S05E100 Pre-Event Glow-Ups: Cosmetic Enhancements for Life's Big Moments

Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic delve into a lively exploration of the fascinating intersection between cosmetic surgery and major life events. We promise you'll gain valuable insights on planning enhancements like rhinoplasty, liposuction, and even the occasional neck lift, all while maintaining a sensible timeline for recovery. As we dissect a New York Times article highlighting this growing trend, we offer practical advice for anyone looking to enhance their appearance, whether through surgery or non-invasive methods like shapewear and makeup.

You'll laugh with us as we share humorous anecdotes and debate the safety of informal settings for cosmetic procedures. We also delve into the motivations behind these decisions and stress the importance of consulting qualified professionals to weigh risks and benefits. From facelifts requiring six months of preparation to last-minute abdominoplasties, our discussion covers it all. Whether you're preparing for a wedding, anniversary, or simply lost a fantasy football bet, make sure you're informed and ready to shine on your special day.

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S05E100 Special Event Cosmetic Surgery: How to Do It Properly

TRANSCRIPT

[00:00:00]

Dr. Sam Rhee: Welcome to another episode of Three Plastic Surgeons and a Fourth. As always, we have Dr. Salvatore Pacella, uh, out of La Jolla, California. His, uh, Instagram handle is at San Diego Plastic Surgery, Surgeon. Sorry, Surgeon. That's right. Uh, Dr. Sam Jejurikar in Dallas, Texas. And his Instagram handle is at Sam Jejurikar and Dr.

Lawrence Tong. His Instagram handle is at Yorkville Plastic Surgery. And his location is Toronto, Canada. Um, the topic today was one that caught my eye, uh, recently. And it was a New York Times article. It was some months ago, but it popped up on my feed just recently. Uh, and I'll read off a little excerpt of it, and then we'll, well, you know what, let's do the disclaimer first, and then we'll get into it right, uh, [00:01:00] into that.

But it's basically about cosmetic surgeries before big events, like weddings, anniversaries, you know, big showcases, and, uh, the pros and cons of doing something like that. Uh,

Dr. Sam Jejurikar: is, uh, this is Texas, so don't forget Quinceaneras as well.

Dr. Sam Rhee: Oh, yeah,

Dr. Sam Jejurikar: uh, I don't

Dr. Salvatore Pacella: yeah.

Dr. Sam Rhee: my god!

Dr. Sam Jejurikar: Alright, so this show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment.

After appropriate discussion, always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care, and never disregard professional medical advice or delay seeking advice because of something you saw on this show.

Dr. Sam Rhee: Alright, thank you for, thank you. Kinsenye, oh my god. Uh, so, the article was written by Sarah Lyon in May, and the topic, uh, the, uh, Headline was Bridesmaids, Bubbly, and Botox. For some, [00:02:00] undergoing a cosmetic procedure or two is an essential component of wedding prep. And it gave the example of a, of a person named Danielle McNamara, thought about getting a nose job.

She was reviewing photos from her wedding proposal in 2021 and she then began Seriously considering scheduling surgery. She was 36 years old. She said she wanted to look at images from her wedding and be like, Oh gosh, I wish, and not say, Oh, wish I wish I had done my nose sooner. So in February of the next year, she called. Dr. Michael Kim, this kind of marketing always gets me, double board certified facial plastic surgeon in Portland and had her surgery done, a rhinoplasty in September and then had her wedding about a year and one month later in October of the following. So, Let's talk a little bit about what your [00:03:00] experiences are like in terms of patients wanting to have procedures done.

What do you do? How do you approach it? Um, what do you think about that?

Dr. Sam Jejurikar: well, what strikes me about that story is that that patient actually went in plenty of time to recover from her procedure. The fact that she went more than a year before her wedding shows that she was very well thought out and had planned this. Dr. Rhee. That is not my typical experience. Um, most of the time patients will come to me and we'll say, my wedding is in two months.

I want to get my nose done. And then you have to explain to them that with post operative swelling, that's probably not a great idea. And you have to think about other things they might be able to do that, that will give them the results they want within the timeframe that they have to recover.

Dr. Lawrence Tong: Yeah, I, I agree that that is probably the most important thing and the, uh, the time to recover is going to depend on what procedure a patient is considering. So rhinoplasty is definitely one of the longest ones and, and you [00:04:00] can, you know, move down the line to something less invasive like, you know, some Botox and some fillers.

Each procedure has, you know, a certain amount of time where you want the patient to be able to heal so that they'll look the best for for their wedding or for their pre wedding photos. And so I think it's very important for us as plastic surgeons to be realistic with them and also even and also let them know that even if Um, you know, we do this at the quote unquote, you know, proper amount of time.

There can be, you know, complications which, um, may impact how a patient looks, uh, at the time of the surgery. I think rhinoplasty is actually, for me, for my practice, pretty popular. And I've been fairly fortunate in that I think that most of my patients who come in interested in something will plan out, you know, well ahead of time, like at about a year ahead of time for a rhinoplasty.

But the other common thing that I, I see a lot [00:05:00] of is, um, just smaller procedures like, uh, liposuction in the neck area. I think that that's actually a nice procedure, some sort of submental liposuction or even a mini neck lift, which is a, which is a procedure to sort of re sculpt the neck. It doesn't involve skin removal like a neck lift because generally most patients who are.

getting married are not in that age where, you know, they have loose skin. So I think some of these procedures are, are, are great. I would say my top two would be some sort of neck thing and, and rhinoplasty, maybe lids sometimes, but generally younger patients don't have as much need for that.

Dr. Salvatore Pacella: Yeah, and I think, um, you guys hit the nail on the head here. I think it's, you know, you divide below the neck and above the neck. And so if you want to have a breast augmentation four weeks before your wedding, you know, I don't necessarily see a problem with that given any rare issue, right? [00:06:00] Um, so you still may be a little bit swollen, but you know, that's gonna kind of look good in the wedding gown, right?

You want to do an abdominoplasty before your son's wedding. Um, you know, four, six weeks, I think you should be good to go. Um, little lipo here and there, same thing. Any facial surgery, I mean, anywhere from three months to a year, I think, is critical. I think, you know, we just sort of talked about facelifts and, you know, not uncommonly do I see Uh, women who want to get a facelift done before a child's wedding or some sort of major event.

And I'd say, at the very minimum, particularly if your lower lids are involved, I would say six months, no question. And, you know, to me the worst thing would be if a patient has an extended complication or some other issue. Chemosis or lid melt position or something that is going to take a little bit of tweaking to, to, to optimize, you know, that's not something [00:07:00] we want to be doing three days before the wedding.

I mean, it's just not a good idea.

Dr. Sam Jejurikar: Yeah. A lot of times I find that we have to talk those patients into Botox fillers, kind of just the best that we can do with the limited window of time that we have. At least that way we know we're not going to make them have a deformity at the time of their wedding.

Dr. Sam Rhee: I am, I must be very conservative because the most I'll do for anyone 2 to 3 months is usually like a filler type of procedure. And then for any kind of surgical procedure, maybe I'm just a Murphy's law kind of person, but I always know if I'm under the gun from, uh, from a time standpoint, it'll take double the amount of time for that particular patient to get to where they need to go.

I don't know what it is. I probably. Uh, had had, like, one experience like that in the past, and now I'm just, like, overly cautious about it. But, um, like, for a breast dog or abdominoplasty, I'm giving them Well, breast [00:08:00] dogs probably a little faster, but I'm still giving them like four months, five months, just because I just want everything to settle and, you know, honeymoon and they're traveling and doing all sorts of crazy stuff, like, I just want them not to, I don't want to worry, uh, even tummy tucks and lipo, I, I'm giving myself, uh, Uh, even if they can recover faster, I'm giving myself six months as a surgeon to make sure everything's good.

Uh, and then the facial stuff, I give myself even more time. So, I, I, maybe I'm just, uh, really, really, really conservative with it, but, but that's sort of where I sit with most of these things.

Dr. Salvatore Pacella: You know, I'll tell you a major, major challenge I have in my practice is, uh, I take care of a fair amount of, um, college kids. Okay. And. They, you know, I may have operated on their parents before, and I want to get my nose done during the summer before I go to college because, you know, I'm starting my [00:09:00] freshman year,

Dr. Lawrence Tong: So you're talking high school kids, not college

Dr. Salvatore Pacella: school kids, yeah, but on the way to college. Or, for example, somebody who's home for the summer, right? And so, or breast reduction, that's a very common one we see in, you know, late high school, early college years. And, you know, think of the logistics of this, right? So, like, they're away, you know, hours away in college.

You know, you have to be evaluated. You have to have a consult, then you have to have a pre op appointment potentially. Right. And so, you know, they may have a window of four to six weeks in the summertime or a short break for two weeks in the, in the holidays. It's exceptionally challenging to kind of map out exactly where.

They're going to do this. Also, a lot of them have like sports careers where they're, you know, they're trying to fit something in between a season. And so it takes a lot of, uh, my, I have to give kudos to my coordinator, Christine. She's a, you know, master of Tetris and kind of putting this all together for patients.

Dr. Sam Rhee: What do [00:10:00] you think about the psychology of changing your body or your aspect or some aspect of your face for an event, just an event, like this is a very short term goal type of thinking for patients when the consequences of the surgery are lifelong. So, maybe all they're thinking about is, Is that photo port, you know, album that they're going to have for their wedding, but have they really thought about everything else?

Like, yes, maybe they would look better with, you know, C cup breasts, uh, during, in the wedding dress, but then maybe they haven't really thought it through living with C cup breasts for the next 20, years. Uh, you know, do you encounter this type of issue or, uh, How do you approach it?

Dr. Sam Jejurikar: This,

Dr. Salvatore Pacella: All the, all the time. This is a, this is a, this is an Instagram filter society we live in, right? So this is exactly what we deal with constantly. Yes. So go [00:11:00] ahead,

Dr. Sam Jejurikar: you guys, did you guys ever see that article in the New York Times probably a decade ago? Where they talked about the 24 hour breast augmentation? Where this was, I think a New York City driven phenomena. Where, uh, Specifically for an event, in exactly the scenario that you're talking about, patients would come in and, you know, the night before their big event would get their breasts pumped full of saline to give them, like, a cup size enhancement.

Um, and the surgeons would sort of make the argument, you know, they may just want it for the event, but, you know, the long term consequences of doing this, the little bit of stretching in the skin envelope that'll happen isn't a big deal. I've never, ever had a patient come ask me for that procedure. The only time that this procedure has ever been done in my practice was for the loser of a fantasy football league.

Um, but

Dr. Sam Rhee: Wait, wait, wait. You got to go into that a little bit more detail.

Dr. Sam Jejurikar: can't, cause I was in the fantasy football league and we did it on a guy. It's a long story, but anyways,

Dr. Lawrence Tong: Was, was the guy's [00:12:00] name Sam?

Dr. Sam Jejurikar: No, no, no. Anyways, I mean, but that kind of, that's sort of a response to your question where Yeah, a lot of times people aren't thinking about the long term consequences. They just want to look a particular way on that particular day, so their photos look a particular way, and they may not want that.

Dr. Lawrence Tong: I, I have not encountered that, but the, the point that Dr. Rhee, uh, brought out is, uh, integral to all cosmetic surgery that we do in that you have to make sure that the patient is doing it for the right reason and they understand what the consequences are, both in the short term, um, and the long term. And.

You know, as, as we practice, we get a little bit better in, you know, identifying, uh, these things and hopefully we won't get into a situation where we do an operation on a person and then they come to regret it. Fortunately, a lot of these things you can, you know, reverse. A breast augmentation you can [00:13:00] take out, um, an implant you can take out if, if you want to.

But yeah, I think that's very, very important to make sure that the patient understands what the implications are for having the surgery. And Making sure that they're not doing it just for, you know, you know, that event or that wedding or whatever it is.

Dr. Sam Rhee: Let me, uh, go onto another part of this article, which kind of bothered me a little bit, and I'd like to hear your comments about it. So they, they talk about doing, um, less invasive treatments such as Botox before weddings and, uh, Here is what they said. For other brides, pre wedding Botox is more than a skin care regimen, it's a group activity.

While helping plan a close friend's February bachelorette party in Palm Springs, they suggested an afternoon of Botox and relaxation. The, uh, um, person's, uh, uh, sister is an aesthetic injector. [00:14:00] And so, uh, and the other, uh, relative running the party was a, uh, children's nurse practitioner who runs a a medical aesthetics practice.

And they both administered Botox to 10 women, uh, receiving injections while the rest of us hung in the pool, tanned, listened to music and uh, caught up. So that scenario sounds very attractive. Uh, if I was a casual person just kind of reading this article, like that sounds like that would be something I would want to do for my wedding. Any comments about that?

Dr. Sam Jejurikar: I think we're all trying to figure out how to, you know, I think, um, as long as the injectors are properly evaluating these patients and they're not drinking and not, you know, compromising themselves in any particular way. I don't have a huge problem with this. It sounds very familiar to, you know, Botox events and Botox [00:15:00] parties that many people have.

Obviously you still have to go through the process of doing informed consent on people, making sure you do an appropriate evaluation of them. But assuming all those steps have been taken care of, why does it matter if they're waiting in a waiting room or waiting in a pool and catching up?

Dr. Lawrence Tong: Well, I would my comment for that would be You know, you said as long as all those things fall into place I would hazard to guess that In a lot of these situations, it's it's not it's not the same. They're not doing all those steps. So that would be my sort of um You worry about that because when you get the Botox and then you jump in the pool and you start swimming right afterwards, you know, we, we, I usually tell patients not, not to, you know, work out or exercise after, um, after they've had Botox until the

Dr. Sam Jejurikar: You think they're exercising in the pool, not just hanging out?

Dr. Salvatore Pacella: Listen, I got, I got one point. I got one point [00:16:00] here. I got one point here. You're all married to women, I assume, right? How, when was the last time your wife actually got her hair wet? Or took a, or went submerged underneath the pool. Okay. Never, never. Okay. So they're sitting in their waist up. That's not a problem, you know,

Dr. Sam Jejurikar: You tell your patients they can't have sun after Botox, Larry?

Dr. Lawrence Tong: they can't have what?

Dr. Sam Jejurikar: Can they not be exposed to the sun after their Botox? Is that your fear?

Dr. Lawrence Tong: No, no, that's, that's okay. I don't know. It just, it seems like there's going to be alcohol. And I, I, I wouldn't, I mean, I, would you go to like somebody's house where they're having a bridal shower or whatever, and start injecting people?

Dr. Sam Rhee: I was about to ask you guys because I've never done that. And nor would I honestly recommend that anyone do that. I feel like I, I don't take anything, uh, lightly. And [00:17:00] again, maybe I'm the conservative one here, but I like having everything that I need to do Botox or, uh, in place. You know, if I go to some rando's house and, or pool and set up all my stuff, like I don't feel like I'm really in control of what I'm doing here.

And then if they're distracted and they're running around in the pool and drinking and having, you know, shots of tequila or whatnot, or whatever, like to me, um, the only, none of this is helping me do my job better. It's only detracting from what I can do. So why would I be in a situation where, All these factors could make things worse.

They're not helping me, they're only gonna make things worse. So I would rather be like, listen, do your bridal shower, do your thing, I'll set you guys all up in, you know, at my office, with, you know, whomever, but don't, don't, don't. Why would you combine the [00:18:00] two? To me it, it trivializes something that, you know, admittedly is less risky than most of what we do.

But, um, you know, again, everything I do, I want to set myself up for success. And this is no setup for success in this, In this instance,

Dr. Sam Jejurikar: mean, To be devil's advocate here, the risks of Botox are migration of the product, which can cause, you know, some drooping of the brow, some bruising. It's not like filler where you can get, um, blindness or real serious things. I'm not going to call Botox a trivial procedure to use your term, but the potential risks Again, I'm all saying this with a copy, but the people doing the injections are not in the pool, not frolicking, you know, doing all whatever.

I don't have a huge problem with it. I've definitely, um, not always injected Botox in my own office. I've definitely, you know, I've done it in other situations. And as long as I have good [00:19:00] lighting, I don't feel like it's that difficult of a thing to do.

Dr. Salvatore Pacella: I mean, I, I personally wouldn't really deliver care in any other place than my office, just from a safety standpoint, but I don't really see a major problem with them with it. As long as, You know, there's no alcohol involved. This is at the start of the event. You know, informed consent is done. All the paperwork is done appropriately.

You know, I mean, we deliver home care for wound patients at home. It's, how is this really that much different, you know?

Dr. Sam Jejurikar: The bigger issue with me is I just don't want to do this.

Dr. Salvatore Pacella: Yeah. No, no, there's no, there's no value. Yeah.

Dr. Sam Jejurikar: yeah, I just, I view this as something that would be not particularly enjoyable and not generally a good utilization of time. But like from, uh, from, uh, from that aspect, I don't do this regularly, but you know,

Dr. Salvatore Pacella: How about, how about when, how about when you get together with your fantasy football buddies and inject each other's man boobs with, uh, [00:20:00] saline? What, what do you, do you do that in your office or in the home setting? laughter

Dr. Sam Jejurikar: don't know what you're talking about.

Dr. Sam Rhee: plausible di plausible deniability on that one there,

Dr. Sam Jejurikar: Every fantasy football league has got to have a good outcome or a really bad outcome for the loser, right? So

Dr. Sam Rhee: Wow. Those are, those are high, high stakes. Uh uh. Is there anything you won't do before somebody's wedding? Or you're like, this is not something you should be doing before. Anything off the table for you guys?

Dr. Lawrence Tong: I think for injectables, um, if they're coming to you like a week before, I would be hesitant to recommend an injection because, you know, you can always get a bruise and the bruise is something you, it just happens. And it's, it's not something like one or 2%, it's, it's higher than that. So if a patient gets a bad bruise and [00:21:00] then they have to get their photos, if it's the bride, especially, I generally wouldn't, that, that I wouldn't do.

I wouldn't inject anybody, you know, if they came in within a week, maybe even two weeks, uh, before, before their wedding. All

Dr. Sam Jejurikar: with injectables. Still two weeks beforehand, but I agree, less than two weeks. You're taking the risk reward ratio may not be favorable.

Dr. Salvatore Pacella: Agree.

Dr. Sam Jejurikar: uh, I, you know, are there things what I wi some of the things that I would do, Sam, I think I'm less conservative than you in this regard. I've done breast augmentations three weeks before big events, body contouring surgery.

Four to six weeks ahead of time. You know, a lot of times you'll have to warn the person that they might be having to wear shapewear underneath their wedding gown. But still, you know, particularly, uh, in this age of bariatric surgery and GLP one agonist and a lot of people have lost a bunch of weight.

They really feel much more confident, um, uh, [00:22:00] you know, even with shapewear than, than they would have having a bunch of loose skin or extra fat. So I, I think the key is you have to figure out as a, as a doctor, what the risks are, if you do it too close to the particular, to the particular event, and then talk about the risk reward ratio with the patient.

Dr. Sam Rhee: I mean, I'm more of the guy telling that person, Hey listen, just wear some Spanx, put a couple falsies in, and you're good to go for your photos. But yeah, I think

Dr. Salvatore Pacella: get some tape behind your neck and just like,

Dr. Sam Rhee: that's right, that little Hollywood trick where you just like pull it all back and, you know, get some makeup and, you know, tell your dude to, uh, you know, work on the Photoshop a little bit and airbrush some of that stuff out.

So there you go. Uh, but all right. Uh, really enlightening. I really appreciate your, uh, thoughts, uh, on all of this. And I think for anyone who's considering any, uh, Procedures or treatments before a wedding. I think this is going to be super helpful for them. [00:23:00] Uh, and just make sure you talk to your surgeon beforehand, someone you really trust and, and, uh, good luck.

Congratulations. If you are out there getting married or you're quinceanera or, you know, loser of your fantasy football, Lee,

Dr. Salvatore Pacella: laughter

Dr. Sam Rhee: just good luck. All right. Thank you guys.

Dr. Lawrence Tong: right. Take it easy.