Episode 8: Sunday August 9

On the next live episode, Drs. Salvatore Pacella, Sam Jejurikar, and Sam Rhee discuss the hottest news in plastic surgery, including the why the pandemic has led to a boom in cosmetic plastic surgery, some of the latest procedures in cosmetic plastic surgery, the upcoming new Dr. 90210 show, and why there are not more women plastic surgeons. Do not miss! On YOUTUBE LIVE or FACEBOOK LIVE

Full Transcript (download the PDF)

S01E08 - 3 Plastic Surgeons & a Microphone - Hottest News in Plastic Surgery
Dr. Sam Rhee: [00:00:00] Alright, we're live and  hello and welcome to Three Plastic Surgeons and a Microphone. We are Dr. Sam  Jejurikar out of Dallas, Texas. His Instagram handle as always is @samjejurikar, Dr. Salvatore Pacella, who should be joining us soon from the La Jolla California. His Instagram handle is, @sandiegoplasticsurgeon. and I am Dr. Sam Rhee from Paramus  New Jersey and my Instagram handle is @bergencosmetic, and Sal should be joining us in a second. 
I just want to go through our, disclaimer as always,  :this show is not a substitute for professional medical advice, diagnosis, or treatment. The show is for informational purposes, only treatment and results may be, may vary based on circumstances, situation in medical judgment after appropriate discussion, always seek the advice of your surgeon or other qualified health providers with any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice because of something in this show. 
Welcome Dr. Pacella, how are you? 
Dr. Salvatore Pacella: [00:01:02] Hi guys. Sorry. I had some technical difficulties getting my laptop back signed in. 
Dr. Sam Jejurikar: [00:01:07] So. No worries without where this is going to be two and a half plastic surgeons on a microphone. So we're glad you made it. 
Dr. Salvatore Pacella: [00:01:14] Oh, wow. Counting each of your pipes. 
Dr. Sam Jejurikar: [00:01:19] No, no, we just, we just knew you would show up about 15 minutes later. We didn't think it would just be a minute late 
Dr. Sam Rhee: [00:01:25] Were you doing bicep curls before you just came in. Cause those are, those guns are pretty big, man. 
Dr. Salvatore Pacella: [00:01:31] Y ou know, we try, sorry about that. I, Got in a little bit late last evening and, was just trying to get everything situated here so. 
Dr. Sam Rhee: [00:01:38] No worries. 
Dr. Sam Jejurikar: [00:01:39] Wonderful. 
Dr. Salvatore Pacella: [00:01:41] Alright. 
Dr. Sam Rhee: [00:01:41] So today we are going to be talking about some of the latest news items that are trending in plastic surgery. And is there anything else that you guys want to add before we start with some of the news items? 
Dr. Sam Jejurikar: [00:01:55] Not really. It's just rare to talk about the news. It's been an eventful week.
Dr. Sam Rhee: [00:02:00] All right. So let's do that. okay. So the first one is something that I think all of us have seen as plastic surgeons and it's that demand for plastic surgery is up, even with coronavirus. this was from ABC news and our very own Michigan Dr. Lynn Jeffers, the American Society of Plastic Surgeons President has shown that, people are still in interested.
She says breast augmentation and liposuction, top of the list for most common procedures. And even during the pandemic, the interest in plastic surgery has not waned, which is very interesting. obviously lands of Americans get Botox and breast augs every year. and, right now they say 55% of plastic surgeons reported that the Botox injections were the most commonly sought treatment during the stay at home order and 40%, reported breast augmentation.
And basically, surgeons have said, there's this pent up demand for surgery, breast augmentation, breast lift, tummy tucks demand is huge. And Dr. Furnas, a plastic surgeon out of California said some of them will say they see themselves on zoom and they just want to feel better in this crazy time.  I think people are looking for something to make them feel better about themselves. Thoughts, gentlemen.
Dr. Salvatore Pacella: [00:03:18] Yeah. So, you know, I think that's, you know, there's a supply and demand curve economically. That's been, I think brewing over the last few weeks and few months, obviously, you know, most of the country was in a bit of a lockdown situation. So the, the supply of patients, if you will, if you, if you put it in those terms, has built up  incredibly - the supply of surgeons that is.
 We've all been kind of shut down. We've all been raring to go back to work. And it's been a little bit problematic economically, I think for our industry to stop working. And then consequently, we have this sort of built up demand. That's that's coming up.
So, you know, most of the procedures had been canceled and then once the flood gates have been opened for, for booking procedures, you know, the demand just skyrocketed. So you have this increasing supply and then this ever increasing demand and it just creates this perfect storm. 
And, you know, I think in this situation we have to, you know, we, one of the things that I see in my patients, is patients are wearing a mask they're sort of at home., they're not doing much. And many of them think that this is a perfect time to undergo cosmetic surgery, particularly the face I'm at home. I'm not moving. I'm not, I can't travel necessarily. So I, I see a lot of that in my practice. 
Dr. Sam Jejurikar: [00:04:40] I love, I love Dr. Pacella flexing, his Michigan MBA with his micro economic analysis. Strong work. I was hoping to see some supply and demand curves. 
I totally agree with that though. I definitely think, not only is that true, but also, You know, there's this, there's this increased population of patients that are now working from home. And so I am seeing much like Dr. Jeffers, I had sort of commented, breast augmentation, liposuction, tummy tuck and in my case, Brazilian butt lifts, demand has gone tremendously up because patients have the ability in some ways to recover faster.
They're having surgery, they're working from home just a few days later. They don't have to go into an office. Other thing I'm hearing from a lot of people is we're not going anywhere. Well, you know, our vacations are canceled. We're not traveling, so this is what I'd like to do for myself. I do notice that the characteristics of how patients are having surgery has changed quite a bit.
You know, traditionally in our practice, people would call our office. They would wait a few weeks, again, an appointment. They would schedule their procedure a few weeks. Weeks months down the road. What I'm noticing now is a much greater sense of immediacy for people. They really want to get surgery done during this period of time when they're anticipating that they're going to be working from home.
So my surgery schedule has opened up. So when operating Monday through Friday, We're seeing a lot of patients via telemedicine after hours. because, that's when it works for their schedule, that's what it works for my schedule and still operating. And then they're getting on the schedule much, much more rapidly.
So it's the, the dynamics of the patient doctor, patient interaction have changed quite a bit, but I would agree that demand is higher than ever before. 
Dr. Sam Rhee: [00:06:19] I would agree with that. I think you're absolutely right. I think the efficiency of how we manage patients has changed dramatically with the pandemic. I think.
You're right. There were way more. And I know there are surgeons out there who probably limit this. They were, I felt like there were way more, physician, patient contacts prior to, and then after surgery, before the pandemic and now, maybe some of that is lost with the video consultation and so forth.
But I feel like patient satisfaction is still extremely high. I think they understand that efficiency in some ways can be helpful with them. They do have, I have to come a little bit more prepared in terms of their knowledge and, and listen to us a little bit more carefully because, you know, we, we may not be seeing them in office, but I agree with that, that, it's, it's busier than it has been.
I think one of the interesting things that Dr Jeffers said here, which I will, which I will say is, "but as patients grapple with the economic impact of the pandemic, as, you know, as it's continuing. Jeffers predicts. A higher proportion of patients will offer less expensive and less invasive procedures. Initially bridging procedures like Botox and fillers, patients will want things like that until they are more secure." How do you think things are going to continue to play? Let's suppose if this continues on for another three months, six months or a year? what trends do you predict will happen? 
Dr. Salvatore Pacella: [00:07:47] You know, I think, this, this was going to be my next point, which is, you know, as doctor Dr. Sam from Texas understands from his, flexing his MBA. 
Am I the only one without an MBA?
Dr. Sam Jejurikar: [00:08:02] Just as a matter of fact  Dr. Jeffers recently got her MBA from Michigan. Well, so 
Dr. Salvatore Pacella: [00:08:09] It's all the rage. I was the trendsetter. I was one of the first .
Dr. Sam Rhee: [00:08:19] I feel so dumb. 
Dr. Salvatore Pacella: [00:08:22] Oh, don't worry. We'll we'll school. You, my friend. So, you know, I think the interesting thing to understand here is, you know, when we, when we talk about, what's happening in the economy, there there's a certain lag economically of the impact of an economic downturn compared to how that affects people in their daily lives.
Obviously. So, and this is particularly true for those patients that may have disposable income. Most of the patients that have, planned surgery even before the pandemic and currently now have certainly a little bit of disposable income to plan their surgery. But, you know, the economy clearly is going to take a downturn.
We're seeing really poor economic indicators, lower GDP, higher unemployment rate things that we sort of look to, as a. As a test for the economy and those appear to only be getting worse. So I think what's going to happen is we're going to see a significant worsening economic downturn. And I think there's going to be a bit of a lag with patients and then subsequently a downturn in the request for, disposable income type of procedures that patients may book.
Dr. Sam Jejurikar: [00:09:34] Yeah. I agree a lot with, with Dr. Pacella has said, but I think it's a little bit more murky. Cause, you know, if you go back to 2008, 2009, you were in the midst of a recession. the stock market was indicative of what was actually happening with the economy at large. And as a result, people's disposable income went down more invasive procedures, went down, Botox and fillers went way up because people were finding, they didn't have as much money in their retirement accounts.
They needed to work for longer than needed to stay competitive in the workplace. You fast forward to now. The federal reserve has just taken such a watch, more aggressive that I don't know, as a plastic sugary podcast anymore, by the way. But anyways, the Federal Reserve has been so much more aggressive in terms of how they've propped up. you know, propped up. Yeah. The they've kept interest rates, low. They bought junk bonds. 
You know, they're buying, the federal reserve, which is. The bedrock of stability in our economy has now unstable assets with a repeat, you know, just with a, with a speed. that was not really forthcoming in 2008, 2009. So I don't know what's going to happen to the market or what's going to happen to people's disposable income.
You would certainly think based on previous recessions, that what Dr. Jeffers is saying is true, but I would've have thought it would have started to set in by now. And we're just not seeing it at all. And it's been, you know, four months of just gangbusters, basically. 
Dr. Sam Rhee: [00:10:52] I think as long as the stock market stays up, the high end market is going to do well., but if, but I, you know, but anyone who is not, on that side of the demographic, I think we're going to see a falloff in that, in that regard probably, but the rich will always stay rich. And I think that they're going to continue to do well. Like you said, the federal government's helping. and there's a lot of confidence, I think, in the financial markets.and I think that as long as that stays up, it'll be okay until it's not. And then the bottom drops out and then that that's when things will change. 
Dr. Salvatore Pacella: [00:11:27] So, this is a good lesson for our listeners. I mean, on this podcast, we don't just know about plastic surgery, you know, Dr. Sam Rhee from New Jersey, we'll be, next week preparing his favorite dish for us. Correct?
Dr. Sam Jejurikar: [00:11:47] It's going to be his favorite paleo recipes. Okay. 
Dr. Sam Rhee: [00:11:50] It  may not taste very good. Alright. so let's go to the next one, which is the top plastic surgery trends of the last decade. And I'd like, my colleagues to comment. This is from new beauty.com and see what they feel is this true or not? So the first one that they say is the, their favorite trends in the last 10 years.
The number one is the biggest trends is micro fat injections through the face, which allow for better contouring either alone or with facial surgery to prevent an over operated or pulled look. and that comes out of a, a guy Robert Singer. So what do you guys think about micro fat injections to the face as being a big trend?
Dr. Sam Jejurikar: [00:12:36] I think it's a trend. I'm not sure I'd put a number one on the list. It sounds like sometimes these lists are generated by plastic surgeons who are promoting things they do in their practice a lot. it's definitely changed, facials that surgery, for sure. I think my fat injections too. And I think you guys would agree fat injections to the face,sides temples, you name it in conjunction with a larger, facial rejuvenation procedure is an amazing adjunct that can add quite a bit. I think also what, what I would say is probably a more representative trend is the knowledge that adding volume to the face, whether it's with filler or with fat, helps you provide youth.
But yes, I would agree with the notion that adding volume provides youth it is a huge trend in plastic surgery. 
Dr. Salvatore Pacella: [00:13:21] So Dr. Singer who's quoted in this article is, out of LA Jolla here, and an absolutely exceptional surgeon, a true gentleman and elder statesman in the community here, was a former president of, of ASAPS, the aesthetic society, our major governing body and plastic surgery.
So clearly has his pulse on what's happening in the world. And I would agree, You know, the, the injection of facial fat and the adding of volume is a huge, huge, advancement in facial plastic surgery over the last, five to 10 years. We really didn't know much about. injection of fat into the body, even, even as much as 10 years ago.
And if you both recall back when we were residents, we were talking, in conferences about injecting fat into the breasts and it was, it was taboo to do that because there was a thought that injecting fat, which can be sensitive to hormones, estrogen, et cetera, was, was dangerous for cancer. And now we're doing it all the time, particularly in breast cancer patients.
And, and so the, the discipline of facial fat injection has really dovetailed off of that. And I think it's huge. I think we're really understanding that, as you inject, as you. Per for facial rejuvenation, particularly in the pulling the face and the, in the outside realm or the outside of the lateral aspect of the face.
It can look pulled or overdone. There's certainly a lot of people walking around the, the streets of San Diego, looking like that. Of course, none of them are my patients are Dr. Singer's patients adding added volume to, to the faces is really a key component to, to, to making a natural rejuvenation. So I would agree with that. 
Dr. Sam Rhee: [00:15:06] It's funny. I first learned about fat injection to the face, not in residency, but in my craniofacial fellowship, we. You know, for a lot of the, congenital conditions or Romberg's, or, you know, where you have half of the face or a lot of facial asymmetry, the old way of doing it was all these free flaps.
Right. So they would just basically put all this soft tissue bulk into the face, which looked amazing if you had. a really talented, skilled micro surgeon who could do that. and then they just figured out that if we just kept doing multiple fat injections, we could take these, hemifacial microstomia patients and these other patients that had major, facial wasting type, conditions and, and correct that. And then it turns out that that became, you know, that was applicable for a very wide variety of cosmetic things 
Dr. Salvatore Pacella: [00:15:57] Jersey Sam, just for our viewers here, when you're talking about these facial free flaps, how long of a procedure, how invasive of a procedure is that? 
Dr. Sam Rhee: [00:16:05] Oh my God. there were all day cases for sure.  and if there were only a couple people in the country that did it really, really well, I 
Dr. Sam Jejurikar: [00:16:14] think the one John Siebert 
Dr. Sam Rhee: [00:16:17] Yes, he stood out as the, as the master. and, I remember seeing a couple of his patients and it was amazing, but, it was a very involved ordeal. Well, 
Dr. Sam Jejurikar: [00:16:28] I will say, having seen him do some of those when I was in New York.  He could do them in about three hours. I will say we have been injecting, I think, fat into the face. Since the early two thousands. I mean, we, we were doing it at Michigan. I saw a lot of it in New York with a Sidney Coleman, but I think what's really changed is the volumes of fat we're putting more and more of the volumes we're putting on.
And the fact that it just becomes so widespread, I would agree Dr. Singer is right. That this recognition, that volume is sort of the fountain of youth is very, is very true. 
Dr. Salvatore Pacella: [00:17:01] And and Jersey Sam, how long would it take you to do, some facial fat injections compared to the bigger microsurgery procedure 
Dr. Sam Rhee: [00:17:12] An hour, maybe, you know, it's fast. Like that's why, this has been revolutionary, I think for a lot of applications. Right. 
Dr. Salvatore Pacella: [00:17:20] And, and you know, those, those larger volume microsurgery facial fat procedures, I was involved with those in residency with, with both of you and, you know, Doctor Dr. Texas, Sam, you know, there's not a lot of people around the world that,
Dr. Sam Jejurikar: [00:17:38] yeah, that's true. I think Steve Buchman can do that though. So yeah, one of our family 
Dr. Salvatore Pacella: [00:17:43] nesters as well, I mean, he could do it. I mean, Henry 
Dr. Sam Jejurikar: [00:17:47] Morris. Yeah, for sure. But not a lot.
Dr. Sam Rhee: [00:17:54] I hope they're not watching.
Dr. Salvatore Pacella: [00:17:58] Yeah. 
Dr. Sam Rhee: [00:17:59] The next trend, that has been popularized is a blepharoplasty and the correction of festoons and mailer bags, which are the puffiness below the eyelids and the bags. between the lower eyelids and mid face. Dr Mokhtar Assaadi I know him, he's out of New Jersey in New York. it is true. They are challenging and difficult procedures for most plastic surgeons who do not want to get involved with them.
And, and there's a number of different ways to address it. I think your thoughts about address, about addressing lower lid, issues and, upper cheek issues. 
Dr. Sam Jejurikar: [00:18:34] I'm going to defer to the master here. 
Dr. Salvatore Pacella: [00:18:37] I could, I could talk about this topic for days on end. but you know, I think, one of the key components of, of rejuvenating this area.
And, and once again, what we're talking about is not necessarily the lower eyelid, we're talking about the area of the cheek, right? In this region, what we call the mailer bag or the festoon. And if you see, sometimes people have this little bit of a back right here in the corner of their eye, right at the bottom portion, over the cheat joints and right in this region right here.
And that's, that's something that we didn't necessarily know, understand the anatomy of for many years and, the some pioneers and facial anatomy. that that really helped us to understand how a body retains the swelling in this region. Joel Pesa, out of Texas, Chris  Sura of Kansas City, really, I think published a tremendous amount on this topic.
And so what we know is that there's some anatomical constraints when we perform surgery in this region. And if we don't release a lot of these ligaments that extend all the way from the skin to the bone, you're not going to get rejuvenation. You're not going to get the pull that we need. The second,I think aspect to, to this topic is what happens to the lower lid after this procedure, we're really going down deep into the face and that puts a trouble  amount of swelling and pressure on the lower lid. So one of the things we want to understand is we want to support the corner of the eyelid afterwards so we don't get this droop and, you know, a few of the pioneers. across the country in the last few years that have discussed this, you know, my mentor, Dr. Codner was a big proponent of what we call canthal fixation or supporting the corner of the eye during eyelid surgery. And I think the combination of those two, two, topics and the understanding of that, that, anatomy really has, has made this a rather popular procedure and quite reliable. Traditionally, it's been a little bit unreliable. 
Dr. Sam Jejurikar: [00:20:31] Yeah, I, I have nothing to add to that. I, I agree. I, those are all the key aspects. I think, again, you've been talking about this and you've been studying this for 15 years. and so that's why I'm, I'm curious that this is a new trend in plastic surgery. I mean, these are, these are, these are issues that plastic surgeons have been struggling with for a long, a long time. But yeah, everything Dr. Pacella says, I agree with. 
Dr. Sam Rhee: [00:20:55] The next I skipped one, but the next, when I wanted to, bring up for discussion was the use of PRP or platelet rich plasma and facial rejuvenation, quote, because it allows us to harness the regenerative properties of the patient's own blood to restore youthfulness to their face in the most natural appearing way. It is such a powerful antiaging tool and that's, Georgia plastic surgeon, Mila Bennett. Thoughts. 
Dr. Sam Jejurikar: [00:21:22] I think, I do think there are some applications for PRP that I've used in my practice. That I'm a big believer in. I think in, in women with, with thinning hair, it can be useful for regenerating density to the hair.
I definitely will use it in some, facial injections or some facial aesthetic surgery. And I do find that in my hands that it reduces bruising and reduces a Timo a little bit, probably because of some of the, Clotting factors that are in there. You know, I think like many things, PRP is an amazing marketing tool.
And so I think it's, it's, it's, benefits sometimes are overstated a little bit, but overall I think its pros outweigh its cons, but, but I don't think it's enough by itself.
Dr. Salvatore Pacella: [00:22:02] Yeah, I think, I would agree with that wholeheartedly. I think, I think what you in economic terms again, here we have to, I think we have to look at. How the system was set up, for PRP to become popular and become a popular marketing tool. So we have a on one, on one side of it, we have facial fillers that are that are synthetic off the shelf. They're also quite expensive comparably, you know, when you're talking four to $600 per syringe and that's, that's expensive and you may have a particular population of patients that say, you know, I don't want to inject anything manufactured into my body. You know, I don't know what it does.
And you know, we may cause some problems, et cetera. And on the other scheme of things, you have facial fat injection, which is, a little bit, quite a bit less expensive. but it does oftentimes take a general anesthetic. It can be uncomfortable. Old patients may not want the recovery necessarily for something like this.
So you don't have anything that sort of bridges, a gas gap, a low cost filler, or a low cost. injectable into the face that has easy downtime, so to speak. and that's, I think where PRP became very popular because it's, it's organic, it's from your own body, it's relatively low cost. It's easy to perform.
And the recovery is quite easy. what we don't really understand about PRP is the longterm effects of it and whether or not it's truly effective in, in, in facial rejuvenation. So just caution or our viewers on that. Yeah. I would agree with that. 
Dr. Sam Rhee: [00:23:35] I would like to get to our next news articles because we could spend all day on these trends, I think, and get some comments about this.
So there is Dr. 90210. came out a couple of years ago and I think it made a big impact in our, in our industry in terms of highlighting what people thought about plastic surgery. There is a new Dr. 90210,coming out this fall in September and it follows four female plastic surgeons in Beverly Hills.
And, this is from people magazine and it basically said as it's set to premiere on September 28th and four powerhouse female surgeons, as far as I know, they're all board certified in plastic surgery with the American Board of Plastic Surgeons. which I think is new. I don't know if all of them were in the past day.
Dr. Sam Jejurikar: [00:24:20] They're all board certified and they're all members of the American Society of Plastic Surgeons, all four of them. 
Dr. Sam Rhee: [00:24:26] And, the names are Dr. Cat Begovic, Kelly Killeen, Michelle Lee, and Suzanne Quardt. And the article says they take on the traditionally male dominated field in Beverly Hills, which the series calls the Mecca of plastic surgery.
Dr. Killeen said she loved the idea of being on a show with four women with very different personalities, showing what it was like to be a surgeon while balancing a career and home life. Women in medicine are held to ridiculous standards and are often told you can be here, but not acting or looking like that. I love the idea of showing little girls like my daughter, that they can only, that they not only can be a surgeon, but you can be the person you want as well. Thoughts. 
Dr. Sam Jejurikar: [00:25:06] I'm excited about this show. You know, the previous iteration of Dr. 90210 was, had plastic surgeons that, particularly one that was most prominently featured, that was not a board certified plastic surgeon.
It, in some ways sort of was divergent promoting plastic surgeons to be standard of care. These are for plastic surgeons that have great personalities I've actually seen some of the promo reels for those, because I know one of the plastic surgeons on there, particularly her husband very well.
And, it looks entertaining. These are good surgeons. They are well trained. They're they're doing things that are, you know, that are cutting edge, but still like very much within the norm of plastic surgery, they have a great rapport with their patients. I think that will do a lot to educate patients and we'll be very entertaining to watch.
Dr. Salvatore Pacella: [00:25:49] I think one of the advancements, and one of the best trends that the first Dr. 90210 when it was started was, scrubs that, that, so I think what we should start a new, a trend, particularly with a Jersey. Sam is you should just get rid of the complete scrub top and just scrub your entire body, go shirtless, 
Dr. Sam Rhee: [00:26:15] like the hot, like the, like the half scrub like a belly, like, you know, showed the belly off?
Dr. Salvatore Pacella: [00:26:23] Midriff. Yeah. But not to joke, I think, I think one of the best things about this new show that I'm really looking forward to is the fact that all four of these surgeons are board certified in plastic surgery. I think that's a, that's a very, important thing that, wasn't necessarily highlighted in the first, first reenter first iteration of the series. And, and I agree. I know, actually a few of these surgeons as well. I've, I've met them at various meetings and even, to fellowship, with one of, with one of them.
And so I think it's going to be really exciting to watch and, you know, it's always entertaining to watch these plastic surgery shows and, and, I think this is only great for our, our specialty in general. You know, it's really fantastic. 
Dr. Sam Rhee: [00:27:07] I think there's no bad publicity. I think. but the fact that they are doing it, with people who are board certified is great. I agree with that. 
I can only say I am so glad that there are other surgeons out there willing to take up the burden and responsibility of doing this because I have seen some filmings and people's lives in reality shows and it is so invasive. It is so disruptive. And I could never imagine doing something like this in my practice ever.
Like you could not pay me enough money to have this sort of stuff. around me, it just, I, so, but I do realize how important it is for people to see it. So, hats off to these four surgeons for doing, I wouldn't want to do it. 
Dr. Sam Jejurikar: [00:27:48] Yeah, totally agree. 
Dr. Sam Rhee: [00:27:51] That's dove tell, sorry, dovetails to our next, article, which is why aren't there more women, plastic surgeons.
If you look at the number of patients who are women and the number of surgeons that are women. It is obviously a huge disparity, as per our American society of plastic surgeons, women made up 92% of all plastic surgery patients in 2018. And yet the proportion of fee of a women plastic surgeons remained at a steady 12 to 13% from 2000 to 2013.
And according to Dr. Tanya judge, this is from pop sugar.com. the lack of gender diversity has a lot to do with the field being a boys club, it's difficult to break into big breaking, down barriers in a boys club has always been difficult, no matter what industry you're in, it's highly specialized and incredibly competitive and men in general have been given access more frequent freely, and the environment has not been easy thoughts. 
Dr. Sam Jejurikar: [00:28:50] I'm actually surprised at that number because we came from a training program where it was almost 50, 50 men and women in the training program and the training programs that I've seen subsequent to that time had been like that as well.
So I'm wondering if, if we're going to see this trend change as more of the older generation of plastic surgeons retire. Because, I agree. I mean, surgery across the board, not just plastic surgery has been a boys club until, you know, 20 years ago. I know a lot of great female plastic surgeons though.
And, and I see a lot of young medical students that are women going into plastic surgery as well. So, hopefully this trend changes. I don't think it's going to be like this 10 years from now. Yeah. 
Dr. Salvatore Pacella: [00:29:29] And I think, you know, it's clear that in surgical training programs and in medicine in particular, you know, there's a systematic misogyny that, that exists in the world with surgical training programs.
I mean, it is male dominated. It's a. It's a sort of an eat your young type of, environment many times, and I think that's changing. but you know, unfortunately that's changing at a snail's pace, particularly when we, when we remember articles like, the journal of vascular surgery that we talked about, to jet that just simply came out three to four weeks ago, you know, that's not helping the situation.
And obviously, you know, all three of us trained with exceptional, female plastic surgeons that we remain very close with today. And it's just, it's just unfortunate that the, the training programs haven't necessarily caught up with us. So 
Dr. Sam Rhee: [00:30:23] I think some of, I agree with both of you, I think, I agree with Sam that in 10 years, the landscape is going to be incredibly different in terms of the, gender breakdown for plastic surgeons. I know that in my area, there are a number of young, up and coming, plastic surgeons, who are women. And I think they're doing great. I think probably when we were in training 15, 20 years ago, it was just so onerous that it was really unpleasant for anyone. And if you had any other additional, considerations in your life, regardless of what they were, be it family or children or any other, just life, you know, general, it was so difficult to try to make it in plastic surgery, I mean on top of the misogyny that existed.
So I think that, as you said, Michigan is doing was I think probably one of the early leaders in plastic surgery, where they had a great number of women, that we trained with. And I think, you will see that as Sam said, probably in the next five to 10 years, you're going to see huge change.
Okay. I think we've hit our mark at this point, for the episode. So are there any other thoughts about any of these articles or anything else that, came across your, desk or table this week? 
Dr. Sam Jejurikar: [00:31:47] Just always love hearing your guys' opinions on things. I always learn from talking to you guys, so informative conversation on Sunday morning as always.
Dr. Sam Rhee: [00:31:56] I hope to, I hope we can inter interview some of our colleagues, either, who have some perspective on this. I know we've trained with some great, women, plastic surgeons, and hopefully, we would, it would be awesome to sort of get their perspectives and their thoughts also on, on some of these topics as well.
All right. Thanks so much, guys. Have a great Sunday. 
Dr. Sam Jejurikar: [00:32:16] You guys do as well.
Dr. Salvatore Pacella: [00:32:20] Bye guys. Bye. Take care.