Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast. 

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today I have one of our favorite guests, board certified plastic surgeon, Dr. Hector Salazar. Welcome Dr. Salazar. 

Dr. Salazar (00:26):
Thank you so much, Monique. I'm very excited to be here every time you invite me. We not only have fun, I feel that we really share our experience with patients and it's an invaluable opportunity for us to stay in contact with our patients. 

Monique Ramsey (00:41):
Now, today's topic is something that sounds so cool. It has a name that you might not have heard about, and it's a neck lift technique and it's called the TZ plasty. So for a lot of people, our necks are kind of a pesky, troubling thing, and with age, they get more and more troubling sometimes, but that neck sometimes can be hard to treat. So with me today, Dr. Salazar is going to talk about the neck big thing, but can you give us all an overview? Let's do, before we get into the TZ plasty, let's kind of go from treatments for the neck, maybe non-surgical to surgical, and then where does this one fit in and what we're going to talk about today. 

Dr. Salazar (01:26):
Perfect. Yeah, no, Monique, it's a really, as you're saying, even the name is a little catchy, right? TZ plasty, but people are not very much aware of this procedure. It is a well-established, well described procedure that has been around for a long time, but as we discuss different options for treating the neck, we could go anywhere from having just some energy device treating your neck to try to obtain some shrinking of the tissue, just like hybrid of frequency, energy, lasers, any other technique, a little commercial here, Ellacor, which is a new device that we have integrated to our practice, I would say fits into the next level, which would be removing a little bit of skin to obtain that shrinkage, to obtain that retraction of the tissue. But you remove many, many, many small pieces of skin that are not going to leave a scar. 

(02:25)
But once everything has healed, then turns out that you have eliminated a certain percentage anywhere from six to seven to 8%. And if you repeat it, you can talk about 24% of skin if you repeated it two, three times. So that's the next level I would say, of treating your neck in a noninvasive or minimally invasive way. Then you can talk about doing some liposuction to the neck, very, very small neck incision here, another one behind the ear, another one behind the other ear lobe. And by doing that, you can go in and you can actually scoop some of that fat out and then allow the skin to retract. So that's another one you can have or undergo something that's more invasive and comprehensive, which is basically a face and neck lift. So either you can choose to have just purely the neck lifted and maintain your incision a little smaller, a little shorter, or you can go for the full face and neck. 

(03:25)
Now that being said, let me explain to you a concept. So let's say that a patient comes in and the patient wants to have a face and neck lift. So plastic surgeons, we are good at creating thin, tiny incisions, and we are good at hiding those incisions, right? So face and neck lift, what you're going to be doing is you're going to be starting your incision pretty much in the hairline over here, above even, or at the level of the corner of your eye. And that incision is going to go down and it's going to go around your ear. And once it goes around, the ear is going to go back up and the posterior aspect and the back of your ear, and then it's going to cross into your hairline, and then it's going to follow your hairline down towards the base of your neck back here. 

(04:22)
And then some patients, when they see the length of that incision, they go like, oh, really? It has to be that long. And I explained to them this concept, the further away you are from where the problem is, the power of your pool, it's going to decrease. So if you try to pull from really far away, your pool needs to be bigger, your incision needs to be longer because as you're moving away from the area of the affected tissue, then the power of your pull goes down. So therefore you need to pull a bigger area for you to get the tightness and the lift that you want. And for that reason is that when you see those incisions are significant, they're big incisions and they provide fantastic results. And the good part about it is that they're well hidden that we know how to hide those incisions. 

(05:21)
So we talked about all these different options ramping up and going all the way up to reaching a face and neck lift, but none of those incisions, none of those interventions directly affect or directly take care of the problem. So if you have, as you were talking about that Turkey gobbler, that for me right here, it's right under between my chin and my neck. And what am I going to do with this? Can you take care of that with a face and neck lift? Absolutely, you can. You can. But in terms, remember the concept we're pulling from far away. So we need big, big incisions to be able for our power not to decrease a TZ plasty, I would say the most powerful or the ultimate weapon against that neck Turkey gobbler deformity. Why? Because you're literally addressing it on site. You're really taking care of the problem, right? Where the problem is, and you're directly wedging or excising the tissue where the problem is. 

Monique Ramsey (06:38):
Now, the name TZ plasty, does it have anything to do with the shape of the incision or where is it getting this name 

Dr. Salazar (06:47):
T for Turkey? No. <laugh> No, it, it's exactly as you're pointing out. It's related to the shape of the incision. So you excise you, and I'll go into details in a little bit, but you basically excise it and close it. So you excise it in a T way with your incisions looking like a T, but then you perform something that in plastic surgery is called a Zplasty. So you excise it as a T, close it as a Z, and that's where the name comes from. So if you want me, I can tell you why or why in the world you have to excise it that way and then close it in the other way. And what is a zplasty and all those things. We can go into those details, but only if you want, 

Monique Ramsey (07:28):
Well, I'm kind of a dork about this stuff. I love it. 

Dr. Salazar (07:32):
No, I think 

Monique Ramsey (07:33):
We can do it as a bonus. If you're a subscriber, you can get this extra information, 

Dr. Salazar (07:38):
Right? Exactly. Exactly. So here we go. Let me explain to you a little bit how well, you know what, before we go into that detail, let me tell you about the classic patient that wants to have this done. Because there is, I mean, I would say we all think about it. I mean, there's not a single patient. I'd say that it's above the age of 45 or 50 that has never said, oh my God, what am I going to do with this? Well, I need to do something. And then probably people just forget about it or they don't take that step or they don't care that much about that. But I would say for the TZ plasty, the classic patient is, tends to be a male patient, tends to be a patient in after the age of 50 that has developed loose skin over here. 

(08:33)
Sometimes the rest of the face looks fine and looks young, but what am I going to do to this? How do I get rid of just this? And the classic statement is, I want to get rid of this, but I don't want to face a neck lift, but I don't want those incisions. I don't want for anybody to see that I had an incision around my ear in the back of my ear when I go to the club with my friends and we're like, no, just take care of this and no other incisions, please, what do you have to offer me? What about a little bit of liposuction? Could that take care of it? And then at that point in time, you realize that the tissue is hanging, that if it would be like a big thick neck with a lot of fat, well maybe let's go ahead and start addressing that fat with liposuction. 

(09:24)
But most of the time it's just that loose skin that's hanging there. Sometimes with a little bit of fat, sometimes the muscles, the tisa muscle that's over here has been separated. Sometimes it hasn't, but it's just this. And so that's the classic patient that can really benefit the most out of this technique. So we take advantage of the fact that we all have this submental crease. So a crease a line underneath your chin, we all have it. Why? Because we all have a little bit of fat, does not need to be too much, and that generates that little crease. So that portion, the T of the incision, the horizontal part, we already have it. And if not, and I don't know if you know this, Monique, but I mean that's the most common place in your body to have a scar not related to surgery. 

(10:19)
It's here and in your forehead. So underneath the chin, if you look at people out of a hundred people, you're going to find many, many scars already there. So we're not adding a lot, right, because either you already have the scar when you've fell and trip while you were running or you were riding a bike. And if not, then we already have a crease there. So that's the top of the T. Then we have the vertical portion of the T. It's going to be an incision that's going to be running up and down, and it's limited goes from that crease to pretty much, if you want to think about this, like the Adam's apple, just for people to imagine that, and that's going to be the vertical part of the T. Once we do the excision, we want, and I know you know this, but let me share it with all the audience. 

(11:06)
You want tension, but at the same time, you don't want too much tension because too much tension leads to scarring problems. Too much tension leads to wounds that don't heal well, and sometimes to development of problematic scars that you don't want. So a zplasty, a maneuver, it's a technique in plastic surgery in which we break the scar from a straight line and then we turn it into a small Z. And by doing that, we decrease the amount of tension. So when I say we want tension, it's because why? Because with tension, if patients would have tension already in the neck, they wouldn't be asking for this surgery. And so that's why we want the tension, but we don't want too much tension because then would have problems with scarring. So you excise it as a T, and then you close it as a Z. And then there's a recent modification of this technique in which calls for a very tiny, a very tiny incision, horizontal incision at the level of the atoms apple, to make it even better. So if you think about, it's still called the TZ plasty because it looks like a T, but it's like one of those special font T's that the T has a little, right, A horizontal 

Monique Ramsey (12:24):
At the bottom tail or something like  

Dr. Salazar (12:26):
Like a little tail at the bottom with a little style. So that's for patients to understand that they're going to have an incision underneath the chin, a vertical incision from the chin down to the level of the atoms apple and a very small tiny incision underneath over here at the level of the atoms, apple and man have an incision really right here, right where everybody can see it. So let me point out to, I mean, our audience that are actually looking at the podcast, the ones that are listening to it, you can't see this, but if you look into the video, I can assure you that if I had a T Z plasty, you can't see it right now. You can see my chin. You hardly be able to see my atom's apple. So where all the incisions and everything's going to be, you can't see it in a regular social conversation. Of course, if I would be doing that and lifting my head, then 

Monique Ramsey (13:22):
You're getting your teeth cleaned at the dentist. 

Dr. Salazar (13:24):
That's correct. That's correct. So if you do that, you definitely are going to be able to find some of those incisions. But let me tell you, those incisions heal really, really well, and they don't become an issue later down the road. We also follow the patients frequently. We would treat those scars and everything and the way we normally do as we follow our patients very closely. But that scar, it doesn't turn into a big issue. It doesn't turn into a problem. Patients are not conscious about it. Once it heals that a year has gone by, as a matter of fact, it looks fantastic. Even after two months, it's hard for you to find it. And during a normal conversation, you can't basically see it unless you start going underneath and analyzing the patient. So patients actually tolerate it very, very well, and they're very happy after, I mean, the day after surgery, they start saying, my God, I can already see the result. The family member there that's taking care of them. Immediately they say like, whoa, it's impressive. Yeah. 

Monique Ramsey (14:31):
Now, when you're doing this procedure, are you treating the skin and the muscle underneath the skin, or is this more the person who's just got that extra skin? 

Dr. Salazar (14:43):
So the great part about this is that it gives us direct access to the territory that normally with other procedures, you're dressing from far away. So when we make that incision and we excise that tissue, then we get access to the platysma muscles that are right there. We get access to the fat that's underneath the skin. So if we feel the need to remove some of the fat, if we see the need to tighten those muscles, if we sometimes underneath those muscles, it's called sub platysmal fat underneath the muscles, you can also have some fat. So you can also remove some of that fat if there's a need for that. So all of a sudden you have all these possibilities that you can address while removing the Turkey gobbler. So you remove that excess can, and then you have access to all these other different structures that you can also improve while you're there. 

Monique Ramsey (15:40):
It's really cool. And being in plastic surgery for so long, I'd heard of the Zplasty, but not in relation to this. So this is so interesting that it's something that's been around, like you said, for a long time. And so in our research for the episode, we noticed this seems to be another invention that came out of Houston for Cronin in bigs, and you trained in Houston, and they published a paper about it in 1971. And if you want to share what these two are also famous for. 

Dr. Salazar (16:11):
Well, yeah. I mean, plastic surgery owns a lot to the Houston plastic surgeons. Actually, one of the things, of course, Thomas Cronin and Brower, Dr. Brower, they actually invented the breast implant and it was created in Houston and pretty much as their integral part of the training program where I trained, and then Dr. Cronin and Dr. Biggs back then his newer associate, then they developed this TZ plasty technique. And it's a technique that over the course of the years, people have been doing small modifications and integrating different other maneuvers as I was explaining to you. But it's something that it's great to have in your armamentarium as a plastic surgeon. It's something that not every plastic surgeon would do this technique. Some plastic surgeon wouldn't feel comfortable doing this technique. Some plastic surgeons are not very familiar with this technique. But in reality, when we have that as our ace under the sleeve, for some patients that are looking for an alternative solution, think about this, think about a patient that's completely a male patient, completely bald, and they have this problem, and for sure they don't want to have a facelift, and it'll be really silly for you to make incisions all the way along the phase and all the way into the back of their neck to try to fix this. 

(17:44)
While you can place short incisions just localized to the area where the problem is, it wouldn't make any sense. Wouldn't make any sense to do if what they want to address is this. If they want to have the completely bald patient wants to have a face and neck lift, that's a different thing. But if you're only doing all that just for this, it's like you'll rather make an incision from here to here, keep it under control and make 'em look better. 

Monique Ramsey (18:08):
Right. And what does that look like when they go home that day after surgery? Is there tape over the scars or do you have a bandage, or what does post-op care look like? 

Dr. Salazar (18:20):
So the incision basically has a steri strip over it, just like a little sterile tape that we use. Then on top of that, what we do is for the first day we like just to put a little gauze on top to protect, and then we get something that's called, and you're not allowed to laugh at this, it's called the jaw bra. So the jaw bra, 

Monique Ramsey (18:45):
It's even hard to say jaw bra. 

Dr. Salazar (18:48):
The jaw bra. Basically, it supports your chin and it goes all the way around the top of your head. 

Monique Ramsey (18:55):
Is this what they also use with a chin implant? 

Dr. Salazar (18:58):
That's correct. 

Monique Ramsey (18:58):
That kind thing. Yeah, I've seen patients with that before. Yes. 

Dr. Salazar (19:03):
Yeah, because what that's doing is not only supporting but allowing extra to get additional shrinking and also gets good nice compression of the tissue. So what we do is that's the way they go home. They come back, there's not a lot of oozing or bleeding. So they come back the next day, we change the dressings for them, we remove that gauze, most likely they're not going to need it anymore. So they'll just have the Steri strips, just like the little tapes that are pretty much the skin color matching kind of thing. And then you go with your jaw bra. So I ask patients to wear the jaw bra for two weeks, 24/7 2 weeks. 

Monique Ramsey (19:41):
Really? 

Dr. Salazar (19:41):
Correct. It adds to the result. And then I ask them to wear it one more week just at nighttime. Now, two more things. I mean, honestly what I tell patients, especially after that first week, I don't know if you have a meal or if you have something where it's a small short period of time and you don't want to wear the jaw bra, do it. But don't tell me no, just if it's something that's really, I dunno, now that zoom visits or you have to go to an important meeting or something and you, you've got 

Monique Ramsey (20:17):
To go watch the Barbie movie.

Dr. Salazar (20:19):
You've got to go watch the Barbie movie, right? Right. No, 

Monique Ramsey (20:22):
Because your daughters are dragging you to it. Yeah. An hour and a half.

Dr. Salazar (20:25):
An hour and a half, it's okay, right? It's okay if you get just rid of that jaw bra, but put it back immediately again, because for instance, when you're taking a shower, if you take a shower with 10 minutes, I mean, you're not going to be wearing the jaw bra, so I'm okay here for a short period of time. If you've got to take it off, put it back on right away, and that's it. But make it the exception, not the rule for those first two weeks, and then after those first two weeks, then one more week at nighttime, and after that, no compression is needed. We asked patients not to exercise for two weeks. We asked them to avoid excessive sun exposure for two weeks, the two weeks that they still have the tapes and all that. Sometimes we had a patient that asked if he could wear a little bit of makeup or covered with a base like the incisions, and we said yes. 

(21:13)
And it depends how they're evolving, but sometimes around 10 to 14 days, they can start applying some makeup there, and then that'll cover pretty much all the incisions while they're continue to heal. Patients feel fine the next day. They feel, well, this is a procedure that we do under general anesthesia. This is a procedure in which it's not a very long procedure. Procedure takes about anywhere from 90 minutes to two hours, one and a half to two hours. It's a procedure that it's very, very comfortable for patients to have it under general anesthesia that we have board certified anesthesiologists that are center squad a certified, extremely safe. So literally for the patient is just like, take a deep breath count to 10, and then, oh my God, are we done? And for us, well, we're going to be working those two hours, but that's how comfortable it's going to be for them. We do not recommend this procedure to be done under local anesthesia because it can get a lot of discomfort in the area here to have being injected in the neck. And then because imagine if we are injecting liquid, if we're injecting anesthesia, what happens is that the numbing medication comes with fluid with volume. So our precision decreases because we have to put in all this volume of fluid here. So for that reason, it's much, much better to do it under general anesthesia .

Monique Ramsey (22:43):
Yeah. And with a board certified anesthesiologists that we have had for 32 years, the same group, they're just absolutely incredible and they're a hundred percent doing your care during that time so that you as the surgeon, Dr. Salazar, can fully 100% focus on the patient and the technique and the surgery, not worrying about are they feeling anything? What are their vital signs? Like you're just doing your thing. Now, you mentioned, what made me think about this is you mentioned the little tape that you put on being kind of skin colored. And so made me wonder, thinking about candidates, is skin color or tone an issue for who might be a candidate or not? 

Dr. Salazar (23:33):
It's important, yes, to take into account the characteristics of the skin of the patient and how they scar. So it's important. I would say I wouldn't eliminate them by being of different skin tones, meaning the Fitzpatrick classification, which is a classification of how your skin responds to sun exposure, and then you have lighter skin here, darker skin here. But what I would mostly do it based on is a good assessment, see how much we need to remove, see how much tension we're going to have, see other incisions that patient has had in different, I mean, I got this appendix removed, or Oh, I got this gallbladder surgery, or look, they remove a skin cancer from back here, so see how the patient has been reacting and then determine if he's a good candidate or not. Because yes, I mean the last thing you want, as you were saying, oh, imagine this. A patient is a keloid former, so let's put some keloids over here. That would be very noticeable. So we know how to anticipate for that, and that's why an evaluation, it's important. 

Monique Ramsey (24:38):
So that consultation is with you in person nine times out of 10, but we have the occasional out of town patient could do a Zoom consult, but what is in that consultation, what is that going to entail with you? 

Dr. Salazar (24:52):
Number one, to listen to the patient's goals. What is that we want to treat, right? Because if we start talking about this, but at the same time I hate this, and at the same time, what can we improve here? Then our conversation is going to be directed towards a different ending. It's going to be, well, maybe could we do the TZplasty? Yes, but what you're looking for more is a face and neck, or you're looking for other techniques. So listen to the patient goals and then do a good physical examination to determine what components of the neck are the ones that we're going to be addressing and assessing. Are we just talking about skin? Are we talking about skin and muscle, skin, muscle and fat, and what are we going to do with those? Then after that, the next part is we go over incisions. 

(25:42)
We go over the technique itself. I mean, I give away my secrets. I tell them exactly how we do it and how we achieve that result, and then we go over the risk and benefits and then the recovery. So it's a good half an hour, 45 minutes, an hour, whatever it takes for them to understand, for me first to understand their goals, and then for them to understand what they're signing off for. Because I think the last thing we want are a surprised patient that doesn't happen in our practice. They're like, no surprises. It needs to, we walk together, we know exactly what's the route, and then you have a happy patient. 

Monique Ramsey (26:21):
And I would think, I'm just going to pontificate here for the man who is looking for this neck area, especially people don't dress up as much anymore, but a neck tie with this closed shirt, and you see the guy who can't close his shirt the same way, got this fold skin in the way. But I would think that if for a guy who wants to do some facial rejuvenation on the sly sort of, and have this wonderful, without all the excessive scarring of a face and neck lift, doing that with their eyes, do you find that that might be a combination that men would gravitate towards the eyes can be such a huge help to rejuvenate the face and to bring that youthful look back? 

Dr. Salazar (27:16):
Absolutely. I, and I have this philosophy of, and I share that with my patients. Honestly, I say, when you say aging gracefully, I would totally vote for doing that or having surgeries gracefully as well. I mean, to go and have small changes at a time, I think eventually pays off more in how people see themselves in the mirror and how people around you can see you and perceive you, rather than I'm 85 tomorrow when I look like I'm 25. And then there's a huge discrepancy there. And then it's when all you're going to be capturing all the attention when you go to that gala dinner or when you go to, rather than she looks or he looks a little bit more rejuvenate, he looks refreshed. He looks like there's something, I don't know. 

Monique Ramsey (28:12):
He just doesn't seem to age, you know? 

Dr. Salazar (28:13):
Right, right. I mean, ah. And to have that rather than Oh, oh yeah, he looks good. But yeah, you never know. So would it be a good combination of doing a little bit on the neck here with the most powerful tool that we have and give you a nice tight neck and get rid of that extra loose skin on top of your eyes and your eyelids? That would be fantastic. Either as a starter or either as, you know what? That's the only thing I need. Also, you brought up a great point about a tie, the complaint that is also very common in patients that want to have this TZ plasty, Turkey gobbler surgery. It's very difficult for me to shave because every time I shave, I cut myself because of these folds here that, I mean, it said sometimes I stop shaving for about, I mean, I shave every week or every week and a half because I don't want to get into, I know that I'm going to get a little cut and I hate it. And with these, we remove all those wrinkles. We remove all that extra skin, and then you can go back and shave again. And the way they used to do it when you were 40. When you were 30. 

Monique Ramsey (29:33):
Interesting. Well, I think that's the idea of doing small things over time, like that preventative maintenance on your car.

Dr. Salazar (29:41):
Absolutely.

Monique Ramsey (29:41):
 Rather than waiting, and I think that was kind of the old generations ago, they wouldn't really allow themselves to have their facial rejuvenation until X age. They were 65, they're 70. You don't do that until then. It's like, well, then it is extreme, like you said, whereas you might do something in your forties and then you may do a little something in your fifties, and that's where I think it becomes more natural and where your friends are like, why does this person never seem to age?  Because it's not extreme. And I would think men and women alike want that natural look, but I see different actresses and actors who want to age gracefully, and I'm like, just a little, something might help. 

Dr. Salazar (30:30):
Might help, right? I mean, remember, we're the most severe critics of ourselves. People start as you age, people start embracing you and knowing you as you're aging. And normally you interact with people that you like, that they like, so people love you because of who you are. So I think a little bit of extra skin here, if we can remove it, fantastic. If we have developed it a little bit of, we can get a little tightening over here, then that's great. And then doing those small changes. And honestly, I mean, I think the analogy you were giving, I think it's fantastic. You've never, I mean, you take your car for service every either 10,000 miles or a year, and nobody has accused you, oh my God, you became addicted to the car shop, right? 

(31:18)
It's so true. I mean, you're so addicted to mechanics now, so known. And reality is, instead of having a huge problem with your motor, why don't we rather give a little bit of maintenance here, little by little, and carry on that car and take it into a classic. And so I would say, yeah, in a way that's something that I like and I like to share with my patients. The fact that small changes will take you. It is a marathon, right? I mean, hopefully we're here until we're like a hundred and it is a marathon rather than a sprint. 

Monique Ramsey (31:55):
Well, this was so much fun, and I love learning about new things, and I hope our audience out there, you've all enjoyed it. And if you got confused at any point, go to YouTube because you can see us talking and talking about different areas of the face. But yeah, in our YouTube, we also will give you chapters you can look, can jump right to a specific question. So check us out on YouTube and it's in our La Jolla Cosmetic Surgery Center YouTube channel, but we have a podcast playlist. So you just click on the podcast button and certainly if you're listening today, you have questions, need info about anything, scheduling, financing reviews before and afters, check our show notes for links. And so thank you again, Dr. Salazar. Any last parting words that we might've skipped over that you want to talk about? 

Dr. Salazar (32:45):
No, I think Monique, we covered it all. I know that sometimes we talk about, I mean, we have a podcast and talking about, I dunno, almost breast surgery. And then we have to talk about all these different things. Right now we're not only talking about one anatomical site, which is the neck, but we're talking about a very specific technique to solve a very specific problem. So I think this podcast, I think it's fantastic for those patients that really have a question about this, what about this? And they grab their neck. This is amazing. I think we nailed the topic. We went from anatomy, origin, history of the treatment, recovery technique, different alternatives. I think patients are going to like it. And just to invite them, feel free. The same way that you see that Monique and I are in our podcast, that's pretty much the same philosophy that has been infused in our D N A at La Jolla Cosmetic. We love to interact with patients, we love to talk to people, we love for patients to be well-informed and to know exactly what we're going to be doing when we do their operations and what results they can be expecting. Because it's all about them. It's all about them liking their surgery. 

Monique Ramsey (34:01):
And I think you can be, not everybody wants to geek out on all the details like I do, but some of us out there and they're like, you know what? Just tell me that price and tell me when I can get on the surgery bed. And that's one group of people. And there's another group of people who might feel nervous or shy about asking 50 questions, but some of us are out there. And that's okay. And I think that's why we do the podcast and why we are so passionate about patient education is because there are a group of us out there who do want to know all those little details because that makes us feel more comfortable. And at the end of the day, we want you to feel comfortable going to the, or making that trip because maybe you've never been in an OR before and you don't know what that's like. 

(34:47)
And I think that's where the more you can learn about it, we're super open. You're not going to bother us. You come in, you have your consultation, you get home the next day, you're like, oh God, I forgot three questions. Come back, have another one. Call us, email us. We're always there for you. And I think that's another thing that we want our patients to understand that there's no such thing as a silly question and we're here to answer it for you. So anyway, thank you again, Dr. Salazar. 

Dr. Salazar (35:15):
Thank you. 

Monique Ramsey (35:15):
And thank you all our audience for listening and drop us a line. If you're interested in any topic, let us know and we will put it on for the next podcast. 

Speaker 1 (35:30):
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 lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis, T H E A X I S.io.