Ask Me Anything with Dr. Johan Brahme, Plastic Surgeon

Monique Ramsey (00:03):
Hello everybody. Welcome to our Ask the Expert, anything with Dr. Johan Brahme. Well, thanks Dr. Brahme for doing this. This is our first in the series.

Dr. Brahme (00:13):
Oh, absolutely. This is sort of like a little fireside chat.

Monique Ramsey (00:16):
Yeah, exactly, exactly. And it's just everybody ask their questions. So I had everybody submit questions ahead of time and we'll also try to take some live, but I really wanted to get them ahead so we could just run through them. So if you would go to the next slide, and I just want to let everybody know what the format is today. It's, we're going to go through the Q and A and answer all the questions we can. So welcoming to Dr. Brahme, he has been such a fixture, I guess La Jolla Cosmetic because he's just celebrating his 20th anniversary with us this year. And so it's perfect that he's kicking off this series and he has been doing plastic surgery for over 30 years. And I'm sure you all have, if we've been in the office, we've met Christina as well. So it's our Swedish stellar team, right?

Dr. Brahme (01:12):
Yeah, the Swedish team.

Monique Ramsey (01:13):
The Swedish team, yeah. So he's double board certified. And I thought the first question I could ask is, what does that mean, Dr. Brahme?

Dr. Brahme (01:23):
So that means that when you train in plastic surgery, you don't go straight from medical school into plastic surgery, you have to train in another surgical subspecialty first. And I trained in general surgery. I did seven years of general surgery, and then I got board certified in general surgery. And then I did another two years in plastic surgery and got board certified in plastic surgery. And board certification is a two part examination. There's a written examination and then a very, very, very stressful oral examination. And so I am board certified in both general surgery and plastic surgery, but I practice only plastic surgery now.

Monique Ramsey (02:09):
So that was the first question. I'll let you go to the next slide and then we'll just go ahead and get into the question. So what I thought I would do is show this adorable picture of Dr. Brahme. That's a little tyke with his, I think, was that stethoscope there?

Dr. Brahme (02:26):
Yeah, there.

Monique Ramsey (02:27):
Yeah, there. So is that the cutest thing ever?

Dr. Brahme (02:32):
That was my grandfather's stethoscope.

Monique Ramsey (02:35):
Oh my gosh. You have a family of physicians, right?

Dr. Brahme (02:39):
Yeah, my father was a physician and my grandfather, my grandfather and father both were physicians.

Monique Ramsey (02:45):
So did you know that that's exactly what you wanted to do right away?

Dr. Brahme (02:48):
Well, didn't have much choice, right? That's all I knew.

Monique Ramsey (02:54):
That's the legacy. That's the legacy. Okay. So we'll get started. And so I wanted to start off with our first question is please explain the difference between liposuction and a tummy tuck or who might be the better candidate for which procedure.

Dr. Brahme (03:11):
Okay. So liposuction is basically what the name suggests. It's sucking fat. Lipo refers to lipocytes, which are the fat cells, and that's done through multiple small incisions that are about, I dunno, an eighth of an inch in length. You basically suck out the fat and then you hope that the skin retracts smoothly so that you're really counting on the skin elasticity to be good. So if you have stretch marks and things like that, you might not be such a good candidate. And liposuction is, depends entirely, I mean a good result from liposuction depends entirely on the quality of the skin. Is the skin going to re drape and not hang? And to evaluate that, you obviously have to see the patient and to see, to evaluate that. A tummy tuck basically is cutting out all the excess fat and skin from the abdomen, tightening the muscles, making a new belly button, and it's a bigger procedure. But for the patients who are good candidates for that, there is no substitute.

Monique Ramsey (04:32):
So another question we have is what's the best procedure for fine lines around your eyes?

Dr. Brahme (04:39):
Well, fine lines, we talk about different types of lines in the face. We talk about dynamic lines and static lines. And the static lines are when you look in the mirror without any facial expression, those are the static lines, the lines that are there all the time. And then they're the dynamic lines, which are the lines that you see with facial animation, like the lines around your eyes, they're lines in your neck when you sort of scrunch your neck down. And those are much more difficult to treat. And those we often treat with Botox, the lines around the eyes. If they're static lines, you can treat them with lasers, you can do a brow lift. There are lots of options for that. There's no really best procedure. It is all individual.

Monique Ramsey (05:35):
And do you still do that temporal tucks where it's just that little from here to here above the ear or do you tend to do both?

Dr. Brahme (05:43):
Rarely I do. Yeah, I do do it, but it's not a frequent thing that I do.

Monique Ramsey (05:52):
Okay. So on that same thought, we had a question about brow lifts. How often, and I'm assuming this person might've had a brow lift, they said how often should the brow lift be done again? So maybe what is the lifeline for a brow lift?

Dr. Brahme (06:10):
Yeah. That's a good question because there are different types of brow lifts. And so there's the open brow lift, which is an incision that goes basically across, just skirts the hairline and it's called an anterior brow lift. And those, I can tell you I've never had to redo one. So that's a pretty darn permanent operation. Then there's the endoscopic brow lift, which is a bunch of small incisions where you go in and you sort of lift the skin up and then try to anchor it. And that brow lift, I've redone quite a few.

Monique Ramsey (06:57):
It just doesn't,

Dr. Brahme (06:59):
Sort of a little funny story. My previous partner was covering for another one of our partners and he saw a patient who had just had an endoscopic brow lift and a facelift and follow up. And the patient said, well, how do I look? And my partner said, well, you look great, but you could use a brow lift. And she had just had one. So that was sort of embarrassing. So not many of us do the endoscopic brow lift. It is just not as effective. But the standard open brow lift, I've redone maybe one in my career, so it lasts for a long time.

Monique Ramsey (07:43):
Oh, that's great. And let's say somebody had that brow lift and then they're seeing laxity again, but if their forehead's bigger, do they have to worry about that or would you do a different approach?

Dr. Brahme (07:57):
I'd probably do a different approach. I am much more fond now of putting the incision just across the hairline in the front, depending on the hair growth and so on. But that way you don't make for a bigger forehead.

Monique Ramsey (08:13):
Yeah, cuz you can see some people have foreheads going for miles.

Dr. Brahme (08:17):
And that's always been the issue with brow lift is the size of the forehead.

Monique Ramsey (08:25):
Okay, here's somebody who's asking about threads maybe or a facelift. So they said, I'm not sure if I want to do the threads, but I would like to do some sort of facial procedure to get rid of jowls and a little bit of a general mid facelift. Do you have a suggestion with it not being a major surgery/

Dr. Brahme (08:45):
Well, I think that you can spend a lot of money on these non-invasive things. They're not very long lasting and they can be quite pricey. And I've seen some disappointed patients with threads. I see the disappointed ones because they come to me. I don't see the ones who are really happy who never come to me. So I'm sure I see a skewed population there. But there are facial procedures like fat transfers that are not facelifts and fat loss in the face is something that we see as we age. And there are midface lifts and smaller facelifts and you can do a little bit of liposuction sometimes. So there are other alternatives other than facelifts. But that being said, I really want to emphasize that a facelift is not as drastic a procedure as patients are afraid of. We see a lot of people walking around in everyday life and some of them, especially in Hollywood and so on, where they're plastered all over the tabloids and you see the terrible plastic surgery. Well, there is a lot of good plastic surgery that you don't see because it's not meant to be seen. It's just meant to look good and natural. And so a facelift is not necessarily a huge change in life. It can be just a little repositioning of the tissues so that you look normal, you look like yourself. So I think a lot of people are afraid because they see some bad plastic surgery. For most patients, a facelift is setting back the clock 10 years and looks very natural. So I would urge people not to have that fear.

Monique Ramsey (10:52):
And we've got a lot of facelift questions that are, so I'll keep it all together. Somebody was asking what's the difference between let's say a full facelift and a mini?

Dr. Brahme (11:04):
Okay. Well, that varies very much from surgeon to surgeon. A mini facelift usually doesn't involve the deeper layers like the muscle layers, and it's not as long lasting. It can be very helpful when you're doing somebody who has had a facelift already and just needs a little tweak, say 6, 7, 8, 9, 10 years down the line. They might get by with just a little tightening, but as a standalone procedure, a mini facelift is for the patient who is young, doesn't need a big correction and just a little tweak to maybe hold them over for a couple of years until they decide that they want to do the real thing.

Monique Ramsey (11:53):
And somebody was asking also, are there new technologies with facelift procedures?

Dr. Brahme (12:01):
Well, there are a lot of new tricks and tools that we use and we always strive for a natural result. I've never had anybody come in and say, I want to look really tight. Everybody comes in and says, I want to look natural. And so that's where the emphasis is on looking natural, addressing the lines in the neck. We're much more aggressive in the neck than we used to be, and we're much more aggressive with the deeper layers of the face. But you have to balance that against the risks of the surgical risks of nerve damage as well. So there are things that come into fashion for about 10, 15 years ago, people were doing what was called a subperiosteal facelift, and that was lifting all of the soft tissues of the face down at the level of the bone. Well, the swelling after that surgery was remarkable.

(13:07):
I mean there was so much swelling and that it sort of negated the whole purpose of doing that because its swelling took months to go away and the complications such as nerve damage was quite high. So things come in and out of fashion and what I recommend people do when they talk about facelift is have some consultations with good facelift surgeons, people who do a lot of facelifts and then look at their pictures if you like their pictures. There are many ways to, as I say, skin a cat. And there are many ways to do a facelift if you like their results. It doesn't matter what specific technique they use, they're obviously comfortable with a good technique that gives a natural result.

Monique Ramsey (14:01):
That's a great point is having somebody who does a lot of them because you've seen everything you can really, I feel like you can customize to that person because all the different techniques that might really speak to this patient and the issues that they have.

Dr. Brahme (14:19):
Oh, and we do, it is rare that we just do a quote facelift. Usually we do a facelift and eyelids, and a facelift and a lip shortening, a facelift and a chin implant, a facelift and some fat transfer. It's rare that we just do a facelift.

Monique Ramsey (14:41):
And when we're saying facelift, you are really talking about the face and the neck together as a unit?

Dr. Brahme (14:46):
Right. Right.

Monique Ramsey (14:48):
Yeah. I know a lot of people think, oh, because the first place that tends to bother people is their neck. And so they're like, can you just do something about my neck? And why is that not necessarily a good idea?

Dr. Brahme (15:01):
Well, the neck is connected to the jawline and the jawline. if you sit in front of a mirror and you take the skin of the jawline and the lower face and sort of pull it back to where it looks attractive, you can see that skin gathers in front of the ear, whereas the skin on the neck when you pull it up, gathers behind the ear. So you always have to do a lower face when you're addressing the neck.

Monique Ramsey (15:32):
So it all sort of looks normal. Yeah.

Dr. Brahme (15:35):
Yeah, exactly. We want to have a uniform pole and it's like some people come in and say, I just want to do my face. I don't want to do my neck. Well, that's going to look strange in a couple of years.

Monique Ramsey (15:50):
So you mentioned something about the upper lip and that's that area from the bottom of your nose down to the top of your lip. Talk a little bit about that because we did have a question about lip fillers and how to make that look subtle or more natural and talk about this sort of a lip lift.

Dr. Brahme (16:14):
Okay, so let's talk about the things that people are unhappy about with their upper lip. There are three things. One is volume loss and that can be replaced with fillers or fine fat. I do both. We used to do lip implant, but they tended to be very visible, but I just recommend that people don't overdo it. Fat is at least part of the fat that we inject as permanent. So if you have lumpiness after you do fat injections, that can be a tricky thing to deal with. The other thing are what people call smokers' lines, which is really not smokers' lines. It happens in people who are not smokers too. And for that there are various techniques. There's sanding, there's dermabrasion, there is laser, there are chemical peels, and I prefer the dermabrasion. It's very effective. It takes about 10 days to two weeks to heal comfortably enough that you can put makeup on.

(17:23):
I think it's better than the laser myself. And then there is the lip shortening, and that is a wonderful little procedure. And basically I tell people if you open your mouth without smiling and you can't see your upper teeth, then you're a good candidate for a little bit of a lip shortening. And when I do that in conjunction with the facelift, that's the one thing that everybody says without fail on day five, six after the facelift, they say, I love my upper lip because it's very rejuvenating, it's very feminizing. I rarely do it in men. I do it in transgender patients sometimes, and it's very feminizing. So those are the three things, the lip shortening, the sanding, and then the fillers, whether they be fat or Juvederm or something like that.

Monique Ramsey (18:24):
Okay. So on that same topic, we had a question about nano fat transfer and Ellacor. And so can you explain a little bit about, since we're talking about the face, this is the perfect time, what that is?

Dr. Brahme (18:42):
Okay, so Ellacor is a fairly new technology where we have a machine that extracts cores of skin. It's really mostly approved for the lower face and it can extract skin from areas that we really can't reach with a facelifts such as the jowl areas and the sort of peri oral, the area around the mouth and so on. And nano fat is fat that has been basically extracted. So we harvest the fat and then we process it through successive like sieves that are finer and finer until we get basically the fat liquid with no cells. But that has growth factors and proteins and things like that. And we use that as a topical agent to promote healing afterwards. So nano fat, you can inject it, but it's not like a transplant like other fat transfers are. It's not live tissue, it's just growth factors and things like that.

Monique Ramsey (19:58):
Ah, to help with the healing. Okay. So we had somebody ask, as an older person, I'm concerned about being under anesthesia for too long. What is the usual duration for being under during a facelift procedure and what can you tell us about the risks of anesthesia?

Dr. Brahme (20:15):
I think that's a great question and that also goes to the question, when is a good time to have a facelift when it's too young, when is too old and so on.

Monique Ramsey (20:25):
We have that question too, so we'll let you do that.

Dr. Brahme (20:27):
Yeah, I saw that question too. So I'm going to sort of roll that question, those two into one. So yes, anesthesia is a risk factor in any surgery that we do and we have only board certified anesthesiologists. We've never ever had a problem, but that's because we screen our patients. We don't do sick patients and we don't do patients who are medically unfit to have anesthesia. And sometimes we turn patients away. About the length of anesthesia, I tell my patients in the consultation, it's sort of flying an airplane. The riskier times are the takeoff and the landing. Once you're up there, you're sort of an autopilot. So a long operation is an operation where you have to keep somebody warm. And when we're operating on the face, we have a heating blanket so people don't get cold. And then I agree, you can't take too long to do these procedures.

(21:30):
I do a facelift, a standard facelift in about three hours, and then if you want to add the eyes to it, and that takes about another hour, if you want to do some fat transfer, that takes about another half hour. If you want to do a little bit of lip work, that adds about another half hour. If we want to put a chin implant in, that adds probably another 15 minutes. So depending on what you do. And men take longer than women because basically men have bigger faces. So the price for a man is higher because it's a longer operation. But a facelift really, I think shouldn't take more than for a standard facelift, three hours for face eyes and the whole thing with a brow lift, maybe five hours. So that should be about the length of a facelift. When I hear people taking a really long, having had facial surgery that took a long, long time, like 8, 9, 10 hours, I wonder what happened.

Monique Ramsey (22:45):
Okay. If we weren't talking about facelifts, let's say we were talking about a mommy makeover. What's kind of your comfort level of the maximum number of hours you want to stay under for any procedure or any type or any grouping of procedures?

Dr. Brahme (23:03):
Well, I think I try to limit these procedures to no more than eight hours. I think that that becomes hard on the patient. It becomes hard on the surgeon, it becomes hard on the team. Now during those eight hours, we do take little breaks. So for example, if we're doing a mommy makeover and we're doing a tummy tuck and the breast and maybe some liposuction, we take a break between the tummy and the breasts and so on. So let's say a tummy tuck takes about two hours, breast lift takes about two and a half hours, and then some liposuction takes maybe another hour and we have to reposition the patient and so on and so forth. But I don't like to do surgery that takes longer than eight hours. And I do a lot of review of legal cases and things like that. And sometimes I see these cases that take 12, 13, 14 hours, I think let's irresponsible. If you can't do it in eight hours, you should just divide it up and do the separate procedures.

Monique Ramsey (24:10):
Yeah, come back and do something. And I think for, let's talk about massive weight loss and because that sort of lends into when you might split something up, if it was an extreme amount of surgery after massive weight loss where they might want their arms and their breasts and their tummy and their thighs, do you tend to split it into two procedures and how long in between?

Dr. Brahme (24:36):
Two, sometimes three.. Yeah. When we talk about massive weight loss patients, that's a whole different category because the skin has been overstretched when these patients were very heavy and they've lost a lot of their elasticity. So I usually start with a tummy because when we do a tummy tuck, we tighten the muscles and most people lose additional weight afterwards. So a tummy tuck for a massive weight loss patient is almost always an extended tummy tuck or what we call a belt, which goes all the way around. So we do that and we make the patient as tight as we can. Now if you make the skin too tight, you have healing problems and you can have tissue death and just all kinds of nasty complications. So we make it as snug as it's safe. Now with massive weight loss patients, all of these patients would loosen up in a year or so and they will not be as tight as they were right after surgery. And there's nothing that we can do that about that. So maybe the second time around, we do a little more tightening of the abdomen and we do the breasts or we do the thighs or we do a facelift and things like that. So to really do a massive weight loss patient, that could be up to three or four operations.

Monique Ramsey (26:14):
Okay, okay. And somebody was saying, I had a tummy tuck and lap band in 2010, can I get a new tummy tuck?

Dr. Brahme (26:22):
Yeah, sure.

Monique Ramsey (26:23):
Then we had a question about high intensity focused ultrasound, high FU, and somebody was asking about they have some loose skin on their arms, inner thighs and neck, and if they can't afford maybe a full plastic surgery, is that something that could be something that's good? And she was asking if it causes cancer, is it safe? And so I've never really heard of it, so I hope you have an answer.

Dr. Brahme (26:57):
Well, I think it's what we call,

Monique Ramsey (27:00):
Is it like Ultherapy do you think or?

Dr. Brahme (27:02):
Yes. Exactly. That's what I thought, because that is high intensity ultrasound. So anyway, these are noninvasive things and they have their limitations, especially in massive weight loss patients and they don't last very long. They can be quite uncomfortable. And if you sort of just imagine these ultrasound waves penetrating the skin and to do some real, real work underneath the skin and tighten that skin, it has to be pretty high intensity. And I don't think that people would tolerate that if it was to do something that was long lasting. I can tell you with assurity that it doesn't cause cancer, but I can also say that it will cause a big hole in your pocketbook. For a challenging patient like somebody who's had massive weight loss, I would venture to say that you're probably not going to be happy with the result.

Monique Ramsey (28:19):
And I feel like it does work. Ultherapy can be great for the right patient, but I think the older you are and or the worse maybe your skin is in terms of quality, I think it's more of a gamble that you would see a really great result.

Dr. Brahme (28:37):
And again, like I was saying earlier, plastic surgery is a game of expectations. And if you have an expectation that some modality is going to do something for you, you better look at and see some pictures of before and after that blow your socks off. Because if they can't show you pictures that are really good, whether you're talking about breast surgery, whether you're talking about tummy tuck surgery, whether you're talking about non invasives high energy or high intensity ultrasound, if they can't show you pictures that you think are really good with that modality, I would not spend a fortune on that. And I see patients, I see patients who come to me for facelifts and they say, I've spent close to $20,000 on non invasives and I'm not happy. And that's sad.

Monique Ramsey (29:45):
They add up.

Dr. Brahme (29:47):
They do add up, and that's why we have a collaboration with our med spa. They know when their resources are used up and when they can't do anymore. So we have a very good synergistic relationship with them and they'll send the patients down and say, Hey, I can't do anymore. You need a facelift.

Monique Ramsey (30:12):
And I think that's nice because sometimes you might send people up who you're like, you're not really ready for surgery.

Dr. Brahme (30:18):
I do all the time. I do all the time.

Monique Ramsey (30:20):
So I think that is nice because we have the full spectrum of ways to treat people and things to do and combinations. So somebody asked about the cost for eyelid surgery, and I'm going to direct you all to our website, so lj csc.com, and that has, you can find all our price ranges listed on the website. We've always been transparent about our pricing since the mid nineties when we first got a website. And so it's there, but what you'll find is a range and the range is because we don't know exactly until you see the surgeon, what combination, maybe it's upper and lower, or upper skin only and lower fat and skin, and there's all these crazy combinations with eyes and other things like a mommy makeover, what does that mean? And so we give you ball park ranges on the website, and then when you have your consultation, then you'll have a quote with exactly what that fee range is going to be. So the next question we have is how soon can I go in the water beach pool jacuzzi after breast surgery?

Dr. Brahme (31:32):
Yeah, it depends on what you have done. If you have just a breast augmentation, I think that you can probably go in the pool or jacuzzi after a couple of weeks. If you have a breast lift or a breast reduction, you have more incisions, and sometimes there are little pinholes and things like that. And we say that maybe three to four weeks would be better. But I tell people basically, you're okay to go in the pool or jacuzzi, just take a shower and wash everything off when you get out. In southern California, we have a lot of bacteria in the ocean, so I'm more hesitant about letting people go in the ocean than in a pool that has chlorine and so on. So usually within a month.

Monique Ramsey (32:21):
Yeah, I think the last thing you want with your brand new fabulous body is to get an infection because you went in the ocean too soon. So it's like, is it really worth it? You can sit on the beach and look fabulous.

Dr. Brahme (32:35):
yeah, and go in the swimming pool. Yeah.

Monique Ramsey (32:36):
Yeah. Okay. So we have a couple of questions all around the topic of breasts, breast lift, do I have to get implants or can I just do a lift? Or how do I know if I need a lift? So let's talk about that.

Dr. Brahme (32:53):
Oh yeah, I do a lot breast lifts. So basically a breast lift is for somebody who has lost volume in the breast and they've deflated and they're sort of sagged and so on. And most patients who need a breast lift know that they need a breast lift. They, in their heart of hearts, they know that they could use a breast lift. And what we do when we see patients for breast surgery is we measure the breast, how far is the nipple from the notch in your sternum up in your neck? And it also depends on where does the breast sit on your chest? And we talk about the footprint of the breast, and that is where does the breast sit on your chest? Does it sit high? Does it sit low, medium? And what is the relationship between the nipple and the crease under the breast and so on.

(33:58):
So there are a lot of measurements and evaluations that we do before we recommend a breast lift. When you do a breast lift, there are different kinds of breast lifts. Sometimes you can make do with just removing a little skin around the areola. Sometimes you need to remove a wedge of skin in the vertical orientation, and sometimes you need to have the anchor type of breast lift. It depends on how much extra skin there is, how big the patient wants to be after surgery, and what size implant are you planning to use. With breast lifts, we are actually making the skin envelope smaller, so there's a limit to how big an implant we can use so we can safely close the skin around that. So I don't like to do breast lifts with large implants. I tell patients you can have a smaller implant and then when everything's healed, you can go in and put a larger implant in if you wish.

(35:11):
But a large implant increases the risk of complications when you're doing a breast lift. And then the question is, do I have to have an implant? No, you don't have to have an implant, but you should know that when you do a breast lift, because you are decreasing the size of the breast, envelope of the skin envelope of the breast, the breast will be smaller. So I tell people, you will lose at least the bra size if you do a breast lift without an implant. Now, sometimes you can do a breast lift and do some liposuction and use some fat transfer and to makes the breast fuller, but a fat transfer fat is not really a substitute for an implant. It can help shape the breast, but it doesn't take the place of an implant in terms of making the breast larger. So that's sort of the breast lift overview.

(36:16):
Yes, you can have just a breast lift, and if you have plenty of breast tissue, maybe that's all you need. Most patients want a small implant. I caution people not to want too large an implant. And the decision about the lift, do you need one? What kind do you need? Depends on the shape of the breast and the measurements of the breast. And really, really for patients who go to multiple consultations, if three of the consultations say you need a lift, and the fourth one says, no, you don't need a lift, listen to the three that told you that you needed a lift because you probably do need a lift, but you can always find somebody to put an implant in. And I see those patients too, and they come back a year later and say, I hate the way I look. I realize I needed a lift.

Monique Ramsey (37:11):
Yeah, I think that avoidance of a scar, people are so worried about scars, but scars, there's all kinds of things that we do to help minimize your scars and they just can fade so beautifully over time. Okay, a couple more questions before we finish. So somebody was asking, what happens if I lose weight after a BBL, which is a Brazilian butt lift, and fat transfer to the breast, will I lose my result?

Dr. Brahme (37:45):
Well, the fat that you put in when you do the BBL and fat transfer anywhere is your fat and it behaves like your fat. So if you lose weight, you're going to lose a little bit of that. You're not probably going to lose all of it, but you're going to lose a little bit of it proportional to what you would lose from all your other fat cells. So it does behave like the rest of your fat. But say we put you have 300 ccs of transplanted fat into your breast and you lose 10 pounds, you may lose a 10th of that, but you're not going to lose the whole thing.

Monique Ramsey (38:31):
Okay. Now here's a great question. Am I too old for a mommy makeover? I'm 63 in good physical shape other than loose abdominal skin and sagging breast implants that are nearing 20 years, it's six and a half hour surgery, which makes me nervous. What do you think?

Dr. Brahme (38:49):
I think if you're 63 and you're in good shape and you have no health issues and you are an active person, I don't think you're too old. I've certainly done it on patients older than 63.

Monique Ramsey (39:06):
Okay. I'm going to do one more question and then because we had so many questions, like I said at the beginning, in case you missed it, we will have Dr. Brahme and the patient coordinators and nursing team get back to you. As long as we know who answered or who asked the question, we'll be able to email you with the reply, and of course you can set up a consultation to see Dr. Brahme. So our last question is, one of my friends is considering traveling out of the country for surgery, what things should she be considering and or questions should she be asking? I feel like it's risky.

Dr. Brahme (39:40):
Yeah, that's a great question, especially since we live so close to Mexico here, and a lot of people go to Mexico for plastic surgery. The problem is that even though the plastic surgeon may be US trained, he may be a great plastic surgeon. There are a lot of other things that go into this like anesthesia who's giving anesthesia. I know that in Mexico there are a lot of sort of sketchy anesthesia issues with patients, and we see people dying in Mexico all the time from plastic surgery. You don't see people dying in Southern California from plastic surgery very often. Yeah, it can happen. And it has happened on occasion.

(40:35):
And if you have a complication, you're on the wrong side of the border. And I just think that you're gambling doing this, and it's not like going south of the border and doing dentistry. You're not going to die from dentistry, but this you're going to put your health and your life in somebody's hands, and I would not recommend it. I would not recommend it. Now, there's medical tourism in all over the world. I mean, people are doing heart surgery in India and they're doing hip replacements in Thailand and so on. I really don't know. But you do need to research the safety record of the place you're going to.

Monique Ramsey (41:22):
I think you're right. It's a huge gamble. Huge. And I know you gamble. I know you've ended up going to see patients who are in the hospital.

Dr. Brahme (41:30):
If something goes wrong, you have no legal recourse. If something goes wrong in America and it's below the standard of care, you have a whole malpractice legal system that can stand by your side. You don't have that when you're going to another country.

Monique Ramsey (41:52):
Yeah. Thank you for all this amazing information. Dr. Brahme.

Dr. Brahme (41:56):
There's one more question I'd like to answer because I hear it all the time, and it is, I've had my silicone implants for 10 to 15 years. They look great, feel great. I don't need to lift, I don't want to go up in size. I want to know should I get them switched out because they've been in there for so long. I tell people, if your implants are fine, if you have no problems, if they're the size you want, you don't need a lift, don't do anything. There's, there's no expiration date on these implants. And so just be grateful that you're one of the people who has a long lasting, great result. Don't go and try to fix something that's not broken.

Monique Ramsey (42:43):
Good advice, good advice. And let me have you hit one more forward, Dr. Brahme, and it gives you how to get in touch with us so you can call email. And Dr. Brahme every once in a while makes an appearance at our med spa up in Carlsbad, so we can do a consultation up there as well. But he's mainly practicing in our La Jolla office. And anything else, Dr. Brahme, that you want to say before we sign off?

Dr. Brahme (43:10):
No, I think this was really helpful. I don't know if there's any way to make it sort of live so that patients can ask questions in real time. But these are a lot of good questions, and I hope that they demystified and gave some solace to people about some scary things about plastic surgery.

Monique Ramsey (43:35):
Yeah, we did have a couple live questions, which I worked in at the beginning, but thanks everybody for coming. We really appreciate it. Thank you Dr. Brahme, for sharing your wisdom. And it was really fun to do this, Ask the Expert Anything format, because I think it is just fun to hear other people's questions that you might've thought about and to maybe dispel myths, et cetera. So we look forward to seeing you any old time. Just give us a ring and we will all see you later. Thank you.

Dr. Brahme (44:06):
Alright, we'll see you later.

Announcer (44:07):
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