Monique (00:01):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey and I as a person in her fifties. I'm super excited about this topic because we're going to talk to Dr. John Smoot and we're going to talk about what kinds of procedures when you're in your fifties seem to be indicated. For some of us, a lot of these aging things start in our forties maybe, but you start to really realize them in your fifties and whether it's your eyes or it's something around your jowls and your neck or if it's on your body. We're going to talk about all that today. So welcome Dr. Smoot.

Dr. Smoot (00:39):
Thank you. Glad to be here today.

Monique (00:40):
Let's talk about things that women and men in their fifties might be considering. I think we'll start with women and we'll start with breasts. I think breasts, depending on even if you haven't had kids, but certainly if you've had kids or if you'd had a previous augmentation. So we'll get into what are the things that women might do with their breasts. I think the first one is maybe a breast lift. Do you see that as something that women in their fifties are kind of looking at?

Dr. Smoot (01:13):
Well, we need to start back a bit of overview before we refocus on those certain age areas. Understand the aging process. As we get older, several things happens to our body, one of which is we either can gain weight or we can lose weight. But more importantly is that what happens to our skin is we age, we lose elasticity, and that's usually what causes the problems as we move into those 40 and fifties and sixties is we see that laxity occurring and it can happen in the face, it can happen in the breast, the abdomen, thighs, all that can happen, and it's when they finally look at themselves in the mirror and go, oh my, this doesn't look like it used to. And losing weight sometimes just loses the weight, but it doesn't allow the skin to correct itself. So understanding that different periods of your life, different procedural work differently and look different.

(02:09):
But you're right, most of the changes most women start seeing is when they're forties and fifties when they said, I don't look like I did when I was 20 and 30 and now even 40. So having said that, some of the things that we're going to recommend or talk about today is what are some things to counteract those effects of aging and gravity. Now, you talked about asking me about breast augmentations. Well, some will think, well, why would we want to have a breast augmentation at 50? Well, some do. They've gone all their life not having some shape or form, not fitting well in their clothes, having to wear padded bras, et cetera. So it is doable. And I do have patients that do come in and want to have augmentations. Usually it's much more conservative at that point in their lives, which is fine, but it's not something we can't do. I've done something in their sixties, finally said, yeah, I want to have this. And so that's one of the reasons we look at is what is our motivation to have this surgery? Mostly at that point, I just want to look better in my clothes. I want to have a little more confidence. So that's kind of how we look at breast augmentations when you're in that fifth decade.

Monique (03:19):
And what about the women who maybe had their augmentations in their twenties or thirties and now they're in their fifties? Is it typically that they're maybe now at this point needing a lift or in a revision or what are you seeing in that?

Dr. Smoot (03:36):
Well, it's a spectrum of things we see. Typically what happens as a woman ages, two things happen. One is they tend to gain weight and the breast can get bigger. So the implants they had put in their twenties or thirties now are, whoa, now I'm just not comfortable anymore. I'm just too big. Or they haven't gotten bigger. But because of that elasticity effect, we get what we call a waterfall effect where the bowel, the tissues droop off the implant or the whole breast sags. Those are the determining factors of what we need to do. Someone say, we'll have to have my implant changed every 10 years. No, you don't. I always tell my patients, if it ain't broke, don't fix it. So if there's no need to change anything or do anything, don't do it. Now, these implants sometimes only last 10 years, sometimes most times they'll last 30, 40 years, but well, that's everyone's individual needs and requirements dictate what we'll do.

(04:35):
It depends on what their goals are. Is it because they're too big, they don't want 'em anymore, or no, they're not big enough. They want to look perkier? Yes, all those factors come in, but when I look at someone basically coming in their fifties is the first question I ask them is, do you still want implants? Yes, I do. Okay. Do you want to be bigger, smaller? It could be either one. Then I look at what is the shape that they want? A lot of times they'll show me pictures, and sometimes it's realistic, sometimes it isn't. But what I want to know is do they want that more youthful look? And what happens is the nipple starts to drift downward, and the big determining factor for me is when I look at the breast, I put my finger in the fold of the breast, and if the nipple falls below that fold, they need to lift. You can do all the augmenting and implant changes or whatever you want, but it's still going to droop. So that's what I look at if they need a lift or not. But again, some women don't want to lift, which is fine, but I want to explain to them the outcomes of each decision.

Monique (05:40):
I think sometimes we tend to shy away from things that seem like, oh my gosh, that's so many scars. But I think one of the great things about having a consultation is that you're explaining the trade-offs. What would the trade-off be if you don't have a lift and you get to see a lot of, and after pictures of mature scars, and there's so much scar management that happens after surgery that's trying to make the best perfect scar that you can, and everybody's body makes a different kind of scar, but those are things that can be managed, and then they sort of disappear after time. That scar issue kind of becomes a non-event. So I think you're right in terms of what's that goal that you're looking to achieve?

Dr. Smoot (06:26):
Yeah, because there is a tradeoff. If they deed a lift or not, then let the trade off is a scar, but that tradeoff for having a more shapely, better looking breast that fits better in your clothing, it might be worth that trade off. And some might say, that's not worth the trade-off for you or, yeah, you already benefit from this. But the other problem comes up is we haven't really talked about this in a previous podcast, is what if the implants are hard? That's probably one of the concerns I see. And I deal a lot of that because I've had these implants for 20 years now they're hard. My breasts droop and there are things we need to do, but it's a little more aggressive. And that's what we talked in a previous podcast about using called ADMs or graphs to keep the pocket soft so you don't look hard and feel like baseballs anymore. That's one of the things we like to manage to, but we talked about that at another podcast

Monique (07:18):
And we can put that in the show notes too. Let's say they are having a lift with augmentation and is it like a week recovery kind of How long and is recovery different in your fifties than it might be in your thirties?

Dr. Smoot (07:34):
Yes and yes. Okay. When we do augmentations later in life, it's a little easier to do the surgery. Our tolerance to pain as we get older is better. Younger patients tend to really fill the pain more intensely. I think it's because of just being youthful and the fact that tissues are tighter and firmer, but being able to heal regardless of your age is still about two weeks before I say, okay. You can do pretty much regular activities at this point. The area that causes the pain is what I have to go into the muscle or not, and I tend to put most pain implants under the muscle, the pectoralis muscle. I think that gives it a better shape. It holds its shape better and longer and reduces one of that concerns of hardening or called capsular contracture. So as we get older, also we scar better too. That's the thing that's interesting that I see. The older patients tend to have fainter wider scars than younger patients. Not always, but that's why it's a little easier to operate on someone later in life.

Monique (08:29):
The more now, if a woman's getting a breast lift and maybe with an augmentation in her fifties, how long will those results last?

Dr. Smoot (08:41):
Okay. Well, a lot of it depends on what their genetics are. What do they have to work with, how big are their implants? What is their desired outcome? Now, none of this we've talked about will last forever, and the young girl comes in whilst augmentation was sitting with the mother, I turn and I say, things change, don't they? And they go, oh yeah, they do. But I don't know. With pregnancy, with weight gain, all those factors can affect the longevity of it, how they look. But one thing I can guarantee is they'll change.

Monique (09:14):
Yeah. Well, isn't that a constant in life? Okay, another area where some of us might be finding that we are aging is around the eyes and eyelid surgery I think is a wonderful sort of quick fix as it were to youth in your whole face. So what happens to the eyes to men and women in their fifties?

Dr. Smoot (09:45):
Well, what typically happens is we get laxity of the upper lid skin and meaning that that skin starts to drift down. We get excess starts hanging over the eyelashes. The brow can also start to descend and relax, giving a heavier look, just don't see that as often. But yes, that's one of the things to encourage. The other problem is bags under the eyes. It makes you look tired. This is an operation. It's quite easy. Don't say easy to do, but it doesn't take a long time to do. But it's one of those procedures that really changes how the face looks and in terms of making it look more youthful, awake, gee, I can see your eyes. And they say, well, how do I need a lift or not? Well, part of the time is do you have to lift your skin up when you have to put your makeup on?

(10:32):
That's one of the tests. I say, okay, if you're having to do that, yeah, you probably could benefit from eye lift. Now, a lift is really not the right name for it. That's what we call it. Basically, it's an excision of excess skin above the eye and it's put in a position so the scar sits right in the sulcus or the curvature of the eye, the crease in there, and we can hide it along the left lines as well. So it's a really good procedure to have someone just kind of get their look back. They see their eyes again to say they look rested. So that's one of the opportunities I do enjoy because it is quite dramatic when it happens.

Monique (11:09):
How long is the recovery if somebody were just to have their eyes done upper, lower?

Dr. Smoot (11:14):
Well, okay. recovery and being in the public are two different things.

Monique (11:17):
True, okay.

Dr. Smoot (11:19):
It takes about a week before the stitches come out and you, you're pretty much functional and doing everything at time, but you'd still may be bruised, swollen usually by 10 to 14 days. You can be out in the public eye. Again, with women, your little makeup fine to do it, and most of the bruising, swelling is all gone by. Then. You do have a little bit of tightness and some irritation. It could last for a few weeks, but essentially you're ready to go by about 10, 14 days.

Monique (11:42):
Okay. Now, what are the typical procedures that people might combine with an eyelid lift?

Dr. Smoot (11:51):
Well, mostly when I'm doing eyelids, now you got to look at both upper and lower lids. Some people are bothered by both, some are not. But usually I do it in conjunction with the facial procedures, the mini lifts, the full face lifts, the neck lifts. Those are usually what I use it in conjunction with. You could do 'em independently, but it's kind of like, well, if I'm going to work this canvas, let's work the whole canvas, not part of it.

Monique (12:16):
And is waiting until you're in your fifties too long to wait for your eyelid lift, or is that very dependent on the person?

Dr. Smoot (12:25):
It's dependent on the person. What I tell patients, I say, this is what you have, this is the result we can get. Now, if that's worth the cost, the risk, the recovery for that kind of improvement, okay, let's do it Now, one of the thoughts are is, well, if I do a little bit more often, it'll last longer. Yes. And I kind of espouse that. The more you upkeep it, the less you have to do as you go along. The other one says, well, no, I'm going to do this once and do it when I really need it, but then it's a little harder to get a better result, and it's more dramatic when it gets done. So I can't fault either one, but mostly it's just when it's worth the cost, the hassle, the risk for the benefit you want to achieve.

Monique (13:03):
Now getting into, you mentioned the face lifting and you mentioned short scar facelift. What is a short scar facelift?

Dr. Smoot (13:11):
Okay, it's a nomenclature that I use. It's a little more common among plastic surgeons. It's a procedure that would describe, Dr. Tonnard did several years ago. It's basically a way of just lifting the jowls and not really addressing the neck. It does help the neck, but that's not its primary focus. It's just to make it, what I more call it is a refresher. You just look a little better. The jaws a little higher. It's not something that you'll look at someone and go, you had a facelift. It doesn't do that. It's basically to refresh and make you a little right. It doesn't mean you can't have the full face and neck lift later, but it just may push it down the road farther. So it's a good alternative for people who just need a little bit of refreshing, but not the major re-tightening.

Monique (13:54):
Is that sort of where we all tend to put our hands close to our jaw and our ears and we pull, is it there? Is that where you're aiming for?

Dr. Smoot (14:03):
Yes. Basically it's the hound dog, the jowls. It's just lifting that up like that, that's what we do. Now, it does help neck a little bit, but I tell patients it's not meant to do the neck. Now if there's a lot of excess laxity and fat in the neck, this is not the right procedure. It's someone who's a little younger has very good skin, and we can tighten it without having to do a lot of aggressive surgery.

Monique (14:30):
And is there a lot of scarring with that or it says it's a short scar? What does that mean?

Dr. Smoot (14:35):
Okay, that's a good question. The short scar means that it goes from the hairline down in front of the ear to the bottom of the ear. Now a traditional lift, you use that same scar, but it now goes behind the ear and back into the scalp. That going back behind the ear allows me to get into the neck and do neck procedures. A lot of times people say, well, can I just have my neck done? Well, you can't really separate the neck and the jowl separately. It's kind of at one canvas, like I mentioned. You've got to make the canvas blend together. So it's very often you have to go in front of the ear to adjust for that excess skin. And when you make it, smooth it out so it looks smooth and looks like it's all one contiguous canvas, so to speak.

Monique (15:16):
And then so at a consultation, somebody might say, okay, I think I want a short scar facelift. And you would look at them and see if that's appropriate or is it maybe better to move to the next step and what's the next step? Is that a full facelift or?

Dr. Smoot (15:30):
Yeah. Well, again, it's what they want. And again, I'm looking at what they're willing to go through for what they want to achieve. Now, some people come in and say, I don't want much done. I just want a little mini lift done. Well, it doesn't work for you. It's not the right procedure. And so you have to, I don't want to use the term upsell, but you needed to explain to them why the full lift was a much better choice than the other. Sometimes it's okay, I could do either, but here's the limitations of this. So I liked mostly what I was just educating the patient so they understand the decisions I'm recommending decision we're making or their benefit. And I'm not doing it just to make more money.

Monique (16:06):
Right. Well, I think that's evidenced by your reviews. We have patients giving feedback every day from the time after they have a consultation with you and after surgery with you. And I think if you were trying to push stuff on people that they didn't need, you'd have a lot of angry patients and that's not the case. So is there any difference for men, because I think men are just talking about the eyes, talking about the lower face. What are some of the things men can do specifically, and what maybe are the challenges?

Dr. Smoot (16:41):
Okay, well, men can do all the same things except for the breast augmentations, obviously, but.

Monique (16:46):
Good point.

Dr. Smoot (16:48):
But the face and the eyes, yeah, that's essentially the same approach. It's a little more difficult with men in the sense that men don't wear makeup, and we have beards, so we have to place the scar a little differently. You have to anticipate that placement so it's not as visible. The other problem with men doing facelift is you pull the beard up behind the ear now, so shaving has to go behind the ear, which they don't do before, but that's a trade off. And getting all that turkey gobbler out and getting that neck tighten kind of cut out again, that chiseled look. Yeah, we have to do that.

Monique (17:21):
I have a wild idea. Could they, okay, if you're a man, you're having a full face lift, face and neck, could they have laser hair removal back in the area that the hair grows behind the ear now?

Dr. Smoot (17:35):
Well, you don't want that. You want the hair to grow through the scar. That's what we're trying to do. That's the way I place the scars is to minimize the visibility of the scar by placing a long hair or in the hairline so you don't see it. That's why I like that. But the other thing that I failed to mention is why men are a little more difficult is because we have beards. We're much more vascular and the risk of bleeding is much higher in men. So we have to take a lot more time and effort to make sure that the bleeding and there is all being taken care of.

Monique (18:07):
More vascular, so there's more little vessels in the skin of a man?

Dr. Smoot (18:12):
So the propensity for bleeding is higher.

Monique (18:15):
Okay. Now getting into talking about bleeding, that made me think about a lot of us in our fifties might be on blood thinners or we might be on statins or we might be on all these different wonderful medications for aging. What kinds of suggestions do you have for patients prior to going into surgery?

Dr. Smoot (18:34):
Well, we want them to be as healthy as they possibly can be. Now, some of the things like blood thinners, that's a definitely contraindication doing surgery, you don't want 'em to bleed to death, so they need to be off those. Most of their medications they continue taking. And most of the ones I see are blood pressure medications, which they do need to take to control that. Sometimes they take some cancer drugs, anti metabolites, but again, we want them to get off it because that's going to affect healing. But the diabetes, as long as they're well controlled, blood pressure is well controlled, these are not real hindrance to doing surgery.

Monique (19:05):
And would you say, if you were going to guess on the average age of your facial rejuvenation patients, where is that? Where do people finally kind of go, okay, it's time.

Dr. Smoot (19:17):
Well, for me it's the 50's and sixties. That's usually when I see it. You see a few getting that little, those mini lifts in their late thirties, early forties, but the majority of 'em, their kids are gone, they're out and about more,they just want to look better. And that's the point I want to make when I do these s I'm not trying to make them look different. I'm trying to make them look better, and that's my goal, so I'm not going to pull 'em tight. So we look like a lounge lizard from Palm Springs. Okay. So you get my drift on that.

Monique (19:50):
Yeah. Well, I think that's what most of us want. We want to look natural. We just want to look like we might've in our thirties and just that youthful restoration. And I think there are so many wonderful things with non invasives, but at some point the noninvasive things just start to not work as well. And you have to jump ship over into the OR.

Dr. Smoot (20:17):
Well, that's right. And that's usually where you see that transition in the thirties into their forties. I just can't, filler's just not doing anymore, I've maybe had some lasers, I've had some thread lifts, and they're minimal procedures, but they have minimal results too. But maybe during that timeframe, that's all you need or want.

Monique (20:35):
Now getting into body contouring, could women still have a mommy makeover in their fifties?

Dr. Smoot (20:41):
Yes, very much.

Monique (20:44):
And I saw something on an article I was reading and somebody was talking about, well, I had lipo, but now my skin is saggy. So how do you talk about to people who are thinking about some body contouring and what that should look like or when is the best time to do that and when is it not?

Dr. Smoot (21:04):
Well, the best time to do that, obviously lipos when you're younger, that ability for the skin to contract is much better. It's much better to get a result. As I mentioned earlier, the older we get, the elasticity tends to diminish, and that's where you get their irregularities, the droopy skin. And some patients will look at 'em and say, look, I can remove the volume, but your skin is going to look exactly the same. If you have cellulite, you have dimpling, you have ity, it most likely will not tighten your skin. And you may need to do that transition to that surgical procedure of having skin removed. That could be from a mini tuck, full tuck, circumferential tuck. With liposuction, we're more into the contouring issue, but we're just not moving skin. We're looking at the upper abdomen, the flanks, the back. So we enhance the silhouette, we hence the figure. So it's very common now not only do a tummy tuck, but to include liposuction around the back of flanks area and sometimes in the legs to sculpt the body. That's why I think some of my partners are doing this 360 lipo. And you got to look at the whole body contour.

Monique (22:12):
And speaking of the lipo, so you're taking fat out when getting back into that facial surgery, do you do any fat transfers to the face? Is that something that can help and how can it help?

Dr. Smoot (22:26):
Yes, that's almost part and partially doing facelift surgery at this point, when I first started, that was unheard of. Very rare did we do fat transfers. But now with the technology and the knowhow, it's very common to add fat in certain compartments of the face depending on what you're trying to achieve. So yeah, it's not a hard thing to do. The nice thing about fat that it's natural, if it lasts, it lasts forever. The unfortunate problem is sometimes it doesn't last and it, it's not always predictable, but if you put fillers in, I can guarantee it'll go away. Now, fat can also enhance it. It's the fat that gives the volumization to the face. That's what gives you your youthful look healthier look. So that's why we like to use it.

Monique (23:07):
Now when somebody comes in to have a consultation with you, can you describe a little bit of what does that entail in terms of the questioning and then maybe what are the things that you can show them to demonstrate how they might look after surgery?

Dr. Smoot (23:25):
Okay, first of all, I need to know what their desires are. What are their expectations? What are they trying to achieve? Now with the breast augmentations, we have a computer simulation, which I can kind of show them. Same with lifts. This is what will look on your, it's not exactly the same how they look on their body. The facial is not, it's easy to show them that with technology is we could show 'em is prior patients, the different procedures and techniques we use so they can understand what we've used.

Monique (23:51):
And then after they have their consultation with you, they're going to learn about the prices. And sometimes there's maybe different ways to go at the problem or the concern for that patient. So what I've seen is that sometimes people will have more than one quote, here's if we just did the eyes, or here's if we added in a short scar facelift and what those quotes look like. And I think if you are going to have things separately, it's going to cost a little bit more because that first hour of the operating room in anesthesia is the most expensive hour. So it's sometimes combining. And then if you're going to have the downtime, sometimes doing it all at one time and getting it over with might be the way to go.

Dr. Smoot (24:40):
Well, agreed. One anesthesia, one surgery, one recovery makes a lot of sense. But we have to also consider the time factor, the age factor, your health. What can we do safely? We don't like to do sages pretty much over six hours, eight hours is absolute max we will go. So we have to limit what we can do. Now, I've done enough in my career that I know how to do most of these pre under six hours, but still we have to be careful about trying to try to do too much. But for the patient, it makes a much better outcome financially and time-wise to have it all done at one time.

Monique (25:16):
And just for people listening in the audience, we have all of our price ranges on our website, so you can kind of get an idea of some of these different procedures and the range. And sometimes the range is kind of big because that procedure could be done any which way from Sunday. And so once you have that consultation and it's free, it's, there's no charge. And you'll meet with the doctor and see the before and afters, get the lowdown of how to achieve your goals and then have that quote. And then the patient coordinators are really great about helping figure out getting the right date on the schedule. If you want to have help with financing, we work with a bunch of companies and that's very typical that people will finance part of it. And that's kind of a nice way to get what you want now and pay as you go.

Dr. Smoot (26:06):
Full package.

Monique (26:07):
Yeah. And now I know we were doing virtual consultations because of covid four years ago, but I think a lot of people still like that, and especially if they're from out of town. Do you still offer the virtual consultations?

Dr. Smoot (26:22):
I do, but it's not the same. You get some general idea of what they're after. Particularly with facial surgery, eye surgery, it's really hard to look at them and say, yeah, or show them what they need to be done. So I give them an overview, but I said, I really need to see you in person. And the same with the breast surgeries. It's just not the same, feeling the tissues, seeing how lax they are, how tight they are, what blemishes they have. You can't see it in a Zoom, but it's helpful to get us as a starting place.

Monique (26:52):
Okay. Well, Dr. Smoot, we covered a lot for our Gen X people and our younger boomers, for the people in their fifties. Did we miss any procedures that you find that is good for this age group?

Dr. Smoot (27:08):
No, that's pretty much the bulk of what I see. Like I say, my practice is aging, so I see a lot of my older patients that I treated 20, 30 years ago we're coming back in now and need adjustments or improvements, which is fine. But the nice thing I have is experience.

Monique (27:26):
Yeah, you do.

Dr. Smoot (27:28):
And knowledge is nice, but experience is always trump's knowledge.

Monique (27:32):
That is true. That is true. And so if you're listening today, you have questions about scheduling a consultation or financing, we will have all the links in the show notes, we'll have links to photos, reviews, prior podcasts with Dr. Smoot, and you'll see some of his beautiful photos. So we'll have links to all that in the show notes. And thank you Dr. Smoot, for sharing your time with us.

Dr. Smoot (27:57):
Well, thank you, Monique. It's a pleasure to be here and I hope I've done some good educating the audience here.

Monique (28:03):
Yeah.

Dr. Smoot (28:03):
I'm happy to., if any of 'em want to like to see us or come see more, I'm happy to see them.

Monique (28:07):
Wonderful. Well thank you and thanks all of you for listening and be sure to like and subscribe and leave us a comment if you go watch us on YouTube, you can leave us a comment there and we'll answer if you have any questions. So thanks everybody, and we'll see you next time.

Dr. Smoot (28:22):
Thank you.

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