Speaker 1 (00:00):
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. Today I am welcoming back to our podcast Dr. Hector Salazar. He's a board certified plastic surgeon and he is one of our favorite guests to have on the podcast 'cause he knows a lot about a lot of different things. So today we're gonna welcome him back and talk about something that affects a lot of men, but maybe they don't talk about it too much, and that is gynecomastia and male breast reduction. So welcome back to the podcast, Dr. Salazar.

Dr. Salazar (00:49):
Hey, thanks so much, Monique. And, uh, no, it's always a pleasure to be here and be invited and especially with that type of introduction. My God, can we do this daily <laugh>? That would be good. 

Monique Ramsey (00:58):
Sure. We can, we can talk about everything. 

Dr. Salazar (01:00):
There you go. 

Monique Ramsey (01:00):
So <laugh>, so, you know, you've talked about a lot of different kinds of breast surgeries, but we've always been talking about women in the past. And today we're gonna switch over and talk about aesthetic breast surgery in men and, or maybe we maybe saying chest surgery is almost a better word. And so the word for the condition is sort of a catchall for a set of conditions is gynecomastia. So what is gynecomastia and what, what does that word mean?

Dr. Salazar (01:30):
So the, the origin of that word to Greek origin and or it's like related to female or women. And then mastia comes from the word chest. So feminized chest or a female chest. And that's pretty much exclusive. The way we, we use that term is exclusively for men. So women have breast and it's, it's a normal condition and it's also a normal condition for men to have breast. But when that breast tissue is a little bit more, it's present a little bit more than normal or a little bit more than what it's desired than it's called gynecomastia a male chest that resembles a female chest. So that pretty much is what gynecomastia means. But that, yeah, that's the precise, you're correct, that's the medical term to describe this entity. So I can go a little bit deeper into anatomy, but that, that's it.

Monique Ramsey (02:27):
Okay. And what causes this?

Dr. Salazar (02:30):
It's completely normal for male patients to have breast tissue. That's completely normal. It's a, as a matter of fact, and I, I know that men, we are not aware of male breast cancer, but by definition, if a male chest can have breast tissue, then we're also exposed to have breast cancer. But it's of course not as frequent. We, I mean, man, we have very little small amount of breast tissue in there and it's also not being stimulated by hormones and the way that a female breast tissue is being stimulated throughout the cycle. So yeah, as I was saying, completely normal for men to have a little bit of breast tissue that fluctuates within the different stages of life. So you can see, if you think about a pediatric patient, you think about a man who's a, a young man is a boy that's going through puberty, that you can see that there is a development of some sort of a breast bud.

(03:29)
They start growing a little bit of, uh, like a small tiny boob right there. But then that with time tends to resolve. And sometimes that happens after puberty and or at the beginning of puberty, it depends. But some patients actually, they still have that tissue, that tissue persists after this, uh, stage of developing. And that's uncomfortable. That patient sometimes find it aesthetically not pleasing and makes patients have a hard time when they're wearing a, the classic description is when you're wearing a polo shirt, for some reason the shape of the polo shirt accentuates gynecomastia significantly. So I would say that's the, the polo shirt test for patients to see if they, how comfortable they are with their male breast tissue. They don't care then that means that it's very, very little breast tissue. Or if it's something that they dislike, then potentially, uh, it's something that they can look into.

Monique Ramsey (04:29):
Now that American Society of Plastic Surgeons reports that 40 to 60% of men are affected by some level of gynecomastia, so that's like half of all men. Do you think that's accurate, or do you think it's age dependent also?

Dr. Salazar (04:45):
Well, yeah, exactly. 'cause we're bunching up pretty much everybody as man and yeah, in terms of different ages, different percentages. But it, it truly reflects what we were talking about. Right? It's completely normal for men to have some breast tissue, but the important part here is how much is okay or how much are you comfortable having? So true, true, true gynecomastia by definition speaks about the breast tissue content. But as well, like in patients that have a little bit of overweight and then they accumulate a little bit of fat, well, we get them or mix them together in the concept of gynecomastia. And we call it sometimes gynecomastia. But in reality, there is a fat component. Every time I assess a patient for gynecomastia, we try to make or differentiate between how much of that tissue is fat and how much of that tissue is actually breast gland or the presence of a breast tissue there, per se. And because that's gonna impact the way we treated it. But yeah, no, I mean, it's high incidents.

Monique Ramsey (05:51):
I remember back in my teenage years knowing a friend who had real, I guess gynecomastia because at that point, when you're a teenager, you are slender typically and more fit. And you know, he really didn't wanna take off his shirt at the beach or, you know, felt really, really uncomfortable. And so in that case, do you find that when you're correcting younger men, it tends to be more of the glandular breast tissue that you're talking about versus fat?

Dr. Salazar (06:24):
Yep. That, that's right. I I would say, um, when you see a, let's say a fit well worked out body, you can still find sometimes some true true gynecomastia, meaning being true gland. And then we talk about some, let's say the other end of things like a non-athletic gentleman in their fifties, uh, sixties, then you can find a little bit more of a fatty tissue mixed with some glandular tissue. But the fitter the younger, and if we're having, or we're talking about gynecomastia, the more true breast gland tissue you're gonna be finding, one of the things is your question is really sharp. Because the way we see, or the glasses that we used to see through when we are evaluating this patients, there have to be very, very, the correlation between the specific case of that patient, meaning how old, how fit, what's the body weight, is there, are there any other conditions of health, et cetera. We always have to take all that into account. It's not just a mirror like, oh yeah, you got gynecomastia, let's go to the operating room and take care of it.

Monique Ramsey (07:33):
Gotcha. So what kinds of things as a surgeon, you know, have you seen that men do to try to kind of minimalize or hide their boobs, <laugh> man boobs before they come to you? Like have you seen any, I don't know, do they wear like compression garments or is there, what are the tricks that men can do prior to,

Dr. Salazar (07:58):
To taking care of this problem? It, it's something that, as you're saying, it really becomes something that they think about every day. I mean, they live with their body every day. They take showers, uh, daily, they look at their body and it's some part that, that they would try to avoid when they're looking in the mirror 'cause they don't like it and they would love to have a better shape. So yep. Things that can help shaping that is number one, using baggy clothing. Try to avoid or take off their t-shirts, try avoid, go to pool parties, go to the beach. Now there's certain things that can actually make you prone to develop gynecomastia. One, we talked about it being a teenager that makes you prone to have gynecomastia. Right? So in terms of intervening or operating on a patient while they're teenagers, it's a no no because most likely, and it can resolve, maybe not, but most likely it's gonna resolve after that period of time.

(08:50)
The second thing is if patients take certain medications, one of them, it's called Lasix, one of those sphera lactone and like special medications that we go over a list with, like in case the patients are taking it, that they can make them prone to develop gynecomastia. Another one is, for instance, marijuana, smoking marijuana can actually make you prone or, or eating, uh, like, um, those edibles or, um, like certain things can also take you there, but some habits that you have. The other thing is, and we see this in patients that exercise a lot and that they're very and fully dedicated to the gym, but then they also take steroids. So taking steroids can also derive in gynecomastia. So you have like this beautifully well-built body and this very dedicated and well-disciplined person that has developed gynecomastia. And sometimes they realize it, they learn about it, they stop taking those steroids, and then what ends up happening is later down the road, then they still have that residual tissue, even though they already stopped taking the steroids. So of course modifying all these different factors can also help to see if that gets resolved. But then if not, uh, then there's always the help that we can provide.

Monique Ramsey (10:10):
Now you mentioned age and teenage years. So do you have a minimum age for treating gynecomastia?

Dr. Salazar (10:18):
Well, I would, I would say pretty much the teenage years. I, I wouldn't suggest that, let's say that the 'cause patients develop at a different pace, at a different rhythm. So even so if you say like, no, I stopped growing already and I'm like 16, 17, but I hate this. I would highly suggest to wait until you get rid of that extra factor. So if you say like, oh, I'm 20, I'm 21, I'm 22. I mean, you're not growing, you're not developing at that point in time in the same way. So you have a mature, fully developed adult body that is not now being subjected to that, uh, wave of, of hormones and then you can start addressing it at that point in time.

Monique Ramsey (11:00):
Okay. And then you were talking about exercise and is there any exercise that can really improve, I guess if it's fat related, maybe some exercise might benefit a guy, but if it's got breast tissue glands, is exercise ever gonna help?

Dr. Salazar (11:17):
Well, no, because if it's, as you're saying, if it's fat related, so if your component is let's say 80% fat, 20% gynecomastia, most likely if you exercise, you tone your pec trial is major muscle, everything's gonna resolve and it's gonna look so much better. But the problem is if, if it's 80% gynecomastia from tissue and not from fat, and if you tone it, I mean you tone your muscles, you lose that weight and everything, the only thing you're doing is you're accentuating and showing more and more that tissue that before it was like a little camouflage by everything else, but now that you have toned your, your pectoral is major muscle and then you have remove all the fat around it, now you truly are gonna be seeing that and feeling that gynecomastia. As a matter of fact, one of the moves that I ask when we are examining the patients, I ask them to put their hands on their hips and then contract the, their pectoral is major muscles to literally mark the gynecomastia tissue and then we can really feel it and localize it. So the more tone you are, the more you're accentuating that gynecomastia. So does it go away on its own? I mean, after teenage years and after you stopped whatever was stimulating it for some time, and if it's still there, it's not gonna go away.

Monique Ramsey (12:34):
Got it. Now, just like women, every woman's breast is different, what they look like. And so when we talk about, you know, the the nipple area mm-hmm. <affirmative> and the areola, I guess maybe, I don't know, we use these things interchangeably as laypeople, but you know, sometimes the, the nipple area is more puffy. And is it that true also with gynecomastia where the, that that nipple area is puffy?

Dr. Salazar (13:04):
Right? So let's say if you, if we're talking about a, a male patient with gynecomastia and the gynecomastia is pretty much all the component is fatty, it's gonna be distributed pretty much everywhere in the chest. If we're talking about that this is more glandular, that this is more true gynecomastia, it's gonna be much more localized towards the center to towards where like right where the nipple is, where the nipple areola complex is. And, and the reason for that is remember that the mission, the breast tissue regardless, male or female supposedly would be to produce milk and be able to get that milk out through the ducks, through the nipple. So if it's pure gynecomastia, it's always gonna be behind the nipple in areola, bigger or smaller, but always back there. And, um, sometimes that works and as an advantage to us, sometimes a disadvantage and, and we'll talk about, uh, different shapes and different things and different techniques that, that we have. But yeah, absolutely creates a puffier areola. Yep.

Monique Ramsey (14:07):
Okay. And so really let's dive into that. Now, the ways that you as a surgeon can approach that male breast and they want it smaller. What are the different ways that you have to accomplish that?

Dr. Salazar (14:24):
So I would break it into two big worlds. And, and one world would be doing liposuction, liposuction, right? We always think liposuction, liposuction of what a fat, so fat response really, really well to liposuction. But breast tissue, it responds to liposuction, but it responds partially. It not, not always responds in the same way because it tends to be tougher tissue. Well, we can all imagine fat is like a little fluffier. And uh, and then when you put in your liposuction cannula, then the fatty part will respond more and the breast tissue part will respond a little less. So, so in one hand we have intervening with liposuction, very tiny incisions. When we do liposuction, we scoop things out and then what we want is the skin and the tissues around the area to shrink, right? Because the last thing we would like is to remove a lot of that content, but then you get a skin envelope that it's hanging and then you develop loose skin.

(15:32)
And that's not gonna be attractive either <laugh>, right? And, and, uh, 'cause you're gonna probably, oh my God, I looked better before. I mean, thank you so much for removing all that, but what do I do with this now? Right? And um, so then on one hand you have the part of liposuction with I, I would discuss in a little bit two different techniques that we can use. And then on the other hand we have direct excision. Direct excision means making an incision. Also, you have two, three different techniques there. You make an incision and then you scoop things out directly. So you are visualizing all the tissue. The incision tends to be around the nipple and areola. And then you go in, you scoop things out, and then you close that incision. Of course, the one in which you're directly removing things is much more powerful.

(16:22)
You have more control, you know exactly what you're removing and the amount when you're removing with liposuction, you're depending on how much the tissue is giving and how much the skin is shrinking or retracting behind it. Let's break it a little bit, if it's okay with you, Monique. 

Monique Ramsey (16:38):
Yeah. 

Dr. Salazar (16:38):
And you break it a little bit. So let's say that we have a patient that has more fat content than glandular content. So the glandular content, as we said, is gonna be a little bit behind the nipple in areola. And then the fat content's gonna be pretty much everywhere. So if we have a case of a patient with those characteristics, most likely, or maybe doing good amount of liposuction will take care of all of his complaints in terms of contour. If he is a young patient, has good capacity of shrinking of that skin, then that's the most ideal intervention for that patient.

(17:21)
If the content of the gynecomastia is, let's say, very fatty, not a lot of glandular tissue, but it's a lot, it's too much, then you start getting worried about are you gonna be able to retract yes or no? Are you gonna be able to shrink as much as I want to for you to not to have that loose skin? And as you know, we, we perform high definition liposuction, which is a liposuction plus, which is perform regular liposuction and then start edging the muscles, demarcating some, uh, anatomical landmarks. And when we do HD liposuction, we get a lot of skin retraction, a lot of skin shrinkage in the right patient. And so sometimes as if we see that possibility, then we suggest them to, why don't we start by doing not only liposuction, but high definition liposuction, taking it to the less next level and giving that skin better chances to retract and shrink than with regular liposuction. So that's why I was thinking when we talked about liposuction, we have regular, and we have high definition, we have used high definition several times on patients that actually are well built already and they want, one thing they want is to have that muscle edging a little bit more clear. And we use that high definition liposuction on them. So applying or extrapolating those principles to pure gynecomastia, I mean, we've done it only and purely for gynecomastia, high def lipo and patients are really, really happy as well.

Monique Ramsey (19:04):
Wow, that's pretty exciting.

Dr. Salazar (19:06):
It's actually great news because in the past when we were not doing that technique, if we would see that maybe the, the skin was not gonna shrink correctly, we were on that borderline, we would immediately recommend them to go into the other part of the world, which we other hemisphere where we are gonna start talking about it now, which is to go in and do a direct excision. So when the tissue is localized behind the nipple and areola and you can feel it and you can basically say, oh my God, I would just love to be able to help this patient. But just removing, just taking it out, that requires an incision around the nipple and areola pretty much underneath. That's what we do following that border between, uh, lighter skin, darker skin, and we make a small incision mark the tissue that we wanna remove, go ahead and scoop it out.

(20:01)
And we have to make sure that we calculate this part in which we say, do we estimate, do we think that the skin is gonna be able to remold and shrink? And if that's the case, then that's what we should proceed with. We should proceed with just that little scoop out. Then you go into, what about if patients have a lot of tissue, that it's not only localized, but it's a little bit, it's expanding a little more. It's not only behind the nipple and areola. Well, you can do this same procedure or you can add some other skin incisions to remove potential excess skin that could be generated after your, after your removal. So then incision is not only underneath the areola, but also sometimes has to come in a vertical form or you have to go all the way around the areola to try to get more skin out as well as you remove some of that tissue.

(21:01)
And then you have the other extremes of patients that really have like a male breast per se. It's not only that it's a little puffy, it's not only that it's a little bit big, it's a breast that even sometimes hangs. And in those cases you have to do a technique in which we call it breast amputation, which is basically creating a large incision to be able to remove all that breast tissue, provide the patients with a flat chest, which is their goal. Price to pay is to have an incision all the way underneath the lower border of the breast and give them a flat chest and then go ahead and do what we call a free nipple graft. So the nipple and areola, what we do is we literally, we shave it at the beginning of the case, we set it aside, we do the case, and once we have given them the, the flattest chest, then we go in and we use that as a graft, the nipple and areola. And so that's, I would say the most extreme case for us to do that. We, we rarely have to do the, these, uh, cases, but when we have to, then we have the secret weapon to be able to, uh, resolve that one. Um, last in terms of the techniques is that we sometimes can combine the direct excision of a specific part with a little bit of liposuction. So also, and, and that's, that's the reason why it's very important for, for me to be able to assess and individualize every single case.

Monique Ramsey (22:30):
Well, that's wonderful that there are ways and differing techniques to be able to solve that for patients. And so I would think that this is something that while men may not talk about it very much, the ones who do get it done, I would think that they're extremely gratified. Now going into the surgery itself, so you have the surgery, how long does it typically take? And I'm sure that really depends on which of these techniques you decide to use, but in, in general, you know, and what does the recovery look like?

Dr. Salazar (23:06):
So, um, in terms of the length of the surgery, can go anywhere from an hour to three hours probably. I would say everybody fits in there within one to two to three hours at the most of surgery. But normally patients recover very, very fast and very well from this surgery. They feel fine, I would tell you probably two, three days after surgery, they feel fine. The only thing is this, whoever performs physical efforts at work, then that becomes a, they need to take some time off because for about a couple of weeks, we don't want them doing a lot. We don't want them doing carrying heavy, we don't want them exercising for two weeks. And also we want to, for them to be as compliant as they can with our instructions. And that includes wearing a compression garment after the surgery. It depends if, if it's a direct excision, sometimes the garment will need to be used like for two to three weeks.

(24:05)
If it's liposuction, then we ask them sometimes to wear it up to six weeks depending on how they're responding. The other thing is, in special cases when we're doing direct excision, sometimes we need to use drains. I mean, it's something that it's, um, it's an inconvenience for five to seven days, which is having like imagine like, and I know that you know this, but for our audience, imagine like a little flexible plastic tube, like an IV tube coming out from where the surgery, like the, the surgical site. And that's to collect some fluid that the body of the patient tries to build up after things were scooped out. Not everybody needs them, but the patients that they need them, we have to place them. But I would say in terms of how much do I need to take off work? So if you do something that does not require any physical effort, you just need literally, if we do it on a Thursday, you should be good to go back to work intellectually on Monday.

Monique Ramsey (25:01):
Okay. And if you are the guy who lifts weights, do they get to do that two weeks later or is that longer sometimes? Or does it depend on what kind of surgery you did?

Dr. Salazar (25:12):
Exactly. It depends a little bit because if you're doing, if we're just doing liposuction, most likely we're gonna let them exercise at two weeks and then they can ramp it up as they need. If we're really scooping things out or we have like a, a more significant in incision, then probably we're thinking about not letting them exercise for two weeks. Then after two weeks they can start doing some cardiac work, some um, some aerobic work. And then probably at week three or four they can start ramping up the weights after that. 

Monique Ramsey (25:43):
Now what's, are there any visible signs after, so once you're fully healed, your scars are fully healed, depending your incision lines, if you had any, is there any telltale signs that people would be concerned about?

Dr. Salazar (25:58):
No, not really. I would say that, I mean in terms of the, for instance, if you think about risks and benefits of, of this procedure, you think about like, uh, pretty much the risk that any other surgery, even like a small little procedure has like a little bit of bleeding. You could have like a, like a difficulty with your scars or like a, but, but something that is really, or it's closely related to this procedure is as you are taking the tissue out, you can always have uh, either some irregularities, you can always have like a little bit of a divot if there's like a lot of tissue that has been removed or your body didn't mold it appropriately or correctly after. But good news is that we continue following up our throughout the journey. So we see the patient the next day, we see the patient the next week after the procedure has been done, then at three weeks, then at three months, then at six months, then at a year. And if we see that there is either a small contour of regularity or something that needs to be improved, then we can always do that. And we always work with our patients for that. But so when, whenever the surgery goes well and all the molding and all, everything is being followed, then the contour should blend and blends very nicely with the rest of the body and it looks completely, completely natural.

Monique Ramsey (27:18):
That's wonderful. And I think, you know, there's, people keep in mind that there's always some trade off, right? So it's like, which was better or worse? You know, you might have a small scar, you might have a little whatever, but the difference is that you don't have to worry and be self-conscious in clothing or out of clothing. 

Dr. Salazar (27:36):
Mm-hmm. <affirmative>. 

Monique Ramsey (27:37):
So Dr. Salazar, what kinds of things have, you know, your patients said to you after going through this little transformation?

Dr. Salazar (27:46):
Wow. Yeah, that brings back memories. It's like immediately I should have done it years ago. That's one of the things, <laugh> like other thing is like, oh my god, I can see the difference right away. Another thing is the classic is my T-shirts. My shirts fit so much better. And the other one is like, uh, thank you so much <laugh> <laugh>.

Monique Ramsey (28:07):
Thank you. Thank you <laugh>.

Dr. Salazar (28:10):
Yeah. But definitely everybody gets excited, everybody enjoys the result. And it's one of those that, oh my God, yeah, I should have done it so many years. And now that I see it and I'm so happy, but you know what, I had it done, now I'm gonna enjoy it.

Monique Ramsey (28:25):
And when you do a consultation for this male breast surgery, tell us a little bit about what you do in that consultation. What's that like?

Dr. Salazar (28:34):
Well, it's important and it's really important to not lose the focus on the fact that we are remember, I mean, yeah, we're plastic surgeons. Before that we were surgeons, general surgeons in our majority. And before that we are physicians, right? We're doctors, we're scientists. So it's important to, to go and assess the patient, listen to how it presented, when it developed, how long it lasted, what has been done in terms of treatment. Any studies that have been done, perform a good physical examination. Remember, I mean, you said it, board certified plastic surgeon, we are all about safety. So we see the patient in a holistic approach and we make sure that nothing calls our attention or nothing gets out of that norm. So a full physical examination, I do a good history. And then after that, then we go into, okay, this is just a normal variant.

(29:28)
Let's, let's take care of it. And then we come up with a good plan. We determine which is your profile. After all of these that we've talked about, we go over some pictures, we show you where the incisions are gonna be done, we show you what exact, uh, procedure we're gonna be performing. And then we go over potential risks, all the benefits and the recovery. And usually we're together for half an hour, 45 minutes or an hour. And, and we come up with a nice plan and uh, we come clarify all the questions and then we're lined up for a successful surgery without any surprises, which is I think the most important part.

Monique Ramsey (30:07):
And when we talk about this range of different options, could you narrow down to like 50% of the people maybe a liposuction does the trick or is are you able to kind of quantify for the audience, like who might be on what edge of the types of interventions you do?

Dr. Salazar (30:26):
I would probably say that it's, uh, it would be right on that gray zone. 'cause uh, I would say probably you're gonna be talking about, we wanna say how many patients go into lipo versus direct excision. Probably I would say that it's 50 50, if not 55% liposuction, 45% excision. But it's really non-significant because it's Right, right there pretty much, believe me. And for our audience and for our patients, believe me, that the way we approach it is we try to do the most minimal intervention possible because that's gonna, that's for sure is gonna give us the best result, the smallest scar and the happiest patient. And then we start going from there.

Monique Ramsey (31:09):
Okay. And when people are thinking about price, you know, we do publish price ranges on our website because we think that helps you kind of know what you're look might be looking at.

Dr. Salazar (31:20):
Mm-hmm. <affirmative>. 

Monique Ramsey (31:21):
But when you have that, that consultation right after they see you and you come up with a plan, you meet with a patient care coordinator, she will show you exactly like, here's how much you'd be looking at. Most of the procedures fall in the range of $8,000 to $11,000. But you know, again, if you're on some edge of the spectrum, it might be slightly different. But we also offer financing. And I think that's a really great way for people to say, oh this is affordable. You know, it's not one big number due tomorrow. It, you know, might be $200 a month or something like that. And so I think this is so interesting.

(32:02)
We did a study within our own practice and you know, we've been around for 35 years and we've used financing for at least 30 of those years. And we noticed that really it doesn't matter what year it is, one in three patients utilizes some sort of financing. So it's very normal and we're used to talking about it. We have lots of different companies we work with. PatientFi is one of the ones we go to and they'll do a soft credit check. You don't have any, you know, penalty for seeing if you would qualify. So that's kind of a nice thing to know about. And then Dr. Salazar, the patient doesn't live in the San Diego area and I know you work with patients who come in from out of town all the time. Do you still provide the virtual consultations for those people?

Dr. Salazar (32:50):
Oh, absolutely. Because that's gonna get us 80% close to the final diagnosis, to the final approach for which treatment you would, you're gonna need. Of course, there's nothing that's gonna be substituting a good in-person physical examination. And as I tell sometimes the patients, I can say like, I would love to be able to be there and virtually do a pinch here and virtually. Right? Like pull it up and bring it down. And, but at least it gives us, I mean, and opens up the discussion. Patients can, I mean, we can understand what their goals are. They can learn our philosophy, they can feel comfortable with us and also we can start planning their surgery and get it really close as you're saying to which part of the spectrum you are, how many hours. I mean it's all about how much time it's gonna take. Right?

(33:37)
So I mean you're more of like minimal intervention, almost done nothing. You're more into like, oh, big incision's gonna take about three hours so it'll give us much more light. And, and it's a good way to get things going. If you say, well what about if they come in and visit and how long do they have to be here after the procedure? It also depends on how much we're gonna be intervening. I mean, sometimes if it's a good, good liposuction, probably I would say that they can be here if it's regular liposuction, as long as they're here three, four days, it's fine. If it's high definition liposuction, they have to be here for about a week. If it is a direct excision that it's minimal, probably about a week, it's fine. If it's something that, it's a bigger incision, more tissues being removed, probably an ideal of two weeks is what's needed.

Monique Ramsey (34:27):
That's the rejuvenation vacation. 

Dr. Salazar (34:29):
Yeah. Exactly. Exactly. And what a better place to come than San Diego.

Monique Ramsey (34:34):
Right? Come to La Jolla, stay along the golf course up there at Torrey Pines and enjoy <laugh>.

Dr. Salazar (34:39):
That's right. One thing that I would like probably to add is if you're listening to the podcast and either you are the patient or you are a family member, take that step. It's not, I mean as you can see you, you get a feeling, right, Monique, of how we are at La Jolla Cosmetic through this podcast and the nothing, it's judgmental 'cause that some patients sometimes like have that barrier, oh my God, what are they gonna think about me? What are gonna like, oh they have a mambo. I mean, number one. And it's like, it's normal. It's completely normal to have breast tissue. That's what we said. The difference is the amount. So you'll see that we're pretty approachable, we are patient focused. That that's, I mean, the patient satisfaction as you know, it's the center of our practice and, and we're extremely professional and we love to work in a very safe environment.

Monique Ramsey (35:24):
I think that's wonderful Dr. Salazar, that you're able to, you know, discuss it like, 'cause it is totally normal and it's something that can be fixed and let's just talk about it. Yeah. Well thank you again. It really nice to have you share your knowledge and some of the experiences of your patients. And you know, if you're listening today, check our show notes because we'll have links about how to schedule a consultation. They're free, so we're not gonna charge you to talk to you. And about financing, you'll see reviews, your reviews for Dr. Salazar, reviews for the procedure itself. And you'll see before and after photos. Check the show notes for the links. And of course you'll see on our website there's a ton of information. So you can learn about board certification, you can learn about operating room accreditation. You know, there we have 360 virtual tours. You can look around our, or there's a lot you can do. So thank you again, Dr. Salazar. Thank you all for listening and we will see you again on the next one.

Speaker 1 (36:25):
Thank you.

Speaker 4 (36:31):
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.