Episode 24: Sunday November 29

Drs. Sam Jejurikar , Salvatore Pacella, and Sam Rhee roundup the latest plastic surgery news, including the "Zoom Boom", the plastic surgeon featured in Borat 2, statistics of the most popular plastic surgery procedures, and proposed regulation of cosmetic surgery advertising.

Full Transcript (download PDF here)

Dr. Sam Jejurikar: [00:00:00] Welcome everyone to, our latest installment of three plastic surgeons and a microphone. I'm dr. Sam  in Dallas, Texas, and I'm joined as always by my cohost, Dr. Sam Rhee from Paramus New Jersey, Dr. Salvatore Pacella from LA Jolla, California. and, we're today talk about current events and current news in plastic surgery.
But before we get into the meat of our program, as always, we have to take care of our business, which is the always scintillating disclaimer. And so just remember this show is not a substitute for professional practice. Professional medical advice, diagnosis or treatment. The 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 treatment for because of something you may have heard in this show. And, before we get into the meat, gentlemen, how are you guys doing today?
Dr. Sam Rhee: [00:01:02] I'm doing pretty well. Yeah. Yeah. Yeah. How's you guys 
Dr. Sam Jejurikar: [00:01:05] good? 
Dr. Salvatore Pacella: [00:01:06] Good. 
Dr. Sam Jejurikar: [00:01:07] It's a 
Dr. Salvatore Pacella: [00:01:08] little brisk morning here. A little cold. About 60 degrees, 

Dr. Sam Jejurikar: [00:01:15] It's actually warmer in Dallas than it is in LA Jolla. Cause it's a, it's warmer than 60 right now. So 
Dr. Sam Rhee: [00:01:20] I'm not doing so right now. All right. So let's talk about the news this time. let me bring up our first topic and, I will just read it a little bit and then, let you guys sorta comment and that'll, sorry to get us going here.
this one is about the demand in plastic surgery. So I saw an article out of facial plastic surgery and aesthetic medicine. it was also reported in ed times, thought I N where plastic surgery demands likes during COVID-19 for an unusual reason called zoom. Boom. many working professionals have no choice, but to switch.
 many working professionals have no choice, but to switch to, the camera and virtual meetings, it's led to a rise in the demand for plastic surgery.
People want to still look good. And although we are supposed to see others on these video chats, we get distracted by the thumbnail that shows us, and we tend to focus more on our physical and facial flaws and video calls. And this is called zoom dysmorphia. Are you guys seeing a, an increase in plastic surgery demand because of this?
Dr. Sam Jejurikar: [00:02:32] absolutely. And I think, as we've talked about in previous episodes before, the overall rise in plastic surgery is. It was tremendous. And, but shell actually pointed out to us, on a more on a, just an episode in the past that we can actually improve the way we look, if we put our face at a higher camera angle.
And I don't know about you guys, but the number of virtual consults that I've been doing have gone through the roof. And oftentimes during the consult patients will actually start pointing to this area of their neck. And they'll actually start telling me what about this. I don't want to take care of this and this.
Not even usually the reason why they're on the consult, but during the midst of the zoom consult, they want to start talking about net contouring. And on more than one occasion, I've brought up the cellos advice, which is, the need to, to put the camera at a higher angle, because I think I'm doing five to 10 times the amount of neck contour and procedures as I did prior to that prior to the pandemic.
Dr. Salvatore Pacella: [00:03:26] Yeah. And, just interestingly know, and on this podcast, I was neck shamed by, These other two plastic surgeons here, which is why I bought my own webcam that wasn't integrated. So I'm just going to start putting it like up here like 
Dr. Sam Jejurikar: [00:03:39] this. Okay. 
Dr. Salvatore Pacella: [00:03:41] the, no, but I agree.
It's a. there's a phenomenon that occurs. I think in the average facial plastic surgery patient, that is a, they notice things about themselves when they start looking in the mirror that they never noticed before or after or before their surgery was. internet aside or zoom calls aside, do you ever have patients that both of you that say, Why is one eyebrow higher than the other.
And you look at their preoperative photos and it's clearly there, but they've had facial surgery and now they start focusing on this. So it's the same sort of selection bias that we see in patients. they've always looked like that, but now they're their faces under a microscope. So I am seeing quite a big push and a big, a huge impetus sorts, facial procedures.
And on top of it, all everybody is saying. this is a time for me to do it cause I'm wearing a mask, I've seen a huge uptick in rhinoplasties in lip procedures, lip lifts, lip augmentation, just everything below here. 
Dr. Sam Rhee: [00:04:46] It's funny, I think, from a recovery standpoint, that's why they're doing all those things in the mask area, but I also have a lot of eye and. periorbital rejuvenation, patients, because that's what they focus on, with the mask as well. it's funny when I never really thought of it, but they point out when we actually talked to other people in real life, we're not actually looking at our own faces. But when we're doing these video, communications, we're always looking at ourselves, in our little window.
And, as Sam said, these webcams are not very flattering. they did point out that these webcams have short focal lengths on their cameras. So the nose looks, they, they found 30% bigger on a portrait, taken 12 inches away than say, a camera that's five feet away, which is normally what. Most regular cameras are as opposed to web webcam.
So when you look at that and you see this round face and these big noses, and as Sam said, like this thick neck, it just sorta emphasizes the things that we hate to see in ourselves. 
Dr. Sam Jejurikar: [00:05:51] Yeah. the interesting thing is when you call it this morphia, that implies that it's pathologic.
But I don't know about you guys. I'm doing more procedures in this area. So am I in your mind? Am I feeding into this demand? Should I not be doing procedures? If it's dysmorphia because I'm doing a lot more net contouring, I'm doing a lot more lik augmentation and lip lift. Just like you guys are talking about what are you guys doing?
 Dr. Sam Rhee: [00:06:16] I think it's a good point when we talk about body dysmorphic disorder, we're talking about patients who get repeated procedures over and over again because they have a psychologic disorder. This is something that's pathologic and is a problem, I think you're right. It's really hard to call a dysmorphia if they see a, an issue and they just want to address that one issue as opposed to, A psychiatric disorder, like BDD, where they're just continually getting procedures done.
Dr. Salvatore Pacella: [00:06:43] I think this just feeds into the whole, pushing our society to label and compartmentalize everything in, in a certain discussion. So I think this is just simply, a, an opportunity for people to look in the mirror on the wall, it's interesting though, when you see patients that they, they're looking on these zoom calls and they feel like their appearance has changed.
there's a man out there right now who looks interestingly, Dwayne the rock Johnson,
 Dr. Jejurikar. Do 
Dr. Sam Jejurikar: [00:07:11] you smell what the rock is? Cooking? I wish I could just raise one eyebrow. But, although I though I appreciate the compliment, the Mac, the rock is an incredibly handsome man. And so I don't want to put myself in that category, but, going back to what you guys are saying, I think that last sentence of this slide and obsessive disorder called zoom, dysmorphia implies a lot of judgment.
And what I'm seeing in these patients are, if they come to me and they say they don't like the way their neck is, and I do liposuction or Kybella. Or anything else for it. And they get better, which they always seem to be getting better. They're generally happy. And so I don't think they're obsessing at all.
I just think they're now having an opportunity to see things that they didn't see before. So looking 
Dr. Sam Rhee: [00:07:53] at him here, I agree with that. 
Dr. Sam Jejurikar: [00:07:55] Yeah. 
Dr. Sam Rhee: [00:07:58] Yep. All right, let's move on to the next, Dallas plastic surgeon, defends cringey, Borat 2 cameo, dr. Charles Wallace on his portrayal and Sasha Baron Cohen's latest quote.
I was flat lied to and take it advantage with all the tools of Hollywood. And, basically, in this bar at two, if you saw the movie in, he was given an out of a, he did a plastic surgery consultation for what he was told were a pair of very wealthy, middle Easterners with an odd way of communicating.
And, they were in the area looking for information on rhinoplasty and breast implant surgeries. Portions of that meeting were filmed and recorded. without him being aware and they arrived and they made it into the bore at two movie. And, there's an article out of central track.com and they basically said at best, the scene is a uniquely awkward and at worst it's wholly offensive.
He's seen speaking stone faced about the possibility of performing surgery. On the girl, supposedly a 15 year old daughter and he is heard saying he would consider sleeping with the girl. If her father were a wasn't there in the meeting. And along with his, Sasha Baron Cohen character Wallace also engages in gross stereotypes about Jewish noses, even using his finger to, exaggerate how long and bad they can be.
 Dr. Sam Jejurikar: [00:09:18] have you guys seen this?
 Dr. Salvatore Pacella: [00:09:20] it is exceptionally cringe-worthy. the one question I have and dr. Jujurikar in Dallas, perhaps you can answer, this is, in the, my understanding in the state of California, to be taped without your consent. Yeah. now this wasn't a hidden camera, but let's just go into it.
this is a, as a, a corollary here. So what are the rules, for audio taping and videotaping in tech 
Dr. Sam Jejurikar: [00:09:46] it's the same as it is. and in, in California to my knowledge, but, I read that article that, that dr. Ray was talking about. And it basically, it sounds as though they had him sign some sort of disclaimer that he did not read.
Which, I think to anyone in the audience don't sign anything without reading it because, I think Chuck Wallace would probably be the first to admit that if he could go back, you probably would have read that disclaimer much more carefully because it is cringe-worthy. But if you read his explanation of why he was saying the things that he was basically told that this was an incredibly eccentric.
wealthy middle Eastern family. He was not told that the girl was 15, that they had an odd way of communicating and to very, be very careful not to offend them. And so you can tell that what he's saying during this scene. There's not a lot of spontaneity in his answers. They're very measured trying, I think, to fall within the parameters of what he was saying, he was, what he was supposed to say, and it just came across.
Without the appropriate context as being very awkward. So my number one impression when I watched the scene with Chuck Wallace was thank God. It didn't come to my office because single one of us right here in the wrong context has made jokes, which we regret are inappropriate. And I'm not defending anything by any stretch of the imagination, but.
I'm also glad that, I was not in that situation and I know dr. Patella has to feel the same way 
Dr. Salvatore Pacella: [00:11:18] a hundred percent. 
Dr. Sam Rhee: [00:11:19] absolutely a hundred percent, I think, it's a lesson learned for all of us that, you never know what the hell is happening, when you're, listen, when you're with patients and, you're in a professional context, I am, I would bet my house that both you dr.
and you, dr. Pacella are a thousand percent professional and you would never do anything that would, not be professional because I've known you guys for, 20 years, But, if you, there are people out there who have been practicing for a long time, they let their guard down, they, get duped and taken advantage of.
And th that's a, that's an unfortunate situation. it's funny. and. Actually he says, if anything, this, publicity for him, there's no bad publicity. He says, it's great for business. he, says he gets an occasional stoner calling in the middle of the night, leading messages. dude, can I get some potato titties, which I didn't see the movie.
So I missed the reference about that. 
Dr. Salvatore Pacella: [00:12:13] I don't recall that part either. 
Dr. Sam Jejurikar: [00:12:16] they asked if a bore I'd asked if they could perform the breast augmentation on his 15 year old daughter with potatoes. and appropriately dr. Wallace. And so the things which are interesting too. So Chuck Wallace is a guy who's been in Dallas for a long time, has a very established practice has patients that go back 20, 30 years.
I'm not sure how much of his business is coming from the internet, but what he actually said was. The publicity rekindled some of his old patients to remember the great care they got in his office and it's been good for business. The other thing which I think is really interesting was they showed a scene right after the scene with him, where they were going through a quote and what appeared to be his office and the member of his staff.
But he says in the interview, that's not anyone he's ever seen before. And it's nobody that works for him. So clearly there's some Liberty being taken here. Trying to frame this conversation in a way that probably wasn't intended. But, and I think that's where the potato, the potatoes came up is with that scene with the fake,
 Dr. Sam Rhee: [00:13:14] listen, it's all in good fun. I think hopefully. And, if he's not, if his business isn't affected and if it's doing better than, God bless and, take it with a, good sense of humor, Yeah, but I'm really glad it wasn't me 
Dr. Salvatore Pacella: [00:13:27] enough said on that topic. 
Dr. Sam Rhee: [00:13:30] all right.
Let's move on the, next item. Okay. That's right. Yeah. Someone asks for potato titties. just say no. rough cuts inside the booming cosmetic surgery industry for designer dogs. Prize pups are getting faceless nose, jobs, and fake testicles. And Greg Miller, the co-inventor of the prosthetic canine testicle known as the new tickle.
Claims to have sold more than 500,000 pairs. That's a million single testicles, 500,000 pairs right there, in dogs. And basically it's an article out of a Robb report.com. They said that, to, achieve physical perfection, owners rely on tricks of the trade, which are, is basically nip, tuck type surgeries for.
Dogs, including skin fold reduction, which is adding or removing wrinkles, and, nose jobs. And then as we mentioned, fake canine testicles, mainly for dog owners who wish to conceal the fact that their pet male, their male pets have been neutered. he, wished to alleviate the discomfort of emasculated dog owners who would otherwise suffer comments by strangers who.
Misidentify the gender of the pet. And according to the, inventor, Greg Miller, Kim Kardashians boxer named Rocky has a set of fake canine testicles. 
Dr. Sam Jejurikar: [00:14:57] Is that a HIPAA violation? Wow.
Dr. Sam Rhee: [00:14:59] That's right, man. That's not right. You shouldn't be outing a dog. That dog.
Dr. Sam Jejurikar: [00:15:04] Hi. my dog does not have no wrinkles because that's interesting because normally when we talk about getting a static surgery, Yeah. we talked about getting aesthetic surgery. we normally tell people, that it's, that, at least I tell people don't have surgery because somebody else wants you to have surgery, do it because you want to have surgery.
And, This is, there's no dog that I'm aware of. It's clamoring to get fake testicles. Now that being said, I don't know what the complication rate is, and if it's done at the same time as the, as the dog is being fixed, maybe you could do it, I'm not sure. Maybe it makes the dog feel better about, about, about him, about himself.
So maybe it's, if there's an outcome study being done, the dog actually has higher self esteem. I'm not really sure. But it seems fairly preposterous, 
Dr. Salvatore Pacella: [00:15:50] curious to know what Peter thinks about this. I'm sure they have a, I'm sure they have a movement to completely cancel this on the internet.
You know what I mean? let's just say, so there are certain breeds of dogs that are prone to issues related to skin and soft tissue. So obviously the sharpei. They've got big, heavy hooded, eye eyelids and, in order for them to see it may be efficacious for them to get a trimmed.
I will admit I have done plastic surgery on my previous Labrador retriever, but for reconstructive surgery, my dog used to get these massive seromas of her ear from shaking, from ear infections. And these seromas would just come back and come back. And, every time I went to the vet, it was about $1,200 for them to fix us.
And so I finally said, Nope. I, it took some lidacain. We had a nice sterile area and I, fixed my own dog's ears. So I'm not, I picture myself on a ranch somewhere in Montana with no vet around. this is just a, this is just a ridiculous story. come on if for the average house pet, why, 
Dr. Sam Rhee: [00:16:54] why do they need this?
Dr. Salvatore Pacella: [00:16:57] What do you think is at risk for 
Dr. Sam Rhee: [00:16:58] infection? It's clearly projection. listen, if you yourself feel inadequate in some way you could imagine your dog is not feeling very happy either. And so then you're like, you know what? I want my dog to feel more masculine than me. I'm going to put a pair of big ones on him and he'll be happy because if it was me, I would be happy with a pair of big ones too.
that's my thought. 
Dr. Salvatore Pacella: [00:17:24] That's a good point. That's a very good point. So 
Dr. Sam Rhee: [00:17:27] it's not the it's it's the owners, obviously the owners have issues here. that being said, that reminds me, there are a lot of breeds that have, problems that do require surgery. I know all my French bulldog, owning friends, they all get. No surgery because they can literally not breathe properly, because of the breed standard. And I think this goes into the deeper aspect of, breeds and yeah.
And, these breed standards. And are we getting these dogs to the point where they literally. I think every bulldog needs a C-section because they literally cannot birth. Cause the heads now are so big on these pups as they're being born. we are breeding these dogs to the point where they're no longer, survivable without medical assistance, which is.
Yeah, 
Dr. Salvatore Pacella: [00:18:18] I have a very strong opinion on this. I'm a firm believer in rescue dogs as opposed to breeders. I think breeders are out to make money. They, there's puppy mills out there. They basically breed in break in breed. Disease into the dogs and all three of the dogs I've had in my lifetime have been rescues and have been absolutely wonderful.
So I highly encourage our listeners out there to rescue dogs. It takes a little bit of work, 
Dr. Sam Jejurikar: [00:18:46] but 
Dr. Sam Rhee: [00:18:48] kudos to you. 
Dr. Salvatore Pacella: [00:18:49] very rough. No pun intended.
Dr. Sam Jejurikar: [00:18:52] I think there was obviously a pun intended. All right. 
Dr. Sam Rhee: [00:18:57] All right. So the next item are the, basically, the ASP S American society of plastic surgeons, our organization, that we're all part of, released, their statistics, regarding 2019, procedures and what was done and as well as predicting trends for the future, this was from PR newswires.com and basically they, listed the top.
Five most asked for treatments, which included number one, Botox. Number two, breast augmentation. Number three, soft tissue fillers. Number four was liposuction and number five was tummy tuck. And then they listed the top 10 cosmetic surgical procedures, just straight surgery in 2019. And it ranged from breast augmentation, liposuction, eyelid surgery.
Nose reshaping facelift, Tummy tuck, breast lift, dermabrasion, neck lift, and number 10 was breast reduction. does this correlate with what you guys see in your practice or what you did see this past year? 
Dr. Sam Jejurikar: [00:19:56] for me largely, yes. I'm curious what they mean by dermabrasion at number eight there, if they're including laser procedures in there as well, if they mean skin resurfacing.
Yeah. that totally fits into entirely what I would see in my practice. I'm sure with all of us are some minor variations within the list, but these are all really common things. So I don't do old school dermabrasion lump a lot more laser resurfacing or chemical peels, which I'm sure you guys do as well.
 Dr. Salvatore Pacella: [00:20:19] I think, breast augmentation I think is exceptionally popular, but it also is, directly related to marketing, I believe. I think those surgeons that do a tremendous amount of advertising and marketing on the internet are seeing much more of this of my patient referral patterns are a little bit different.
So I'm seeing a little bit more facial procedures, but I would say that eyelid nose and face, are right up there, exceptional. and then the soft tissue fillers from non-surgical treatments and Botox Dysport are exceptionally popular. 
Dr. Sam Rhee: [00:20:51] I think it does depend on what you focus on.
Like you said, if you're, doing a lot of facial stuff. facial procedures were three, four and five eyelid nose and facelift. If you do a lot of breast work, breast dog was one breast lift was seven. A breast reduction was 10. If you do a lot of body work, it's, lipo was two, Tommy tuck was six.
regardless, I think any one of those top 10 procedures, depending on what you do a lot in your practice, those are our bread and butter. That's what we're doing constantly for sure. And I think it's going to grow. 
Dr. Sam Jejurikar: [00:21:23] Do you guys do your own Botox and filler injections, or do you have people that you do you have nurse injectors and then what are your thoughts on that?
 Dr. Sam Rhee: [00:21:30] I know, you are part of a large group of surgeons and so you are all part of that, MediSpa, right? the one with that Nina, heads up, bruh, and epi epicenter, which is great. I do my own because I'm a single surgeon practice. I have no problems. working or having other, non physicians, do treatments.
It's just what I do in my own practice. I think I have gotten, I've actually gotten, trained by nurse practitioners and other skilled injectors, as long as they've had a lot of experience. I feel like these are things that. anyone with a lot of experience and knowledge can, can do, I don't mind doing my own.
I feel like, it's, still something I enjoy doing. how do you feel about 
Dr. Sam Jejurikar: [00:22:17] it? No the same. I do some of my own, I definitely do some Botox. I, myself and I do some fillers myself, but the majority of it goes to nurse injectors that really have a passion for it because I'm, I spend more time operating.
but I have a lot of established patients, so we'll keep doing it for, I'm limiting the number of new patients that I do Botox and fillers on just because of time issues. And the fact that just like you said, there's a lot of other people that aren't necessarily core plastic surgeons that are really good at doing it as well.
What about you, Sal? What do you think? 
Dr. Salvatore Pacella: [00:22:48] Yeah, I usually do it myself. it's, I, part of a big group as well, and we have, an exceptionally good cosmetic dermatology group that, I work with that we, are constantly sharing patients, sending patients back and forth. So it just works out well for our practice to have them do a majority of it, did it, but I still do it on my personal patients, 
Sounds 
Dr. Sam Rhee: [00:23:08] good. All right. And the last cap, which is a committee of advertising practice, proposes ban on cosmetic surgery ads around kids' content. Now this is out of the UK and it's out of an article called the drum.com, but I thought it was interesting to spur some discussion about. advertising and who we should be marketing to, especially, in this day and age with social media, the committee of advertising practice, suggest, and this is, a body in the United Kingdom, proposed rules that would outlaw cosmetic surgery ads around all media geared toward under 18 year olds or.
Shows that are like, or media that is likely to appeal to young audiences. So viewers of shows that are targeted towards young people would no longer be subject to breast augmentation. Breast enlargement offers during airtime procedures, typically that were advertised included, breast enlargements, nose, jobs, and Botox treatments, but cosmetic products such as cream makeup and hair care products would be unaffected.
And I think this. Was in part because there was an ad last year in the UK featuring a 21 year old fashion bloggers, Sarah Ashcroft. And that picture there is of her. And she was in an ad talking about her dislike of her body before having a boob job. And she said in her ad, I never really looked at any part of my body past my neck.
Cause it wasn't something I like, I feel like a new person. everyone was like, they're so natural. I was so impressed. I feel 10 times more confident. It's an amazing feeling. And this was, an ad that was basically played on TV. during shows that young people were watching. 
Dr. Salvatore Pacella: [00:24:57] Yeah, this is a very controversial subject, obviously. children, and teenagers and, it's it. I'm sure your guys both will agree that it's much more difficult to be a teenager or child. In 2020 than it is probably even when we grew up with social media and expectation, and this is just one more fuel to the fire, listening to ads while you're watching television.
But, I don't think this really addresses the core problem, which is social media and imaging, that kids see when they're, cruising the internet or on social media. It's, there's an expectation that they have to be perfect. but we were just talking about that with our first topic.
So it's, I think this is a good step, but it's, it's a drop in the bucket.
Sam, can you hear me? Oh, what is going on here? 
Dr. Sam Jejurikar: [00:25:45] Yeah, I would agree entirely with Sal. I think, I don't even think it's that controversial of a topic. Yeah. We shouldn't be running cosmetic surgery as to children. I don't think any of us would be in favor of doing that. I just haven't seen, are you hearing me okay?
Dr. Sam Rhee: [00:25:59] Yeah. 
Dr. Sam Jejurikar: [00:26:00] Okay. I'm just. I have three kids. We all have kids. I've never seen cosmetic surgery as during dedicated kids programs. I've not seen Botox, breast, enlargements, whatever. I just see a bunch of toys that my kids want to buy. And literally I then get hit up for all these toys that they want to buy thereafter.
But, but I think Sal is right. I think the biggest thing is social media. a lot of targeted ads will come up on, particularly my teenage kids, social media feeds. and this sort of ban on television content is simply just not going to address that. 
Dr. Sam Rhee: [00:26:35] I think that's the issue, I think, Facebook or any of these other, Media companies can run ads wherever, and whenever there's no regulation in terms of how we target or how they target the audience.
And, I think that is the concern. And we have regulation for TV shows. We have no regulation for social media in regards to what they can and cannot target people for. And if, if people want it to start targeting young people for these ads, in, on their tick talk or on their Snapchat or anything else there's no, I don't think there's regulation stopping them.
And I think that this is something that is, that needs to be discussed and we need to have a good, conversation about it. And, in our country, I'm not for more regulation for everything, but the fact that we have nothing and we haven't really talked about it much, is. we as plastic surgeons should take the lead in terms of making recommendations before someone tells us what we can and cannot do.
Dr. Salvatore Pacella: [00:27:34] And the other important thing I think to point out here is this is not to say that children and teenagers. not benefit from plastic surgery. Okay. So for example, on the reconstructive side of plastic surgery, we see, young women who have, may have hit puberty early at age 16, at age 12 and have large breasts that are causing neck and back pain.
They're socially ostracized. We may see kids with exceptionally large noses that are being ridiculed. We may see, Young women with asymmetric breasts that they're in the locker room and it may be a huge challenge. And those are patients that we can really touch and really, change their lives with positive things through plastic surgery.
But that's not what this is talking about. This is purely a, make your breast bigger type of situation. 
Dr. Sam Rhee: [00:28:26] And actually that's a very good point. Sal dr. Rohrich, I remember publishing an article some a little while ago about, underage or under 18 plastic surgery. And, the categories of procedures that were considered reconstructive were gigantic.
Symmastia severe asymmetry otoplasty obviously something like a cleft lip. rhino likes some cases of rhinoplasty you're right. There are certain, categories of conditions in juveniles that should be addressed with plastic surgery. and, but you're right, this is not that case.
Dr. Sam Jejurikar: [00:29:01] here. Yeah. Great point. I, I think, I honestly haven't ever seen television ads have you guys for, cause for purely cosmetic surgery during kids program, I didn't realize this was even a problem in this country. So 
Dr. Salvatore Pacella: [00:29:17] I haven't seen that either. Either. Yeah. 
Dr. Sam Jejurikar: [00:29:19] Yeah. Yeah. 
Dr. Sam Rhee: [00:29:20] A Botox like morning news shows and stuff like that.
That's really about it stuff. 
Dr. Sam Jejurikar: [00:29:24] Yeah. I think the advertisers are really smart and because, I know with my four year old child, if I leave him alone in front of the television, which we are, in a bad parenting moment, I might do, he has about three new toy ideas afterwards that he wants that he simply can't cannot live without.
So Botox would just go right past them.
Yeah. 
Dr. Sam Rhee: [00:29:43] All right. excellent. Thank you gentlemen, for another awesome episode. I really appreciate it. I always learned something from you guys. 
Dr. Sam Jejurikar: [00:29:54] It was great as always gentlemen, always, never know where this is going to go, but, I had, I learned a ton as always. 
Dr. Sam Rhee: [00:30:00] All right. All 
Dr. Salvatore Pacella: [00:30:00] right, Gents.
Dr. Sam Rhee: [00:30:02] Thanks again.