Bye-Bye Saggy Skin: Best Non-Surgical Tightening, Bald Spot Taboos, and Kris Jenner’s $300K Regret

Dr. G (00:02):
You're listening to another episode of All the Bs with me, Dr. G, and my scrub tech, Bri. Well, let's see. Searches for sagging skin, which is hard to say, searches for sagging skin jumped almost 170% in one year.

Bri (00:21):
Ozempic.

Dr. G (00:23):
I don't know why. And now there's more non-surgical things like lasers and plasma and non-surgical facelift and machines. Everything's out on the market. I love this idea. There's more non-surgical options for skin tightening than there are Real Housewives, which-

Bri (00:45):
I don't know why that actually seems really funny because there's a lot of fucking housewives.

Dr. G (00:50):
There are a lot. But anyway, so what's the deal with a non-surgical tightening? The promise is always the same. You're going to get tight skin, tighter skin. There's no incisions involved. There's no scalpel and no downtime, which we all love to hear. Amen. And we all see it on TikTok and Instagram, but we know the reality is a little bit less clear. And so we're going to talk through most of the major skin tightening devices available on the market today. That includes radio frequency. We have a device for that. Ultrasound, we don't have a device for that, but it is an option. Laser is very popular and so is healing and plasma. And we'll go over the ones that actually work, which ones are oversold and wear maybe Renuvion. Morpheus eight, we have the virtue, which is radiofrequency tightening, actually fall in the lineup. But first I have to tell you about the Nikki Glasser Hulu special, which I then forced everybody to watch.

Bri (01:54):
I watched it last night and I had to keep pausing it as my kids came downstairs to make sure they couldn't hear any of it.

Dr. G (02:01):
Yeah.

Bri (02:01):
The fact that she is not ... I love her so much and I appreciated it, but the fact that she did not get canceled over so many things that were said was mind boggling because nowadays you can't say anything without

Dr. G (02:15):
It's a really good Hulu special. She spends, I feel like the last 20 minutes of this good girl set or whatever talking about labias.

Bri (02:25):
Yeah. And how hers just dangles down to her knee. And the best part is her dad's sitting there right in front and she's just having a heyday about her labia. It was great. Among many, many other things in this special.

Dr. G (02:39):
She does break down things that we're aware of, the time wasted at a nail salon, which I thought was super funny.

Bri (02:48):
The dipping your hands in the bowls of cancer tilts down to the bone.

Dr. G (02:52):
Yes. Spray tans, also how we're doing a service for all the teenage girls that are forced to spray tan us.

Bri (02:59):
To learn their anatomy. And then you turn around and they're like, they gasp because things are drooping down. They're like, "I don't want to be like you. " She's like, "You can see how old you are based off the rings under your butt cheeks, the stacking layers of where your butt used to be. "

Dr. G (03:20):
It's like the rings of a tree. I was like, "Oh my God." But literally 20 minutes talking about labia. And I hadn't heard that stuff before. So she does briefly talk about how she entertained having a labioplasty, but then her and her five friends compared labias and she realized she was pretty much right in the middle of things. She wasn't dime slot Barbie, I think is what she called her one perfect friend. And then everybody else was sort of a mix. And then the one girl who had really, really, really long labia that was nuts.

Bri (03:59):
I've never compared labias with ... Actually, I have a couple times, but that was after I started realizing that I just thought all ... I didn't realize the difference in labias, I think, until I started at least seeing them being done. I just had no idea. I had no idea that they could just be so different at any age, not just after having children.

Dr. G (04:24):
Right.

Bri (04:25):
But yeah.

Dr. G (04:26):
I think it's just everyone is born with different labia and it's all fine. It's all part of the normal, but if it bothers you, you can get it fixed.

Bri (04:36):
It's kind of like the way dudes measure penises and they have a dick contest. Now it's just labias. See how long your labia is.

Dr. G (04:47):
Yeah, it's wild. I highly recommend if you have any questions about labias, watch that.

Bri (04:56):
Yeah, you have to watch it. And at the same time, she like ... Oh, I laughed so hard about just the ugly people thing, which is ... We don't have to talk about that, but it was like, you really ...

Dr. G (05:10):
Yeah, she should be canceled.

Bri (05:12):
Between the pedophiles, the toddlers getting off their babysitters.

Dr. G (05:16):
Yes. There's a lot. A lot of unpack.

Bri (05:19):
But it was fabulous. Do watch.

Dr. G (05:21):
Do watch. I feel like labioplasty's going to come front and center again after that little blip.

Bri (05:26):
Yeah. They usually kind of spike. When Jesse came out and said she had a labioplasty on Mormon wives, I feel like we had a pretty big spike. Well, we do them pretty consistently, but I feel like there were so many inquiries about it.

Dr. G (05:38):
Correct. And I think it's because we don't talk about it and women tend not to talk. It's not like book club conversation unless you have the misfortune to be in my book club. But yeah, so women don't talk about it with each other and then you're just searching on the internet, I guess, which can go quite wrong, honestly, if you go down the wrong rabbit hole.

Bri (06:04):
Don't Reddit.

Dr. G (06:05):
Yeah, don't go down to Reddit.

Bri (06:06):
I feel like with OnlyFans and everything being on social media, because we just looked at a post right before this that I won't get into too much, but it's on the $200,000 penis, everybody just wants to make their lady bits and their male parts looking better because they're showing them to everyone nowadays. It's now the new normal to just whip out your labia or your penis or your butt hole. So there's dudes out here wanting to put 60 syringes of filler in their penis.

Dr. G (06:35):
Yeah.

Bri (06:35):
Crazy, crazy.

Dr. G (06:37):
I will say that's a no. For a lot of reasons. There's a lot of downsides to that or potential risks. I'm not sure the risk outweighs the benefit on that one.

Bri (06:48):
Dick might just fall off.

Dr. G (06:49):
Correct. I feel like every time that topic comes up in a professional setting, so like at one of my conferences where they'll talk about male genital enhancement, I'm like, "Oh, okay. Have they come out with something new?" And I think the last time I watched one, it was recorded, so I was able to watch it and I kept trying to call you guys in because it was just a like, don't do this, don't do this, don't do this, this is a complicated ... The people talking aren't talking about, "Oh, I've got these great results. I'm doing this for penis enhancement." It's like, "This is how I clean up the messes happening elsewhere." And you're like-

Bri (07:27):
All the reasons not to do it.

Dr. G (07:29):
So I'm like, the end of the story was don't do it.

Bri (07:33):
It's giving shin implants to make you taller.

Dr. G (07:37):
Or a calf implant.

Bri (07:38):
Calf implants, yeah. Or whatever, where you could add six inches of bone or something. Maybe I saw that in a movie.

Dr. G (07:44):
Like leg lengthening.

Bri (07:46):
Yes. Yeah. The materialist or whatever with what's her face? But just like, I feel like if you have to go to that extreme, we just need to find somebody that loves you a little bit more.

Dr. G (07:58):
Yeah.

Bri (07:59):
Nikki would say your daddy or mommy issues. Call him a good boy and move on.

Dr. G (08:04):
Good boy. All right. So let's do some of our actual celebrity news, making the rounds and Nikki Glasser comments on Kris Jenner's facelift during her comedy special as something to be revered. But now apparently Kris Jenner is unhappy with her results.

Bri (08:20):
I said that. I was like, this must have come out before she just came out and said her facelift was falling.

Dr. G (08:26):
I don't know. I think she looks fine. I think the original pictures of her after her facelift were filtered, which was crazy. I was like, "I can put a filter on and then I don't need to actually have a $300,000 facelift."

Bri (08:39):
Right.

Dr. G (08:40):
And it's all like the swelling goes down right, doesn't it? You're tight and right when you're a little swollen, but ...

(08:46):
Yeah. Everyone looks good for a year. And then depending on your skin quality, those photos are filtered. The one, I don't know.

Bri (08:57):
And she's also ... How old is she? 70. I almost said 78. This is why I also don't guess age. And I mean, she looks great for her age. I feel like she just needs to ... Would I be upset if I spent that much money on a new face? Of course.

Dr. G (09:12):
Yeah.

Bri (09:13):
But you can also-

Dr. G (09:14):
I feel like a $300,000 facelift should come with a year of maintenance or two years of maintenance or something where you can get additional lasers and skin boosters and things like that. I should come with that because that's what you need to keep your skin going. And I'm sure she's doing all of those things. It's just ... I just think usually the problem is the neck because it's just very thin skin and there's only so many times you can pull it back. And as you get older and the skin is not as good of quality, that tends to be what kind of relaxes first. And I do think she's part of the problem, right? She came out with this amazing facelift and everyone has this expectation that that's what's going to happen and that it's going to look great like that for 10 years and it just isn't. That's not reality. She doesn't actually look like that and that's not an average result or it's just unrealistic expectations, I guess. It's like showing women in these amazing dresses with their great boobs and then people come in and I'm like, "Yeah, you need a lift and a blah, blah, blah." And they're like, "Oh, I don't want the scars." I'm like, "Okay, well, these ladies have scars.

(10:36):
They just get them Photoshopped out or something or your doja cat and you don't care and you show them off." But for the most part, yeah, you don't see the scars, you don't see the unfiltered version of that surgery. And I feel like Ben Talia who did Denise Richard's facelift, he had a before and after post where someone was like, "I don't see a difference." And it was the funniest thing because he commented on it and he was like, "It's a facelift. It's not witness protection program." Because it was a normal person that he had done a facelift on. And so they look like themselves just refreshed, which is what the expectation should be. Not witness protection. I would be so mad. Yeah. So Denise Richards looks good, but if her skin isn't ... I mean, I think in those articles, Kris Jenner's comparing her face to Lori Laughlin and Denise Richard's. Girl, they're 20 years younger than her, so their skin's going to hold up a little bit better. And Denise looks great, but also she's immediately postop. Let's see her in a year, let everybody calm down. And some people didn't love it, but her neck is awesome to start with. She just really ...

Bri (11:52):
It wasn't bad.

Dr. G (11:53):
Almost didn't need one, but it's fine.

Bri (11:55):
She looks great.

Dr. G (11:57):
Yeah. Speaking of that, there's a clip in here about comedian Katherine Ryan reveals the insane quote she got for a facelift from Kris Jenner's plastic surgeon.

Bri (12:07):
She wants a facelift?

Dr. G (12:08):
I know. I was like, what does she need a facelift for?

Bri (12:10):
She looks like the result of a facelift already.

Dr. G (12:14):
And 250,000. Yeah, I feel like duh. That's what the going rate is for some of these. If you pick the top five guys in the country, that's what they're charging, but you should be able to get a legitimate, effective facelift for somewhere between 20 and $40,000 for reels because these guys are not magic. They just have a lot of hype. They cater to celebrities. They have to deal with someone like Kris Jenner who's pissed a year out.

Bri (12:46):
Right.

Dr. G (12:47):
I just think if you're charging that kind of money, your patients are ...

Bri (12:51):
A different level of-

Dr. G (12:53):
High maintenance.

Bri (12:53):
Yeah. You're asking for a new face. You're not getting a mole removed.

Dr. G (12:59):
Right.

Bri (13:00):
So keep that in mind. You're like, "Make me younger."

Dr. G (13:04):
Right. But I do think that it's quite easy to find in San Diego, a 40,000 or less facelift. And I think there is a guy in town who charges over 100,000.

Bri (13:15):
Yeah.

Dr. G (13:16):
Do you need to go to him? Probably not.

Bri (13:19):
If you're paying over 100,000, I do want to look like I'm in witness protection. I want to be a whole new bitch.

Dr. G (13:26):
Yeah. Yes. You're like, "You better be throwing in a rhinoplasty and I don't know. "

Bri (13:33):
They better drop me off at a local high school somewhere. I better look 18 again.

Dr. G (13:38):
We got to be 21 jump street.

Bri (13:39):
Yes. I want no one to know if I'm in high school or not. Anything over a hundred grand.

Dr. G (13:49):
But I don't think that's not the reality. So I just think it's good click bait, but that isn't the reality. Just find someone who's board certified, who's experienced in it, who you can see some results on, and then go for it.

Bri (14:03):
I think that is important. I do have to say, I was traveling one time and I was on one of those air buses at the airport, which was totally irrelevant to my story, but I saw somebody with her. Her scars had, they we so, her face was pulled so tight and her scars were so thick and they came down the entire ... I'm not stereotyping nothing, but you know this facelift came straight out of Mexico. Too much was taken. That's why you do want to find somebody credible because you don't want to look like this girl on the Airbus and my 11 year old's pointing to her with her face. And I'm like, "Put your fucking fingers down, girlfriend."

Dr. G (14:43):
Yeah, don't do that.

Bri (14:44):
You can't just point at people that look that way.

Dr. G (14:47):
Yeah, that is unfortunate. And there are board certified plastic surgeons in Mexico, but yeah, you need some help negotiating that. I have a friend who I just saw, I didn't get to talk to her. I was at the San Diego Plastic Surgery Society quarterly dinner and she's there. She's a plastic surgeon in Mexico and she looks phenomenal. She looks so good. And my sister is like, "Find out where she ... Who did it? Who did it? " And I'm like, "I know it's probably one of her partners in Mexico, but girl, we're not going down there." I know.

Bri (15:25):
Can they give me a rhinoplasty?

Dr. G (15:28):
But whoever, she's board certified, she lectures, there's definitely-

Bri (15:33):
She knows better.

Dr. G (15:34):
And she's going to ... Even when we had that woman from Mexico City who came to deal with her breast scars, I was like, "I know there are legitimate plastic surgeons in Mexico City that you could see for this pretty straightforward problem, and then you get the followup that you need." So I feel like that's kind of the problem. I don't want to go to Mexico for surgery and then what if I need something and crossing the border to get a suture out or something, that's part of it. You want to be somewhere close. And so I encourage this woman, I actually reached out to my friend and said, "Hey, who would you recommend for breast surgery in Mexico City?" And she gave me some names and that's what I told the patient, "That's what you need." Yeah. And they're like, "No, we don't mind coming to San Diego." I'm like, "I know, but you need close follow up." So find someone who does good work and don't go-

Bri (16:30):
Follow up care.

Dr. G (16:31):
... to Turkey or somewhere cheap. Just make sure you're not going for the Groupon version of surgery, but you also don't need the $300,000 Mark Jacobs facelift either.

Bri (16:43):
Yeah. You can meet in the middle.

Dr. G (16:45):
Correct.

Bri (16:45):
For sure.

Dr. G (16:46):
Speaking of not being able to meet in the middle, Helena Bonham Carter dropped out of White Lotus. Do you know who that is even? Yeah. A little bit.

Bri (16:56):
She says that only when the people are too old for me to know.

Dr. G (17:01):
Yeah.

Bri (17:02):
Actually, I do know she played in something.

Dr. G (17:07):
She was formerly married to Tim Burton. She's been in a lot of stuff. She was in Alice in Wonderland. She was-

Bri (17:14):
That's what I'm thinking, Alice in Wonderland. More famously in fight club back in the day. She was a girlfriend. Edward Scissor Hands. She's freaking awesome. Okay.

(17:25):
I do know her.

Dr. G (17:26):
Something

Bri (17:27):
Harry Potter.

Dr. G (17:28):
Something went down, I guess, and she no longer on the set, which sucks.

Bri (17:33):
She got kicked off of it?

Dr. G (17:35):
No, no. I think they said something like the casting or the character wasn't right. I don't think we'll ever know.

Bri (17:43):
She doesn't give me the vibe of being on-

Dr. G (17:46):
White Lotus?

Bri (17:47):
Yes. I mean, I don't know. I don't know.

Dr. G (17:51):
I don't know.

Bri (17:52):
She gives me a little too spunky for that show.

Dr. G (17:55):
Yeah. She's a little too funky, steam punk, dark. But maybe that ... Who knows because I feel like that show always takes a turn for crazy.

Bri (18:04):
Exactly.

Dr. G (18:05):
So I was super excited for her to be on it and I'm sure I'll just wait for the next thing she does.

Bri (18:11):
Interesting. Okay.

Dr. G (18:12):
This last little article is Knives Out, Celebrities Reveal Plastic Surgery Secrets, but one procedure is still taboo. I had to read this article five times to figure out what the taboo procedure was. And then at the bottom was the stupid link to the $200,000 penis enhancement. And then we went down that rabbit hole.

Bri (18:31):
You got distracted.

Dr. G (18:34):
But I think it was just talking about how more plastics or more celebrities are revealing that they had plastic surgery, which I think is fair, but also there are so many that don't. And I feel like that's a disservice when you're like, oh, I rub olive oil on my face and you're like, "Get out. " Lindsay Lohan.

Bri (18:53):
Martha Stewart.

Dr. G (18:54):
Jennifer Lopez.

Bri (18:56):
Yeah. You are not drinking green juice and horseback riding and looking like that. You look amazing. Just be honest about it.

Dr. G (19:04):
Share the secrets.

Bri (19:04):
Yeah. We don't gatekeep in 2026.

Dr. G (19:08):
So interestingly, like I said, I read the article a couple times and I'm like, where did they bury the lead? Which is the one procedure that's not talked about was male plastic surgery, specifically hair transplant. So I think that's interesting because men are still a little less inclined. I feel like there's always a rumor about-

Bri (19:29):
You guys are so caught up on your hairline. Literally, you guys can't ever talk crap about women getting plastic surgery because the amount of men on a turkey airplane back home to the States, you guys, you just can't talk crap on women's plastic surgery. If your wife wants new boobs, be like, "Yeah, of course." Because we know you want a new hairline.

Dr. G (19:52):
And I do think, just like everything else, I feel like who is it John Cena or whoever it is in the article is like, "You guys were giving me so much grief about my bald spot that I have no control."

Bri (20:08):
Not John Cena because he's fully bald.

Dr. G (20:09):
I think that's who it was. Anyway ...

Bri (20:13):
Maybe he's not bald. Okay. He's not bald. I take it back.

Dr. G (20:19):
Who are you thinking of?

Bri (20:21):
Somebody totally different. That's his bald spot?

Dr. G (20:24):
It was his bald spot. He had it fixed. I kind of love him.

Bri (20:29):
I love him too.

Dr. G (20:30):
He's so funny. Are you thinking of the-

Bri (20:32):
I'm thinking of somebody totally different.

Dr. G (20:34):
I know. I know who you're thinking of and I can't come up with a name either. How embarrassing.

Bri (20:37):
I was like, wait, he's so bald.

Dr. G (20:40):
The Rock? Are you thinking of The Rock?

Bri (20:41):
Yes. I think so.

Dr. G (20:43):
Dwayne Johnson.

Bri (20:44):
I know those are hard to get.

Dr. G (20:45):
Fun fact, I served him as a waitress.

Bri (20:49):
You did?

Dr. G (20:50):
Way back in the day.

Bri (20:51):
Oh.

Dr. G (20:51):
Yeah.

Bri (20:52):
Wow.

Dr. G (20:52):
Before he was anybody. He was just a wrestler. Anyway, back to the story.

Bri (20:56):
Just a wrestler.

Dr. G (20:57):
And I wouldn't have known, but somebody in my restaurant knew who he was. So John Cena, he got a hair transplant and he said, "You guys were on my ass about this bald spot, so I did something about it. So now you can't hate me for having it handled." But I do think guys are super embarrassed to talk about it, and so they hide it. There was a whole Tom Brady thing, people looking for the scar.

Bri (21:24):
Men are so insecure about their hair.

Dr. G (21:27):
Which is stupid because literally it's just mostly genetic. It's not anything that they're doing.

Bri (21:35):
But then again, all the problems that we have are genetic. If I got small boobies, that's genetic or a labia down to my knee.

Dr. G (21:43):
Also genetic. Yeah. Genetic. We didn't ask for that. Yeah. We're like, yeah, I would like small boobs, large labia and-

Bri (21:52):
Yeah, I'd like to go back and fix a couple things in my DNA sequence.

Dr. G (21:59):
But I mean, some of it is aging or whatever, but yeah, Andreo genetic alopecia, whatever, male pattern baldness is male pattern baldness. And if there's something you can do to fix it, then go do it. And I feel like that should be the new trend, these guys talking about what they're doing.

Bri (22:16):
Yeah, absolutely. I want to know if you've had filler injected in your penis.

Dr. G (22:21):
You'll know.

Bri (22:22):
Most importantly. I want to know if you've had app sketching.

Dr. G (22:28):
Personally traumatized. I've been personally traumatized by the male penis injection.

Bri (22:33):
I thought we were just going to say the male penis and I was going to say same. The Me Too movement. Me too.

Dr. G (22:41):
Hashtag me too. Only because when I was hospital based and on call, I had to take care of somebody who had had penis injections and had a failure of them and urology needed to treat it, take out the foreign body. And then I had the skin graft and I was like, "Who does this? " So it's been around for a while. I just think it comes and goes and people forget about how bad it can go sideways and then people are like, "Oh, I've got an idea. Let's inject this. "

Bri (23:12):
Let's do this. Yeah, let's not.

Dr. G (23:14):
Stick to treating hair, man.

Bri (23:17):
Yeah.

Dr. G (23:17):
I do think it's wild that we can have an article about how a $200,000 penis, but if you look for articles about the popularity of male hair transplant, it's probably not as-

Bri (23:28):
And in that same article, they talked about just getting hole tox because it's too tight to get in and they don't want hemorrhoid. There was so much going on in this article. I feel like I could have a whole just conversation about this.

Dr. G (23:42):
A hundred percent. But no one's talking about the bald spot.That's taboo.

Bri (23:48):
We can talk about putting Botox in our butt holes, but not our hairline. That is just way too far.

Dr. G (23:55):
Get out. Okay. So let's move on to radio frequency.

Bri (24:00):
Oh yeah. I forgot we were talking about that.

Dr. G (24:03):
So it's interesting. Renuvion won the 2025 New Beauty Award for best minimally invasive skin tightener.

Bri (24:11):
Yes. But it is invasive, which I do have to say.

Dr. G (24:14):
It's minimally invasive. Not maximally invasive, I guess.

Bri (24:20):
No judgment. But I just feel like for me, if you still have to make an incision and insert fluid and recover and it gives medium invasive.

Dr. G (24:36):
It's giving medium invasive. Right. So we do Renuvion. I think it's a great procedure. We offer it. I feel like the alternative, to be fair, is in mode's body type. They both use radio frequency energy, but people fail to understand that we're going to make really small incisions, just under half a centimeter, so five millimeter incisions. And then I do have to inject fluid that has numine solution in it into the space that we're going to tighten. So this isn't like a magic wand. I have to put fluid in. And then because the device itself is a pretty thin wand, I also need to create space for it. And that is done with a liposuction cannula. So even if we're not doing liposuction, I need the cannula in there to move around, create some space in that fluid, and then we're going to add the Renuvion wand after to heat up the tissues, contract the tissues, and then that's kind of it.

Bri (25:40):
Is there a more invasive skin tightening than this?

Dr. G (25:43):
No,

Bri (25:43):
Exactly. We're going with invasive.

Dr. G (25:48):
Yeah, that's true. So yeah, I mean, actually the more invasive skin tightening is me excising the skin. Yeah. I guess if you're comparing it to actual surgery, then yes, it is minimally invasive. And I do think the other thing about this procedure is, for example, for neck tightening, you could do it under local, and I have done it under local. So same thing, you inject fluid in the neck, you create space with the cannula, and then you use the Renuvion device or body type device, whatever. Renuvion is our mode of choice and you tighten the skin from underneath and then you have to ... It depends on who you are, but I'm not going to suck all the fluid out, generally speaking, because if you don't have fat in your neck, then I'm trying to preserve that layer. So it gets milked out, a little bit of suction to get the helium gas out, and then you're pretty swollen and we're going to put you in a wrap and you need to stay in compression.

Bri (26:47):
Yeah.

Dr. G (26:48):
So I guess it's minimally invasive if you're comparing it to excisional surgery. It is certainly more invasive than getting a laser, right?

Bri (26:57):
Yeah.

Dr. G (26:58):
And then the other thing is the downtime. So I would say four to six weeks for the neck, for you to be in compression, you're going to be a little bit of swelling, you're going to feel a little tight, all of those things.

Bri (27:11):
But it looks so good.

Dr. G (27:12):
It does look nice.

Bri (27:13):
So good.

Dr. G (27:14):
And for other areas, for the abdomen, kind of the same thing. The abdomen's a little tougher because you want to avoid having any creases or wrinkling and people just want tightening in one little spot. You really should treat the whole area to maximally kind of shrink wrap your whole 360, if you will. The areas that it does do well are abdomen, the neck, the arms. But again, there's always a caveat because we're shrinking the subcutaneous tissue, so the layer below the skin. If your skin's thin and crepey on top, as you shrink from below, it's gathering, the skin on top is getting gathered. And so if you have crepey skin and that's your issue, it's going to make it worse. So I feel like in the upper arms, it's great if you have good skin quality, if you have thin, crepey skin, you don't want that to get worse and I would not do a skin tightening device in that manner.

(28:14):
So we love Renuvion. It's a good adjunct. It definitely helps tighten things because sometimes if you're just doing straight liposuction, then you might end up with loose skin. So it helps kind of tighten that up as well.

Bri (28:27):
Yeah, absolutely.

Dr. G (28:29):
And currently we have the Aon system, which you love for its-

Bri (28:34):
Don't get me started.

Dr. G (28:35):
... small footprint.

Bri (28:37):
Yeah. Very small footprint. Barely move past this machine.

Dr. G (28:43):
So we upgraded, we have the Renuvion, but it also has our Aon system has ultrasonic assisted liposuction. So we will often do the ultrasonic assisted liposuction at the beginning, then do safe lipo with a power assisted microair version, and then we can follow with Renuvion. And so then you're getting all of the options. So I do like ultrasonic assisted. The other competitor version of that is Vaser, which I've used before as well. I like it because it does gently melt the fat. So I guess there is ultrasound technology that we use. It's just not the one I was thinking of in this list and kind of heats it up a little bit too, and all of that impacts tightening. I don't think as a standalone tightening, it's great. I think it's a really good adjunct and that's why we bought the system and really our only complaint with it is how bulky it is, but it's fine.

Bri (29:39):
I mean, I have a couple more, but I won't say it on here.

Dr. G (29:42):
It does offer the nice heating of the IV fluid.

Bri (29:46):
Fluids, Yes. It has a great bag warmer, has some other great things that we're not allowed to use yet, but when we can, I can see the benefit.

Dr. G (29:56):
And it has these giant canisters for suction

Bri (30:01):
Which has been great. And I've actually repurposed a couple into mini trash cans.

Dr. G (30:07):
Literally this machine has, what was it, like five, six?

Bri (30:11):
There's just so much.

Dr. G (30:12):
I'm like, what? Like

Bri (30:14):
12,000. You can only take out five liters when you're doing without staying overnight.

Dr. G (30:20):
Yes.

Bri (30:20):
And there's 12,000 of available fluid you can take out. There's like four, three liter things all over. And then there's warmers and then the giant machine and then-

Dr. G (30:32):
I was like, on what planet would we need 12,000 ccs of liposuction?

Bri (30:38):
I want to know who's taking out that much. So I have yet to fall in love with the machine, but it's a work in progress. I made my own little DIY projects on it to make a little lap counter and a little trash can.

Dr. G (30:54):
Yeah, we have notes. I'll just say that. But our beloved rep is aware of them.

Bri (31:00):
Yes. Oh yes. He loves to hear it from me. I also made him a little video. But overall, the machine itself is great.

Dr. G (31:08):
Yeah, it is because it offers those modalities.

Bri (31:11):
Yes.

Dr. G (31:12):
It's just the bulkiness we could do without. Yes.

Bri (31:15):
I just really like to complain because ... Why not?

Dr. G (31:18):
Why not? I mean, things don't get better if you don't give feedback, I guess.

Bri (31:25):
Yeah. Constructive complaining feedback.

Dr. G (31:28):
Right. Okay. So that's our radio frequency. I feel like the original was Thermage.

Bri (31:35):
I've heard of that, but I've never actually seen it. Is that the machine that's not invasive? It's literally just you put it and it's supposed to melt the fat on top.

Dr. G (31:42):
That's Ultherapy. That's ultrasound. Thermage was also a little wand. Oh, I'm

Bri (31:47):
Thinking of something totally different.

Dr. G (31:49):
It's just the OG version of it. And then- I'm thinking

Bri (31:51):
Of Cool Sculpting.

Dr. G (31:52):
Oh, yeah.That's not really skin tightening. That's fat melting.

Bri (31:58):
And I've also never heard from anybody that's done it that they liked it and it was worth the money. I feel like it'd be good for small little areas.

Dr. G (32:08):
We used to say it's good for a stick of butter.

Bri (32:12):
Yeah. But I feel like it's the people that don't have the stick of butter that want it done and think it's going to melt everything.

Dr. G (32:17):
Right. And by that point, you should have just done liposuction for sure. I feel like CoolSculpting's era is over and that Allergan's pulled back from ... I feel like those machines are going to go away.

Bri (32:30):
Yeah. I haven't even heard about it in a long time. I just ...

Dr. G (32:32):
Yeah. Thermage also has not been around for a minute. I mean, people probably still have those devices, but it was similar with a probe that heated and provided radio frequency energy, but there is no helium gas component, so there's no cooling effect. And so you were watching a temperature screen and heating- I wanted the burn rate on that. Yeah. So a little bit harder. Now you can, I guess for all of these, the body type, the Renuvion, Thermage, you are heating, right? Yeah. So there is a potential for injury if you overdo it with skin burns. I haven't seen that in our practice personally.

Bri (33:17):
No, but I've seen some via Instagram and they're wild.

Dr. G (33:21):
Yeah. You're like, what are people doing and why? That would be terrible. Okay. So then those are ... Profound is one is also just for the face, which I'm not going to get into. It's a more painful treatment with radiofrequency energy delivered to the face. But then ultrasound is its own category, and that's old therapy is a big name. And it's also good on the face. Okay. So these are ... Ultherapy is truly non-invasive, meaning that it's sitting on the top of your skin. So whenever you're looking, so you're not putting the probes. So whenever you start moving to outside, the results are not going to be as good. And usually the comparison, you're not going to do old therapy to your body. It's really designed for the face, but then there's so much variability. And that was one of the problems with CoolSculpting. There's a lot of variability on the thickness of your skin, you personally, and the area of your body, right?

(34:21):
The thickness of your skin on your back is much thicker than the skin on your neck. So where are you applying the device? Is my skin thinner than your skin? Some of that's age related, some of it's genetic. And then the person who is applying the treatment, what modes are they using? And so there's a lot of variability when you start doing stuff from outside in that's a little bit hard to control. And then that's when you see these amazing before and afters and you're like, oh, I want to achieve that. But it's a one-off because it was a perfect set of circumstances. So I've looked at old therapy before as a device I wanted to bring into the office and I haven't because I do think it's hard to get consistent results with that.

Bri (35:11):
So what device would you, what non-invasive device do you think is best for skin tightening on your face?

Dr. G (35:20):
I would say radiofrequency microneedling, which we'll talk about, and laser. And then there is something that was starting to make waves and is starting to fade a little bit called ... It's like microchoring the skin. So Ellacore was the device that came out originally.

Bri (35:39):
So brutal.

Dr. G (35:39):
I know. It's like taking an embroidery machine to your face and

Bri (35:44):
Perfect.

Dr. G (35:46):
And then just takes little cores of skin out. Again, the concept is really interesting because if you're taking out micro cores of skin, you're removing skin. And then as your body heals, the skin's going to tighten up because it has to make up.

Bri (36:01):
And that doesn't cause any scarring?

Dr. G (36:05):
No, it hasn't. I do think originally the downtime was just supposed to be a few days, but you can imagine it was not because people bruised from that. And also multiple treatments are usually required. And I thought, because I'm always looking for the modality that we can use to tighten up the skin on the arms, I mean, on the face, of course, and anterior thighs. Those are two areas that we do not have good solutions for. We've tried radiofrequency microneedling. It's good in certain areas, but it doesn't defy gravity. It's not magic. So this had potential, but I don't think people have gotten great results on the body and then variable results on the face. And now there's like a laser assisted version of that machine that also, I think it's called UltraClear or something like that, but it hasn't made a big splash. So that generally means that it's not replacing ...

Bri (37:05):
Its results aren't that great.

Dr. G (37:08):
So radiofrequency microneedling for the face. Morpheus eight is the Instagram brand everyone associates with it. We have a Cartessa different company's version of it. I think the downsides are if you go too deep, you can melt fat, which is sometimes beneficial. Maybe that's what you want to do if you have like a little fat you want to get rid of, but certainly not in the face you don't want to melt fat. So it, again, has to do with who's doing it, how deep are you going, what settings are you using? It's nice because the needles are penetrating the skin and delivering that radio frequency energy below the surface so that the tightenings below the surface and the risk for hyperpigmentation is a lot lower. So it's safe on all types, skin types, which is another factor. Laser is great for skin tightening. It's probably the gold standard at this point still, but for people that are like my shade or any darker, it's a little risky in terms of the heat generating hyperpigmentation.

(38:16):
So I am a Fitz four, which means I tan easily. I have an olive colored complexion. I have a risk of having hyperpigmentation, what we call post-inflammatory hyperpigmentation. So I need to pretreat my skin, be super careful about sun exposure afterwards, all those things. You, your blonde, well, red head, right?

Bri (38:42):
She just called me a fake bottle blonde. Strawberry blonde.

Dr. G (38:46):
Strawberry blonde.

Bri (38:47):
Very pale.

Dr. G (38:48):
Pale.

Bri (38:49):
Don't tan.

Dr. G (38:50):
Pale eyes. Right. Don't tan, burn easily. Yeah. The downside of that is you would burn out in the sun, but the upside is that we can kind of blast you away with the laser and you will unlikely have any pigmentation issues. Those are all ... I know I just mishmashed all the devices, but I would say microneedling is safe for all skin types. Laser, if you're darker than me, probably not. It's probably not in your future. And then it just depends on your skin quality and what your goals are. None of these are a magic eraser though, unfortunately.

Bri (39:27):
Yeah. And this is why it's also really important to get a consult first, because I remember you actually, you don't really know what you need. You just assume that if you don't work in this industry, you just kind of think that every laser is for you. You don't think about your color of your skin affecting what laser you can and can't do. I remember before I started working here, I bought an IPL Groupon for Revive. And then I get in there and she's like, "You actually are not a candidate for any of this, but for $200 more, you can purchase this. " And I was like, "Oh, you motherfucker." Set a lot of efforts in this podcast, but it is good to know and see what you are a candidate for and what you're trying to treat.

Dr. G (40:09):
Right. And I think we discuss that because we're bringing on a new laser. So excited. Yes. We're to bring on the Sciton, the BBL Hero Moxie platform, and we are talking about how instead of doing a BBL special or a MOXIE special, those are options, but to also maybe just to just say, "Hey, this is a laser treatment plan for you. " What are the things you want to address? Are you looking to address sunspots, pigmentation changes, texture? Is it skin tightening? Is it surface wrinkles? What's your goal? Because those are all different lasers. So we can mix and match that and you can stack lasers to give you the result you want in a series of treatments. What if it's redness that you don't like? Lasers are set for a wavelength and they're there to target something. And so some lasers are set to target redness, some are targeting brown spots, some are targeting the water in the cell.

(41:19):
So some are targeting the pigment, right? So that's a laser hair removal is based on targeting the pigment in the hair. So maybe don't come in saying, "I need a Morpheus8 treatment," or, "I want radiofrequency microneedling to say, I'm looking for some skin tightening. What are my best options?" And that's how I usually present it because the trade offs like a really deep CO2, fractionated CO2 laser is going to give you a result that's pretty comparable to a virtue radiofrequency microneedling series of treatments. So usually the less downtime you have, the more treatments you need to accomplish that. So then it comes in a series. So it's not a one and done procedure. And then you have those options. I want the one and done. I'm just going to be out of work for a week, not going to see anybody because my face is going to look like a burn victim or I'd like to do every four to six weeks, I'd like to do this other treatment that's going to kind of get me close to where I need to be and then do maintenance after that.

(42:24):
And so a lot of it has to do with what your goals are and both your budget for finances and for time, time off, like social downtime, I guess is what we're talking about. You're going to look crazy.

Bri (42:40):
Yeah. Last time I got the CO2 laser, I had plans the next night and I had to send a picture and forewarn everybody when I showed up in my hoodie with my hat and my scarf over my head and I looked like a burn victim. My eyes were so swollen, but

Dr. G (42:58):
I mean, as long as you're

Bri (42:59):
Just stay home.

Dr. G (43:02):
No, you don't want to miss out. So I think-

Bri (43:04):
I have FOMO, so I had to go.

Dr. G (43:09):
Yeah. I think that we can talk about all of those options and that's when you, like I said, you pointed out, just don't come in saying, "I want X." That usually just be open to what we might advise as the best thing for you. My other little pet peeve is when you come in for one of these consultations and we ask what you do for skincare and it's like, "Girl."

Bri (43:36):
St. Ives scrub.

Dr. G (43:39):
You need to use sunscreen. You need to be using some sort of medical grade or active, something that's boosting your skin, collagen elastin production, doing something on a daily basis to help your skin out. Otherwise, then you're just ... Yeah.

Bri (43:57):
Getting a laser for nothing. It's like surgery without the aftercare.

Dr. G (44:01):
Right.

Bri (44:01):
Well, not quite surgery, but you know what I mean.

Dr. G (44:04):
Yeah. Or it's like getting your teeth cleaned at the dentist, but then you decide not to brush your teeth every day. That's weird. You would never do that. You were going to brush your teeth every day and go to the dentist twice a year to get your teeth deep cleaned or cleaned, but you're not going to just show up twice a year and get your teeth cleaned and call it good. Just you need that other piece in there.

Bri (44:24):
You're going to spend all this money on doing lasers and stuff. You have to just do it. Invest money in skincare.

Dr. G (44:33):
Yeah.

Bri (44:34):
Sunscreen, most importantly. Yes. I like this one. When do you look at a patient in the eye and just say, "You're screwed. You need surgery?"

Dr. G (44:44):
I don't think that's exactly what it says.

Bri (44:47):
It's not. I made it my own twist.

Dr. G (44:49):
No, I think that comes up quite a bit. We've had some older patients that haven't done anything, no skin routine. Their 70s and 80s, they don't want a facelift, but they want to do microneedling or laser. And you can do that. You just have to understand that your results are not going to be earth shattering. It's going to be minimal. You're fighting the clock at that point. It's better if you've already done certain things already and now you're crispener and you're trying to maintain your result. You're not trying to get facelift results by doing microneedling every six weeks or something.

(45:27):
It's just not going to happen. And so I think that happens not infrequently. I have people come in for Renuvion and I say, "It's going to make your crepey skin on your arms worse." Or, "You have so much skin laxity in your abdomen, we're not going to be able to tighten it and you need a tummy tuck." There's no getting around that. You need skin excision. So I will not offer it if I don't think you're going to get a result. And people want to know how much of a result. It's really hard to judge. That's the thing is, is it a 25? Is it a 50% improvement? Some of it has to do with your own skin quality. So I think a lot of it is my best judgment and what I think we can accomplish. I think one of them is, again, the anterior thighs not found anything that really magically works on that except for thigh lift.

(46:19):
And even then, you're pulling from the top, you're fighting gravity, that stuff above your knee is not going to be dramatically better. So there are, again, non-invasive treatments, but nothing has been so dramatically great that I'm like, "Oh yeah, you should really invest your money in doing microneedling to your legs or whatever. Don't morpheus your legs."

Bri (46:44):
And what's the difference between ... I know we do microneedling, microneedling with PRP and VirtueRF microneedling. I feel like I get a lot of questions about that.

Dr. G (46:53):
So, right. So microneedling on its own is not heat. There's no radiofrequency energy. It's literally just tiny little needles penetrating your face with a gliding serum and it's mechanical stimulation of collagen and elastin. It's great. So it's good for two things. It penetrates to if you're putting something on top that you want to get good penetration of, so like an exosome or your own PRP or a brightening serum, it's helping that get in deeper than when you're just applying it at your face at night. So it's great for that. And the mechanical injury to your face is also stimulating collagen elastin. Because there's no heat involved, it's safe to do on all skin types. The only person who shouldn't be doing it is somebody with acne, like active acne, because then you're just spreading bacteria all over the face, not a good idea. So aside from that one contraindication, everyone's a candidate.

(48:01):
The downtime is like you're red for a day. So it's a really nice treatment. The results are not as dramatic as radiofrequency energy added in. So that's the difference. And PRP is a good booster for all of it. It really does make your skin look super glowy.

Bri (48:20):
So good.

Dr. G (48:21):
I need to do another one. Yeah. I'm a big fan. You just have to numb for about half an hour and then ...

Bri (48:28):
Have to add myself on the schedule today.

Dr. G (48:30):
I know. Well, I was thinking I should just take it home and do one ... I could do it on my own face at night. Just need to carve it out. So I think that is a generally cheaper. Like I said, less invasive, less downtime, but it's probably something you could easily do every four to six weeks and maybe alternate that with a lighter laser. So it's better for younger people or people who are just trying to maintain things just want to freshen up. Whereas the virtue, it definitely is more like three days of looking a little swollen and red. Yeah. For sure.

Bri (49:06):
Added heat.

Dr. G (49:07):
Yeah. Right. With the heat. What do you think is our probably most popular procedure out of all of these?

Bri (49:15):
I feel like we do a lot of microneedling, but we also do a lot of Renuvion because most surgical patients were like, "I'm already getting surgery. I'm just going to add it on. "

Dr. G (49:23):
Right.

Bri (49:23):
So for the medium invasive, Renuvion's the most popular and then microneedling.

Dr. G (49:30):
Yep. All right. But soon to be laser probably with our new laser.

Bri (49:35):
So excited. I'm going to be your number one client. All right. I have some questions for you.

Dr. G (49:40):
Okay.

Bri (49:41):
Myth or reality, Morpheus eight is basically a non-surgical facelift.

Dr. G (49:44):
That's a myth.

Bri (49:46):
One Renuvion treatment is all you need.

Dr. G (49:48):
That is true. Fact.

Bri (49:51):
Ultherapy hurts more than Morpheus eight. I've heard Morpheus eight is

Dr. G (49:55):
Morpheus eight is ... I feel like the physicians that are unhappy with it are because it's so painful, unlike our version of microneedling, that patients don't tolerate it. And so they don't come back for more treatments and they end up getting rid of the machine.

Bri (50:11):
Yeah. Laser tightening is safe for all skin tones.

Dr. G (50:14):
That is not true.

Bri (50:16):
If a device is FDA approved, it has been proven to tighten skin.

Dr. G (50:20):
Myth.

Bri (50:21):
You can skip the SPF after these treatments because the heat sealed everything in.

Dr. G (50:26):
Oh, my heart hurts. Myth. FDA approved just means it's safe to use on humans. It doesn't actually prove that it does anything. It just means there's a low chance we're going to hurt you with it.

Bri (50:42):
Doing these in your 30s means you'll never need a facelift.

Dr. G (50:45):
Oh, if that was true, that's a myth.

Bri (50:47):
We'd be doing it every day. All right. You heard it here, first folks. Yeah. Okay, maybe not first, but ... You did hear a lot about penetration and labias.

Dr. G (51:03):
Oh my goodness. Okay. Well, I think that wraps it up. If you have questions, if you're thoroughly confused about the difference between radio frequency, microneedling, Renuvion, and all the other things that are out there on the market.

Bri (51:16):
It's a lot.

Dr. G (51:18):
It's a lot to keep track of. And we're always learning. We're always excited about what's new, but also skeptical. So we're happy to talk you through it. I mean, I have friends who randomly text me like, "Heard about this. What's this? "

Bri (51:33):
Yeah. And I'm also happy to be the guinea pig on all new lasers, so I'll give you guys my advice on all of them.

Dr. G (51:40):
Yes, we do. We're often willing to take one for the team and see what it's all about.

Bri (51:45):
Sucks.

Dr. G (51:47):
All right. So if you have questions, please reach out, DM us, or call the office and we'll scrub in.

Bri (51:54):
And scrub out.

Dr. G (51:58):
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 restorestplasticsurgery.com or follow us on Instagram at RestoreSD PlasticSurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.