Well with Arielle Lorre - 241: The Ultimate Guide to Minimally Invasive & Surgical Facial Procedures, Celeb Surgery Gone Wrong, Trends & more with Dr. Miguel Mascaró

Episode Date: April 12, 2023

Dr. Miguel Mascaró is a fellowship trained and Board Certified Facial Plastic & Reconstructive Surgeon, also concurrently Board Certified in Head & Neck Surgery. Dr. Mascaró is 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. He joins the show to discuss minimally invasive procedures vs. surgery, how to know what procedures is right for you (and when to do it), and how he analyzes someone’s face in an initial consultation. We go over various lifting techniques of the face, lip and brows, restoring volume via injectables and fat transfer, Morpheus and other RF lasers, the benefits of doing procedures at a younger age, cultural differences in aesthetics and aging, bad celebrity surgery and so much more.   Visit athleticgreens.com/blondefiles for a FREE 1 year supply of immune-supporting Vitamin D and 5 FREE travel packs with your first purchase.   Go to Zocdoc.com/BLONDE and download the Zocdoc app for FREE. Then start your search for a top-rated doctor today. Many are available within 24 hours.   The Blonde Files Podcast is sponsored by BetterHelp. Give online therapy a try and save 10% off your first month at betterhelp.com/files and get on your way to being your best self.   Discover how Shuteye Chai can revolutionize your sleep and get 15% off with code BLONDE. Go to helloned.com/BLONDE or enter code BLONDE at checkout.     Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Auto-hue with Sunny Cars feels as if the children not be made. Kiselsrandle, Zandvo. Actisvercare, verdwine, vacancy can chaotic

but who'sorgalos an auto-hurt says, Uno dos, no stress. No, no-vervicted costs, always fullledgird. So,

would auto-huees without your re-sadviseur or sunnycars. The following podcast is a dear media production. Welcome to the Blonde Files 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's so much information out there, so I'm bringing on expert guests and sharing my own experiences to help you sift through all the wellness stuff without the BS. Enjoy the show. Hi, everybody. Welcome to the show. I was going to let Miguel do that intro. So you guys are going to hear that again once or twice, but my guest today is Dr. Miguel Mascaro. He is either he's not a three-peat. Maybe he's a four-peat or a five-peat. I don't know. He's been on the show many times. And I was so happy to have him join the show again. This is such an amazing episode. So he is a fellowship trained and board-certified facial plastic and reconstructive surgeon. Also concurrently

board certified in head and neck surgery. He is 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. So he joined the show today to discuss all of that. We talk a lot about minimally invasive procedures versus surgery. We talk about how to know what procedure is right for you and when to do it. This is something people ask me all the time. We also talk about how he analyzes somebody's face when he first meets them, which I found to be really fascinating. And then we get into more specifics. So we go over various lifting techniques of the face, lip, and brows. We talk restoring volume

via both injectables and fat transfer. We talk a lot about Morpheus and other. We talk about morphis and other radio frequency lasers. We talk the benefits of doing procedures at a younger age, cultural differences in aesthetics and aging. We talk a little bit about bad celebrity surgery and so much more. So please enjoy Dr. Miguel Mascarro. Hi, everybody. Welcome to the show. I've been practicing this for months. I know you've been practicing and I feel like that was like a six maybe. I feel like you can go a lot of pressure, but there was a lot of pressure. And I didn't want my voice to crack. Try it again.

Hi, everybody. Welcome to the show. That's pretty good. That's much better. That was like a seven and a half eight. Pretty good. That's better. I can't remember how many times we've recorded.

Are you a three Pete or a four Pete? Do you know? One or the other. You've been on quite a few times. So we might be repeating a little bit. But it's a refresher. I feel like it's been so long that a lot of times people, like to kind of hash back and listen again to some of the things that we talk about.

Definitely. And I have a lot of new listeners. So I want to start with you are very in demand at this point in your career and you're still very early in your career. Champagne problems. Do you consider yourself successful? Yes. I mean, I think more so than I ever thought I would be. You know, if you would have asked me 10 years ago when, you know, this whole little lazy river ride started that I would have a one and a half year wait list for a console, I would have told you you're insane and you're out of your mind. And it still blows my mind. And we joke about this all the time when we're talking about how people wait so long to see me and then they pop up on the Zoom and I'm like scruffy and a hoodie. And I'm like, I can't believe people wait so long to talk to me because for me, introspect. I just still think of myself as like someone who's still trying to prove themselves and work so hard and do everything perfectly. It's pretty impressive and just kind of taking a step back and looking at everything.

It's very very gratifying. What is your definition of success? Happiness. I think like being just happy with where you are. And so for me, it's not necessarily about like the full schedule or, you know, having patients fly in from all over the place. It's just knowing that my patients are genuinely happy. And, you know, every day I get thank you cards from patients that are coming from all over the place. And every single time it touches me because they take the time to pick out a little card and write it out by hand.

And it's so moving. And Monday to Friday, getting a card. It just blows my mind. You're so spoiled. We see you post on Instagram all the time. You get gifts every day. You get food. And that's not even all the gifts that I get.

I'm just like randomly posting the stuff that I get and it's insane. It's wild. And my staff also says I'm spoiled. But it's nice because they get spoiled too because they get, you know, the benefit of the you're a hard person to shop for because you get so many gifts all the time. I get everything, which is crazy. Mm-hmm. Got to get creative. Okay. So sometimes when you and I are talking, I see you like check out a little bit and I know that you're analyzing my face. It's a problem. I can tell. It's a party trick. When you're doing it. So what is the first first thing that you are looking at when you look at somebody's face, like if they come to see you?

So the first thing I look at is their eyes. And there's a lot of research that goes into this. And the way that the human mind recognizes a face is by looking at the eyes first, then the lips, periphery after that, and then the nose at the end. What's periphery? So jawline, hairline, ears. And the way that the research kind of goes is that when things step out of order, that's when they really jump out.

And so from an aesthetic standpoint, you kind of want to make sure that they follow that order. So you want to make sure that the eyes look good, lips look good, periphy looks good, nose looks good. So how do you think about it? If the nose is kind of taking precedence, meaning that it's jumping out in front, so if it's pointing to the left or it's like super big, it doesn't fit the face, then we need to get it back in position. So we've got to get it back in line. It's not about making a pretty nose. It's about making a nose that fits the face. And so the easiest way to think of it is when we're trying to get to a positive place, there's two ways about getting to a positive place.

there's two ways about getting to a positive place. We can either add positive attributes or we can subtract negative attributes. And by subtracting those negatives, we can end up with a net positive. And that's much easier. So when I'm analyzing a face, the first thing I'm looking at it's like, okay, so eyes, how do they look? Are they framing the face appropriately? Are the brows in a good position? Is there a little bit of creakiness under the skin?

I'm going, yes. You're like, yeah, I'm familiar with this, yes. Going to the lips, tooth show, smile, volume, hydration, periphery, jet. Bowels, neckline, contour, ears, propping out, popping out, popping a knot out. Like, if they're tiny like mine or yours. Yours are smaller than mine. We do have similar little. Little baby elf ears.

And then hairlines. So, you know, there's all these things that are analyzing. And as I'm talking to people, and I check out, as you have always noticed, and you're like, what are you looking at? You're kind of looking at how they talk and how they move and how they smile. Because not only are we looking at those static changes, which is what people see in pictures, but also how they talk and how they move. And there's often people that have a more dominant side of their face.

So, for example, I know for a fact that I move one side of my face a little bit more when I talk. And I'm very self-conscious over it. So you also move your lips. You smack your lips a lot when you talk as well. A little bit like a Muppet. Everybody who's watching this. I know. I know how many times.

Lips. I know. I know. It's bad. He says it's because he speaks Spanish. I don't buy that. I think so. I think it's because I yeah, that's my excuse. See, I just did it. So that's my excuse. Well, you analyze my face and I watch that so we can both be self-conscious. Yeah, exactly. But it's a combination of both. You know, you were really looking at what fits their face both statically and dynamically. And that's when you kind of orchestrate the plan because it's not cookie cutter. You know, you can't say, hey, my friend had this, this, this done. I want those same exact same things done. It's very, very different. I mean, especially now with brow lifts that are. You know, you can't say, hey, my friend had this, this, this done. I want those same exact same things done. It's very, very different. I mean, especially now with brow lifts that are. I mean,

are so popular. And I have so many patients that come to me and they're like, hey, my friend got a brow lift. This person got a brow lift. I saw you did so-and-so's brow lift. I want a brow lift. And the interesting thing about that is that, well, that doesn't fit your face whatsoever. You know, you've always had a nice tight frame right across the midface covering the eyes. And so if we pick them up, while when we look at the micro, yes, the eyes are going to be looking a little bit more open, take a step back, look at the macro. It's going to change your face completely. So you have to be aware of what the end goal is and where you want to go. And that involves both static and dynamic changes. So if somebody is like, well, my brow is a little bit low. I have a little bit of

hooding. I feel like my nose is dominating my face. I have some creepiness and my lips are, I have a long philtrum. Where do they start? My standard consult. So I think it's very important to determine goals. Right. So my first question and all my patients will tell you is that as soon as They sit down and the first thing I do, and this is a little secret, is I basically just hang out and talk to you. And so when I'm talking to you is, number one, to me, I feel as though we need to establish a relationship. And so I'm seeing if we have a good vibe together, number one. But number two, more importantly, is I'm seeing how you talk, how you smile, how you laugh, what parts of your face you're covering, what parts of your face you're being a little bit careful of. Because that will give me an idea as to what subconsciously you're already thinking about before I even ask you what it is.

is that you're looking for. So we'll talk for about five, six, seven minutes. And that whole time, I'm taking notes. I'm writing things down. I'm seeing exactly what it is. I'm describing things on my little piece of paper. And once you sit down and then finally we kind of stop, I'll just say, so what is it that I can do for you?

And then they'll compartmentalize things. Then they'll start breaking things down. And at that point, I will point things out to them that they may have already been noticing about themselves. So I never try to point things out to people, but I let them. them give me the information. So once they start telling me the litany of things, the brows, the hooding, the creping, the nose, the lips, then we start going about it pragmatically. So we'll say, okay, well, you know, what juice is going to be worth the squeeze here?

You know, yes, you have a tiny little bump that you see in your nose. But is that really worth it? No. This is what's going to give you the most change for your face. Because when you're talking, when you're smiling, when you're laughing, when you're conversing, I'm noticing these things about you. What do you think about that? And at the end of the day, really, the most important thing is figuring out what is going to benefit the patient the most? Because I have so many people that come to me, much as you just described, seeing all these litany of things. And I'm sitting there with them in front of me. And I'm thinking, you look fantastic. There's nothing wrong with you. And they will immediately say, and I want you to think about this, they'll immediately say, but look at this picture.

And I'm just thinking, well, but in real life, you look incredible. There's nothing wrong. Like, no, but when I take a picture from this angle and I'm smiling, this is what's happening. And I want to change that. And so I think that there is a fine line that we have to kind of judge as surgeons in determining what is right and what is not. And that's where the ethics come into play. So when someone comes in with that litany of concerns, super important that you

compartmentalize, see what's worth it, see what's not, see where their mindset is and where their heads at, and then move forward. I think in general, people look so much better in person than they do, like, in their edited photos and, like, filtered Instagram stories. I meet a lot of people that I follow and then they come on my show. And I'm like, whoa, you're so much prettier in person. Same thing. Then you are on social media, even though you're doing all these things on social media to try to make yourself look better. So interesting. Yeah, we've had this conversation many times where, you know, as I was getting busier and I was getting more and more quote unquote famous people, I meet them and I'm just like, you look so much better than you do in your pictures.

And that image that you're portraying that you think that you need to portray to others through social media is unnecessary. You know, so it's like, and you're always in motion. It's like dynamic and we see a picture and we fixate on one thing. But that's not what anybody really sees when they look at you. And it comes down to the fact that you've never seen yourself in three dimensions. Like when you think about it, you've never seen yourself in three dimensions. You've never heard yourself either. And so you've only ever seen yourself in either a two-dimensional mirror.

And as everybody knows, there's skinny mirrors, there's fat mirrors. Mirrors can really mess you up. But also focal length when you're talking about cameras. So anything from a very narrow focal length, like a selfie fixture or all the way up to a portrait telephoto lens, which flattens the face, it's very, very difficult to know what you actually look like because you've never seen yourself in three dimensions. What trends are you seeing, if any, like in the last year since we've been on? You were talking about noses.

Have you seen people going more towards like their natural nose? Yes. Big time. Big time. And so I think that there's been a big reversal back towards natural. I talked about that last time. And a lot of your guests have mentioned that that, you know, people are slowly starting to veer away from the extremes. And now going back to that natural look.

And when we talk about brows, lips, volume, noses, everything, people are just trying to be a little bit more subtle, a little more understated when it comes to those things. And what we're seeing is that a lot of times people were doing a lot of fillers and minimally invasive procedures. And those can help, but the problem was when they were trying to fix everything with that. And it's akin to when you're fixing your house. and all of a sudden you're just trying to put knickknacks all over the place. Sometimes you just got to remodel things a little bit to get them back to where you want them to be. So we're starting to see patients do surgery a little bit younger, but it's a lot more natural looking compared to, you know, doing a ton of fillers, threads, radio frequency.

And there's a time and a place for all those. I don't want you to think that, you know, I'm here singing praises for, you know, the knife and everything else is garbage. Because there's a time in a place for everything. But what we're seeing is that patients are starting to notice early on and they're slightly more savvy as consumers when they're being pushed on fillers, injectables, threads, minimally invasive treatments, lasers. And they're saying, you know what? Like, I don't think that the solution is more of that. I think that there's a different solution. I think that there may be something else that I can do.

Who are those things appropriate for? Because I know that that's everybody's question right now. Like, when do you know it's time to move on from like the morphius or the thermi and the fillers and the threads? And it's time to like lift things. I think that's really important when it comes to having the adequate guidance. So anytime that you have excess laxity or elasticity, there's lexicity as we trademarked. Yeah. The thing to be aware of is that at some point, all these devices are dependent on your own body's ability to tighten and create collagen.

in skin. So what that means is that there's going to be a limited response anywhere between three and five percent. And so three and five percent is not much. But if you're looking at before and after pictures and you're focusing on that micro, that little wrinkle line does look a little bit better. You have to think, would I be happy if I spent a couple thousand dollars and made that little wrinkle a little bit better? And so... And are you talking about what like radio frequency Just in general, just in general, just minimally invasive and all encompassing. Because Morpheus, I feel like all of a sudden, it's all anybody is talking about. It's a good machine.

I mean, it really is. It has good technology. So that's where it gets tricky, right? So for those that don't know, Morpheus is microneedling with radio frequency. So microneedling with radio frequency has been around for a long, long time. The patent was originally created for profound RF. Profound RF, very good device, very aggressive device. Don't do it multiple times.

Don't do micrneedling with radio frequency multiple times. So the Morpheus doesn't go quite as aggressive as profound. Morphus is very good. Pixels very good. Infine is very good. There's a litany of products that are out there. As a consumer in general, this is a good way of thinking about it. If there's a lot of competitors out there, the technology works.

Right? It's good stuff. And so there's enough companies that have found the basic science that they want to do it. Morpheus was one of the first ones that actually came out with a second handpiece, which is the face tight or the body tight. So you get the benefit of both. Because the microneedling with radio frequency, it's literally a bunch of tiny little needles

that go under the skin, deliver a radio frequency pulse between them. And that elicits collagen creating response, tightening from the skin, et cetera. But it can only go so deep. And not only that, it's going through the skin. So you have to be careful because you can also burn the skin as you're going through it.

Then they have face tight and body tight that you can do in conjunction with it. So that goes underdain. the skin and just provides the radio frequency directly underneath. So the radio frequency does help and does work. Morpheus is a great machine and a great company. Pixel is a great machine with a great company. Infini is a great machine with great company.

Morpheus kind of took over and was the first kid on the block that really had good results. That being said, you have to be aware that when you're delivering this radio frequency energy, particularly in the face or the neck, what you're doing is you're creating microchannels of scar tissue. And so eventually once it's time to do surgery, you're going to be compromising your results. So right now you're probably thinking, it sounds like you're just complaining because it makes your life a little bit harder. And the truth of the matter is that if I have a patient that sits down in front of me and says, Miguel, I don't know if I'm ready for a little mini lift yet. I don't know if I'm ready for a face lift. I don't know if I'm ready yet.

And I'm thinking maybe in like six, seven, eight years. I tell them, go for it. Do the micronane with radio frequency. It'll tighten. It'll improve the quality of your skin. It'll give you very, very, very, very minimal lift. I don't want you to think that it's a replacement for surgery. And I've seen some results that are pretty impressive, some that aren't,

and that's part of the issue too, because it's dependent on your body's ability to create that collagen and elastin response. It's somewhat unpredictable. Some people do better than others. I tell them, go for it. However, if you're telling me, listen, I'm thinking next year. I just don't have the time this year. I'm thinking next year. I tell them it's not worth it because you're going to do three treatments of microdine with

radio frequency across your face, you're going to end up seeing the results at about six to nine months. And then three months later, you want to do your lift. Meanwhile, you've created all these microchannels of scar tissue where you're going to be limiting how much lifting you're going to be able to do. So if you have excess skin, if you have significant laxity and elasticity, and the easy way to test this is just to put the fingers on the angle of the mandible and go all the way up towards the ear. If the corner of the mouth is moving, that means you don't have excess elasticity or laxity.

So then that means you're not quite ready for a lift yet. then do it. But if you have that excess skin, excess tissue, you're just going to be spinning your wheels. One of my other wellness non-negotiables that I have been incorporating for a couple of years as well is taking magnesium. I have talked about this countless times, but when I started supplementing with the right kind of magnesium, it really felt like kind of a missing puzzle piece that my body had been looking for. I felt overall less anxious. I have more restful sleep. I feel like I recover better from soreness. And there are a few forms that I like. I've been taking Ned Mello for a long time now. And I'm currently obsessed with their new product, Shudai Chai. It's inspired by 5,000 years of ancient healing tradition. And it is

Ned's biggest product launch to date. So it's a mellow superblend latte for sleep that combines adaptogens, aminos, functional mushrooms, and magnesium. Seriously, the best ingredients out there. And it's all wrapped in this heavenly masala chai-inspired, spiced body. So think cinnamon, clove, ginger, all that good stuff. And I like to mix it with a little bit of macadamia milk at night. I add a tiny bit of honey. And it's just this like warm, sweet, kind of rich, soothing thing that I look forward to.

as much as I look forward to my matcha in the morning. So I kind of bookend my day with that. And it doesn't just set you up for amazing sleep. It has ingredients like Chaga, Rishi, and Ashwaganda, which are deeply nourishing to your body. So you're getting a ton of additional benefits. It helps to make your body more resilient to stress. It's crafted from the highest grade single origin ingredients, ethically sourced from some of the world's best small-scale farms. And this is the attention to detail and the integrity that Ned brings into every single one of their products. They also have amazing CBD that I love. Like I said, the mellow. So definitely go check all of that out. Shudai Chai will help calm your nervous system, nourish your senses, and send you

peacefully off to dreamland. So discover how Shudai can revolutionize your sleep and get 15% off with the code blonde. Go to hello ned.com slash blonde or enter the code blonde at checkout. That's H-E-L-O-N-E-D dot com slash blonde to get 15% off sweet dreams. This show is sponsored by Better Help. Most people know that I had a kind of turbulent year last year and then things kind of calmed down and settled. And for whatever reason, I have recently started feeling like I am ready to go deeper. Getting to know ourselves can be a lifelong process, especially because we're always growing and changing and we go through periods of kind of stagnation and we go through periods of transition and then we go through periods of real growth, I think. And therapy is all about

deepening your self-awareness and your understanding because sometimes we don't know what we want or why we react the way we do until we talk through things. Therapy has been one of the most transformative tools in my toolbox. I've been in therapy my whole life, but it really got effective and helpful when I finally got sober. So BetterHelp connects you with a licensed therapist who can take you on that journey of self-discovery from wherever you are. I absolutely love therapy not only when things are challenging, but when things are good because it helps me to tap into what is working for me. It helps me to navigate new situations and it is just something that I truly think everybody should utilize in their lives. So if you're thinking,

Thinking of starting therapy, give BetterHelp a try. It's entirely online, designed to be convenient, flexible, and suited to your schedule, which is so helpful. Just fill out a brief questionnaire to get matched with a licensed therapist and switch therapists anytime for no additional charge. Discover your potential with BetterHelp. Visit betterhelp.com slash files today to get 10% off your first month. That's BetterHelphelp.com slash files. Hi, friends. I'm Cameron Rogers, host of Freclet Foodie and Friends podcast, which is now on Dear Media. Are you wondering what just happened to your life after having a baby or struggling with your mental health during postpartum? That was made just a few months ago. Are you

working on healing your relationship with yourself, your body, and or food? Same. We are all on a journey to self-love and acceptance, and I'm right there with you. That's what Freckled Foodian friends is all about. Remind you that no matter what, What? You are not alone. Make sure to tune in for season five launching with Dear Media on November 9th and subscribe to listen to new episodes every Wednesday morning. Okay, so let's talk about the difference between a mini lift and a, what's the other one called? Just a regular face lift. So, and this is a point of contention with me because, so I'll speak about me personally and then about the industry as a whole. So for me personally, a lot of times I call things mini lifts because the patient is sitting next to their husband and their husband feels a little. lot more comfortable when you say mini lift as opposed to you know a cheek neck lift they'll feel

much more comfortable with that but as a whole for me a mini lift does not involve addressing the central compartment of the neck so the central compartment of the neck involves a deep neck dissection cleaning the salivary glands getting rid of excess fat doing a platismoplasty doing a whole bunch of work across the midline of the neck on the lateral side where we're doing the actual pickup that is really where I'm talking about a mini lift so the scar is a little bit shorter but you're still doing an deep plane entry point that extends down into a platismo. So you're still doing a lateral platismo sling. As a whole, from an industry standpoint, it gets tricky because everybody calls things differently. And my point of contention in what I try to explain to patients always is there's no such

thing as trademarked surgery. So, you know, you can't trademark a kidney transplant. You can't trademark a liver transplant. And that doesn't mean that that particular surgery that has a name is not good. it's probably pretty good. But more often than not, they find themselves in a very competitive environment and they need to stand out. And so if you call it the same thing as, you know, you know, Fulanito down the street, then unfortunately you can't stand out. But as a whole, a mini lift usually does not involve as much work in the central compartment of the neck. You're still getting a nice muscle lift and release through here as well as down below. When you get in trouble is if your surgeon is describing a mini lift as a skin only.

only lift. And so when you're just picking up the skin and tightening it up, that's not going to work. Because your skin's going to relapse. What you really need to lift is those deep muscle layers underneath. So you mentioned like people can put their fingers on their mandible and pull up. And then if their mouth moves, they're not ready. Correct. What are some other signs that somebody is ready for a lift versus like the minimally invasive things that we talked about? So to me, that's a number one. And when I have patients come in, they sit down in front of me and they're sitting, Miguel, I think I'm ready. I'm ready. I'm putting it down. You're like, I want to do this. We put the thumb at the angle of the mandible, index finger right at the cheek, and we just lift gently up. I take a look

at the corner of the eyes, make sure that's not lifting and moving because as we release that ligament, all this tissue is going to come up as well as down here. So if the corner of the mouth is moving, then that means you're going to get that fish mouth look because you're going to over tighten and overstretch and looks very unnatural. Like a few celebrities have that. Recently, too. Yeah. Who are you thinking of?

Allegedly. Allegedly Madonna. Allegedly Demi. Yep. I just saw a picture of her last night on Instagram and I was like, oh, that lip lift and then that mouth pulling thing. Like, who did that to her? Yeah.

I mean, allegedly. Allegedly did that to her. Yeah. But yeah, that's a conversation for a different point. Mm-hmm. Yeah, not good. You don't want that to have. happen. And then what's like the more involved when you involve the neck? When you involve the neck. And so

this is something we're seeing in some young patients who've had multiple procedures in the past, as well as in older patients. And so that involves lifting the bands, cleaning up the glands, etc. I'm, for example, when it's my turn for my lift, I will need to have a central compartment. Who are you going to go to? I don't know. That's a good question. You don't have any names? Nobody in mind, no. yourself. Actually, I had, yeah, myself. There is one very good surgeon that I know, that I trust, but she only does surgery

on women. Hmm. So. You won't need one for like 20 years. Yeah, maybe. I got to fix my eyelids, though. That's the one thing. We've talked about this.

I wear glasses just to cover my eyes for that reason. And I look smarter. So it helps. You think you look smarter. Tush. Yeah. Okay. Let's talk about eyes because you mentioned earlier.

doing the brows. Everyone wants to know about upper blephroplasties. Seems like it's a very popular procedure among younger people now too. Absolutely. Especially because younger and younger people are doing a lot of Botox, fillers, et cetera. And what we're seeing is, number one complaint is I was doing Botox. It was picking up my brows and my eyes were looking really good. And now it's not doing the same. Speaking of, not to, I feel like mine are starting to lift already. We did disport yesterday. Yeah, Disport. Listen, I think. I think so too. Like on the hat on the tails. Yeah, well, I told you, you know, you wanted to go up, up in a way.

So it's easy. But the disport works a little bit faster than Botox for a lot of people. So, you know, particularly in your case where we're doing this, you're going up to New York, like, got to look good quick. It's a good, good option. But when talking about chemical brow lifts, chemical brow lift's only going to pick you up three or four millimeters at most, best case scenario. And so there comes a time where, you know, you start noticing that that brow is just not coming up as much as you wanted to. And that's when it's time to start talking surgically. As far as the hoodings concerned, that's a little different.

And so you always have to think of the eye complex together. Is it the brow? Is it just the upper eyelids? So many times patients come in and say, I need to have my eyelids done, and I'm looking at them, it's not the eyelids. It's the brows. This hooding out here on the side, that's brow skin. It's not eyelid skin. And if you take too much eyelid skin, it'll pull your brow further down.

So aesthetically, it'll actually make you look older because you'll hollow things out and it'll pull your brows down. So it'll almost look like your little caveman Neanderthal. It's not cute. Also, celebrities recently have run into that too. Yeah. And so I'm seeing a lot of patients coming in from L.A. and New York, particularly to do browlifts as opposed to their upper eyelids. That being said, a lot of younger patients are also doing their upper eyelids. And I see that in anywhere from late 20s, early 30s.

And that's not to say that if you're in your 20s, you're ready for it. It's very individual. There are some people that develop excessive hooding early on genetically. And so then at that point, it's very easy to do a very conservative upper blephroplasty where you're just trimming the skin, contouring that crease and reconstructing that muscle very, very delicately such that it looks natural like it did before. Healing time is very quick. Within, you know, seven to ten days, you're back to fighting shape and ready to go.

Sometimes you bruise. Sometimes you don't. It is surgery. But overall, pretty straightforward. Do you think that in the same way that there's a trend towards a more natural nose, there's ever going to be a trend back towards like hooded eyes? I think it depends on the region. So I have a lot of patients from Spain and France.

And for them, when they come over, to me, their eyes jump out. But they don't want their eyes done. Because culturally, it's frowned upon to look overly cleaned up and over and done. You've kind of earned your stripes. And so I have a couple of patients from, South France, a couple of patients from Spain coming up in the next month, and I just did their pre-ops virtually. And their main contention was, I just want my jawline and neck fixed, everything else, just leave it alone. Even when we pick the cheek up, sometimes I end up

doing what's called a little baby skin pinch because we're picking the cheek up so much that you get some of that creasing and wrinkling underneath, and I'll bring that up to them. And they'll tell me, Miguel, just leave it. Like I leave the brows, leave the hoods, leave my eyes. It's a family trait, leave it alone. So I think culturally it's very different. And I see the exact opposite from my patients from Southeast Asia, where they'll be super young and they'll say, I want absolutely nothing left on my face. I want everything to be like a porcelain doll. So there's a little in between and your eyes just let up be like, maybe I have Southeast Asian. But patients are a little different. I think in the United States, it's also very geographically mediated. My patients from

L.A. have a very different aesthetic than my patients from New York do. I think that my Miami patients and my L.A. patients are somewhat similar. My Texas patients and my New York, more is more. Yeah. Whereas my New York and my, you know, Texas patients, although Texas is starting to become a little bit more L.A.ish. But they're very similar in that, like, less is more. Let's keep it very conservative, make it look like almost nothing happened. I did notice that when I was like in Italy with Nicole last May. We were looking at everybody and we were like, oh my God, people are age too. I mean, look. They look old. Is this what we would look like if we didn't? I mean, nothing wrong with it. But there's such a different aesthetic. And they do embrace like aging. And we don't.

100%. Well, we embrace aging in a different way. You know, I think that over there and I mean, I'm, I'm speaking just from the experience of, you know, speaking of patients, you know, I have family over there. And it's very much a, you know, you are a kind of. of earning your wisdom as you get older and it's just a sign that, you know, you're getting smarter. Even my, you know, my stepmom jokes when she sees me and she sees that now I'm getting like white patches on my scruff. And she's like, oh, you're getting, you're gaining wisdom as you gain older. And I'm like, I'm getting white hairs. Like, what are you talking about?

Whereas over here, you know, we're constantly trying to put up a fight and look our best. And so I think that, you know, we really focus on the external appearance here a little bit more so than in other places. What do you think are the best things that people can do to like age gracefully here? I mean, do you advocate for like a young facelift? Because I know that you said that can put you back like what 10 years and then you're still aging. It's a time machine. I mean, it's a true time machine.

If we're just talking about things that everybody can do, sunscreen, sunscreen, you don't wear sunscreen. You were not supposed to say that. You are not supposed to say that. But my people don't. people with tan. So I look better tan. This is the classic do as I say, not as I do. Guys, please don't be like me. So sunscreen, sunscreen, sunscreen. And you got burned last weekend. The sunscreen, yeah, I got burnt. But sunscreen, sunscreen, sunscreen, very, very, very important.

Moistrarize as well. Very, very important. Overall, if you're looking at how to maintain your skin the best possible, very easy. You need something to clean your skin. It doesn't have to be anything super fancy, just whatever your skin will tolerate. Something to treat your skin, a vitamin see a retinol, you know, something that'll chemically exfoliate your skin and thicken the dermis. And then finally protection. So the sunscreen, moisturizer, et cetera. There are numerous variants within it. Some people are more sensitive than others. Everybody's skin's a little different. But if you're just thinking, what can I do to kind of help myself as much as possible? It doesn't matter what surgery you do. Spoiler alert, you're still going to have to take care of

your skin. So that is something that if you set a good treatment protocol before you do anything more involved, then it will help you out afterwards. Light lasers work very well, BBL, Moxy, Halo, IPLs, like every one of them targets different things. They're all great, great procedures. From a surgical standpoint, if you need it, do it. So I'm a big believer and put the smoke out before it becomes a fire. And we joke about this all the time. I say, you know, your job is to be kind of like Smokey the Bear. You don't want to be a firefighter. You know, when you see smoke, put it out. Because then it becomes more of a beautifying process. And so historically, the acumen was, you know, you wait until you really need something to get it done.

Like, oh, I'm too young. I need to wait until it's time. And if you think back, we used to do noses only when they were broken over when they were pointing in the wrong direction. And they didn't, and you couldn't breathe. And so about 35 years ago started saying, you know what? Like, we can just straighten it, make it a little cuter, take the hump down. And yes, there was an extreme where people went the exact opposite way and people were getting over scooped, et cetera. But now it's common to see like, oh, you're 16, 17, 18, your cranial skeleton's done developing.

You could do a rhinoplasti if it bothers you. And we're starting to see those trends along with faces, brows, eyes, et cetera. As long as your tissue is at the point where you can take it, you can put out the smoke. You guys know this scenario. You are having some kind of mysterious symptoms and you stumble down a TikTok rabbit hole full of questionable advice from so-called experts and you work yourself up into a frenzy. I know we have all been there, but there are better ways to get the answers you want and the care that you deserve from trusted professionals and not random people on the internet.

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slash blonde. Zock.com slash blonde. You guys know that I tend to have a moderate approach to wellness, but I do have some daily non-negotiables that are things that make me feel really good, little micro habits that have a lot of benefits that are really easy to incorporate into my daily routine. And one of those micro habits that I've had for a couple years now is drinking AG1 from athletic greens in the morning. So this is literally the first thing that I do when I wake up before I make my matcha, before I meditate. it's so easy I just mix a scoop of AG1 with water and shake it up. And I am giving my body 75 super high quality vitamins, minerals, and whole food sourced ingredients that deliver benefits like mood, immune system, and sleep support, sustained energy, really amazing gut support, which is why I initially started taking it. And it's just this habit that I don't even have

to think about anymore and it has so many benefits. Also, actually when I was in Florida and recorded with Miguel, I shared some with him because I happened to know that he goes to the gym super early in the morning. We always see him posting about it at like 5 a.m. And he doesn't eat before or after. And he usually doesn't eat till later in the day after surgery. And I was like, you got to get some nutrients in your body. So I gave him some AG1. I don't know if I can go so far as to say that it is, is officially doctor approved by him, but we'll have to check in with him later. I'll keep you guys posted. So if you want to take ownership of your health, today is a great time to start.

Athletic Greens is giving you a free one-year supply of vitamin D and five free travel packs with your first purchase. Go to athletic greens.com slash blondefiles. That's athletic greens.com slash blonde files. And you can get started today. I mean, I think we talked about this during the last interview. I have two favorite procedures. You know, if someone's in their mid-30s and they need a browlift, upper bluff, and a lip-lift, it's a game-changer.

Legitimate game-changer. Same thing if someone's in their mid-40s and they need a facelift, like late 30s, early-40s facelift, you will look like you're in your late-20s. It's a legitimate time machine. And it's an incredible thing. They heal faster. They bounce back quicker. And it looks like nothing was done.

Well, as opposed to if you wait to your 60s, then, yes, you know, need the jowls, you need the neck, you need everything done. Not that there's anything wrong with waiting, but it's not quite as subtle anymore. Okay, we've talked a lot about lifting. What about restoring volume? I get tons of questions from people about fat transfer. How do I like my fat transfer a few years later? Fat transfer is awesome. I mean, if we take a look at your pictures from when you first came in my office and we're not, and we should have put them up. Yeah, we should have put them up. The most humbling thing. Yeah. You were supposed to. Delete them.

No, but it's, yeah, it's a totally, totally different. I look like a different person. Yeah. My face shape,

completely different. No. Even I look at pictures from back then that like I would send you before. I was like. There's a football. Pancake football. Yeah.

The pancake football. It was like a reverse. Hey Arnold. Yeah. Yeah. Exactly. So. I just aged myself more.

Yeah. Fat crafting works very well to replenish a lot of volume. And the interesting thing about fact crafting is, is that patients always ask, how long does it last? Is it forever? Is it permanent? And my response is always, my permanent is very different than your permanent, because when the layperson thinks of permanent, they think of like a breast implant or a chest or, you know, like a chin implant where even as a cadaver, it'll always be there. How often do you see chin implant illness, by the way? Chin implant illness? Never. Never.

Yeah, it's because of the placement because it's under the lining of the bone. Yeah. So it doesn't get exposed. So I was talking about fat. You're right. So the fat itself, because we're harvesting adipose-derivoregenerative cells. So that's what a lot of people will discuss and call them as fat stem cells. Kind of a cheeky way of describing these fat cells. But there's different parts of the body that have particular fat cells that are a little

richer in cytokines, interleukins, growth factors. And so these fat cells are the ones that we take for the face. We concentrate them. We spin them down. and then we gently inject them back into the face. So you get a couple benefits. Number one, they restore the volume. Number two, they improve the quality of the skin.

But more importantly is, they last a long time. Because once they get that blood supply, they're with you forever. However, as you age, so do the cells in your body. It's living tissue. So those fat cells get smaller and smaller and smaller. It's not uncommon for patients to come in 10, 15 years later and say, you know, that fat didn't last. It's been 10, 15 years. You do a facelift.

And when you're doing the lift, you can actually see the different layers. of fat and the different color of the fat. And you can say, you know what? This person had fat transfer. And they had it a couple years ago. I had a patient. I did a brow lift on last week or two weeks ago. Everything blends in. When I lifted her up and I was dissecting in the temple, I saw fat. And that's an area where there's literally no fat. And I'm lifting things up. And I was like, oh shit, she had a fat transfer. Can we curse? Okay. So she's got. Like you don't listen to every episode. Listen, you've blown up my spot. So I took a look and there's a little bit of fat cells there.

She never listed that she had fat done. And it's not uncommon for patients not to put stuff down on their intake form. It happens. I mean, people forget about things they forget, especially things that they think didn't do anything. They don't list them. Afterwards, you know, I asked her, I'm like, do you have fat grafting ever? She goes, yeah, they did a little bit in my temples and a little of my tear troughs about six, seven years ago. didn't do anything.

And I told them, like, you know what, fat's alive. It was there and it was alive. And always shocked and surprised. So it is last, it does last a fair amount of time. It just gets smaller and shrinks up. And then you may need a little bit more. The other thing is that it has memory. So I think this is very important when patients are going on, for example,

something like OZembek, because when you get that global fat wasting, if you're doing a fat transfer to replenish that fat and that volume, then what's going to happen is if you come off Ozempic and you just used it specifically as a way to lose weight, you're going to gain that weight back, which means that that fat transfer that you put on there is going to balloon. So you have to be a little careful with it. And I have a lot of patients that are on Ozempic. And most of my patients are very healthy patients that are just using it as a little extra push, get them to where they want to be. And then they're stabilized and then they come off it. But my concern is the ones that are using it from a trendy standpoint and just trying to knock off 40, 50, 60 pounds, hop off it.

They didn't change their lifestyle. They didn't change their diet. They didn't do anything. That's going to come back. And so when talking about fat transfer over the last year or so, that is one of those points that I harp on a lot. Because particularly my younger patients that are trying to replenish the volume, they don't like how the fillers doing their face. They're getting that filler look where they're getting lymphatic obstruction and they're starting to disres. they want to plump up a little bit, I always throw that caution out there.

Who's a good candidate for fat transfer? In general, someone who's starting to lose volume and who's been doing a little bit too much filler and they're starting to get the lymphatic obstruction from filler, they're starting to get that classic filler phase. So a little bit of filler is good. You know, I don't want you to think that it's bad. The way that I like to think about is almost like when you're fixing a wall, right? So if you're fixing a wall and you just use spackle over and over and over again, you're going

to be able to see it. It's not going to be nice and smooth. But if you redo the drywall, fix the hole, and then you do gentle spackle on top, it looks nice and smooth and even. So in this case, what the drywall redo in the drywall would be the fat. So you're replenishing that volume because the fat cell is very large. So when you're putting that fat cell, you can't go right under the skin. You'll get those lumps and nodules and it'll feel a little funky and weird. But what you can do that is the very small molecule of the H.A., the filler.

So I have a lot of patients that overdue filler, particularly early on in their lives. And so just because you're 27, 28, 29, and you've got that filler face and you look like you're 40, even though you're in your late 20s, that does not mean you need fat. That just means you need to get that stuff out of your face. And as you get that stuff out of your face, most patients actually like the way they look. And they say, you know what, I look much better with a lot of this stuff dissolved. But then once it's time to refill with volume, they'll start noticing. some hollowness and some deep hollowness.

And that's when you need it. So particularly buckle area, nasal labial fold, as it breaks into the cheek area, all this complex along the midface that goes into the temple, that's much better with that. Okay. I would be remiss if I didn't ask you about lip-lifts. Okay. That's what I do. Yep.

It's what you do. You're the lip-lift king. That's what they say. It's kind of cool and cheesy, but whatever. Okay. So what's that? That's a lip lift for people who don't know. So a lip lift is a procedure that was historically devised for older patients.

So as we get older, our buttfalls, our boobs fall, our face falls, our brows fall, our eyes fall, and our lip falls. Part of that is both skeletal because you get osteoporosis in your facial skeleton as well. So things shrink up. So teeth get smaller, mandible gets smaller, eye sockets get bigger. Area around the nose gets big. It gets a little bit resour, so it gets a little bit bigger. and the nose gets bigger. Because the lip doesn't have the structure to support it, starts to lengthen. I mean, it's just a hanging piece of tissue. So it's going to lengthen

with gravity over time. So historically, as you did a facelift, as you did a brow lift, as you did these things, you'd also pick up the lip. Now, the techniques weren't very good. So you'd have issues with mobility, you'd talk funny, you smile funny, bad scars. And it just wasn't worth to squeeze, right? Juice wasn't worth to squeeze. So people kind of threw it off to the side. about 15 years ago, we started to get better, started to revisit it. Things started to improve. And so we started to really understand the necessity in releasing the tissue. And so when you release the tissue from the deep structures, then you can attach them in such a way that mouth function doesn't get affected.

Scarring is much better. And it gives a much more natural result. So older patients jumping for joy, that's great. Now they look much more natural, much more rejuvenated. However, we also have a subsegment of the population that has been doing filler for a long, long time, and has accelerated that lengthening process. Because now they have a big, wet, hanging weight at the bottom of their lip. So what happens? You get these younger patients where all of a sudden it starts to pull down.

As it pulls down, slowly but surely, they no longer have the teeth to back up on it. So what ends up happening is it pushes forward. So as the lip pushes forward, you start getting that duck. lip. So what we need to do is we need to take that surface area that's now flat, turn it up a little bit. And so a lip lift is a perfect way of doing that. So with younger patients, it's a slightly different technique. What's done, but the lip will come up, roll nicely. However, there are some caveat. Some patients are better candidates than others. And that's where it gets tricky. There's some patients that have very long philtrums, but they also have a very long cranial skeleton.

And so if you've got a very long distance from the nasal spine, so the bottom of your nose to your incisors, so it's a very long distance, then guess what? Your window is long, so the curtain's going to be long. So you don't want to pick up that curtain too much because then it's going to be all teeth. So the opposite also happens where you have patients that want that tooth show, but they have a very tiny cranial skeleton. And so I could suture their lip up to their nose. You still won't see their teeth. So that is a cosmetic dentistry issue. So you have to think about what the end goal is with your lip in order to kind of assess what the right procedure is for you.

How does it compare to a Botox lip flip? Very different. I'm just anticipating all of my audience's questions. Very different. So the Botox lip flip is great. It doesn't last very long because of the dosing. So you have to go very low dose because otherwise you end up talking like me like a Muppet and you can't move your upper lip. Not that I have Botox in my lip.

I just talk weird. So you put very light dosing. it does is it relaxes that muscle. So think of it this way. A lip lift picks from the front and rolls upward. The Botox lip flip relaxes the muscle from the back and has it ever from the bottom. So it can actually make the distance look a little bit longer, but you don't mind because you're getting more surface area. So I've seen some really bad ones though where the person almost makes it look longer and there's no movement. Yeah, that's over done. It's a very, very thin line when it comes to the dosing. That's the problem. Can you do both? Yeah, absolutely. And so it's not

uncommon for patients to do lip lift and especially when they have a very dense lip and it contracts a lot. So for example, the M-shaped lip, the one that I say looks like a flying seagull. So that one you pick it up, it's going to be very dense. It's not going to want to roll a lot. It picks up more like a curtain rather than rolls like a carpet. So that is going to be very, very thick. So once we pick that up, We'll do a little Botox to relax that muscle, let it come down. And then when you're doing filler, because the other question people have is, I don't want to do filler anymore. I want to do a lip-lift.

I always tell them it's not an either-or proposition. It's an, you do both. But once you do the lip-left or the Botox lip-flip, you're putting the architecture in the right position such that now you're doing less filler, less frequently. It looks better and lasts you longer. So, you know, would I benefit from the Botox thing? Lip-lip?

Yeah. No. Is there anything that you're seeing people do that you wish they wouldn't? Like any trends right now or just things that you're seeing a lot with your patient population where you're like, I wish this would end? Honestly, I mean, we always talk about like threads and overdoing, you know, the minimally invasive treatments. But I think that over the last two years, there's been so much information out there for the consumer that, they've kind of slowly stopped doing it. So very rarely do I ever cringe. Usually the only time I ever truly cringe is when I have patients that come in and they say, I just did threads three months ago.

I didn't get much of a result. I think I'm ready for my face lift and I'm like, I can't do that. I got to let those dissolve a little bit and settle down and then they get frustrated. How long does that take? Depends on the thread. It depends on the person as well. I've had patients that have threads that they did him five years ago. They're still intact encased in scar tissue. And then I have other patients that go, we go in six months later, and it's like nothing happened. And they had a ton of it's super individual. But you can feel them under the skin. You kind of get an idea of who's going to be a little trouble. Who's not. Okay. My last question. How do people skip the line? I'm trying. I'm trying. So we're we're have an experimental process right now to try and shorten

the line. So it's not a year and a half. So we, we're, we're, we're, we're, we're, we're, we're, we're, we're, we're, we're, we're, we're we have a beta launch right now this month, seeing how it's going. And hopefully we'll go into our widespread launch in the next month or so. No special code for my listener, unfortunately. Just when you email, just put a code name blonde, B-L-L-L-N-D-E. Don't do that. You're screwing yourself by saying that. Yeah, code name blonde.

You'll be fine. Thank you for coming on. Always good. Good to see you in Miami. Absolutely. Thank you. I hope you enjoyed that episode. And 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. You can go to areallori.com. And I'm always posting about each episode over on my personal page at Ariel Laurie. Please note that 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.