Well with Arielle Lorre - 155: Current Plastic Surgery Trends + Q&A with Dr. Miguel Mascaró

Episode Date: February 14, 2022

In this episode I’m talking to board certified facial plastic surgeon Dr. Miguel Mascaró about beauty trends and best practices when it comes to rejuvenating the face. We discuss the most popular trends of the past year, what people are asking for the most, what trends are fading out and what he hopes to see go away. He also shares what trends he sees on the horizon when it comes to beauty and surgical procedures. Additionally we discuss non invasive procedures; celebrity surgery; what he thinks I should do next and listener questions.   This episode of The Blonde Files is brought to you by the House of CHANEL. Harnessing the revitalizing powers of the Red Camellia flower, CHANEL Research introduces a new generation of sustainably developed skincare: NUMÉRO UN DE CHANEL. Beauty Ahead of Time. Discover the collection at www.chanel.com    This episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct, or indirect financial interest in products, or services referred to in this episode.   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. This episode of the Blonde Files podcast is brought to you by the House of Chanel. Harnessing the revitalizing powers of the red camellia flower, Chanel research introduces a new generation of sustainably developed skincare, numeral Ene de Chanel. Beauty ahead of time. Discover the collection at Chanel.com. Chanel introduces a new generation of sustainably developed skincare,

infused with a high concentration of ingredients, and derived from the uniquely revitalizing winter blooming red camellia flower. Packaged with lightweight glass, organic ink, and other bio-based materials, No. 1 de Chanel forges an unprecedented path of skincare innovation. Numero 1 de Chanel, beauty ahead of time. To learn more about the line, visit Chanel.com. Hey, welcome to the Blonde Files podcast. I'm your host, Ariel Lorry, and I'm here to talk all things wellness. 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 have one of my favorite people on today. I'm talking about Dr. Miguel Mascaro. He's also the only guest that I've had on three times. So if you have not listening to to the first two episodes that we did together, definitely go back, search for those and check them out. So today we are talking a lot about trends. We're talking about best practices when it comes to rejuvenating the face. And we just get into so many different interesting topics here. So we're talking a lot about like popular trends of the past year, what he's seeing people ask for the most, what trends are kind of fading out and also what he hopes to see go away.

And then he also shares what trends he sees on the horizon when it comes to beauty and surgical procedures. We talk about non-invasive procedures. We talk a little bit of celebrity surgery, although I can't really get him to spill anything. We talk about what he thinks I should do next, if anything. And we also take your listener questions. So a little background on Dr. Mascarro, he is a fellowship trained and board certified, facial plastic, and reconstructive surgeon. He's also concurrently board certified in head and neck surgery. He's a specialist in cosmetic and

reconstructive surgery of the face, nose, eyelids, ears, neck, and scalp. And in addition to that, he has extensive experience in non-surgical treatments of the face, neck, and scalp, including injectables and laser therapy. He is also currently actively involved in aesthetic and reconstructive surgery research, co-authoring several journal publications and book chapters and is an active member of the American Academy of Facial Plastic and Reconstructive Surgery. This is a super fun episode and he is so smart and knowledgeable. So I hope you guys enjoy. Welcome Dr. Mascaro back to the show. So first of all, I want to tell you, you're the only three Pete guest that I've had so far. So I should get a t-shirt. I want merch. I want merch made with my name on it and my face on it that says three-peat.

We should do some exclusive merch for that. So if anybody, listening has not listened to those first two episodes. Definitely go back and check those out because we covered a lot of like beauty, aesthetic, surgical basics. And we'll go over some of that in this episode too. But I also want to talk to you about like trends, what you've been seeing a lot of what you might hope is like going out of trend, what you see coming on the horizon. And all of that. So to start, I know a lot of people who sent in questions on Instagram are very frustrated because they want to get in to see you and you're booked out until like 20, 35. Yeah.

Which is great. It's a great problem. But it's also really frustrating too, you know, because you obviously want to try and help as many people as you can and you want to see as many people as you can. But at the same time, you also don't want to drop the quality of the work that you're doing because you want to put the time and the effort into everybody. And that's part of the reason why your backlog gets so big because you're putting all this effort in time into each individual case.

And people can sense that. So it's a great problem. And we're trying to improve on that. And I actually now have changed my surgical schedule to accommodate a couple more cases here and there. And that opened some spots up, but then the backlog kind of keeps going, which is great and it's super humbling and it's amazing. But yeah, I'm trying to figure things out.

So if anybody has any ideas on how I can do this, that does not involve me working on Saturdays and Sundays. please feel free to DM me and let me know what you can come up with. If we can crowdsource this, I would love it because the more ideas, the better. You're opening the floodgates right now to a lot of DMs, probably, from people who are trying to get into see you. Yeah, it happens anyways. So might as well, if they can give me a good idea, like, that's fine, I'll use it. Well, given that you're so busy and you obviously have a front row to like what everybody wants to do, what everybody is doing, what have you been.

the most of since we last spoke? I think it's a pretty good transition from what we spoke about last. We were talking about how there was this shift from the minimally invasive procedures to more surgery. And we're starting to see that a lot with younger patients. And I think that part of that is because younger patients are, A, seeing a lot more of themselves with selfies and cameras and pictures and all the stuff that we've talked about in the last couple episodes.

But also, more importantly, is they're seeing that they're spending a lot of money and not getting a lot of results. And one of my really cheesy phrases is, you know, the juice has to be worth the squeeze. And there's a lot off of squeezing and not a lot of juice coming out when you're doing a lot of these procedures, particularly threads, plasma pens, things of that nature. And so, you know, people want things picked up. People want things volumized. people want skin improvements and don't get me wrong.

Some of those things are great and there's a time and a place for all of those. But there's no replacement for some of the other things too. And you kind of need to know when to do what. And that's when it's really important to make sure that you will have a good guide that can kind of point you in the right direction that will honestly tell you this is a good thing for A or this is a good thing for B or where you find yourself. You need to do C. So we are starting to see a little bit more younger and younger patients coming in and saying,

Hey, Miguel, listen, I was doing this forever and I'm tired of spending the money. It hurts. I don't see the results. What can I do to get there? That does not mean, don't get me wrong, that the answer is always surgery. Because there are sometimes when you get that 22, 23 year old that wants these certain results. And the correct answer is you're not there yet. and it's not something that people want to hear, but at the same time, it's something that they need to hear because they need to understand that for surgery, and particularly for certain types of surgery, what we're doing is we're playing with the soft tissue. And so when I'm playing with soft tissue, I need the soft tissue to have the adequate elasticity, and I need the soft tissue to have the adequate laxity, meaning that I need there to be enough amount of excess tissue there for me.

me to either cut that out or it needs to be loose enough that when we release certain ligaments, we can reposition them while still keeping the natural beauty of the face. Because when things are tight and you're just starting to see some of that looseness, I can release ligaments. But guess what? Then those ligaments are going to reattach and I'm going to be having to pull so tight that it's going to deform your face. It's going to kind of give you a weird look.

It's going to change the overall appearance that you have. And while you may think that that is what you want, it's never good to do surgical changes to chase fads, right? Chasing a fad is not a good thing. You kind of have to take an overall holistic approach to your face and go forth. So we're seeing a lot of younger patients coming in for that. And even older patients, too, because they get caught up in that trend of minimally invasive, minimally invasive, minimally invasive, and okay, this is not working. I need to do something else.

So are you saying that you're having like 22-year-olds that come in and they want facelifts? 100%. So I know that I just talked about like flood my DMs with crowdsource ideas. I will welcome those all day, every day because most of the time I'm getting, you know, a lot of messages from patients who are in their mid-20s and early 20s who have had face lifts or who are looking into facelps. And nobody who has ever been in their 20s and had a facelift has ever thought that it it was a good idea ever. And I know that I mentioned this in the past, and particularly in the last podcast,

but you need to fit the criteria to be a good patient. And don't get me wrong, you don't treat the age, you know, you don't treat the number, you treat the patient. And there are very extreme cases where someone who's in their late 20s or early 30s may be a good candidate for some of these procedures, particularly patients who have undergone bariatric surgery or have lost a ton of weight and they have excess amount of skin,

They have a ton of laxity that needs to be addressed. And those are very extreme cases and very individual cases. But you kind of have to pay attention to each individual person one at a time. And as such, I think that the more important thing is you need to be able to guide the patients. And a very common discussion that I have with some of my other surgical friends is how much of what we've seen over the last two years has become a lot of, guidance towards patients because patients have grown frustrated with some of the results that they're getting with some of the beauty fads and trends that they find on on some of the social media platforms where they'll see certain results and they're expecting that to happen when they go and

have that done and you have to compare apples to apples you know you are not that person that we've seen there you also do not know whether or not those pictures were doctored and we've talked about this in the past where there's a lot of stuff that gets doctored up there And there's a lot of times where people don't show close-up pictures. They don't show how the sausage is made, so to speak. And you end up having to guide a lot of patients and explain to them why certain things are doable, why certain things are not doable, what to expect, what not to expect. And it's a difficult conversation to have because some people just don't want to hear that.

But the amount of patients that are coming in for surgery has certainly increased, but also the amount of patients that are getting turned away from surgery because they are not ready or there's better options for them or, you know, they need to find other options for what it is they're seeking has also increased. So I'm sure you can attribute, like, the increase in people coming in for surgery to social media. And, you know, we've talked about it here before, like different models and influencers and celebrities having a certain look that people want. Is there something that people specifically ask for or somebody that they ask for when they come in?

Like, who's trending right now? It depends. it's very cyclical, right? So, and you know, I mean, I tell you all the time when ever something happens, I'll start all of a sudden getting a bunch of consults from L.A. or from New York, and they all want, like, the exact same thing. I'll always ask you, I'm like, what is going on in L.A.? That all of a sudden I'm getting all these consoles for X, Y, Z procedure, and it's all, you know, 25 to 30 year olds, and this is what they want. And so it varies. You know, I mean, I think you, you have the classic, the heavy hitters. You'll always get your candles and you'll get your,

Kylie's, especially for lips and those things. But, you know, still, yeah, Kendall's huge. People love Kendall. I believe Kendall. What's interesting with Kylie? Well, the thing with Kylie is people now are referring to, I don't want the old Kylie lips. I want the new Kylie lips. You know, or with Kendall, it used to be, I want the Kendall brows. Now people are saying, I want Kendall's nose. You know, so, so the focus is a little different, but it stays the same. Hey, Lee is always a big one. your favorite. And then obviously... Bailey is looking lifted AF.

Yeah, she's looking pretty tight. Can I get you on the record? No, absolutely not. Zero. I will never go on the record about anybody. Just like just an opinion. I don't know if you answer to this either. But what in your opinion?

I mean, do you think that those women who are obviously young, they're like in their early to mid-20s, are they doing some of those more? aggressive surgical intervention. Okay. I know how to answer this question for you. So there are certain procedures that are good for older women, such as facelifts and lower facelifts, neck lift, et cetera.

And actually, older women is not good, good term, but rather patients who have the right laxity and elasticity. Feel attacked. And then there are procedures for patients who have had some volume loss and that I've had some issues with elasticity and tissue falling that can be repositioned with incisions that are hidden within the hair that do a great job of rejuvenating and picking things up without necessarily taking excess skin out. And so there are some procedures that are great for patients who are in there. I don't want to say great because that sounds as though anybody

who's in there mid till 820 should be doing this. But there are procedures that are apt. that you could do for someone who's in their late 20s, early 30s, who wanted to get a little bit more of that lifted look that are safer and are more appropriate than some of the other procedures. That being said, these procedures are not minimally invasive. These procedures can sometimes be even more invasive than I would consider like a necklift or a plitismoplasty or even a lower face lift. So the recovery can be quite long.

Yeah. So like an endo lift. Yeah, 100%. 100%. And so when I do the end, sure. So an endoscopic lift is a lift that goes from the hair and is meant to address and pick up the underlying tissues of the face. And so I know this is an audio format and audio media, but if you were going to take at the peak of your eyebrow and feel where that peak of the eyebrow is and feel where the bone is. And you literally just follow that bone all the way down to the bottom part underneath your eye, then carry that. up towards where you start feeling that rise of your nose. Now carry that all the way down where you start feeling the teeth, starting to come down underneath right at the top of the jaw, the maxilla. Then you carry that all the way across to the ear.

All that gets lifted. And you're not just lifting the soft tissue. You're actually lifting that lining off the bone and all those soft tissues. At the same time as you're also separating the cheek muscles that are attaching along those bones. So you're really doing a lot of heavy lifting in those areas to pick all that tissue up because you need to separate those ligaments. If you don't separate those ligaments, you don't free that tissue, you're just tightening up a bunch of skin that's going to relapse and fall back down. So you need to reposition all those tissues and ligaments. And when you do that, you need to do it

in the right vector. And what that means is it has to be in the correct direction. You also cannot be overly aggressive because if you're overly aggressive, you can change the position of the eye. and that's where you can get some of that fox eye look that some people really like, which looks good in makeup, looks horrible in person without any makeup on. But that is a procedure that's exceedingly invasive compared to a face-up. So when you're looking at the swelling and you're talking about lifting all that tissue and picking all that up, you're going to look like a pumpkin for, you know, good two weeks. But, you know, afterwards, you will look like a Bratstall and you will look like a little Barbie doll.

And if that's the look you want, you can get it. But it's exceedingly invasive and you can do it. Now, the caveat is not everybody's a candidate for that. So that is a classic procedure that people come to me to see because not a lot of people do these endoscopic lifts. And they'll say, I want to look like this person. I know you did this person and I want to look like this person. I'll just tell them you just don't have the bony structure.

You don't have the tissue for this procedure. Or conversely, you have too much excess skin. And so when you have too much excess skin, this procedure is not good for you. I need to do a lift where we're actually addressing skin, which would be a facelift or a necklift or a jawline tuck or a mini lift or other sorts of procedures that are going to address the areas that they want. So, yeah, it's a little more invasive than what people would want. So how are those procedures though, like a facelift or a necklift? How is that less invasive than an endo lift? they're still super invasive.

You know, particularly a necklift or a facelift. I mean, you know, when and there's a couple different ways that I do a, you know, if you're just talking about a facelift or a mini lift, to me, you know, they're all extended deep plane lifts, meaning that you're doing deep plane face lift, where you're going underneath the muscles, carrying that forward, releasing the ligaments and tightening things back up, bringing that down all the way down into the neck and the platism of tighten up that neck as well. However, sometimes in some patients, we will not do that.

because not everybody is a good candidate for that procedure. Other patients, we will do a high SMAS procedure where it's a little bit more of an old school lift, but some patients do better with a high SMAS and a biplanner lift. There's other patients where I'll do something that's a bit of a hybrid that I've been doing for quite some time, which is I do a deep plain face lift, but then we actually been converted into a high SMAS hybrid, where we actually release the skin once we've tightened up the deep tissues and redrape the skin in a different position. in a different way. So it's a pretty invasive procedure.

You know, when you're doing it and you have somebody there and they've never seen one before and they're taking a look, it's pretty invasive. However, the difference is that when you're doing an endoscopic lift is even though it's minimally invasive and by that we mean by the access because the incision is much smaller and it's hidden within the hair, you have to release a lot of really tough tissue right along the bone. So you are lifting a lot of tissue that you don't necessarily touch when you're doing a facelift. So for me, the invasiveness of the procedure really comes down to the recovery because it's just a tougher recovery. You know, a facelift or a mini lift, realistically, on a scale of 1 to 10, the pain is like a 2.

It doesn't hurt. You're going to be numb and you're going to be uncomfortable and it's going to be tight. But it's not painful. I mean, it sucks. You're a little bit, you know, you're a little numb. and it feels like you got a tight leather mask on, so it's uncomfortable. But the endo lift, you know, that is painful because you're anchoring to muscle, you're lifting deep tissue right on the bone and, you know, you're swollen pumpkiny.

And I have a lot of patients that we do this on. And, you know, two, three days later, they send me a picture. And they're like, you know what? You were right. I look like a pumpkin. What did I do to myself? And then 10 days later, they send me the picture and the selfie and they're like, this is the best decision of my life.

this was incredible, but it still hurts, you know, whereas you never get that feedback from facelift or a necklip patient. That's funny. I'm just thinking about not that this is comparable, but like the fat transfer where you're like, you're going to look like a pumpkin. And I was like, yeah, yeah, whatever. And then, I mean, how much did I blow you up when I was recovering? A lot.

There was, I mean, there was, there was, I think it was day three or day four where you, you you texted me and you're like, I mean, it was like the wheels were falling off the wagon. And you're like, what is going on? Like, I'm going to, like, things are going to be terrible when I get back home. I said Chuck's going to divorce me. Yeah, I didn't want to say it. But yeah, you literally texted me that. You can say it.

We're all in the nest year. Yeah. So you're like, I'm going to have a divorce. This is going to be a mess. And I was like, it's fine. And then two days later, you'd type. something, you're like, so this is not going to go down any further, right? I kind of love how I'm looking right now. And the changes that happened between day four and when you sent me that text

message were so minimal. But it's just you're getting used to those changes. And, you know, then afterwards, after you've healed up and a couple months later, and, you know, I sent you like your before picture. And you know, like, I can't believe. Yeah, of course. Yeah, I totally have that. But So the, I mean, the funniest comment was you just kept saying, I can't believe my friends let me walk around like this. You know, like, I looked horrible. And it's a totally different look, you know, and you get used to it, and it changes how you feel about things. And the recovery is very different. It's very, very different for a fat transfer compared to anything else.

And an endolift is very similar to that, where you do have that emotional rollercoaster. And that's something that a lot of people don't talk about facial procedures compared to you. to body procedures is the emotional roller coaster they have. And I don't want to downplay the emotional roller coaster that people go through it. This is something that I have a body plastic surgeon, a friend of mine in New York, and we joke about all the time where, you know, we talk about how we're just a fancy hairstylists and also a fancy therapist because, you know, part of what we do is the aftercare more than anything else is talking to patients through the difficult times they're going to have. And in body plastics, it's a little different than in facial because in body,

you can cover things up a little bit easier than in the face. And so the difficulty with the recovery in a lot of these patients is mental more than anything. You know, for the first three to four days to think, oh my God, what have I done? I don't recognize my face. It's completely normal. And that phase can often last a month or two. And even up to three months later, it's not uncommon for people to be like, did I really make the right decision? I'm kind of seeing on some days the light at the end of the tunnel, but I don't never know if this is going to get better. And then six months later, they're sending you their best

friends because they think that it was the best decision they ever had, and they never tell their friends all the issues that they had mentally about it. So it's definitely an interesting psychology that we go through when it comes to the recovery process. I recommend if anybody is getting a procedure

done to find a friend and do it with them. Surgery buddies are always fun. Surgery buddies are always good. Because it is such, like recovery is such an isolating feeling, which is something I did not expect at all. Like when I first got my nose job, that was such a mind fuck because I expected that it would be kind of uncomfortable, but everyone said it would not be painful. I didn't really realize that like I was not going to be able to breathe.

And it's just, you just feel kind of like lonely and like what the fuck did I do, like you said. And time goes by really slow. when you're alone and you're sitting in a room and, you know, I tell you, you know, I tell my patients, listen, you literally, if you just sit at home and get a bunch of books, put some Netflix, put some HBO Max and hang out and let the time go by, you're going to heal incredible like nothing happen. But I might as well have told them, hey, you're just going to sit there and stare at a wall and watch the paint drive. It's going to be miserable. And so when you're by yourself, it's difficult. And it's nice to have a support system. And so it's really, really nice when I have patients that

come with their friends to come in and do surgery with them because they're not necessarily going going through the same emotions. Sometimes they are, which is nice. And sometimes they're not. And so it's nice to have that person there to be like, hey, listen, I know you're feeling super depressed, but like I don't feel so great about myself. And you can feed back off each other and you can say, well, I look like a pumpkin. You look like a pumpkin. And even though I think you look like a I can see how you're getting better every single day. Even though you don't see it, I'm seeing it. And then you get that same feedback back from them.

So surgery buddy is always a good time. And I think every one of my patients that comes with a surgery buddy always ends up having a good experience. Just because it becomes a story. It's funny, when you're in your teens and when you're in your 20s, stories often involve going out clubbing, doing all kinds of crazy stuff, and then waking up with some sort of recollection of what happened the night before and then laughing about it. And then as we get older and get more mature,

similar things happen. But instead of waking up and wondering what happened, it's more because you're waking up from anesthesia and having some sort of surgery. And, you know, kind of just recollecting about the cheesy jokes and all sorts of mayhem that happens afterwards. So what are you seeing less of, if anything? Like something that was trendy that people are asking for less? It's hard because I'm kind of biased because obviously my practice. is a surgical. We do a good amount of non-surgical stuff too, but I'm seeing less and less people asking me about, you know, tightening, like non-surgical skin tightening. So things like Ulthera have gone down like ultrasound, ultrasound therapy, some of the radiofrequency therapies

has gone down significantly. And they've been replaced by other radio frequency therapies. So, and that's not to say that Ulthera doesn't have its place or Thermage doesn't have its place or, you know, thermi doesn't have its place or, you know, all these, they're good, face tight, you know, all these, they're good in the right patient. Again, apples to apples. You know, it has to be for the right person at the right place, at the right time. But they've been replaced by others. So now micrneedling with radio frequency, everybody asked me about Morpheus, everybody asked me about pixel, everybody asked me about profound. And in the right person, and for the right patient, those are great. You know, two or three years ago, those were pretty novel.

They were, you know, gaining traction. They've been around for a year or two, not long enough for people to have experience with them, certainly long enough to have some patients that had great results and some patients that haven't had as well or as good a results, but not enough to have a large enough sample size where you're able to really cherry pick and say, you would be great for that one or you would be great for that other one or you are definitely not a candidate for any of these. And so now we're a little bit more selective.

And you probably can see that too, because there's, there's, a lot of doctors out there who, and this is not just facial guys, but there's body docs, there's dermatologists that do a lot of these procedures where you see that, you know, procedures that they were kind of advertising or going over two, three years ago, four years ago and, you know, promoting hard, hard, hard, they hardly talk about them anymore. And so this is one of those things where we're seeing where as the sample size gets bigger, we're starting to see that. And that's what's so important about, you know, don't jump on a fat. And this is actually something that Melinda, the beauty broker, spoke about when she did the podcast with you, was it's really important before you jump on on any one of these procedures.

You got to give it time. You know, you really have to give it time to see what the results are. And, you know, shout out to her because God knows that she sees a little bit of everything. And she really told it how it is where there are some patients that are good for that. There are other patients that are not good for that. And particularly with newer technologies, we really. have to stick around and wait before we figure out who is good for what. And we see a lot of that nowadays where the patients that are coming in and asking me about, hey, I want to do face-time. Hey, I want

to do thermage. Hey, I want to do all therapy. And now we're saying, listen, you are not a good candidate for that or you're not a good candidate for this. And not only are we saying that, but we're also giving them X, pleasures. And because of X, Y, Z, you should do this. And that's only something that comes with time. But yeah, we're seeing a lot less of that. What do you hope people will stop asking for if we didn't already cover that. Like, is there a trend that you want to see go away? I think I asked you this last time and I can't remember. Oh, man, cat eyes, fox eyes.

Oh, you know what? Guys are now asking for wolf eyes. So it's the male version of the cat eye. No, that has to stop. That has to immediately know. But why don't- I've seen what I needed to see? Yeah, immediately no.

Why don't they just call them cat-eyes? Why do they have to be a wolf? Is it like more masculine? I think it's because it's more masculine. You know, it's a trendy name, but it's, it just looks so bad. And the thing that people need to understand. So I think I'm sure that either I touched about this with you, it's a more, it's hard to remember when it's us just, you know,

just BSing, talking about stuff and what we actually talk about on a podcast. But the thing that people need to understand is how the brain recognizes a face. And so when you're looking at this from truly a developmental standpoint, the way that your brain recognizes the face is the first thing it looks at the eyes, then it looks at the mouth, followed by the periphery, and it finishes with the nose. And so that's also a good template to give you as far as like what things you kind of want to do first when you are looking at aging face procedures.

Or it also gives you an idea as to why it is that you notice when someone's tired because they have bags under their eyes or whatever may be. But when you're thinking of how the brain recognizes the face, you not only are thinking about how your brain recognizes other people's faces, you're also thinking about how the brain recognizes itself, right? And so if you think of the brain or consciousness as this little passenger that sits in between your ears, and it's kind of pulling some levers and some strings and trying to figure out who it itself is, the easiest way to change that, both for good and bad,

is to change the shape of the eyes. And that's part of the reason why an upper blaphropasty or a browlift or the combination of both can be so, impactful in improving the appearance of the face and making it more youthful, making it look less tired, making it look a little bit more awake. But it can also change it for the worse. And when you're doing these procedures that are changing the shape of the eye into a more element look or into a more upward turn, while that may be trendy and that may look good, there are certain degrees that you can go. And you don't want to burn the boat, right? There's always the saying of burn the boats. Like, one,

Once you burn the boats, you're done. You can't get out of the island. And that's one of those boats you don't want to burn. When you're taking that ligament that's called the lateral canvus, the aspect right at the side of the corner of the eye, when you're lifting that separating off the corner of the bone and attaching it higher, can't reattach it lower. Because you're going to lose that laxity. You're stretching that eyelid out. And once you change the shape of that eye, you're changing how people recognize you.

You're changing how you recognize yourself. And while that may look cute on a filter and it may look cute with a little bit of makeup on, when you see yourself in person, it's hard to recognize that person. And I've had a couple of patients of mine that have had those procedures done just because I didn't want to do them for them because I told them it was stupid. And they went overseas or they've gone to other doctors and come back. And when they come in and they want me to fix certain things about their other stuff, you know, they'll casually mention, they're like, hey, is there any way I could maybe turn this

from a 10 to like a six, like I think it's a little bit too much, you can't. It's, it's done. You know, you've burned that boat. And so it's hard to go back. That's one thing that I wish people kind of stopped asking for. Okay. And then to round out the trend questions, is there something that you foresee in the near future or that you're starting to see more? I know you mentioned earlier like, you know, maybe lifting things at a younger age, people wanting more like the endo facelift, that kind of thing, but is there anything aside from that that you think is going to be a trend? The huge importance in the recovery part of surgery. So I think oftentimes patients think of surgery, and this goes for both body and face. Patients think of surgery as you go in, you get your

haircut, you walk out, you look incredible. And a big part of surgery and of the experience is it's a relay race. You know, so I run 80% of the relay race. You know, so I run 80% of the relay race. but then the last 20%, you've got to get us there. And realistically, you need some help to get you there in that relay race. And that 20%, whether that be postoperative lymphatic drainage massages, LED light therapy, the adequate counseling with massages, rollers, whatever, I'm seeing a huge increase in demand for that from our patients, as more education has come out about it, but also more and more doctors talking about that.

along with understanding that sometimes surgery is not going to get you there. And you need a little bit of help with those minimally invasive procedures and those minimally invasive treatments. So, you know, understanding that the amalgamation of small little things added on to, you know, whatever surgical advancement you do is going to get you much further than trying to do one huge big surgery with a crazy recovery time that you may or may not end up meeting to do some tweaks down the line. So that's something that I'm seeing a lot of and a lot of requests for. And that's something that we're actively doing. So for example, in my practice, you know, we're expanding. We're getting three more operating rooms. We're bringing in a body person to do some work. Eventually we'll have two body people within our practice as well. We're incorporating hyperbaric oxygen treatments. We're incorporating LED light therapy treatments. We have, you know, massage therapists that we recommend patients. see that specialized in emphatic drainage of the face and little things that kind of just come together that before it was rare. You know, you just kind of told someone, don't worry, you'll be fine, it's the swelling, it's going to go away, this is going to help up, but we're slowly

incorporating more and more of these things that people are asking for because now there's a little bit more understanding and knowledge of it. And there's more literature and more research that has been done into it because you got to remember cosmetic surgery and cosmetic research for a long time. It's very voodoo. You know, it's very much. you know, snake oil salesmen telling you and pitching you different potions and elixirs and, you know, crazy machines that are supposed to change your life. And then, you know, next year, you come back and they tell you, oh, that thing that we were doing last year is complete BS. We don't do that anymore. And you're like, well, you were selling it to me. Like, it was like the next

great thing. And now as more research is coming out into some of the benefits and more of a holistic approach to the recovery process, both from nutrition to both preoperative post-operative nutrition, care afterwards. I love seeing that. And we're seeing a faster recovery from our patients. And we're getting better results, even faster as well. Like you say, actually, I can't remember what you say,

but something about like not crashing the Ferrari, right? Yeah, listen. I mean, we give you the keys to the Ferrari, you know, when it's all said and done. But, you know, once you leave a dealership, you can't crash it. You've got to make sure you don't crash it. And there's a lot of people that love crashing really fast cars.

They love crashing the fast car. So you got to take care of it. You know, you have to take care of it. And once you learn how to drive it, then you can kind of take it for a spin. But you've got to learn how to drive and you've got to take it easy at first and do the right thing.

And as long as you do the right thing, you'll be fine. Right. So let's do some listener questions. I got questions for you from my followers. So, you know, what's funny. So one of the biggest questions and most common questions that I got was,

how did you hear about me? Somebody who I'm very close to who's very, what's the word? would use here. In tune. Very in tune with surgeons and their work and everything was sending me your lip-lifts. This is three or four years ago, I think, post one lip-lift and pre when I came to see you. She was sending me your work and she was wanting to go see you and I loved your aesthetic

and I started following you and then I came to see you not long after that. Yeah. I mean, I think that's true. for how most people find me, I think. Word of mouth? Yeah, it's huge word of mouth. It's because obviously, I mean, I practice in a small, tiny town north of Boca Raton. Like, you know, it's not, it's not a fancy place. Del Rey Beach is very small.

You know, when people come in, they think, oh, you're in Miami. And I'm like, no, I'm not. I'm 45 minutes north. I live in Miami. But, you know, my office is 45 minutes north. It's really 45 minutes north at 5.30 in the morning when I drive up. But it's all word of. mouth. And so, I mean, I have patients from the Middle East. I have patients from Australia. I have

patients from Asia. I have patients from South America that, you know, it gets spread through word of mouth. And so, you know, I think it's very, very true for most because I don't have the usual New York City, Chicago, L.A., Dallas, like big market following that most people have. But clearly, you kind of do because now yeah now it's all word of mouth and so people are like yeah just go to Florida there's this tiny little place in just north of Boca Raton

and everybody knows Boca everybody's got a grandparent who's retired in Boca at some point so yeah people end up here somebody asked if we could discuss the plastic surgery

on the women of Real Housewives of Miami yeah I can't comment on any of that Well, you know, they're redoing, they're refilling it. They're redoing it. I think they're starting filming next month, I believe, because I know some people that are going to be on it. You definitely can't say. Yeah. So I can't comment on that stuff. But yeah, it's a different aesthetic. You know, I think that some of the women that you see on there have had a lot of work done obviously, and it's a totally different aesthetic. And, you know, some of those people like that

aesthetic and they go for that look. And so, you know, you can't hate on that. If they're happy, then who am I to say anything about it? Very diplomatic answer. And you say a celebrity who, in your opinion, has had the best work, allegedly. There's a lot, actually. In a one. Allegedly, what would you say?

Allegedly. For you? Isaac Gonzalez. Allegedly has had great work. I would agree with that. I would agree with that. Yeah, yeah, she's allegedly had great work. I mean, it's pretty obvious.

Allegedly had literally everything done. Yeah. Well, you know, those people who have allegedly had everything done, it can go either way where it can be life changing both for the good or in not necessarily the best way, but oh, for sure. You know, there's, I would say actually probably recently there's been a lot of really good work that's been done, particularly in a lot of, I don't want to say patients. And a lot of celebrities who may have been out of the public eye for two to three months.

And then all of a sudden, they kind of perk their way back up and they look a little bit more refreshed. There's also been some horrible work done in the last couple months on some patients who have been, you know, or some celebrities who kind of have made the rounds as very bad. I think that what we're seeing of is it used to be, it was very, it was very, obvious when people had stuff done. Now it's becoming more obvious when people had bad stuff done. And I think that's a good trend. They're getting better advisement from their, from their agents, because as we know, agents are the ones that kind of drive the traffic as to where people go, allegedly. Okay. Somebody asked, what do you think I should do next? Did you ask that question? Is that, is that, did you plant that question?

Swear to God. Swear to God. There's always tweaks that we do, but we don't talk about them. Until you spilled the beans like two months later, when you swear you're not going to talk about it, and then you talk about it in any way. Fair enough. Okay.

Okay, I have a question for you. When the time comes, are you going to get a facelift? I don't know. Maybe. Or would you? Maybe. Yeah, I would. Okay.

I would. I think I'm probably going to be. my eyelids done in the next like 10 years or so. I mean, I just kind of see where I was and where I'm heading. And so like my family has a history of like heavy lids. And so I just don't want to let it get too far gone before I tweak. I know now I'm opening my eyes a lot more as you're like focusing and staring at the camera. No, I was looking at questions. Now I want to say. No, no. That's, yes. You were staring at the camera as soon as I said that. Your thing is too small. I just stepped back. I just stepped back so you couldn't see my eyes. Yeah.

Your screen is tiny. Because I'm self-conscious about it. Yeah. So, yeah, I mean, I would do it for sure. Absolutely. You know, when the time comes, when the time comes and I'm ready for it, I would do it. Facelift is a little tricky because I think that face lift done, male facelifts done in the wrong hands can end up looking a little overfeminized. And so you kind of have to be a little careful of when you do a face. stuff I fit for a male. I think that waiting too long could be incorrect. You also have to make sure that someone does adequate volumization at the same time. They don't really, they don't, you know, kind of depends so much on, you know, lifting the tissues too much because then that over-positions things vertically and can feminize you a little bit. So, yeah, you know, I think that at the right time

I would do it. Is there a sweet spot, like, where you're not doing something too early, but where there could be not as good of an outcome if you do it too late? Like, is there a point there? Or is it always good to just wait as long as you can? No, there's a sweet spot. There's definitely a sweet spot. So particularly with aging face procedures,

you know, I usually joke about this with my patients. If you look historically, it used to be that you would wait until you were in your late 60s, early 70s, and then you would do your brow lift, you know, forward lid bluff, upper lower lids. You did your facelift, chemical peel at the same time and you were done. And that was your hurrah. And that was the mantra for

quite some time. And about 15 years ago, 15, 16 years ago, there was an article written where people were starting to look at this trend and say, when is it that people are starting to think about doing aging face procedures? Because we're starting to see that it's not just people waiting anymore until they're in their 60s and 70s. Like it used to be in the 80s and early 90s. And what we saw was that, you know, really started to happen postmenopausely. Like the number was between 52 and 54 years of age, which makes sense because as hormones start to change and hormones start to drop, then hair quality changes, skin quality changes, elasticity starts to go.

And you really start to see those changes rather than every few years. You really start to see it. I mean, I hate to sound so crass, but you do see it overnight. And so patients, when they come in and they're like, I literally did not look like this last year, it's what starts happening as the hormones change. And so. So that I can replace my hormones. So I can start right away on hormone replacement therapy.

So well, does estrogen progester and testosterone levels proportionally go up? You start seeing some of those changes. So the interesting thing is that we've actually seen a change from that where we're starting to see kind of the sweet spot in like mid 40s or so for people really, even people that didn't think about it before, starting to think about it. So it used to be exceedingly rare to have that person who was in their early 40s come in and say, hey, I'm thinking about a mini lift. It's very, very odd. Now it's exceedingly common to be doing that surgery on someone who's in their mid-40s or early 40s. And it's a little bit more common to start seeing someone who's in their

late 30s come in to start thinking like, hey, starting to see these changes. I know it's early, but what can we start thinking about doing? Or like, what is the next move to either prevent or kind of put the smoke out before it becomes a fire? And so there is the sweet spot where you have enough excess skin and you also have enough elasticity issues where you can reposition the tissue and you can trim some of that skin or do an endoscopic lift like we were discussing earlier and kind of put the tissue back to where it was. The interesting thing is that with younger patients, when you talk to older patients, they still have that old mentality of, oh, they don't need it. But they don't understand that the goalpost is completely different. The goalposts when you're in your 60s and you're doing it is I'm trying to kind of get rid of all of the saggy skin and this saggy neck and rejuvenate my jawline and my neckline.

For a patient who's in their early 40s, they're not trying to look like they're 15 or they're 20. You know, the patient who's in their 60s is trying to look as well as possible. But the patient who's in their late 40s or late 30s, they're trying to look like they're in their mid-30s or early 30s or late 20s at most. They're just trying to turn the clock back a little bit. And so the thing to remember is a conveyor belt of time. And we talked about the conveyor belt of time before. It keeps moving. But if you're positioning yourself when you're in your late 40s and now all of a sudden you look like if you come in and you do surgery when you're 43, 44, and you come out and you look like you're 34, 35, guess what?

When you get to 50, you're going to look like you're in your. early 40s or your late 30s. And so then at that point, you do a little baby tweak. And as you get into your mid-50s, now you're looking like you're in your early 40s, mid-40s. And so you're aging gracefully and you still look like yourself. And I think that what we're seeing is the benefits of doing not small tweaks, but doing the right tweaks at the right time just to kind of keep you looking the way that you should. So yeah, I think that's the trend. To close, what is the worst thing that somebody can do for themselves when it comes to preventing accelerated aging. Does that make me? That's a double negative. No, it's double negatives. So I think that are you saying what's the

worst thing that someone can do that will accelerate their aging? Yeah. Yeah. Okay. So now we're sunscreen. Okay. I mean, I think that's it's one of those things that if you had one piece of advice and this is something that Jen spoke about in your podcast with her was very clear about it is you need your sunscreen. You know, if you were going to do any sort of treatment on your skin, it's sunscreen. And it sounds dumb because most people think that they need the super expensive and fancy cleanser and they need the fancy and expensive toner and they need the fancy and expensive retinol or retinae or bleaching agent and they need all these fancy moisturizers that. afterwards and they need the fancy cream and the fancy peels and you need to do all this stuff.

Truth of the matter is sunscreen. It's UV-ray exposure. You know, even something simple like a UV-blocking hat, like, I mean, or the hat that you like to wear when you go on walks, like something that kind of makes you look like the handsmaid sale, like that's perfect, you know, like something that's going to block those UV rays from really hitting you because it's very hard to turn the clock back on those. Because what's happening is all those UV rays, what they're doing is they're changing the DNA structure of the skin around it. So, yeah, I can get rid of some of those spots with lasers and creams and peels and all this other, you know, hocus, focus that I have.

But the cellular damage and the molecular damage has already happened and has already occurred. And that cellular memory is there. And you can't go back on that. However, if you see some of those patients that are older that have done a ton of, of sunscreen and have put a ton of SPF on and that have watched themselves and taken care of themselves, their skin looks immaculate when they're in their 50s and 60s. And you can't get that once you, once you cause of damage, you can't go back on that. However, aren't scientists now able to like return a cell back to its embryonic state in mice? In mice, but remember that, you know,

returning to an embryonic state is not necessarily the best. Because embryos, like to make, you know, full fetuses. So turning cells back to a full embryos not necessarily the best thing. The key is to get it to the right cell lineage. And so if you can get it to either, you know, ectoderm, mesoderm, or endoderm, and then from that point, it can be a little bit better. Yeah, that's the, that's the trick. And so will within the next 15, 20, 30 years, will there be some magic bullet? Maybe. I mean, there's a lot of really, really rich billionaires that are trying to stay young and youthful and vibrant and, you know, powerful for as long as possible. And if they can't do it here, they're going to do it in Mars.

But, you know, they're putting up the good fight. And so I'm sure that people will come up with something at some point. But there's some barriers to that technology, obviously. Amazing. Well, I can't wait for that day to come. Yeah. Put me out of business. Yeah.

It's going to be the worst day of my life, best day of your life. Well, thank you for coming on. again. Oh, did you have any more questions for me before we end? Yeah, of course. There's always questions. Actually, what's your favorite cheat meal? I didn't know this. There's a lot of these questions that I had. And I was like, obviously, cookies, but that's not a cheat meal because you have a cookie every time. I don't want to blow up your spot because I know Harley's probably listening to this. But what would be your guess if you had to pick? Diablo pizza. Yes. I think right now it would be pizza. I kind of go through different phases, but right now I like a good pizza with like the

little oil pools. It's the best. That's not even a cheap meal either because I just eat that. Yeah. So kind of like a non-answer answer, but that's what I'm into right now. Yeah, the cheat meal was a good mom. I was like actually I don't know. I mean, I know what she would say about that. Or any kind of pasta. Like I'm a pizza pasta fiend, but also Mexican food, but that's not really a cheat. I don't know. I don't consider any of it. really cheating. Yeah, that's true too. I mean, I'm the same way. I just kind of eat whatever I want. I mean, I also eat like, I eat like a pelican half the time. I don't chew it and I just inhale it. So it doesn't really count. Now we're going like way off, but somebody, someone asked if it's true that surgeons don't drink caffeine. And then I realized you don't drink coffee, do you in the morning?

No, I don't. Put it together. I just thought you were like weird. I don't know. I mean, I don't. I know a lot of surgeons that do. Oh, so. It's not a surgeon thing. No, it's not a surgeon thing. But yeah, I know a lot of people to do. I know people that live off their coffee and their surgeons. But it depends. I mean, I don't drink coffee or caffeine because I just need so much sugar in it to make it palatable for me.

Because I grew up drinking Café con Leche when I lived in Ecuador. And so Cafe Con Leche or, you know, it's kind of like if you go to New Orleans and you have like cafe Ola, like, it's very similar where it's just like sugar and super sweet in order to like overcom. compensate for the actual like bitterness of the coffee. So like I grew up with that palette. So when I have coffee, I needed to be super sweet. And then when I was in college, I was having like these like white chocolate mocas and all this stuff. And I'm like, why am I gaining so much weight? Like this is ridiculous. And then I realized that I was having like 3,000 calories just like having these coffees at the library. So I'm like, oh, this shit's not good for me. I should probably not be

doing this. And then I just kind of got used to not drinking like I just don't need it. And I mean, it's gotten to the point where, you know, I just drink a lot of water. I drink a ton of water during a day. I probably drink close to a gallon of water a day, if not more. Right. So it's just a you thing. It's a me thing. Yeah, I'm weird. But yeah, it's a me thing. All right. Where can everybody find you? Easiest place to find me's Instagram on IG, Dr. Mascaro, D.R. M-A-S-E-E-E-S-E. A-R-O, no dot in between. Dr. Dot Mascaro is a band in Barcelona. That is not me.

But Dr. Mascaro without the period between, that's me. So don't get it confused, although I have a feeling that you'd probably notice if it was me or not. That's probably the easiest way to find me. Always, MiguelMascaromd.com. That's my website as well. And probably the best ways to find me. Thank you. No problem.

My pleasure. 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 Blond Files podcast on Instagram. I'm always posting about each episode there or over on my personal page at Ariel Laurie. Sunny Cars feels as if the children

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