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Should the plastic surgeon question the wishes of the patients? Today's guest is Dr. Jonathan Sykes. One of the most respected board-certified plastic surgeons in the United States, specializing in facelifts, rhinoplasty, and eyelid procedures, he will answer this question. Dr. Sykes has been in practice since 1986 and has performed more than 20,000 aesthetic and reconstructive surgeries. He is a truly dedicated and ethical physician, who has been a true educator and influencer in the field of surgery on the board of the American Academy of Facial Plastic Surgery, and also as a past president of the American Academy of Facial Plastic and Reconstructive Surgery. His incredible academic track record includes national teaching positions, international conference presentations, as well as an extensive list of over 100 published articles specializing in all aesthetic and reconstructive facial plastic surgery.
Highlights
To learn more about Dr. Sykes, you can follow him on Instagram, or visit his website.
Check out past episodes!
Join us on our website for more information.
Download Podcast Transcript
Should the plastic surgeon question the wishes of the patients? Today's guest is Dr. Jonathan Sykes. One of the most respected board-certified plastic surgeons in the United States, specializing in facelifts, rhinoplasty, and eyelid procedures, he will answer this question. Dr. Sykes has been in practice since 1986 and has performed more than 20,000 aesthetic and reconstructive surgeries. He is a truly dedicated and ethical physician, who has been a true educator and influencer in the field of surgery on the board of the American Academy of Facial Plastic Surgery, and also as a past president of the American Academy of Facial Plastic and Reconstructive Surgery. His incredible academic track record includes national teaching positions, international conference presentations, as well as an extensive list of over 100 published articles specializing in all aesthetic and reconstructive facial plastic surgery.
Highlights
To learn more about Dr. Sykes, you can follow him on Instagram, or visit his website.
Check out past episodes!
Join us on our website for more information.
Expert Guide to Ethics in Facial Plastic Surgery with Dr. Jonathan Sykes
Dr. Torkian 00:04
Welcome to Beauty In Progress. This is Dr. Torkian. Together, let's explore what it means to have an eye for beauty. Hi, this is Dr. Torkian. From Beauty in Progress. And I'm really excited to have with me today Dr. Jonathan Sykes, one of the people that I'm proud to now call a colleague, although, in years past, I've always called him a teacher and an educator, Dr. Sykes has been influential in I would say, not just my career in my practice, but probably everybody that I know in my field, and all the other colleagues of mine that you'll ever hear talking to me has been somehow, some way touched by Dr. Sykes teaching. This is a true, really dedicated physician who has been a true educator and leader in our field, I served on the board of the American Academy of facial plastic surgery and also as the past president of the American Academy of Facial Plastic and Reconstructive Surgery. And has, we were just talking about this before we started recording so many videos on our academies website for our continued education. But he can't even remember how many true Dr. Sykes,
Dr. Jonathan Sykes 01:15
it is very true, I'm actually pretty honored to be here. And as you as a person, I've known for a lot of years, a friend, a colleague, and somebody who likes to continually learn as I do, because I think one of the things that's beautiful about medicine is we get to take care of our patients what we get to continually learn. So that's, that's what's a great thing for me. And it's
Dr. Torkian 01:35
not just required of us, but I feel like if you don't do it, then you say sales stale, or you become stale. And that's that's one of the things that I think is so important about us being involved in our academy and being involved in continued learning and, and trying to contribute as much as we can to each other's learning, sharing information with each other going to conferences and speaking and so on. So Dr. Sykes, the concept of beauty and progress has been something that I think you have a lot to say about, because I've seen some of your lectures. And I've seen some of the lectures where you start out and the concept of the lecture or the real topic of the lecture may be something really specific, but you start out going through, this is how it was when I first started my practice, this is who I learned from. And then this is how it evolved. And that evolution was not just in our practices and in the advancement of the surgical skills that we obtain, and the advancement of science and knowing how things fit together, and so on, but more in a sort of shift that happens about every couple of years. And it's speeding up now, in the concept of beauty or what looks good, what people expect from a certain treatment, what people expect in terms of outcome from a, from a certain visit into your office, or so on. So I want you to try if possible without photographs, and I love your PowerPoint presentations because of the photographs. But to give us an idea of how you perceive the concepts of beauty changing over the past few decades, the things that we all look at as attractive,
Dr. Jonathan Sykes 03:07
and beautiful are sort of hardwired in our brain, they happen to do with the way the skin is the way the bone is the way the fat falls on the face. They're sort of hardwired into our brain. And if we look at a baby, they can actually recognize something attractive and something that's not attractive. And and we've seen that when we look at the MRI scans a little babies were as they as they get presented with an attractive person and, and not. But the reality of it is then what gets overlaid on to what we all perceive as attractive things is the style is ever changing. And that gets influenced by the media. And the media then then has people want different things. It has people now wanting bigger bottoms. And it has people wanting longer fingernails and and bigger lips. Maybe sometimes the desire by many people is something that doesn't even look natural. But the basis upon which it's built is something that's natural and attractive, and is relatively hardwired, it's actually beyond opinion. It's something that we actually can know, in the Malcolm Gladwell way of blink on knowing something knowing we were attracted to something, we can blink and know it, we don't have to study it, our doctors go and then they try and study it very carefully to make a science out of it. But we actually can know that you know, in a brief second,
Dr. Torkian 04:36
and it doesn't necessarily have to follow any specific guideline or any special guideline.
Dr. Jonathan Sykes 04:41
I think that's true. For instance, let's take something that we all look at the eyebrow there was a time when we people liked the eyebrow very thin and penciled in, and maybe even high and now we appreciate it more lower and fuller The eyebrow, and people are microblading their eyebrows, the bottom line, those are stylistic things. The attractive part underneath it is how the skin lays on the bone structure. And what makes an attractive iron orbit the brow is a cosmetic feature on top of the brow of the the eyebrow eyebrow errors, all of our perceptions know is whether we see the orbit in the eyelids as attractive. And we know that we can know that very quickly.
Dr. Torkian 05:28
It's more a matter of contour than the position of the eyebrow hairs or the whatever is drawn in as eyebrows. eyebrow hairs,
Dr. Jonathan Sykes 05:36
it's a matter of shape more than height, it's a matter of on tour, I would agree with that very much.
Dr. Torkian 05:41
So in the past, let's say, well, let's let's kind of look in the past decade, because I think that's probably going to be the most relevant to our listening audience in the past decade, I would say we have kind of fast forward, the trends. And the trends, as you say, has people wanting bigger lips and bigger behinds, and, and so on, but we fast forwarded it and what we started out as is print, and then we went to online, we were seeing some of like, it was almost like a mirror of print, in Cosmo Vogue, and some really influential magazines as such, that were in the hands of usually younger women, the influential ages. And then you know, they also could see them online, of course, eventually. And then we all of a sudden had social media and we all of a sudden had a change in the way that these images were being projected to the audience, right? There was somebody initially looking at these images going through 1000s and 1000s of pictures to pick three or four that fit into a certain layout for a swimsuit, for example, right? And now, and we saw that body and people wanted that body and they said I want that nose, and I want those eyebrows. And I like cheeks like that, right. And now we have everybody who's who's on social media capable of just posting whatever they want. And it could be a little different each day. It could be filtered, not filtered. And it can be, you know, somehow or another altered or face tuned or not. And now that's what's affecting our perception of beauty. And what we get asked for it. To what extent do you think this has an effect on on the expectations that the ability to get to people's expectations in our field?
Dr. Jonathan Sykes 07:27
Yeah, let me say first, that individuals have always been very highly influenced by the media, and by what the media and what the transfer of information made them think about their parents. So people's perception of their own appearance and that a walrus was always media driven, they would see something first in print in the newspaper, and it would affect people, they would see it on TV. And it would affect people more because they don't have visual image, and the image would be moving. But now that is fast forwarded because of social media, and the ability of media and other facets to bring these changes to the public. So now we're bombarded by more than just the newspaper, which might get printed once a day or once a week, then we would get bombarded by TV which would see at night and the more sexual things. And the higher stylize things would always be shown at night versus in the day, relatively speaking now we're bombarded with it 24 seven, and not only by people in the media, or people who design what goes on television and the ads that go on television, we're bombarded by individuals, because we see their posts, and we see many of them. And we flip through them. And we do this in the dating world world where we move from side to side we do this is what we like to look at. And when we like something that we look at, we stare at it for a while. And then it does and I'm sorry for now mentioning the same author twice because I just mentioned mountain LED will blink. But he describes the tipping point where something where we had a thing like a hush puppy, and that got worn a little bit but the number was popularized and then one hipster award and they look good on them. And that was the tipping point everyone wanted hush puppies. They wanted these sort of corduroy kind of you know these. So what's going on with this is we see people with large bottoms lots of people have large bottoms, but then the right person, Kim Kardashian or someone like that has a large bottom and it's a little curvier and everybody wants to says I want mine a little bigger or someone shows a little large lip so we're bombarded with it and then it hits the tipping point and that's why we have people that are asking us for very trendy things like cat eyes or overly done lips or now what has gotten popularized lip lifts and we have many of these It's almost shaped what we do as surgeons, because surgeons are like other people and beauty people in the beauty insurer like others, if we have the demand for it, we change our playing field, and we give it to them. Because we can sell that there's a high demand for something, all of a sudden, we modify what we can do. People weren't doing cat eye procedures. 10 years ago, the cat eyes even look good. And a lot of people know. But they show the couple of individuals who that looks great on. And then everyone asks for are many s. And I think that's what goes on. That's the that's sort of the glorification, or the the business end of what we end up doing. And we are business people beyond anything else. You know, if a surgeon gets asked for something a number of times,
Dr. Torkian 10:46
they're going to figure out how to do it. In my own practice, the buckle fat removal, which has gone through a couple of different trends has been something where I would hold my patients hands, and I would say no, I'm going to talk you out of this because no, it's not the right thing for you, this is down the line going to affect you negatively, and we're going to have to figure out a way to fix it. And that sort of transitioned after a number of times that you get asked and knowing that if I don't do this, for this patient who I've known for X number of years, and if I don't provide it for them it ethically safely, they're going to find someone else to do it. And not only am I going to lose this person as a patient, but then I risk having them get into the wrong hands and potentially getting a treatment that's not really right for them. So I try to work with them through other options and so on or just, you know, just bite the bullet in some cases and just go for it nowadays. I have a little bit more of a, I would say, kind of openness to some of these treatments that in the past, I'd say no, no, absolutely not. Absolutely not. The Fox eye or the cat, I am still a little torn on. I think I think that's kind of a trend that is you know, we saw it I think a lot of people who I have some patients from the Persian community and and some of them have friends or acquaintances or family members from Iran, who would sometimes come here, and their eyebrows would be super high. And they say hey, can you do my Botox like hers and get my eyebrows like that, where the corner is just so so high. And I would just look at him and say, honestly, I don't even know how to do that. Because I tried to do for you, is keep you looking like you just a little bit like better version of you. Maybe just soften some of those lines a little bit and bring the eyebrow up a little. But I'm not trying to get that aggressive of an eyebrow lift on your tilt, so to speak with this treatment. So it's it's kind of Yeah, it is a challenge for us. It really is. And of course, like you said, there's a tipping point, I'm going to get asked so many times until I finally say yes.
Dr. Jonathan Sykes 12:41
There's another thing that happens with the internet and social media that's so prevalent, and it's it provides people with an very easy access to seeing a lot of procedures and what they perceive as education. So patients are always coming to me, and I'm sure they do the same view. But they're saying, Yeah, I did my research, and I did my research. And the research may have been about you or about me. But it may have been about a procedure. And they're they're asking me about a given thing relating to a particular what they read on the internet is stuff that's being marketed to them. It's in the same way that Facebook is marketing to the general public, the people they read things about from procedures, or, or surgeons like you and I that under the guise of education are really trying to market because the reality of it is I don't I don't really want to I realize that social media has made it a little easier for all of us. But it's also toughened our job a little bit. They're reading things about procedures, not really having knowledge about that. And they come in wanting the procedure, whether it's good for them or not. So I see surgeons as as adding to the problem, because we're marketing to our patients. So an example of that might be a patient will come in to me and I do a lot of facelifts and a patient will come in to me and say do you do the snazzy facelift. And and so they read you know, somebody has been marketing to them about the smells. And and I might turn to them in a tongue in cheek kind of way and say I'll be glad to describe it. As you know, you know, I'm an anatomist at my poor. And I'll be glad to tell you what I do to this mess. If you can tell me what it is. I don't even know what the term is. And they're asking me about it. It's like, if you were if you were to go to Italy and ask the question, you know, in Italian and the Italian language, how much does this cost? And then the answer and you don't know what the answer means. So so people are coming in thinking I need to do my research that's beyond it all in the research is based on marketing that's being subtly or not subtly done to them, by industry by us by men. And this is very common. I don't know what your comments about that are, but I think that's pervasive now.
Dr. Torkian 14:52
I'm really, really glad that you brought this up. This was on my list of things that I wanted to talk to you about as I was premeditating this this interview was with you last night I was thinking about it. And it was basically probably the most challenging part of my practice has been dealing with the way that people are learning on social media. It's mainly social media, but it could be anywhere. It could be our blogs, the marketing efforts that we have online, all kind of blend in together with social media together. But but it's you know, how fast and how rapidly work and get out about like, for example, someone here who's very relatively new in their practice, for example, saying they're the only person that can do a deep plane facelift. And this, like, I've heard this from patients of mine who I've known forever, who come in one day, and I tell him, how could you after all these years that I've been treating you and talking to you about getting your face done? How did you end up going somewhere else? Oh, he's the only person that does deep plane facelift. And that's the best. And I said, let me just like try to educate people and try to tell them, I put some videos out there trying to discuss this, like, Look, the facelift techniques have been out for a long time. And we all learn how to do that. And we all should know how to do that we all have different ways of managing our own personal style in surgery. But a deep plane facelift didn't just get invented,
Dr. Jonathan Sykes 16:08
the anatomy has always been there, I used to do a lot of cleft lip surgeries, you know, and I had the saying that if you think you're inventing a new technique, in cleft lip surgery, it means that you don't read German. It's all out there. And it's been there for years and years. And people are saying I've got this new technique that and people always want to describe it, they have something new, because our patients always want to think that they're getting something new, as if something new is better. Occasionally something knows better. But often something new is just a new way to market and term tournament, the doctor torquing lift or the DR Sykes lift, or whatever that is, or the duck lip,
Dr. Torkian 16:50
or the quote unquote, ponytail lifts the trade trademark ponytail lift or the diamond tip. You know, it comes up all the time where people will come and say I've done a lot of research and I want the diamond tip do you do that? And I say well, let's first talk about what that really means. Because there you go, I have a tip for you. It's really interesting, because I basically I try to educate people as much as I can, when they're here. Like you know, it works on your anatomy, it's not about some little emoji that you put on on picture and Instagram that then demonstrates the shape of the diamond on the tip of the nose. It's not like that. So it's a it's a challenge. It's a real challenge. But I think in the big picture and kind of if you look backwards in the end game surgeon stand out when they are ethical and true to not only withholding the standards of beauty, but also ethically allowing their patients and guiding their patients to transition from one thing to another from one effect to another. And I think some of the more you know gimmicky things will hopefully be fading away I just is I think I've seen we've seen that. I'm only 15 years in practice now. And I've seen that probably half a dozen times in my practice. And it's you know, from the Lifestyle Lift to a number of different things that have come and gone. And you know, eventually the scarless nose jobs or the scarless open rhinoplasties and no, no breaking rhinoplasties and stuff like that, that have come and gone,
Dr. Jonathan Sykes 18:18
I might even bring up another thing that is a bias that all of us have you and I and everybody else, we're biased a little bit by what our patients asked us for. But then we're also biased by what we're able to see. And I was teaching a class yesterday in Beverly Hills, I'm up at my I have two homes, as you know, I live in Beverly Hills and I practice have weakened or have weakened Sacramento. I'm in North Node after my class. Yesterday, I flew up north, I say this in a lot of classes, our eye only sees what our mind knows. So what's going on now is we get people that can only do one thing. And they tend to see the face or the wrinkle or the skin through that window. And when I teach practitioners what to be their best. What I tell them is when you see a new patient don't first think about what you're going to do. Think about what you see, when a patient comes to me and I say, you know, tell me about yourself. First I want them to tell them about themselves not about what when I say why are you here, they'll often say for a laser or four of this and I say well actually let's pull back a little bit and tell me what bothers you. And for the person analyzing them don't look right at the big bump on their nose. Look at all their features, even though the bump may stand out, look at their chin, look at their dental occlusion, look at their skin. Look at all of that and that makes you the best at what you can do. And then the next room comes in which is communicating with that patient well, but as far as diagnosis and choice when I try to teach practitioners, even advanced ones which I teach a lot of advanced ones, it's step back and try to ask her So what you see, not what you're going to do, and if that if that can be, and I try to, I try and get patients to do that, although now I'm no longer teaching the patient. But I, I sort of moved the conversation around a little. So that actually I am teaching them without them knowing it. So I will say to them, what do you see when you and I try and get practitioners to do that, because that makes them the best at diagnosing. Sometimes, a patient is fixated on one little thing, and they don't see the whole picture. So you do have to then cross what you see and what you can do with what the patient wants to what they see.
Dr. Torkian 20:34
So and a great example of this is, for example, today, I had a patient that I saw about two months ago, who was fixated on the upper eyelid skin. And they had heard from a friend of theirs that I prefer in some cases to do upper eyelid blepharoplasty is under local anesthetic in the office. And it's a really easy recovery and so on. Right? It's not not rocket science. It's not a new idea or concept. But she just heard that. And when she came in, I looked at her and I said, Well, let's talk about what's really bugging you is that the skin? Is it this that because that's that's not what I saw, I saw something totally different glaring in my face, which was the position of her brow and I thought she needed a brow lift. And so it was a totally different item now that she's that she's getting recommended to get, which is basically she came in for a product, and now she's getting sold a different product, right? If you think about it that way, she came in for like jeans, and someone told her No, you really need a skirt. And it's a totally different thing. And it's a totally different price tag and a totally different downtime and so on. But some people downtime is different, and seizure is different. And so some people will come in looking for a thing that they want, others will come in just looking for a feeling. And they come in and they say I just want you to look at me and see what you can do to help me through this process of aging. Or I want you to look at me and tell me what you see before I tell you why I came to see you and and I like that. I'm wondering how do you approach it? Because this is something I like to learn from some of my colleagues who I think know more than me. And obviously you're one of them. How do you start with people like this?
Dr. Jonathan Sykes 22:05
Well, it's a tricky thing, because it's a it's a communication thing. And communication between people is different between all you and I communicate on some level, we think a lot the same, so we can communicate. But if you were communicating with a different person, you might do it totally differently. So you have to, you have to sort of size them up, I think a couple things are important. A couple of things that I see are important. One is really listening to the patient, and finding out who they are and what they're able to tolerate. Because there might be some patients that even though a brow lift and upper blepharoplasty might be good in the example you just gave, they don't want that, and they're not going to have that. And that's and you might need to size them up, even though you're going to tell them I think you will do better with a brow lift, but we can get some improvement with your islands only some people are wanting that product and you size up that they want that. And they may be a little no at all kind of make. It may seem like they know already with you. And and you want to listen to them on people who are more open to what your ideas may be. And that's true about you know, person that you just socialize with them. So what I try and do is I try to after I listened to what they came in for. And I asked them some questions, then I tried to tell them what I see and what I might suggest. And if it's something outside of what they came for, I asked for permission to do that. They come in for their nose, and I think their chin is too small. Well, as you said, it's a really different thing. It's it's different than their their genes. It's a real different thing. So I'll say to them before I said I've been analyzing your entire face. Would you mind if I told you about that I asked for that permission. And if I hear from them, that they're they're open to that I start to but if I hear from them as I discuss it, that they're not interested I back away, because even though I think they may look better, with a rhinoplasty and the chin implant, some people just don't want that. They just don't want that. So we're always the art of what we do is careful diagnosis, and then really good communication, looking at somebody and diagnosing them both physically and psychologically, and then communicating that to them. Because as you know, the your most satisfied patients aren't necessarily the ones on whom you've done the absolute best surgery and gotten the best result. And your least satisfied people aren't the people that you've had the worst results on their people, you can almost break those two people into the happy people tend to like their results, because we'll almost always improve them and they see the parts that you've improved in them and unhappy people tend to see the parts of what you've done to them that has fallen mildly short, and we typically have a couple of those as well. within all of our results. We've made 90% of things better, but 10% didn't get better and unhappy people concentrate on the 10% and the happy people Very happy with the 90%. So that's the psychology and the communication.
Dr. Torkian 25:04
There is a tremendous amount of psychology behind it. How do you how do you look at when you look at them? How do you begin your own process of evaluation, though, because what I'll tell you what is interesting to me because I think people want to see that you're doing some kind of a calculation on them, they want to see that you're calculating ratios, and drawing angles, and circles and so on. And although I love doing that on in theory, on paper, I don't do that on my patients, I like you said with will refer back to the author again, of blink when I see it, I know that I like it. And and I tell my patients, I'm just like a stylist, hairstylist, clothing, stylists, whatever, whose tastes you either like, or you don't. And if you don't like my taste, then you're not going to like what I have to produce, right? Even if I can get like, forget about the surgical skill and if I can get to that point or not. But first we have to interview and we have to discuss what our tastes are, and see if they match, right? So do you make measurements on people? Or do you just give a Gestalt look and see what you like and don't like,
Dr. Jonathan Sykes 26:05
I don't, I've read all of the measurements and actually written some of them myself, as you know, but but but at the end of the day, it's an eye test, we go out with an attractive person, and we don't line up their face and say, This is attractive, because your cheekbones are adjusted, but I can apply what is attractive about the most attractive faces to average people's faces and say, What do I need to do to make them better. So I don't do a lot of measurements, but I do measure their psyche, and there is a measurement and that and I'm how I, I try to get a sense of how they feel about themselves. Because people that don't feel great about themselves, they tend to concentrate on the part, the little part that we haven't improved. And people that feel good about themselves are very happy with any improvement that they get with the improvement that I typically give them. And so what I tell practitioners is, when I'm, and I've given lots of lectures on psychology, it became an interest of mine. And actually, I'll tell you an interesting story. Because I don't know if you know this or not, but it came out of some real hardship in my life, I had a patient that really was difficult for me back in the early 2000s. And her surgery had come out well. But she you know, and she really tortured me, actually. And many of us have had that in our careers. If we're cruising along. Mine's been 35 years. So I've had a few of those patients. And I asked myself, what, you know, what was going on there. And what was in result was at least in the 50th percentile, probably better. But she was and I missed some some some times. So now I try in my regular life, and even in my consultations to listen to people more because the signs are always there. And so I might ask them some open ended questions. But often, surgeons are so driven by trying to make themselves seem important to the patient, they forget to listen to the patient. And so I might ask the patient something like how much per day do you think about your appearance seems like a pretty innocuous question per day. So you know, if you're like me, you can see I came to this thing, my listeners can't see this. But my hair is sort of messy and look like a mad scientist. But I have patients that look me in the eye and say, Well, I'm like other people, you know, four to five hours a day, I think about my parents, and they think that's normal. You think about your appearance four to five hours a day, you're afraid. Okay. Your anatomy, you know, you're literally a freak, but it's that sort of freakish. And there are a lot of people in your practice barrows and in mind that do that, and the chance that we make them happy when they're so fixated on their appearance, we might think, well, we get it just like they want it, they'll be super happy. But that's not actually it. It's never, it's never just like they want it because these people often get a lot of surgeries. So it's sort of an interesting, touchy thing. We want people with a little bit of insecurity and a little bit of insecurity might be healthy, it makes us you know, be cleaner, make our haircuts, more styled, wear nicer clothes, a little bit of insecurity, a lot of it makes us obsessed with our appearance. And you and I both see some patients like that. So we've got a ferret that out. And then once we get a patient who's able to tolerate this, they're fitting in zone that they'll be okay, then we've got to diagnose them. Well, we have to communicate what we see. We have to listen to them again. And then we've got to try and do our best. That's the secret to me.
Dr. Torkian 29:31
And to some extent, like I was saying it just keeps on kind of coming up in my mind. I feel like especially if they're already there, and they're trusting me that I have a responsibility to guide them in the right direction. And if I don't do my job properly, and they end up in someone else's hands who just says yeah, I can do that. Definitely charge money for it and I can do it. Then I'll be seeing them again for the revision for the fix. And I've seen that it's happened so many times that I know you've seen Where you meet with someone and you say like this is that's not it. But this is what I think I can accomplish for you. This is what we think I think we can achieve. And I use the 3d I use the Vectra 3d imaging system for the rhinoplasties. And sometimes I'll use it for other facial features as well, but the mainly for rhinoplasties. Now it's all look, I can do whatever you want on this thing, I can image this till the cows come home and make it look like a totally different person. But I can't really do that on you in real life in surgery. And so we have to stick with what we're starting with and have a, you know, healthy expectation for what we can achieve. And then they say, Okay, thanks, no problem. And then they go somewhere else. He couldn't talk and couldn't do what I wanted. So go somewhere else, and they come back crying like oh, my gosh, a couple years ago, you recommended don't do this, or do it this way or whatever. And here I am now can you fix it?
Dr. Jonathan Sykes 30:51
You know, it's sort of interesting that you certainly there are a couple of things with that. They're, they're the people that want something that they can't have. And our job is to tell them what they can have somebody that comes in wanting a super narrow nose, and a very thick skin, I see that all the time. And we can make their nose narrower, but we can't make it like the model picture they bring in, that's super narrow, we can't do that. And if we try to do that, we get issues like we've seen in some, you know, celebrity kind of things that have been, you know, horror things, they're patients that want something they can't have. And then the patients, that one something that my experience tells them is not good. But they could have. And I'll give an example of that. So they want lip implants, because they, they want something permanent. And they don't like going back for lip injections, which with which, if done well, can look very natural and nicely enhanced, but they want an implant because it's permanent. And I will never do that. And even if a patient decides to go elsewhere, I'll tell them what I know. And I do know this, and that is most looked implants end up coming out. And they end up having problems. And they're they're not a permanent, you know, come in fix it one and done thing the patients are looking for. That's what they're looking for. But that's not what they get. So I won't do that. Even if I know that they may go elsewhere, I'll be very honest with them, I'll give them my my honest rendition, but I won't, I won't squeeze their square into the peg that I know is better for them and safer for them, and reproducible without complications. So and and for that reason, I have a few procedures on the face that I've stopped doing. I don't do lip implants, I don't do cheek implants. And I think cheek implants can work very, very well. But for me and Jonathan sites hands, the number of revisions and removals is higher than I like to tolerate. I don't like we all have to redo our own surgery once in a while I like that to be you know, something that was there's a very low incidence, and I found the cheek implants, the incidence is higher. And I've redone the theoretic gurus in cheek and jaw implant in the country. And I redo their cases and or take them out, not renewal, why don't put them back in. And in reality, I don't want to be putting in implants that I've got to take out. Right, you know, I don't want that to happen. I don't think that's your patient. And I have to tell them that so so the more there's the patient that wants something that they they can't have or reasonable surgery won't get them and there's the patient that wants something that they shouldn't have. So I don't know what your thoughts are about that.
Dr. Torkian 33:42
I think these are probably the best two examples that I could think of, I wholeheartedly agree with both, if you have a certain effect that you're looking for, and you're trying to get it permanently done, when there's a really good option, as you said, That's reproducible, that I can do over and over again, that can change with you as you age and as you grow and has way lower of a risk profile. I always prefer that and yes, there are always things that people come in for and they say I need this particular exact thing, but it's not the right thing for them. But there are options for people out there for almost almost every effect that they're looking for. There's there's options out there for them to fit their particular needs, right so if someone comes in and says I want something surgical, that lasts a really long time for enhancement of my cheeks, then I will guide them towards a fat graft for example, which I feel way more comfortable in my hands than doing a cheek implant like as you said, that's gonna end up coming out that's gonna end up causing some kind of a male or edema some kind of a numbness and overall just long term problems infection so on and so yeah, it's it's what's tough though, is that some sometimes people will come in with that preconceived notion of this is exactly what I want.
Dr. Jonathan Sykes 34:52
And a lot of preconceived notions I think are generated on the internet and they read about them. They read until they find what they want. I like this, whether this is good for them or not,
Dr. Torkian 35:03
it's really tough to guide people through that. So, in a nutshell, I just try to tell them, I say, look, I want you to just think about this and consider it. But I'm going to tell you, as a professional, I don't want your money on this, okay? You don't have to do this with me, and you don't have to. But this is what I recommend. Because this is going to be in my experience, the better thing for you and I try to guide them that way on principles of beauty. It's a little different, though, on principles of beauty. Sometimes people will come in and they say, I think I would look better with my, with this feature changed. And there are some parts of the anatomy that I may agree with, or some parts of the anatomy or their features that I may agree with. But almost always I find something where I tell them look, I that that's really not such a great idea, which is one of the reasons why I love to 3d imaging because I get to pull it out and show them like this is what you're asking for. And this is what it would look like on you. How do you approach people who have this preconceived notion now not just about a procedure about about a certain appearance that they think they should have? Or a certain change that they think they should have?
Dr. Jonathan Sykes 36:03
I used to poopoo that and and try and but now I almost like it a little bit because I like hearing from them about what they think and then I can make a decision, was that doable or not? I can communicate with them back, can we get this or not. And me the basis of any human interaction is communication. And the basis of our human interaction with a pre op pre you know, or their initial console is communication. And as you know, solid your patients you communicate really well with you feel like they're on the same plane with you. Some of them, I tell surgeons and injectors, and if you're not communicating with someone, well, before you do something, the procedure won't make it better. It's like having a bad relationship and deciding I'm gonna try and fix the relationship with a kid, you know, that's not going to make it better. That's going to make more reasons to make your relationship bad and contentious. So procedures create stress. And if you're a little stressed out as an as a surgeon, and if the patient's a little stressed out by you, in the initial consultation, the procedure is going to make that worse, if you're communicating really well. And you think that they're listening to you and you're listening to them really well. And it has to be bi directional, it's probably going to be good afterwards. They're going to trust you afterwards, they're going to you know, but but if they're not communicating well, and they're not hearing what you say beforehand, what's the chance it gets better when you do something invasive to them? Zero very level, you know, it's, it's not like, well, you took the bump off their nose, now we're communicating really well. No, that's, that's not, you know, because this really, when I look at all my happy patients, which is most of them, we've communicated well, and when I look at the small subset of unhappy patients are bad communicators with me, I'm bad communicators with that, whatever we're not, we're not on the same page. I said that wrong. They're not bad communicators with me, we're communicating poorly together. So it's like any relationship between two people. It's not one person's fault. It's two people's fault, you know, and it's a relationship. And, you know, I've given lectures about communicating and listening and plastic sort of respect psychology as graduation speeches. And what I say is, you know, the consultation is like a date. It's like your first date and you ought to be listening during your first date, even though we want to tell them how great we are. You got to be listening during your first date and you don't get in that much trouble with a consultation but doing a surgical procedures like marriage, they're your patient for a while longer, you have to listen to what their issues are a while longer and they've trusted in you so that you that's the that's what we given them by accepting their fee and accepting the contract of doing what they say it's sort of a contract a little bit that contract you know, it puts us It puts us together for a while longer and if you don't think that's a good match on either direction, the patient or the doctor, it's it's not good, you know, and it's a little different than doing these things that are reversible like Botox if we decide we had a bad Botox or botulinum toxins, it should be called or filler we can choose to go to a different restaurant we go to a different practitioner, you know, these are reversible things, but if we do a nose job with somebody, and then we get their skill level, their communication, their care, all of that afterwards, and I take that really, really seriously. I take it so seriously that every one of my patients gets my cell phone number, my personal cell phone number so because I value that trust so much, I agree with you.
Dr. Torkian 39:23
I think it is super important to have that trust. This is one of the things I actually it's so nice to hear you saying it I tell my patients when they're trying to decide between different physicians and they'll sometimes come in I had I think the most consultations I've heard anyone telling me they had his 15 for revision rhinoplasty The first one was because the advertisements look really good. And I said How long did you talk to that first rhinoplasty surgeon before you decided to have rhinoplasty with him or her and the answer was really didn't spend that much time with me. I think it was like 1520 minutes kind of walked in said yeah, I can do it and then someone else came back in and gave it away. And I said, and now you've gone to 15 different people and spent one hour at each office or maybe less, maybe more, but you spent some time because the revision rhinoplasty consultation is totally different than a primary. And now you're trying to pick between 1515 different people. And I always tell my patients that are in the same boat, which none of them have been 15. But in that same sort of position, like trying to decide between multiple people, you want to pick someone who has tastes that matches with your swipe we were talking about before, like, look at me and look at my work and look at some of the other before and afters that I'm going to show you and just see whether you think that matches your tastes or not. If it doesn't go away, you know, it's not good for you. Second, you want to make sure that you believe I have this skill to do what you need, right. And so that comes in the before and afters, as well as the morphing and the concepts of what I think go into correcting what they see, and so on. And then third, make sure you can talk to me because if you have an issue that you don't like, or that you need some kind of support on after this in your healing process, because the healing process is huge. People think they're going to go and have surgery and come out things are really realized that there's a healing process and who's better to guide them than me. It's not like they can go on the internet and search on real self, how long is it going to take for my nose to heal? It's only been five days, I hated seeing that question on real self. Because I thought it's the surgeons responsibility, you need to have a relationship with the surgeon so you make sure you can talk to him, right,
Dr. Jonathan Sykes 41:25
trust me. But interestingly, it does underscore how little patients listen to what they get told, because I've got a thing that most doctors that do rhinoplasty tell their patients that it takes longer than five days or a week or two weeks. But patients don't hear that and for what you tell them and they hear what they want to hear a little bit but interesting, neatly, if do real self stop stuff anymore. But when I used to look at that, that was the most commonly asked question people would ask it often after they've had a rhinoplasty. And they're asking it to all the network of doctors around the world. And
Dr. Torkian 42:02
they have their own doctor, that sort of an interesting kind of thing. They have their own doctor that they trusted enough to cut on them. And now they're asking everybody else and they don't trust the answer, they probably got that input from that doctor. Exactly. It is really disheartening thing to see because I value the relationship, I tell them, Look, I want you to feel comfortable with me and be able to talk to me, but not just that, I want you to come back when you're older and have me do your facelift, I want you to bring your mom and have me do her eyelids right, I want you to come for your wedding and have me do your Botox for you before your wedding day, you know, and that's the relationship I want to have. I don't want you to just get surgery and go away. So you got to make sure you like me. If you don't, then it's not the right fit, right? It is a business, it's tough. There's a lot of competition out there, we have to be competitive, we have to keep going, you know, we have to bring in brand new patients and do the procedures to keep going. But it's important that people listening know, as many of them can be patients of ours and or listeners who are interested in this field that the real goal is not just that business transaction, the real goal is for everybody's well being and betterment for you to have a good treatment that based on what you need. That's ethical that's not going overboard. That is based on the principles of sound surgery, sound principles of beauty and enhancement, and not just something we just read about or saw or that looks good on someone else. I think these are really important concepts. I think we're getting close to running out of time. Actually, I think we have run out of time. It's 302, we usually go for about an hour. So I wanted to see if you have any closing remarks. I have tons of closing remarks always. But I like your comments better.
Dr. Jonathan Sykes 43:39
I just would say, you know, pretty happy to be in a field that I get patients to trust me with their faces. And I've been able to do that for 35 years. And I love teaching. I love doing my craft. I love teaching my craft other doctors and nurses. I love being able to shape the face in the best way possible for myself. And that is an ever changing thing for me adapting to styles, adapting to the internet, the new trends that come out in the internet and trying to listen to my patients in the best way possible. I can't always do it, but I'm trying to do it. And that's what makes me work on Sunday nights. And you know, this week from Sunday, I have four rhinoplasties on a Sunday, if any you know my age, I'm past the age of thinking that that's a good idea. But But I love I love doing it. I'm honored to be able to do it and to be able to do it for so many years.
Dr. Torkian 44:29
That's awesome. Dr. Sykes, thank you so much for joining me. We'll take some of our other colleagues out here, around town with us out and now that we're able to go out with masks on and maybe sit outside at avar or something. It'll be kind of a nice, nice little visit. Nice day out. Thanks so much for joining me Dr. Sykes. Again, this is Dr. Jonathan Sykes. Dr. Sykes, do you have an Instagram handle or a website that you would like to tell our listeners
Dr. Jonathan Sykes 44:54
I do as a person who never liked social media I have over 100,000 followers on my at the Are Jonathan like, Yeah, I don't know if it's awesome or not. It's a little bit embarrassing actually, you know, I would think that like three people would follow me not. You can follow my other website which is I'm a winemaker. I have newfound wines at newfound wines. It's a side passion of mine.
Dr. Torkian 45:15
That is so so cool. It's at Dr. j. o n a ATHANSYK II s at Dr. Jonathan Sykes calm and you can follow me at Dr. Torque en and please make sure you click Subscribe on your Apple podcasts or Spotify or wherever else you get your podcasts so that you can keep following and hearing up to date information from our colleagues and people in the health care and beauty industries. Thank you