Exploring Anti-Aging Options with Dr. Carolyn Chang

Would you like to age gracefully and understand the influences that societal judgment and cultural pressures have on beauty and cosmetics?

In this episode of "We Should Talk About That," host Jessica Kidwell engages in a conversation about anti-aging and aging gracefully with Dr. Carolyn Chang, an aesthetic plastic surgeon and vice chairman of plastic surgery at California Pacific Medical Center. Dr. Chang shares her expertise and educates listeners on fighting the natural signs of aging while emphasizing the importance of natural results. The discussion also touches on the concept of anti-anti-aging. Tune in to gain insights and explore the possibilities of embracing the aging process.

More About Dr. Carolyn Change:
Dr. Carolyn Chang is a San Francisco aesthetic plastic surgeon and Vice Chairman of plastic surgery at California Pacific Medical Center. She is certified by the American Board of Plastic Surgery, is a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and is a Fellow of the American College of Surgeons. She is also a member of the Communications Committee for the American Society for Aesthetic Plastic Surgery. Dr. Chang graduated with a Bachelor of Science with honors from Stanford University and received the Deans Award for Excellence in Clinical Medicine at Stanford University Medical School. She did her general surgery and plastic surgery training at Stanford University Medical Center. She completed an additional advanced surgical fellowship at New York University, and a second year of further specialization under the guidance of Dr. John Q. Owsley, one of the pioneers of the modern SMAS facelift. Dr Chang is an invited lecturer both locally and nationally on a wide range of topics in the field of aesthetic surgery. She is a long-time resident of the Bay Area and is committed to the betterment of her community through her active philanthropic involvement and as a patron of the arts. Dr. Chang lives in San Francisco with her husband Patrick and their children, James and Jemma.
Instagram: https://www.instagram.com/carolynchangmd/
LinkedIn https://www.linkedin.com/in/carolyn-chang-83106526/

Transcript

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This podcast was created to be a space for conversation. The topics will vary, but the conversation will always be honest, authentic, and sometimes even a little uncomfortable. My hope is that through these conversations, we will build a community of people who might not always agree with each other, but will definitely feel less isolated and alone. So I'm Jessica Kidwell, and this is We Should Talk About That. Well hello everyone. Welcome back to We Should Talk About That. This week we are going to talk about anti-aging and aging gracefully and what that means to me, how that might differ for you and I'm especially excited because I get to have this conversation with an expert who will be able to answer questions, but also provide lots of education about the process in which we can fight back against the natural signs of aging and also kind of open our minds as to what the possibilities are out there. I would love to introduce you to Dr. Carolyn Chang, who is a San Francisco-based aesthetic plastic surgeon and vice chairman of plastic surgery at California Pacific Medical Center. She hopped onto my radar because of her Instagram, where I have been following. She has excellent, excellent information and before and after photos that I really can't get enough of. But my favorite thing is that she refers to herself as being passionate about natural results. And there are some people who would think that that might be a bit of a conflict to be a plastic surgeon, but also be passionate about natural results. And I am excited to talk to her about all things aging, anti-aging, and maybe even touch on anti-anti-aging. Welcome, Dr. Chang. Thank you, Jessica. And I'm so excited to be on today. I really enjoy your podcast. Oh, thank you. I am especially excited to have you on today because as longtime listeners of this show may or may not recall from a full disclosure standpoint, the beauty expert we have had on a handful of times has been my sister, Jennifer Daniels, who is a medical esthetician in North Carolina. And she has been good enough to come on a couple times to answer some questions about this topic, however, it's always a little bit personally laced and often ends up being A, what I should be doing to my face personally from her sister point of view. So I'm looking forward to having a conversation without necessarily the sister baggage. Sounds good to me. We can definitely keep it neutral. I think you look great, by the way. Oh, thank you. I know the listeners know it's a podcast, but I can see you. Thank you. And I assure you, she looks just perfect. Well, thank you. That's very kind of you. So as I explained to you before we started the recording, the demographic of this podcast definitely skews towards the female, not to exclude our male listeners, who I do appreciate very much. And we do tend to skew to topics that are relevant to me, the host, who is 48 years old. And when we were scheduling you to come on the show. There was a discussion about really focusing on postmenopausal therapies and treatments and giving people information that can provide real results and in addressing what kind of happens to us as we move into this active perimenopause and then that postmenopausal time frame. Can we just start off talking a little bit about what physically is occurring to us at this time in our lives? Well, having gone through it already, I'm a little older than you, and I do think that this conversation, just to digress a little bit, is also appropriate for a perimenopausal person and also anyone who's interested in being proactive about aging and aging gracefully. So it really can be a much broader conversation than just postmenopausal. But basically what happens, and this can happen at various times of your life, I think the most common is in your mid to late 40s that you start to feel some hormonal changes. And that is usually due to the slow, steady loss of estrogen. And with that, what happens is you can start to get some spotty periods. Maybe you have some fatigue. Some people say their hair may fall out a little bit. Things start to change in your body. And you may not even be aware that it's going on or that's what it's from. And that can go on for quite some period of time until I call it sort of a feverish pitch is what's happened. And that happens, you know, you hit the wall in your early 50s, I think, truly. And you know, there's a lot of different average ages of actual menopausal commencement in the United States, but I believe the last I saw was around the early 50s, around 53 specifically. And in my case, that's exactly what happened. So gradually over time, I noticed that things just weren't as easy for me in terms of controlling my appetite or getting results from exercise. Sleeping has always been an issue, but it became a worse issue, actually. And I didn't actually have the early hot flashes, but people will get that, but I did have some irregular periods and things starting. And then as that goes along and the estrogen gets lower and lower, the other hormones start to go out of whack. And so one of the most common things that happen is that something called cortisol actually goes up in the body, and that is responsible for that middle-age spread that we talk about. And when I was younger, I thought, there's no way, I will never get that. And sure enough, it happens. And there's not much you can do to control that, because it's truly hormonal. Your appetite might change. My appetite got bigger. And you can't control that as well. And also, I think what happens with some people, and it creeps up on you as well, with the appetite increasing, you might be eating a little bit more, maybe not as well, sleeping not as well. Insulin resistance can actually happen during this time, too, which is unexpected. And that then further makes all of the aging changes and weight gains and mood changes and brain fog worse. And then specifically, what is happening to our skin? Because when you just referenced hitting the wall in around 52, 53, I believe that's an actual phrase I have heard amongst my peers, although we may have more likely said it's like we have fallen off a cliff. All of a sudden, you just stop recognizing the face that is looking back at you in the mirror, and it doesn't seem to match how you feel inside. Yes. So I've always joked that the fifties in your mind, you think there's still hope, you know, to retrieve some kind of youth. And so you're grasping at things to do. And that's what I mean by hitting the wall because it's a relentless progression, unfortunately. But what happens basically is that when the estrogen goes down, the skin thins, it gets drier, your hair gets drier, the wrinkles show up more, and then the sagging of the tissues accelerates because everything thins, not just the skin. But the outward manifestations is early what we call jowling, which is some irregularity in your jawline, the neck might get extra loose skin that falls forward, it may even band, you know, when you talk. And you lose facial fat as well, so everything just moves, I call it down and forward and thins. And that's all related to age and especially estrogen changes. The irony is not lost on me that we are gaining fat in so many other areas of our bodies at this time in our lives, and yet it is just falling off of our faces and kind of adding to this skeletal look that women and men, I seem to notice it more in women, but that's probably a whole other conversation, seem to have as we age. We as a culture, I think, I'm going to speak in a lot of generalizations and I also will own that some of this is my own bias for sure. There seems to be an obsession with youth and yet a You're obviously in the field, which I think would tend to have a bias towards being much more open-minded and accepting about what people want to do to their bodies as they age and make decisions. But have you, with all of your experience, been able to glean any insight as to why there's so much judgment around cosmetic surgery? That's a really good question and it goes to the heart of what I do, actually. And I've thought about it a lot because You know, I come from a culture, I'm Asian, I'm Chinese, where we don't really have surgery unnecessarily. We don't like body modification. So, scars are definitely not in the running for things that we seek. So my whole life I've been sort of anti... medicine, even pills. It took me forever to take an Advil. And I've been, you know, I wouldn't want surgery for myself because God forbid I get a scar. And so to work in a field where that's what you do actively and electively is a little bit of a counterintuitive thing for me. But I see the power in it, I appreciate aesthetics, and I do value very much not only the way I look, but the way other people look in terms of feeling good about themselves. And I think that that's the number one reason why people seek plastic surgery or even smaller changes, is they want to make the most of their appearance in the life that they have and in the environment they have. And so then the question is, I get a lot of people that come in and I call it window shopping and they just want to talk about what's possible. And inevitably once we get into things like surgery and the expense of it, the taking time off, the stressing the family out or the loved ones out, the recovery, A lot of people, I would say probably a good 25% of people will say, oh, this seems so selfish, or how can I be so vain, or I feel guilty because I have young children. I mean, there's a lot of guilt wrapped up, I think, in wanting to do something for yourself in this way. And this is very controversial and it's very black and white, but I've often thought that maybe our culture has this more than, let's say, Brazil or something in South America, because they don't seem to have the same hang-ups. It's maybe from our religious backgrounds, honestly. You know, we were brought up, or the country was brought up in sort of more puritanical, Protestant. It was a very traditional do good for others, you know, not being selfish, not being greedy. And that, I think, has always been the backbone of what we think of from early times in the United States. Unfortunately, our culture is quite polarized and it's an interesting combination of both capitalism and those basic values. I think there's a lot of push-pull in people's minds with accumulating possessions versus doing good for others. Am I being too vain? You can judge people for having a big house. doing plastic surgery, indulging themselves. I think we've always been taught not to be overindulgent as a culture. So I think these are some of the things that people are grappling against, and it's subconscious, and it's cultural, and it's absolutely legitimate. And I think that plastic surgery or even a simple Botox injection or even a facial is not for everyone. And I'm extremely more and more sensitive to that, I think, as I talk about this topic more. And so I think today, my take-home message is that it's okay to feel guilty about doing things or vain for doing things, but it's also okay to take pride in yourself and to want to take care of yourself. And then each individual person has to really make up their mind as to how they're going to go, or maybe it's a blend of the two. And I think that the other thing that's great about the United States is that we're an open culture, and we're a tolerant culture. And so I'm going to ask my listeners today, who maybe aren't so interested in furthering this topic, to just bear with it and try and keep an open mind. Because there's nothing wrong with aging gracefully. Either way, you do it. Absolutely. There's also, I know for myself, Um, fear of judgment as far as the sheer privilege that elective surgery, uh, or elective procedures of any type kind of projects out onto the world. And, and the vanity sometimes is less my concern than the appearance of ostentatious. I don't know that that it is only because of great privilege that I'm even able to joke around with my sisters or my friends about what procedures I would or would not be interested in having. I think that's very true, but I do want to say that most people I think do understand that it is privilege to come in and talk about something that is purely elective. I think the drive to do it still stems from trying to make the most of the way that people feel about themselves. I also find it interesting culturally, since we're kind of talking big picture, there's an endless fascination, I think, culturally, especially if you think about celebrities, for instance, of what have they had done, or when we admire someone who is a peer who looks in our estimation to be looking good, we admire it. And then if you find out that it's not just the good luck of genetics and I don't know vegan diet that there has been an intervention then all of a sudden that admiration becomes this judgment and it's just so interesting to me from just kind of a 50,000 foot standpoint how quickly that light switch just flips like as soon as you find out that the mom at the pool who you thought had such a beautiful natural fresh scrubbed looking face who never wears makeup but looks beautiful has had 45 units of Botox and oh well that's why she looks good and it and and it just can't be a it has to be so binary. Yeah that is an interesting thing and I do find that to be the case. Sometimes I think that judging I'm just going to call it judging, judging celebrities or other people that you know for doing certain things may come a little bit from a position of envy and that was something that I learned in my fellowship. I did a fellowship in facial plastic surgery or facial anesthetic plastic surgery from one of the major founders of how we do facelifts today. And I remember I would have patients that would come in and they would look beautiful and I would say, well, how are you doing? And they would say, not well, my sister, you know, is so mad at me and da, da, da, da. And then I went to my mentor and I said, why is this happening? Why are people mad that, that, you know, at their family members? Because that wouldn't be the natural reaction that I would have. And he said, well, you know, they're jealous. And I thought, that's ridiculous. Why are people jealous? But I think that there's something that touches people's nerves when you see somebody doing something to change the way they look and maybe get ahead of the game that way. And this can be extrapolated to celebrities. So maybe there's some judgment that, oh, well, they're only able to look like that because they did this. and that somehow devalues them or you can knock them off their pedestal a little bit. And I think that causes some internal conflict for people. Maybe somebody sees their best friend all of a sudden in a, you know, like a peacock transformation, looks great all of a sudden, and you feel left behind, but you maybe don't have the finances to do it or you're just too afraid. And that threatens people. So I think that Watching others do things artificially to achieve a goal can sometimes really touch the nerves in various ways for people. I have been pretty open with my use of Botox and, in fact, the judgment that then occurred when I started being more and more open about my use of Botox. And it's just this interesting catch-22, I think is the right term, You know, the more we talk about it, the more stigma seems to fall away. And yet you have to get through that initial judgment that people have. You want to kind of hide it because you're afraid that people are going to judge you. And it's a very damned if you do, damned if you don't. What comes to mind from a celebrity standpoint is, I don't know if you follow on Instagram or in general, Paulina Portskova. She was married to Rick Ocasek from the Cars and is like a breathtaking, well-known beauty from the 80s and is pretty open on her social media about how she has chosen not to have any type of surgical intervention. She has used laser and, but she has not had facelift and she doesn't, uh, I think she has used Botox, but it's not regular and she has never used filler. And it's just so interesting, this celebration of her choice and degradation of her choice and how it doesn't seem to you can't please anyone. I'm sorry, you can't please everyone. So the most important thing you need to worry about is pleasing yourself. I absolutely agree. And it's funny because I don't follow her, but I am fascinated. She's on all news feeds all the time because she's so controversial, I think, and so out there, and a spokesperson for the 50 Plus set, aging gracefully, and a real advocate, too. And so when I look at her face close up, I think, you know, when she posts them with no makeup, I'm sometimes shocked, actually. And I'm almost relieved when I see her dressed up with makeup on. And I think it's because as a society we're so used to seeing pictures that are pleasing everywhere we go, whether it's an advertisement or a magazine or a box of cereal, TV. We're used to seeing people look a certain way. And whether or not that's right, I think that's what's so jarring about seeing celebrities with no makeup on and wrinkles and everything, and that's probably something that other people are feeling as well. So I have a glass is half full, half empty feeling about the entire thing. Yeah. And to make it even more personal, the other thing that I really struggle with is I am the mom of a 16 year old daughter and the idea of her seeing herself as less than or wanting to change something about herself breaks my heart and to me she is perfect and yet I'm sure there is someone on this planet, my mom has passed away, but my husband probably falls into this, that looks at me and with those same kind eyes and thinks to themselves, she's perfect. She doesn't need to do anything. Why does she feel like she needs to do this to herself? So just this push pull with wanting us to, wanting for everyone to feel okay in their skin But what if that means they want to change their skin? Well, I think that, I mean, I think the topic is huge. I think that the bottom line issue where all of this conversation is really revolving around, the core issue really is beauty and how our society views beauty or how the world, the entire society views beauty. And I would say even the animal kingdom. Yeah. And so it's all very primal to strive for being beauty, the most beautiful. And I think it has to do with procreation. And so I think there is a lot of emphasis, both conscious and subconscious, on maintaining beauty standards. And there's well-known statistics that people that are more attractive get promoted more. There's definitely appearance bias in the workforce. I live in Silicon Valley. where being over 35 is not great sometimes, which is silly to me. But there's a lot of emphasis on our culture as well as I think a lot of the world on beauty. And so it would be natural for someone who's 16 who doesn't maybe have a fully developed sense of self. Most people don't at 16. and they haven't, you know, they're susceptible to what you read and see and hear and experience in high school. You know, high school is brutal when it comes to beauty. And so I think the most important thing with kids and with anyone struggling with this is to is to really make sure that anyone who's choosing to change something, especially at that early age, really has a solid foundation. They have achievements in, let's say, sports, or they have a good core, maybe not fully developed self-esteem, but they definitely have self-esteem, and they definitely are not seeking this as a desperation measure. I think that's when it gets to be dangerous for especially someone who's in their teens. Yeah. I had the good fortune of listening to your conversation with David Stewart on the Super Age podcast, and I was really struck by you pointing out to him that plastic surgery and cosmetic surgery kind of has this overarching stereotype that it's all about vanity. And you talked about the psychological and emotional components that your field also has to take into account. Can you talk a little bit about how you see the emotional and psychological component plays into your line of work? Well, there's a lot of it. I'm actually I feel like I'm a part-time therapist. I mean, maybe a full-time therapist, actually, because I hear it all. So people, it's been my experience that people tend to do plastic surgery for a reason. You know, first of all, they're a subcategory of people that are open to it to begin with. And most of the time, it was something that they've been thinking about for a longer, much longer period of time than even like a year. I mean, it could be like a lifelong thing that people are thinking about. or they grew up in a culture in their family where everybody had facelifts when they were younger, and so it's something they always knew that they were going to do. But usually what I found is that something that occurs either mentally or happenstance-wise, life circumstances, will take that passive desire and make it active. And it can be very positive. You know, it can be because they're celebrating a 50th birthday and they want to go into their 50s as good as possible. Or it could be, you know... self-preservation mode, like I'm getting a divorce or I'm widowed. It could be, you know, I'm having a big party or I'm going to a family reunion. So it can be a lot of more trivial things and then more major things in people's lives. But no matter what, I think that there is a psychological component to the desire to actually actively do something as opposed to passively thinking about it. So I do think that there often is some kind of overarching reason. I think where it gets to be unhealthy is if you're expecting secondary gain from it. So there's a difference between just achieving some self-confidence. You know, let's say you've nursed four children and your breasts are completely deflated and are saggy. And you really, it's not your body image. You were never like that. And you get them back. And so there's a lot of reconstruction in that. And you have some self-confidence back. And it can be as pure as that. Now if you're doing the breast implants because you want to get married, well then you're setting yourself up for failure. So there are different ways that people think about doing plastic surgery and I think the job that your surgeon has or anybody talking about aesthetics is that you suss out the people that really are going to benefit from it in a healthy way and try and maybe dissuade those where you know the secondary gain is not going to happen with the surgery. I imagine for anyone who is still with us listening, perhaps some actual brass tacks recommendations could be helpful for those who are still with us. In fact, I hope everyone is still with us as we continue to widen people's lens on the whys of any type of aesthetic enhancements. I'm going to start with this question, and my husband will be most interested in it because of the amount of salves, serums, and balms that collect in our bathroom and the drawers full that I assume will work. When you are in your late 40s, early 50s, late 50s, are the topical things going to be enough. The topical things are never enough, but they are definitely positive adjuncts. So I don't ever want to minimize skincare. But if you're starting it at 65 and you're expecting it to be perfect by 66, you're in for disappointment. So It's never too late to start, but consistency and time really is on your side when it comes to skincare. So, as far as concrete recommendations, I have a few. As we start to age and as our hormones change, we do get, for the most part, drier skin. And there is a large part of the population that will get hormonal acne as well, which was a surprise, maybe even facial hair. I mean, there are things that occur that you're thinking, oh my God, what is this? So the most important thing, I think, in this time is to really moisturize and really hydrate the skin. Because even something as simple as a really good moisturizer that truly penetrates can make dried out, old-looking skin look much more supple. Especially if you use it consistently for even a short period of time, like a month, it can really help. I think that the cornerstone to good skin care, especially when your skin's getting drier, is a really gentle cleanser. There's so many people that think that if I just strip my face down to nothing or exfoliate it or use an acid wash or something that's really harsh that I can get really clean and that's better for my skin. Well, I think, honestly, as we get older, I think the gentler cleansers and even the cream cleansers tend to be better for people. It may not feel as clean, but it actually is less harsh on the skin and you don't get the reflex oil development and clogged pores and all that stuff. So a really good cleanser, I think. It doesn't have to be expensive. And then also a really, really, really good moisturizer. And when I mean by a really good moisturizer, I mean something that will actually penetrate the skin. So there's a lot of moisturizers that feel good going onto the skin, but the problem is they stay on the skin. And you can even feel it when you wash your face. You can feel it coming off. So part of it penetrates, but a lot of it doesn't. I find that at this time of your age, sometimes the more medically bent products tend to be a little bit more useful. So things with hyaluronic acid, for instance, which is a natural hydrating substance in your body, if you can get a formulation that penetrates your skin, can really go a long way to keeping your face completely hydrated for a long period of time. The other thing that I think is really helpful is things that are going to improve pigmentation. So as we get older, all of a sudden you see all the brown spots pop out that you didn't see five years ago. So acids and things like that that go with your regimen, like serums, can really help. And then finally a sunscreen. So we'll call that level one. Level one attainable things that one could could go out to their local drugstore or possibly schedule a facial and talk with a esthetician as far as products that when you use them topically there you're getting the most benefit that you can. Is there any validity to any of the ingestible things that I feel are highly marketed to women of a certain age as far as collagen or mitochondria, things that we are putting into our bodies as opposed to just on our skin. I worked with a company not too long ago, Augustus Botter, which was a very popular beauty line. I remember they sent me these supplements to take, and they tasted horrible, so I didn't make it past maybe one or two days. But then I started noticing on the market a huge rash of them coming on, and I'd never noticed it before. So clearly it's helping somebody. Is it though? Is it? I don't know. It's helping you mentally for sure. Is it like the lemming? Is it the lemming concept of, oh my God, everyone else is doing this. I should do this. I'm really genuinely curious. Well, there is some placebo effect, I think. But I do think that having good nutrients in your body, through your foods especially, and getting the right vitamins is definitely helpful for your skin. Because if you are malnourished, your skin doesn't look good. So there's some truth in that. Now, whether or not these supplements are truly better than just having a really good diet and maybe a good multivitamin, I don't know. That I can't say. Okay. Fair enough. Fair enough. That's not your area of expertise. But while I had you and while I look at everything that Jennifer Aniston sells, because I hope to age exactly like her. I was just curious if I should be having more collagen in my daily smoothie or if it doesn't actually necessarily matter. So as we move up the scale of invasiveness and procedures that can be done, if you are talking about women who are looking at mid-50s and beyond, what are the most effective and more invasive treatments that many of your clients benefit the most from? Well, unfortunately, by the time we get into our 50s, unless we look like Audrey Hepburn, naturally, there's usually quite a bit of jowling and sagging and laxity that's occurring. that unfortunately most of the non-invasive things or even lasers can't adequately address in order to really get a true rejuvenation. But I do think there is a place for the non-invasive things in helping you. I think some of the most effective things actually tend to be things that resurface the skin. So one of the simplest things to do would be something as simple as microneedling, and it really can improve the texture and quality of the skin for a very low amount of commitment, let's say. Low downtime, low cost. It is multiple treatments, but there are some definite benefits. People love it. It's like polishing your face. I think that if you go up the line like some of the vascular lasers for pigment problems and then the gold standard ones like the CO2 or the Fraxel which really resurface, they take the total top layer off and allow your skin to come back. I think those can be truly rejuvenating for people especially with quite sun-damaged skin. You're not going to look younger per se from a contour standpoint because the amount of tightening that those lasers can provide is very minimal. But you are definitely going to get a better skin quality, a fresher complexion, and I think that a healthier glow and a more even skin tone, and I think that can go a long way to making you feel that you're looking a little better than before. So those are probably the most powerful. Things like Botox and fillers I think can definitely help, but I do think that especially the fillers start to lose their effectiveness once you have true, true contour problems in the face, you know, from aging. But the danger there is to try and fill enough to lift the face and then you're starting to look like some of our more prominent celebrities that people talk about. And not in an admirable way. Exactly. Okay. And then if you are ready to have surgery, what are some of the terms or types that are the most common for women in their, your female clients in, in their 50 and 60, 70 year old age range? Well, I think as far as the fifties, the most common requests have mostly to do with face. You know, we didn't talk about the body at all, but you know, with menopause and the middle age spread, you do definitely get people requesting a tummy text and liposuction. But as far as the face goes, you know, it depends on the person. There's almost nobody on the face of the earth that can't benefit from every surgery by the time they get to 50 something. But that may not be the right thing for everybody. So just to sort of recap the whole face as to what we can do. We separate it into the upper third and the lower two thirds. So the upper third of the face is the eyes and the eyebrow. And there are a certain set of procedures that can be done there, and they can be done in isolation. They can be done one at a time, all together, separate than the rest of the face. And so what that is, it would be a brow lift. And the most traditional one that we do these days is called an endoscopic brow lift, where you make small incisions on the top of the scalp behind the hairline and you use a camera and more minimally invasive techniques in order to lift the brow to a little higher position. Because sometimes as we get older, that brow gets scowly and low. More common probably would be eyelid surgery. So upper eyelids is one of the most common things in my practice and it can provide a huge perk with just a small surgery which can actually be done under local in the office. Just taking that droopy skin off your lids without doing a single other thing to your face can really make a big difference in how someone looks and it's quite surprising. Now this is the number one thing that my sister wants me to have done. She says it I mean at least more than twice anytime we're together. And I just want to address the elephant in the room because my mind, and I'm sure lots of people of this generation, we go straight to Renee Zellweger. The actress who almost was unrecognizable and after she, it is reported, had that upper eyelid bleph. How do patients know whether their doctor is going to change the way that they look or just turn back the dial on time? That is an excellent question. I think the very best way to know is to look at pictures of that doctor's work and ideally that doctor has a lot of pictures and they're consistent. because that's how you know you are going to get what you're looking at. So everybody's going to say, oh, I deliver something natural, or I want you to look natural, or everyone wants to look natural. But your definition of natural must match your surgeon's definition of natural. And that is actually quite important, because if you don't like the pictures that you're seeing, or you're only liking part of what you're seeing, then you're not going to probably be happy, because that is what that doctor does if they do the procedure a lot and are able to show you consistent results. OK, so it is incumbent upon anyone who is thinking about finding a plastic surgeon that they need to have access to lots and lots of before and after pictures. And if we aren't given that access, is that a big red flag? Well, not necessarily. It depends on the explanation. So I don't want to say that for everyone. But in general, I think if you're in practice and you know how to do procedures, you have pictures and you can really show an adequate representation of what you do. The other thing I didn't talk about actually is word of mouth. So if you see your friend who has a result that you really like and that friend has four other friends that you really like, then you're probably going to like it. All right back to the moving down the face so the upper bleph and then Is there a lower version? There is a lower version and the lower version is a little trickier But commonly what we do is remove the extra bagging that you see so people might see bagging all over the place But you have to know that the lower lid actually is from the bottom of the orbit the bone up So anything on your cheek doesn't get affected. But if you have little bags in that area or extra skin, that can really be improved by surgery. And then if you go back down the face, the most common thing is probably the lower face and neck lift, which I think always is the most powerful rejuvenation for really turning back the clock and really looking refreshed. You will often get the exact contour that you had 20 years earlier. You may not look exactly that way, but the shape of your face should end up that way after you have this surgery done because you're putting the tissues back where they started. Now of these, I guess we basically had four major surgeries, what is the recovery time? Is bleph like the easiest or is brow lift the easiest? I can't imagine the lower and neck lift is is a quick turnaround time. So all of it does require some investment on your part and some planning. So yes the smaller the surgery generally the small the smaller the recovery. So there are also little tweaks that I didn't talk about, which are like a lateral brow lift, which can be shorter recovery as well, or an upper lip lift, which can give you the simulation of a lift without doing the entire lower face. But in general, things that are smaller, like the lids, with or without a brow, are going to be anywhere from a week to a week and a half. And something that's a little bit larger in area, like the bottom two-thirds of your face, is going to be more on the order of two weeks. And then I always have a caveat to that. It's not like all of a sudden you're going to be perfect at two weeks. You're going to be presentable enough that you feel confident with some makeup, maybe some creative hair, that you're going to go out and about in your normal world. And then I do always tell people if you really want to be pretty darn close to perfect and you want to be sort of event ready, public speaking ready, special occasion party ready, then I would wait a full six weeks. And that's true for almost any surgery that we do. Okay. How does one go about starting the process of trying to find the plastic surgeon, especially if word of mouth isn't so easy to come by because many people like to hide whether they've had any plastic surgery. Well, therein is the bane of my profession. I go to parties and I'll meet my patients because someone will introduce them to me and I won't all pretend like I don't know them. So this is the problem is that word of mouth is hard to come by unless you have really, really open patients, which is only some of the times. I personally think the best way to find medical professionals, whether it's me or a urologist or eye doctor, is your own doctors. because your own doctors really know, especially if they've been in the community, really know the community. And they've had patients come through, you know, especially if they have large practices where they have experience with people using these other practitioners. I think that is one of the most valuable referrals there is, because that is an insider referral. And that goes also with, you know, even better referral is someone that actually works in the operating room. Because not only do they see the results, they see the care, time, and attention, the process that the surgeon uses, and they get a real sense for the skill level and the number of procedures that are done. That matters also. So that's a quite accurate assessment of what's really going on. So I think that's more of the true referrals. And then I think word of mouth is the next best thing. And that's, like you said, harder to come by. And then finally, you can do the regular things like look at magazines and online and Google and do your own research. But if you go that route, I would definitely recommend that you see many, many providers. And then you get a better sense of what's out there. How has social media changed your ability to reach clients? Social media, well I am at a generation that's sort of a watershed generation where we're not that comfortable with social media for the most part. So my younger colleagues are much more out there and much more comfortable with it. I came up in an environment where you don't advertise, it's all editorial, it's all word of mouth and it's all hush hush and it's quiet. And now all of a sudden everybody's self-promoting everything from themselves to their dog to plastic surgery. So it's a whole different mindset. I do think it's a very powerful tool if used in the proper way. I think it really gives you a sense of what that surgeon is like as a person. and what that practice is like, and what that practice's aesthetic and value structure and customer service bent is. Which all that, I imagine, plays very much into the satisfaction of clients. It's not just the before and after picture. It's the whole package. Absolutely. And I think that's where social media can be quite helpful because you get a chance usually in a well-developed Instagram to meet the providers as well as their staff. You get an idea of what the aesthetic is of the actual surgeon by maybe glimpses of their personal life. So it can be quite informative. You have to remember though that this at the end of the day is an advertisement. Yeah. So, you know, you have to take it with a grain of salt. Right. Wow. Well, I know self-promotion is not your thing, Dr. Chang, but if anyone wants to find out more about what you do personally or get in touch with you, what are the best ways to reach you? My name is Carolyn Chang. C-A-R-O-L-Y-N-C-H-A-N-G. And I'm in San Francisco. It only takes one Google, and it'll all pop up. And then I also have a nice Instagram, which I've, you know, it's not as well developed as some, but I'm definitely putting some time into it, because I'm forced to at this point. It's called Kicking and Screaming. Carolyn Chang, M.D., is what it is. And I have a personal one also, which is more fun, because I'm very into fashion and that sort of thing. Well, Instagram is how I found you, so it is an important tool. Now, as I am embarking on season five, I like to have a theme and then tie that theme in with every guest that I have the good fortune to interview. And this season's theme is evolution. A show is going through an evolution. My life is going through an evolution. So I am very curious, Dr. Chang, plastic surgeon, what comes to mind for you when you hear evolution or what it means to evolve? Having gone through this, I would say it's menopause. So that's evolution. And I do think that it can be a very positive thing. It doesn't have to be a whole conversation only about how miserable you feel and how miserable you look. So there are definitely positive things about getting older. And how you choose to do that is your personal choice. But it is all an evolution. And I think it's important for everybody to keep it going in a positive direction, with or without plastic surgery. If we could only spread that message far and wide, whatever anyone chooses to do, maybe we could look at it through a kinder and gentler lens. And we can look at ourselves with kinder and gentler lenses. Thank you so much for your time today, Dr. Chang. I've really enjoyed it. I hope I did not overwhelm you with questions. And I wish you best of luck. Well, thank you. And I so enjoyed meeting you as well. We Should Talk About That is hosted and produced by me, Jessica Kidwell. The audio engineering is done by Jarrett Nicolay at Mixtape Studios in Alexandria, Virginia. The theme song, Be Where You Are, is courtesy of Astra Via. Graphic design is by Kevin Adkins. Do you have a topic we should talk about? Let me know. Submit your idea on our website, www.westatpod.com. There's a form right on the main page for you to get in touch with me. And if you don't have a topic, but you want to let me know what you thought about the show, think about leaving me a voicemail. You can call WeStat at 631-4-WeStat. That's 631-493-7828. Or you can send me a comment on any of our social links, Facebook, Instagram, LinkedIn, threads, that platform formerly known as Twitter. On all of these, you can find me at WeStatPod. You may even hear your comments on the air. And finally, there is no we without your participation. I really couldn't do this podcast without your support, so thank you for being here. And if you or your business want to monetarily support the show, I'd appreciate that too. Email me at info at westatpod.com for more information. Constellations, love tonight.