32. Questions Keeping Patients Up at Night | Anesthesia, Regret, Recovery & Results

Surgery has a way of getting loud in your head at night. You can feel excited, prepared, and confident in your choice, then suddenly start thinking about anesthesia, regret, recovery, swelling, implants, or what happens if the result feels unfamiliar at first. In this episode of HKB Uncut, Dr. Bill Kortesis and Dr. Gaurav Bharti answer the questions patients often carry quietly before a procedure. They talk through common fears with the clarity patients need before making a personal decision, covering anesthesia safety, implant flipping, filler balance, GLP-1 medications, liposuction, and the emotional side of healing.

5 things to know when surgery nerves show up:

• Anesthesia fear is common, especially for people who like to feel in control. Experienced anesthesia providers do this every day. Their job is to keep patients safe, monitored, and comfortable from start to finish.
• Implants can flip in some cases. Pocket size, implant firmness, and implant shape all play a role. When flipping does happen, it can often be addressed. In some cases, it can be corrected with a simple maneuver.
• Regret is less likely when the consultation is honest. Clear expectations matter. So does choosing an experienced, ethical surgeon who listens, communicates clearly, and helps you understand what is realistic before surgery day.
• Filler should support the face instead of overpowering it. A natural result often comes from a thoughtful mix of treatments. Conservative filler, biostimulators, skincare, microneedling, lasers, and neurotoxins can all play a role when they fit the patient’s goals.
• Recovery affects the body and the mind. Swelling, discomfort, bruising, fluid, and post-surgical blues can change how someone feels in the early healing window. Calling your surgeon early can bring clarity, reassurance, or a plan.

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. 

Dr. Bill Kortesis and Dr. Gaurav Bharti are board certified plastic surgeons and Co-Founders of HKB Cosmetic Surgery, an award-winning practice with ten locations across five states. 

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Transcript

SPEAKER_00 0:00

What if I wake up and hate my results?

SPEAKER_01 0:03

Call Dr. Baharty immediately, even if it's 1 a.m. Welcome to HKB Uncut, the health, knowledge, and beauty podcast.

SPEAKER_00 0:16

On 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 Gora 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_01 0:37

In 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.

SPEAKER_00 1:13

And, you know, there's a certain level of anxiety that comes with, you know, thinking about doing something for yourself from an aesthetic standpoint and from a standpoint of risk worries. And like Bill and you and I both have been there kind of thinking about these things because you know all of us have had little stuff done. And um, we're gonna go through some questions and kind of give you some kind of thoughts on how uh you can deal with those concerns or anxieties.

SPEAKER_01 1:38

It's interesting. I always ask my patients, how many crazy dreams have you had about the surgery prior to doing it? It's like it's amazing that your subconscious like produces things in dreams all the time because like they're thinking about it constantly.

SPEAKER_00 1:52

All right, Bill, first one question for you. How scary is anesthesia really?

SPEAKER_01 1:58

I I've had surgery. I'm a control freak. People that know me know that I'm a control freak. And it's very difficult if you're a control freak to undergo general anesthesia and let go. But what I realized is, and what calmed me down personally was uh these individuals do this every day, all day. We see it all day, every day. Patients do extremely well. They go to sleep, they wake up, they do great. It is general anesthesia is very safe. Now, are there complications? Are there risks? There's always risks, there's always potential complications. But that being said, those are few and far between. Anesthesia is safe, we do it all the time. The providers do it all the time. It is safe to do, no problems. Nothing to worry about.

SPEAKER_00 2:43

Yeah, and I would say it's crazy when you get it, it's like you get it, and you wake up and it's done. I mean, it is it's it's it's remarkable to be honest with you. Um, but like it's it's okay to be scared and worried, you know, and that's that's that's normal. I think anytime we don't have patients who's scared and worried about like getting anesthesia, I'm like, what's going on here? So anyway, what's next? Gee, do implants flip and should I be worried about them? Yes, implants can flip and they do flip. And um I think you should be worried about it, anything that's that could happen. But the truth is with the techniques that we do now, you can you minimize the the the issue. The thing about implants flipping are twofold. One is you got a pocket that's too big and an implant that's just sloshing around in there. Okay, so that could be one reason. The other is that the implant is a um the highest cohesivity level, meaning that implant is very firm, and some of the implants have kind of a flat back and then a round front. And so if it flips, your breast shape's gonna change and you can see it. So actually, the softer the implant, the less likely that you'll ever know that an implant's flipped. The firm the implant, the more likely. But it happens.

SPEAKER_01 3:49

I've seen it with mammography too. Like I had literally just had a patient said, Hey, something's off. I just had my mammogram done, I don't know what's up. And I'm like, hey, do me a favor, kind of do this maneuver. And I flipped it back forward. She's like, Oh my god, you fixed it. Yeah, you fixed it. You can't believe you just fixed it like that. I'm like, Yeah, it happened. It was just upside down. So they they do happen. IG. Am I going to regret this later?

SPEAKER_00 4:13

Regret be on this podcast with you, but with me, no, with you, I don't know, maybe. Um now, you know, I I will say, I'm be really honest. It's very, very unlikely for you to regret having an aesthetic surgical procedure, at least with like you know, a high-quality surgeon like anyone who's a part of HKB, because like the thing is you have to go through so much rigmarole to get ready. Like, you know, you're not you you we don't you're not just gonna like on a whim do do a big invasive intervention.

SPEAKER_01 4:42

I will tell you, do your homework, yeah. Go with a provider who does this all the time, make sure you've communicated what you're looking for, what expectations are, and then there should be no regrets afterwards, right? If you go with an ethical plastic surgeon and just gonna do a good job, they'll take care of you. And the off chance you have a complication, they'll fix you.

SPEAKER_00 5:00

And I would say if there's something you don't like or you're you're unhappy with, then you have to use your voice, talk to your surgeon, they want to know, we want to know, and it can get addressed. All right. Bill, how do you know when enough filler is enough?

SPEAKER_01 5:14

Oh, I think it's pretty obvious. If you can see somebody across the room and they look off, they're off because they have had too much filler. I'm a less is more kind of guy when it comes to filler. I I know there a lot of injectors are out there, like, oh, you need a lot, you need a lot, you need a lot. I think you need enough, but not too much. And um, I I just wouldn't go crazy. For me, it's a conservative approach. What do how do you how do you think that's a good idea? Yeah, I agree.

SPEAKER_00 5:42

I think, you know, I think the most important thing is you can't be a one one-trick pony, meaning you can't just keep filling somebody up. And so now with the advanced techniques and the differential product selection, which what I mean by that is you know, great skincare regimen, using HA fillers, but also using biostimulators like Sculptra, um, aka PLLA and um Radius, calcium hydroxyapatite, and other biostimulators that are coming, including, you know, autologous fat crafting, PRF, PRP, um, you know, recombinant PDGF. There's all kinds of tools that can be used to get you to a point where you have an elegant facial aesthetic. You don't have to be a full, super full face, but you can have fullness delivered with you know thickened collagen, thickened collagen production and thickened skin constituents.

SPEAKER_01 6:33

I think you're you're spot on. I think it's a better overall approach that we need to focus on versus hey, I'm just gonna do filler. You need to be on skincare, you need to do microneedling, hydrofacials, you know, proper laser stuff, and some filler, and you know, your neurotoxin of choice, right?

SPEAKER_00 6:49

I think that goes a long way. Yeah, it's like a multimodal approach, lots of little hits here and there, not just one knockout usually.

SPEAKER_01 6:56

AG, should we all be on Osimphic or GLP ones?

SPEAKER_00 7:00

No, I don't think so. But I might differ from others. I think that it's uh the overwhelming high volume of patients would greatly benefit from it, but like me, I would not benefit from it at all. Like I'm already scrawny. You need you need fat.

SPEAKER_01 7:13

But no, but let's just let's talk about the obesity issue in in the US right now. Um vast majority of of uh individuals are obese. We live a sedentary lifestyle, we eat poorly. I think GLPs are a good answer for a lot of those individuals.

SPEAKER_00 7:31

It's a piece of it, right? It's a piece of the puzzle, but it's not the uh absolute solution.

SPEAKER_01 7:37

But we we we now understand it's got a a bunch of uh potential benefits, but it doesn't take away proper diet, nutrition, and working out.

SPEAKER_00 7:47

But when you combine it with that, it's ridiculous. A game changer. I mean it's insane. Um I think that it's it's a really incredible, and I guess you know what's really special is about the advancements that's happening in those, you know, like where these these newer generation ones are way more targeted. The downstream side effects, like you know, huge horrible muscle wasting is virtually being eliminated.

SPEAKER_01 8:11

If you have to work out and you have to eat enough protein in order to build muscle.

SPEAKER_00 8:16

So otherwise, like you're toast. So it's it's very remarkable. You know, god god forbid we uh hopefully we don't see any kind of you know horrible downstream other side effect. That's the only thing that keeps me up at night when I see something that's being rapidly adopted that's fairly new and current. I think there's always a a potential side effect from anything you take. You know, I'm the type of guy I love synthetic stuff, I love protein, I love bars, I love all the crazy synthetic stuff, but unfortunately I tend to respond and poorly into them. And so, me, I have to be careful taking anything that's non-natural. And so it's been a tough battle for me, like where even I don't I currently I'm not taking any peptides or or any synthetic protein just because I had some funny labs. And so now I've I've basically stopped everything and now I'm gonna add stuff back. So I think people need to be very cautious and cognizant of their health and when they're trying to improve their health and do it in a way that's you know, um, you know, with with support and do it with purpose, and then also to monitor what they're doing because we're all different. That's an amazing thing about humans and animals and you know, this earth we live in, we're all just a little different, and so we all might respond to things differently. And so I think you know this, like the the way the healthcare is evolving, we're starting to take care of each individual as an individual versus like, all right, you take 50 milligrams of Lipitor and blah, blah, blah, of of metoprolol, and there's they're not making any adjustments for weight.

SPEAKER_01 9:39

We we gotta move away from this uh disease to treatment situation that we have in the U.S. I think we we need to move to this model of preventative health care and really take care of ourselves and do the right things.

SPEAKER_00 9:53

All right, we we digressed. What if I wake up and hate my results?

SPEAKER_01 9:58

Call Dr. Baharty immediately, even if it's a 1 a.m. No, I I think um I think you just need to have an honest discussion with your surgeon, right? It could be just swelling that that happens. Um they're they're always called uh for instance in in breast surgery, there's a roller coaster that occurs with augmentation. You know, love them, they're you know, they're gonna be too big, too small, all they're just right. It it happens like there's odd swelling that's occurring. So, one, take a deeper deep breath, two, have an honest conversation with your surgeon. They'll talk you through it and say, hey, this is okay, this is not okay, or no, we can switch it. And in the end, if you're not happy, everything can be adjusted.

SPEAKER_00 10:41

Yeah, everything can be adjusted and fixed. I mean, one thing I would say is that the post-surgical blues are real and it hits people in different ways. It can happen like right after, or it can happen a week or two later, or when it's like getting in the way of your your your lifestyle can happen, or if you have a bunch of swelling, or you have like a little fluid collection. So I think those things are real, and and patients need to be educated on the front end that hey, you're gonna have a down, a couple of days, you may have a down day or a couple down days when you have those days, know that it's okay, and then also reach out, call just so we can help you and walk you through it. Because sometimes that really can can be hard, and and the the mind is a powerful thing, and sometimes when the mind gets in a in a dark place, it really makes things harder. And when you're beat up surgically and recovering, it can be a double whammy. So patients just need to be aware of that.

SPEAKER_01 11:27

This question is so perfect for you. I can't even like if I dreamed of a better question, it couldn't be perfect for you. Is lipo worth it even if I'm already skinny?

SPEAKER_00 11:39

Uh I think it the answer is is probably yes, because like it depends on what we're treating. Like, there can be people who have you can do finesse, you know, kind of high definition lipo to remove fat to get a little bit more definition to show, kind of like for example, in their abdominal contour, or they could have like a little area of fullness, even like someone who's skinny can have a little submental fullness, and you remove, you know, five to ten tcs of fat, and it's it's it's a big change. Now, if somebody has like something where there's just nothing there and like they're trying to have a procedure done, then that's not gonna do anything, then obviously as a surgeon you can't ethically do that.

SPEAKER_01 12:16

Correct, but I you know, I I laugh just because of uh um you know, they're there patients have different body habitus and stuff. And I do think that sometimes that liposuction is better on patients that are fit because ultimately you're you're getting rid of targeted fat um versus kind of liposuction is not great as a weight loss procedure. And if patients come in expecting a weight loss procedure, it's not gonna occur with liposuction. Liposuction is a good adjunct to body contouring. Removal, skin, tummy tuck, you know, thigh lift, arm lift is a good adjunct uh on its own just to have weight loss, not great. You're better off. GLP1, targeted liposuction with body contouring, skin excision.

SPEAKER_00 13:04

That makes sense. Um all right, last one. What's the hardest surgery to recover from? I have them in order. I think gluteal implants in the muscle. Intramuscular gluteal implants, I agree.

SPEAKER_01 13:17

Number one by far. Um and I think that takes the cake for all of them. There's no I don't think there's any other procedure that's that's harder than that. Followed by some version of the tummy tuck. And then everything else is pretty honestly not bad from a recovery standpoint.

SPEAKER_00 13:35

Pretty nominal. What about like circumferential trunk liposuction? Not bad.

unknown 13:42

Not bad.

SPEAKER_01 13:43

I think within advances in liposuction techniques, you're sore, but you're you're not the recovery's not bad. Awesome. Gluteal implants though. Intramus gluteal implants. Not for the faint heart. Until Jim comes around. We can't talk about that. But nuances are coming.

SPEAKER_00 13:59

Yeah, there's some innovation coming to the US finally.

SPEAKER_01 14:02

All right. If you have questions like this, you know, come just go ask your surgeon. You don't don't spend time with your your favorite AI tool. You know, Claude is a good friend of yours, but talk to your surgeon about any of this stuff. Uh, if you're a patient or ours, reach out to us. We're we'd be happy to help you. And if you like episodes like this, shoot us uh shoot us a message. We can do more. Thanks for listening. Thanks. Till next time on the HKB Podcast. Thank you for listening to HKB Uncut. If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.

SPEAKER_00 14:37

To 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.