Dr. Martin Jugenburg (00:00):

Aging is a process. You can't escape it. Anti-aging is a big buzzword. Everybody's trying to do anti-aging. I want to be very clear. Plastic surgery is not anti-aging. I cannot reverse the nature of your tissues. I can reshape them, I can reposition them, I can make them look better. But the nature of it, the way it's built, it's still that same age.

Michelle MacDonald (00:29):

Today we're going beyond aesthetics. This is about autonomy, power, and informed choice. I want to introduce you guys to Dr. Jugenburg He is a trusted voice in modern plastic surgery. I'm so excited to have this guy on the real DR.six on ig. I'll share his credentials with you all in the show notes. And he's a pioneer in women's health. He's the founder of Listen to this, the Toronto Cosmetic Surgery Institute, and he's widely respected for his ethics and innovation. If you're 40 plus and you're deeply invested in how you feel, how you perform, and how you show up in the world, this conversation is for you and we're going to keep it real. So welcome to the show. I so excited to have you on board.

Dr. Martin Jugenburg (01:15):

Thank you. Thanks for having me.

Michelle MacDonald (01:17):

Let's talk about the evolution of surgery for the high achieving woman. This is often a taboo subject. We're whispering about it in the back corners. There's a lot of judgment around it. I want to hear from you, in your experience talking with women, how has the industry shifted less about anti-aging and more about agency and natural enhancement?

Dr. Martin Jugenburg (01:42):

So things have changed. The biggest change is that it's no longer such a taboo subject. People are not so ashamed of talking about it. It's a little more in the open. This started in the early two thousands. Things changed before then people would just hide it. Nobody would ever admit to having plastic surgery. And now it's come to the point where people actually show it off. You still have the group that tries to be very subtle. There's a very subtle, very natural plastic surgery, and there are people out there that I paid for it. I might as well show it off. So there's two different approaches. I do a lot of breast augmentations. For example, in the field of breast augmentation, you can go for a very natural tear drop type of a look. Or for the real full bubbly pushup kind of look, I call it a power boost, kind of gives you the boost and the cleavage. Women want that, and it may come as a short of people, but quite a few women say, you know what? I've paid for it. I want to show it off. I don't want to be subtle about it.

Michelle MacDonald (02:41):

Do you find a difference in at all in women that are older versus younger women that are running a business? Executives? I mean in terms of what they're looking for,

Dr. Martin Jugenburg (02:58):

Younger women are little more about showing it off. Older women, more professional people, they're more about subtle changes. They want to feel good in their own skin. There's all this misconception that people with that one plastic surgery have self-esteem issues, have mental health issues, not at all. Your typical professional young woman, there's just something that she wants to make a little bit better just to feel better in her own skin. One of my patients, an athlete, someone who scales Mount Everest kind of thing. She said, I just want to feel still confident when I walk down the beach. It's not because I'm trying to show off. I want to feel good when I put on a bikini. And that's the thing. People want to feel great in their bodies, and I think that's something that I think you see in your clients, in your population. People try to be healthy because they want to feel good in their body, want to feel healthy, and they want to feel confident in the way they look and how they feel and how their health is. And this is about feeling great in your own body.

Michelle MacDonald (03:57):

Yeah, it is a shift away from trying to fit look like somebody else, but really with the people in my audience, these are women that are really investing in themselves, whether that's through career counseling, they're joining mastermind groups, they're learning how to train at the gym. They're building muscle. They're really trying to optimize as much as possible. They're changing how they're feeding themselves. They're conscious of their bone health and all of that. And it's really more a move towards being proactive around the aging process and trying to enhance their own natural beauty. It's that confidence and that harmony with how they're feeling inside and their refining versus completely reinventing. They don't want to look like somebody else. I don't want to look like some supermodel. I want to look like myself the best I could possibly be.

Dr. Martin Jugenburg (05:01):

Absolutely. It's the woman that spend millions of dollars looking like a bar to make the headlines. But your real plastic surgery patient is the woman who just wants to be the better version of herself, more confident in her own body, like your patients. They spend all this time and effort to be healthy. They work out, they build muscle, they tone the muscles, they burn fat, they get beautiful physics. But there's certain things that just no amount of that exercise can help. And that's where I come in and I'm able to help with the final step that you just can't do on your own. There's some things that no amount of willpower can do.

Michelle MacDonald (05:35):

Yeah, there's a lot of, I know the glide world is awry with a lot of judgment. People should just white knuckle it through the diet process. And my husband and I were discussing for people that have a lot of food noise that can lead to emotional eating, binge eating and that sort of thing. It can a very, very powerful lever to be able to pull. And it's true. There are some things that if I think of in my family, the woman genetically have a lot of eyelid skin. And I had my first eyelid surgery, just the upper lid, but I had that done when I was 36 and it made the world of difference. It was very subtle, no one noticed. Very discreet, very subtle, but it was incredible. And I thought, gosh, this is incredible. What's possible these days? And my mother, everyone knows my mother, but my enticement for her, which she didn't take up until two years later, but one of my enticements for her to join my transformation program, I said, if you can lose 30 pounds, I'm going to pay for your uroplasty. And because she was 70 and she could barely open her eyes, she barely open them. There's just so much excessive skin. Yeah, that's

Dr. Martin Jugenburg (06:57):

A great example. So excess skin is something that doesn't go away with that exercise. SUH, you lose elasticity in your skin, skin stretches out. You get saggy skin. There's no magic. There's no exercise that you can do. You simply have to trim it up. There's only surgery that can help in a situation like this. You don't make it subtle. You want to look refreshed. You want to look like you're more awake, not wide open eyes like, oh my God, what did you get done? It's subtle. You look beautiful. You look like yourself. Less tired, less exhausted, more alive.

Michelle MacDonald (07:27):

Yeah. Yeah. I think a myth worth dismantling is that surgery is about vanity versus surgery is self-respect and it really has to die.

Dr. Martin Jugenburg (07:41):

It takes a lot of courage for women to come in and get surgery. It's scary. People are scared. It actually takes a lot of courage, a lot of time for 'em to sort of cross the thresholds, the fear of the surgery, fear of pain and recovery. But there's also unfortunately this shame. People feel like, oh, I'm kind of cheating. You're not cheating. We are here to help you. We are not trying to fast track or skip some steps. You've done all the hard work, you've done your part. Now we come in and we can help you with what we can help with.

Michelle MacDonald (08:09):

Do. Just probably, this is an obvious answer, but do you only work with women or do you work with men as well?

Dr. Martin Jugenburg (08:17):

We have men as well. In our practice, men represent about 5% of our patients in some practice could be go up to 15, 20. But women are mostly the people that are interested in cosmetic surgery, plastic procedures, men, it's a little more limited. Men would get a facelift, men would get gynecomastia, which is male breast reduction, tummy attacks, maybe liposuction. Those are the more common procedures in men and women, the whole gamut of it. We do it all.

Michelle MacDonald (08:44):

I feel like I see a lot more men, especially in the bodybuilding world being very open. I think sea bum was probably the most open about getting hair, plant hair,

Dr. Martin Jugenburg (08:56):

Hair restoration.

Michelle MacDonald (08:57):

Yeah.

Dr. Martin Jugenburg (08:58):

Yep. Yeah, we do quite a lot of that. So that I didn't mention, but yeah, it's probably one of the more common procedures for men. So as women are more concerned about their body, men tend to be concerned about their head than their hair. Yes.

Michelle MacDonald (09:09):

Interesting. And it makes an incredible difference when you see those hairlines change. It's fascinating. Dr.J, what is the most self-honoring reason you've heard from a woman 45 plus pursuing a procedure?

Dr. Martin Jugenburg (09:23):

Pretty much every patient is just so grateful for what we can do for them. I dunno if you watch me on social media, but just yesterday I reposted a video. It was actually a younger woman, she's in her twenties who was crying because she's never felt comfortable wearing a bikini. We did a tummy tuck for her with some liposuction and she just posted a picture of herself in a bikini and started crying. This is the positive impact we make on people. We make people happy. I spoke to some other healthcare professional about this, and I said, I work with happiness. I'm not curing cancer. I make people happy. And if you're not happy, sometimes life's just not north worth living. So we try to make quality of life better. We are quality of life, happiness type of procedures.

Michelle MacDonald (10:09):

I love that. That's a great byline. I make people happy. We're kind of in similar businesses, but I'm on the slower road.

Dr. Martin Jugenburg (10:20):

True. But people think it's because it's quick. It's a little bit of cheating. It's not cheating.

Michelle MacDonald (10:26):

No.

Dr. Martin Jugenburg (10:27):

There goes a lot into this. There goes a lot of work and people need to understand that what I do is just a part of it. Best results come when the doctor and patient form a partnership. I do my part and you do your part in recovery and maintaining what we give you. Because once I do a tummy attack or liposuction or a facelift, you're not frozen in time. You're not a admirable statute sculpted, and that's going to be like this forever. You have to work hard to maintain it. If you don't, it's all going to fall apart.

Michelle MacDonald (10:58):

And on that note, I know that emotional resilience, decision making power is pretty huge for you. And I think we were talking earlier, you had mentioned that for some people you recommend that they're not a candidate for surgery. So I'd love to talk about that a little bit with the listeners. In this phase of life, we like to think we know who we are, but judgment can still really linger and especially around choosing surgery. So let's talk about emotional readiness. I know that you screen for motivation and mental state and grounded expectations, so it'd be great maybe if you would talk about what an ideal, what would you recommend to somebody if they're interested in this, whether it's the eyelids or whether it's the jawline or whether it's a face, whatever. How would you get them to be in the right frame for this?

Dr. Martin Jugenburg (11:50):

So the screening we go through is a separate screen process. First, we want to make sure that you're medically healthy. So we do a medical screen, medical questionnaire. We want to make sure that you're mentally ready, you're in the right frame of mind. And then comes the big one. The big one is realistic expectations. And that's really difficult these days with social media. Nobody posts stuff. Everybody's filtering results. Everybody's just forcing the best version of themselves. So people see these perfect bodies. Now AI is getting into, it's going to be really a big problem, and they're seeing these things and they're thinking, oh, that's normal. I can look like this. And so for me, the biggest challenge in my practice is explaining to my patients is and what is not realistic, what I can and cannot create for them. People don't realize it, but I'm not a magician. I'm a plastic surgeon. I got to work with your anatomy, with your body, and I can't create something out of nothing. We got to work with your existing anatomy. That's the biggest thing. And again, going to expectations. Unfortunately with social media, even people that post about their surgeries, they still filter their pictures,

Michelle MacDonald (12:53):

Filter. They're filtering,

Dr. Martin Jugenburg (12:55):

Even if they're being honest about their surgery, what they're putting out there is the best version of themselves. People still filter things. So even though you've shown me a picture of women that had, let's say BL present, but lift or a facelift, whatever else, but that's not how you're going to look. That's filters, that's makeup, that's sliding in real life results are not as great. Recently, there's a couple of celebrities, I don't want to mention any names, post the results and everybody was going crazy like, oh my God, who's a surgeon? I want to know. The answer is it's a filter. So no surgeon can really do that. They look great. They had a beautiful work done. But those filters, they just push you just that tiny little difference that as a plastic surgeon I see, make all the difference. And that is just unrealistic. That one last little step is just so difficult to achieve.

Michelle MacDonald (13:42):

Yeah, it's that navigating enhancement. We want to enhance what's naturally there versus, and we can all see it. We're hurling. I think we've been hurdling since the Kardashians came to that celebrity status. We've become so normalized to filters and to excessive amounts of makeup, and it's a real problem, especially for the younger people, but for the women who are listening to this really doing the work, whether it's researching, whether it's talking to other women who have gone through it. I know one of my clients is interviewing several doctors and really taking her time and not being reactive. Like, okay, I'm going to cut my bangs today. Really being thoughtful and making sure that it's the best decision, it's a healthy decision, and that they've got clear and guided expectations for the outcomes. It's so important.

Dr. Martin Jugenburg (14:47):

If I can give one piece of advice to your

(14:50):

Viewers, your followers. If you're thinking about cosmetic plastic surgery and you're sort of doing your research, trying to find some inspiration, please, please don't go on social media. Don't look at models, don't look at influencers. Go on plastic surgery websites which have standardized before and after pictures, nude pictures or minimal coverage. Bikini pictures where you have the standardized lighting and position before and after, hopefully respectful plastic surgeon or the side hasn't altered their pictures. You're seeing the real results. And then try to find somebody who looks like you in the before picture. I'll give you an idea of what someone with you anatomy your body can expect. Because if you're a short person with really wide hips, I'll never be able to give it a tiny waist that somebody else may have. That's tall, lanky, and super, super narrow

Michelle MacDonald (15:39):

Structure. Yeah,

Dr. Martin Jugenburg (15:40):

Two different structures, different skeletal structure, different fat distribution, two different people. It's just not possible. So try to find someone who looks like you in the before to get an idea of what we can do for you in the after.

Michelle MacDonald (15:54):

I love that. Okay, so just to reiterate that for people that are listening, instead of going to social media, I mean you might find somebody on social media, but then what you really need to do is go find that surgeon on a plastic surgery website. Is there something, is there a specific site to go to?

Dr. Martin Jugenburg (16:11):

So each surgeon has their website with their before and after gallery. So you can go on plastic surgery websites. There are some sites which cover a lot of, there's one called the realself.com, which has surgeons from around the world, thousands of pictures, great resource and look at their galleries. And the idea is you want to find pictures where the before and after in the same position, same lighting, same shadow, because posing makes such a big difference. I see this so much and it's like one of my little pet peeves when surgeons post before and after, they showed a sterile before picture that they take in in their office where a patient's standing and then they send it next to it is after is the patient selfie where she's twisted, smiling, filtered, completely different position. It's not a good fair assessment of the before and after. You really don't know what happens. So you don't want to have standardized photos. It's so important. Same pose, same light, same shadow before and after. Very important.

Michelle MacDonald (17:08):

Very important. I love that. Let's talk a little bit about surgical interventions through the longevity lens. This is dear to my heart. When I think of how I want to be when I'm 90, I want to make sure that I'm doing all the things preemptively that I can do and then also being very timely with any other larger interventions and that I'm sure a lot of listeners are, they're with me. I know when I'm on socials, I'll see some of my clients, I'll see their names on the same doctor sites. I'm like, oh, she's looking at that too. My clients and most of the gals listening to this show, they train hard. They're eating intentionally. They're doing everything to optimize muscle growth, bone density, all of that hormonal health. How does surgical strategy fit into this performance forward life?

Dr. Martin Jugenburg (18:02):

So when I work with athletes or people have gone through weight loss journeys, the issues we are facing is skin laxity. Skin laxity is just something that no amount of death or exercise can really help with. And this is where surgery comes in. So you need to understand that if you have loose skin, you're going to be treating loose skin for scars. There's no magic. People are always asking for non-surgical skin tightening procedures. There's millions out there. And if they worked, I would be out of business. That tells you how well they worked. Okay,

Michelle MacDonald (18:30):

Say that again. There are a million non-surgical skin tightening

Dr. Martin Jugenburg (18:35):

Procedures,

Michelle MacDonald (18:36):

Procedures,

Dr. Martin Jugenburg (18:37):

And if they really worked,

Michelle MacDonald (18:39):

You'd be out of business. Did they work? A little bit? A little bit. Not statistically significant.

Dr. Martin Jugenburg (18:45):

A little bit, right. So there are some little treatments for the phase where a millimeter makes a difference. But if you try to do the same thing on your tummy where you have lots of hanging skin, you're not going to notice much of a difference. So we do offer some treatments to our patients. This is usually ideal for somebody who's got really minimal skin laxity. If I'm doing liposuction, I add a treatment called Renu VG plasma, which just kind of tightens things a little bit. It is not a replacement for a tummy attack. If someone needs a tummy attack, nothing is going to replace a tummy attack. And tummy attack is ideal for somebody who's got a lot of loose skin. And if you're wondering, am I one of those people, the best thing you can do is sit down. So you're sitting, you got a 90 degree flexion at your hips, grab your belly skin.

(19:27):

If you can grab your skin and pull it down, you have enough skin for a tummy tuck. If you are struggling to pinch your skin, then you don't need a tummy tuck. You can't get a tummy tuck. And I'll go on a little tangent. We sometimes see women who want not necessarily, they want an arm lift or a thigh lift, and they're in a really, really good shape. So there'd be an example of somebody that would turn away. You really need to have excess amount of skin because you are treating the skin for scars. And sometimes having the scar is just not worth it. Sometimes it's better to have a little bit of skin laxity. So don't be so hard on yourself. Accept little imperfection. Sometimes surgery is not the best option. Sometimes doing nothing may be the best option.

Michelle MacDonald (20:08):

Yeah, I remember you saying that on our call earlier. You're replacing loose skin with a scar. Same thing with a breast lift, right? Like do you need a breast lift knowing that you will have that scar. And that's something to really get the head wrapped around because otherwise you're living with a choice that you weren't really fully aware what exactly you were making.

Dr. Martin Jugenburg (20:33):

Exactly. And if you think for a breast lift, look at a breast lift scars. Again, go on a plastic surgery website. Look at the scars. If you go for consultations with a plastic surgeon, ask them to show you, not one, but a lot of scars. You don't want to see the one best scenario. You want to see a lot of breast lift scars to get an idea of what the scar is going to look like and what the surgeons able to create for you.

Michelle MacDonald (20:55):

So that being said, are there things like, I'm going to ask some questions that my clients have wanted me to ask you. So say a Gail has had a lot of filler done and she wants to be best prepared for surgery. Would you recommend that she dissolve her filler? Would you recommend that she do any procedures to help amplify the quality of her skin? Is radius something she should be doing? Any kind of kneeling, whatever? So I'd like you to talk about what could somebody do if she was really thinking about preparing for that kind of a surgery to give her the best outcome?

Dr. Martin Jugenburg (21:30):

The only thing I would recommend is try to dissolve your fillers, but that's actually difficult. Fillers spreads a little bit. It's difficult to get the digestive enzyme that dissolves fillers just in the right place. So do your best. See if you can dissolve it. But if you can't, maybe give it some time so it dissolves on its own. But don't do anything else. Don't do red ideas, don't do any skin rejuvenation, nothing that, just let it be pure, untouched. Virgin skin is the best skin for a facelift.

Michelle MacDonald (21:58):

Interesting. All right. So if you can't dissolve the fillers, do it. Don't stress about it. Definitely don't get more fillers put in. Is that because it complicates things as you're working? Does?

Dr. Martin Jugenburg (22:10):

Well, there's the illegal fillers and the illegal fillers. Illegal fillers would be things that are permanent, like silicone people used to inject silicone or all kinds of different things. Those are horrible. The legal fillers most commonly are called hyaluronic acid ha fillers. And these work by sucking in water. So you inject this molecule called hyaluronic acid and it absorbs water and the water kind of swells things up, gives you volume, which is great for filler purposes. The problem is when you do surgery and you operate through these water swollen areas, if you're trying to put some stitches into it to put traction, you're trying to pull on the skin, attract something, you're putting sutures into water, it's not holding, it's going to rip through. So it's difficult to get a good traction and pulling up the skin.

Michelle MacDonald (22:55):

Well said. Alright. And then in terms of what are best practices that a woman can do if she's sort of taking a more minimal approach. So let's say, and then I'm going to ask you what's worth it and what's not worth it. So for example, say you've got a 30 5-year-old and she decides like I did, I'm going to get my eyelids done or whatnot. But I also can see that my skin's starting to get a little bit lax. What are some things that she could do in terms of enhancing her skin? Can you talk about that at all and what's not worth it? What is it that needling that they put in and pull, is that worth it? Is it not worth it?

Dr. Martin Jugenburg (23:39):

The threats don't even get me started, but lemme start by saying the best, the most effective and the cheapest anti-aging process treatment you can ever do is don't smoke and wear sunscreen. Smoking and UV radiation are by far the worst things you can do for your skin. And it's so easily demonstrable. UV radiation creates wrinkles, degrades the elasticity of your skin, obviously skin cancer, but that's the quality of a smoker who's been out in the sun. Their skin is just absolutely horrible. So those are the simple things. Now this would be advice from early on, this the advice I give my younger patients and my girls who are teenagers away from the sun and don't ever smoke. As you get older, what can you do? So again, you want to protect yourself from the sun. So avoid your variation, sunscreen when you can or have protect yourself. Next thing is moisturizer. Vitamin C is great. Topical vitamin C or vitamin supplements. These are great things that are pretty cheap and are very, very good for your skin.

Michelle MacDonald (24:52):

You didn't mention retinol or any of the other.

Dr. Martin Jugenburg (24:55):

So retinol is vitamin A. That's great too as well. Retinol creams. Yes.

Michelle MacDonald (25:00):

Alright, that sounds pretty simple. So everything else, so you didn't mention it, so that's taboo.

Dr. Martin Jugenburg (25:06):

So you mentioned threats. I am not a big fan of threats. When I was a resident, I was trained to be a plastic surgeon. I remember my teachers telling me about threats, the old threats, how horrible they were. And so I never had the desire to even try them. And they kind of made a comeback. And it's unfortunate, 20 years later, people kind of forget about all the bad things. Now they may comeback. So you have all these threats and I have not heard any good stories about them. They either don't work, lead people with complications or fail after two, three months, which you would expect. So if you're happy spending money on a treatment in the last three months, go ahead. The downside though is that every time you put a thread in, it's going to create a bit of scar tissue and you can create a lot of scar tissue. You keep doing this so that when one day when you come back and need a facelift, the scar tissue is going to prevent easy mobility of your tissues can potentially create scar tissue that creates contraction between a scar and facial nerve, which is very dangerous. So it can cause more complications. So yeah, I'm not a fan of threats at all. Not at all.

Michelle MacDonald (26:17):

Yeah, okay. Thanks for covering that. I know I've seen other plastic surgeons talk about that and they're definitely not enthusiastic about it. It's like a stop gap and it's not that effective.

Dr. Martin Jugenburg (26:28):

You'll notice people that do threats, people that are not able to operate. So they're limited in what they can do. That's all they can do. So that's what they push unfortunately.

Michelle MacDonald (26:39):

Okay. Let's talk about some other hot topics. What about things like cellulite? Is there anything that you can offer surgically for that?

Dr. Martin Jugenburg (26:48):

If I had a solution to a cellulite, I'd be a billionaire. There's a few treatments out there that simply promising. There was one a while ago that sort of helps to sort of break the adhesion. So what is cite? Cite is not lack of fat. It is when you have skin and there's little ligaments that are holding the skin down and it's pulling full down. So the treatment is to go and cut that little ligament. The skin can pop out. The problem is when you cut that little ligament, it's a cut, it's a surgical cut. And how to cut heal by scars. So scar again forms and pulls it down. So there's treatments that can make things a little bit better, but if you have cellulite just accepted that you could have treatments, they could make things better, but they'll never go away. There's no perfect cure for cellulite.

Michelle MacDonald (27:35):

So you're looking at maybe augmenting it, maybe not. And then how significant is the result versus what you have to go through?

Dr. Martin Jugenburg (27:42):

You could be a little bit better for a little bit, but eventually C light just comes back.

Michelle MacDonald (27:47):

So no big breakthroughs with that yet.

Dr. Martin Jugenburg (27:49):

Unfortunately, I'm still working on it, but I have yet to invent it.

Michelle MacDonald (27:53):

So let's talk about skin laxity. What about skin laxity around the glutes or the knees, elbows, these sorts of places? Are those operable or not?

Dr. Martin Jugenburg (28:05):

Unfortunately, no. Two reasons. One, you could technically, the problem is those are really, really bad places to put scars because you put a scar in an area that's small bowel and the scar as it's healing, it's going to be a very, very ugly scar. Second thing is unfortunately you do need the skin access to allow you to bend the elbow to bend. Because if you tighten up the skin, then you won't be able to bend your elbow. And if bend it, you'll rip it and stretch it out again. So that's sort of an anatomical problem that we can't curate.

Michelle MacDonald (28:38):

And it's also all of this is taking place against that backdrop of age. And again, are we enhancing something or are we trying to

Dr. Martin Jugenburg (28:51):

Turn back time? And what happens when you were 18, when you were a little baby, you have a lot of elasticity. You could bend your elbow, you straighten your elbow, and the skin would stretch like lasting band, SUH, your elastin fibers and molecules that provide us unfortunately age as well. And surgery does not regenerate that. Maybe in the future with some sort of stem cell therapy, some sort of true molecular origination, we'll be able to use our cells to rebuild more youthful elastin. But until it happens, there's no real treatment for that.

Michelle MacDonald (29:24):

Another important thing to remember when we're trying to modify our expectations and being, I feel like realistic is such a buzzkill, but we want to go into this knowing I love getting older. I can't wait till my hair goes totally silver. I'm excited about it. Like I said, for a lot of women, if there's things that they can do that have a good, I'm going to say ROI on them, it's worth it. But we're not getting into that narrative of I'm afraid to age. I'm trying to get back to being 18 again because now we're being incredibly vulnerable. And when we're vulnerable, we're going to end up doing things with getting thrifted, working with charlatans. And ultimately it's a very bankrupt journey.

Dr. Martin Jugenburg (30:14):

Aging is a process. You can't escape it. Antiaging is a big buzzword everybody's trying to do. I want to be very clear, plastic surgery is not anti-aging. I cannot reverse the nature of your tissues. I can reshape them, I can reposition them, I can make them look better. But the nature of it, the way it's built, it's still that same age. So if I do a facelift for somebody, I can make them look better, but their skin is still going to be same elasticity as it was before. It will not be. It may look better, but inside of it, it's still an older person, not an 18-year-old person.

Michelle MacDonald (30:51):

So being able to modify those expectations and really doing that mental work of being in love with your age and who you are as a person. Super important. The last question I'd like to dive into is more about people that are in fitness and what would be do's and don'ts. How can they prepare best for surgery? I know to be transparent, one of the things I'll say to my clients, oftentimes they'll say, I'm really thinking about having a breast lift or a tummy tuck. And what I'll recommend that they do is let's pursue with what we're doing until we get to maintenance. So you see the curve, the rate of loss sort of goes from this to sort of flat lining and then it's like, alright, this is maintenance. Let's reverse diet, let's get you on some good calories. And now this might be my fantasy, Dr. Martin, but I'm like, let's get that subcutaneous matrix kind of stabilized to this new size that you are. Let's see if there's some tightening that happens naturally, maybe a two or three months and then that would be a great time to go and pursue surgery. Don't get it right away. And plus I'm also thinking of any possible rebound effects where they're not able to train for a month or two months. And I worry about the psychology of that because of course training and having a routine releases endorphins supports you mentally and there's a negative effect mentally for some people at least of getting surgery and recovering from it.

Dr. Martin Jugenburg (32:35):

So actually I understand. So you're referring to patients who have losing weight

Michelle MacDonald (32:39):

Patients? Yes.

Dr. Martin Jugenburg (32:40):

Okay.

Michelle MacDonald (32:41):

And getting muscle. We specialize in that body recomp.

Dr. Martin Jugenburg (32:45):

So if somebody is in the process of losing weight, my recommendation is for 'em to lose the weight, get to the level that is stable and achievable. You can push yourself really low, but if you bounce back, that's not worth it. So get yourself to the level where you're comfortable, you're healthy, and then you want to be there for at least three months. You want to make sure that you're not bouncing up and down, then your body is adjusted to this new level and it's comfortable there. That's sort of a way point of view when you're asking me how to prepare people to be honest, this is the easy part. The more difficult part is mental have realistic expectations. In my business, in my practice, the biggest challenge is managing people's expectations. That is by far the most difficult thing I do in my consultations, in my preparations for surgery and wanting to make sure that people understand what they're getting themselves into, what they can expect, what the recovery is going to be like, and that they're not disappointed. So they don't have, I tell my patients, even if I do the world's greatest surgery, if it's not what you wanted, you will not be happy. So I want to make sure that what you want and what I can deliver can match up.

Michelle MacDonald (33:53):

Is there anything else that they should prepare for in order to have the best possible outcome? So they've done the diet, they've maintained for a bit, is there anything else that they can do

Dr. Martin Jugenburg (34:04):

In terms of health? You want to be nutritionally stable. When people lose a lot of weight, their protein levels may be out of balance. You want to make sure that their protein levels are good, their vitamins, vitamin C and folic acid supplementation is always very, very good. We do blood work on our patients to make sure all the from blood levels are all appropriate. Avoid injuries. Avoid injuries. If you're talking to somebody who is very, very vigorous athlete, make sure you don't hurt yourself while you prepare yourself for surgery.

Michelle MacDonald (34:38):

Is there a timing for this? Right? So if say somebody wanted a facelift, orlu, plasty, breast lift, tummy tuck, should she do it all at once or is it better to space these surgeries out in terms of just the hardship on the body? Because traumatic right to get the surgery done,

Dr. Martin Jugenburg (35:00):

It is possible to combine multiple procedures in my practice. So the limiting factor is the total amount of time I'd like to keep my surgeries under six hours. If you go over four to six hours, potential risks of infections, blood clots, other problems can increase. So we want to try to keep it to minimum. Sometimes we do longer surgeries. Let's say if you have a patient traveling from across the world and they can't keep flying back and forth from New Zealand or something. So we just try to combine it. But if you're a local patient and if it is possible for you to break it up, then we try to break it up to maybe one or two stages and see what we can do for you.

Michelle MacDonald (35:33):

I have a couple more key questions again, just for the people that are probably going to be listening to this and that, that are interested. Another would be recovery time. I kind of joke with my joke with I

Dr. Martin Jugenburg (35:46):

Was going to talk about recovery.

Michelle MacDonald (35:47):

Okay, alright, dive in.

Dr. Martin Jugenburg (35:49):

Your clients are people that work out a lot are very physically active. So you do have to plan ahead your recovery because after surgery you want to take it easy. You have to give your body time to recover. Now I'm not saying stay in bed, but we don't want vigorous recovery. I don't want to reduce your heart rate blood pressure, don't want to create any bleeding, bruising. You don't want to rip open any incisions. So you do have to plan on taking it easy, which I find can be a struggle for some people are very health-minded and can't imagine living without going to the gym. But six weeks is how much it takes for your body to recover to the point that it's able to withstand sort of daily activities. So for the first six weeks, take it easy, sort of like a leisurely office-based lifestyle. After six weeks is when you can go back to the gym and slowly build yourself up. So for your clients, if they're very, very go-getters into the gym, they need to plan. When is a good time for me not to go to the gym and prepare themselves mentally because sometimes people get very, very anxious. I got to get back, I got to get back, maybe plan ahead. What can I do that's low impact gets my heart going, but allows me to recover without damaging my surgical results.

Michelle MacDonald (36:58):

And let's talk about some red flags too. When you're vetting your surgeon, what are some red flags? What credentials should be looking for? You talked about the recovery approach. Can you talk a little bit about how would you vet your surgeon? This is key, right? This is a big investment. It's financially a big investment. Health-wise it's a big investment and outcome. It's a big investment.

Dr. Martin Jugenburg (37:22):

This is a tough question because with social media, with advertising, anybody can make themselves look like they're super genius. They have the breast one procedure no one else can do. What you want to do is basics. You want to see what is the qualification of your surgeon, what is the board certification? There's a lot of, I don't want to say fake boards, but there's boards that just require you to pay a membership and there's boards that require to be properly examined. So in Canada we have the Royal College of Physician Surgeon of Canada. So if you're certified by the Royal College, that means that's your specialty. In the states is the American Board of Medical Specialties that has different specialties. So you can be specialized in let's say a plastic surgery or ENT or internal medicine. So these are the official specialties. So you want to see what is their certification, what did they train in, what did they do residency.

(38:14):

That being said, there's a lot of doctors that may have sort swayed away from their area of specialty and could be very good at what they're doing. So the next step is you want to look at their reviews. You want to look at their reputation in the community and you want to look at their before and afters and any surgeon can show you two or three really nice results. You want to see a lot of good results. You want to see a pattern of good results. If you're on social media, you want to sit and post a lot of different night results. If you look at the reviews, look at the reviews. Now nobody's perfect. If you see someone who's got perfect reviews, run away. That's to be a red flag. Everybody's got one or two unhappy patients for whatever reason. But look at the unhappy patients, see if there's a pattern to it.

(38:53):

Get a sense, is this somebody that I like? And then finally you go for a consultation, get a feel. Now it is difficult because you can get fooled so easily and going by your gut, that's not really a good biometer of who's a good surgeon. If you can ask, do you know anybody who's gone through this surgeon? Do you know other people that have gone through this person? Do they have good results? Are they happy with the results? If they had a complication, which can happen, how was it handled? No surgery is perfect, no procedure is foolproof. There will be complications and if it happens, did the surgeon handle it well? Did they help the patient recover and salvage the situation? Those would be the things I'd be looking for.

Michelle MacDonald (39:33):

People that are active and maybe they're really busy in their careers give up. They don't want to have a lot of downtime in their year with tri, but they're interested in the best that the low hanging fruit, if that makes sense. For investing in some enhancement, is there anything that you would recommend? It really pairs well with that active lifestyle and doesn't have that big downtime.

Dr. Martin Jugenburg (40:03):

So liposuction has minimal downtime, but liposuction may not be the ideal treatment for your clientele because your clientele, I imagine that people who build muscle and lose weight and that means they probably have loose skin. Liposuction does not help loose skin. If anything, it makes it worse. So for patients that have lost weight, there's really no shortcuts. You really have to realize that if I have loose skin, there's no magical treatment, it just needs to be trimmed and if I trim it, I probably need about six weeks recovery before I get back to strenuous physical activity

Michelle MacDonald (40:41):

About, I mean, I don't think all women that are in fitness have loose skin problems other than the normal C creeping of your neck and all that sort of thing. Some do, but I'd probably say at least in my clientele, the majority don't. So more towards women that don't have those issues where they would need the tummy tuck. Is there any kind of surgeries that you feel have remarkable results in terms of that enhancement but more minimal downtime?

Dr. Martin Jugenburg (41:16):

Well, when you combine the right surgery for a patient with a good surgeon, you'll have remarkable results regardless of what the procedure is. So really it's individual to get nice results. You want to have a skilled surgeon and the surgery that addresses the problem because if you're doing the wrong surgery, no matter how hard you work, it's not going to look good.

Michelle MacDonald (41:35):

Great. So also probably working with the surgeon that has quite a bit of experience and the feel that you're having, I don't know if this is true or not, but the feel that you're having in their chairs, not that they're trying to sell you on something.

Dr. Martin Jugenburg (41:47):

So if you want find someone reputable, go for consultations and ask, listen, here I am, what would you recommend? What do you think? But that being said, personally when people come to me, I'd like them to tell me what's bothering them. I personally don't like it when someone comes to me and says, doctor, here I am. I'm a blank canvas. Do whatever you'd like because I'd like them to identify what bothers them. If I'm going to identify something I see but it doesn't bother them, then they should not be having surgery.

Michelle MacDonald (42:16):

That brings me to my next question. What's one mistake you see high achieving women make when approaching surgery?

Dr. Martin Jugenburg (42:23):

I would say that the mistake or myth is again with social media, making things look so easy. So simple. People forget that going for surgery is a real deal. Going for a facelift is not the same thing as going for a facial. It's a real surgery with real potential risk and complications and real recovery time. It takes a while. You'll be out of commission for a while, which is what a lot of high power women don't have time for. They want to get back and busy lifestyle. You do need to plan for the fact that you will not be presentable for a while and it'll be a while before you feel back the normal

Michelle MacDonald (43:03):

How long? Let's have the heart, how long. Somebody says, I want to have the, what is it, the deep plane, deep plane

Dr. Martin Jugenburg (43:07):

Facelift,

Michelle MacDonald (43:08):

Deep plane, right? So how long is it going to be before they can go on that zoom meeting?

Dr. Martin Jugenburg (43:13):

Two weeks for two weeks, you'll be wrapped up. You're not going to look presentable. After two weeks you're going to look good. Now you will note something's been done, but people have never met you before will hopefully just not realize. Three months is when you're fully, fully healed. Your scars have faded, all the swelling is gone, everything is good. But two weeks for sure, you don't want to leave your home. You can do zoom meetings with no camera.

Michelle MacDonald (43:36):

I think two weeks is not too long period of time. What about the breast in tummy tuck skin?

Dr. Martin Jugenburg (43:46):

So those things you can cover up. Again, two weeks plan on being home two weeks after two weeks you'll go out and if you fully dress, no one sees your bandages, your scars, and it'll take three months to heal. So it's always the same sort of pattern. Three weeks, three recovery, and then three months to be well healed. But for body work, because you can get dressed. Yeah, you can go back to work and no one, no one will know anything. You just look good.

Michelle MacDonald (44:09):

I think the last question, this is my second last question, but it's so great to have you here and you have such a calm and straight up no BS approach to all of this, which is I love that, right? I mean I'm all about giving options for people that are evidence-based and allowing women to make empowered choices for themselves. The last one is going to be around breast augmentation. I think a lot of my clientele have had breast augmentation and they've had them for now 20 years or so. I've had a couple of gals who've had complications with getting, not an explan, but a reconstruction, right, where they've had to have multiple surgeries, which seems very, for me, it's heartbreaking as their coach because it's one surgery after another surgery. What are the expectations? What would you cancel women that maybe have had breast implants for a long time, what maybe should they be doing? How to find a great doctor? I think there's so many people doing breast surgery right now. There's probably the likelihood that people are getting surgery based on the price point versus really vetting. Is that surgeon a really great surgeon? God forbid you have to have multiple surgeries.

Dr. Martin Jugenburg (45:33):

Yeah, so breast augmentations and Brazil, but lips are probably the two that pop to my mind where people really bargain shop and it's your body don't bargain shop. Groupon is not the place to look for a plastic surgeon. So the question was what would I suggest to people that had implants for a long time? So the recommendation by the FDA is to do screening. If you have silicone breast implants, you should get screening. So either high resolution ultrasound or MRI to make sure they're not ruptured. If you have sin implants, no worries. Because if you have a sin implant, if it leaks in ruptures, the ceiling salt water comes out, your body absorbs it, your breast deflates right away. So that's one of the reasons why I like seal implants. They're very, very simple things that you sort of mentioned. People sometimes have multiple surgeries.

(46:19):

So what can happen with breast implants is they can develop what's called capsular co contracture. Capsular co contracture is when the SC around the implant solidifies hardens and contracts and it becomes hard misshapen and components become painful. If this happens, the treatment is surgery. The treatment is to go in, cut out all the scar tissue, potentially change the implant, put everything back. The problem is we don't really know what causes cancer co contracture. We suspect too many causes being either blood collection. So if you bleed during surgery, there's some blood in the space that can stimulate contracture or bacterial contamination. And this may come as a shock load of people, but women's breasts are not sterile. There's a lot of bacteria in there. So if you think about it, you have milk ducts that come out to the nipple and those are sort of empty ducts.

(47:08):

So bacteria crawl in and there's bacteria inside the breast ducts. They're not infecting the breast. It's called colonization. But sometimes it's bacteria can spread out, especially in women that have cystic breasts and can affect the capsular on the implant. Cause capsular co contracture. So if somebody had a capsular co contracture, unfortunately the risk of recurring a capsular co contracture is higher than somebody who's never had a capsule co contracture. And this is when it happens that some women have multiple surgeries and we treat them, we do it one or twice. If it keeps happening back then I tell my patients, you know what? Maybe we should take them out. Maybe your body's just reacting and this is just not good. Take them out before it becomes a serious problem.

Michelle MacDonald (47:50):

Interesting. Okay. And then so for women getting a screening, if their screening shows it's not a problem, then they really don't need to go and get that reconstructive surgery, or do you still recommend that they see a good doctor and have a consultation?

Dr. Martin Jugenburg (48:09):

So ideally, you're still in touch with your original plastic surgeon already. Your breast augmentation, who's screening you sees you once in a while if that surgeon has retired or left, maybe you can get referred to somebody else or talk to your family doctor. But in terms of what you need to do, so the old recommendation was every 10 years to have them exchanged. The current recommendation is let them be, do the screening. If the screening shows that your implants are perfectly fine, there's no need to go and have unnecessary preventative surgery. So I don't recommend to my patients that they need to come back every 10 years. You don't need to change them every 10 years. You just need to do screening to make sure they're intact. If there's a problem, then we'll change them for you. If there's no problem, just let them be

Michelle MacDonald (48:49):

Perfect. That actually was surprising to me. I was under the thought process that they were still saying you had to replace 'em every 10 years.

Dr. Martin Jugenburg (48:57):

That's no longer true.

Michelle MacDonald (48:59):

There you go. See, I learned something. I learned many things today. Thank you so much. I think we've covered a lot of grounds and certainly people that are listening are going to be very interested in number one, what options are out there for them, the costs of course, but also the recovery time and then really how to vet a great surgeon. And certainly I would say that it's not just how expensive a surgeon is, but as you said, you look at their credentials. Look at if you can get some word of mouth, lots of photos, lots of different types of women, different. Hopefully finding someone that has a similar structure or issue that you might've had for evidence that they can really do great work. And you didn't mention this, but one of the things I always, always thought about when it comes to choosing a surgeon is, and maybe it's because all great surgeons are the same here, but somebody who's really has really great results with their scarring in terms of the stitching that they do, the meticulousness of their work.

Dr. Martin Jugenburg (50:10):

I agree. The thing is though, you rarely see scars. People rarely show scars, so it's difficult to see. But yeah, when you go and see a plastic surgeon and they show it a before and afters, ideally they should a new before and after. So you can really see the person's body and you can really see their scars. It does say lot about the fines of the work.

Michelle MacDonald (50:29):

Yeah, I think if you're meeting a surgeon that's proud to show you evidence of their scars, you probably found a really great surgeon.

Dr. Martin Jugenburg (50:36):

I can do a little plug in there. We show a lot of stuff on our social media so your folks can go on or watch us on Instagram on real Doctor six real D-R-S-I-X. I do show my scars. I show my scars a lot. I'm pretty proud of my scars. So I think we are known for our scars. So thanks for bringing it up.

Michelle MacDonald (50:53):

Yeah, you bet. And guys do head over to the real DR six. A lot of incredible social media there. A lot of great information. Interestingly, a different version of the guy that we're listening to right now. There's the music and the editing. It's a whole other level and you have an enormous following. Actually, you're kind of famous.

Dr. Martin Jugenburg (51:22):

I guess I jumped on this early on, so early on it kind of blew up. But I think what helps is we are different. Your typical plastic surgery account is really sort of static before and after and boasting about how good they are and all that stuff. We try to put an educational spin on this. I try to set realistic expectations. So when I show my stuff, I always talk about what I'm doing. Why am I doing it? I talk about the limitations. Each particular case, we actually show real surgeries now with the community guidelines. I've seen them, we've had to sort of scale back a little bit. We used to show complete surgeries and we were very transparent. We would show anybody who would consent to social media. So every person you see on our social media has consented, has in writing. And we don't cherry pick who we show.

(52:06):

We show anybody who agrees to participate. So you get to see real things. And I'll say, I am probably the only person on social media I know that shows his own problems. You rarely see complications on social media and if you do, the surgeon makes it very clear it's someone else's complication that they're fixing. I have no problem saying, this is my patient, this didn't work out and I'm here fixing it and showing you how I'm fixing it. And the purpose is, again, people need to have release expectations. They need to know sometimes things don't work out. Sometimes we need to come back and do a touch up or something else to finally get the result. And sometimes I show people with what's called hypertrophic scars. I show that not everybody can get perfect scar. We do our best. I would say my scars are very nice, but some people unfortunately have genetic predisposition to abnormal scars and no matter what I do, they always will have abnormal scars.

Michelle MacDonald (52:58):

Thank you so much for everything that you've shared today and for being so frank and so honest. Not only here, but on your socials. I wish we could just normalize all of this and get rid of a lot of the judgment from it and have that not be in the way. I know, again, talking about my mother, one of the resistances she had to getting that the eyelid surgery was a combination of not thinking she was kind of worth it and also feeling that it was a vanity surgery even though literally she could hardly open her eyes. Also fear that she couldn't recover from it. And in fact, she recovered incredibly well, incredibly fast. She was so healthy. I really want to make sure that this conversation resonates with elicits. We're not talking about chasing youth. It's really about being aligned with how you feel, look and lead your life. It's whether or not you ever pursue surgery. This conversation should really just be a reminder that you're allowed to shape your own evolution. How you decide to age is entirely up to you.

Dr. Martin Jugenburg (54:10):

Absolutely. I just had a patient a couple of days ago who came for a tummy tuck, her last child was 15 years ago and asked her, why did you wait for 15 years? She said, well, I spent all this time looking after my kids. Now it's time to look after myself.

Michelle MacDonald (54:25):

I think that's going to hit home for a lot of people. Thank you so much.

Dr. Martin Jugenburg (54:29):

Thank you for having

Michelle MacDonald (54:30):

Me. Guys. I'll share all the links so you can follow Dr. Martin Jugenburg in the show notes. And if you have any follow up questions, please message those to us and we'll make sure we get you an answer.

Dr. Martin Jugenburg (54:43):

Thank you again. Thanks for having me.

Michelle MacDonald (54:45):

Thank you so much. Remember, this conversation isn't about promoting surgery, it's about choice, about thinking critically, doing the deeper work and recognizing that no external changes mean anything if they are not grounded in self-respect and purpose. You can't outsource alignment. The work starts with clarity, intention, and ownership. From there, any decision you make becomes an extension of your power, not a substitute for it. If this episode resonated with you, share it. Leave a quick review, send it to a friend or post to take away. Check the show notes to follow Dr. Martin Jugenburg and explore more of his work. And if you are in Canada, join Joan McDonald and myself at the Menopause Show in Toronto, October 18th, 19th. We'll be deep diving into strength, longevity, and what it means to lead from the front at any age. Until next time, stay strong.