GLP-1's Dark Side No One Warns You. What Rapid Weight Loss Does to Your Face and Skin - Dr. Kristy Hamilton

22:03Dr. Gabrielle Lyon:Absolutely not. There's silicone and saline, yeah? Still breast implants. Still, yeah. Is there, if someone's listening to this, because then we're going to have to then obviously touch on the obvious, which is breast implant illness and where the data is with that. Silicone versus saline. Is there a preference for one or the other? So most surgeons, including myself, predominantly use silicone these days because they have a more natural look and feel. They're lighter than a saline implant. And one thing I always like to remind people of is that the the saline implant is still in a silicone shell.

22:42So you're not silicone-free with either option. But pacemakers are coated in silicone. Knee implants are coated in silicone. The state of the evidence with breast implant illness is that...

22:58I think we talked about this last time. We did. And we're going to just remind people. Yes. So there was a really interesting study done. It's like a four or five part study at this point. They looked at women who had never had implants. So these were women having lifts or reductions. And they looked at women who had symptoms and were having their implants removed. And then they looked at women who were having their implants exchanged. They left their breasts implants and they never want to be without them. And they looked at everything, right? It was a study done in conjunction with NIH. They sent tissue off to be examined.

23:36They looked at presence of heavy metals and toxins. They looked at presence of bacteria. And they did not see a statistically significant anything across those broad categories. there was an association with baseline higher levels of anxiety in the breast implant illness group, which is not to say that it's not real. I think that's a really, really important distinction. But I will tell patients who come in and see me, if they are already a highly anxious person or have a diagnosis of anxiety, we really need to think hard about whether we're going to go in and place a breast implant because we know that's a risk factor for developing breast implant illness.

24:16Also interesting is the brand of implant that I like to use, which is called Motiva. If there's an inflammatory component to this, which has not been proven, but just in general, to have a lower level of inflammation in your body, that specific implant is associated with the least amount of inflammatory response of any implant. So I like that as well.

24:38Dr. Gabrielle Lyon:Does breast implant illness have an ICD-10 code? No, because it's not a medical diagnosis. But it's a very controversial subject. It is something that impacts a lot of women. And so that's why I'm proud of our plastic surgery societies because they've taken this very seriously. They have pushed a lot of our funding dollars towards taking a look at these groups of women and trying to understand. You know, because just because we don't have a diagnosis or know something doesn't mean that it doesn't exist. So these things are understudy. And the great news is that all of our studies show that if you just take the implants out, overwhelmingly, these symptoms disappear in about six weeks.

25:25So that's fantastic news.

25:28Dr. Gabrielle Lyon:Yeah, unusual. Yes. And you don't have to do a capsulectomy or cut out, like, whatever is remaining on the breast to have that happen. And both you and I are treading lightly here for two reasons. This is very controversial, and both of us are women, and I would never want to diminish, and also I'm a practicing physician, I would never want to diminish someone's experience, and neither do you. So I know you personally, I know that that is really important to both of us. Secondarily, there is a lot of predatory behavior by other surgeons. And these are not words coming out of your mouth. These are words that I am saying because I am seeing it, that we have patients that come in our clinic that have had capsulectomies, have had implants that were not bothering them physically, meaning they didn't have capsular contracture, they didn't have problems with it, but they felt because they had been reading or they'd have all these experiences of what would fall into this kind of group discussion about breast implant illness, breast implant illness, and then they have completely deformed them, their bodies.

26:45They've become deformed from this and their symptoms did not resolve. Right. And then if you were anxious and depressed before, then you're really anxious and depressed after when now your body doesn't look normal either. And so then there's this whole like explant regret group as well. So I think it's not cookie cutter. It's not one size fits all. When I have patients come in for a consultation with me, I like to cite those studies I just talked to you about. I like to give them their options. And they are some of the happiest patients I've ever had. we take out their implants, maybe we do a lift, something just to make the remaining breasts look pretty.

27:23And all of those patients have, you know, they tell me they feel better and that's it. We're done. I've yet to have one of my patients come back to me and feel like they have breast implant illness. The longer I'm in practice, the more likely one day that will happen. But it's just a conversation that is ongoing and we're going to be learning more about this as time goes on.

27:46Dr. Gabrielle Lyon:Very well said. Also, just wanted to mention that because we're not saying it doesn't exist, but there's also this kind of predatory behavior. Yeah. And I think what you absolutely do not need to do. So if you're if you're a woman, you have symptoms and or you're just ready to be done with implants and that's fine. You do not need a thirty thousand dollar detox program. You do not need to have what's left of your breasts cut out. this has all been proven and you can have symptomatic relief and you know go on to have a nice normal breast implant free life without complications from surgery and in addition we've put both our thoughts on the table for a breast implant illness the idea that women in other countries are getting to do implants that are in front of the muscle so they don't have to cut the muscle, which, you know, I am going to have my physical therapist, JJ Thomas on the podcast.

28:42Dr. Gabrielle Lyon:And she talks a lot about scars that when that there are these lines in the body, not just fascial lines, but when you cut muscle, it changes the way that you move. And it might be very subtle, but it can create a lot of problems. And I do think that as we think about how we age, We have to also be careful as to what kind of procedures that we're doing. I mean, it just makes a ton of sense. Why are only 32 surgeons in the U.S. that are offering pec muscle sparing breast augmentation? So you can do a pec muscle sparing augmentation in general. So I have been a proponent of that style of breast augmentation for a long time.

29:25But this is a more advanced or more minimally invasive version of that. And we were invited to train on it in Costa Rica. And then I think most of us found it very compelling working with the surgeons down there and understanding their motivation for developing this. It's a technique. It's a philosophy. It's a set of tools. muscles and it speaks to me because I like preserving the pec muscle if possible.

29:56Dr. Gabrielle Lyon:You know, I'll still do the - I mean, it's great. And what I love about you is you always find solutions. You're very innovative in terms of how you think about plastic surgery. You really think about it as an art and also just taking care of the patient and making sure that they are able to preserve their fitness, which is why I think a lot of our patients have gone to you, including myself, which we're going to talk about this skin tightening technique, because ladies, I'm telling you, I just in full transparency that aging is a luxury. It's amazing. And not everybody gets to do it. And if we're lucky enough to do it, there's all kinds of things that we get to benefit from, which is becoming wiser and watching our kids grow up.

30:43Dr. Gabrielle Lyon:And then the downside, which I mean for some people might consider a downside, others not, but your skin sags. Yes. Especially after babies, your boobs sag, your skin sags. Yeah. And, you know, I'm not a fan of that. Just for me personally, not a huge fan. I am not either. I do want to talk about what we did for me. which we did the quantum RF. Yes. And also I've done exosomes for my hair. I do. I want to talk about all of it because I think that my experience can help other people who are like, well, what do I do? This hair procedure costs whatever thousands and thousands of dollars or someone is telling me this skin tightening technique.

31:34Dr. Gabrielle Lyon:Is it worth it? Is it worth it? And it becomes very confusing and also very costly. So do you want to say anything more about the pec-sparing breast augmentation? I just wanted to bring that up because our audience really likes to get after it. And they can return in a week. Is there anything else that you want to mention about the pec-muscle-sparing breast augmentation? So I think what is so interesting about Preserve is the type of patient that is coming in for this. it's patients that have maybe always been interested in having a smaller volume breast augmentation but they're moms or they're super active they love playing tennis they love lifting they're not gonna compromise their lifestyle and so now they're like oh i can have this conservative chic elegant smaller volume breast augmentation and i can still get right back to it whether it That's being like a busy executive, someone with small children, someone who has a very active lifestyle.

32:42Or what I find is oftentimes it's someone who is all three of those things. And so I think it's met a need for that type of patient. Ballerina breasts. Yeah. We did not talk about size. No, we did not.

32:54Dr. Gabrielle Lyon:Now, I was very surprised that you can, well, not us, but one could get a penile implant. You don't get to pick the size. A penile implant, because it is typically just used for performance, for being able to have an erection. Okay. Which I was shocked because you get to pick your size of breast implants. So you're taking me back to residency here. And on a urology rotation, I think they're just fitting the size that is there, right? Because it's more of like a supportive mechanism. That's right. This is right. I don't want to make a light of the fact of someone requiring a penile implant. Sure.

33:35Dr. Gabrielle Lyon:Because that's a big deal. Yes. And I will say, you're all just get yourself together because on the female side, you can pick your breast size. Yes. Still has to be anatomic. Still has to make sense. Wait a second. Okay, let's just put it all out there on the table. It doesn't have to be anatomic because I will tell you. For me, it has to be anatomic. For you, you are like, that's the right size. But we have seen people, and I may or may not have made that decision, that have gotten massive breast implants when they were in their 20s. Yeah. I think there's implications for all this. Like, one, it just doesn't look right.

34:19Two, we have a surgery called breast reduction, and we do that surgery all the time because when you have enormous breasts, it causes back pain, neck pain. Like there's all these – it's a medical surgery. So why would we want to add so much volume that we then create all those symptoms for a patient? It's a hindsight type of thing. Yeah.

34:42Dr. Gabrielle Lyon:It's a hindsight type of thing because there was a time where the Pamela Anderson look was very – Popular. Popular. I know because I was there. That's all I'm going to say about that. And then there are subsequent challenges with that. And you call your aesthetic the ballerina breast. Yeah. And that's, I would say the favorite aesthetic in my practice is just having something that is proportionate, fits the body, not overwhelming. I mean, do we still do a voluptuous breast augmentation here and there. Yes. If I have a patient that is six feet tall, broad-shouldered, then maybe a 600cc implant is appropriate for that person.

35:25It's going to look tasteful. But the average implant I order in my practice is 250ccs. Which would be a B cup, C cup? What is that? It depends on... A cup size in general is about 150ccs, but you have to consider how much breast tissue the patient has baseline. So a 250 on you is going to be very different than someone who is 5 '11 and where you would be to begin with, or where you would double A. So you don't get a certain cup size with a specific implant. Okay.

35:56Dr. Gabrielle Lyon:I love this. I love that there are options because I did not know that. I did not know that there are other options other than above and behind the muscle. And I only knew of those two. I did not know that there's a way to spare, you know, to have a pec muscle sparing technique. Yeah. Which is awesome. It is. And the fact that the return to lifting is one week, I don't think people know that. In fact, I know for a fact people are unaware of that. Yeah. It's just a much more pleasant recovery too because muscle is important. It's functional. It hurts like crazy if you cut it. But breast tissue, skin and fat, much more forgiving materials.

36:42They do not hurt nearly as much. And so that's what we that's what we want out of aesthetic surgery these days is like we we want to make the adjustments or changes that we would like to do. And then we want to get right back to living our lives like we you know, it's it's not acceptable to have six week and 12 week recoveries from these things.

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38:32Dr. Gabrielle Lyon:Don't miss it. Moving on to the topic I'm really excited about, which is the non-surgical skin and tissue tightening. Yes. Now, I have done this. I, after having two kids and also just training and I don't know, all of a sudden I woke up and I have like extra skin on my stomach and extra skin on my back and extra skin on my knee, which is annoying. Obviously, I called you and I said, okay, what are the options without cutting? Yes. And can I say two things? One, you look amazing. I always tell you that. She's my friend. You literally do. She's my friend. She's supposed to say that. Okay. But two, I would say I applaud you for talking about it because I think there's a lot.

39:23There's this misconception out there that if you are, you know, if you take care of yourself and you're fit, then you don't have these issues. And there is no fitter person than you. And yet you see some of these skin changes as time goes on. A lot of this is pregnancy related. there was an expansion you know even if you've been fit your entire life you grow during that period of time and then come down and you actually grow more skin so that's a design flaw yeah it's a design flaw um and then the leaner you get um the less support you have of that skin with fat and everything looks looser so what what we did was we went in and used this device called quantum MRF, which is a radiofrequency tightening device.

40:11And basically, it's minimally invasive, tiny little incisions that you probably don't even notice anymore. And we go in. In fact, I didn't even know I had incisions from there late. Okay. Because they're tiny. I wouldn't even know where to look. Yeah. You can't see them anymore. And so how it works is that if you look at fat, it's a honeycomb structure, and the globules of fat are housed in this supportive connective tissue called the fibroceptile network. So that is what we are heating on the undersurface of the skin, and it's cinching up those fibroseptae and getting everything to stick back down.

40:48Does this have anything to do with cellulite, the quality of the structure? So that's a different type of fibroceptile band, except it connects from the skin down to the fascia. And so those are little tether points. And so you can also see cellulite get worse as skin gets loose because the skin is then increasingly held up by those septal connections going to the deeper tissue. So that's why with weight loss, you can see those dimples get worse.

41:16Dr. Gabrielle Lyon:And that's what cellulite is. And is that genetic? I mean, in my mind, I'm thinking if it's a structure is because some people have cellulite and some people don't. But overwhelmingly, people have cellulite. They do. It's like 97 % or 98 % of women have cellulite. So when you meet a woman without cellulite, that is a very special woman. Very lucky. Most people have it to some degree. Okay. The honeycomb structure of the skin, and again, we're not talking about fat now. We're talking about the skin that then changes, right? So we're talking about the subcutaneous fat underneath. And there's the skin.

41:57Then you have different layers of fat, actually. But surrounding those fat globules is this fibroceptile network. And so when we cinch that up. And that's what the radiofrequency does? Yes. And so if we go in on the inside through a two millimeter incision, we can heat that structure to a much greater degree than we can when we're doing outside lasers or other tightening treatments. And so we heat it to a degree that if we were doing that through the skin, it would burn you. But on the undersurface, we can heat it.

42:32Dr. Gabrielle Lyon:And I want to frame this up for people. I asked around to a lot of different people. Obviously, this was before we were friends. And I said, okay, well, what do I do for the skin on my knees and the skin on my back? Which, again, this I didn't even know I had it until I looked at a video and I thought to myself, wait, I didn't even know I had it. Where did that even come from? This, you know, I was just wearing workout pants and it was just kind of over. and when I went to various individuals what they told me was that I could do microneedling that I could do something called a j-wrap I could try lotion I mean I went through a series of here are my options I don't know if you are aware of some of the things that are being just to clear this up for people because I don't want them to have to go through that and waste a ton of cash and just waste a ton of time on something that isn't going to work.

43:37Dr. Gabrielle Lyon:Can you lay out what, if you feel comfortable, laying out things that are being promoted for skin tightening? Because there's facial skin tightening and then there's body skin tightening. I think a lot of it comes down to, first of all, the diagnosis or what we're working with. When we look at someone like you, you do not have oodles of extra skin. You've got some laxity. So that's where... And when you say some laxity, sorry to interrupt you, for someone who's at home thinking, okay, well, am I a candidate? Are they pulling an inch? Are they pulling two inches? So if you have an overhang, let's just talk about the abdomen because it's kind of easy with women after having kids.

44:15If there is tissue overhang, you are not a candidate for these tightening machines. So I think...

44:22Dr. Gabrielle Lyon:But I feel like I had tissue that was above the elastic band. That was from, I think you were wearing something tight. And then the skin would kind of come over. Which in your 20s or before kids doesn't happen. Doesn't happen. But that was like laxity. So when you stand up straight, like you look fantastic in tone and you can see all your abs. And then it was like a movement thing. If you would lean over, you would see it. Yeah. Or skin or clothing. Right. Or a sports bra. Or a sports bra. Yes. but if you stand up and you look in the mirror and you see that you already have an overhang of skin then that patient needs to have a tummy tuck and a tummy tuck is different than than you're not taking fat it's not liposuction it's just the skin the tummy tuck i i always do some liposuction with it to create natural hills and valleys but we are removing the difference is about how much skin.

45:18We are removing about this much skin off of the abdomen. For someone who's listening to this, that's six inches.

45:25Dr. Gabrielle Lyon:This is a joke, but yeah, that really is about six inches, except more. It could be more. It's a huge amount of skin. So that is like a removal. So that's why if you've lost a tremendous amount of weight, if you've got pooling skin, like none of these tightening devices are going to do it. Don't waste your money. Do not waste your money on someone that says, we're going to do radio frequency on your body. It's not going to work. Minimally invasive devices where you are not removing skin are not going to address a major skin issue. This is a great device for patients who are not a tummy tuck candidate, or they're not a buttock lift candidate, or they don't need an arm lift, but they want to do something.

46:08Dr. Gabrielle Lyon:I had my friend who was saying, you know, what did you do for your skin? Because when I'm in a push-up position, I'm seeing skin hang down. Yeah. If an individual pulls – because I feel like I could pull an inch. Is that – Yeah. Is that true? But I don't – I feel like I could pull an inch. I don't know if it was two inches. That's probably it. More. I feel like I could pull like two inches off of you. More than two inches? But it's really about the fact that your skin fit the form of your body and you didn't have overhangs. So that's the best way I can describe it to patients. So this is good for this in-between patient, the patient who's not a full-on excisional candidate and someone who – Basically, what I'm trying to do for people is I trust you.

47:02Dr. Gabrielle Lyon:I want them to come to you. And I want them to not be a victim of going to someone that's going to say, you're going to a med spa. Because this is what happened. I would ask around and they were like, oh, come in. You know, here's your package. It's going to cost you$10 ,000. I would have been completely out of line and out of cash if I had, again, just done topical. So I think a skin treatment, skin treatments are fantastic. They're going to treat the skin. They're going to treat texture. They're going to treat tone. They are not going to transform structure. So then, okay, then we're moving into things that can adjust structure like quantum RF.

47:46And then most importantly, surgery, major surgery is going to provide the most significant transformations. But I think what can be helpful is going to someone who offers all of those things. That may be one way to be safe is to go and see, you know, if all you have is a hammer, everything by definition is a nail. I don't think any skin treatment is going to treat structure. And so that is – that's where a lot of people run into trouble. They're like, do microneedling and that's going to give you a facelift result. Like, no. Microneedling is going to enhance the quality of your skin.

48:24Dr. Gabrielle Lyon:But will tighten it and reduce wrinkles as well? It's going to reduce wrinkles. I don't know that I wouldn't say that it's going to tighten it. You know, now if you add some if you start adding in heat, so radiofrequency microneedling performed at a more shallow depth, or then we move into bigger guns like CO2 laser, which I call that cinching of the skin. But still, it's a predominantly a skin quality treatment. Once someone needs a facelift or we see jowling, like loss of neck definition, none of these surface level treatments are going to address structure. And that is, that's just the absolute truth.

49:02So if someone is trying to sell you like a package of skin treatments to give you a facelift result, that's just never going to work.

49:08Dr. Gabrielle Lyon:Radio frequency uses, is it heat, aka energy? Yeah. So when you look at with all these energy devices and there's different kinds, ultrasound, radio frequency, laser, energy. That'd be Ulthera or SoftWave. Yep. SoftWave is ultrasound. They're all trying to heat tissue to a certain temperature, which is going to stimulate collagen induction. So it doesn't really matter what type of energy you're using to get there. It's all about creating heat. That's what creates this controlled injury. And that is essentially what gets your body to start working on healing itself. And if we were going to say there's levels of skin laxity, I'm sure there's graded levels of skin laxity.

49:55We go more by scales called ptosis. So it's levels of sag. So we have them. Yeah. So we have eyelid ptosis. We have breast ptosis if your nipples are at your breast fold. Or if they're on your knees. If they're below your breast fold, it's a two. Once they're pointing to the floor, it's a three. Okay. Nipple ptosis.

50:17Dr. Gabrielle Lyon:Nipple ptosis. But we don't have a, I think laxity, you would define that in surgery by how much tissue you remove. Sagging, I didn't have. Ptosis is drooping, aka sagging, or laxity would be both. Laxity refers to just like a loss of elasticity in the skin or associated structures. Ptosis is used to describe droop, but of specific structures like eyelids or the brow or the nebbles. Okay. Radio frequency internally was something that I was new to because a lot of the radio frequency machines are on the surface. we used quantum radio frequency does someone take me through what kind of result that they can expect because I want to do another another round because I I think that I got a fantastic result and I think that yes we could probably it's probably time for a little bit more can work on it again yes it's something we've been doing is an initial round and then a second round at six months.

51:27So it is a 25-week total, I don't want to say recovery. It doesn't take 25 weeks to recover, but 25 weeks to see your entire result. At that point, also everything softened up again that you could go back in. I do. I don't remember.

51:41Dr. Gabrielle Lyon:I feel it. Oh, wait. I remember. Oh, yes. I remember. Should we tell the story? Oh, man. I did this. And we did my, we chose to do it under general, right? Yes. Let's keep people through what their options are. So you don't have to do an under general, but you are someone with a very tight schedule, and we had a limited time frame to do this. And so if you're going to do this treatment awake, that's fine, but there's only a certain amount of lidocaine that you can inject into someone safely in one session. I didn't want to do that. And we could only have then done your thighs and knees or your back or your front, and that's not how you live your life.

52:23You've got one time frame, one window of opportunity, and then you have to be in perfect shape a couple days later. No pressure. No pressure. So we chose to do you under general anesthesia just so that we weren't limited by lidocaine and how much we could inject into you. And to be fair, we don't take that lightly, and it's very safe. There's quite a bit of concern and conversation around general anesthesia.

52:47Dr. Gabrielle Lyon:I feel like, And I think the data suggests that it is very safe, especially if it is done under controlled conditions, rather than, for example, for my case, to go and get a ton of lidocaine. I mean, there's only so much that can be utilized. Yeah. And you just have to go to people that know what they're doing. Like, you know, I only work with amazing board-certified anesthesiologists. a lot of these procedures are done in these outpatient settings where if you can numb everything with lidocaine that then means like you don't have to do it in a hospital setting and then all of a sudden you know in a med spa setting someone may be given a toxic dose of lidocaine they may not know it until 10 or 12 hours later when it peaks they're at home your heart stops and then that's just a tragedy so that aside that's not what that's not what we We were doing.

53:41We're not doing that. And so we were able to get, I would say, like a 20 % to 30 % reduction with this device. I feel like it was more. Well, then we've got to do it again. You can do it again.

53:51Dr. Gabrielle Lyon:The totality of treatment after the second treatment, is it typically more than two? Or after two, you say, I know what to expect? Yeah, I think after two, that is great. Patients are happy with that result. Then aging will continue. And then, again, to your point, it's a luxury to get older. At a certain point, we'll see laxity again. And then we can do that again. But this is not – it's not a treatment that wears off. It's that aging continues. How long – and then is there an average improvement that you see? When you could pull my skin, maybe it was two to three inches of laxity, which is insanity.

54:30Dr. Gabrielle Lyon:Probably now it's – I don't know. I haven't measured it, but we'll measure it after this. Maybe it's one to two inches. I haven't pinched you after the fact. But we're going to determine. And then would you say people get 50 % better conservatively, 20 % to 30 % after that first treatment? After the second one, is it doubled? Is it 40 % to 60 %? It's again. So I guess it depends on if you're measuring another 20 % to 30%. So it's a really nice option for this gap patient, someone who doesn't need excisional surgery but has meaningful laxity and wants to approve upon it. And so it's been very popular.

55:09I'm excited to do it for myself too. I would say I'll do it for you, but I would have no idea what I'm doing.

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56:50Get started today. I'm not a facelift candidate.

56:53Dr. Gabrielle Lyon:I haven't had plastic surgery on my face. Yes. I would love to try the radio frequency underneath my chin on my face. I don't know where we can do it. We were talking about using it in this area. So kind of what we call the submental region or the under the jawline region just to cinch that up. So for this area, and I've told you this too, if you were someone who was interested in having a facelift or needed a facelift, which you do not, in the next one to two years, I would say do not do this. It's going to kind of complicate things by creating inflammation and some scar tissue in that area. But if you're someone who may not have a facelift for another five to ten years or we just keep on collagen banking and improving things and trying to avoid that entirely, then this is a great option because it's going to do the same thing.

57:45It's going to cinch up this area and tack everything. It's similar to what I was describing with the knees for you. We were like, okay, we can't just go in and treat the knee. We're going to treat the whole thigh because it's like pulling four corners of a blanket. So this is a cinching procedure. So we have to make sure that we're cinching across a larger surface area to get that so-called tightening effect. So same thing. We're going to, even though you just have this tiny area of concern right underneath your chin.

58:16Dr. Gabrielle Lyon:Here's what I would say to the ladies. I was irritated about that skin for a long time, and I wish I would have just dealt with it instead of just say, okay, well, that is what it is. Because I just appreciate the fact that there was something to do about it. Again, take it or leave it. I'm not telling anyone what to do, but I would heed for someone to be on the fence and then do something and go, oh, my gosh, why didn't I just do that in the first place? I mean, these are happiness-inducing procedures. And I wasn't trying to minimize your area of concern, but what I meant by that is, like, it's a small area relative to this whole area underneath your neck.

58:59So the whole key is that we have to heed the entire underneck area so we can have the blanket effect and pull that across.

59:06Dr. Gabrielle Lyon:Someone would then wear a garment after. Yes. You know I love some garments. Oh, my. Okay. Goodness. And then do the other things that you recommend. I highly recommend that people learn about this, this radio frequency. Is quantum the only device that is doing it that is underneath the skin? It's the only one in my mind that has ever worked this well. So I'm very skeptical of the tightening machines. There's millions of them out there. We refer to most of them as very expensive coat racks because a lot of them just don't work. This one was developed by a very dear plastic surgeon friend of mine, Dr.

59:53Alfredo Hoyos. And that's what got me interested and actually made me try it because I was like, well, if he puts his name on something, it's probably you trust him. I trust him. And it does.

1:00:07Dr. Gabrielle Lyon:And to clarify, it works different than the topical radio frequency. For example, quantum was not used topically, is it? Correct. Because if we heated things to that degree, you would be a burn victim and you have scars all over your face. So that's why we have to go inside. Otherwise, this would cause tremendous issues. Compression garment has to be worn for how long? Just for a week or until the small line comes down. So it's not like liposuction where you're creating all these spaces, removing fat, and it's filling up with fluid. But we want to tack everything down and get that swelling down faster so that you can go back to normal life.

1:00:44Dr. Gabrielle Lyon:If someone chooses not to do that, does it affect the end result? No, but you're just going to be so swollen and so uncomfortable. Like you really want to do that just so that you recover faster. What about face? Asking for a friend, myself. How long does someone have to wear a wrap? For one week. For one week. Okay. Is there anything topically that can then help the laxity of the skin? So retin-A, tretinoin, we think about our face all the time. You can put that on your entire body. And that will help with laxity? And it helps. It increases collagen in your skin. And we know this for a fact. I made people angry when I said this last time, but sunscreen, that not to not go out in the sun.

1:01:36Did you make people angry about that? I did make people angry about saying the word sunscreen. And I'm not saying to not go out in the sun ever. And obviously we need sun to live. But we know that excessive sun exposure is going to break down collagen. Isn't any sun exposure going to – because I look at your skin, I look at my sister's skin. you guys never go in the sun without a hat and and sunscreen but we but we live in texas so we're still gonna my sister lives in new york okay but you and i you and i live in texas so we're getting we're getting what plenty of sun from like a vitamin d level um just by like living in this very very bright very very hot place um so i don't feel like i need it anymore i'm super fair So skin cancer is like more of a concern for me.

1:02:25And of course, I like to keep it looking nice. But I believe very strongly in the concept of collagen banking. We were texting about this the other day. It's like collagen is not something that we don't just do a treatment and leave it. We don't just do a skin care, skin regimen and leave it. We are constantly working on building collagen in our skin. And so that's why the CO2 lasers, the microneedlings, the red light therapy, the retin-A, all of these things are like I'm constantly working on my skin. I've been doing these treatments since I was 27.

1:03:02Dr. Gabrielle Lyon:I mean, you look great for 27. You must have just finished last year. Are there things that help with wrinkles versus laxity versus something else? These are going to help across the board. It's going to help with texture, tone, pigment, wrinkles, elasticity. But it's not going to do a structural reset of your skin. And there's nothing. Is there anything that someone can do to prevent the structural changes? You can't prevent aging from happening, but you can slow it down. And you just have to spend a lot of time and effort building collagen in your skin. And when you say effort, you mean microneedling.

1:03:46Dr. Gabrielle Lyon:Procedures. Procedures. What about CO2? My favorite. Okay, yes. And those are, guys, I have done this. I think I do a CO2 laser every couple, every six months or so, would you say? Yeah. I want to talk about pain. And two pieces of advice. Number one, make sure you use product after. do not I'm like looking at you I'm looking at the viewer do not let your skin dry out after co2 laser don't that is not um that's not a fun experience I was crying in a corner in the shower because I didn't listen to the directions I pain people will say is it gonna hurt what what do I have to expect for pain and you gave me a medication the I think I took it the night before and maybe the morning of, and it completely blunted anything.

1:04:40I am very passionate about this drug. Okay. I took it myself. And the drug is? It's called Dranavix. Dranavix. It is the first new class of pain medication in decades. Really? It's a whole new class. It is a whole new class. So what we've mainly had is another kind of narcotic or another kind of NSAID. We haven't had something new. This is a drug that works on the sodium channel receptors specifically in the peripheral nervous system. So it has it does not change anything in your brain. So you're not there's no euphoria. There's no like there's no change in your level of consciousness while you're on it.

1:05:29It doesn't it's not addictive. It's not addictive. so I have been loving this drug specifically for in-office procedures but also any of the more uncomfortable surgical procedures like tummy tucks we put we put patients on this afterwards it is incredible and I will say I took it myself a couple months ago after I had the baby and did my most recent co2 laser and I was like this is such a pleasant experience I was like I had a pleasant I had a pleasant experience which is co2 laser hurts okay yes it does um it works extremely well. It's the gold standard for skin rejuvenation, but it is not for the, you know, like the occasional, the faint of heart or the occasional dabbler, which you are literally burning your skin.

1:06:12But it has made it so that we can do stronger treatments for patients who have done it before or just to have patients be able to do it at all. So the only other option we had before that was to give people general anesthesia for a laser, which feels a little excessive. or just to give them a bunch of narcotics and kind of zonk people out during the treatment. So it's great. We really like to avoid narcotics if we can because there's so many issues with that. So it's a fantastic drug. It's indicated for acute pain. So whether that's surgical.

1:06:45Dr. Gabrielle Lyon:That's the FDA indication? Yeah. So anyone that shouldn't take it? It's a CYP inhibitor and also an agonist. So if you are taking a bunch of medications, you just have to make sure that it doesn't interact with that. But it's very safe. That is interesting. So FDA is dronavix. FDA approved for acute pain. How long is the time of onset? So just a couple hours. Technically two hours. But I usually have patients start the night before they're preloaded. Could someone who is coming in for a basic procedure, in-office procedure, take it? Would there be any downside is what I'm asking. No. Could potentially make things much more comfortable in general.

1:07:36Yes. And then you get a better result. So a lot of these, you know, you have to consider the level of treatment that you're getting. When you hear about someone saying, oh, like that didn't work, it's like, well, was the patient able to tolerate the procedure? If you never got the level of energy to what you wanted, then they're not going to get the result that they're expecting. So you have to get patients comfortable enough so that you can do the type of treatment that you want to have.

1:07:59Dr. Gabrielle Lyon:I want to run through a few things before we close out. The things that I want to touch on are who it's not for. And this is just all of it. The Miami Thon Lift. Who is that not for? It is not for someone that has so much excessive buttock skin that they need a traditional body lift. So it's for someone who specifically has laxity in the lower inner quadrant. Who is it not right for? Anybody in particular? I don't think it's – I think it's – as long as you are a candidate and, like, need a buttock lift, I think everybody can be a candidate for it. You obviously have to be a good surgical candidate in general and be healthy.

1:08:47What about the zombie BBL, zombie breast augmentation?

1:08:54Dr. Gabrielle Lyon:Again, this is a terrible name. Yes. Are there any safety concerns with that? So I think the main question I get asked is, are there long-term studies? And no, because it's a relatively new product. So that's something that the company knows. And they are working to get studies like in breasts, specifically things like that. Because right now we are placing it in the subcutaneous tissue of the breast because that's what the on-label indication for. You can place Alloclate anywhere there is fat. So there's fat in the subcutaneous tissues, but we're not necessarily placing it in the gland of the breast.

1:09:32Dr. Gabrielle Lyon:In the world of aesthetics, someone can use drugs. Can they use drugs off-label? Obviously, there's certain off-label indications. I think we have that flexibility as physicians. So there has to be an on-label indication for it somewhere. but then we can choose to use it off label and we can choose to use our our physician medical judgment for that there seems to be a different look i was in new york and lancome by the way that's how you pronounce it lancome if you're uh if you're in the u.s or you sound like you're from new york like me but lancome but if you're front it's very refined and i was at the event where they, you know, I'm on their advisory board and they have a new MD, Absolute MD, which is a longevity product for skin.

1:10:28Dr. Gabrielle Lyon:But what struck me was that the event, the younger girls, it's a totally different look than, I don't know, I think last year or even kind of when we were younger, it's almost the no makeup makeup look the aesthetic is glass skin it just is different and i'm curious as to what you think is going to be the next iteration next year i to me it's like this french girl skin or like this clean girl skin i think that's that's the key for a long time it's been putting on a ton of makeup covering out the skin obviously i've got makeup on today because we're filming but i like to rely on the low maintenance look, which is if you have really, really, it's a very high maintenance look to get the low maintenance look.

1:11:22It's the undetectable error of skin. It's the undetectable error. So I'm doing massive CO2 lasers so that my skin looks great without makeup so that on a daily basis, I don't have to do a lot of camouflage. It's about having healthy skin. So I think that is the look. You just want to keep people looking normal and human and just the prettiest version of themselves, this elegant version of themselves. But we want to respect anatomy, maintain proportion, and just keep people looking normal. I think aesthetics really veered off course for a while where everything was just like big lips, big breasts, big butt.

1:12:03And it's like, no, What are the lips that look right on you? Do you think that we're getting back to the more natural era? I do. I do. Definitely in my office.

1:12:17Dr. Gabrielle Lyon:Yes. And I think we're seeing that. It's people perhaps are not overdoing injections. I mean, I don't know, but at least that's what I saw. It was surprising and beautiful. There was a lot less makeup. And, you know, I say that I have a ton of makeup on because, again, when filming, I'd love to get to the place where a makeup-less look looks great on camera. If you're interested in that, you can see the story. It's not so pretty, but whatever. What, you know, you had mentioned the Kardashian body and that ideal is shifting. You called the new version Kardashian 2.0 as a more toned, athletic look.

1:13:01Dr. Gabrielle Lyon:what is it that your patients are asking for now that they didn't say perhaps three years so i think i mean it it's just how your popularity has skyrocketed like i think people want to be healthy and fit i mean when you see style icons right they usually last about a decade the kardashians have been relevant for much longer than that and i think it's because like they are savvy enough to evolve with the time so look at them now like they're very very fit they're training you're they're all you know on their show they're always in the gym people want this toned athletic look now um it's the best version of them what i love about it is it's a version that while we're talking about plastic surgery there's a component that sets you up for great results that you cannot buy.

1:13:54Dr. Gabrielle Lyon:You can't pay for it. You can't inject it. You actually have to be disciplined, less distractible, and put in the work to have toned muscles, to do all the things that I think create better outcomes for patients. Do you find that the fitness-oriented patients, do they struggle with one thing in particular from a skin it's skin it's always a skin they i will tell you they are phenomenal patients they cruise through recovery because they're so healthy they're so fit they're on your you know you're they're on your diet so they're all eating tons of protein they they heal very very well we tend to see very few wound healing issues in that group of patients which is great for me and also great for them um but it's skin because like the leaner you are, the less fluff that you have, the more you're going to see that laxity.

1:14:50Dr. Gabrielle Lyon:Would you agree with the statement that people are paying more attention to it now because of the use of GLP-1s? Yes, because we talk about this in our plastic surgery conferences. Like plastic surgeons, we're going to be busy for the next few decades just trimming skin away. You know, people have lost so much weight so quickly. And that's part of it, too. They lose weight so quickly on the GLP ones that everything kind of just collapses. And it doesn't matter how much you exercise and how much muscle you build. There is no way to exercise loose skin away. And in fact, the more you exercise, the more you get, the worse it becomes.

1:15:33And so that can be very, very frustrating to patients. And so I think a lot more patients are pursuing surgery now because they're really excited about their bodies. Like they're excited that they're stronger. They're excited that they, you know, they're seeing these changes in their lives. Like now that they have this healthy body that can carry them through their day. And then when they want to see that as well. And so then if we can trim away the extra so they can actually see their core again, the muscle is there. But now they get to enjoy it. And that is it's fun for me as the plastic surgeon to be, you know, like the last step on this journey because they've already put in a ton of work to get there.

1:16:16Dr. Gabrielle Lyon:Speaking of journeys, you just opened a brand new surgery clinic, which is so beautiful. I want to have complete control over the entire patient experience from start to finish. Like there's a certain way I like to do things. I want to curate that entire patient experience and the results. So I feel like I have to have control over the entire process. So that was the main motivator. You are a phenomenal surgeon. You are a phenomenal friend. You are what I would consider the resident lion plastic surgeon, which is why I love having you on. And if you are listening to this or you're watching this and you are considering undergoing some type of procedure, there is not one person that I recommend more than Christy Hamilton.

1:17:10Dr. Gabrielle Lyon:You are extraordinary. You are an absolute superstar. And not just in speaking about things, but also your dedication to your craft and your trustworthiness as a physician. I couldn't be broader of you. So thank you so much for coming on the show. Thank you so much for having me. Where is your new surgery center, your new office? So it's at 2311 Bissonette, just down the street. 2311 Bissonette. We're going to put the address, all the links to find you. It's beautiful. And I hope you guys have a really good coffee machine. We will. You were working on that. And just thank you so much for coming on.

1:17:55Dr. Gabrielle Lyon:Thank you for having me. feel.