Which Tummy Tuck Should I Get?

Speaker 1 (00:07):
You're listening to the La Jolla Cosmetic podcast.

Monique Ramsey (00:15):
Welcome everyone to the La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today we're going to talk about tummy tucks. And our guest today is Dr. Brahme. And I'd like to start out with a quote from one of his patients. And she said, "I walked into their office feeling so unhappy with myself, no confidence at all. Dr. B. and his team were so kind and professional. They understood exactly how I felt and what my goal was. They gave clear communication and answered all of my questions. After the surgery, the care was the same, outstanding. I cry when I see myself in the mirror. I'm so overjoyed at the results. My confidence is back and I'm finally able to be the mom and wife I knew I could be. This is all a result of the wonderful team. I will be forever grateful to you. Best team hands down." So I'm about to cry just reading that.

Dr. Brahme (01:15):
Yeah, you sound like you had a little tear there.

Monique Ramsey (01:18):
Aside from the obvious compliments, Dr. Brahme, what do you hear in this review that's important for anyone considering surgery?

Dr. Brahme (01:26):
Well, really considering any surgery is communication both before and after. And preparing people so that they are not afraid, and so they have realistic expectations, and that they know what's going to happen to them. And that they're safe.

Monique Ramsey (01:46):
I love the fact that she says my confidence is back.

Dr. Brahme (01:49):
Yeah, I mean, that's what this is all about. You know, that's what everything we do is about, is giving back that confidence and making people feel good about themselves, and so that they can function better and feel better.

Monique Ramsey (02:01):
And also just her to talking about the team, the team effort. And I think that's such a big part of La Jolla Cosmetic in that the doctor obviously is incredibly important, but then so is the team surrounding the patient as they go through the journey.

Dr. Brahme (02:18):
Oh, absolutely. I totally agree with you. And we have the best team. Our teams actually, I should say. So it's a joy to work here.

Monique Ramsey (02:27):
Walk us through the variations of a tummy tuck from sort of least invasive to most.

Dr. Brahme (02:33):
I get a lot of people who come in and a friend of theirs or something has had a mini tummy tuck. Mini is a big word, implies less invasive and all that stuff. And very few people actually are good candidates for mini tummy tuck. So there are basically four different kinds of tummy tucks. There's the mini tummy tuck, which I do maybe 5% of the time. And then the standard tummy tuck, which is what a lot of people have. And the extended tummy tuck, which I'm doing more and more. And then what we call the belt lipectomy, which is sort of an around the world. And the differences are not the length of the scar so much, but the difference is what you are addressing. So for a mini tummy tuck, which like I said, not many people are good candidates for. That's if you only have extra skin and bulging below your belly button, because the work with a mini tummy tuck stops at the belly button, doesn't go above.

Dr. Brahme (03:36):
So if you have extra skin or bulges or fat deposits above your belly button, that is not going to change. In most tummy tucks we tighten the muscle and in a mini tummy tuck, you would only be tightening the muscle up to the belly button. So if you have any loose tissues above, that's not going to be addressed.

Monique Ramsey (03:56):
Oh.

Dr. Brahme (03:57):
The next order of tummy tucks is a standard tummy tuck. And a standard tummy tuck basically addresses everything in the front from your pubic bone that you can feel down at the bottom, all the way up to your chest. And what we do is that we make an incision basically from hip to hip, and then lift up the skin and the fat and tighten a muscle as we go along. And then cut around the belly button, pull down all the extra skin. And once we tightened the muscle, we cut off the excess skin and sew it up.

Dr. Brahme (04:34):
So that's a standard tummy tuck. Now a lot of people have extra fat or loose skin in their hips. And I used to do a lot of lipo suction there to try to contour that, but that doesn't take care of the skin. So for all these people who have extra skin, sort of in your flank or your hip area, that's going to sort of spill over the jeans, I recommend an extended tummy tuck. And an extended tummy tuck the scars go around that area and to the back. And that gives the most amazing waistline. And even people who have, are sort of hippy will have just an amazing, amazing waistline after that. And yeah the scar is longer. But, you know, you already have a long scar and just pulling it around the back a little bit makes such a big difference. And one of the reasons I'm doing it more and more is that A, the recovery is no different. The scar is only a little bit longer, but it just gives such an amazing result in that area.

Dr. Brahme (05:42):
And the last of the choices is what we call the belt lipectomy. And as the name implies, you know, it goes all the way around like a belt. And that's really reserved for people usually who have lost a ton of weight. I mean, like you know, 75, 100 pounds, something like that. And they just have extra skin everywhere and they need to be tightened like a belt. So, you know we don't do them often, but we do them more often than the mini tummy tucks. But I would say that I do probably 50% of extended tummy tucks now. And that's a change in my practice. I used to do maybe 10, 15% of that. But I saw so many patients who came in after a tummy tuck and they said, you know, I just don't like all this extra skin that's in my hip that falls over my jeans. So I sort of became more liberal with it, and now I do it probably half the time.

Monique Ramsey (06:38):
Wow. Now, is there a way to know which tummy tuck is right for you? Or is that something that is better just during a consultation?

Dr. Brahme (06:47):
Well, I think that people can sort of look at their bodies and see well, yeah, you know I do have some extra skin there over the belly button. I don't think that a mini's going to do. And then they can pinch their hips and say, oh yeah, and I do have some extra skin there too. So it's usually comes down to between the standard and the extended tummy tuck. And the difference is really just the length of the incision, because the recovery is almost exactly the same. So you can sort of gauge yourself a little bit.

Monique Ramsey (07:19):
Yeah. That makes sense. Now, is there a BMI limit, or is there a certain criteria for somebody who's a candidate for a tummy tuck?

Dr. Brahme (07:28):
Yeah. I think that, you know first of all, you should be in good health. And we don't operate on poor candidates and sick people, although surgery is much safer than it used to be. And we have done patients who've had liver transplants and heart transplants. And so it's actually, there are a lot of people who are candidates. But I think that you look at your body and you see what sort of fits what your goals are. The BMI is the body mass index, and it's a chart that measures your height versus your weight. And above a certain number, surgery becomes a little bit more risky. And so the anesthesiologists like for people to have a BMI around not much over 30. That's not a hard and fast rule because people have different builds, you know some people may be heavy, but their bones are heavy. They have a lot of muscle mass. And so the BMI is not always right. So we'll see the patient and individually really decide, yeah, you're a good candidate or not.

Monique Ramsey (08:34):
Now what is a mons lift and how would you know if you need this too?

Dr. Brahme (08:39):
Oh, you know if you need this. You know the mons pubis is basically the area above your genitals. Both men and women, and especially people who are older, people who have lost a lot of weight, that area tends to sag down. And that's not a happy thing for anybody. So basically it's lifting up the pubic area. And sometimes that's an isolated procedure. I've seen patients who've lost a lot of weight and they haven't seen their genitals for years. And so it's sort of a reverse tummy tuck in that it lifts things rather than pulls things down. And it's about the same level of complexity as a mini tummy tuck. But I have had patients who have that sagging pubic area and they are so happy.

Monique Ramsey (09:31):
Oh I bet.

Dr. Brahme (09:32):
So happy.

Monique Ramsey (09:33):
Now how long after someone's done having children can they have a tummy tuck? Is there a certain waiting period?

Dr. Brahme (09:42):
Well, you know after pregnancy and delivery, the body goes through amazing changes. So I've actually had patients call who were pregnant and say, how soon can I have my tummy tuck? This is my last child. And I tell them, you know there's no fixed number of months or years or days. Basically when you're back to normal and stop changing. So whether that's four months or six months or a year, it's different for everybody, but nature will tell us.

Monique Ramsey (10:12):
Now say they have an old C-section scar or a hernia scar.

Dr. Brahme (10:15):
Yeah. For the scars that are low in the abdomen, I always remove the C-section scar because you know a C-section is a pretty quick operation and they don't really pay as much attention to the very careful closure as we do when we do elective surgery. You know their goal is to get out a healthy baby and sew you up. So I usually end up cutting out the C-section scar so that it's just gone, and then close it very carefully. And the same with lower hernia scars. Now, for patients who have midline scars, sometimes we have to make different accommodations. But we tend to work with patients who have these scars and we hide them as much as we can.

Monique Ramsey (10:59):
And so speaking of scars, so where are your incisions being made?

Dr. Brahme (11:05):
Well, the belly button sits at the level of the top of your hip bones. So that's sort of a pretty trusted rule. So we go from hip bone and then we curve down in a gentle curve to a couple of inches above your genitals and pubic area, and then to the other hip bone. And that's for the standard tummy tuck. For the extended, it goes around to the back a little bit, but for the mini tummy tuck, it's almost as long as the standard tummy tuck. So not much difference there. And then there'll be a scar around the belly button too. And that is really important. And you want to see pictures of belly buttons, because there are many ways to make a belly button. And the belly button has to be really pretty because that's a dead giveaway when somebody's had a tummy tuck if you have a bad belly button scar.

Monique Ramsey (11:59):
Oh, interesting.

Dr. Brahme (12:00):
So you want to see pictures of belly button scars and what they look like.

Monique Ramsey (12:05):
Oh. That's a good hot tip. Hot tips from Dr. Brahme.

Dr. Brahme (12:10):
Yeah.

Monique Ramsey (12:11):
Now what can you expect the scars to look like? I mean, do they fade over time? And how long does that take? And or does that depend on the person's skin?

Dr. Brahme (12:22):
Well, it depends on a lot of things. It depends on the skill of the surgeon. It depends on how you scar. And the scars, they go through maturation and changes. And in the beginning, they'll be red because there are all kinds of new little blood vessels that are healing there. And they stay red for a long time in some patients. I would say that scars take a full two years to mature and you can have a good scar. You can have a bad scar. I do the same closure on every patient. And I show them before and after pictures. You know some scars you can barely see them, and some scars are more prominent. And if we could figure out what made the difference there, we'd all be going to pick up a Nobel prize, but we haven't figured that out yet.

Dr. Brahme (13:10):
But we know that protecting the scar after surgery, taping it, using scar creams, massaging it. These are all good things that we can do for scars. The good thing about scars is they tend to get better with time. So the scar at a year is better than two months. And at two years better than a year, and keep getting better and better and better. And in some patients it's really hard to see the scar.

Monique Ramsey (13:34):
So are there any tricks for faster healing that you tell your patients?

Dr. Brahme (13:40):
Well, are there any tricks in life? I don't know. Good living, just following directions. Don't do things that are... If you think, is this a good thing to do? It probably isn't. So you keep it clean. You can take a shower. The scars can get wet, you know, as quickly as a couple of days after surgery. Keep it clean, and massage it, and use scar creams, and then let nature take its course. And if there is a bad scar, there are always little things we can do. We can inject steroids for firm scars. We can do lasers for red scars. I don't recommend that people you know rush out to the laser and laser every scar, because a laser is a burn itself so it leaves a scar too. But for the problem scar sometimes lasers will help, especially with the redness.

Monique Ramsey (14:31):
Now, how long is the surgery in general? Like how long are they under?

Dr. Brahme (14:37):
In general for a standard tummy tuck, depends on how big the person is, and how heavy they are, and all that stuff. But I usually do a tummy tuck in about an hour and a half to two hours. If you do an extended, you probably have to add another hour because you have to flip the patient and so on, but two to three hours.

Monique Ramsey (14:58):
Okay.

Dr. Brahme (14:59):
And you're in the office for pretty much half the day, an hour before surgery, an hour to an hour and a half after surgery, but it is outpatient.

Monique Ramsey (15:09):
So they can go home.

Dr. Brahme (15:10):
They can go home, yeah.

Monique Ramsey (15:10):
They don't need to go to any kind of aftercare. Do you ever recommend that they have help at home?

Dr. Brahme (15:18):
I always recommend they have help at home, because, you know, tightening that muscle, it's not the skin incision that's uncomfortable, it's tightening the muscle. It's sort of like wearing a girdle on the inside. And so that's the uncomfortable thing. When people cough, or they try to sit up, and things like that, you need somebody to help you for the first few days for sure.

Monique Ramsey (15:40):
So that's really going to be important as people think about preparing if this is something that they're thinking about doing, that they do it at a time during the year that they know they have help. Or they're not having to run their kids 15 different places, because I would say they're going to be on, you know what kind of pain medication after surgery for a few days or?

Dr. Brahme (16:03):
Yeah, I tell people to make sure that you have somebody around for a week just to help you get up and out of bed. And we want people to walk around a little bit, but we certainly don't want them to be too active. So we want them to get around, and they're going to need help, and they're going to need help with their kids if they have kids, or with their pets, and with shopping, with dressing, with going to the bathroom, taking a shower, they're going to need a lot of help in the very beginning. And I tell people, so about a week for that. In terms of recovery, the full recovery is at least a month to six weeks. At six weeks or a month, you can start to think about things like exercise, taking walks, that sort of thing. But, you know your body's an amazing machine, it'll tell you when you're ready to exercise. If you exercise and it hurts, you should probably not exercise.

Monique Ramsey (16:59):
It's not time yet.

Dr. Brahme (17:00):
You can use that as your excuse. And besides we've tightened your muscles anyway. So you don't need to do exercises in the very beginning. But we do like to get for you to get up and get around. And yes, we obviously give pain medication and we're very liberal with it. We have lots of options. The medication is better now, the combinations of medications. Then we use things in surgery that decrease the need for narcotics.

Monique Ramsey (17:25):
Oh, that's good. Now being prepared for recovery, since we're talking about recovery, is a critically important step. And so I wanted to share this comment from a patient review. "Dr. Brahme and team were very honest with how my recovery would go. And they were right on the money when it came to a timeline." So it sounds to me like you give really good, specific instructions of what they can expect.

Dr. Brahme (17:54):
Well, we do because A, they need to know. And B, to protect them. I mean, some people think that they need to be in bed for a month. And some people think that they can go to the gym the next week. So, you know, the spectrum of expectation is so different. And in most of the things we do, whether it's breast surgery, or facial surgery, or whatever, the recovery is about a month. And for the full effect, about a year. That's just sort of the rule of thumb for almost any surgery that we do. So when you look at yourself right after surgery and say, oh my goodness, I'm so swollen, I'm bruised and all of this, well, it takes a while for all of that to go away. And that's where we manage the expectations and sort of relieve the tensions and the fears. And we try to do as much of that as possible before surgery, but anesthesia is a great forgetter. So people tend to forget right away.

Dr. Brahme (18:50):
So we reinforce that and, you know, the important thing is that once the surgery is done, it's not like it's over then. You know, there's a lot of management afterwards and that's really in some cases more important, because they don't know what they're facing. They don't know is this normal? Is this not normal? What can I expect next week?

Monique Ramsey (19:11):
Right. Right. Now I've heard about something called Exparel. What is Exparel, and is it something that you use?

Dr. Brahme (19:20):
Yes, Exparel is, it came around I think probably about three or four years ago. And it's an anesthetic just like when you go to the dentist. It's a local anesthetic, but it's packaged in such a form that it has a long life. So it's effective for three or four days. And that really helps in terms of cutting down on the need for narcotics and other pain medication, and people feel better in the recovery room. So it's immensely helpful, because we want people to feel comfortable so that they can get out of bed and so on. So it's something that we actually inject into the muscle and the tissues before we close up the surgery. And so it stays around for, like I said, about three or four days.

Monique Ramsey (20:06):
And I feel like I remember back in the day there was a pain pump. What is the difference?

Dr. Brahme (20:13):
Right. So a pain pump was actually a very slim little tube that we would implant into the muscle. And then it came through the skin and had a little reservoir of local anesthetic that it distributed where we put the thin little tube into the muscle over about a week. The problem with that was that you couldn't shower with it. It was another little tube coming out of your body. And it just was not as effective.

Monique Ramsey (20:42):
Now, speaking of tubes coming out of your body, makes me think about drains. Do you use drains? And what is the purpose of them? And why? Where? How? Tell me all about them.

Dr. Brahme (20:57):
So let's talk drains. I do use drains for all my tummy tucks. And there are people who don't use them, but the statistics are that you get more fluid collections, they're called seromas, you get more fluid collections after surgery if you don't use drains. And even the people who advocate not using drains admit that yes, they do get more seromas. So it's a little bit of an inconvenience to have these drains. They come out below the incision in the pubic area. Some people put them in other locations, but that's where I've found them to be least interfering with life. They usually stay in for a week or so. We have a benchmark fluid volume that we like to see the patients be below before we take them out. And sometimes the drains, I tell the patients ahead of time, I have never taken out a drain before a week. And I have rarely taken out of drain over two weeks.

Dr. Brahme (22:00):
So in that span between one or two weeks, you have drains. If you have a standard tummy tuck, you have two drains. If you have an extended tummy tuck or a belt lipectomy you have four drains because you have a space in the back that you have to drain as well. And then we take them out when appropriate. And some people will still make a little more fluid and most don't.

Monique Ramsey (22:21):
And why does your body do that?

Dr. Brahme (22:23):
Well, you know, there's a space there where we've lifted up the fat and skin and then pulled it. So there's a potential space under the skin and the fat. And we like for that to heal sort of like a sandwich, but if patients are active, I mean, they're going to make some fluid and that fluid is going to collect there. And unless you have something draining it, then you're counting on the body to absorb it, but it doesn't always absorb it. And the drain is really the most effective way of getting rid of that fluid so that you have that healing like a sandwich.

Monique Ramsey (22:59):
Now, speaking of sandwich, is there compression garments? Or with a tummy tuck are there, I know with lipo suction you guys use a kind of like a girdle. What is the norm with a tummy tuck?

Dr. Brahme (23:13):
Pretty much the same. We have people use compression garments for six weeks. And sometimes patients want to use it longer. They just feel more comfortable and more secure with the pressure garments. So sometimes I have patients use it for three, four, six months. And that's fine. It doesn't cause any problems, but they don't have to use it for more than six weeks as long as everything's healing well.

Monique Ramsey (23:37):
Now are there any nonsurgical ways to get a tummy tuck?

Dr. Brahme (23:43):
In a short answer?

Monique Ramsey (23:44):
Yeah.

Dr. Brahme (23:44):
No.

Monique Ramsey (23:44):
No? Oh, darn it.

Dr. Brahme (23:46):
No. Yeah. Wouldn't that be nice? I mean, there are some things that will do a nice job for you in terms of getting rid of fat, but you know everything is about the quality of the skin. Skin is everything in our business. And if you have good skin that has good elasticity, you may be able to get away with lipo suction, or we have a new technology called Renuvion, which is an internal plasma unit that will heat up the inside, the bottom of the skin and cause it to contract. It works great in the back, in the hips, the abdomen the skin is sometimes a little thinner, so it's not quite as good there. But I have seen some very nice result, but you have to really choose the patients. You know, unfortunately there is nothing that's going to do for you what a tummy tuck does. I mean, you can, I tell my patients, you can do sit ups till the cows come home and it is not going to do anything. If anything, they're going to just lose more weight and have more loose skin.

Monique Ramsey (24:51):
Oh. That makes sense.

Dr. Brahme (24:52):
So, you know I have a lot of patients who come in who are really fit, really trim and have that extra skin. And, you know they don't want a tummy tuck. Nobody wants a tummy tuck really, but that's what it's going to have to be.

Monique Ramsey (25:08):
Now, men get tummy tucks as well. Right? And what percentage of your patients who get a tummy tuck might be a man?

Dr. Brahme (25:16):
You know it's a much smaller percentage since men don't have children. But, you know we do see a lot of men who've lost a lot of weight, who are training and active. And I just did a big belt lipectomy on a man just last week. But I would say that the percentage of men is somewhere between 10 to 20%.

Monique Ramsey (25:36):
Okay. And let's say they have massive weight loss and they have a lot of extra skin. Is it sometimes just the skin that you're dealing with or do they still need muscle work as well?

Dr. Brahme (25:46):
Well, you know, you would think, oh, well you've lost the weight, you know it's all skin now, you know your muscles are fine and you don't have babies. So why do you need to tighten your muscles? Well, people forget that you have fat everywhere. So you have fat inside your abdomen as well as outside on top. And so your belly might have been full of fat that's now gone, and that might have stretched your muscles too. So I'm there, the muscles loose, we're going to tighten it. Unless they absolutely tell me that they don't. We listen to them, but we make our recommendations too.

Monique Ramsey (26:21):
Talking about things that should be important to you as a patient. Safety is something to look for and that's something that's super important to us at La Jolla Cosmetic. And here's how we think about it. Taking the time to listen, never rushing you, building a relationship with you, getting to know you, and your lifestyle, and your goals. And service, if something needs to be addressed or fixed, that's part of this relationship. And you'll see this in our reviews. And Dr. Brahme has over a thousand reviews on our website for you to read, to kind of gauge his personality a little bit. You get to see how he's made a difference in someone's life. And if you go look on his review on his bio page, you'll see all his reviews. And then when you go to our tummy tuck page, you'll see reviews specifically about tummy tucks as well.

Monique Ramsey (27:13):
And then when you're thinking about surgery, you want to know...the other thing you really want to know is price. You know, what's it going to cost? And we publish everything on our website. The range for a tummy tuck starts around $8,250 for a mini, up to maybe $16,000 for an extended. And we do have financing. Life is short and a lot of people finance to get the results today. Can I have it today and pay you next week? So we have financing available and I think that makes it really affordable for people. Now, Dr. Brahme talk to us about your consultation process. You know with COVID we were having virtual consults only. Now things are a little more back to normal. Do you still do virtual consults if people want them, or do you mostly see them in the office?

Dr. Brahme (28:04):
It's funny how this has gone through changes. And for a while we shut down, we didn't have any consults at all. Didn't really know how to respond to this. And then we started virtual consults and they were great. People really loved them. I mean, we had consults from people from all over the country and outside the country even. And then things opened up and we sort of offered a possibility of coming in, but you could only come in by yourself. And now that we have the vaccine and more people are protected, at least I do mostly in person consults now. But yeah, I do virtual consults as well, especially if people are out of town, but virtual consults are great. People sometimes like them, they're in the comfort of their own home. And it's comfortable.

Dr. Brahme (28:50):
Even if I do virtual consults. I see everybody to just confirm what we talked about on the Zoom meeting. I would never operate on somebody without seeing them. I mean, that's just doesn't happen. But I would say both are available now, but I prefer the in person consults. You get a lot more visual cues and get to know people better.

Monique Ramsey (29:12):
Uh-huh. Now who's present besides yourself during a consultation or even a virtual consultation?

Dr. Brahme (29:20):
So in the virtual consultation I used to have, or I still do have my nurse Christina, who's been with me for God over 20 years. So she's on a separate screen on the virtual consults. And in the clinic, what happens is that the front office person will take you and put you in a room. And then the nurse will come in, Nancy or Christina, and they'll get the history and all the preliminary information. And then they'll give me a little cheat sheet and then we'll come in together, Christina or Nancy and I, and talk to you, and examine, and measure, and all that stuff, and go through some before and after photos, answer any questions. You know, we have our little spiel that we give where since we've been doing this for so long, we know the questions that that most people want answered so we sort of preempt that. But there's always some interesting questions that come up, and we get to know them a bit and that's always fun.

Monique Ramsey (30:20):
So Christina's is in there with you, so it's having a chaperone, I think is important that there's somebody else there.

Dr. Brahme (30:28):
For many reasons. One is to remember what they say. And you know now we have these electronic medical records and if you've ever been to a doctor, they're sitting there typing while you are talking and it's very off putting. So I do the talking and she does the note taking, which is just fine with me.

Monique Ramsey (30:46):
I've every once in a while been pulled in as a chaperone for a consultation, and to be sort of a patient advocate too. Like if they're asking something and the doctor's not quite picking up on what they're asking, it's like, well, I think she might mean this. So it's like you have kind of a friend.

Dr. Brahme (31:04):
Yeah. And also, you know Christina has had most of the procedures that we talk about. So she can answer from a patients point of view as well. Christina, I'm sorry. I didn't mean to reveal that, but that's a big thing you know to talk to somebody who's actually had it done.

Monique Ramsey (31:19):
Mm-hmm (affirmative). That's true. Now to bring it all full circle, I want to read one last review. "I bought my first bikini in 40 years. I don't feel shame now when I put on a bathing suit or when I get a massage. I'm wearing clothes that are fitting and I'm wearing dresses, which I never did before. I can do yoga poses now that I couldn't do before, because the extra skin was in the way. I love getting dressed in the morning, and I don't hate going to costume parties because I had to deal with finding an outfit that would fit me and would look flattering. Having this surgery, and it was a belt lipectomy, has changed my life. I have never been this small, even as a teen at this weight. I feel so blessed and I am so grateful to have a body that is fit and healthy, and reflects how I care for myself. Eating healthy, exercising, getting enough rest, et cetera. Life is good." Aside from her joy, Dr. Brahme, what do you hear in that review?

Dr. Brahme (32:21):
Oh you know that makes my day. That's what we try to achieve. Whether it's face or body, you know just restoring and confidence building. That's everything. That's how you perform in your life and your job, everything is to how you feel about yourself.

Monique Ramsey (32:37):
It's so true. So getting in contact with La Jolla Cosmetic, you can call us, text us, email us, and you can go into the show notes, you'll see links there. And we also have a special offer. If you subscribe to our podcast, we'll give you $25 off of $50 or more in our med spa. And so Dr. Brahme, do you have any favorite skincare products? If you had $25 to spend on $50 or more, what would you buy?

Dr. Brahme (33:07):
Well, my wife just bought the Elta skin serum and she swears by it. So I'm not a skincare guy myself. You know, I'm a guy, I do everything in the shower.

Monique Ramsey (33:19):
Oh. So the Elta skin serum. All right. That's a good hot tip.

Dr. Brahme (33:25):
New product.

Monique Ramsey (33:26):
New product. I was going to say, I don't even know about this one. Wonderful. Well, that's fabulous. Thank you, Dr. Brahme. Is there anything else that you want to say that we might have missed?

Dr. Brahme (33:35):
No. Just that, you know this seems like a scary thing to do. You choose to have surgery for yourself. And it's very rare that people say, I wish I hadn't done this. The most common thing is people say, I wish I'd done this so much sooner.

Monique Ramsey (33:52):
Sooner. Well, then I think that's really good advice, you know? Get in, see Dr. Brahme, see what the possibilities are. So you can start planning, because it is a surgery you need to plan a little bit for. So thanks everyone. And we will see you all next time.

Dr. Brahme (34:11):
Thanks, Monique.

Speaker 1 (34:19):
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