Liquid Nose Job and Other Ways Filler May Surprise You with Dr. Rod Rohrich

Dr. Furnas (00:02):
It is all over TikTok. Liquid nose job, liquid rhinoplasty. You sit in a treatment chair, you get an injection, and you've got a new nose. So our rhinoplasty surgeons going out of business. Welcome to Skintuition. I'm Heather Furnas.

Dr. Korman (00:20):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the nonsurgical world to bring you what's new, what's safe, and what to look for when you're ready to hit refresh.

Dr. Furnas (00:34):
It is a true pleasure to introduce my good friend Dr. Rod Rohrich. Dr. Rohrich is internationally recognized as a leader, a teacher, an innovator, and as the former editor in chief of the most influential Plastic Surgery Journal in the world. You know how well known and respected George Clooney is among actors. That's Dr. Rohrich among plastic surgeons. Welcome, Rod.

Dr. Rohrich (01:04):
Well, thanks so much. Thanks so much, Heather. I wish my mother could have heard that.

Dr. Korman (01:09):
Yeah, exactly. This is the love fest group. So Dr. Rohrich, you're known for your advancements and expertise in rhinoplasty and many other areas, but we're going to focus on rhinoplasty today. But not everybody wants surgery. Liquid nose job, liquid rhinoplasty are acute names for a nonsurgical approach with filler. So what is liquid rhinoplasty? When is it a good idea and when is it a bad idea?

Dr. Rohrich (01:39):
Great. First of all, great to be on your podcast. It's awesome. And the amazing thing about liquid rhinoplasty, it's a total misnomer. It's really not a liquid, nor is it a rhinoplasty. You're really injecting a filler, a hyaluronic acid filler, hopefully onto dorsum of the nose, and.

Dr. Furnas (01:59):
The dorsum of the nose means the up and down part.

Dr. Rohrich (02:03):
Yeah, the top of the nose and the tip. And it has limitations because what it does, it actually makes the nose bigger. And that's one of the things I always tell patients. So is it a good procedure? I think in selected patients, it's a good procedure. Is it a safe procedure? I think in the hands of a board certified plastic surgeon or a rhinoplasty expert, it is because it also can be fraught with problems because the nose is one of the most vascular parts of the nose. And as both of it can have problems with skin loss, even blindness. So you've got to be very careful. Even some of the most sophisticated injectors that aren't plastic surgeons or facial plastic surgeons avoid injecting the nose because of that fact. So it is useful in selected patients, and I do it because I do it both in patients that want to kind of see what potentially their nose may look like if they have a low bridge, which is the top of the nose. And also in patients that have had a previous rhinoplasty that just have had multiple nose jobs and they're not a candidate for another nose job or they don't want. So it's useful, but this is a one area of noninvasive techniques that you have to be very careful and very selective in your patients.

Dr. Furnas (03:25):
So if I've just been on TikTok and I've got sort of a tip that points down something like that, and I come to you and I say, I want a liquid nose job, how are you going to evaluate me? And what are you going to tell me?

Dr. Rohrich (03:44):
Well, I'm going to tell you first and foremost that your nose, no matter what I do, is going to be bigger. Some people are taken aback by that. And number two, if you have a truly a drooping nasal tip, really is not so good for that. A liquid rhinoplasty is good for if you have a low bridge or if you want to just get your tip up a little bit. But to try and bring a tip up that's truly drooping, which means hanging down, that will take a lot of filler and it won't be sustainable because those types of patients that have a really droopy tip or a big hump, they're not good candidates because it doesn't work well. And as a general rule, the bigger the hump, the more the filler and the bigger the nose, and that doesn't look good.

Dr. Korman (04:32):
So can you help us understand a little bit about the irregularities? So if a real rhinoplasty, or let's just say a surgical rhinoplasty has irregularities, and you're talking about maybe using that filler as a fix. If you inject the operated on nose, is that the same as injecting a filler nose? Is there any issues with scar tissue or is it because it's small amounts you can do it, and is there any other, what's the best way to look at it? Meaning fillers for correction of irregularities after rhinoplasty versus using a filler for what we call a virgin nose, a nose that hasn't been operated on?

Dr. Rohrich (05:16):
That's a very good question, Josh, because a couple of things. Revision rhinoplasty has a lot of scar tissue. That means that the blood vessels in that area are a little more diverse or abnormal, so it's a little more dangerous injecting that. But having said that, if there's a small little irregularity and you can, I think correct that quite safely with a small amount of filler. And the remarkable thing is if you use a safe filler hyaluronic acid filler that doesn't disperse or does not absorb water, one like Restylane for instance, which is one of my favorite ones in this area, because it doesn't absorb a lot of water and it stays where you put it. So I like it that. But there is an area, probably the highest area of skin loss is in areas where people have been injecting in areas they probably shouldn't.

(06:05):
You shouldn't inject along the rim or along this groove here, the alar groove, because that's where the blood vessels live. But in a revision rhinoplasty, the blood vessels may be totally abnormal or anomalous as we say, and that can be a problem. So the interesting thing also is in the rhinoplasty world, about 50% of the rhinoplasty experts use fillers. The other 50 don't like it. I get patients referred from other rhinoplasty experts that just have refused to do fillers, and that's fine. I always tell a patient that it may last six months or a year, and often I see it lasting a lot longer amazingly, and especially in a small contour irregularities, sometimes it lasts a long, long time.

Dr. Furnas (06:49):
You mentioned danger and skin loss. What does that mean to the non-plastic surgeon, the patient who should understand if I've had three rhinoplasty surgeries before, what are the risks of filler?

Dr. Rohrich (07:05):
Well, those are real Heather, and that means that the biggest, well, one of the biggest skin loss, that means the skin around that area dies. And then sometimes even if you inject higher, it can actually cause you to be blind. It's rare, but it can happen. There are very distinct blood vessels on the sides of the nose and on the sides of the rim that are large, and those are the ones that are kind of no fly zone. So those are not insignificant risks. That's why you really need to know the anatomy. And when I teach it to other plastic surgeons or random plastic surgeons, I always say, stay midline, stay deep, small volume, go slow.

Dr. Korman (07:45):
So in the world of, like you mentioned, the no fly zone, and you mentioned just a little bit ago that you hope it's hyaluronic acid that people are injecting, what's your feeling about something like a Bela fill, which is a longer lasting filler? What would you say to a patient who came in and had it before and it was fine, we somewhere else and wants a little more, what do you tell them?

Dr. Rohrich (08:14):
Well, I don't inject Bellafill. I mean, I know it's the only FDA permanent filler that's approved in the United States. I think the science seems to be reasonable, but I just don't inject permanent fillers other than fat. But I will tell you, I don't do Bellafill. I take out a lot of Bellafill. I take out a lot of Radiesse, which is a good filler, but you shouldn't inject Radiesse in the nose. I just am a strong advocate for not injecting things that are permanent in the nose and they're dangerous. And honestly, I don't know how to remove Bellafill, Josh, and Heather. That's a real problem. And if it's in the subcutaneous tissue, what I've seen is that it gradually moves upward to the dermis, and then you have to remove it or cut it out, and it's a disaster.

Dr. Furnas (09:03):
Yeah, unlike the hyaluronic acid that is reversible.

Dr. Rohrich (09:07):
Yeah. Well, hyaluronic acids interesting that you mentioned that Heather, the short-term data shows that it's reversible, but the long-term data shows that it actually may not be so reversible in some areas that there's some fibrosis in that area or neocollagenation or collagen vascular formation. So I would say that even fillers aren't totally reversible, but they're better integrated into the body, and I think that's the most important thing.

Dr. Korman (09:39):
Yeah, isn't the, I mean, hyaluronidase, it breaks the hyaluronic acid into lots of little pieces, but I don't know that it actually makes it go away exactly.

Dr. Rohrich (09:51):
That's exactly right. And that's what's been kind of a myth. I see patients all the time have these big lips and they say, well, don't worry, I can remove it. I said, not necessarily. You can remove part of it, but we've all seen these patients with big lips and sometimes their whole perioral, it's just inspisated, which means that it's just inderated, it's hard. You can't ever get rid of that. You could inject hyaluronidase, which is the melter of hyaluronic filler forever, and it wouldn't make it go away. It's a pretty challenging problem that I think people don't talk about enough.

Dr. Furnas (10:29):
I'd like to shift a little bit from the nose and the lips. You've done a lot of anatomical work defining the fat compartments of the face. So tell us what these fat compartments are and their impact on the changes we see in aging, like the deflation of our cheeks and what filler can and cannot do.

Dr. Rohrich (10:54):
Well, Heather, I think in the article, we've written several, but we've written the first one that was written by Dr. Pesa and I in 2007 that was published in the White Journal, the Journal of Plastic and Reconstructive Surgery. Really, I kind of laid the framework for better understanding the science of aging. Because if we think of, we know the bones are the structural framework over the face of some of it, but really for facial aesthetics and appearance, it's the fact that's the structural framework. It's the I-beams that are on the bones that actually give us our identity. And when we age, they predictably atrophy. In other words, you predictably lose the deep and superficial fat compartments of the face. And we describe, there's over 21 of 'em that we describe both deep and superficial, that as we age, they predictably lose fat, especially in the nasal lial fold in the cheek, the temple around the eyelids. And that's predictable. And we see that starting at age 30. So it kind of began the evolution of why we need to add fat when we restore the face. So it's not just about lifting. You have to fill it. And I think that's the, hence the reason why when I do a facelift, I almost always do face fat centrally because it is vital to restore what's been lost versus just pulling like crazy like we've done historically. And those results, as you know, have not always been so great.

Dr. Korman (12:26):
So for patients that either don't want their fat or actually don't have enough fat, where does filler come in as possible replacements for deflating fat pockets? Meaning fat pockets that are getting smaller over time from the aging process. Does knowing where the fat compartments are help a practitioner inject the filler?

Dr. Rohrich (12:54):
A hundred percent, Josh. And I think the irony is that the dermatologists know the anatomic facial fat compartments almost better than the plastic surgeons, the true excellent injectors. They know the facial fat compartments better than anybody. And so the answer to that is a resounding yes, because the days of just kind of willy-nilly injecting facial fat or even fillers anywhere is gone. So if you really want to get improved results, I inject the deep fat compartments with fat in an operation with a facelift. But when I'm doing fillers in the office, I inject the deep mailer compartments, the high mailer compartments, the lateral chin compartments and nasal full. I inject all of those. I do it systematically, and I use different fillers deep, and I use different fillers for the superficial fat because the deep fat is a little larger globulins of fat. So you want to use a more stable filler in that area, one that's got a little bit bigger g prime and then more superficial, a softer one. So I would say resoundingly, if you understand the anatomy of the face, and most expert injectors do, in fact, they all do, and they get great long-term results doing that.

Dr. Furnas (14:11):
Can you describe what the fat compartment really is? It sounds like a room. And what are the walls, and can you explain it so that somebody who is not a physician understands?

Dr. Rohrich (14:25):
Well, you know, the crazy thing is, of course, it's our innate anatomy. It's always been there. In fact, there's fat compartments everywhere in the human body. Recently they were described in the buttock and thighs and stuff, but they've always been there. And the fat compartments, in fact, your dad described the ligaments, and really what he described was the ligaments in the face, two major ones, the zygomatic continuously and the mandibular ligament. But the other ligaments in the face, they're really effusion points between the fat compartments. So basically when you elevate that deeper layer, the SMAS from the outter to inner layer, you're really elevating that inside. That is a superficial fat compartment, especially when you go to the high cheek and the middle cheek. That's all the superficial fat compartments, but in the muscles below that here in the cheek. That's why the irony is the common or the popular new reinvention of the deep plain facelift is even if you do deep plain facelift, you cannot affect this part of the face significantly long term, because

Dr. Furnas (15:37):
That's, that folds from the nose to the corner of the mouth.

Dr. Rohrich (15:41):
Right. Because what happens is you can pull it tight and then you'll look like not a good, it won't look good, but that's why you have to fill it, because this is all deflating as we age. So the deep fat is below those muscles of the face below the sma, and that's called, those are the deep fat compartments. They're the ones that are just above the bone, are cranial facial skeleton. And I personally think those are the most important ones in the face. And if I inject one fat compartment, I'll inject the deep maler.

Dr. Furnas (16:14):
So maler being cheek,

Dr. Rohrich (16:16):
The cheek right here in the cheek.

Dr. Furnas (16:18):
Yeah.

Dr. Korman (16:18):
Yeah. So how do you direct a patient that clearly is unhappy with their facial aging and would like improvement, and they don't really know whether they really want to have a facelift and thinking, well, what could they do instead? Do you think there is a role in which a patient could come to you, for example, and then get the fat injection first and see, okay, well maybe that will tide me over for a while, or does it need to be done at the same time as the facelift? And if it's the facelift, then I know I have lots of patients who I would encourage them sometimes do some fat transfer at the same time, and they're, oh, no, no, I don't want to do that because I'm worried I'm going to look two full and maybe do the first thing first and then, so help us out here. How do you approach this?

Dr. Rohrich (17:17):
Well, great question. I educate them and tell 'em. I tell 'em about the short story of what I just told you about how we age. It's not just the bones that get weaker and softer, but it's also our facial fat and that you selectively using words like I selectively add fat where you've lost it. So it only makes sense that we restore it. We lift the deep layers, but we fill the central part, which you can't really affect. So I tell 'em about that, and I mean, it's a pretty patient that says, well, okay, I don't want it. And then I can tell you invariably, and the ones that don't want it, they'll come back and I'll have to add fillers in their deep mailer compartments in about six months to a year. I don't say told you, but I just say, listen, these are things that we talk about.

(18:05):
And the other cardinal rule is I will inject fillers, you know, there are people, as a plastic surgeon, I'm not a purist in saying, oh, yeah, I'm only going to do a facelift. Or some people they're doing facelifts on 30 and 40-year-old, which is not necessarily appropriate. But the moment you have a significant jowl, I think you need to stop fillers. Once you have jowls, then you start looking kind of cartoonish. You're looking out of sync with your innate beauty. And people understand that because if you're chasing a nasalabial fold or a jowl, and then you're starting to make people look a little different and a little weird, and no matter where you live, people necessarily don't want to look weird. And we have all those classic examples of the famous people, some that we all know and some that are no longer with us, but you don't want to look like somebody else or another species.

(19:06):
And we're in a face protection, not witness protection program as plastic surgeons. And that's kind of our hippocratic oath. I can tell you I see one or two patients like that a week, and you just can't melt that fat. I mean, I did a facelift on a lady that the day of surgery, I had done her FaceTime, and I saw her two days before, and she had so much filler in her face, you can remove part of it, but she had some permanence, some Radiesse, which again is a good filler, but it was so challenging to remove that. And it makes the facelift a lot more difficult to do today. But that's a normal, I don't know how it is in California, but in Texas, I get a virgin primary facelift, probably one in five. Everybody else has had either fillers or some radio frequency or ultrasound therapy, and it's made it more challenging for us.

Dr. Furnas (20:00):
Yeah, I think there is some geographic socioeconomic impact in that people getting filler are commonly charged based on the number of syringes. And so it's fine if all you need are one or two syringes, you agree to that. Now, there are downsides because sometimes people will try to increase their revenue and maybe inject too many syringes. Sometimes it's patient driven. But what about the reverse? If somebody really needs eight to 10 syringes to sort of reconstitute all these deflated fat compartments and they just want to pay for one, how would you handle that patient?

Dr. Rohrich (20:43):
Well, the way I handle, I don't do fillers or surgery by syringes or ccs. I really don't. Not even Botox. I don't do any of that. I say, this is what I'm going to do for your lips. This is what I'll do for your cheeks. Or if they say, this is what I want to do for your face. So I tell 'em, this is what the treatment will be for. Same with Botox, which is any of the neuromodulators. They're all great. I charge it by the results. I've never charged for ccs or syringes or per unit. And if they need 8 ccs of filler, I'm not going to do it. They need fat or something else. I just can't do that. But I just think I don't do that. I want to see what that looks like. And when people ask for a lot more, I usually do about half of what people want me to do.

(21:30):
And honestly, Heather and Josh, people respect that because I say, listen, let's come back and see me in six, eight weeks and let's see if we need to do more. Many times they don't, but that way I'm not overfilling 'em because nobody wants to look like the state puff marshmallow. I mean, they don't look good. And also, they're a signature of who we are, and I don't do that. Now, some of my patients, they know I don't like huge, huge lips, so they'll go elsewhere. But then in about a year or two, I'm taking out, I'm doing hyaluronidase.

Dr. Korman (22:00):
Yeah. Well, I would argue that maybe the stay puff marshmallow would like to look like the stay puff marshmallow.

Dr. Rohrich (22:07):
True, true.

Dr. Korman (22:09):
Yeah.

Dr. Rohrich (22:10):
I love marshmallows, by the way.

Dr. Korman (22:12):
Yeah. Yeah, I know.

Dr. Rohrich (22:13):
At least as a kid.

Dr. Korman (22:14):
Yeah. So Val Lambrose is a plastic surgeon who we all know well, who has really helped define facial aging by taking photos of people like his plastic surgeon friends year after year. He showed that our faces don't fall as much as they deflate, like we were just mentioning. So what are the physical signs you look for in a patient wanting only a nonsurgical approach? I know you mentioned that when there's a jowl, you can't fill it anymore, and that's one important thing. What is it so that you, so it's not a waste of the patient's time or your time, what is it that you look for that kind of distinguishes whether okay, a nonsurgical is an option and no non-surgical is not an option.

Dr. Rohrich (23:03):
One of the most important things that I see early on is the presence of an early nasolabial fold, which is in this area.

Dr. Furnas (23:13):
The crease from either side of the nostils.

Dr. Rohrich (23:15):
Right on the other side of the nose. Once they start getting a little bit of that fold. And also temporal hollowing, once they start getting an early peanut look, and especially in, you see that in younger women because that's an estrogen dependent muscle. It's a skeletal muscle. So once you start seeing that nasolabial folds and early loss of fat around the chin, those are three early cardinal signs. There's also some fat loss around the eyelid. But I don't like to inject fillers in the tear trough unless the patient is very young, has good skin tone, has no fat in that area, because tear trough fillers are challenging to do and should be done in highly selective patients.

Dr. Korman (23:57):
So nasolabial folds though, there's some young people that have nasolabial folds from very early on. So would you recommend they have fillers as a way to help stop the aging process when they go? How do you deal with nasolabial folds in a young person?

Dr. Rohrich (24:18):
Well, we show 'em in the mirror usually. I don't actually tell them what I'm going to do. Just like in a rhinoplansty, I never say, this is what I think your nose looks like. I always ask 'em, what are your top concerns about your face? That way it puts them in their court. And then my job as a skilled practitioner is to tell 'em, well, those are things that will help and these will not. So if they don't mind their nasal fold, that's fine. And then sometimes if in their late thirties, if they have some, because there's two types of faces in general, there's many types, but there's that full face, which is one that really doesn't need a lot of fillers except for here. Then there's a thin face that needs pan facial filling, and that's the one I push towards using autologous fat, which is the best filler or a bio stimulator.

(25:07):
But I let them tell me what they think is bothering them, and then I'll counsel them on what really would look good. If you fill in general from upper and outer to lower, you'll need less filler. Your patient will look better. That's one of the secrets of facial filling is use less filler precisely place, go upper outer and go from outer to medial. If you follow that cardinal rule in general, the patient will look so much better. I'll tell you, sometimes I'll just inject temporal area and the commissures and they'll come back and say, wow, it looks like you did my cheeks. And I said, no, I didn't do that at all.

Dr. Furnas (25:50):
So the temporal area would be between the side of the eyes and the hairline. And the commissure is basically the corner of the mouth area.

Dr. Rohrich (26:00):
Yah, the corner of the mouth. But people look older sometimes, especially thin, younger patients when they've lost the hollow, when they've lost this muscle called the temporal muscle. And once they lose some of that, just adding a small amount of filler in that area really makes 'em look great.

Dr. Furnas (26:18):
Now, Allergan just came out with something called Skinvive, which is a hyaluronic acid product described as micro droplets for smoother cheeks. It's the first FDA approved hyaluronic acid for micro droplets. It's not really being used as a filler, even though it is hyaluronic acid, but more like a skin enhancer and filler can plump the hand as it loses volume with age. The ear lobe is another area people don't talk about. Are there other unusual areas you use filler in? And can you tell us about the impact of what you think Skinvive is doing with the skin?

Dr. Rohrich (27:02):
I think first of all, you know what I call Skinvive back to the future. Zyplast Zyderm came from Stanford. All those, I mean, it's really a skin simulator, and basically it's an intradural injection of a very light. I think it works well. It kind of gives the face a little more refreshed look. I think other areas, and we've been using this for years, by the way, I've been blending all of the fillers for, I've been doing this for years. I like it in the decollete. I like it in the neck lines. And I'll use intradermal injection of a blended because those transverse neck lines you can't do even with surgery. So to me, this is just an FDA approval of something I've been using for well over a decade. So it works, it's fine, and it's a little more time consuming to do, and you'll see a whole array of these being approved by the other companies as well. There's several more coming down the pipeline. It's been used in Europe a long time. The good thing about the FDA and the bad thing about the FDA is that we are a little slow in getting approval of fillers in the United States. But personally, I think that's a good thing. I think we have a couple of dozen in the US and in Europe they have about 120 and probably about 80% of 'em are ones I would never use. So I'd say it's a good thing.

Dr. Korman (28:19):
So what innovations do you anticipate beyond fillers in the anti-aging space, energy devices, anything related to non-surgical wellness, aesthetic practice? Will we be injecting patients with their own cultured fat cells? Anything that with your crystal ball that is a crystal ball?

Dr. Rohrich (28:41):
Well, I think as noninvasive, everybody wants their surgical result without surgery. And of course, to date, we still can't do that. We're getting much better. We're using radiofrequency. We're using ultrasound therapy. We're using laser devices to go deeper into the skin, and then we're kind of filling the deep layers. Obviously, fat's still the best, but resurfacing the largest organ in human body with lasers and things, it is all improved dramatically. So I think we're getting closer, but it's not going to replace true facial rejuvenation where you're lifting the deep layers and removing some extra skin as we age, since we live on the planet Earth. So we have to fight gravity. So I would say in the future, as these techniques and technologies improve, we're pushing the need for facelifts out a little later. Is that good or bad? I don't know. I think to me it means that when you do do a facelift as a plastic surgeon, as all of it makes facial rejuvenation, a little more challenging to do, not impossible, but a lot more challenging because the planes are really kind of not messed up so much, but there can have some scarring because the body only responds to stimulation or these devices by one way, and that's by causing scarring, and that can really mess up the facial planes for surgery.

Dr. Korman (30:17):
Do you think that there's any devices better than the others that can help fat last longer the transplanted fat?

Dr. Rohrich (30:26):
Well, there are things that are proposed that are obviously not FDA approved, because as we all know, there's no way in the FDA, the FDA will allow any way to alter chemically or otherwise fat without calling it a drug. But other than altering and adding stem cells and other growth factors, maybe exosomes I think are also on the horizon that can enhance fat cell survival will be in the future. I think those are all things that are important, but as long as we're not altering the fat cell, we can still use fat without FDA approval because it's part of what we do in the art and science of plastic surgery.

Dr. Furnas (31:09):
We've been talking about injecting the fat, but the first part is getting the fat. So we should probably mention a little bit about that. Would you mind describing how we get the fat Rod?

Dr. Rohrich (31:21):
I think the most important thing about the science of fat and how to get it to survive the longest and the best is to harvest it and then minimally manipulate it, which means don't do a lot to it and then re-inject it. Now the science for that is pretty good. Once you start manipulating or altering fat, that's when you get into variables of fat survival. So I usually harvest fat from the inner thigh, Heather, the fat's a little small.

Dr. Furnas (31:46):
So basically it's like a mini liposuction.

Dr. Rohrich (31:49):
Yeah, very small, two, three millimeter little cannula that takes it. I alter it minimally, centrifuge it maybe for a minute, and then just inject it immediately. Don't let it sit around. So I think you, the fat will survive 60, 70% in the face. In the other parts of the body, it maybe is less, but obviously I would like it to be 80, 90%, but in general, it's 60 70%, and that's reasonable. So I over inject my facial fat compartments modestly. The deep ones, I don't over inject. The superficial ones I do because the superficial fat, just in my level five experience does resorb more. But the deep fat that I put in, I don't over inject except for males redo, facelifts and massive weight loss patients, and now Ozepic patients. So those are the patients I over inject by 50% in the deep because they tend to lose fat more.

Dr. Furnas (32:48):
Is there anything else you'd like to add?

Dr. Rohrich (32:50):
I would say in medicine less is more listen to your patients. Don't do crazy stuff. Do stuff that works in your hands and follow what you think is an aesthetic result, not what the patient necessarily thinks, because if you always do and listen to the patient, but I think your job is to also protect the patient if they want things that don't look good or you don't think is good in their hand. I don't do them. I just say, I can't do that. Because if you do things that you don't think look aesthetically good, when do you stop? We see examples of that every day on TikTok, the crazy overdone extreme. Facelifts the extreme. I mean, I think if patients want that, that's fine. It's just that that's just not my aesthetic and it's none of yours. You all are fantastic plastic surgeons, you guys would never do that either. I mean, what do you think?

Dr. Korman (33:48):
I think the problem is that a lot of people don't know what they want. They want to look better and they don't really know, and they look to experts to help them look better. And I think it's a job of experts to try to help them look better and not look strange or weird.

Dr. Rohrich (34:03):
But that's our job as skilled plastic surgeons, is to help them look better. I mean, the problem also is social media has mirrored the whole framework because it's made the social influencers, megastars, you know the Kardashian group, which I think they're phenomenal. But does every Kardashian always look, they almost all look alike. They've had the six pack, they've had the same six things, all of 'em starting at age 18 from lip fillers to all kinds of other fillers. And that's fine, but we shouldn't have our children emulate them, I don't think. But they do. And I think that we just, as physicians, we still need to say, Hey, is that really going to look good on you, those big lips, and you have a very small, beautiful face. Does that many look good in you? And that's just my thoughts. And I just feel better when I drive home at night saying, hopefully I help somebody not look weird.

Dr. Furnas (35:03):
I think those are wide wise words, and it's up to us to kind of normalize the distortion that we see on TikTok and social media and filters.

Dr. Rohrich (35:15):
You have a lot of filters.

Dr. Furnas (35:19):
Yeah. So join us every two weeks as we tackle topics from hair loss to hormones and pimples to wrinkles. Discovering new ways to feel better about ourselves. It has been a true honor to have you on our show, Dr. Rohrich.

Dr. Rohrich (35:33):
It's my pleasure.

Dr. Korman (35:34):
So follow us, comment, ask questions, keep in touch. Have an idea for a topic? We'd love to hear from you. Theme music by Diego Canales, production and Engineering by The Axis. Thank you, Dr. Rohrich. See you on the radio.