Gwyneth Paltrow x Julius Few: The Holistic Plastic Surgeon

0:00Chronic migraine is 15 or more headache days a month, each lasting 4 hours or more. Botox on a botulinum toxin A prevents headaches in adults with chronic migraine before they start. It's not for those with 14 or fewer headache days a month. It prevents on average 8 to 9 headache days a month versus 6 to 7 for placebo. Prescription Botox is injected by your doctor. Effects of Botox may spread hours to weeks after injection causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems or muscle weakness can be signs of a life-threatening condition.

0:30Patients with these conditions before injection are at highest risk. Side effects may include allergic reactions, neck and injection site pain, fatigue, and headache. Allergic reactions can include rash, welts, asthma symptoms, and dizziness. Don't receive Botox if there's a skin infection. Tell your doctor your medical history, muscle or nerve conditions, including ALS Lou Gehrig's disease, myasthenia gravis or Lambert-Eaton syndrome, and medications, including botulinum toxins, as these may increase the risk of serious side effects. Why wait? Ask your doctor, visit BotoxChronicMigraine.com, or call 1-800-44-BOTOX to learn more.

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2:10When you are pioneering anything or introducing new ideas to the culture, you get criticized. You do? Yeah. Did you hear about that? I didn't find the one. I found someone I respected and we made it the one. In a sort of longing kind of view of love, people understand each other as if by magic. Nothing in itself is addictive on the one hand, and on the other hand, everything could be addictive if there's an emptiness in that person that needs to be filled. I now know that nobody changes until they change their energy. And when you change your energy, you change your life. I'm Gwyneth Paltrow. This is the Goop Podcast, bringing together thought leaders, culture overchangers, creatives, founders, and CEOs, scientists, doctors, healers, and seekers.

2:57Here to start conversations, because simply asking questions and listening has the power to change the way we see the world. Here we go. Today, I was fortunate to sit down with Dr. Julius Few. He's a renowned plastic surgeon and a close friend of mine. Over the years, Julius and I have had many conversations around beauty, vitality, and finding the balance as we grow older. His subtle approach to aging astounds me. I have learned so much from him. Today, I got to ask him the big and small questions about aging, his philosophy on longevity, and the future of the facelift. We talked about recognizing our emotional states when we're thinking about cosmetic surgery.

3:43And Julius shared his honest advice about popular procedures and the new non-surgical advancements he's most excited about. I should also mention that we teamed up with Julius on our new Youth Boost Peptide Serum. It's an amazing collaboration, years in the making, and we couldn't be more proud. I'll let him tell you more about it. And finally, before we really get into it, I'm thrilled to share that the Goop podcast hit a major milestone this month. We surpassed 100 million total lifetime listens. I cannot believe it. So thank you to everyone listening today and who have followed along with us on this very special journey.

4:24Let's get to Dr. Julius Few. Thank you for joining us today. This is very exciting to have you on the Goop podcast. Thank you for having me. I feel like we have had and continue to have over the years so many conversations around beauty and longevity. And so I guess as I want to know from you more, like as a person first, what does longevity mean to you? Well, I, and you're right, we, for so many years now, we've had a chance to have these deep philosophical conversations about a lot of things, life and kind of inner peace versus outer kind of projection of appearance and so on. For me, longevity really boils down to really living our lives to the fullest potential, meaning that we are at a spiritual place of peace.

5:26We're at a place of peace with friends and family, that the work that we're putting into being healthy, we can see that translation and kind of our appearance, our body, not necessarily according to what a book says. or what your eyes say, but really what that individual feels is kind of their best kind of foot forward. And that's, that's really what longevity boils down to. I, like you have met, you know, many people who outwardly look perfect, everything in their world looks perfect. And then when you, you kind of start to peel it down, their, their inner reality is the exact opposite and they're trying to find something.

6:11So to me, I think there has to be that balance of, you know, as a person balance, living life to, to its fullest, its fullest balance. And, and that's where I think all these things come together. And do you bring that to the office? Like, I know you, we were talking the other day and you were, you were talking about how being a plastic surgeon, it's, it's like being a priest or a therapists, like people come in and kind of confess everything to you as if it's part, you know, I was thinking after we spoke, like the confession, it's almost like as if it's a part of what they're trying to change or become, like in some way it's conflated, like it goes hand in hand.

6:54Do you, do you find that, that there's a, an interweaving of the story? A hundred percent. And I think as I've gotten older and I've done this longer, it has been impossible to separate the story that somebody has to tell with the journey that they're willing to take to, in the case for me, as a plastic surgeon, for them to look better. So classic case in point, this was I had a very busy clinic yesterday. And I saw somebody and she ultimately confided in me all these different things that were going on in her life. And ultimately, how she really wanted to do something just for herself. She said, Look, I'm not trying to look better for anybody but me, I feel like I've given everything.

7:44And I just want to get something for myself. and can you give me kind of your perspective of what I may wanna do to look better and feel better? And in that case, and in all the cases that I, you know, who I encounter, the people who I ultimately, many of them I consider friends over time, I gave my honest advice that I would give to my own brother, which is, here's what you technically are asking for. Here's what I think, given all the things that you've shared with me, I think you can handle. Here's how we let's try to reconcile or kind of come up with a compromise of balancing what your goal is, because at the end of the day, you want in her case, you just wanted to feel a little refreshed.

8:32But she kind of came in based on things like social media and etc. Okay, what about what about this deep plane lift? Or what about this? Or what about that? And she was just rattling off all these things that she had heard about, instead of just saying, okay, this is what I want to get to. This is my final feeling that I want to get to. How can you, Dr. Few, help me get there? And so I think too many times, you have people who go in to see a doctor, and they're saying, okay, I've read about this or heard about that, or this is what I want to do. And they don't take into account any of the other dynamics in their life.

9:14And ultimately, that sets the stage for disappointment at the end of the day. And so for me, I, you know, I do feel and you've known me long enough to know this. I mean, I don't look at my work as just, well, I'm cutting on people, I look at it as, okay, I want I get a a significant amount of gratification, matching up that inner kind of balance of wellness and what somebody is looking for relative to the change that I believe I can achieve. And also that the third dimension, which is the idea that I don't want to do anything that draws too much attention to the issue that they're after for people around them.

10:00And that's one of the biggest things. that's the reason why I'm so against the idea of people being overdone because ultimately that does the opposite. It actually, it creates more attention in a negative way. Yeah. It's funny. I have a couple of people that I know in my life that sort of had plastic surgery in response to either a breakup or infidelity. And I said, I wish the surgeons would say, you know what, come back to me in a year when you don't have a broken heart. I think that would be sort of the more ethical thing to do because there really are a lot of women who are making big choices about big surgeries coming from a place of heartbreak or weakness or deep distress.

10:50I ask the questions that I think most people would consider obvious. I do ask, which is, and not as obvious from a doctor's perspective, but obvious as a person, I ask kind of why now, what is driving it? And the most common answer I get is, well, my, my life is calm enough that I can do, I want to do something, or I have something I'm trying to build into, like I, you know, there's a big wedding that I want to go to, and I feel like I haven't taken care of myself, or some of them, but it's not because like you said, it's a broken heart, or they're dealing with something that has destabilized their sense of balance.

11:31And if somebody has, like you described, a broken heart from infidelity or broken relationship or the like, a change on the outside is not going to change that anyway. So they can do all these things and it's going to almost be a double hit because then they'll look and they'll say, I really don't feel any better. I've had all these changes, but I still don't feel any better. And so that confounds the level of you know, despair. So chronic migraine is 15 or more headache days a month, each lasting four hours or more. Botox on a botulinum toxin a prevents headaches in adults with chronic migraine before they start.

12:05It's not for those with 14 or fewer headache days a month. It prevents on average eight to nine headache days a month versus six to seven for placebo. Prescription Botox is injected by your doctor. Effects of Botox may spread hours to weeks after injection causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems or muscle weakness can be signs of a life-threatening condition. Patients with these conditions before injection are at highest risk. Side effects may include allergic reactions, neck and injection site pain, fatigue and headache.

12:32Allergic reactions can include rash, welts, asthma symptoms and dizziness. Don't receive Botox if there's a skin infection. Tell your doctor your medical history, muscle or nerve conditions including ALS Lou Gehrig's disease, myasthenia gravis or Lambert-Eaton syndrome and medications including botulinum toxins as these may increase the risk of serious side effects. Why wait? Ask your doctor, visit BotoxChronicMigraine.com or call 1-800-44-BOTOX to learn more. I think what's so wonderful about you as a surgeon is that you are really taking the less is more approach always. And I love your philosophy around, you know, these kind of smaller things that you can do.

13:09As we talk about the importance of keeping your skin healthy and doing your threading, which you helped pioneer, which I forced you to do live in front of a huge audience at the first in Goop Health, which was still the highlight. Those stacking treatments, as you call them. But you do eventually believe in a facelift, right? You know, as I think a lot of the women who listen to the Goop podcast and men, you know, I think we are probably a group of friends, even though we all don't know each other personally, but we're like-minded group of people who I think are interested in kind of aging as best we can.

13:52A lot of us who are in our fifties, I think are, and those of us who are thinking about when we get to our fifties and what can we do today and, you know, at age 32 or like, we want to be ourselves. We want to live long and healthy and we want to look great. And by the way, as you know, I don't judge anybody. Everybody should do exactly what makes them happy. I do think if you want to do stuff that's more power to you, and if you want to age like a fabulous French actress or grandmother who never does anything, great. I think most of us are probably somewhere in the middle. So what do we start to do in our, even in our twenties and then into our thirties to kind of preserve the longevity of our skin, the vitality of our skin as it relates to health?

14:46Like, do you also believe in a sort of a lifestyle nutritional component? Yeah. It's no secret that I'm also like-minded with kind of how you look at, at this subject. For me, the highlights would be, I do think in the 20s, for sure, that is the low hanging fruit time to do good skincare. You know my boys. I hound on them to do basic skincare of a cleanser that exfoliates to try to use products that help to balance the natural kind of changes and both hormonal balance and so on. The obvious thing of hydration, I mean, one of the biggest things that people who are young kind of stress the skin because the skin is really our biggest organ is just hydration, drinking enough water and so on.

15:40I think that from the standpoint of the big, big picture and taking advantage of where we are technologically today versus when I was in training, you know, more than 25 years ago is the idea that you don't wait until things are broken down so badly that you feel like you have to do surgery. But really, I think plastic surgery slash dermatology, cosmetic dermatology have up until recently largely been more of a you see the problem, you fix it. Instead of what the rest of medicine is doing, and ultimately what I've been moved to do is think more preventatively. So one of the things that appealed to me about doing threading, because to be completely transparent, when threading was being introduced to me as something that the main manufacturer wanted to launch in the US about eight years ago, I said, no, I said, I said, surgery is the gold standard.

16:41I'm not really interested in the threading idea and so on. But ultimately, when I really started to think about, okay, well, what about somebody who is younger, where doing a facelift is too much? What about for them? And could this be the tool that could help to slow the outward signs of aging and actually give a bridge where somebody who otherwise maybe would have pursued a facelift at 45 or 50, can we push them out to 60, 65? What is a thread lift for those of us who? So a thread lift is basically using a, it's a fully absorbable surgical grade stitch material that has little anchors on it.

17:28It's passed non-surgically. There's no cutting. It's just a needle point of access, similar to what you do with a filler placement. but this thread is woven under the skin. It's painlessly done. Once a little bit of local anesthesia is put in, the person's totally awake for it. And it goes under the skin and a kind of in a structural way to lift the skin up and let, you know, kind of much like a mini facelift would do. It works best in somebody who has very early signs of like sagging. If somebody has a lot of sagging, it's not going to do the job or it will only do part of it. So, but conceptually using that as an approach for me, that really started down the path for my journey as a plastic surgeon of, well, what can we do to prevent?

18:19And so the way I look at fillers, the way I look at things like Botox, the way I think about lasers, all of these things are really into, I put them in one of two categories, one being preventative versus truly therapeutic. So if somebody has gotten to the point where you say, look, I really don't want to do fillers. I don't want to do Botox. I'd rather wait until I get to the point where I see something I don't like. And then I do surgery. And I have those patients. And so I have an example of that. A woman, very nice woman I've known. I take care of her daughter. She waited until she was 66.

18:55And just at 50, I did her eyes. so she had heavy eyes that did her eyes she said i'm not really interested in the other stuff and then she waited until she was 66 and then she said okay i'm ready to do a facelift in that case that that's a model that's tried and true and it works but like for this person's you know offspring they're wanting to do it a little differently they're saying well how maybe i want to push off a facelift until i'm 70 75 as an idea you know what are the things that i can do to go that direction. And so I think doing conservative replacement, conservatively lifting and addressing things, certainly in the in the 30s, I think is a sweet spot to really get in there and think about, you know, and that's why I applaud what you've done with your goop, you know, goop jeans line as is kind of thinking about things from the outside in.

19:49And then of course, balancing, you know, nutrition, lifestyle, exercise, all those things. Do you talk about that as well? And from a nutritional aspect with patients? We do. And a matter of fact, what we are embarking on right now is, and I've been working through it over the last year or so is, is actually really an integrative medical approach to this. So having a nutritional lifestyle slash component mixed in with what we're doing, doing IV therapy, for example, to enhance the results of some of these external treatments. You're going to hear a lot more about that. You know, at the end of the day, I'm a scientist also.

20:31So a lot of these things have been done and done very well. And I think, you know, certainly in New York and California, there's some very well-known outlets for this stuff, but up to now, it really has not been studied. Okay. So if you're doing an IV drip of like a glutathione, for example, how could that help enhance a Botox treatment or how could that help enhance a hydrafacial treatment, hydrafacial being a microdermabrasion treatment, or how is it going to enhance some other minor surgical procedure like having an eyelid lift? And so these are real questions that I've had. And really the reason, you know, kind of the question I've had over the years, you know, of how, you know, I've done over 8 ,000 eye lifts.

21:17How is it that somebody can kind of go into it and have almost no bruising, no swelling look like in a week, like almost nothing was done. And then I can have someone who had just as easy as surgery. And they look like I hit him with the back. Like, how is it? Why is that the case? Like, you know, and so you start to look at it. So I've over the years, I've started to dig into, okay, well, what do you do? What is your lifestyle? And I've learned things from patients. I would advise everyone to start to look into and research nutritionally what can be done to augment or enhance an outcome. And that's certainly what we do.

21:56So that's a huge part of it. And are doing eye lifts, is that like your specialty? I love eyes. I'm a sucker for eyes. I've always loved, loved. I just, I think it's, it's just one of the prettiest features for a woman, one of the most dramatic features for, for a man in terms of conveying confidence, I've always thought was the eyes. I wanted to initially in medical school become an ophthalmologist, but then I got snagged or snared by the surgical bug. So then I went the surgical route, and then ultimately did a fellowship in oculoplastic. So that's, yeah, so eyes are, that has been my thing.

22:39I've contributed chapters to the encyclopedias in plastic surgery. I've written probably over 20 published papers on the subject. So yeah, this is a super specialty. I developed some operations around it. I'm not trying to pound on my chest, but the eyes I've thought an awful lot about and kind of just the mechanics and how to allow them to look their best and most natural. And it seems like they're sort of the first to go. Like you hear a lot, oh, I did my eyes first. And then I waited 10 years to do anything else. I've only done my eyes. Is there anything non-surgical that works for eyes or not really.

23:20Absolutely. I think we kind of touched on this a little bit when I last saw you in person. I started thinking about fillers, for example, in people of color, primarily because the risk is higher for things like scarring with surgery. And so really using filler in the under eye, for example, in the right person, very small amounts can be a hugely powerful tool to make you know, kind of dark circles look like they're better at going away. What the hell? Why did you never pull me aside on that? Because you don't have any dark circles, you know, I, you got to have the problem to, to, to actually talk about it, but, you know, and so, you know, that's a great thing.

24:07I mean, doing something to improve the appearance of skin up until probably five or 10 years ago, So you would never think of lasering the upper eyelid skin, but that is a great way to help tighten up or make the upper eyelid skin look less crepey without cutting. Using Xeomin, for example, a form of Botox, you can use that to actually lift the eyelid and the brow. So there are different things technically that can definitely buy time. And what I'd advise anybody, especially if they start, because you're right, that's like the area you start to see go first. And most people is prevention first to push off surgery.

24:50I want to talk about our peptide serum that we created together, which is so exciting. So, well, the reason why we wanted to create this together. Well, I know why I wanted to create it with you because you're a above everything, a great friend, but be one of the most respected plastic surgeons in the country. And again, we have this alignment around skin health, keeping the skin great. And it was, it's such an honor that you were able to do this with us. Why did you want to do this with us? Well, I, the, the starting points were, were very much so for me, the same. I, I've always thought that you are a frustrated doctor, actually a frustrated surgeon, not even not just a doctor, a frustrated surgeon, plastic surgeon.

25:45And we've had conversations where, and I say this all the time, I teach, I've taught lots of students, residents and other doctors, you ask questions like, like a colleague would. And so, you know, besides just being a dear friend, I realized that you would be able to, and through your team, to be open to different ideas of how to come up with something that is clean, but yet effective, and that you'd be willing to allow me to subject it to clinical study. and I think there are lots of brands out there that would not necessarily want to undergo the scrutiny of a controlled clinical study because you don't know what's going to happen and so we were tracking the results on a regular basis and in the process and I'm going to step back because really this started a couple of years ago and when I talked to you know your Akshay your chemists.

26:49I mean, we were brainstorming for ingredients, we were brainstorming for things that people often probably don't think about, like smell and so on. I think that coming up with something that would be really uniquely kind of dynamic, and doing it with one of my dearest friends at the same time, that's like a dream. I mean, I couldn't ask for a happier thing, because at the end of the day, it's just, it's a really beautiful thing. I just cannot believe how well it works. I've been using it now twice a day since I got my bottle. I mean, I do not need a facelift today. Well, that's the thing. I mean, you never know what you're going to see with the study, but the results at a week, people were reporting to us because in the study, We had all the people who volunteered for the study.

27:45And by the way, nobody was paid to do this. This was all voluntary. They recorded - Very few people dropped out of the study, right? No one dropped out. No one dropped out. Which you said is unheard of. It is unheard of. Any kind of study, you could have a study of three people. One of them is going to drop out. So, you know, and we had many more than that. So I think, you know, that was, A, a testament to the product. And we even had a question in the diary, which a percent said it was easy to use. Over 90 % said they would recommend it to their friend or family member. But I think at the end of the day, what surprised me the most is that people were reporting across the board.

28:30And we saw this in our graphics. One week it took to start to see signs of improvement. So it just, yeah, it's an amazing, amazing concoction. So, and what I loved seeing in the before and afters in the study was the diversity of the patient's skin tones, genders, different, you know, sort of quote problem areas, whether it was rosacea or pore size, even, even fine lines. Like I could see the improvement in the photographs, like of the studies. It was so amazing to see. Were you surprised? I was very surprised. There were older people in the study as well. We have individuals in their late 60s in the study.

29:15And everyone, the data that we're talking about includes everyone. And so yes, we did pull some before and afters because we wanted to show diversity. I personally, as a person of color, I think so much of what is shown in the cosmetic space prior to you. You do this more with the goop site, but lots of other outside entities, they do not show diversity. So, yes, I wanted to show people of color because this is something for everyone, not just somebody who has fair skin. I think the other part is that we wanted to, you know, we wanted to show, and this study included men and women. and we had diverse ages.