Statins Explained: Risk, Benefit & The Cholesterol Debate

Statins have transformed cardiovascular medicine, yet they continue to generate significant discussion among physicians, researchers, and patients alike.

In this episode of Vitality Unfiltered, host David J. Bauder, PA-C, is joined by Stephanie Lattimore, FNP-BC, and Dr. Shah Ahmed, MD, to explore the science behind statin medications, cholesterol, and cardiovascular disease.

The conversation begins by examining why statins became one of the most commonly prescribed medications worldwide and why so many patients remain uncertain about whether they should take them. The team explains how statins reduce cholesterol production, lower LDL levels, stabilize arterial plaque, and decrease inflammation—helping reduce the risk of heart attacks and strokes in many high-risk individuals.

The discussion then explores how atherosclerosis develops, why cardiovascular disease involves much more than cholesterol alone, and how inflammation, insulin resistance, hypertension, smoking, and metabolic dysfunction all contribute to cardiovascular risk. The episode also addresses common concerns regarding statin side effects, including muscle aches, liver enzyme changes, and blood sugar effects, while emphasizing the importance of individualized monitoring and shared decision-making.

Finally, David, Stephanie, and Dr. Ahmed discuss why modern cardiovascular prevention extends beyond a single cholesterol number. Advanced biomarkers such as ApoB and Lipoprotein(a), coronary artery calcium scoring, comprehensive metabolic evaluation, and lifestyle interventions all contribute to a more personalized approach to reducing long-term cardiovascular risk.

Whether you're currently taking a statin, considering one, or simply trying to understand the ongoing cholesterol debate, this episode provides a balanced, evidence-based discussion designed to help patients make more informed healthcare decisions.

In This Episode

• How statins work
 • LDL cholesterol and cardiovascular risk
 • Understanding atherosclerosis
 • Primary vs. secondary prevention
 • Benefits and limitations of statin therapy
 • Common side effects and safety considerations
 • The cholesterol debate explained
 • Inflammation and metabolic health
 • Coronary calcium scoring and advanced cardiovascular testing
 • Why lifestyle remains the cornerstone of prevention

Key Takeaway

Statins can be powerful tools for reducing cardiovascular risk, particularly in individuals with established heart disease or elevated risk. However, long-term heart health requires looking beyond cholesterol alone. The best outcomes come from combining evidence-based medicine with nutrition, exercise, metabolic health, and individualized patient care.

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⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_02 0:00

Vitality.

SPEAKER_01 0:02

Vitality Unfiltered.

SPEAKER_02 0:04

Unfiltered.

SPEAKER_01 0:05

With David Bowder. Welcome back to another episode of Vitality Unfiltered. I'm Dave Bowder, your host today, and with me is Dr. Alicia Sanderson, double board certified head, neck, and facial plastic surgeon. Today's topic, we're going to be exploring facelifts. This is a super confusing topic to the average listener because there's so many options and so many big words that are used to describe this. So with us today, Dr. Standerson. She's going to help break us down, break this down for us so we all can understand. Dr. Standerson.

SPEAKER_00 0:40

Yeah. So facelifts, again, it's a big topic going in there. There's kind of a resurgence in the surgical correction of the aging face. Things kind of go in a sine wave pattern where people have wanted more conservative, less surgical options. But there's always been a need for, you know, surgical reconstruction of the face. So in other episodes, we talked about non-surgical options of treating the aging face. So we'll kind of focus a little bit about the options for surgical facelifts and kind of break down the different types of facelifts out there, what patients need and what you should be looking for when you're, if you're thinking about, you know, getting a facelift done. So facelifts have been around for a long time. Way back in the day, we just kind of tightened the skin or pulled the skin. Probably earlier on in my training, before the, you know, kind of the explosion of, you know, facial fillers and a lot of the more advanced treatments coming out, the non-surgical options, facelift was your only option. And when we talk about the face and the aging face, one of the things that happens is that we lose volume in the face and the skin starts to sag. So then we start to see the jowlings, a lack of skin, the you know, the loss of the normal youthful um structure of the face. Back in the day, we would just kind of address that way back when with just like skin and removing skin in there. So as time went on and facelifts evolved, um, we started addressing the underlying structures of the skin and addressing what else was happening below the skin level to create aging of the face. So nowadays there's lots of facelifts out there, and unfortunately, there's a lot of you know marketing, so it can be very confusing because people want to sell one facelift better than the other, and you know, they'll come in asking, you know, like for the ponytail lift or you know, deep plane lifts, or those in there. So I'm gonna try and break that down as best I can. So essentially, when we're talking about a facelift, we're talking about the you know, lower half of the face that we're talking about rejuvenating. So we're talking about necklifts, we're talking about the jawline, and we can talk about the mid-face in general. So some of the things that happen as we age, we lose volume and we and we lose fat in our face. And then also gravity starts to take place. So we have descent of the fat pads that are normally higher up in the face, they tend to tether and fall down. There are ligaments that hold all these fat pads in place. So as you start to have descent of the face, you have kind of um tethering points where these ligaments are stuck to the face. We also lose bony volume, so there's a loss of you know, supporting structure underneath the face. So essentially a facelift for improving the jaw and the neck and the midface usually involve incisions in and around the ear. We try and hide them in and around the ear, and then we'll go in and we'll lift up the structures of the face to support those, um, support those structures that have gone down. There is not a one-size-fits-all facelift for anyone. And I think most, you know, facial plastic surgeons and surgeons that do facelifts on a regular basis will mark, you know, will market a certain type of facelift. But most of us are very much trained in different types of facelifts. And the goal is to do what the patient needs, and that's gonna vary based on what their defect is, what their concerns are prior surgeries that they've had in the past. So um, common facelifts that are out there are that we call a SMAS facelift, which is a superficial muscular apineurosis system. So there is um connective tissue that that encompasses all the muscles of the face. And so that um that is continuous with the neck muscles, the platism muscle in there. And then you'll talk about the deep plane facelift. So the deep plane facelift has kind of had a resurgence in popularity as addressing the issues of the aging face, first identified by Hammer back in I think 1990, um, it came in there. But that's going to be something that's gonna address more of the nasal labial folds and the fat pads in the cheeks. Hammer then came back later and talked about a composite facelift that also involved the the muscles around the eyes as they sag. So the most important thing, you know, when assessing what type of a facelift somebody needs is figuring out what they need. So if somebody comes in and they have good facial volume, either because they haven't lost their facial volume or because they've had fillers to their face, and they're just, you know, kind of concerned about jowling in the neck. They're otherwise thin, so they don't have a lot of heavy, you know, heavy um banding or fullness underneath their neck. They may be somebody who benefits from, you know, lifting and tightening the smass or the superficial um muscular apineurosa around there. So that lift may be something to address the jawlines. Somebody who has more heaviness of the nasolabial fold and wants more lifting of the mid-cheek may need a deeper plane lift. But if somebody doesn't have a lot of mid-face, you know, descent or they've had fillers in their nasolabial folds and they don't need that address, they may be, you know, better off with um a, you know, you know, I guess a less extensive dissection to go through there. Are they ever done together? Yep, absolutely. So yep, so they absolutely are done together and they all can be done together and different patients will get, you know, they get whatever they need. So I think most when you go and you meet a surgeon and you, you know, talk to them and you go over things with them, uh they're most of them are gonna do the procedure that you need to have done. So I would not get caught up by any label of I need to have a deep plane versus mass or not doing that. Make sure that whoever you're talking to can correct the issues that you're concerned about. So if somebody does not need their mid face lifted because they have plenty of, you know, mid-face, then that may be somebody I, you know, keep the dissection more lower and tightening in there. It all refers to the extent of the dissection. So once we, you know, we lift up the skin, uh, certain component of the skin, and then we go in and we start to lift up that superficial muscular apineurosis. So every all of them get that lifted up. The question is, how far do we need to go into the midface to loosen those ligaments and resuspend things? So when you're talking about true deep deep plane facelifts, it's about releasing a lot of the ligaments that are tethering the face. So when so you go in and you elevate up the fat pads and the ligaments, and then you resuspend that tissue. It's going to be different for every person, right? Some people, their ligaments are so lax that you don't need to release them, right? So you get in there and you lift up the, you, you know, lift up the plane that you're going through and you pull to lift and everything kind of lifts at that moment. There are other ones where it's very tethered and you have to go in and kind of elevate a little bit more and do a little bit more of an extensive um dissection to get that lift. So the most important part of all of that is don't get hung up on the name. Make sure that, you know, when you're talking about having a facelift is that you're addressing the issues that are most concerning to you.

SPEAKER_01 8:21

What uh what kind of risks are associated with and and specifically the different the different um areas? Is there a different risk associated with the different areas?

SPEAKER_00 8:29

Yep, you sure sure is. So um, you know, common risks of surgeries include bleeding or what we call a hematoma in there. You can have loss of skin um in the facelifts. And then very importantly, there's little nerves that control the muscles to the face. So those are all common aspects of um the complications for surgery in there. So if you're doing a lot of skin dissection and lifting it up and you're putting too much tension on the skin, that will put your high at risk of skin slough. Now that can happen in any facelift in there. Um when you're doing the deep plane lifts, you're going out, you know, into the structures. Now, a skilled surgeon knows where the nerves are, right? Most of the nerves come on the underside of the muscle, but definitely you're in the risk, the more extensive you go into the face, the more dissection you do. There's little branches of those facial nerves that, you know, come out so they can be injured. So, you know, the nerve risks of the nerves are component. Some people will argue that with the deep plane lift, you're preserving more of the skin, you know, like the skin, so the left risk of skin slough, but you're still doing skin, you know, dissections in and around the ear, which is a common place that you have skin sloth.

SPEAKER_01 9:42

And then with with uh so either of these procedures, I guess it just is there's a lot of variability that goes into this, but some of them can be done outpatient, correct without without sedation, and some and have to go to the hospital for full-on surgery. Yep. So what separates that out?

SPEAKER_00 9:56

Yeah, so um there is a you know, it uh some of it is um patient preference. Like some patients would prefer to be completely asleep. If you have a high level of, you know, anxiety or very anxious about that, you may be more comfortable with being completely asleep. A lot of the facelifts can be done as an outpatient procedure. Um, a lot of times we'll give you a you know oral medication like a perk setinovalium that keeps you calm, but you definitely can anesthetise or numb the whole area with the local anesthesia. So a lot of this can be done under local and it can be safely done under locally. Um so barring patient preference of what they would like to do, um, some of the things that would push me to go into an operating, to an operating room or into the hospital is if you need a more extensive dissection. So if you are doing a lot of very advanced, you need a lot of lifting, um, if you need to do a lot of work underneath the chin. So some of the, you know, you know, one of the things I didn't touch on before is addressing the anterior part of the neck and, you know, and sewing the muscle of the neck together in the front area. Um, you have bigger flaps, uh, more extensive dissections. So sometimes if you have a really like heavy neckline, you know, less, less forgiving anatomy in that area where your high ed bone is a little bit lower and you want to do a little bit more work, those patients may, if they're extensive longer surgery the um surgeries, they may be better done in uh an area where you have an anesthesia provider and they're under um anesthesia. And that can be done at an outpatient clin um uh same-day surgery center. They don't have to be admitted as an inpatient. And the recovery time on on these Yeah, most of them, again, like I would say definitely a week of um of you know a little bit of discomfort, pain, swelling. You want to keep yourself out of the, you know, out of society for a little bit because you may look a little bit rough. But depending on which surgery you you decide to go with, um, either like a, you know, a less, you know, a less extensive dissection versus a heavy dissection, you know, you're probably looking at a few more weeks if you're doing the more extensive things as far as swelling and recovery. As far as when you look okay to go out in public, it can be as short as a week, it can be longer, like two to three weeks. The whole healing process takes a while. It takes probably like six to eight weeks for the you know, swelling to go down and to um, you know, have a have a little bit more normal appearance.

SPEAKER_01 12:27

And then some of these times, like when you do these surgeries, like are you are you sometimes adding the non-surgical stuff at the same time? Absolutely. You are doing that already.

SPEAKER_00 12:35

Yeah, so you can definitely do a combination of procedures. And a lot of times people need that. They need resurfacing of the skin, right? So you can, you know, pull and tighten the skin as much as you'd like, but if you have bad quality of skin on top of it, then you may need to have um a laser surfacing, a chemical peel or something. Um if you need more volume replacement, you may want to do volume replacement at the same time as well.

SPEAKER_01 12:57

Fantastic. Uh that's very interesting. And it is uh and when the patients are do you see like a common age bracket, like when patients are doing this, are is it mostly mostly patients are coming to you in their 50s and the 60s, 70s? Is there a certain demographic that men, women, is it mostly women, is mostly men?

SPEAKER_00 13:13

Yeah. So nowadays I have the whole spectrum, right? So back in the day, it was, you know, you know, you waited till you're older and you had that done. But nowadays, aesthetic procedures are common. They're common for lots of people, right? And they and they seek those options. So depending on what somebody is looking to correct and what they need to correct, you can have the whole spectrum of care. I do a lot of facelifts um probably in like 50s to 60s, but then I have a lot of 70 and 80-year-olds that come in. And one of the common questions I always get asked is how long does this last? And a facelift where we're repositioning um tissue and we're removing tissue is always going to last forever, but the aging process is gonna still continue to go. So when do you have it done? You have it done when it bothers you enough that you'd like to look good now, right? So if you want, if you're concerned about certain features at age 50 and you do it at 50, I can't say that in 20 years from now you won't need to have another procedure, but you've actually looked good from 50 years on. If you wait till you're like late 60s and 70s, it's going to be more a dramatic change, right? Because we're moving and repositioning those things, and you may not need another surgery, but you also lived from age 50 to 60 with those signs of aging. So really when you choose to do the facelift procedure is when those features are something that you would like to have addressed. So they are in conjunction with each other. I think all of the procedures, you know, last forever, but we don't stop the aging process.

SPEAKER_01 14:50

Makes sense. Yeah. Dr. Sanderson, thank you for being here today. Thanks so much. To my listeners out there, if you enjoyed the show, make sure you click below and subscribe or follow so you don't miss the next episode. I'm Dave Bowder, your host, and this is Vitality Unfiltered.

SPEAKER_02 15:03

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.