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Elle Sera
The Ugly Truth About Plastic Surgery, Body Changes After Pregnancy & GLP-1 : Shan Shan Jing
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00:00 Meet Shan Shan Jing
00:24 Why Plastic Surgery
02:32 NHS vs Private Work
03:08 What Is Labiaplasty
08:33 Surgery Step by Step
11:09 Risks and Complications
14:44 Best Outcomes and Function
20:19 Monsplasty Explained
23:45 Fat Grafting vs Fillers
28:17 Brow Lifts and Trends
30:12 Surgical Brow Lift Options
35:37 Are You Ready for Surgery
38:44 Tummy Tuck Options
42:41 Scars Placement Strategy
44:54 Arm Lift and Lipo Basics
48:51 Weight Stability Before Surgery
54:17 GLP-1 Skin Laxity Surge
55:50 Fat Grafting Reality Check
57:43 BBL Extremes and Longevity
59:57 Identity and Long Term Planning
01:02:24 Closing Thoughts
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Welcome back to the Else World Podcast. And today's guest is Shanshan Xing. She's a plastic surgeon from London. She joined us today. And I'm really excited because she's got this particular area of plastic surgery that I'm very, very interested in, and I know the audience will be too. So welcome.
SPEAKER_00Thank you so much for having me. This is a beautiful space. So you know I'm really excited about having this conversation.
SPEAKER_01Thank you. So tell me first of all, how did you end up in plastic surgery? Is this something that you've always been interested in, or tell me a bit about you?
SPEAKER_00Yeah, well, that's um it's a bit of a long-winded answer, so apologies. I'm gonna try to summarise this. So unfortunately, I come from five generations of doctors, and my dad was a Maximura facial surgeon and used to always have patients around our house and things, but I never really fell into surgery until much later on, really, because uh I've always seen myself as a bit of a creator. I love doing things with my hands. If anything, I wanted to be an artist, right? But unfortunately, being the first generation of immigrant parents, they just thought, gosh, you know, I'm gonna be walking on the street with with no roof over my head with that kind of job. So um, what really brought me to plastic was um just going on some um observerships. I very early on went to South Africa um and saw the what plastic surgeons did there to sing some more westernized medicine plastic surgery in Austria. And it was the fact that uh you can be so creative with your hands um and using the scalpel and recreate a form and function that was something that really attracted me to plastics. Yeah.
SPEAKER_01That's good. Yeah. I always, I mean, the best uh, you know, plastic surgeons are like artists, you know, even when you get aestheticians, there it's an there's artistry to it. You're trying to create facial harmony and balance. And I think some people get it so wrong, but absolutely yeah.
SPEAKER_00Well I did, I studied art, I did all my I did all my scientific A levels, maths, and I also did art um at A-level, and I don't know if people even do A-levels anymore, but I also then continue doing courses at Central St. Martin's doing med school times because I wanted to maintain that creativity aspect of what I do and as a person, so you know I I actually see myself as almost sometimes less of a surgeon but more of a body creator because so much is about artistry and what you see and how you apply that to a patient.
SPEAKER_01Yeah, definitely. So, what does a typical week look like for you?
SPEAKER_00Well, uh at the moment it's very busy, so I work in the NHS as well as um privately for myself. So um typically I spend some time in the NHS, which is a lot more about trauma work and some of the work you may have seen that that had been featured, um, and also uh mostly reconstructive work as well. So I do a lot of hand and peripheral nerve work in the NHS and for my own private practice, it's what ladies come to see me for, and that'd be mostly um some faces, some breasts, tummies, and labias.
SPEAKER_01Yeah, well, we should pick up on that actually because labioplasty is something I'm very interested in, and uh a lot of our listeners will be interested in. So let's you know start from the scratch if people don't know that terminology. What is a labiaplasty?
SPEAKER_00Well, labiaplasty quite simply means um refining or generally reducing the size and refining the shape of the inner lips, essentially, that's what's called a labia minora. Um, and that is primarily served as a functional enhancement for ladies.
SPEAKER_01Is there a particular age at which we should be coming in for a labia plasty?
SPEAKER_00No, so it very much depends on you know what you're born with to lifestyle changes or life changes that results in changes to your labia because look, none of us stay static from the time we're born to you know when we age gracefully and and and die. So um, you know, the breath of patients I see are some of very young women, you know, who are very impressionable. We know the social pressures they're facing, whether it's through social media or just the unkind words that's been passed by partners and things like that. So, you know, I definitely see um that category of women who are, you know, quite often the late teens or early 20s, mostly early 20s. Um, but other women sort of later down the line who have either had several children because we know that hormone and childbirth, right, can stretch the uh genitalia and really change the shape and size of uh of the female anatomy uh in that area with the increased use of isempics and things like that, uh, really has changed women's body quite significantly as a result. You know, women are finding themselves with different set of problems, and that is skin excess, and quite commonly does involve the genitalia area.
SPEAKER_01Yeah. And so who's your largest co cohort of women coming in? Is it the young 20s or is it the older ladies?
SPEAKER_00I would say at the moment it's more actually younger women that I'm actually seeing, yeah.
SPEAKER_01And do you think that's being driven by the quest to have a perfect vulva because they're being fed these images on pornography or I don't know, just social media or or whatever?
SPEAKER_00Yeah, I think that's there's definitely a combo of the two, but I think often is that, you know, uh we know from from scientific studies that actually every woman's labia is still normal, even the women who come and seek this kind of surgery, you know, just because we don't walk around with genitalia exposed, we don't actually know what a natural labia actually looks like. And there is no medical textbook definition for for that. So when younger women, sort of I meet, um, get just the unkind words uh that's being mentioned by partners. Yes, really.
SPEAKER_01If all their partners are just watching, I don't know, porn all day, which is just a gross misrepresentation of a woman's body because it's usually been enhanced to the point of nothing natural anyway, in every way, whether it be breasts, the vulva, it and you know, it even so far as to the act of sex itself, is not not anything like I've ever experienced in when I'm making love anyway. Do you know what I mean? It's not reality, is it? No. And if that's what men are being fed, that that's how they should treat a woman or that's how a woman should look, it's not the reality.
SPEAKER_00No, absolutely not. I think you have to be so careful now, you know, what the porn industry is feeding the men is often the men who's feeding the insecurity to women, because you know, absolutely right. The women in the adult entertainment industry aren't real, you know. So much of uh, you know, the the perception that there's also a lot of the AI-generated content as well. So a lot of it's is being sexualized in a way that is really, really unhealthy. And it's actually just trying to educate women. I think protecting their mental health and as well as their physical health, that's a really important part of my job.
SPEAKER_01Well, that was kind of my next question. When somebody comes in to see you, how do you distinguish between somebody who's coming in for functional need or and a well no, I I just want it to look prettier?
SPEAKER_00Yeah, no, it's a really hard one. And then I would say, you know, you have to go about your experience and often gut instincts, you know, uh one of the some of the key questions I would ask is, you know, how long have the problems been affecting them? Who's encouraged them to actually come and get this operation and why now? Um, and um, so there's certain important factors I decide based on also assessing the size of the labia and how in proportion it is to the rest of their body. Uh, can I see a functional or physical problems that they're presenting with as well? And often, right, you know, so much our physical health impacts our mental health. So I always make sure that, you know, women are mentally ready uh and psychologically safe to proceed on with a surgery like this. So for all sorts of reasons, I might decline purely because they're not mentally or psychologically ready, or that you know, um, the physicality of the labia is not a beginning of a problem where they've been compared to somebody, you know, in the porn industry.
SPEAKER_01Yeah. Okay. So talk me through the surgery itself. Let's demystify the process if anybody's actually thinking about having this done. Um I mean, so you get assessed and you go ahead and say, Yes, I think actually in your case, I think the function will be better and you're gonna get a great result. You know what I mean? It can be painful, can't it? If you've got I don't know about the the labia manora, is that the right terminology, yeah, kind of like hanging out, and it can be quite uncomfortable. Yeah. So um walk me through kind of the the process then on of the surgery.
SPEAKER_00Yeah, of course. So um, given it's a sensitive part of the body, I always try to make sure that I see a patient twice before committing the patient to surgery. You know, it's never a sales process. You know, I want to make sure that women understand the recovery, the risk, and complication. Let's be honest, you know, surgery is something invasive, and to say there's absolutely no complications or risks, it's just not realistic. So, of course, after careful assessment, I mean taking a history, asking questions, examine the patient, then I would give them some cool down time of at least two weeks, okay, to think about everything that's being discussed before seeing them again and you know, answering more questions that they may have before considering surgery. Surgery can be done either under loco anaesthetic, that means you're awake and just have some bee sting injections in the lips, inner lips themselves, and then of course you'll be awake during the operation, and there may be other people around in theatre that may sometimes make ladies really uncomfortable and just really embarrassed. So, in those ladies, then we would consider general anesthetics when you'd be asleep throughout. Um, but of course, general anesthetics contain their risks as well, so you have to weigh up the balance.
SPEAKER_01How long would you be put under for if you did have a general balance of surgery?
SPEAKER_00The surgery is actually quicker because often sometimes I find like you know, I will have to spend a little bit more time if a lady's awake because I want to make sure that they're comfortable. So sometimes a little bit of stop and start, especially putting the local in, sometimes take more time. Um, and normally even before putting the local in, you know, I'd uh normally advise some topical anesthetic cream to numb the area before doing the injections. So if it was under general anesthetic, um, and that can normally take between half an hour to 45 minutes, really. Um, and under local anesthetic, just because you know, we want to make sure the lady's comfortable in theatre, it can actually take a little bit longer. Right. Okay.
SPEAKER_01And you know, what are the complications? Obviously, no surgery comes without its risks. What are the complications with this one?
SPEAKER_00Yeah, no, 100%. So bruising, swelling, wound breakdown uh is um, and and spotting and bleeding are the key. But it all depends on the technique and how careful the cuts have been made. You know, asymmetry, which means that um the lips being slightly different shape and different length are something, it's something that you know ladies have to be mindful for. And this is why, you know, you really have to carefully screen the ladies before putting someone through this because the last thing we want is someone with possibly even body dysmorphia, and you know, just obsessing over the tiniest of differences that may be pressing. That, you know, I always say to every lady, you know, if you split yourself in half, you're not copying mirror images of yourself. And I've done surgery, you know, breast surgery are identical twins and not the same. So to achieve perfect perfection, it is not possible. So I think that's a really important one for ladies to understand. And then, of course, shape, you know, as you heal, as you scar, the scar itself can contract and actually change the shape of the lips a little bit. So you have to be mindful of that. But generally, another problem that can be associated is of course scalloping. So traditionally, some surgeons, not all, but some surgeons would put the stitches on the outside, which are all dissolvable, because obviously no one wants to put non-dissolvable stitches in that area, it's just not very nice to have to remove the stitches in that area. Um, and so uh if you put dissolver stitches on the outside and as the lips swell, which swells very, very quickly after surgery, you know, that tightness against a stitch can cause um ridging of the lips and the very edge of the lips. So sometimes I do see that, but that can even happen if you bury the stitches. So, you know, that may or may not need a little revision surgery to sort out.
SPEAKER_01Right, okay. And what about loss of sensation down there?
SPEAKER_00Yeah, so really important question, actually. Sometimes it's not even just a loss of sensation, but hypersensitivity. So look, pain sometimes can be really subjective. Some ladies, you know, touch wound, it hasn't quite happened to me, but you know, I have heard that some ladies after their surgery have chronic pain in that area, and it's actually um something that's really difficult to to um uh to preempt, you know, before surgery. So chronic pain for like forever. Yeah, so you know, could it be scar-related discomfort? I mean, look, after any surgery, um, you know, the scar tissue itself may change the sensation of that area. Quite commonly, sensation may be less than what they currently are before or before surgery. Um, but some ladies, you know, because scar-related tightness and things like that, and they don't massage the scar or getting used to touching that area, so sort of help to rewire the brain, you know. We're we're human beings and sort of nerve endings in that area. The more that you get used to touching, the more sort of it creates, I always think, like neuroplasticity in your head to help to desensitize that area. So ladies who are really, really nervous about touching that area are probably more prone to um after surgery pain and possibly long term. So that is something that ladies really have to think very carefully if that's something they want to proceed with.
SPEAKER_01And what's best case scenario? Like, go on, we've gone through the risks. So that's best case scenario.
SPEAKER_00Um, best case, um, I should also add, like in the wrist, sometimes you know, I'm very conservative of how much I remove as well, because look, there's no textbook of how these things should really be done, but we sort of roughly gauge on a cosmetic or aesthetic ideal, which is that hopefully the inner lips are not hanging so far below the labia majora majora that it looks really disproportional. And you know, some of the comments I get from ladies that you know they don't want to look like they have a little penis, you know, which is true. So the whole aim is trying to take enough away so the lips are tucked away from the rest of the labia majora, so it's not so obvious. So that would be the main aim of a trying to do this, but also, you know, making you a little bit more balanced and improve your functions. Whether you know, some ladies I've I've operated on very fit, active ladies who wear a lot of leggings, you know, fashion has massively changed. Um, I think cosmetic industry as well, you know, if we're wearing tight leggings, of course, it's gonna show a little bit more if we have a little bit of levier mature excess. So um really is trying to enhance and improve that. All other ladies who feel like you know, that we're also very, very more a lot more active now. So ladies who ride bikes a lot, for example, may find the lips are rubbing um because the excess of lips may rub on the saddle more. So again, a success of the operation would be that they will improve function from that. And finally, of course, during sex, then they're not finding that you know the lips are being forced or tucked in, and it can be really uncomfortable. Yeah.
SPEAKER_01Yeah. Okay. And how do you vet your patients? Have you ever turned anyone away thinking red flag, not doing it?
SPEAKER_00Absolutely. So, you know, my job is to look after every patient's health and well-being, okay? So it's not just their mental health, their physical health, but this, you know, their their uh psychological health as well. So if they come and they have unrealistic expectations or that they're copying themselves too much to, you know, images that they've found online or through social media, um, and they're not really intently doing it for themselves, then I would definitely, you know, give them more downtime to think about it and I would counsel them very, very carefully. And if they don't understand that, you know, I feel like um the important thing is I have to protect them. I I'm gonna have to unfortunately decline because you know, doing surgery, any surgery is permanent. The last thing I want to do is give them a physical operation that scars them for life.
SPEAKER_01Yeah, quite right, definitely. Okay, so I mean that's labioplasty. Let's just go slightly wider onto that. There's other procedures in this place. I mean clitoral hood reduction.
SPEAKER_00Yeah. Um yes, and that's I've never even heard of this before researching it, but yeah. Yes, and that is becoming uh against some things that women ask about. And I was saying, you know, in my practice, I probably get very few clitoral hood requests, firstly, because it really um gets into a quite potentially dangerous territory of you know FGM. I I don't know if you heard of that.
SPEAKER_01I have actually, yeah, which is I actually did a walk through China for a charity for it.
SPEAKER_00Right, okay. So you you probably know all about it. So, you know, we know that some famous models who've had it done in in the countries where they're crystal, yeah. It is, it is so you know, the last thing we want to do is being seen as doing something that remotely um mimic that. And then secondly, you have to be so so careful because everything on a lady's body has a function. So if you take too much away of the clitoral hood, what you can happen is, I mean, the the function of the clitoral hood is to protect the clitoris, right? And so if you remove too much away, what can happen, or even like if you've been extremely conservative and during the scarring process, you know, or during the healing process, the hood is being pulled up even a little bit, you know, you can leave the clitoris exposed.
SPEAKER_01Yeah.
SPEAKER_00And if that happens, you know, you can really um and the lady just you know wear normal underwear, they could be so sensitized or desensitized as a result. So, you know, you could be.
SPEAKER_01Also that delicate part, maybe rubbing against underwear, can't imagine that's doing any good for like I don't know, it's so delicate down there, isn't it? Like thrush and everything, you know.
SPEAKER_00So I think you really have to be just so careful in selecting the right patients, you know, in the really excessive, you know, after massive weight loss um type of ladies, I suppose. If there is a very clear indication for it where you're not you're being conservative with your approach, you counsel the patient appropriately, they understand the risks and happy to accept the risks, then you know, that might be something that that can be considered, but I must say majority of the times, and even amongst colleagues I know, it is not a common procedure.
SPEAKER_01No, yeah. Oh, and one uh another one that I'd I had no idea about until I was researching this was um monsplasty.
SPEAKER_00Yeah, so monsplast is more again, you know, normally after pregnancy or massive weight loss, the whole areas of the the the mons area um can hang.
SPEAKER_01We should say this would be the like pubis. So pubic. The pub, yeah, the pu the pubic bones and like the the pubic lift basically, isn't it? Yeah.
SPEAKER_00The bit that contains a pubic hair. So, you know, that often is because of significant weight loss or or pregnant, multiple pregnancies where you've got skin excess and the whole areas, the fat is deflated. So, yes, what happens is that all that can hang and protrude um and can be very uncomfortable for ladies. So, you know, of course that can be considered something as a functional thing to do for ladies.
SPEAKER_01I don't know if you've seen a programme on um Apple TV, I think it's on, uh, called Your Friends and Neighbours.
SPEAKER_00No.
SPEAKER_01Okay, well, they did a whole episode, and I'm sure this was product placements because it was like mentioned too many times. I was like, oh my god, shut up about this now. They uh had slipped into the whole storyline. Um, one of the ladies got menopause, but she was having some re uh vaginal rejuvenation with a with a device be call uh called the Mona Lisa.
SPEAKER_00Right.
SPEAKER_01Have you heard of this?
SPEAKER_00Um, I mean, look, I can imagine these being, you know, there are a range of devices out there. There are.
SPEAKER_01It was like a laser rejuvenating. I can actually have a look what the Mona Lisa is, please.
SPEAKER_00I think they basically use what laser or ultrasound to tighten them the vaginal muscle and sometimes you know the the mucosal skin on the inside, which is obviously a different a different area entirely. But it is more for women, again, you know, with unfortunately with aging and pregnancies, particularly, you know and vaginal atrophy. Yes. Um, and that comes, you know, postmenopausal changes and things like that. So the skin and uh particularly on the inside hang, right? And so uh you get vagina prolapse and you know, a problem that women really struggle with and unfortunately don't talk enough about either.
SPEAKER_01I'm just gonna have a lot.
SPEAKER_00What was it that I don't do vagina plastic, but you know, I also know that people fat graft that area, right?
SPEAKER_01Yeah, so um oh this is like looks like a probe. Yeah, you put it on the inside. A vaginal laser. Oh, it's a CO2. Painful. Yeah, for inside. Yeah. God, I feel like this is like, you know, you're gonna look back at a hundred years and be like, can you believe women were doing that to themselves?
SPEAKER_00Painful, painful, yeah. Yeah, sure.
SPEAKER_01I would Joey's out on that for me. And then like I'm seeing trends on Instagram and whatever social media about vaginal rejuvenation post-birth.
SPEAKER_00Yeah, and that is, you know, um, and I don't do that personally, but I'm aware that, you know, that essentially is taking fat from elsewhere from your body and uh essentially tightening the vagina wall, and that can be done, you know, non-surgically, as we talked about. There are all sorts of devices that people are trying to sell you.
SPEAKER_01I've had a lady on here who does labia filling.
SPEAKER_00Okay, yes, you can put fillers, and but look, um, I personally don't don't do fillers, and I don't personally don't believe it. You know, good luck to everyone who do who do do them, um, is that they're gonna migrate, you know, anything non-permanent is only gonna firstly last you so much of time, but also the last thing you want is really filler migration, you know, gravity is gonna act on everything, right? And so what I think, you know, is a better option 100% is actually doom fat grafting. So, you know, that can be taken from the tummy, from the love handle area, from the inner, yeah, and and essentially put into the vagina wall to tighten that area to rejuvenate it, or does it just tighten it, or does it just fill out the skin? Yeah, like you say, I think there's definitely uh tightening in that, you know, people put a decent amount of volume in. So, what is essentially a wider tunnel? Essentially, if you put fat around all the vagina wall, particularly on the front and the back, it squashes the walls inwards, right? So, yes, you know, um, it does narrow the tunnel.
SPEAKER_01I'll be honest, like and I don't know why there's too maybe too much of information for the listeners, but I don't care. Uh well after I so I got to nine and a half centimetres uh in birth, and at that point, after 48 hours, they were like, give it up, it's time for an epidural, it's time for emergency C section.
SPEAKER_00Oh my goodness, yeah.
SPEAKER_01So I've basically got the whole hog anyway, yeah, you know, been through labour, all the contractions, whatever. And then my so and having sex after birth, it's just never felt the same ever. Yes, of course. Why? Well because I actually never gave birth through the canal, yeah, like the vaginal canal, but it feels tighter and it feels like stuff has shifted. Yeah. I don't know what, I don't know the terminology for kind of like uh is it my use to it? I'm gonna get a diagram up. Um but it feels like that's slip, that's come down a bit.
SPEAKER_00Yeah, I mean your body will change, you know. You've carried a baby for nine months. Yeah. A baby that's grown inside your body, of course, is gonna change your internal anatomy and the hormone on board on board, right? It's you know, deliberately acting on the key areas, and that's your genitalia and your uterus. Everything is acting in preparation for a natural childbirth. Of course, you know, C-section's taken a lot of that away, but of course, that that change, the hormonal change, is something you're not going to be able to take away. And of course, none of us are aging backwards, right? And so, you know, there's there's probably just a combination of effect, and women go through weight loss after pregnancy. Number of things will yes, the vagina wall.
SPEAKER_01The this bit's come down, yeah. So, yeah, it's a vagina wall. I feel like the vagina wall has definitely come down, and it's like I don't know, ever since I had her, yeah, sex has never felt the same. It's actually more painful, yeah. A lot more painful.
SPEAKER_00I think it's also to do with the pelvic floor muscles as well, because what is suspending everything up is essentially pelvic floor muscle. So if that's all being stretched, you know, after pregnancy, I haven't had children myself, but I'm very aware that um pelvic floor becomes very weak after pregnancy and the muscle needs a retraining to really support it, essentially it's a sling for the vagina wall itself. So I wouldn't be surprised that you know, after any pregnancy, really women is what it is.
SPEAKER_01Yeah. Okay, that's interesting. Because I've got this like device at home that I've never but sat in the drawer for two years now. It's a pelvic wall trainer. So I've got an app on my phone, and then and then it tells me. So I do if you put it in, and then you're supposed to clench it, and then it tells you, it gives you a score of how good your clenching is. Yeah. And you do that like 10 times a night and then take it out, wash it, and then do it again the next night. Yeah, I think. It's got the LV trainer.
SPEAKER_00Okay, well, I think that's probably a really good device because you know it can't do any harm.
SPEAKER_01No.
SPEAKER_00The more that you do with these, the better. And so if it makes a materialistic difference for you, definitely.
SPEAKER_01Yeah, definitely. Okay. Um, but you don't just do, you know, intimate surgeries.
SPEAKER_00No.
SPEAKER_01Um let's get on to faces because that's always interesting. Um, so massive trend towards brow lifts. You know, I I mean I I spend every other minute looking at them. I'll be honest. Yes. You know, I'm always looking at brow lifts. Um, you know, what's the difference between like a surgical brow lift and I I personally don't think you can achieve nothing with a boat with Botox.
SPEAKER_00No, I mean, of course you can it's like nothing lifts. Yeah. So look, you know, I think I think also the reason why things like brow lifts and things sort of come and go so much is because there's such a fashion trend with these, and this is why I've really counseled ladies. I mean, um I did a post recently on my on my Instagram, is that um I worked in the designer fashion industry when I was a teenager, you know, just working designer stores in Chelsea, and you 100% see a massive rise of something just because the trends coming up. But the problem with trends is that they're always going to fade, you know. So that foxy eye look, which some uh some women love to a period of time because you know, celebrity influences and things like that. Yeah, like that bella bellaheaded, like yes, and and the thing is it's incredibly difficult to recorrect. So having having that having surgery for it, which create permanent change potentially, to then I don't think you could do it.
SPEAKER_01You couldn't ever undo that. Are we gonna do it? Add more skin back to like it make it come down again. Once you've done that, you've done it. You might have never like done it.
SPEAKER_00Yeah, I'm scared. And the key thing about any lift, so you know, of course, there is there's some like medical definitions that ideally where the brow should sit in in women in general, how it should be shaped. And the shape, as I say, follows trends a little bit, but generally for women, the brows sort of sit above the eye bone, so it's called the orbital rim, so it should sit above that just and it sort of is about harmonious balance with the rest of your face as well. So there are different ways to do it. Yes, of course, you can consider non-surgical uh techniques, so there are some muscle acting that pulls the eyebrow down, and sometimes I do that, just a bit of a Botox on the undersurface that just weakens the muscle that pulls the eyebrow down. You can just do it to the corner, okay, so that the corner lifts a little bit. Yeah, just a very small amount. But for more of a visible change, I suppose, is that you're probably looking at surgical uh approaches for these, and there are different ways to do it. So anything surgical, of course, uh comes with scars, and this is something that women often worry about. So, of course, a younger woman will want something that's more endoscopic with a scar sort of hidden in the temporal hairline, so you can't actually see a physical scar. Well, you can if you really pull the hair back and things like that, but you know, that will give you a quite well-hidden scar and still give you a quite dramatic change. And it's really just lifting the whole of the forehead. If you see how it's done, I'm sure you probably see some of it on YouTube these days. It's lifting the all of the muscle.
SPEAKER_01So, would you do uh like I see people just like lifting skin? Yes, but you wouldn't really want to do that because there wouldn't be much longevity in that because skin would go lax over time. Yeah, you would want to lift the muscle up as well, wouldn't you?
SPEAKER_00The muscle would, and you know, a composite lift, you know, with your muscle, your fat and your skin would probably give you the most natural look as well. Um, and it's it gives you better balance overall. Um, skin lift, yes, but some women, and I would say probably it's more for women who are a little bit older. So uh a composite lift is all an you know endoscopic lift is probably for younger women, okay, but uh where there's less skin excess, but they just want to lift the whole of the brow, not just um uh and in relation to the forehead as well. And so women who are older and have heavy, heavy brow, um, or heavy skin, I should say, you know, you can there are some surgeons who only do direct brow lift, where you know, you you essentially just cut a melon slice of skin away just above the brow, and generally that can be hidden really well, so you can either do it in the brow hairline or just do it to the very, very top of it. And women, you know, a lot of women get their brow tattooed these days, so that can be tattooed and be doing really well.
SPEAKER_01Yeah, yeah. Um, but as so a big trend I'm seeing is one particular doctor down in London, he's doing Korean eye lifts. Yeah. So where they had the scar underneath here. Yes. The results have been very good in like the girls that I've seen that are before and afters, like they look really awake.
SPEAKER_00Do you know what I mean?
SPEAKER_01So it's they're not really they're not lifting anything here, they're literally just it's like a blephroplasty, but with this, yeah. But when I was asking an aesthetician that I'm good friends with, she was like, no, don't do that. She was like, the scar, it's right visible, right there. Just get it done in the hood. The crease. And don't waste your time with that.
SPEAKER_00Yeah, I mean, what do I think? Okay, so I'm aware of that, you know, it's not just in career in the whole of Asia. Look, yeah, the thing is, I've I've worked a little bit in Asia as well, you know. I know that um uh how the uh cultural consideration to cosmetic surgery is, you know, there's a lot of that as well. Yeah, of course. So, you know, if you go to Brazil, how women want their breast and how they want their tummy and how they want their butt is completely different from someone in Asia, or completely different to someone in Europe, and probably even different to people in North America. So do not copy trends. I always say to ladies is that firstly identify what is your identity, what's your personal identity, and work backwards. You know, what are your personal aesthetic ideals? What are you trying to achieve? And then trying to find the technique that fits you. So for me, it's it's taking all that into consideration and someone's biology as well. So, why did uh this particular brow lift, or sorry, I should say upper eyelid lift become so popular? Because unfortunately, I'm Eastern Asian, right? I know we we can scar really, really badly. We tend to form redder, thicker scars that is also more visible. So uh in the crease itself, it's going to and our skin is even thinner in this area. So, for that reason, women want the scar to be hidden even more, but it's uh absolutely um is gonna be less effective, I think. Um, and I definitely something I want to get into more to do myself as well. It's gonna be less effective than getting to the bit that really is a problem, which often is just the hooding right around the crease. So um for Caucasian ladies, um, to be honest, their scar heals so well. Uh all the Caucasians lady are just do a direct upper eyelid lift in the crease because it's hidden so well, the scar set it down so well, there is no need to make it more complicated. So um I would say yeah, it just really depends on the individual. Yeah. Do you think I'm ready for one? Uh to be honest, like lots of ladies, um, even in their 20s, you know, it just also just depends on how genetically blessed you are. It is nothing to do with aging. I think what uh accentuates the need sometimes for eyelid lift is that we're all staring at screen now. You know, technologies massively change how we age and how we look ourselves. So if you're staring at screens all the time and scrunching up your eyes, of course it's gonna leave a bit more of an effect than a lot like a bit more like awake and that like more like you know, I don't know, Megan Fox looking looking looking eye.
SPEAKER_01Because I feel like on photos, especially, I don't know, and I absolutely hate doing this podcast, guys. I hate it because all I do is nitpick what I look like every week. But I yeah, of course I do.
SPEAKER_00Well, you're firstly a beautiful person, anyway, but you know, it's it's too all to do with the upper lid crease. If you feel that, you know, you're getting transfer. A common thing I say to ladies if you feel that your mascara is definitely causing problems, you know, with time, or that your eyeliner is rubbing or you know, going on to the upper uh part of your lid, you probably 100% have a skin excess that could do something about it.
SPEAKER_01I don't think I've got an excess like that. I mean, I'm thinking I'm just crap at putting mascara on, to be honest.
SPEAKER_00No, but but of course, you know, this degree of um skin excess, you know, with after any age, really, but even I see it in women in their 20s just because they're not genetically blessed. Yeah. So it really depends on and I think that also the key uh the trend certainly has changed from a quite dramatic look of a surprise look to something that's really subtle, really fit your uh frame and face, and you can't really actually see what you've had done. That is good work, yeah.
SPEAKER_01That is absolutely if I'm wearing hair extensions, which I'm not, this is all my own hair, but if I was, you should not be able to tell that I've got them in. Yeah. If I've had any injectables, you should not be able to tell I've had them. That that's good work, I believe. And if you if I can go, oh god, look at her lips, it's bad work, even though the trends is to have them so over-inflated that they look like I think people Yeah, duck lips. I honestly can't get my head around people who love it.
SPEAKER_00Um I think we moved away, thankfully, we moved away from all of that now. I think definitely in Europe, I think in North America and maybe in in uh South America, you know, there is uh still a perception how you should or how women should look. It's a massive industry out there. But generally, if you look in in Asia or in the rest of Europe, women want to look like just good without even having people to say, Oh, where'd you have that done? You know, it's not about uh it's just about refreshments and refining and keeping to the natural look than something that is dramatic.
SPEAKER_01Yeah, absolutely. Okay, so let's come on to abdominal plastides. Uh Tommy talks, basically. This is something I was looking at myself the other day, and um people go, shut up, you don't need it on. No, you're absolutely right. I'm like slim, healthy, you name it. I've got like a actual good definition on my stomach, like bud, like abs. That's not my problem. The problem is I've got loads of skin because I was pregnant. So when I sit down when I'm in the gym, honestly, I've got so much excess skin. Whereas actually, and when I'm stood up and stood back, I look brilliant. Yeah, as soon as I slightly decrease, it's like concertiness.
SPEAKER_00Yeah.
SPEAKER_01And then I so obviously I sit around Googling what can I do about this, blah blah blah. And I don't want so and I'm not like I don't need weight loss surgery or anything like that, it's just pure skin. Exactly. So, but I don't want that massive hip-to-hip scar. Yeah, it's what can be done.
SPEAKER_00It's really exactly right. Um, so the way I like to think about it, no, I have operated on ladies very similar to yourself, you know, very slim. You pinch the skin and it's just literally paper-thin skin. But like you say, they have lost a lot of weight and it's just a skin excess. So unfortunately, like there's not really any quick way of removing excess skin apart from trading it with scars. So for ladies, uh, you know, the last lady I've done that for, you know, you can think about reverse tummy tuck, okay? So where are the scars hidden right beneath your breast crease, right? And it does come to a degree sometimes, depending on the excess, the ends can join right in your breastbone in the midline in the cleavage. So that that sometimes is not so acceptable for patients, but you know, other ladies might find that being absolutely fine. So it's actually a quicker procedure, you know. I don't have to um so it'd be in your broad line, basically. Exactly, exactly. Um, and then there are other ladies, you know, just need a mini tuck if it's more the lower part of their tummy that they're really dressing, so you don't need to move where your belly button is. So you wouldn't need to do that on there. Yeah. All I just want to get is like, I don't know. A little tuck at the top, a little tuck at the bottom. I don't know. I don't know what I need. People that shut up, we don't need anything, but um I feel like like I wouldn't wear a bikini anymore. Yeah, I have had a lady who say that actually, you know, she came for you know, I hate this term mummy makeover because um she never had kids and it's just Oh really? No, and this is the thing, I I basically trying to call it, I don't know, I'm trying to I'm trying to rebrand it to to consider it as more of a body reset rather like a mummy makeover because I find it a little bit undermining for women really um to to just label women as all mummies and actually with a zempix and all these fat loss uh injections and things like that. Um, and uh many women don't have kids, but they have the same problem. And so, you know, the last lady I did, um, I did do a full tummy tuck for her only because you know she didn't want that scar really under the bra crease, um, and really just she was happy to accept sometimes, right? Because there's so much skin to take, I am able to remove the little cut around the previous belly button all the way out, so that you only end up with scar from hip to hip. Well, that's what I look like there. Yeah, well, you have got a good definition, good on you, yeah. But yeah, I I try and lean back.
SPEAKER_01Yeah. So when I'm not leaning back, like I've just got loads of excess skin. Let's say I was on a sun lounge in a bikini, yeah, right, and I'm bending over, I would I look like Mr. Burns.
SPEAKER_00Oh, because I've just got like concertina with loads of excess skin, and I feel like the problem is, you know, with it, and and I totally empathise, the only way to get rid of excess skin is surgery. Oh, I'll cuss it off, don't worry about that.
SPEAKER_01But I don't want um I don't want fixed hip scar. Where can we put it where you can't see it? Or can it be like in my C-section scar? Could we put it there?
SPEAKER_00Yeah, so absolutely. I mean, if I do a tummy sec, I always cut the uh take it down to the level of C-section scar. So it's I even advise ladies to bring their favourite bikini or underwear and then see where it is. Exactly. And um, this is why again, culturally, if you go to Brazil, they love the high-waisted, you know, triangular um bikini. And so the scar tend to be quite high in those um areas, but it, you know, most people in the UK prefer low waist uh bikini. So I take that C-section scar away, and how long is the length of a scar? One depends on where you have the excess. Is it just in the bottom half? Then great, I can just keep it low. If it's more the upper half, so reverse tummy tuck is an option. Um, but how what how long the scar is, it really depends on where how how much skin excess you have. So if you have a lot all over, then to only limit it to a small section where you still have the unbalanced over.
SPEAKER_01behind it on the side exactly so a lot of it is is tailor tacking and you know I draw on patients to show them what the scars are gonna be like yeah my friend had a body lift yeah so she's got a scar all around her body yeah yeah 360 body lift yeah she was like I'd rather have that than you know yeah than than whatever yeah I mean she's she wouldn't mean might mind me saying but I've never known a woman to have more surgery than she last week at Ranger I was like hi how you doing she's like oh I'm just waking up from drugs I was like hi she was like I've just had my arms done I was like what again it's like the third time she's had them done and she's like no I needed it I really needed it I was like right she's just like I was getting lipoedema I was thinking no but anyway but she has just had done um a mini arm lift so obviously this is actually a big thing and as women get to a certain age their arms do get bigger yeah like you get bingo wings don't you I work out loads as much as possible and I am always saying to my PT, I'm like you've got three months or I'm going to the surgeon and it all and listen I've got brilliant muscle I'm really strong I've got great muscle not to tip me on horn here but I have so but it's not ever getting shown off because I've got so much fat there and as soon as I lose a bit of weight like they pop and look amazing but it's very difficult to me to stay at that weight. I'm already underweight for my height and stuff anyway but then well I'm just normal weight probably for me to drop another like four five pounds life as I know it would have to look very very different. Yeah but I don't want that like fatty arm. Anyway she had this mini arm lift so it wasn't a full brachioplasty which for people who don't know what that is it's like you will UT it's a massive scar there and you would remove maybe armpit yeah so you'd have like lipo to take those fat cells out.
SPEAKER_00Yeah I mean I generally so it depends on where the problem is so again you know I do that surgery it is is this isn't a careful assessment of each lady is a fat excess or is it skin excess and how much of skin excess right so you know if you have a skin excess problem liposuction they ain't gonna do it. So um I generally do liposuction a bit on every lady because it's actually proven to be safer um even if you have skin excess to go with it because it preserves the lymphatic channels and the veins and the nerves that are 100% important for your arms. And so um liposuction is a lot of vaser liposuction. It can be vaser and there's so many you know there can be laser ones as well so there's all different um you know liposuction has advanced massively recently because the high body definitions that women want. And then mini yeah yeah well she had the uh mini with the J plasma yeah if you want to explain what that is so I mean the mini really is just taking a wedge of skin primarily in the the armpit essentially so the scars really well hidden away because you know if we want to wear short tops or you know wearing bikini you can't actually see the obvious scar when you raise your arm and so for a small amount of skin excess and you if you just tug that little bit away you can just hide the scar right in the armpit where you don't even see it.
SPEAKER_01It doesn't have any armpit hair anymore.
SPEAKER_00Yeah because which is another bonus you don't have to shave anymore. Yeah yeah well you have to be careful not like how much you take away I mean in general you have to be very careful how you place a scar because as we know scars do contract and the last thing you want is really have a scar related problem or wind breakdown in the recovery process. So um yeah on the back of that if you then you have a bit more than uh the the small amount of skin excess unfortunately you are looking at a whole wedge or like ellipse bit of a skin that goes really from the inner part of your arm all the way to your I feel like let's say I'm unhappy with my arms now and I am.
SPEAKER_01And I'll post a bloody picture of them if everybody thinks I'm just whinging and there will be loads of women who go yeah you are but they um I feel like it's preventative. If I had a mini arm left now it would stop me needing a brachioplasty later on.
SPEAKER_00Yeah and that's really quite subjective. I see your logic that you're no I wouldn't say that I wouldn't say that but I definitely see your logic look we don't know how women age or how we age none of us can predict that and what I have done is you know I say to every woman is that before they come to or see anyone really for body contour surgery number one make sure they do the MOT for their own body and what that means is that they get to the ideal weight and it's a sustainable weight. You know they're not killing themselves to get to a specific weight and they know they're gonna put on weight again because guess what um after any body contour surgery it will be only applied to how your body and your frame is at that point in time. So if you lose more weight right afterwards and I have seen that things are just like gonna hang again and you'll be disappointed with your result or that if you put on weight you know I had a lady who lost a lot of weight and I did tummy tuck and I said please just maintain your weight and she put on weight very very quickly and then she grew more love handles down the side and she required revision surgery.
SPEAKER_01So none of us can predict yeah I I completely hear yeah if you have spent two three years at the same weight great lifestyle your weight training which I say every week on this podcast and will not stop saying it because people still don't do it. You know but anyway you're doing it everything you're building that muscle tissue because muscle tissue is the key to looking sexy and longevity and everything. Absolutely so you need that and if you've got you've like your diet right you know your gym's locked in you're optimizing every area and yet you've still got this bits of loose skin. I'm just talking about myself personally let's be honest you know because I am dialed in in so many different ways and I'm still like I know but like there's nothing that's gonna get my arms tighter the only thing I can do is is lose rapid amounts of weight and I'm already below the average and I'm already for me to get a lot lower you know is getting really really low and life would look a lot different.
SPEAKER_00And this is what I caution ladies who actually take weight loss medication because guess what? If you lose weight rapidly the skin is not going to recoil at the same rate so you're obviously gonna have um you know skin hanging if you lost weight more naturally the skin actually does shrink as part of that process.
SPEAKER_01If you were weight training as you were doing that naturally that also helps the whole look and feel of your body contours anyway. Yeah truly believe that yeah there was a woman I looked at the other day in her 40s she was very overweight yeah you should see her now she's 52 wow I mean wow her just I'll get her up because she was amazing. If you want to add this in Dylan her name on Instagram is Alice Alicia E Alicia Erickson and she was like a bigger woman at 40 I mean now like she's a fucking animal she's amazing yeah oh wow and I'm like oh wow that's a 52 not easy to do but it's all natural with no surgery nothing. I'm not too sure but I know she's obviously done the hard graft yeah along the way I looked at that I was like whoa because I know what that takes to get there. It's difficult. Absolutely I mean I think also you know it's great now seeing women that you know who who can bulk up a little bit because as we know exactly like you say you know losing muscle mass at after the age of 40 I don't know if you know but a statistics that I was shocked by and I've always remembered is that after the age of 40 you lose 1% of your body mass and a yeah yeah um so actually uh and you stop laying down bone mass at 40 to boost bone mass yeah so you've literally got to about 40 and then that's it and you're now on a big decline. Yeah big decline you're gonna go have osteoporosis you need to keep your muscles strong to keep your bones strong yeah so this is why I say non-negotiable have to be weight training all I mean literally all the time.
SPEAKER_00Yeah no as that's a really important it's not just for your physical health but for your mental health as well 100% but yeah you know coming to to this um idea now women you know with a bit more muscle on them do look sexy and look good um I think that's really changed even how the cosmetic industry you know when it comes to body contouring how do we contour a body to give women more of that muscular definition so you know even for tummy tucks and things like that I try I don't do crazy high definition because I think that can that can to lead to other problems but I do try with liposuction as part of tummy tuck to give women some sort of six packs definition so that they actually feel a bit more healthy about themselves. And what I've seen a a shift is actually even in my own patients who initially might have come feeling quite depressed about their body and decide to go for a tummy tuck once they've lost that um excess skin and fat and they've seen the even a small amount of contour they get so confident about it they start going to the gym more they actually build on more of the muscles themselves and actually look refine their look even more which I think is wonderful.
SPEAKER_01Yeah no absolutely yeah no I completely agree with you completely agree with you and I can't imagine how the landscape's changed for you since GLP1 drugs hit the market.
SPEAKER_00You must be busier than ever with skin laxity issues I think you get a skin laxity issue um everywhere really you get that very stigmata look don't you unfortunately a very gaunt face you know you lose healthy fat as well as you know but fat that you want to lose um so you get your face expression changes everything hangs a little bit more um you know the arms breasts tummy and thighs are you know common common areas that everyone complains about so you know what I'm seeing also arise is not just a body contouring surgery but combo surgery as we talked about you know it's not infrequent that I'm doing this one this weekend for example lady wanting tummy done same time as their arm or you know people having breasts done as well as the same as their arm. So you know sometimes I I I sort of tailor tack my technique a little bit depending on where the excess is so sometimes you know women if they don't want to implant for example I can use a bit of that excess skin even and a little bit of the fat that they that remains that creates this you know roll on the side of the chest and I use that to fill it into the breast to give you know what I would call like a type of auto augmentation to give themselves to give their breasts more volume more enhancement and more of a lift without the need of using implants.
SPEAKER_01With fat graftin I've never got my head around fat graftin I obviously get it but I'm like how does the fat stay there?
SPEAKER_00Yeah and so it not all of it retains in fact you would have to have like pumping let's say you pump the like just breedy mass like a hundred percent of the fat that you put in yeah how much retains on average every lady's different of course it depends on how healthy that area of the part of the body that you're injecting fat into anything graft of anything is fat grafting really any um parts of something you've taken away away and transfer somewhere else wherever you're putting it it has to have healthy blood supply to if you want to think about it like healthy soil for some for plant you know for seeds to grow and fertilize and you know develop so for any healthy fat to maintain um is not realistic we pack it all in one go so on average I would say to ladies you know a a realistic expectation is about 50% of the fat will remain so if ladies who have have you know um medical conditions such as uh I don't know diabetes or their smokers or vapors of course those things affect the blood supply in that local area so you're probably the the fat grafting is going the fat is going to retain less and you know people have tried and I don't know how you know my I don't normally um offer that as a as a combo service but I do know fix so in Switzerland is a big thing that after fat grafting women are sent into hyperbaric chambers and things like that to encourage the oxygen getting into the fat and and maintain the fat and trying to keep the fat as much as possible. But it doesn't always work and I think it really just depends on the individual.
SPEAKER_01So yeah like you'd come out of surgery I don't know I see these BBL girls you know what I mean I follow loads of surgeons there's one in particular Dr. Oslani in Marbeya and he does these supercharged BBLs. I mean it's a bit grotesque actually but he takes your ribs away yeah right it's fucking I don't know about like so he's taking out your bottom ribs yeah right and then can you believe this Dylan? And then he's taking all the fat out of you and then banging it in your bum.
SPEAKER_00Yeah I mean I have seen such clinics even in Nigeria um believe it or not because people want that crazy hourglass look yeah like really yeah huge and it must look good after surgery for a few weeks because you're swollen I would like to see them a year down the line but also I like to see them five to ten years down the line because I bet as I said to you before anything that is fashionable will fade right so if you've done that to yourself can you imagine like if I had that even if I want to have that done to myself would I really want to look like that when I'm like 80 years old um you know like cranny yeah even Kim Kardashian's relaxed hairs hasn't she because there's there was at one point it was absolutely huge and then she must have had something removed or like it toned down or she's a bit lipo and BBL they have unbelievable lipo. Whoever's doing their lipos doing it amazing yeah and also I wouldn't say necessarily like how many ghosts has it been is it actually real you know some of these are digitally enhanced and lighting. I keep looking at like Chloe Kardashian's arms and I'm thinking oh god those are the arms I want do you know she works out she works hard but she doesn't work out as hard as me I'll tell you that because I've seen her workouts and the crap yeah and I was thinking this is just all smoke and mirrors but um yeah she works out and she's got that it looks like she works out because she's obviously had lipo on her arms I don't know if you want to bring up her arms here Dylan and have a look obviously it's she's jabbing must be because she's absolutely gone rail thin as well but I mean also I just think you've got to be so careful in comparing you because you are a beautiful person you know you're never gonna be a copy paste of someone else so expecting someone's internal NASP to be like yours you know you're two different people so I think sometimes you've got to be so careful how you you you you portray yourself and it comes down to you know the way I like to think about it is that I like to support women from the inside out. You know I want to support them on an important journey which is you know something that is essentially quite destructive to the body I'm not gonna lie any surgery is destructive you know supporting them through that process and really make them understand the short term and the long term outcome and how these things can affect them in the future because you know it's not infrequent particularly when it comes to revision surgery women like oh yeah that was a phase of my life there was a chapter in my in my in my book that I'm no longer that person right how often have we done that younger women want breast implants and then when they get old and they're like no I'm totally done with implants I've had kids now a lot of people are explanting. Mm-hmm absolutely health benefits they say absolutely you know I even though I do you know I do put implants in but I also you know understand the risks and you know I also remove them I do breast lifts so what women have to understand particularly when they're young and impressionable not just following like I don't know the next TV program that's just come out with someone walking around the beach with with implants is that they need to understand their breasts will age entirely different with implants and they're most likely to need uplift earlier and you know how and and second revision surgery and possibly you know um fat grafting and things like that if they want to maintain the volume even if they feel they're done with with implants. So it's really teaching women from the uh right uh offset the right choice for them but not just for the next two years, five years for the 10-year journey that they're gonna have you know I wouldn't want to be a mum with big implants and walking around taking my kids to school with obviously enlarged breast so I think you have to be so careful with how you identify and see yourself.
SPEAKER_01And that is the first and most important thing that I try to educate women about yeah well I think that is a perfect place to end this chat Shan Shan I've loved it. I feel like I've learned a lot the audience has learned a lot I think you've got a very good approach to surgery and you know that kind of you haven't got a cavalier approach to it and you try and balance as you said kind of people's expectations along with you know looking after the patient and you know realistic outcomes and is this right for you? Absolutely there's too many unscrupulous people out there. Yeah definitely but yeah I uh I've really enjoyed talking to you today and thank you so much for coming in. Oh thank you so much for having me.
SPEAKER_00Yeah I love the conversation so do carry on.
SPEAKER_01Thank you