Facial Plastic Surgeries with Dr. Hani Rayess

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Hani Rayess to discuss Facial Plastic Surgeries.

Dr Hani Rayess is a fellowship trained facial plastic surgeon. A native of California, Dr Rayess completed his medical education at Case Western Reserve University in Cleveland. Following that Dr Rayess was selected to complete an otolaryngology/head and neck surgery  residency at Wayne State University in Detroit Michigan. This is where he built the foundation for a future in facial plastic surgery, spending five years focused only on surgical training in the head and neck area. Dr Rayess is American board certified in head and neck surgery. During this time Dr Rayess developed a passion for the field of facial aesthetics and reconstruction.

Dr Rayess then completed a fellowship in facial reconstructive and cosmetic surgery with Dr Langsdon at the University of Tennessee in Memphis. Dr Rayess spent this additional year honing his skills in both aesthetic and reconstructive surgery of the face and neck. There he learned state of the art procedures in facial and nasal aesthetic surgery from one of the leaders in the field in addition to performing trauma and facial reconstructive surgery at one of the busiest trauma centers in the nation. This was an important experience which helped shape Dr Rayess's career trajectory. Helping restore the form and function for patients who have suffered from trauma and accidents is challenging and requires patience as well as a thorough understanding of head and neck surgical principles.

00:00 Welcome back to the Get Healthy, Tampa Bay Podcast!
0:50 Guest Introduction
04:13 Facial Nerves
06:48 Age considerations when having plastic surgery
09:57 Procedures done on kids
12:42 Do patients bring in a picture of what they want?
13:55 Long term results
14:19 Age Rejuvenation
16:04 Cases that lead to botox
17:53 Skincare, skincare, skincare
20:01 About his profession
24:47 Risk & Complications
27:47 The secret to...
32:13 Where can you find Dr. Hayess. Closing Remarks

Connect with Dr. Hani Rayess
Email: info@rejuvenatetheface.com
Website: https://www.rejuvenatetheface.com/
Instagram: @rejuvenatetheface
Phone:  813-800-FACE

Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
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Transcript

Kerry: 0:28

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have an awesome guest, Dr. Hani Rayess. I know I probably said it wrong, so help me again. Anyway, welcome to the podcast and please introduce yourself and tell everybody a little bit about who you are and what you do.

Hani: 0:48

Thanks Dr. Reller For having me on the podcast. So I'm Hani Rayess, facial plastic and reconstructive surgeon here in Tampa Bay. My practice now is mainly focused on cosmetic surgery of the aging face, so facelifts, upper lower eyelid surgery resurfacing. But I spent an earlier part of my career doing a lot of reconstruction following trauma, both like accidents and gunshot wounds. And I still do skin cancer reconstruction. Skin cancer is huge here in Florida because of the sun. So many times if the defect is large or it's encompassing more sensitive areas, I'll help the dermatologists and we work together on those cases. So that's a little bit about me and what I do and what I like to do.

Kerry: 1:27

Yeah, definitely. The skin cancer ones can keep you busy, down in Florida. Where did you do the trauma training, if you don't mind me asking

Hani: 1:34

I did a lot of my trauma in Memphis, Tennessee. That medical center was one of the busiest trauma centers in the country. And yeah, I mean, you get a lot of experience there dealing with all kinds of different things. So it's Definitely a change of patient now that I'm out here doing cosmetics, it's obviously very elective and you're dealing with normal anatomy. People are trying to younger as opposed to over there you're dealing with missing tissue, with things that have been lost, things that have been moved around because of whatever reason. So each thing presents its own challenges. There's definitely a good experience to have before coming out here doing the cosmetic side of it.

Kerry: 2:06

Excellent training for sure. So let's start with basics. Can you explain the role of a facial plastic surgeon and what kind of procedures that you typically, or a general one might typically perform?

Hani: 2:19

Yeah, absolutely. So facial plastic surgery, I mean, the core of my training was in head and neck surgery, so doing reconstruction, cancer surgeries, all kinds of surgery in the head and neck area. And then I subspecialize in facial plastic and reconstructive surgery where I got exposed to the trauma and reconstructive side as well as the cosmetic side. Our area is really, hyper-focused on the head and neck area. That's the only place we've been trained in. That's the place we focus on. And it's a area with a lot of expensive real estate, so to speak. You have a lot of important nerves that travel there. Important blood vessels. So, all that experience and training that we have in that area is good. So some of the procedures that we typically perform honestly, it ranges from, you know, facial plastic surgery can be divided into five or six main categories. So you have the cosmetic aspect, that's mainly like the aging face procedures. You have rhinoplasty. Rhinoplasty is considered to be the most complicated cosmetic surgery just because it is a three-dimensional structure on your face and subjected to different contractile forces. You have congenital facial plastic and reconstructive surgery. That would be patients with cleft lip and palate with microtia, ear deformities. We have trauma, so that's patients who are, you know, either, whether it be gunshot wounds or accidents. We then have the other subset would be skin cancer reconstruction. So that's patients who have had most surgery where they have a controlled defect that you have to fix. The last major discipline I would say is facial nerve paralysis. So that's the nerve that controls your face and it's paralysis can cause a lot of issues with smile blinking and just your overall self-esteem. So that would be the last major discipline of facial plastic surgery. Currently in my practice, I focus on the aging face aspect of it, so the facial rejuvenation, the rhinoplasty, and the skin cancer reconstructions.

Kerry: 4:09

Okay. Then let's do the quick question about the facial nerve paralysis to get that out of the way so can you actually like improve the smile and create the smile again? Or are they,

Hani: 4:19

Yeah, absolutely. I mean, there's been a lot of advancement in that field. You have what we call static and dynamic therapies for that. So static therapy would be where, so when you smile, you want the corner of your mouth to be lifted up. And what happens is what you can do is statically lifted up. You basically get some fascia, tie it to the corner of the mound and suture it to your. Temple area and that pulls the corner of the mouth, but it's not dynamic. But, statically it will look like your corner of your mouth is pulled back. Now dynamically where a lot of advances have been made is using what we call free tissue transfer. So a muscle from your leg is surgically removed, leaves no functional impact'cause it's you know, kind of like a redundant muscle and transplanted into your face with its nerve and its blood supply. So the blood supply is connected to arteries in the face using the hair thin sutures, the nerve of the muscle is then connected either to your chewing muscle or the facial nerve from the other side. So it's a multi-stage procedure and that muscle's then attached to the corner of the mouth. So when you smile, the nerve fires and triggers That muscle to contract. That would be the more dynamic aspect of it, which you using patients who've had, loss of their muscles in their face. If you still have muscles in your face, which is the case, if the paralysis is still within the ear, you can connect the trunk of the nerve, the facial nerve to your masseteric nerve, which is V three, a cranial nerve, and that's the nerve you use for chewing. So that way when you bite down, you smile. that takes a lot of therapy to learn how to do it. It doesn't happen right away and it takes training'cause it's not intuitive to smile when to bite down to trigger your smiling mechanism, but those would be some of the options that you can have in terms of facial paralysis.

Kerry: 6:02

That is super cool. I did not know that it was possible. I mean, that's more than just someone that would have Bell's Palsy or something like that. Right.

Hani: 6:09

It can be Bell's palsy. Bell's palsy that doesn't resolve, and if you don't get it treated over time the muscles will atrophy, so then you'd be a candidate for that. But say someone had Bell's Palsy and it's six months out and there's no recovery, they'd be a candidate for like a masseteric nerve innervation or something like that. But say it's been two years since the Bell's Palsy, the muscles of the face will atrophy'cause muscles need neurostimulation in order to maintain their tone. That's true for any muscle in the body. So they'll lose their tone, they'll be non-functioning even if you reconnect the nerve. So that's why you have to transplant a muscle up there.

Kerry: 6:43

Hmm. Super cool. All right, well now that I know you don't do that one very often, why don't we focus on the age stuff? So are there any specific age considerations for facial plastic surgery?

Hani: 6:55

Yeah, absolutely. So the way to look at cosmetic facial plastic surgery is to divide it into what we call sculpting procedures and rejuvenating procedures. That's the way I kind of describe it to people. So sculpting procedures, you're looking at your rhinoplasty, your otoplasty, which is your ear, your setback surgery. So that's where you have the actual structure there and you're just sculpting it. So the nose, people most commonly want a hump taken down and they're tip refined and lifted up. You're sculpting what's already there. Same thing with the ear. You know, I'm not talking about the anomalies where patients are born without a ear. I'm talking about where they're born with a protruding ear. So in those cases, you wanna set the ear back, and again, you're sculpting. So the sculpting procedures, Tend to be younger patient surgeries. So you're looking at rhinoplasty for females from about 15, 16 males, about 18 onwards. Otoplasty, which is where your ears are protruded, you can actually perform as young as six. That's when the ear has reached about 95% of its adult size, so it's not gonna grow a lot more. And that's when kids start entering school and start being teased about it and it can start to affect them socially. So that can be performed from six going up?

Kerry: 8:03

I've seen some parents use like headbands or something like that. Do you think any of that, like can help prevent the need for that in the future

Hani: 8:11

No, I think if it's done very early on, like you're talking two, three days after birth. Like when you're a newborn, you can mold it, because you're trying to mold the cartilage at that point, when born, the cartilage is still very pliable. But once the cartilage is formed it has memory and it's in that shape. So the way we do it is we use permanent sutures to hold it in place. The sutures are permanent and I mean, I tell patients the biggest risk of is that a suture getting loose and'cause their cartilage, it's a malleable structure. It's not like bone where you break it and it's broken, it's malleable. It wants to revert back to its preformed like it's a form before you did the surgery. So that would be the biggest issue with Otoplasty is like a suture getting loose early on within the surgery and the cartilage returning back to its original shape. So I don't think that headbands would help us. But any point, like after surgery, we have'em, wear a headband just to help set it back. But you've created a wound there. You want new scar tissues forming. So that's a different process.

Kerry: 9:07

Yeah. Well, I will definitely not speak to that if they really think that it's a problem and the kid is getting made fun of, which is definitely not something people want to go through, that they're able to do that. And you said as young as six? Is that what you said?

Hani: 9:20

Yeah. Six. I mean, ear reaches 95% of the adult size at six, so you're not stunting its growth at all. And it's not a big surgery, honestly, you're going through skin and cartilage. So relatively speaking, in terms of invasiveness, it can be done under local or just with a little bit of pro-nox to give them some sedation and comfort. But in terms of invasiveness, it's not a very invasive surgery. It's

Kerry: 9:41

Is it something that is covered by insurance or is it still considered like an aesthetic thing?

Hani: 9:47

very hard for insurance to cover it. Very, very difficult

Kerry: 9:51

there any other procedures that you might perform on someone that young or basically a kid?

Hani: 9:58

No, inside the congenital surgeries, which I don't do in my practice, but you're looking at like the cleft lip and palate, which a series of surgeries that have to be done starting from the first few weeks up until like, or 10 12, depending on how severe it is. So those would be surgeries that are performed on younger patients. But in terms of cosmetic surgery, so to speak, which this one would be considered otoplasty you don't really perform any of these surgeries on patients that are young. You really want'em to have gone through puberty. the nose job would be the next earliest surgery which you would consider performing. And in both boys and girls, you want them to have gone through puberty before you do anything elective on their nose.

Kerry: 10:36

Let's say it's not really as elective, like there was a injury or something. I don't know. Would you do something that you would work on like on the

Hani: 10:44

Yeah, so say for example a bite or. say someone gets a baseball to their nose and fractures their nose, then you have to set it back in place. I mean, you wanna do it as soon as possible, but then like, say the inside of the nose, the septum is also injured there. You wanna be very careful with what you do. Because when you get in there and you take out cartilage, you can disrupt growth plates and you can, you can cause an issue. So, You try to really just go in, gently push things in place, take out only what's severely obstructing and tell them that, once you go through your growth phase, then you'd be a candidate for further surgery. But you really want to minimize what you do so that you don't stunt the growth to their midface.

Kerry: 11:21

Okay, so what about I guess as we're talking adults, everybody who's completed puberty, you see a lot of rhinoplasty and the facial rejuvenation. So how does, can you explain those?

Hani: 11:33

rhinoplasty is definitely a more younger person surgery. And yeah, we do get a decent amount of consults for them. Mainly, people looking to get their hump improved, their nasal shape. We sculpted it's a good surgery. I mean, what I tell the nost job patients is pick the top three things that bother you and we go after them. The key thing is that I try to set expectations early on, and that's important in this industry because we cannot sculpt the perfect nose. I tell'em, pick the top three things and we'll work on those? When you try to fix every tiny thing is when you can actually end up making things worse. I really feel that's why you see a lot of bad plastic surgery out there is'cause they're trying to do too much with What the surgery can do. Everything has limitations in medicine and as you know, any doctor will tell you that, whether you're primary care, orthopedic surgeon, neurosurgeon, everything has limitations on what we can do. So, you know, you gotta recognize limitations and convey those to the patient like it's not a magic wand. Surgery has, I tell people like, if you're okay with an 80, 85% improvement, half surgery, if you're looking for 90, 95%, a hundred percent perfection, you're not a candidate. Surgery's not gonna achieve that.

Kerry: 12:38

Do they like bring in a picture of what they are looking for, or do you have some sort of three D modeling, or

Hani: 12:45

Both.

Kerry: 12:45

How do you plan, I guess?

Hani: 12:47

So both. So for rhinoplasties, I do do modeling. I do two D modeling, but what I do it's really effective for the bridge. So some people want a straight bridge, some people want a slightly scoop bridge, and that's where discussion is in terms of bringing in pictures, that can be helpful from my standpoint to see where their head is but then I either have to tell'em like, this is achievable, Or tell'em like, this patient has a completely different structure than your nose. Like we're not rebuilding a nose. We're sculpting what you have. So I'll tell'em like for example, like the biggest thing about noses is the skin thickness and different ethnicities have different skin thickness, right? So Northern European are very thin skin. And as you go South Mediterranean, it gets thicker. As you go further south into Africa, it gets much thicker. So in terms of definition of what you can achieve, it changes depending on the thickness, depending on the strength of the cartilage. And these are things that are inherent to your body. Genetically we cannot modify it As surgeons, you can make things better and stronger, but not to the point where you're changing your genes or anything like that. It's good in terms of triggering a conversation and either telling them, you know, that's achievable or no, like that's just different anatomy.

Kerry: 13:52

Yeah, so you're obviously, know, preparing them for expectations, but can you speak toward like the long-term results on the surgeries?

Hani: 14:00

Yeah, so rhinoplasty, I mean, it has good long-term results. Once it's done, like it should maintain itself for the rest of your life. There is about an eight, 9% revision rate with it. Normally I tell patients it's, to sculpt the bridge a little more. But other than that, I mean, it's kind of a surgery that's one and done.

Kerry: 14:17

Okay. And how about age rejuvenation? What are the procedures there that you do?

Hani: 14:22

So whenever I see an aging face patient, I explain to them what I call the three Ds of the aging face. You have descent, deflation, and deepening wrinkles. So those would be the three different buckets. Look at the aging face, and surgery really only treats descent and deflation. So descent, you're looking at your facelift. I do the deep plain facelift upper and lower eyelid surgery. And lip lifts. Those would be the main things that you treat for descent. Deflation is where you have your synthetic fillers and fat and deepening wrinkles. That's where resurfacing procedures come in. So that's your skincare, that's your sunscreen, that's your laser resurfacing, chemical peels, all that stuff. So in terms of surgeries, I do a lot of facelifts. Deep plain facelift is my most common procedure that I do in general. Oftentimes people will combine that upper upon lower eyelid surgery brow lift, just to get'em all done at the same time, one downtime, and the aging face surgery is different from rhinoplasty in that, what I tell people is that it winds the clock doesn't stop the clock from ticking though. So you'll continue to age just from an earlier standpoint.

Kerry: 15:25

So the deflation, are you talking about like ptosis, like when the, for the eyelids dropping?

Hani: 15:30

I'm talking more like your cheeks sinking in the hollowness under your eyes, showing your temple sinking in. A little bit of your jawline receding, especially around the angle. That's what I mean when I say deflation. Ptosis is different. It's a muscle leak.

Kerry: 15:45

Yeah. Do you do surgery for that? Because that sometimes is covered by insurance? Right.

Hani: 15:50

I don't need too, too many

Kerry: 15:51

Okay. Okay.

Hani: 15:53

If it's a minor, possibly, but that's not something I specialize in.

Kerry: 15:57

So where is somewhere like you might point them towards Botox or something rather than getting surgery.

Hani: 16:03

So they're not mutually exclusive. I tell'em they compliment each other. And I think that's where we see a lot of troubles, where people try to substitute Botox and fillers for other procedures. I mean, at the end, like we are still doctors and we have to diagnose the problem. So if you try to use the wrong treatment, you know, you try to use a treatment for the wrong diagnosis, you're not gonna end up with a good result. So, for example, Botox is a paralytic. It paralyzes muscles. It's not gonna help descent at all. Where it helps is where you have wrinkles form perpendicular to muscle contraction, whether It's in your forehead, in your glabella region. Wrinkles form'cause the skin contracts perpendicular to the muscle. So by paralyzing the muscle, you try to relax the skin. That's the only thing Botox will do. And it helps the lines in between your eyes, it helps the lines in your forehead, it helps those radiating lines around your eyes. And facelift will do nothing for those lines. Those lines are superficial in the skin. So facelift, if someone comes and tells me that's a problem, like, a facelifts not gonna help you there, you need Botox. So they're more, they more compliment each other as opposed to being a mutually exclusive treatment option. Same thing with filler, like the lines around your mouth, your nasal label, and your marionette lines. While they get better with a facelift, they don't go away. I tell people beforehand, you'll still need filler there. The facelift lifts up your midface that's dropped down. It's great for jowling, which is, the saggy tissue around the jaw. If you have a neckline that's dropped down, you have the smal bands, all that gets lifted, but the lines are due to deflation. Also, around your mouth, your nasal label, and your marionette line, you still need filler afterwards. So, that's where I tell people, I'm like, you know, filler, you're still needed there. So they compliment each other. I like to tell people the facelift is the cake and everything else, the filler and Botox are like icing on the cake skincare. These are stuff that you need to do to maintain the results and to address the different issues that come along with the facelift. Yeah.

Kerry: 17:52

you're mentioning skincare a lot, so tell me what are the things that you recommend to your patients to have the best skincare to reduce aging and all of that, and yeah, answer that first.

Hani: 18:03

So yeah, we're big on skin over here. I have a aesthetician who helps with all those consults and she's very good. The thing with skincare is you have to think about it's the covering of your face, the biggest organ in the body. So the number one thing is protecting it from the sun. Obviously living in Florida, that's crucial. So sunscreen in the morning. And then at night we like to do different things. So we have a retinol. Retinol is great. It has the most science behind it in terms of skincare products, in terms of stimulating collagen and helping find lines and wrinkles. So retinols are a little bit weaker than you have Tretinoin, which is prescription strength, which is stronger anyway. Both of them, depending on their formulations are good. They can cause a little bit of irritation'cause they can exfoliate the skin. They do have the most science behind them in terms of Stimulating collagen and then we like to use also vitamin C. It's great as an antioxidant. It's caven free radicals. You can apply that in morning, morning it works well before your sunscreen obviously. So that helps to strengthen the skin. Then we have different, serums that we use also for the face that stimulates growth factors, helps your skin regenerate itself. So whenever you go out, your skin's being exposed to so many different chemicals. So it helps the d n a repair and enzymes by giving them co-factors just so that they can deal with all the insults that they face. then the last thing that you wanna look at is that your skin is maintaining the barrier. The skin is a barrier. So using a moisturizer or some sort of hydrating gel just to plump up your skin and maintain its function as a barrier.

Kerry: 19:33

you don't use vitamin E at all?

Hani: 19:36

Vitamin E, not so much. I mean, you can, I don't think it hurts, but vitamin C has the most data. For skincare in terms of being an antioxidant that incorporated into the cells and helps scavenge the free radicals.

Kerry: 19:49

We did a recent podcast on antioxidants, so hopefully somebody listened to that and remembers the importance of having to capture those free radicals and obviously, yeah, vitamin C is one of those things, so that's good. What else would you like to tell us about your business and what you do? What did we not ask?

Hani: 20:07

So, yeah, I mean there's questions about consultations and here, lemme see. So what advice I think do you give for individuals. Recommending facial plastic surgery? I think that's a good question. Like if you're a patient, you're thinking about, okay, this bothers me, whatever it is. Like, know, your jowls your face, you're like, what can I do? And key thing is I would say you have to keep an open mind and you have to have your expectations in line. So even, for example, a facelift, if you're a skinnier patient, you're gonna get a better result because, It's easier to show the underlying structure. There's certain things that you can and cannot change. I think that's very important to keep in mind. So you know, it can make a significant improvement, but not everything can be changed. Second thing is, mentally you have to be in the right place to go through these surgeries because while they do enhance your appearance, and that's their number one goal, you know, they're not gonna completely change things around. So if you come in and ask for a facelifts and say, I'm like, well, why? I usually ask facelifts. I'm like, why are you motivated to do this surgery now? And most commonly what I hear is, you know, I feel young, I'm working, but every time I look in the mirror, I see this old face, and I know that's not me, because, I still have a lot of energy. I'm like, all right, that makes sense. Like, you know you. Rejuvenate your face, get you 10, 12 years younger with the surgery, you'll do good. But if someone comes in and is like, Hey, I want a facelift because I wanna be America's next top model, alright you know, it doesn't work like that.

Kerry: 21:33

Right

Hani: 21:34

Expectations and motivations are key. So you really have to understand patients history, patient's motivations for getting the surgery. And you have to understand as a patient yourself, like you probably will find someone to operate on you, even if that's your motivation, but you're not gonna be happy afterwards. And yeah, so that I think is important. Understand why you want the surgery. Understand that it is a process. You will go through a recovery phase where you most likely will regret having it done for the first week. And I actually just saw patients a few months out from a facelift. It was a big procedure'cause she had eyelids done also fat grafting, like the works. And in the first week you look bruised, you don't recognize yourself. But after that, after usually the second week, people start to see the improvements and and you know, most people say it was worth it getting it done, and yet it is, obviously, You're spending money on it. But yeah, so I think being patient with it is important and understanding why you're doing it are the two critical things you have to think about before you move forward. And the last thing I would say is also understand the limitations of procedures you get. For example, most times I see people they would've done the whole gamut of non-surgical procedures. Botox fillers, which you said are complimentary, but you can also use them the wrong way. People will sell you on fillers to lift. And I always ask patients, I'm like, all right, the filler is the gel substance. That's one cc per syringe. How is that gonna lift? If anything, it's gonna inflate, it doesn't lift and when you use fillers to lift is when people start to look like, pumpkins and it gives the whole industry a bad reputation.

Kerry: 23:03

It's not as natural looking as

Hani: 23:05

No, and it doesn't do the job. I mean, there's no way a filler that inflates can defy gravity. I tell'em, if you look at the x, y, Z axis, the filler pumps you out in Z axis. It doesn't lift you up in the Y axis. So how does it lift? And then they show me these pictures. I'm like, these pictures happen'cause they had the wrong treatment done. You know, you try to treat one thing with the wrong issue. For example, if you try to treat your forehead line, say with a forehead lift. That wouldn't last because say you pull your forehead out so tight that the lines are gone. And I get that all the time. They're like, well, look, the lines are gone, the face of puller. I'm like, yeah, but first of all, you cannot put that much tension on the skin. You're gonna end up with a wide scar. Second of all, skin will always relax. It's a viscoelastic organ. Skin. That means it has stress, relaxation. So when you subject it to force, it relaxes. I tell people like, imagine when you're pregnant, it's subjected to force, it expands the same thing here. You subject it to force, it expands. That's why in a facelift, we do the deep plane lift. Where all the forces on the SMA layer, which is a fascial layer that's much thicker and has much more tensile strength than skin'cause if you just pull the skin back, it doesn't work. So that's why when you're doing any sort of lifting procedure, you don't put tension on skin only. Only thing that's removed is excess skin. So skin that overlaps, redundant skin is removed, but the skin is not holding the tension. It's not holding the lift. It can't hold lift. So I think that's very important for people to understand is each treatment is designed to treat a specific diagnosis. So fillers they fill, they're not gonna lift you. Most times I see patients they've had filler to lift during their thirties and forties, and they're like, oh, it stopped working. I'm like, it was never designed for that.

Kerry: 24:44

Okay. Are there any risks or complications to any of the procedures that you wanna point out

Hani: 24:49

Absolutely every procedure I tell patients every procedure has risk and complications. nothing that you do without it. From getting, something as simple as an injection in clinic to doing surgery. So for facelift, the biggest things we look for are bleeding and infection. They're rare. I use a drain. So drain's a little piece of plastic too. It collects fluid, it helps with swelling, it helps your recovery process be quicker. But, bleeding can happen and infections can happen. So that's one thing to be cognitive of. There's a very small risk, cause you are in the deep plane. You know your facial nerve is right there, right under the deep plane. So you actually see it during the surgery and they're very small risk of temporary weakness to the nerve. That's why it's important to see someone who does a lot of it and has training in like head and neck surgery where, in my prior career used to follow the nerve, trace out tumors around it and just have experience being around the nerve. Temporary weakness comes back after a few weeks, but it can be annoying, but it's still only like 1-2%. So it's not a big issue, but something that you should know going into it. Those would be what I would say would be the most common things for people to know about the surgery. But they're very safe procedures. They give'em good results and we're also very selective with the candidates for it. One of the toughest things I have to do is tell people no to the surgery, and obviously it goes against my financial interest to client surgical patients, but I can think of a couple of patients recently who had transplants. One I believe was a liver and one was a kidney. And they were, you know, had like a second lease on life and you could tell that they were enjoying themselves and the transplants had gone well. And now they were a point where they wanted to, like I said earlier, you wanna look as good as you feel. But unfortunately, I mean, I'm careful when it comes to that because they cannot get off their immunosuppressive drugs and not only do you need your immune system to fight infection, you need it to heal. The first phase of wound healing is inflammatory. It's when all those cells come in and they start laying down collagen, they attract other cells to come in and do the wound healing. So the immune system not only plays a role in fighting off infection, it plays a role in healing. And that's what I tell'em often, they have other comorbidities. So that I would say is one of the, you know, it's a tougher those patients we turned down. So we really look for people who, I'm not saying any comorbidities, but you know, you have to be managed well medically. If you have hypertension, it has to be under control. If you have diabetes, the higher the A1c, it's shown to be a significant risk factor for complications. So think when your A1c is 6.57, and after that you're really pushing elective surgery. Elective cosmetic facial surgery.

Kerry: 27:16

Yeah, obviously you wanna have diabetes under control, otherwise you're gonna have the same problem with the non-functioning immune system as well.

Hani: 27:22

Exactly.

Kerry: 27:23

I just wanted to say, I think when I was in training on trauma, we had the first face transplant at where I was training. It was pretty, pretty cool at University of Maryland. I'm pretty sure it was the first, like in the world, it was like a million hour surgery. But I just was thinking of your trauma comments and thinking of that. So I thought it was neat. I wanna ask one important question, and it is a pop question, but what do you think is the secret to longevity since you're a age, I guess, specialist guy.

Hani: 27:53

I get that, I get that question all the time Dr. Reller. So, we're in very exciting times now in terms of longevity. I don't know how much you guys follow the advances in the field made by a lot of it's being made by scientists, like obviously David Sinclair up in Harvard. A lot of things are focused on nutrition and what they're doing in terms of, especially in the science labs in terms of epigenetics, reprogramming cells, removing different epigenetic factors that trigger age. Those would be the most exciting things that have the most I would say potential in engineering age. Historically speaking or what the old dogma was, you look at nature, you look at nurture. there's things in nature that you couldn't change or that was thought you couldn't change. Like as you get older, you get senescence in your cells, genetically speaking, which basically means that the cells don't replicate as efficiently as they did when they were younger. That's why things start to start to lose function. You start to be weaker as you get older. And so that was something you couldn't change. And as of now, you still can't change it. So we'll leave that for the second aspect. And then you have nature. Those are things you can change. Number one the easiest thing that you can do with smoking and sun. So avoid nicotine and the sun. Not saying avoid the sun. I think the sun's very important for mood regulation and for triggering your circadian rhythm. But be careful, you know, wear a hat, use sunscreen and wear those long sleeve shirts that block off the sun and so be safe around the sun. Avoid smoking. Those would be the number one things for nature. Second thing you have to look at is diet. So, there's, depending on what, who you listen to for diet, there's always someone who's gonna say something that, disagrees with the other person. But I think balanced diet is important. I think, obviously staying away from saturated fat, processed foods are important. Now, different people say being vegan is important. Other people will go and say animal protein is the most critical thing and gives you the most diverse sources of amino acids, which you need. So I'm not gonna get into all that. That's a matter for discussion. But I do think a balanced diet is important where you have, and you stay away from the things that are proven to be bad, like saturated fats, trans fats, I mean those things where there's a lot of data out for them. I do think doing everything in moderation is critical. So most times when I see people try to go to extreme whethers with exercise and diet, it's much easier to fall off the wagon. Doing everything in moderation is better. Staying hydrated, exercise, and same thing with exercise, right? Depending on who you listen to, you'll hear people say, speak to the importance of cardio. Like Peter was a big cardio guy. Other people speak about the importance of resistance training and I think you gotta marry both things together, like reasonable amount of cardio where you get your heart rate up but you don't wanna do it too much'cause you can inflame joints and things like that. And then you want resistance training also to build muscle, which increases your metabolic rate, you know, makes you feel good. So I tend to focus and I've listened to this a lot and I'm presenting a little bit of both sides. So my approach is honestly moderation. That's what I tell people in terms of things you can control. So that would be all the nature aspects and the nurture, the DNA stuff. I mean, that's still in research, like I said, but if they come up with a way to, start reprogramming cells and modifying genetics, that's a completely different ballgame. That kind of like the chat GPT of medicine, you know?

Kerry: 30:58

Yeah, I mean that was excellent answer and I agree with obviously all of it, avoiding the bad stuff, right? Trans fat, smoking, the sun in moderation, like you said. And I mean, that's a really good, good philosophy that you have too. I definitely have listened to a lot of Peter Attia's stuff, and I thought he was more towards strength training lately, but maybe I'm

Hani: 31:18

Lately he is. earlier he was on the cardio. Exactly.

Kerry: 31:22

Mm-hmm.

Hani: 31:23

that's what I'm saying, like things shift. So it's better to be moderate because if you follow someone dogmatically and then they shift it.

Kerry: 31:31

Yeah, the research certainly I think lately is pointing more towards strength training, but a big topic, right, this longevity, and I thought you would be a good person to ask. So thank you for sharing your thoughts

Hani: 31:42

Oh

Kerry: 31:43

Is there anything else you'd like to share with the audience?

Hani: 31:46

I think we covered a lot of different topics and questions about the field. it's a field that I enjoy doing. It's very diverse, like I said, in terms of what we do, because I still do a little bit of the reconstructive part, so, I enjoy doing that. And yeah, like I said, that's, you know, very, very different ways to think about it.'cause when you do reconstruction, you're trying to reconstruct something's missing. But when you do cosmetics, you're operating on normal anatomy, which makes the stakes higher'cause people are coming in really with no abnormality, so to speak. Just natural progression of things.

Kerry: 32:13

Awesome. Well, where can people find you

Hani: 32:16

yeah, so we're located just off Veterans Expressway in Hillsborough County, so, It's about five minutes north of the Tampa airport from Pinellas. I mean, there's a few major roads that come in including Tampa Road. And our office number is 813-800-face. Pretty easy to remember. It's callable and textable, so you can text the office and we can get you in and we offer virtual appointments also.

Kerry: 32:37

Do you have a website or anything?

Hani: 32:39

Yeah, our website is www.rejuvenatetheface.Com.

Kerry: 32:42

Awesome. Okay. Anything else you'd like to share?

Hani: 32:46

No, I think, you know, it's been a pleasure being on the podcast. Thanks for having me, Kerry. I look forward to seeing you down the line.

Kerry: 32:52

All right. Thank you so much for coming on. I definitely learned a lot today and I'm sure our audience did as well. So stay tuned everybody next week for our next topic, but thanks for listening.