Plastic Surgeon Dr. Ashley Robey

Breast Augmentation: Bigger, Rounder, Better

jay@robeyplasticsurgery.com (jay robey) — Tue, 31 Jan 2023 15:37:25 GMT

Breast Augmentation

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Ashley : Welcome to Nipped and Toxxed we are talking about breast augmentations today. I am Dr. Ashley Robey. I am a quadruple board certified plastic surgeon. And with me is Katie Reichart.

Katie : Hello, I am a CPCP and a cosmetic tattoo artist. And we're talking about breast augmentations.

I don't know a ton about breast augmentations. I don't have one. I know people who have had them.

Ashley : Sure. Well, breast augmentations have been classically one of the most popular cosmetic plastic surgeries that is performed in the United States. So a lot of people have had them for sure.

Katie : Right.

Ashley : Yeah, so it's one of the more common procedures I do. In general, a breast augmentation is a procedure where you are enhancing the size and or volume of your breasts. So it's mostly women that are interested in this, right.

Katie : Say, you know, Trans, I guess if you want to enhance your upper area.

Ashley : Sure. That could be a thing.

Katie : So how many breast augmentations do you do a week?

Ashley : I don't know, maybe. Two three.

Katie : Two or three? Yeah. What are the prerequisite say, someone comes in and says, I want a breast aug. What do they need to be BMI? All that stuff.

Ashley : The BMI restrictions. I don't feel as strongly about for breast augmentation. Because it's a really small incision and I don't think it is as impactful having extra weight with regards to healing after breast augmentation. But ideally, the person would be at their ideal weight. I think that's true for all things, as far as health is concerned. So being healthy enough to have a surgery. Having realistic expectations and understanding the pros and cons. Those are the main criteria.

Katie : So as far as where the incisions are. Are, are they all in, always in the same place? Do you do them different areas depending on the outcome or does it depend on the implant?

Ashley : So the classic incisional options for placing an implant would be either under the breast crease. So that's called the inframammary fold. Or. Usually at the bottom of the areola, but anywhere around the areola. So periareolar, some people will do an armpit. And incision. So transaxillary, and there are some people which I think is quite rare that even do an umbilical incision.

Katie : That seems strange to pull it up through the abdomen.

Ashley : Yeah, that's a long slide, right?

Katie : Are they doing other things when they do that? Like how would you even have an area to pull that through?

Ashley : Well, you have to make a tunnel.

Katie : Oh, okay. Yeah. So it's not like you're doing it along with liposuction or something like that.

Ashley : I'm sure you could.

Katie : Interesting. Yeah. So, When you said areola,. You're talking about around the areolas.

Ashley : Yes.

Katie : So you take the areola off or you just.

Ashley : I just put it in an incision. Yeah. I'm usually like a half circle or less than half a circle of incision at the border. Around the areola.

Katie : Oh, okay. And as far as does that depend on if it is above the muscle below the muscle?

Ashley : So usually most surgeons have their preferences. But you can go under the muscle or on top of the muscle for any of those.

Ashley : So for me, I do prefer the crease or the inframammary fold incision. It has a lower risk of what's called capsular contracture. And we can get into that earlier. That's an unwanted outcome associated with a breast augmentation.

But besides incisional differences, another big difference that people will want to consider when they're trying to decide what they want to do for their breast augmentation is what kind of implant, right. So. In general Gumby. Yeah. So in general it falls into two broad categories, saline and silicone, right?

But within each of these categories, there are subdivisions. So for the silicone implants, The gummy cell implants you're referring to. Are the fifth generation more form stable form of silicone implants. So they're a type of silicone.

Katie : So it was just like a gummy bear.

Ashley : It's yeah. That's how people.

It was described like a gummy bear, because just like a gummy bear candy. If you were to cut that implant in half. You still have two well-formed pieces of the gummy bear candy or an implant? Whereas some of the older generation silicone implants, if you were to cut that implant in half, they, you would have extruding Ms. Sticky, gel.

Katie : Right. So, which one looks more natural?

Ashley : They look very similar. Okay. Yeah. So it's more about how

Katie : is it saline like saline solution.

Ashley : It's saltwater. Yeah. So saline.

Katie : You know, you would think that it is more like, I dunno, moveable.

Ashley : Saline is. Going to be

Katie : It has more of a droop to it.

Ashley : Not necessarily because you're filling the implant. Full. So think about. Like a water balloon. And not like, just like that, but it's not like once you fill the balloon, like there's parts of the balloon that look droopy, right? So you fill the saline to what's called a nominal fill. So a minimum required amount. So that you don't have that overly,

Katie : do you have to worry about it popping?

Ashley : You have to worry about implant failure for any kind of implant. Whether it's salient or silicone.

Katie : What, if you, I don't know. Jumped in the pool and did a belly flop, would you have to worry about the impact of something like that popping your implants?

Ashley : That shouldn't be enough to break your implant.

Katie : Like a car accident or something?

Ashley : If you like that. And I think if you had a really old implant and it was on the verge of potentially failing. Sure. If you were involved. In a car accident and your airbag deployed your chest, hit the dashboard or steering wheel. Yeah, that could be enough to

Katie : it wouldn't matter what was in it, saline or gummy or whatever.

Ashley : No, but certainly in that situation, you're, if it's that much force to your chest, you're thinking about how are my ribs? How are my lungs? So yeah, the breasts would be an afterthought in that scenario.

Katie : I was just thinking about a water balloon. You know, my kids have a water balloon fight, some like oh boy it's like a water balloon in your body, obviously. It's way more. Durable right.

Ashley : More technologically sophisticated, for sure. But yeah, so the saline implants, there's the traditional single lumen implant. That all of the companies or not all companies, all the companies that have saline implants usually have those.

And then there's. An ideal saline implant. So that is the company's name is ideal. That's not me saying it's ideal. The company's name is ideal and they have what's called a baffled shell saline implant. So instead of just a single lumen, meaning an outer lining, all filled with saline, it has layers of shells of. The

Katie : extra protection.

Ashley : It's just like a layered extra layer. Extra extra layers and it reduces fluid waves. And it tends to be a little more, stable with regards to rippling and that kind of thing.

Katie : Okay. So as far as textured and non textured, What would be the point in having texture?

Ashley : So the idea behind textured implants would be that. You have, a reduced risk of capsular contracture. Okay.

Katie : So encapsulation.

Ashley : Well, everything's going to get a capsule around it. So the difference is you don't want that capsule or lining to become a thick scar that starts squeezing the implant.

Katie : Right? So I've seen that in when they like repair breast implant. You know,

Ashley : Right. So capsular, contracture, we were talking about that just very briefly earlier. That's when so a capsule is the lining of your cells. That would be next to the implant. So anytime you get an implant, your body will have a capsule around it, right?

Katie : Because it's a foreign entity

Ashley : Right? So we mostly talk about it in terms of breast augmentation, because we're really concerned with a certain feel of a capsule. And if you have a tight capsule, around a metal prosthesis.

That metal's not going anywhere, but in the case of a soft press implant, it can start to make the implant feel more firm. It can be yeah, can be distorted and, and some more severe cases can even become painful. So capsular contracture would be an unwanted outcome, certainly. Things that can be done to reduce that because no one wants that. So what we were talking about earlier,

Putting the incision in the breast crease that has a lower risk than. In the armpit or around the areola, putting the implant under the muscle. So that's another decision that people are making to do they want that implant under the muscle or on top of the muscle? So under the muscle, does reduce your risk of capsular contracture.

Katie : Does that change the way it looks? Because when I think of, you know, the muscle. I'm thinking. Okay, now that is going to, you know, breasts are made of fat. And then muscle's obviously much denser and then an implant under that.

Ashley : It can change the way it looks. Usually it tends to make things look a little more.

I would say natural because you get more of a gentle slope transition from above your breasts, where your chest wall is. And the muscle provides kind of like a thicker blanket transitioning from no breast to breast or implants. So instead of having like an abrupt, like blip where you're all of a sudden the implants, they're like an orange on a board kind of look.

You're seeing more of a smooth transition under the muscle. So the thinner you are. The more likely you are to see that obvious and abrupt transition on your chest wall and you are more likely to see it when it's on top of the muscle, because he's just have less of a blanket of coverage.

Katie : So, how do you determine, like what size.

Ashley : So just like you have to get your, before you stop growing right you had to get your feet measured to find the appropriate shoe. Those measure, the same kinds of measurements, although on your chest wall would also be performed. To find out which implants would fit you. So.

Classically the main measurement that I'm looking for with regards to implant options would be check breast width. So the, footprint, so to speak of where your breast sets, how wide is that? Once you have that measurement. And you have some kind of idea as to how thick their tissue envelope is. Right.

So someone with a really thick layer of tissue or fat that's going to occupy some of that space. As opposed to someone who's really, really thin that won't occupy as much of that space in the chest wall. So once you have those measurements, then it goes down to looking at what implants are available and picking out the profile. So people.

That are looking at implants are considering the profile. So profile means how much projection slope. Or projection. How much distance off the chest wall, the implant will go. So if you have. Put like your. I feel like you need some visual aid for this, but if you.

Katie : Like the profile of your face. Yeah. To the side. Is it kind of like that same thing? Like.

Ashley : Yeah, how, how much it's coming off the chest wall. Sure. So the bigger the profile, the more your chest would stick out away from your chest wall. So we already have a fixed measurement for what your breast width is like, but that's not going to change. Right.

As you add more volume to that fix width, the only direction really to go is forward. Is out right. You can't really go to the side without starting to get under your armpit. So, yeah, as you add volume, you're going to really increase the projection. So once you know those measurements, you and your surgeon can look at, okay. If I did a low profile, low plause moderate.

Full extra full. How much volume would that be? Right?

Yeah.

Katie : What about somebody who's like, I want, you know, these giant breasts. Sure. Are you, you know, there's obviously a limit to how much your body can take for sure.

What do you say about that?

Ashley : So the biggest implants that are available in the United States are 800 ML implants. You can get into just huge, just really big you can overfill. So the saline implants, they come with a film.

Katie : What's the visual of 800 ML.

Ashley : Bye. That's at least four cup size bump.

Katie : So like a large grapefruit.

Ashley : Oh, bigger than that.

Katie : Or a single serving. Watermelon.

Ashley : Well, so it's just under a liter, right? 800 MLs. Think. About like a liter of

Katie : liter of Coke.

Ashley : Sure

Katie : Per side.

Ashley : Yes. So you're almost getting two liters.

okay. And also you have to remember that's the breast augmentation is in addition to what you already have. So. If you already have some breast volume, you're just adding your bad. To it.

Katie : So 800 N D U is already comes full. I've seen how sometimes they fill them.

Ashley : The silicone implants are going to be pre-filled.

Katie : Right

Ashley : and sealed. So you don't. So there's no free silicone floating around. The saline implants will all come empty and then sterile saline is. Yeah, once it's in the pocket, you have a little fill tube when you fill it. And

Katie : so what if someone comes in and says, I want 800. What do you say?

Ashley : Well

Katie : I thought it was cc's. Not MLS.

Ashley : Same thing. Okay. One cubic centimeter equals one milliliter. So if you come in and say, I want 800 ML implants. Well first, just like anyone else, you would have to have measurements, right? So you can, your body take it. Can I even fit on you? Now, that's not to say that you couldn't theoretically just accept a way bigger implant. You maybe you're saying I'm. That sounds great. If my breasts goes away off to the side.

Because I think unless you were your chest was wide enough. The only way to fit that volume on, but to have a lot of side cleavage, right. Where some people would be, I'm assuming if you have 800 CC breasts implants, you kind of want some of that side. Great. Projection.

Ah, yes.

But that's a lot of strain on your tissue. And I think about this analogy. Okay. I imagine an 80 year old woman with a cup breasts. I think they're probably not too bad. They're not big there. They're small, but they're probably not too droopy. I imagine this same 80 year old woman with. Triple D breasts, right?

Katie : To see kids. Did she have. If you breastfeed.

Ashley : Right. But they're just not, you just know they're not going to be perky. Right. So that same concept. So as you add more and more weight to your tissues, And as more time as a lapsed, the less likely your body will be able to maintain that tissue in a perky position. So I think that's definitely something to take into consideration. There's some kind of happy medium.

Also the other thing I think about too is Now people get breast reductions for those, for that kind of volume, right. And volumes way smaller than 800 MLs. So people will say, I have.

Katie : Personal preference.

Ashley : Yeah. People will complain about chronic neck back shoulder pain because of heavy breasts. Right.

Interestingly, I. For the breast augmentation population. That's not something I hear as feedback consistently. In other words, I don't have people coming to me saying, oh, this. Yeah. This extra 500 CCS is really killing my back. Right. I just don't hear that. I'm sure there's someone.

Sure.

Katie : I think it's different for somebody who's already has big breasts for a long time. And it's like, Hey man, I need to take these down

Ashley : probably. So I'm sure there's some psychological parts to it, for sure. Right.

Katie : And as far as, you know, breast lift and implants go. I had a friend who had a lift and implants. And she was actually pretty young. Hadn't had any kids. I was like, oh, Interesting. Like, I wouldn't have even thought that you would've needed a lift.

Ashley : I know a lot of people do. A lot of people think that exact thing, like I shouldn't need a lift because I don't have kids and, or my I'm I'm so young, but I would say that's not the case

Katie : just depending on what their size.

Ashley : Well, just, some people just never really have perky breasts.

Katie : Is it genetic? Like people who sag.

Ashley : I'm sure it was. I'm sure there's a genetic component to it. Right. Some of it is. Yeah. Some of it is that.

Katie : You wear bras maybe.

Ashley : Oh, that too skin elasticity, environmental factors. Also, I think just

A genetic component to your breast shape, right? Some people just, when, as soon as they hit puberty, they just start off with these droopy conical breasts that were never perky. And the nipple and areolas were never in the center of the mound.

Katie : That's where you do a breast lift and maybe breasts aug to get them to the right.

Ashley : Yeah. So anyone.

Katie : Desirable shape, I guess.

Ashley : Yeah. So that is part of when I was talking about doing the measurements earlier. One of the measurements I do is called a breast droop or ptosis PTO. S I S so a ptosis measurement will tell you how much below the ideal position on the breast mound.

Are your nipples. So the bigger that number, the less ideal they are classically,

Katie : I've heard about the pencil test.

Ashley : Sure.

Katie : How you put the pencil. I wonder, and if your pencil can hold, if your boob can hold the pencil, you need a breast lift or where your nipple is in relation to the pencil is that what it is.

Ashley : Yeah.

Katie : Yeah, does that work?. So I'm going to try it at home.

Ashley : So the pencil for you would be. Your breast crease. So the ideal nipple location would be at, or just above a point where that breast crease is transposed onto your breasts. So if you've got a pencil, so you put a pencil on your breast crease, and you're seeing that, Hey look.

My nipple is below this pencil. That suggests that you have breast droop

Katie : and that you would need a lift.

Ashley : Yeah. Needs a relative term. Right? You cannot need to do anything, but. Like to get the best look, I would say.

Katie : If you're looking for an aesthetic. You know, And just bringing things back up to where they were.

Or whatever, just want to add correct something. So as far as do you, do you do under the muscle and over the muscle?

Ashley : I do. More of my patients select under the muscle, but I do both.

Katie : And so I mean, what determines. So we talked about you know, projection, we talked about size. What determines otherwise, whether or not you do under, over.

Ashley : So there are a couple additional things. So we talked a little bit about enough thickness, right? So if you're really thin. And that blanket of tissue above your muscle is so thin then. You're going to see every little fold undulation of your implant. And not that you couldn't do that, but it's usually recommended that you wouldn't just because people don't want to see all those. You don't want your breasts look like it has folds and rippling, meaning being able to see little. Changes in the surface of the breast.

Katie : It's silicone or

Ashley : all implants can actually have rippling. Saline implants have a higher risk of rippling than silicone implants. The more. The nature of the material. Of fluid. The more cohesive silicone gel implants would ripple less.

Then the less cohesive and also the ideal saline implant ripples less than the traditional single lumen saline implant.

Katie : So it has a lot to do with this, what the skin looks like.

Ashley : So, yeah. So the thickness of your tissue of your soft tissue envelope, the kind of implant you're selecting. The other thing that people consider when they're trying to decide above or under the muscle would be an animation deformity.

So when you put implants under the muscle. If you were to, let's say, go to the gym, look in the mirror and do some chest exercises. When you flex your pectoralis ross muscles because the implant is beneath them. You will see the implant move. Oh. So people say describe that as a animation deformity, meaning.

All of a sudden your breast is positioned higher and different because you're flexing your chest wall. Some people don't like that.

Katie : Okay. Yeah. I can't flex my chest.

I don't know.

Ashley : Yeah. If you're one of those. People that likes to pop their Peck muscles.

So the alternative to breast implants for augmentation purposes will be a fat transfer.

I know we talked about fat transfers a little bit on one of our previous podcasts, but basically you're liposuctioning fat from an area of relative excess. And then adding it to the area of relative deficiency. So whether it's your abdomen or your flanks or wherever you feel like you could borrow fat from, and then you transfer it to the breasts.

Not every single fat cell survives at somewhere in that 50 to 80% range. And I would say classically with a fat transfer to the breasts, maybe you're getting a cup size bump. So, if you want anything more than one cup size, Then you're talking about more than one surgery, which is fine.

That's just an extra hurdle to jump through, to get that kind of volume.

Katie : What about fat transfer to add volume where, you know, say, you know, you've had kids, your, Your boobs are droopy and maybe just taking that fat and plumping them back up.

Ashley : Sure. You can do that.

Katie : So that can just help kind of

Ashley : restore some of that deflated volume

Katie : through it, you know, bring them back at least two plumper sizes.

Ashley : Yeah. People do that all the time.

Katie : So, where do you take the fat when your liposuctioning? We kind of talked about this in liposuction, but

Ashley : wherever you have extra fat,

Katie : So just looking, you just look all over and say, Hey, you know, this might be a good spot.

Ashley : I'll usually ask the patient where they would want to.

Where they're most concerned about or where they would most like to want to donate the fat from now.

Katie : What if they don't have any fat.

Ashley : Well, then that's a problem.

Katie : Then that's just not gonna work.

Ashley : Like, you're not, if you don't have enough fat to donate. So you're not a candidate.

Katie : I also think this is a great option for somebody who's scared of implants.

You know, you hear about people who are just, you know, they just don't want to put foreign things in their body since like, Hey.

Ashley : I think it was a good, really good alternative. We should talk about those things though. So things that people are scared of the complication, so.

For a breast augmentation. As the most surgery is a small risk of bleeding, small risk of infection. We're going to add a scar. Your breast can be numb. Usually that gets better.

Katie : Are you under for this?

Ashley : Yes,

Katie : For this surgery. Completely knocked out.

Ashley : Most people like to be knocked out, especially if you go onto the muscle.

I mean. Thing is like what's on the other side of the muscle ribs. Right, right. And what's right under the ribs.

Katie : You don't want to be even semi awake. You want to be asleep.

Ashley : I I've done. So I've done some in-office like little tweaks and revisions. It's not like it's hard. It's just not that fun.

I've done someone under someone who really wanted IV sedation. And we were going to do it on top of the muscle. And I don't think that patient was a really good candidate. She didn't, she didn't even tolerate getting her IV without squirming a bunch. So, yeah. So that failed. But I think, yeah, there's a, I think you could potentially do with the right person.

A sub fascial or subglandular meaning on top of the muscle and implant pocket under IV sedation. But. Okay. I don't think there's a huge advantage for IV sedation versus a general anesthetic.

Katie : Talk about more with complications.

Ashley : Oh. So the implants, none of them are considered to be lifetime devices.

Katie : Yeah. So how long do you have them in for?

Ashley : So the rule of thumb is to consider changing. Every 10 years. So every decade that doesn't mean they expire or go bad,

Katie : but do people really do that?

Ashley : Hmm. Some people.

Katie : I always think about people with implants, like what, you know, they get them maybe in their. Twenties thirties. What it's going to be like when they're like 70.

Ashley : Yeah.

Katie : And what happens when you die? They still

Ashley : they're still there.

Katie : They're still there and they just, they just don't go away.

Ashley : they wouldn't degrade the same way organic material would degrade, right. Yeah,

Katie : or do they say.

Ashley : It's a very strange line of questioning.

Katie : I'm just wondering, didn't you ever wonder, like what happens, you know, Cause it's not like you. I don't know. I feel like in recent years, breast implants have been someone, you know, so popular that now we're getting to the part where people are getting older and having breast implants.

Ashley : Yeah. So you should consider turning them on every 10 years. That doesn't mean you have to, that doesn't mean they expire. No, one's going to be knocking on your door, telling you a time to change around plants, but you know, they're not gonna last forever. So you should go into breast augmentation surgery with the mindset that, Hey, this isn't the first and last surgery I'm ever going to have my breasts.

Sure. If you have your implants longer than 10 years. Great. You got more, you were out of that implant, but. The 10-year mark does coincide classically with most of the companies warranties. Okay, so let's say so to be in warranty. Yeah. So if something happens, certain plant in 10 years have not elapsed.

The implant companies classically will cover the cost of a new implant or implants depending, and a good portion of the associated exchange costs. Okay. If something happens to your implant and 10 years have gone by, they will still cover the cost of the new implant, but then you're responsible for all the exchange costs.

Katie : That's so interesting.

Ashley : Yeah. So the other thing that I think is interesting too, is with regards to warranties.

How most companies do warranties from my understanding is that. Let's say you think you have a product that. On average would last 20 years.

If you made the warranty 20 years, that means half of the people that have the product would be cashing in on the warranty just based on statistics. Okay. Okay. So that wouldn't be very financially optimal, right? So what most companies will do is whatever they think the average. Length of the implant or product. Excuse me.

Is, they usually make the warranty half. Otherwise just numbers wise and statistically, if they actually thought it was going to last 10 years. Oh man. They would just be like shelling out money, right. And left for these warranties.

Katie : Do you see this very often at all?

Ashley : Implant failure. No, I don't, but , not for new implants, but for really old implants.

Katie : You didn't do.

Ashley : Yeah, I've been at this point. Cause I haven't been. I'm just kind of around the 10 year mark, right?

So I don't see a lot of implant failures. I have seen some but they're pretty rare.

Katie : Right. So it's like, you know, you even just from a doctor's perspective, you're not saying it very often anyway.

Ashley : Right? I'm not seeing. Half of the people.

Katie : You have a warranty? I had no idea.

Ashley : Yeah, it comes, it comes with the implants. So that's.

Katie : Anything else in the warranty? That's pretty amazing.

Ashley : I don't think so.

Katie : Do you like, fill out paperwork, like your car or yeah. Like send it in, then you can get like,

Ashley : I mean, , the patient does all that stuff, but usually it's just, I submit. Tracking data just with serial numbers, serial numbers and patient numbers, basic patient information. So they have in their system that, Hey so-and-so has these one or two, classically two, implants. So if they're trying to get their warranty, like, you know, this is legit. The legit claim, potentially

Katie : exactly what you've done.

Ashley : The other thing, the other couple of two things that I think come up a lot people. See a lot of it on social media, our one. ALC L so anaplastic, large cell lymphoma. That is a very rare. Cancer that has

Katie : never heard of this.

Ashley : Well, you don't do plastic surgery all the time.

Katie : I mean, even on like plastic surgery websites,

Ashley : You don't know. So it's a very rare cancer that has been. Associated essentially with just textured implants. And it seems to be one of the one form of texturing. So not all of the textured implants, just one of the companies that did a more of a macro salt loss texturing. They have a higher risk of that.

Katie : Is that company still in business?

Ashley : Yeah, they just don't sell the implant anymore. Oh, Yeah. But from, so from the incidence of that, So on the higher end, it's about a 0.03% chance of developing. The ALC L then. Anaplastic large cell lymphoma. Which is not, it's not zero, but then also you think about in the United States, one out of eight women get breast cancer. So that's 12.5%.

I don't know. I mean, 12 point no one wants additional risks of breast cancer, but going from 12.5 to 12.5, three it doesn't seem hugely significant. Anyways,

Katie : pretty small in the grand scheme of things.

Ashley : Yeah.

Katie : Rupture. And malposition and, and other.

Ashley : Yeah. So the rupture is means implant failure. Right. Malposition, meaning it's not sitting right where you want it to. So either it's too high.

Too low or too right. Or too left. All those things could theoretically happen. The other thing that comes up is The breast implant related illness.

Katie : Yes. I have heard of somebody who had that.

Ashley : Yeah, so that

Katie : Does it go away when you get them removed?

Ashley : Well, it's interesting because so in the United States there was. A period where enough people had proposed this as a problem. Meaning I have implants and I have this right. I have a myriad of classically autoimmune symptoms. So I'm pretty sure my implant caused these symptoms so enough patients. Had proposed that kind of relationship that the United States actually took silicone implants off the market for several years.

Katie : Interesting.

Ashley : And they decided to, after reviewing so much data that to reintroduce them back onto the market with a little more. Close follow-up with regards to imaging and such. But I'm patient. So data doesn't support, statistically breast implant related illness. I do see patients that have concerns that they have are, might have that.

Of the patients that. I have removed implants for that. I would say. Maybe half get better or feel like they're better. Yeah. Okay. Maybe.

Katie : So it's like their body overcomes, whatever it was. Attacking.

Ashley : Again, it's it's You know, hopefully it's something that. As a scientific community, we can parse out, but right now,

It's hard to. Give that anyone a definitive diagnosis, cause there's not data to support that.

Katie : And it could be any number of things.

Ashley : Sure

Katie : they just happened to have implants as well.

Ashley : Yeah. So it's hard. And I, I tell patients about the placebo effect. So if I tell you for example, that. If I gave you this pill, you're gonna feel better. It does this, that, and the other 30% of the time.

Which is what the placebo effect is, is 30%. It will get better. And you know, the negative placebo effect is a real thing, too. So if you decided that this is what's making me sick and you're just determined it to be so. I'm sure that their negative 30% placebo effect comes into play too.

So , I don't know. It's the jury is still out with regards to that, but so far.

Katie : Is there a statistic for that? How many people say that they get that statistically?

Ashley : No, it's pretty rare, but yeah, I don't have

Katie : So that's rare as well.

Ashley : That's rare.

So. For a breast augmentation. If you feel like your nipple and areola are in a different position. Afterwards.

It's most likely due to pre-operative asymmetry. And everything gets augmented. So not just volume and size, but some of those asymmetries get augmented to.

Katie : Exasperated.

Ashley : Accentuated, You're already a

little bit over and then adding everything. The thing is just makes it look okay. Yeah. How do you.

Fix that. You just, well that's so, okay. And that's a lift, right? So you can, you can technically do a lift where you're moving the nipple and areola. Right left. And when I do that regularly, because it's rare to have someone for whom the nipple and areola are perfectly centered on each breast, over the, kind of over the breast Meridian, over the center of the breast mound.

So usually I'm adjusting that and trying to get them as close as possible as I can. One side for the other.

Katie : Can you tell that when you've done them, if it's off, it needs to be corrected.

Ashley : afterwards.

Katie : Like right when you're in the surgery.

Ashley : During an augmentation? Well, that's why you do measurements beforehand. Right? So I do measurements.

From the nipple to the midline, pre-op. So I already know what it is.

Katie : Well, like for someone like that after they've healed, it seems like it's gotten worse.

Ashley : I don't know.

Katie : Just wondering.

Ashley : I'm not sure. I mean I don't know. Usually if there's some, asymmetry pre-op, you're still going to see it post-op. Just with the augmentation and if you're wanting to adjust that. You were asking earlier about, you know, what are some lift options will that would be part of your lift plan?

Would be to try to move one of the nipple and areola Right or left just depending upon what would be the most symmetric

Katie : you want to talk about the different types of lifts? Lollipop and

Ashley : oh, sure. So lifts generally fall into. Two broad categories. So one, I would say it would be the traditional surgical and that's what the vast majority of people and or plastic surgeons would perform. So.

You're adding some centralized incisions on the breast mound to try to. Reposition than a nipple and areola in a more desirable location. So usually up. Maybe to the right or left just depending on where it is. So the incisions that you could utilize would be one or the smallest lift is called a Benelli lift. So you're basically just doing a little Crescent shaped excision on the top of the areola. And that is good for, I would say.

Less than a centimeter. Tiny.

Katie : That doesn't seem like a big change. I mean depends on the breast size.

Ashley : Sure. That's subtle. The next one would be a circumareolar, a periareolar lifts. So. So an incision that goes all the way around the areola.

Katie : And down.

Ashley : Nope, just to circle around the areola. That's good for somewhere in the one to three CM,

Katie : where you cut the circle bigger than the area.

Ashley : And you're doing that purse string. Kind of wagon wheel type suture to tighten it down. So that's good for one to three centimeters. Okay. And then you have the lollipop incision. So that has. Kind of like, not a semi-circle, but maybe seven eights of a circle and decision on marking above the nipple and areola where you want it to be.

And kind of a V like, Almost like a D shaped incision at the bottom. Yeah. At the bottom of that.

Katie : Are you taking out excess tissue.

Ashley : So you're. Lifting the nipple and areola up, up into that seven, eight to the circle, and then closing that V into a line. And then you ended up with the lollipop pattern.

Katie : Do you take tissue out?

Ashley : Not necessarily.

Katie : Can you just tighten the skin and leave the tissue.

Ashley : So. You can do either one. The downside of the lollipop incision is that. If you have any vertical skin asymmetry, or you have vertical skin excess. It would not address that very well.

Katie : Right.

Ashley : So that's where the people will talk about a wise pattern.

Or anchor pattern, incision,

Katie : anchor pattern.

Ashley : So in addition to the lollipop part, You would also have an incision that runs along the crease, so that can help when you have more asymmetry or you have a lot of loose skin in the up and down dimension.

Katie : Okay. Now I had a friend that. Got to lift. And then after the lift, she had the incision around the areola. The borders of her areola. Blended with the rest of her skin.

Ashley : Hmm.

Katie : Now what is that called?

Ashley : Really pale.

Katie : Her skin is really light. Yes. Yeah. But like it made it so that there wasn't really a distinction between her aerial anymore in her regular skin. It just kind of all blended into one. Kind of muddled.

Ashley : Was her areola really stretched out.

Katie : I only saw the after and didn't see the before.

Ashley : Well, I could see in a scenario that if you were really pale kind of light skin and your areola is really light colored too. And you had some wider scars where it could look like that. Usually, I think the opposite is true where you know, the average person doesn't have a perfectly circle finite border where you can tell like the, this is where the areola ends, right.

So when you do a lift, you actually do make a perfectly round circle around it. And then you're sewing that into another circle. So it tends to give you more of an abrupt transition between. You know, perfectly round areola, right. That's the end of the areola skin. And then there's the rest of the breast again, so I could see how it could happen, but usually it's more of the opposite.

Katie : So as far as stitching goes. Can you see this stitch marks? How's the stitching done?

Ashley : Well, I can't speak to how everyone else does it, but I think most people opt to put sutures under the skin. So that you don't have the, the train track marks where you're seeing them poke hole on both sides of the scar.

But that just tends to make the scar look wider and less good.

Katie : Right. You have those little dots, which don't seem natural. So do you have to go and have stitches taken out or do they dissolve.

Ashley : So all stitches that are under the skin. ideally are dissolvable. Yeah, that makes that I've seen people put permanent. Some people will do a permanent suture in the circumareolar lift, but that's deep enough that you wouldn't have to remove it.

Katie : What about where you see or hear about people getting out internal bra?

Ashley : Oh sure.

Katie : What does that mean?

Ashley : So if you're putting Implants. Well, you can do it either on top of, or below the muscle. So if you're going on top of the muscle, I will use what's called GalaFLEX, which is an absorbable mesh that you essentially are wrapping the implant in.

And you're fixing that mesh to the chest wall and it allows you to so it in your body in process of absorbing that mesh will lay down its own connective tissues. And it will leave that tissue layer four times stronger than it would have been without a mesh being there. And also, if you're going on top of the muscle, that extra layer will help reduce your risk of capsular contracture.

If you're going under the muscle. So the pectoralis muscle usually has poor coverage in the lower outer quadrant of your breast. Meaning there's probably not muscle there. Anyway, it's just the way that muscles running from your breast crease up toward the arm bone. That angle will just show you that there's this part that doesn't even have muscle there anyway. So when you're standing up.

That's where gravity tends to take implants down. And when you're laying on your back, it tends to take the implants to the side. So that lower outer quadrant certainly is a potential weak point. So you can take that same mesh and in a smaller piece, certainly. And so that your breast crease and that lower border of your muscle and provide a full coverage.

For the implant pocket. So that's like an internal bra.

Katie : Does that mean? Like you don't need a bra. After that, like you can just go around with

Ashley : no, I think I actually did advise patients to wear bras not only during the day, but when they're sleeping too. And that goes back to the

Katie : healing or all the time,

Ashley : all the time. And it goes back to our same 80 year old lady at breast analogy. Right.

Think about covers of national geographic, where women have never worn breasts. Right. I'm sorry. Women have never won bras. And you know what their breasts look like. They're deflated, droopy big kind of pancakes.

Katie : So, I mean, underwire, no underwire or does it matter? Anything that holds them up?

Ashley : Yeah. I don't think it matters.

Katie : So can you do an internal bra? If you just do a breast lift?

Ashley : Mm. I know people describe that, but.

It's not something that I really employed a lot of. Okay. Yeah.

Katie : Not really necessary? Or well, not a way to put it since there's not a breast implant.

Ashley : So it, it would depend. So if you were saving a bunch, so for some patients that get a breast lift and they're trying to save all of their breast volume,

So I think we talked about the auto augmentation type thing before, where you're lifting up the nipple and areola in one little blood supply, and then you're maintaining another area below. That area below you could, you could make a little sling of a internal bra with some mash and help support that extra weight below.

Katie : So that maybe you don't get the same spot again.

Ashley : Yeah, it just, it provides additional support. Right. It's just, it's the same thing. It's like, okay. Isn't is a bra helpful? Yeah. Well, you can tell people that never wear a bra versus a woman to do. The same thing, like is having that extra connective tissue better. Sure. Does that mean that you're never going to have a problem? No. it just reduced it. It's kind of risk reduction.

Katie : I feel like, you know, I had three kids at breastfed, all my kids. I feel like everything was great before that. And then after breastfeeding, that was where it really took a toll. You know, personally now, do you see that a lot? As far as women who have breastfed versus not.

Ashley : Well, yes, so. One with breastfeeding, your breasts will get really engorged. So they get transiently bigger than they've ever been. And so that stretches out all the connective tissues. Obviously, including your skin. And then you can also get some involutional changes, . So less kind of glandular tissue, more fatty tissue.

So both of those things can lead to less volume and more skin.

Katie : After the retraction,

Ashley : right. So less volume. More skin. Is not. That's not a great set up for an awesome looking breast. Yeah. Okay.

Katie : So Another thing about breastfeeding actually. Can you breastfeed? If you get breast implants.

Ashley : Yes. So. That is a theoretical risk and it's on most breast augmentation consent forms said there could be lactation or breastfeeding difficulties. For someone who has a breast augmentation and has an incision place in the breast crease. Statistically, I don't think it should really be impactful as far as your ability to breastfeed. Now, that being said, there are people that can't breastfeed and they've never had breast surgery. Like they just have issues breastfeeding, right?

Once you start doing things like breast lifts and you're cutting into the breast tissue or putting in incisions. Right by the areola, which is where all those all the ducts emptying to nipple are and we had talked about earlier for the breast lift. You are impacting the blood supply too, so certainly.

If the blood supply was so poor that the tissue didn't heal all that obviously would not be good for breastfeed.

Katie : Does that depend whether or not they're over under the muscle as well.

Ashley : The ability to breastfeed.

I think that there. Could certainly be some. You know, so there are some potential impacts. Associated with having implants in. So as you have more pressure applied to the tissue. So whether it's a back pressure from the implant, I could see how you can get some more involutional thinning. So thinning of that tissue.

Okay, so potentially.

Katie : So it wouldn't matter either way. Just depends on. Personal,

Ashley : maybe. I would guess more on top of the muscle. I would guess. But I don't think I have data to support that right. Just a hypothesis.

Katie : Yeah.

Ashley : So after breast augmentation, I have patients avoid strenuous activity or exercise for about two weeks. And then I have them not lift more than 15 pounds for six weeks. And when you wake up from a breast augmentation surgery, especially if the implants under the muscle, you're going to notice that.

That muscle. It's an extreme muscle pull. So if you ever pulled a muscle or strain something It's kind of like that, but to an extreme. So we've pulled the muscle away from the chest wall. And we put an implant in there. So the muscle is tight and spastic. And it's going to force that implant up into an artificially high position on the chest wall. So when people wake up after breast augmentation, .

They will notice that their implant is really. They're really high. Like as close to their collarbone or clavicle. It's firm. So not that soft.

Gummy cell implant. They felt in the office and it's kind of boxy. So they get that overly full top. The bottom of the breast is really flat and then it otherwise looks really boxy. So doesn't look great.

Katie : How long does it take to relax.

Ashley : Different people, different amounts of time. I think by the two week appointment, most people still are pretty boxy and tight.

By six weeks. I think most people have made some really substantial improvements, but I think the total duration to that settled phase. There's going to be a function of. How much. Muscle bulk, you have some more muscle means it's going to take longer. And then how big your implant is. So a bigger implant is more stretch on the muscle will take longer.

I think another part that I don't really think about as much as probably I know comes into play is, you know, stress levels and activity levels. I have. I've had some people that have had like really stressful jobs. And I quite certain that they never took any substantial amount of time off to recover from the surgery. And I think that they definitely.

Katie : Took longer.

Ashley : Yeah.

Katie : So how long were you off work?

You have a breast augmentation.

Ashley : Well, it depends on what kind of work you do. So. If you have,

Katie : if you're at a desk job,

Ashley : I would say maybe a week.

Katie : Okay. Yeah.

What, what is, have you ever heard of these commercials that, that. I haven't heard of in recent years, but it's like, oh, get a breast aug on your lunch break.

You can go to the mall the next day.

Ashley : that. And then the whole. Lunch lifestyle lunchtime facelift to,

Katie : oh, I don't know.

Ashley : Like go got a facelift. I don't know.

Katie : Facelift. Maybe with injectables.

Ashley : But yeah, liquid facelift. Sure. Yeah. I haven't heard those commercials of recent, but I certainly know the phenomenon that you're talking about.

There certainly are patients that can do that. So I think that's more of a sales gimmick than, oh, this person has some amazing technique that allows patients to return to work. It's just after lunch.

Katie : Just getting people in the door or something like that.

Ashley : Yeah, it sounds appealing, but I don't think they've got some special trick up his sleeve. Things that could help you?

We're trying to work out earlier. On top of the muscle probably does hurt a little bit less. If you use Exparel which so long acting local anesthetic that lasts about three days, I think that would just mean you have less pain and you probably would be

Katie : What about your diet.

Ashley : So yeah, certain foods are more inflammatory than others.

Katie : Well what about like collagen? I heard collagen helps.

Ashley : I think that, I mean, I take collagen supplements. It's going to be hard to have a randomized controlled trial of augmentation patients. One group that takes collagen in their coffee and one that doesn't and be able to say, look, wow, look how much better this group did. But yes.

In general, I think the healthier the patient, the more nutritional optimization and stress reduction and whatever, all those compliance things, the better they are in that regard. Yeah.

Katie : So, what about , can you sleep normal on your back? How do you. Yeah. How has recovery at home? Do you have drains?

Ashley : No drains for breast augmentation. I don't do drains for lifts either. So breast Aug and lifts or lifts or reductions or combinations of those. Yeah. Don't need to.

Katie : Okay.

Ashley : You can sleep however you want. After a lift I wouldn't have you sleep on your chest,.

Katie : Right. But like you could sleep flat on your back.

Ashley : Oh yeah.

Katie : Okay. You don't have to worry about. I don't know.

Ashley : No, I mean, I just like, if you have, let's say you sprained your ankle and your foot got swollen. Yeah, elevating the effected area probably reduces some of that postoperative swelling. But yeah, you don't have to

Katie : do you need painkillers?

Ashley : Most people do. Yeah.

Katie : For how long?

Ashley : Maybe a couple of days. Just two, three days.

Katie : Tylenol or Aleve.

Ashley : Usually I give a prescription. So I do prescription pain medicine. So usually hydrocodone. And then I do a prescription Valium or diazepam to help with that muscle tightness. Right. And then I do singular. So we, I know we had talked a little bit about.

Capsular contracture. Which is that we get that type scar ball around your implant. It can make it look and or feel bad. So Singulair has been associated with reduced risk of that. So I give that to patients. It's an asthma allergy medicine.

Katie : Okay. I was going to say that's like allergies.

Ashley : So I give that to patients for 30 days after surgery and then usually a handful of days of antibiotics. And then the anti-nausea.

So a little micro pharmacy of sorts.

Katie : Seems pretty easy.

Ashley : Yeah. It's not bad.

Katie : How soon until until you can like be out say you, you know, what about on the lake or something around the pool.

Ashley : So for the incisions to be totally healed. That will be required to be getting in a pool or a lake. And so I would say about at least 10 days,

Katie : Okay.

Ashley : but you'd want to have your surgeon take a look at those incisions, especially for

Katie : And you have a post-op.

Ashley : Yeah, especially for a lake. I mean, a pool, assuming it's appropriately chlorinated would be less risky. But for You know, a lake or ocean water, that's just teaming with microorganisms. So.

You want to make sure it's totally, totally.

Katie : You don't want any incisions opening

Ashley : Yeah. Fortunately for breast augmentation. I would say that I feel like having an infection is super rare. I've only, so in my

Katie : How big are the incisions

Ashley : usually about two inches. Okay. So in my career I've only seen two. So one of them was someone who went to gosh, I want to say like Costa Rica or something. I can't remember. Like they went to Costa Rica for their breast augmentation and they came back with just like a bad infection. So I saw them for that.

And then the other one was someone who Was in the tub, the night of surgery, took a bath. Just soaked in the bath water. Like, what are you doing? Right. So yeah,

Katie : they just thinking, like, I can't take a shower, so I'm just going to sit in the bath,

Ashley : I guess I'm just gonna write it off to they weren't thinking because.

Maybe

Katie : I could see how you were like, maybe it just won't touch the breast area, but accidentally did or something like that.

Ashley : Whatever. I don't know wasn't thinking.

Katie : What's the treatment for that? I. Obviously it's rare, like you said, like,

Ashley : oh yeah. I mean, if your implant pocket gets infected, you have to remove your implant.

Katie : Oh, that's no good.

Ashley : Yeah.

Katie : That's an extra cost.

Ashley : Oh yeah. So then let's assuming

Katie : your fault. Yeah, the person's fault.

Ashley : Yeah. So classic would be taking the implant out. So you'd have one in. And one out.

Katie : Oh so then you have to wait.

Ashley : You got to wait until the infection cleared up

Katie : and then put one in.

Ashley : So you can't just like clean it out. Like you'd have to get it removed. Wait, let the infection clear out then have it replaced.

Katie : And then is there possibility like scar tissue and

Ashley : yeah, sure. I mean, I, again, I have to tell you I've never actually had that happen, but oh, the person that yeah, the Costa Rica person, yeah. That happened to them.

Katie : I hadn't even heard of Costa Rica being a destination. It just seems really interesting to me. You know, you hear about Brazil all the time.

Ashley : Do you? I feel like I hear a lot about the Dominican Republic. People go to the D.R. a lot.

Katie : And I've heard Brazil is really big on plastic surgery. If you look in the pictures,

Ashley : Also Miami people. I mean, that's not a different country, but a lot of people will go down to Miami for. And I think we had to touch on this in an earlier podcast, but you don't have to be a plastic surgeon to do plastic surgery.

Katie : Which is scary.

Ashley : Yeah. And I was actually just talking to a patient yesterday from Europe and they asked me, why does everyone make a point of saying they're a board certified, so, and such and such in the United States? And I said, because a lot of people do, but they shouldn't. I said, because you don't actually have to be a board certified plastic surgeon to do plastic surgery and , he was totally taken aback.

He couldn't believe it.

Katie : Right. It could be a dentist. Yeah. Putting in breast implants. And there are those out there. We just scary, which is why you should do research

Ashley : so. Yeah, in general, I would say, yeah, make sure you have a legit surgeon and probably stayed in the United States.

Katie : So I know somebody who went down to Miami to get a breast lift. She's like, Hey, I'm.

Bodybuilder type person. And she went to a really great surgeon, but she had said there was another surgeon that she looked at. And down there and she said it was like a chop shop. There was just lines of people. Like, they were just churning them through this. This guy was literally just like one after the other. Breast augs all day long.

Ashley : Yeah,

Katie : which I don't have none of that. Ideally, but the bedside manner of.

Ashley : Well, I mean, I think if your consultation is a quick phone call from several states away, And you're meeting the doctor as you get ready to roll back into the, OR it's just a, not a lot of time to have those kinds of, I think, ideal discussions about.

You know, measurements of your chest and what's an appropriate implant size, and for you to try on sizes, all those things that are part of a regular consultation. I just think you're probably missing a lot of them.

Katie : I think I'm those people, you know, doing these tons of breast augs down in Miami, you all daily show the pictures of like 20 year old.

Super hot breast augmentations that don't show the ones of like 40 and 50 year old women. Sure. Like you don't know what those ladies look like. You only see the ones, you know, the cute ones.

Ashley : Yeah. That's unfortunate.

Katie : Well, Well, then it's misleading a little bit. I think. But anyways.

Ashley : Sure. Well, that's a whole nother issue.

Before and after photos, right? I've seen a lot of this on Instagram where people will especially then BBLs where they will show. Preoperative photos of someone's standing of their, their buttocks and then their post-op photo is them. They literally are still on the, or table

Katie : Yeah, just finished

Ashley : and they're all greased up with, I don't know, some kind of like muscle oil and they do a view from the bottom of the table with a butt up in the air.

Yeah. And the butt looks huge. And then they will orient the photo. So it kind of looks like they're standing. but if you are paying close attention, you can tell they're not, they're laying down.

Katie : and you could see the stitches. So it's like, okay, this isn't healed. Yeah. I'd love to see healed pictures.

Ashley : Cause I think, I think that's disingenuous to, to present before and after photos like that.

Katie : Right. So definitely before and then after, but healed. Sure. And in the same position,

Ashley : right? Definitely. Not still on the, or table plumped up full of fluid and having, you know, a hundred percent of the fat in there because none of it's gone away and a bunch of fluid from your numbing stuff. And a fish eye view from the, but I mean, it's just, everything is so much bigger and I think it gives people this false sense of what they should and could expect.

Katie : Right. And I know that BBLs are not the subject, but what you were saying about fat transfer. You know, there's, there's an atrophy of some of that fat.

Ashley : Yeah. Not all the fat cells survived. Yeah. So regardless of whether it's the buttocks or the breast, same thing,

Katie : even if you saw that of a breast. You know, whatever. It's not going to end up like that. You know, that is interesting. Do you ever have anyone come in and say, I have lopsided breasts. I need two different size implants

Ashley : all the time. All the time,

Katie : how do you assess that? I mean, I actually, it's normal to be asymmetry and most asymmetrical.

Ashley : Right. Most people have some degree of asymmetry.

Most of it is just by looking at the breast. I mean, you can tell, right. The measurements reinforce what otherwise appears as an obvious source or subtle asymmetry. But with regards to figuring out how much volume that is, I do a lot of it with sizers. So I'll have people try on differential sizers and try to figure out how, at what point do I think and do they think they're pretty symmetric?

So it's helpful to narrow down what that absolute difference is between the two breasts. And then most of those people tend to have some breast droop too, and not always, but so if it's different sizes, And they don't have any drip. I'll have them fix one side, like let's say, okay. The left side. I know I really liked 300. So I'm just going to keep that I know left side is 300 then for the right side, whether it's bigger or smaller, I'll just have a couple of sizes available and I can try on those sizers during surgery.

Okay. Yeah. And I'll set the patient up while they're still asleep. And figure out which of those is the closest, they're never going to be exactly the same. Which of the, of those is the closest to the one side that we've set. The volume for.

Katie : Can you do a custom size. If you can with saline because you're filling in.

Ashley : Yeah, so you can do whatever random number for saline within the fill range and the silicone implants are prefilled. So,

Katie : so would, saline be a good option to get the most symmetry.

Ashley : I don't think so. I mean, not for that reason. I mean, the difference of, you know, let's say the silicone implants come in somewhere in that 20 to 30 ML incremental difference, one size for another.

If your differences is smaller than that. You're probably not even noticing it.

Katie : Most people probably might even use these

with clothes on. Yeah. So I'm looking at you, you know, right. What about. Leaking. Do you have to worry about since you fill the saline? Do you have to worry about it leaking the port in which you fill it.

Ashley : So there are two ways in which an a salient implant could leak. One is a tear in the shell, or poke in the shell. So it would, the saltwater would extrude through that hole or tear. The other would be a valve incompetence issue. So if the valve stopped functioning, optimally, it could leak, it could leak all the way or could leak partially. I've seen both.

Katie : Now, if you have saline implants in. And you fill them, you know, halfway up or whatever. Can you go back in through that same port and fill them out more?

Ashley : You could.

Katie : Later. You can just say it. 10 years.

Ashley : Sure, but it's another surgery. So

Katie : why not just replace them?

Ashley : So like, let's say you're like, oh, I want you to add.

15 and more MLS. That would be so subtle. It would be hard to justify. The cost

Katie : went from like added 200 minutes.

Ashley : Well, then that would be a different implant. Okay. So most implants have maybe like a. Maybe 50, 70 or something ML fill range. Sometimes smaller. So it's only 25, ML range, like let's say, okay, here's a 300 ML implant. You can fill it from 300 to 3 25.

Or maybe it's a, a four 20, you can fill it from four 20 to four 70, something like that.

Katie : Okay. Now, what about after you've had your implants for 10 years, you decided, Hey, I don't want them anymore. What's it going to be like, if you take them out. Are you going to need a breast lift? Are you going to be super deflated?

Ashley : Again, that's needs a relative term, but yes, you may want to have something done. So it depends on how big your implants are and how much of that volume they were occupying for your breasts. So the bigger, the implant, I think the more likely. You would want to do something to restore the other, probably otherwise deflated you're be looking breasts that will be left otherwise.

But yeah, you could either. Remove your implants or remove and replace. You could remove and do a breast left, you could remove and do a fat transfer. There's lots of options. I've done all of the above.

Katie : I just saw Pam re remove her plants or something like that.

Ashley : But didn't she put them back in?

Katie : She probably did.

Ashley : I can't keep up. I feel like she's been through lots of breast sizes. Yeah. Like Dolly Parton too. Like she's been through lots of breast sizes too. Holy moly. Yeah, those are big

Katie : poor Dolly. She still cute though.

Ashley : So, if you're interested in the breast augmentation and you're healthy and you're wanting to increase the size of your breast volume, my best advice would be to visit a board certified plastic surgeon. Go and have a consultation, discuss your goals. Have an exam.

And consider the options that are available to you.

Katie : I do have a question. How much does it typically cost? Like a range.

Ashley : Oh, so the most price favorable option would be a saline implant. Augmentation only. And that would probably be around. 6,000 something.

Katie : Okay. That's pretty affordable.

Ashley : Yeah, something like that. Maybe the mid sixes and then as for a silicone, that's going to be in the eights. And then as you add. Lifts or that kind of stuff.

Katie : But starting around six.

Ashley : Yeah. Not too bad.

Katie : It's not too bad at all.

Ashley : And the surgery takes about an hour and hour and a half. You get to go home the same day. Someone has to drive. You obviously can't drive for 24 hours after a general anesthetic.

And then yeah, once you've been 24 hours after anaesthetic and are no longer taking pain meds, you can drive yourself.

Katie : Sounds pretty easy.

Ashley : Yeah, it's a lunchtime thing, I guess.

Maybe not, maybe not though.

Katie : That's where that gimmick comes in.

Ashley : I don't advertise that.

Katie : You don't do lunchtime.

Yeah. Well, I think that's all we have to talk about, about breasts. Anyone has any questions? Kind of monitor Instagram page,

Ashley : which is what nipped and toxxed. Nice. Okay everybody

Katie : pretty easy

Ashley : yeah got it thanks bye bye

Unbotched: A Real Patient's Perspective

jay@robeyplasticsurgery.com (jay robey) — Tue, 31 Jan 2023 15:37:23 GMT

Plastic Surgery from a Patient's Perspective

Nipped and Toxxed Episode 6: Unbotched - A Real Patient's Perspective - Now Streaming on Spotify, Apply, Google Playlists

Ashley : Welcome to Nipped and Toxxed: episode six, Unbotched - a real patient's perspective. I am Dr. Ashley Robey, and I'm a quadruple board certified plastic surgeon. And with me as always is...

Katie : hello, I'm Katie Reichart. I'm a CPCP, which is a certified permanent cosmetic professional, which is when you're certified by an outside body. So in the state of Indiana and a lot of other states, you can literally just walk into a place and get quote unquote certified. So that means nothing. So that means really you could have had no training. Through what I have, you have to have had fundamental training as well as continuous education. And, you have to go take it an actual exam.

Ashley : You're legit.

Katie : I'm legit.

Ashley : Too legit some would say.

Katie : Yes, exactly.

Ashley : And we have a special guest with us.

Katie : Yes!

Ashley : Jordan Dunne.

Shay : I'm gonna go by Shay. Jordan Shay Dunne, preferably Shay. I am an experienced surgical patient. I have had five surgeries, I would say Dr. Robey, also my sister, mm-hmm, has performed two surgeries that included a few procedures. I had a tonsillectomy and a few other procedures not performed by Dr. Robey. So I have a lot of surgical surgical experience.

Katie : So with your tonsillectomy, we know why you had that, but for your first surgery, why did you decide that you wanted to actually get the surgery and what was it?

Shay : Ugh, because I was just really unhappy with- I had two kids, but I have to preface this with when I was pregnant with my first child. I told people that people would regularly come up to me and say, are you having twins? And this was when I was like, Seven months pregnant.

Katie : Mm-hmm

Shay : And I was telling my in-laws that when we were out to lunch, once in Chicago, that this was always happening to me,

Katie : Uhhuh.

Shay : ...and I think they kind of didn't believe me, but we walked outside and this guy's like, oh man, you got two babies in there. Congrats lady .

Katie : And you're like, I know.

Shay : So I was very belly forward.

Katie : Right.

I would say in both of my pregnancies.

I was the same way with mine. All my children were huge.

Shay : My kids weren't that huge, but my stomach man, It was large. So after they came out, I had lots of skin.

Katie : So, did you have a diastasis?

Shay : I did. I don't remember...

Ashley : It was like three or four centimeters.

Shay : Yeah.

Katie : Do you want to explain what that is?

Ashley : Oh, so a diastasis recti is when you have a separation between your rectus abdominis muscles. So the muscles that give you that six pack look ,if you're thin enough, you can see the muscles underneath the skin, but with pregnancies or weight fluctuations, those two muscles can get pulled apart. And so it creates a separation and they call that a diastasis.

Katie : Does it actually tear?

Ashley : Yeah.

Katie : So it's actually torn down the middle?

Ashley : Well, the muscle bellies are already separate.

Katie : Oh, okay.

Ashley : They're two separate muscle bellies and there's ...

Katie : cause it separates so that the belly can grow, right?

Ashley : Right. So everything is stretching. And they usually get better after delivery, but they don't necessarily get to the extent that they were. Yeah.

Katie : Right.

Ashley : In addition to creating some cosmetic concerns, there are some functional impacts. Your abdominal wall or your abdominal musculature works in concert with your back muscles to provide torso stability. So when you have a separation in the front, you've created a relative weakness and your back can have to overcompensate. So some people will get chronic back pain from it.

Katie : Mm-hmm .

Ashley : It's not a hundred percent cosmetic/ aesthetic. Unfortunately, insurance companies, even though it does have some functional impact, will not cover that.

Katie : Right.

Ashley : So, out of pocket

Katie : aesthetic.

Shay : Yeah, first Ashley had told me that just losing weight wasn't going to help that abdominal skin.

Katie : Right.

Shay : I had a lot of skin.

Katie : Cause your belly had stretch.

Shay : Oh, yeah. Yeah, just like a big sack of skin but I did liposuction first. The best thing about that liposuction was I felt like I had like gotten back to mostly my pre-baby weight, but my thighs were still touching in the middle.

Katie : Mm-hmm

Shay : And just that feeling of like ...

Katie : right.

Shay : ...was really annoying. So I did liposuction on the back of my legs, the inside of my legs and my flanks love handles.

Katie : Mm-hmm. How was that recovery?

Shay : That was not a big deal.

Katie : Nothing.

Shay : I would say it. ..I felt like pretty much...

Katie : well, we already talked about this with liposuction, but talking to a real person.

Shay : Yeah. I had some pretty bad bruising on the back of

Ashley : a real person.

Shay : on the back of my legs, but it looked way worse than it was. It didn't really hurt. I felt fine pretty quickly. Within four days I felt pretty normal.

Katie : Mm-hmm

Shay : like, I wasn't gonna go do a hardcore workout or anything, but

Katie : right.

Shay : That wasn't bad. Yeah. Abdominoplasty seemed like a bigger surgery, so I waited another year to do that and, oh man, I tell people all the time that it was one of the best things I did in my life, blah, blah, blah, blah, blah, marrying my husband- so smart. having my kids such a great decision. Then an abdominoplasty is right up there.

Katie : Right.

Shay : I didn't like sitting down and having that skin hang over my pants all the time.

Katie : Right. And there was no way to retract it. I have seen Kim Kardashian is doing some tightening. She says she hasn't had an abdominoplasty. I call B.S. on that, that she had some skin tightening, something done.

Ashley : Maybe she had BodyTite .

Katie : Oh, maybe. But did you see her when she was pregnant?

Ashley : No.

Katie : She was giant. There's just no way.

Ashley : You and I have had this conversation about the Kardashians before, where in which I know few details and you know many details.

Katie : This is the kind of thing that pops up on Google. So I'm sorry Shay, go on.

Shay : My stomach looks really good now. I went from never feeling comfortable in a bikini to I feel like I rock it. I do.

Katie : I saw your Dominican Republic pictures.

Shay : I know. You should probably post those to your website

Katie : probably should. pretty hot

Shay : or to your Instagram. The abdominoplasty, from a recovery standpoint, I wanted to give a relative pain scale. Like liposuction, I would give maybe a two or three.

Katie : Really?

Ashley : Out of 10?

Shay : Out of 10.

Katie : What do you compare that to? Like getting a bikini wax? Is that worse?

Ashley : That's so transient though.

Katie : What would you compare it to pain wise? So like the soreness after a really bad work-out?

Shay : What, liposuction?

Katie : Yeah.

Shay : No, because it's not a muscular soreness. It's more like a bad bruise. And I didn't have that same bruising on my love handles. It was just the back of my thighs for some reason.

Ashley : Gravity is the reason.

Shay : There you go.

Ashley : I hear a lot of patients saying, well, my spouse told me just to go work out more and the skin will get better. Nope, Nope. Right. The skin doesn't get better. And in fact, sometimes working out, if that means you're going to lose a little bit of weight can often make the skin look worse, droopier. So, there's no magic cure for excess skin. Then the question is, is it so much skin that it needs to be removed? And, classically, something like an abdominoplasty would be what you would choose to remove the skin. Or is it a little more subtle and maybe you can do something that's minimally invasive, like you're talking about whatever Kim Kardashian did.

Katie : I think she had a full abdominoplasty. I'll show you a picture of her pregnant.

Shay : Can you see her belly on belly button?

Ashley : But not every single abdominoplasty has an incision around the belly button. So that leads us to what are the kinds of abdominoplasties? Because this is definitely something that I hear frequently and most people are interested in the prospect of being a good candidate for a mini abdominoplasty. And what a mini abdominoplasty is, is the incisions are still in the same location. So low in your underwear/ bikini line, but the difference is for a mini abdominoplasty that the incision would be shorter in length. The other main difference between a regular and a mini abdominoplasty is that classically for a mini version, you would not have an incision around the belly button and you would also, Katie is showing me a picture of Kim Kardashian's big belly. You would also have ...

Katie : I telling you like that doesn't snap back.

Ashley : You would also only have skin removed from the lower abdomen.

Katie : Okay. So what did you have Shay?

Shay : Well if there's a mini, I guess I had the maxi.

Ashley : You had the traditional .

Shay : Traditional.

Ashley : So that involves an umbilical transposition, so the belly button is moved from where it was on the excess abdominal skin and all that extra skin is pulled down and then you make a new opening so you can see the belly button.

Shay : I'm gonna explain that in real people talk.

Katie : Yes, please.

Shay : When people ask me about my abdominoplasty and how does it actually work? I take the shirt I'm wearing and I draw a circle around my belly button and I say you cut a hole to free the belly button from the skin. So there's a hole in my shirt. The inside of my belly button isn't moving. You take the shirt, you yank it down. And then cut the bottom of the shirt off and cut a new hole in the skin to let the inside of the belly button stay where it is and free that belly button.

Katie : Right.

Shay : Amongst all of the tight skin.

Katie : I feel like the belly button is art. Like people come in and they pick from a menu of belly buttons?

Ashley : No.

Shay : No, the belly button is the same on the inside as ...

Katie : no, but what people want their belly button to look like? When you look on the, of all these different people.

Shay : We're shaking our heads.

Katie : I know you're shaking your heads, but ...

Ashley : we need a video of this.

Katie : When you look at plastic surgery befores and afters, there are some good belly buttons and there's some bad belly buttons.

Shay : Sure.

Katie : That's what I'm saying.

Shay : So I've seen people with abdominoplasties where, I don't think that you would notice, now, like if you look at pictures of me, you're gonna notice, but, this is how you find abdominoplasties, you look for the belly button scar. And I've seen some bad ones.

Katie : Right? That's what I'm saying. I've seen some bad ones.

Ashley : So the bad things are when you close the abdomen incision, All that skin's under tension. So I think sometimes the surgeon will make the opening the appropriate size, what they think should be normal. And you really need to make it way smaller because as soon as you cut the skin, that like stretches a lot. So that's part of it. You get this stretched out elongated belly button. Hopefully that's something that if you have some experience you pick up on pretty quickly. The other part is I really think that the sutures placed should all be under the skin. Some people will still do sutures that need to be removed. And so you'll have those little poke marks all the way around the circumference...

Katie : stitch marks.

Ashley : ...of the belly button, and it almost looks very much like a sun.

Shay : The way a belly button looks after an abdominoplasty is the mark of whether or not...

Katie : right, that's what I'm saying, whether you or not, you had a good one.

Shay : Yep. I've had plastic surgery from multiple surgeons so I can speak to the difference of surgeons. So I had a double mastectomy reconstruction. The first half is not the plastic surgery part, but yeah, there are some differences that I didn't expect. Like after that surgery, I woke up without a compression garment on.. And I thought, where is my compression garment? When Ashley did the surgery, I had one and now I'm not wearing one and I had to go buy my own. I just didn't expect it because I had woken up with one the last time .I feel like my belly button looks pretty natural.

Katie : No, I think your belly button looks great.

Shay : It looks like it did before. Except I have a very faint scar around it.

Katie : Right. I'm just saying, does someone come in and say if they had an outie, are they gonna get an outie again?

Ashley : Classically, an outie suggests a hernia.

Katie : Okay.

Ashley : Classically. Not a hundred percent.

Katie : But what if they're like, I want to look the way I did look?

Ashley : I'm like, I am definitely fixing your hernia

Katie : but what did they want the outie again?

Ashley : I literally had someone that was mad that I fixed their hernia.

Katie : Oh yeah?

Ashley : Yeah.

Katie : They're just used to it. Or what about if someone wants a hooded belly button.

Ashley : There was a study that looked at ideal belly buttons and all the shapes and having a slight bit of hooding and not perfectly round, is considered to be...

Shay : what's hooding? I don't know what you're talking about.

Ashley : So if you think about a belly button, being able to see a perfectly round circle, seeing all 360 degrees of it ,versus a little bit of flattening at the top, flat from maybe 10 o'clock to two o'clock and then circular. That's called hooding. When I make the new opening for the belly button, I don't create a circle. I actually make it flat at the top. So just to create a little hint of that hooding look.

Shay : Something I think we should talk about in abdominoplasty, which before I had an abdominoplasty, I didn't know anything about is drains.

Ashley : Mm-hmm

Shay : Do you wanna talk about drains?

Ashley : Sure.

Katie : Did you have drains?

Shay : I've had so many drains.

Ashley : Drains are annoying, I agree. And I am putting in some more quilting or mattress sutures that help close the dead space.

Shay : I don't understand. What are trying to...,

Ashley : So dead space is a space between the fascia of your abdominal muscles and the fat underneath the skin that we just lifted up. So that space that we created, so we could repair your muscles and pull loose skin down. There's a open space.

Shay : Yeah.

Ashley : People call it dead space. So that's where all the fluid would accumulate. That's a space that the drains sit in. So I wanted to make this a dead space clipper so you could close it off by a absorbable staple and close, close, close. I've kind of tabled that future plan, but you can put sutures and it's just annoying though.

Shay : Let's explain what a drain is because when I first wanted an abdominoplasty, I thought this was the scariest part.

Katie : Having drains?

Ashley : So this is the analogy I used to describe the purpose of drain. So, you know, when you scrape yourself, let's say you scrape your knee, right. It stops bleeding. Right. But then on your bandage, there's still some yellow fluid. So that yellow fluid is called serous fluid. It's the kind of fluid that weeps with an injury once the bleeding has stopped. So you can imagine, for a knee size scrape, how much fluid that collects in your bandaid. For an abdominoplasty, think about the amount of fluid that would collect from a scrape the size of your abdomen but then double it, because it's really the front and back of that surface.

Katie : Mm-hmm.

Ashley : ...both sides. So it's potentially a lot of fluid. So just like your knee heals after a scrape, it stops weeping fluid. There's more healing present. Your abdomen will heal as well. As those two layers of tissue heal together, you'll stop seeping so much fluid, and those two layers of tissue will be healed. The drains provide an egress point for that fluid. So instead of the fluid collecting in that space, there's a place for it to go. So basically, a drain is a little tube that allows the fluid to be sucked out so that while your body is healing, the fluid is not just sitting there preventing the layers of tissue from healing together. The fluid is going out into the drain, so the tissues can heal.

Katie : Right.

Shay : So it basically looks like a long tube, part of that's inside your body with a little, I'd say light bulb sized,

Ashley : Clear plastic grenade.

Shay : Yeah. clear plastic grenade. And post-surgery, you're supposed to empty them, measure the fluid. Measuring the fluid helps you determine how much longer you need to keep the drains in. But, the whole idea of having a plastic bulb grenade attached to your body that's filling with your bodily fluid does not sound appealing, but it sounded like something that like, I don't know if I'm gonna, I'm not a blood person.

Katie : Right? Was there blood in there?

Shay : It's kind of like a clear to slightly bloody colored liquid, like light pink, I would say.

Ashley : It starts off red and then it turns pink and then yellow. So it just takes a couple drops of blood to turn an otherwise a serous straw yellow color into either pinkish or red.

Shay : As a patient, when you're sent home, you have to open up the drain, squeeze down the length of the tube to get all of the stuff that's in the tube into the bulb before you empty it. They're not as unpleasant as I thought they would be, but wow, once they're out, it's a relief. And Ashley, how long do you typically keep a drain in?

Ashley : Usually in the range of one to two weeks.

Shay : I think mine were in for about a week and a half. And then when I had my mastectomy, I had four drains.

Katie : Oh really?

Shay : And those were in for two weeks and then three weeks.

Ashley : That's fun.

Shay : There's a lot of drains.

Katie : So you said it's a lot of drains.

Shay : Yeah. I know people that have had abdominoplasty or other procedures where they have really pushed their surgeons to remove them early...

Katie : Just because they're uncomfortable?

Shay : They are uncomfortable, and you want to wear blousy clothing. So have some blousy dark colored clothing prepared postsurgery. Not that I think I only had like a little bit of leakage.

Katie : One. Are you doing just like sitting around?

Ashley : No.

Katie : Living your life with your drains hanging out your crotch?

Shay : One week postop, I went out and had lunch with one of our friends and actually went shopping.

Katie : Actually one of our friends saw you at the mall and they were like, I just saw Shay the mall.

Ashley : Yeah. You just put them in a Fanny pack, or what?

Shay : You just wear loose clothing. You could tuck them into things. I had a little lanyard I'd attach them to sometimes. When you're wearing drains, you're still wearing your compression garment, so they're attached to your compression garment. They make all kinds of garments that have pockets in them, so instead of your drains hanging from just your garment, you can actually like put them in a little pocket.

Ashley : For your breasts ?

Shay : This is when I had just a tinge of the breast cancer .

Ashley : Some mild breast cancer issues.

Katie : Exactly. That's how she told us, you're like, oh, Hey guys, can't come this weekend, got a tinge to breast cancer.

Shay : But I had stage zero. So I thought, oh, this isn't a big deal.

Katie : I didn't know that was a thing.

Shay : It is. So if it doesn't leave your ducts, it's stage zero.

Katie : That's amazing.

Shay : But the treatments are still either mastectomy or lumpectomy.

Ashley : But lumpectomy with XRT potentially. Radiation.

Shay : Yes.

Ashley : In the ideal world, you don't get large doses of radiation to your body.

Katie : Of course.

Shay : Long story short, I called Ashley immediately. I explained my diagnosis, asked her what she would do. She explained all my options. She didn't try to convince me to do anything.

Katie : Right. It's a good thing you have a sister that...

Shay : I know. I don't know what you would do. Like, you can call me guys. I'll explain it to you. But a double mastectomy, obviously it's different than other cosmetic surgeries, but there are a lot of the same things you experience like the drains. So I had four drains for that.

Ashley : But a breast aug is of course zero drains, and of breast lift is zero drains.

Katie : Okay. So only because you had the mastectomy, are you having drains?

Shay : Yes. A breast reconstruction, which I assume is not totally comparable to a breast aug, but there are a lot of similarities.

Ashley : Yeah. Pain- wise, I would say.

Shay : So after you recover from the mastectomy, you get a breast reconstruction, and I had a prepectoral breast implant, which means over the muscle and I had an inframammary incision, which means underneath the breast .

Katie : Uhhuh .

Ashley : In the crease.

Shay : Yeah. In the crease. So you can't really see it. And I have breast implants now. They're quite large.

Katie : They look good though?

Shay : They're pretty comparable to what my breasts were before.

Ashley : I think so.

Shay : But I had some fat transfer with that, had some abdominal sculpting, which I heard you guys talk about.

Katie : Yes. Let's talk about that. When did you do that?

Shay : As they do the reconstruction, because I knew... I'm just so thin guys. So like, where are we gonna take this fat from? I'm really not that thin.

Katie : Oh, that guy.

Shay : So he took the fat from my abdominal wall and put it in the top of my breasts.

Katie : In your boobs..

Shay : Yeah. To hide ...

Ashley : that transitional change between no implant and implant.

Katie : To give it a more natural look.

Shay : Well, yeah, I imagine otherwise it would be like putting two balls...

Ashley : Some people really like that.

Katie : I would prefer a more natural look. I mean, aren't there different kinds of breast implants?

Ashley : Yes, we should do a whole nother podcast on breast augmentation.

Katie : All the things.

Ashley : It's a very popular surgery.

Katie : Yes.

Ashley : You know, what was the most popular surgery in 2020? It was rhinoplasty.

Katie : Oh really?

Ashley : I know.

Katie : Interesting.

Ashley : I wonder if it was because of COVID. Everyone had a mask over the face, and no one could tell they were recovering from rhinoplasty. And also all the zoom meetings. Everyone's getting that immediate feedback like my nose is so crooked and terrible. Both of those things in combination.

Shay : What was it before that ? Breast augs?

Ashley : Liposuction / breast augs.

Shay : Well, liposuction almost seems like a non-surgery to me. It's not a big deal. If your thighs touch, just get liposuction. It's not a big deal

Ashley : One thing we did not discuss about abdominoplasty is the ideal candidate.

Katie : Okay.

Ashley : So the ideal person is someone who's already at their ideal weight. Calculating BMI, which is something you could pull up on the internet, is your weight in kilograms divided by your height in meter squared.

Shay : I don't know my weight in kilograms and I don't know my height and meter squared.

Ashley : That's why there's internet calculators. So if your BMI is less than 25, that's ideal. So 18 and a half to 25.

Katie : Gotcha.

Ashley : Anything 25 to 30 is overweight,

Katie : Right. .

Ashley : Over 30 is obese. So being the ideal weight is going to give you the best results. So someone who is, let's say morbidly obese is not a great candidate for an abdominoplasty.

Katie : Right.

Ashley : It's not like, Hey, you know what would be great to help you lose weight is an abdominoplasty. No, you can't come in 80, a hundred pounds overweight. and think all I needed is a tummy tuck and I'll look great. Not the case.

Katie : Mm-hmm

Ashley : That's a common misunderstanding.

Shay : I had the abdominoplasty in September 2015, and my son was born in April, 2013, so I tried to work out a lot. I wanted to be as fit as I possibly could be going into it, because I think that that has to lead to a better result., Right?

Ashley : Mm-hmm .

Katie : It's probably harder for you because you're her sister. She's probably like now you don't need it.

Shay : That's not true.

Ashley : I like to keep it real with everyone.

Shay : Yeah

Katie : you do.

Shay : No, she did tell me. I said look at my stomach. I've been working out.

Katie : You're like, what do I need to do?

Shay : What do I need to do? That skin's not going away. You need to cut it off.

Ashley : I didn't wanna give Shay false hope, right. That her skin was going to...

Katie : By the way, Shay, you look amazing.

Shay : I'm pretty happy. Like I said, one of the best things I've ever done, yeah, it feels good. Feels good to look good.

Ashley : It's like the end of that movie with Eddie Murphy and Dan Akyroid where they're trading places... looking good Lewis looking good Lewis feeling great.

Katie : I have no idea what this movie is.

Ashley : You've never seen that movie?

Katie : No, God

Ashley : classic .

Shay : Our parents let us watch that in 1985 and, Jamie Lee Curtis is just dancing around with her boobs out. I was five.

Ashley : Our parents let us watch a lot of things.

Shay : Yeah.

Ashley : They're like, go away. If our parents listen to this podcast, maybe I should be concerned and hold back.

Shay : But do they?

Ashley : I'm quite certain they do not.

Katie : They're like, what is Spotify?

Shay : I saw them yesterday. I told them I was coming here to do this.

Ashley : Yeah.

Katie : Maybe they're gonna start listening.

Ashley : That's still not going to be enough of a catalyst to get them to listen.

Shay : They'll never get around to it.

Ashley : That does not speak well for our viewership. Even my own parents will not listen to this, but you, you viewers...

Katie : Our viewership is growing. And by the way..

Ashley : I guess you can't say viewers, if they're not viewing, right? Listeners. I said it wrong. Sorry.

Shay : Hey listeners, text Katie. She'll send you all the pictures she's looking at. You know what, just DM me on Nipped and Toxxed on Instagram. And I will show you the pictures I'm talking about.

Ashley : For sure.

Katie : You wanna see what Kim Kardashian looks like pregnant?

Ashley : All of her pictures are all over online. There's enough Kim K photos.

Katie : Exactly. Just Google.

Shay : Yeah.

Katie : So what other, what other surgeries have you had then?

Shay : So I've had five surgeries, but not all plastic. So I had tonsillectomy. That was the most painful of all of my surgeries. Childbirth is probably more painful, but I had all of the anesthesia. What's your pain level? I'm like, it's an eight. I would say a liposuction was like a two or three out of 10.

Katie : Mm-hmm.

Shay : Abdominoplasty was probably like maybe a five or six. So, I like to take the drugs after my surgeries.

Katie : Right.

Shay : But, there's a whole pooping problem. I would like to take them for three days. And then you should really try to wean yourself off.

Katie : And get yourself on Tylenol?

Shay : Tylenol, ibuprofen.

Ashley : Ibuprofen has antiplatelet...

Shay : so you have to wait

Ashley : effects

Shay : until like

Ashley : usually two weeks.

Shay : Two weeks, you can do Tylenol, ibuprofen. Oh, so wait, did we talk about what happens if your drains are removed too early?

Ashley : Seroma. We did not.

Katie : What's a seroma?

Ashley : That's when you have a collection of that yellowy fluid we were talking about earlier with regards to knee scrapes, that collects between your fascia and your abdominal flap.

Katie : What do you do? Go drain it?

Shay : I live in the Chicago suburbs, and Ashley's here in Indianapolis /Carmel. So I drove down from Chicago because I was afraid I was getting a seroma and Ashley said there's basically nothing here, but I can try to...

Ashley : Aspirate

Shay : aspirate! Thank you. It was on the tip of my tongue. Aspirate.

Ashley : You numb up the skin, you stick a needle in, see if you can suck out any fluid.

Shay : I would encourage everyone, like I know they're uncomfortable, but just leave the drains in a couple of extra days. Again, I'm not a needle person; I did not like the attempt at the aspiration. So just to elaborate on how much I don't like needles, I don't like getting Botox, but I still do it because ...

Katie : I just shut my eyes. Just don't look.

Shay : I don't like the sound.

Katie : You can hear it?

Ashley : Shay, as a frame of reference, doesn't like looking at her own tendons in her forearm, so ...

Shay : they're gross.

Katie : Interesting.

Shay : I don't like needles. I don't like blood. I wish that I could get my Botox when I'm just unconscious. I wish I could.

Katie : Who does that?

Shay : Well, I have to have another procedure.

Ashley : It's hard to justify.

Shay : Yeah.

Ashley : It's hard to justify.

Katie : Well, let me put you out for this. Do some laughing gas.

Ashley : You could do pronox.

Katie : Do you do laughing gas?

Ashley : Yes.

Katie : There you go.

Ashley : Yeah, I do.

Katie : That is great. I think that's a bonus.

Ashley : Yeah, you could do ProNox for Botox, but it's not without cost.

Shay : I've done laughing gas with Ashley. I did the Immortal facial. That's real fun for about five minutes..

Katie : Can you drive after that. Yeah, yeah. Wears off. Okay.

Ashley : Yeah. 20 minutes after you're done.

Katie : That sounds like a lot of fun.

Shay : Hey, it was pretty hilarious. Everything Ashley was doing. And I'm like, I don't know if this is gonna work, but it's hilarious, right?

Ashley : I think everyone's voice sounds very distorted.

Katie : On laughing gas?

Ashley : Mm-hmm. Yeah.

Katie : It's been a long time since I've had that, like wisdom teeth.

Shay : Yeah. Well, I like, I like anesthesia. I think that there's something really interesting about waking up.

Katie : See in my family, we have a allergy to succinyl choline. It's a anesthesia. So my aunt always tells us, you have to tell them we have this in our family, but I've never had the tissue sample to know whether or not I have it. I just know that it happens.

Ashley : But what happens to everyone else?

Katie : It was trouble waking up out of anesthesia.

Shay : Oh, I have the opposite.

Katie : Oh, you wake up too soon?

Shay : No, I just wake up very quickly. I think I metabolize drugs quickly.

Katie : Oh, okay.

Ashley : That's what happens when you use lots of drugs, develop tolerances and your metabolism increases.

Katie : You have recreational anesthesia?

Shay : I don't use recreational drugs.

Ashley : Same

Shay : not anymore Addy. I don't use recreational drugs. That's bad.

Katie : Yes. What's your other child's name? Just in case .

Shay : James. James. Don't do it.

Ashley : James is not listening.

Katie : He will someday. This is the internet; things live forever.

Shay : Yeah, maybe someday. So, I have a few tips.

Katie : Yeah.

Shay : Figure out your garments in advance. Your surgeon can give you one, but get them on Amazon.

Ashley : Oh, I will get my patient the first set of garments. I fit you into garments.

Shay : When I had my...

Ashley : mastectomy.

Shay : They give me nothing

Ashley : fine, your surgeon's a derelict, but everyone else will give you an initial garment.

Shay : They'll give you a shitty binder. Everyone else... I had two friends get abdominoplasties recently. They both got shitty binders.

Katie : So what do they provide at Robey Plastic Surgery?

Ashley : A personalized abdominal garment that provides you the ideal level of compression in your postoperative recovery.

Shay : When I had my mastectomy reconstruction, I thought they were going to give me a garment. I woke up, I had nothing.

Ashley : Not at bra, even?

Katie : Literally, you're just hanging out there.

Ashley : That's weird.

Katie : Were you taped?

Shay : You know what, they did give me a crappy bra after the mastectomy.

Ashley : There you go crappy bra. That sounds plausible.

Shay : And then an abdominal binder.

Ashley : That's not terrible.

Shay : I was not impressed. But, I didn't wake up with it on. They're like, here you go.

Ashley : Oh, that's weird.

Shay : I thought it was weird too. So I would say, figure out your garments in advance.

Ashley : I don't think that the average plastic surgery patient needs to figure out their garments in advance. Sure. Ask your plastic surgeon. Am I going to wake up with a garment? If the answer is no, you can say, why? Do you want me to wear a garment? If they say no? Well, that's another, that's another story. But if they want you to wear a garment, since you're unconscious, I think you should wake up with a garment on.

Shay : Well, even with one or two, I sweat when I sleep, so my husband could always be washing those and delivering to me. He's the best.

Katie : Right.

Shay : The one that you gave me was the most comfortable, but I'd never liked not wearing something. So while that one was being washed, It's nice to have some backups.

Ashley : Yes. Logistically having one garment that you're supposed to wear 24/ 7. I mean, think about what else in your life do you wear 24 /7? Nothing.

Shay : Nothing.

Ashley : So logistically that would be very challenging. I don't think anyone's gonna freak out if you take it off for two hours. But having another garment, just as a backup...

Shay : oh, something else I learned is as I was recovering from my last surgery is I was wearing a binder over another garment because I thought that my results would be more optimal the tighter it was .

Ashley : Sounds terrible.

Shay : But Ashley told me that's terrible and not true. It was terrible.

Ashley : You just want some compression. I have a lot of patients that will get abdominal boards. They read it online or they see it on Instagram? It's just something that you insert between your skin and your compression garment to provide extra compression. There's minimal evidence on garments in and of themselves, and certainly no evidence on boards. And actually, in my experience, I have found that the boards actually create more problems. The boards will create areas centrally that have extra compressions. You have a board running along your midline around your rectus abdominis muscles, but off to the side there's that transition space where you have an overly compressed area next to an underly compressed area. And, it makes people more prone to form seromas in those spaces off on the side.

Shay : Oh yeah.

Ashley : So, I don't really like them. And some people will occasionally just start wearing them on their own. And over the years, I've had a couple of patients after liposuction that have had seromas. And most of them are doing something weird like that... like using the board. There are the occasional patients that just happen to get one out of bad luck. And sometimes it's their immune system, but having a seroma after liposuction is very uncommon. Having it after a tummy tuck is not as uncommon, but either way.

Shay : I think everyone just wants their results to be the best they can be. I liked wearing my compression garments, but the super tight ones with another compression garment on top is probably too much.

Katie : See right now. How do you go to the bathroom?

Shay : So actually the first one I had my abdominoplasty, I had one with a P-hole on it.

Ashley : Oh, open crotch.

Shay : Yes. I call it P-hole.

Katie : I mean, obviously gotta get up and go to the bathroom.

Shay : It's just the first two days. Beyond that, you're quite capable. I have also had friends that got the toilet seats that helped them up, or they got a cane because they thought they were going to be impaired.

Katie : Extending toilet seat.

Shay : Or maybe it is just a raised toilet seat. I don't know. Look it's a recovery, but it's not that bad. I will say recovery from my breast implants that I did like to be elevated. So, if you have a reclining chair, that's very comfortable sit in. I actually have one of those old people beds that elevates. That was really nice.

Katie : You just have that anyways?

Shay : When I bought my bed, they're like, you can get this free thing. So why not?

Katie : You're like, yeah., I wanna sit up and read. Might as well.

Shay : Yeah. We never use it, but I did use it a lot when I was recovering from surgery.

Ashley : So a lot of people think they need to walk in a stooped fashion. And I have patients sometimes buying things like walkers, like you were saying, to try to maintain that. Yeah. Maintain that position.

Katie : Why would you wanna maintain that position?

Ashley : I don't know. You're concerned. You're anxious. That's fine. So it's fine if you wanna do that for a few days, but doing it long term is not going to feel good. And, yeah, it's going to hurt your back.

Shay : I was gonna say, I don't remember ever having problems walking upright.

Ashley : You shouldn't have problems walking upright. It's just that it's going to be tight. And I think you're going to feel, oh, maybe it's a little more comfortable hunching over. That's fine. Do that for a few days, but I will assure patients, at the end of the surgery, they are laying totally flat. Everything is intact and closed with them laying flat. So it's not that they can't stand up straight, they may just have a little bit of tightness and discomfort with standing.

Katie : Right.

Ashley : But to maintain that hunched over a position long term, not optimal.

Shay : When I had the breast reconstruction, I did like being a little bit elevated. I don't know if your breast aug patients say the same thing. It's just, I don't know.

Ashley : I think it's a swelling/ gravity thing. Goes back to physics, which I love.

Shay : Gravity.

Katie : Do you?

Ashley : I do like physics It's so interesting.

Shay : I had another recommendation though. Another recommendation is ...

Ashley : another recommendation by a real patient now

Shay : ...was so for my breast reconstruction and my mastectomy, they just recommended colace and you said.

Ashley : Yeah, I like colace. So colace is a stool softener mm-hmm . So it's going to make all of the stool in your large intestine, more water-loving. So it's going to be more plump, not dried out, but the peri part has the Senna. Senna is a laxative. So, it will actually get the things moving.

Shay : Yeah. So you don't wanna just soften it up. You wanna get it out of your body.

Ashley : You don't want a colon full of soft poop.

Shay : But that's important.

Ashley : You want things moving, moving.

Katie : Now, why is this a problem?

Shay : I'm so glad I'm on a podcast talking about my bowel movements. It's a big deal.

Ashley : Everyone knows that narcotics classically hydrocodone, oxycodone are constipating.

Katie : Is this what happened to Elvis?

Ashley : I have no idea.

Shay : maybe.

Katie : he died on the toilet.

Ashley : And the strain of pushing a hard ...

Katie : That's exactly what happened.

Ashley : ...BM- bowel movement- did him over.

Shay : Well, long story short, they just gave me Colace and Ashley said, they didn't even give you any Senna? You need that, too. Yeah. Which you can buy over the counter Walgreens. So if you're taking narcotics, it's a big deal to be backed up after surgery for days.

Ashley : That's the thing - the pain associated with constipation does not get better with more pain medications. Obviously, it gets worse.

Shay : Yes.

Ashley : And if you haven't had a bowel movement for a few days and normally you're an everyday kind of person, then that's the source of your cramping, abdominal pain. Not specifically the surgery.

Katie : I gotcha.

Ashley : Yeah.

Shay : I'm a big believer in taking look, if you need to be medicated, take those pain killers. They're good, but I think people probably take them for, look, I did it- for one of these many surgeries I've had. I did it for too long. Try to wean off them after a couple of days.

Katie : So like after childbirth, how, you know...

Shay : it's very comparable.

Katie : Medicine and, but you know how your first bowel movement is like the worst?

Ashley : Elephantiasis of the perineum is how I would describe it. You had a C-section or three?

Katie : No, I natural giant children. Yeah.

Shay : But you, you had epidurals, right?

Ashley : I did.

Shay : Yeah.

Ashley : Yeah, but your perineum, that's not, again, back to the peroneum.

Katie : Yes, everything circles back to the perineum.

Ashley : Very swollen.

Shay : So it's the peroneum.

Ashley : The perineum is the space between your vagina or penis and the anus. A lot of people like to use that term to describe that whole area.

Katie : Exactly.

Yeah. So, but is it like that after childbirth? After you have your surgery, you're having your painkillers...

Shay : I think it's probably comparable. Like if you've had any procedure or birthing a giant child, like, if you're taking painkillers you probably want to make sure that you are taking a stool softener and a mild laxative. But my other surgeon did not...

Katie : advise you of that. And, and

Shay : he was, he was great. He was lovely. But had I been able to choose Ashley to do this, I would've.

Ashley : No, I think he did a good job.

Shay : He did a pretty good job.

Ashley : I was trying to provide him gender anonymity, but you've pointed him out.

Shay : He was pretty handsome too. I kept telling Jim that he was a kind of handsome guy. Sure. You're the husband loved that. And then he was just like all up in everything.

Yeah.

Yeah,

Katie : I'm sure it is refreshing

he was like, I don't think Jim

liked that. No, I'm talking about your surgeon ones. Probably like, oh, she's really cute.

Shay : don't, you know, well, I do think that the majority, yeah, I, I probably was like, Hey, Hey, if you get your first mammogram and your first mammogram, you get cancer, like I got to you on the younger scale.

Katie : It's better to catch it early because well, the more progressive it is at a younger age. So, you know

Ashley : how many years of oral estrogens did you...

Shay : I do think we're seeing a much greater incidence of people with breast cancer our age. So I'm now 42. I started taking oral estrogen birth control pills. I started taking when I was 17.

Ashley : Yeah. So for how many years did think ?

Shay : 17 to age 30. So 13 years.

Ashley : Yeah.

Shay : And then after that I got IUDs.

Ashley : Which contained...

Shay : estrogen, but it's minimal, yes?

Katie : Aren't there some that are hormone free ?

Ashley : There's para guard... has copper.

Katie : Gotcha.

Ashley : But it's interesting and by interesting, I mean, I guess kind of sad that I'm not sure that's something that's really discussed with someone that's considering oral birth control pills as a means of contraceptive.

Shay : But what's a good alternative. Like what?

Ashley : I'm not sure.

Katie : But your Catholic, Shay.

Ashley : Like a patch or something ..

Shay : I'm not Catholic. My kids

Katie : Addie, abstinence-

Ashley : That's the best way. But it's a well known fact that oral estrogens increase your risk of breast cancer. And so I think, unfortunately...

Katie : For a doctor, but I don't think that's well known for.

Shay : Yeah, I didn't know that

Ashley : Unfortunately, that is a fact, whether or not it's well known. And so for all of our listeners out there, for all the people that have been on birth control pills, it's something to consider.

Shay : You're screwed. No, just kidding. Get your mammograms. Yeah.

Ashley : With mammograms, you can potentially catch it early.

Shay : I said to my primary care physician, I'm 40. Shouldn't I be getting a mammogram? And she said, do you want one? I said, well, will my insurance cover it? And if the answer was, no, I probably wouldn't have gotten it because I was so young, so young. But she said, yeah, we could do it .

Katie : You know, I went to my gynecologist and I asked about a mammogram because of you actually.

Shay : Yeah. You're welcome.

Katie : And thank you and actually I said, is it bad for me to get a mammogram at this age? And she said, no. And I said, well, I thought it was discouraged. I thought you were supposed to wait. And she said, no, you live in an area where it's prevalent that you can get, you know, a mammogram it's really more about where they discourage you is where they don't have the resources. This is what my gynecologist told me. She's there's no risk to you. Just go ahead and get it.

Shay : What risk would there be with a mammogram?

Ashley : Minimal radiation.

Shay : Yeah.

Ashley : and expense.

Katie : But I would pay the out of pocket just for the peace of mind. Having had a friend that just had breast cancer

Shay : pay, especially, if you've been taking birth control since your twenties, teens, whenever. Get your mammogram.

Katie : So I actually just had a her scan, and It's ultrasound ...

Ashley : of your uterus and ovaries?

Katie : No, it was of my breasts. And they said maybe, I don't know if their pamphlet is correct, but they said it was more, it catches more cancer for people with dense breasts.

Shay : So are you saying it better identifies potential risks than a mammogram?

Katie : They said that people with dense breasts on a mammogram, a tumor can look the same as dense breasts.

Shay : I will say that my diagnosis was one centimeter because I had dense breasts. Right. And when they did the pathology after the surgery, it was five centimeters.

Katie : Wow.

Ashley : That's big.

Shay : Yeah. It's pretty big. But, it was all in the duct.

Katie : I'm glad they removed it. So now that you've had your mastectomy, your chances are zero, right?

Shay : No, not zero.

Ashley : No

Shay : minimal.

Ashley : Minimal.

Katie : I have a breast implant reconstruction. And I go in every six months, I actually was a little bit freaked out by these things. I visited Ashley and I had her feel them. I said, feel this and you said it feels like necrotic fat.

Ashley : Oh yeah. You had a fat transfer.

Shay : So I had a fat transfer to smooth that transition between the implant and my chest wall. I assume this happens with all fat transfers, like some of the fat dies. Right. And so I have these little nodules of dead fat.

Ashley : No did your surgeon do expansion vibration lipofilling?

Shay : No.

Katie : Is that what you should do?

Shay : Can you fix it? Can you get rid of those?

Ashley : You already sucked out the nodules, right?

Shay : No, they're they're in there.

Ashley : Oh, did he attempt to aspirate them?

Shay : Hey, this is insurance covered cancer care. He was great, but like I'm done. He's done with me.

Ashley : Oh.

Shay : So

Ashley : sure. I'll do it.

Shay : Sweet. What would else would you like to talk about about abdominoplasty? It takes a year before my scars looked normal, and they still are visible. For the most part, my scars look like white lines. Obviously I wear bikinis all the time. People can regularly see the scar. So I have a scar around my belly button and also, Ashley, what do you call that vertical scar?

Ashley : Oh, your retained umbilical scar.

Katie : I never noticed that.

Shay : Back to my t-shirt analogy, they cut a hole around where my belly button was and then pulled the shirt down. But, it couldn't be pulled far enough down- it was still above my bikini line, so Ashley vertically sutured that line.

Katie : Right.

Shay : So I have a small vertical scar that...

Katie : I never noticed that.

Shay : Yeah, most people don't, they're very non noticeable. I will say the horizontal line that's the biggest surgical line, underneath my bikini line of my underwear, that's hidden, but that scar is it's worse than those other two scars. But that just has to be a result of tension. Right?

Ashley : I think primarily that's the main contributing vector, yes.

Shay : Right. So you're pulling the top skin down to the lower skin.

Ashley : The highest tension is the midline, for sure.

Shay : on the sides, it's not that bad. I regularly wear bathing suits that you can see it in my upper thighs.

Katie : I have to say though, I've seen you in a bikini. I've never noticed.

Ashley : You can see your incision in your bathing suits? You want me to adjust it? Lower it?

Shay : Should probably adjust it. Let's just tighten it up again, surgery, number six,

Ashley : whatever.

Katie : So Shay is a lighter Fitzpatrick skin tone. What about somebody who's like a darker Fitzpatrick skin tone?

Shay : What's Fitzpatrick?

Katie : It's there's a Fitzpatrick scale.

Ashley : So one is an Irish, pale skin lady, and six is dark skinned, lots of melanin.

Shay : So, one to six?

Ashley : So two is classically like the average caucasian.

Shay : Am I a one or two?

Ashley : Two.

Katie : Yeah, you're on the lighter side.

Ashley : you're a light two.

Katie : How does it adjust per the scars? Do you see difference in scars the way they heal?

Ashley : I don't think those scales are absolutely correlated, but having more melanin could increase your risk of having a more hyperpigmented scar. Meaning darker .

Katie : Right, right.

Ashley : Mm-hmm.

Katie : Just wondering.

Ashley : Yeah, sure.

Shay : that's interesting because I would've thought the opposite. I would think Katie would scar less than me and you're saying the opposite because she's more olive toned than I am.

Katie : No, but more pigmented.

Shay : More pigmented.

Katie : And there's also risk of keloids in all, you know, so what happens with somebody with keloids?

Ashley : So there is a difference between keloid scars and hypertrophic scars which escapes the average person.

Shay : So keloid is a raised ...

Katie : mm-hmm

Ashley : no, keloid scars are scars that extend well beyond the borders of the natural scar. A hypertrophic scar is a scar that made that existing scar wider and raised- both of those things. So most people that think they have keloids actually just have hypertrophic scars, but obviously, there are some people that have true keyloids, meaning they are extending well beyond the boundaries of the scar that was created initially, or that happened initially.

Katie : So if someone says, Hey, I'm at risk for these things, are you saying you're not a good candidate?

Ashley : Well, I'm not saying that they're not a good candidate, but it certainly involves some additional counseling about the pros and cons. So that person would have some additional cons, meaning they are at higher risk for having thicker, wider, more raised scars.

Shay : So my scars only show because I like to wear like, kind of tiny bikinis.

Katie : Right.

Shay : You still can't really see them. If you're never wearing bikinis, like then it's not a problem.

Ashley : Sure. Who does that?

Shay : Who never wears bikinis?

Ashley : It's so hot outside -like hundred degrees.

Katie : I don't know, whatever people's comfort level is.

Shay : Yeah. Whatever your comfort level is. I didn't like to wear bikinis post children before I had my abdominoplasty. I had all this saggy skin made me uncomfortable.

Katie : Mm-hmm

Ashley : yeah.

Katie : So how do you feel now, now that you've had all your things? I mean, I know you have a high confidence level.

Shay : I don't regret any of the things that I've done. Liposuction - it's a no brainer. Again, to Ashley's point, it's only gonna make a difference in terms of it's not gonna help you with weight loss. But, I had that little part of my thighs that were touching...

Katie : a little bit stubborn that you wanted to....

Shay : oh, and it was great, just to have my thighs not touch anymore.

Katie : Right.

Shay : And the abdominalplasty was just the best. My stomach is pretty flat and that abdominal repair that I had done looked like I had been working out a ton.

Katie : Right.

Shay : Which I actually in fairness had been, but it was never gonna give you that results ...

Katie : show until the diastasis was prepared.

Shay : Yeah. I recommend all of the things. My breast implants are not your typical breast implants.

Katie : Mm-hmm

Shay : I had actually a pretty great chest before, so...

Katie : right.

Shay : I can't make a recommendation on that. I don't love it, but would I have done the exact same thing? Yes.

Katie : Right. I mean, you had breast cancer.

Shay : But yeah, there's a big difference between breast reconstruction and breast augmentation, because I don't have any fat except for the minimal fat they transferred on top of my breast.

Katie : Right.

Shay : I've seen friends' breasts who had breast augs, and they look great. Mine don't look as great, but I mean, Jim likes them.

Ashley : But you're also cancer free and that's the main,..

Katie : Exactly

Ashley : endpoint.

Shay : Oh yeah. I guess.

Katie : I do have to say actually the other day, I don't know if I told you this Ashley, but I was doing someone's eyebrows in the, I was just talking about, our podcast and she goes, dr. Ashley Robey, she did my tummy tuck, my breast lift, a BBL. And I was like, show me all your stuff. And she showed me everything. She looked amazing. I was like, you didn't know that I did this podcast before you came in here for your eyebrows? She was like, no, I know, but it was just a coincidence and it was great.

Shay : I feel like you need to wrap it up .

Katie : That's why I was getting to the, uh, you know, are you glad you had it done?

Shay : Yeah. Um...

Katie : Because that was a good wrap up.

Shay : I'm happy with everything.

Katie : Is there anything else you would do?

Shay : Yeah, of course. I'm gonna do stuff until...

Katie : until you die?

Shay : Never stop. Never stopping. look, I don't wanna be somebody that looks like they've had a ton of plastic surgery, but I could already see that at some point... so I have to get my implants in replaced in 15 years. I'm automatically going under for that.

Katie : Right.

Shay : Uh, we gotta probably get my neck done. I don't know. Uh, if I'll get some kind of like lift anywhere else...

Katie : in 15 years? Yeah, 15 years I'm won it.

Shay : Then I'll be in my upper fifties. I'm probably old are kids.

They might be like about the verge to get married. You're gonna win a little facelift

Ashley : thing going down. Think about how your parents look and then extrapolate from there.

Katie : That's a good way to tell.

Ashley : Sometimes, well times,

Katie : well,

Shay : I think my parents look great. They're the best.

Ashley : I agree. Good point.

Shay : But, I definitely do more preventative care just in terms of exercise and facial maintenance in terms of Botox obviously...

Katie : ...immortal, facial fillers, the Immortal facial, medical grade skin care, TNS

Shay : I haven't had fillers yet, but I would .

Katie : You haven't had fillers?

Shay : No, I feel I, they still

Katie : I'm shocked, you look amazing.

Shay : Oh, thanks.

Katie : You look like you look plump and nice.

Shay : Mm, nice and plump.

Katie : Well, your skin looks amazing.

Shay : Well, I've had been doing Botox for a long time and I did have the Immortal facial. I did. IPL which, um, that's the laser.

Ashley : Yeah. Intense pulsed light.

Shay : Mm-hmm intense pulse, light.

Ashley : Um, not a laser.

Shay : It's not a laser. It's a bright light. That right. Is applied to your face. And the only shocking thing about it is you can, with your eyes closed and your eyes covered, the light comes in underneath your skin. And it's so bright.

Katie : Mm-hmm

Shay : but your eyes aren't open. That's distracting.

Katie : I think I've had that done.

Shay : Yeah. That's to remove pigment, right? Ashley?

Ashley : Correct. The only reason why it's not a laser is because it's multiple wavelengths. So classically a laser is a single wavelength.

Katie : Okay.

Shay : But that's, that's not painful. It's just very, very bright.

Katie : Right? So normally they put goggles on you.

Shay : No, she does. That's what I'm saying is even with the goggles on, so it's like a tanning bed type Goggle...

Katie : right, right.

Shay : The light comes in from, through your skin and up through, so...

Katie : I always shut my eyes.

Shay : Katie. I know!

Katie : Maybe I haven't had it that intense.

Shay : It's intense. I feel like you guys next podcast goal. ..Maybe you can get through it without talking about the Kardashians.

Katie : no, this is the funny part. I add the funny.

Ashley : I .Blame Katie.

Katie : She's the smart person and I'm the layman. I'm just talking about I'm all the normal people out there Googling shit. And I wanna know...

Shay : we're real people, Ashley

Katie : what is real. What is not real.

Shay : Let's let's sum this up.

Ashley : Abdominoplasties are a great way to get rid of not only excess skin, but treat some of the excess fat in that love handle or flank area. And especially for a lot of women, it will treat the separation of the rectus abdominis muscles or rectus diastasis. That being said, I don't only do it for women. I also do abdominoplasties for men.

Shay : Nice.

Katie : Thanks for joining us, Shay.

Ashley : Yeah, that was fun.

Katie : Do you have anything else to add? You love plastic surgery?

Shay : Uh, only when Dr. Robey does it. I regret nothing. I will continue to...

Katie : You look amazing.

Shay : Maintain and have surgeries to maintain this banging bod - Body by Robey.

Katie : That should be a hashtag.

Shay : Wasn't that a workout, some workout guy? Wasn't like body by Blaine or something.

Ashley : probably

Shay : circa 19. So what, no one remembers bring it back. Like stranger things, everything retro is cool again. Bring it back -Body by Robey.

Katie : Sounds good.

Shay : I appreciate you having me. It's been great.

Katie : You should join us again.

Shay : Maybe after my next surgery- my next procedure. Maybe I want to do a live surgery. I feel like I could really do another Immortal facial live.

Ashley : That's easy.

Shay : Now I'm gonna live forever. Thanks to Dr. Ashley Robey and coming up on a future episode... how to live forever.

Ashley : Episode five: live forever or die trying. A brief overview of anti-aging medicine, but today we're talking here with Shay Dunne about her abdominoplasty and various other plastic surgery experiences, and we thank you all for joining.

Katie : Thanks, everybody.

Ashley : Yeah.

Shay : Thank you. It's been a pleasure.

Ashley : If you've got loose skin and muscle separation:. Tummy tuck. That's the way to go.

Katie : She's got you.

Ashley : Yeah, we've got your back. All right, everyone. Bye.

Anti-Aging Medicine: Live Forever or Die Trying

jay@robeyplasticsurgery.com (jay robey) — Tue, 31 Jan 2023 15:37:21 GMT

Turn back time - We're talking about Anti-Aging

Nipped and Toxxed Episode V: Antiaging Medicine - Now streaming on Spotify, Apple and Google Playlists

Ashley: Welcome to episode five of Nipped and Toxxed with

Katie: hello

Ashley: with me, Ashley Robey and Katie Reichert. I'm Dr. Ashley Robey. I'm a board certified plastic surgeon, actually quadruple board certified, and Katie Reichart.

Katie : I forgot that part. Quad board certified. I am a CPCP and permanent makeup artist.

Ashley : Nice.

Katie : Also aesthetic aficionado.

Ashley : absolutely. So today we're gonna be talking about anti-aging medicine.

Katie : I'm all about anti age, me up.

Ashley : Right.

Katie : So Dr. Ashley Robey had me go get my blood drawn.

Ashley : Mm-hmm

Katie : and she's gonna read my labs and tell me I need to do no,

Ashley : I will. But I need more than..

Katie : she's gonna do an abbreviated

Ashley : I literally just got them. They're hot off the press here.

Katie : Right? So we're gonna do a whole remake anti-age meet?

Ashley : Yes. So anti-aging medicine is the field of practice where you are treating aging as a disease process. And so we're thinking about what can we do to slow and or reverse this process?

Katie : Rewind.

Ashley : Because no one wants to age. Once you're mature. Once you're 20 something you're not particularly interested in...

Katie : what is the age of maturity? Isn't it like 25. Your brain's still growing.

Ashley : It's like 26.

Katie : 26? Your brain's still growing till 26?

Ashley : You can buy alcohol when you're 21. So you don't have the normal decision making process that a fully developed adult would have.

Katie : Hey, 26 years old. That's good. Okay. So tell me how to anti-age tell me how to age backwards.

Ashley : Anti-aging or regenerative medicine, our focus is on those things that are associated with aging, things that make you look older, feel older, taking a look at those aspects, breaking them down and figuring out ways to treat that. So classically, if you were to have an antiaging medicine consult, it would start off just like most doctor's visits with a full history, a questionnaire, exam and then a lab panel as well. So looking at the various biochemistries and the current state of those things in your body and looking to see where you fall with regards to normative data.

So, literally I'm just looking at your labs now. So

Katie : while you're looking at that, what I typically think of when I think of antiaging therapies is hormonal drug therapies, which I think I told you this before, but I have been getting a little bit of hormone therapy over the past year mm-hmm cause my primary doctor told me my hormones were a little outta whack.

Ashley : Oh yeah?

Katie : So I get...

Ashley : Actually I just peeked at one of those. Do you wanna talk about this right now?

Katie : Yeah.

Ashley : Well, your testosterone's high.

Katie : Well that's cuz I get testosterone pellets.

Ashley : Okay. You're still high. Your cholesterol's high.

Katie : Really?

Ashley : Yeah.

Katie : That's interesting. Cause my cholesterol's always been good.

Ashley : Your vitamin D's low.

Katie : I take a vitamin D supplement.

Ashley : Do you really?

Katie : Right!

Ashley : I mean it's not bad, but it's not optimal.

Katie : Okay. So I need to sit out in the sun more. I'm a sun lover.

Ashley : Are you?

Katie : Yes, I would sit out in the sun every day if I could. I occasionally take a multivitamin. I need to take it more often. When I was pregnant, I took one all the time because you know, because of prenatal. And my hair was amazing then, and then I had babies and then I stopped taking that prenatal vitamin. So I've been taking neutro foil, which is a hair vitamin.

Ashley : Okay.

Katie : And it doesn't have all the other stuff in it. And sometimes I take you know, whatever, just like a gummy multivitamin, cause I'm lazy. That's vitamin D I take fish oil. And thyroid, I take a thyroid medicine, 40 micrograms

Ashley : synthroid?

Katie : Levothyroxine.

Ashley : Yeah. Nice.

Katie : So what do you think?

Ashley : Well, with the 30 seconds that I had to look at your labs, like you're in pretty good shape.

Katie : Okay.

Ashley : But you need some tweaks.

Katie : I'm all about the tweaks. Tweak me up. I have to tell you, my husband likes the testosterone.

Ashley : Yeah.

Katie : Because it obviously enhances your libido.

Ashley : He likes that you're taking it ?

Katie : Yes.

Ashley : Okay.

Katie: yeah, he likes that I'm taking it.

Ashley : That's funny.

Katie : Cause you know, after every you have kids, you're like a little bit outta whack, and the testosterone really helped when I used to wake up every morning and my whole body would hurt.

Ashley : Oh.

Katie : And so when I started getting the testosterone, it really helped that go away. Cuz doesn't it lubricate your.

Ashley : I mean the hormones, each of the various sex hormones do a lot of things, and having low levels of any of those is not optimal.

Katie : Okay. So what else now? What else with my anti-aging?

Ashley : For anti-aging medicine, there are various subgroups of patients that are coming in here for those kinds of consultations. There is the group that, perhaps like you, comes in and is saying, well, in general, I I'm doing really well, but I am interested in the prospect of aging less... at a reduced rate. So that's one group of patients. Then we have patients that are interested in things like weight loss, people that come in because they have decreased energy- they're fatigued. People that...

Katie : I feel like I'm fatigued, but I have three kids.

Ashley : Yeah.

Katie : So I think that's my kids.

Ashley : Kids are exhausting definitely in some ways, but then obviously it's very fulfilling too. So yeah, we see patients for a myriad of concerns. It just depends on what facet of that antiaging medicine, but because all of those health issues, whether it's being obese or having reduced energy are associated with more of a progressed aging state. So, in the United States, one third of people are at least overweight. Another one third...

Katie : so that's, it's the BMI over 30?

Ashley : Over 25, overweight. Over 30 is obese.

Katie : Okay.

Ashley : So that means two thirds of adult Americans are overweight or obese.

Katie : I'm not shocked by that whatsoever.

Ashley : It's a problem. Carrying around the extra weight is in and of itself inflammatory. And I think about the analogy of being pregnant and carrying around an extra 30 pounds of pregnancy weight.

Katie : Right. It's hard on your body.

Ashley : But for those patients, they're doing it all the time. So it is really hard on your body and, and it is inflammatory, and those patients tend to have more problems and age faster.

Katie : So what do you have in the way of options as far as someone who wants to lose weight? If you have someone who's in that BMI in the obese category or overweight category, what would you have to offer them?

Ashley : The crux of any weight loss plan is always going be diet and exercise. Those things are obvious, but you'd be surprised the number of people that don't effectively implement those parts into their lifestyle. Some of it can be convenience. Some of it can be stress. It can be they don't have time to exercise or they don't have time or the money to buy organic, fresh vegetables. Unfortunately those kinds of things do matter. And as a populous, the American people, you know, you're seeing the direct consequences of that.

Katie : And fast food, convenience into things. Yeah. Not looking at actual labels .

Ashley : Some of it is interesting just from a historical perspective. I feel like when I was a kid the whole low fat trend was popular.

Katie : Right?

Ashley : But so I was reading, you know, Kellogg cereal.

Katie : Mm-hmm

Ashley : the maker of Kellogg cereal actually came up with that cornflake cereal because he described it as a quote "healthy ready- to- eat anti masturbatory morning meal"

Katie : masturbatory?

Ashley : Yeah, he thought that spicy or overly sweet foods would ignite your passions. And he wanted to have a breakfast that was bland so that people would not have their passions ignited and they would not...

Katie : what

Ashley : fornicate and masturbate, I guess he was married.He's super religious. I know he got married and never consummated the marriage and adopted kids. Oh Lord.

Katie : Sounds like he had some issues of his own.

Ashley : The backstory of your Kellogg cornflakes, I suspect the average person...

Katie : I never wanna buy those again .

Ashley : but the interesting thing about it is that the precursor of testosterone and other sex steroids is cholesterol.

Katie : Okay.

Ashley : So that's the precursor of all the sex hormones. You need cholesterol to be able to make those sex hormones. You get cholesterol from fatty foods, right? If you are consuming a extremely low fat diet and instead of of healthy fats, you're substituting more carbs or potentially some more proteins, you'll have a lower testosterone level, right. You'll have a lower libido. So, you know, John Kellogg, he is right. And to some extent, interesting, like it does, it does put a damper on things.

Katie : Well, with that test, you had me track my food and it shoving the macros. And I was pretty good about the macros mm-hmm but, man, I should be way skinnier. Like I only eat like 1600, 1800 calories a day.

Ashley : That's not very much.

Katie : Yeah. So I should be like tinier. So I need you to tell me what I'm doing wrong.

Ashley : Well, the diet stuff is key and I'll tell patients things like, it takes me a half hour to exercise away. Let's say 400 calories.

Katie : Right.

Ashley : At least a half hour. Do you see high intensity? It takes me like 30 seconds to eat 400 calories.

Katie : Oh, right.

Ashley : So, the human body was designed to be in a time of famine. Like we're, mm-hmm, hunters and gatherers food is sparse. There's not a lot of choices we can survive, but that's not the case now - food is a plenty.

Katie : Yeah.

Ashley : It's so easy to get calories and it's, it's harder to burn them away. So if you're gonna make some kind of impact - Sure, go to the gym. That's great. That's helpful. It's good for your body building muscle mass burning calories. It's great. But you can't go to the gym a half hour and then eat two trays of lasagna.

Katie : But if you're tracking your calories, you're working out. Let's say, you're one of those people in the obese category, you're serving your calories, you're working out and you offer them an aid mm-hmm to help them lose weight. What are those a so.

Obviously you're a doctor and you're supervising all this.

Ashley : Right, you're already doing the diet exercise components. You're drinking water. you're getting sleep. I mean, I mean, I, I laugh, but it's, it's serious now. I, I wait, let's

go back. How much water should you drink a day? How much sleep should you get a day

you should sleep about....

Katie : I love sleep

Ashley : six to eight hours a day.

Katie : Oh, I would love eight hours of sleep.

Ashley : And as far as how much you drink people say things like eight glasses. Yeah.

Katie : I've been trying to drink between 75 and a hundred ounces.

Ashley : If your urine is yellow, like darkish or medium yellow, you're definitely dehydrated, but if it's kind of yellow, you may still be a little bit dehydrated. So it should be just the slightest, hint of yellow. Okay.

Katie : So keep drinking until you get to light yellow.

Ashley : yeah, that's tough. Unless your toilet's white, you got like a tan toilet. you gotta get a toilet color.

Katie : and so what options do you have medically to offer people?

Ashley : We will do things like peptide therapy.

Katie : I'm interested in this, for sure.

Ashley : Yeah. So semiglutide is a peptide that has been associated with weight loss. Patients will take it for management of glucose issues and prediabetics and diabetics. But we all use different doses for weight loss purposes.

Katie : I've tried that sublingually but it wasn't consistent.

Ashley : So we usually do it in the subcutaneous. So like a small injectable yourself, you inject yourself small injectable dose and it has impacts on glucose/ insulin homeostasis.

Katie : and it kinda slows everything down, like the digestion process.

Ashley : It improves the way your body metabolizes sugars and insulin sensitivity. There are some other peptides that are available. This is the one we've seen to have the most impact . there are some other ones like AOD and CJC 1296 that can help people lose weight. And for lower doses, people will take 'em for anti-aging purposes. Those are some of the growth hormone...

Katie : What's a low dose?

Ashley : Just a smaller amount than you would take for weight loss, like maybe a third of the amount. But there are things like people being on stimulants, like Adipex right for weight loss. That works while you're taking it. But as soon as you're off the stimulant...

Katie : right, that's just a fat burner.

Ashley : Right. Yeah, it just revs up your metabolism.

Katie : And then when you stop taking it, you don't have that rev anymore, so you better be working out that hard to keep that going . Or you have to eat less.

Ashley : So I have had patients that have lost weight on it, but then as soon as they stop it, they put it back on. As in a lot of things, if you haven't made the appropriate associated lifestyle changes then it's not gonna be effective. A diet has to really be a lifestyle change. It can't be I'm going to drink peppered lemon water for two weeks and lose a bunch of weight. Like, yeah, you probably will.

Katie : Right.

Ashley : Because if all you're drinking is peppered lemon water, you're gonna shed weight like crazy and that's not sustainable. What you called normal. Right. That's not sustainable. Right. So a successful diet has to be a lifestyle change where, in which you can permanently change the way you live and eat.

Katie : Right?

Ashley : Not temporary. That's why diet don't work, because if they're temporary, right, it's only gonna work while you're doing it. It has to be something that you feel like you can do forever.

Katie : How long can you do peptide therapy for?

Ashley : Well, the idea is that you're doing the therapy, you're doing the lifestyle changes. And you continue that therapy till you're the ideal weight. So it's not forever.

Katie : And you have to do maintenance, but ..

Ashley : Yeah, but just maintenance of lifestyle.

Katie : Right. So like, hey, maybe don't eat that cupcake. Right. Right. I mean, you do have to, I feel like past a certain age.

We all had those stages in college where it's like, yeah, I could eat three pieces of pizza and I'm fine. And I won't gain any weight. And then after I actually feel like it's about 27, 27. Yeah. Right, right. After my frontal lobe stopped crying I was like, wait a minute. I have to start going to the gym. Like, this is not the same. My metabolism is not where it was. I have to change something.

Ashley : Mm-hmm

Katie : and then when you have kids, your hormones are kind of outta whack, but also it's not as easy to get to the gym for most people.

Ashley : Yeah. It is harder to find time to set aside for yourself to do things like exercise for sure. But you just have to make the best of it and find a way to incorporate activities with your family that are active.

Katie : Right?

Ashley : Like we went, I made my kids go mushroom hunting yesterday.

Katie : That's fun.

Ashley : It was really hot. We didn't find anything good, but it was still..

Katie : It's not a good time for mushroom hunting though.

Ashley : It's a bit early.

Katie : Early?

Ashley : It's a bit early.

Katie : I feel like spring is good.

Ashley : Well, it's too late for morels. It's early for chanterelles.

Katie : Yeah.

Ashley : So no luck. But anyways, there's lots of things that you can do for weight loss, but that's just one of the facets of anti-aging medicine. And the thing is, it really does impact a lot of people here in this country. So it it's certainly significant.

Katie : Right.

Ashley : Another thing that we see patients a lot for, in like you were alluding to earlier, the group of patients that are coming in. I feel pretty good, but I wouldn't mind feeling better.

Katie : Right.

Ashley : I can tell that I got, when waking up feeling like I'm 20, some of these insidious instead of 40 aches and pains and a little bit more tired. A lot of aging has to do with inflammation.

Katie : Well, inflammation leads to disease,

Ashley : All kinds of disease, heart disease, cancer ..

Katie : Attacking this helps you fight off disease.

Ashley : Right. And as people are figuring out more about gut health and the implications of having a healthy gut on your overall health, it seems that is a very significant thing.

Katie : Right.

Ashley : Even if you are not someone who specifically has the classic gut symptoms, like I don't have diarrhea, constipation, I'm not vomiting. I don't have abdominal pain in my gut's fine.

Katie : Right.

Ashley : Well, maybe not. So having a healthy micro flora or amounts of diverse bacteria living in your intestine, that's actually very important to...

Katie : I definitely feel like this happened to me. So I used to have really chronic sinus infections, and I was going from one antibiotic to the other ...

Ashley : mm-hmm

Katie : and I think it screwed up my stomach

Ashley : probably.

Katie : And then I developed all these food allergies when I was about 27 years old and it was like, wait a minute. Duh, all these antibiotics definitely kinda had cuz they kept getting stronger and stronger.

Ashley : Sure, sure. They disrupted the healthy bacteria in your gut.

Katie : Right. And it's taken me ever since then to get to a good place of taking probiotics and low sugar type situations to you know, but it's so important. I just kept getting chronic sinus infections.

Ashley : Not all probiotics are good.

Katie : Right.. My sister used to work for a probiotic company. And I'm like, is this good? She'll tell me how many live bacteria it needs to be.

Ashley : Sure. And some of the probiotics are histamine producers and that's not as helpful as other types.

Katie : Right.

Ashley : So just because you're getting a probiotic doesn't mean it's a helpful probiotic. Having someone guide you and direct you towards the ones that are actually helpful is important.

Katie : So what else besides probiotics, what other supplements?

Ashley : So, NAD which is nicotinamide adenine dinucleotide.

Katie : I've heard of this in IV . Do you do it in an IV ?

Ashley : Mm-hmm

Katie : and I've heard it's painful.

Ashley : Oh, no, it's not painful.

Katie : It's not painful to get?

Ashley : You've had an IV before, right?

Katie : I haven't not the...

Ashley : not that NAD?

Katie : It's several, right? You can't just get one.

Ashley : Most people do a series of them. What I usually like is to do a series of the IVs, and then I have patients do at home subcutaneous doses.

Katie : And there's a little bit of downtime.

Ashley : I mean, other than the time to get the IV.

Katie : Oh, sometimes I go get IVs at this place. Mm-hmm and they have it. And they're like, it's really intense. After the first one, you need to make sure that you do not have like anything big that day. So I've never gotten it .

Ashley : It depends on the rate that it's run in through your veins for the IV. If they run it really high, like you sometimes get this weird chest pressure, tingling.

Katie : Uhhuh.

Ashley : I wouldn't describe it as pleasant, but it's not bad. It's just, it's weird.

Katie : Right.

Ashley : You're like that doesn't seem right. But that definitely happens with the NAD infusions.

Katie : What's the maintenance on that after you have a couple infusions?

Ashley : Then I'll have people do it at home. Not IV it's forever the subq

Katie : but let's say like a year goes by.

Ashley : You're doing a couple injections a week.

Katie : Okay. Forever?

Ashley : Or as long as you want to maintain your ideal levels. So the NAD plus versus N ADH, you know, oxidize and non oxidized. The ideal ratio is 700 to one of NAD plus and NADH. And as we age, that ratio goes down and NAD is an enzyme that is part of our energy metabolism pathway.

So our mitochondria are little parts of our cells that produce cellular. They make energy. Yeah. That make energy. So as your ability to make energy goes down, your cellular functioning goes down too.

Katie : Right.

Ashley : So repleting that has been associated with increased lifespans in animals. A lot of the studies are on animals that classically have shorter lifespans, because that's easier to create statistically.

Katie : So like my deserve it for shorter period of time. Right.

Ashley : To do it on humans you'd have to have a hundred years.

Katie : Mm-hmm yeah.

Ashley : That's a more involved study for sure. But, the NAD reduces dysfunction that occurs in your mitochondria or part of your cells that produces energy. It reduces senescent cells. So senescent cells. Cells in your body that are basically so poorly functioning people describe them as zombie cells ..

Katie : Uhhuh. So where are they? Everywhere?

Ashley : Well, they can be everywhere. And as we age, the percentage of cells that are in that senescent stage increases.

Katie : Okay. So like that way older people's skin sometimes looks grayish?

Ashley : They have way more senescent the cells.

They just have more cells that function poorly. So not that a zombie's a real thing, but comparing a functioning, normal human to what you think stereotypically a zombie might function. Right?

Katie : Right.

Ashley : Like they look terrible. They're dissheveled, going through the motions, like jerky movements. They can barely speak. It's kind of like that ..

Katie : Walking dead of cells.

Ashley : Right. So you don't want walking dead cells. You want good cells, right? Because those walking deads, senescent cells don't function properly and they can contribute to disease. They generate more free radicals that damage surrounding cells. They're just bad. So, increasing your NAD levels can help reduce that. The other things that well, that I do personally, other than NAD is epitalin, which is a telomerase so it lengthens your telomeres.

Katie : Okay.

Ashley : So telomeres are little caps on the end of your chromosomes.

Katie : Okay.

Ashley : And as we age those caps shorten until the point they're so short, your ability for the cells in your body to divide and replicate is significantly inhibited. So there is some advantage to maintaining that appropriate telomere length. And Katie, I have with me a special guest and her name is Tara Covey. Tara say hello to everyone.

Tara : Hi guys. It's great to be here and talking with you today

Ashley : and Tara, tell our audience a little bit about yourself.

Tara : Yeah, so I'm trained as a family nurse practitioner board certified in traditional medicine and in antiaging medicine, so I'm able have a foot in both worlds and see both sides of the coin. So that makes life interesting.

Ashley : yeah. So Tara and I both did anti-aging medicine training, and Tara works with me here at my practice and sees more of the non-surgical patients. Although I do see some of those patients myself, I am able to help direct some of those patients that have the non-surgical needs with regards to the anti-aging medicine towards Tara. So, it's been a nice complimentary service to be able to offer people.

Tara : And a good collaboration. I think it really helps having worked in traditional medicine and kind of see where maybe some people's needs aren't being met a hundred percent of the time. And then luckily we have a lot of freedom here to cater to the needs of the patients, you know, are really wanting to focus on and hone in on with their health goals.

Ashley : We already touched on some things during this episode, Tara, what are some of the other things that you feel a lot of patients are coming to see you about? and, or what are some of the favorite things that you like to treat?

Tara : Well, one of the biggest things is people struggling with long term weight loss challenges, you know, that's a big one.

And, it is not a silo health issue. It almost always is accompanied by two or three other things... maybe their cholesterol's been creeping up over a few years. They're resistant to taking some medicine or lifestyle changes on their own just haven't worked. It's scary to be told you're pre-diabetic when you have seen aging family members go down that road.

Ashley : I agree. Whereas there is commonly a presenting concern or a chief complaint in medicine, there are usually multiple other things that can and should be optimized for that patient to get the best results. So whether it's, like you said, concern about your weight. There can be many other things: sleep issues, sleep apnea or diet..

Tara : Fatigue is a big one. You know, everyone's just walking around in a fog.

Ashley : Mm-hmm. So Sleep. That is an interest for me too. Tara and I both have kids, so getting appropriate sleep not only for ourselves, but for our children is very important. And there are some studies that suggest that, as a child, someone who's still growing, you release most of your growth hormone at night. And I certainly remember growing up with my parents telling me things like. If you don't get to sleep, you're not gonna grow. Do you wanna be taller? Or if you don't get to sleep, you're just gonna be short. So there is actually some truth to that because you're releasing that growth hormone, which is responsible for signaling your body and telling the various body parts to grow at night. So yeah, that is interesting, but sleep is also super important for adults too.

Tara : Yeah. People downplay the importance of sleep... almost wear it as a badge of pride, you know, like I can get on with just four hours a day. But that's when all of our cellular and body repairs are happening . we're really short changing ourselves. And then that compounds over time. Wouldn't you say?

Ashley : For sure. How many hours of sleep do you say you get a night or do you shoot for?

Tara : I would love eight hours every night. I don't get that, but that's definitely what I try to set myself up for.

Ashley : So, there was a study that the American cancer society performed where they followed a million people for about six years and they found that the people that slept seven hours were more likely to be alive at the end of the six year study, as compared to people that slept less than that, or more than that. So it appears that seven hours is kind of the magic number. There was another study that was done in Finland that followed twins over the course of 22 years. And they came to a similar conclusion and that those twins that slept less than seven hours were less likely to be alive at the end of their study than those that slept closer to 7, 8, 8 plus. So there is a correlation between inadequate sleep and disease processes. So during the day, your body is busy doing all the things that you have to do, but at night, your body is trying to repair.

Tara : It's important too people realize we can't bank our sleep and you can't catch up on sleep. This is a try to make good consistent habits kind of thing. Cuz I know a lot of people are working the nine to five and they're not getting much through the week and then they're doing a 10 hour sleep on the weekend. And that as supported by your study is also not beneficial.

Ashley : Do you have advice that you regularly offer patients about good sleep hygiene?

Tara : Oh yeah. And it's definitely one of the first things we talk about when we go through lifestyle changes. And a lot of it's pretty basic, but it's mostly about setting yourself up with a good routine, and then you know, this is a whole nother topic, but controlling our, our light influences through the day.

Ashley : For sure. So it does make a difference. I try to go to sleep at the same time, every night. That is helpful. And having a normal circadian rhythm for yourself where you're going to sleep at the same time, waking up at the same time. It's also ideal to avoid eating for at least two hours before you go to bed, reduce the amount of electronic use some of the high energy blue light that's emitted by our various electronics: iPhones and tablets...

Tara : And even all this bright white L E D lighting that we're putting in our homes. We just recently did some freshening up in the house and I took a lot of that bright blue light out of my house.

Ashley : Well, it's supposedly more energy efficient, but it can really mess up our sleep wake cycle. That blue light is actually signaling to your brain that it's morning time. Yeah, time you get up. So if you're getting those signals right before you go to bed, it can be difficult to fall asleep. For those patients that you see that do have issues falling to sleep, do you prescribe sleep medications for them regularly?

Tara : We definitely try to make that a second step because we have so many modifiable lifestyle things that maybe we haven't addressed yet. There are some sleep aids that can be beneficial, but we don't wanna get anything that's a habit forming or that then we're lagging in the morning.

Ashley : I agree. And I worry about some of the more popular sleep aids the benzodiazepines, or even the over the counter Benadryl type medications, because they are associated with an increased risk of Alzheimer's disease and dementia. So yeah. As is not sleeping well, so you have to get...

Tara : but also, are you being sedated or are you sleeping? There's a difference between being knocked out and getting restorative sleep.

Ashley : Absolutely. And then you're right. So those medications that are just knocking you out, it's not the same quality sleep as if getting true restorative sleep.

Tara : Now, do you wear a sleep tracker? Do you do any sleep data?

Ashley : I do. I wear the Oura ring. I'm not sponsored by Oura, by the way.

Tara : Sure.

Ashley : Yeah. I wear the Oura ring and it does give me some sleep data.

Tara : I wear a watch. And I don't think it has quite as much Intel as the ring that you wear, but it is helpful to see what the quality of our sleep is rather than just hours with the head on the pillow.

Ashley : Sure. Some of it is obvious. I mean, if you are out and about the night before hanging out with friends, till the wee hours, you pretty much know your sleep score, which Oura provides you, is going to be not great. So, it reinforces the good decisions that you make: going to sleep consistently, not eating before you go to bed... like, if I eat a late snack, my resting heart rate at night won't be as low as other nights.

Tara : Sure.

Ashley : So I do get a lot of that feedback and that's helpful.

So how about just to switch gears a little bit, how about hormone therapy? I think people are really interested in that. From my perspective and from what I've learned over the course of anti-aging medicine studies is that if, as a woman, you wait until you're already in menopause to start your hormone therapy, that that's suboptimal. Same thing for men. I think there's a lot of advertisement out there for the low T, the andropause, replacing that. And I think that that gets a lot of air time and advertisement time.

Tara : Hormones are such an interesting topic and always have been to me. In my traditional training, the hormone therapy that we talked about was birth control. And then there was a little bit taboo to talk about replacing hormones in the later stage of life. And so I think it's really important that people are aware of where their hormones are and monitor them and not wait until things are so bad. It's hard to turn around . And I think that there's a lot of great tools, lifestyle wise and then supplementing and making sure that your diet is giving your body the ability to make the hormones that it needs. And there's a lot of extremely restrictive diets that are popular right now that have a huge impact on female hormone production. But then also supplementing hormones before, like you said it's too far gone, you know, so then, and then you're not having to use as much either, which I think is the sweet spot. Just tailoring things to what your body needs.

Ashley : The interesting thing I think about at least for me as, as someone who's been on birth control pills before, is that taking oral estrogens... it is a known fact that that will increase your risk of breast cancer. And I don't recall as a younger woman, that was something relayed to me. And so many women are on birth control pills as a form of regulating their cycle or decreasing heavy periods or for truly just birth control reasons that there are some disadvantages to that.

Tara : Yeah.

Ashley : One thing that with regards to more of the bio identical hormone replacement, which by the way, The birth control pills are not bio identical...

Tara : right.

Ashley : There was a women's health initiative study that came out in the early two thousands. And it showed that if you supplement with oral non-human estrogens and progestins as opposed to biodentical hormones, that there was an increased risk of developing things like breast cancer and heart disease. What do you have to say to people that are concerned about that ...that they ask you? Well, I heard cause it, it, it was pretty big in the news. I heard that this is potentially bad for me. What do you say to those patients?

Tara : First off, a lot of those patients are just surprised that they are the ones that have to bring up hormones to their provider. It's really never talked about, And so they just need to be armed with knowing what screenings are appropriate. Having a good conversation with their provider about their personal health history and their family health history, and then talk about the best use of safe amounts of hormones and then being monitored while they're on that therapy. But it, it's not one of those things that has to be all or nothing, and I think that's where in the early two thousands, when this data came out okay. So maybe there can be some harm with some equine based or, you know, equine, meaning it comes from horses is where hormones came from.

Ashley : Tell me more about the difference between synthetic hormones and bio identical, because I think that that's something that most people probably don't think about.

Tara : Yeah. So these studies were based on the marketed hormones that are equine based. So they come from estrogens from horses and then given to human females.

Ashley : Right, pregnant horse urine is the source of the progestins.

Tara : Yeah. So the bio identicals are usually soy based or they're compounded in a way that are as close to our natural hormone structure. So the difference being when you have a horse based hormone not horse based, I know horse based equine when you have an equine hormone, it is not as similar to our structure as these

Ashley : Okay. So hormones derived from pregnant horse urine... your body will metabolize those differently. It's a different chemical than the natural hormone that your body is used to, and so the way your body metabolizes or breaks down that chemical is going to be different. For the synthetics, you can get breakdown products that are more inflammatory, which obviously no one wants more inflammation in their body. From just bio identical oral estrogens, You get more inflammatory byproducts. Do you find that you have many patients that are taking oral estrogen or oral testosterone?

Tara : No. I really don't see a whole lot of that. Most patients find the best benefit with transdermal medications or maybe even intravaginally or injectables.

Ashley : Or pellets..

Tara : And then I was gonna say, and then now I think becoming popular as pellets because of the ease of.

Ashley : Yeah, the nice thing about pellets as compared to some of the other routes would be that you can get a pellet or pellets classically placed. And then every three to four months you're getting them replaced. So the pellets will slowly release a sustained level of the hormones. And that tends to be more close to your body delivery.

Tara : Right. Rather the high peaks and low troughs, you know, the high

Ashley : that you get with injectables, because usually things like injectable testosterone, maybe you're doing it once or twice a week, but right. You get these really high levels transiently, then you get these low levels. The pellets can make that more uniform and consistent, which is an advantage of that option.

Tara : From a patient perspective, what patients do you see come in that you think would benefit from hormone therapy?

Ashley : Anyone that is approaching their peri-menopausal age for women and for men as well, I think that should be part of a workup. you know, you go in and you get lab draws, you get your blood counts checked, you get your cholesterol checked. Getting those hormone levels checked should, I mean, we get our thyroid hormone. Yeah that should be part of a workup. So having an ideal, whether it's an ideal estrogen level or testosterone level, or really in all of the above is going to Allow you to, for example, maintain better bone mass, have improve a muscle, a mass have better cognitive function, have more energy levels. Hormones.. They're essential to normal body function. And so if your goal is to have an optimally functioning body with less disease, less dementia, less bone loss, less fractures, all of those things as you age, then assessing for hormone levels is an imperative part of that treatment.

Tara : Yeah, we do a hormone assessment on each patient that comes in when we do our baseline workup. And, once we correct those hormones, we see other cascade effects within that patient... an improvement in their lipid profile, their thyroid will work more optimally or will be utilized more optimally. So it definitely is all connected.

Ashley : Yeah. That goes back to what we were saying before. If your chief complaint is being overweight, there's usually a myriad of things that are contributing to that. So in our practice of anti-aging regenerative medicine, it may not be that the first thing that you think is what you want addressed is the first step in your treatment plan. And I think that could potentially be frustrating to people, but there are things that need to be optimized potentially before things like adding biodentical hormones. And in that one specifically.

Tara : I do hear that a lot, but I like to let my patients know, we're gonna make sure your foundation is good before we just start throwing stuff on top of it,

Ashley : but putting the walls and roof on?

Tara : That's right. Yeah.

Ashley : Nice analogy. I think that's super important. So salivary cortisol is one of the hormone levels that we regularly check for patients in the initial workup. Do you find that most of the patients you're seeing have that normal curve? They have normal levels?

Tara : Well, first let's talk about that curve that you referenced. So, a healthy cortisol curve should have a awakening response in the morning where your cortisol levels rise. They taper off through mid-morning and they kind of go to a baseline low through the night during your repair time. And so what I often see will be those bumps that we expect will either be missing or blunted. Rarely do I see people running just consistently high. But it happens, especially afternoon rises due to patients daily stress. We all hear about high cortisol being bad, but low cortisol is just as bad. So making sure that your body has the time to support that cortisol output, and then maintenance of your stress. You know, I talk with my patients a lot about stress as a constant, right? The only thing you can really count on in life is has stress coming your way.

Ashley : Death, taxes. I want to say laundry, but maybe stress...

Tara : I don't know. I'd put laundry in there too. But yeah, we talk a lot about not how was your stress this month, but how did you handle your stress this month? Cuz it's gonna happen? You know, good stress, bad stress, even like new job, new house that's stressful, right?

Ashley : Yeah. Those are some of the highest stress events, right?

Tara : Yeah. We like to pile on, right?

Ashley : It can be a bit overwhelming. And that stress level can be reflected physiologically.

Tara : Absolutely.

Ashley : So initially...

Tara : hair loss, right. People come in and their hair thinning. Mm-hmm , it's one of the first things we look at. How's your stress?

Ashley : Yeah. Hair loss, insomnia, weight gain, right.

Tara : Libido changes.

Ashley : Mm-hmm , all of those things. So as in all the other parts of anti-aging medicine and all these pieces are just closely intertwined. So managing your stress levels, whether it's exercise. I mean, there's certainly benefit to relieving some of that stress. You get an endorphin rush during exercise, so that can always be helpful. That always is something that I have utilized... just even getting out and walking, being in nature.

Katie : Yeah. I was gonna say bonus points if you exercise in a green space, right.

Ashley : I know it's, it's fascinating that actually is associated with reduced stress levels for people. Going on a hike in nature.

Tara : Yeah. Meditation. You can meditate at home on your porch, meditate while on your walk. Yoga is good. Yeah. That introspection..

Ashley : Just finding time to be focused on yourself and in our society, there's so much constant input. People don't just sit on your porch, swing and stare out at the sunset anymore.

Tara : Right.

Ashley : You're on your phone, looking at websites or playing game. You're just constantly...

Tara : bombarded.

Ashley : Yeah.

Tara : Well, and don't you see the change we've had over the last couple years with meaningful relationships, you know, social distancing did a lot of damage there.

Ashley : I think so, but also the social media part too.

Tara : Oh, polarization

Ashley : The things that people will say to each other on social media versus you would never say some of those things. Yeah. Filters are gone, just gone. Right. Truly they're gone. And so I worry about the implications for my kids as they're growing up.

Tara : Yeah.

Ashley : What does that mean for their social interactions?

Tara : Do you have any healthy stress reduction that you're like trying to really give to your kids as they're growing up in this crazy world?

Ashley : Well, I do try to minimize their device time. Right. So I think that's important. I want them to exercise regularly, too. And sometimes they'll complain. They're usually pretty good, but just, going for a walk, going for a swim, going for a run. That's helpful.

Tara : Yeah.

Ashley : It is stress reducing

Tara : and it is like a family affair. Right. When you model that behavior, it's hard to say, Hey, go run in the yard if you're not doing it yourself.

Ashley : Right. So, we'll do a lot of those things together. We'll go on a walk. We'll go on a bike ride. I love to go on hikes. So we'll do that. If you want your kids to have a certain lifestyle, one where they exercise one where they don't spend all their time staring at the TV or playing on their phones, then you need to step up and be a good role model.

Tara : now, do you have any favorite adaptogens? You know, those are our nutraceutical supplements that we use to manage stress. Do you have anything that you found to be particularly helpful?

Ashley : So I take some ashwaganda myself but a lot of these adaptogens will come in combinations. So ashwagandha and, and Rhodiola, ginseng

Tara : that synergistic activity, working together. I know mushrooms are getting a lot of press for adaptogenic activity lately.

Ashley : I do like mushrooms. Yeah. Which mushroom is the best one?

Tara : There's a whole list of them. I hear a lot about lion's mane.

Ashley : Oh, sure. Lion's mane. That one is one I've never found .

Tara : Out in the wild?

Ashley : Yeah. I would like to.

Tara : If you didn't know, Dr. Robey likes to go hunt for mushrooms.

Ashley : Yeah. I've never found lion's mane. I really like chicken in the woods. Morell's yeah, but they're seasons too short chanterelles. Great. My kids like finding mushrooms too, so yeah, it goes back to finding activities that aren't TV or device focused. And yes, like you said, there are some nutraceuticals and supplements that can help modulate that response. So these supplements are not just for people that have low cortisol or just for people that have high cortisol, they're for modulating that like a normal, healthy response. So yeah, that's a helpful adjunctive therapy. Yeah. Right.. The nutraceuticals, but just like weight loss, you can't just do whatever you want - that would be ignoring the foundational parts, which are exercise, stress reduction, healthy social interactions.

Tara : Yes.

Ashley : All of those things would be more important than, you know, taking some ginseng. But, it's nice to have as something that can be added to your regimen.

Tara : Yeah. I'm sure my patients think I'm a broken record, cuz I'm always well lifestyle. Here's our lifestyle intervention, and then here's something we can consider putting on top of that, but always the lifestyle basis.

Ashley : You were telling me some interesting statistics with regards to people's perceptions about their lifestyle.

Tara : Yeah. So I was reading a study the other day about our perception of the healthy components of our diet. And that basically it was overestimated by about 80 to 90%.

Ashley : That's wild.

Tara : But the people that ate poorly overestimated less. So those of us walking around thinking that we're eating well, overestimate more than people that know that they're eating a junk diet. They're like, yeah, I ate a McDonald's .

Ashley : Oh, sure. So that makes sense. Every person has room for improvement with regards to making healthy choices, just some of us more than others. And, you'll recommend patients to keep journals, right? And that can be certainly eye opening. If you're doing it honestly to see what is it that you're actually putting in your body? I think as humans, we have a tendency to look through rose colored lenses and just kind of block out the parts that don't seem...

Tara : don't fit the narrative. Yeah. yeah. I'm a big fan of tracking for short periods. I love data, so I don't mind tracking for myself, but I know for a lot of people, it's a big burden. that's more we're adding to their stress pile. So I'm a big fan of tracking for a little while and see what our norms are. Because we really rotate through, most families, 14 to 21 meals, and then you have the oddball thing that you eat that's outside of that. But if you know what your mainstay meals consist of getting your portions down appropriately, making sure you're hitting the protein goals that you want, that does a lot to keep us accountable for what we're putting in our body. And then knowing when you do over indulge, you know, life happens. We're gonna go to the celebrations and things. That's okay. Get back on it the next day when you're going back to your norm.

Ashley : That's good advice. So for someone let's say, who is either healthy, but wants to be healthier or someone who feels like they really have a lot of things to tweak from a health perspective, what would be your best advice for them? What should they do as far as our next step in getting to a better place?

Tara : I think if you haven't had a comprehensive lab review, like we offer, where we dig deeper into what your baseline of foundation of health looks like., I think that's really beneficial. When I do that with patients, I spend 60 minutes with them and we talk about what all your labs mean, which sometimes is a component that's missing in other venues. Right?

Ashley : Sure.

Tara : Here's your labs. Everything looked good. And we both walk away. We're gonna talk about 'em for about an hour and I'm gonna give you a problem list of things that could be optimized, you know? So even with the healthy person, there's always something that we can say, Hey, we can fix this ratio here. We can tweak this there. And then know your body and know what it needs.

Ashley : Right. I think education is super important in that way. You can make the patient their own best advocate. So if you just tell them that, okay, your, your cortisol is high, but they don't know that cortisol is a stress hormone that it increases your blood glucose and that it is responsible for your immune responses and digestive system, all those various processes in the body, then they're not gonna care if it's high or low.

Tara : Right.

Ashley : I mean, just, just a number. So you're right, adding that educational component and getting patients to be their own best advocate so they know where they are and where they need to be, and why it would be so important to make that change.

Tara : Yeah. I'm all about adding years to someone's life, but not only that adding life to those years, what good is living another 10 years, if it's in total care and not able to move.

Ashley : Doesn't sound optimal.

Tara : No, not my way to go.

Ashley : Well, thanks Tara. That was super fun. And I know we just barely touched on some of the various things that we treat in anti-aging and regenerative medicine. I'd like to have you back on and we can delve into some of these topics in more detail because they certainly could deserve their own hour or multiple hours in and of themselves.

Tara : Yeah, this was great. Thanks for having me, Dr. Robey.

Ashley : All right. Thanks everyone. Bye.

Fill'er Up: Injectable Fillers in Plastic Surgery

jay@robeyplasticsurgery.com (jay robey) — Tue, 31 Jan 2023 15:37:19 GMT

This is a subtitle for your new post

Nipped and Toxxed Episode Take 2, Episode IV Fillers - Now streaming on Spotify, Apple, and Google Playlists

Katie: Welcome to nipped and Toxxed. Which episode is this?

Ashley: Four!

Katie: Episode four. It's all about fillers -fill 'er up.

Ashley: Hi, I'm Dr. Ashley Robey. I am a quadruple board certified plastic surgeon certified in plastic surgery, facial plastic surgery, otolaryngology, and anti-aging medicine. And with me is Katie Reichart.

Katie: And I am a CPCP and a permanent makeup artist. I think the last episode I was too nervous. I was like, I'm a makeup artist. I'm like, no, not I'm a permanent makeup artist.

Ashley: Permanent. It's something different.

Katie: I tattoo people's faces.

Ashley: Well, you were saying that there are only how many CPCPs in Indiana?

Katie: There are only three.

Ashley: Yeah, that's pretty cool.

Katie: I know. Right.

Ashley: And I think I'm the only one in the world with my certifications.

Katie: I had never even heard of anyone having a quadruple certification. Having three is pretty amazing, but having four...

Ashley: When I had three, I was one of 13 in the world. Now, I think I'm one of one.

Katie: I think that's pretty amazing.

Ashley: So today we're talking...

Katie: let's talk about filler fillers. So really what is a filler?

Ashley: Fillers are things that you use classically to add volume to something. So we're talking about fillers in the realm of aesthetic medicine, and they can be either permanent or temporary. And they're injected.

Katie: So where's the most common place to have filler. I personally love filler. I'm all about filler.

Ashley: Well, definitely the face. I mean, you can put fillers most places, but the face by far and away is the most popular location. The most common, temporary filler I use falls into that HA or hyaluronic acid filler category, but I'll also use things like Radiesse or Sculptra. And then for permanent fillers, fat. That's my go-to permanent filler.

Katie: So with HA fillers, since it's not permanent, what does that mean? I know you can dissolve it.

Ashley: That means that your body will degrade them. So whether it's the HA filler or the Radiesse or the Sculptra, they're all temporary. And so your body will break them down and absorb them. And depending upon which filler it is, that timeframe is a variable. Some of the ha fillers, especially in some really mobile areas could take as little as six months to go away. But others, it's closer to two years.

Katie: So is it about viscosity? Is it about how hard the fill is? Cause I know like you use softer fills for your lips, use harder for your cheeks.

Ashley: You mean as far as duration?

Katie: How long it takes to break down

Ashley: A lot of it can have to do with, for the HA fillers, the degree of crosslinking and how long it would take your body to break down that product.

Katie: So depending on the person. What's crosslinking?

Ashley: So just the way that the chemical is actually synthesized.

Katie: Okay.

Ashley: How many crosslinked bonds are placed within it. But yeah, the other variables that you're talking about with regards to pliability and viscosity and how much strength is in the product, those are definitely characteristics that come into play when you're thinking about where do I want to put this product? For example, in the cheeks, you may want something that has the ability to add a lot of height.

Katie: Right.

Ashley: And maybe it's a little more firm because you want that kind of bone cheek volume, but you wouldn't want that same kind of thing in your lips.

Katie: Right.

Ashley: So the cool thing about the hyaluronic acids is that most of the companies that make them have a portfolio of products so that you can tailor exactly what product fits which location best.

Katie: So I love a good cheek filler.

Ashley: Yeah.

Katie: And so I usually get it every, I'd say two years to 18 months, so it's probably been probably two years. Am I safe to say that it's completely gone or can you go up to somebody and you can feel it's still there?

Ashley: Probably most of it is gone, but I would say in my experience, sometimes there are smaller amounts that linger beyond that timeframe. And I'll notice it in some areas where you'll have a really obvious bump, like let's say, in a liquid rhinoplasty where you'll see someone's cartilage curling, and you'll see a really defined transition at a certain location where like, wow, look at that shadow. Look at that protruding cartilage. I've seen adding some of the HA fillers to those locations that even beyond the two years, although it may not be as good as it once was, it seems like it's not quite as bad as baseline.

Katie: Right.

Ashley: But yeah, around two years.

Katie: And does it depends on the person's metabolism, so people metabolize it better than others I mean faster.

Ashley: Faster, which would probably be worse. Right? Like you don't wanna be a fast...

Katie: I wouldn't wanna a metabolizer. I think I'm a slow metabolizer.

Ashley: I burn through a Botox pretty fast.

Katie: I'm pretty good on Botox. I'm like four months.

Ashley: I'm like 89 days.

Katie: I just need to come in here and just get shot up everywhere.

Ashley: Yeah. So filler the face is the most common location, but within the face, I would say cheeks and lips are the most popular. but really you can add it to a lot of locations. I like adding it to the tear troughs, which is that area where you're seeing the dark circle under your eye.

Katie: Wonders under the eye. How do you know if you're a good candidate for that or not? Because some people are not good candidates for tear trough filler and some are. How do you know when you look at somebody, whether or not that's gonna work for them?

Ashley: Well, if you have an area that looks like a volumetric depression, if you're seeing some fullness above a line and some fullness below and then a depression in between mm-hmm then adding volume to that depression can look really good.

Katie: Oh, definitely. I'd love the before and afters on the eyes.

Ashley: Yeah.

Katie: And how do you know if you are a person that needs surgery and that, you know, filler's not gonna be enough?

Ashley: Filler is good at volume replacement, right? And if you have some degree of loose skin, sometimes replacing that volume can fill that skin out a little bit, but if you have a substantial amount of loose skin, then there's probably not enough filler to re drape that skin.

Katie: Mm-hmm .

Ashley: That doesn't mean that you're not a candidate for filler. It's just, it comes down to. Meeting patient's expectations. If you're saying, Hey, there's no way I would ever want to have surgery. What's my next best option?

Katie: Right.

Ashley: Then I think it would be reasonable to do things like filler. But for some people that's all they need. So it can be really patient dependent.

Katie: So let's talk about lips.

Ashley: Sure.

Katie: What is your favorite product to use on lips? Cause there's all these things out there. There's Restylane Kysse there's Voluma or Vollure?

Ashley: I use both the Restylane line in the Juvederm line .

Katie: Uhhuh

Ashley: so the Restylane Kysse is pretty popular in the lips, and then we use a fair amount of Vollure in the Juvederm lines.

Katie: is that basically the same thing? Just different brands?

Ashley: I know that they would say no. There are differences other than just the name, just like Pepsi and Coke or different other than the name, like they have different whatever ingredients, et cetera. So there are differences, but there are certainly things that are overlapping with regards to where you can apply that product.

Katie: So I've also seen that the products for lips have lidocaine in?

Ashley : Yeah.

Katie: Is that true of all of them?

Ashley: That seems to be the trend. When they first came out, it was almost an exception for the product to have lidocaine added, and now I think it's more of an exception for it to not be there.

Katie: Right.

Ashley: So yeah, people like it to be numb.

Katie: I had a client that has a lidocaine allergy. Okay. And so I was tattooing her lips and I was asking her about when she had a lip filler and she said well, it cost me more money to get the lip filler without the lidocaine. And I'm like, really? That's so interesting. I actually gave her number. I'm like, go see my friend.

Ashley: I'd have to look and see because I feel like we almost universally stock the stuff with lidocaine.

Katie: It's not like it's hard get right?

Ashley: No, you can get it just that you'd have to know beforehand.

Katie: You're gonna numb the lips with a topical all over anyways. Why would you need the lidocaine inside?

Ashley: It helps. it makes a difference

Katie: I guess I've never had it without, so I don't really...

Ashley: okay.

Katie: Yeah, but I've always been numbed.

Ashley: Sure. That's unfortunate. That's a rare thing.

Katie: Right?

Ashley: Mm-hmm

Katie: I feel bad for her.

Ashley: Yeah.

Katie: I had to do her whole tattoo of her lips with no numbing but it looked really nice.

Ashley: The lips would be more sensitive than other body parts, certainly. Most people that get tattoos don't get numbing.

Katie: Well, that's also about different locations in the body different pain, but also it's about how much it costs. A lot of tattoo artists don't wanna do it cause its costs a lot of money.

Ashley: Oh sure.

Katie: It's like $50 for two ounces, so imagine you're doing a big area.

Ashley: you can go to CVS or Walgreens and get those lidoderm patches, right?

Katie: Who wants to be in pain?

Ashley: Like maybe a few like sadistic people?

Katie: Right.

Ashley: Or that would be masochistic. I'm sorry.

Katie: You're right.

Ashley: Yeah. I'm confusing my S and M terminology.

Katie: We'll get into that later.

Ashley: Yeah. That's episode five.

Katie: I dunno about that. That has nothing to do with Nipped and Toxxed.

Ashley: No, it doesn't.

Katie: Okay. So as far as lips go, there's lots of different trends with lips. So you see like Russian style...

Ashley: Yeah, you were talking about that.

Katie: You see you know, different ways of injecting lips.

Ashley: Mm-hmm, , there's definitely different techniques.

Katie: Yeah. What do you say about all of that?

Ashley: There are some universal techniques that we utilize. To some extent, you're kind of working with what you have.

Katie: Or you're building?

Ashley: Right.

Katie: Somebody comes in, you're like, okay, we're gonna start with this. If you're come back, we'll add more.

Ashley: If you're starting off with a certain look, you could only push it so far in a different direction, especially at one time but, depending upon what the patient's starting with, it's volume addition and adding height, adding width. Mm-hmm just depends.

Katie: So let's talk about volume loss. How much volume are we losing in our faces year to year? Because, I keep telling all of my friends I'm like, you look, you are going to need filler. You are losing volume in your face. They always look at me and they're like, you don't look overfilled. I'm like, yeah, I know. Cause I'm just putting back what I've lost.

Ashley: So every decade we age, we lose about six to seven CCS of facial fat volume. So that really starts adding up, especially if you've never had anything done. So replacing volume is really helpful to restore that young look. The other thing, apart from the HA fillers is Sculptra.

Katie: So, I'm super interested in Sculptra.

Ashley: So Sculptra is a collagen bio stimulator. So you inject this absorbable polymer that your body degrades and gets rid of, but in that process, your body lays down more collagen.

Katie: Right.

Ashley: So after the...

Katie: so it's kind of like a really natural approach?

Ashley: I mean, you don't have, you don't have polymers in your face transiently, right?

Katie: Right. But that goes away in the left with the collagen, right?

Ashley: Absolutely. The goal is to restore the collagen levels toward a more youthful level. So by the age of 40, you've lost about 25% of your collagen.

Katie: Wow.

Ashley: I know.

Katie: That's wild.

Ashley: So a lot of people will mix those together. They'll add the Sculptra not only for volume, but for stimulating their own collagen levels, and then they'll come back later and add the HA filler to specific areas where they really want to target and enhance the volume depletion.

Katie: So I saw Sculptra being used in the nasal labinoidal folds.

Ashley: Labial.

Katie: Whatever. Whenever we go labial, I'm thinking of our first episode.

Ashley: They're lips. It's like oral lips, vaginal lips.

Katie: So I feel like this is a big aging spot on a lot of people, you know, so I saw it being used there. And I thought that is really interesting because I like getting fuller there. But a lot of doctors are scared because of that major vein right there.

Ashley: You have to be thoughtful and considerate about anatomy. Absolutely.

Katie: And you definitely wanna go to someone that knows what they're doing.

Ashley: I should think so.

Katie: Right.

Ashley: Don't go to someone's garage.

Katie: What are your ideal places to use it, anywhere?

Ashley: Sculptra?

Katie: Uhhuh?

Ashley: So it's supposed to be injected in a subdermal plane, so underneath the dermis

Katie: You're getting down pretty low...

Ashley: but some products like Voluma, you're injecting it supraperiostial. So just on top of the bone, so this is gonna be. A little more superficial than some of those types of injections.

Katie: Okay.

Ashley: Because you are trying to stimulate collagen growth, which is going to be in the dermal layer.

Katie: Right.

Ashley: To restore collagen levels and to try to improve tone and, and volume associated with aging. So are there different firmness of Sculptra or is it all one?

Katie: It's one.

Ashley: So the interesting thing about Sculptra, and I think that anyone that's going have a Sculptra injection needs to be well aware of is that you're injecting poly-L-lactic acid microparticles. Your body will break them down and in the process of doing so induces an inflammatory response and creates more collagen. The Sculptra is mixed with sterile water at the time of your procedure. And so that water is a carrier, meaning the water component, your body's gonna absorb it. It's gonna go away in the first couple of days. So you'll see an initial volume improvement, but that's because you've just injected your face with a bunch of water. Okay. So let's say you're doing two vials of Sculptra, so 18 CCS of water. That's a lot of volume to add to someone's face, but ...

Katie: But then the water goes away.

Ashley: It's absorbed.

Katie: So how do you equate that to how much volume it will add to your face?

Ashley: Classically, for Sculptra ,they talk about percent increase in collagen, so the net volume is going be a function of where you're starting from.

Katie: Okay. Yeah. So how deficient you are.

Ashley: It's interesting because for the HA filler, you add two CCS of HA filler, you get two CCS of volume.

Katie: So, if you're looking for the after effects of Sculptra, how far out do you need to be injected to then see the...

Ashley: it's about two months before you're seeing what you got out of about treatment.

Katie: So if I might got an event, I wanna wait two months, two months before. My birthday's coming up.

Ashley: To see the full impact of it. Right?

Katie: Right.

Ashley: But that doesn't mean you can't go to an event prior to that you just won't see the full results. So more for your event is, are you ridiculously swollen or bruised? And that probably, I would say a couple weeks just in case

Katie: do people mostly bruise with this?

Ashley: No, there's always that oddball that gets really bad bruising. Yeah.

Katie: It's like any other injection, right?

Ashley: Sure.

Katie: Okay. So let's talk about Radiesse.

Ashley: Oh, sure. Calcium hydroxy appetite.

Katie: Yes. I've seen radius use a lot on bony structures when you wanna create a really nice angular cheek bone or jaw lines.

Ashley: You're trying to recreate bony support or restore some of the bony loss that actually can occur with aging as well. Those are popular areas that people add Radiesse. I don't do a ton of Radiesse in my practice.

Katie: why is that?

Ashley: there are so many options and from an end result perspective, I think you can get just as good a result with other products.

Katie: Gotcha. And you can't dissolve radius, right?

Ashley: That's one downside. But Radiesse can last up to two years, which is appealing.

Katie: I like that. I have noticed I had Radiesse one time. I did notice. I felt like it attracted more water. So I felt a little more swollen, and I didn't like that look because when I had it in my cheeks, it kind of made my eyes feel swollen. So I didn't love that.

Ashley: long term or just transiently?

Katie: It was a couple months after.

Ashley: oh. Huh.

Katie: So from then on I went to Voluma. And, I think that a lot of people like to use HA fillers in general because they can dissolve them if there's any complications, right?

Ashley: Yes. There is a hyaluronidase, which is an enzyme that can be used to degrade fillers. And interestingly, I have been working with a neuro interventionist to develop a protocol for emergencies associated with filler maladventures I have never, myself, had a serious complication, but it's certainly been reported in the literature. Mm-hmm

So if you inject a filler into a vessel, instead of blood flowing through the vessel, you have filler occluding it, there can definitely be problems.

Katie: Right.

Ashley: So if that vessel is feeding your eyeball, it can result in vision loss. If that vessel is feeding, let's say the skin of your nose, you could have skin loss.

Katie: Which is why it's also so important to find an injector that knows what they're doing.

Ashley: I think so. Yes, absolutely. That's certainly eyeopening, right. When you're talking about consent and weighing out the pros and cons of fillers, when you throw that out there to patients, oh, well there's a small chance you gonna go blind. That's pretty disturbing. So whereas it's extremely rare. So current protocols are, let's just say someone does that... They inject filler into a vessel that's feeding the eye and, and the patient has vision loss. The recommendations are to inject a bunch of hyaluronidase, which again is the enzyme that can break down the filler, right around the vessel. And my thought is, let's get it into the vessel.

Katie: Right.

Ashley: So doing an interventional radiology procedure where you can cannulate that vessel and get the degrading enzyme exactly where you need it.

Katie: So would it be you go to the emergency room and they would have that?

Ashley: Yeah, you would go to the ER and we would have to get that whole process going expeditiously. You have basically have like 90 minute.

Katie: Oh, wow. For the eye area. Cause I know I've seen on the internet where some people might get it, you know, around the nose and

Ashley: it's a true emergency.

Katie: They might leave though. And they don't know that they have an emergency, but then they start to have necrosis and start to have issues. And if the injector you went to is not prepared, does not have the solution to like dissolve it, whatever. Then you're in a really tough spot.

Ashley: I'm not sure that everyone keeps hyaluronidase. I would hope so, but I certainly would not assume that .

Katie: No, I wouldn't assume that either, which is why, again, you wanna I'm neurotic, and I always go to a plastic surgeon because I wanna make sure someone has got things ...

Ashley: knows what's going on.

Katie: And you know, a quadruple board surgeon, plastic surgeon I know is going to so I think that's one of the things though that people need to be aware of. And also when looking for an injector, a lot of people have, you know, as, as do. befores and afters mm-hmm, where you can really look at what someone's work looks like instead of just...

Ashley: what's the cheapest price per vial.

Katie: Exactly. Don't look for the cheapest price. I mean, of all, for anything plastic surgery...

Ashley: people do though.

Katie: I know, but it's then you're gonna pay more to have it corrected. It's just like a bad tattoo. You're gonna pay more to get it fixed.

Ashley: I know.

Katie: but you know, I think that it's big to do your research. A lot of people have Instagram pages. You can see there before and afters. But also check out the person's credentials and make sure they are who sure. the other thing I was gonna say about Radiesse is I've seen it used hyper diluted sure. In like neck lines. Okay. And in hands mm-hmm and things like that. And I thought that looked kind of neat.

Ashley: You could do the same thing for all the fillers. And I've used HA fillers in both neck lines and hands and, and you could do it for Radiesse.

Katie: So there wasn't a reason that they used radius hyper diluted? I don't know.

Ashley: If they wanted hyper diluted, maybe they just wanted better dispersion.

Katie: Okay. So another popular filler I'm saying is the jaw line.

Ashley: Sure

Katie: Because it's all about the snatched jaw.

Ashley: I know -everything's snatched.

Katie: Everything's snatched these days

Ashley: snatched waste is still in, but ...

Katie: exactly everything snatched up, but as far as jaw lines go, what's your favorite kind of filler and how many syringes is someone really gonna need? I mean, it's not just like a one syringe deal.

Ashley: Probably not, but I suspect you could probably see results with a couple syringes. So the most common thing that people will do for that jaw line would be, so people have jowls, which is that little hanging thing, right. Just below the corner gel.

Katie: And you're starting to sag a little.

Ashley: Yeah. If you have that little bit of fullness or even hints of it, you are adding some volume just in front of and behind it to smooth it out and define that nice jaw or mandibular border.

Katie: And what about where you take it all the way back by the ear and create you a nice little angle?

Ashley: So to build up the ramus and angle of the mandible.

Katie: Yeah. Or even the chin... more chin projection. I don't know what it is, but I feel like my chin is recessing. Is that normal? Maybe I'm just not 20 anymore, but a little bit of chin projection changes your whole look. And aesthetically you're looking at someone you're looking at, okay, what do we need to do to balance out their face? If someone comes in and they never had filler, how do you address looking at their face and everything?

Ashley: Prior to any filler treatment, you're going do a comprehensive facial assessment. That starts off with examining the patient's face, looking at symmetry, looking at areas of relative volume deficiency, relative volume excess. There are some aesthetic norms and ideals that are considered when you're evaluating someone's face. And then you'll think about those things as you're trying to figure out what can I do to make this person look better?

Katie: I notice a lot when I'm looking at people's faces, one side is flatter than the other and a lot of times I ask them, do you sleep on this side?

Ashley: You told me this.

Katie: For example, I sleep on my left. So my left side is a little bit flatter. So whenever I go get filler, I'm like, Hey, fill up the left a little more, puff me up a little more. And then now I've tried to rotate. Now I try to sleep on both sides.

Ashley: Try to sleep on the back of your head.

Katie: I can't do that.

Ashley: You can't?

Katie: No.

Ashley: Maybe get one of those special pillows that don't let you roll.

Katie: I'll probably snore ...my husband will probably...

Ashley: he wouldn't like that smack. I think if you sleep on the side of your face, you're gonna get more wrinkles on that side of your face.

Katie: And volume.

Ashley: maybe.

Katie: But everyone's born asymmetrical anyways.

Ashley: There's usually one side of your face that's a little bit shorter and wider and one that's a little bit taller and skinnier. Like pretty much universally, even, even super models.

Katie: Oh yeah.

Ashley: They probably have a little bit less of that.

Katie: Well, and they're getting some things done. Well, let's be real. Most of them. Probably they like go to Egypt or something and they're airbrushed

Ashley: Why are you go to Egypt?

Katie: Because Egypt, this is why I say this. So you're talking, you were talking about, so Elle yes. Was caught. She got some plastic surgery on her face. She was caught. Is it ACA the thing that like mm-hmm covers your face? Right. And they caught her, they figured out it was her by her shoes. She was with her sister's like Giselle. It was someplace overseas.

And if you look at Tom Brady, he's had work done too.

Ashley: Think so?

Katie: Yeah. His before and after, when he graduated. He's been worked on for sure.

Ashley: I don't know why you wouldn't. I mean, you have the resources

Katie: And why wouldn't you wanna look like the best version of yourself?

Ashley: Well, that's a good question.

Katie: But the, I think the question is finding the right person that's going to make you look like the best version of yourself and not overdo it.

Ashley: Absolutely.

Katie: And not make you look crazy. Cuz that's where a lot of our friends get a little bit weary about anything plastic surgery. They're afraid I'm gonna look like I have duck lips or I'm gonna look overfilled and it's like, you would have to get so much, so many syringes to look overdone. I don't think that that people really understand how much you'd have to get to look that overfilled.

Ashley: You're probably right.

Katie: You know, I mean, if, if it have to be upwards of five to six syringes.

Ashley: It would be a lot, but sometimes what people will do is they'll get a vial in their lips and they like it. But then they like how the first couple days it was really swollen.

Katie: Right.

Ashley: And then it goes down because it was swollen, then they're like, oh, I liked it. And then they come back, get another. And then they're like, oh, I liked it when it was swollen with that time and went down, right.

Katie: They come back and it becomes addictive, but that's, that's someone turns him down and says, I think that's pretty rare.

Ashley: Even porn's addictive.

Katie: Everything's addictive. So as far as filler goes, how much is a syringe?

Ashley: It depends on which product, but I would say around 700 to $800.

Katie: No, as far as a volume.

Ashley : Oh, sorry. Classically one ML. They make one that's at like 0.65 MLS.

Katie: Which is like, when you look at a teaspoon, I mean, a third of a teaspoon?

Ashley: Teaspoon is five MLS.

Katie: So how much is ?

Ashley: A fifth of a teaspoon.

Katie: A fifth of a teaspoon? When you look at how much volume it is, it's not really that much.

Ashley: It's not a lot. People that are banking, one MLS. I'm like, no, man, just use it. It's one ML and there's always, definitely somewhere put

Katie: there's always someplace else you can put it.

Ashley: For sure. One ML is not a huge amount of volume.

Katie: Just use that whole thing.

Ashley: You can put it in your earlobe

Katie: I never even thought that.

Ashley: When I do facelifts, I always put fat in people's ear lobes.

Katie: Oh, nice. You know what? We haven't talked about fat: the ultimate filler.

Ashley: it is a great filler.

Katie: So tell us about using fat. Where are you getting this fat?

Ashley: so a very common question that people will ask me is, or usually it's the friend or spouse of whomever the patient is.. Mm-hmm is, can I give her my fat? No, you can't.

Katie: Right.

Ashley: You can't. Has to be, right, same person. So classically to do fat as a filler, you have to first harvest the fat and that's done...

Katie: lipo back to episode three.

Ashley: I know, liposuction. And, usually for the amount of fat that's required for, let's just say the face, let's say we're adding fat to the entire face. Uhhuh, usually it's depending on the age, but somewhere in the 30 ML range.

Katie: Okay.

Ashley: 30 something ML range.

Katie: And there's some atrophy, right?

Ashley: So not every single fat cell survive. Adding fat to the face is called free fat transfer. And that means the fat is separated from its donor site blood supply. You've disconnected it from the blood supply where it was ...

Katie: uhhuh.

Ashley: So let's say in your abdomen it had a blood supply there. You've removed it. So it it's free from its blood supply.

Katie: Okay.

Ashley: And then you add it to the new location. When you add those fat cells to the new location, not every single fat cell will establish a new blood supply.

Katie: Okay.

Ashley: So those fat cells that do not, will not survive .

Katie: They'll just be absorbed.

Ashley: And the expected fat survival rate is about 50 to 70%.

Katie: Okay.

Ashley: That's pretty good.

Katie: so you go a little bit up, but come a little bit down.

Ashley: Yeah, I don't try to overfill a lot because you don't know really within that range, how much is going to survive.

Katie: You do it til it looks good?

Ashley: Yeah, my end point is looking good and I know I'm gonna lose a little bit. And then either we can come back with some more fat or we can add just a little dollop of HA filler or whatever.

Katie: Right. When you do the postop

Ashley: mm-hmm .

Katie: So, if you're doing some fat transfer with you know, with fat your face , there's the same risk of bruising? All that stuff, right?

Ashley: Sure.

Katie: Are you just gonna look pretty normal when you're injecting the fat or is there any other thing that's different when you're injecting fat in the face?

Ashley: So when you're injecting fat, usually you're getting an anesthetic. I mean, not always.

Katie: Well, if you're harvesting, you probably got that anesthetic anyways.

Ashley: That's what I'm saying. It's a bigger production. You have to prep the donor area, numb it up. So whether you're getting numbed up with some anesthetic or you're just doing local injections or whatever, and then you're harvesting it, then you're preparing it, then you're reinjecting it.

Katie: Right.

Ashley: So yeah, it's different. But, the cool thing with fat transfer is that whatever fat cells survive, and like I said, it's about 50 to 70% of the fat that's added, that is a permanent filler. So it it's appealing, especially if you have a substantial amount of volume loss to add fat that you don't have to keep adding every one to two years.

Katie: Well, permanent, but your body continues to lose volume. So then that just becomes part of your volume, right?

Ashley: You've reset the clock. If you went back two decades as far as volume loss ,unfortunately yes. Time does tick on and surgery doesn't freeze your look. And I say that to patients, they'll ask me, how long does this face lift last? Well, it resets the clock...,

Katie: but you will still age.

Ashley: You're still going to age. Stop the clock. Exactly. It doesn't stop the clock. So, same thing with. Fat transfer. It's going reset the volume with regards to how much volume was lost, but you're gonna still continue to lose additional volume.

Katie: So where else can we use filler? We've talked a lot about the face.

Ashley: People will use filler in the dorsum of their hands...

Katie: uhhuh

Ashley: where you're seeing that tendoness or overly bony top of your hands.

Katie: My kids say that to me..

Ashley: Your kids do?

Katie: They're like, you're old; I can see your bones

Ashley: I've always had really skinny bony me hands. So,

Katie: so I'm like, that's just how I am.

Ashley: I know I'm over it. And then the other thing is like breasts and buttocks.

Katie: You can put filler in your breast? I guess fat's filler.

Ashley: Yes. Price per volume, it would be tough to do something like Juvederm to your breasts. It could be done. It would be really expensive and it would only last so long, So that wouldn't be appealing.

Katie: So fat would be the better option for that.

Ashley: Yeah. Most people would do fat. Absolutely.

Katie: I've heard of people getting fill in their butt.

Ashley: Mm-hmm, it would be classically Sculptra. They're getting one of the temporary injectable fills.

Katie: So let's talk about like the Kardashian butts.

Ashley: Yeah.

Katie: Do you think those are filler butts or, but implant.

Ashley: Well, I thought Kim got an x-ray or MRI or something

Katie: if she had an X x-ray, but implants would show, but filler wouldn't right. So she could have butt filler.

Ashley: I don't really care what Kim has in her butt. I guess. I don't really care.

Katie: Well, and they just say Khloe's butt got smaller. So I'm like maybe her filler either...

Ashley: Where do you find this stuff?

Katie: I'm telling you, this is the stuff that I'm interested in.

Ashley: That you're sucked into? This is the worm hole you go down?

Katie: This is the stuff that Instagram shows me.

Ashley: Oh, okay.

Katie: So her, her butt got smaller. I think her audience wants to know.

Ashley: But is she skinnier also?

Katie: She is skinnier, but it's, it's significant. And actually I'm gonna show you a picture. So what they're saying is either she got her butt implants removed. What else would you create that?

Ashley: What if she just had padding in? She does look way skinnier.

Katie: She is way skinnier, but definitely something happened to that.

Ashley: The butt ...something's been done.

Katie: Don't you follow plastic surgery on Instagram?

Ashley: Who's that?

Katie: They're good. It's just a plastic surgery thing on Instagram. This just shows you different things, which I'm just intrigued. You know, which I sent her a picture the other day of a, of a no implant breast lift. And she's like, why are you sending me pictures of saggy boobs? I'm like, it's a video click on the video, but you're not super into social media. So, you don't really see that stuff.

Ashley: Well, I just don't watch stuff that I already know.

Katie: Right.

Ashley: I already know that. I don't want to watch a video about, look, you can save the tissue. And, but what I think an autoaug

Katie: interesting is just, just to see what other people are doing, just to see, no, I think's what's going on out there.

Ashley: It's important to keep your finger on the pulse of what's going on in the field. And the latest technology are absolutely

Katie: the Kardashians have their butt and implants removed.

Ashley: I don't think they're gonna tell you.

Katie: Right. They're probably not going to. Yeah. But I think that's all we have on fillers. Is there anything else that we forgot?

Ashley: For the ha fillers, we talked about how there's so many different types, right? Whether it's.

Juvederm or Volbella or Vollure, Voluma that family or the Restylane Lyft, the Restylane Defyne, Refyne, Restylane contour, and there's the Revanesse, or Belotero . There are other brands, so I don't wanna exclude anyone. As a patient interested in filler, it's important to find someone with experience, and rely on their knowledge to select the appropriate filler for you.

Katie: One thing you mentioned with another one is some people push what they have. If you go to someone who has a selection of different things, You're going to get a better scope of what's the best thing out there.

Ashley: I that's true across the board, especially in plastic surgery things like med spas, if let's say, as a med spa provider or owner, all you do is cool sculpting...

Katie: right.

Ashley: ...then everyone that comes in that has a body contour concern, that's the only thing you offer. It's the same kind of concept with fillers.

Katie: Which you have everything. So, you're gonna recommend...

Ashley: what I think is best, the best, even if, yeah.

Even if the patient doesn't prefer what I recommend, they still knowand have been educated that I'm recommending, this as my first choice, and this is why this is an alternative, and these would be the pros and cons. I mean, I think that's important and I'm not sure that's the experience you're going to get with potentially

Katie: everyone else. There is one more thing we forgot to mention is cost.

Ashley: Sure.

Katie: You know, typically a syringe of filler is gonna be like between six and 800, right? Depending on what it is.

Ashley: That's fair. Yeah.

Katie: And typically you're gonna need, I mean, minimum of one, right?

Ashley: You can't buy a half.

Katie: You can do a half for the lips.

Ashley: I guess. You can't buy a half a syringe.

Katie: Oh, you can't?

Ashley: some of the companies make a 0.65 ML syringe, which would be cheaper than a one ML syringe.

Katie: Uhhuh.

Ashley: But you can't buy half of a one ML syringe. Like you buy the whole syringe mm-hmm

Katie: so minimum, you've got one syringe.

Ashley: Mm-hmm

Katie: But if you're looking for a total fixer upper situation on the face, obviously depends on the volume loss.

Ashley: Sure.

Katie: You know, multiple syringes. So you multiply that out.

Ashley: For sure.

Katie: You need to be prepared, you know, it's gonna cost more than Botox. And, there is a little bit of downtime you.

Ashley: Again, when it comes to providing options, okay, we could do five syringes, maybe they'll last one to two years. You're going to need more in two years. At some point, the consideration of what's the cost to add fat as a filler should be part of ...

Katie: what's the difference in cost with fat?

Ashley: Well, fairly substantial.

Katie: Okay. Well, then I guess you're multiplying that out.

Ashley: It depends on how you do your cost analysis. Right? Right. Are you talking about a two year, window of cost analysis or a 10 year window?

Katie: Well, in fat harvesting, I mean, that's like a two for one, because you're taking away from an area that you don't want it adding it to another area.

Ashley: I think so. There are very few people that look at their body and say, I wouldn't mind if I had a little less here.

Katie: So what's the minimum on harvesting some fat?

Ashley: Like ,what would I need? So let's say we were wanting to add 30 CCS of volume to the face. I would need to at least harvest about 60 CCS of lipoaspirate.

Katie: But pricewise, what's the minimum? You can gimme a range.

Ashley : So, maybe four -5,000.

Katie: Okay. But you're getting long lasting results. And it's a two for one. You're gonna be skinnier in one area. Plumper in another.

Ashley: Yep. It's got it's appeal.

And if you get a few syringes, you're gonna be a couple thousand dollars in.

It's good to have options, and for each person, it just depends on how you weigh out the pros and cons of those choices and different people would weigh them differently.

Katie: Right.

Ashley: And my job is to educate people as to what's available, what would make the most sense for them and to some extent, just putting the ball in their court. I'll provide recommendations. . But that doesn't mean if I think, oh, well you need a facelift and you need a fat transfer that they have to do that.

Katie: Right.

Ashley: They may say to themselves, well, I don't wanna do that. What else can I do?

Katie: Right.

Ashley: And that's okay.

Katie: I do love how straightforward you are. cause you're gonna really tell somebody like, this is what I think. And I don't think a lot of people are like that. And I love someone just telling me, Hey, this is how it is.

Ashley: Some people might not like it, but I want my patients to be happy.

Katie: Right.

Ashley: And I want to be satisfied with the result, and I want them to be satisfied with their investment in how they look at the end. Just telling them what they want to hear will not serve either of us well.

Katie: Okay, one more place. I've heard about getting filler and we talked about this in episode one.

Ashley: Oh, the vagina?

Katie: I've heard it in the G spot. How would, you know, if you need that?

Ashley: Just like you're losing collagen in your face, you're losing everywhere. Right? so...

Katie: you plump it back up.

Ashley: Plump it back up, fill 'er up. You're trying to restore the volume that's associated with aging and it unfortunately occurs everywhere.

Katie: Interesting. You can almost fill anything. All right. I think that's all I have on filler.

Ashley: All right, cool.

Katie: Tune into the next episode: anti-aging.

Ashley: Yeah, we'll just do an overview because that topic is so broad and so we're just gonna touch on it, and then we'll delve further into the various aspects of it and break it down. Yeah, I love it. All right. Bye everybody. Bye.

Liposuction: It Doesn't Suck

jay@robeyplasticsurgery.com (jay robey) — Tue, 31 Jan 2023 15:37:16 GMT

Liposuction - It Doesn't Suck!

Nipped and Toxxed Episode III

Ashley: All right. Welcome to episode three, liposuction. It doesn't suck, starring Ashley Robey and Katie Reichart

Katie: I am a CPCP and professional makeup artist. We are talking about liposuction on Nipped and Toxxed.

Ashley: I'm Dr. Ashley Robey, a quadruple board certified plastic surgeon. So plastic surgery, facial plastic surgery, otolaryngology and anti-aging medicine. So, Katie, liposuction, like we said, it doesn't suck. What are your thoughts?

Katie: I've actually never had liposuction, but I am super intrigued.

Ashley: Yeah. It's a great way to do body contouring. First and foremost, it's about establishing what can this do and what can it not do? And what it is not good at doing is helping people lose weight. So it's definitely not a weight loss procedure. And I feel like that's a common misunderstanding about what it could potentially accomplish, but it's for body contouring. So someone that is already near or at their ideal weight, but despite that just thinking, okay, I have this resistant spot or two that is still not the shape or contour I want it to be.

Katie: So what BMI would somebody need to be if they're looking for their ideal body weight? What BMI are you going to say? Okay, I'll do some liposuction on you.

Ashley: Sure. So BMI is body mass index, which weight divided by your height in meters squared. So it provides you a number. If that number for you is in the 18 and a half to 25 range, that's considered to be an ideal BMI. If your BMI is 25 to 30, that's considered to be overweight and anything over 30 is in the obese category and there are different levels of obesity. Obviously the higher, the number of the more obese you are.

So obviously someone comes in and they're on the high end of this scale. You know, help them with some medical weight loss instead of doing the lipo route.

So that is a service that I offer in my office. And, in part, because earlier on in my practice, I saw a lot of patients that were wanting to make those changes for their body, but they weren't really great liposuction candidates.

And I didn't feel right just saying, okay, well, go lose weight. It's going to be easy. See you later because, you know, they would never come back. So, I had the ability to help patients with regards to medical assisted weight loss. So we do do that in my office with my nurse practitioner, but yeah, like I said, ideally, you're in that ideal BMI range.

I do patients certainly that are overweight. My general cutoff, as far as body contouring is I like patients to be under a BMI of 32. That does technically account for some patients who are in the obese category, but over that losing weight first will definitely be preferable and safer.

Katie: the other thing I think of when I think of this is BBLs are really popular and so...

Ashley: Brazilian butt lift?

Katie: Yes! Brazilian butt lift, BBL. You know, if you want a big butt, but a small waist, you know, I want to be taking it out of the middle and then maybe you should actually describe how they do a BBL, because I think a lot of people don't understand.

Ashley: So BBL or a Brazilian butt lift is also called fat transfer to the buttocks. What you would do is liposuction areas of relative excess, and you're right, classically it's the abdomen and the flanks, or love handles or whatever other area that seems like a good donor site.

And then you inject it into the buttocks. You can only inject so much volume to a specific space at a time. You reach a point of diminishing returns. And so that's just going to be a function of how big your butt is or how flexible or mobile your soft tissue envelope is in the beginning. If you have very muscular buttocks with no loose skin and no fat, it's going to be really hard to fill that up because there's not much space to fill up, but if you have deflated, saggy buttocks with already some fat, that will be more amenable to adding fat to.

So for me, and also this is also recommended by the American Society of Plastic Surgeons, transferring fat to the buttocks should be only performed in the subcutaneous layer. There are some surgeons who will inject fat in the muscular layer, and granted with that extra space, so to speak, you can get more fat into the buttocks, but it's way more risky. If some of that fat goes into your gluteal veins, that could be life ending.

Katie: So, one of the most dangerous procedures.

Ashley: If you're doing it wrong. Sure. So you have to find someone who knows how to do it appropriately. Anything that's done in an unsafe fashion is dangerous. So you have to find someone who knows the correct way. So there's lots of different little technique differences that you would use to make that safe.

Katie: So where else can I inject fat, that you had already extracted from another spot?

Ashley: So we want to get all on about fat transfer?

Katie: So if you're got to take it out of one spot and put it into another…

Ashley: I tell patients that if you're thinking about fat transfer, and you're already doing liposuction, it makes sense. You can't do a fat transfer without doing liposuction. So, if you have an area of excess, and you're liposuctioning that, and you're thinking, Hey, I wouldn't mind having more volume in this area. Like, we're either going to throw the fat away or you're going to use it. The most common areas that I use fat are the face, the breasts and the buttocks. Not specifically in that order, but all three are very popular. You can put it in all kinds of places; sometimes I'll do more atypical areas, like filling in little divots or dents or a previous liposuction contour irregularity.

Katie: Rather than getting a breast implant, like just taking some of your own fat.

Ashley: It is appealing because it doesn't have the maintenance associated with breast implants. The downside of doing a fat transfer to the breast is that one about 50 to 70% of the fat injected will survive and two, there's a maximum amount of fat that you could fit into a specific space.

I would say like maybe a single cup size bump and that's it. So if you're looking to go up one and a half, two cup sizes, that would not be achievable with a single surgery. Not that you can't have more than one...

Katie: We have a friend that has asymmetrical breasts . One side is significantly smaller. This would have been probably, or would be a good option for her if she wanted to correct that, you know, and keep it natural.

Ashley: The truth is that I think most patients have some degree of asymmetry. I've definitely done a handful of patients that have substantial degrees of asymmetry where one side is an A/B cup, another one's like a C plus where we're just adding fat to the small breasts because it's just so far behind the big one that they're just, they're just trying to play catch up.

Katie: So if I'm coming in for liposuction, am I doing it in your office or are we going to a surgery center or does it depend?

Ashley: The vast majority of patients are done at an outpatient surgery center. I occasionally will do in office liposuction but, it's not very fun for me. And I don't think it's really fun for the patient either.

You have to get really numbed up. Plus even once you're numb, I think you can kind of still feel some of the, not pain, but you kind of feel someone like tugging and kind of pushing your tissue around.

Katie: a rod, right?

Ashley: Yeah. Canula,

Katie: that's the word. You know, hollow. Right?

Ashley: The most popular cannula size that I use for body contouring is a four millimeter diameter cannula to the internal diameter. So it's not huge, but still, you have to be really numb. So it's doable for like one area.

But the vast majority of people for whom I'm performing liposuction, aren't doing a single area, liposuction. They're coming in like, oh, can you do my upper abdomen and my lower abdomen and my flanks and this and that.

Katie: So you want you to be in an environment where you have a anesthesia?

Ashley: How long would the procedure take? Let's just say I just did your upper and lower abdomen...

Katie: Right.

Ashley: I feel like that's easier. It's actually quicker too. Yeah.

Katie: So, are they asleep?

Ashley: Yes.

Katie: Okay. And how long does it take, like if you're going to do someone's abdomen? I know it's relative because I wasn't sure, but like how long would that kind of procedure last?

Ashley: Like an hour. Most people would do the upper and lower abdomen and the flanks, which would be an hour and a half.

And some people that have really full love handles, or flanks, we'll flip them over so I can see that whole space completely. And then that takes like two hours.

Katie: Now do you liposuction the back?

Ashley: Yeah.. So the flanks are kind of like the lower back love handle area. So , I have like upper back, which is, for women, the part above your bra strap.

Katie: Right.

Ashley: And then you have your mid back, which is like bra strap down to the flank area. And some people, if you have a lot of fullness there you'll have that crease and then that space below it is the flanks. So any loose skin above that crease in the back, like in order to get rid of that, you have to pull everything above it up and everything below it down, because it's pretty adherent.

Katie: Are you ever doing that by itself or the flank area and all of that, are you doing this in combination with the tummy tuck?

Ashley: I would say of the people that get a tummy tuck, 95% are getting flank lipo, in my practice.

Katie: What about other parts? You know, you also then lipo stomach area?

Ashley: When you're doing a tummy tuck, you have to be careful about overly aggressively doing liposuction in that area that you just lifted up, called an abdominal flap, because you can really start disrupting the blood supply.

Katie: But you know, you don't want to be going to somebody that's on the internet, you see a lot of this 360 lipo and things like that and whole body lipo. So what are people talking about when they say 360 lipo?

Ashley: So there's a lot of marketing terms that I think are utilized just to appeal to different patients. So the 360 lipo is basically doing liposuction all the way around something like your body. So going all the way around your midsection, going all the way around your leg, going all the way around your arm. But classically it's talking about the torso because that's where most people are getting it.

Katie: So what about, I saw one of the Housewives said that she went before one of the reunions and got full body lipo. So what does that mean if she got full body lipo?

Ashley: I think it's a kind of vague terminology, but it sounds like she's had multiple areas liposuctioned. As a rule of thumb. If you're wanting to do outpatient liposuction, the maximum amount of lipoaspirate that's recommended is five liters. And if you do more than that, then it's recommended that you stay overnight. But for the most part, I try to limit my lipoaspirate to five liters.

Katie: So if I get five liters taken out or whatever, I get. Am I going to go home that day and what am I going to feel like? Can I move around?

Ashley: Liposuction in and of itself isn't particularly painful. And I think that's one of the nice things about it. It's a minimally invasive procedure, meaning that you have small one centimeter or approximately a thumbnail width incisions. Ideally if your surgeon is doing things correctly, they're trying to hide them. Although that being said, I've certainly seen incisions right in the middle of structures and I'm thinking, why would you ever put that there? Yeah, they're small, they're hidden. I do use a lot of long acting numbing medication , Exparel, which is a numbing medication that lasts about 72 hours.

So for my patients that just get liposuction, it would not be uncommon for them to say well, I was sore, but not even enough that I needed like a Tylenol.

Katie: Now are they going to look bruised?

Ashley: It depends on the person. Some people are easy bruisers and some people not

Katie: Someone that just doesn't bruise goes and gets liposuction. For some reason, I'm thinking like you're going to be bruised.

Ashley: You should go into it with a mindset, like you're going to have bruises. And then, if you don't, you're like, yeah, yeah, I don't have bruises. But if you do it, you're like, oh, I thought so.

Katie: Are you to continue to have fat loss in that are?

Ashley: After liposuction?

Katie: Settling period? Cause you've just created 10 of these?

Ashley: Your initial volume change will be masked by swelling. Right? It'll seem fuller in the first handful of days and actually longer than that because of post-operative swelling, but the actual amount of fat that's there won't specifically go down.

Katie: So how long is the post-operative swelling?

Ashley: It can vary from person to person. I tell patients, depending upon the area, it can be six, nine months before all of it is totally resolved. If someone was interested in revising an area of liposuction, that it's helpful, that you've waited a period of approximately that duration until all the swelling has resolved so that you're not working on a, on a potentially moving target

Right. And if you have an event that you're like, man, I'm going to look really good. Like you need to back that out by nine months.

I think you'll notice some things right away. Right. You're not going to suction out multiple liters and be like, it looks the same.

Katie: Well it’ll definitely look different, but you want to be like completely healed and feeling fine.

Ashley: I would say a minimum of six weeks before an event would be ideal.

Katie: Now say I have like dimples? Will it get rid of dimples?

Ashley: Liposuction can help. So you can get cellulite or kind of dimple changes because of vertical septations or pieces of connective tissue between your skin and the deeper layers of tissue. So they are little tethers. Liposuction can help break those up. And there are instances, especially if I find one area particularly problematic, then I'll break out what's called a pickle fork, which kind of looks like a V-shaped fork that has a cutting part. And you can find those little things and then just cut them

Katie: And just snip them, and you can improve irregularities just while you're in that procedure.

Ashley: For sure.

Katie: Amazing.

Ashley: But, you're not going to get rid of all of those things, but you can soften them for sure.

Katie: This is what I like about the fact that you're a woman and that you notice what a woman's gonna want, like the aesthetic part of things.

Ashley: I'm assuming male plastic surgeons also feel the same, but men and women think differently.

Katie: I just think that, you know, from a woman's perspective, I liked that you're thinking of those things and doing those, not that other people would have done. That's really cool.

Ashley: Thanks.

Katie: So as far as liposuction goes you know, obviously there's visceral fat and there's subcutaneous fat. When you have somebody come in that you can tell, like, hey, you're not a good candidate

Ashley: And unfortunately, I think for men, specifically, the visceral fat component tends to be even more of a problem. By visceral fat, I mean, the fat that's in between and around your intestines, the fat that's not going to be addressed or improved with liposuction because we're not going to be getting into that space. You're not going to liposuction, your intestines. The extra abdominal fat is the part that you can get with a liposuction.

And what I'll tell patients to do is look in the mirror and look at your abdomen and then flex your core, really tight, like you're sucking in. Right. And the part that's left, the part that you kind of still grab and pinch that's on the outside, that's the extra abdominal fat. So if that part is substantial, that's the part we can make some impact on with liposuction. If when you do that, you're like, well no longer do I have a problem, then you've just basically have compressed all of your visceral fat. And that really is only addressed via diet and exercise and not liposuction.

Katie: So what does liposuction cost? Talk about traditional liposuction?

Ashley: So there are different ways to do liposuction. People will do things like traditional, suction assisted lipoplasty, which just means you have a canula it's hooked to a vacuum and you're sucking.

There are other ways to do it: laser liposuction and ultrasonic or Vaser liposuction and then power assisted liposuction. Really the biggest difference between traditional and the different kinds of modalities is from the user end point and by user, I mean, your surgeon. If you have some laser or power assisted or whatever, it does tend to help make it a little bit easier to suck out the fat. You're not just relying on, so to speak elbow grease, you're using some other modalities to break up some of that connective tissue. So that's helpful, but as far as results go, not really different.

Katie: So what about their skin?

Ashley: So I do a thing called Body Tite and that uses radio frequency, energy to heat up the overlying tissue and then it causes a contraction. So at about six months, patients are averaging approximately a 25% contraction. And then at a year it's closer to 40%. Whenever you remove volume or suctioning out fat, that is, you have to always think about what are the impacts for the overlying skin. So in general, it tends to make whatever bit of laxity that's there worse. If you're suctioning out a substantial amount of fat and there's already hints of skin laxity, It would be helpful if your a surgeon had a plan to address that.

So for my patients, if it's not hugely problematic, but it's a little bit concerning, we'll do Body Tite, which allows us to utilize the same minimally invasive incisions that I use for liposuction, but that it will heat up the tissues and cause some contraction. And again, it's a little bit of a delayed fashion.

Katie: So there's no such thing with skin tite?

Ashley: When you use Body Tite, you're always using liposuction with it. It's part of the treatment.

Katie: Is that different? You also do liposuction or you always do Body Tite?

Ashley: So you can do liposuction alone and you can do body tite with liposuction, but almost never would you do Body Tite without liposuction. If you don't have a lot of fat, but you have some loose skin, you could do Body Tite, but you'd probably do what I would describe as a cleanup amount of liposuction, meaning maybe you only get a handful of CCS, but you're going to still go in there and kind of clean up whatever tissue that the Body Tite has rendered non-viable.

Katie: So is there a price difference? Is Body tite more expensive?

Ashley: It's just like you're doing a whole other thing, so it takes longer. So time is money.

Katie: So if someone comes in and says, and let's say they're an average BMI, they want their stomach done. Like what's a range on what that costs?

Ashley: Just liposuction?

Katie: Yeah.

Ashley: Maybe like 7,000, 8,000, something like that. You know how bad I am about I am with giving you numbers.

Katie: Give me a range.

Ashley: Something like that. And then as you add more and more.. . It does get more expensive, but it's a function of time and how long it takes to do it.

People that are bigger and they have a lot more fat -it takes a little bit longer to do it. So it can be a tad bit more expensive for those patients.

Katie: So, now in regards to high Def lipo, someone is pretty fit, but they want to create the look of abs or they want to have a more defined abdomen. You know, what is the range on that? And what is that procedure like?

Ashley: Abdominal etching is a way to create almost like a six-pack abdomen. I think in some cases, it does look really good, but the patient also has to consider their BMI and their body habits. In other words, you're not going to have someone who's obese that is kind of plump everywhere else, but just has like a ripped abdomen. Like it just, some things don't go together. And as a plastic surgeon, I'm always thinking about what makes sense. What's harmonious, you know, you want all of these body parts to fit together.

And so in my mind, creating some ripped abdomen when you have rolls of fat elsewhere. Like I just, I don't buy into it. So I wouldn't do it in most cases

Katie: As, you know, some people's abs look different.

Ashley: You can get more aggressive with some techniques. You can try to make it more defined or less defined. Create just some vertical lines versus trying to create the whole eight-pack..

Katie: Do we know people who have had this done?

Ashley: Yeah.

Katie: Do I know this one? I thought it looked really great on the first one I had it done. I thought it was really amazing. So is the cost for that going to be around the same?

Ashley: no. It cut costs a little bit more because it takes more time.

Katie: That's more like artistic.

Ashley: For my practice, anything that takes more time, you're doing more stuff comes at a price.

Katie: Can someone come in and say, this is the pattern that I want, are you going to be like hmm, no

Ashley: If their pattern is a good pattern.

Katie: If it makes for their body .A lot of people are going to show photos, right?

Ashley: Yeah. I mean, I'm not going to create like a Batman nine pack or whatever, right. Just because someone wants that.

Katie: No, no, no. But, if someone comes in and says, you know, maybe they don't want a nine pack that definition of little like valleys, because you see these celebrities out there aren't this fit naturally. I mean, some of them are getting some work done. They might not look like they have an eight-pack, but they might just look like they've got two toned areas, you know, there's different ways.

Ashley: Some people will just define that transition between the two rectus muscles in the midline.

Some people will do that lateral border of the rectus muscles, and some people will try to do all those various conscriptions in between to get six pack eight pack - whatever it is..

Katie: So, if I was going to get lipo , what would I do to prepare, to make sure that like I have optimal healing? What would be the best?

Ashley: Being at your ideal weight. Being healthy enough to have the procedure .And having appropriate expectations.

Katie: So do you do a checkup on somebody before they come in? say like, Hey, you're going to be good. Or say they're in their consultation, do you like examine them or do they need to give you like a physical?

Ashley: It depends on their history. Some people, if they have zero health problems, don't need to go get clearance from their primary care doctor or a cardiac clearance. So it's very patient dependent -depends on your history and risk factors and those kinds of things.

Katie: So, basically just healthy and at a good BMI?. I don't need to cut out alcohol or…?

Ashley: I definitely wouldn't drink right before surgery. It's bad. And I wouldn't drink the night before. Not even when you can't be like a heavy drinker that would not be helpful.

Katie: Inflammation coming to play?

Ashley: Alcohol is inflammatory.

Katie: I feel like I'd have inflammation. So like, should I, you know, do an anti-inflammatory diet, is that going to help me have better results?

Ashley: Probably just help you be healthier. And I think those are two problems that are related.

Katie: Well, shouldn't you follow a specific diet, obviously you don't want to gain weight after you have lipo.

Ashley: So after liposuction, I have patients avoid strenuous activity or exercise for about two weeks. And then I also fit them into compression garments that they're wearing for about three to six weeks. Sometimes the garment that seems to fit best right away after surgery after a week or so it can become loose. So it wouldn't be uncommon for someone to need a secondary garment.

Katie: So when they buy the garments from you or do you just direct them in the right way?

Ashley: I usually have them buy them from me because I buy so many and I get a bulk discount, but that being said, they can buy from whomever they want, but I don't make money off garments. I just help facilitate patients getting the appropriate garments.

Katie: So the garment is contracting?

Ashley: Yeah, it's called a compression garment. It helps with the swelling and it also helps try to minimize fluid collection seromas, yeah.

Katie: So what's the ideal time to have this done? Winter?

Ashley: I don't think that there's an ideal time. It's whenever you feel like you have some downtime in your life to take a break. And I know sometimes that can be hard and sometimes it just has to be like, you're just going for it and just setting aside some time.

Katie: So can you lift heavy things?

Ashley: After liposuction? Yeah. You don't have any lifting restrictions after liposuction. That's not the case with things like tummy tucks and breast augs, but liposuction, Yeah, you can lift.

Katie: You say no strenuous activity, what exactly does that mean?

Ashley: Things that get your heart rate and blood pressure up. So like, don't go for a run. Don't do what's going to get you breathing faster or get your heart rate up.

Katie: So no like cleaning the house?

Ashley: Yeah. That's like ever, you can never clean the house again, or do laundry, make dinner.

Katie: As far as skin retraction goes after lipo... If you're a healthy person, is your skin going to retract on its own? Or do you need to do other procedures? Like, do we need to combine this with like Morpheus 8? Or Body Tite?

Ashley: That all has to be part of a comprehensive evaluation. So that's always something I talk about during any consultation. Like I was saying earlier, you have to address not only the excess fat, but the implications for the overlying skin. Your options are one, do nothing, right? You could just like, okay, well maybe it's already loose, it might be looser afterwards. Two, you can cut it off. Or three pick something in between.

The Body Tite does a good job for those patients. It can tighten the skin, but you're not having the excisional, traditional surgical approach to address that.

Katie: So where can you do Body Tite? Can you do it on your chin?

Ashley: Yes it's really the same technology, but like in a smaller kind of hand piece. So just like for like a smaller area. So there's an AccuTite; there's a FaceTit e and there's a Body Tite, there's actually an Aviva which is like a tiny Body Tite for your labia.

Katie: Okay. So is there any other application that you would use the Aviva? Like any of them?

Ashley: Oh, I mean, it's very similar to the Acutite just has a slightly different settings. So, it's a tiny little, like 18 gauge needle canula. And I actually did someone who only was concerned about their superior umbilical hooding. Sometimes I'll do it in that excess skin in the front part of your armpit that hangs outside your tank top or whatever, but also I'll do it in the nasal labial folds. You can do it up in this kind of like lateral brow area. You can do in the jowls.

Katie: So tell me about FaceTite. Tell me about with what application would you use Face Tite?

Ashley: They have loose neck skin.

Katie: So, not only are you removing fat, but you're also tightening everything up. At what point do you say, Hey, you need a necklift?

Ashley : When the amount of loose scan would exceed the amount of contraction that will be optimal in what I could achieve with FaceTite.

Katie: So, FaceTite, is the contraction the same 25%

Ashley: at like six months? Yeah. Same as a Body Tite.

Katie: This is like a really cool option.

Ashley: Let's say you came in and your neck starting at your chin just went like a straight diagonal down to your, your sternal notch. Like that would be facelift. There's too much skin. That amount of skin laxity would not be amenable to a minimally invasive approach. But if you're like, yeah, I just have a little bit of loose skin, and I'm not really interested in a facelift. I would like you to kind of lose some fat and tighten the skin then I think FaceTite is great.

Katie: So when you're injecting fat into the face that you've taken from liposuction, where are you injecting it?

Ashley: It can be in so many places. Starting at the top, some people have that temporal hollow. You get that kind of sunken temple look, so some people will put it there. I've had patients that have had previous blepharoplasties where I think the surgeon probably got a little bit over aggressive in removing some of that orbital fat, and then they have that kind of. And they had that kind of no upper and lower. And then, so I've replaced fat in there.

I've had patients that their eyebrow was kind of wrinkled and deflated, and I put some under the eyebrow. I've put fat in the nose like a liquid rhinoplasty. You can just put some in the nose to kind of contour some bumps. Whatever fat survives is a permanent filler that's episode next, what FOUR, fillers.

We'll talk about that. Yeah. So I'll put that that's one of the fillers we'll talk about same thing that, so I put it in the undereyes. I put it in the cheeks are very popular, the lips, the chin, you know, as an alternative to a chin implant. People get those little jowls. Sometimes I'll put a little bit of fat just in front and a little bit behind to create a more smooth mandibular border. So yeah. Fat has lots of great applications in the face.

Katie: Especially if you're losing X amount of fat in your face.

Ashley: Yeah. So every decade we age, we lose about six to seven CCS of facial fat. So when you're thinking about, and this is again getting to the next episode, but when you're thinking about your options, Okay. You can break open 10 vials of filler, or you could have some liposuction and get, you know, at some point it becomes not price favorable to use filler, especially as this at best case scenario last two years.

Katie: And so is there a migration?

Ashley: No, you're expanding the matrix of tissue that's there and you're doing it in little micro-aliquots, little tiny droplets. And so it, it should stay where you put it.

Katie: So can you create like bone structure of looking in the cheeks? Are you just, is it just been, looked like an overall fullness?

Ashley : No, you're not going to create big fat chipmunk cheeks. You're going to add it just where you want it. Yeah. You're going to add it along that bony zygoma and it depends. I mean, the truth is like every face is different, so you can't be like, oh, these are the only places that I add it. Some people have great cheeks, then they have that submalar hollowness below the cheekbones and I'm like, okay, well that's where they need it.

Katie: What about malar lines on the cheeks?

Ashley: If there's a volume deficiency, you can probably fill it. You're talking about like those festoons?

Katie: Yeah, malar festoons.

Ashley: I usually call them tear troughs where the tears would run down. Yeah. We use filler there all the time. So you kind of get the one under your eye then that one that kind of goes diagonal. Yeah.

Katie: Lifting everything up?

Ashley: Yeah. And adding volume to your face also helps with the jowls, too..

Katie: This segues perfectly actually into the filler episodes.

Okay. So if I'm going in to get liposuction and I don't live near you... I live across the country. What do I need to look for?

Ashley: And the flights are expensive, so you're going to get it done locally. I would say first, I would make sure your surgeon is a board certified plastic surgeon.

Katie: Not a cosmetic.

Ashley: Well, ideally a board certified plastic surgeon and also someone that has experience. And I mean, I think before and after photos are helpful too. But you want them to see you in person.

Katie: You definitely want to have an in-person

Ashley: in-person exam is super helpful. And because I need to be able to assess your abdominal wall. They need to make sure you don't have hernias. They need to assess the degree of skin laxity so that whatever recommendation exists, it's gonna take any potential skin issues into account, too..

Katie: So what else do I need to know if I'm going in to have this done? What areas do I need to make sure that he's taken care of? He or she?

Ashley: As far as areas of liposuction, it's more of a function of what areas you're bothered by. When a patient says something to me, like, okay, just take a look at me and tell me everything that's wrong. I don't really enjoy doing that because I think it's hard to make improvements on something that someone doesn't really see as a problem anyways. I don't make a habit out of doing that. I encourage patients to tell me what it is that they.. what bothers them. Isn't it like? Isn't that what I say int that Nip/Tuck TV show, like, tell me what you don't like?

Katie: No idea. I remember that show extreme makeover, which of course they stopped doing that show. Somebody probably died.

Ashley: I don't know the background.

Katie: It was everything from head to toe.

Ashley: That's a lot. Extreme. Literally the word extreme was in the title.

Katie: I think people probably had mental issues after.

Ashley: Who knows. Body dysmorphic disorder is a real thing. It's not common. We should probably do to do a whole topic on the psychiatry of plastic surgery at some point. I wanted to write a book on it, but...

Katie: I think you should. Social media makes things even crazier now because people constantly see photos of people with filters on.

Ashley: You're getting a distorted view of reality for sure. And then you're feeling bad about yourself because you don't match up to this fake view.

Katie : And obviously, you know, you gotta love yourself no matter what.

Ashley: Yeah, you should love yourself but you should also take care of yourself. And, sometimes we deserve a treat, we deserve something special, and there can be areas that are hard to address on your own. Like if you have loose skin, if you have muscle separation... Some of the things aren't just going to get better.

Katie: Right. Especially if you have multiple kids.

Ashley: And I'll have people say , okay, no matter what weight I am, I still have this, you know, this fullness here. And, I'm sure that's very frustrating. So I think that's who liposuction is really great for, for those people that despite being a perfectly ideal weight still have this contour irregularity that I just can't get rid of.

So that's to make it better. It's smoother silhouettes, more definitions. We need to be nipped and toxxed. All of us.

Katie: Thanks for joining us on episode three of Nipped and Toxxed and tune into episode four:

Ashley: Fillers:

Katie: fill 'er up,

Ashley: Yeah, fill 'er up, fillers. Alright. See you guys later. Bye.

Empower - Not Just a Verb

jay@robeyplasticsurgery.com (jay robey) — Tue, 12 Jul 2022 14:20:38 GMT

Women helping women take control of their health

Occasionally, we pee when we laugh. We don’t experience sex the way we used to. We give birth and our body doesn’t go back to the way it was before. Sound familiar?

As women, we are incredibly strong, and our bodies can do amazing things. However, it can sometimes feel like our body has turned on us.

Common gynecological problems such as painful intercourse, vaginal dryness, sexual dysfunction, stress, and mixed and urge urinary incontinence can cause us to feel helpless, less than confident, and alone.

We at Robey Plastic Surgery are here to tell you that you are not alone, and you are not helpless. We are now offering the Empower treatment by Inmode to help you take back control of your life and health.

What is Empower?:

Empower is an FDA-approved, innovative platform that combines multiple technologies to restore vaginal and pelvic tissue. EmpowerRF can assist with a multitude of gynecological concerns such as:

Urinary incontinence
Sexual dysfunction
Pelvic floor disorders
Post-partum concerns
And many more

The treatment: 4 different treatment options

VTone : A gentle, FDA-cleared technology designed to provide transvaginal electrical muscle stimulation (EMS) and neuromuscular re-education to rehabilitate weak pelvic floor muscles and address stress, urge, and mixed urinary incontinence.
AViva: A minimally invasive alternative to a surgical labiaplasty. This innovative technology is designed with extensive safety features to reduce the risk of thermal injury during remodeling the soft tissues.
Morpheus8V: A fast and effective bipolar radio-frequency technology that provides a wide range of customized solutions. Fractional tissue coagulation up to 3mm depth allows providers to address multiple tissue layers.
FormaV: A comfortable treatment that provides uniform volumetric deep heating for tissue remodeling with real-time temperature control. The versatility of this RF technology allows the practitioner to provide customized solutions to improve tissue health.

We can perform the painless Empower treatment in-office with little to no downtime. Our practitioners will customize a treatment plan based on your specific concerns to help you regain your confidence in the bedroom, the bathroom, and in everyday life!

Let’s start talking about the things that trouble us and take back control when it comes to our health!

Skin Rejuvenation: Fillers or PRFM?

jay@robeyplasticsurgery.com (jay robey) — Fri, 04 Jan 2019 15:41:19 GMT

Which skin renewal choice is right for you?

Is your skin in need of revitalization? Lots of factors can contribute to making your skin look less than its best. Stress, age, and environment can make the skin on your face appear slightly dull or less toned than you may like. There is a solution that can restore the health and appearance of your skin as well as your confidence—with absolutely no downtime!

Platelet Rich Fibrin Matrix (PRFM) treatments are appropriate for anyone who is looking to bring new life to their skin. PRFM works well to smooth the skin and fill in fine lines. It can also help to reduce hyperpigmentation and improve the elasticity and texture of skin by building collagen. PRFM uses your own growth factors, making the treatment 100% organic and virtually risk free.

Benefits:

Refresh your skin using your own growth factors
100% organic treatment
No harsh or synthetic chemicals
Quick, in-office procedure
Only requires 1-3 treatments for most patients
Results can be seen in as little as one month
No downtime
Long-lasting results

PRFM is not the only way to revitalize the skin. A variety of facial fillers can add volume, boost collagen production, fill in lines and wrinkles, and improve your skin’s texture. Some popular facial fillers include:

Botox (Botulinum Toxin A) - to reduce the appearance of lines and wrinkles
Juvederm (Hylauronic Acid) - plumps up sunken tear troughs and adds volume to the lower face and lips
Voluma (Hylauronic Acid) - adds volume to the temples and mid-face
Volbella (Hylauronic Acid) - softens periorbital (smoker’s) lines
Vollure (Hylauronic Acid) - adds subtle volume to smooth moderate to severe facial wrinkles and folds, such as nasolabial

How to determine if PRFM or facial fillers are right for you

Deciding between PRFM treatments or facial filler injections is a point of preference. Facial fillers work more efficiently. Upon receiving the injections, a patient may experience mild swelling and bruising, but that should calm down within several days, with expected results typically being achieved in 2-3 weeks. Results last anywhere from 6 months- 2 years, varying filler to filler.

While PRFM requires anywhere between 1-3 treatments received about a month apart to achieve desired results, the results are permanent. If you have any allergies to the ingredients in traditional facial fillers, PRFM may be a great alternative, as there is zero risk of an allergic reaction.

Regardless of your prefered method to improve the appearance of your skin, it is crucial to find a reputable plastic surgeon who has a complete expertise of all of the available methods and can make the best recommendation for your specific needs.

Is Botox the answer?

jay@robeyplasticsurgery.com (jay robey) — Wed, 31 Oct 2018 15:28:17 GMT

A quick look at the miracle cure for facial lines and wrinkles

It happens to the best of us. One morning, you’re minding your business, getting ready for the day when your reflection in the mirror looks a bit...different. You’re still your gorgeous self, of course, but with a few more little reminders of a life full of laughter, frustration, joy, and deep thought. The lines on your forehead and by your eyes are a little deeper and more defined than you remember them ever being. If you are particularly bothered by these lines, there is something you can do about it! Botox is probably a word you’ve heard before, but what exactly is it?

What is Botox?

Botox is the brand name of the botulinum toxin injectable solution manufactured by Allergan . Botulinum toxin may sound a bit off putting, but is a very popular and considerably safe injection. In large doses, the toxin can be poisonous, but in small doses, as those administered during a cosmetic procedure, Botox is safe .

How does Botox work?

Many think Botox is a solution that works to fill in your lines and wrinkles, but this isn’t the case. Botox works to temporarily (for approximately 3-4 months) paralyze the forehead, glabella, and orbicularis oculi muscles. When you give these muscles a break, your body’s hardworking growth factors are better able to deploy and repair the tissue damage that presents as the tiny wrinkles and lines on your upper face.

How can I learn more about Botox and move forward?

Dr. Robey and her medical assistant, Kristen, are available to carry out a Botox consultation and perform the procedure Monday through Friday. During your consultation, you can learn all about the injection, the procedure, the risks, and the rewards! A number of Botox specials are currently available. Please fill out a form on this site or call us at 317.721.7110 to schedule your service today!

miraDry | Frequently Asked Questions

jay@robeyplasticsurgery.com (jay robey) — Fri, 15 Jun 2018 15:43:09 GMT

What is miraDry? How does it work? Is it right for you?

Are you one of millions, perhaps billions, of people around the world who suffers from hyperhydrosis of the underarms, a condition marked by excessive sweating? Are you tired of having your wardrobe dictated by your condition, only allowing you to wear the colors you won't sweat through? Or maybe you don't have hyperhydrosis, but are tired of using antiperspirants and deodorants with questionable ingredients.

If you relate to any of the above, miraDry ® may be the solution for you! If you are wondering how it works, you aren't alone. We've compiled a list of the questions we most often hear from patients during a miraDry ® consultation.

What is the miraDry® treatment?

miraDry is a revolutionary FDA-cleared non-surgical treatment that permanently reduces underarm sweat, odor, and hair - in just one hour. Over 100,000 miraDry treatments have been performed worldwide.

Don’t I need sweat glands?

While your body does need sweat glands to cool itself, your body has 2-4 million sweat glands - only about 2% are found in your underarms. Eliminating this 2% of sweat glands does not affect your body’s ability to cool itself. With miraDry, you will experience the many benefits of reducing sweat in the underarm area, but you will continue to sweat in other areas of your body.

How does it work?

miraDry uses thermal energy to create heat in the area where bothersome sweat, odor, and hair glands reside and safely eliminates them.

What results can I expect?

You can expect immediate and lasting results. Once the miraDry treatment eliminates the sweat, odor, and hair glands, they’re gone for good. Clinical studies show an average of 82% sweat reduction. As with any aesthetic treatment results, patient results and experience may vary.

How many treatments will I need?

You can see results in as little as one treatment. However, as with any aesthetic treatment, your physician will determine the best protocol for your desired results.

How long does it take?

An office visit appointment will generally last about one hour.

Is there any pain or downtime?

Most patients describe the procedure as painless with little to no downtime. Local anesthesia is administered to the underarms prior to the treatment for patient comfort. Most patients experience little to no downtime and return to regular activity (like returning to work) immediately. Exercise is typically resumed within several days. You may experience swelling, numbness, bruising and sensitivity in the underarm area for several days post-treatment.

Are there any side effects?

Some localized soreness or swelling will occur, and typically clears within a few weeks. Some patients have short-term altered sensation in the skin of their underarms or upper arms, which gradually disappears.

How much does it cost?

Pricing can vary depending on the treatment protocol to achieve your desired results and will be discussed during your consultation.

If you are interested in learning more about miraDry ® or would like to schedule a complimentary consultation, submit a form on this site, or give our office a call today!

Top 5 Things to Consider When Looking for a Plastic Surgeon

jay@robeyplasticsurgery.com (jay robey) — Fri, 18 May 2018 15:16:55 GMT

Making the choice to meet with a plastic surgeon and discuss a potential procedure is not one that should be taken lightly. There are many factors to consider during your search for the perfect plastic surgeon to help you meet your aesthetic goals. Starting the process of selecting a surgeon can be confusing and daunting. We've done our best to help make the process easier by providing the five things we believe should be considered on your journey to becoming a more confident you.

Find a Qualified Surgeon
Make sure your plastic surgeon is board-certified . It is possible for doctors without any form of certification in cosmetic or reconstructive surgery to market themselves as a “plastic surgeon”. In order to ensure you are getting the best care with excellent results, make sure your plastic surgeon is board-certified in plastic surgery. The more certifications they have, the more you can rely on their expertise.

Stay Close to Home
Medical tourism is becoming more and more popular. People travel outside of their countries for surgeries, both cosmetic and otherwise, for a myriad of reasons. Most often, lower cost of surgery abroad is highly appealing. While the pricing may be more convenient, the risks may be higher. It is best to look for a surgeon close to home who is easily accessible, especially post-operatively.

Review the Reviews
Find a surgeon who is highly recommended by others. The reputation of your surgeon is very important. There are several ways to verify the track record of your potential surgeon. Sites like RealSelf and HealthGrades allows real patients to leave testimonials of their experiences with individual surgeons. We recommend doing your homework and selecting a surgeon who is reputable.

A Picture Is Worth a Thousand Words
Look for before and after photos. Before & After photos are great indicators of how you can expect your procedure to go. As every body and every patient is different, look for photos that most closely resemble your body type. Find a surgeon who has operated on a vast variety of different body types.

Meet Your (Potential) Doctor
Schedule as many consultations as possible. Beyond doing your research online or getting recommendations from your friends, it is important to reach out to several doctors and meet with them one-on-one. This is a big decision and deserves careful consideration. Cost of consultation may be a barrier, so make sure you connect with us for your complimentary consultation t oday!

Plastic Surgery - Advancements - Latest Techniques

jay@robeyplasticsurgery.com (jay robey) — Tue, 25 Jul 2017 04:14:40 GMT

What credentials are important when selecting your surgeon?

When women and men consider plastic surgery, it is often based on their preconceived notions of how traditional procedures might help them look and feel better. However, medical and surgical advances provide so many more options than just a facelift or liposuction. This is one reason why Dr. Ashley Robey is triple board certified by the American Board of Facial Plastic and Reconstructive Surgery, the American Board of Plastic Surgery and The American Board of Otolaryngology. On-going, continuous learning, and advancement in the latest techniques allows today’s clients a wider range of options, often less invasive and with better results.

As someone considering plastic surgery, why should you care? Board-certification is easiest to understand when related to a driver's license. Can you operate a vehicle perfectly fine without having a valid driver's license? Absolutely. Let's say it was your first time in a vehicle with someone and you're about to embark on a road trip - would you be comfortable knowing they did not have one? Maybe/probably not?

Board-certification tells the patient, the public and the medical community that this Plastic Surgeon is certified (similar to how a driver proves they can drive by obtaining a license). Certification means that the surgeon obtained a specific curriculum to be proficient in plastic surgery. They studied, were examined, studied more and were examined more. It is a costly endeavor, a long process and one which holds merit.

Being certified by these prestigious boards “shows dedication and expertise to your field of study,” says Dr. Robey. A Board Certified Plastic Surgeon has had rigorous training for between 6-8 years or longer after medical school on all aspects of surgery and plastic surgery. As such, those certified represent the gold standard for plastic surgeons. All plastic surgeons are cosmetic surgeons but not all cosmetic surgeons are plastic surgeons.

For example, Dr. Robey’s additional certification with the American Board of Otolaryngology acknowledges the growth and complexity of medical science, clinical care and the importance of the physician’s relationship with the patient in delivering quality clinical outcomes. Otolaryngology is a regional surgical specialty which is devoted to disorders, anatomy, birth defects, and reconstruction of the face, neck, and structures associated with it. This includes cosmetic and reconstructive surgery on the face and this training gives unparalleled knowledge and surgical anatomy of the face and neck.

Choosing a plastic surgeon is an important decision. By dedicating time and effort to advanced certification, Dr. Ashley Robey wants to ensure your best outcomes. Only by scheduling a consultation with Dr. Robey will you be able to understand all your surgical options as a patient.

What are my body makeover options?

jay@robeyplasticsurgery.com (jay robey) — Tue, 27 Jun 2017 14:04:19 GMT

Learn more about renewing your body

You wouldn’t trade your children for the world. But the changes that happen to our bodies through child-bearing can be surprising. Luckily, there are a host of options available to you and Dr. Ashley Robey, quadruple-board certified plastic surgeon, offers The Indy Mommy Makeover. This can be any combination of cosmetic procedures which restore your pre-pregnancy appearance, typically focusing on the breasts and abdomen. A typical makeover might include a tummy tuck, pelvic floor tightening, a breast procedure such as an augmentation, lift or reduction, and liposuction of the legs, arms or abdomen and flanks.

According to the American Society of Plastic Surgery (ASPS), 20.7% of the 13.5 million cosmetic procedures performed in 2020 were on women between the ages of 20 and 39. New moms are choosing more and more to consider plastic surgery after having children.

Women’s breasts are greatly affected, due to milk production and weight gained during pregnancy. Plastic surgeons report the breasts of one-third of mothers return to normal after pregnancy -- if their weight does. Another third experienced stretched skin and less breast tissue. The final third, which often includes those who do not lose the baby weight, have larger breasts after their deliveries. Becoming a mom can result in larger, smaller or less-firm breasts, which can leave women feeling uncomfortable in their new body. Dr. Robey will consult with you to determine if the size and shape of your postpartum breasts fits your lifestyle and desired body image.

As pregnancy continues, our stomach grows along with baby. After pregnancy, it can be common for the excess skin in your abdomen to stick around and be unresponsive to diet or exercise. In this case, you may be considering a "tummy tuck," which doctors call "abdominoplasty,” a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fibrous tissue of the abdominal wall. A tummy tuck is not a substitute for weight loss or exercise. Although the results of a tummy tuck are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies would be advised to postpone a tummy tuck. And while a tummy tuck cannot correct stretch marks, these may be removed or somewhat improved if they are located on the areas of excess skin which will be excised. Along with a breast procedure, the Tummy Tuck is a very popular part of the mommy makeover.

Most women gain weight during pregnancy, and often find it difficult to lose when done having children. Dr. Robey offers both surgical and non-surgical fat reduction options for all areas of the body. However, the majority of new moms typically choose to have excess fat removed from their buttocks, thighs, arms, neck, and more. Combined with a tummy tuck and breast enhancement, fat reduction can be the final piece of the puzzle to help you regain the body you want.

No matter which procedures you include in your mommy makeover, Dr. Robey will spend time discussing all your options, including preparation, day of surgery, postoperative recovery, cost and future considerations. Dr. Robey is a specialist and as such, is experienced using the latest techniques and state-of-the-art equipment. She will tailor your treatment plan to reach your individual goals while focusing on minimizing scars for an ideal cosmetic appearance.

Silicone vs. Saline

jay@robeyplasticsurgery.com (jay robey) — Fri, 09 Jun 2017 18:57:15 GMT

Board Certified Plastic Surgeon Dr. Ashley Robey

Breast implants add volume to existing breast tissue to create a fuller chest during a breast augmentation. Women considering this procedure often ask, “What's the difference between saline and silicone implants? And which is right for me?”

Patients are often surprised to learn both saline and silicone implants have an outer silicone shell, yet differ in material and consistency. Silicone implants are sometimes superior, especially since the introduction of the new generation "gummy" silicone implants. Dr. Ashley Robey notes, “I am sure this is different from practice to practice, but would guesstimate about 70% of my clients choose silicone and about 30% choose saline. Worldwide, those numbers are skewed even more choosing silicone.”

Saline implants are filled with sterile salt water; they are inserted empty and then filled to a previously-agreed upon volume. Silicone implants are prefilled with silicone gel (like a gumdrop or gummy bear consistency), which more closely mimics the feel of human breast tissue. Most women think that silicone breast implants look and feel more like natural breast tissue.

“All implants, regardless of type, are not considered to be lifetime devices,” says Robey. “You can think about the wear patterns that you see on the bottom of your shoes after walking around for a few months - it's the same phenomenon with implants except the wear and material stress occurs with breathing, chest movements and arm movements.”

If an implant ruptures, the approach might vary depending on whether the implant is saline or silicone. If a saline breast implant ruptures, the implant will deflate, causing the affected breast to change in size and shape. The leaking saline solution will be absorbed by your body without posing any health risks, but you'll probably need surgery to remove the silicone shell.

If a silicone breast implant ruptures, you might not notice right away, or at all, because the form-stable silicone gel sticks to itself very well and tends to be well contained within the implant capsule, which is natural tissue that forms around the implant. A ruptured silicone gel implant isn't believed to cause systemic or long-term health problems; it could, however, cause a change in the feel or contour of the breast. If this happens, you may likely need surgical removal of the implant.

Other implant options also include rounded or shaped, and textured or smooth, all of which come in a variety of sizes. Your best route is to schedule an initial consultation with Dr. Robey, who will discuss all these options with you, taking into account your body type and goals.

Learn about Tummy Tucks

jay@robeyplasticsurgery.com (jay robey) — Mon, 03 Apr 2017 00:00:00 GMT

Plastic Surgeon Dr. Ashley Robey

An abdominoplasty (tummy tuck) is a surgical procedure that can address excess skin and fat of the abdomen. If the patient has a diastasis (separation of the two "six-pack" muscles in midline abdomen, commonly seen with pregnancies), the two rectus abdominis muscles can also be brought back together at the time of surgery; this will create a tighter core and improved contour.

Liposuction of the love handle areas is also commonly performed during this surgery to achieve the best contour. A typical abdominoplasty incision runs along the bikini line from one hip bone to the other. If a significant amount of tissue needs to be removed to achieve the desired results, an incision may also be made around the belly button so that it can stay in an aesthetically ideal position.

Types of Tummy Tucks Dr. Robey performs:

Tummy Skin Removal
Mini Tummy Tuck
Full Tummy Tuck
Extended Tummy Tuck
Circumferential Tummy Tuck