Better Safe Than Sorry! The Guide to Getting Ready for Plastic Surgery That You NEED

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech. Bri. Welcome back to All the B's you're listening to, unfiltered plastic surgery podcast and all the hot celebrity gossip you don't need to know. Here with me is Bri. Hey Bri.

Bri (00:25):
Good morning.

Dr. G (00:26):
Today's episode we're going to talk about how to prep for surgery, which is super important, but first we got to go through what's up in the Daily Mail.

Bri (00:36):
Nothing says good morning like Man dying after penis enlargement.

Dr. G (00:40):
Yeah, so this happened in Russia or whatever we're calling that now. I think it's still Russia.

Bri (00:46):
Is it worth enlarging your penis to never be able to use it again?

Dr. G (00:50):
I mean he is not using anything cuz I think he died unfortunately. But yeah, I know. I mean women do a lot of high risk things all the time. It's just interesting, I've presented on the risks of fillers, injecting fillers. So when you inject filler in the face, which is more common, it is potentially you can get into a blood vessel obstruct the blood vessel and you can end up with either tissue necrosis, so tissue death or potentially blindness. So generally that's what we're talking about. But now you can inject filler everywhere, including the penis, and so you could end up with the same problem. You could get necrosis in the penis, which is probably more common or in this unfortunate case, an embolism and death from having your penis injected.

Bri (01:45):
What kind of filler would you put in the penis? It'd have to be really soft, right?

Dr. G (01:51):
Yeah, it looks like they're injecting, so the two things you can inject are hyaluronic acid based fillers, so your Juvederm based, Restylane based fillers, like the common fillers we use for face lips, et cetera, and fat. So both can embolize. I think fat might be more common, but I can't speak to that cuz I don't do this procedure. But always potential for adding that to our repertoire of offerings.

Bri (02:22):
No, no, there is not.

Dr. G (02:24):
No, we've talked about this before. It is trending. Male genital enhancement is trending, but in an all female office, we feel pretty strongly that we're not going to dip our toe in that water.

Bri (02:39):
I understand it. I guess it's just like women wanting to enhance their breasts. Their penis is the same thing.

Dr. G (02:47):
I know. And in this article there's a bunch of stuff about penis size change and whether penises are getting larger.

Bri (02:54):
How much actual length, smaller. Let's see.

Dr. G (02:56):
And I was like, what? Who's doing this study and why?

Bri (03:04):
So you're enhancing it like 3/4 of an inch or what is that?

Dr. G (03:08):
That's just looking at average penis size over time, which has nothing to do with injecting filler into it. Also in filler generally they're using it to enhance the width and not the length because it's hard to increase the length anyway. But yeah, and then I think that was what was interesting is that the use of fillers in the UK and in, I think Russia is unregulated, so it does vary from state to state in the United States, but you usually need some sort of licensing to inject filler. But any beautician can inject filler into any part of the body with impunity at the moment in the UK.

Bri (03:52):
Crazy.

Dr. G (03:53):
That's awesome. Your hairstylist can inject filler, which as we know, unlike just having your hair fall out or have it break or something because they over colored it, this comes with real risks and I'm guessing they don't carry hyaurlonex or have any of the rescue products that you need in case you do get into a blood vessel. So I don't know, everything comes with consequences, which is why it's important to prep for surgery. And the first thing if you're going to prep for surgery or for procedures is to know that your person doing it is credentialed.

Bri (04:25):
It does say micro penises are usually developed in the womb. So you can just

Dr. G (04:30):
Blame your mom?

Bri (04:31):
Yeah, exactly. It's all genetics. So have a good personality. It'll make up for it.

Dr. G (04:40):
And a really nice car.

Bri (04:42):
Exactly. A really large truck.

Dr. G (04:46):
Alright, moving on because we will get to Blake Lively in a second, but I just have to say we've been obsessed with this in our office and it's the Meghan Markle, the new show Netflix show. I mean, Bri, you've actually watched it.

Bri (05:01):
The trying to be relatable show. I don't want to absolutely trash this series, so I'm not going to say a lot. But what on earth? This was the most unrelatable show possible. I mean from the get go, this was just terrible. First off, she's not in her own house. They rented a house down the street where she can pretend to cook and do things in. And it's like I'm not cooking in an all white outfit and then she's pouring, I could go on and on about this. I have so much to say. Meghan.

Dr. G (05:39):
Grossly unreliable. I feel like this girl is hosed. She can't do anything right at this point. She's going to get lambasted no matter what, but she also, she's sticking herself out there to make money. So I don't know if she's just not surrounding herself with people who are like girl.

Bri (05:59):
But she's almost giving me Blake Lively vibes because the way she went on Mindy about her being a Sussex, she didn't say it in a kind way. She's like, I just can't believe that you would call me Meghan Markle when you know I'm a Sussex. It's so stuffy. It's so stuck up. She doesn't talk, she's not a relatable person. She talks like she is higher than everyone and then, she could have done it tastefully and I think she did it. No mom, no working busy mom is going out to their beehive to get their bees to make honey and then their eggs.

Dr. G (06:38):
I mean do believe she encourages you to find a beehive or whatever they call it a bee farm so that you can get soy wax so that then you can make your own candles.

Bri (06:52):
I'll be buying my candles for $10 at Target. Thank you. That's my Ted talk.

Dr. G (06:58):
Yeah, and I think there are a lot of this article, this review article about the show is like she is talks about how she would eat farm fresh and that's what. And then in her show she talks about how they ate TV dinners growing up. So which is it? What are we doing here? I don't think she has a clear identity or she has a clear identity, but she's not putting that forward. So she just comes across as super inauthentic. It's very easy to lambast and it's so out of touch because it's so out of touch because it's so welcome to my home, actually not my home. Look at me pour peanut butter pretzels from Trader Joe's into another plastic bag for my friend who loves peanut butter pretzels, but I'm also going to label them in case he has a peanut butter allergy. What are you talking about now? I'm so confused. And what am I learning from that? Is that I can use plastic and more plastic to make things look, it's wild. But just like the Mormon wives Secret Lives and Mormon Wives, which their second season's coming out in May.

Bri (08:12):
I can't wait to watch.

Dr. G (08:13):
This guy Kai Cameron on Instagram does the best little skits of them. So he has

Bri (08:22):
So good.

Dr. G (08:23):
Yeah, that he does where he's, welcome to my new show, not my house. So welcome to my set.

Bri (08:31):
Yes.

Dr. G (08:31):
And then

Bri (08:32):
And we're in all white because we obviously cook in all white and then I am going hot tamales.

Dr. G (08:39):
And then he puts, he takes the tamales out of the box and he puts 'em in a plastic bag. Or actually he just rolls 'em up in Saran wrap.

Bri (08:47):
He wants his guest to feel every little detail has been thought about while going into this house. And then she puts corn in a bag and pops it.

Dr. G (08:56):
But he puts tamales from the garden.

Bri (08:58):
From the garden. I love it. Just put the tamales. You don't need to make bath salts. If I had the energy and maybe I was a stay-at-home mom and the money and I was like making bath salts and candles for people and then wanted to write that I grew the bath salts and candles.

Dr. G (09:20):
Right? You're like a mommy blogger. I get it. It's very trad wife. It's very, who's that ballet dancer that's on a farm and makes everything, I mean they've spoofed her too. I can make my own toothpaste. Why? You really have nothing else to do? I feel like your kids probably have homework or something that they need help with. Just in my experience as a mom, there's better things to do with your time.

Bri (09:46):
She did not, she could have done so much better. I don't know what the show is or just be relatable.

Dr. G (09:54):
Show us some life hacks man, this is not.

Bri (09:56):
My favorite part was at the very end when Harry is finally featured in the very last episode and he just looks absolutely miserable, trying to remember to smile when the camera comes across.

Dr. G (10:12):
Well good news, it got a second season already, I think

Bri (10:17):
Already been filmed.

Dr. G (10:18):
Netflix loves a controversy. I feel a lot of us hate watched it.

Bri (10:23):
I did. I a hundred percent hate watched the whole season and I made Eric watch it with me and it was perfect. It was everything I needed.

Dr. G (10:33):
Alright, let's go on to our next. I love Kai Cameron. Just going to plug him.

Bri (10:38):
So good.

Dr. G (10:39):
He should come on the show. And then back to Blake Lively. So she has another movie coming out. Another Simple Favor.

Bri (10:46):
Where did she film this?

Dr. G (10:49):
We were trying to remember What a Simple Favor was about whether we had seen it. I don't think I ever saw it. You and Rachel said you had seen it but couldn't remember what the plot was.

Bri (11:00):
Yeah.

Dr. G (11:00):
Somebody decided to make a second one. I mean, I kind of love Anna Kendrick.

Bri (11:06):
We're just here for all the Instagram memes and the drama.

Dr. G (11:12):
It looks like maybe they didn't get along on the show or they did or tolerated, the narrative coming through is that Anna Kendrick and the producer Paul Feig or director Paul Feig tolerated Blake Lively and her whole routine and nobody wants to say anything.

Bri (11:28):
But then every video you see, she is just dodging every Blake Lively question for good reason, but it just looks so uncomfortable. And then Blake's up there speaking on the stage and Anna just looks like she's looking like fuck my life.

Dr. G (11:44):
Right. You can't pay me enough to be here.

Bri (11:46):
Yeah.

Dr. G (11:48):
Yeah. And then I guess she just tried to post a bunch of pictures of behind the scenes, Blake Lively did, but in all the pictures it's just usually her with her squad, her publisher, her hairstylist, her makeup person. Also Anna Kendrick is tiny.

Bri (12:07):
Oh really?

Dr. G (12:08):
Wait, I feel like there

Bri (12:10):
She is tiny.

Dr. G (12:12):
She's like a little person I could carry her around in my pocket. That's great.

Bri (12:16):
That's crazy. I love that.

Dr. G (12:18):
Some boots though that Blake's wearing.

Bri (12:22):
Look how big Anna's shoes are too. They're like four inch platforms.

Dr. G (12:25):
I know. She has to be like four 11 or something.

Bri (12:30):
I love that.

Dr. G (12:30):
Anyway. More I'm sure that will continue to feed into our podcast for the entire year.

Bri (12:36):
I'm so surprised, Blake. She has to be so uncomfortable going out and doing all this stuff, right? She just got dragged and then still getting dragged through media and then she has to go present her new movie.

Dr. G (12:50):
I guess so I don't think she cares.

Bri (12:52):
Stay home, you have enough money.

Dr. G (12:54):
She's insulated by all the people around her that tell her she's amazing and she's a genius.

Bri (13:01):
Her dragons.

Dr. G (13:03):
Her dragons. She's good. I don't feel bad.

Bri (13:08):
I feel bad for Ryan, but also he condones it.

Dr. G (13:12):
Yeah, they're a team. Alright, so this is celebrity and plastic surgery related. So this comes around every couple of years with a new celebrity. So there's been a question about, we were just actually randomly talking about Justin Bieber again yesterday in the OR because a song about,

Bri (13:29):
I thought he was having a mental breakdown. I am not quite sure that it's not accurate, but I've just seen so much recently saying he is doing all this weird stuff, making these weird videos. But I guess maybe he was just trying to hide the fact that he had a hair transplant.

Dr. G (13:45):
I don't know.

Bri (13:47):
I think he's going to have a mental breakdown. He's going to pull a Brittany soon.

Dr. G (13:51):
Poor Brit. Anyway, he was seen I guess running around without a hat or a beanie. And so in an effort to say that he has not had a hair transplant. But then people, if you scroll down on this article, they do this super weird closeup of his hairline. Okay. So there we see him pixelated and I guess the argument is that the hairline see how his hairline was receiving there and then if you go back up it's

Bri (14:24):
It's back.

Dr. G (14:24):
Not, yeah, so they're saying he got that filled in with a transplant.

Bri (14:30):
I believe it.

Dr. G (14:32):
Which, okay.

Bri (14:34):
I feel like that picture on the right if you go up a little bit is the first actual picture where he kind of looks kind of good. He almost looks like a little Calvin Klein model.

Dr. G (14:45):
The one where he has hair?

Bri (14:47):
Yeah, we all, yeah, with hair.

Dr. G (14:49):
And a beard.

Bri (14:49):
And a beard and wet and

Dr. G (14:52):
It doesn't even look like him.

Bri (14:53):
No, not at all.

Dr. G (14:54):
Yeah, he looks hot there.

Bri (14:54):
He does. That's the winner, Justin.

Dr. G (14:58):
But that's with his fake hairline, which I feel like looks weird in that photo, but whatever.

Bri (15:04):
It's not fake. It's the same thing as getting a BBL. It's not fake. You're just transferring fat to your butt. It's still your fat. Yeah, it's still your hair.

Dr. G (15:12):
Still your hair. Yeah. Okay.

Bri (15:13):
Still your hair is still your fat. You're still all natural.

Dr. G (15:15):
Bri has spoken. No, I'm all for hair transplant. I think it's a great option for men also. There's no risk of, I won't say there's no risk of dying, but there's a very lot less than getting your penis injected of having some.

Bri (15:33):
That's true.

Dr. G (15:33):
As long as you do it, I cannot restate this enough, at a reputable place. If you are going to Turkey and getting these crazy hair transplants for cheap and then having scalp necrosis and massive infections and horrible hairlines. 90% of doing this is doing it so it looks natural, which is all about the placement of the hair. And then, yeah, so don't go to some garage in Turkey and get it done. Please make sure it's somebody credentialed.

Bri (16:04):
Take the Turkish hair lines to someone's basement.

Dr. G (16:08):
I know, but yeah, I mean it is your own hair, so you're right. It looks good. It just takes a long time. You have to be patient. It takes a long time for the hair to take to grow out. Some of it you're going to lose. It usually takes multiple rounds depending on how much hair loss you have can be supplemented with some medication to improve the hair growth if it's done properly. Like Justin Bieber looks like he's had it done properly. I think it's a win.

Bri (16:36):
I would hope he has it done properly.

Dr. G (16:38):
I mean it looks like he has, I can't imagine he is going to cheap out on that. You wants somebody with discretion and somebody who knows what they're doing. So props to whoever did it.

Bri (16:48):
He looks good.

Dr. G (16:49):
Yeah, I like it.

Bri (16:50):
Even if you're having a mental breakdown, Justin, you look good.

Dr. G (16:54):
I know that baby face. He almost kind of looks like Scott Disick. I'm just kidding.

Bri (17:01):
That's tragic. Did you see the Timothy Chalet? The, what was it? SNL and he did the Babyface song.

Dr. G (17:11):
Oh no, I didn't see that.

Bri (17:12):
I'll have to show that to you. That's so good catch up.

Dr. G (17:15):
I did see Scott Disick on that other Mindy Cowling show, Running Point where he shows up in

Bri (17:22):
Oh yeah, that was such a good show. Okay. Kate Hudson.

Dr. G (17:25):
I know it was cute. Okay.

Bri (17:28):
Good thing to come back to. She hasn't been on anything in a while, I feel like.

Dr. G (17:31):
Yeah, she was cute in it. And the Scott Disick cameo was weird, but

Bri (17:37):
Netflix bring out Running Point another season, not Meghan Markle with Love and Inauthenticity.

Dr. G (17:48):
Your inauthentic self.

Bri (17:50):
Oh Jesus.

Dr. G (17:51):
Oh my God. Okay. Alright, let's get to the meat of it. So today's topic, how to prep for surgery. First up, there's a Forbes article, which I think is interesting from, it's from last year. Okay, so this is not new. I love this photo of everybody leaning over the patient. This is exactly what it's like when you go to sleep. Jk. Jk.

Bri (18:16):
You just see my face.

Dr. G (18:18):
I mean, you're going to see the mask, but there's not four people peering over you. Just the anesthesiologist. Jesus.

Bri (18:25):
I know, it's a little extra.

Dr. G (18:27):
It is extra. I was just speaking to a patient yesterday that was starting tirzepatide with our office who has surgery scheduled, and I was like, well, you know, need to stop two weeks before surgery so that you don't aspirate. And she was like, wait, what? So it's not well known amongst patients, which is important because although you might be prescribed Ozempic, Wegovy, Mounjaro, Zepbound, you also might be getting it as a compounded formulation outside of the insurance and you might, I think it's become so, what's the word? Ubiquitous?

Bri (19:03):
Ubiquitous in a commonplace. So common.

Dr. G (19:08):
It's become so commonplace that patients don't even think to mention it when you ask them about what medications they're taking.

Bri (19:15):
I think the best way to prep for surgery is to have transparency. And I don't understand sometimes why patients don't feel it's necessary to. You're going to a place to be put to sleep and have a surgery and people don't find the importance in letting you know medical history, medications they're taking. Oh, I'm just casually taking blood thinners or I'm on GLP-1s. And I don't think if you want to prep for surgery, transparency is the most important thing right now that I feel like you can do. Because had a couple patients that have, I think one of 'em, while she was maybe going to sleep or the morning of her procedure, she was going out of it and she's like, oh, I'm on this, this and this. And it's like, yeah, I mean you'll get your surgery canceled for that. It's very important. Our anesthesiologist is very by the book, he's not going to mess around if you have an increased risk of aspiration because you're taking a drug that he doesn't know you're taking, he's not going to do your surgery. This is an elective procedure and there's no point of jeopardizing anyone's safety for not telling your provider the medications you're taking.

Dr. G (20:27):
Amen. Well said.

Bri (20:28):
Amen sister.

Dr. G (20:30):
Yes.

Bri (20:30):
Call it a wrap.

Dr. G (20:34):
No. So I think there are two kinds of patients. There's a patients who know that they're not supposed to be smoking. They're supposed to let us know all the hinky supplements. They're supposed to let us know that they're on GLP one drugs. Fen-Phen is another one that we need to know about. But they withhold that information because they know we're going to tell them no. So that's one set of patients. And then I think there's the people who genuinely just don't think of it like, oh, the supplement I take every morning's not a medication. And so I just don't even think that that's something I need to tell my doctor. So it ends up being on us to be like, are there any things you want to tell us? It's like when I see a new patient and they say no surgeries, and then I'm examining them and I'm like, okay, well what about these incisions on your abdomen?

(21:35):
Oh right. I had a laparoscopic blah blah, blah. Or I've had lipo before. They just forget, they're not trying to hide it. I'm going to find out, so I think sometimes they're not trying to be misleading, they're just not thinking about it. So I think education's important so that you understand. The reason we need to know this might be something that you are unaware of, which is that GLP-1s used to manage diabetes. It's not like metformin. You will not empty your stomach out and currently whatever the American Society of Anesthesiologists recommends coming off of it for two weeks before elective surgery. Now if you get appendicitis and have to go to the hospital and they need to put you asleep to take your appendix out and you've been on ozempic, are they going to still do it? Yeah, they're not going to make you wait two weeks. Is there an increased risk of aspirating, which means basically vomiting and then ending up with that in your lungs at the time of anesthesia? Yes. Are there things they can do to help reduce that? Yes, but that's called a rapid sequence intubation and it's not something routinely done unless necessary, usually done for emergency procedures. And so you don't want to aspirate and get aspiration pneumonia because you're having your implants exchanged and you forgot to tell us.

Bri (22:56):
Not worth it.

Dr. G (22:57):
It isn't worth it. Now what's interesting, I think this restriction will possibly get modified over time, but this is the safest, most conservative option because if you are taking it to manage obesity or type two your diabetes per se, then the recommendation is to not come off of it for as long, but it's still a little squishy because a lot of people are on something else in addition to GLP-1s for their diabetes. So if you're on insulin or something like that, then we're going to also deal with that as part of your preoperative planning. When do you take the last dose? We're going to check your sugars during the procedure. So all of that's relevant for us. And I know people think, oh, what do you need to know about that? We need to know

Bri (23:49):
If your liver is not working properly.

Dr. G (23:52):
Need to know.

Bri (23:53):
Need to know.

Dr. G (23:53):
Please tell us. And then the category of patients who don't tell us because they're afraid of getting canceled or something, I mean again, it's just not worth it. So

Bri (24:03):
Safe surgery is the only kind of surgery we like to do.

Dr. G (24:07):
Absolutely. And then Fen-Phen is another one that's actually, I'm always surprised when people are on that medication because I thought we weren't using that anymore for weight loss, but that messes with your blood pressure and can make it kind of crazy during your anesthetic. And so again, we have patients come off of that prior to surgery. So it's helpful if we know that you're on it. It's an actual medication.

Bri (24:33):
Yeah, I think one patient actually said as she was going under, when the mask is coming down, that's what she said, those were her last words.

Dr. G (24:46):
It's usually that or I also smoked a cigarette right before. It's like they get a little truth serum as they're going to sleep and they're like,

Bri (24:54):
Right.

Dr. G (24:55):
I am smoking. And then you're like, ugh.

Bri (24:57):
It's just so important. I mean, nicotine delays, wound healing and pretty much what every surgery, it's not like a, oh, I'm going to be the exception. Just if you're going to have surgery in an elective non-emergency situation, just do it. Do it the right way.

Dr. G (25:16):
Right. Quit.

Bri (25:18):
Let's minimize all risks here.

Dr. G (25:21):
So that leads us to our next category, which is how to prep for surgery. Don't smoke. So usually when I ask people if they're smoking and they say no, I say, well, don't start.

Bri (25:32):
Right. I know. And if you are smoking, you're most likely going to get nicotine tested before, the morning of your procedure.

Dr. G (25:39):
And there have been studies on this and it's shown. Usually if someone tells me they smoke at a consult and then we say, okay, well you need to quit. We're going to test you before surgery. Those people usually quit and are in the clear. It's the ones that say, I used to smoke, I don't smoke anymore, are usually the liars in all of this. They are actually still smoking. They've learned to say that they're not smoking anymore. So we still test them as well. If you give us any hint that you might be smoking, we're going to test because it's not worth it to have any kind of complications. So smoking and surgery are a bad combination. Back to anesthesia, it hurts your lungs to smoke. So even for those who smoke marijuana, any vaping, anything that's going in your lungs, it's compromising your lungs.

(26:31):
And then when anesthesia is breathing for you during the surgery, you also, you wake up, sometimes you have a cough, your lungs aren't fully expanded. We want you to take deep breaths after surgery. All of that is you're not at your best self when you've been smoking up to the day of your anesthetic. So those lungs are not healthy. And it can take a couple weeks, two to four weeks to kind of clear the damage that your cigarette smoking is doing. And that's why we recommend a month before and a month after. First of all, anesthesia is not going to be happy if you're smoking. So for those of you on smoking marijuana, we say switch to edibles, it's not the marijuana, it's the inhalational damage. Number two, the heart has to work harder, enough said.

(27:18):
And then the part that really, really is where plastic surgeons get excited about is nicotine inhibits wound healing. So your tissues aren't getting as oxygenated and the nicotine actually inhibits wound healing. So if I'm making an incision, I need it to heal. And if you're doing nicotine, anything, whether it's inhalational or a nicotine patch or nicotine gum, all of those things are going to make the little blood vessels in your body kind of shrink down. And then you can have wound healing problems. That means the incision can fall apart. You can get tissue necrosis, which is the tissue essentially dying. It's just gnarly. So don't do it.

Bri (28:09):
Don't smoke.

Dr. G (28:11):
Right. One of the worst procedures you can do is labiaplasty, which we do a lot of with you're smoking because

Bri (28:17):
Can you just imagine that part of your body not healing well.

Dr. G (28:21):
Yeah, falling apart? It's no bueno. And then the other area we get super excited about is anytime I'm messing around with the nipple, so any kind of breast lift, breast augmentation, breast reduction, implant exchange, anytime we're breast implant removal, we're doing something to the breast tissue and rearranging it, we're interrupting the blood supply to the nipple and the areola complex. And so what I don't need is an additional interruption to the blood supply via smoking or nicotine.

Bri (28:51):
Quit. Mic drop.

Dr. G (28:53):
Yeah. Also, if we're doing fat transfer again because of the blood supply issues, you're at an increased risk for fat necrosis and having wound healing problem from

Bri (29:03):
We want fat to stay.

Dr. G (29:04):
Yes, if you're going to bother to take the fat out and put it somewhere else,

Bri (29:08):
It's valuable fat. That's fat you're not going to have back in your body unless you're transferring it, of course. But

Dr. G (29:16):
Less and less people smoke, at least in Southern California. But a lot of people do vape, which is the same freaking thing. So just make sure you're letting us know. And then you absolutely need to quit two to four weeks before and you need to stay quitting for two weeks after. And then once you're healed, if you want to go back to poisoning your body, go for it. But I'm not trying to be judgy. I just literally need you to have the safest possible surgery and have the best results possible. And that's why we harp on smoking so much.

Bri (29:49):
Right. And speaking of fat transfer, nutrition is so important after surgery, and a lot of patients feel like once they have surgery, it's like their time to starve themselves and lose weight of some sorts. If you are having surgery, you need to maintain your nutrition. If you're getting a fat transfer, I always say, you got to feed your fat. Okay, we need to optimize survival. Do not start starving yourself after surgery. I feel like it's the most common thing that I hear, you stop eating.

Dr. G (30:23):
Yeah, they're not hungry for maybe the medications, you're tired. Wounds need nutrition to heal, and that's protein, that's hydration, basic vitamins that you can get from eating whole foods. Eating, so the two things can be not eating or eating garbage, like please don't eat processed foods.

Bri (30:43):
Cheeseburger and milkshake.

Dr. G (30:45):
Yeah, peanut m and ms.

Bri (30:47):
Yeah, please don't.

Dr. G (30:49):
I once did, had a patient who had a tummy tuck and I, or some sort of surgery, it might've been a tummy tuck, but this was back when I was at the Navy Hospital and we went to go see her the first morning after surgery because everyone stayed overnight there and she had Krispy Kreme delivered and I thought, really? What are we doing here?

Bri (31:06):
Maybe if you're having a baby. There is no other acceptable food delivery Krispy Kreme, cheeseburger, unless you're having a baby.

Dr. G (31:17):
But yeah, right after having liposuction or some body contouring surgery, Krispy Kreme is not going to help you heal.

Bri (31:24):
And I also, a lot common thing is people are like, well, I've had lipo, I'm not going to ever gain weight back in that place. That's is not how it works, first off,

Dr. G (31:34):
No.

Bri (31:35):
And then if you're spending all of this money to have surgery and then you're getting a fat transfer to your breast or to your butt or to wherever you're getting it and you stop eating, don't waste it. Your post stop care is just as important as having surgery. We were talking to another doctor the other day who did a facelift and his patient went back on her tirzepatide right after the procedure and he is like the wound completely stopped healing. He's like the second she stopped eating, we put her back on nutrition shakes and so forth. But nutrition is so important.

Dr. G (32:10):
You need extra calories to heal. It's most demonstrable in burns, so when people are burned, they need so many calories. So if you've ever done a burn rotation or worked on a burn unit, they have all this food stocked there because they really need the patience to eat. So they just need calories. So this isn't as intense as a burn, but any kind of incision or surgery requires healing and you need to keep your energy up. So usually I think it's a half a gram of protein per kilogram of body weight. So you're aiming for at least 50 grams of protein a day and you can go up from there. More is sometimes better up to a point. So if you're having more than a hundred grams of protein for the average size woman than you're probably not doing yourselves any favors. You're just going to excrete that extra protein. It's going to make your stomach hurt. But somewhere between 50 and a hundred grams of protein is a good starting point and making sure that you're just paying attention to protein intake is helpful. And then balanced diet or taking multivitamin.

Bri (33:17):
Yeah, definitely.

Dr. G (33:19):
If you have a hard time trying to choke down grilled chicken and broccoli or something after surgery, then yeah, a protein shake or a nutrition shake is a great option, honestly. Or something lighter, but making sure you're taking a multivitamin with it is also a great option so that you make sure you're getting all the nutrients that you need for healing.

Bri (33:42):
Feed the fat.

Dr. G (33:43):
Feed the fat. Yes. Feed the incision.

Bri (33:46):
Yeah, feed the incision.

Dr. G (33:50):
Incision wants to heal. Okay, so no smoking, tell us about your medications, including GLP-1s and then what they don't tell you about a BBL, a TikTokers Brazilian butt lift warning goes viral. I mean,

Bri (34:07):
Let's hear it.

Dr. G (34:08):
A cautionary tale where

Bri (34:10):
She contracted a hand, foot and mouth from shopping at Goodwill.

Dr. G (34:14):
No one told her how to sit, sleeping, showering, cleaning her support garments and the emotional. So basically she had a normal process but didn't have any info?

Bri (34:29):
Which leads you to believe, what kind of office did she go to? And I could be totally wrong, to get this done because when we do pre-ops, I mean we are telling you pretty much supplements. We're going through how you can sit. We're giving you advice, we're giving you post-op instructions, pre-op instructions. I mean we even tell you how to shower the night before. I feel like we're very big on post-op care here. So if you're going to an office who gives you no, I mean even if they do give you no post-op care, you can pretty much go on Google and do anything. When I had my first one, I watched so many YouTube videos, I felt more prepared just watching YouTube. So I think that's also, you have to advocate for yourself too and do your research. Don't just go in and have a procedure and then just think, oh, I'm going to have surgery, I don't need to do anything else. Yes you do. You need to not sit on your butt for a certain amount of time. You need to wear your garments, specific garments. There's a lot, surgery is a big thing, even though I feel like people take it so lightly. Oh, it's easy.

Dr. G (35:38):
Right. And we do try to prep people as much as possible. And again, there's patients that take all the information that we give them and take notes and ask questions and are super attentive. And we do understand that when you're talking to a patient or talking to anybody, they get about 10% of what you said is retained. Let's take our average labiaplasty patient, when they come in, Bri, well first of all, they talk to Ava. Ava asks them the questions that we think are important. Are you smoking? Do you have any history of herpes or yeast infections? Cuz that impacts the medication treatment you're going to get around the time of surgery and what's your timeframe for surgery? These are the restrictions after surgery. So don't come in and be planning to move to Dubai in two weeks and think we're going to do your surgery really quick, for example. And then they meet with Bri and go through your spiel with them because it's very similar.

Bri (36:38):
And I pretty much tell them from the get go. I'm like, what I'm going to say, there's going to be a lot of repetitiveness. I ask a lot of the same questions, I go through pre-op, post-op. I go through our medications, I go through their medical history, their allergies, reconfirm medications they're taking. We go through the procedure, we go through the layers of suturing. I go through yeast infections. I go through why it's important to let us know this, and then at the end I bring Dr. Gallus and she goes through the procedure again. And then after that I let them know that I'm going to send them an email a week prior to the procedure, which also has the pre and post-op instructions in it, medications, everything we talked about. And then there's that, like you said, that half the population will have it ingrained in their brain by then and then half will be like, wait, what? I have no idea

Dr. G (37:27):
What, nobody told me anything. Oh, also Ava, when she meets with the patient after we've gone through our spiels, she meets with them and she gives them a packet, printed packet with pre and post-op instructions because again, for these particular patients, it's under local. So we're not even getting into the anesthesia side of things, but it's under local and they don't come back again until it's the day of their procedure. So we are making sure that this is like you are fully informed so they have it in their hot little hands. Then Bri emails it to them again and then on the day of the procedure, we review it yet again. But at least you have been given the opportunity to prep and know, okay, I'm going to need to lay flat. I'm going to need to put my butt on a pillow. I need to have some towels. I need to have pads available or period underwear or whatever it is you're going to wear for the few days afterwards. Know where your loose sweatpants are. All of those things are, you don't want to be doing that after we've just done the procedure and you're waiting for the local to wear off. Prep and the post-op care are super important and we can't underscore that enough.And yet we still have people who are like, gonna to go to Spain.

Bri (38:44):
And here's another thing people love are like, oh, I have time off from work for this two weeks, cuz I'm healing from surgery, I'm going to book a trip. That mindset to me, I can understand. You need to rest. Let your body heal. Don't go, don't go to other countries, go skiing, go cliff diving, do whatever. Now is not the time.

Dr. G (39:08):
Yeah, no, you need to take up scrapbooking or organize your photos or something. I mean, I used to go through the, you're going to be kind of stuck at home for two weeks. So if you don't work from home, it can get a little, you can go a stir crazy, but that is not the time to start moving your furniture around or overhauling your closet because we want you to take it easy. So find something that is relaxing, whether it's binging, hate watching, Meghan Markle's new show or reading a book.

Bri (39:43):
That will make you even more stir crazy.

Dr. G (39:45):
Or finding some project you wanted to reorganize the photos on your computer or on your phone or stupid stuff like that that you never have time for. Those are the things you can do, but please don't jet off somewhere because you're going to be in the airport going to be hauling luggage. So we definitely think, I think prepping for surgery includes deciding what you're going to do after surgery while you're healing, and that is putting your gym membership on pause because you're not going to be able to go for at least two weeks. So just put it on pause for a month and then you don't feel like, oh, I just paid for something I'm not going to use.

Bri (40:23):
Finding appropriate childcare and making sure somebody can help. If you have small children, when we ask all those questions in their pre-op, do you have somebody to help you? Do you have somebody to help if they want to be lifted up? And you're not supposed to be lifting. Even planning your meals, planning, childcare, planning, what you're going to do after everything comes into play after surgery.

Dr. G (40:46):
I recently did a minimally invasive neck lift on a patient and she looks so good and she's the perfect patient.

Bri (40:54):
She was so on top of her post-op care.

Dr. G (40:57):
She was like, when can I stop wearing my garment? And I was like, I feel like she was six weeks out. I was like, oh my gosh. Bless you. You've been wearing it.

Bri (41:07):
I wore my first garment for six months, actually both times. So I had a lift done through another doctor and I ended up getting a hematoma and the suggestion was to not wear a bra post mastopexy, which was not what I should have been told. No hard feelings or whatever I'm supposed to say here. But anyways, because I didn't wear a bra and a lot of people hate wearing it, and they're like, when can I just go back to, I just got to lift free nips, that's fine. But my incisions particularly stretched out and I had to get it all redone because I was told not to wear a bra. I feel like there are certain things, your garments are important, for swelling, it's important for compression. I mean, they help just wear them, just do it.

Dr. G (41:56):
They really do. I wish I had that series of photos that Meghan took where she had liposuction and a fat transfer to her breast and then she had a photo of herself pre then post early on. Then when she kind of got to her final result at three months and then wearing compression at that three months and what you look like and then not wearing compression at that three months and what you look like. And it made a huge difference because you're still healing for three to six months afterwards. So it's very important, which is why we make you come back postop day one and check to make sure garment fits properly. We really want it to work for you.

Bri (42:33):
If you have lipo, they're going to get smaller, come back, get a smaller garment, order a smaller garment, get your lymphatic massages, get the fluid moving. There's so many things postoperative postoperatively to do that are so important.

Dr. G (42:47):
We really do feel strongly like taking some sort of multivitamin or supplement's important. So we do give you Heal Fast, which is a supplement that has all the things you need for healing. We give you that at your pre-op visit and you can keep taking it afterwards. And we also give you arnica. I feel like it does help reduce bruising and swelling. You do need to take your pain medication. I always say no one gets points for not taking it. You don't want to be in pain. You don't want to be uncomfortable. I don't want you to be pain free. I don't want you running around doing crazy stuff, but I want you to be comfortable and not have your blood pressure skyrocket cuz you're in so much pain. You need to take your antibiotics if that's what we're prescribing you, because it helps prevent infection. If you're on a blood thinner or GLP one, we're going to tell you to not take it for two weeks and then not take it for two weeks potentially after surgery. So don't ignore our request.

Bri (43:43):
Think about your, when I had my, I always relate it to experiences, my second lift after I got it redone, I felt so good. I was like, oh, I'm good to go. I was moving after day two, popped a stitch after the pocket was closed up, like you can't be re-fixed unless you have surgery again. You may feel good, but take it easy.

Dr. G (44:04):
Rest. It's so hard. I mean, I get it. It's so hard. We're all very fitness oriented. I think when I had my breast aug at four weeks, I was like, can I go back? And the argument was like, really? You just can't suck it up for two more weeks just to make sure. Two weeks is really a small drop of time in the grand scheme of things. So just really be sure that it's time to go back.

Bri (44:28):
A lot of patients ask if they can take their garments off for events. I feel like that's a very common question. And it's like you can take it off, but you might be a little bit more swollen after put it on when you get home and keep it off indefinitely.

Dr. G (44:43):
Absolutely. Why is this important? It gives you the best result and then also decreases the need for having a revision or having to do something again. So it's worth it. Definitely worth it. And we're here to help you with that. So if you're going somewhere and they're not giving you a lot of information about pre and post-op care, then I would think about how much support you're going to get after surgery from them and maybe ask those questions. Because most good board certified plastic surgeons are going to let you know what you need to do.

Bri (45:17):
And maybe you can touch on why it's important to finish your antibiotics. I know nowadays people do not like to take antibiotics.

Dr. G (45:24):
I'm not a huge proponent of using antibiotics when they're not necessary. So in labiaplasty, you don't use the antibiotic. But for most other procedures I do. And you need to take it for the full course because if you're taking two or three days of antibiotics and then just stopping and not taking the full course, and it's been shown that you're just putting yourself at risk for resistant bugs, resistant bacteria. So that's why you're supposed to take it for the whole course. So all you've done is knock out the bacteria, that's the weakest link, and then whatever bacteria was able to hang on for the three days is going to come back stronger than ever because you didn't give a full seven days of antibiotics to knock it out. So that's kind of how that works. That's why we have those, what we used to call football times of antibiotics. It's like a football score seven days, 21 days. Now with a two point turnover, I feel like it's really messed things up, but back in the day when I was a baby resident, we were like, it's seven days, 21 days, 14 days. Why are these all football scores?

Bri (46:23):
I'm just impressed. You know that because

Dr. G (46:25):
That I know a football score or two point conversion?

Bri (46:27):
Yeah. I'm like, I don't even know what that is.

Dr. G (46:32):
All right. This is not a sports podcast. This is the opposite.

Bri (46:37):
Go Sports.

Dr. G (46:38):
Go Sports. All right. Well, if you have questions about post-op care, recovery, we encourage you to check out our website, explore our YouTube channel where we all have videos about that. If you need information about scheduling, financing, reviews, photos, definitely reach out and give us a call.

Bri (47:04):
Yeah, give us a ring-a ling.

Dr. G (47:08):
Going to pretend you didn't say that.

Bri (47:08):
Unless you have a ding-a-ling.

Dr. G (47:10):
Yeah, yeah. Unless you want penis enhancement surgery, then we're not here to help. Sorry.

Bri (47:16):
Then you're done.

Dr. G (47:18):
Anything else though, we're here for you. Alright, so that's a wrap. Thanks for joining.

Bri (47:26):
Alright. Be back soon. Catch you later, bitches.

Dr. G (47:30):
Bye. If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.