Botox, Filler & the Blurry Line Between Youthful and Yikes

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. Hey everybody, I'm Dr. Kat Gallus and you're listening to All the B's, the Unfiltered Plastic Surgery Podcast with myself and Bri. Hey Bri.

Bri (00:18):
Hey, good morning. I love how you emphasized on the Unfiltered.

Dr. G (00:23):
That's right. This is not a scripted show.

Bri (00:28):
I feel like I get filtered a lot.

Dr. G (00:31):
You do not think you get edited out?

Bri (00:34):
I think some of the things, well, in all fairness, some of the things should be edited out.

Dr. G (00:39):
Okay, well today we're going to go back to basics. We're going to talk about fillers and Botox because those are the basics that plus skincare is the foundation of what you need to look

Bri (00:52):
The things we can't live without.

Dr. G (00:54):
Correct. But first we got to hit the celebrity events. The first one, it's sort of mean to talk about this I feel like, but everyone else is. Bradley Cooper shows up with his face transformation. I mean, I think he just had an upper bleph and he has a lot more mileage show than he used to. I feel like we talked about Brad Pitt at one point where he had a great facelift and they didn't mess with his eyes and I think that's the key there. He

Bri (01:27):
Looks very like Edward Colon.

Dr. G (01:30):
I don't know.

Bri (01:30):
Oh Colin.

Dr. G (01:31):
He's the vampire, the twilight one. I don't want to say Robert Patson.

(01:36):
Rob Pattinson. Okay. Yeah, he does. He just looks different. So I think the issue is

Bri (01:42):
And his hair part.

Dr. G (01:45):
Yeah, I mean someone, that's not someone should fix his hair.

Bri (01:49):
Yeah. That's not the look. And he has kind of that dark, almost like it, the scarring maybe like that dark upper eye. It just looks really red, maybe

Dr. G (01:59):
Yeah, it looks inflamed. I mean he's recovering from an upper bleph. It'll probably settle down. I can't tell if they did anything to his lowers, his face looks more narrow, which is wild, but I dunno, he looks a little feminized I think is an issue. His eyes are still blue though. Props

Bri (02:19):
Some buccal fat removal.

Dr. G (02:21):
I would hope not. That would be crazy. That's

Bri (02:23):
What it looks like though, right? He's

Dr. G (02:25):
Got like a snatched lower face.

Bri (02:26):
Some maseter Botox. I mean he'll always be Bradley Cooper. We love him, but I just feel like this is not,

Dr. G (02:35):
It doesn't look like him.

Bri (02:36):
It doesn't look like him. This isn't the vibe.

Dr. G (02:40):
No, but maybe he'll look better as everything settles down. It's also hard to tell. Maybe he lost weight. He just looks like a smaller, a shrinky dink version of himself. He looks slightly smaller, his head looks smaller.

Bri (02:55):
He needs to eat a cheeseburger.

Dr. G (02:57):
His neck is smaller, so maybe he's just skinny.

Bri (02:59):
And his ears look bigger.

Dr. G (03:03):
I think that's the haircut. People are freaking out though. I don't know.

Bri (03:11):
I don't like this.

Dr. G (03:11):
I do think he just needs time to settle down. It sucks to be out there with everybody commenting on the face, but there's nothing you can do about the eyes. I guess you could just cruise around in sunglasses until it

Bri (03:27):
Very feminine

Dr. G (03:28):
Settles out.

Bri (03:29):
Unless that's it settled.

Dr. G (03:32):
I don't think so. I doubt it.

Bri (03:35):
Well slay. At least he's doing things to take care of his appearance. He does get some points for that.

Dr. G (03:40):
Yeah, his skin looks good.

Bri (03:42):
Yeah, he is Botox. He is rejuvenated.

Dr. G (03:46):
Yes. Okay. And then speaking of people who are willing to talk about the plastic surgery, they may or may not have. Jennifer Lawrence, this girl J law, I love her. She cracks me up.

Bri (03:57):
She's my favorite.

Dr. G (03:58):
She's going to get her breast aug after baby number two, she's rushing to get it done. She has an upcoming film and she has to shoot a nude scene and she's like, my boobs are like not it after two babies and I just want to do this aug.

Bri (04:14):
I love that.

Dr. G (04:16):
Currently her plan, she even has a date in December,

Bri (04:19):
Although did you see that movie where she's nude coming out of the ocean? I don't remember what it was. And her just boobs are flopping around. I just feel like that was so great.

Dr. G (04:29):
That was pre-baby though. And I think her boobs look good. I mean they just look natural

Bri (04:34):
Now she's going to look like Baywatch coming out for these nude scenes

Dr. G (04:38):
Maybe. I'm sure she'll do something subtle. I don't think she's the type to change her whole look with giant implants, but yeah, you never know. Love that. Yeah, so she definitely has been doing the rounds of interviews and that was one of the things she talked about and they asked her, well, would you still get the breast dog after having kids if you weren't in Hollywood and on screen? And she said, probably I just might not be rushing it. I know I have these deadlines to make, but I would definitely be considering it. So I think that's fair. And I think we're going to see a lot more smaller, more natural augmentations in that population of people who've just had kids and they want just a little bit of upper pole fullness or just fill out what they had kind of want their breasts look like they did when they were breastfeeding and they were all swollen. And then when they deflate, you just want a little something to fill that out. We did one of those yesterday.

Bri (05:33):
We've been doing a lot of smaller implants, like very small. Just a little sum something.

Dr. G (05:40):
Yes. And hopefully with the advent of getting the preserve, the local anesthetic breast aug, we can start offering that. So we'll see The little small

Bri (05:51):
You can get your boobies lunchtime.

Dr. G (05:54):
Yeah. That you could do with just some alloclae. But yeah, you could do a lunchtime aug. So we'll see if that's going to be the new thing. Next is Jennifer Aniston shutting down plastic surgery rumors. Girl, we know you get plastic surgery.

Bri (06:10):
What is she trying to shut down?

Dr. G (06:13):
Well, she was,

Bri (06:13):
You can't look like that and age gracefully, with nothing.

Dr. G (06:17):
And be a smoker. I know she smokes. Is

Bri (06:21):
Is she a smoker?

Dr. G (06:23):
No, Jennifer Don't. Why?

Bri (06:28):
Because she can afford to do all the oxygen facials and whatnot to combat that I think.

(06:34):
She doesn't give me the look that she's aged gracefully. Like her face looks too good.

Dr. G (06:41):
No, she looks good. I think she looks, I mean if you compare her to her 30 years ago, I mean she looks older, but she looks good. And I hate when they say they don't do plastic surgery, but she then cops to lasers and other stuff. I'm like, well, that's plastic surgery. We're talking. It's all in the same domain. You don't have to have a brow lift or have your face lifted an actual surgery to.

Bri (07:11):
Is she denying Botox and fillers or

Dr. G (07:13):
No.

Bri (07:14):
Okay.

Dr. G (07:15):
She said, oh, because she's on the morning show now, which I regrettably am watching. And she was doing an interview and Marianne, I'm probably mispronouncing that is on the show this season and was commenting on how she's aged so gracefully and she's like, well, I do a lot of little tweaks, lasers and facials and skincare. I'm like, okay, well sure.

Bri (07:42):
Okay.

Dr. G (07:43):
She's been doing a lot consistently despite the smoking to maintain herself, which is what you should be doing, instead of waiting and then just hitting the panic button at 55 and being like, I haven't done anything. Can you fix me? Definitely. She's been playing the long game for a while because if you remember when she was on friends with Courtney Cox? Courtney Cox was already deep into Botox and fillers back when they were first coming out and I'm sure introduced her into the world of facials and microneedling. And our chiropractor is in the office this morning and she was saying people were commenting on our skin last week because she got a PRP facial, so microneedling with PRP. And she's like, no one ever comments on my skin.

Bri (08:27):
It works wonders.

Dr. G (08:29):
And I was like, yeah, those kinds of treatments are great, especially if you're able to do them consistently. It really does help. And we know she's probably had a fat transfer at some point. Jennifer Aniston, not her chiropractor. So all of that, PRP, all of that is definitely helping maintain her youthful appearance without something dramatic like a neck lift. But you could also do thread lifts and ultherapy and there's so many things you could do.

Bri (09:01):
How often can you do microneedling and PRP

Dr. G (09:05):
Every four weeks if you want to do.

Bri (09:07):
Perfect. I'm gonna start scheduling myself in.

Dr. G (09:11):
I know. Well, I told her, I said I did it probably a year ago and was like, oh, this is great. And then that was the last time I did it. Because I never scheduled it.

Bri (09:19):
I did it two weeks ago. I know. It was amazing. I was like, my skin looks so good. It's helped with my little acne scars. It's like, I need this all the time. I know.

Dr. G (09:29):
So she is maintaining, unlike Sydney Sweeney who claims she's never going to get anything,

Bri (09:38):
Girl, don't even don't even.

Dr. G (09:42):
That's like, shut up.

Bri (09:45):
Yeah, that's not going to happen because she looks like that right now. But give it a couple years and when she does start to age, she's going to be Botox and fillers all day. I just don't believe that.

Dr. G (09:58):
So the arrogance of youth to be like, I'm never getting anything done. I don't do Botox. I am,

Bri (10:10):
How old is she? She's so young.

Dr. G (10:12):
I dunno, actually, how old is she? 28.

Bri (10:17):
28, okay. Yeah, once you hit 30.

Dr. G (10:20):
Yeah, you don't need to do anything right now. You look great.

Bri (10:23):
You're going to wish you had preventative Botox.

Dr. G (10:27):
You haven't had a kid, you don't have anybody stressing you out. You're living your best life. Yeah, but I will say she is blonde and fair and that ages poorly without some support.

Bri (10:40):
Yeah. We'll circle back in a couple years and see where you're at. I just don't believe it. I feel like she's too prominent in Hollywood. I know people like Jennifer Aniston want to grade age gracefully,

Dr. G (10:53):
But Jennifer Aniston, like I said, has been doing stuff since that age.

Bri (10:57):
Yeah. Im telling you, there's no way

Dr. G (10:59):
You start with facials and then you just ratchet up a little bit and then you do a little tiny bit of Botox. Maybe not when you have a dramatic role to play. And then she really doesn't need anything right now, but she has pretty large breasts. I hope she's keeping those strapped up and in. I mean, all of that stuff is,

Bri (11:20):
And those are natural, right?

Dr. G (11:22):
But I think if you live on a planet with gravity and you're going to animate your face and or have some kids and or age, you're probably going to need something.

Bri (11:34):
Love it for you if that's what you decide.

Dr. G (11:37):
Yes.

Bri (11:38):
Not the life I want to live.

Dr. G (11:39):
Which reminds me, I heard the most bananas story this morning on my podcast about, I'm just trying to remember who the celebrity, oh, do you know who Buzz Aldridge is? Is it, oh God, he landed on the moon. Is it Aldrin? Oh no,

Bri (11:59):
Recently?

Dr. G (11:59):
It's Aldrin. Sorry. No, we didn't land on the moon recently.

Bri (12:05):
Okay. I wasn't sure if this was a,

Dr. G (12:09):
He landed on the moon in the sixties. Remember? And so this only came up because Kim Kardashian said something irretrievably stupid about how Buzz Aldrin, who's now 95 and can't recall landing on the moon because he's 95. She's like, yeah, he's recanted. All of that was faked girl. No, they landed on the moon. So anyway, what I thought was wild,

Bri (12:37):
They'd be hard to fake right?

Dr. G (12:37):
Especially back in the sixties.

Bri (12:40):
This is giving Katy Perry vibes going to space and they all said they faked it for the photo shoot. Right.

Dr. G (12:48):
So anyway, the quote from Buzz Aldrin was taken out of context and we've been to the moon a hundred percent. So I don't know, Kim, if you believe that, no wonder you didn't pass your boards right? No, not boards bar. Sorry. Wow. I am just on one today bar exam. God forbid she tried to take her board,

Bri (13:12):
Haven't edfinish our coffee.

Dr. G (13:14):
Yeah. Anyway, why I thought this was wild is because he's 95, which Bri and I have this running joke with my sister about how that's like the ideal age to marry, especially if they're wealthy.

Bri (13:28):
If I can, if anybody's out here watching and you're single and you're 95, holler at your girl.

Dr. G (13:35):
Call us up.

Bri (13:37):
Yeah, we're here.

Dr. G (13:38):
So anyway, he did marry somebody with a major age gap in her sixties maybe a couple years ago, and then she died and I was like,

Bri (13:49):
Wait, she died.

Dr. G (13:50):
She died, which is just bananas. So they were talking about it on my who weekly podcast, which I love to listen to. So yeah, that's crazy. It's, ironic.

Bri (14:01):
I'd be so bummed if I did all that work.

Dr. G (14:04):
Right. I mean she was like 64 or something when she married him, and then 66 when she died. So they were only married for a couple years. This guy outliving everybody.

Bri (14:15):
That's wild. He

Dr. G (14:16):
Got married in his nineties.

Bri (14:17):
Something on the moon that gives you youthful live forever. I don't know. Not a conspiracy theory. Like the Fountain of Youth.

Dr. G (14:27):
Yeah, yeah. He took a little moon dust with them and snorts a little in the morning every day. And he's good to go. Anyway, the only reason it even registered on my whole that's insane is that that's our long time goal to marry someone wealthy in 95. You could share two sister wives.

Bri (14:51):
I'm down for it. So if you want two wives, hit us up. We require a monthly allowance.

Dr. G (14:59):
A huge monthly allowance. All right. And then, okay, so moving on back to actual celebrity news. And although I heard the new Kardashian show All's Fair got canned.

Bri (15:12):
Did it.

Dr. G (15:13):
Yeah.

Bri (15:14):
I keep seeing all the commercials and I was like, hmm.

Dr. G (15:17):
No, even the names are bad. It just looks terrible.

Bri (15:22):
They're not actors.

Dr. G (15:24):
She isn't. And then they have actors on the show. You've got Sarah Paulson, Glenn Close, Naomi Watts, and I guess it's just a fail and not in an entertaining fail. Like Emily in Paris, watchable fail, but it got a 0%.

Bri (15:40):
A rare 0% score. This is unwatchable.

Dr. G (15:47):
I know Meghan Markle to move over. There's something worse.

Bri (15:52):
Now. I'm going to watch it.

Dr. G (15:56):
Well, people are saying that it's not even like, you know how some stuff is unwatchable, but watchable, there's a lot of those shows out there. This isn't even watchable, so I sort of feel like I need to take a crack at it, but I'm busy rewatching Stranger Things with my kids in anticipation of the new season coming back, which is hard to watch because of what's his face harbor? Is it David Harbor?

Bri (16:20):
Oh yeah. Now that he's gone and cheated his a little like

Dr. G (16:23):
Yeah. Now that he's like a sex addict or whatever. Anyway, if anybody wants to know what it's like being in the OR with us, you just got a little vision of how we go from topic to topic, but let's go to

Bri (16:37):
That and all that's what she said. I think we have scarred our anesthesiologist, but yesterday he gave such a golden, that's what she said. I was so proud. A little shocked, honestly. But he's like, I feel like I should be in jail. That was arrestable. I was like arrestable. Yes. I am honored. This is great.

Dr. G (17:03):
We have corrupted you sufficiently.

Bri (17:05):
So good.

Dr. G (17:06):
Okay, let's talk about Emma Stone's latest looks. I mean,

Bri (17:12):
She looks great.

Dr. G (17:14):
Who cares? I feel like I saw this and I was like, everything sparks a frenzy on social media, literally everything. And honestly, a lot of times it's just a different angle or a different lighting or she's not smiling as hard because I saw the picture in question and I was like, she's just looking at the camera different. Are you kidding me? What are we doing? She looks the same. She looks great.

Bri (17:39):
She looks the same. She's very natural. She's nice and beautiful. Botox and filled and it looks fabulous.

Dr. G (17:46):
Yeah, she looks like herself.

Bri (17:49):
The lighting, she obviously has got some good lighting there. Yeah,

Dr. G (17:53):
I think if you scroll down the image that they were freaking out about is that one. Yes, that one where she's with Lisa, just little fox. Yeah, but she's making a face and her angle of her face is different.

Bri (18:09):
Yeah, that looks different than the top one.

Dr. G (18:11):
Right, but she's in the same outfit. She's like, it's just different lighting, different angle of the camera. It's so dumb. Yeah, I feel like she looks great.

Bri (18:25):
She does. She's always looked super cute.

Dr. G (18:29):
Whatever she's doing is

Bri (18:30):
Slay.

Dr. G (18:30):
Slay queen

Bri (18:33):
Slay.

Dr. G (18:34):
Yeah, she looks good. It's just the angle of her face, honestly. She's just scrunching her face in a different way

Bri (18:40):
And that just looks photoshopped anyways.

Dr. G (18:43):
Yes,

Bri (18:44):
There's certain things that you can tell that are Photoshopped.

Dr. G (18:48):
Yeah,

Bri (18:49):
Let's, trust me, I love my Photoshop. So that just looks photoshopped. A little face tuned.

Dr. G (18:56):
A little face tuned.

Bri (18:57):
Yeah.

Dr. G (18:57):
Okay. All right. So leave Emma Stone alone.

Bri (19:01):
Yeah.

Dr. G (19:01):
And then you should always leave Chrissy Tegan alone. She will come for you. That's next.

Bri (19:06):
She will come for you.

Dr. G (19:09):
She rants at everybody about her cheek filler and then apologized for the rant because she said she took a sleep gummy, which is, I mean is that

Bri (19:19):
She did the rant because she took a sleep gummy?

Dr. G (19:22):
Yeah, she was pissed.

Bri (19:23):
And so she go to sleep.

Dr. G (19:25):
I dunno. She was just like, stop being miserable. What happened to just thinking things? I kind of honestly agree because we post stuff and somebody always has to comment about my face, which is literally my face. We'll get into what's been done, but it's not that much. So when you bust on my face, it's literally my face. People love to troll anything they possibly can. It's so painful and it's hard to not take it personally. But on the other hand, we pick apart people's faces on this podcast because people want to know what's been done. But honestly, you used to be able to do that. She says you'd flip through a magazine and be like, oh man, look at those teeth or whatever. Those eyebrows are crazy. Or she looks crazy and then move on. But now you get to directly tell that person, this is your thought. I would never do that haircut. We all do it. We used to do it and then spit it out and go into the universe and it would disappear. And now people take the time to type it out. Why?

Bri (20:30):
And they hide behind their accounts and do things. I literally think people find a lot of joy from this. They go home and they have their glass of wine and they're sitting on their phone miserable, and they're just going through leaving hateful comments on things. I mean, it's one thing to pick apart someone. We pick apart ourselves all day long. Well, I do.

Dr. G (20:50):
Yeah, No, for sure. And maybe I'll think, oh, that looks whatever we are just talking about. I mean, I think there's nothing besides Bradley's eyes looking a little weird, which may just settle down. We're not really,

Bri (21:05):
We're just doing our girl thing.

Dr. G (21:07):
I don't know. I don't think her cheek filler looks bad, so I don't really know what the issue is in the first place, but I do think somebody has something to say about everything.

Bri (21:16):
Everything. I was waiting for someone to comment about little things like flushes or it's always,

Dr. G (21:23):
Oh, right, yes. Why are you in the OR or whatever about our little posts.

Bri (21:27):
Yeah. They can comment. Dr. Chao made this super cute little video inthe OR before it was, I don't know, but I hadn't turned it over. And they're like, well, I wouldn't want to go on that OR if you're sitting or it's just stupid stuff, of course we're going to clean the OR. None of that makes sense. People just pick apart anything they can,

Dr. G (21:50):
But it's usually from an account that's anonymous, which is really just part of the problem. She's not hiding behind anything. She's out there. We're out there and it's just part of the game, but it's really shitty for the people who are anonymous doing that stuff. I think it's kind of hateful. And I do think people are constantly picking apart stuff. I have a friend who posted about her pain regimen and people, which I thought was like, okay, that's awesome. It's like taking care of puppies. Where's the downside? But of course somebody had to be like, how dare you deny people narcotic pain medicine? And you're like, okay. I mean, sure. I guess if you do what they want to do, I don't know. Yeah, I would think that's a positive thing in light of the opioid crisis that we have to lean into non-narcotic pain alternatives.

Bri (22:46):
And don't you think those patients probably want that?

Dr. G (22:52):
I tell my patients, for example, with a non-narcotic stuff, we have non-narcotic alternatives and the patients who come to me and be like, I don't want you to prescribe me any Oxy or Percocet, I want to do this. I have a very high pain intolerance. We're like, fine, but here's the other alternatives you can take. We're going to give you an nsaid, we're going to give you Vics, we're going to give you Tylenol. And then if you know, you can do it without the narcotic rate, but you might want to pick it up anyway just in case or have

Bri (23:21):
It's good juju to just have on hand.

Dr. G (23:23):
I know. But again, the ones who have not taken have been the ones who came in requesting non-narcotic. The people who are like, I don't care, or I definitely don't want to feel any pain are the ones that are going to take it. So I think it's partially patient motivation and we can tailor that. So if absolutely are motivated to do something under local, you'll probably be fine. If it's because for the right reasons. If you're just trying to be cheap, it usually doesn't work out.

Bri (23:56):
Just do let people do what they want.

Dr. G (23:58):
You know yourself. You know yourself the best. And sometimes I can't tell what's motivating people. So you have to ask those other questions like, well, how do you do with the dentist? And if they're like, oh, it's fine, or I'm terrified, then, or like you with flying, right? You don't flying. So it's all a little, I do

Bri (24:18):
Not like flying

Dr. G (24:19):
A little flag that maybe people aren't going to be okay in certain circumstances. Yeah. Anyway.

Bri (24:26):
I don't sit there and hyperventilate, but I do not flying. We'fre traveling on Friday and I was like, don't judge me when I have two glasses of wine at the airport. At 12.

Dr. G (24:39):
At two in the afternoon. Right before we get on shots, shots, shots. Hey, that's a,

Bri (24:46):
I'm going to see how many shots she needs before she takes me to the Chanel store.

Dr. G (24:51):
Yeah, I'll be all better buzzed up. So that's what I miss my, I get to the airport and I'm like, where's the coffee? Where's the coffee?

Bri (24:58):
Really? Yeah, no caffeine. I want to be out.

Dr. G (25:03):
I don't know. I associate it with Diet Coke or Starbucks or Better buzz if we're in the right terminal. So shout out to better buzz Love. Okay, so let's look at Botox and fillers. The basics we're going to talk about, which we've just kind of talked about because everyone needs, maybe not everyone, but when did you start doing Botox? Do you remember how old you were?

Bri (25:28):
I think I was about 25 and I started very just small here and there. A little in my 11 baby Botox. Yeah, baby Botox. And then I started working here. Just kidding. Now you need 150 units. And now, I mean the fact that I'm moving, this is not a good sign, but shove it everywhere. I have it in my maseters. I feel like I have the lip flip. I've got it in my elevens, my forehead and my crow's feet. I've tried it all over my nose, tried it in my DAOs. I've tried it everywhere.

Dr. G (26:05):
Yeah, I feel like there's probably, I don't have a gummy smile, so I've never tried that personally, but I've done the lip flip. Currently my lip flips a little much to be honest.

Bri (26:14):
I love a lip flip. It is so good.

Dr. G (26:15):
I do. But you got to get the dose exact.

Bri (26:18):
My favorite is when you know it kicks in because you go to brush your teeth and the water just comes all back out and you're trying to spit and you're like, huh, perfect. I have dribbled water all over myself in public trying to drink a drink out of a straw and it just goes everywhere. And I'm like, Botox is kicking in.

Dr. G (26:35):
Like me with working out the first week and I'm like,

Bri (26:40):
Eric's like, are you okay? And I'm like, oh yeah, it's just the Botox.

Dr. G (26:43):
I'm not having a stroke. My lip flip just kicked in. Oh my God.

Bri (26:47):
Sorry. Yeah, no, we are Botox. I've had filler in my lips. I've tried filler a couple years ago in my nose and my jawline. I think now I don't really love the jawline because I like the slimmer face. Now I just Botox it, but I do want to try it one day in my cheeks, some filler. But other than that, that's all I've had done.

Dr. G (27:14):
I guess I want to never say I see a celebrity that has too much Botox when it's noticeable. I feel like it's when it's

Bri (27:21):
In correlation with your eyebrows, sometimes

Dr. G (27:25):
When it's done poorly.

Bri (27:26):
Like the Spock eyebrow.

Dr. G (27:30):
The Cruella look, or both Spock. So that's when you have really gotten the central part of the forehead. But the lateral part of the forehead is not Botox. So you get the Spock brows. That's very noticeable.

Bri (27:45):
There is a Christmas movie and I don't, what is it?

Dr. G (27:49):
It's Christmas with the cranks where he has classic Spock brows. We'll try to pull it up for you, but that is when your forehead and it was probably done purposely. Honestly, he looks insane. But when I do see that,

Bri (28:02):
This is what I think about every time.

Dr. G (28:04):
Tim Allen.

Bri (28:04):
Yes.

Dr. G (28:07):
And the fake tan is good too, honestly.

Bri (28:10):
So good. And I love a frozen look. I want my face to be frozen. I want you to look at me and be like, I don't know if she's mad or sad or happy. I love that, but I don't want to look like that.

Dr. G (28:24):
Yeah, well, so again, that is just improperly placed Botox. So I think most people, even if you get, I get totally frozen, which I think we've seen Nicole Kidman do before too. It is a little wild when they're supposed to be emoting for their job, but I don't think it's necessarily, I feel like it's pretty hard to overdo Botox. What's hard to do is what's more likely to happen is that it's just improperly placed and then that's usually the forehead, but you can also drop the eyelid, which is crazy when that happens. Unfortunately, you can drop the cheek and make you look like you have a stroke. That's also pretty rare to happen. But it can happen if you get around the crow's feet and you get too low. So those are all things that are the things I might notice, but I don't notice that someone's aggressively Botox for the most part. It looks good. I mean, I don't think it's hard to overdo Botox. It's easier to misplace it. Filler definitely, you can overdo, Right?

Bri (29:34):
Yes, yes. I also feel like you can underdo Botox. So what I noticed before I started working here is I would go to a med spa because I got it cheaper and it was like a Botox happy hour. And I feel like it lasted like, yeah, I can feel the eye roll. I feel like it lasted like a month. So I was like, can you overly dilute it to where you're really not getting more Botox? Absolutely. Because then you came here and mine lasts. I know how you guys make yours. And I know I've talked to a couple other nurses about this and they're like, oh, I was told that you're supposed to do this and this, I won't say it via on the podcast, but she's like, oh, I put this much sodium chloride in it or whatever you guys put in it.

Dr. G (30:24):
It comes as a powder. It has to go to the freezer. It doesn't have to, it could be just refrigerated, but we like to keep it in the freezer until we reconstitute it, which is when we add bacteria static saline. And then that's the trick is how much saline are you adding to what is a hundred units of Botox? Are you adding four ccs of saline? Are you adding two and a half ccs? Which is probably the most common. Dr Chao adds two ccs, so it makes it even more concentrated. And depending on the concentration, that's how much you're injecting is how many units you're getting. And so sometimes the med spas will over dilute it and they'll inject you a bunch of times, but you're only getting 20 units total instead of 50 because they've diluted it down.

(31:15):
And we do know that Botox is dose dependent. So the more you put in up to a point, the longer it'll last. So if you put 20 units in my elevens, it should last three-ish months, two and a half to four months. If you put 12 units in there, it's probably going to last closer to two months. If you put 25 units at some point, you won't get longer lasting Botox. It just doesn't last any longer than four months would be the most. So most of the studies were done to titrate for that max dose and max effect in other areas of the face, you don't want to put more in. So if you put too much in the lip, sure it'll last longer. So the lip flip usually doesn't last as long because it's either two units and two units total, four units or 2, 4, 6, 8 units. I personally prefer just four units. Dr. Chao likes to do eight, and then it's an aggressive lip flip, but it will last longer. I just like to be able to use a straw.

(32:19):
And then the same thing goes with maseters. It'll last longer if you put more in, but you're not going to paralyze your maseter muscles, your jaw clenching muscles, you're just weakening them a little bit. So you don't need to go crazy. You just need enough to knock it down a little bit if that's what you're trying to do is not jaw clench. And it just depends it on how strong the muscle is. Men tend to require a little bit more Botox than women. Their muscles are bigger and bulkier and need more, but if you dilute it down and you don't use enough units, it's not going to last as long. And then people metabolize it differently as well, or they get used to it. So there are other products, we keep saying Botox, but it's really a neuromodulator and it's the OG. That's why it's like the Kleenex or Coke of Neuromodulators. There are some alternatives. Have you tried any of the alternatives?

Bri (33:13):
I've tried Daxxify. I really like Daxxify and I tried, what was the one we sampled recently that I didn't love? Maybe that's what it was. I think Dr. Chao loved it and I wasn't a fan. I have not tried Dysport. So do you recommend switching if you're doing Botox all the time, do you recommend, I know some people say like, oh, if you do Botox this many times, transfer over to Dysport, so maybe it lasts longer. Your body doesn't metabolize it as fast.

Dr. G (33:46):
The idea is that you don't get used to it because they're all bound in general. I mean to different things, usually some sort of protein. So it's not just a pure toxin. The only thing that's pure toxin is Xeomin. Daxxify is bound to a peptide. This gets into the science of things and then all the rest of 'em are bound to some sort of human derived albumin protein. And then some of them are different versions of the toxin strain as well, which gets even more complicated. But in general, the thought is that you get used to the protein and so it's not as effective. That's one of the theories. But I don't think you have to switch unless you really honestly think you're not getting the same result because people are on Botox for years and years and don't have an issue. I think if your metabolism is higher, you're working out a lot, you're eating a lot of protein, maybe you're doing hot classes, sometimes that can, in certain patients that can metabolize it faster.

(34:43):
There is one tiny little study that says that taking zinc makes it last longer, but you have to take the zinc before you get treated. I don't know. I've tried that before. I wouldn't say consistently. It didn't really change anything. I mix it up usually because I'll use whatever we have on hand and I'll try new stuff. So there are a lot of very similar products to Botox. So you're right Latibo, we tried, there's so many more products available in South Korea and in Europe than we have because here they have to go through FDA approval and it's a big deal to get through that. And so Latibo is recently available, but then you've got to market it and you're coming up against Botox, which is the one name. So what are you offering that's different? And I think the other alternatives haven't offered anything else. So I just tried Xeomin almost a month actually.

Bri (35:41):
Your skin looked so glowy though.

Dr. G (35:43):
It did look good, but I just really needed some Botox. But yeah, I'm waiting to see how long it lasts. Right? Because otherwise then what's the point? I'm just using an alternative. It kicked in great. It looked great, but now I'm a month out, so how much movement am I going to have? My forehead usually kicks in pretty fast. That's the first thing that kick back in, so we'll see. And then Daxxify, which is the one I've tried to, is really nice. It's attached to a peptide. They did a study that showed that it gave you an actual glow, but they didn't compare it to another neuromodulator, they compared it to saline or whatever, nothing. So yeah, I think they all actually give your skin a little bit of a glow. So

(36:31):
Compare the daxxi to another neuromodulator and then tell me about the glow. But because it's attached to a peptide, it acts a little bit different and it lasts longer. Originally they said it was going to last six months. It does not last six months. It lasts about double what you would normally get from Botox. So if you're the type of person that it wears off in two months, sure, try the daxxi. You'll get four months out of it. If you're somebody who can get three or four months out of Botox, then maybe consider trying the daxxi. And then if you only come in twice a year anyway, I mean, we have some people who come in once a year, it's way worn off.

Bri (37:06):
That's crazy.

Dr. G (37:07):
That's crazy talk. But yeah, I mean I think

Bri (37:11):
Unless you're pregnant.

Dr. G (37:13):
There's a budget for it. So if you don't have the funds to be doing it every three or four months, then that's fine. You're going to stretch it out. And if you're going to do that, maybe try an alternative that's supposed to last longer. I always tell people it's reasonable to start once you start seeing lines that are, we're not trying to freeze your face. We're trying to prevent lines from happening. So if you come in and you're 48 years old and you haven't done anything with your skin and you have a deep 11 here, I can Botox it. But that wrinkle is not going away for maybe two years of consistently doing Botox. Botoxing one time is not going to erase. What is a wrinkle at rest. When you are going to wrinkle your face when it moves, that's fine. But if it's starting to stay when you relax your face we're already kind of too late. I mean you can soften it, but once it stays there, and I think that's when I started doing it. I think I was early thirties and I was just starting to get a little creasier and I was like, oh hell no. And so I don't have one because I've been consistently botoxing since then. Five years.

Bri (38:24):
So with that, do you think preventative Botox is a thing?

Dr. G (38:28):
Yeah, I think it's a good idea. You don't have to start at 20. My 19-year-old daughter keeps pushing. Yeah, she can move her forehead 19 and it doesn't matter. But once you start getting a little crease there, that doesn't go away. When you relax your face, sure, put a little Botox in there and it's just a small amount. But I would say it's usually 30, 35. That's when you need to start. For most people that unless you're really animated, but it's okay that you can move your face right now as long as those creases aren't there when you relax your face. So you still got, it's not an emergency. You don't need to get Botox right now. I mean you can, but that's what you're trying to do is you're able to move your face. It's fine. I stretch out my Botox appointments sometimes because I'm just busy and my face will move and I don't mind that what I'm preventing is permanent wrinkles.

Bri (39:21):
Eric has a very deep line and he just started getting Botox in his forties. That sucker is not going to go away. That is deep. No matter how much you put in it. He should have started a couple years ago. So now you can't prevent that. It's just there. It's there.

Dr. G (39:39):
It will unfurl if you're consistent with it, but it will take a variable amount of time and usually a couple years. So that's my spiel on Botox. Let's talk about filler where you can. I feel like there's been, this is a year of filler backlash, to be honest. A lot less filler being placed.

Bri (39:56):
I feel like once they came out with that, the filler just migrates and it always stays there. People were like, ah.

Dr. G (40:03):
I know. Which is ironic because when filler was so first introduced, if you go all the way back to when we first, okay, so back when I wasn't even a plastic surgeon, we used to do collagen based products. And so you had a skin test and we use this bovine cow collagen. That was the filler article, which I think you can still find in Mexico, you're saying. But then they came out with hyaluronic acid fillers, which you could just inject. You didn't need a skin test. It wasn't a foreign body. Your body breaks it down. So the original products, the problem was that, and it was indicated for lips. The problem was that it disappeared too fast, right? So 10 or 15 years ago, people were bitching that their filler didn't last. So what did we do? The industry cross-linked the hyaluronic acid and tweaked it and made it more elastic and longer lasting.

(40:57):
People kept pushing, I don't want to pay $700 for lip filler and then be done in six months. So now we have lip filler that lasts a year, lip filler that lasts 18 months. And now people are like, this lip filler won't go away. I can't dissolve it. So I think we're our own worst enemies now. We have filler that lasts a really long time. It maybe moves from place to place, which is not ideal. And then when you do go to dissolve it, sometimes it's hard to dissolve or it's persistent. I think when you're layering it on top, let's say you've had cheek filler and then two years later you do a little more cheek filler. There's still a little bit of the original cheek filler left. And so as you stack on top of that over years, you're going to need less and less. Ideally, it's a bio stimulator, it's helping with collagen production. There's all these things going on that it's not just an on off switch. I put filler in and a year later I'm not going to see that filler anymore. No, there's probably still going to be a little residual filler.

Bri (41:59):
I feel like when I got my lips done the first time I did, I feel like that they were back to the normal in three months. And then I haven't done my lips in two plus years such a long time. And I still have, from where I came from, I still got some lips.

Dr. G (42:16):
Same. I started lip filler and then I hadn't done anything for over two years. And then I had Dr. Chao inject my lips, I want to say a year ago now, and I am not due for any lip filler anytime soon. I'm good for a while.

Bri (42:32):
Speak for yourself.

Dr. G (42:36):
And same thing goes.

Bri (42:36):
She loves me in all my requests.

Dr. G (42:40):
Same thing goes for cheek filler, under eye filler, I feel like got the most, I don't even doing it anymore. You can put a tiny bit here and here, but it does migrate.

Bri (42:50):
So is that for the little lines or to make it look more filled in? For volume?

Dr. G (42:56):
For volume. The little lines that crepey skin. That's good skincare, laser, filler's not going to help with the crepey skin.

Bri (43:04):
Why do people hate doing under eye filler? I feel like I've talked to a lot of people that do not like it.

Dr. G (43:10):
So it's a high risk area. So you can inject into a vessel that could potentially cause blindness. Nobody wants that. So there are some vessels kind of in this area that are high risk to inject around. This area too is high risk. This area is actually one of the first areas we used to inject is also high risk. Anything around the nose. So you can get kind of backflow, a filler into a vessel that then goes to your eye and can cause temporary or permanent blindness. Very rare but possible. Yeah. So you're injecting right on the bone of your orbit and it's still, sometimes a little bit of product just sits there and maybe migrates around. And if you inject two superficially under the eye, this is where you get problems. It can get trapped in the muscle and then it bulges up, and so you get little balls of filler, not a great look. Or if it's very superficial. It's something called the tyle effect where it makes your skin look blue. And that cannot be good. I mean, my skin looks blue, but that is just a vein. I didn't see the blue. I have a little blue, I don't know. I have makeup on, but that's just this prominent vein that sits right there on this side of my face. And someone was like, oh, you could just make a little stab incision and rip it. And I was like, no, I don't.

Bri (44:32):
This is why it's important to go to somebody that knows what they're doing.

Dr. G (44:36):
No, no. One of my friends said that, and I was like, I'm not doing that. I can't gross.

Bri (44:40):
Oh my goodness.

Dr. G (44:42):
Tie it off gross. But yeah, you could do, so what I should do is laser over it, right? To thicken up the skin, then you won't see the vein as prominent. But putting filler around that, it's just fraught with problems. So I think under eye filler has for the most part gone away. A lot of us will prefer to do PRP, which isn't adding volume, but is improving that crepey skin or laser or nano fat. So taking your own fat and breaking it down. So it's almost like a slurry or a liquid. And layering that in there too, because all that is doing is rejuvenating the skin and not necessarily adding volume. You don't necessarily need volume there. You just need that skin to be just a little bit thicker.

Bri (45:22):
Can you dissolve filler anywhere?

Dr. G (45:23):
Anywhere in the face?

Bri (45:27):
Yeah. Are there any places you can't dissolve it.

Dr. G (45:30):
If it's a hyaluronic acid-based filler, if it's s sculptra or radiesse, those you can't really dissolve. You have to wait for your body to break that down. So that can be a little tiresome. So yeah, most people, but I do, we've seen more and more patients that become fixated on filler that they had that they're trying to reverse, and then they feel like there's still filler in there, even though you can't visually see it or feel it. And I think either they have a little bit of scar or biofilm, but that filler is, there's nothing more to break down and they get a little fixated on it, which is unfortunate.

Bri (46:07):
How long does filler last? How can somebody, what can they expect? Is it different depending on what filler is being used?

Dr. G (46:15):
Yeah, I would say on average though, I just ballpark a year. Okay. Some fillers will last longer. It depends on the product. And then it also, so what brand of filler? A little bit, and then it depends on where you're putting it. So filler in the lips tends to last not as long as filler in the cheeks because filler in the lips isn't a place that's moving all the time. And that helps kind of break it down in the cheeks. It's deep on the bone and it's just sitting there, and so it takes a lot longer for your body to break it down. That being said, a lot of times people don't want to commit to the amount. One syringe in your lips is usually pretty good. One syringe for your entire face is probably not going to make a big dent. So ideally you would do a syringe here, a syringe here, and a split one between your temples to get a nice lifted cheek fill out the temple area. But not nobody, but people are a little reluctant to do three syringes a filler. So if you do one syringe, then yeah, you're probably split between your cheeks. You're probably going to come back in a year and want more because you just didn't treat enough. But that's fair. Again, people have budgets. My sister's always aghast at how much filler costs. I'm like, yeah, that's what it costs. It's it's expensive for us to purchase. Then you have to also compensate me for injecting it and not having you have a vascular accident or go blind.

Bri (47:42):
Yeah, we would not like any of those.

Dr. G (47:44):
Right. So I know. So then there's marketing things where get free, blah, blah, blah. Well, it's not free because first of all, the product costs something. And even if Allergan gives it to me for free, I still have to inject it. So it's my professional fee for injecting it and knowing where to inject it and how to inject it. So those are all things that get factored in. That's why that little program didn't last because people were like, what I'm not doing free for?

Bri (48:08):
Well, even we had somebody that worked here at one point that they went to one of those places that give you the free filler. You just have to post and so forth. And she came back and she bless her soul, but it was insane. She looked like a totally different person. She was upset. And then she had to argue to try and go get it back, dissolved from that place. And then when she wasn't happy, they were like, you can no longer be a patient here.

Dr. G (48:40):
There's a lot of med spa turn and burn.

Bri (48:42):
That's why it's important to And what do you do to avoid that?

Dr. G (48:47):
Well, I'm crazy

Bri (48:48):
Overdone.

Dr. G (48:50):
More conservative.

Bri (48:51):
Yeah.

Dr. G (48:52):
Again, there's a difference also when you're doing a training and you can inject as much as you want and no one's paying for it versus I have to pay for this product as a patient, then you're like, no, I'm not doing eight syringes of filler in my face. Like I'm not paying $7,000. I could have just done actual surgery. So yeah, so I think that's always a downside. And then a training is also a little, I think she was getting it done for free was part of the problem. And so they were just throwing it in there and not a lot of personal feedback, but if she had to pay for it, it would've been different.

Bri (49:29):
Right. Yeah,

Dr. G (49:31):
You just definitely have to understand what you're asking for. In general, I think our patients are asking for the filler to do a lot more than it can. People are so afraid of being overfilled. They're like, I just want to do one syringe, and one syringe is one cc. That is one fifth of a teaspoon of volume, so it's not going to dramatically change your cheeks or whatever it is. So I feel like our patients are conservative and that's fine. Yeah, they definitely, well, I think we've covered, I mean, we could talk about the different brands of filler, but I think that's something maybe for a different day.

Bri (50:09):
I was going to ask, but then I wasn't sure if between, there's a lot, RHA and Juvederm, if you want to talk about your preference.

Dr. G (50:20):
I think there's probably three major players on the market. There's the Restylane made by Galderma brand. There's the Juvederm line made by Allergan, and then there's the RHA brand made by Revance. And those are mostly what's out there. There's another product called Versa, but it's kind of a standalone. And then you have sculpt, which isn't technically a filler, it's more of a collagen stimulator. Doesn't necessarily add volume and Radiesse, which I tend not to use in the face, which isn't a hyaluronic acid filler. What gets confusing is that in your Restylane line, you have six or seven products. In your Juvederm line, you have six or seven products. And then in the RHA line, you have four. So there's all these equivalency. Are you going to use Volbella from Juvederm or Silk from Restylane or Redensity from RHA? They all have kind of the same offerings to some degree.

(51:21):
And I kind of like the RHA products because they have a little bit more stretch. They move with your face a little bit more. And I hadn't seen, I recently had somebody have an adverse reaction to one of their products, which we've all seen with Juvederm. So Allergan's always argued, well, that's just that much product out there. It's been around longer, so you're more likely to see an issue. I've seen it with the Galderma products for sure, but you can get a delayed hypersensitivity to it, which is a massive bummer when it happens. And it's usually triggered by something. In this case, I had injected someone's lips, I don't know, several months ago actually. And then she had a dental procedure for a root canal, and her lips got swollen, which I've seen happen before. It happened to a girl who used to work in this office.

(52:10):
She had volbella. This patient has an RHA product. I've seen it with Galderma products. It just does something to the, it creates an inflammatory reaction to the product that you still have. And we treat it with antibiotics and sometimes steroids, and it usually calms down. You can dissolve the filler, but that's a bummer because then you lose all the filler that you just put in there. So if you can ride it out, that's the way to go. It's just uncomfortable. It's the equivalent of getting a really horrible cold sore. You just are stuck with it. If you have an allergic reaction, you can get something called angioedema, which is swelling of your lips and sometimes your tongue, but mostly your lips. And that can happen. I had that happen, I had an allergic reaction, which I almost am never allergic to anything. And my lips got massive and it wasn't. I was like, Ugh, is it 10 times worse cuz I have lip filler? Or is it just my allergic reaction? Hard to know. And there were, people remember who were having when the first COVID vaccines came out, their filler was getting that delayed hypersensitivity reaction after the COVID shot. So who knows what's going to trigger it. Oh, well, the things we do,

Bri (53:17):
Things we do for beauty. And there's also filler that you can put into other areas of the body, correct?

Dr. G (53:23):
Yeah. So we can do alloclae, which is we've talked about before, is fat. Human derived desensitized, DNA, cleaned up fat plus extracellular matrix. There's renuva, which is just the extracellular matrix without the fat cells. And there's lipoderma, which is again, both the fat and the extracellular matrix. But in a slushy form for the face, you can use alloclae and radiesse in other parts of the body to either add a little bit of volume, sculptor to or to stimulate collagen and hopefully reverse some of that creepy skin. So we do a fair amount of that, and it works great in the booty and sometimes in the upper arms. I would say those are the two places I like to do it the most.

Bri (54:07):
I want some in my butt as well.

Dr. G (54:11):
There you have it. Alright, I think we're good. Covered, if you have more questions for us about Botox or fillers, reach out. We love to talk about it.

Bri (54:20):
If you're 95 and single also reach out and wealthy.

Dr. G (54:23):
And wealthy. Yes, please. Alright, I think that's it. I think we'll scrub in.

Bri (54:29):
And scrubbing out.

Dr. G (54:33):
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 Podcast, Spotify, or wherever you like to listen to podcasts.