Bold Implant Sizes, Big Questions & Blake Lively’s Bad PR

Dr. Gallus (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. On today's podcast, we're going to go through some of the random plastic surgery questions that you're dying to have the answers to, but before we get to that, I have some Blake Lively stuff I need to get off my chest. Bri.

Bri (00:19):
Tell it girlfriend.

Dr. Gallus (00:19):
What is actually happening with this movie.

Bri (00:24):
What a disaster.

Dr. Gallus (00:26):
I just don't know how you can try to promote a movie and then

Bri (00:32):
With such a significant message.

Dr. Gallus (00:33):
And then turn around and end up almost getting canceled. Like Girl who's your PR? Now, it's well known that she doesn't have a stylist as is reflected in her choices for the red carpet, but does she not have a publicist?

Bri (00:52):
I mean, whose bright idea was it to also launch her haircare at the same time?

Dr. Gallus (00:58):
I know it's very self-promotional, and I heard her and her husband, Ryan Reynolds got involved in the movie, This Is Us, This Ends With Us? This Ends With Us.

Bri (01:08):
Yeah, because they both produced it and they funded most of the movie, and then there was all that like, oh, she casted herself as the lead, and then they don't get along, and then, like this is a disaster.

Dr. Gallus (01:22):
Yeah, it is all about not getting along, and I feel like this is a classic case of you've bought your way into this movie, and so your expectation of what you can control is tied to that. And then you have Justin Baldoni. I don't know. I know as Raphael from Jane the Virgin.

Bri (01:43):
Yeah, I know.

Dr. Gallus (01:44):
I was like, who? And then I'm like, okay. Anyway, he clearly had an agenda and imagined himself as being in charge, and I think slowly just gave up at some point was like, I can't with these people, her and her husband tagging along and sticking their fingers into everything and having a completely different approach. I would just say, yeah, especially as the actor that is,

Bri (02:08):
It was not very demure, not very mindful.

Dr. Gallus (02:12):
Right. Poor him, because I feel like as the actor there is the one who's playing the neurosurgeon that is the abuser in the abusive relationship in question. There is no way he can walk the red carpet and be like, where are your florals, and bring all your girlfriends. You play the bad guy. So there's no way he cannot not approach it by talking about domestic violence and how important it is to have resources and all these things. And then she's on the other end promoting her haircare and wearing florals.

Bri (02:45):
Wrong time. Wrong time, Blake. Not appropriate.

Dr. Gallus (02:48):
I know.

Bri (02:51):
Also, can we side note that she made her one-year-old a boob cake?

Dr. Gallus (02:56):
Oh, right. Yes.

Bri (02:59):
I don't know why.

Dr. Gallus (03:02):
I don't either.

Bri (03:02):
Out of all the cakes. Okay, now we can move on.

Dr. Gallus (03:06):
Yeah, let's not dredge up every weird thing she's done because there's been a handful. Okay, so here's our headlines for the week, Is Christina Aguilera on Ozempic? That was also, asked and answered moving on. No, she looks radically different.

Bri (03:23):
She looks phenomenal, but there's just absolutely no way, and I would love to give her all the respect that that's, I'm sure green juice and diet like Martha, horseback riding and green juice, but there's just no way in such a short amount of time that she's not taking Ozempic or some sort of weight loss drug. I mean, she's tiny.

Dr. Gallus (03:48):
Yes, she is back to her 16-year-old self in these images. And then I don't know how long it's been since we've seen her, so how fast this weight loss happened, but the fact that everything's tight and right in this setting is impressive. Some of these pictures, her face doesn't look like her face anymore. So then I guess you could speculate on what she has had done. But I will say a lot of times there is some intense makeup that's happening.

Bri (04:26):
She definitely got some masseter Botox of some sort.

Dr. Gallus (04:30):
Or buccal fat pad removal or just the weight loss. It's hard to know what has slimmed her face so much. But yeah, her lips look insanely larger, so that's probably filler. And again, makeup, it almost looks like she's had a lip lift. Her nose looks different.

Bri (04:46):
Looks like she got her nose done.

Dr. Gallus (04:49):
Pretty similar, but yeah, I don't know if she had any laxity after losing weight, the so-called Ozempic face and she had to have had some tightening done.

Bri (04:59):
I just feel like these stars, celebrities are larger for such a long time and then all of a sudden everyone's just getting skinny. There's no way that the diet just kicked in within the last nine months or a year. Ozempic has been out or popular at least.

Dr. Gallus (05:18):
Yeah, it's not possible, so just admit it. That's fine. We would love that for us.

Bri (05:23):
Be at peace with it. You look amazing.

Dr. Gallus (05:26):
Yeah, and you still don't get to eat when you're on these medications. You're just not as hungry, but.

Bri (05:34):
So what do you think when people do take Ozempic, what happens with all the loose skin? What do surgically do you have to surgically remove it? Do you tighten it?

Dr. Gallus (05:44):
So it depends on your age because the younger you are, the more resilient your skin is in terms of stretch and bounce back. And also probably she's 43 now, she's probably gained in lost weight multiple times. So every time you do that, your skin's losing a little of its elasticity and she's older, so that probably doesn't help. And then probably most important, it's the rate of weight loss, so how fast you lose the weight. If you are able to titrate your medication, your weight loss injectable carefully and not go for broke, then you should be losing one to two pounds every week to two weeks. But if you drop all that weight quickly, you're going to have a lot more loose skin because your skin doesn't get a chance to tighten as you go. So slow healthy weight loss is still the way to go no matter what tool you're using. But a lot of these celebrities have basically plastic surgeons and med spas at their disposal so they can do non-invasive skin tightening and invasive skin tightening through the whole process so that they get optimal outcomes.

Bri (06:50):
She just looks like a mix right there of Kim K, Lady Gaga and Christina.

Dr. Gallus (06:57):
Oh yeah, she is giving some Gaga vibes.

Bri (07:00):
Yeah.

Dr. Gallus (07:00):
She's on the cover of Glamour and her speculation over her weight was not any anybody else's business. Okay.

Bri (07:11):
Just say, yeah, Ozempic body, be proud.

Dr. Gallus (07:14):
It kind of is everyone's business when you pose on the cover of Glamour.

Bri (07:18):
Right, exactly.

Dr. Gallus (07:20):
Wearing a super short dress, but that's fine. Her face does look totally different. And again, on these photo covers, it's always hard to know how much of it is just photoshopped photo edited, what she looks like in real life, how much of it is plastic surgery? Good for her, but I'm glad she's at a healthy weight. Okay, well enough about Christina. Let's talk about Sammy Sheen's OnlyFans model. So this is a daughter of Charlie Sheen who had what she's calling the scarless nose job.

Bri (07:59):
How? Is this filler?

Dr. Gallus (08:00):
No, so that's what I thought when I first read about it. So you can do something called a liquid rhinoplasty where we use filler to change the contours of your nose, and that's done with an injection, and so it doesn't last as long as obviously a permanent surgery, but can give people a little bit of an idea of what they're going to look like. It does also, your only tool is to inject, so you're going to make things slightly bigger. You're not reducing anything by injecting filler. She is talking about what is known as a closed rhinoplasty. So the two major ways of doing rhinoplasty are through an incision, usually right at the columella, so at the base of her nose, which is it is visible in this image, there's clearly no incision there, although that incision heals really well. And then going through incisions kind of inside past your nostrils, so you're making little incisions on the septum and on the inside of the nostril to do all your work.

(09:00):
It's interesting because that has kind of swung back. It was super popular to do closed rhinoplasty 20 or 30 years ago. Then everybody did open rhinoplasty, which is through that open incision, and now closed rhinoplasty is trending again. Usually when things are swinging back and forth, it just means that there is no one right way to do it. I think rhinoplasty is a classic example. I don't do that in practice anymore, but Dr. Chow who's joined us does. She prefers open rhinoplasty, but to be honest, it depends on the person's nose and what their goals are. So if you're doing a ton of tip work, which is that pointy part of your nose, you probably need to be open. If you're just taking down a little bump on the nose, that can probably be done closed and then you can imagine anything all in between. And it looks like she just had a dorsal hump that they were reducing. So she's a good candidate for a closed technique. Again, it depends on the surgeon's experience and what they're comfortable doing and what their actual plan is, because there's such a wide variety of how rhinoplasties are approached depending on all those factors.

Bri (10:13):
Well, it looks great.

Dr. Gallus (10:13):
It does look really nice, to be honest. I've seen some presentations because her surgeons in Beverly Hills from Beverly Hills Surgeons where they show these before and afters and the before is totally normal.

Bri (10:30):
You're like, why?

Dr. Gallus (10:30):
Wait, and then after they just have a different prettier nose, but their nose was already pretty, so it's kind of unclear what we're accomplishing. But she did have a little bit of a hump, which I'm sure bothered her, and she mentioned that she was constantly photo editing it out, and this is take two on her journey of plastic surgery. Hopefully she slows it down. Her breasts look great. She's had a breast augmentation and now she's had a rhinoplasty.

Bri (11:00):
And now is a closed rhinoplasty also done under general or is it something you can do under a local where you're awake?

Dr. Gallus (11:09):
Most people will do that under general anesthesia. You can do rhinoplasty under sedation, but it's pretty uncomfortable.

Bri (11:17):
That doesn't seem very fun.

Dr. Gallus (11:18):
No, it does not seem fun. So the recovery already feels like you've gotten punched in the face. So I feel like I would like to be asleep for the actual procedure. In my opinion. That's what I would recommend. Yeah. Yeah. It's interesting that, I mean, what's the return on your investment for that? I hope she's making good money on OnlyFans.

Bri (11:39):
I know, right? I have nothing to justify the rhinoplasty. I'm going to make Dr. Chow give me. You'll get zero return.

Dr. Gallus (11:46):
Okay. Moving on. Charlie XCX, who I thought we would never hear from again, but then we approached our brat summer had has, she had a fox eye facelift, which, you know.

Bri (11:59):
She looks like she had PDO threads all up and everywhere.

Dr. Gallus (12:03):
Yes. Why don't you tell us, do you know what, can you explain to everyone what PDO threads are -ish.

Bri (12:09):
PDO threads, I'm sure you can explain so much better, but they look like little barbed suture and you place it and you pull it up and it kind of pulls all the skin up and I'm just so curious what happens to all that bunching?

Dr. Gallus (12:24):
Oh yeah. That's always a potential problem. The bunching can happen. You need to kind of smooth it out in some patients. So to be honest, she's a good candidate just because she's young and has nice healthy skin to put over the, you don't want to put it on a thin skinned, older patient using the threads because you will get some bunching in different places. So it's important that the person know they're what they're doing when they place the threads.

Bri (12:50):
Because that won't settle, right?

Dr. Gallus (12:52):
No. Yeah, there's no settling there. Just the threads will dissolve over time most of the time. The original threads back when I was a resident were actually permanent, which was such a terrible idea. The original thread lift and caused all kinds of problems. So they took 'em off the market and then now they're back with these threads that are made of absorbable suture and they have either little cones or spikes so that once you put 'em in and pull it, pulls your tissue and catches it, and then it depends on where you're placing it, what the lift is, the effect is, and it can't lift heavy tissues. It's really good for that brow lift. However, the amount of time it lasts is about six months. So it's like a filler but not adding volume. So it's pretty temporary, which is great because if you hate it or your brat summer is over, then you can go back to how you look.

Bri (13:47):
She's like, it's gone. Yeah, she doesn't look like she's had a facelift, just looking at her ears specifically.

Dr. Gallus (13:54):
She's too young, I think

Bri (13:55):
She looks like she's just had filler and possibly threads.

Dr. Gallus (13:59):
And some great makeup contouring and the way her face is angled, you have to remember, these celebrities know how to pose for photos and all those things. They get their best side.

Bri (14:09):
Right? Yeah. Don't come into our office. I'm like camera down here, like double chin. We got to work on our angles.

Dr. Gallus (14:18):
Yeah, I don't have the, oh my right side's my best side.

Bri (14:21):
Well, it's just super convenient because my left side is my best side. So when we pose together,

Dr. Gallus (14:27):
Yes, we get that right.

Bri (14:28):
We already have designated sides. It's really inconvenient to have friends that also have a good left side. I'm like, Nope.

Dr. Gallus (14:37):
Yeah. Then you're like, no, I can't be friends with you.

Bri (14:38):
You can't be on my left.

Dr. Gallus (14:43):
All right, well, let's get to it.

Bri (14:45):
Okay, so some random questions all over the board. First off, board certification, why should we care about it? But to state, I personally did not know this, that barbers used to do surgery and I was so caught off guard. They used to cut hair and then cut limbs and fix ulcers and lesions, and I was like, and then pull teeth. We've really evolved.

Dr. Gallus (15:15):
We have evolved.

Bri (15:16):
I would not let my hairdresser cut off my limbs.

Dr. Gallus (15:22):
So that is going back a few hundred years. But yes, there were barber surgeons originally, which I find hilarious that you're figuring this out. But no more do barbers cut hair and also remove body parts. Didn't work out that way. And then the discipline of medicine was created.

Bri (15:41):
Certification is important.

Dr. Gallus (15:44):
So not only is certification important, but certified in the right things is super important. So board certification is something that once you've trained as a physician in a specific specialty, you take these tests and depending on the specialty, the tests are a little bit different. Sometimes they're more challenging than others. You can imagine the more sought after residency, like plastic surgery or ENT or neurosurgery, have some pretty demanding tests that you need to take for certification. So for plastic surgery, for example, you take a written test once you're done with your plastic surgery training, which is anywhere from, let's see, is it six years or three years if you've already been board certified in something else. So somewhere between six and eight years of training, you then get to take a painfully long written test. Once you pass that written test, then you spend a year collecting every surgical case that you've done for that year. Once you're done collecting all those cases, you submit them to the board on the American Board of Plastic Surgery, they review your cases, they pull five for you to defend essentially, and then you go for an in-person exam where you sit in three one hour rooms. It's usually in a hotel room, which is bananas, but that's just how it's done.

Bri (17:05):
And was it you that told me one time some guy walked into a closet and was so embarrassed he stayed there in the first exams?

Dr. Gallus (17:12):
Yeah. I cannot underscore how terrifying these exams are. So classic, so they were talking about how in the good old days, because the setting was a hotel room and you stand outside the door and then you're let in, and then three board examiners are going to ask you questions that it was so nerve wracking and that now there's rules like the three people have to sit in chairs and you have to sit in a chair. But these jokers would ask questions by laying on the bed or from the bathroom, just really inappropriate.

Bri (17:43):
Imagine having your preceptor in the bathroom.

Dr. Gallus (17:47):
Just awful. So anyway, they terrified this one resident so much that when he went to leave, cuz he thought he had failed, he panicked and went into the closet instead of out the door, and then just stood there. What are you going to do?

Bri (18:02):
He's like hmmm.

Dr. Gallus (18:04):
I managed to get in and out of my rooms. It was a little bizarre. So you're in there, two of the rooms, the examiners are going to ask you questions about any cases they want to ask you about plastic surgery, and then in the third room, they review the cases that they've chosen from your year of collections. So ENT is also very similar where you have to take a written test and then you have to present cases, and then general surgery, you have to take a written test. You do do the same three room situation, but there's no cases to present. All the cases are made up, which was plenty terrifying at the time. Just I didn't know there was another level of pain with plastic surgery, with talking about your own cases that you had done, but it's still pretty terrifying. You have to make sure that you're listening carefully as they're asking the question.

(18:54):
You don't want to misunderstand what they're asking and screw something up. It's exhausting to be mentally on in the game for 30 minutes while these people are firing questions at you. And then you get penalized a little bit if the first scenario that they feed you, you answer everything correctly. Well, they have to fill the 30 minutes, so the less hemming and hawing you have, then the faster they get three questions. And so in my last room, I distinctly remember in general surgery, I ripped through a bunch of questions, and so they were on a last scenario, and I was just over it. I think they presented me with a very, very old man who had I think a hernia repair and then had maybe a testicular vein thrombosis. What did I want to do? And I literally probably had 30 seconds left on the clock and I was like, I'd just removed the testicle. He doesn't need it.

Bri (19:54):
He's fine. He's fine.

Dr. Gallus (19:57):
Then I left and I was like, I just didn't want to have to explain taking him back to the OR and exploration. It was like the last 30 seconds of the last room of an hour and a half of all this nonsense. And I was like,

Bri (20:08):
Yeah, he's good.

Dr. Gallus (20:08):
I'm just going to a mic drop. He doesn't need it. Just take the testicle. And then I was like, I left.

Bri (20:15):
I feel like that was kind of in my school, you would be like, oh, this patient has shortness of breath. And they'd be like, oh, but you didn't find the gunshot, the stab wound, the perforated bowels. I'm like, oh, okay. It's fine.

Dr. Gallus (20:28):
Anyway, so you can imagine you go through eight years of training. You do this test, you do a written test that takes eight hours. You have to travel somewhere to do the oral exam that you've prepped for a year for, and then you finally get to be board certified, and then you have to do maintenance of certification. So every year I take another test and fill out paperwork and dues and all of that. So I am a board certified plastic surgeon. Nothing is more infuriating than someone who recently advertised themselves as a board certified plastic surgeon on social media, and she's in Ohio, I believe, and we all went bananas because she considered spending some time with an ENT surgeon who's also not board certified in plastic surgery and doing over a hundred cases with him, the equivalent of board certification in plastic surgery we're like,

Bri (21:22):
You are way to undermine everyone that's actually a board certified plastic surgeon.

Dr. Gallus (21:26):
Nope, not the same thing.

Bri (21:27):
I'm also a surgeon because I work in surgery.

Dr. Gallus (21:31):
Yeah, I was like, so if I spend a couple weekends delivering babies, then does that make me an OB GYN? It is not the same thing. Yeah, I guess so.

Bri (21:41):
Yes. Okay. What are the biggest breast implants that you have put in and were they silicone saline?

Dr. Gallus (21:51):
So I would say, okay, so the largest silicone implants you can place currently are 800 ccs. That's the biggest you can place.

Bri (22:01):
Ouch.

Dr. Gallus (22:01):
And I have placed those, but not of my own accord. So I put them in, when I was in training, I worked with a surgeon who had no boundaries. You want three hundreds? I'm going to give you eight hundreds. The patient already had four hundreds, but she wanted bigger. So we were exchanging 'em to eight hundreds and she was a tiny person. So I can't say that I endorsed that practice. And there was somebody in town who did extremely large implants for a long time before he retired. So since 800 is the largest you can get with silicone, then he would do saline implants, which I believe go up to 900 ccs, but doesn't matter because you can overfill a saline implant. So you can go to 1,011 hundred ccs, which is a little over two pounds in weight on each breast.

Bri (22:49):
So you can subtract 10 pounds from your weight. That's what I do.

Dr. Gallus (22:54):
No matter what the procedure.

Bri (22:56):
Exactly.

Dr. Gallus (22:58):
Yeah. So 2000 or less or a thousand ccs of saline in each breast is a lot. Really just, I can't imagine a scenario in which you might need that for a cosmetic procedure. I don't recommend putting that in. I would say the largest implants I've put in are just shy of 600 ccs, but depending on where you live, that might be more than norm.

Bri (23:25):
Now we have had a couple of patients who are like, oh, I thought they were three hundreds or my doctor put in six hundreds. Are there any legal issues around that?

Dr. Gallus (23:35):
So I mean that's between you and your surgeon. You should probably know what they're putting in. I would say in most cases, people just don't remember what they put in. The surgeon is supposed to provide an implant card after the procedure. It's just that often gets lost. They're supposed to register the implant. So if you could at least narrow down what manufacturer you used, you would be able to call them, give them your kind of protected health information, and then they could find, look you up in the system. But we just had a situation today where someone had sort of agreed on a size of an implant, but then woke up with larger implants. It's less often now, but a lot of times doctors will make that agreement with the patient, I'm planning to do this, but I'm going to let you know that I'm going to go with my best judgment, if you're comfortable with that, and women agree to that. I tell my patients, we're going to decide what size implant we're putting in, and that's the size implant we're putting in. So we want to make sure that conversation is complete and we know what we're getting into because I'm not going to change my mind on the table and be like, yeah, you know what? She'd really like five hundreds because I see the downside of that all the time. So we're going to agree on a size, and that's the size we're going to put in. That's much easier for primary augmentation, so first time. When you're exchanging, that's where when people don't know what's in there and they want to be the same size or a little bigger or a little smaller, it would be really nice to know what we're starting from. And we've seen that be all over the map where people are convinced they have X in, and then you get in there and you're like, oh no, girl.

Bri (25:14):
I feel like we did a case a couple years ago and the implant size was so off, and I think we waited like an hour or two to get totally different sized implants.

Dr. Gallus (25:24):
Yes.

Bri (25:24):
Not even close to what we thought they were.

Dr. Gallus (25:26):
No, I usually pick that up in advance, but the patient was so confident that she had 400 CC implants in and she wanted to go up by 50 ccs. So I ordered probably 300, 350, 400, 450, you know, you still cover your bases. And we got in there and they were 200 ccs. You're like, cool.

Bri (25:51):
Wow.

Dr. Gallus (25:53):
So she wants to be 50 ccs bigger, so I need a 250 cc implant, which I did not bring to the OR because why would you? We weren't in the ballpark. So it's nice to have the information, but a lot of times you just flat out don't.

Bri (26:08):
And what do you do to help patients pick their size implants? What do you have in office if they have no idea what size implants they want?

Dr. Gallus (26:16):
So we talk about how much larger they want to be in cup size. So if you want to go up a cup size or two cup sizes, you can kind of loosely translate that into a hundred ccs. We have the 3D vector camera, so if you don't have implants in, we can simulate putting implants in that give you an approximation. If you tell me I want to go a cup size or up, I can give you a range of options based on the dimensions of your current breast, how much volume you currently have. And then the other thing that's sometimes helpful or actually is oftentimes helpful are wish picks where people show me, oh, this is what I want. Because almost everyone to a fault as they want a natural look, they show these big 500 implants. Yes, I've had that happen where the images they show me from, they're showing me Kat Von D, I'm like,

Bri (27:11):
I want to be super natural. I don't want anyone to know I have implants, but this is what I want.

Dr. Gallus (27:16):
But this is the look I need. And you're like, okay, well she has 600 cc implant. So that's the OnlyFans model. Not natural, but that's fine. Still, it's kind of what you want. Some people don't want to have implant surgery and then have no one notice. There's every spectrum. Some people are just trying to kind of fill out what they had before they had kids. Some people want something for effect. It depends on so many other factors. Are you a petite person? Are you four 11 or are you six feet tall? So those are all things that we use to decide. So really talking to the patient, having them look at the implants in office, having them look at simulations on the computer with the vectra, having them show me wish picks, and then my least favorite thing to do is use the sizer system where they can put that in their bra. It's these little chicken cutlets. Although supposedly they're upgrading that. I feel like it gives the least accurate assessment of what they're going to look like, but it's not unhelpful. I know older plastic surgeons who have used bags of rice to put in their bra.

Bri (28:26):
Oh, interesting.

Dr. Gallus (28:26):
I've never tried that personally, but that's another option.

Bri (28:31):
I have to get some rice in the office. Here just shove this in your bra.

Dr. Gallus (28:37):
And they weigh it out. So like 200 grams of rice is a 200 cc implant. It's obviously not.

Bri (28:43):
It's like an OG system.

Dr. Gallus (28:45):
I know, in a pantyhose, that's what they do.

Bri (28:48):
I love that. I just can, can't imagine that like a patient, you just hand them a pantyhose of rice.

Dr. Gallus (28:54):
Yeah. It's really not the vibe of our office.

Bri (28:58):
Not at all. So yeah, so I could talk about implants and ask many questions, but I'll save that for our segment on breast augs. So do you or other plastic surgeons Photoshop any before or afters?

Dr. Gallus (29:13):
Oh yeah. That's not a common problem, but it's something that you see on Instagram all the time I think.

Bri (29:23):
Heavily filtered

Dr. Gallus (29:25):
The OG before and afters are those, I don't want to get a cease and desist, but generally skincare companies that are part of a multilevel marketing scheme where they're trying to sell you something and it's like facelift results with using their skincare. Those are probably filtered. Yeah. It's either airbrushed or as you well know, lighting and angles can dramatically change how someone looks so you can get a different result. That's why with those celebrity before and afters, oftentimes we're not looking at them in the same smile. Their head's tilted differently, the lighting's different, the makeup's different. All of those things can enhance or make your before and afters look different. The amount of flash. And then my personal current pet peeve is the on table afters where the patient is lubed up in, I don't know what.

Bri (30:24):
Showered in baby oil.

Dr. Gallus (30:25):
Yeah, they have baby oil or lube or something so that they look shiny.

Bri (30:30):
And I'm start doing that to our patients. I'm just going to get some of that lube out of the back and just be like,.

Dr. Gallus (30:35):
I don't know why they do that.

Bri (30:36):
Please hold.

Dr. Gallus (30:37):
I feel like it's very popular in Brazilian butt lift or gluteal fat grafting before and afters to do that on table and abdominoplasty tummy tucks. It's that on table, lubed up, overly.

Bri (30:50):
I've seen that in this, I follow this account from, it's from Mexico, but it's literally on the table after surgery and they're completely shiny, the whole everything. And I'm like, huh, interesting.

Dr. Gallus (31:04):
So for starters, you're lying flat, which makes you look better, especially for the gluteal fat transfer. It's immediate on table, which with fat transfer, you're not going to hold onto all that volume. So I mean, they're smart. It looks good. But what's the six month post-op look like? How much did they keep?

(31:24):
Yeah, and then I'm not exactly sure what they think the baby oil adds to the look, but it's definitely a vibe and it's definitely what people do. And the same thing for the tummy tucks, and I find it just a tad objectionable on so many levels. And then I had been for a brief, well, so I had been elected to be ethics for the American Society of Plastic Surgeon. I was on the ethics committee and then became ethics chair. And as ethics chair, you review cases that are, people complained over the course of the year of which it was enlightening. But one of the complaints actually came in for another, multiple complaints came in when someone sees another person's Instagram before and afters that have been clearly photoshopped, and they will report their fellow surgeon to the board of ethics. And we usually have them speak to why they did that or if they even know their social media people are doing that, or have them correct it or take it down. It depends on a lot of things, but it's a professionalism problem. It's a violation of the ethics code to do that. But it was interesting because I saw some of these before and afters and you start to learn to pick up what's photoshopped. So pretty much anything the Kardashians put out is photoshopped. I mean, they're not promoting before and afters, but you can tell because a patient's posting and the wall is a little warped. That's a clearly altered after, which is just unnecessary.

Bri (32:57):
Do you ever do or any colleagues that are plastic surgeons treatments on yourself?

Dr. Gallus (33:06):
Oh, of course.

Bri (33:08):
Duh.

Dr. Gallus (33:08):
Duh. Yeah, so I mean, just because we're doctors doesn't mean we can't do stupid things. So a lot of us will not want to ask for help is really the bottom line here. So I have done my own Botox before. It's just a little bit challenging. You can't see how much you're injecting at a time. I've injected my,

Bri (33:28):
It's fine.

Dr. Gallus (33:28):
Yeah, it's fine. I mean, I have to deal with my own consequences. I've injected my lips before by myself. I have a pretty high pain tolerance, so I can handle those things, but the smart move is to have a qualified other person do it. And most of the time that's how I do things. I've had friends excise their own skin cancers on their face before.

Bri (33:50):
Stop.

Dr. Gallus (33:52):
Yeah. I've never been brave enough to do that. I had a little mole that I was worried about and I had my husband remove it, and

Bri (33:59):
That's how she knew he worked in general surgery, not plastic surgery.

Dr. Gallus (34:03):
I know I let a board certified general surgeon remove the mole, albeit it wasn't on my face.

Bri (34:08):
He's like, I'm going to make sure all the margins are gone.

Dr. Gallus (34:11):
Right. Yes. I have a large scar from that. Luckily, it's on my back. Yeah. I don't know, I think the other procedures would be harder to do on yourself. I'm certainly not capable of doing liposuction on myself or any major surgery, but you already know a whole crowd of people who can do it. So we usually reach out to our friends for procedures if we need them.

Bri (34:35):
Don't be the after hours nurse who fatally killed herself trying to do liposuction.

Dr. Gallus (34:41):
Right. That's never a good move. Yeah, something shouldn't be do it yourself, for sure.

Bri (34:49):
DIY lipo.

Dr. Gallus (34:52):
What could go wrong?

Bri (34:52):
I know. It's fine. It's fine. So being a doctor, when you're out in public, if you're on a plane, if there is an emergency on the street, do you help? Can you help? Are you the good Samaritan?

Dr. Gallus (35:06):
That's a great random question. Yeah, I do help if I'm,

Bri (35:09):
Are you going to put a pen through someone's, trach someone with a pen?

Dr. Gallus (35:14):
I mean

Bri (35:15):
Like the Good Doctor.

Dr. Gallus (35:16):
My plastic surgery training wouldn't help with that, but as we all recall, I did spend seven months in Afghanistan doing trauma surgery with limited options. So I have the capabilities, if I think it's indicated, I definitely went through a phase where I feel like people were trying to die around me in public places. So I've given CPR multiple times, on a bike path, at a restaurant. It got to the point where I would

Bri (35:44):
Gotta stay clear of you.

Dr. Gallus (35:46):
Yeah. I was scoping out my environment like, okay, who's the most unhealthy person here? One time I actually saved a guy from choking at, I was just out buying something with my, I think it was at a deli kind of deli meat market, and I had, my youngest daughter was two years old, and she had her sippy cup and we were behind the guy who had a baby, an eight month old baby strapped to his chest in one of those Bjorn things. And at this place they had chips and dips you could sample, and I guess he had just taken a chip and he started choking on it and he couldn't speak. So he is looking at Juliana's sippy cup, her unicorn sippy cup, and I'm like, do you want it? He didn't do this. He didn't do that. But eventually I figured out what was going on, got the baby unhooked, gave the baby to my mom, and was ready to start the heimlich. And then he thought the cashier gave him water, and then it all was okay. And the meantime, my daughter was like, what is happening? Wait, are we taking that baby? What's going on with your baby?

Bri (36:55):
I thought you were going to say you gave the baby to your 2-year-old.

Dr. Gallus (36:59):
No, my mom was with me.

Bri (36:59):
Gotta do what you got to do.

Dr. Gallus (37:01):
I know. I was like, someone hold the baby for two seconds. Yeah. He was so embarrassed, but I was like, again, why can't I just go pick up some food without having a crisis? But he had been gesturing to the unicorn sippy cup because he thought if he could just get some water in, he could clear whatever, the chip.

Bri (37:18):
You're like get your won sippy cup.

Dr. Gallus (37:19):
Right. We don't know where this has been. Oh my God. Yeah.

Bri (37:26):
So do you think social media nowadays has changed the way plastic surgery is done? People try to be more trendy with plastic surgery?

Dr. Gallus (37:35):
I think plastic surgery might be more acceptable because people are talking about it on social media, but I just think it's the way everybody communicates and searches for things is through social media. So I think Gen Z is now, nobody Googles it

Bri (37:49):
Googles anything.

Dr. Gallus (37:51):
They look for it on TikTok, which is,

Bri (37:53):
I tried to ask my sister something and she was like, oh yeah, I don't even use Google. I just TikTok it. And I'm like, what?

Dr. Gallus (38:00):
Yeah. Yes. Okay. So I think that has changed how plastic surgery is marketed for sure, because you have to be able to reach people where they're at. It's interesting though, because Google values highly informed Google search results are based on how accurate something is or how well they can validate something being true. Whereas if you can throw it at the wall and it sticks, it's going to trend and you can't do a deep dive. I mean, you can do a deep dive in TikTok, but you're still only hitting the surface, so you're not going to get some long form blog about the ins and outs of liposuction on TikTok. You're going to get snippets of, I don't know what nonsense sometimes. So it's really hard, I think, to convey accurate and complete information on social media. You have such a short soundbite to do it in, but it's definitely the way stuff is getting distilled down.

Bri (39:01):
Every time I come home, my daughter is like, oh, I need this. I saw it on TikTok today, and I'm like, yeah.

Dr. Gallus (39:06):
I know. I know. Well, I remember when my kids were growing up that they didn't watch tv like we watched tv, so they're watching streaming, right? You are on whatever, Netflix or something. So I'm like, cool. There's no more commercials.

Bri (39:26):
What is a commercial?

Dr. Gallus (39:28):
So how are they going to know what they want to buy?

Bri (39:31):
Right. Where's QVC or what was, how am I supposed to buy diamonds and Tupperware?

Dr. Gallus (39:39):
So the way things are advertised are totally different. And I was like, oh, I wonder what's going to, I didn't think what is going to fill that void? I just thought, cool. They're not going to see commercials about my little ponies, but nope, because you've got YouTube with ads, you've got TikTok telling you what's important, and it's like they're all on the same page being fed the same consumeristic stuff, so whatever.

Bri (40:02):
I feel like that's how people vet surgeons before and afters. I mean, everything's through TikTok.

Dr. Gallus (40:08):
Yes.

Bri (40:09):
Yeah. Okay. So when you're out and about and you're looking at people, do you ever look at somebody and you're like, oh, that really needs to be fixed? Because I'm not even a surgeon, I don't want to sound shallow, but I look at somebody, I'm like, that really could be fixed. This could really be enhanced.

Dr. Gallus (40:32):
I mean, sometimes I think I tend to notice things that I know my general surgery husband doesn't notice, so I will pick up on maybe a scar or a congenital hand anomaly or maybe some subtle something that the person has that the average person might not notice because I know what to look for or I can pick up on it. I'll be like, oh, they have a trach scar, like a scar across their throat. I wonder what the story is behind that kind of. So I definitely pick up on that more often, and sometimes I see things that could be better.

Bri (41:12):
But you can't go and offer it to people.

Dr. Gallus (41:16):
No, I think that is the absolute worst thing to do. So tacky, someone comes into me and tells me, I mean, I have a lot of older patients that have these implants that have been in for 20 or 30 years, and they're coming in to talk their implants. I'm not going to tell them they need a facelift if they don't want a facelift. That's ridiculous.

Bri (41:36):
I know what your boobs done, but have you considered your face?

Dr. Gallus (41:41):
Yeah. I mean, you've done no Botox, no fillers. You look your age because they're happy looking their age, and they're comfortable with that.

Bri (41:51):
No one else's place to suggest.

Dr. Gallus (41:53):
No. Yeah. I don't know. I hate it when people are like, okay, so now we've talked about my breasts. What else do you think I should fix, doctor? I'm like, Nope.

Bri (42:02):
Don't ask me.

Dr. Gallus (42:04):
No, it has to be important to you. Right? Everybody is their own worst critic, and I think if it doesn't bother you, why would I point that out? You need to be confident about yourself.

Bri (42:15):
However, I just want to say there was a point where my pants were off in this office and she pointed out a dimple.

Dr. Gallus (42:23):
You're different.

Bri (42:26):
We were looking at cellulite in all fairness, and now I can't unsee the dimple, and I'm like, you have to fix this dimple.

Dr. Gallus (42:32):
We will fix the dimple.

Bri (42:35):
But once somebody else points it out, then you kind of hyper fixate on it and you're like, I've really never paid attention to this until now that I know it's there. It's your fault.

Dr. Gallus (42:45):
It's a little bit of a volume loss. I know, see, that's why I don't do that. You were asking me about cellulite, which you don't have. Yeah. See, that is the downside of pointing out things people didn't ask you about. To be honest, there are some circumstances where I think, so this comes up with facial surgery all the time. If someone comes in for eyes and you don't point out that you're going to make their eyes look younger, but their brows are going to be heavy or that they want to do a facelift, but they don't want to do their eyes, I mean, sometimes you're treating the face as a whole or the chest as a whole. Sometimes it's important to say, oh, you might want to consider this. But a lot of times, again, if it's not bothering them or it's not in their budget, then fix the thing that they're most concerned with and that is bothering that person individually and is going to help them be more confident and smile more and have a little bit more sass in their step. Then that's all you need to do.

Bri (43:51):
We love that. Put some pep in your step.

Dr. Gallus (43:54):
That's right. Tight and right.

Bri (43:57):
Amen. Sister, did you know the first rhinoplasty occurred in 600 bc? Very first cosmetic surgery ever? I did a lot of research today on Google.

Dr. Gallus (44:11):
I feel like you should look that up on TikTok and verify.

Bri (44:14):
I know. I always thought it was like an leg amputation.

Dr. Gallus (44:19):
No, I feel like it is, I don't know that it was a rhinoplasty. I thought it was a forehead flap to reconstruct the nose. Not to get too technical.

Bri (44:25):
I probably looked at Wikipedia.

Dr. Gallus (44:26):
But yes, the first plastic surgery was a nose nasal reconstruction using a forehead flap in 600 bc. I believe that's correct.

Bri (44:37):
We're close.

Dr. Gallus (44:38):
But it's like a rhinoplasty. You are making a new nose, I believe back then if you were a captured prisoner of war before they returned you to the other side, when said war was over, they cut off your nose.

Bri (44:50):
Stop.

Dr. Gallus (44:51):
No, I'm serious. That was the punishment. So then the surgery evolved to cover the now hole in your face.

Bri (44:58):
Voldemort was born. Okay, last question. Okay, so when you are asked what you do for a living, what do you say? Are you like, I'm a plastic surgeon, what?

Dr. Gallus (45:10):
It often depends on the context. So I'll be honest, a lot of times I'm very evasive with that answer because it opens up

Bri (45:23):
Whole can of worms.

Dr. Gallus (45:24):
Yes. It opens up, immediately, people are self-conscious. If I don't know them, I mean, they think, oh great.

Bri (45:32):
Don't look at my pores.

Dr. Gallus (45:36):
And then they have a lot of questions for you. And then now the whole conversation's going to be like, there are questions about plastic surgery, which sometimes I don't really feel like spending my evening making small talk about that. So a lot of times I'll just say I'm in medicine and leave it at that, and then go from there. I try not to volunteer what I do for a living with new people because it just, like I said, it is what it is. When I do, oftentimes the response I get is that, I don't know, that's not what they expected. I was going to say.

Bri (46:08):
I'm a nurse.

Dr. Gallus (46:11):
Yeah. When I, I say I'm in medicine, they just assume I'm a nurse and move on. They don't think to ask any deeper questions, but sometimes I'll just say, I'm a doctor. Then they ask What kind? And then you end up talking about plastic surgery again. So it's an interesting question I try not to.

Bri (46:26):
They're like, what do you think? I dunno if we can talk about this. What did you say you were in a hotel?

Dr. Gallus (46:33):
Oh my god. Well, alright, to be fair.

Bri (46:35):
I was like, you're going to get kidnapped and murdered, just saying.

Dr. Gallus (46:39):
To be fair, I was at a plastic surgery conference, so the hotel was full of plastic surgeons and I did get in an elevator with a man, his wife and his wife's sister, and they were hammered and they were like, are you also a plastic surgeon? And to be fair, I feel like I was still in conference attire and had my stupid badge lanyard. And I was like, yes. And then got asked about her incisions and if she had healed properly and it just should not. That's what I mean. That's why I,

Bri (47:09):
They're like, come back to my room. Can you just look at these really quickly? And she's like, sure.

Dr. Gallus (47:12):
Yeah. Big mistake. One that didn't end up with me dead. But yes, that's the kind of

Bri (47:19):
You're going to be on another Dateline story.

Dr. Gallus (47:21):
I thought, what could possibly go wrong? Those are the kind of conversations I try to avoid. I've been at cocktail parties where people have dragged me into the laundry room to look at their abdomen or their breasts to take a peek at something and I just, maybe I'm trying to have a glass of wine myself. I don't want to give unsolicited advice at that point in time. You can't make this stuff up. And so I try to go with the medicine. Hopefully they just assume I'm a nurse.

Bri (47:54):
Nurse Kat.

Dr. Gallus (47:56):
Yeah, nurse Kat, when I'm trying to stay on the down low.

Bri (47:59):
I love that.

Dr. Gallus (48:02):
Alright, well I believe that's a wrap for today. Our random plastic surgery questions have been answered.

Bri (48:08):
So if you have any more, feel free to DM us. You'll get a really good response back.

Dr. Gallus (48:15):
Or we could address your questions in another podcast for sure. 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 @RestoreSDPlastic Surgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts.