HKB Uncut | A Cosmetic Surgery Podcast
Welcome to HKB Uncut: the Health, Knowledge, and Beauty Podcast. On this show, Dr. Bill Kortesis & Dr. Gaurav Bharti unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure.
HKB Uncut | A Cosmetic Surgery Podcast
19. The Truth About Preventative Aesthetics | How to Age Well Without Overdoing It
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Most people think of “preventative” aesthetics as starting early with Botox or trying to stay ahead of aging. But in reality, it’s a lot less about doing more, and a lot more about doing the right things, at the right time, for the right reasons. In this conversation, Dr. Kortesis and Dr. Bharti take a step back and walk through what actually holds up over time: from the unsexy basics like diet, sun protection, and muscle, to how injectables, skin treatments, and even small procedures fit into a bigger, more thoughtful plan. It’s a grounded look at how to take care of your face and body in a way that still feels like you.
Resources mentioned:
In this episode you’ll learn…
- Prevention and treatment aren’t separate decisions. They work best when layered together over time, combining lifestyle habits with the right treatments at the right stage.
- The right provider matters more than the latest treatment; honest guidance and knowing what not to do is often what protects patients from poor outcomes.
- Aging well today is less about big transformations and more about small, thoughtful interventions done earlier and maintained over time for a natural result.
Welcome to HKB Uncut: the Health, Knowledge, and Beauty Podcast. On this show, Dr. Bill Kortesis & Dr. Guarav Bharti unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure.
Dr. Bill Kortesis and Dr. Guarav are board certified plastic surgeons and Co-Founders of HKB Cosmetic Surgery, an award-winning practice with eleven locations across six states.
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I had a patient I saw, massive weight loss patient, lost over 150 pounds, went to a cool sculpting clinic.
SPEAKER_01There you go.
SPEAKER_00All they have was cool sculpting. No other interventions whatsoever. And they said, sure, we can take care of you. Sure enough, the lady spent over $15,000 on cool sculpting when all she had was excess skin. Oh, that's tough. Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
SPEAKER_02On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure. I'm Dr. Bill Cortesis. And I'm Gorov Bahardi. We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
SPEAKER_00In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you. Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week. Bill Cortesis.
SPEAKER_02And we want to welcome you to another podcast with us at HKB. Today we're going to talk about preventative medicine and how um it affects our space of uh aesthetic and and surgical um procedures.
SPEAKER_00I mean, that's something that's near and dear to both our hearts, especially as we're aging, right? Like how can we prevent the whole aging process?
SPEAKER_02Yeah, and I think that you know there might be there's a lot in the in in that you can be doing, but there's probably a lot of stuff that like people are doing that probably doesn't do anything. It's hard to sift through what is actually high yield and what's high value from a standpoint of like products or treatments. You know, I think uh at the foundation of it, I mean who are we kidding? It's it's how you lead your lifestyle. And I know you've been doing all kinds of stuff recently for um you know health and wellness. You know, from a from a standpoint of what what what a patient should start doing as like uh foundation pieces, what are what are things that you've seen that are integral for them to look good?
SPEAKER_00I think number one is hydration. You know, I I think that makes me want to take a sip, bro. You drink your water. But no, and all honesty, I think as a society, I think ultimately we're dehydrated and we don't we don't drink enough um of the H2O, the stuff that we really need to be doing. And I so I think personally hydration is number one. Number two, diet. I think you have to have a healthy diet. I think unfortunately, we live in this world, especially in the US, that's full of processed stuff everywhere we go. And all this processed sugar everywhere. And the key is if we can hydrate and eat right, take years off.
SPEAKER_02Yeah. You know, the this processed stuff is a real issue because like so for the person who's trying to be really healthy, all right. So what do you gotta do? Everybody says protein, protein, protein. All right, so then you're gonna take all these protein supplements. Protein supplements are probably okay, but they're probably they're just as processed. And so like this, there's this tension that exists in our society, and that that uh all these commercial interests that are there where everything that we're sold has some level of being processed. So it's it's so difficult to actually lead the healthy and active lifestyle that we want to lead and then have our kids involved that it's like we all have to open our eyes, and I think it's a it's a compromise, meaning, like how how many of us can get like literally farm to table food? Like how many have the ability to be self-sustained on and stuff on their farm? Not many. The other day we ordered all the stuff from Whole Foods or whatever, delivered to our house, like everybody does. It's really expensive. But like all the shit we got was like all the stuff was kind of spoiled and messed up, and it's like our our food source is just so difficult to get the high-quality foods that we need. But then when people are trying to be healthy, like you're taking synthetic substances to be healthy too. So it's like there's this interesting thing about like how we we all have to approach things, and I guess it all goes back to these simple principles of like temperance and like small amounts and not overdoing one thing. I I've just personally been struggling with it because like I love protein bars, I love synthetic protein, I love all this stuff, but then they come to find out like, oh man, it can have high levels of iron, it can have lead, it can have all this weird shit in there.
SPEAKER_00That's why that's why personally I'm cooking more. I think the first thing patients should do, or anybody for that matter, is track what you eat. Isn't it amazing? Like if you just write it down, you know, there's so many apps out there right now. If you just use one of the ones that are out there that are common, you use one of them and track what you eat, and then just track the the macronutrients that are there and the potentially calories that are in that thing you're ingesting, it's it's astonishing, right? If you go to a fast food restaurant and get a burger or you know, a chicken biscuit, that thing is like four or five hundred calories versus you could have a whole plate of food, better macronutrients, and less calories. That's crazy.
SPEAKER_02So obviously, what you eat, what you drink is super important. Um, what else you're exposed to, i.e., you know, sun exposure, UV exposure. I think that's a big thing that everybody needs to know that we all need to pay attention to. The biggest surprise to me is like people of my skin tone, people who are darker skin tone, people who are straight up black, you will get accelerated aging by being in the sun. So even the darkest of the darkest people need to wear sun protection. Now, there are different forms of sun protection. There's been some thoughts that sun protection can lead to other shit, meaning the sun block is bad for you too. So it's like there's this general balance that we all have to maintain. But what has been very well shown, especially from all our dermatologic colleagues, is that you know it does rapidly accelerate aging. It does put you at high risk for skin cancers. So protecting yourself from the sun, but getting enough of that sun is very important.
SPEAKER_00You still need the vitamin D.
SPEAKER_02You need the vitamin D. And most guys, like us, I have low vitamin D levels, and I'm in the sun I eat, but like I have to supplement with vitamin D. So that's one of the most common nutrient supplements that guys need. Women need it too, but guys historically are very low on vitamin D. And vitamin D is super important for hormone production. So before you go jump and start tea or start growth hormone or other peptides, a little pill in the you know daily can be very, very valuable to you.
SPEAKER_00Yeah, some people have malabsorption with vitamin D. So you got to be careful of that. And so if you do, then you have to take different versions of it to be able to uh to supplement.
SPEAKER_02So obviously there's there there's ways of you know preventing-ish things by just being healthy and active. Exercise is another big thing that you know is super important, building muscle. A lot of women were doing a lot of things where they were just doing things to be really thin and and and very lean and healthy, but like now it's being shown that women need to do weight-bearing things, build muscle, prevent osteoporosis.
SPEAKER_00I think mobility is huge and and movement, right? Like track your steps, it's as easy as that. Making sure you get a set number of actual steps in a day.
SPEAKER_02Yep, for sure. Next thing is coming into our field, like what we do. Like, so here's I I would say, you know, your biggest organ in your body is your skin. So you got to take care of your skin. A lot of people don't do diddly for their skin. Guys don't do shit for their skin typically. So, you know, even for someone as simple as for you and I, moisturizing is very important and washing your face. And so when you start to do that, and a lot of women have different facial skincare regimens, and we have, you know, pharmaceutical grade regimens. But in those regimens, there are things that have active agents that will stimulate your skin to essentially turn over quicker because your skin's living. What are your favorite ones that you use? I like using revision, revision products because the packaging is simple, it's black, it doesn't smell weird, it's not super fragrant, but also doesn't smell bad. So I use like a moisturizer in the morning and then a moisturizer with a retinol at night. That's pretty good for me, and then a face wash. Yep. You know, guys shouldn't use the bar soap for their face, it's just not great for it. Um, but I think for there are others though that are available, like you know, more high-intensity retinoic acids that'll stimulate cell turnover. There are high dose vitamin C serums that can help stimulate cell turnover. And I think the biggest thing that we're learning now is when people are doing this preventative stuff and taking care of their skin is apply it to your face for women, apply to their neck and declete. And if you can, apply it to your arms, apply it to the back of your hands. You know, I'll see some, sometimes we'll see some women who have these beautiful, youthful faces, and you look at the back of their hands and it's just like, you know, just beat the hell out of, you know, crocodile skin, which is no big deal, but like it's because they haven't been taken care of.
SPEAKER_00It's the sun exposure you're talking about, right?
SPEAKER_02So I think those little things, those small things can really help. Um, you know, what are some of the other treatments that you'd like to do for patients that's kind of preventative for kind of for generalized skin health?
SPEAKER_00I mean, it's it's I'm gonna skip a little bit because I think Botox is actually super important for prevention.
SPEAKER_02And by Botox you mean neuromodulator. You mean neuromodulator, right? I think i.e. wrinkle reducer, yeah.
SPEAKER_00Correct. And just reducing the wrinkles in certain parts of your face can actually improve the skin quality as well. So uh I think that goes to the phone.
SPEAKER_02So picking up on that is that not only that, because there have been real studies done and they've been and these have been followed through and they're they're legit, is that people who get wrinkle reduction, um specifically in the face, you know, maybe between the eyebrows, forehead, and crows, um they're there they're they're like kind of scores of happiness and then go up, their signs of depression go down. So there's like a psychological improvement too. Kind of a crazy thing when you realize that the things that we do from an aesthetic medicine standpoint, aesthetic surgical standpoint, like really do have much bigger of a potential change on the on the on the back end versus just like, oh, I'm smoother. It can do a lot. And literally, you can't even make sometimes people can't make those expressions, those negative expressions. And by not being able to make those negative expressions, in some ways, you have a little bit more of a positive behavior. So that's kind of crazy that that can happen. And that's with all the neuromodulations.
SPEAKER_00But then it tell you in and of itself that mindset is so important and how you view yourself. And yeah, we can go down that road.
SPEAKER_02And then also how you're perceived. When you come at me with a scowl, like versus you come at me kind of in a more relaxed state, like I'm gonna perceive you in a different way. That's why patients like me more because they they see the scowl that you have.
SPEAKER_00I can't move anything right now.
SPEAKER_02I'm trying to scowl at you right now and I can't, I'm kidding. Unfortunately, I I take like mega doses of of these things to take effect. But you but no, you're right though, these neuromodulators are really valuable in what because what you're doing is you're preventing the muscles from moving as much. So those deep wrinkles, those dynamic rank wrinkles are not forming as badly.
SPEAKER_00Yeah, you want to prevent these static wrinkles, which is a telltale sign of aging. Right. And so I think that's why these neuromodulators really do work. Yep. And sometimes, you know, we're not.
SPEAKER_02I mean, the thing that I think we I personally kind of also think about too is like my perception of of youth and vitality and aging is different than others, but like when I think about it, it's not like you want someone who's 60 to look 40. It's like you just want someone who's 60 just to look good, youthful, and and and and great for their age. And I think these these agents help that. They don't make you look pulled or frozen. Like that's actually not the look that anybody is wanting.
SPEAKER_00I think we all are striving for that best version of ourselves and figuring out, hey, how can we look the best that we can individually? So I think that's all ultimately what we're striving for.
SPEAKER_02Talk about neuromodulators, which is kind of that wrinkle reducers. Those things are agents that last three to four months. If you increase the dose, all of them have a dose-dependent dose dependency, meaning you do a higher dose, you get longer duration. So that's an interesting thing for patients thing. When they're when they come in, they're like, I only want to spend this. The truth is that they spend more money, they're gonna get longer duration, and they don't have to come back to the office as quickly. So it's an important thing that patients may have not have a concept about. You know, fillers have gotten a weird, a lot of kind of negative press recently. I think that the pendulum is shifting. What's the purpose in your eye for a dermal filler?
SPEAKER_00I think ultimately as we age, you know, again, one of the signs of aging is we lose volume in areas that we usually had volume, right? And so ultimately what we're trying to do is is fill that volume back up. And so we're we're trying to put it in places to avoid that deficient appearance of aging. You know, a lot of times that it's the cheeks, it's the temples, certain parts of our face that feel like we've lost all that youthful look to us, and we're trying to rejuvenate our face by adding it back up. But I'm one of these people that I'm I'm a less is more kind of guy. I'm not gonna come in and put 10, 15 syringes of filler in your face because I think that looks unnatural. I think if you swing to the point where you're putting too much in, then I think it ages you drastically.
SPEAKER_02Yeah. And the other thing is it kind of you can you can kind of pick them out of a lineup. And I think our our goal is to not do that necessarily, but there's times when you need to kind of augment focal areas. I think like places like the lip, it works so well. You know, places like the cheek, it works well. Um, but it has it works also well in, you know, jawline, highlighting, and things of that nature. But I think you're right. I think we can't rely on filler product to lift the face because typically when you're lifting the face and there's a real laxity component, you're adding so much that it's distorting anatomy. In those situations, the result actually is better with a surgical intervention. It's more natural, actually. So this is the thing where it's it's kind of fun now recently, where people are like, oh my gosh, what's the most natural thing? Well, the most natural thing actually is to put things back where they are, add volume back to where they're supposed where it's supposed to be, get rid of the excess skin. So the surgical intervention actually is more natural. And so we've we're seeing that now. Yeah. Where um people are adopting that. But that's not to say that filler is bad. Filler is not bad. Filler is bad when used inappropriately or in too large of an amount.
SPEAKER_00I think you need somebody who is a professional at doing it and knows your face and knows your expectations is not going to just take advantage of you.
SPEAKER_02And slow and steady can be a nice way to do it too. Now, the with with the filler, we talked about dermal filler. You know, other things that can be used from a preventative standpoint or a restorative standpoint are things like biostimulators. So they're in the class of dermal fillers, but they're they're different because they actually stimulate something. They're stimulating collagen production. Name a few of those. So some of those agents are um radius, which is uh calcium hydroxyapatite derivative. There's something called sculptra, which is polylactic acid derivative, and then there's some other ones that are actually kind of more um allop alloplastic, meaning there's uh one called RENUVA, which is um um uh cadaver fat products. There's also another one coming soon called Derm Clay, and there are other biosimors that are coming. They're all a little different, um, but what they do is they give you a volumization, but they also stimulate your own collagen production. So the nice thing about that is that it's not meant to really fill a spot, but it's meant to add a little bit of volume, but also improve the generalized um quality of the skin. So that that's a unique thing where you can do things. So when you start thinking about that, there's different layers of the face. You can you can treat and achieve different things with different layering.
SPEAKER_00You know, you we're moving slightly away from prevention a little bit into intervention. So, you know, the the lines are blurred, right? It's like how when when patients come in, they're like, hey dog, I want to prevent aging, but now you're talking to me at intervention. Is it static? Is there prevention than intervention, or is this kind of a continuum? And I know where you and I lie.
SPEAKER_02I think I think you just you just said the word that I is one of our my favorite words. It is a continuum of care. You know, when we were in training, we both trained together at Wake Forest back in the day. You were obviously many years senior of me, you know. But look better. It's crazy how that works. Some some might say, but I'm not, I haven't met those some. But so like, but the idea though there, you know, remember we had this reconstructive ladder of how to handle and deal with a plastic surgical problem. And there was like 20 things in that ladder. And you could kind of and some people call it the elevator, like you can stop on whatever floor to get it. It is the same exact thing with kind of people's aesthetic surgical aesthetic journey or their aging journey. And even the word aging is such a it has a negative connotation to it, and it just maybe it just shouldn't. It's more about like, I think what we're really helping people do, and even ourselves is like when we look in the when you look in the mirror and you reflect on who and what you are, that you it represents how you feel. And I think that's really what we're doing. You're reconciling that, but you're you're spot on in the fact that there's there's situations where people are trying to modify, alter how they're perceived by others or they're how they're aging. And like sometimes it's gonna be something non-surgical, sometimes it's gonna be something surgical. And like it doesn't necessarily mean non-surgical, always before surgical, or you once you do surgical, you can't do non-surgical. They're all there's an interplay there.
SPEAKER_00I always think the best treatment or care of any patient is to do all of it together. Yeah. Right. If you do surgery, you get a great result. But if you don't do the prevention part, you can ruin all those results. For sure. So like it has to be all inclusive.
SPEAKER_02You know, here's so here's an example of someone that I could I could describe. You have a patient who has um a lot of wrinkles between their eyebrows. They have um some cheek volume deficiency and some skin textural issue. So that patient probably is gonna benefit from, we haven't talked yet, microneedling, just simple office-based treatment to improve the quality of the skin. These deep wrinkles here, they're not gonna go anywhere. Neuromodulators are gonna work best just to relax that. But this upper lid skin, which I didn't mention, she's got all this upper lid skin that's hanging over her eyes. That's not gonna go away by putting Botox in here. And who wants to walk around with their eyes, eyebrows arched up like this? We see it all the time. And so when that happens, you know, that person needs uh a treatment like microneedling. They need like neuromodulators for wrinkle reduction, they need upper lid bleplasty. And that can happen to someone who's in their 30s, 40s, 50s, and they're gonna look the most natural by getting all of those respective things versus just trying to maximize this with non-surgical options. So I think, like you said, you know, combining stuff actually leads to a better result.
SPEAKER_00Well, I think that's where it also leads to where do patients go to get this stuff, right? Like if you go to, let's just say you're going to a fast food restaurant, they only sell burgers and you're wanting and you you need you know a fish sandwich, and you're not gonna get it, right? And so you got to be careful of where you're ultimately going to get these treatments, because if you're not going to a place that kind of offers everything or potentially everything, or is gonna lead you down the right pathway, you might get sold a bill of goods on, hey, you know what, for that eyelid lift, I can do it with Botox, and you spend a little a couple hundred extra dollars to do that, and in essence, that's not the right intervention for them.
SPEAKER_02Yeah, and I and I think that um there's a there's like this, like you said, there's a responsibility in our space to do to do no harm and to do the right thing for our patients and um also to be collaborative. And you and I and and all of our team members here have such a lovely network of people, and we all work with so many incredible aesthetic providers that are outside of our practice, you know, within several hundred miles of our area. And and and if any of them are listening, we we just appreciate you so much because they're so smart and they know they're like once it gets kind of outside the scope of what they can offer, um, then it's like, hey, you need to have a potentially have this approach from a surgical standpoint, and even our internal, you know, aesthetic provider, same thing because the reason why is so simple. I think at the end of the day, people who want to do the right thing for the patients and have a good reputation, a great business also, you know that. And so like leading them in the right direction is the right thing to do. Because at the end of the day, we all have a responsibility to produce, not to even produce, to make people's dreams come true, make them feel good, and not to have like bad outcomes. The bad outcomes suck for everybody.
SPEAKER_00I will tell you, I had a prime example. I had a patient I saw, massive weight loss patient, lost over 150 pounds, went to a cool sculpting clinic.
SPEAKER_01There you go.
SPEAKER_00All they had was cool sculpting, no other interventions whatsoever. And they said, sure, we can take care of you. Sure enough, the lady spent over $15,000 on cool sculpting when all she had was excess skin. Oh, that's tough. Which is tough to swallow, right? And it's not at every location. It's but again, I think individuals need to do their homework. That individual thought she was ultimately gonna get her the outcome that she wanted, but in essence, it wasn't gonna do zero for her. You and I know that.
SPEAKER_02Like, let's be real here, though. Part of this is that so there's responsibility by us, by the provider, or whoever that provider is who did that cool swim, but there's also responsibility like that poor provider also is prey to industry. These people coming and like say, hey, this is the device you need to get, it'll do this, this, and this, and this. And then this device costs $200,000, $300,000. They've gotta make a return on it. So it's like this little interesting, vicious concept to where you know when somebody's considering making an investment in something and then has to use that thing to generate revenue, they're gonna be very motivated to do it.
SPEAKER_00And so we just need to be careful from um from a space and and and and um kind of provider standpoint about what comes into our space that make sure it's it's a good product, it's gonna actually achieve those things and not gonna cause problems, and also where it's not gonna just debilitate the people who are trying to, you know, always I always say the lines are blurred in plastic surgery because we're doing procedures, interventions for money, right? Right, for for cash. And um, a lot of times it's like, are we doing we have an obligation because you said it obligation is the right word. We have an obligation to do the right thing for the patient and not necessarily take advantage of them.
SPEAKER_02100%.
SPEAKER_00And right, and for for me, and I know you do the same thing, you just always put that yourself in their shoes. What would I want to do? You know, how would I, if you were my family member, what would I tell you to do? And how many times do you say no to a patient?
SPEAKER_02All the time, all the time, or really just level set and get them to be like, hey, this is what the results are gonna be like. Is that what you want? There are many times when we will do things that I personally don't agree with and wouldn't want to do for myself or them. But after I can get that clear understanding that that patient understands that, you know, these are the opportunity costs for what we're gonna do, what we're not gonna do, but they prefer to do this for. I saw somebody earlier today for a big facial rejuvenation procedure. You know, she's the best candidate for you know full face and neck lift, brow lift, eyelid lifts, and micro fat crafting, facial resurfacing. Um she's like, you know, I just want to get just this. And I was like, well, the other option is that we can kick the can, you can do ELICOR microcoring, which is an amazing preventative restorative treatment. By the way, we're gonna have to chat about that for a minute because it's it's a big deal for our practice. But, you know, in talking to her, I think she immediately was like, Oh, yeah, that's what I want to do. And then I was like, Well, let's let's hold on. So that's gonna be a treatment you're gonna have to do two to three times. You're gonna get an interval improvement, an incremental improvement, sorry. And you know, how do you describe the change they're gonna get?
SPEAKER_00Yeah, so with L Cor, what you end up doing is you're taking tiny little microcores of skin out. So you're actually removing tissue at the same time.
SPEAKER_02Like you're a like you're aerating the lungs.
SPEAKER_00Yeah, it's one of the reasons I actually like the device for kind of minimally invasive stuff because you're actually removing tissue, but you're only removing a small portion of the tissue. So what I intend to tell patients is like, listen, hey, we're we're putting the machine, we're setting it at a certain percentage that we're gonna microcore. So that's really kind of the tightening effect you're gonna get. And as you do this stepwise, it's not like an additive thing, right? You you know, at some point you you kind of get to the point where you get maximum return. Right.
SPEAKER_02And I told I tell them you're gonna get maybe maybe max, maybe a 25% improvement. Maybe you'll get a little more, but I can I can be comfortable saying 25%. And after explaining that, some patients are like, that's great, I'm good with that. Others are like, Whoa, no. I mean, I'm gonna invest this much money and I'm gonna get that. And I think that's that's why I think we can have we can have those difficult conversations and like be able to accomplish what we need to accomplish and it not be a negative issue with them. You know, but going back to this elecor, you know, do a quick pivot back to the preventative side is that, you know, we were using the word preventative, we're using the kind of the concept of continue of care. The other thing that is happening in our space, a lot of people like to use this word is regenerative. And um, I think these are all kind of loose terminologies that are all used somewhat interchangeably, but that concept does make sense. And you know, when we talk about our space, plastic surgery and recon plastic and reconstructive surgery, I kind of hate that terminology. Like the better terminology is you know, aesthetic surgery and aesthetic and regenerative, you know, um, medicine is really kind of what what we're all pivoting into. Um and I I think that you know, when we talk about some of the other things that are done, what else are you recommending? Because now we have some other things that are also used for pre-surgical, you know, and these ideas of early how do you enhance yourself before surgery and how do you enhance yourself during and after from a recovery standpoint?
SPEAKER_00Yeah, one of the things we have is Elixir MD, right? Is you actually using light therapy to work at the cell level to kind of incite change to make patients' recovery that much easier, that much faster. Right. And it is the studies have been pretty amazing looking at, you know, just using a little bit of distinct light therapy for certain parts of your body to help enhance that recovery process.
SPEAKER_02And part of it is like, you know, before people think plastic surgery, big body contouring, abdominal plastic, facelift, like, oh my god, downtime, downtime, downtime, bruising, horrible, not moving. Uh when in truth, what we're really trying to do is we're trying to accelerate all that. So now, you know, from a surgical intervention standpoint, we want people up moving and grooving better. You know, one thing we forgot to talk about, which is, you know, just just incredibly massive. And the reason why I think it has a big, big discussion point is that all these preventative concepts and dealing with patients in in our space are, you know, these GLP1 massive weight loss patients. All the tools we talk about really are very important during that process because when someone loses weight from like 200 to 150 or maybe even higher, 250 to 150, some of them are going like this, some of them are going like that. And, you know, I think it's important for us to help patients understand the what's the best way to lose weight. And while they're losing weight, what should they do so they can maybe obviate the need for big ass surgery?
SPEAKER_00So before, we would tend to tell patients one to two pounds per week is a good steady weight loss, right? If you're doing it the traditional way, right? People blowing that out. Yeah, now it's like they're blowing it out of the water, right? It's like crazy the numbers patients are getting. And so it's this rapid weight loss that really creates a havoc on patients' body, which ultimately will lead to needing plastic surgery and interventions by individuals like you and I. The biggest thing that I come across with people with GLP1s is this muscle wasting. So you got to make sure that if you're on one, you have to lift weights.
SPEAKER_02Right.
SPEAKER_00And supplement. And you have to be able to eat enough, you know, you mentioned this protein diet earlier, but like you have to have enough protein in your diet so that you don't have this muscle wasting. Yeah. Because it's real. That sarcopenia is it's real. If if if patients do not do the right thing.
SPEAKER_02The other is that that when people cycle, when people cycle on, then cycle off, cycle on, cycle off. If you have the the weight gain, weight loss, weight gain, weight loss, the sarcopenia that can happen to that can be profound and it can be irreversible sometimes. So I think that's an important piece. These GLP ones are getting more targeted and getting better. So I'm sure it's gonna improve further.
SPEAKER_00But it doesn't number on the patient's skin, right? If you're just going up and down on your weight, it's like you especially as we age, it doesn't bounce back as fast as it did when you were young. Yeah.
SPEAKER_02So some of these patients, I would I would say that you know the things that so we had mentioned earlier that you know there's different you know things that you can do from a preventative standpoint. I think so. There are situations where in somebody's been, as they're losing weight, and if they have a big weight loss target, we can actually start implementing, you know, some preventative treatments like you know, um biostimulators to their face. Because a lot of people, the body stuff, it's kind of hard to really prevent. Like if they're gonna have a ton of extra skin, like need like you know, skin resection, but on the face, there's things that you can do to where you can replenish, you know, cheek volume loss, um, skin, skin texture with biostimulators like sculptra and radius. There are treatments that we can be doing along the way, like um Locor, microcoring. If there's just a little bit of laxity, maybe they don't want to have a big incisions. And then combining that with biostimulators is an interesting kind of thought processing concept.
SPEAKER_00But you brought up a good point. Is this something you do as the patient's losing weight, or do you wait for them to lose weight to do something? And and you know, there's two schools of thought here. Yeah. It's like, hey, look, lose your weight, then come back to see me and we'll take care of everything. Yeah, super nuts, or are we gonna just tiptoe into this and and and do both?
SPEAKER_02I think for the facial stuff that that needs to be as you're losing to try to obviate or avoid the need for an intervention. The body stuff, I think I would probably wait. I don't know how you feel about that, but I think for the facial stuff, it's probably important to go as you go. And also, it's just sometimes people can have tremendous facial volume loss and wasting. And they still might need a lower facelift and necklift and eyelid. They might need all this stuff. But I think that um you see some patients who have had this kind of incredible transformation, but sometimes you look you look sick, you look gaunt. And I think that this is there's a night, there's a way to still look kind of elegant and healthy. Um and some people don't need anything, but it's just stuff to be considerate and mindful of.
SPEAKER_00Well, I think you hit the nail on the head in regards to there's not one regiment that fits everybody. Right. Right. And we have to take every individual by themselves and figure out what is best for them. And that's kind of part of what we do as plastic surgeons is really figure out what's the best algorithm for you.
SPEAKER_02Right. It's a nice place to be in so that you can you can use all the tools in your toolbox. Instruments. Instrument, instrument box. You know, one of the interesting things too though, Bill, that we we saw a big rise of is kind of small micro procedures. And what I mean by that are procedures that can be done under local anesthesia that are little tweaks. You know, some examples of those, and maybe we can talk real quick about them, are things like buckle fat removal, under your chin lipo, central lip lift, maybe a little eyelid lift. Walk us through a little bit about kind of um how much of those we've been doing as an organization, why we do it.
SPEAKER_00I think we do them all the time. And I think the reason is patients want to feel better about themselves. They want to look more youthful, but they don't want the downtime, they don't want to go under general anesthesia, and they're like, hey doc, what can we do under local that has minimal downtime that can give me a huge result? Right? What's the biggest bang for my buck that I can get? I think submentalipo is by far a worse.
SPEAKER_02Submetal submental means under the chin. How do you do that procedure?
SPEAKER_00One small incision typically, right underneath the uh kind of chin here. And occasionally you have to put a couple behind the ear that are super small, so a little less.
SPEAKER_02And they're awake.
SPEAKER_00Awake.
SPEAKER_02What do you do? So you go in there and just suck it out, or do you do any other anything else with it?
SPEAKER_00Yeah, typically we we do a combination procedure when we do liposuction. Yeah, right. So we use um what's called vasor, which uses ultrasonic energy to kind of cause the fat to disrupt, uh, makes our liposuction a lot easier. Plus, you get some uh skin tightening with just the the vasor alone. Then we do traditional liposuction where we actually remove the fat. And oftentimes we add that with a skin tightening device. Right. What do we do? There's a couple of different ones that are on the market. The one we like to use a lot of times is Renuvion. The trade name by you know Old Sanders was called J Plasma. Some people may have heard of it by that name. It's it's Renuvion, and that will ultimately help tighten the skin. Again, 15-minute outpatient procedures that can make a dramatic difference.
SPEAKER_02So important things there when people are are hearing about this is that it gets you that contour here to get rid of that fullness. And sometimes we notice that there's a little deficiency in the chin. And so we can help that with a little chin filler because that gives you that length, or we can do a little chin implant. So that's another one of those small microprocedures done under local, super easy. The difference about the chin implant, though, it's not like a boob implant, it's a firm implant. So when they touch their chin, it's like they're touching their chin. Yeah, nobody would ever know that you had one. And we also mentioned Vaser. There's another new um hot off the press in our hands. We have another ultrasonic device that's made by um the Apex company called Aeon, and it is a very nice um uh ultrasonic probe, too, that we're using as well. All right, so you talk about submentalipo. And so that's an the nice thing is that's like an instantaneous. Literally, the next day or two, it looks normal.
SPEAKER_00Yeah, one one day of swelling.
SPEAKER_02So what so then what about this buckle fat? This is this is one I want to talk a little bit about.
SPEAKER_00So this one's this is a little controversial, right? And so uh a lot of patients, particularly younger patients, come in asking for it because they want a little bit more chiseled of an appearance. A transition, right, between the cheek, jaw, and the mid kind of the mid-it almost gives you kind of the sunken in appearance right in the mid-face region. Um works really well, can easily be done under local anesthesia, outpatient, minimal swelling. You'll get a little bit internally, but you make an incision on the inside of the mouth where nobody would ever know, and you ultimately remove that fat pocket. And within a couple weeks to months, you'll be able to see a dramatic change that appeared through your face.
SPEAKER_02So we here's my thought on this. There's a lot of people saying you should never do this. Terrible surgery, horrible. I've never had one patient I've done this on who's had a negative experience. I've had a couple where I didn't remove enough, but maybe that's how I'm removing it. Because like when I'm removing, I'm not pulling it under maximal traction. We're seeing what herniates out easily and then debulking it. You are not doing a radical buckle fat excision. At least I'm not.
SPEAKER_00I'm not either. You know, the the the issue people always claim is long-term.
SPEAKER_02Sure. But guess what? When we're doing facelifts on people, I've I mean, I've seen it countless numbers of times. You go and do a facelift, you go in there, you're doing the face of lifting up the flap. There'll be women who come in and in there, you're you're doing it, you're trying to get their jawline defined. Oh, guess what this gel is? Oh, it's the buckle fat that's dropped all the way down here. So even in the in the thinnest of women, that buckle fat or men, that buckle fat pad kind of still can kind of lead to descent and kind of get into the wrong place. So my my real the provocative concept in questions here is like, is it really that controversial? Like, or is it when it's being super resected and then when people are getting over-augmented in their cheeks and over-augmented here that it leads to this harsh look? There are certain people though that have truly large cheeks, and they they're like no-brainers to do this on. Um, I just think that it got a lot of weird press that people kind of got really hot and heavy about how horrible it is. And I just don't think it's horrible. I mean, using everything with discretion is normal. And so, like, if someone has fullness there or they don't like that look, it's easy to resect it. You can, in theory, replenish that area again. I haven't had to do it, but I don't know why that got such a so many you know thoughts behind it, it being controversial because it's just hot.
SPEAKER_00One of my favorite, I'd love to kind of switch gears a little bit under local anesthesia that can make a dramatic change is upper eyelid skin removal. I mean, talk about that a little bit and how minimal of a downtime and how dramatic of a change.
SPEAKER_02Oh, it's great. And we'll make sure to put in some photos of this. So, you know, upper eyelid um surgery, aka eyelid lift is tremendous. You know, many of my loved ones have had it. I'll have to have this. You you're probably ready soon. Um but the but the but but the idea is very simple. You know, especially you I always, you know, it's for guys and women, but it's women when they think about if they're trying to apply makeup, there comes a point when they try to put eyeliner on or they try to put eyeshadow on and oh no, it's caking, or I can't even see it. That's usually their moment, like I got to do something. And initially they'll think this is when Botox comes in. You add Botox, lifts it up. But the thing that people don't realize is if you want a smooth forehead, sometimes people will get Botox in their forehead. So you put Botox in the forehead, and then other brows will come down. And then this is actually worse. So sometimes it's a really simple thing to have this done. And there are women or guys who always have a little bit of extra eyelid skin. And this can be early. We've had some, you know, one of our staff members, you know I'm talking about, you know, it was she's in her 20s and had had this done, and it was just such an amazing change. She looks so much more rested and alert. But so the idea is you just remove extra skin up here, but you do it in the eyelid crease.
SPEAKER_00So the incision never shows.
SPEAKER_02It doesn't show. So when she closed your eyes open, it just looks like an eyelid crease. It's under local, sutures are out in a week, but it's an elegant procedure. It doesn't mean your eyes are like bug-eyed afterwards. They look all normal. I had a patient now, and she she even said no consent, you know, no social. And I always get pissed when patients say no social. Just kidding. But she was like, Oh, this looks so good. Here, post, here. I'm gonna send you all my pictures because it's such an amazing change. I think I think it's great. Definitely one of the things.
SPEAKER_00And one of the one of the things, I mean, what what people will, their family members will say, friends are like, Oh, you look rested, you look great. I don't know what you're doing. What they're gonna realize is they see better, right? They don't realize how much of a difference just taking that eyelid skin out actually has with their visual acuity and what they can actually see.
SPEAKER_02And the last one will be the central lip lift that's gained a lot of traction recently. I think that one is probably overdone. There are plenty of people who are getting that who don't necessarily need it. It still looks good, but if you shorten this distance too much, then all of a sudden you get the lip living close to the nose and you have too much teeth show. But for the right patient, it's amazing because you shorten that distance, you evert, unroll the lip, and it just looks beautiful. And you can make that cupid's bow look really pretty. And the scar hides really well. The scar hides beautifully. So I it gives a huge thumbs up from us, and patients have been so happy. But my biggest call out though, and I think I've talked to you about this, and I try to get all anyone who does them, is to do the central lip lift, but always add corner lateral lip lifts. Because if you pick up the central two-thirds of the lip, you're gonna have this kind of triangulated look. And so by elevating and repositioning the lateral ones, you keep it in harmony. That's the thing about like it's like when we do, you know, jumping off course, like when me and Cal are talking about rhinoplasties and a patient comes in with a focal interest on the nose. Well, we have to redirect them and say, Hey, we have to take care of your nose as a whole. There's multiple subunits, and you got to treat all of it. Because if you treat one spot, it'll not be in harmony. Yep. So one of the other things that we can kind of wrap this up with is this concept of you know, facelifts. When to do a facelift, is it almost like a preventative one? Before when we approached facelifts, patients would come in. They thought they needed to come in looking haggard, old, gobbled neck, jaws, looking like, you know, just like, oh no, doc, I'm ready to be where I looked like 25 years ago. But obviously now the paradigm is changing. It's it's great because you and I have talked about this forever in that I think people just want to look like themselves. They want to look like themselves kind of in in perpetuity, ideally. So concept of when to do a facelift.
SPEAKER_00I think it's whenever one there's correction to be had, and when you feel ready and you want the change to happen, and yes, the trend is sooner and earlier, right? Because people want subtle changes over time versus these big dramatic changes because they don't want everybody to go, right? You've definitely had a facelift. And they are they want to look natural. So I I think you know, you asked me a few years ago, I would have told you a different answer. But I think my answer nowadays is I think the sooner is better.
SPEAKER_02Yeah, and I think you know, a couple of things to dispel is that just because you have a facelift, just because you have two, three, four facelifts, you can do that and you can look great. So that's the thing is more facelifts doesn't mean look more surgical. Look at um Chris Jenner, you know, and look at the her work she's had. It's built, it's built on itself. So she looks great now because it built on, you know, decades and decades of maintenance, of interventions. And so it can be done, and it can be done very well. And that that type of um availability should be for every person who cares about their aesthetic appearance. Like that's our you know, mantra. So I think we we definitely want to spend more time really diving into the nuances of facelifts and mini and short and long and deep and smash and placation and all the all the approaches. But the the gist is that they can actually do very well and you can build on them.
SPEAKER_00Which which is a good point. Be sure to hit us up on any of our social accounts to text us any questions or anything you want to actually uh hear us talk about or um want us to uh dive deeper into.
SPEAKER_02All right, thanks everybody for listening. We'll see you for the next one.
SPEAKER_00Thank you for listening to HKB Uncut. If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
SPEAKER_02To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.