Breast Augmentation: The Natural Look is Back

Monique Ramsey (00:07):
You're listening to The La Jolla Cosmetic Podcast. Well, welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. I'm here today with Dr. Hector Salazar, one of the plastic surgeons in our surgical center. Welcome back to the podcast.

Dr. Hector Salazar (00:28):
Thank you so much, Monique, for having me here. I always enjoy talking to you about different things and now plastic surgery.

Monique Ramsey (00:36):
Today, I want to talk about breast augmentation and really breast augmentation for the person who's never had an augmentation before, so we call it a primary breast augmentation. Tell a story maybe of a recent patient who had a successful result, maybe for an interesting reason.

Dr. Hector Salazar (00:54):
Recently, we did a breast augmentation on someone that appears quite often on TV. She came to us for a breast augmentation and she said that she always wanted to have a breast augmentation. She would always consider it like that her breast size was suboptimal, that she wanted to have larger breasts. We can go into more details later about this, but after her breast augmentation, which was, I would say a very successful breast augmentation, believe it or not, she came back and showed us a picture of her at the beach. She's beautiful, she's gorgeous, but she said, "This is the first picture that I take at the beach where I show a bikini top." She never had that before, never. She said, "Oh, I feel not like a different person," she said, "but a better version of me." I said, "That's, I think, the goal. Again, she's still like, she's on TV, I mean of course, what she does not require any bikini shots on TV, but well, maybe if she's required to do that now she's ready.

Monique Ramsey (01:58):
That's neat. What is maybe the first question most women have when they're starting to consider breast augmentation surgery?

Dr. Hector Salazar (02:08):
I would say it's definitely the question about sizing, question about they want to know how can they achieve a certain cup size or how, what do they need to get into a certain measurement? That's pretty much, I would say, the first thing that we start discussing with them because they open up that conversation. We like to always listen to what their concerns are, what their goals are, and pretty much that's quite frequently the first thing that they want to address.

Monique Ramsey (02:38):
So is there a way to sort of know what size or shape of implant is going to look good before they come in the office, or is it really something that they have to determine with you?

Dr. Hector Salazar (02:50):
Well, I always tell patients that the main goal of our first office visit is for them and I to close our eyes and be able to have the exact same mental image of how they want to look, because patients, when they come in pretty much all the time, they know how they want to look. Now it's our job to be able to, after our visit, be able to achieve that same image and both of us be in the same channel. We have several instruments and several ways to do that, but that's the main goal of that visit, to be able to find that perfect implant for them. So to answer your question, I think it's imperative that we see them and evaluate them in clinic to be able to put into words and measurements that look that they want to achieve.

Dr. Hector Salazar (03:42):
The classic thing is that they always talk to friends about this before they come in. You talk to, you have 10 friends that of which maybe three or four have implants, and you ask them, "What's the size that you have?" they'll tell you, "Oh, I think I have 200ccs or 250," or, "I have a 400cc implant." There's another one that's going to say, "Don't accept anything less than 300." It's funny because all of those friends, I bet you that all of them, they have different body complexions and different size of native breasts to begin with. It's something that I think to be very accurate, it's good that they start getting information from their friends and discussing different types of implants and how their experiences took place. But I think it's really, really important that we listen to what they want to achieve so we can get them our best advice possible.

Monique Ramsey (04:38):
Now, how big can a person go, or how small can a person go if you only want a really tiny augmentation, is that possible? What are the body limits that you have to consider?

Dr. Hector Salazar (04:51):
I would say that everybody that wants a breast augmentation, they want to look and remain looking human. Right? So when I say that is... In a way, even the patient that wants to be very big or very large, she wants to look like a woman. One thing that I tell patients is this, "We have to respect the natural boundaries of the footprint of your breast."

Monique Ramsey (05:22):
Oh.

Dr. Hector Salazar (05:22):
Right? It's imperative that God gave that patient a breast footprint and that we respect that breast footprint. We can enhance the breast in different ways with a little bit more upper fullness or with a little bit more volume at the bottom or a little bit on the side, but it always has to be respecting that footprint. So that's, in reality, the limit that we have. Then yes, sometimes you get a patient that is on the shorter side that is, she's very thin, she's very petite, and if somehow what she is requesting translates into having a 800cc implant, which is one of the biggest or largest size implants, it's going to be very, very challenging to do that while you're respecting that native footprint of her breast. It's then when we normally tell them when we're sizing, we have carte blanche, "You can pick whatever size you want, but then we're going to be helping you landing it into something that it's going to not only achieve your goals, but do it in a very realistic and safe way."

Monique Ramsey (06:30):
Now, is there a celebrity maybe that people bring in? People might bring in their phone and show you an Instagram from somebody and say, "I want to look like this." Is there somebody that's always on the wishlist these days?

Dr. Hector Salazar (06:46):
The absolute answer to that is no. There's nobody that would say the most celebrated breasts of these days or something like that, no, but trends come and go all the time. The same way that I would say maybe 10, 15 years ago, it was a little bit more of an exaggerated augmented look. Nowadays, the trend tends to be more green, more organic, "Make me look natural." I'm not saying that, that all patients come and ask for that, but in reality, when we talk to them and we're choosing between, try to see if they're looking or liking more an augmented look, nothing wrong with that, or a natural look, nothing wrong with that. But it's important that we review, we go over some pictures that they like and sometimes pictures that they don't like so we can actually narrow it down to what's the look that they're trying to achieve.

Monique Ramsey (07:39):
Is there anything that prevents someone from being a good candidate for a breast augmentation?

Dr. Hector Salazar (07:46):
To give you an absolute answer to an absolute question, the patient has an active issue or in terms of health with her breasts, yeah, it would be a no-go. The patient has to be healthy and actually the patient is at the age where a mammogram is recommended, we always command that yeah, maybe it's a good idea to get a baseline before we get breast implants. Giving you a partial answer to your question, there are some patients that are going to have more favorable anatomy than others, and there are patients that have some congenital breast deformities or congenital malformations of the breast in a way that probably they don't even know that they have those anatomical variants or differences in terms of shape.

Dr. Hector Salazar (08:28):
But that's why it's important to have that nice first consultation, spend a good amount of time listening to what they want to achieve and also, very carefully and meticulously examine their breast to bring up realistic expectations. It's rare that we find those anatomical variations that I'm mentioning, but when we find them maybe what patients need are breast augmentation plus other surgical procedures that we could add to allow their breasts to look better.

Monique Ramsey (08:59):
Give me an example of what that might be.

Dr. Hector Salazar (09:00):
Well, it can go anywhere from having what we call a tuberous breast, patients sometimes tend to call them Snoopy breasts, or some patients actually have said, "Oh, they look a little bit like a banana breast." Having those variations, if you put just an implant in, you're not going to correct the shape of the breast just by placing an implant in. It's something that it's important that we analyze together and then we have to make special other maneuvers to be able to compensate for that and give them a nice shape. Same thing with patients who come in after having kids and sometimes after breastfeeding, the shape of the breast changes so much that if you just place an implant, sometimes it's not enough to make them look good and to achieve the goals that they want. But it's something that, again, the most important, it's a good assessment.

Monique Ramsey (09:51):
Now, what brand of implants do you prefer or does it matter?

Dr. Hector Salazar (09:55):
In our practice, we work mainly with Natrelle from Allergan. We think it's a good brand. We think it's a safe brand. MENTOR is also a good brand, and those two have been out there for a long time. There's Sientra as well, and then there's the IDEAL IMPLANT. So anything that the FDA has given an approval for breast documentation, I would say is safe or it has proven to be safe. We have our favorite, but it doesn't mean that other brands are not good.

Monique Ramsey (10:25):
When you're looking at, even within a brand, let's take Natrelle®, how many variations of implants are there within that line? Aren't there quite a few now?

Dr. Hector Salazar (10:36):
I would say, yeah, quite a few. If you combine all the elements, you can make an almost infinite combination. That's part of the beauty about breast augmentation, that there's so many choices that you can make. For instance, within the same line of implants, you're going to find implants that are filled with saline or filled with silicone. You're going to have implants that are round, you're going to find implants that are shaped, so then boom, there you go. Out of those, you can get already a bunch of variations, then you can talk about projection. What's the style of the implant, how flat the implant is or how much it projects, how much it raises from the chest wall. Just with that, you have different styles of projection, the low-projecting implant, the low plus. You got the moderate, you got the high profile, you got the extra projecting implant.

Monique Ramsey (11:26):
Wow.

Dr. Hector Salazar (11:27):
Then after that, you can talk about texture, something else. You can talk about consistency. How does it feel? Is it cohesive, meaning a little firmer? Is it, responds a little bit more and it's a little softer? But the shape of the implant changes a little bit with position, so there's a lot. There is a lot to talk, and we cover all of that during a consultation. So patients can expect to understand pretty much almost at the same level that we understand what implant they're getting at the end of the consultation.

Monique Ramsey (11:59):
Now, you're talking about all these different kinds and the possibilities are endless. Do most people end up, let's say, if it's moderate profile, would it be the same on both sides or do sometimes you do a different shape of implant on one side than the other?

Dr. Hector Salazar (12:18):
I would say extremely rarely.

Monique Ramsey (12:20):
Okay.

Dr. Hector Salazar (12:20):
The most common would be, honestly, to use the same size implants on both sides with the same style. In some cases, we always tell patients that, "Our breasts or sisters, they're not twins." Some patients come actually not with sisters, but with cousins or acquaintances. So if that's the case, then sometimes we can entertain the idea of using a different size implant on one side and a different size implant on the other, understanding that perfect symmetry can never be achieved, because one of the things, Monique, and you know about this, that we are very, very precise when we measure our patients.

Dr. Hector Salazar (12:58):
We take several measurements, the distance from the sternum right here, the sternal notch to the nipple, and the distance from the nipple to the crease to the inframammary fold and the areola diameter and the breast-based diameter and how much tissue they have in the upper pole. So we give a little pinch and measure that, and so all these different things, we realize that pretty much nobody is fully symmetric. Understanding that, we try to achieve the best symmetry possible and something that patients actually enjoy and we get it. We do it.

Monique Ramsey (13:32):
Let's move into that consultation process. So they come in, they meet with you, you do an examination, I'm assuming they get to see some before and after pictures of people that maybe look like them where the breasts are similar or maybe the size is similar. Then what tools do you have to help them visualize that after?

Dr. Hector Salazar (13:54):
One of the most important things is again, is you're correctly saying when they say, "Dr. Salazar, I have some pictures that I want you to see." "Oh, fantastic. Let's sit down and go over those pictures." Some of them actually, they've already been into our website and then they started ... They actually already come out with some printouts or captures of saying, "Out of your patients, I feel that I'm like her and I like this, and I like that and I don't like this, and I don't like that." Then another thing that's very important is that we have the option of using sizers. So in sizing, what we do is we provide them with a special bra that allows you to basically stuff in the bra with different implants; implants that have more of a breast shape so it can translate a little bit better how they are going to look. The thing that I tell them most importantly is for them to feel the size, to actually feel it and see how they feel wearing that size.

Dr. Hector Salazar (14:56):
We give them a tee-shirt, we actually take some actual pictures of them so they can actually see it from a different angle. What we're trying to find is proportions of their body, the proportion between the shoulders and the lateral aspect of the breast, the proportion about how much the size projects and that in relationship to their body. Then I would say most of the patients, we can actually use an additional instrument, which is called Vectra, so that's a computer simulation. We bring the patients to a dedicated room for this simulation and we take pictures of them. Then what we do is we go ahead and simulate how a certain type of implant would look or a different one, so then we can compare before and after, or we can compare implant to implant. That's a very, very nice part. Honestly, it's a very fun part for patients. They have a good time when we are doing this because at some point, they realize that this is not like purchasing shoes. Sometimes they find that very hard to select either one or the other one, but this is like their implantation, their breast augmentation.

Monique Ramsey (16:09):
Well, I think it's cool in that like shoes you could try on with the sizers and the bra, so you can wear them, but then also you get this high tech, so you have the IRL, in real life, versus this high-tech projection. I would think that that's a helpful tool for patients because if somebody says, "Oh, I have three 375s." What's that mean? It means nothing.

Dr. Hector Salazar (16:34):
Exactly, it means nothing.

Monique Ramsey (16:36):
Yeah. Let's say if somebody's a first-time augmentation and they've never been a mom, but they want to be a mom someday, if they want to have kids someday, what happens to their implants?

Dr. Hector Salazar (16:49):
In all honesty, and most likely to their implants, nothing will happen, okay? But their breasts are going to change for sure. So everybody goes through the process of hormonal stimulation during pregnancy and then during lactation or breastfeeding. Then what will happen is most likely the oversize of their breast is going to increase, and what happens afterwards, it varies a lot from patient to patient. Some patients actually shrink back in a very nice way and that's it, nothing happened, or some other patients actually, they shrink in a nice way. They have their implants in, but now they've tasted what it feels to be slightly larger. Then maybe they say, "You know what, Dr. Salazar, why don't we switch the implants, and now I have larger implants to give me the volume that I had when I was breastfeeding?" Some other patients, actually, what happens is that after they lose that volume, their breasts deflate and that can happen, but the implant-

Monique Ramsey (17:59):
Nothing's happened.

Dr. Hector Salazar (18:00):
... the implant, nothing has happened to the implant, but the breast itself. The tissue actually loses some of that volume and then it can drop. But then you're talking about, or do you need to do some tweaking? Well, to respond to your question to the implants, nothing happens, but the breast is going to be changing in shape and form.

Monique Ramsey (18:17):
Now, you mentioned breastfeeding. So if you have implants, can you then still breastfeed? When you put in that implant, where are all the glands that produce the milk, and are they disturbed and what happens in that?

Dr. Hector Salazar (18:31):
Right. No, they're not disturbed. The gland is in front of the implant, so the gland is there, and the gland is producing milk, and the gland is getting that milk out through the nipple and to the outside world, so it's very safe. There's no contraindication of breastfeeding. Some patients actually that have never had kids, or they ask me, "Is my augmentation going to prevent me from breastfeeding?" The absolute answer to that is no. There's no proven fact that it prevents breastfeeding, but the only thing at the same time is those patients that have never breastfed before do not know how capable they are for breastfeeding. So that's one of those [inaudible 00:19:13]

Monique Ramsey (19:12):
That's a whole nother thing.

Dr. Hector Salazar (19:13):
That's a whole nother thing, but no, completely safe, no problem. You can breastfeed after a breast augmentation.

Monique Ramsey (19:20):
Then if you decide you want to tweak later on, how long do you want them to wait after they stop breastfeeding before they would maybe entertain the idea of either a lift or a different size implant?

Dr. Hector Salazar (19:36):
Depending on how big of the intervention, but you can think about it anywhere from six months to 12 months. The reason for this for your audience to understand why is because when you do surgery and you're actively breastfeeding, basically what you have in your breast are pockets of milk. As we are operating, and you remember, when we go to the operating room, everything has to be sterile, everything's super clean. It's a very, very special environment, and the last thing you want on your operative field is some milk thrown there. You could never imagine doing a surgery then like, "Oh, why don't we put some milk over here?" So that's the reason why, because milk, it's communicated to the outside world because of the anatomy of the milk ducts and everything, and it's not going to be sterile. It's safe for babies to drink the milk, but it's different if you're putting a sterile breast implant in there. You want it to be as sterile and as clean as possible, and milk, it doesn't help with that.

Monique Ramsey (20:45):
That makes total sense. I've never really heard it explained that way before, so that's very interesting because I know people have to wait, but I didn't really know why. When a patient, let's say that it's the first day of the reveal when they come in, and I don't know how many days after surgery do they come see you?

Dr. Hector Salazar (21:03):
Normally, I would say always day one.

Monique Ramsey (21:05):
Day one? Okay.

Dr. Hector Salazar (21:06):
Mm-hmm.

Monique Ramsey (21:06):
So they come in and we do the reveal and what is their, on average, their first impression or their first reaction?

Dr. Hector Salazar (21:16):
Wide open eyes, all the time, wide open eyes and it's like, "Oh." It's nice because it's shocking. One thing that I tell them during that consultation visit is, "We don't want to have, and you don't want to have any surprises," meaning that we find the perfect implant together and then they know exactly what they're going to get. There are no surprises. It's not that they're going to wake up, and I've heard these stories in which they have surgery somewhere else, and then they wake up and say, "Oh, we talked about a 300. But then when I woke up, the surgeon said, 'Oh, congratulations, 550 or 600,' and that's never what we talked about'" so of course there's not going to be any surprise like that, but it's always shocking. It's always shocking, right? It's-

Monique Ramsey (22:00):
Like in a good way, shocking.

Dr. Hector Salazar (22:01):
In a good way, shocking.

Monique Ramsey (22:02):
"This is me. Wow!"

Dr. Hector Salazar (22:04):
Right. Exactly. It's like, "Oh. Oh, wow!" Even if it's a small implant, the only reason why we see each other at that first day is because we want to make sure that there are no problems. Of course, that first day surgery just took place, they're going to be swollen. The implants are actually going to be riding a little higher. We always talk about that because implants initially, they write a little higher and then they come down to the perfect position.

Monique Ramsey (22:33):
Let's talk about incision placement.

Dr. Hector Salazar (22:36):
Incision placement, you can have an incision around the areola, mainly at the bottom of the areola, just following that circumference, but just at the bottom. Also, you can find incisions that go underneath the breast, right on that inframammary fold or the crease of the breast, you can put an incision there. Axillary incisions that you can also see that some doctors like to put their implants through the axilla-

Monique Ramsey (23:03):
Which is the armpit for those-

Dr. Hector Salazar (23:05):
... which is the armpit, exactly. You can also find some other rare incision sites such as the belly button. I would never recommend anyone getting their implants through the belly button. Number one, you can only get saline implants because you need to go in and tunnel all the way up, and then you put the implant wrapped like a burrito, completely wrapped. Then you inject the water, but you violate natural boundaries of the breast, you're actually, you have to go through that inframammary crease or fold, and you're disrupting the natural anatomy. Then if you get into any problem, any complication, then you don't have good access and you cannot have good visualization of your operative field, so not a recommended place.

Dr. Hector Salazar (23:53):
Transaxillary breast augmentation through the armpit, it is doable. I don't favor that technique because, again, you're also working from a distance. The only advantage that you're getting is that you don't have an incision near the breast, but in reality, putting an implant through the armpit is, we were talking about how clean things are in the body, and it's not the cleanest part of our bodies. In addition to that, implants tend to ride very, very high. You're limited in terms of sizes of implants that you can use, and also you don't have the same good control. I would say if you're going to have a procedure, you want your surgeon to have full control.

Monique Ramsey (24:35):
Would that also be, if you were going through the armpit, would that be saline only as well?

Dr. Hector Salazar (24:40):
Or small silicone implants. Then I would say concentrating into the two most common ones, which are around the areola and underneath the breast, I would say I do both techniques. It's also patient preference at the same time, but I must say that I favor going underneath the breast because with that incision, it's only a four centimeter incision. It's very, very tiny, goes underneath the breast, it's really, really hard to see. You don't disturb the nipple or the areola. Sensation doesn't change. You stay away as much as you can from the nipple and the areola, as we were talking about.

Dr. Hector Salazar (25:19):
It's in communication with the outside world and the inside world because of the milk ducts. So the more you get into that territory, the more you can be exposed to developing infections and capsular contracture and other complications. With that four centimeter incision underneath the breast, it's a very safe to go in and leave that implant in a very, very nice position. Lastly, around the areola, there are certain patients with certain anatomy that could benefit from having that, or it's a matter of preference. As long as we discuss the pros and cons with patients and they fully understand what they're actually compromising in by doing it through the areola, we could do it as well.

Monique Ramsey (25:59):
Do those incisions heal nicely for most patients?

Dr. Hector Salazar (26:03):
They tend to heal very, very nicely. In addition, we're obsessed with getting the best possible scars, so when we do our closure, we do it in three different layers. We make sure that all the skin is very, very well opposed, and patients will see it as a very nice thin line. Then we start giving them advice of what to do to that scar to make it better and better and better. Then in addition to that, we follow them up closely so if the scar starts to misbehave, then we know what to do and when to do it. Then God forbids, let's say that as we are following this scar, it's very, very rare, but if when the scar has finalized its maturation process, we still don't like it for some reason, we can always revise it and give them the best scar possible.

Monique Ramsey (26:53):
Oh, that's great. How long does it take for those scars to fade?

Dr. Hector Salazar (26:58):
One thing that I tell patients is they will be fading with time. They're never going to disappear. You always are going to be able to find it if you look for it, but they're going to turn into a very inconspicuous scar. I say that at about three, four months, the scar actually looks angry and looks a little purple and a little pink.

Monique Ramsey (27:18):
Oh, interesting.

Dr. Hector Salazar (27:20):
But as time goes by, at about six months, it's start to tune down. At about a year, then sometimes it's hard to find.

Monique Ramsey (27:29):
Now, I would guess that some percentage of patients are worried about pain. How do you help patients manage pain?

Dr. Hector Salazar (27:42):
In terms of pain, we always want them to be as comfortable as possible. During the procedure, we put some local anesthesia, kind of like the anesthesia that you get when you go to the dentist, so that helps a lot. We prepare patients because we like for them to take ... we give them basically four different type of medications to try to prevent that pain from becoming a real issue. So we prepare them with nerve-ending pain medication, which is called gabapentin. We also give them a muscle relaxant, because we're going to be stimulating those pectoralis muscles by having an implant underneath, which they normally don't have anything, and muscle relaxants also help. We give them an anti-inflammatory medication as well to decrease the amount of inflammation. We use the local anesthetic that we talked about already, and then on top of that, in case they need it, they could either have a good extra strength Tylenol or some narcotic.

Monique Ramsey (28:39):
Okay. If they need narcotic, is it for just a day or two usually?

Dr. Hector Salazar (28:45):
Usually, if anything-

Monique Ramsey (28:46):
Or not at all?

Dr. Hector Salazar (28:47):
Or not at all, not at all.

Monique Ramsey (28:49):
Right. Now, when could people, in general, I'm sure it depends on the person, but in general, when can they go back to the gym, or out for a run, or ... ?

Dr. Hector Salazar (29:00):
We ask them for a very strict three weeks of no exercise. It's very important for patients to digest this information that what we're trying to protect them for those first three weeks is from any possibility of bleeding. If you get your heart rate up, it doesn't matter if you're exercising just with your legs, but if your heart rate goes up, your blood pressure goes up, and then you can be exposed to having some bleeding where around the implant. After those three weeks, the risk of having any bleeding, it's very, very null, practically null, so two to three weeks of no exercise, and then in three to four weeks to go back to their regular exercise routine.

Monique Ramsey (29:45):
I think there's always a question for people, "When do I have to get my implants replaced," because they're not a forever device, right?

Dr. Hector Salazar (29:54):
Correct. The FDA recommends that 10 years after the placement of implants that implants should be replaced.

Monique Ramsey (30:03):
Now, is there a warranty on these?

Dr. Hector Salazar (30:06):
Yes, absolutely. It depends, and it varies from, as you were talking about brands or trademarks of implants, it varies, it changes. But the brand that we favor actually, in terms of rupture, which is a very ... an implant rupture, it's an exception. It's not common. It's extremely uncommon. But in cases that happens, the lifetime warranty for rupture, and then the company actually will replace that implant for that patient. The same thing with other conditions such as capsular contracture, which is when the implants get encapsulated or hardened, and there's also some warranty for those implants.

Monique Ramsey (30:43):
Now, let's get into something that I don't know how much you know about because you're the one doing the surgery, but cost. Let's talk about cost a little bit. So I'm looking on our website, we have all our costs on the website. It's a range, obviously, because I think of what you brought up earlier, it depends on the type of implant used. They have different costs just for the actual implant itself. So it says here our cost range is from 7,200 to 8,500. Would you say that's generally correct? A person could say, "Okay, that's going to be my range," or are there other things that they would need at the same time?

Dr. Hector Salazar (31:24):
So the pricing that they see, they can rest assure that that's pretty much when they come for an augmentation, that that's what they can expect. That includes all different type of implants, et cetera, et cetera. Now, that being said, if after our assessment turns out that they could benefit from additional surgery, it does not mean that we have to do it, but if they consider doing it, for instance, you can benefit from a lift from a mastopexy. Do you want to add that? Can you combine it? Yes, you can combine it. Is that going to affect or change the price? It's not going to be double, but it will change the pricing significantly. But for pure breast augmentation, I truly believe that what the pricing that patients are going to find on our website, there's not going to be any surprises when they come here.

Monique Ramsey (32:08):
A former babysitter of ours, and my kids are grown now, so it goes way back, she had breast augmentation. They did a little bit of liposuction right above that armpit area where it was sort of full. Is that something that you find that you do?

Dr. Hector Salazar (32:25):
Yeah, we do that. That area over there sometimes improves with the breast augmentations, and just itself just by stretching and give it a different shape. Sometimes you don't even need to address that later. Of course, every individual patient is different, but if we see that it's something that it's not going to be improved by just mere augmentation, can we address that? We can. Yeah.

Monique Ramsey (32:46):
Okay. Now, could it be dangerous when we're talking about getting a deal? Here's a normal range, if somebody goes, "Oh, wow, but I was quoted 4,900 down over here," how do you advise patients to do their due diligence?

Dr. Hector Salazar (33:07):
This is your body that you're dealing with. You want to go and see a board certified plastic surgeon that gives you a certainty that that surgeon has been recognized by his peers as a safe plastic surgeon, someone that underwent a very rigorous training and a very rigorous examination. So you got to make sure that the person is certified in plastic surgery, not in surgery, not certified in cosmetic surgery, he has to be certified in plastic surgery. Our facility is Quad A certified. Basically, what that means is that it has the same level of certification that the outpatient surgery centers of the hospitals here have, meaning Sharps, Scripps, Kaiser, they all have the same certification that our surgery center has for outpatient. Then you can get into even anesthesia. We have board certified anesthesiologists.

Monique Ramsey (33:58):
Yeah, that's it. It's little too risky and rolling the dice. The last thing that I want to let everybody know is in our show notes, we will have all the links to the things we talked about. We'll give you a link to the gallery. We'll give you a link to financing because we do a lot of financing for surgeries here. If you don't live nearby and you want to come to San Diego and see Dr. Salazar, I know that you could do a virtual consultation with more in-person stuff when they get to town, but that is something that you offer as well.

Dr. Hector Salazar (34:34):
Absolutely. We do it all the time.

Monique Ramsey (34:36):
Then I would also encourage everyone, if you have questions about anesthesia specifically, we do have an episode about anesthesia and how to understand the differences there. Thank you so much, Dr. Salazar. This was super informative and I appreciate your time today.

Dr. Hector Salazar (34:52):
No, Monique, it's always a pleasure to talk to you and your audience, people that enjoy our podcast. To me, it's a way to reach patients and to start clarifying some of their questions.

Monique Ramsey (35:03):
Yeah. All right. Well, today is International Podcast Day, so the fact-

Dr. Hector Salazar (35:08):
Oh, wow.

Monique Ramsey (35:08):
... that we're doing this podcast today is just perfect. All right. Well, thank you so much. We'll see you again next time.

Dr. Hector Salazar (35:15):
Thank you, Monique.

Speaker 3 (35:22):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @LJCSC. The La Jolla Cosmetic Podcast is a production of The Axis, the axis.io.