Turn Your Knowledge Into Impact (Not Just Content)

Turn Your Knowledge Into Impact (Not Just Content)

This episode is about something bigger than content—it’s about impact.
In a world where attention is cheap, real education is rare. This conversation breaks down why sharing knowledge freely isn’t just content—it’s a responsibility.

From podcasts to social media, the mission is simple: reach more people, educate at scale, and give value to those who may never step into your office.
This is what separates creators from leaders.

What You’ll Learn:

- Why free education builds long-term authority
- How content can reach people you’ll never meet
- The power of using expertise to educate at scale
- Why modern platforms are redefining learning
- How passion drives real impact

Learn more at https://wegotyournumberpodcast.com/

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The content shared on the “We Got Your Number” podcast is for educational and informational purposes only. It is not intended to provide medical advice, diagnosis, or treatment. Always seek the guidance of your own qualified healthcare professional with any questions you may have regarding your health, nutrition, or medical care.

Transcript

SPEAKER_02 0:00

Okay, this is Dr. Thomas Romo, plastic surgeon in New York City, and I'm here with my co-host, Dr. Ali Phillinger, and we are at We Have Your Number Podcast today. Our guest is a national and internationally known facial plastic surgeon from New York City who specializes in hair transplant, hair replacement, and lip surgery. And it's Dr. Gary Linkoff who's with us as a very special guest, and we're very excited to have him and question him today. And I think we're going to start off with Dr. Phil and Jerry. You uh uh gave him some uh good questions to start off, and then I've got a lot of them to go for.

SPEAKER_00 0:40

Yes, so thank you so much for being our guest. When looking through your wonderful presence on social media, there were so many questions I was thinking to ask you. There's so many areas and domains that I thought that we could get into, but I think that the first piece that I really just wanted to ask you is hair and lips. So what is your journey and how did you end up um with such a unique specialty?

SPEAKER_01 1:05

Thank you both for having me on today. It's really an honor to be here. I've known Dr. Romo for uh since the I was a little you know puny student in medical school, and uh, you know, throughout the journey he's been there. So uh it's it's really special to be here with both of you. Um, you know, my my uh experience was interesting. It started off in uh ENT, um, yeah, had a neck surgery, uh, always loved the anatomy of the head and neck, uh always liked uh art and the ability for us to interact with our environment, so the senses, and it sort of drew me to that field. And during that um residency, I really got into facial plastics. I I liked the reconstructive side, I liked the cosmetic side, um, I liked the creative thinking that went into figuring out you know how to best uh structure a repair for someone or to make them you know feel better about themselves or whether it's after an injury or you know some some sort of um you know congenital you know difference that they have, and and all of that was very interesting to me. So I did facial plastics as a fellowship. Um and then during that fellowship, uh there was just an opportunity to do a weekend course with this one facial plastics uh hair restoration surgeon in Miami. So I I took them up on the offer and just went there for a long weekend. I didn't really think too much about it. I didn't know much about hair restoration at that time. I had a full head of hair um you know, still then, and uh took the course and uh I really liked all the you know the the micro nuances of it. I I really felt like that was something I'd like to you know explore more. And I was in touch with uh with that mentor of mine who's um Dr. Epstein, and we we kept in touch uh throughout fellowship, and then at the end I started my own practice in New York City, and all of the hair activity was like under his umbrella. So I was um managing the New York City arm of his uh hair restoration practice, and I was I started my own practice right away, and he was actually even sending me patients at that time for some of the other uh facial plastics work here in the city, uh, and then I had a VA job to pay the bills, and that's how it all began back in like 2018. And then um two years in, you know, right before COVID, actually, we just decided we decided to part ways. There's different interests. Um, I took all the hair activity under my practice, and then COVID hits, and I realized I have like just a few before and afters, couldn't, you know, do elective, uh couldn't practice elective medicine. And uh basically things were just um very uncertain at that time. Uh I went on to start this YouTube channel because someone just recommended, oh, there's doctors on YouTube, maybe you can start making videos, and that's how it really took off. And then post-COVID, or or you could say still during COVID, there was this, you know, zoom boom or whatever you want to call it, right? More interest in in plastic surgery for a variety of different reasons. And uh I sort of rode that wave, and then with the online visibility on YouTube, that helped me accelerate uh the growth of my practice. And then during this time with COVID, I actually lost all of the hair on my body because of an autoimmune condition called alopecia ariata, and um that was a very interesting experience. It was um somewhat cathartic to be on the internet talking about hair loss while going through my own struggles. Right. And then about three and a half years ago, I decided hey, there's enough traffic coming in for just the things that I really enjoy. I I already was sort of getting known for this lip procedure, um, and and that was sort of a strategic move from the start of the practice to be known for something because when you're the new guy in town, it's like if you don't have a niche, then why should people come to you at all? Exactly. Um and yeah, and so I had the hair thing going and the lip thing, and then I said, you know what, I can let everything else go, and I think I'll be okay. It was a big decision. Uh, but then I just started to refer people out to to wonderful colleagues and uh kept doing just those things and really focusing in and day in and day out doing the same general types of surgeries and getting good at them. So that that's been my journey.

SPEAKER_02 5:14

Well, it sounds very interesting uh because we all end up where we do what we do best. Uh I have another question for you, uh, sort of on topic to this. And it's more of before we get into talking two surgeons to two surgeons here uh about surgical procedures and things, I wanted to talk to you more about uh the cultural aspects. Um The Beatles come in, they have long hair, then everybody starts getting long hair. Uh then you've got uh Yule Brenner, uh Kojak, uh Michael Jordan, a lot of guys who are bald headed, that's another style, uh military kind of short style. Uh more recently we had uh the the California Beverly Hills Kardashian uh Hadid uh lips were bigger, then they got bigger and bigger, then they got ridiculously bigger, now they're swinging back. I think the other way, you're the expert on this. Uh, and uh, and then about uh that's in young women, and then we have postproposal women. So how do you address, I know it's a big topic, but how do you address and see that? Because now that's your specialty and your expertise.

SPEAKER_01 6:23

Yeah, I mean the cultural trends are really important. You know, people get so heavily influenced by what's going on, especially with the celebrities, and they sort of set the tone uh most of the time. And you know, that's part of what's been interesting on YouTube because I got into this arena. It's not the only type of video that I make, but like I do celebrity analysis videos, and what I think is the most like uh in-depth, like um you know, respectful way that I possibly, you know, can can do it. And that's just kind of my style. Yeah, people like that, and I just put out, for example, a Jim Carrey analysis that's doing quite well on YouTube, or people were wondering, you know, what he had. And I wasn't the first one to put out a video, but I took my time, spent a lot of time analyzing him. And it's really, you know, I used to not like that style of video. I used to feel like, you know, maybe it's a little bit cheap, maybe it's you know being hypercritical, even though I'm not criticizing, but it's like it can be interpreted a certain way. But then as people really started to like it and they just wanted to kind of know, and and I I use it more as like a tool to educate. Um, and it's almost like you're kind of like Sherlock Holmes, like trying to look through, and I spent a lot, I mean, my analysis, it takes me about three to four hours to do the analysis, and then of course I have to film it, and my team puts together all these images over the years. So it is like actually, and then there's the editing and my reviewing of the editing. It's a lot of time that goes into these, but I think people like them. Um, but that really I think sets the tone, and then people decide, you know, how they want to respond to that if they want to fit right in with that latest cultural trend, uh, which I don't think is the healthiest way. I think it's always better for people to take their time with these the decisions, especially around like you know, permanent like cosmetic surgery. Absolutely. So I always think that people need to step back and and really see where that fits in with their lives and not rush into any um decisions on that. But but yeah, for sure, like that influences people's uh decision making. But I think like, you know, there's certain procedures that you know are kind of tested, you know, over many decades um and aren't really going anywhere. And maybe sometimes they might get a little more popular, less popular, but there are certain things that I think, especially when you're focused on natural results and um things that can exist in the test of time. Like they'll always be around, you know? Yes.

SPEAKER_00 8:46

I think that well, I really value you just talking to us about the fact that when you're putting information out online, it does take time. Um I think sharing any sense of free education is really driven just off of the passion and the fire to really, you know, give accessibility to your knowledge to maybe people that you don't directly influence. I know me and Dr. Romo, even when we started, you know, our little podcast, we always had the thought process of how do we reach more people, how do we take my expertise, your expertise, the expertise of the amazing people that we know, and um, you know, share it with as many people as possible.

SPEAKER_02 9:25

And I think that's where you're uh where you're uh with the present technology and and we're kind of where you you were right there in the cutting edge of that, you know, it's kind of uh just a critical review of celebrities. But I know you personally and I know how how smart you are and you're technical in your eye uh for evaluating this. And now that this medium is the way people do get their education, younger people, uh, and you taking the time to look at those uh uh faces and uh and say, why do they look like this, why they don't look like this the way they should look, I mean they're getting a great education, and that's what is so difficult because we have so little time during consultations on all physicians uh to really explain things. So you you taking the time to do that is outstanding.

SPEAKER_01 10:11

I think Yeah, what's interesting is I really I mean if you watch any of the videos, like you can literally just take a look at the most recent one, the Jim Carrey one, and you'll see how like how much of a lack of bias there is. It's never saying that something was done great or or or poorly, or that they needed to get it done or they shouldn't get it done. It's never like that. It's very like um, I mean, of course it's speculative, but it's more like look, you can see this change here, this is the type of surgery that could, you know, result in this in this type of look. But what's really fascinating to me, honestly, um, and I used to get like uh you know emotional about some of these comments, but now it's just like it's almost just intellectually interesting to step back and because I've gotten so many you know comments in all different directions, but people like they ascribe their own biases like based on how they feel about the actor or the actress or the celebrity to say, like, oh yeah, like you're ridiculing them, like you shouldn't talk poorly about them, or you should get your own plastic surgery, or you know, or some of them just you know, kind of like say, like, yeah, this this was done amazingly well. Yeah, it's but it's like they're putting their own, however they feel inside about whether the general plastic surgery, whether it should be done for cosmetic reasons or not, or just like how much they love or hate that celebrity, and you see it all play out in the comments.

SPEAKER_02 11:35

And I'm always that's kind of implicit in the in the media that you're uh that that you're using, and not everyone's using today, this virtual and uh TikTok and all the available uh uh virtual mediums that people are watching. Uh everybody's got an opinion and they're and they're not there in person, so it's very easy to to make that opinion. Uh, and I can imagine. But the the great thing about you is I know how skilled you are and how accurate you are in the time you put into this. And so there's that also you've got you're always gonna have criticism, but your actual uh ability to put that, evaluate that, and then put your uh statements about it are actually really great. I think it's fantastic. I've watched some now, and they really are great.

SPEAKER_00 12:16

Yeah, and since we're talking about social media, right, I want to say that hair loss is trending. And I think that we've just seen so much conversation around hair and hair loss, and I think that it's partially due to the wave of weight loss medications. I think it's partially due to the fact that there's so much information or there really is a boom, especially when it comes to the nutritional world and like the intersection between the doctor world with things like perimenopause and menopause. Um but before we get into those topics, I want to actually just talk about nutrition. So, of course, the doctor of clinical nutrition has to talk about nutrition. Of course, um any conversation that we're gonna have to do. Absolutely. Absolutely. So I want to talk about the fact that of course not all hair loss is related to malnutrition. Um so what do you see in your practice? What percentage of people are coming to you either post um poorly managed weight loss that are coming in seeking alternative treatments for hair?

SPEAKER_01 13:20

You know, I think it's a contributing factor, probably in many cases, but I do think it's a fairly you know small uh piece of the overall um you know problem of hair loss, if you want to see it as a problem. But you know, I majority is gonna be androgenetic for men and women, right? A vast majority. We're talking about probably for guys uh 90-95% plus, and for women at least 60, 70% related, right, to androgenetic. So that's still the kind of overwhelming um cases that we see in the practice. Um so there are times when we get into the discussion of like other potential causes, especially if the you know, there's a reason it's called patterned hair loss, right? For men and for women. The patterns are different, but there's still general patterns that we see. So if we see like, you know, the the standard pattern, we don't necessarily do like a full workup for other problems, you know, unless the the way that we're we usually treat these um you know types of conditions are are not working, then we look for other potential causes. Um but yeah, but like full, like full-on malnutrition is the primary driver, we don't see that often in the practice. Uh, but of course, like that's becoming more common with the GLPs and other forms of weight loss, you know, that that could trigger a telogen a fluvium. People come in, you know, they're worried, they're losing hair. Most of the time they'll gain it back, sometimes they don't. But yeah, uh it's not like the majority of what is um you know coming in.

SPEAKER_00 14:58

Yeah, and I think that that's actually super valuable to know because you hear on all media outlets hair loss associated with medications. Um so you see it a lot on social media, so it's so great to hear from the expert that that's not actually what you're seeing in practice. Um I've gotten referrals for patients on you know restrictive medications like GLP1s and so on. And the interesting thing, and I'm also interested to hear what you have to say about this, is oftentimes the recommendation on my end is a um well-balanced diet. It's no crazy supplement, it's no, you know, extra herb, botanical, and so on. It really is the fact that let's analyze your dietary patterns and see if there's an area where maybe we can optimize whole foods, antioxidant-rich foods, optimize protein intake. So it really is the basics versus going and looking into the multi-million dollar supplement industry on hair.

SPEAKER_01 15:55

Um, no, I I agree. Uh you know, I I sometimes get asked this, not often actually, from patients, but they'll ask, like, well, what's the best diet for me? And I I tell them, look, that this is not like my area of expertise. Like, now there's Allie to refer to.

SPEAKER_02 16:12

Now you know Allie, and she's in the city too. So yeah. Exactly.

SPEAKER_01 16:16

You're you're gonna get all of them. But but basically, I'm like, I say the same thing, and then they look at me like, uh, you know, they're hoping for a little bit more guidance than well-balanced diet. But but it is true that like most of the time we get enough, like, for example, let's just say biotin, collagen, right? Those are probably like the top two supplements being sold out there. But like you get enough in your diet, and there's no data to suggest that like you know, supercharging that in the system leads to like improved uh you know, hair gains. It's just there's there's just zero data to support that. So, you know, I don't give them any special supplements either. And if they really want something, you know, I'll just say, like, okay, take neutrophil, but it's gonna be expensive and probably unnecessary.

SPEAKER_00 16:56

Yes, so$88 a month. Um, I've seen I was looking in preparation for this meeting last night. It's like midnight, I'm scrolling through their website, just looking at, you know, what is in this product and um why is it that it's so popular. And as a doctor of clinical nutrition, I'm always looking, and you know, we did an episode on supplements maybe a few weeks ago, and I always look at it through a hypercritical lens. So I like that you said, and I always say that we can't supercharge pathways in our body to go faster than they can. Um so I'm gonna give two examples because I think that they're super interesting. So the first is in vitamin C's role in collagen synthesis, right? So without a vitamin C deficiency, there's no indication that taking more vitamin C is going to necessarily um result in more collagen synthesis. Where vitamin C works is it works as a part of the coenzyme that's going to connect the two amino acids that are going to help collagen develop its structural integrity, right? So in signs of deficiency, we see an issue. It doesn't necessarily mean that we take more vitamin C and we have you know less that we're getting more collagen synthesis. And when I was looking through the different supplements in preparation for this, I kept seeing the same themes and the same trends in all of the same supplements, right? So of course we're seeing biotin. I completely agree. Um, I always think actually biotin's red flag goes up with the endocrinologists. They say, no biotin, that is going to throw off, you know, that TSH value, and you're actually gonna do more harm than benefit. Um so you know, I see it with biotin, I see it with vitamin E. Just because we know it works as an antioxidant in the body doesn't mean taking more of a fat-soluble vitamin is necessarily gonna help with hair. Um I'm a nerd if you can't tell. I could go on and on about every single micronutrient. Um I would have to do.

SPEAKER_02 18:43

Well sometimes more, sometimes more isn't is just more. Yeah, more is more than a lot of people. You're not gonna kickstart the pathways uh uh by taking more. But the supplement market is a multi-billion dollar industry. And I've you and I've talked about there are people out there who have uh products uh and they're not even they're not even physicians or they're not a PhD nutritionist either, uh, and they're out promoting products. So it's a huge market. Uh but it's great to have some experts like uh you, uh Dr. Linkoff, and you, Allie, uh on that topic.

SPEAKER_01 19:14

Yeah, I mean it's honestly like similar to surgery, I think, where uh you you can over-surgize and then things just look worse. You know, it's about doing the right amount of work, but not necessarily going overboard.

SPEAKER_02 19:25

And it's well, let me to that end poke at you a little bit from surgery-wise. Um it's interesting, uh, because we were got back to the the the female guy, I in my aging face patient uh practice, uh it's probably 75% women uh and uh 25% men. Uh and it's uh in that age group where you start looking at the aging face and perimenopausal and particularly postmenopausal women are uh all of them are talking about they don't want to lose one hair. Uh so I want to get into that with you uh with just uh a little bit. There are um uh but I'm thinking about uh from a surgical-technical point of view, um the the thought process of um follicular grafting. Uh first of all, it came out and and everybody looked kind of like a doll head or something, and then I think he got more sp specific. And then I want you to comment on the guys like Toby Mayer and Fleming, who were flappers and the difference between the flapping industry and the uh the individual hair uh transplant uh technique. Why why did one proliferate? And also, is robotic harvesting better than the way you do it uh by hand?

SPEAKER_01 20:38

Yeah, yeah, no, great questions. Yeah, no, basically the evolution was that, you know, it's funny, the the microfollicular unit was something that they first discovered in Japan like over a hundred years ago. And then uh it sort of was like lost, you know, it was harder to to to to you know to spread the message uh at that time. But then when we look back at you know some resources, like we actually we can see that there were attempts uh like in the early early 1900s. Um but around like the the 50s, uh Orantreich uh brought this concept over, I believe from like Australia, but it could be mistaken. But anyway, he brought it over to New York um as this like the the punch graphs, you know, like four millimeter punch graphs. Yes. Uh you know, it's interesting because I at first like I didn't really understand like why were they like it looked so bad? Like, you know, you see all these terrible results. It's like what what were they thinking? But then it was explained to me that they were putting them, especially the hairline ones, like behind the existing hairline. So it wasn't like they were trying to line the hairline with them, but again, there was no finasteride, so guys were just especially for you know, this was mostly done in in men at a certain point, and even now, in the majority case, they're still male, but you know, the the guys would lose more hair, and then they were just left with these these uh dominants. Hair type of um appearances and it looked highly unnatural because that's all that you know because the rest of the hair faded out, it was nothing preventative. Um and then there was uh yeah, there were different flaps, the Uri flap, there were different flaps uh created scalp reductions, all this kind of stuff. There was like a lot of surgery, and sometimes they would fail, and then even when they were there, just wouldn't it was like a the Donald Trump look where things aren't exactly combed uh properly, like you have to really put it together. You can't have a blow in the wind, or else it's like the directions are very unnatural, right? So, so that no one really does those procedures much anymore. Um, and then you had strip surgery, so we realized that yeah, like this the microfollicular unit was much more natural to transplant, but how were we getting it? We only knew about this strip method, this this cutting out of a section of the scalp, and then doing all this work under the microscope to basically cut it up into these little graphs and then placing them in a more natural, a more sophisticated way. And then around like 2015, the FUE method started to take off more. So it was described uh maybe 15 years before that, but it really started to get popular about 10 years ago. Um, and that was the removal of these individual miclo microfollicular kind of graphs um instead of cutting out a big strip and and basically dispersing it in a kind of random fashion in in the donor area.

SPEAKER_02 23:32

Sort of reducing the scarring in the donor area.

SPEAKER_01 23:35

Yeah, like you still get scars, but you get like little tiny dots instead of the big long line. Yeah. For people with shorter hair, it becomes visible, and then if they lose a lot more hair, then they're just left with this long scar. Yeah.

SPEAKER_02 23:51

Okay, well that's uh so that's kind of that uh the historical uh go ahead, Alec.

SPEAKER_00 23:56

Do you have any questions nutritionally on this stuff or uh uh I always get so much out of these conversations, you know. Um joining forces with a plastic surgeon, I think I've been educated on so many different topics um over the years, which has been so helpful. I think that's something that we have spoken about, which is a good intersection between plastic surgery um and what I do, nutrition, which is also I think very culturally relevant, is um menopause. So I'm wondering if you could just talk about um you know the transition with menopause and if you're seeing menopause women coming into your practice and what are the options so past just surgery um that you can do for women that are experiencing this um you know hair loss due to fluctuations in hormones.

SPEAKER_01 24:48

You know, surgery is actually just a small um piece of uh the solution there. It it probably I think there could be more, you know, good surgery done for uh kind of post-menopausal women. Um I think a lot of times there is like a lack of understanding of when someone is an actual surgical candidate. Um that can become you know tricky for some people and they they don't necessarily refer them when when they are candidates, but then if they're referred um as potential candidates, oftentimes they're they're not actually good candidates. So it gets a little bit trickier to find the right people for for surgery in in that category, in that demographic. But so I think overall we could probably do better, um, both on the hair transplant side, you know, hair surgeons like over-surgerizing patients who really shouldn't have surgery, and then people who are referring and they don't always know how to and when to refer. So um, because a lot of times what happens, so estrogen goes down, androgen effects go up, and then these kind of patterned female patterned hair loss uh starts to starts to take hold, but then you get like a lot of diffuse thinning too. So then the issue is if you don't have enough good supply in the donor area, and you have like just broad thinning, like where are you gonna be concentrating your efforts with surgery? Because if you just put a little bit everywhere, there's really very little visible change, and then it's just like a waste of effort and time and money and and you know putting people through surgery they didn't need. So that's the tricky thing. Um, so of course, the first step is to uh we like to get uh blood work uh on patients in that demographic, and that usually looks for um different hormones, um, it looks for thyroid levels, um, it looks for things like iron deficiency, ferritin deficiency, vitamin D levels. So we kind of know there's a little bit more going on, it's not like super straightforward. So let's do some blood work, let's see if there's any underlying reason, you know, for it before we just jump into like treatment. And then on the treatment side, usually you want to start with something that's again preventative. Really, for men and women of all ages, you know, you have to think about prevention first. So usually the most effective medication for prevention is spironal lactone in that category. Women and post-menopausal. Yeah, spironal lactone, and then for the stimulation side, which is also important without surgery, uh, we like oral monoxidil, we've found it to be the most effective. Um so those two pills are usually the best kind of medical therapy, and then you can add stuff to it. You know, there's other things, laser lights, there's PRPs, there's all this stuff, and then reserve surgery for the smaller percentage that qualify well, where there's enough of like thick hair. There's gonna be enough thick hair in the kind of classic donor space, and then like a more confined zone that might be thinner. That could be the forelock, it could be the frontotemporal areas, you know. Absolutely. That's a big goal of theirs, and that is transplantable, but you shouldn't jump into it before going through all those other steps.

SPEAKER_02 28:03

Yeah, it's it's being a good physician, a good surgeon, and having a good treatment plan, uh, comprehensive. Uh so we're not gonna let you get away until uh you talk a little bit about uh lips. Uh you're a lip expert and uh we always go eyes, lips, face once we reduce the nose. Uh so you gotta give us uh your philosophy, your uh intellect on uh lips. What's going on with uh lips?

SPEAKER_01 28:30

You know, I think a lot of it comes down to strategy. I I think of uh hair the same way and and anything else, right? It's like properly setting the the strategy. Um some of it starts, of course, with like what the patient's wishes are. But as we know, sometimes patients they just don't know. They they they know they don't like something, but they don't they can't exactly explain it. So it's our job to but I I always like to start with like what's bothering them. Like, especially sorry to go back to hair, but like there are sometimes surprising situations where I'm like clearly like this area is the problem, and to them, they're like they don't think about that at all. It's some other part, yeah. Absolutely we try to figure out like you know, sometimes you gotta follow them where they're going, and sometimes you just have to bring them back to like reality. You know, I've had people where they have literally no like frontal scalp at all, it's just missing, and they just can't stop thinking about the crown. And I'm like, that makes zero sense. I'm not doing a crown procedure, and you've got no hairline at all. Like there's some things we just you know, you gotta, you gotta you gotta say no to. But but anyway, so with lips, it's like that too. You know, some people they don't they don't understand like what the proportion should be. They just know you know whether time has passed and things have deflated and the filtrum has gone longer, they know they don't like that. Um, maybe they're younger and they just are born with a thinner lip, and you know, or there's no tooth show and they keep getting like dental work, and they're like, Well, the teeth aren't even showing, so like what can I do?

SPEAKER_02 29:57

Yes.

SPEAKER_01 29:58

That's always the best type of patient that comes in just kind of a little bit more open-minded, understanding general options, but open-minded. Because some people come in and they're like, I want this surgery, I want a lip lift. And you're looking at them like there's no way, because maybe their distance is a little longer, but they've got like full tooth show when they just part their lips, and you're like, I don't want to make that worse because that's just gonna throw everything off. But they don't understand that, and they think it's not a problem. Oh, I don't care if that happens, but they will care afterwards when they're stuck with that result. Absolutely.

SPEAKER_02 30:30

And the old and the low and the bottom lip is bigger than the upper lip. Is that usual? In the uh in the it is, it is.

SPEAKER_01 30:37

I would say going back to like your point on the kind of the cultural trends, I think having a little bit more of an even proportion, upper to lower, is a bit more accepted these days compared to like in the in the kind of classic uh beauty sense. So it doesn't make it right, but it you know, it's a little bit more of acceptable these days. But yeah, you don't want an upper lip that's twice as big as the bottom eye, it shouldn't attract like way too much attention. And so that's definitely something we're thinking. But with the lip lift specifically, there's different changes that occur, and people want to isolate one variable. They say sometimes, oh yeah, I'm okay with this distance, I just want a fuller lip. So like just give me a full and I'm like, no, no, no, like it all happens together, or they or they already have a big lip and they they want the distance shortened. They said, but don't make my upper lip bigger. And I say, Well, that's it doesn't work.

SPEAKER_02 31:28

One plus one still equals two. Yeah. That's I love when Dr.

SPEAKER_00 31:32

Romo says, Did you go to medical school? Yeah, we're gonna go. We've talked about that. Like when a patient will come in asking for something, um, and you know, he'll say, like, did you did you go to medical school? Do we have to argue?

SPEAKER_02 31:44

It's and and as uh uh Dr. Linkoff knows, uh the the treatment plan is driven by the diagnosis and the evaluation. So, you know, you don't start off with the treatment plan. So uh and a patient comes in, I had a she's talking about a woman I had who came in who uh I told her about who said, Hi, Dr. Romo, I need a facelift. And I said, Where did you do your plastic surgery training? So I didn't because I hadn't made a diagnosis yet, so how do I know if she needs a facelift or if she qualifies? Yeah, and then when they tell you exactly the technique that you should use, you gotta use a deep plane. I got the guy advertising a deep plane on the billboard on the way out to Newark. Uh it's I'm going like, you know, Hamra uh designed that 40 years ago. It's not anything new. It's like you're talking about hair with uh orange right. Uh it's been around, it's just getting the applications and uh and the evaluation. Like you said, I I I'd love to hear what you're talking about, uh the in-depth evaluation. Uh it's not a knee-jerk. They walk in, you're gonna do a hair transplant. It's it's uh well thought out, as I would expect from you. Uh and I and I really uh really love that uh about uh your diagnostic capabilities, not only your treatment plan.

SPEAKER_01 32:51

Well, patients who you want in the practice will really appreciate that, I found like if you tell them no, or no, like for this specific procedure, or no now, but like we'll re-examine in the future, um, the right patient, you know, that that you really want to be operating on and you won't regret later, you know, they they really respect that. You know, they they they're they're like, yeah, like this is a surgeon who's telling me no, he's giving me reasons, so maybe we'll reassess in the future. And I find that they often come back and then they're very happy that you know you you just treated them, you know, with uh with with care and you weren't just like trying to get their money.

SPEAKER_02 33:30

Um correctly too. Yeah.

SPEAKER_00 33:32

Well, I think that a lot of these topics are so personal to people. So their hair, um, you know, if they're going to do plastic surgery, there's there's these things that um you know they experience and they have emotions about in their daily lives. So I feel like when they're coming to your office, they're already supercharged by all of their experiences. Um that they want someone that's going to one guide them in the right direction, but to also guide them in the right direction. I have patients that sit down and start crying before I even spoke to them. I'm sure there's very similar experiences for both of you guys. Um and often just being the authority, you know, people don't always respond well to that. So I really like the fact that um, you know, especially if it's like a menopausal woman, you know, you're working them up to see underlying what's going on, and then saying, like, this is the best course of action for you. Um versus like, you know, this is the course of action, that's one, you know, could be easier, or you know.

SPEAKER_02 34:26

It's to try and do it correctly is difficult. And you already mentioned it because there are motivations, uh uh there are all kinds of reasons why and with social media with with physicians doing procedures, and it's great to get back to having physicians being uh real physicians and or surgeons being that way. I have one more uh for you before we have to let you go. I know you're this is a busy weekend for you. This is esoteric and it may end up on the cutting room floor. Uh but I uh having a practice where I actually do facelifts, and if we're doing the post-auricular temporal incision, uh you're cutting out hair-bearing skin. Um and uh uh that's the standard operating procedure, and some people never even offer uh uh an incision along the hairline, uh which makes it more visible, but you don't lose hair-bearing skin, which I always like to at least advise them about uh when I'm doing that. But the other thought I have is if you're actually taking out hair-bearing skin, uh what's the viability of that uh hair in that skin that you could not use that the next day or something to put back into their head? Is that too long?

SPEAKER_01 35:34

A little bit long, yeah. We usually aim for just a few hours of out-of-body time. Um, you can go up to maybe you know six hours pretty safely at just you know room temperature or slightly cooled conditions. Um, some people have, you know, there's you know, like case reports of people putting it in the fridge for a day or two and then still using it and you know getting some degree of regrowth and and survival, but it's not great, especially after 24 hours. So, yeah, I mean you could use it, uh, especially if there's an area just centrally, for example, that's just thinner. Um, you know, if it's a woman uh menopausal, whatever, like you you could definitely use it there. Um, it's just like, yeah, you have to have like the setup has to be there. And then you do worry a little bit about just the inflammation of surgery and will the survival be impacted from that. Yes. So you definitely don't want to use it along, of course, incisions that that kind of early and and fresh in the course. But um, I I think you'd have pretty good survival like if they have an area that's thinner centrally. But again, just having the logistical kind of setup for that, it's tricky.

SPEAKER_02 36:44

Well, I promise you, after my facelifts, I'm not gonna be doing hair. It's gonna come your way either before or after.

SPEAKER_01 36:50

Yeah, yeah. I think it's I think it's probably gonna be doable the following day if it's like refrigerated or you know, something like this. But uh yeah, it's a it's an interesting idea because yeah, it's like you're kind of like if you're cutting out a strip uh lose it, not toss it. Yeah, I get that.

SPEAKER_02 37:08

Yeah. Well, uh it's it's just a thought and it's another uh I know you're a cutting edge uh and uh academic, also uh uh physician, and it's just something I've been thinking about. Uh it's really great to have you here today. And really have you coming in on a weekend and uh uh leaving your family, and I did tell you you could wear pajamas because we got too uh virtual. So uh question for him, Allie?

SPEAKER_00 37:35

So I think we should just leave with like an interesting question. Um so in your experience, what would you say is um the one most motivational thing you could say to a patient that is um considering coming in for an evaluation to see you? That they're feeling nervous, um but that you know it would probably be best for them to to seek treatment.

SPEAKER_01 38:03

Yeah, uh like like reason for see seeking it or just just general words of comfort.

SPEAKER_00 38:08

I guess words uh I guess both.

SPEAKER_01 38:10

Yeah. Yeah, I mean I think at least for the procedures that I currently do, um the risk profile is is very low, you know, when things are done properly. So I think there's a high chance of success and and and that leads to you know very happy um people afterwards and a very like low um chance of of issues happening, you know. So I think it's it's it's very like calculated risk, and as it is for for any of these cosmetic surgeries, um, but I think I've specifically selected for ones that are are overall very, very low risk and and very high reward when they're performed properly. So that should give people peace of mind. And you know, the other thing is like I'll never operate unless I feel like it's truly gonna be in the person's best interest. And um that should give them you know some some confidence as well, you know. Like I think that's important. You know, you have to know when to say no. Um so if I'm already saying yes, it's because I really think that this could benefit them.

unknown 39:15

You believe in it, yeah.

SPEAKER_02 39:16

Fantastic. Huh? Well, we want to thank you, uh Dr. Gary Linkoff, transplant surgeon and lip surgeon in New York City, being on our uh podcast, We Got Your Number, with my co host, Dr. uh Allie Fill and Jerry. Thank you, Brian, being here, Gary.

SPEAKER_01 39:32

Thank you, Dr. Roma. Thank you, Allie. Thank you so much, guys. Thank you, brother.

SPEAKER_02 39:35

Thank you.