From Trauma to Transformation: The Art of Plastic Surgery with Dr. Rodney Schmelzer

Dr. Rodney Schmelzer of Selarom Utah joins the Go Higher Podcast to reveal the unspoken truths of plastic surgery—from reconstructing gunshot wounds to empowering moms through elite cosmetic makeovers. We dive into the Ozempic weight loss revolution, risky trends like BBLs, and how owning the full surgical process gives patients better results and peace of mind. Get ready to see plastic surgery through a higher lens.

In This Episode, You’ll Discover:

• What it’s really like to be a board-certified plastic surgeon
• The truth behind “Ozempic body” and the rise of post-weight loss procedures
• Why Dr. Schmelzer says BBLs are risky and what he offers instead
• The transformation from trauma surgeon to aesthetic specialist
• What makes a real mommy makeover and who it’s best for
• How to spot red flags when choosing a plastic surgeon
• The hidden dangers of discount surgeries and medical tourism

🔗 Connect with Rodney / Selarom here

Presented by Daniel Walton (@yourpropagandist)

Transcript

0:00: Yo, what's cracking. 
 0:01: This is Daniel Walton, and this is the show for those who don't believe in limitations. 
 0:04: So if you're ready to be better than you were yesterday and hit new levels mentally, physically, financially, or spiritually, it's time to go higher. 
 0:11: So what's the day in the life of a board certified plastic surgeon? 
 0:17: It really depends on the day. 
 0:18: Sometimes you're seeing patients, sometimes you're in the thick of it in the operating room, just, trying to help people out, yeah, yeah, outside the operating room, what's, what's that like pretty, pretty normal life or do you have a a routine that allows you to operate at such high level? 
 0:35: You know, if you're talking just like interacting in the real world, I don't think if I was out with, my kids at some event or restaurant, you would know as a plastic surgeon, it's. 
 0:46: Just really like everybody else. 
 0:48: Yeah. 
 0:49: You know, I, I used, I don't know if I told you this. 
 0:51: I used to be a, a histo technician. 
 0:53: I would process skin cancer for, for mostly like, dermatologists, most surgeons. 
 0:59: And, yeah, some of them took it very seriously. 
 1:02: They would be to bed at a certain time, go to sleep at a certain time, eat certain diets, but I can see why, you know, when you're operating with a scalpel, if you're sensitive, which some of them seem to be a little bit more sensitive to their sleep and their caffeine and all those levels when, when in the surgery room, but. 
 1:21: , I mean, that's a good point. 
 1:23: So it depends, especially earlier in my career where I did a lot of finer surgery on kids' facial deformities and you're wearing what we call loops, it's like magnifying glasses and, you know, a little shake could look like a small earthquake under there. 
 1:35: So then I would be careful about caffeine intake and, you know, you're starting your operations on time at 7:30 so you gotta be. 
 1:42: So, but when we're doing aesthetics and I have my own surgical centers, you know, it's a little more, I have a little more control. 
 1:49: Yeah, yeah, you have a lot of control. 
 1:51: You're, you're unlike other surgeons, you own the whole center, right? 
 1:54: Yeah, so that gives the, the surgeon and the staff a lot more flexibility and when we wanna operate and things that we wanna do, right, right. 
 2:03: So going back on what you said about these facial deformities, you've fixed some of the most severe facial deformities from cleft lips to gunshot wounds. 
 2:14: How, how do you connect that to aesthetics and how does that transfer from 15 years of doing that to now doing some, you know, some of the most high-end cosmetic procedures? 
 2:25: How, how does that connect? 
 2:26: I think it's kind of your journey through life. 
 2:28: I came to Utah. 
 2:29: I'm not from here. 
 2:30: I'm from Ohio and trained in Saint Louis and Dallas. 
 2:32: , because I joined a very, very famous guy, who helped fix children with deformities, which I was trained in bread and butter would be cleft lip, cleft palate, but it could be no ear, no jaw. 
 2:44: I also did significant trauma, gunshots, blown off faces, so very interesting anatomy, a lot of excitement, very challenging and very difficult procedures. 
 2:53: And that wears on you. 
 2:54: It gets tiring, you take a lot of call and so when we came here we had our own offices and our own surgical center which I didn't even think I'd be using back then you know that was 20 years ago now, but as you get older and you have kids of your own and journey through life you become a little more. 
 3:11: Goal oriented things that you want to do and so I put in my time, did that, trained a lot of folks to take care of kids all over the world. 
 3:17: I have one that just was on the mercy ship about two weeks ago fixing cleft kids so I feel like we did our, good there and then I just kind of slowly ventured out into more and more aesthetics and I've enjoyed that as I get older because of what we talked about more flexibility and your time and your life and it's still some very interesting operations. 
 3:34: It's just a little bit of a different lifestyle, but it's been a lot of fun in the transition. 
 3:37: Do you feel like that helped train you and prep you for for cosmetics and aesthetics? 
 3:43: I, you know, I think any plastic surgeon can venture into the aesthetic realm and there's fellowships for that, but I think when you're doing what I did earlier on, which is called craniofacial, it's some of the hardest plastic surgery except for maybe microsurgery, which is putting things together in a very microscopic level, very difficult surgeries, long surgeries. 
 4:03: So along with craniofacial. 
 4:04: You're really at the upper end of how difficult it is, how arduous it is, you're really pushing the envelope, a lot more stress, and that really trains you. 
 4:13: I like to call it Navy SEAL. 
 4:14: You're really in the trenches really taking care of difficult problems and that really prepares you and so I wouldn't say aesthetics is easier, but you're really well trained and so when you go into here it's a little more leisurely, a little slower pace, a little bit easier and that's been a little bit more fun as you get older. 
 4:31: Yeah, yeah, I bet. 
 4:32: So what specifically makes the craniofacial so much more challenging and and more technical than than the aesthetic side of things? 
 4:40: I mean, frankly, I did a lot of children, and I'm talking 3 month old, 23 year old, and you're working with a neurosurgeon and you have their skull open and you're looking at a brain and you're looking at their their eyes and their orbits and you're around very vital structures. 
 4:54: I mean, you're playing. 
 4:56: In a big game where high stakes, you can help somebody, you can fix them and make it look better, you can actually really hurt somebody. 
 5:04: And so the stakes, so we call it sphincter tone, the pressure is really high, especially when you're dealing with a newborn. 
 5:10: I remember when a mom handed me the first kid that I ever did. 
 5:13: You know, I hadn't had kids of my own. 
 5:15: I wasn't married and they're handing me their whole life at 3 months old and saying fix my kid. 
 5:20: It's a lot of pressure, and so it's a little bit different, when you're doing aesthetics, but that prepares you so it makes you a better, more conscientious surgeon over time that trained you to to handle pressure and be very. 
 5:33: Very calm and strategic in in the operating room. 
 5:37: Yeah. 
 5:38: And then the other thing about plastics is a little bit different than some of the other disciplines because all surgeons are a lot of training is there's really not a cookbook. 
 5:45: Everybody's different. 
 5:46: Every anatomy is different. 
 5:47: So you can't be like trained and say, well, every gallbladder is the same or every, you know, thumb. 
 5:53: Everybody's body is different and so there's not a cookbook. 
 5:56: You kind of have a design, but you gotta be able to be malleable, flexible on the table at that time and that takes a little, you know, a little bit of experience and time because you can't show stress. 
 6:07: You'd be like, hey, I've been here before and I'm gonna figure out the problem and the answer and that that just takes time and experience. 
 6:14: Yeah, so with being pliable in the operating room, you also have to be pliable in the market and the market has evolved a lot now too from what people used to want or maybe what the demand has been. 
 6:28: And now with Ozempic patients who have lost these, you know, hundreds of pounds, they're literally walking around with just loose skin, bags of loose skin hanging off their bodies, their arms. 
 6:39: What's the most shocking transformation that you've seen in, you know, this, this trend of everybody going to you now for these weight loss procedures that they've done? 
 6:49: What's the most shocking thing that you've seen in this, in this process? 
 6:52: Well, number one, I get this question often when you fix kids for so long they be like, what's the most rewarding thing? 
 6:58: And I always say it's the massive weight loss patient. 
 7:00: I mean they've gone through such a journey whether it's bariatric procedures which are surgeries that help with weight loss or this new category of medicines which I think is like the closest. 
 7:10: To a miracle that I've seen in medicine in 20 years, whether it's Ozempic or Monjero or what have you, I mean, people are losing on average they'll come to see me 68, 10 pounds a month. 
 7:20: I mean you extrapolate that over the year. 
 7:22: People are losing 100 pounds in a year without surgery, which is just game changing. 
 7:28: But the ramifications besides their health getting better or maybe their diabetes going away is, they have a whole body, a whole bunch of skin hanging off, and there is no way unless they're very, very young, that it's gonna snap back, and I always say there's only one way to get it off is you gotta cut it. 
 7:43: But as a plastic surgeon, we want to cut it and of course make it aesthetically as pleasing as possible too. 
 7:48: So I think that category of patients is in from cosmetic point of view, some of the most rewarding patients who have been through a big journey and super happy when you can help them. 
 7:59: Why are These weight loss patients walking around with all this extra loose skin, you know, when you lose that much weight fast, it's just, you know, I, I, I, my best analogy is pregnancy, you know, 20 year old, you know, 9 months of pregnancy can snap back. 
 8:14: A 41 year old much harder any mom will tell you. 
 8:18: And so now you're in life and you're not 21 anymore and you decide to go on a weight loss journey and you're 41 or 51, and your skin just doesn't have that resiliency to contract back and so. 
 8:28: You know, your sugars are better, you're able to walk and you feel better, but you have, let's say 100 pounds, 60 pounds of excess skin, arms, breasts, tummy, legs, and so that's where the plastic surgeon can come in and really move the bar to get that person back to where they really want to be. 
 8:46: So if you're over the age of 40 and you've lost what, over 50 pounds from one of these, weight loss injections like Ozempic or Turzepatide surgery might be the only option to help you really tighten yourself back up and get back to how you used to look. 
 9:03: Usually that's it. 
 9:04: Now it's funny because I always bring up the big 4 if we're not talking about faces which are arms, breast area, tummy, and legs and everybody has a. 
 9:13: and I'll say let's start with the first two. 
 9:15: Some people are really focused on the arm. 
 9:17: Some people like and I had a lady just yesterday, her arms didn't bother her at all. 
 9:21: So people will contract or change just like when you gained fat because whatever you had a bunch of whoppers, some people go to their behind first and some people to their chin. 
 9:29: So really I let them kind of pick the areas that bother them the most because I think that's when they get the, they see the biggest gain. 
 9:36: But it's very interesting to see how people. 
 9:38: Themselves and some people come and say I swear it's my arms and some people be like it's my tummy. 
 9:44: So it's really where it distributes, but it's all gonna be once you lose the weight you don't really have fat it's just a lot of excess skin. 
 9:51: It's just hanging there lady come in yesterday, she had dermatological conditions from the sweat, and she's like, I just gotta get rid of this. 
 9:58: So it's not just functional but it's aesthetic as well. 
 10:01: So it's combining them both. 
 10:02: What exactly is Ozempic butt? 
 10:06: You know, they coined these terms, which I, I, I don't, I don't like them because you could take somebody who's a marathon runner all of a sudden or doing the cold plunges for six months and just start stripping fat off them and they'll have Ozempic butt and Ozempic face. 
 10:22: They're just throwing a name to it. 
 10:23: It's massive weight. 
 10:24: Loss patient. 
 10:25: I prefer that. 
 10:26: You have massive weight loss and you're over 30, you're gonna have excess skin, whether it's the chin, the arm, or the butt. 
 10:32: But what you're asking is, is they tend to lose the fat, which is counter to the BBL or Brazilian butt lip where we're trying to increase it. 
 10:41: And now they just have a flat butt. 
 10:43: And if you talk to any woman, most of them are gonna want a little bit of a, a butt. 
 10:47: And so when it's flat and it's just hanging there. 
 10:50: It's sometimes a little bit off-putting to them and they want to get a little more form and a little tighter and so a butt procedure will help raise that and tighten the skin. 
 10:59: Is that something that you offer? 
 11:01: Yeah, so I don't really like the BBLs. 
 11:03: that has been a procedure that had the biggest problems with our society kind of putting some constraints on that because people can die. 
 11:10: First of all, you have to put in extra fat because fat's a living organism. 
 11:12: It could live or die, and a lot of times it dies, so we have to overdo it and they have to kind of sleep on their tummies for quite a long time. 
 11:19: But, and it can really cause harm. 
 11:22: We had people getting fat, Mboli and and dying. 
 11:25: So I really wasn't for that procedure. 
 11:27: That's different than a 30 year old just putting fat in, which can be very good for them, but I don't enjoy the procedure versus someone who's just lost the weight and has a bunch of skin and they just have a flat butt. 
 11:36: And so we're gonna tighten the skin and lift the buttocks. 
 11:39: we're not really adding volume so much as tightening, and, and that could be really rewarding. 
 11:43: It really depends on what the patient's needs or wants are. 
 11:46: I find that they ask about that, but that's usually not in the top 2 or 3 at first. 
 11:50: They're really focused on what's going on here first. 
 11:53: Most of the time. 
 11:53: Why are BBL's dangerous and so overrated? 
 11:56: You know, each doctor does their own thing and they might love the procedure and there's nothing wrong with it, but when you're putting fat in and you could put it in the muscle or above the muscle and right now our society wants to go above the muscle so we lower the risk but when you're going into muscle, which has vascularity, blood supply, if the fat goes into a vein, you just like if somebody had a clot on the plane, it can shoot. 
 12:19: Through your body and if you get a fat embolist, you can get a stroke, you can go to your heart, you could die, and that's happened to patients and so, you know, these are elective procedures unlike the kids that I was talking about and you don't want to put somebody's health or life at risk. 
 12:33: And so when it when the number starts getting high where you're over 45, 6% of people that can get injured, you got to question, is this the best procedure? 
 12:41: It's a good procedure in the right hands, but there is some inherent risks to that one. 
 12:45: Yeah, I understand. 
 12:46: I think somebody that I was speaking with a surgeon and he, he was completely against them. 
 12:51: I, he refused to do them and he said, you never see anybody doing a fat injection for, for breast implants. 
 12:56: Why is that? 
 12:57: I was like, that's a true point. 
 12:58: You know, I've never heard of somebody doing that like, and you can, some people do them. 
 13:03: I don't like the results for that either. 
 13:04: So fat injections can be great and we use them a lot in faces and things like that. 
 13:08: But I'm not a big proponent of them in the butt or the breast. 
 13:11: That doesn't mean there's some other surgeon, male or female throughout the country who's really perfected it and thinks it's great. 
 13:17: So in the right hands it can be. 
 13:18: But for me, I, I don't think it's a, a, a great procedure. 
 13:21: So I don't offer it. 
 13:22: I'll send them out. 
 13:23: In my hands. 
 13:23: I want to know, could I deliver a consistent good result? 
 13:25: And if I can't, I'm not real thrilled about that procedure. 
 13:28: Yeah, so talk about. 
 13:29: Being in the right hands, your specialty now, you've transitioned to really perfecting the mommy makeover, the real mommy makeover. 
 13:38: How is that your specialty? 
 13:40: How did you really decide that that was going to be the lane that you stayed in? 
 13:43: You know, everybody can pick their niche, whatever they're interested in. 
 13:46: And you would think my Seway would have been, well, if you're fixing gunshots to the face. 
 13:51: In the skull and jaws and fixing kids' skulls and eyes, which I'm very familiar with that anatomy at a high level. 
 13:57: Why aren't you doing faces? 
 13:58: It just wasn't as fun for me. 
 14:00: I have more fun with the staff doing body work. 
 14:02: It's much more lax because I'm not hitting an aorta or somebody's eye, and we have music in there and I have a bunch of usually female nurses that are weighing in on the aesthetics of the patient and it's just more, at this time in my life more enjoyable. 
 14:15: And when I did that, I just started perfecting the craft with consistency. 
 14:20: And and doing it, you know, at a high level and I just really enjoyed essentially I'll still do some facial procedures, but I really focus from the clavicles down. 
 14:28: I do a lot of breast, a lot of abdomen, arms and thighs. 
 14:32: So with, with, like you said, mommy makeovers kind of being the sweet spot because I really enjoy, tummy tucks or abdominoplasty and breast work. 
 14:40: Yeah, now you've done over 600 mommy makeovers and correct me if I'm wrong, you've said most of the plastic surgeons in Utah are. 
 14:49: bunch of Groupon surgeons. 
 14:51: I mean, that can seem a little bit harsh. 
 14:53: What specifically makes you stand out versus some of these coupon discounted surgeons that might be out there? 
 14:59: Van, this is one, it's ironic, Utah, where, you know, depending on what study you look at, a top 5 aesthetic market. 
 15:05: I can't really speak to as why that is, but it's super saturated for relatively small metroplex. 
 15:11: There are a lot of surgeons. 
 15:12: I mean, when I got here, not including ENT facial or cosmetic, I mean, there was over 60 plastic surgeons and now there's well over 100 for. 
 15:19: A relatively small big city. 
 15:21: I mean, there's only like 3 to 4 million people in the state. 
 15:23: So it's super saturated. 
 15:24: When you're super saturated, that breaks down the price. 
 15:26: There'll be people flying from Vegas or Boise because a lot of surgeons, just like a lot of restaurants, the price goes down and that's fine. 
 15:33: But, you also, you know, like you said, you don't want a group on it, but I think we're cheaper here in Utah just due to the competition. 
 15:40: But either way, it's a results business. 
 15:42: You gotta to deliver and there's always gonna be issues or problems or social media reviews or people who have unrealistic. 
 15:49: expectations, but you want to look at the bulk of it and go, can I do this at a high level and give good results? 
 15:53: And you know, I've been doing this for 20 years and I think over time, you just get better and more comfortable. 
 15:57: And there's a lot of really quality surgeons here, but I hope that we can deliver some of the best results around. 
 16:02: Yeah, you've been doing this for over 20 years. 
 16:04: What's the worst discounted surgery disaster that you've had to operate on or fix? 
 16:10: Fortunately, thank goodness, you know, everyone has issues, but I've never had some disaster or some legal or court thing, and I really can't comment on my colleagues, but, you know, We are not from you, not from you. 
 16:22: One that maybe somebody went to a discounted surgeon came in and said, I need this fixed. 
 16:27: This is a disaster. 
 16:29: Doer saved my life. 
 16:31: The most frequency with that is when people go to, below the border in Mexico and you'll see it for dental, you'll see it for breast, you'll see it for liposuction, and I gotta tell you, it's either in my view, 100% win or a disaster. 
 16:45: If you get a win, you saved money, God love you. 
 16:48: The problem is if you have a disaster because bad anesthesia, the injections went wrong. 
 16:53: I saw it with liposuction, horrible tummy tuck, if it goes wrong and when it goes right, it's fine, you know, no other American surgeon wants to take care of that problem because they didn't operate and so it becomes hard as those patients doctor shop because they were like, hey, I was in Guadalajara, can you fix it? 
 17:10: And your heart goes out to them, but nobody wants to take on that issue. 
 17:14: And so. 
 17:15: , I always tell people if they're going to go to Turkey for something or hair transplants or go to Mexico, you could absolutely get a win, but as you could absolutely get a loss, and if you don't have your surgeon available with a surgical center, it's really frustrating because it's hard to fix problems, right? 
 17:30: So what is the worst problem that that you've seen or most horrific problem that you've had to fix? 
 17:35: I've seen people who went to Southern Florida from other outside of the US and had horrible fat injections. 
 17:43: Some of them grew fat can also. 
 17:45: Grow, not just die, on their forehead and they had these big growths. 
 17:48: They weren't cysts, they were just living fat from fat transplants and significant asymmetries of the breast, and liposuction, when you do, can cause, I call it undulations. 
 17:57: If you get too superficial, you can see the marks. 
 18:00: And so I don't know the surgeon was, you know, technique's important, but you know, I never want to align my colleagues. 
 18:06: But the bottom line is, is you really want good care if you're going to sleep, a good anesthesiologist and you want, a competent surgeon. 
 18:13: If you put those two together with more than 10 years. 
 18:15: of experience and board certified, you're probably gonna get an acceptable result. 
 18:19: So you can get a fat injection and fat can start growing in other parts of your body. 
 18:25: So fat's a living tissue and we often think of fat as dying, like in Brazilian butt lifts, we overdo it. 
 18:31: Because you're gonna sit on it, you're gonna move and a lot of those cells die, so most surgeons who do BBLs will overdo it, try to kind of compensate to see where we end up, but there's a lot of variability because we don't know, but it could also go the other way it usually does die. 
 18:45: It can actually live and grow and in this particular case that you asked me, they were growing because they got fat injections in their face and and they were growing and it was fat, which means you have to go in and take it out because instead of dying, it actually proliferated. 
 19:00: Wow, that's crazy. 
 19:02: I never even knew that. 
 19:03: Do people even know people talking about it, you know, a lot of people come in, it's funny and they don't, they don't always hear what the doctor says. 
 19:08: That's why we dictate it and have a note because they often hear parts of it or what they want to hear. 
 19:14: And that's really tough on the doc too because you know you educated them because I have a script for let's call it breast augmentation. 
 19:21: And they're not hearing all the downsides, and it's really critical to tell people the downside because we over aggrandize and like you see the billboard or Instagram and everything is gonna be perfect. 
 19:30: It's human bodies, it's biology, 3 to 10% are gonna have problems. 
 19:34: Whatever procedure, a stitch reaction, an infection, it's gonna happen. 
 19:38: If you have all 5 star perfect answers, you haven't been doing this long enough, but you just have to roll with it and treat the patient because every human being has different healing, you know, and they could be poor healing because they're on steroids or lupus or diabetic, and that's not always the patient or the doctor's fault, it's just biology. 
 19:53: And so I think managing expectations is one of the hardest things in aesthetic surgery. 
 19:59: What, what are some of the hardest expectations you've had to manage as a surgeon? 
 20:02: And and I think this is what we have a record is just people not hearing and then of course it's in the note. 
 20:08: So I'll give you an example. 
 20:10: I had two gals recently and they were a little harsh on me on, on, social media reviews, and we usually consent people for surgery. 
 20:18: I almost never do more than one consent. 
 20:21: I've probably done 5 in 20 years. 
 20:23: Both these girls, I double consented, meaning an an additional consent saying. 
 20:27: You're going against my medical advice. 
 20:29: I think you're choosing too large of an implant and you're gonna have problems. 
 20:32: What happens? 
 20:33: If you put oranges on the chest, they're reasonable. 
 20:36: You put watermelons, it's just too much weight on the body. 
 20:39: Things are gonna sag, things are gonna drop and more importantly, you're very likely going to put pressure on the incision. 
 20:45: And if the wound opens, you're like, well, if you just cut yourself and then your wrist and the wound opens, clean it and close it. 
 20:51: But You have an implant and the wound opens, now you have exposure and you have infection and so both those girls ended up having open wounds and possible infections because just too big. 
 21:00: And of course it's in there with the consents, but they don't hear that. 
 21:03: They just hear, oh, surgeon didn't know what he was doing and they're literally telling me how to sew. 
 21:08: This one husband was literally a, do I know how to sew? 
 21:11: I'm like, I think so for 25 years, I kind of have an idea. 
 21:14: But of course you. 
 21:15: Don't want to escalate into a fight, but this is just the body and physics and sometimes the patient isn't hearing the doctor recommendation and you can only guide them. 
 21:24: I make patients choose the size of the implant based on measurements and their body, but I ultimately put that ball in their court. 
 21:32: They're gonna make the call and if they go outside of what I think is reasonable, I'm gonna tell them and or consent them for that so that they know the risks. 
 21:40: And sometimes these things happen. 
 21:41: Yeah, a lot of people aren't in control of their mind. 
 21:45: They have only one way of seeing things. 
 21:47: It's, it's, they can't see the opposing side of things and it's unfortunate they can cause a lot of problems. 
 21:54: remember that's an end of one because it's your wife or your daughter or your sister. 
 21:58: But when someone like me or any plastic surgeon has been doing it for 20 years, they've seen hundreds if not thousands. 
 22:04: And so they have a little more experience with that and they're just trying to convey their experience, but as you know, as a family member or a husband, you don't, they don't always hear it and then that's a tough issue between the doctor patient relationship because of course every doctor wants to have the patient have great results, but that's social media. 
 22:24: Right, Social media can really beat up the dock or a restaurant or a movie, and that doesn't mean it's true. 
 22:29: It just is them voicing their opinion. 
 22:31: Yeah, they have internal biases that can be very conflicting with reality. 
 22:36: I've definitely experienced that in my own family members before that there's no amount of reasoning or I guess debating. 
 22:43: That can get them out of that. 
 22:45: So now, I mean you do mostly mommy makeovers. 
 22:49: What are some of the other most common procedures that people come come to you for other than the mommy makeovers? 
 22:56: You know, it's, it's variable depends on stage in life, time of year. 
 23:00: Like a lot of people come in for eyes because you could really show a lot of age here and it's really. 
 23:05: , very fine anatomy. 
 23:07: It's, it's fun. 
 23:08: It's kind of nice, but you could really make a major difference in rejuvenating people's faces just by the age of their eyes. 
 23:13: I think obviously breast augmentation is usually besides liposuction, the number one procedure, and that's usually really highly rewarding because people are happy. 
 23:21: as we get older then they need a lift because the skin and the sag. 
 23:24: I, I really enjoy tummy tucks. 
 23:26: I mean, you know, especially if it's a mom, had 2 or 3 kids and they're done. 
 23:29: Boy, it's just nice to take him back to pre-baby and they're just really happy about that. 
 23:34: And then, of course, I mentioned the massive weight loss. 
 23:36: I mean, that's probably the highest rewarding patient because, you know, they have month-long journeys, if not years, and then all of a sudden they get to the end of the line and you're like, OK, I can fix this for you and it's. 
 23:47: It that's a, that's a really rewarding patient, right? 
 23:50: They, they did step one, they lost all the weight and now they need to come to you to step two to gain that confidence back and feel like their old self. 
 23:59: Yeah. 
 24:00: So who is the best candidate you said for, for the, the tummy tucks? 
 24:04: What what is the ideal candidate for a tummy tuck? 
 24:07: You know, I used to have a lot of people come in and they're putting the cart before the horse because they're really looking for weight loss reduction and I was like, You need to go on that journey whether it's Ozempic or something else and then come to me. 
 24:18: And so it's really the the the ideal patient is is the mom. 
 24:22: A mommy makeover is a tubby procedure and a breast procedure, whether it's a lift or an augmentation. 
 24:28: And you can do those at the same time under the same anesthetic, but that's really the best patient because, you know, they're not obese, they're using really good health, and they just want their body back and it's really good anatomy to work with. 
 24:39: And so if you could take them back and they had their 3 or 4 kids and you tighten, we tighten their abdominal. 
 24:44: musculature, I say we're putting the muscles back and then tightening the skin and it has a lot of longevity. 
 24:49: I mean, that one's good for really a lifetime if not 1020 years, decades and so you get a lot of bang for the buck on that one. 
 24:55: So,, when someone does come in asking for a mommy makeover. 
 25:00: What are they really asking for? 
 25:01: They're usually asking for abdominal procedure, a tummy tightening and in the skin, and a breast procedure. 
 25:07: A lot of times it's an augmentation, but a lot of times it's an augmentation with a lift, which means we're not just putting implants in which are usually silicone giving volume, but we're tightening the skin because maybe they've had some deflation or or drop and that's a really common patient too. 
 25:22: So a full mommy makeover in my world would be in a. 
 25:24: Abdominal procedure, breast implants, and a lift. 
 25:27: OK, great procedure. 
 25:28: Yes, so we keep hearing people asking about recovery time. 
 25:32: What is a realistic recovery time for someone who's, you know, maybe at home with, with 2 or 3 kids? 
 25:38: Yeah. 
 25:38: So let me separate those out because if it's a tummy, I tell them to take 2 weeks off of work. 
 25:43: I mean, they'll be off pain medicines except for, let's say Motrin Tylenol in 4 days, narcotics, but it's tight muscles. 
 25:49: sensitive and they really need 10 to 14 days to bounce back if they're in decent health. 
 25:54: If they're not or they're older, I did a 62 year old recently. 
 25:58: They need a little more time because we often put a drain in too to help with removal of fluid. 
 26:02: If they're younger and 30 or 45 year old and they have that, they're gonna feel pretty good by day 78, but I tell 2 weeks. 
 26:09: And, and that's just to get back to functioning. 
 26:12: But I mean, they're not going out and playing racquet. 
 26:14: Ball and bowling and golfing for a minimum of 6 weeks. 
 26:18: I'm talking about, you know, 2 weeks is you're walking the dog and you feel good doing all the cooking. 
 26:22: So it depends on what your goal is. 
 26:24: If it's just a feel good and you're off medicines, at the end of the first week you're off medicines and the end of the second week you feel pretty good. 
 26:29: I say about 80% back. 
 26:31: But if you're like, well, I want to go back to my golf swing, I'm gonna be like 6 weeks. 
 26:34: Breast is less painful, bounce back faster, and so that's usually. 
 26:39: 7, 10 days, 14 days, but when you're doing them together, they need a little time off to recoup. 
 26:45: They're not bouncing. 
 26:46: It's, it's really a fatigue factor. 
 26:47: It's not a pain factor. 
 26:49: And I'm like, you're not gonna feel close to 90% till about week end of week 3. 
 26:54: So it sounds like you set very clear expectations with everybody. 
 26:57: Yeah, because you don't want them running to Hawaii and going to the beach if they got a bunch of stitches 100%. 
 27:01: That's just asking for problems. 
 27:03: Yeah, yeah, yeah. 
 27:04: So a lot of these people, they think they're ready to go, but you've told people not to get surgery even though they had the $30,000 ready to go and wanted these procedures. 
 27:15: What red flags have caused you to reject patients before? 
 27:19: First one would be unrealistic expectations. 
 27:22: I mean, my entire staff knows that sometimes we talk about an aesthetics, about 3 out of 10 patients have some body dysmorphia and that's normal with. 
 27:29: Instagram society. 
 27:30: I have two daughters myself, but the point is, if they're not realistic about the goals, then we're gonna have a problem. 
 27:37: Then we have health issues. 
 27:38: Are they on steroids? 
 27:39: Are they diabetic? 
 27:40: You know, did they just injure themselves because they had an ankle surgery and, you know, do I want to put them under anesthesia again? 
 27:46: So weighing all that in, you're looking at the medical history, the patient's health, and trying to make the best call and sometimes we just I just bounced a guy recently. 
 27:54: Today, because we have what's called a BMI, a measurement of sort of body weight and height that's just too high. 
 28:01: And if it's high, he's gonna have a protracted long recovery and his chances of having problems instead of being 3 to 5% is probably 15 to 20% and I flat out said you're gonna have fluid, it's gonna open the wound, you might get an infection. 
 28:14: It's just not worth the risk that I might have done 10 years ago, but having a Patient frustrated, changing dressings, unhappy at this point in my career, it's just not worth it. 
 28:24: So you gotta do a lot of education, right? 
 28:27: Understood. 
 28:27: What is the main difference between somebody who's like ready for surgery now and somebody who's just price shopping around? 
 28:34: I think if they're ready, especially the patient with major weight loss, I, I first thing I ask him is, are you stable at this weight for some time? 
 28:41: And if they're stable and they're happy at that weight, they're ready. 
 28:44: Depending on the rest of their medical history, you know, if they're like, no, I really want to lose 35, I'm like, we're not there yet. 
 28:49: I want them within 10 of their goal. 
 28:51: And so I really have to listen to them. 
 28:53: Are we just shooting for the stars? 
 28:55: Because I have 5 sisters and 2 daughters and or we, or is that a real goal? 
 28:59: And if that's the real goal and they're within 10, I'm like, you've done your journey, we're good. 
 29:03: But if they're really shooting for 20 or 30 more, I'm like, let's not put the. 
 29:07: ahead of us here and let's work on that first, because we'll have more optimal results if we're patient. 
 29:14: Yeah, I see. 
 29:15: So making sure they're actually ready to go. 
 29:17: And the other thing I use is I use a lot of pictures and I've only had one patient be like, gory, I can't take it because I want them to see, I mean, intraoperatively with your stomach open, what it looks like. 
 29:27: So when I say 2 weeks, we're not walking the dog. 
 29:30: Going to every baseball game, so they go, oh, that's a really big procedure. 
 29:34: And I'm like, it's, it's registering in their mind what's going on while they're asleep and they're like, oh, that's a lot of anatomy. 
 29:41: Now they're listening to me about, hey, let's just take it easy for two weeks. 
 29:44: So I think showing them before and afters and durings sometimes really helps educate the patient to know what the process and the anatomy they're about to go through. 
 29:52: Yeah, understood. 
 29:54: So I'm sure you get the, the price objection a lot. 
 29:57: I'm in the high ticket service business as well. 
 30:00: Doctor Smith down the street, he's $10,000 cheaper. 
 30:03: How do you handle that? 
 30:04: There's a lot of variability. 
 30:05: We talked about state because, you know, Vegas is not far away and there are $2500 more for breast augmentation. 
 30:11: You know, you can charge what you want. 
 30:12: I think based on your experience, your outcomes, you can charge more. 
 30:16: I mean, you're gonna pay Picasso more than you're gonna pay the average artist. 
 30:18: And so you got to find the sweet spot based on what's going on in. 
 30:21: Your town. 
 30:22: I'm not saying that we ever want to just, you know, rag paper over the coals, and we're also not Grouponing. 
 30:26: I've been practicing for 20 years. 
 30:28: I've seen a lot. 
 30:28: You got to pay for that experience and skill set just like if you're buying a Mercedes, you know, over the lower end Toyota. 
 30:34: The Toyota will get you there, but if you're buying the Mercedes, your expectations are I'm buying quality. 
 30:39: If there's a problem, they're gonna fix it, and I know that I got quality. 
 30:42: And so you don't want to be braggadocious, you just wanna sell yourself on your experience and time for what your value is worth. 
 30:48: Yeah. 
 30:48: So when somebody actually books their mommy makeover with you or one of these procedures like what's the start to finish process? 
 30:55: So typically they'll come in 45 minute consult see pictures, go home with written and web-based information and once they sign up, you know, they'll pick their date, but let's say it's in 2 weeks if they're on one of those medicines such as Ozempic, we make sure they're off it for at least 2 to 3 weeks. 
 31:11: It's changed a bit with anesthesia, but that's a safety factor just due to mo. 
 31:15: Utility of the stomach and we don't want them to what's called aspirate so causes pneumonia. 
 31:19: I've had that happen twice in the last two years, so we really want to be careful with what medicines are on something that doesn't make them bleed bleeding is a problem for wound healing, so we take care of all that. 
 31:28: Then they get ready for their surgery. 
 31:30: They come in, they get re-educated that day, pictures are taken and they sign consents and then we go back to the operating room. 
 31:35: Then they go to what's called the PACU or post anesthesia care units, go home. 
 31:39: I usually check in if it's over a weekend or my staff the next day. 
 31:42: And I usually see patients at day 7 and day 21, and then if things are going well we really spread it out with time and pictures so we have a pretty close relationship for at least 3 weeks after the surgery and every patient of mine has my personal phone number. 
 31:56: I don't know how it works in other practices that can usually they can also talk to my nurse, but they can all reach me personally. 
 32:01: Love that. 
 32:02: So when somebody is in this process, like, what's the biggest hesitation that they normally have obviously aside, aside from price of like committing to that, that mommy makeover. 
 32:12: You know, like you said, price is probably the biggest, but time. 
 32:16: So for example, if somebody has kids, is it gonna affect their vacation and time in the ocean because I did a tummy tuck and I'd be like. 
 32:23: Look, you really, you, you can shower, but you can't soak for 6 weeks. 
 32:27: You can't be in the hot tub. 
 32:28: And you know, let's say we do something where we don't want a lot of sun on the scar, you know, so those things go into it's what's your life, what's going on with your life? 
 32:35: And if it's a bigger procedure, do you have someone to help you for a week? 
 32:38: you're gonna convalesce for 7, 10 days. 
 32:40: If you're a single person and don't have caretakers or close family, that could pose a problem. 
 32:45: So there's other factors that go in with the post-operative course. 
 32:48: That you want to educate them on so they're making sure that like, hey, this is 2 weeks. 
 32:53: I really got to get prepared, stock up my fridge, get some help, stay out of the sun, so those things and and those are important things besides the surgery itself. 
 33:01: Understood. 
 33:02: Now, I know you're not the biggest TikTok dancer out there, but a lot of surgeons are, and they really pride themselves on more followers and views from staying on top of these TikTok trends. 
 33:14: , what do you have to say to that and why aren't you doing that? 
 33:19: You know, I think it's just a different era. 
 33:21: I mean, I was joking with the guys when I came in here because when I came to Salt Lake, we had Yellow Pages. 
 33:25: Yes. 
 33:26: You guys probably don't even know what Yellow Pages are. 
 33:28: And so it's changed, you know, with social media, and one of the guys in town is, you know, a wonderful guy. 
 33:33: He got really big on TikTok and, you know, God love him. 
 33:36: He's really busy. 
 33:37: But for me, being old school, you know, I didn't sign. 
 33:40: When I was in medical school and hang my hand up and go, hey, I want to be all over TikTok and social media. 
 33:44: I just thought I was fixing people, but that's really kind of changed and merged with modern medicine and you gotta tell people what you do. 
 33:50: If you're selling a Mercedes or a Corvette, you gotta tell and so you gotta tell people what you do and be a little more open, but a lot of doctors are a little closed or maybe they're bookish and it's a little uncomfortable. 
 34:01: I I I'm fine giving talks and being in front of folks, but I don't always want to like Hack my wares. 
 34:06: You hope that your quality will speak for itself. 
 34:09: But in, you know, 2025, you gotta tell people what you do. 
 34:12: Yeah, that's the point of getting on this is so we can get your word out there. 
 34:15: Let people know that you've been doing these procedures for, for 20 years. 
 34:19: You own the process end to end from the operating room to the entire patient journey. 
 34:25: Have you ever had a consultation, that you just knew you weren't the right fit for and you, you push The way. 
 34:32: For sure, you know, and, and that's why in this town I'm collegial with every all the other folks. 
 34:36: For example, you asked about BBL. 
 34:38: I just wouldn't do it. 
 34:39: So I just sent it to two or three people that I think are really good surgeons or I'll say go get a second opinion or I'll just, if you find like it's not a good match, you'll be like, hey, here's 2 or 3 colleagues I really like because you want them to have a good experience. 
 34:51: But if there's red flags or I see that, I'm just gonna try to stay away from it because. 
 34:57: At this point, I don't, I don't think it's worth it for the dollars that it could produce. 
 35:02: If we don't have a good rapport and you can't get the result that you think that you want, not just what the patient wants, then it, it's just not gonna be a good match and it might be a good match somewhere else. 
 35:11: So why don't you compete on price with people? 
 35:14: I mean, like I said, to some extent you do because if I was in Boise, Nevada or New York. 
 35:17: New York, you got to be in the ballpark. 
 35:19: I mean, you can't, but I can tell you Scottsdale from our mommy makeover is going to be 30% higher. 
 35:24: They're not better surgeons. 
 35:25: They're not more experienced. 
 35:27: That's just what the market commands. 
 35:28: They're like, well, you're in Beverly Hills. 
 35:30: Well, you know, I'm affiliated with the Beverly Hills practice here in Salt Lake and in Beverly Hills, and those prices are significantly higher. 
 35:38: I could be doing the same procedure in Beverly Hills or here. 
 35:40: It's the same dock. 
 35:41: So you gotta look at your surroundings, but in this particular surrounding, I mean, I've been doing this a while, and you know, I feel like you're buying a Mercedes and you're, you're going to an experienced physician and that's a little different than somebody who just finished. 
 35:54: And so there's a little bit of price variance there. 
 35:56: Yeah, everybody thinks the other thing I, the, the other thing not to interrupt as I'll tell you is, you know. 
 36:00: Not all plastic surgeons have their own surgical center. 
 36:04: I bought that when I joined here and it's really nice to have the autonomy of your own control. 
 36:08: Whether somebody has a problem and I have to take them back so they don't have to pay a hospital or just have control of it if I want to stay till 7 at night or start at 4 in the morning, you know, having your own surgical center really changes the bar and it changes the price because you have a lot more control than some ambulatory center or the hospital. 
 36:23: So what is the truth between a hospital and a private operating room when it comes to these surgeries? 
 36:29: Like, for example, we're what's called quad. 
 36:31: That's the it's the highest certification you can get. 
 36:33: We just went through it this past month, it's every 3 years. 
 36:36: That's the safety factor. 
 36:37: You have to be safe wherever you go. 
 36:39: But after that, you can certainly control your cost a lot more than. 
 36:44: You know, throwing stuff away and using all kinds of extra stuff that adds so much more to a patient's cost if you're at an ambulatory center or a hospital. 
 36:52: And so you have a little more negotiation and a little more control between the patient and you if you have your own surgical center and you know, that's kind of the way a lot of doctors are going. 
 37:00: I just happen to have bought a practice where I had it from the inception. 
 37:04: What are the hidden costs if somebody goes to another surgeon possibly? 
 37:08: I mean, you know, they're gonna have their own costs, but let's say you use mesh, which is another way we have a dissolvable hammock that we can use to support the breast. 
 37:17: The literature is still up in the air whether that's good or not, but some docs swear by it. 
 37:22: That's $4000. 
 37:23: Whether you're in Arizona or here. 
 37:25: I don't use it a lot, that doesn't mean in the right patient, it's very applicable, but some people just carte blanche used it across the board, and they even name that mesh after themselves cause you can do that. 
 37:36: It's the Smith hammock mesh network, and it sounds all fancy, but any doctor can do that. 
 37:41: It has applicability. 
 37:42: I don't know that it's the end all be all, but to me I just added $4000 for the patient. 
 37:48: I'm thinking, do I really need it because otherwise I just don't feel like adding someone who's already paying a lot, another $4000. 
 37:53: So those are just common thinking. 
 37:55: If you have kids and you have life, these are people in real life that you're trying to make sure it's fair for them and I don't wanna add unless I feel like it's gonna bring value, right? 
 38:05: And then that paired with the, you said the hospital costs, the anesthesiologist, those can all be added costs versus going to you since you own the center you're able to control the cost more. 
 38:16: You're always gonna have the cost. 
 38:17: There's the same three costs. 
 38:18: It doesn't matter if it's general surgery or urology. 
 38:20: You're gonna have an anesthesia cost wherever your operating room is, hospital or me and the surgeon, and those 3. 
 38:27: Don't vary wherever you go as far as those three costs. 
 38:29: The amount of that cost is different. 
 38:31: I can control some of those that, you know, the surgeon's fee is a surgeon's fee. 
 38:35: You can change that. 
 38:36: But anesthesia, I've been working with the same group for 20 years. 
 38:39: So we already have set rates with a really good report and the facility when you own it, such as myself, it just gives you a little more latitude, but I have to tell you the biggest pro is. 
 38:48: Invariably people are gonna have problems, whether the big or small, stitch reaction fluid, and it's super nice. 
 38:53: I on a weekend, somebody calls me from Boise, which is 6 hours away. 
 38:57: I'm like, come on, we're going right there. 
 38:59: I don't have to call a hospital. 
 39:00: I don't have to call. 
 39:01: It's and it's, it's really nice, convenient and helpful for the patient, and that's a huge plus. 
 39:08: So if somebody's lost 100 pounds from one of these weight loss injections, why should they call you? 
 39:13: Two reasons. 
 39:14: One, I have the experience and the results, they can come see her are all over the net. 
 39:18: and that's why I affiliated with Roxbury, who does the weight loss and lipedema in Beverly Hills and Salt Lake. 
 39:23: They picked me. 
 39:25: but more importantly, I think I have a passion for that one, like when I was doing Clef Kids. 
 39:28: I just think those are the most gratifying patients in the aesthetic thing because they've really worked hard, whether it's running every day for 2 years or had a gastric bypass or Ozempic, and they finally reached their journey, which was a long journey end, and they're like, hey, I'm ready. 
 39:43: And that's super rewarding for the surgeon. 
 39:46: Yeah, they've had to change their their life to get there. 
 39:48: Any any closing remarks? 
 39:51: I think if you enjoy what you do, which I do, even though I'm switching from, let's say pediatric facial stuff to this, that makes you, good. 
 39:59: I think consistency, time and experience, and when you put those together, whether you're in Miami Timbuktu or in Salt Lake like I am. 
 40:07: It makes for good ingredients to get a good result, and that's the kind of thing that patient a client wants to look for in the surgeon, not how much glitz, how much glamour, how much TikTok, what's the experience, what's the results that's gonna yield the best experience and opportunity for that patient to have a nice outcome, understood. 
 40:26: Now, no plastic surgeon is perfect. 
 40:28: They all have their possibly patients they might have wished they didn't take on, or maybe scenarios that they've gotten themselves into through taking on some of these more troublesome patients. 
 40:39: So are there any negative reviews that you've received that there might be a two-sided story to unfold? 
 40:46: Yeah, I mean, I'm, I'm pretty lucky on our aesthetic site. 
 40:50: I mean, I think we have a 48 or 4 rating. 
 40:52: With hundreds of reviews and, you know, I'm, I'm lucky for that. 
 40:55: But you're always gonna have some bad. 
 40:57: You know, sometimes you just have to look at the bad or the good. 
 41:00: Some people like the movie, some people didn't. 
 41:02: But of course they're hurtful if they're untrue, but I'm not, I don't want to get in an argument with them. 
 41:06: And so sometimes I'll reply and I usually don't reply at all because there's their version of the story is just not true and of any surgeon's gonna be hurt by that. 
 41:14: Like I talked about the breast one where they went too big and the wound opened and I told him it was gonna happen and they still did it. 
 41:20: They have to take. 
 41:22: Some accountability. 
 41:23: They're not all victims, but when it's your money and it's your wife or your husband, sometimes you're like, you know, you wanna point the finger. 
 41:29: But if somebody's been out for 20 years and board certified, but in the US they're probably a good surgeon. 
 41:34: It's not always their fault. 
 41:36: Wound complications and infections happen anywhere across the board. 
 41:40: And to blame surgeons for that usually isn't fruitful, and you feel bad and you want to fix it, but sometimes you end up butting heads because Again, some people are unrealistic about anatomy and biology, and you're just trying to educate them and so then it becomes a battle or they're unhappy and frankly, for all my colleagues that are board certified, it happens to all of them and most of the time it's just patently unsupported and it's just something you got to deal with when you're out in the real world in social media nowadays. 
 42:08: Yeah, understood. 
 42:09: Well, I think that's everything for me as far as questions goes. 
 42:13: Any questions for me? 
 42:15: No, I think that was pretty good interaction. 
 42:18: Yeah, and I think we got a lot of good stuff. 
 42:20: I think we got a lot of good content. 
 42:22: What I'd love to do is possibly have you on again after we get some, some traction and see like what the market responds to. 
 42:29: , see what people want. 
 42:31: We're gonna post all this stuff to short form content. 
 42:33: So all these people, they'll be able to start commenting and responding and then we can really see like what angles we want to lean into. 
 42:39: But I think we got tons of great clips, for this. 
 42:43: We were able to really more than anything, I think just educate a lot of people that might be interested in working with you. 
 42:49: So we'll wrap it there.