight in the cheekbone area. There's going to be a hollowness underneath the cheekbone area. And what that's going to get accentuated is if you're already in that area, you're going to start looking a little bit like Maleficent. And so not everybody likes that look. So it's not for everyone. When you're a little bit shorter, a little bit wider face, a little bit more,

a little bit more ovalish look, it's amazing because it'll, create a little bit of that contour and it won't change your overall appearance too much. It'll just give you a little bit of that shape that we all like. And so it'll turn kind of like a little pumpkin look into more of a heart. And so we always want that heart shape. So it looks really, really, really pretty to kind of turn that teardrop upside down. Now, I'm super biased. And this is where I'm going to throw my bias. I always tell people what my bias is before I give them the information. My bias is, I would rather look good now than look good in 10, 15 years. That's just me. And so I'll always tell them, listen, buckle fat is not for everyone,

but that doesn't necessarily mean that you shouldn't do it. Because if it's going to mean that you're going to look good now, then do it. But understand that 10, 15 years later, we may be adding some volume back in. Are you ready and are you prepared? So if you are one of those patients that do not fall into the green light, little rounder, shorter, stockier, going to look amazing with buckle fat, if you do not fall on those and you also do not fall into the red light of long skinny frame, it's going to look terrible, absolutely do not do it. And you're somewhere in the middle because

the truth is most people are somewhere in the middle, I'll give you the option. And I'll tell you honestly, listen, if it was me, the juice is worth the squeeze. Or conversely, I'll tell you, honestly, this juice in particular, not worth the squeeze. You're going to do the buckle fat. It's going to look okay. It's not going to give you that dramatic contour result that you want. And then you're going to end up wanting to do volume again in another five, six, six, seven years. So you have to be somewhat realistic. Everyone's a little different. You have to evaluate everyone individually. But the run around the bush answer that I just gave you is it's good for some and it's not for others. And the volume that you're referring to, would that be like fat transfer? Yeah. So there's only two things that

you can do to replenish that volume. You have to understand how filler works. Filler is a soft-ish product depending on how it is. Some is thick like molasses. Others more like like syrup, like pancake syrup. And then there's some that's like really, really, really thin. So different products are better for different areas. All these products need to be onto something in order to be built on. What does that mean? Cheek filler built on the bone, right? So it uses the bone as a backbone to push the plump out. Lip filler. Lip has to be somewhat thin. Otherwise, what happens? It gets the drug down, makes you look like you've got duck lips. Why? Because you're not really building on it. So you have to be somewhat careful with what you do. Buckle space. Guess where the buckle space is?

The buckle space is in the cheek. So there's nothing to build on that. That place is a black hole. I could put 10 syringes of voluma, which is one of our thickest fillers, or I could put one syringe of voluma. Guess what? You're going to get the same result. It's going to be somewhat similar because of what that space means. So you have to use particular types of products. So what's a better product in that area? Sculptra, if you're going to go the non-surgical route, sculptor is a great product. Sculptor is polyelactic acid. It's a collagen inducer. So what it does is it goes in that skin area. And then it stimulates your own skin to create or it stimulates your own tissue to create collagen. So it activates the fiberless all the way from bottom to the top.

So when some people talk about that sculpture glow or that red carpet glow, that's culture. So not only do you get a little bit of volume, but you also get some improvements in the quality of the skin. So it's really, really, really cool. Downside, because right now it sounds like an amazing product. You need a bunch of it. So it gets expensive. Two, results are somewhat subtle. Three, you need multiple sessions.

So you can see where the expense starts to add up. So for some people, you know, they don't want to do the surgical. they have the money to spend. Sculpture is a great option. It also is somewhat subtle. So when people don't want that dramatic, oh my God, what did that person just do? But just kind of like a slow and gradual improvement.

It's great. But it's unclear where the end point is. So you may find yourself constantly doing it for a couple months before you're finally happy. So that's the big downside of Sculptor. Like, for example, sculptor bought augmentation. It's going to be a fortune. Like you could buy a G-W.

wagon. Like how much? And realistically, you're looking at $80,000 to $100,000 to make a reasonable difference in your, this way that you're, so that it looks nice, right? So if you're comparing it to like a BVL, like if you came down to Miami and you were to do a BBL, get a nice sculpture, a nice sculpture on the side, get a little bit of the hip dips filled in, get a little bit of the blending down the sides. You're going to use a ton of sculpture. I mean, you're looking at, you know, at least $80,000 worth of product. I mean, it's going to be insane. And at a discount, it'll be like $55,000, whatever. Go out by a BMW. You'll be much happier. So the, or just use your fat.

Or just use your fat, which leads to the next point. So, you know, I mentioned BBL, Brazilian buttlift. That's something in Miami. You see a lot of. You see them all over the place. They're getting big here too. They're starting to get big. Yeah, because in L.A. for a while, they were doing a lot of implants.

It looks bad. And the fat is amazing. So fat done right does really, really, really well. Fat is your own fat. It's living. it's not breathing, but it's, you know, it's thriving. And once it gets some blood supply, it's amazing. It's almost, it's technically forever because it ages with you. And the nice thing about it is that it has memory. So the fat, once you put it in there, it gives you this nice plumpy glow. And then you ride

the wave. You'll see it. It shrinks down a little bit. And then once it gets blood supply after about two, three weeks, it starts to plump back up. And then you're good. And then after about two, three months, it plumps back up again, and then you're really good for about a year. So it's almost like you're transplanting hair. So it's very similar to hair grafts and hair transplants. A year. Yeah. A year. Wait, I thought it was permanent. No, no, no. I'm saying it's going to be permanent. It's going to be permanent. What's the year? Are the fluctuation? Fluctuation. Fluctuation for a year. Yeah, fluctuations for a year. So yeah, you're going to ride away for about a year. And then at that point, it's alive, right? So after a couple weeks, once you get that blood supply, it's alive. It's alive.

It's good, but until it kind of settles in, it's going to go up and down, up and down, up and down. But after a couple weeks, you're good. And then it's permanent. Now, what does permanent mean? So permanent means that it ages with you, right? So a lot of times people think of permanent, almost like we think of silicone breast implants, or we think of any sort of implant that's just kind of there. And then you die in the cadaver, and there's just like this like thing sticking out.

That fat ages with you because it's alive. So as you get older, it gets smaller. It atrophies. it's very, very common that we'll do a facelift on someone who's in their 50s or 60s. They had a fat graph 15, 20, 30 years ago. They'll say, Doc, it was amazing for about 10 years. I loved it. And then after it didn't last, it went away.

You do the facelift and you see different colors of fat underneath the planes because you'll see that the fat comes from different areas has different colors. So what's really, really, really nice about it is that you put that everywhere. So not only can you put that in that buckle space, you put that. along the cheeks, you blend it in. That's the one thing that's a little more artistic than anything else, and it's really, really hard to explain. It takes the longest to do. If you compare doing filler, doing filler to me, takes like 10, 15 minutes tops if I'm doing like a lot of filler and I'm just balancing stuff out. Backrafting will take me an hour. And so I'm doing micro-droplets

a little bit at a time looking at you from the top, from the side, moving your head from side to side, sitting it up, doing all these things over and over and over again. And, you know, for most patients, for example, if you were used to doing like one syringe of cheek filler here and there, I'll put 11 to 12 syringes along the entire midface, which will plump you up. And even from that, it goes down a little bit and then it plumps back up. So you're putting a lot of product over a large area and the key is in blending it in so that it looks super nice. And I hate being jazzy, but you kind of have to go by feel a little bit in this. And super important that, you know, you're turning the lights,

moving it from side to side, taking a look from above, moving it a little bit. And so that's the thing that probably takes the longest surgically, that doesn't seem like it would take the long. So you think like, oh, fat grafting the face, two seconds. Like just harvest the fat, do that. And how we harvest the fat, what we put in it, how we concentrate it, make sure that we don't damage the fat. You have to respect the fat.

The one thing that I was always taught was you have to be nice. of the fat. If you're not nice to the fat, the fat's not going to be nice to the patient. So, you know, how you take it out, how you put it in, you have to be super, super gentle. It makes a huge difference. Is it always under sedation? Yes, you could brave it if you wanted to, but if it was me, I wouldn't want it done because it's a long procedure. And so if you imagine getting fillers for like an hour and a half and add lipos like super painful lipos, like super painful lipo. No, it's not fun. People were asking you, about fat transfer to the lips.

Is that, I mean, same process, same harvesting, everything? Yes and no. So there's a couple of people that really like to do fat grafting to lips. I'm not a huge fat grafting to the lips person. I do a specific type of fat graft to the lips. And the reason why is when you look at lips, there's three major things that I try and talk about. Shape, volume, proportion, right?

And so you kind of have to find the harmony between all of them. And there's the right instrument, right tool for all of them. So for me, shape is like the most important thing. Pretty shape is like killer. You can have very little volume. The proportion may be okay, but if the shape's right, you're good. The problem with fat is that it needs blood supply to survive. Right. And so the only place with really good blood supply in the lip area is unfortunately the ribicularis muscle. So that muscle that when you pucker, you see that there, that muscle is really what has the best blood supply. There's a nice, thin layer lining the lip, the mucosa, which is the puffy pillowy part. In between them, there's minor salivary glands, so there's a little space in between them. And then behind that is where the muscle sits. So when you're injecting fat, traditionally when you're doing micro-droplet technique, and that's the best technique for the face, when doing micro-droplet technique, it gets very difficult to do the lips because you're going to lose the shape, because the molecule is very big. So if you're putting a lot of that fat in order to get it to survive, you're going to blow out the lip. And so once you blow that shape out and it's in the muscle, it's going to look bad.

It's going to look really, really, really bad. So people have tried to work with nanofat. And so what's nanofat? Well, you know, I just told you about microfat, where we're taking out the individual adipose and we're concentrating to individual adipose cells. The microfat is we're trying to separate that adipose into more by running it through different sifts. So those independent sips get thinner and smaller and smaller and thinner and thinner and

and smaller and smaller and smaller. And eventually what you're doing is you're passing the fat in between it and you're making and breaking it up into small pieces. So far, all the studies that have been done have shown that the survivability of that nanofat somewhat questionable. It's great for the skin. There's a lot of good healing factors

that are released when you do that. So some people were doing it for tear-truff augmentation. Some people were doing it for lip augmentation. And the results are somewhat mixed. They're not really predictable. And in my mind, when you're doing something cosmetic, you want it as predictable as possible. And so the fact, the fact,

grafting there, I'm not crazy about it. So I told you, well, I still do some sort of fat graphing. What kind of fat graphing I do? So I do a fascia graph. And so what a fascia graft is, is we take a little piece of fascia from the hip. And fascia is just the lining that the fat is attached to. So we take that fascia and we slide it in the lip, almost like a little implant. So it's really, really cool. The nice thing about that is that you won't blow the shape out because you can only fit so much, so much of an implant in there before it's, before it physically won't fit in there. I think of it almost. I think of it almost. like if you've got a shoe that's like a size six and your foot is a size 12, it's never fitting in there. But if it's a size seven, it'll still fit in there and the shoe will still look about the same. Once you start getting to a size eight or nine size foot, it starts to blow that shoe out. It doesn't look the same. So, you know, you're somewhat limited by the size of the shoe. In this case, you're limited by the size of the lip, how big of an implant you can get. So it's a nice measure of like, listen, man, this is as big as your lip will allow me to go, which is nice. The other advantage of that is that because we have that strip of fascia,

Think of it almost like Christmas lights. So only one small area of the fascia needs to get a blood supply. And then the whole fat graph lights up like Christmas lights. And so you only need that blood supply survive in one spot. Whereas when you're doing the micro droplet, you need all that stuff to survive. And God forbid, you get more survival over here than here or here than here. And then it looks really, really funky and weird. Plus you lose the shape.

So I like doing the fascia graphs a lot. And, you know, if we're doing a facelift, the advantage of that is that, guess what? I just take the smass, the fascia that's down here that's a little. extra that's behind where we enter the deep plane, we take that in there and slide it in there. And you don't even have an extra incision. I feel like I need a fascia graft. You don't like this fascia graft sounds interesting. Let's discuss.

Let's see. Okay. So a lot of people asked about endoscopic browlift and upper blephoroplasty, how to know which one to do or when to do one or the other or both. Cool. So I think it depends on the age group, more importantly. So let me start from youngest to oldest. So with the young patients, brow lifts, very popular, that cat eye look, really, really popular, really in.

I usually tell people stay away from trends, especially when you're talking about permanent changes to your face. Not to interrupt, but what do you think about that trend? Do you think it's a trend that will go away or do you think that it's a look that's kind of here to stay? It's a trend. I mean, so let me put it this way. That look is a trend. That procedure is not a trend. That procedure has been around for ages, but it's been modified very, very slightly.

And I can tell you once this is not recording what that change is, because it's really, really, it's like a tiny little thing that people do. And because they're changing, they do that tiny little thing, they're trademarking it, and they're charging like a bazillion dollars for these procedures. And they're really monetizing on like young people that want to look a certain way when in reality, it's a procedure that's been around for a long, long time. And they're just literally doing a tiny little change that's the space of a centimeter, like an extra five, ten minutes worth of surgery to give a certain look.

So realistically, when we're talking about brow versus eye, those are two different types of skin. So when you're trying to figure out, you have to evaluate what the position of the brow is. So whether you need a brow or not is, where is my brow and where should it be? traditionally if we were going by the textbook for most people the arch of the brow should or for most women the arch of the brow should be about a centimeter above the brow bone Miguel we live in America centimeter what is this nonsense so a centimeter is about a pinky so it's about the width of a pinky so if you feel the edge of the brow bone and then you feel where that brow is you kind of wanted to sit

like about a pinky you know kind of where you are you know like that's about right and so any higher than that, you start looking a little bit dear in headlights. And so you have to be somewhat careful without talking about like the rest of the brow because that's important. But, you know, we like to use the arch and going down towards the tail as kind of our measures of what we do. And so traditionally when people grab the heaviness and the hooding on the side, oftentimes they think it's the eyelid. That's actually the brow. And so you need to kind of establish where that brow is in order to realize where it needs to sit because you can't evaluate what is eyelid skin until you put that brow in its rightful position. Once that brow is in the right place, then you can do a little bit

of eyelid skin. That is not to be confused with a temporal brow lift or a lateral brow lift or an endoscopic brow lift or a more involved mid-face lift or a more involved endoscopic face lift. So all these things are kind of like, it's a gradient, right? It starts with one and then it finishes in the other. And so the biggest confusion that young patients have is, oh, I just want a little temporal browlift and that's going to pick up my nasal labial folds and it's going to get rid of my jowls and it's going to tighten everyone up. No, temporal browlift is just going to pick up the hooding a tiny little bit. And it's just going to open up that corner of the eye.

It's a beautiful cherry on top. Like it's the ultimate subtle, like just tiny little stroke that most people aren't going to notice. But it's going to be, like I said, the cherry on top. It's going to look amazing. It's icing on cake. It's just what decorates everything at the end. The lateral brow lift gives you a little bit more of an arch. The endoscopic brow lift picks everything up.

Most people need an endoscopic brow lift. And then you can modify it if you want a little bit more tail, pick up, et cetera. The one thing about brow lifts, people need to understand, brows fall down. So if you pick up about 10 millimeters or 11 millimeters, it's going to fall about five. So it kind of drops in half. So, yes, at first, you're going to look like a deer in headlights. But then it settles down a little bit.

And usually somewhere in between those two is what you like, but in reality, where you end up settling at is the most natural look for most people. So as we get older, the browliff becomes a little more important. However, it does change your appearance a little bit more. So that's where looking at where you were when you were younger comes very, very, very important. In particular, where you are. So, for example, I have a lot of patients that have heavy brows. And so I look at them in a media, I'm thinking, man, she, you know, needs a brow lift. It's so bad. And they're talking to me about their eyelids. And she's talking about. She

needs her brows. And before we say anything, I'm like, okay, well, you know, do you have any pictures of yourself when you were, you know, 10 years ago, 15 years ago, 20 years ago? And like most good patients from Boca Raton and Miami and Palm Beach, they break out like actual pictures that they bring and like framed pictures. And you see the pictures from them. They're like 20. And you're like, I can't believe you're showing me a picture when you're 20. You're like 65. But their brows have always been flat. And so then you start thinking like, oh, that would have been a horrible choice for her. However, I need to tell her that we need to at least pick them up a little bit. So it may be a little bit more subtle. It may not be quite as aggressive in some areas as with a younger patient. And so in some

older patients, we end up doing a combination of a more subtle brow lift to put the position of the brow a little bit higher, not quite where we would. But we also need to do the upper eyelid excision just to create that contour and get it back to where it was. So it's not quite very defined. who needs what is very individual, but there is a gradient that you need to follow and you kind of have to see what the end point and what the goal is. Another question that I got a lot was,

is there anything non-surgical to do to help with maybe excess eyelids, skin, and some of that hooding? I think a lot of people are under the impression that Botox will, you'll get a little Botox and suddenly you'll have that lift and the smooth eyelids and everything. So can you talk about what Botox can and can't do?

and if there is anything non-surgical that you can do to clean up that area. So remember how Botox looks, right? Botox is a neuromodulator, which means that it impedes the movement and contraction of the muscles. So if you've got a wrinkle that's caused by movement, Botox is great. However, and this is like the gypsy curse, you know, may all your wishes and dreams come true. So something's going to come back and bite you in the butt a little bit. So if you can't move, it won't make that wrinkle, but you can't move. So, you know, if you are trying to get rid of these crows feet, that's great, because it's going to pick up the brow because it's a brow depressor.

So when you get rid of the crows feet, that's going to pick up the brow. However, then what you need to realize is that you can only go so far down because guess what when you smile, the zygomaticous muscle that picks up your cheek is right at that border. So if you want to get rid of all those wrinkles that go all the way down, you may be knocking out that smiling muscle and you won't be able to smile. So there's a fine line as to what Botox can do and can't do. it's great for the orbicularis contraction underneath the eye. So for lower eyelid skin, that's crinkly, great. But the dosing is low because you don't want to collapse that muscle too much. And it's not going to last you very long.

So you have to be somewhat careful with what you can do with it. On the upper eyelid, it's tricky because you don't want to paralyze that upper eyelid. That looks really, really bad. So non-invasive, and this is where we kind of border on what exactly is non-invasive. I like to infractionated CO2. You know, so CO2 laser works very, very well in the upper eyelid skin. It's thin enough where you see a significant response from tightening it. It's non-invasive enough in that, you know, you give me three days of downtime.

You're good. You're down here. You're wearing sunglasses all the time anyway. Like, you just wear sunglasses. Give me five days of sunglasses wearing or, you know, just not going out. And it'll tighten it up significantly. But at the end of the day, it's only going to improve it so much. You know, I think that's the thing that most people need to realize with a lot of these minimally

invasive treatments is you need to be at the right stage to set yourself up for success. And so if you're too far gone, you're going to be overpressed and you're going to be underdelivered with some of the minimally invasive stuff. So if you've got a little bit of creping, if you got a little bit of wrinkling skin, the upper eyelid, even if you do an upper eyelid surgery and you've got a tiny little bit of excess, you zap that with the laser, tightens it up. It's almost like ironing a shirt. But if you've got a lot, then you have to kind of reevaluate what the goal is. Let's do a couple rapid fire. So best procedure for a weak jawline.

Radio frequency. I like this. Okay. Best procedure for chubby cheeks. Buckle fat. Okay. How can I get rid of under eyebags? If you're young and you're the right patient, a little bit of filler goes a long way, like me.

If you're on the older side, fat grafting and lower eyelid surgery. Can lasers damage fat cells in the face? When done inappropriately, yes. Is a lip lift permanent? Your boobs are going to fall. Your butt is going to fall. Everything falls as you get older. So, yes, it's permanent.

So, yeah, it's permanent. But it's like anything else. You know, you do a facelift and guess what? It's going to fall after 10, 15 years. But it helps you in that short period. What surgeon do you admire most? Oh, actually, there's this, the chairman of neurosurgery at a skull-based neurosurgery at Lennox Hill. Yeah, he's what I would call.

He's like the guy. He's like, if I wanted to be like someone, that's the guy. What's his name? Gotti Harrell. Interesting. Oh, didn't you write a book that you told me about? Mm-hmm. I think we talked about that on the last episode.

Okay. Best tips for post-surgical scar healing. Take it easy. Don't do anything. The biggest mistake you do is do too much. Follow your doctor's advice. They know what to tell you. But my usual advice for patients is if you can imagine me saying don't do it, don't do it. Don't crash the Ferrari. That's it, man. Just don't crash the Ferrari, please. Is there anything we can do to prevent sagging of the lower face?

aside from like radio frequency. Yeah. Radio frequencies, yeah, in a tie machine. Okay. I was hoping you were going to say salmon. Salmon, ton of salmon, as much salmon as possible.

All the salmon in the world. And cookies. That was my next thing. Yeah. Can a lip lift alter the look of nostrils? In the wrong patient, yes. If you've had multiple nasal procedures or in ethnic patients, it can,

but very minimal. when done inappropriately, it can significantly. So when done right with deep anchoring and deep dissection with minimal tension, at most it may change it by a millimeter, but not anything that'll notice. The close analogy that I have is when you go home, you move your coffee table in your living room, a foot forward. Nobody is going to notice, but you'll always notice a little bit.

And so that can happen particularly in patients who've had significant rhinoplasts. So multiple rhinoplasty patients, I always counsel them on that. What's the downtime for a bra lift? Realistically, restaurant ready, 10 days. How many rhinoplasties performed would indicate expertise in a surgeon? Ooh, that's weird. Because you can qualify that in so many different ways. I mean, I think it's like anything else.

You know, if you're doing, you know, over 50 a year, you know your shit. Okay. And last question that I'll ask you, do Botox lip flips work and Botox under the nose? Yeah, super short term. It's a very low dose.

I did it and it did not work, but I also had other issues going on. I had the longest philtrum. The thing is, but the thing that people don't, it's not going to pick it up, right? It's actually going to make it long. So the way that it relaxes the lip to flip it is it relaxes the muscle, which in turn makes the lip longer, the filter from longer, in order to get it to flip.

So it's almost like you're can't delivering it downwards. So yes, you can get more surface areas shown, but it may not give you the result you want because guess what? It's going to decrease the amount of tooth show you have when you talk and smile. It's going to make it funky when you eat or drink, like you won't be able to suck out of a straw for two weeks. And all it's doing is increasing the surface area. So when you add filler, it looks a little bit nicer. But when the fill trims long and the wrong patient, it looks bad. But one of my surgical texts, like I do a lip flip and filler on her all the time.

Amazing. Well, where can everybody find you? And how can everybody skip the line so that they're not waiting until 2022 to get a consult with you? So everyone can find me on Instagram, Dr. Mascarro, D-R-M-A-S-C-A-R-M-A-R-O, like I-M-Scarra, but with an O at the end. Really easy. Also, my online, my website, MiguelMascaromD.com. Well, thank you so much, and I'll be seeing you in like four days. Actually, when this comes out, it will be, I will have seen you two days ago.

So thank you. No problem. I hope you enjoyed that episode. If you liked it, and if you like the show in general, please take a second to rate, review, and subscribe. It goes a long way, and it's actually the best way to support the show. Also, if you want to see more about each episode, you can head over to The Blonde Files podcast on Instagram.

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