Ep.157: What Every Woman Needs to Know About Plastic Surgery and Cosmetic Procedures: with Dr. Tony Youn

This transcript has been edited for clarity.

Robyn:  Hey everyone. It’s Robyn Openshaw, and welcome back to the Vibe show.

Today, if you could believe it, I’m actually going to interview a plastic surgeon.

I’ll tell you a funny story about him. He’s become a good friend.

His name is Tony Youn and I think he practices in New York city. He lives in Michigan. Probably practices in both places.

He is a board-certified plastic surgeon — like graduated top of his class kind of a guy — but he’s super humble. He tells it like it is, and you are going to hear some truth bombs in this episode that I think women who consider getting any kind of plastic surgery would pay lots of money to learn.

This episode is juicy as heck, so you’ve got to stick around because he has a blacklist of plastic surgery procedures that he really is willing to tell us the truth about, and he really dishes on this.

We’re going to get a little bit into breast implant illness and some topics like that. He has a really great balanced approach to all these subjects because he’ll tell you what the literature says, and he’ll also tell you when we don’t have enough research to really come to a conclusion on that, and he’ll tell you when he doesn’t know something.

He talks about some really interesting stories that might remind you of Grey’s Anatomy (if you were a Grey’s Anatomy junkie like I was for years) about what it’s like to be a resident, and what that does to a doctor and where we got this whole “doctor is God” complex. He’s actually coming out with a book called Playing God: The Evolution of a Modern Surgeon.

The book is funny and it’s heartwarming. He actually tells me a story in this episode you’re about to hear that really got me misty-eyed. And it’s also a pretty harrowing journey that he goes through to become one of the top plastic surgeons in the Eastern United States.

He’s an assistant professor of surgery as well; he teaches surgery at Oakland University and William Beaumont School of Medicine.

A funny little story before we get started: two and a half years ago — it was the day before my 50th birthday — I was playing tennis and I swung the racket — and this is the most unglamorous sports injury ever — I hit myself in the lip with my tennis racket and I had about almost an inch long, very deep gash in my upper lip. Well, your upper lip is not a place that you want a gash, right? But the next day I had big birthday plans. I was having a big birthday party, you know, it was my 50th. And so I’d been looking forward to it.

JP Sears was flying in, and on my 50th birthday we did a video that you could find on YouTube where he pretends to be a missionary because he was coming to Utah (he had never been to Utah before) and he’s riding his bike and he has a missionary name tag on, and he comes to my door and he’s teaching me the gospel of green smoothies. He comes in and makes a green smoothie in my kitchen and he puts a yoga mat in it and things explode. And there’s a celebrity guest appearance.

I never really pushed that video, but I should because I think it’s super funny. And people see it and they think that I’m super boring [laughter].

JP Sears is a YouTube comedian and he also goes out on goes to comedy clubs all over the country and does his shtick. But I think he’s funniest on YouTube and some of his videos get millions and millions of views.

You’ve probably seen him. He has long red hair and he always wears yoga pants and he makes fun of lots of “woo woo” earthy, crunchy, holistic health-oriented content. Super funny.

He was coming out the next day and I was super excited about making videos with him. But people thought that I was really boring in the video; what they don’t know is that he and I had scripted it. We kind of kicked the script back and forth a little bit.

I wrote the first script and then he added to it, and then he did some off the cuff stuff and I was trying so hard not to laugh during the video. There are a couple of times I just couldn’t help it. But I was trying very hard to be dead pan and not laugh at people took it as, “She’s boring.” I was actually just trying to play a part, and I’m not used to doing comedy.

But because I had all that going on the next day — and it was also my son’s baseball banquet for his junior year — I didn’t want to miss that. I didn’t want to go in and get stitched up.

In fact, I actually presented at InstaCare and they said, “We can’t stitch that.”

Well, I didn’t even know Tony Youn, but he was in a community of physicians and influencers, health and wellness people, that I was in.

I had posted this picture of my lip and I was like, “Hey guys, what do I do?” And he said, “I will fly to Utah and do it for you for free. You want to just get my plane ticket, put me up in a hotel overnight if you want. I will do that for free.”

And here he is, this top-rated plastic surgeon. I thought that was so sweet. And it really sets you up for the kind of person we’re about to talk to, because he’s really quite amazing. Open and honest.

But I did not actually do it. I did not take him up on that. And I think my lip looks fine. There was definitely a pretty hardcore scar there for a year or so. Now it’s faded.

I’m glad I didn’t get stitched up because the next day I just really wanted to have fun. I didn’t want to be in pain and on lidocaine and looking weird. It was also a vanity thing. I didn’t want to look weird on my video with JP. But that’s another reason why I looked boring, is that laughing or smiling really hurt with that scab on my lip. I look super weird in that video with JP, but I didn’t want to look even weirder having just barely had plastic surgery.

That’s my little lead-up story. With that, I want to introduce you to my friend Tony Youn.

Welcome to the Vibe show, Dr. Tony Youn!

Dr. Tony Youn: Thanks so much for having me, Robyn.

Robyn:  I’m really excited about today because we’re going to ask you so many hard questions that nobody ever gets to ask a plastic surgeon. No one would dare. But I’m just going to start right out with it.

I’m going to come right out with it, Tony, because you hang out with all of us influencers and authors and people in the holistic space; people who are, very frankly, pretty critical of Western medicine. And you’re almost the only one who like dares to walk into our circles and professional conferences and Facebook groups.

You’ve done it; you’ve walked right in and you’ve been very well received.

PS, Kristi Funk, MD from Beverly Hills was at Ocean Robbin’s retreat last week and we hung out a ton. Do you know her?

Dr. Tony Youn:  I know of her. I have not met her before. She was the breast surgeon, wasn’t she? Angelina Jolie’s doctor.

Robyn:  Yep. I’m going to have her on my show to talk about breast health soon. And she has some really cool content to talk about. I doubt that if I asked her that, that she would say that, but from other people I know.

I think there are people who are ready to pick up a big rock and throw it at her because — what do you guys call it? I call it preemptive mastectomies — because she was BRCA positive. I’ll ask her about that. I’ll see if I can find a nice way to ask her about that.

Besides the two of you, I don’t know anybody else who does plastic surgery all day, who are also super interested in holistic conversations and interventions and nutritional and functional medicine.

Tell me, how do those two co-exist for you and how do you become so holistic leaning even though you went for plastics as your specialty?

Dr. Tony Youn: I think that this is something that came a little later on in my career.

I went through three years of general surgery residency. After four years of medical school, I did three years of general surgery residency, two years of plastic surgery residency. I worked at a year fellowship out in Beverly Hills with a top Beverly Hills surgeon.

During that entire time, I was really in what was, traditionally, traditional Western medicine. And a lot of that is built on this old-school mentality of old-school surgeons where, when you go through your training, you beat down the younger residents to a pulp, basically, because you make them work ungodly hours, you treat them like they’re indentured servants. We used to call them “scut monkeys” and you can kind of guess why. It’s a terrible, derogatory term.

What happens with these doctors is that they become so beat down that they become bitter. And this is the beginning of this God complex that a lot of surgeons develop.

That was the name of my new book, Playing God. It’s this idea that you are, as an old fashioned doctor, old fashioned surgeon (it’s a patriarchal system), you’re the leader, you’re lording over everybody else.

There’s this saying that we used to always say: to cut is to cure. In surgery, that’s the idea: to cut is to cure. And that’s what I was all raised in.

I went into practice and I did very well, because I’m a pretty meticulous type of a guy, as you probably know by now, Robyn.

Robyn:  You better be; with what you do for living you better be.

Dr. Tony Youn:  I hit this pinnacle of practice where I was busier than I think probably anybody in town was. I had this long waiting list.

I had this patient who came in for a facelift, and it should have been very routine. She said, “Hey look, I’m in my early sixties and all my friends have had work done. I haven’t. And I feel like when I sit around them, all the guys look at them, but nobody ever looks at me. And they’ve all had work done and I haven’t. So I think it’s time.”

I look at her, and she looked like a reasonable candidate. I said, “You know, that’s fine. Let’s do this.” So I bring her to surgery and I do a facelift on her. The surgery takes about three, three and a half hours. She spends a night in the hospital. Everything goes well.

As I’m actually leaving the hospital after her surgery a couple of hours later, I’m about 10 minutes out of the hospital and I get a page on my pager. The page is from the nurse taking care of her and said 911 page. That’s as bad as you would expect. A 911, it’s an emergency.

I call the nurse back immediately from my car and she says, “Your patient is bleeding, and you need to get back now.”

I flipped my car around and I pressed down on the accelerator and I’m weaving through traffic, hoping that a cop would see me speeding and maybe try to pull me over, and at the same time pull everybody else over, so I could get a clear lane to the hospital.

I get to the hospital, I run up the stairs, enter her room, and I don’t see my patient.

I see somebody who resembles Jabba the Hut. Her neck is so filled up with blood that my worry — which is the big worry that you have when this happens — is that it’s going to basically suffocate her.

I throw a couple of gloves on, not even sterile, I take a pair of scissors and I cut all of her sutures out and in front of her husband, the staff, the nurses, I stick my hand into her neck and I’m grabbing globs of blood out of her neck. And then I bring her to the operating room.

The great thing about it is that she did great six weeks after surgery. She looked perfect. She’s hanging out with her friends. She’s so happy. But it really got me into thinking that, “Here I am at the top of my career, and I’m still following that whole belief ‘to cut is to cure.'”

 

Is Plastic Surgery Always the Right Path to Take?

Well, to cut is also potentially to create a major problem. And if you have a problem in surgery, the worst obviously is somebody can die. It really got me into really rethinking, “Why am I doing this? How am I doing this, and is there a better way?” And that’s what I’ve gone to.

That’s this whole idea of holistic plastic surgery. Looking at a patient as a full person, not as a procedure that I can perform, and looking at everything from skincare to what they eat to their environmental exposures to noninvasive and minimally invasive options, and really using surgery as a last resort.

Robyn: That is beautiful, but how do you get paid teaching them about prevention and less invasive options? You’ve written this book called Playing God, let’s just go there too. We have this sense that when all you’ve got is a hammer, everything looks like a nail. So when somebody comes in the door, you’re going to sell them plastic surgery.

Are you actually telling people they shouldn’t get the surgery in some cases?

Dr. Tony Youn: Yeah.

It’s interesting because I have been inspired by people like you where I can, in my practice, see 30 people in a day and I may change 30 lives in a day that way, but via my podcast, via my email newsletters, via YouTube and Instagram, I can reach thousands of people a day and help them. So that’s really what has been a huge change in focus.

I still operate a lot, Robyn. I operate two and a half days a week. I do a lot of facelifts, I do a lot of other types of operations, but it is always the last resort and I turn a lot of people down. I try to educate them on other ways that they can achieve what they’re looking for without going under the knife.

Sometimes there’s nothing else you can do. If you’ve had four kids, you’ve got skin hanging from your tummy and you don’t feel like you, you don’t feel comfortable going to the gym because all that extra skin is in the way, then yeah, the only option you have is the surgery.

I’m not beating around the bush that way, but at the same time, always looking at other options. If there are any.

Robyn: Yeah. And I think we should point out that beating up plastic surgeons is a terrible idea because, if we are unhappy with the idea that women feel they have to slice up their faces or slice up their breasts to be acceptable in society, to be desirable to men, to have status among women, you didn’t create that situation. You just meet the need.

I’m sure most women who come to you know exactly what they want, and they just want a really good surgeon who is well-rated, and patients find him approachable, which you are.

A side note, I should tell everyone the story of how you had sent me your first book. Was it your first book? What book did you send me?

Dr. Tony Youn:  That was my second one. The second one was The Age Fix. My first one was In Stitches, which was a memoir. That is the precursor to my latest one. I’ve written and published three books.

Robyn:  And you’re actually pretty young. I think it’s amazing that you’ve written three books while also you’re a dad, you’re husband, and a man of faith.

I love watching you, and I’m fascinated by your life.

I’m fascinated, like I said, by the fact that you’ll walk into this community of people who are historically pretty critical of your profession. But I don’t think that we need to hate on the plastic surgeons because the need for them is huge. Need being created by our society.

Someone like me, who breastfeeds four babies — some of them for almost two years — what you end up looking like at the end of that isn’t acceptable to society. Nobody should throw a rock at the woman or rock at the surgeon. It’s the culture that created this.

I love listening to you on other podcasts and I love when I have a conversation with you personally. I love how you don’t just tell a story that’s slanted to favor your profession, like “breast implants don’t make you sick” and the like. And don’t worry everybody, we will get to that.

I hope that you could tell me a story from your book Playing God, this new one coming out that reveals the real truth about plastic surgery.

Dr. Tony Youn: I appreciate you asking.

Just like you said, I think that there is a lot more to plastic surgery and the practice of it than meets the eye. There are those people, yes, who are on either side. There are people who are so anti-plastic surgery that they feel that anybody who has it done is being not truthful to themselves. The other side of people who are so plastic surgery addicted and crazy that they love classic surgery, that they recommend it for everybody; and it isn’t for everybody.

To give an example of what really I think the truth of plastic surgery — honestly, I think the truth of medicine is — is, I was early in my practice and I had this patient who came to see me. I was referred for, actually.

This was a woman who had open heart surgery, and during open heart surgery you basically cut the sternum, the breastbone, in half, so that the surgeon can get at the heart. She had this surgery and the actual heart part of it went well, but her sternum, her breastbone, got infected. So they called me in as a plastic surgeon to help reconstruct it. A lot of people forget that there is reconstruction and plastic surgery too.

I performed this operation, and for the first six weeks she does really well and I’m seeing her every day in the hospital for six weeks. I literally miss one day of rounding on her because I was working really late and I said, “You know, I’ll just see her tomorrow.” And when I go to check on her the next day, she’s not in her room.

I think, “Huh, did she go home?” I looked on the computer, and it says that she’s been transferred to the ICU. So I run over to the ICU and she is intubated on a ventilator and I think, “Oh my gosh, what happened?”

I looked down at her chest and her chest looks fine, everything had healed fine, but she had had a massive heart attack. And I talked to the family; the family said that she had this huge heart attack and that everybody says she’s going to die and that there’s nothing that they can do. So I basically stood over this patient who I’d spent six plus weeks taking care of. My patient.

As a doctor, honestly, I felt really helpless. The only thing I thought, the only thing that came to mind, is holding her hand and praying for her.

So, I held her hand, I said a few prayers, and I just kind of sat there for a few minutes holding her hand and then I left. And for the next two weeks I came in every day. And as a surgeon, it’s weird; because as a surgeon, I’m used to doing something and intervening and taking care of things and taking things into my own hands. And this was one of the only times in my practice ever where I couldn’t do anything.

I would go in and hold her hand every day for a few minutes and just sit there and be with her.

Well, two weeks into it, I show up one day (and every day that I’m there, they’re telling me she’s going to die any day now. You know, it’s over), I walk in her room and, holy crap, Robyn, she is sitting up in bed, breathing on her own with a big smile on her face.

I go to her, I go, “Oh my gosh, look at you.” I said, “You’re going to live.” And she said, “You know what, Dr. Youn?”

She said, “I knew.” And I go, ‘Well, you knew what?” And she goes, “I knew every day you came in to see me, and you held my hand every day.”

I said, “You did?” And she goes, “I did. And I looked forward to that every single day.”

She said three words after that that I remember to this day. She said, “You saved me.” Yeah.

And at the time, Robyn, I had hit rock bottom in my practice. I was early in practice, had a couple of patients that really threw me for a loop. And I actually was considering quitting medicine altogether.

I told her that she saved me too. Because this event in and of itself brought me back to the reality of what real medicine and even real plastic surgery is; sometimes it’s more important to look at the big picture and the holistic perspective of a patient, and the successes that you can have that way, versus just looking at the actual surgery and the procedure.

That was a huge point in my life that I think also has set me on the course of where I have gone today.

Robyn:  Oh, so beautiful. I actually got misty-eyed hearing that story because I feel like what you’re saying is, you came to the conclusion that it wasn’t just this surgery that she needed, that your skills could help her, it was also just your love and care and compassion.

Does that make you feel like you have more to offer as a surgeon?

Dr. Tony Youn:  Yeah. And I think that’s a difference between this old-school surgeon mentality and the modern surgeon.

I’m not going to say I’m the only one or anything like that. There’s so many of us now in this generation where we’ve been trained differently, we’ve reacted to training differently and we’re not the same doctors, the old-school surgeons that treated the nurses and the support staff poorly, that thought that they were gods.

It’s different. And that’s what I’m trying to help bring out there, for people to understand that there are these modern surgeons, like myself, where we look at a patient’s holistic wellbeing as the overall goal. We’re not this patriotical ruler, we’re part of the overall healthcare team. We use surgery as a last resort. And possibly the most important part of it is that we don’t think we’re God. We are not playing God. But we acknowledge that there is spirituality and belief, and that that can play a very integral part in a person’s health and wellness.

Robyn:  I feel like something has happened in the last 10 years –and my guess is that it has something to do with the fact that it’s somewhere between two thirds and three fourths of Americans in the last year have used some kind of holistic intervention, outside the drugs and surgery approach — maybe standard of care doctors can’t be arrogant and narcissistic and condescending.

Anyone hearing this should know that Tony couldn’t be less like that. Just doesn’t have the personality, doesn’t have that attitude. But I wonder too, if our doctors are just getting, like you said, beat down; beat down from medical school on and criticized as we rise up and say, “We want more from medicine, we want different from medicine, we don’t want the monopoly or the arrogance.”

Do you see a shift, in your 20 years of practicing medicine, in how doctors are?

Dr. Tony Youn:  I do, I do. I think that it’s looking at things in two ways, and I think it’s very simple.

It’s like when you grow up; you grew up as a kid and you’re treated a certain way by your parents. And if you have a parent who makes mistakes (and all parents do), you can do two things from it. And it really depends on the person. You can learn from your parents’ mistakes and vow not to make those mistakes as a parent yourself. And that’s something that I have very consciously tried to do with my kids. Or you could do the opposite.

What a lot of surgeons do is say, “Well, this is how I was treated. I was beat down as a kid, so I’m going to beat my kid down.”

And that’s how surgeons have been traditionally, that “I’ve been beat down as an intern, as a resident. So when I get there, I’m going to beat them down too, because that’s just the way things are.”

I think that there’s a difference between this old-fashioned surgeon and the more enlightened doctor who says, “I’ve been through this,” and that’s part of my book, going through being trained by these old-school doctors who are trying to beat you down, who are trying to make you in their bitter, arrogant image. But how do you overcome that and say, “You know what, that’s not me”?

I actually went into my residency with the knowledge that I’m kind of a weak guy. I’m not a strong person. I don’t look at myself as a strong person and I am not going to go somewhere that’s going to create that, that will make me that type of a bitter, angry, terrible person.

I went in specifically saying “I’m not going to allow myself to change that way.” But not everybody goes through that. There are other people that don’t quite have that. And if anything, they enter that old school idea of, “Hey, I was treated this way, so now I’m going to treat them that way.”

Robyn:  It almost reminds me of fraternities; there’s been a lot of legislation and a lot of attention to kids who get killed by hazing incidents. I don’t know what that’s called.

My son is going into his second year in a fraternity, and when I found out last year that he was going to pledge a fraternity, I was like, “No, please no. They get ridiculously drunk every weekend and they’re mean to each other and it’s like you’re either being bullied or you get past whatever milestone it is, then you’re the bully.” It sounds like a horrible culture.

It sounds like hospitals — and just the way doctors are trained up — is kind of like that, and probably because, “You are going to be the most well regarded, the most educated, the highest status among us. Let’s put you through bootcamp.” A military metaphor too, to see if you can handle it. There’s probably some of that too.

Kristi Funk told me this last week (because she was telling me how she was this art student, and they had no plans to be a doctor graduating college, and then God told her, “You’re going to be a doctor.” And she’s like, “What?”) she just went into residency knowing, “I will not have any life for five years. I will not have any sleep for five years.”

And that’s how she survived it, just expecting if you ever get to go outside and see blue sky and sunshine just consider it a gift. She went into it knowing that’s the culture of it. It sounds terrible, honestly.

But I feel like you probably know some good stuff. Let us in on it.

 

What You Don’t Know About Surgeons and Plastic Surgery (and Some Tips!)

You’ve worked in hospitals and ICU and the operating room for 20 years. Tell us something that most people don’t know about surgeons and plastic surgery. Even if they’ve watched all 13 seasons of Grey’s Anatomy, like I have.

Dr. Tony Youn:  Here’s a tip: July is not the time to go into a university hospital. I’ll tell you a little story why.

Every July, July 1st is the first day that the new residents come in, or is the day that you move up. The first year of residency is called your internship, your brand new year, just got out of medical school and you don’t know jack, you don’t know anything. You’re an intern and you’re a doctor, quote unquote “doctor.” July 1st is when they show up.

There are actually studies that do show that in university hospitals, the chances of you being injured by a medical error is higher in July than any other month of the year. And I give a story in my book that kind of illustrates this; I was actually a second year resident. It was my first day as a second year.

When I was an intern my first year, basically you just do what everybody tells you to do. And at the hospital I was at, they didn’t rely on you to necessarily save anybody’s life or anything. You just did paperwork, you did the small operations, and you just follow the people around and were their indentured servants.

But second year residency is a whole different story, and after five o’clock all the other residents leave. And the ones who are on call that night are there to basically put out fires. And what we mean by that is if something bad happens, you’re there to put that out and take care of things.

It was my first day; it was July 1st, my first day as a second-year resident and I had been so busy in a Jimmy Buffett cover band that I did not take the time to review all of my advanced lifesaving stuff.

I was on call with an intern, and we were just walking in the hall and this nurse grabs me and she says, “Dr. Youn call a code, Dr. Youn, come in, I need your help!” I looked to my left, looked at my right and was like, “Holy crap, she’s talking to me!”

I go into the room and here’s this woman lying on the bed. She’s probably in her sixties or seventies, and she’s not breathing. And [the nurse] said, “Call a code! My patient’s not breathing, I need you to run this code!” My mind goes blank because I literally had not taken the time to review any of this stuff. It was my first day in July.

I look at the guy, my intern, who just moved from Pakistan and basically spoke no English and he mouths to me, “No English,” and he basically tells me using hand gestures that he doesn’t know what to do either.

I’m thinking, “What do I do?” I just started picturing Grey’s Anatomy. I say “Get the crash cart!” So the nurses hook the patient up, we look at the heart monitor, and my intern and I look at it and we are smart enough to know this: she was in ventricular fibrillation, which is basically the heart rhythm that immediately precedes death. So if I don’t do something soon, she is going to basically die.

I know enough that I know I have to basically defibrillate her, or shock her heart, to bring her heart back to life.

Liked Dr. McDreamy on Grey’s Anatomy, I yelled, “Get me the paddles!” They put the paddles in my hand, I set the paddles down on her chest and I yell “Clear!” Like I’m on TV!

The nurse yells “Stop!”

Right before I press the buttons to defibrillate her, to basically shock her, the nurse grabs my hands, moves my hands into a different position on the patient, steps away and says, “Okay, go ahead.” I pressed the buttons, the patient’s heart gets shocked, and we stare at the monitor for a few seconds and she’s back into normal sinus rhythm.

We saved her, but it was not because of me; it was because of this awesome nurse who realized that the way that I had the paddles put on her chest, I probably would have shocked her liver, not her heart. And thank God that this patient ended up doing just fine. She survived, not because of me.

I left that event, went straight to my call room, and reviewed my ACLS, my advanced lifesaving, basically up until Dawn. And I never was caught in that situation again.

I tell you this story because yes, it is true that July is the month that has the highest risk of potential medical errors if you’re in a university hospital. If you’re not, then there’s no residents and you don’t have to worry about it. But that’s something definitely to know about.

Robyn:  First of all, best tip ever. Don’t get surgery at a university hospital in July. How interesting that it’s documented that there are more errors in July. And thank you for telling us that because I’m sure that that’s a secret that the whole plastic surgery industry and surgery industry in general would love to sweep under the rug.

But also, honestly, that story you just told is the most humble thing that I have ever heard a doctor say. And I am positive that in 20 years of practice that every single surgeon has almost made a huge mistake like that or been tired, has been up all night, has poor residents. Also people who work on call and people who work shift work. Two ER surgeons came to my Swiss liver detox retreat this last year and we were talking about that. And one of them only works like all night, like twelves and sixteens or something like that.

My point is — first of all, thank you for telling us such a humble story — my point is, it reminds me of my experience with attorneys, going through a horrible struggle, trying to get my kids’ father to pay child support and many, many other issues.

Over the course of 10 years of raising four minors pretty much by myself, I learned that attorneys are human beings, and you don’t just walk into court and hope that your attorney is going to represent you well because she might stand up there and be flipping through her notes and super embarrassed because she can’t remember your case from somebody else’s. Or she’ll say something wrong.

I’ve gone to court with several friends who are going through a divorce, and now if I counsel somebody who’s going through a divorce, I say, “You sit down with your attorney for one hour (pay her; pay her, it’s worth it) before you walk into court and you remind her of every single detail of your case.”

You want it front of mind for her because guess what? She walks into court; she might — and I’ve seen this happen by a very good attorney, my attorney actually but representing a friend, walk into the courtroom — after a sleepless night with personal issues right out of another courtroom situation and didn’t bone up on your case and has no strategy because she thought she was going to settle, and then you don’t settle with your ex in the hallway before, and she is standing up there with her pants down.

My point in telling that lawyer story is that it’s the same thing, if you’re listening to this: doctors are people. They might have had a long night, they might be in residency and just overworked. They might be depressed, they might be whatever. Maybe you could give us some pointers, because my pointer would be go in and meet with your doctor and ask really good questions. Be that educated patient, be the patient that they know they’re not going to get away with any shit. Am I wrong?

What other tips do you have?

Dr. Tony Youn:  It really taking the time and asking those questions. In my field, in plastic surgery, it’s super important because it really has become in some practices like fast food. It’s like an assembly line, where doctors go, “Oh, you want breast implants? Alright, go ahead, sign up over here.” And they just go and do it.

I’ve heard stories of, and I’ve seen patients where, they’ve had the wrong size implants put in. I’ve heard of practices where the implant is put in back to front, but the doctor doesn’t care. They just close the patient up and let them go. I’ve heard of stories of and seen stories of patients with breast implants in the armpits that are stuck there because an ER doctor that put the implant in, not a real plastic surgeon.

Especially in today’s wild West of medicine, you’ve got to do your homework. You’ve got to talk with your doctor, you’ve got to make sure that that doctor — especially if you’re going under the knife — takes the time to know you and know your case. Because there are some doctors who are doing 10, 12 operations a day. How do they keep track of all these patients? How do they keep track of your specific individual differences between you and the next person? It’s really important to make sure that you feel comfortable that that doctor is doing that.

Robyn:  Thank you. Great tip.

Once I had a surgery when I was younger, it was supposed to be at 9:00 AM and I couldn’t eat from the day before. I was there at nine at the surgical center and I sat there with my surgeon in the lobby talking to his accountant right in front of me until 2:00 PM. He literally talked to his accountant about all his financial problems until 2:00 PM. I was supposed to be the first surgery of the day.

That’s another thing: I think everybody should try to be the first surgery of the day, because I’ll tell you what, when I was a piano teacher and I taught eight students or 10 students in a row, the last student didn’t get as good a lesson as the first one did. So I kind of just innately knew that.

I was there at 9:00 AM but then he ended up not taking me until 2:00 PM and I think he was in a hurry and I got the wrong surgery!

Dr. Tony Youn:  Oh God.

Robyn:  I got the wrong surgery. And then another one, where I was in an emergency ectopic pregnancy out of state — didn’t even know I was pregnant, my ovary blew up — middle of the night, some guy comes in… I’ll tell you what, my scar from that is some crazy looking scar. I’m like, was the guy drunk? It’s not a straight line at all and it doesn’t really matter. It’s really low. But I look at it. I think they were trying to save my life, so I’m not mad about it, but, you know, doctors are humans. Try to avoid the OR, try to avoid the whole medical system if you can.

Dr. Tony Youn:  Totally agree.

Robyn:  Good. And that’s why you’re allowed in the holistic community. [Laughter].

Since we agree on that, you’re going to give us the inside scoop, everyone. We’re going to task Dr. Youn with going through like two minutes at a time telling us his download. And maybe we’ll go a little sideways and ask some clarifying questions.

He has a holistic beauty blacklist that he and I talked about, and I’m super excited to have him talk to you about these. About breast implants and the connection between a certain kind of lymphoma, Brazilian butt lifts, injectable fillers and the risks of that. Breast implant illness. People who do plastic surgery but aren’t real plastic surgeons. And we’re going to talk about thread lifts. So stay tuned if you’re into any of that.

Here we go.

Let’s start with breast implants and ALCL: anaplastic large cell lymphoma. This kind of cancer is pretty new, that there’s a real link there. Talk us through that.

Dr. Tony Youn:  This has been going on for the last few years. And interestingly, the media hasn’t reported on it, but it hasn’t really broken really big. My guess is a lot of patients still have not heard of this.

We started discovering that there’s a very rare type of cancer called anaplastic large cell lymphoma, a cancer of the scar tissue surrounding certain types of breast implants. Whenever you put a breast implant in, or really any type of a foreign body implant into the body, the body will create scar tissue circumferentially around it. And that’s for everybody. We used to think that the worst thing that can happen if you have breast implants: you’d get that scar tissue, which can get thick and can make your breasts feel hard and can even get calcified. And that stinks, but it’s not going to necessarily end your life.

But what we started finding over the last few years is that there’s this rare type of lymphoma of that scar tissue that can develop with textured breast implants. What those are, basically, is that implants can either come in a smooth shell or a shell that’s textured. It feels kind of like sand paper. If you’ve ever heard the term “gummy bear implants,” these are typically the gummy bear implants.

It’s interesting because we know that every single — right now, there’s been over 500 confirmed cases in the United States out of millions of women with breast implants, over 500 confirmed cases — every single one that is confirmed has some connection with a texture breast implant. We know of not even one confirmed case of a patient having a smooth implant and developing this cancer.

This cancer has resulted in the deaths of, I think, around a dozen people maybe. It’s not like pancreatic cancer where pretty much everybody who gets it is going to die, unfortunately. But it is something that people have died from.

Recently the FDA has actually issued a recall — and Allergan, one of the big implant makers in the United States has recalled — a certain type of textured breast implant. But that’s only one type. And there are many other types that are still available in the United States that plastic surgeons are still putting into patients today. And the argument of those plastic surgeons that they use in using them is that they feel they can get a better cosmetic result, and that the risks of this ALCL and the patient dying is worth it because they get a better cosmetic result.

I’m dumbfounded by it honestly.

That’s something that’s really important for women to know of. If you’re not sure if you have a texture breast implant, definitely something to know about and to contact your old plastic surgeon, your previous surgeon, and look at your paperwork so that you know whether you may be at risk of this rare type of cancer.

Robyn:  Super dumb question: why would a breast implant have the texture of sandpaper? Why is that a good thing?

Dr. Tony Youn:  Because they’re made basically to stick to the surrounding tissues.

For example, in a lot of women who’ve had breast cancer, the breast tissue is removed. They undergo a mastectomy. Because of breast tissues being removed, there’s nothing there to hold the implant up. If you put a smooth implant into a breast like that, it can drop very, very quickly. The idea behind this textured shell is that it allows the implant — especially if the implant is shaped like a teardrop — it allows it to hopefully stick in place so that it doesn’t fall, or so that it doesn’t go upside down and you have a teardrop-shaped implant that’s now sitting in the opposite way.

Robyn:  I want to say 25 years ago, silicone implants were banned. Okay. 1992 let’s see, how far off was I? Oh, 27 years. Okay. So it was banned. They were off the market for a long time, but now they’re back. They’ve been back for a good long while. Why did I think Congress… Weren’t there like congressional hearings and stuff? Why would they ban it from all these health problems? Kind of a similar sort of political situation?

Dr. Tony Youn:  ALCL, which is this cancer we just talked about, is separate from I think what you’re looking at, which is breast implant illness.

Breast implant illness is completely separate. Some people get it mixed up, but these are two very separate things. Textured surface breast implants are the risk of ALCL, whether they’re sailing or silicone. Breast implant illness is why the implants were taken off the market for that period of time. And this is a plethora of potential issues that some women get from their breast implants, whether it’s fatigue, rashes, muscle aches, hair loss. I know you covered that in a recent podcast.

The reason why they were taken off the market was because people were worried about it. The FDA did look and there were studies that were performed, and the studies did not, at that time, appear to show a connection between breast implants and these types of symptoms. And so they were put back on the market.

Robyn:  Okay. So basically there’s this very specific kind of cancer related to a specific kind of implant. And then there’s more and more information coming out about it over the last 30 or 40 years — since people started having implants for 10 years or so to even document it — is this whole gamut of illness that people blame on breast implants. A lot of that is legitimate I think is what you’re saying.

I think your stance is also, correct me if I’m wrong, if you have breast implants and you’re healthy, don’t do this big invasive thing to have them out necessarily. Because that’s got risks of its own, right?

Dr. Tony Youn:  There’s a couple of issues here.

When you look at breast implants, the satisfaction rate of breast implants is upwards of 97%.

Robyn:  Wow.

Dr. Tony Youn:  Yeah. It’s one of the highest satisfaction rates in all of plastic surgery. That being said — and really it is a bit of a sacred cow in plastic surgery, there are doctors I know of who the thought of breast implants making you sick they scoff at that and go, “Oh well we took care of that years ago,” that’s not true — I had a patient of mine who I did a breast augmentation on 12 years ago.

She was having some issues herself of some rashes, some muscle aches, and she saw an old-school surgeon down the street actually about 10-minute drive from my office. Because her husband was seeing this doctor. And she told the doctor, “Hey, I had this breast augmentation”, I think she had saline implants too, because they were done quite a while ago, and she said, “I’m having these symptoms and stuff. What do you think I should do?”

He said, “You need to see a psychiatrist.”

She came to see me a few months later and I was shocked that this idiot would say this to her. But that unfortunately has been the dogma in this old-fashioned plastic surgery group. The old-school docs. That, “Oh, you have issues from your breast implants? Your issues are psychological. It’s in your head, you need to see a psychiatrist.”

Well, there are some studies that are coming out (and granted they’re smaller studies), that are being performed in the rheumatologic literature. They are being published peer reviewed scientific journals, showing that there may be a connection between breast implants and certain autoimmune diseases like scleroderma, like Sjogren’s syndrome, and others. And more and more, thousands of women are coming forward and saying, “I think that I’ve got these symptoms due to my breast implants.”

And I’ll tell you, Robyn, I’ve had a handful of my patients who have had symptoms like that. And it appears two things can happen (and this appears to be consistent with the studies that we’re seeing in the literature):

If you’re a female, you’ve got breast implants for the last several years and you’re starting to develop these symptoms — but you don’t have full blown autoimmune, you haven’t been diagnosed with rheumatoid arthritis or Sjogren’s or something — and you take your implants out, then there may be about 50 to 70% chance that your symptoms will improve.

If, however (and I’ve seen this in my patients as well), you’ve had 20 years of terrible autoimmune disease, you’ve been on multiple medications and this and that, and you’ve had implants all this time, the chances of your symptoms improving when those implants are removed are fairly small.

I’ve seen that in my practice as well; when I get those patients who’ve got terrible autoimmune disease, who go, “Look, I’m at the end of my rope. I don’t know what else could be causing this. Let’s take my implants out,” I’m happy to do that. If you want me to take your implants on it, no question. That’s what we do. Unfortunately, they don’t seem to get much better.

What it really comes down to, Robyn, is that we need more research. We need more research to determine what percentage of women are at risk, who’s at risk, and what are the options that we can do to help these patients to get better.

Obviously, the final question is, should we keep doing this operation? That’s something that, unfortunately, with a lot of plastic surgeons, it’s not even on their radar of not doing the surgery.

Robyn:  The surgeons, and like I said before, the women; I had an OBGYN friend tell me — and maybe you corrected this and said, no, it’s lower — an OBGYN friend told me that it’s one in three women (maybe it’s one in three women in Utah, I wouldn’t be surprised about that at all — this is an interesting state with its own flavor on many things) one in three women have breast implants. Is that way off?

Dr. Tony Youn:  I don’t think really that many. However, there was a survey several years ago that named Salt Lake City the top city for plastic surgery in the United States.

Robyn:  Stop [Laughter] I’m telling you; I didn’t want to say anything rude because I do live here. I do love this place. All my family and friends live here. It’s so interesting because it’s a pretty holistic-leaning culture here. But nothing healthy ever flies here. All those businesses just go out of business and there’s very little interest in environmental stuff. And some Utahns love them some plastic surgery. And, number one for consumption of depression medications, SSRI, nationwide.

My ex-husband’s second ex-wife — everybody got that, my ex-husband’s second ex-wife — is a plastic surgery addict. I’m going a little sideways here, but I didn’t even know some of these things could happen with surgery. Of course I learned these things after she was his next ex-wife, you know, the kids talk or whatever, but she actually had the equivalent of a tummy tuck on her arms. Never knew there was such a thing. She literally had surgery, she had scars on the underside of her arms and she had a tummy tuck, or multiple tummy tucks, to the point she did not have a belly button.

Do you have these surgery seekers who are addicted, and like every year they plan their two surgeries? Do you say no to them?

Dr. Tony Youn:  Oh God, yeah.

I had a patient who came to see me, and anybody would look at and go, “Oh my God, this woman’s addicted to plastic surgery.” And she kept making appointments to see me. And every time she would come in, I would say, “I’m not going to do anything for you, but let’s talk about reversing what you’ve had done. This is what we should do, blah, blah, blah.” Then she’s like, “Okay, thanks.” And leave. And then a year later she called, wanted another consultation.

It got to the point where she would come in many, many years in a row and we’d always book her at the end of the day because I don’t want any of my patients thinking that I am the one operating on her. [Laughter]

So, I see that all the time. Unfortunately there is this plastic surgery addiction. There’s body dysmorphia. I talk a lot about that in my new book Playing God, of just how do you deal with patients.

I had one patient with body dysmorphia who I operate on mistakenly, not knowing she had BDD, and she ended up threatening to hit me with her car. She tried to extort me for all of my money. And at one point she was screaming that she was going to destroy me if I didn’t operate on her again, or pay her all of this money, and make it so the only people who would allow me to operate on them are the whores and she’s running through my office screaming the whores, the whores, the whores.

There’s some crazy stuff that happens.

Robyn:  Yeah. I would imagine body dysmorphia, is a pretty extreme mental health disorder. I bet a lot of those people are also bipolar. I mean, they just almost go together.

Dr. Tony Youn:  It tells me something that 1% of population have BDD — body dysmorphia — and 10% of plastic surgery patients have BDD. And if you look at specific operations, like a nose job, you’re probably looking at closer to 30%, maybe even more.

Robyn:  I should have said borderline actually, more borderline than bipolar, but both.

Dr. Tony Youn:  Yeah. Borderline.

Robyn:  Pro-tip, everyone: do not threaten the person that is going to be operating on you. Treat them well, bring them cookies. Oh geez. Okay.

 

What Is A Filler? Cosmetic Surgery, or Plastic Surgery?

We’ve got to talk injectable fillers because I know this is super, super hot. And I’m going to completely reveal my ignorance here.

I had someone come to my Swiss retreat two years ago who had to get on the plane two days late because she was having a massive reaction to, I think it was Botox. Here’s my ignorance. When you say injectable fillers — because they’re on your holistic beauty blacklist and I’m sure you’ll fill us in — are we talking about Botox? Are we talking about the stuff that you inject in your lips? Are we injecting the forehead or injecting the lips? What? What are all those?

Dr. Tony Youn:  Botox is a neurotoxin and that’s not a filler.

Robyn:  Okay.

Dr. Tony Youn:  Botox is a neurotoxin; it causes muscles to weaken. Those muscles that create wrinkles, typically of the upper face — like the forehead lines crow’s feet, frown lines — those are usually treated by Botox.

Robyn:  Do you think that safe at this point? Let’s go sideways on that for a second. It’s not on your list.

Dr. Tony Youn:  Yeah. Botox is the most popular cosmetic procedure, probably in the history of the world. I’ll tell you, Robyn, in my practice we probably treat at least 10 patients with Botox every day for the last 15 years. And I’ve never had a serious complication from it, or anywhere close to that.

Robyn:  Okay. In the few stories I’ve heard, this lady who came and she (you know what, maybe it wasn’t Botox because I know you’re going to talk to us about fillers that can make you go blind) she couldn’t see. So it might’ve been something else.

Dr. Tony Youn:  Yeah, that’s different.

I do want to preface that, however, saying that there are some people online and some people who do feel that they have developed some medical issues from their Botox injections. I’ve never seen it; it’s not in the literature or anything like that, so I can’t really say what’s going on with them. But like anything, there are people who are just not going to do well with it. But in general I say yes, Botox is safe for the vast majority of people.

Robyn:  Is there any longitudinal research at this point? I mean, people have been doing it for, what, at least 15 years?

This is my whole issue with it, even like you said: we need more research. And I’m really glad you said that because why would the two big industries benefiting from the popularity of Botox and breast implants and all that, why would they study it?

We need somebody else to study it. But who’s going to study it? Who’s going to spend $1 million to track women for 25 years and say, “Because you had lots of Botox for 10 years, you have more of this or this or this health issue.”

Do you have anything? Like, if you’re going to go wrong with Botox and what’s the other one? Juvéderm? No, what’s the other Botox?

Dr. Tony Youn:  Oh, there’s a number of them. One called Jeuveau, there’s Dysport and Xeomin.

Robyn:  Is there a way to go wrong with those? Like keep it under X number of units, I think is how it works.

Dr. Tony Youn:  There are little things, like you can get a droopy eyelid for three or four months from it. That type of stuff. You can look weird from it. But if it’s not black market, if it’s not injected in with overly excessive amounts, if you really are following the general guidelines that the vast majority of doctors follow, once again the serious risks are very, very minimal.

Fillers are a whole other story though. And that’s where I would really exercise caution.

Now, fillers are not on my blacklist. It’s the type of filler that’s important. There are fillers that are made of hyaluronic acid. They’re typically Restylane and Juvéderm. And those are the ones that we use in my office. One reason why is because they are completely reversible, because the worst thing that can happen with the filler — and we’ll get to this whole blindness thing — basically the way describe it, it’s like liquid skin.

The earliest filler was collagen. And collagen would come in this vial you injected into Barbara Hershey’s lips and her lips would look bigger and it lasts about three months and then it goes away. Well, the new fillers are hyaluronic acid and other substances and they’re used over college nowadays because it lasts much longer.

The danger of filler, however, is when it’s actually injected into a blood vessel. And especially an artery. Arteries supply blood to parts of our body, parts of our face. And if you clog an artery, then that part of the body that needs that blood can turn black and die. It’s like if you take a string and you tie it around your finger really tight and you don’t get blood supply to your finger, it’s going to die, turn black and fall off someday.

What can happen with filler is, if you actually inject filler into a blood vessel and it clogs that blood vessel up, you can lose parts of your nose, you can lose parts of your lip, and people have even gone blind from it when it’s injected inappropriately.

It can happen to anybody. That’s a risk of it. No matter how good your doctor is, no matter what technique, no matter what they’re using, it can happen. But your risks are much, much smaller if you do two things:

The first thing: use the right filler, which is a hyaluronic acid filler like Restylane or Juvéderm, because you can melt it away if there’s a problem.

And the second thing is use a cannula. A cannula is a blunt needle that is made to ideally not a puncture a blood vessel. Well, a needle can go right into a blood vessel. But the idea behind these cannulas is that in general, they don’t know. Sometimes they still will, but your risk is lower.

Those are two huge things that I recommend. If you’re going to consider filler, make sure it’s a hyaluronic acid one and make sure that the doctor, if possible, is using a cannula because that’s going to make it much safer for you.

Robyn:  When I was at the spa, a lady there told me hyaluronic acid is what Restylane and Juvéderm are and she was like, “It’s just sugars.” And I was like, “Oh, I bet that there’s more than that in there.”

Are there heavy metals in there? Do you know?

Dr. Tony Youn:  I don’t know specifically.

Robyn:  Okay. I can’t get anybody to tell me that and I couldn’t learn it on the internet.

Dr. Tony Youn:  I don’t know that that’s information that we would even be privy to. Honestly. We understand in general what it is, and hyaluronic acid is a naturally occurring substance in the skin and the body completely breaks it down. But yeah, is there a chance that there’s anything else in there that we’re not privy to as physicians? I suppose that’s always possible.

Robyn:  So, if your spa is selling you on fillers, find out if it’s Restylane or Juvéderm, the two that are just hyaluronic acid, and don’t go for the hyaluronic acid plus other substances, which is other brands, right?

Dr. Tony Youn:  Yeah, there’s permanent fillers out there that are bad, bad news. There’s one with calcium hydroxylapatite, which is basically bone paste. Also not a good idea. The majority of them are hyaluronic acid, but there are some that are not. So just make sure if you really want to remember, just remember Restylane or Juvéderm and you should be safe from that perspective.

Robyn:  Okay. Really good information.

If anybody’s expecting me to say, “Nobody should ever get any cosmetic anything done,” listen, my audience is doing a lot of that. I want to serve them, I want to give them good information. I don’t want to be judgy. And like I said, it’s not the women’s fault we live in this weird culture.

Dr. Tony Youn:  And you and I both know that the majority of holistic health practitioners, people who are out there, they’re getting stuff done.

Robyn:  Totally! [Laughter]

Dr. Tony Youn:  They may not admit to it, but I’m friends with a lot of them. And you are too. And we know this stuff and it’s fine. I think it’s doing it in the right way and doing it safely, and not glamorizing it and making it, “Oh, it’s as easy as getting your hair done,” no, it’s not. We have to take it very, very seriously.

Robyn:  I’m not a junkie myself, but I will freely confess that I am not immune to it. I’m not one of the ones saying I would never, because maybe I would.

Dr. Tony Youn:  A lot of times that people saying, “I would never,” are in their twenties and don’t need it anyway. And how will you feel when you’re in your forties or your 50s or 60s?

Robyn:  Oh, right.

Dr. Tony Youn:  You can’t really judge people when you already look great, and you haven’t had to go through any of that.

 

Let’s Talk Plastic Surgery: Facelifts

Robyn:  That reminds me of face lifts. A friend of mine said to me 10 years ago, “You don’t do a face lift until you’re in your 50s.” I don’t actually have any interest in a facelift myself, but it wasn’t on your black list.

What do you think about facelifts? Aren’t you cutting the top of someone’s face and pulling it up?

Dr. Tony Youn:  Yes.

Robyn:  Do you do that surgery?

Dr. Tony Youn:  I do it once a week probably. [Laughter]

The issue with a facelift is yes, if there’s anything you can do to avoid a facelift, by all means do it. I tell my patients when they say, “When do I think I’m ready for a facelift? When do I know that I’m ready for a facelift?”

I tell them, basically, “When you hate your neck and your jowl so much that you are going to spend upwards of $15,000, go under the knife for three and a half hours, get permanent scars around your ears and underneath your chin that we cannot guarantee how they’re going to heal, you’re going to have a two week recovery time with the potential risk of complications and an overnight stay in the hospital and you’re excited because you hate your neck and your jowl so much, then that may be the right time.”

Robyn:  Very well put. That was hilarious.

Did we cover fillers in good detail? I feel like we did.

Dr. Tony Youn:  I think so.

Robyn:  Okay.

 

Cosmetic Surgeons Vs Plastic Surgeons

I know that you have a small rant that I would like to hear, I haven’t heard it, about doctors who do plastic surgery who don’t have your additional years of training. They’re not real plastic surgeons.

How do you know the difference? Because honestly I don’t think most people know.

Dr. Tony Youn:  One of the things I put in my book Playing God is what does it take to become a modern surgeon, especially a modern plastic surgeon. It’s four years of medical school. Then you have to get into residency.

The joke is, what do you call the person who graduates last in medical school? Doctor. [Laughter] That doctor cannot be a plastic surgeon because it’s so hard to get into the field. When I tried to get in, it was like one out of every 20 people could get into plastic surgery, and these are people who are at the top of their classes.

You do four years of medical school that you have to excel in because otherwise you won’t get in. You do three to six years of general surgery residency, and that’s when you get beat down to a pulp. You do two to three years of plastic surgery residency, and then quite often an additional year of fellowship. Then you take board exams. You do oral exams. And you have to maintain a certain ethical standard and all this stuff to become a true board-certified plastic surgeon.

To become a cosmetic surgeon and to operate on people and put an ad out there, all you have to do is finish four years of medical school and get a medical degree. That’s it. And there are people who are doing that. They may do an internship year — some of them haven’t even done that because they have been grandfathered in — you do a weekend course in liposuction or you follow somebody doing breast implants for a week or two.

Technically you open up your own in-office OR and you can do anything that you want. Because the law allows a doctor to perform any procedure that they want to as long as the patient signs on the dotted line.

And therein lies the rub.

That’s this little loophole that these phony plastic surgeons use to perform these operations. They put these fancy ads out there, they buy maybe some type of an instrument or a laser or something to try to get people in the door, and some of them will even join phony societies because then they’ll say that they’re board certified by this society that real doctors have never heard of. But they put a certificate on the wall and dupe people into thinking that they actually know what they’re doing. And that’s where you see all these stories and you watch Botched on E and bad stuff comes out of it.

Robyn:  Anybody thinking about plastic surgery? We’re not here to sell plastic surgery. I’m certainly not. What is the question, Tony, that you ask a surgeon you’re considering because your friend had a good experience with him (which I don’t think is good enough research to go under the knife and let somebody potentially change your life, and not necessarily in a good way). What is the question you asked them to make sure they’re a quote unquote “real plastic surgeon?”

Dr. Tony Youn:  What you want to ask them is, “Are you certified by the American Board of Plastic Surgery?” The American Board of Plastic Surgery is a big thing.

And obviously you want to sit down, spend some time with that doctor. If the doctor is in a rush, is in a hurry, zips out of the room, they have their assistants do everything, then you know that that’s the time spent doing your operation too. And that it’s probably not the right doctor.

Robyn:  Okay. Critical question: “Are you board certified?”

Dr. Tony Youn:  “Are you certified by the American Board of Plastic Surgery?” Because you have doctors say, “Yes, I’m board certified,” but in the back of their mind, they’re saying “…in internal medicine.” But they don’t tell you that.

Robyn:  These are the ways that people can be squishy around that question.

I have this slight pet peeve about how people only pick doctors based on bedside manner.

I know you know that very famous study, about how the predictor of whether people will sue their doctor is how many minutes he spent talking to them or whatever it is. Like, people sue their doctor or not depending on whether he was nice. So my pet peeve is this: people who don’t ask anything about the qualifications of their doctor or their surgeon.

I have actually asked this question of a doctor (you have to take a deep breath to do it, you have to be very committed to having hard conversations and asking hard questions) I have actually said, “Where did you graduate in your class?”

I’m going to play a game here, now they told you that I have done that — and I don’t do that because that’s my only criteria, but how nice the guy is and how much we connected should not be the primary determinant of whether you hire this person or not to do a very, very important job — I’m going to make a prediction.

If I ask you, “How many people in 20 years of practice have asked you where you graduated in your class?” I’m going to guess that it’s less than five.

Dr. Tony Youn:  You’re correct. It’s zero.

Robyn:  What?!

Dr. Tony Youn:  Zero.

Robyn:  Stop. Zero. What should we ask our doctor? Oh my gosh. [Laughter]

Dr. Tony Youn:  I think that’s a good question, but I’ll tell you my answer. And the truth is, I graduated in the top third of my class in medical school. But when I took my plastic surgery stuff, I was in the top 4% I think, something like that, with my plastic surgery exams. So you have to take all of that into account, and honestly it’s hard to.

There’s no one thing that you can look at with choosing a doc. You have to look at everything, the whole big picture, right? Because I know doctors who have gone to really prestigious residency programs and stuff, and they are crappy surgeons and they move from town to town because they just mess everybody up every town they go to. So unfortunately, even if academically you’re strong, it doesn’t necessarily mean you’re going to be a good doctor.

Even if you go to the right school this doesn’t necessarily mean anything. You have to take everything into account and look at reputation. Look at the time they spend with you. Bedside manner is important. The most important if you develop a complication, because if you develop a complication and bad stuff is happening and you need somebody to explain things to you and to help you and to get you through it, if the doctor has poor bedside manner, that makes it so much more difficult.

You and I both know — and it’s the stuff that you’ve gone over in your podcast and your information — that mindset makes a huge difference in your health. People who stress a lot are going to have a higher risk of complications.

Robyn:  If your doctor is kind and listens to you, that seems to bode well for him being good at what he does as well. It shows conscientiousness.

However, my reason to ask, “Where did you graduate in your class,” is I don’t want the guy who graduated in the bottom half of his class. I really don’t. You want to hire someone who’s good at what they do.

I listened to a podcast called Dr. Death not long ago. It’s this story of this dude — he’s in prison now — but he was killing people right and left. He was not a plastic surgeon by the way, but he was stoned or drunk all through med school. And then he just went from place to place, and nobody wanted to go to the trouble of taking this guy’s license away. And it was finally two, I think two doctors, maybe one, went to the trouble of stopping him from just jumping from hospital to hospital.

Maybe another good question is, “How long have you been here in this private practice, doing surgeries at these hospitals? Maybe if you’ve been doing it for five years or more, that’s a good sign.

Dr. Tony Youn:  That’s true, because a lot of the bad doctors do move around. I’ve seen that here in Metro Detroit, where we get a bad plastic surgeon come into town and they have ads everywhere for a year or two and then they disappear and they go to the next town.

Robyn:  Like you said, it’s not one question is the definitive metric by which you decide whether to work with this doctor or not. But just because your neighbor had a good experience, guess what? What if your neighbor is the one in three who has a good experience, and two out of three are bad? We just have to dig a little deeper.

It’s getting harder because the internet used to be just good information with people who have stuff to say, and now everything’s bought and paid for on the internet and people can really bury bad reviews. And I think doctors can really curate good reviews, like go out of their way and pick the 10 patients who like them to give them amazing reviews, maybe even write the reviews for them, and the patient signs off on it.

Lots of crazy stuff goes on. So not to scare y’all, just to say, “Hey, do a little more homework. This is a big decision.”

Dr. Tony Youn:  Definitely.

Robyn:  One more. One more. You’ve been just so generous with your time and given us so much great information.

What about thread lifts? You told me that this is a horrible procedure and they abandoned it 10 years ago, but we were talking about silicone breast implants were banned 25 years ago too and they came back. Thread lifts are making a resurgence. What do you have to say about that?

Dr. Tony Youn:  What I have to say about that is, these are procedures that were really popular about 10 years ago.

Doctors were performing it and singing its praises and “Oh, what a great way to do an instant facelift with no cutting,” and blah, blah, blah, blah. And then they figured out that the procedures didn’t work. Initially it would look pretty decent, and then a month or two months later they would lose most of the results and these permanent threads that would be going through their face would still be sticking out of little holes in their face. It was just not good.

So, these companies, some of them went out of business; they stopped making them.

Well, what happens in our field, unfortunately, is that new doctors, there’s a new generation 10 years later, who don’t necessarily do their homework and they say, “There’s this new procedure called this thread lift, and they’re using these absorbable sutures. So what can go wrong?” And, “Hey look, I just did it on somebody and look at how lifted they look,” and they start advertising it.

Well, unfortunately they don’t work.

There was a study that was literally published just a month or two ago in the Aesthetic Surgery Journal showing that these things don’t work. But unfortunately they’re out there, and there are a lot of doctors promoting it because they promoted this simple, easy way to do a facelift. And the results don’t last longer than about six months typically.

Unfortunately, what’s probably going to happen with this is that over the next year or two they’re going to eventually fall out of favor and then 10 years from now, Robyn, people are going to say, “Hey there’s this idea of thread lifts!” [Laughter] And start doing it again.

Robyn:  You know what? I know they will, because this is just the way of profit industries. When you make a ton of money on something and then it gets run out of town because it’s really bad for you (we could give examples, the HCG thing, we already knew 40 years ago that it caused cancer and massively ramping up your human growth hormone with injections as a terrible idea ) but you just let people forget, just let them forget for a decade or 15 years, and then they’re going to bring it back.

If there was money being made, they are going to bring it back. The Adkins diet got ran out of town on a rail, went bankrupt. The founder of it did not die in a healthy way. And so what do we do? We just wait until everybody forgets and then we get it back as the Keto diet.

Make sure we all think about our critical thinking skills before we jump on a bandwagon; just because somebody is selling it doesn’t mean it’s safe for us. I talk so much, Tony, about critical thinking skills and asking more questions before we jump into a fad and waste a bunch of our money or potentially cause ourselves some unwanted side effects by just chasing bunnies down a trail instead of doing the basics of being healthy.

This has been a completely amazing conversation. You’ve told us stuff that I don’t think one in a million plastic surgeons would be willing to say; you’ve told us so much in a humble and open way. I just am so grateful.

Tell everybody what your other two books are, besides Playing God coming out. Everybody should go get Playing God. Pre-order it, if this comes out before it’s available on Amazon, preorder it. Tell them your other two books again and where they can find you and follow you.

Dr. Tony Youn:  I’ve got a book In Stitches, which is the precursor to Playing God and The Age Fix, which is the one that Robyn mentioned earlier.

I also have a podcast, the Holistic Plastic Surgery Show, which I have been very fortunate to have Robyn on in the past. So if you’re interested in the holistic anti-aging, then it’s a podcast that hopefully you may find very interesting.

Robyn:  Well, thank you so much for being with us. This has been fantastic. I really appreciate you.

Dr. Tony Youn:  Thank you so much for having me, Robyn. It was my pleasure.