Today, we have an informative chat with the celebrated plastic surgeon Dr. Carolyn Chang, from San Francisco, who shares her insights and thoughts about the societal consequences, moral implications, and realities of aesthetic improvement. We know this can be a hot-button topic for our AGEIST community, so not only do we discuss the pros and cons of aesthetic procedures, but we also get Dr. Chang’s inside opinion on operations, and hear why some of her clients make this choice. From the risks associated with Cool Sculpting to the effectiveness of tummy tucks for people over 70 to the psychological and emotional aspects of plastic surgery, highlighting that it is more than just a vanity-driven choice. Join us for this conversation and let us know your thoughts on plastic surgery; I would love to field questions and comments in next week’s show. Email me: [email protected]
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Key Moments:
“It is surgery. It’s not something you want to take lightly.”
“What I really enjoy in plastic surgery is the immediacy of the outcome and the joy that it gives people. It’s a pretty simple thing. If you feel good about yourself, life changes.”
“So many more people get orthodontia as children, they don’t really think about it quite the same way; but it is the same. You can see how good [Invisalign] made you feel. That’s what’s going on with plastic surgery.”
“Patients that I have are normal people. They’re your neighbors, they’re your brothers, they’re your sisters, and they really just wanna fix something that bugs them.”
Get in touch with Dr. Chang
Website
Instagram
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Contact Her
Transcript
David: 0:19
Welcome to SuperAge. My name is David Stewart. I am the founder of Ageist and your host on the SuperAge show. We talk about how to live healthier, how to live longer and how to be happier and who doesn’t want that? Today’s show is brought to you by InsideTracker, the dashboard to your inner health. Go to insidetrackercom. Slash agist Save 20% on all their products. Today’s show is also brought to you by Element LMNT, my favorite electrolyte mix. It’s what I put in my water in the morning and it’s what I put in my water at the gym. Go to drinklmntcom slash ageist and receive a free eight serving sample pack with any purchase. Today’s show is also brought to you by Timeline Nutrition with their breakthrough product, Mitopure, the first clinically tested Eurolythin A supplement which is showing tremendous results for mitochondrial health. Go to timelinenutritioncom. Slash agist. Use the code AGEIST at checkout and save 10% off your first order of Mitopure. Welcome to episode 147 of the SuperAge podcast. It is wonderful to have you with us. This will be dropping on August, the 16th 2023. This week we are in Park City, Utah. Pro tip: the summers in Park City are incredible. Everybody comes here for the snow and for skiing and that’s really great, but the summers are kind of the bomb. All the locals know that it was sort of a surprise when we first moved here how amazing the summers here are, but it’s true. So we’re just here until Friday morning when we go to Hawaii and we’re going to Oahu and we’re staying with the folks at the Hale Kalani, which is an amazing hotel. And I had this sort of incredible opportunity. They invited me last spring to come for next week to be their visiting master in residence and I’m just wondering do I get a name tag that says like master on it or something? I don’t know?
Dr. Carolyn Chang: 2:19
Maybe, not.
David: 2:20
So we’re going to be there. We’re going to be talking about super aging and, specifically, sleep, because I thought what am I going to talk about? At the Hale Kalani They’ve got a lot of the stuff that we talk about here really well dialed in. But the thing is, anyone who is in Hawaii who’s not a local is jet lagged, because Honolulu is just this sort of odd place in the middle of the Pacific. It’s this major Asian city that happens to be part of America. That’s like in the middle of the Pacific, and I just love it. It’s just one of my favorite places because it’s such a mix up of surfers and tourists shopping at Louis Vuitton and then the locals and it’s the whole native Hawaiian culture and get this. I mean people talk about like blue zones and all that stuff, which I truthfully have some issues with. The US state with the longest longevity is Hawaii. You know Hawaiians are really not known for their particularly good diet. They’re really into roast pig and, yes, there is a lot of spam there. But what is remarkable about Hawaiians and being in Hawaii is that everything is just kind of chill. The stress level there. It’s just lower. People don’t worry about stuff too much. So if you want to go to the state with the longest longevity, hawaii would be it. This week on the show we have Dr Carolyn Chang, who’s a well known plastic surgeon in San Francisco. Now, the reason we’re having Dr Chang on is because I think that of all the things we talk about aesthetics, aesthetic improvement it’s just fraught with controversy. I don’t really have an opinion either way on this. I get confused about it too. So that’s what I want to say about this, and I think maybe my confusion about it is bad. Plastic surgery it just sort of creeps me out. But who am I to say what’s bad and what’s good? Because these are aesthetic judgments and I think that they are to a large extent, cultural. I think people should do what makes them happy and I sort of wonder. Aesthetics are on a continuum right. There’s from you know, I’m doing zero to okay, you’re going to like clean up your teeth, or you’re going to wear lipstick, or maybe you’re going to do something, you’re going to laser procedure on your skin, and then you go into more surgical procedures and then really extreme surgical procedures, and I think all of this stuff is. It’s really hard for us to get our minds around why people do this, why some people don’t like other people doing it, the downsides the sort of social downsides to doing it, because sometimes people are judged very harshly for this but on the other hand, some people get judged harshly for other things. It’s something that I love having these conversations because it helps me sort of figure out how to untie this, which I think is, as I’ve said, it’s complicated. It involves sense of mortality, it involves sort of a religious Calvinist thing. And you know, you can see, in different cultures it’s really looked at quite differently. And you know, someplace like South Korea it’s, you know, not just accepted, it’s sort of like the norm. In Brazil also very much so. In other places less so, it’s really frowned upon. And then there’s the you know, the idea of if you want a procedure, why do you want the procedure, what do you think the outcome of the procedure will be and how do you choose someone to do something like this? Because it’s, you know, it is surgery. It’s not something you want to take lightly. I do recall a quote from the wonderful photographer Peter Lindbergh, talking about the terror of perfection and this drive for constant youthful perfection and how terrible that is. And I think there’s something to that too. Driving for trying to keep yourself at some level of perfection, boy, that’s like really hard. I appreciate things that are done well. I mentioned earlier I did Invisalign earlier this year, which is sort of in the same camp, sort of a very light version of aesthetic improvement, and I love it. I was always really shy about smiling because my bottom teeth were just kind of gnarly and they just kind of embarrassed me. But once I had my Invisalign done, like I just smile all the time. I love my smile. I see my smile in pictures and I go oh my gosh, I have such a great smile. Anyway, we’re going to have this conversation and we’re going to see how we can get Dr Chang’s opinion on this. I know she has a lot of experience with this. She’s really smart and really fun and I think you’re going to enjoy this conversation. We’re going to get with her in just a moment. After a quick word from our sponsor. Hydration is not just about pounding water. We have to have some electrolytes in there, specifically sodium, potassium and magnesium. My favorite electrolyte mix, the one that I use every day, is element LMNT. You know, one of the things that I learned last year was the importance of sodium. We may actually not be getting enough sodium and I know there was a lot of sodium fear out there. And it’s true if you have hypertension or prehypertensive you do want to check with your doctor. But for most of us, having sodium actually helps us to absorb water and in fact, drinking straight water without any minerals in it we will be pulling the electrolytes out of our system. Go to drinklmntcom. Slash ageist. That’s D-R-I-N-K-L-M-N-T. Dot com slash ageist. Get a free eight serving sample pack with your next order. My favorite one is citrus salt. What’s yours? Let me know. Today’s show is also brought to you by Timeline Nutrition with their breakthrough product Urlithin-A. Mytopure is the first and only clinically tested highly pure urlithon-A postbiotic. There have been over 300 published scientific studies on urlithin-A, including human-completed and ongoing clinical trials involving over 900 participants. The results are impressive. By energizing cells, mytopeure is revolutionizing cellular aging. Urlithon-a is the only known substance clinically proven to trigger a crucial recycling process within our cells called mitophagy. I’ve been using mytopeure for several months. The members of our scientific board and their families use it and many of our friends use it, because we have read the science and we can feel the difference. This is a product I’m going to be taking for as long as I possibly can. Receive 10% off your first purchase at timelinenutritioncom. Slash ages. Use the code AGEIST at checkout. And I want to remind everyone to stay tuned. After my conversation with the lovely Dr Caroline Chang and we’re going to do just try this, that little tip at the end of the show, We’ll see you then. Let’s give Dr Chang a call right now. Hey, dr Chang, how are you today?
Dr. Carolyn Chang: 9:33
I’m fine, thank you. Thank you for having me.
David: 9:36
Thank you so much for joining us today. This is a topic of endless fascination and controversy, and I’m hoping that you can help us out with this, because I think that this is a button like no other for people and you can help us understand why I think. Before we get to that, I want to ask you why are you a plastic surgeon?
Dr. Carolyn Chang: 9:57
Why am I a plastic surgeon? That is, I’ve never been asked it quite that way and I love it because it’s deeper than why did you become a plastic surgeon? I grew up in a scientific community. I’m a child of immigrants, and so you know you were going to be a doctor or a lawyer, or maybe not even a lawyer. You’re just going to be a doctor pretty much. And so if I wasn’t going to have a PhD, I was going to have an MD, and so that’s kind of the environment that I grew up in Everyone around me had PhDs and it was an interesting thing. And so I grew up thinking that you had to do science. And that was in Tennessee, believe it or not. And then when I came to college, I ended up on the West Coast in Palo Alto, at Stanford, and it was like a culture shock. And when I started college, you know, I naturally thought, okay, well, you know, what am I going to do in science? You know, meanwhile everybody else was doing economics and you know political science and all these things, and so I brought in my thought a little bit into okay, maybe I won’t do bench research, I’ll do something that’s more hands on with people, something that’s more social and I gravitated towards that. So I always knew just because of my background probably that I would do something in medicine from an early age because I ruled out the basic science. And then, as I got into it, thank goodness I enjoyed it and thank goodness I excelled at it, and then I ended up at medical school and that was still at Stanford. And then when you do that, you kind of think, okay, well, am I going to go into internal medicine or am I going to go into surgery? And they actually asked you to sort of choose that at the beginning, because in medical school in your first few years you’re only in the classroom and so they are going to pair you with a mentor and you decide the mentor based on what kind of field you want to go into internal medicine or surgery. And so I picked surgery and then they assigned me to a woman plastic surgeon and she was the only plastic surgeon that’s female on staff at the time and she brought me into the operating room really early on and she did breast reconstruction. She did a lot of breast reconstruction and my first experience was that she taught me how to look like a surgeon. She taught me how to sew. I was embraced by the team, and so you know I was hooked. So that’s how it happened.
David: 12:17
Tell me about your experience with your work. What do you get out of doing the work that you do? How do you feel from doing the work that you do?
Dr. Carolyn Chang: 12:26
Well, there’s a lot of me that’s very superficial. I like good-looking things.
David: 12:31
Okay.
Dr. Carolyn Chang: 12:32
And that’s natural. That’s always been for me. You know, when I was young, barbie is a big deal. Right now, right, I never played with Barbies. I played with Don Dolls. That dates me, but I played with Don Dolls and Don Dolls things were fashion, right, barbie did think she was an astronaut, she was a doctor, she had her own car and all that stuff that were revisiting these days in the movies. But Don Dolls were just about clothing and how they looked, and I really liked that. I liked changing the outfits and the aesthetics of it and the shoes matched and it was just perfect, and so I’ve always gravitated towards that, and so what I really enjoy in plastic surgery is the immediacy of the outcome and the joy that it gives people. It’s a pretty simple thing If you feel good about yourself, then you’ve, you know, life changes, and that’s what plastic surgery gives people. It gives people confidence because of the way they look, and that’s shallow in one way, but it also is not in another, because there are certain things that can actually be quite debilitating for people and that we can fix with plastic surgery. But at the end of the day, it’s about aesthetics and also function.
David: 13:48
So I, at the age of 64, I had crooked teeth my whole life because my family couldn’t afford to give me braces. And I just said I’m tired of looking at my crooked teeth because I’m on camera all the time and I didn’t fizzle on and I love the way my teeth look, like I smile all the time now and I didn’t before. No one seems to have a problem with that, like everybody’s okay with that. But plastic surgery seems to be in sort of a different, basically the same thing. Why is it so different?
Dr. Carolyn Chang: 14:22
Well, I think it’s the idea that you’re spending money to make yourself look different than you used to, in search of something that is often thought of as frivolous and vain. Now I think that some people could say Invisalign would fit in that, but I think maybe because so many more people get orthodontist the children they don’t really think about it quite the same way, but it is the same, and you can see how good it made you feel, and so that’s what’s going on with plastic surgery. I think on the one hand, it makes people feel good, but then, on the other hand, people feel guilty doing it.
David: 14:58
We live in a culture where, for better or worse, beauty has value. So what’s the contrast there? There seems to be this sort of moral issue about plastic surgery that I don’t fully understand.
Dr. Carolyn Chang: 15:14
We live in a society that values doing good for others, and it should. It values being frugal and practical. The Puritans are the ones that were some of the original settlers in the United States as we know it today, and I think we have a lot of those same values now still carried on in our culture from our history and the way we’re brought up, and I think that plastic surgery in a lot of ways goes against that value, because now, instead of being low key and doing good for others, you’re doing something purely for yourself, and not only is it only for yourself, but it’s about appearance, and so it’s vanity, and vanity is a four letter word, so to speak, in the Puritanical culture. So I think that’s probably the dichotomy. Now I do like to say and this is also because I not just because of my plastic surgeon, but because I do believe it that I think that the way you look goes far deeper than the way you look. Patients that I have are normal people. They’re your neighbors, they’re your brothers, they’re your sisters, and they really just wanna fix something that bugs them, and a lot of times it’s something that is not. The result is not something that’s necessarily beautiful. It’s more functional like a breast reduction, but what it does is it improves their life in such a way both in the way they look but also functionally that it gives them so much more confidence and so much more ability to enjoy life that it’s really far more than vanity. Self-confidence and feeling good about yourself, I think, is really what plastic surgery is about. Not necessarily all looks.
David: 17:03
Suppose I went out and I bought a fancy car. Okay, yeah, I might get a little bit of grief about that, but mostly people are gonna say, wow, that’s a great car, whereas plastic surgery it’s a little more mixed right.
Dr. Carolyn Chang: 17:22
I would say so, One of the things that can happen to patients in their post-operative period. You know how they say. You find out who your real friends are. Right, it happens with plastic surgery.
David: 17:33
believe me or not, it’s something Really, oh, tell me about this.
Dr. Carolyn Chang: 17:35
It’s actually not a great thing, but it’s a true phenomenon. So I remember when I was training, I trained with a very famous surgeon who developed a lot of the ways that we do facelifts today, all of the basic anatomy and the principles, and he was a real groundbreaker in the field and I would have these patients. So I was a fellow with him and I would have these patients that would come in and say X, y and Z, my aunt is so mad at me, she doesn’t like this at all, she’s so negative, she thinks I look terrible, right, and I would be like what are you talking about? You look great. And they would be so disparaging and so condescending, just horrified by it, that the patient would feel really bad and it would make the recovery really difficult, emotional and mentally. And I told my mentor this and I said why is it that people do this? Cause I didn’t really have. Someone wants to do something. I’m not gonna make them feel bad about it. It’s not my job to do that, to pass judgment on someone else. That’s how I am. And he said to me he goes because they’re jealous. And I said to him I said jealous, they’re not jealous. Why would he be jealous? It’s plastic surgery. But as I got more into the field and actually had my own patients, I began to see what he meant by jealous. It wasn’t jealous in the Green-Eyed Monster way. It was jealous in the way that they felt like they were not gonna be able to keep up somehow. So they were being held. Someone was doing something to quote unquote better themselves, and this particular individual couldn’t do it for a lot of reasons. Maybe they didn’t have the money to do it, they were too afraid to do it, they were too afraid of surgery, they just couldn’t. And so, because they weren’t able to have the same experience and have the same outcome, they felt somehow threatened. And that’s really overreaching a lot. It’s generalizing a lot of this, but there is a lot of that kind of sentiment that can happen around this topic, and it’s really amazing all the different emotions and reactions that people will get, even within themselves, to plastic surgery. It is a very psychological and emotionally charged field, and I think that’s why people are endlessly fascinated with it.
David: 19:56
Maybe just tell people what is plastic surgery.
Dr. Carolyn Chang: 20:01
Well, you know, the first couple of words in our basic textbook back in the day was plastic surgery comes from the I think it was a Greek word plasticus, meaning to mold and to change. So plastic surgery is not about plastic. It’s about changing things into something that is more functional or more aesthetically. So in the field of cosmetic surgery, functional means or is an acronym for, looking better. But real plastic surgery you know when we train is all about function. So it’s about, for instance, if someone has trauma and loses their hand and then we put it back on, that’s pure plastic surgery. If someone has a big skin cancer on their face and a big hole, then we rearrange the rest of the face to make that to cover it. That’s functional, and so that’s really what plastic surgery is. And cosmetic surgery or aesthetic surgery I guess it’s just a small part of plastic surgery and that is to improve the appearance, so to make the skin look better.
David: 21:06
I guess you mentioned, you studied with someone who’s very well known and you know, with facelifts and I would think how do you choose? Because there are certain consequences if someone makes a mistake. You know, maybe they’re not as good a plastic surgeon. How does one determine that? Like? Who’s your doctor? How do you pick a doctor?
Dr. Carolyn Chang: 21:29
Yeah, that’s a really good question. It’s a hard question and it’s individual. So there’s the obvious things. You know that if you look at lists of what to ask your doctor, you know you want to be board certified, you want to actually be a doctor, you want to actually be trained, you want to actually know what you’re doing. Ie have some experience in the field. So one of the important things is that you go to someone who actually does do that procedure. You know plastic surgery is a huge field, and so you could have rhinoplasty specialists that don’t really do breast surgery. You could have general plastic surgeons that do only reconstruction or only breast reconstruction, and they don’t really do cosmetic facelifts, let’s say so you want to be sure that the person not only is has the basic credentials, that has specialized experience in the area that you’re interested in, and that comes from word of mouth, it comes from some of the best ways to find excellent doctors in your field is to ask other doctors. I think, and people in the operating room Because they look past all the marketing and all the websites, because they actually see the product and see what the people are doing day to day. So that’s probably the most valuable way. But in general you want to be sure someone’s experienced in what it is that you want to do. You want to be sure that you can communicate with that person, that you like the office. So a lot of the experience that people have is colored by the experience they have with the physician and how well they feel taken care of by the office, and so that does make a difference. It’s like you if you go to a hotel it makes a difference your experience does not just the actual room itself, so that’s part of it too. And then you want to see that you have the same aesthetic viewpoint as that physician that you’re choosing. So particularly in the field of aesthetic surgery, you want to really look at before after photos and you want to look at a lot of them, so not just from that doctor but from other doctors, and then you’ll be able to see some differences and you’ll be able to see which aesthetics that you actually like and which you don’t. And you want to be sure that that doctor is going to be able to provide that to you. And the only way you can tell that really is with pictures. So every doctor in the world says I do a natural look. No one’s going to say you’re going to look unnatural or you’re going to look alien. No one says that. But if you look at the photos you’ll see some of them should say that, and so you really just need to look and interview a lot of people. Talk to doctors, talk to other people who’ve done it, that sort of thing.
David: 23:57
I actually know a lot of it. For some reason, a lot of anesthesiologists.
Dr. Carolyn Chang: 24:02
And they’re the ones that’ll give you the inside out, they give you the real story, absolutely, absolutely.
David: 24:09
Can I ask you some questions about some of the possible procedures that you do?
Dr. Carolyn Chang: 24:12
Love to answer it.
David: 24:14
Okay, so as people get older, we have a puffy end of the eyes. I don’t even know why. You can tell me why? And then what do you do about that? Is that a difficult thing? Is it a dangerous thing to fix?
Dr. Carolyn Chang: 24:28
Well, it’s not dangerous at all if you’re the right candidate. So that’s part of it, but assuming you are the most common reason for puffiness under the eyes is, or we call, bagging is because as we get older, the fat that’s naturally surrounding the globe so there’s a bit of fat that’s around the eyeball it cushions the eyeball from the bony socket. That fat herniates out a little bit so, just like all the other tissues start to sag, that little septum that holds back that fat starts to sag and it starts to push out onto the surface of skin and you see the bags, and then, simultaneous to that, the skin overlying the eye actually thins with time and the cheek falls and so it’s unmasking that whole area. So it almost looks in some people like you’ve got a hollow plus a bag and that’s why it’s just from aging, loss of elasticity and loss of volume.
David: 25:25
See, I went to you like I’ve got sort of bags I don’t know, they don’t really bother me. But if I went in and I said like Dr Chang, these are making me crazy. What’s the recovery process, which is always what I’m concerned with, like how long am I gonna be out?
Dr. Carolyn Chang: 25:37
Right, so usually so. The surgery itself is called a blepharoplasty, and that’s more commonly known as an eyelid lift, and we would be specifically talking about the lower lid. So it’s a lower eyelid lift or lower blepharoplasty, and what we do during that surgery it’s a small surgery because it’s a small structure, but it’s an important structure, so you have to do it carefully. But basically what we do is we will open up the eye and either an external incision or one on the inside of the eye and we’ll take the fat out and we might take a little bit of skin out as well and tighten the lid, and in doing so you’re gonna have a little less wrinkly skin and a little bit less bagging because you’ve taken out some of that herniated fat. So it should be a look a little bit flatter. There’s other things that you can do, like laser resurfacing to tighten the skin further. Some people will do some fat grafting to give you some of that volume that we talked about. That’s missing back and that whole surgery usually only takes a short amount of time you know less than a few hours and recovery is usually pretty quick if it’s problem free. So you would expect to be pretty well on your way in about a week and a half. If results will get better and better with time, the lid will tighten, the swelling will go away and by six weeks you should be feeling pretty much picture ready or event ready or, you know, feeling like the surgery’s past.
David: 26:58
You so something that I know there have been some mishaps with recently not necessarily your field like cool sculpting, which seems like I mean there are people like I think in like many spas do it and yikes. What are your thoughts on that?
Dr. Carolyn Chang: 27:14
So cool sculpting is a. There’s several machines that do the same thing. It’s the topic. It’s called cryolite policies and I think Lydith Evangelista recently was the most high profile person that came out and I think that was maybe a year or two ago and that was pretty horrific what she was saying. So what happens is with the cryolite policies is you have a machine that literally freezes a portion of your skin and fat and then by doing that the fat then sort of breaks away, disintegrates and then it gets absorbed by the body and for the most part people do just fine with it, has low problems. It may not be super effective, like liposuction is, but it generally can do something for you if you’re in the right area. But one of the things that we were seeing and this has been going on since the beginning of the field it was PAH or paradoxical adipose hyperplasia. So what was happening and I remember seeing this one when the cool sculpt first started people would come back with, instead of smaller areas, they would grow fat in places, and I think that’s what Linda Evangelista was talking about, and so that is something that the only treatment for that really is to do liposuction again, but it has to do with the energy settings, I think. I think there was a lot more of it before when the and then the company reconfigured some of the settings and things and it’s gotten better. But every the take home message is that every modality there’s no such thing as a free watch. Let’s just say Every modality has pros and cons.
David: 28:49
One of the readers wrote in and wanted to know is 72 old to have a successful tummy tuck?
Dr. Carolyn Chang: 28:57
70 is definitely not too old, but there are concerns. So a tummy tuck is, on the scale of plastic surgery, one of the more painful and difficult things to recover from, and that’s because we’re making a pretty large incision, we’re taking a pretty large amount of skin and fat out and we’re tightening the abdominal musculature and that’s the part that really hurts a little bit and you have to do that in order to get the best result that you can, and so it also can commonly have drainage and just a little bit. You know it’s a little longer recovery, like two weeks. It’s a bigger body surface area so people can have a little bit more hard time with that. But 70 is not too old if you’re healthy. There are things that you can do to really mitigate the pain and you’ll hopefully prevent a lot of the problems. On the front end, one of the things that I’ve been doing is a trans abdominous planar block or a tap block, which the anesthesiologists in my practice will commonly do for things like general surgery even, and I do that during surgery while the belly’s open with an ultrasound and I can deposit some local anesthetic in the area where they’re nerves in the abdominal wall. It’s been a game changer. So I’ve been in practice for over 20 years. There’s a handful of things that have really improved my practice. That’s one of them. So that really takes the edge off the pain the first night, which then massively decreases the potential for complications on the back end and makes the experience way more pleasant. But there are other things you can do. You can do a little bit less surgery like a little less tightening. You could do it skin only, you know just to get some of the bulk off. So I mean there’s definitely ways to get someone who’s a little older through a difficult surgery.
David: 30:35
The other thing that a lot of people are sensitive about is the neck, the sort of like turkey neck sagging jaw thing. What are your thoughts on that?
Dr. Carolyn Chang: 30:47
Well, the neck. You know you don’t want to be nor-affron, right, you don’t want to go through life saying I hate my neck. So you can absolutely do something about your neck If you’re healthy. You know once again you have. This is elective surgery, so you don’t want to be. You know health comes first, but the surgery that we typically do for that, if all of the non-invasive things don’t work, people usually go to surgery, and what that does is it removes the extra skin and the fat and it repositions the muscular layers under the skin to a more youthful contour, and in doing so you’re tightening the neck. So I commonly will call that a lower face and neck lift. It’s difficult to do just a neck lift because the neck is all in continuity with the jaw or the jaw line, and so usually you need to lift both the lower face and the neck together in order to get the best result.
David: 31:37
And someone told me that as we age, one of the things that happens is the amount of bone material we have in our face decreases, which causes not only we have this like gravity issue, but there’s like less bone there. Is that true?
Dr. Carolyn Chang: 31:53
Well, you do get a little bit of bone reabsorption, just like you get some osteoporosis. All of that does happen. And then you also lose facial fat too, so everything just sinks a little bit and go downward. So that’s the lot that happens, or that’s what happens when you get older. So one of the things that we talk about a lot that’s been a really hot topic and let’s just say it’s an Instagram sensation is the lift. Lift, which I actually love. I think it’s a really pretty surgery for the most part, for most people, but what happens is you get a little bone reabsorption in the upper part of the jaw and then the lip starts to fall and look a little bit longer over time, and so, no, the phenomena is real, so it does happen, and some of the fillers that we do can help to mitigate some of this volume loss, both from the soft tissue and from the bone. So, yeah, it does happen.
David: 32:42
What’s your feeling about fillers versus surgery?
Dr. Carolyn Chang: 32:45
I think there is a use. So if you look at them in isolation, they are totally different fields and they have different indications. So typically, if you’re only doing something that’s noninvasive, the way you can kind of think about it is that small procedures give you small results, and that’s pretty much true across the board for almost anything that we do. So really the fillers and the noninvasive things are going to make a bigger difference when you’re younger and have less to fix. When you get older and you have actually a lot of skin and real contour problems, then surgery is really going to be the only way to go. But the more modern way to think about all of this is not the two things in isolation, it’s the two things synergistic, because what you can do with surgery is you can bring the face back to an earlier anatomic state, but you sometimes can’t bring back all the volume that you’ve lost or you can’t make the skin texture as good as it was once before, and so some of the fillers can really help augment those problem areas that you can’t fix with surgery alone, and it can really be the difference between a great result and a great result. So the two I think these days as practitioners, we like to look at them as synergistic and not exclusionary.
David: 34:07
Let’s talk about breast implants. The two kinds that I’m aware of. There’s silicone and saline. There were a lot of I heard anyway problems about leaking silicone ones and bad things happening, and do you feel that implants need to be replaced, like do they have a lifespan and need to be replaced? Are there cautions? Do you have feelings about safety of saline versus silicone?
Dr. Carolyn Chang: 34:35
So that’s a really big topic. But I have some pretty distinct feelings. I think my feelings are probably pretty mainstream in the plastic surgery set. So that’s a good thing. You know, silicone implants have been the source of a lot of agitation. You know a lot of investigation, a lot of spotlight. So the FDA, probably in the last five years or so, completed a huge study and they had all kinds of results and conclusions and the final conclusion is, yes, silicone implants are safe, even though they were taken off the market ages ago and put back on and this and that and the other. And they also had a lot of warning, information or informational paperwork that is actually mandated to be given to patients before they had breast implants by all of the implant companies. So we actually have a whole special set of informative paperwork that we give patients that’s mandated by the FDA. And all of that I think is extremely responsible because breast implants, although I think are very safe, I think time and time and time again it’s been proven that they do have problems and they do have upkeep.
David: 35:50
And so wait, wait, wait, they have upkeep. Yes, help me out I. This is this breast implant maintenance.
Dr. Carolyn Chang: 35:57
Yes, absolutely. That’s the biggest problem with them, I think tell me exactly what does that look like?
David: 36:03
I don’t understand.
Dr. Carolyn Chang: 36:05
So what it is is? It’s different than a surgery where you’re just rearranging your own skin OK, because that’s all your own body parts so like a liposuction, assuming you don’t gain weight, you never have to do it again. That’s it. It doesn’t wear out. The tummy tuck doesn’t wear out you know my age, but it doesn’t wear out Whereas a breast implant is a prosthetic device that you’re putting into the body and that prosthetic device can wear out. Now, if a breast implant, let’s say, ruptures, which is a failure of the implant, it’s not like if a car tire blows out. You know it’s not as dangerous immediately like that, but you do have to take care of it. And so you know, even if you don’t get to rupture, you might get to impending rupture or you might have what we call caps or contracture, which can develop with time as well, which is abnormal scar tissue that forms around the implant, distorting the implant and could cause pain. And so there’s a lot of things that can happen with implants and also they can just not look as good over time. So there are a lot of reasons why people need to constantly monitor implants as they have them, and that’s one of the biggest changes in the implant culture from a physician standpoint, even since I’ve been in practice, because it used to be that we just put them in and nobody talked about it. But now every patient that gets implants understands all of the risks and benefits of the breast implants and they understand that they’re making commitment to the implants to being responsible and taking care of them responsibly and taking care of problems if they occur.
David: 37:42
You’ve used the word taking care of it and maintenance, and is that something that a woman would every few months come and see you or do some kind of self-exam or something? What does?
Dr. Carolyn Chang: 37:55
it look like the self-exam or the maintenance or the monitoring. I think is the point of the start, because when the implants are new implants, you’re going to just monitor them. So you need to get the FDA recommendations is that once you have the implants, you get a baseline MRI at around three years after and then every other year thereafter to try to look for what we call silent ruptures, meaning ruptures that happen then you don’t know it. You also need to obviously get your mammograms and do regular breast health and that can pick up the implant problems as well. And you need to feel them yourself. So you need to do what we call self-massage. So self-massage, on the one hand, can help keep the implants soft, but on the other I think even more important than hand it will tell you when implants have changed. So if you know what your implants feel like, then you know when there’s a change and you can have a heightened sense of urgency for investigating them and just making sure that you’re not missing something. Is this the same as, that’s what, and then if there is a problem when you said, what does maintenance look like? Well, then it usually means you have to have another surgery.
David: 39:04
And is this the same with silicone and saline?
Dr. Carolyn Chang: 39:07
Yes, the saline’s a little easier to monitor for rupture because it’ll just deflate, so it’s more obvious Quicker.
David: 39:15
And so say I come in and I see you and I have some sort of OK, so here, maybe I want to pull, I want to get the Brad Pitt. So whoever does Brad Pitt’s face is amazing, fantastic plastic surgeon. So it’s just, you know, you just like, pulled it back a little bit. Ok, that looks good. So say I come in and I say Dr Chang, like do the Brad Pitt on me, whatever that is, I want the Brad Pitt, so there’s, he looks amazing.
Dr. Carolyn Chang: 39:44
I mean, I couldn’t believe it. The French open pictures are unbelievable.
David: 39:48
Yeah, whatever he’s haven’t done it.
Dr. Carolyn Chang: 39:50
I don’t know, I want it.
David: 39:51
It works right. So I come in and I see we do a little work on my face. How does this age so you know, is something? Am I going to expect negative, either health consequences or aesthetic consequences, 10 years down the road from making my face a little tighter?
Dr. Carolyn Chang: 40:11
OK, so this is one of my favorite topics, so thank you for asking this question. So people always say how long does this last? What happened, right? Yeah, so if you do in my this is my opinion as to what I think is the correct way to do a lower face and neck lift or a face lift Is you want to take the tissues that have aged, ie they’ve sagged In general. What they’ve done is they’ve sagged down and forward, so you get that turkey neck, you get that hollowing around the cheeks. Everything’s gone down and forward. So what you want to do is you want to take those tissues and the underlying tissues that are responsible for that, for the look that you’re getting, and you want to put them in reverse direction, back where they started. So you want to put them in the anatomically correct position from where they started. And if you do that now, your face is theoretically at an earlier anatomic step point again and you can’t stop aging, so you go on to age from there. So if you do the lift and put the person back together the way they were, they are going to look normal for this sort of life. I mean, you have to look like yourself if it’s back anatomically correctly placed, and so that is really the way, I think, that you keep people looking normal over time and looking really good over time. So I’ve been in practice for now over 20 years and I’ve had the pleasure of having patients again for a second lift. So I can look at a pre-op photo from someone, let’s say, 13 years ago, and then I’ll have a pre-op photo from, let’s say, now, before the surgery, and I can see that over 10 years they may have had some loss of volume or their skin might not be as nice, they might have more wrinkles, but the contour is very similar. So what happened was 10 years ago they got a lot better right and then they started to age a little bit over time because you have to, but they never got worse, contour wise, than where they started, and so over that 10 years that’s what you call truly aging. Gracefully, you’ve kind of cheated that time and that’s because if you put everything back anatomically correctly for that patient, they’re just going to look like themselves continually over time.
David: 42:26
Fascinating. That makes complete sense. So like I’m 64, you dial me back to 50. Yeah, and then-.
Dr. Carolyn Chang: 42:34
You end up 64 when you’re 75.
David: 42:36
Okay, what are the resistances that and I’m not advocating people get plastic surgery. I just want to be clear about this. Like I’m just open to the whole field and people can do whatever they want to do, I’m fine with it. I don’t have any positive, negative feelings on this. When people, if they think that this might be something they want to do, what are the sort of resistances that would keep someone from doing something? And you know, and what I want to do is I don’t want to frame this in terms of an age thing because that can get sort of complicated but say somebody, they I don’t know, their nose is misshapen or something what would prevent them?
Dr. Carolyn Chang: 43:19
I think personally that the number one, if someone truly wants something and they don’t do it, I really think that if not, that I mean in the vast majority of people, I think the number one reason is fear Fear of the unknown, fear of looking bad, fear of antiseesia, fear of dying, fear of judgment you know, negative judgment from their family that’s a big one actually but mostly fear of dying and looking bad those are. I think fear is by far the biggest contributor to hesitation to do surgery, even though you desperately want it. I have people that will come and see me every year for seven years and never do it, and it’s just something that they just can’t pull the trigger for various reasons. You know there’s also finances. There’s logistical problems, like if you’re really busy at work and you just can’t take the time, if you travel all the time, if you’re in front of people, you just can’t take the work. And that’s why we had the pandemic boom, because all of a sudden, all these people that always want to do it were landlocked, weren’t going on. You know, they were on Zoom. They could turn the Zoom camera off. They were at home, nobody was seeing them. So you just had this, you know, in the middle of the biggest health crisis ever, I had people, person after person after person, calling me to get a facelift. It blew my mind, but it makes sense now looking back on it.
David: 44:44
And do plastic surgeons get together and talk about like, oh, like, brad Pitt, he looks amazing, what happened there? Or some other person who’s had something done that you all think looks great. You guys get together with beers after work and say like, wow, that was really great, they did the XYZ procedure. Like does that go on?
Dr. Carolyn Chang: 45:07
Well, I think it depends. I mean, you know, we’re plastic surgeons and we’re still humans, so everybody’s right.
David: 45:14
So I think we I could honestly.
Dr. Carolyn Chang: 45:16
I mean, brad Pitt was a huge topic for me in the operating room actually. Really All of us independently saw those photos and I think today I actually the Uber driver was talking about the other day I mean, it’s a you know, talking about celebrities and what you see is a big topic and it’s fun. Whether or not we get together as a group depends on who your friends are. So I’m lucky that I have several very good colleagues and we do talk about fun things like that. But yeah, I mean, we talk all the time about problems that we might be having, get advice on how to manage something. Sometimes I’ll get a second opinion from someone if I think that would be the appropriate thing to do. So, absolutely, plastic surgery is fun at the end of the day.
David: 45:59
That’s funny. I want a teacher that says that I did some real hate mail about that. Martha Stewart who claims to have never had plastic surgery, really skillful injections or something else going on there.
Dr. Carolyn Chang: 46:19
Well, martha has a really good genetics, so that’s one thing. She was a model, martha is charismatic and a lot of beauty is inner beauty and she has that star power. So, that can erase a lot of flaws that people have and aging flaws to take great care of herself. I will say I have an Instagram feed where I know people who are personal friends of hers and I see her unfiltered photos and she still looks good. So has she had surgery, probably? Can I prove it? No, I don’t know what to say. I think she’s a great example of aging gracefully. I do think that the sports illustrated I think she was in sports illustrated. Those clothes were probably touched up a little bit I think a lot of it, but even so, she has the basic bone structure to carry it off. Kudos to her.
David: 47:06
I think what’s fascinating to me is like I used to work in that world. I did a lot of magazine covers of a photographer for a while. The thing is, supermodels are not regular humans, no more than Olympians are like normal athletes. It’s a different thing. You can’t really compare yourself, and then you have an enormous amount of resources put into the photo shoot with all the glam squad who are like the best in the world, and then you have retouching on top of that. So supermodels don’t even look like supermodels by the time you get done with them. And what’s interesting to me is the Martha Stewart thing. People were like, well, this is terrible, like she looks great, but she’s clearly had all this work and somehow that was a negative. I just find that it’s so hard. So if she looked like hell, like you know, and she just like roll out of bed and like, okay, I’m going to take my picture, well, she would have gotten a lot of grief about that. And you know she looks great, for whatever reason, she gets a lot of grief about that and I just think like I mean, give her a break. What do you want her to do?
Dr. Carolyn Chang: 48:16
Well, I think that one thing that you know if you step back from the whole field as whether it’s frivolous or not, because at the end of the day, we don’t really need it to survive Absolutely not. But I think that there’s a large part of plastic surgery that treats the psyche and it treats the soul. And the people that want to do it, generally speaking, are healthy in terms of mental, mentally healthy, and they just want to take care of themselves and be the best selves that they can be. And that sounds cliche but it really is true and I sort of think that there is. You know, when you take the time to take care of yourself whether or not it’s putting on two shoes that match your purse and your, you know your outfit and doing your hair you’re taking pride in yourself. And when you take care of yourself and you take the pride in yourself, it shows the world that you care about yourself and you feel like you have self worth. And I think in that way it’s more than just vanity. I think that it is being optimistic about life and wanting to be the best you can. And you know there are people in plastic surgery they get plastic surgery that are not mentally healthy, but they are by far and away the few and the vast majority of people, like I said, are your neighbors. You just don’t know it and they are really. You know. They feel good about themselves for doing it and they feel proud of themselves for doing it and taking taking initiative to do something positive for themselves.
David: 49:44
So what do you say about the camp that says why can’t we just accept aging naturally?
Dr. Carolyn Chang: 49:53
Well, that camp probably looks good. They probably look like Martha Stewart. So you know, I mean I always laugh when I see some actress or something say I will never do plastic surgery. But she’s 25, right, and I mean you see it in the species. I mean you see it in even in Asifari. You know it’s the survival of the fittest. The fittest and the best genetics often are the flashiest tail feathers or the biggest, you know the brauniest specimen. So there is a certain amount of that that goes on, even in our society, the civilized world, where if you look good, you are thought of as you know, more somehow virile, and you know. So it’s an innate thing that we want to do, I think, and it goes deeper than just you know how your nose looks, and so you know I don’t ever say to people that they shouldn’t always do surgery, absolutely not. I mean, I come from an Asian culture who doesn’t want a scar to you know that’d be the last thing in the world you want is a scar and you would never change anything unnecessarily and so. But I think that as a surgeon, you know I see what it can do for people, but I also know that it’s not for everyone, and sometimes patients will or people will say to me oh, I can’t believe she did that and I’ll be like you know. My feeling is that it was her choice to do it. It may not be your choice, but it’s not wrong either way. It’s not for everybody, but I think that as a culture, it would be nice to be able to sit back and look at it a little bit more holistically than just I want to look prettier, because it really does make people feel a lot better and and it does make people feel a lot more confident and it does improve their lives in a significant way.
David: 51:41
I think Tom Ford is about my age, but he’s like within a year of me and he I read a couple of years ago Tom’s a big fan of Botox.
Dr. Carolyn Chang: 51:53
He’s another Brad Pitt. Though he looks good, he never does look good.
David: 51:56
Well, yeah, well, tom used to be a model that’s how he started but he started putting pictures of Georgia O’Keeffe around his house because he felt like, you know, his whole thing was like sexy 20 year olds and and he’s got to get away from that. So he started. He wanted to sort of re view, redo his view of the world by putting these, you know, the Georgia O’Keeffe photos up, and I don’t see that Tom is suddenly not attracted to beauty. It’s just an interesting thing. I think this, this idea of the, you know, taking it out of a moral thing and putting it into an aesthetic thing, okay, you want to wear lipsticks, or I got Invisalign, or I want to wear like a fancy clothes or something like. So, like, what’s the difference here? I don’t, I don’t, I don’t see it, but some people very much do.
Dr. Carolyn Chang: 52:46
And that’s okay. Yeah, it is, it’s okay. Some people are Democrats, some people are Republicans. It’s good, it’s okay. The world needs variety. But it is nice to think about plastic surgery and I still want to say the take home message is that it’s more than just you know. It is For the patients that do it. It’s definitely more than just that.
David: 53:07
Absolutely, Dr Cheng. If people wanted to get in touch with you, what would they do?
Dr. Carolyn Chang: 53:11
Well, I have an Instagram. I don’t want to be promotional, but that’s probably the easy way Go ahead, go for it.
David: 53:16
That’s what we’re here.
Dr. Carolyn Chang: 53:17
People DM me, so I have two. One is pictures of my kids and it’s that so the doctor. One is Carolyn Cheng, md, c-a-r-o-l-y-n-c-h-a-n-g-m-d, and that has all the information. I have a website, wwwdrcarolanchengcom, so those are the easiest.
David: 53:36
Super. We’ll put the links in the show notes. Thank you so much for coming on the show. I feel that this is a bit of an interrogation. I didn’t mean for it to sound that way, but you were great.
Dr. Carolyn Chang: 53:45
Thank you, I really enjoy speaking to you and I hope to do again soon.
David: 53:49
Yeah, maybe do my neck sometime.
Dr. Carolyn Chang: 53:51
No problem.
David: 53:52
Okay, take care. Bye-bye, dr Cheng.
Dr. Carolyn Chang: 53:55
Bye, thank you.
David: 53:57
Well, that was wonderful. Right after that conversation I went into the bathroom and I looked at myself in the mirror and I thought well, if I went to see Dr Cheng to do something, what would I have her do? Well, I have these bags under my eyes and they sort of bug me, but I wear glasses so people won’t really see them. My neck, well, yeah, sort of bugs me, but I’m not sure what I would do about that. I just sort of came to the point of, like, I’m kind of okay the way I am. I’m kind of okay with it for today, but have an open mind. Who knows, maybe next year my neck really will bug me. I’ll give Dr Cheng a ring we’re going to get with. Just try this. After a quick word from our sponsor Today’s show is also brought to you by Inside Tracker, the dashboard to your inner health. I’m a big believer in getting blood tests taken because it’s simply the only way to get in-depth data about your metabolic factors, your hormones and the things that inform your immediate and long-term health. There are also excellent DNA tests that can further inform you about your immediate and long-term health. The problem is the most blood tests out there is. You get a lot of information back and you get a lot of numbers and they’re not really going to tell you what to do about it. In addition, they can be very confusing what all the factors are, what they mean. Inside Tracker has a dashboard and a platform that simplifies all of that. I get food first, supplements second, recommendations about how to optimize my inner health. For instance, I just got my test back and I saw that my calcium levels were a little low, which were surprising to me, but I have suggestions now about how to correct that. I would not have known that had I not done an Inside Tracker blood test. Go to insidetrackercom. Slash agist. Save 20% on all their products today, this week on Just Try this. My tip is noticing things that I think a lot of us, myself included, were just like in our heads all the time, or dwelling on the past or projecting into the future, or we’re just not very present. One of the things that I learned from some of the Buddhist folks that I listened to occasionally is this idea of noticing things and paying attention to your surroundings. It’s as simple as you walk into a room and what are the wall colors? What’s the wall surface, what color is the carpet? How’s the carpet feel? Whatever is the floor feel under your feet? This idea of just taking a second we enter a new environment to just take one deep breath and just notice. We’re these sensory beings. We have eyes, we have ears, we have all this touch centers around our bodies and we just don’t use them because we’re so often locked in our heads, thinking about some bad thing in the past or fearful of the future. Just get present just for that, like a couple of breaths, and then whoever you’re there to me or whoever you talk to, you’re going to be able to be much more present for them too. Today’s tip notice things. Where are you? How’s it feel? Thanks for listening to the show today. I know this one was perhaps a little controversial for some people and I would love to hear what you guys think on this topic. Email me, david, at superagecom. Are there plastic surgery things you’re thinking about? Does this horrify you? Do you feel neutral about it? Where do you stand on this? It’s just so interesting and if you send me some comments. We have a few. We’ll bring them on the show next week. If you have a moment right now, you can help us out. Go to wherever you’re listening to this show and leave us a comment and maybe leave us a rating. Super easy, just hit five stars. We would love that. What would really make our day is if you share this program with someone you know. I know this one in particular. It’s thought-provoking and maybe there’s somebody out there that you think could use this. Until next week. Everyone, have a wonderful week and we’ll see you then. Take care now.
