The “Undetectable” Era Flex with Dr. Catherine Chang: From “Jellyroll” Botox to the Bijoux Lift and are 20-somethings *Actually* Getting Facelifts?

24:36We're starting to see. So I mentioned earlier like we we don't have that plastic surgery face that we had 10 years ago which was kind of that like walking down fifth avenue shopping yeah it was like the early adopters yeah exactly but there is starting to be a little bit of a sameness I'm sure you've noticed where it's just like a bigger kind of Disney character kind of eye and like a heart-shaped chin you know what I mean? Like there's just proportionately, it seems like there might be some of that sameness starting to come around. Yeah. And then it was like the Kardashian thing. And now it's kind of going into, I don't know, it reminds me of like a Disney princess look, you know?

25:22You know, I would say with going back to undetectable plastic surgery and keeping somebody's essence, I try not to mimic anything between my patients, but it's really what looks best for that patient. So I know what you're saying. I haven't really seen that in my patients though, because I think maybe - Well, not in your patients, of course. Pressing company excluded. Thank you. But sometimes a heart-shaped face on one person, like you're saying, or the bigger eye might not look better on somebody. So I did have a patient come in and they said, I want my crease higher. I want my eye to look a lot bigger and brighter.

25:59And I actually told them, I didn't think that was a good idea. And we should keep their existing crease position. Because even if you lift the crease higher and it makes the eye look bigger, it wouldn't look right. So I think, again, that's where that counseling comes in and the artistic judgment comes in. And then going back to your question about what makes something undetectable, it's also the vectors, specifically for face lifting. What vectors are you pulling it in? Because if you pull it in an incorrect or unnatural vector, it looks off because the face you know, doesn't lift that way. And I think something you said was incredibly key, which is that sometimes you see a really tight face, you know, someone who's had a lift and they look really tight, but they don't look younger.

26:42Yeah. And I think that's also really key. It's not just about making somebody look tight. It's about, I think, making them look more rejuvenated, more rested. And it is normal to have a little bit of skin. You know, 20-year-olds come in and when they do this, of course, they have excess skin. So I think, you know, it's not just about making sure someone's like perfectly tight with no excess skin. Yeah. Sometimes you say no, it sounds like. Yes. Yes. Often. Yeah. What percentage would you say that is that you say? Well, to even make it to me, we actually have a two to three step screening process.

27:18So somebody has to make it through those screenings to get to me. And the screenings are a multitude of things that we look at. Sometimes it's aesthetic based. So if someone says, people sometimes when they request a consultation, we'll send in a photo of what they want, or they'll say, you know, a photo of themselves, and this is what I want with a morph. And if it's something that is definitely something that my team and I don't feel looks natural, they wouldn't even make it to see me. So of the people that make it to see me, probably 25 % I, you know, either don't take on or I counsel to do something else.

27:58Yeah. Yeah. That's a lot. That's a lot of business to say no to. So I commend you for that. Oh, thank you. I mean, it's anytime you operate on somebody, it's a long-term relationship. And so that's how I view it. Is it somebody that number one, you have an easy way to communicate with to a similar aesthetic? And is this somebody you want for years? Yeah, right. One major point of difference, as far as I can see that you do in your work is custom facial implants. And you create these with CT scans. So they actually fit the face extremely precisely. They're really custom as opposed to, you know, taking them off the shelf.

28:39So again, it's just like really enhancing. It sounds like almost like restorative of what this person probably once had. And I read that you also co-authored a textbook atlas of facial implants so yeah tell us about this like what who would be a candidate for this and yeah just tell us more yeah so custom facial implants are something that is pretty unique only a handful of surgeons in the country do it and so what that is is if we want to augment or change the facial skeleton through implants this i think is the best way to do it because you can actually customize it to the patients precisely.

29:19And so what we do is the patient gets a scan, it gets rendered into a 3D image. I then design the implant on the skull, on the computer, and then that implant gets made, sterilized, and shipped to me. And what is it made out of? There's two different types of material. There's silicone or porous polyethylene. I tend to prefer the latter because I think there's better soft tissue integration. Most surgeons aren't as comfortable with that material, but as long as you know how to use it, I think it delivers better results. But if you think about someone's facial skeleton, which having not seen it for most people directly, there are so many different contours.

29:57There are so many angles that are different between one person and the next. So expecting an off-the-shelf implant to match somebody's chin between two people, it's just they never fit right. And then you also save a lot of operative time because you do a lot of the pre-planning off the operating room table, as opposed to off the shelf, you're on the table carving the implant, shaving it down, trying to manipulate it to fit onto the skeleton. And so with facial implants, you can pretty much put it anywhere. So common places are the chin, which I love. I feel like almost everyone needs a chin, myself included.

30:34Jaw implants. So people who have a short, what's called the ramus, which is the distance from this bone, the vertical bone on the jawline from the ear to the bottom of the jaw, that in certain people is really short. Okay. And so that can create a less defined transition between the jaw and the neck where people feel like their jaw blends into the neck. So with the implant, you can change both the length of the ramus, drop the jaw down. I'm measuring. I've got my short one or a long one. Let's see. That's my ramus. Not bad. And then you can change like the width. So for men especially, a longer and wider ramus tends to look more masculine.

31:19Okay. I have so many questions. Now, one of the things maybe people don't realize is that your bone actually starts to kind of erode, right? Around your chin and jaw area, like you start to lose it, right? Just in general, as we age, we not only shrink in height, But our facial skeleton, there is bone resorption. So if you already had a weak chin to start in your teens and 20s, when you're in your 40s and older, you'll have even more recession. So there definitely is that. But the whole facial skeleton, not just the jaw, the rim, the temples. Okay. And now is this something primarily men are having done, this masculinization?

32:02Or is it like evenly split? or who's mainly wanting this? Really? So the chin implants, I would say, perfectly evenly split between men and women. And also a lot of women are initially worried about chin implants because they think it will make them look more masculine because they'll look too wide or too long. But that's the beauty of customization is I create these really tiny implants and they blend seamlessly into the jaw so there's no step off. And then you can make a one millimeter implant, two millimeters, three millimeters. It's a really small and it's like this big, but it makes a big difference.

32:41Out of the box implants, sometimes the smallest size is a five millimeter, depending on what company you're using. So that is way too big for most women. For jaw implants, I would say that's 80 % male. Yeah. Okay. Okay. I remember we spoke with another plastic surgeon. He was talking about how most people think they need a nose job, but they just really need a chin job to balance because then you get the better profile. And people are like obsessively looking at their nose, but they don't really think about the chin. So this is really interesting. Yeah. So definitely looking when I assess a face and a nose as well, you look at the harmony between and the proportions between the rest of the face, the chin, the nose.

33:23So a lot of people hyper focus on one spot. And that's why when people are focusing on like a line, you know, I counsel them. No one is seeing that line but you. But yes, that's very true. So you really want to balance the nose and the chin together. Zoom out, everybody.

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35:28I wanted to ask you about fat transfers versus implants. If there are certain people who are candidates more for one versus the other. We've definitely had this conversation when it comes to breasts before. And, you know, some people want what maybe they think is more natural or that their body won't have like a reaction to. So how does that apply when you're talking about the face area? Yeah. So I think it depends on what somebody is looking to achieve. So if somebody has had volume loss and we're talking about just facial rejuvenation and restoring volume, I like fat. I think it looks natural.

36:05It ages better too. And you're replacing like with like. You can sometimes do filler depending on the location, depending on the amount, but I do tend to prefer fat. With implants, it depends on where we're placing it. So if it's in the chin, I always prefer an implant over fat. I don't put fat in the jawline. Some people do, but nobody wants like a saggy kind of jaw. And I don't think fat is structured enough. You're looking for structure. Yeah. And which is why I also don't love filler in the jawline. So a lot of people do that, but I don't think it provides enough definition. And then in the cheek, it depends.

36:44If somebody is just, it's due to volume deficiency, then I think fat grafting makes sense. If I think it's due to skeletal deficiency, then that's where the impact comes in. And I did go to an event where they were talking about a newer, I forget the name, but it was a newer filler that was like the most dense one on the market. I think it launched in Canada before the U.S. I think it was from Gelderma. Yeah. So you prefer... I still do. I think even the most, so that's referring to G prime, which is how compressible a filler is. So even the highest G prime filler is not going to be as effective as an implant.

37:23Right. Which still feels real and everything, just like a breast implant. Yeah, I mean, 100 % of the patients that I've placed implants on, everybody says they don't feel it. Yeah, okay. So once it's in, it's in. It's known as, if anyone wants to look it up, it's Restylane Define, D-E-F-Y-N-E. Oh, we have that one. Yeah. I did have a question about the prevalence of that, these facial implants. Is this something you're seeing more of now in the era of weight loss, semaglutide medications? People are like losing that volume and they want to come in to you to fix it or what? Like this facial implants seems kind of crazy to me.

37:58I'm sorry. Like putting a foreign type of object in your face to hold the structure that's not your bone. I just don't know. So I would say that facial implants are much more common than you think. Okay. In Hollywood? In Hollywood, in just your models, your friends. Right. No, I think it's a lot more common than you think. Okay. Good to know. I'm not saying no. I'm not saying no. Even back in the 60s, people were replacing implants in. Really? And at one point, people were using like goat cartilage and we don't do that now, obviously. I don't think I've been seeing specifically semi-glutides leading to an increase in facial implants.

38:46But I think with rapid weight loss, regardless of the cause, you can have skin laxity. So we are seeing, you know, people coming in saying they feel like their face is falling or it looks looser than before. Right. Which is also true. When you lose fat, you lose the support on the skin. So what are you recommending for those types of patients? Yeah. So it really depends on what I'm seeing. But if it's really a lot of facial laxity, facial skin laxity and soft tissue laxity, then face and neck lift. Yeah. Straight to the lift, everyone. What is the bijou lift? because this is something that you developed and kind of coined.

39:24Yes. Tell us what that is. Yes, I'm laughing because my operative team always knows anytime I'm operating on somebody and doing a Bijou lift, I'm very jealous because I want one. They always laugh at me because I'm always like, oh, I really wish I could get this. You need to do that severance thing where you're like the Audi Dr. Chang and cooperating on the inner Dr. Chang. That would be amazing, actually. And by the way, unless you're watching this on YouTube, which you should be, Dr. Chang also could pass for 19. But in a realistic way, in like a very natural way, this is what we're talking about.

40:01Thank you. She's on brand. Thank you. I started young. Yes. I'm on brand. Thank you. Tiny tweaks. Yes. And starting early. So the Bijou is for my 20, 30 year olds who feel like they are seeing facial aging, but don't have enough skin and don't qualify for a facelift. And also have already tried all the conservative treatments like lasers, radiofrequency, ultrasound based and skin tightening treatments. But they have soft tissue internal descent. So this is a one hour procedure. It's very quick. I make a small access incision in the scalp. So it's hidden. then I tunnel down and essentially do a mini deep plane facelift.

40:42And so I lift the soft tissue. But these patients, when you're 20, 30, you don't really have a lot of skin excess. You are starting to get descent of the SMADS, which is the internal layer that we want to lift. So you don't want to put incisions around the ears in somebody that you're not removing skin in. Now, would this be an alternative to threads? Like a thread lift or a ponytail lift or whatever? So it's a more permanent and better alternative to actually lift. I find that threads don't actually work. So not really an alternative. I think just people shouldn't do threads in general. Yes. Right, right.

41:20The reason I thought of it is because that was really the first time that I think we as beauty editors heard of people in their 20s and early 30s, right? When there was all that speculation around. Fox eye lift and whatever. Yeah, exactly. we used to debate whether preventative Botox was really a thing. Now, is it when you were talking about surgery? So I think the use of the word preventative is maybe not the correct word in the sense that doing it early doesn't mean it prevents you from needing a face lift down the road. But what I think early lifting does is there's a multitude of factors, but one, I think it allows you to enjoy the lift for longer.

42:04So a really key component of how long a lift lasts is how good your skin quality is. So if you have better skin quality, which everyone does when they're younger, because we know that collagen decreases by 1 % in the face each year after the age of 25. So the younger you do it, the more collagen you have, which means the longer the lift will last. Two, your healing potential is better. So you recover more quickly. And then I think three, as opposed to waiting until you're 65 for your first lift, it's a less drastic difference. So I think a smaller tweak, which you can enjoy for longer is definitely much more appealing than waiting a long time, feeling like you don't look how you feel on the inside for a long period of time, then doing the lift and then not having it last as long as if you were to have done it earlier.

42:56Right. Because the quality of your skin is not as, doesn't bounce back as quickly. Exactly. Okay. So it won't prevent you from needing a facelift down the road, but I think people are much happier. So the patients that I have who've waited for some time and after they get their lift, they routinely say, I wish I just did this a lot earlier. Yeah. And if somebody comes to Beverly Hills to get a facelift, this sounds like something you would do in a movie. What are we getting? What are the extras you're getting? Yeah, I mean, every practice is different. But with my practice, even if I wasn't in Beverly Hills, I think they would still get this.

43:30But they get really concierge care. So we really try to set up from beginning to end. We try to take care of and handle things for the patients. We get their scripts for them. We can get it delivered to their hotel, especially for our out-of-town patients. We provide transportation from the after surgery to the hotel. And then from the hotel to my office. and then from my office to Hyper Barracks and from Hyper Barracks back to their hotel. It is typically in a Rolls Royce, which is nice. Yes, this is what I'm talking about. Oh, come on, girl. You need more than pennies. You need a jar full of loonies and tunies and a lot of hundred dollar bills.

44:07Loonies and tunies. Our Canadian-ness is just being flaunted now. But okay, Rolls Royce is telling more. Yes, I've never even been in a Rolls Royce, but my patients have, which is nice. We don't allow people to drink immediately post-surgery, but if we could offer champagne, we would. Right, right, right. Yeah, and then they have, you know, 24-hour access to our team, to our clinical team. Okay. Which usually people don't need, but at least, you know, we're there for them. Yeah, it's that peace of mind. Yes, exactly. That you're getting. I did want to ask you, because I feel like a lot of people come to you for blepharoplasty, and you've kind of pioneered this technique.

44:43Have you not? Do we talk about this already? The cat eye? Yeah. No, we haven't. I want to know about it. Ah. So I would say I don't do a specific cat eye exactly because I do think that tends to look a little too aggressive. What do you call it? I actually just call it a straightforward blepharoplasty. But I think what I do that's a little different. One, I think 99 % of the people that come in are really worried about changing their eye shape. And so I think the key is to not change against somebody's essence, which a lot of it comes from the eyes. So really maintaining the shape, but accentuating it.

45:21And so I think one component of, you know, a blepharoplasty I don't like when I see these results are when the incision curves downwards. And this is on the upper eyelid. On the upper eyelid. And so you and I think this is, you know, love, love my male surgeon friends. Nothing against them. But I think one one kind of benefit I have of being a female is that I do use eyeliner. Yeah. And, you know, you want that kind of cat eye and what we call a positive canthotilt, meaning an eye typically looks more attractive when from the inner corner to the outer, there's a slight tilt towards the outer. When it tilts downwards, it tends to look sad.

46:04And that's why, you know, with cat eye makeup, you know, the eyeliner goes upwards. And so when I'm designing my incisions, I design it so you get a slight flare at the end, which kind of opens up the outer corner of the eye. Versus bringing it down. I wish I had asked for that. Damn it. Damn it. What about for people who don't want to go under the knife? They're not ready like me. What are you doing? Like me. What are you doing to see? Is there anything that's impressed you like with radio frequency or any other types of modalities? Yeah. Yeah. So I think it, again, depends on the face and what we're seeing.

46:42So if there's skin quality, you know, I think radio frequency is great. I love a CO2 laser. I like PRP, PRF to the neck, actually basic microneedling, I really love. And then - It does make a difference. Yeah, it really does. And it's something that people kind of glaze over now because there's so many new devices out there, but I think that makes a huge difference. I think consistency is key. So even with the lasers, I laser my face probably every six, eight weeks. I do PRF under my eyes probably. I try to do every six weeks. I'm not always on time. So sometimes it's three, four months in between.

47:18But being consistent, I think, with like non-surgical rejuvenation treatments is really important. So like microneedling twice a year kind of thing or more. If you could do it more, I would do more. Yeah. I know the estheticians love the microneedling. I don't know that I've ever gotten it. It really is great. Like the pore size is so much better after the acne marks are so much better after. It really is. All right. Is there anything we haven't talked about today? And I know you're not trend based, but you're keeping your ear to the ground. Yeah. And always learning. So tell us. I think, you know, one area that most people come in early for men and women is the eye area.

47:58And it's a common area that gets neglected. but it's often because the skin is thinner, it's often the place in the face that people see aging the most, the soonest. So being mindful of eye creams, I think are really helpful. Making sure you're using tretinoin and retinol-based products is important. I do love kind of early Botox around the eyes. I think there was a lot of debate over whether or not it's preventative but I actually think it is I think early treatment around the eyes with Botox and then early treatment with leferoplasty is is really key and I'm doing a lot of that now talking even like late 20s okay yeah so late 20s early 30s right okay easier to get in front of it than treat it after the fact right yes and especially for the eyes just like the face as you get excess skin on the eyes, it'll crowd on this outer corner.

49:00So if you do it early, you have less crowding here, which means you can keep your incision shorter. So if you wait too long, you have excess skin not over the actual eyelid out here. You now have to take your incision out, which will look more obvious down the road. This woman is an absolute pro. Our last question for you, what are the three post-surgery or cosmetic enhancement products that you can't live without? So this is going to sound very basic, but I actually think everyone should keep Vaseline at home. I think Vaseline is a really key product, especially for people that have overly sensitive skin.

49:39So while I use very specific post-procedure creams after lasers, if someone's allergic, I always just put them on Vaseline. So that's one. Definitely my Naked Beauty MD eye masks and now face masks. But these were initially developed for my patients post-procedure. So after their eye procedures, whether or not it was surgical or not. So even after PRF under the eyes, microneedling, lasers, but surgery, patients were using them to minimize swelling, decrease recovery time. But then patients started to use them, you know, and continuously use them after their procedures. And they kept telling me how, you know, great it worked.

50:16And so we ended up doing a third-party blinded study, double-blinded study. And then after one week of use with 94 participants, so 188 under eyes, we saw 97 % improvement in the under eyes. I really do notice a difference with those. Anything else that's great for post-surgery or post-cosmetic treatments that's just like a must-have? I love anything with growth factors and peptides in it. Okay. So just, you know, I think growth factors and peptides we're going to be seeing a lot more of in our products. It's just exploding. Yeah. It's crazy. I definitely think they're legit. What's the brand that has made the grade with you where maybe you've looked at their studies or whatnot?

50:55Yeah, there's a few. But right now I do like TNS. Oh, yeah. It is pricey. So for some people, it's, you know, it might be a little tricky, but I do think it works. Okay. Yeah. Great. Well, thank you so much for spending time with us, enlightening us. We will be getting our consultations. but thank you honestly so much for spending time we know how in demand you are and we really learned so much so thank you oh thank you both for having me thank you conversation this is great thanks for listening you can find details on every product mentioned in today's episode along with our exclusive promo codes on our blog at breakingbeautypodcast.com while you're there be sure to sign up for our newsletter every episode will be delivered directly to your inbox so you won't miss a single thing.

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52:34Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.