Sex, Drugs and Skincare
Comedian and esthetician, Nicky Davis, along with side kick/boyfriend/assistant Sandro Iocolano, interviews comedians, actors and other practitioners as we learn about the latest, as well as the oldest techniques for staying young. We get weird but educational.
Sex, Drugs and Skincare
LABIAPLASTY & THE ART OF SURGER/ PLASTIC SURGEON DR. DAHLIA RICE
What happens when a stand-up esthetician, a board-certified plastic surgeon, and a Sherpa set decorator walk into a podcast? Pure entertainment and education, that's what! Join me, Nikki Davis Jr., alongside my boyfriend, Sandro Yocolano, as we host the brilliant Dr. Dahlia Rice, who shares her unique journey from the morgue to the OR. Dr. Rice offers a fresh look into the world of plastic surgery, blending her experience in criminology with her passion for helping people feel confident in their skin.
Ever wondered what it's like to sculpt human anatomy with the precision of bonsai tree trimming? Dr. Rice takes us behind the scenes of labiaplasty, where art meets medicine, and patient expectations are delicately balanced. Our chat gets real about the quirks of patient requests and the importance of setting realistic goals. We also touch on gender dynamics in the operating room and how they can influence patient comfort during these intimate procedures.
Curious about the healing prowess of the human body? Dr. Rice enlightens us on the wonders of mucosal recovery, especially for labiaplasty patients, busting myths and adding a humorous twist to societal perceptions. We also tackle the topic of vaginal atrophy and the role of hormone therapy in women's health. With a sprinkle of humor and a heap of valuable insights, this episode empowers listeners to make informed choices about their healthcare journeys.
You are listening to, watching, hearing, smelling, tasting and feeling sex drugs and skincare. Like and subscribe. Hey, welcome back to sex drugs and skincare. And this is weird I have headphones on.
Speaker 2:You mentioned, your ears were cold. Earlier I did, and now here we are.
Speaker 1:I am Nikki Davis Jr, stand-up esthetician and licensed comedian Yep Yep 25 years of esthetician work.
Speaker 2:They've been sending those. You know how they get the CE credits, the continuing education credits.
Speaker 1:Yeah.
Speaker 2:They've been sending them for your stand-up license. You're supposed to go in and have a refresher course on the new techniques of comedy.
Speaker 1:Oh yeah.
Speaker 2:And they're really making some advances in the field of comedy, In which part oh in the comedy. You don't have to wait quite as long to go on stage.
Speaker 1:Okay, and the jokes are getting. Yeah, you have a lot more time to not get the laughs.
Speaker 2:And now, when people do crowd work, it's just the audience doing material in the audience and you have to sit there and either laugh or not laugh at them. Wow, the audience and you have to sit there and either laugh or not laugh at them. Wow, yeah, but I just want to let you know that you have those available.
Speaker 1:If you, maybe I could sign up for some adult education something like that, like night school yeah, night school, yeah exactly yeah, so you're board certified.
Speaker 2:No, sorry, you're just bored.
Speaker 1:I'm just bored, I'm not certified, except for I'm a stand-up esthetician, like I'm not staff. I'm a licensed esthetician for 25 years.
Speaker 2:She can't stop it.
Speaker 1:I know I can't, the joke keeps just coming.
Speaker 2:The one joke the one joke.
Speaker 1:And with me is Sandro Yocolano, my boyfriend. Sherpa set decorator. Holder of my hand.
Speaker 2:Sometimes Yep.
Speaker 1:And so, yeah, this is interesting having you right in my head like this, this is bizarre it.
Speaker 2:Yeah, and so yeah, this is interesting. Having you write in my head like this, this is bizarre. It almost makes I feel like the headphones make it more official, uh-huh, and I feel like, oh, what I'm saying really matters, you know.
Speaker 1:It doesn't. It doesn't Nope At all, it just reverberated back into my head. As a matter of fact, of all three people that are going to be in this room talking, I wouldn't say yours is the least important, but definitely ours.
Speaker 2:Ours. Do you mean like hours of being the least important?
Speaker 1:No, because that's me, and by the way, this is only going to go a little less than an hour just to our guests who we have not brought up yet. Yeah, but I'm super excited about this. This is the first time, a that we've done headphones and, b that we've done a remote location guest. And when they contacted me, I was like, hey, this is super cool and it doesn't seem like it's ai trying to get a hold of me, which has happened to me numerous times since then yeah, sometimes they'll email and be like hey, we have a great um guest for your podcast, just send us really quick, just send us your social and your fear and the list of your fears, um, and your daily schedule and, if you have, how many locks you have in your apartment.
Speaker 2:But we're, we have a great guest for you.
Speaker 1:And then, anyway, two apartments later, yeah, I've got them all supporting me now, though, so that's fun that's hilarious so we can get some sponsors up in this bitch yeah, yeah, yeah, I dig it all right what's that?
Speaker 3:yes exactly glad I could.
Speaker 1:Yeah, put that out. Yeah, there into the universe. Yeah, all right. Well, why don't we bring her out?
Speaker 1:I'm excited okay, so obviously it's a woman. I'm not sure if you're going to be seeing her as we're talking during this beginning part, but at any rate, because we haven't done this before, I wanted to bring her out. This is so exciting to me, I just wanted to make sure I get it right. She's a board certified plastic surgeon and the founder of DMR Aesthetics and, by the way, tonight we're going to be talking about labioplasty. Okay, so, coming to your screen and not our couch, give it up for Dahlia Rice. Dr Dahlia Rice. Hi, I'm doing well. Thank you so much for having me. Hey, my pleasure. This is super cool. Tell us a little bit about, tell everyone about your background, just for a second before we get started, so we can rope everybody in with interest.
Speaker 3:Yeah, so I actually am considered a non-traditional surgeon. This is actually my second career. My first career, I was doing autopsies before I came to medical school. Whoa and yeah, so I went completely in an opposite direction. You know dead people to like. I love plastic. So the joke I always tell is that you know.
Speaker 2:I to like I love plastic.
Speaker 3:So the joke I always told that you know I went from wanting to work on dead people to people who are dead inside.
Speaker 1:So I just like you work with a lot of comedians, then yeah, entertainers well, I'm one of.
Speaker 3:I'm one of five kids, so you gotta have some comic relief in that. Oh my god family first first doctor.
Speaker 3:So there's no medicine in my family, there's no education In my family. There's no education really. My parents were the first ones to graduate high school, but I always had a love for art, beauty, symmetry, skin care. I think that a lot of people go into this field not entirely knowing what they want to do, but the variety of plastic surgery is amazing and it's just enough to keep my ADHD happy. What they want to do, but the variety of plastic surgery is amazing and it's just enough to keep my ADHD happy.
Speaker 1:Oh my gosh, I know there must be so many different ways that you could approach this and I'm still just hot. Autopsy person. What do you call an autopsy person?
Speaker 2:An autopsist.
Speaker 1:Autopsist.
Speaker 2:I think that's the one yeah.
Speaker 3:She's like yeah, yeah, that's it. Well, I mean, who doesn't want a person who you know can solve mysteries, bury a body and look good while you're doing?
Speaker 1:it. I mean it just totally makes sense. I'm so glad we caught you, because you're gonna have your own show 15 minutes after this airs, and so we're to be so lucky to have even had you and your hair is amazing and you would have looked so good on this couch we decorate with lots of purple and things around here, Next time I'll have to come out and sit on this couch.
Speaker 3:Please do, Totally blend into it yeah, exactly.
Speaker 2:I remember the first show I watched on hbo I think was autopsy, and it was with dr bader who had this very, very like soft way of speaking.
Speaker 2:And I remember the first thing he said was like yeah, it was always like kind of like, and then the person had potatoes in their stomach and I noticed the potatoes and it's just like I was like, oh my god, you can do that. And he was just so fascinated. And then I was fascinated that, like this person had this job, that was just like telling a story that the person who's dead couldn't that's amazing yeah, it's fascinating it's so interesting.
Speaker 3:I never I mean I was all never had a shortage of stories, you know, and there is so much dark humor in dealing with that. But you know, being in your early 20s doing autopsies was so sobering because you got to see the parts of society that is kind of adult corners that nobody really talks about. It was really, but then the problem solving portion of it was fascinating. It was so interesting.
Speaker 1:Wow Did you solve a lot of crazy cases.
Speaker 3:There was. There was a lot. You know it was a very so. The county that I worked in in Colorado is called Brighton County. It's a huge county just north of Denver One of my really good friends she's still cornered there. My other really good friend is Chief Deputy Corner, who I won't be answering back then law enforcement agents, and so it was always very interesting what people choose or you know how things happen when you're solving crimes like what that looks like. You learn a lot about ballistics and other things that I mean I've never shot a gun in my life, but I know a lot about ballistics. I bet you do.
Speaker 3:It's interesting learning those and then coming into medical school and realizing that I'm actually a huge empath, and it was the stories that I brought with me that just were hard. Yeah, they were just really hard and, and so when I thought about what I wanted to do for the rest of my life, I thought a lot about how I really enjoy making people happy and I like seeing people very confident and being the best version of themselves, and so that really kind of helped me choose going from one field where I'm allowing some closure for families into another one where I'm giving closure to some people who have maybe had a very difficult time losing weight, and so now they've lost all their weight and they want to see that result for other aspects. You know, maybe they've had multiple breast surgeries or they've always had insecurities about things that they want to take care of, and I wanted to be that person that they could come to and feel approachable and say hey, you know, these are my biggest insecurities right here. That's hard, that's scary to do.
Speaker 3:As a person, I really like psychology a lot and criminology, but a lot of the psych portion of it also comes into plastics. We learn not only how to operate on people but also who not to operate on and who's a good candidate and who's not. And so the side portion of the huge components of plastic surgery, because no, I'm sorry, I was gonna ask you struggle from it absolutely and I was just.
Speaker 2:I don't mean to interrupt, I was just wanted to. Um, I forgot about the delay as well, so I apologize. Um, is there something you do with, like you, do you have an evaluation that you'll do specifically yourself? Or is it like kind of meeting up with people to kind of get an idea if this person is maybe, let's say, if they're being hasty, or is it something they thought about? Is there anything like that to you, or is it something like you know more like in depth, like like cycle analytical?
Speaker 3:A lot of it, you know. For me personally, one of the reasons I decided to open up my own practice is because I really enjoy taking a lot of time with my patients. My consults will last an hour and so in that time I learned about the patient's family and their motivation and their history and the things that really drive them to want to have these procedures done, have these procedures done. And during those times usually the times where you can tell like, is this a realistic expectation this person has or are they chasing something that's just not possible for their body and a lot of times during that consultation, that's when those portionful sort of become teased out, because you want to make sure that if you end up operating on someone, that you're going to make them happy and you're going to give them the results that you promised.
Speaker 1:That way. It makes me think of um, so, if you're coming in for some sort of you know whatever augmentation, whether it's your lips, your ears or your boobs and in this case, your labia do people bring in pictures of what? And then specifically like with labia and we I love to, I want to get more in depth with that too um, like do they get like?
Speaker 3:here's a picture of one that I think is pretty, like you know, yeah well, at least I try to encourage people to bring in like, what we call wish pics, because sometimes that also guides me into the reality of like. Is this a realistic expectation or not? Like, is this a body type that matches this person? Is this an expectation that I can get this patient? And so if they're bringing in actors that are completely unrealistic for their body or, you know, they don't match up with my aesthetic, then that usually is a sign that we're not a good fit, and I tell my patients, if that is the case, that you know, I think that you may want to find a surgeon who you know can give you the results that you're looking for. Or this is maybe not the aesthetic that I align with, and so because for me I tend to like a more natural aesthetic, I tend to not like the over-exaggerated features. Thankfully, that is falling out of favor a little bit as well.
Speaker 2:Yeah, somebody wants to go ahead, I was just gonna say I was wondering a picture somebody coming in and been like, oh, I forgot, I forgot my uh pictures of it, but I can draw it from memory like almost like a tattoo artist, it's like trying to trace or whatever it's got to be like, because people will try to describe it and you're like it's like it looks, you know yeah exactly it looks like a roast beef sandwich, but like, with, like I don't know like, how would somebody describe that?
Speaker 2:like in a sam in the buns, or is it pita pocket right?
Speaker 3:yeah, exactly hot dog in a bun. That's the one thing that's hilarious. That's amazing. I want a puffy pussy. That is what I heard people say. I want. You know, I want this. This is what I want for my life. These are the things that I'm looking for.
Speaker 1:I love that you brought you busted out the P word before we did, so that is amazing.
Speaker 2:People have to be super vulnerable at that point. So like I figure, like either you get people that are shy or maybe they're like no, I want a puffy pussy like, you're just like screw it, I'm here.
Speaker 1:Yes, this is what it is yeah, that's, you've gotten to that point I mean not you one has not him, but yeah, I'm not, I'm, I don't not yet he's been pushing me. He keeps saying that my vagina is way too big for my body'm like.
Speaker 2:I'm like it's why I say it's too big for its britches, because it wears, it, wears, it wears pants.
Speaker 1:It's very full of itself.
Speaker 3:So what got you? I know someone who can help you with that, I know, and I'm looking right at her.
Speaker 3:So tell me, what got you into? Um, well, I mean, obviously, when you study plastic surgery, I'm assuming that's maybe one of the things that they, you know. But you have to pick your own specialties, right, right. And so when you're a medical student, you rotate through all the different specialties and then, at that point, that's when you're like, okay, it's sort of like speed dating. You spend like four to six weeks in each field and you're like, okay, I like this, I like that age field. And you're like, okay, I like this, I like that.
Speaker 3:And so I always, you know, whenever I'm mentoring young medical students, I always tell them you know, you have to find your tribe. It's the group of people that you meet along your path and you're like you know, these people are amazing and I want to spend time with them outside of this. They like the same things I like, our personalities are similar, and so that usually tells you what field you're going to align with, because that's a personality type that's drawing you and you're going to mess with a lot of the same people. And so, for me, the field of plastics. I loved the idea that, um, then a lot of creativity with it, and so if I need something that's off off the cuff a little bit, or something that's not super mainstream, or a little bit of a different, of a variation of that procedure, then that makes me creative and unique, and in plastics, the field of plastics rewards that. If I was in general surgery and I decided some novel way to do a lap pulley, then people would look at me and say, oh, this is not the way we do it and this is how it's been done for so many years.
Speaker 3:And so plastic surgery still has a lot of the creative aspect to it, because there is a large portion of, you know, taking someone's ideas and what they're wanting and pictures, and then creating that with a three dimensional reference into what that looks like on their body. So to translate that to their body, to make it match and work for them, is a different skill set than some of the other, some of the other surgical fields. And especially when we're talking about, you know, manipulating someone's genitals, like that's a huge thing and people are very insecure about that and a lot of it depends to like how, what, where. I think things like the wife make a big portion of that too.
Speaker 3:If people have had children before, these tend to be the people that I see sometimes that have had, you know, either a traumatic childbirth, and so then they have problems with their labia because of that or it's they're just naturally built that way. So in general we're talking about labias. You know, the average size of our woman's labia is four to five centimeters, and that length is pretty long when you think about it, when we're talking about going from a length of four to five centimeters down to a centimeter and a half when we're doing a labia blast.
Speaker 1:Is that what your?
Speaker 3:goal is. It depends on the person, but in general, because you want it to mimic that kind of gentle curve that has a natural labia to it. Some people need a clitoral hood reduction, others don't. It depends. Everybody's labia are so different. The majora and the minor are extremely different. The comparison between them do you have more clitoral hood tissue? Who does it? And a lot of those things are super different depending on the patient. But one of the things that I do tend to see is that it is the patients that um tend to have the larger, longer labia that get twisted, irritated. Whenever they're, you know, trying to ride a bike with a peloton or they're trying to exercise, the labia can get twisted and get folded. Sometimes they suffer from yeast infections because there's not enough airflow, and so those things all contribute to the reasons why people get lady of plastic. It's not only cosmetic, right? People don't oftentimes come in and just like, oh, I want that. I'm like pretty pussy.
Speaker 3:That's why I'm here oftentimes don't come in because there's some functional problem to it, that either they have too much redundant tissue and it does affect them sexually. So lady pussy has been shown to increase rates of sexual satisfaction as well, and so sometimes that has to do with the redundant tissue causing it to be a little bit more difficult to experience sensations, to be a little bit more difficult to experience sensations unless you have, you know, someone who you know. The biggest question that everybody always asks is is there going to be a change in sensation? Because obviously that's super important, and I tell my patients a lot of times with any surgery. Sometimes a surgical scar itself can have poor sensation, but for the most part some people will actually get hyper sensation from it afterwards, especially with the clitoral reduction, because then they have just more exposure of the clitoris and that makes a huge difference. For what?
Speaker 1:it is. I love that. It's just so much easier to take a look under the hood now, right when the latch is already popped, it's already there, it's ready to play. So like would you say that your patients are? Would you say they're like half and half Like. Some of them are like you know from, like you said, from traumatic births or something like that, and some of them are just born that way or like, or what would you say is more common for you to work on?
Speaker 3:I think it's probably more common to see people have a variant of normal is what I like to call it, because it's not abnormal to have larger labia.
Speaker 3:And different ethnicities will have different size labias and you know everyone's preferences are very different too, and so you know some people want a small reduction of their labia, some people want a more aggressive reduction of their labia, some people want a more aggressive reduction of their labia. Some people, you know, because it really just depends on the person and how it matches with their body, but a lot of times that really I would say the majority of people that come in primarily have some variant of normal. So they have not had a traumatic childbirth necessarily, but you know, childbirth itself can create that some abnormal adhesion. Oh yeah, for the most part, a lot of these are kind of more. You know, obviously, that the people who've had some of those traumatic childbirth experiences are oftentimes people who've already had large alabia. They get either degloving injuries or some sort of situation where the tissue cards and then can cause flushing or irritation of the olivia, and so that can also be part of that. So they can actually have both some normal variant plus some trauma situation that occurred.
Speaker 1:Yeah, that's really interesting. I obviously I've seen pictures where they just show like vagina after vagina for John, seen pictures where I they just show like vagina after vagina for john, like looking inside and they all look weird. I mean, you know, I mean like nobody's it looks better or worse to me, like it's just like oh, I could see why that one would work and that one works for this and this one looks cute for that person like a family photo album, it's like.
Speaker 2:It's like that everybody looks weird. But I'm just used to them. But but to somebody else they must look bizarre, yeah.
Speaker 3:That one artist that did like all the different, like labias, they did all the impressions of all the different vaginas and there's so much variation within it, and so, again, a lot of it depends on the person.
Speaker 3:And you know, when you're looking at this, especially from a scientific aspect of things, you know when you're looking at this, especially from a scientific aspect of things, you know when this is so funny because, like during my training and this it's a similar path and you go down when you're talking about very specific, like very low minute details, like so you know, whenever I'm doing top surgery, when we talk about nipple sizing and male nipple position, like that's a huge part of that surgery, right, nipple sizing and male nipple position, like that's a huge part of that surgery, right.
Speaker 3:And so whenever we're talking about labiaplasty, like the variations can be huge within the population. And so that's another reason why it's extra important to sit down and have that conversation with the patients to figure out exactly what they're really kind of envisioning for themselves, and to also know that people will scar differently. Some people will, their scar contract is going to be a little more aggressive, and then they may end up getting what we call a Barbie deformity, which is exactly what you think of when you think about Barbie's vagina which is essentially not existing.
Speaker 3:That's one of the deformities that can occur and that's probably the most common complaint is just too aggressive of a labiaplasty, and then you end up with this, what they call a Barbie deformity, where it literally is just nothing.
Speaker 1:It sounds like you're probably someone that's not going to get. I feel like you would go less rather than more with a patient, as opposed to like let's just, you know, just start throwing it out there you look like a ken doll.
Speaker 3:Now, what does that mean, right? Well, it's like a haircut, right? I mean you can't add more on after you've taken it off, so you really gotta make sure that it's so funny so is there now, when you're doing? Sometimes you gotta go back and trim it up one time, a little different than the other.
Speaker 2:You know, it's like, it's like bonsai tree, you know, just like you know going back a little bit.
Speaker 3:So you like take a step back, like while you're all like in your gown, you take a step back, I'll cover it up and everything.
Speaker 2:And you're like, hmm, okay, yeah, yeah, yeah. And then these little something so then you have to plan off the top yeah, so then you have to plan for what it would be like after it swells, or what it would how it could. Potentially it swells so fast, okay, and then you have to plan for like how it's going.
Speaker 3:Yeah, exactly the local numbing medicine. I mean, it swells like that so you almost have to remember what it used to look like so that you can then make sure that you complete the procedure. You know, in a timeframe where there's their swelling isn't so severe that it makes all the tissue look abnormal. But yeah, that is true.
Speaker 1:Does the local anesthetic make you swell faster than other anesthetics?
Speaker 3:Oh, we always use local anesthetic, whether it's in the operating room or in the office. It's pretty common that we do labia class. He's actually in the office under local nominative medicine. We actually can do a really good job with that. If you give it enough time, it helps a lot with the blood loss and the bruising and the swelling afterwards. So people are less likely to get a thing with calomers. They really got to give it the full 21 minutes, which is an awkward 20 minutes sometimes. They really got to give it the full 21 minutes, which is an awkward 20 minutes.
Speaker 3:Sometimes, um, you know, because the patient's there, we're waiting, and so I oftentimes will set it up so that we're doing things in succession. So I'm always moving, the patient is always comfortable, the patient only feels that they're being um, that they're sensitive, that we're being very sensitive to their um. Any discomfort, um, obviously know, when you're in in a field like this, you know a lot of it, and really modesty in the door sometimes with that. And as women, I think I can't imagine having that procedure by a male physician because of the woman. I'm not sure that they would, I'm not sure that they would understand what it's like, and so for me, I I, you know I can acknowledge how I'm male. My male colleagues can do this as well, but I, as a female, that would make me feel more comfortable. It's not like having a woman OBGYN versus a male. Yeah, I don't want a man's opinion, yeah.
Speaker 1:I don't want a man's opinion on what it's supposed to look like. I want my own opinion. But did I get it right? It only takes 20 minutes, did I hear that correctly?
Speaker 3:Yes, it doesn't take that it can take. Well, it depends on the amount of resection that we have to do. But it takes 20 minutes for the local mummy medicine to really kind of kick in.
Speaker 1:Oh, I see what you're saying. Once we do the injection.
Speaker 3:we let that epinephrine really work, so we got to give it the full time. But the procedure itself can be as quick as 20, 30 minutes. It can take an hour and a half. Again, it depends on what bonds I treat. Wow, that's really good, because I'm a perfectionist and so you know I will go back and forth until I feel that there is the perfect, perfect amount of symmetry, because a lot of times people have just, in general, asymmetry at a baseline.
Speaker 1:Well, I mean, we all have asymmetry, it's like even with eyebrows, it's like they say their sisters, never twins, and sometimes their cousins, you know. So I'm sure it applies to pretty much everything.
Speaker 2:Yeah, mine were the same person for the long time.
Speaker 1:So they were, so they were like, and then it was like oh my god, these two. Yes, exactly, that's perfect.
Speaker 2:I had to get rid of the get out of here. So when you're saying bonsai now, you're saying that when you make the cut it will grow back right. So it'll eventually.
Speaker 3:Well, yeah, so skin lax, like the reality is, no matter how much tissue laxity we remove, it's like inevitable that it always comes back Right, and so you will regain some of that laxity. And the other thing I think too, is that during the labiaplasty and the postoperative recovery period is there's a bunch of handholding right, because people come out of surgery their vaginas look crazy.
Speaker 3:They're so swollen Sometimes they can't even pee afterwards. And that's one of the big things I talk to people. It's like if you're so swollen that you're not able to go to the bathroom, that you can't pee, you're going to have to call me right away, because that's not normal.
Speaker 3:But some people will get so swollen, and so I tell people, I'll tell you that, get your pelvis up, so get a wench pillow, get the pelvis lifted and then ice, lots of ice. So ice after ice after ice. And so my ladies who've had babies know that you can take newborn diapers, wet them, put them in the freezer and those are perfect ice packs. So I will tell my patients about that. That's a great idea. Or diaper inserts I like that.
Speaker 1:Or you could freeze like a can of beer and stick it in there and then just put it. I mean yeah.
Speaker 2:Yeah, I remember you.
Speaker 3:Yes, pour it out for your homies, one for you one for your vagina Exactly.
Speaker 1:It's hilarious.
Speaker 2:What were you going to say? I was going to say you did that THC soda, oh the can.
Speaker 1:And yeah, you would like, because it was in the freezer we were having sex a lot Like and for long periods of time, and you know, and like it hurts. And yeah, we did. We used a can of something.
Speaker 2:Yeah, I was. I think it was WD-40. I think it was a can of, but it was in the freezer for some weird reason.
Speaker 3:WD-40 in the freezer.
Speaker 1:Yeah, I already in the freezer no, yeah, I won't do it again. I won't do it again. It made things a little weird. Um, I have a question for you, because this is called sex drugs and skin care and like this is not really like the normal kind of skin care, but I mean it's obviously skin. Do you find that?
Speaker 2:it's care and it's care for sure. That's definitely care. And sex, oh, and sex and drugs. We actually we hit all three.
Speaker 1:I think we're all good yeah but does the skin react a lot differently down there than it does anywhere other, you know, in any other places on the body?
Speaker 3:a really good point that you bring up.
Speaker 3:This is what we consider a privileged area, um, similar to inside the mouth, and mucosa that is created that the vagina has, and mucosa lining of the labia minora in general specifically have great healing properties.
Speaker 3:The patients heal super fast. They also tend to um be patients that don't have as many wound care issues as other locations. They heal extremely quickly, and so that's one of the things, too, um, that I have to make sure that I tell my patients about is they're going to heal very fast. You know, typically, you know, if we have seekers, I will leave the knots on the outside actually, so I have to trim those knots, typically at one week, but even by one week they're already trying to like grow into the skin and sometimes I have to unroot them to get them out. So this, it's like they heal so fast down there and the patients do so remarkably well. People think a lot of times oh, labiaplasty is barbaric and horrible recovery and all these things, but the reality is is actually the recovery is super easy and I tell my patients work if you can have a baby.
Speaker 1:I was just going to say that.
Speaker 3:Just pop out of like a 10 pound baby out of your vagina.
Speaker 3:They send you home the next day with this newborn and some ice on your vagina and call it a day, like these women do. Great after leggy glasses. They have no problem, like within a couple of days. Within five days the swelling goes down significantly. Patients are moving around. Sorry, it's not really too much of a downtime for this procedure and there's really not a lot, as far as you know. Side effects necessarily Like these are not the type of things that you're going to see in other locations. Like I said, the wound healing issues, the biggest thing to get is patient selection. So patients don't want you want to make sure patients aren't smokers, because nicotine can affect wound healing significantly. Really, in general, the labia is just, it's like a. It is such a privileged area they heal so well.
Speaker 1:I feel like the vagina itself is just as a health. It's like it's a self-cleaning oven. It's a self-cleaning everything. It's just it's made to be, you know, like it's made for to take a lot and then to just to grow back really quickly. Well, yeah, it's it.
Speaker 2:You know right, that's where life comes from, I think, I think but also we haven't had the talk yet. I don't, yeah, I don't want. I told a lot I don't know but um, I think that-.
Speaker 3:Mom and dad love each other very much. Yes, then they get a divorce and you come.
Speaker 2:What. That's weird Right, but people that call it barbaric, I feel like are misinformed, because I don't know many barbarians that can do plastic surgery.
Speaker 2:I don't know of any barbarians out there that had the force or even could have like the instruments you know. They just had like rocks, right. And I think it's bullshit, because people just hear one thing and they're like oh, you're altering the body, oh, it's part of the body where we're not supposed to talk about, and then their beliefs come in, which is probably something instilled from other family members and barbarians.
Speaker 3:And barbarians, yeah Right, well, I mean, I think it's very equivalent to when we talk about a male circumcision, right? You know, some people view it as barbaric. Some people agree with that, Some people don't. Obviously, in the United States, like the majority of people have, of males have circumcision, or those born with penises have circumcision, but you go to other places and they don't. So it really is. Again, it's a personal preference more than anything else.
Speaker 1:Would you say that the skin heals faster on a woman or on a man, on a circumcision, a shin?
Speaker 3:uh, well, I mean the, for in general, the majority of the circumcisions are done on newborns, and newborns, oh well, yeah, are like basically like newts. You could like cut off an arm and they would regrow it like these, like I don't understand.
Speaker 1:They are like, as we age, it's just conquered way down in the exactly, take the lockdown for your hand to grow back. But yes, that's the worst. But I mean like if a man comes into you and says, listen, I didn't get circumcised, can you do it now for me? What's is it like? Just as I don't know. Just as painful, just as complicated is it? Does it take longer to heal?
Speaker 3:I think there's just a lot more whiny um more than anything else.
Speaker 1:I love you so much.
Speaker 2:I had one. I had one at 22.
Speaker 1:I didn't want to bring it up, I wanted to.
Speaker 2:I didn't think I'd be bringing it up.
Speaker 1:Yeah, here we are.
Speaker 2:No, it's fine, I don't care. Yeah, I had one at 22 and it took about six weeks. But it's also different because every morning, you know, as a guy, you have to pee so much that you're like that it hurts, you know, and you're like I gotta go. So it was really bizarre. I was like how is this gonna? But I guess the stitches were fine and it did have a little bit of pain, but it wasn't a lot of whining, though you're right I didn't whine, I'm not surprised yeah but um the thing is too, is the adhesion like with the circumcision?
Speaker 3:like it tries, the adhesions start to come back, and so you have to like, remove those adhesions, make sure those adhesions don't work right, and that is probably more uncomfortable for men than it is for women, because we don't necessarily remove adhesions around the clitoral region.
Speaker 3:And so for men, you have to make sure that those adhesions don't form, and so that is pretty painful. But I will say that the labia granula can also have adhesion problems. They just don't seem to be as uncomfortable for women, and maybe it's because we're like superhuman strength, like our pain tolerance is so different. Right, you know, when we talk about insertion of INGs, as women we're finally getting pain meds for that male, we're told for many, many years. Oh, the cervix doesn't even have nerve endings, and so it's pretty fascinating how, as women and girls in general too, you know at very young ages, like we have long hair so you know, I remember, you know, growing up having a brush like ripped through my hair we somewhere started at a very young age as women, dealing with pain at a very regular level.
Speaker 3:And so it makes sense why women can tolerate it better than men.
Speaker 1:That's insane, though that they I didn't realize that we were supposed to like. It's like when you say the animals don't have feelings, like, yes, my cervix has feelings like big time feelings. I've I've known, you know, for you have a anything put in and out. I had an ectopic pregnancy and so they went in and out of there to do like some testing and do some stuff. And I've had in vitro and I've had, I've had a lot of stuff happen in that area. So like I know that it hurts and it feels awful, oh yeah.
Speaker 3:Horrible. But yeah, it was not talked about, like women's health in general was not talked about, and I think that's why we're seeing so much more alibi aplasty like on the forefront, because we're finally talking about it, like people can say vaginas without flushing, and you know, now we're talking about these things and making it more of a normal conversation, because it should be.
Speaker 1:That's really cool yeah.
Speaker 2:I think it should be normal because you know, the more you know about this kind of stuff, the more you can, the more you can. Kind of it's all other people's lives as well it's like your partners, like who you're with, the more you kind of you know, open it up. I don't know, it just makes sense, but I get it though but also, you know penis and vagina are really stupid words. You know it's like you gotta make them cooler I think one day people will think of different words for me.
Speaker 3:I mean they thought of so many different words over the years.
Speaker 2:Like you know, and so growing up.
Speaker 3:You know, in our era it was like we don't really use those words. We use, like you know, not really intolerable words, and we're talking about it again like the birds and the bees conversation, right Other than having like real conversations. I'm 42.
Speaker 3:Yeah, yeah, yeah, yeah, that's hilarious hey, um, we don't actually talk about those things. We don't learn about women's bodies in medical school. We didn't really learn about these things either, and so a lot of these things I remember sitting in my conferences as a resident, hearing my attendings to, you know, primarily male because, right, currently, there's only 1400 female plastic surgeons are born in the United States and that's increasing. But you know, during my training it was not that high, and so there was conversations during our conferences to discuss, you know, do you reconstruct the person's vagina or not who had our cancer because of the vagina and they're older, they don't really need it, right? But if we were talking about a penis or testicles, like you best believe, we need to pull out all those stuff.
Speaker 3:If you're doing implants, yeah right, right, exactly, and so so those conversations are switching a lot. You know we're having a lot more conversations about women's health, um, what bothers women, you know we're, you know we're not expected anymore, during perimenopause, menopause phase, to go in the woods and, just, you know, die so like there's a huge push now on the forefront because you know, women in general, as we approach those, the middle ages, uh ages and it feels like the middle ages and as we're approaching those midlife years, you know there's that's the time where we see a lot more skin laxity and and that's definitely, you know, probably the time where I see the majority of people come in is right in the 70s and 40s, gotcha.
Speaker 1:I was going to ask you that.
Speaker 2:The fact that they say birds and bees. I remember, just it popped into my head again. I remember thinking like do the birds have sex with the bees? Like you know, you're just confusing me. You could have just been like where babies come from, yeah, but the birds and bees was like okay. Now I have more questions and it has nothing to do with anything so I just, it's just that.
Speaker 3:Yeah, come on, parents right, it's just like, exactly. It's like the stories, like the, the, you know what will the neighbors think. Right, exactly, shut up, clutch your pearls, oh my God.
Speaker 1:I love the pearl clutches. Yes, somebody's after them. Oh my goodness, I wanted to ask you a question Do you use filler ever in that area, like in the vulva, or either in the labia or vulva?
Speaker 3:Yes, so for labia majora in general, um, especially during the perimenopausal um phase, a lot of women, before they become menopausal, will start to atrophy in those areas. Some women just don't have a lot of cushioning in their perineum makes it super uncomfortable for them to sit for long periods of time. I mean so you know, bulking up some of the labia majora with filler, but filler is not fun. So that always ends up becoming the question is you know, do you use filler or do you just transfer at that point? Right, because sometimes you know that area. You know, adding some fat graft into the region can really help round everything out so that it can, you know again, have more padding, because we lose a lot of that. When you think about doing that perimenopausal phase, with the atrophy that occurs when we're losing those fat compartments in our face, it's happening down there too.
Speaker 1:Yeah, it's that subcutaneous fat layer. Thanks a lot, nature, except on the other side.
Speaker 3:Men end up gaining more weight down there. Their mons area tends to just get a little bit more fatty, is what I've been noticing. I see a lot more males come in for liposuction procedures.
Speaker 1:What's the mons area? Is that, like their vulva? That's the mons, the mons, the mons area Is that like their vulva, that's the fat, that's the mons.
Speaker 3:The mons, the pubis area, exactly so that right above the penile shaft will tend to have a fat pad there and so that fat pad will sometimes gain near volume in men as they approach that kind of midlife era.
Speaker 1:Maybe you could give me your fat to put from your mons.
Speaker 2:Yeah, yeah oh my god, from my bond, from my yeah, from my, my mons to your venus is right. Yes, thank you, that was a strip club in tampa called mons venus. I just really yeah I'm sure it's burned down by now. It was a shithole um, but that's interesting, how that, how that happened, is there like a evolutionary, is there like a reason why that that happens?
Speaker 1:which part, the thinning or the thickening of both.
Speaker 2:I guess the thinning and the thickening of it, but I guess both of it is, or well, yeah, a lot of this is related to hormones, right, and genetics.
Speaker 3:You know, a lot of this comes back to that your body diarrhea in general, so sensitive to hormones, and so when we're talking about that common, you know, for women especially, you know, you know, even at a postpartum period, you know, using um, intravaginal supplementary um with progesterone to help, um, you know, increase the lubrication, um, these are the things that people are finally starting to talk about, because preventing the atrophy from happening in the first place, before all the hormones are going crazy, is a huge part of this um, because, but for why this happens to males? I don't really know that answer. I think a lot of this again has to do with the way the body changes over time, because men, as they get a little bit older and again this tends to also be um has to do with genetics. You know they will gain weight along the midsection, that spare tire, and with that comes the mom's area better punching over men.
Speaker 3:Visceral fat, the visceral fat on the right right, because women will get that too. But in general, the the genitals are so sensitive to hormone shifts and changes, which makes sense. But at the same time, that is a large component of why we're losing fat in that area, why there's apathy. People will get an increased risk of urinary tract infections because of the loss of some of those hormones. They're really kind of looking at everything as a whole, not necessarily just like I mean the bonsai tree and calling it a day. It's more about the fact that we got to give a skincare in there too. So now they're creating sexual lubricants that have hyaluronic acid in them. No way all kinds of other cool stuff.
Speaker 3:Oh, yeah, oh I love that um one of our our skin brands Necessary.
Speaker 1:that company makes a hyaluronic acid Necessary okay, we'll put a little link to them in the comments so people can find it in the description so that they can see that. I wanted to ask you about atrophy, if you don't mind, is there a way to prevent vaginal atrophy. I can't say it Vaginal atrophy, you did good I did.
Speaker 3:Is there a way to prevent?
Speaker 1:vaginal atrophy, I can't say it Vaginal atrophy. You did good, I did Okay, thank you. Yeah, it's a tongue twister. Yeah, that it is.
Speaker 3:So yeah, so a lot of that's going to be related to hormone replacement. And so when we're talking about hormone replacement for women in particular, we're not talking about necessarily hormone replacement systemically. It can be local as well, you know, because one of the things we talk about it with women, you know, obviously, you know one of the risks or concerns is also is in does the hormone replacement therapy increase the risk of cancers, um, like breast cancer specifically? And so what we do know is that women can have a more local effect without the systemic effects of the hormones. So they can still get the benefits of having that suppository, the intravaginal progesterone.
Speaker 3:But the thing is, too, is that the vestibule also needs testosterone. Sometimes as you get a little bit older as well. Like there's so many things that they're going to a gynecologist that specializes in premenopausal menopause medicine is going to be huge for that time frame in a woman's life, and so I always joke that during the times that when we're younger, we want an OB that's really good at delivering babies. When we're younger, we want an OB that's really good at ordering babies, but when you get into your 40s, you need a bad apologist, a really great surgeon that understands part homes really well.
Speaker 1:Yeah, definitely yeah. I mean, if I were going to have a baby in my 30s or 40s, I would for sure want to come out of there looking spic and span, you know, and I deserve it, that's right yeah, absolutely.
Speaker 1:That's a good push present. Yeah, new car smell. Yeah, totally right. Wow, this has been so informative. Um, I'm like, I don't know, I've just blown away. When, um, when you guys contacted me, I was like labioplasty, like I said I was thinking about it, and then instantly I was like, yeah, because there's skin and it's not something I've really thought much about.
Speaker 2:So, um, yeah, but it's also, it's fascinating to me on really thought much about so, um, yeah, but it's also it's fascinating to me on the side that, like, you really don't know what it is until you, I mean, obviously, research it. But then everyone has so many different reasons, all different walks of life. People come in there, and I also like the fact that, like, even if somebody comes in there because it's purely um aesthetic, so what, like it's like we do everything to ourselves in every way. We have no problem telling people we're on diets, which is physically altering ourselves. So I mean you know, people do research on it.
Speaker 2:They don't just come in and go do it. Don't talk to me about it, Right?
Speaker 3:You're absolutely right or people have been thinking about it for many, many years. They feel a lot of shame with it, and so coming in and talking about it is a huge step for those patients Because, again, you know you don't want to. You know, come in and feel shamed for something and I think that having those conversations, more people being out there talking about it, normalizing this procedure, is very powerful for a lot of people, because this can create a lot of discomfort for women that we just don't talk about as women. There's certain things we just don't discuss and for the longest time that was part of it and I talked to so many women and a lot of women don't either know about it, don't know that was it, don't know that there's an option, didn't realize that maybe plastic was a thing and that it can be done in the office under local with minimum downtime. I think that that's the other part is, people are really scared of pain and this surgery is not a super painful surgery for most patients Relatively speaking in terms of cost.
Speaker 1:What would you say for most patients, relatively speaking in terms of cost? What would you say Like it's, it's an more on the high end of you know, like cost-wise, or a little more towards you know, or in the middle, I would imagine, depending on what you're comparing it to. I suppose yeah.
Speaker 3:This procedure typically will run anywhere from four to $8,000, depending on the geographic location, right, and if you're in a higher cost of living it's going to be more, but a lot of it will depend on the anesthesia. Some people don't want to be awake for this procedure, and that's totally fine too, so it's going to be more expensive because the anesthesia is more expensive than that has to be done in the operating room, and so there's various levels of numbing and anesthesia that we can use, depending on the person. So we can tailor it for them depending on if they're too anxious for it doing it in the office or it's just not something that they want to do, or they combine it with other procedures, and so that tends to be one of the things that I do the most is it ends up being combined with other procedures. Not as many people walk in saying, oh, I just want a leg atlasty. A lot of people will have multiple things that they want to have done at the same time.
Speaker 3:What's a good combo that somebody would come in and ask you for so a lot of combos that I tend to see are going to be body-conferring based things, tummy tucks as well, and so with that that tends to be kind of more like a lot of that 360 lipo, high def lipo, some fat transfer into labia majora and then labiaplasty and those work really well together.
Speaker 1:obviously, because you're taking out fat, but are you not? Are you taking out like the pad, or are you taking out just the fat and putting how? I don't even really don't understand how fat transfers work, now that I think about it.
Speaker 3:Fat transfer is so magical actually it's it's pretty cool. So, uh, the way that that works is that within your cells and your body and your fat cells, there are some cells, and those stem cells can be certain things. They can only be a handful of things, so they can't be every single thing right and so one of the things that they can still be is fat cells. And so we take those fat cells, we process them, meaning that we wash them, and then we re-inject them into an area, and we know that if we inject them into a region, that they will, the stem cells will actually set up shock and then they will start making you know that we're changing and then make their own fat.
Speaker 1:It's so cool and the fat cells in the body.
Speaker 3:we learned a lot of this during breast reconstruction. We do so much large volume fat transfer BBLs, things like that so we're learning so much more about our fat transfer. We're doing a lot of fat transfer in the face nowadays, too, because we're finding that it not only does it replace volume, but it also helps with skin quality. It stimulates collagen production. There's so many good benefits to fat transfer and it's your own tissue which is huge.
Speaker 1:And it's probably not a lot of adhesions underneath the skin If you're doing like with fillers. I guess it's been more in this sort of in the in the news, like you know, like there's, they're seeing like adhesions underneath where the fat does, I mean where the filler doesn't necessarily leave, but it's your fat so with that it has, I see less people will retain fat really well.
Speaker 3:Others won't. So that's our biggest problem that we have in plastics is that because I do fat transfer to the breast as well, that is actually a very popular breast augmentation technique that I use for more natural augmentation, because breast is primarily made of fat. We have fat really well in our body and so that is you know. That's the biggest issue is that the fat can be a little unpredictable. We know we probably will lose 30 to 50% of it over time, and so sometimes I am retained 80 to 90% of it, and so it depends on the person and the techniques that you use. If you have a gentler hand, you are a little bit more conscious with the fat cells, then you get better take.
Speaker 2:I think of all those times my uncle was like do something about your fat head, and I'm like oh. And I was like no, it's like oh, I can.
Speaker 1:I can literally remove fat, or I can make it fatter.
Speaker 2:He didn't say what to do with it.
Speaker 1:That's right, yeah, all right. You should have been more specific. Yeah Well, this has been super cool and so informative and I'm so glad that you guys reached out and that, um, that you and I'm just thanks for coming on our show and just I don't know, oh my gosh.
Speaker 3:Thank you so much.
Speaker 1:Oh man, this has just opened up a whole new world of questions and uh topics that I want to talk about no-transcript, for most might be phone claims, you know, take that step.
Speaker 3:If that's really something that you're interested in, if that's something that truly is bothering you, then find someone that you feel safe saying that with and that can be, you know. You know, make sure that you do your homework. You want to see an award certified plastic surgeon, someone who is a specialist that does these things on a regular basis, and so going to see them, feeling comfortable with them, you know, getting to know them a little bit in their aesthetic before you come to see the surgeon, is a big part of that, because it is important and that's what's going to make someone feel what we see. They feel like what they want is being listened and heard and spoken back to them in a way that they understand and that we can comprehend and we're speaking the same language basically.
Speaker 3:Because that's what it is. Your medicine is its own language, but I have to be able to take that. For us women in general, we all feel the same insecurities. We're always either too thin, too fat, my leg is too big, too small too, this too that, and so you know, we're always on that spectrum of, like, you know, chasing something or having an insecurity that because our bodies are always on display as women and that tends to be something that, as women, women in general I think, um, people see other people and think, well, they don't, they don't feel that way, or they don't have those insecurities that I do, and the reality is that we do.
Speaker 1:We all have to say, oh, we really do I'm sorry, yeah, yeah um.
Speaker 2:So I was gonna say and this actually ties in because um, uh, what can people find you on your social media and whatnot?
Speaker 3:uh, and I'm on facebook, so instagram, and check back on, um, dr dolly brdolleyrice, okay, um, and so I'm primarily, uh, you know, depending on the algorithms, but instagram tends to be the one that likes my content better, so but I'm on both those platforms. Then you can find my website at dmraestheticscom, and if you're in Chicago, you can find me in Wickham Park, which is a really cool neighborhood in Chicago. The next time you guys come to Chicago with me now, I'd love to host you, dude we're going to go to Mars Cheese Castle and we're going to hit you up right away.
Speaker 1:That's in Wisconsin, it wasn't. It's between the two airports, though.
Speaker 3:Well yeah. Yeah, man, I'm all for the Mars Cheese Castle. You might as well get off those way there too.
Speaker 1:Right next door. I just I love that you knew what I was talking about. Yeah, I know exactly. I was in Wisconsin for three and a half years, drove by that Mars cheese castle oh my gosh, all right, well, thank you again and, um, let's stay in touch. And uh, yeah, this has just been so great. So you guys have a great, uh, you guys in land of the podcast land, and then, um, um, this will be out probably this coming Wednesday at 3 AM and and I look forward to watching it myself, yeah, so thank you again.
Speaker 2:Thank you so much.
Speaker 3:I had a great time. I would love to come back to you in LA as well. Absolutely, please do.
Speaker 1:All right, well, you guys, everyone, have a great day and we'll see you next time. All right, bye, thank you, yeah, thank you Bye.
