Bri Breaks it Down: Breast Implants, 2 BBLs, & Botched Filler in Mexico

Dr. Gallus (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. All right, we're back. So last episode, Bri, you told us that you had your lips done in Mexico and I feel like it's relevant, we're going to get to that part of your journey, but Simone Biles just talked about also non-surgical stuff and she talked about how she had Botox and that was covered in the Daily Mail or actually People magazine don't really know why she

Bri (00:29):
Never doing that again.

Dr. Gallus (00:31):
Never doing that again. I feel like someone should quote her on that and then just call her back in 10 years.

Bri (00:39):
Right? You would be horrified the amount of Botox in my face.

Dr. Gallus (00:42):
Right? 27 I would say a little on the young side for Botox. Unless you work in our world where you're like, why not? Right.

Bri (00:53):
It's preventative, it's fine.

Dr. Gallus (00:54):
Yeah. And so she said she did baby Botox, which is usually what we recommend for people who are under 35, under 40. You're just trying to soften things so you don't have permanent wrinkles. And it looks like from her images that they just did glabella Botox, so just addressed her elevens and did not adjust her forehead, which there's an old picture of Reese Witherspoon on the red carpet that I used to use in one of my Botox lectures for the residents where it does, if you just directly do one area and don't really balance the other areas, it looks weird. She has this weird flat space in the very center of her forehead, but her eyebrows go up.

Bri (01:38):
Oh yeah.

Dr. Gallus (01:39):
Yes. There it is.

Bri (01:40):
Never noticed until you pointed it out. Now I can't unsee it.

Dr. Gallus (01:44):
It's hard to unsee. It's that one where she's going like this and you're like, what is happening there? So you can see the very center of our forehead has been Botoxed and they didn't do anything with the lateral forehead. So it's really just about balancing it. I know people are afraid they'll look fake and I think the forehead's probably the hardest area to do properly because you don't want to overdo it. If you overdo it, people are not happy. They can't move their forehead. They feel frozen, their forehead feels heavy, maybe their eyes feel almost like they're dragging down or they can't open their eyes properly. So those are all downsides of doing too much. But the alternative, which is when you do nothing like Simone Biles, like Reese Witherspoon, and you just do the elevens and you go for what looks like a max dose, then you're going to get a weird paralyzed spot in the center of your forehead. She also describes in the people article that one eyebrow, it's gets stuck up, which is

Bri (02:48):
Like the Spock eyebrow?

Dr. Gallus (02:49):
Yeah. If it's just one eyebrow, usually that is just you need to go back at two weeks, especially if it's your first time and they can tweak it. Most injectors, whether you're a plastic surgeon or a dermatologist or nurse injector will let you know that after two weeks everything's fully kicked in. And then if you have one eyebrow that's still up or something is asymmetrical, just go ahead and come back in and they can put a unit or two and fix it. And it is hard when you're doing it for the first time on someone just to make sure that you're balancing everything right. I don't know. Did you ever have a bad Botox experience, Bri?

Bri (03:28):
I personally haven't, and I've been a fan of Botox since I got it. I can't ever imagine not getting it. It really just keeps a happy home life because my kids can't tell if I'm mad or sad. Just kidding.

Dr. Gallus (03:42):
Can't frown.

Bri (03:43):
Yeah, I know I, I did have that one time where my eyebrow was raised a little bit, but it was fixed at my touch-up.

Dr. Gallus (03:50):
Right. And I think that's sometimes the hardest area to get exactly right, cuz you're using pretty small doses.

Bri (03:57):
I feel like people are really terrified of just looking super frozen, but if you have a good injector, it looks natural. It doesn't, you don't look crazy like you can't move your eyebrows or your eyes.

Dr. Gallus (04:09):
Yes. And we've all seen that and it's just like whenever somebody does that, it makes the rounds of the internet and then everyone's scared again. But so many people have Botox and just basically complain that it wears off too fast or they're not completely frozen. But those people aren't crying to People magazine.

Bri (04:28):
Yeah. My favorite new Botox is masseter Botox, getting it done in my masseters and I also grind my jaw a lot.

Dr. Gallus (04:37):
Yeah, so your masseter muscles are muscles on the side of your face. It comes up a lot. The original indication for masseter Botox, in addition to helping with jaw clenching was to slim the face and it became pretty popular in South Korea. So they would Botox the masseter muscles and as the muscle got less strong, it would create a slimming to the lower third of your face. Then you mentioned the other popular reason, which is that if you clench your jaw or grind your teeth at night because it's decreasing the amount of power those muscles can forcefully pull down on your jaw and clench your jaw, then it reduces that tension can lead to reduction in tension, headaches, all of those things. So yeah, we do quite a bit of that too for our patients as well, masseter Botox.

Bri (05:28):
Yeah, that's become super popular.

Dr. Gallus (05:29):
And I have patients that are like, this is a game changer because they already have the trays, they've had dental work done due to the amount of teeth grinding they have and this is the one thing that kind of takes it out. The other thing that's been circulating around on the internet is creating a lifted jawline or snatched jawline. We're not inhibiting muscles that pull down, I don't know, it's very controversial. I think a lot of times that's overrated. It's lifting anything, it's just inhibiting a muscle that might be pulling down, so you just can't do that. But it's not going to lift it more than it already is, if that makes sense. But we're always looking for new ways Botox can help.

Bri (06:13):
I'll try anything.

Dr. Gallus (06:14):
Nothing wrong with that.

Bri (06:16):
I'm always the first to volunteer.

Dr. Gallus (06:18):
Yeah, you are. So let's talk about our other article from the Daily Mail, which I almost feel bad about, but not really. It has to do with Tom Cruise.

Bri (06:28):
Not too bad.

Dr. Gallus (06:29):
I mean he has a movie coming out or he is filming a movie. I don't know, I can't keep track of all his mission Impossible 12 or whatever he is on.

Bri (06:37):
I know.

Dr. Gallus (06:37):
And he showed up at the Olympics and so he's back in the spotlight and he's 61 or 62 and there's a picture of him with no body fat but kind of some loose skin.

Bri (06:51):
For 61, he looks great.

Dr. Gallus (06:53):
Yeah, he does look good. No disputing that. I don't know, the sagging skin can be due to a lot of things and we're going to talk about some of that when we talk about your surgery journey today. But yeah, sagging

Bri (07:06):
Well the did say was due to the lipo section.

Dr. Gallus (07:10):
Yeah, that is what people are positing that it was due to liposuction. I feel like somebody like Tom Cruise is probably not doing liposuction and then having loose skin and not addressing that. And there are things you can do to address that. So you can have excisional surgery, you can use a skin tightening adjunct like Renuvion or BodyTite to try and tighten the subcutaneous tissue, but the bottom line is you can't fight aging. So if he has aging skin that's just lax, it's not going to respond to any of those things except for maybe excision and excision is probably not what he wants to do at this point. And looking at his abdomen, I don't know what you'd have to do a reverse tummy tuck to get some of that laxity out. I don't know, it's just life is rough and there are so many things that are available to do skin tightening. I would say my only joy in this article is that Tom Cruise is facing the same scrutiny that every actress, female actor has to endure all the time. So welcome to the club, in terms of has she or hadn't she? What has she done to her face? What is going on with her body? Has she had more surgery? Why is this every female celebrity, every time they walk out is being scrutinized head to toe. And I think that this just shows you the guys can have at it too.

Bri (08:42):
You're not immune.

Dr. Gallus (08:43):
Yeah, my older patients say it's better than the alternative.

Bri (08:48):
It's true.

Dr. Gallus (08:49):
But yeah, I mean he just has in these comparison photos from his original Top Gun now he just has tight tan skin that he didn't have and maybe he had liposuction and that led to some laxity or just maybe it's just aging skin. He's 60, he's not 25.

Bri (09:08):
Yeah. They did mention, and I can relate to this is when you take out a certain amount of fat, your body, when you do it naturally over time your skin can tighten up with your body. I don't know how much fat being taken out really affects that, but in my case, I definitely feel like I had a lot of fat taken out in my skin, wasn't able to tighten as much as say if I had lost it naturally. And I think that was

Dr. Gallus (09:36):
So yeah, if you do slow controlled weight loss, the idea is that your skin is given the chance to contract as that space is shrunken down. Of course we've all turned that on its head now with Ozempic and other GLP-1's because it causes you to lose weight rapidly. And when you lose weight rapidly, your skin doesn't have a chance to contract and you can end up with loose sagging skin. Some of that's determined to by, like you mentioned, how much fat's removed at once or how fast you lose weight. And the other thing is sometimes it's age. So I see older ladies that want me to address their sagging skin. If they come in and they're over 60 and super tan because they spent their life, some good years out in the sun playing tennis or gardening or golfing, that skin is just not as resilient and is a little bit more stretchy then someone who's 20 and is going to liposuction and take some mass off. And you've heard me a thousand times, but liposuction is not a weight loss procedure, it's just removing ideally localized areas of fat, but it's not creating movement on the scale per se. So moving on. Okay, so I think we alluded to, like I said, your plastic surgery journey. When we first met, you were working as a scrub tech for an OR that I used to operate out of and you were new, and you had showed up one day for work looking insane. Insane. Now to be fair, I asked what had happened to your face, but your lips were massive, like comical, Goldie Hawn, First Wives Club, next level, so crazy.

Bri (11:31):
Rock solid.

Dr. Gallus (11:33):
And your response was...

Bri (11:37):
I went to Mexico to get filler.

Dr. Gallus (11:42):
Yeah, I was aghast. I was like, why would you do that? Now I didn't realize that the office that we were both you were working out of, I was operating out of, didn't do filler. Cuz to me, I was like, well why wouldn't you just get it done at this place? But that office didn't offer filler at the time, so you went with a bunch of friends to go down to Mexico and do it, with the whole, what could possibly go wrong attitude.

Bri (12:08):
So we found, I have a lot of girlfriends that go down there. We found a really reputable place, I believe at the time we looked it up and they were certified surgeons. So I was like, what could go wrong? And I think that's a huge difference here and then down in Mexico is they really just give you whatever you want. They don't tell you, like, I've had you do my lips and you're like, you need to stop. I'm not doing anymore. And I think that's the big thing is you're just like, oh, just shove a whole syringe in my lips, it'll be fine. And they're like, okay, whatever. I'll just take your money and that's fine. So that's what I did. And they were so big, they were so swollen, they were rock solid. I think I ended up having an allergic reaction to, and it had blistered or it was too superficially put in. There was just so many things that were not okay. And then I walk in and she's like, your face. I'm like, yeah, learned my lesson.

Dr. Gallus (13:15):
So I can't remember if you knew what product they put in or?

Bri (13:19):
So they do show it to you. And I was pretty sure it was Juvederm

Dr. Gallus (13:26):
As far as you know, and you do make a couple of points. There are board certified plastic surgeons in Mexico certified by their national organization and there can be reputable places to get things done. It's a little bit hard to navigate when you don't speak the language. And a lot of times people go based off my friend had this done here, so it must be safe. Which we know even in the states, that's how some of these charlatans who are pediatricians or whatever doing liposuction, once you've gotten away with enough liposuction or whatever, even if it's out of your wheelhouse, you start building that reputation as a go-to, and you're getting referrals from word of mouth and it's just a beast that keeps feeding itself, until something goes wrong. And I do think you did have an allergic reaction to your dogs or something all at the same time, which really just

Bri (14:15):
Cherry on top.

Dr. Gallus (14:17):
One two punch for the lips, was really great. So yeah, we discussed what a terrible idea it was. I think you had microneedling done as well and they didn't numb you or something crazy.

Bri (14:29):
It was terrible. I think you just assume you're go down and you're being treated by doctors that they're just going to do what's best for you. And that is not always the case. But I had microneedling done and they don't numb you and they just inject, I don't even, she had to have been, I mean I don't even think she was certified in anything. And I obviously wasn't like, Hey, where are your credentials? And it was hands down the most pain, I have done a lot of surgery. It was so painful. I mean they just jammed with no regards I'm sure to any sort of vessels or facial nerves. They just jammed this needle in your face and over and over. And I think there was one point where I was like, I can't do anymore. And she's like, yes, painful. They don't speak English. They're like Pain. Yes. And I'm like, no, it was never, I would never do that again. That was the worst.

Dr. Gallus (15:22):
I think from what you were saying was maybe it was PRP injections.

Bri (15:25):
Yeah. But there was no, it was just like a stabbing all over the face. There was no thought given to any of it.

Dr. Gallus (15:33):
Yeah, it's just truly unfortunate. And then, I mean with PRP, so also known as a vampire facial, it's often done with microneedling, but did they draw your blood for that?

Bri (15:45):
Yes.

Dr. Gallus (15:45):
Or okay. Did they use someone else's? I'm just kidding.

Bri (15:50):
Yes.

Dr. Gallus (15:51):
So they draw your blood and spin it down and then they take the platelet rich plasma, which is what PRP stands for, and you can either kind of smear it on your face and microneedle it in, which is a kind way to do it or inject it into the dermis, which is what they sounded like they did to you. Neither have really great proven to do a lot. I mean it's nice, but certainly you're at a higher risk if they're injecting and you can't verify their sterility or what their standards are, how are they spinning it down, all of that. And there was a huge lawsuit in, of course it was in Arizona at a strip mall, like an unregulated med spa that was reusing needles and they had a patient with HIV and then they managed to expose quite a few patients to HIV because they're sterility and certification and reusing needles and God knows what else was going on, exposed all these patients.

(16:44):
So a lot of times I just say, you get what you pay for. People are like, oh, it's so expensive. Yeah, it's expensive because we have standards, we have regulations, I have inspections, we have the aesthetician board come in and inspect us because of an aesthetician in our office. We are quad A certified. So we have that governing body, make sure that our standards are met for the OR. I have credentials at a hospital in the things that I'm doing in my office OR, which is a lot of times when you see people practicing outside their scope, they don't have credentials because if you're an OB GYN or a pediatrician, no one's going to credential you in liposuction at Scripps Memorial or Mercy Hospital or whatever your local hospital is. So you're just operating without a safety net. And there's a lot of leeway with a medical board, honestly, until things go south south.

Bri (17:39):
And it's not really, I had just started working there, so I wasn't too familiar in a healthcare or clinic setting. And it's things you do not think about until you actually start working in the specific industry. And then you're like, oh my God, I can't believe I did that.

Dr. Gallus (17:57):
Right. I know. And you were still working as an EMT there back then. You were working shifts as an EMT. Those stories were legit. You could tell us she would entertain me with the stories from her weekend shifts or whatever. And you knew that side of medicine.

Bri (18:14):
You don't take it into consideration in something else. My first surgery, now that I know, I would definitely look into surgeons credentials. I look at their office, their staff, their, I'm sure there's actually a lot of other things I would look into. But yeah, my first surgery, I had a breast aug and I just went by word of mouth from my girlfriends who had got hers done because he paid like $5,000 cash. And I mean, come to find out he wasn't even a board certified surgeon. There was just a lot of red flags that I would not have thought about unless I knew. So yeah, you really have to do your research because I've had a couple girlfriends go to that same place and had really horrific stories. And it's a shame because you're getting cheaper surgery, you're paying a cash price and you're like, yeah, what could go wrong? It's in the states, it's fine.

Dr. Gallus (19:13):
So that's the other thing is in the United States, again, you have to verify people's credentials. And those that are not credentialed in plastic surgery, for example, will say that they're board certified period.

Bri (19:30):
Tjey're certified in something,

Dr. Gallus (19:31):
They're board certified in something. And this just came up in Ohio actually, but where someone is promoting themselves as a plastic surgeon, but she's not. And she's saying she's triple boarded, she's not board certified in plastic surgery. She's board certified in general surgery. She's board certified in trauma critical care, and she does not have any training in plastic surgery aside from shadowing an ENT person who is also not board certified in plastic surgery. So in the state of California, you cannot claim to be board certified unless you state what your board certification is. And so the California Society of Plastic Surgeons, along with the California Medical Association has managed to enforce that so that if somebody is saying that there are board certified surgeon, they're saying they're board, they have to tell you in what. Because it's a sneaky tactic that happens in other states and was happening in California.

(20:27):
I'm going to aesthetics are us with a board certified surgeon, well the dude's board certified in pediatrics. So how does that help you? And I always think just the hubris or confidence that these people have to just start doing surgery in something that they weren't. First of all, if you weren't a surgeon, if you're an ER doctor, you're a pediatrician, you have no business doing surgery, full stop. If you did general surgery like the person who did your breast augmentation, you still have no business doing plastic surgery, however, at least your way around the OR before you even start doing stuff. But that is like me saying, you know what? I'm just going to open up this book and spend a weekend learning EKGs and now I'm going to be a cardiologist. Like what? That doesn't even make any sense. I'm going to just know everything there is to know about EKGs and I'm going to be, and then I'm going to advertise as a cardiologist. Nope. No, it doesn't add up, but it happens all the time, which is why you have to do your research. So you had your original breast augmentation with this guy who remained unnamed, but practices locally. And then do you want to tell us what size implants you had or do you get a choice in that or?

Bri (21:45):
Sure. So I definitely did get a choice. I'm going to backtrack really quickly to what you said earlier, being a plastic surgeon. So when I went in there, I breastfed two children. I went from an eight to a quadruple D. I had so much, once I was done breastfeeding, I had so much extra space, it was just like tissue. It was super unfortunate. But when I went in there, I was like, I would think I need a lift. And anybody that I feel like would've been certified in plastic surgery would've been like, oh yeah, yeah, of course, you need one to achieve what you want, you need one. And he was like, oh no, you don't need the one. And he didn't even, he maybe looked at my boobs for two seconds. Yeah, yeah, yeah, you're fine. And I'm like, I don't think I am. And I'm not sure if that comes from a place where maybe he doesn't do them a lot or he's not confident, but I feel

Dr. Gallus (22:35):
I don't think he does 'em right?

Bri (22:37):
Yeah,

Dr. Gallus (22:37):
You just get an aug.

Bri (22:39):
Yeah, I think it must have just been an aug, but any actual plastic surgeon would've looked at my boobs and be like, oh, you need a lift to get what you want. But yeah, back to the implants, I did spend quite a bit of time, he had with his MA who went over implant sizes. And like I said, these are things I wouldn't have thought about except for now that I'm working in an office that might've been a red flag that he didn't ever really go over sizing with me. I have Natrell implants, I believe they're 535's. Sedation wise, they said if I went over 600's, I would have to go under general, which I thought I was doing in the first place.

Dr. Gallus (23:21):
Ugh.

Bri (23:21):
And then I guess it was just, I know, but at my age, 20 something pain, it's like, whatever. I just want a breast aug. I guess it was twilight sedation, and then it was like, oh, well, we have to charge you more. It was a whole thing. Don't get me started. But yeah, so they're 535's. I really love them. I did unfortunately have to go back and get my lift.

Dr. Gallus (23:47):
Right. So eventually you had a lift.

Bri (23:49):
Yes.

Dr. Gallus (23:50):
And that was with the board certified plastic surgeon that you were working for when we met, right?

Bri (23:55):
Yes.

Dr. Gallus (23:55):
And he took care of that? Yeah. And he left your implant same size, is that right?

Bri (24:00):
Yes. I haven't touched my implant since.

Dr. Gallus (24:02):
Okay. Yeah, I don't know what that is about sedation and non sedation. Was there an anesthesia provider there if you needed to convert?

Bri (24:09):
I think it was CRNA. So yeah, I was a little nervous after that because having children, I've always been, even my epidurals lasted like two hours. It was a whole mess. I am hard to numb, so I was super nervous about going under a twilight sedation, and she was like, it's fine, it's fine. It did end up being fine, but I think I would've liked to probably know that more than the day before my surgery, or you have to pay another a thousand dollars cash. I'm like, okay.

Dr. Gallus (24:45):
Yeah. So the advertised price is contingent on you picking a certain implant, getting anesthesia, all of those things.

Bri (24:52):
Correct. Anesthesia.

Dr. Gallus (24:53):
Yeah. I don't do breast augmentation under sedation. I just don't think there's a reason to. General anesthesia is safe and effective if you're going to do IV conscious sedation. Again, this is where some people on the fringes get into trouble. They try to cut costs by not having an anesthesiologist or someone monitoring the anesthesia that's qualified. And so they're directing a nurse to do the sedation while they're doing the procedure and that you can get into trouble that way.

Bri (25:26):
Terrifying.

Dr. Gallus (25:26):
Because now you're managing two different things and if there is an issue with anesthesia, are you're going to stop operating, so you can figure that out? Or are you going to rely on your anesthesiologist? So unfortunately, there's multiple examples of that going sideways as well. So then, okay, so you had your augmentation, then you started talking to me about doing a BBL when we were operating together, which is a Brazilian butt lift. And you had found a guy.

Bri (25:54):
Yes. Names will not be named, but I found somebody here locally that did him awake, and I started talking to Dr. G about it and she was like, wait, what? And he ends up not even being close to a plastic surgeon.

Dr. Gallus (26:10):
He was an ER doctor.

Bri (26:11):
He was an ER doctor, not even somehow, I guess offices can do local at a certain cap, I believe. Is that correct?

Dr. Gallus (26:21):
I mean, I feel like if you're going to be practicing outside your scope, then the general rules don't apply to you at all. But you should not be practicing general anesthesia without having a transfer agreement, there's some standards. I mean, you can practice general anesthesia and just not have a certified OR, but one way people get around it is doing everything under local, and so they're doing fat transfer under local, which is doable. But I feel like he was an ER doctor, not sure what his fat transfer method was. I do know he had videos on his website that showed a complete ignorance of sterility. His ponytail hanging out of his scrub hat was so good.

Bri (27:07):
Yeah.

Dr. Gallus (27:08):
Yeah, it was.

Bri (27:09):
That's not how it works.

Dr. Gallus (27:11):
And it was surprisingly not cheap. We just let our trusses fall while we're operating. Right?

Bri (27:17):
Right. I'm just hair out in the OR, because it looks better. Yeah. I think it was almost more expensive than what I was charged after the fact, doing at Soltero's, for it being awake. And he did less areas because there was a cap on how many areas I could do awake and how much he could take out while I was awake.

Dr. Gallus (27:40):
Oh, right, that's what I was going to say. Technically under local, you're not supposed to do more than 500 ccs, which I guarantee those people aren't doing if you're not certified to a certain level. So that's quad A certification level. If you want to go up from there and get higher certification, then you can do more volume. But I'm telling you, these guys aren't certified at all, so it just doesn't matter. Right. Their facility isn't certified.

Bri (28:09):
Cuz I know generally though, you say about five liter is the max.

Dr. Gallus (28:11):
Five liters is, yeah, is this max you should take out at one time in one patient, without just monitoring basically for fluid status. And five liters honestly is a lot of liposuction. So probably not going to want to do that as an outpatient anyway. You should probably be staging it at that point. So yes, I about had a heart attack when you told me about this plan, BBL.

Bri (28:37):
She was like, look him up. Look him up.

Dr. Gallus (28:39):
I was like, can't you see, it's not even, it's an ER doctor. Come on. And then I said, you're working at this facility, at this office. Talk to the coordinator, see if you can get this surgery. You're an employee here, have this done, and if not, I'll do it. But you should be able to cut a deal, cuz you work for this person now. And so you ended up talking to him and talking to his coordinator and working something out. Tell me about why did you want a BBL?

Bri (29:09):
I just wanted my butt as big as possible. I had a very flat, it was flat, it wasn't too flat, but I just didn't love it. I wanted my hip dips filled in. I just kind of wanted more of that actual hourglass shape. There's something you just feel super extra feminine. I just really wanted it, and I know you're not supposed to do this, but I was like, my girlfriend got one done and she was like, I didn't have enough fat, so I have to go back and get it done a second, so don't do this. But I was like, I'm going to eat as much as possible and I'm going to gain as much weight as I can so I get all the fat. So for the next two and a half, three months, I just ate and I gained all the weight. And I believe the first, I got a BBL done twice, the first time I got, I dunno the exact numbers, but I think I got about 800 ccs in each side. We took the full five liters. The only thing I do regret is I did arm lipo and inner thigh lipo at the same time, and it was super uncomfortable. And I did a lift at the same time, so I could not lay on my stomach, I could not move my arms, I could not move my legs. So yeah, that was a little rough. I got this big giant canoe that I stuck on the bed and I just kept Eric in the small corner of the bed, propped myself up on some pillows. But yeah, I really just wanted it to have a more hourglass shape.

Dr. Gallus (30:57):
And you do accomplish that with this surgery, even if it's small because you got to steal the fat from somewhere. So by taking it usually from the waist or the lower back, you already start enhancing that feminine curve you're talking about. And then if you add it to either increase production, production, increased projection, or fill out laterally where the hip dips might be, you are really enhancing the shape in two dimensions, right? You're making the butt a little bit bigger, more rounder, perkier, but you're also tightening up the waist. And so it adds to that feminine effect. What about, so that's funny, I hate doing arms and legs at the same time. And really it has to be special circumstances because taking out all four extremities like that with surgery is really just hard. But generally you can do breast and arms together. You can do tummy and legs, but arms and legs at the same time, you just cannot get around because your legs are out of commission. And then you can't help yourself get around because your arms are also sore and recovering from surgery. So adding arm lipo onto things is doable. It just sometimes you have to decide what's a reasonable amount of surgery. In your case, you might've needed it just to get the fat that you could get.

Bri (32:16):
Well, that was the unfortunate thing. I had you redo my arms because we only ended up taking out about 50 ccs from my arms, and I feel like I gained so much weight in my arms when I was actively trying to gain weight. So then I came back and I begged Dr. Gallus to do my arms.

Dr. Gallus (32:35):
So I do like doing arms and I do them a little bit different from the office he worked at. And I go all the way around a 360, make sure that we're sculpting the shoulder, the tricep and the bicep. And sometimes surgeons are just like, it's fine.

Bri (32:52):
I didn't realize that, not a lot of people like to do the , they only like to do the posterior part of your arm, and I didn't know that.

Dr. Gallus (33:00):
I don't know, I feel like when you're doing it all the way around, you're sculpting the arm one and then that additional liposuction all the way around helps tighten the skin as well. So yeah. So we did your arms to kind of complete that, but that brings

Bri (33:12):
And my little chicken nuggies.

Dr. Gallus (33:14):
Oh, yes. Such a popular area.

Bri (33:16):
It's a game changer. I'm serious.

Dr. Gallus (33:19):
Yeah, so the little axillary fat pad that sits right at your underarm crease that drives everyone crazy when you're in a sports bra or a bikini or a strapless dress is really amenable to just a little bit of liposuction, which can easily be done under local. So let's go back to gaining weight for a fat transfer. I mean, it's not a great idea for a lot of reasons, but it was recommended early on. Just there's a couple reasons you shouldn't do it. One of them is if you lose weight afterwards, what was the point? Right? You only have a limited number of fat cells. So as you gain weight, you don't make more fat cells. Your fat cells that you have get bigger. As you lose weight, the fat cells that you have get smaller. So if I take fat from let's say your arms or your waist and put it in your booty and then you lose weight, you're going to lose weight everywhere.

(34:11):
But the fat cells in your booty are going to get smaller too. So then your butt shrinks when you go to lose the weight that you gained for the surgery. So yeah, that can be rough and it can backfire. I had a partner who was doing a reconstructive case and needed fat for a transfer. It was a male patient and he asked him to gain weight and the guy gained weight, but in true male fashion, he gained weight intra abdominally. So there was nothing more to liposuction, and then he just needed to lose the weight. I was like, that was a terrible idea, don't have people do that.

Bri (34:46):
And then I did end up going to lose weight, and then that's what prompted BBL number two.

Dr. Gallus (34:57):
So where did they get the fat from that? Because I did not do that procedure. You were still working at the other office?

Bri (35:03):
I was still at Soltero's. So he does an absolutely amazing job.

Dr. Gallus (35:10):
Board certified.

Bri (35:10):
Yes, he's board certified. He's awesome.

Dr. Gallus (35:14):
In plastic surgery.

Bri (35:14):
Yes, but I did not have a lot of fat just coming from having it done prior. So we really scrounged for all the fat possible, and we did Renuvion at the same time to tighten some of the loose skin. And with that, I don't think possibly enough fat, I think you need a little layer of fat. You just don't want skin on muscle, and that's kind of how my stomach is. And you can see every little vessel, every little lump. So that is the one thing I do regret is having every ounce of fat taken out. And people do ask for that, like I've had patients come into this office and they're like, I want absolutely every fat cell gone. And I'm like, you really don't, you just need a little layer.

Dr. Gallus (36:06):
Yeah, it starts, yeah. I mean, it's kind of a Kardashian look to have skin on muscle. And to be honest, you are much harder on yourself than, you look great. But yeah, you don't have that little subcutaneous layer that sort of protects or hides any kind of one fat cell decides to plump up and it just sticks out.

Bri (36:27):
It's like, hello. Yeah.

Dr. Gallus (36:29):
So I think over time, it definitely helps to have a small layer, which stands to reason all those people who have high definition lipo where they're sculpting it out and getting on skin, we're not sure exactly. If you don't maintain that body habitus or age over time or whatever it is, what is that going to look like? I mean, maybe we'll have another option at that point in time, but at least in the liposuction to take every last little fat cell out so that they could put it in your butt. They did decide to do Renuvion. So tell me a little bit more about that, because we do Renuvion in our office as well.

Bri (37:06):
Yes. So I did it on my back, my upper and lower abdomen, and it was awesome. It definitely helped my skin tighten so much. And I was super fortunate that with my pregnancies, I didn't really have too much loose skin. I feel like that was really caused from me just doing too much lipo. I didn't have that time for my body to just slowly my skin tighten as I lost weight. It was just like, so, but other than that, Renuvion I think helps a ton. I think everyone with lipo should do it personally.

Dr. Gallus (37:45):
So I do it a little bit more selectively. But I do agree that it's awesome for helping to tighten the skin. It's not a substitute for tummy tuck, unfortunately, for those people that need that. But if someone certainly over the age of 50 came in and wanted liposuction, I definitely recommend based on their skin quality, but definitely recommend doing liposuction with Renuvion or some sort of skin tightening. That just happens to be the machine I own. BodyTite is a major competitor. They both use radiofrequency energy, which is under the skin and tightens that collagen network under the skin. So below the dermis and the subcutaneous fat, the energy is basically heating up those tissues and shrinking it so that you get a little bit of tightening. So yeah, I think that was probably a smart choice to use that technology.

Bri (38:39):
And a question I get from patients all the time is if Renuvion has to be specifically in conjunction with lipo, if you can do it itself and they want to know how invasive it is. Some people think it's just on the top, but you really are making an incision and going in.

Dr. Gallus (38:56):
And even actually, I was the one who brought Renuvion to that particular office, and I remember having to explain, so if I'm just doing Renuvion to somebody, so we're just doing the skin tightening, I still need the liposuction equipment because I need, you can't put the little radio frequency wand in without having tumescent fluid. So that fluid that helps keep the skin, keeps the energy spreading diffusely, and then also keeps the heat, the temperature internal temperature down. So first of all, you have to put the tumescent fluid in, and then second of all, you need to create channels for that Renuvion or whatever wand you're going to do to get through it. And so we usually use a liposuction cannula to do that. So I'm doing liposuction but not under suction. So I'm moving the cannula back and forth to create space and then putting the Renuvion device, which is a small wand and tracking in those spaces to heat up the surrounding tissue.

(39:55):
And then afterwards, I'll often use the suction device to suction out the helium gas that comes with Renuvion and try to get a little of the fluid out. But you're definitely more swollen than when you start it, if I'm not doing it in conjunction with liposuction, which can be tough. You just have to mentally prepare for that recovery, right? Because I've put fluid in, I've created all these channels or tunnels, and then we're done. So I've put fluid in and then we're going to put you in compression. So now you're even bigger than when you started, and you just have to wait for all that fluid to get absorbed, the compression to do its thing, to recover from surgery to see the skin tightening. So it's not a like, oh, wow, a week out, I look fantastic. You're still probably going to be swollen.

Bri (40:39):
Yeah, I definitely was so much more swollen with Renuvion and when I did just lipo.

Dr. Gallus (40:44):
Yeah. And so maybe at six weeks you look fantastic and things are pretty tight, and then there is a little relaxation, and then you get more tightening as the collagen builds. So that takes three to six months. But often I have my patients that are asking for, that are trying to get away with without doing excisional surgery. And it is not a substitute for if you have hanging upper arm skin, it's not a miracle worker. It will tighten someone who has toned arms, youthful skin. It's really going to help with that, but older sun damaged skin doesn't do a great job. And if you have overlying creepy skin, so that sun damaged wrinkly skin at the very epidermis, it tends to make that look worse because it's like putting a duvet cover on top of a bedsheet, and you're shrinking the bedsheet. And then the debate cover is just getting more wrinkled on top because it has less, you need to flatten the whole thing out. So with regards to recovery, how long would you say it took for you to recover from each surgery?

Bri (41:48):
So my breast aug, I was in bed for a couple of days. The first couple of days were really hard, just because you have that muscle ache when you go under the muscle, it just hurts. But I had to go back to school at that time after a week. So the first I took a week, I was driving on day seven because I was no longer taking any pain meds, and that was a little hard. I definitely probably would've taken a little bit longer for a breast aug. I unfortunately didn't have a choice, but yeah, I was about two weeks until I was feeling a little bit better. And then I think I went back to working out at about four weeks. My first BBL, the recovery was a little bit longer because I had a lift, I had my arms, my legs. I felt like I healed a little bit slower.

(42:39):
I was super committed, I did not sit on my butt for six months. I wore my garments for six months. I was like, I'm going to do everything I can to keep every possible fat cell. I don't know if it makes a difference or not. But yeah, I was very strict about my post-op care. And so I think that took a little bit longer. I was still working on the ambulance at that time, and I took about six weeks work off work then. And then I just came with my butt pillow and I was like, don't judge me.

Dr. Gallus (43:11):
Not sitting on my butt.

Bri (43:12):
Yeah, not today. And then my second BBL, I don't know if it's because I had lipo prior, but my recovery was so much quicker. I felt like it was a couple weeks. I didn't feel as bad.

Dr. Gallus (43:25):
Did you take a week off or two weeks?

Bri (43:27):
I took a week off.

Dr. Gallus (43:28):
Yeah. And then did you take any time off for the arm lipo? Because I feel like you came over and did it and then went back to work, essentially.

Bri (43:37):
The arm lipo was, I took time off, but on day three, I was feeling better. I don't know if it's because I did it awake, but that was a little bit easier recovery for sure. I just stayed in my compression garment with my arms and that was about it. They leaked for about the first day or two, and then after that, I just kind of chilled. I remember one of the kids had come in the house and I had my arms all bandaged up and I was kind of leaking some blood and I come in and they walk in, they're like, oh my God, what happened to you? And I was like, oh, don't worry about it. They were terrified.

Dr. Gallus (44:20):
We always tell our patients that after liposuction, if you lay down on your bed, put some towels down or chuck's pads or puppy pads or something because you will leak fluid. We don't get it every last little bit out, and the fluid will be blood tinged. And so I tell patients it's going to look like a crime scene the first day or two. So don't be alarmed. That's expected.

Bri (44:44):
Yeah.

Dr. Gallus (44:44):
Alright.

Bri (44:45):
Trying to think about what other surgeries I've had.

Dr. Gallus (44:49):
Those are all the surgeries. You still have your appendix?

Bri (44:53):
Yes, for now. Nonsurgical things.

Dr. Gallus (44:57):
What do we do regularly here in this office?

Bri (45:00):
Botox.

Dr. Gallus (45:00):
Botox.

Bri (45:01):
Fillers

Dr. Gallus (45:01):
Laser.

Bri (45:03):
We do laser and chemical peels all the time. Let's see here, the last filler, I just get it in my lips now. I did have it before where I tried putting it into my jawline. For me personally, I liked the Botox in the masseters better where everything thinned out.

Dr. Gallus (45:24):
Because you end up adding volume when you do, I mean, jawline filler was super popular, but it looks good from the side angle and then you turn forward and then you're like.

Bri (45:34):
Yeah, it wasn't personally for my face shape. And then I had a little bit of filler in my smile lines, which probably needs to be redone. I did one time try filler in my nose. Yes. I've done everything non-surgical to try and make it thinner, and I think it looked really good, but it's definitely, it's no replacement for a rhinoplasty.

Dr. Gallus (45:59):
Correct. You're correct there. I feel like the question we were going to ask is what's on your wishlist for surgery, which leads us right up to that, right?

Bri (46:09):
Yes. So Dr. Gallus doesn't do rhinoplasties, so I could not force her to do my nose. But we have,

Dr. Gallus (46:18):
I mean, I could take a weekend course and decide that I was willing.

Bri (46:21):
YouTube it.

Dr. Gallus (46:21):
Yeah, YouTube it. What could go wrong?

Bri (46:24):
Yeah. We have an awesome new ENT facial surgeon, Dr. Chow. She just joined our practice, so

Dr. Gallus (46:30):
And she loves rhinoplasty.

Bri (46:31):
Yes, she does so many rhinoplasty. So I have already put my name into the line for a rhinoplasty.

Dr. Gallus (46:40):
And I think we can probably do a whole podcast where we talk about that.

Bri (46:46):
Yeah, a whole

Dr. Gallus (46:47):
Rhinoplasty, all like how do you decide? I can't answer any of those questions. So we probably need to bring Dr. Chow in so that it's been a hot minute since I've had to do one.

Bri (46:57):
Yes, very nice. I can document my whole journey. So do you have anything on your wishlist for surgery?

Dr. Gallus (47:05):
I mean, there's always things on the radar. It's hard because I don't have anybody to operate on me unless it's facial plastic. So now that Dr. Chow is here, there are probably some things I wouldn't mind doing. I've always wanted to do Renuvion to the abdomen because I have just a little bit of skin laxity. Tummy tuck would probably be overkill, but there's really no way to address that. There's no way to address it without some skin tightening. So I mean, I figure I could do it under local. I just can't do it to myself, so I just need to figure that out. That would be on my wishlist. And then, I don't know, upper eyelids, face at some point. I will say my biggest detractor from doing any kind of procedure is I like to work out. And so I hate not being able to work out. So I think when I had my breast aug and I didn't work out, I didn't do chest stuff or yoga for four to six weeks. I did six weeks. It was painful. It was super painful for me not to do it.

Bri (48:06):
Yeah, she is the worst. She's like, oh, I just got Botox. I'm going to go do a class. No, you're not supposed to.

Dr. Gallus (48:13):
Yeah. I don't even like blowing my hair out with a keratin treatment because you can't sweat for three days. My hairdresser thinks I'm nuts. Most people are excited to have three days where they have an excuse not to work out, and it really is my stress reliever, and I love my yoga and sculpt classes, and it's hard for me to take a break. So yeah, that's usually that. And oh, and my three kids, busy lifestyle, blah, blah, blah. It's all hard to take time off for yourself, which is, I think I have that in common with a lot of our patients. When are you going to take time off to recover? When are you going to not work out? Who's going to take the kids to school? All that stuff has to get factored in. And some of my patients that have been the most successful have really planned things out to the T. I mean, they're prepped in advance. They've got meals planned, they have everything set up. They know their schedule, and it also helps if you work from home.

Bri (49:05):
Yeah. I had some really bad acne for quite some time. I actually made Dr. G. rip out my birth control out of my arm.

Dr. Gallus (49:14):
We did YouTube that.

Bri (49:15):
That was special and hoping that it would clear up my acne. The first couple months was so rough. My acne got so bad. So I did tons and tons of, I did lasers and peels and I mean, I was doing stuff to my face every week. And I would come home and before I even got home, Eric would text me, be like, can we go to the gym? Or Did you do stuff to your face today? And we got in that habit, and then it's like when I really wasn't feeling the gym, I was like, oh, yeah, we did a laser on my face. I can't work out. Sorry. You go. Yeah. Sorry. I'm laid up. I did a peel one time and I worked out that night and my skin was bubbling, and I think that just terrified him. So I was like, oh, yeah, no, just stay home, stay home. And I'm like, okay.

Dr. Gallus (50:00):
Yeah, you really shouldn't sweat

Bri (50:01):
I love the gym, but.

Dr. Gallus (50:03):
After a chemical peel.

Bri (50:04):
Yeah.

Dr. Gallus (50:05):
It's not that I haven't done it, it's just not a smart idea.

Bri (50:11):
He's like, have you messed with your face today? I'm like, not today.

Dr. Gallus (50:16):
Not today. Not today. We can go to the gym.

Bri (50:18):
Yes.

Dr. Gallus (50:20):
Awesome. Well, thank you so much, Bri, for sharing your surgical journey with all of us. I feel like there was so little things to address and cover and educate about. It's really helpful.

Bri (50:32):
Yeah. I feel like I could, need a whole day to talk about all my surgeries.

Dr. Gallus (50:38):
That's why we have the podcast. And we're all looking forward to the rhinoplasty that I don't think you actually need, but it's fine.

Bri (50:44):
It's gonna happen.

Dr. Gallus (50:47):
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.