Facelift Facts, Styles and Myths

Dr. Javad Sajan  00:01

Ever wondered what motivates people to get plastic surgery? Did they regret it? What can we learn from the stories of plastic surgery patients? I'm Dr. Javad Sajan and this is the plastic surgeon podcast. Hello, welcome to the plastic surgeon podcast where we listen to real plastic surgery stories of triumph in pain from real patients and providers to further understand the motivations or why they would risk their life under the knife. Today I'm so excited to have Dr. David Santos on the show. Dr. Santos is a world renowned, esteemed board certified facial plastic surgeon. He's someone who's done thousands of facelifts he's here today to share his experience his stories, his motivations, his ambitions, his stories of people And try him. David, thank you so much for being on the show. How are you? Excellent, thanks. Thank you so much for that intro. I love it. I also love your music. The music's great. I want to just dance here. David, tell us about yourself. Where did you go to school? And where are you from?

Dr. David Santos  01:19

Well, I'm initially from California. So I did my undergrad at UC Berkeley. Of course, that's where all the action is these days politically, but fortunately, it's been a while since I've been there. I went to Tulane University Medical School in New Orleans for four years and did most of my training in California at UCSF and the Bay Area in Oakland, California, in otolaryngology head neck surgery, and then also went on to do a facial plastic surgery fellowship in the Midwest with in Indianapolis with Dr. Bill besian, which was a fabulous fellowship. Love Facial Plastic Surgery, love facelift surgery. I've been in Seattle now for over 20 years and and settled down here. You know working enthusiastically doing facelift surgery.

Dr. Javad Sajan  02:13

David, why do you like facelift surgery? What's so good about it?

Dr. David Santos  02:16

Well, it's one of those things you kind of--it's a chemistry thing. You just sort of fall in love with it when you first first see it. And, and the first facelift surgery I did was with Dr. Steven Mathis at University of California, San Francisco, who's written a lot of the textbooks in terms of plastic surgery. Also, Jack Anderson in New Orleans was the was the first plastic surgery that ever witnessed. And so, you know, right from the beginning, it was just a you know, I love fest because it's something that you just love. You love it because it's it's so intricate because it's so delicate, it's so refined. It makes a huge difference for people. And, so once you see that when you experience that then it's just something you fall in love with. It's a labor of love. It's not--everybody gets a has a job and and you know gets a paycheck and so forth. This is just something you just love to do. 

Dr. Javad Sajan  03:12

You often see doctors specialize in one particular type of surgery. Is it because they're not good at the others? What specifically about facelifts attracts you to it?

Dr. David Santos  03:23

Right, so a long time ago, I had the choice of doing general plastic surgery, breast augmentation, liposuction cosmetic that way and--but but I really chose Facial Plastic Surgery too. Because the there's I mean, there's so many reasons but but one on one is the intricate aspect of the of the face and the neck and and, you know, delivering the best answer you can for for the particular challenges that we see in the face and neck. But, you know, over the years, you know, facelift surgery became the thing that I just love the most. There's a demand for it. There's a demand for good surgery. And all you have to do is talk to many of the patients that after they have a facelift surgery, have it done well. They are excited, they're enthusiastic about it, it changes their life. And so, me seeing that, you know, time and time again, it's a it's something I fell in love with.

Dr. Javad Sajan  04:29

That that's amazing. And I don't think anyone in this city has more than you. And one of the things that you're the most known for is being able to do these surgeries under local anesthesia without general. Now, I know in some circles that's controversial. And you do it all the time. Why is local? Well how is it possible really to do a facelift under local? How are you cutting off half of someone's face making a tighter without putting them to sleep

Dr. David Santos  04:58

We don't cut off half the face. We just tighten it up make it look good. So, you know local anesthesia, I think is still not standard in the plastic surgery world as best I can tell. I think I think that my training and most surgeon's training is that for general anesthesia for facelift surgery. And, and, and, indeed it isn't something you can do if you're only doing a few facelifts. You can't do it under local if you're just doing you know 10 or 15 a year or something like that. And, indeed if you look at the surveys for ASPS or you know, plastic surgery, you know, groups and so forth the average number of faceless surgeries of plastic surgeon does is in the 10 to 20 to 30 a year. There are a handful people that do more than that. But in order to really be good at facelift surgery under local you just have to do a lot and and have that that training to do it well. But, there's so many good reasons to do it under local anesthesia and I think that the others and an occasional individual says, "You know what you got to put me under just just general anesthesia." and that sort of thing. But, the the truth is that over 90 90% 95% of our patients, we do it under local, it's a choice of the patient. I think that the, the elements that go into that are pretty important of--

Dr. Javad Sajan  06:23

So, I want to hear what you have to say. Before we go further. Can you tell our listeners, what's the difference between local and general? I know you and me know because that's what we do. Tell them. Tell the listeners.

Dr. David Santos  06:35

Right, right. So, general anesthesia, of course, we're using anesthesiologists and nurse anesthetists. We're going to sleep. We're putting a tube down into the, into the throat into the lungs so that you're you're breathing with, you know, automatic anesthesia.

Dr. Javad Sajan  06:52

So you're on a ventilator and all that.

Dr. David Santos  06:53

A ventilator and so forth. Right. And so that's that's needed in traditional. And a lot of our plastic surgeries we do are that way. Local anesthesia, it essentially, you use the one of the main components to it is the tumescent anesthesia component, which is using a dilute lidocaine mixture to provide excellent anesthesia to the areas to be treated. And so this is a main component of it, but also, we're not doing IV sedation. We're doing oral sedation, oral medications, usually a benzodiazepine type of combination to provide excellent, what we call -- or basically, you know, sedation. You're not completely asleep, but you're very, very comfortable. And that's titrated and treated basically, for each individual in a fashion that is tailored to the individual's needs and so forth. So, it's a local anesthesia that can be done you know separate from the general anesthesia components. 

Dr. Javad Sajan  06:54

So, does the patient have an IV for local? 

Dr. David Santos  08:07

So, you have an IV access, of course, but you don't need the IV medication. You're using oral medication. So, the benefit of oral medication over IV. Oral medication, it's going into the gut, and the gut has a very good way of, of, you know, providing medications slowly to the system over time, that's not as rapid and as is IV would be. So it's it's a very natural, tailored medication for anesthesia. So.

Dr. Javad Sajan  08:10

The patients do get an IV before for a local surgery or not always?

Dr. David Santos  08:43

Well, I think it's, it's, it depends. I think it's it's nice to have that. You don't necessarily have to. There are accreditation issues that that sort of dictate to have an IV access, but, you know, essentially we do it, can do it with with just oral and not even have an IV.

Dr. Javad Sajan  09:03

So, when you say local that's sort of similar to what the dentist does when you get a cavity filled?

Dr. David Santos  09:08

Right, so, yes and no. So the dentist is is using his methods his her methods to provide anesthesia to the to the teeth. You get this little shake to the to the cheek and in sometimes my dentist is so good I don't even feel it. And we're doing that component too. But, but the tumescent component provides more than just that local, you know, just little shot. We're providing a diffuse amount of anesthesia throughout the area to be treated with which which of course is underneath the neck, around the ear, and the face and so forth. And so that that tumescent anesthesia stays and provides anesthesia for for hours and also provides hemostasis. And, there's also discussion about preventing infection and things of that nature. So, it's a combination of treatment--that provides a really good--so it's different than the the dentists of course because of the two message component to it.

Dr. Javad Sajan  10:10

How long does it take to do a facelift under local?

Dr. David Santos  10:15

So, that you know, so, you know it, it does vary. But I think that, you know, in a normal situation, it's an hour and a half. When you throw in additional steps to it, then it could be longer 

Dr. Javad Sajan  10:28

So, you can do an entire facelift in about one and a half hours?

Dr. David Santos  10:31

Yeah, so, if you have just a simple facelift, that's an hour and a half. Then, we throw in other things like what we call platysmaplasty, which is a small incision underneath the chin that provides tightening to the neck area, then that might add a little bit more time. And then, you throw in the laser component or the fat grafting or the blepharoplasty. All these other things that add time to it, but you just want to do a simple, for instance, a mini facelift. Then, then, you can do it in an hour and a half and certainly. But, you know, we really don't count the time or look at the clock and so forth. We just simply get it done. But you can't do it in an hour and a half as a decent average.

Dr. Javad Sajan  11:09

Are the patient's moving around when you're doing it?

Dr. David Santos  11:12

Yeah. So with the, with the oral sedation, it's actually beneficial to move intermittently. We're not completely still as if you're sleeping, or still as if your general anesthesia. So there's not a lot of moving around, but a little bit of moving around is great because because when we get it so this is one of the safety factors of local anesthesia. Movement provides safety and so much that that, you know, general anesthesia where you're where you're not moving for three hours, four hours, there's the risk for blood clots and things of that nature. So, under local, that risk goes down substantially because we're moving intermittently. But, but, essentially, you know, to answer the question appropriately. Yeah, patients are not really moving. They're, they're sort of still but you once in a while move their hip and move their leg or that sort of thing.

Dr. Javad Sajan  12:10

And I've looked at your work and the local work that you do is better than I think what many people can do in general anesthesia. At least as good if not exceeding. Really impressive. Do you feel that when you're doing it under local, you're limited in your what kind of surgery you can do?

Dr. David Santos  12:29

No, not at all. The main thing in terms of getting a great result, I think number one, two and three is experience. You know, really doing this a lot knowing all the tricks of the trade. You know, experience is just just huge. You know, I can remember back when I first started doing facelift surgery. And, and, just, you know, it's it's a you know, there's a lot to it and, and the more you do it, the more you do it, then all of a sudden becomes really intricate, easy to to get a great result, but I think experience is real important. 

Dr. Javad Sajan  13:07

Mm hmm.

Dr. David Santos  13:07

But, so the local anesthesia, you know, I think it helps, but there is no way that you know, general anesthesia or local anesthesia one better than the other in terms of the result. But, but there is a big difference, I think in terms of the safety and the desire of the patient to to not have to go under general anesthesia. For instance, general anesthesia, and you know, comparing the two, there are studies out there starting to talk about the particularly for individuals over 60 or 70, that that could potentially accelerate dementia, that sort of thing with general anesthesia. Doing repeated general anesthesia procedures so that so we're avoiding that with a local anesthesia. And then, like I mentioned the aspect of diminished risk of blood clots or deep veins thrombosis and so forth when we do that are local and that's, that's established I think. And then and then patients are, don't have as much nausea and vomiting afterwards because with local because we're not giving you that big bolus of, you know anesthesia that you see with general anesthesia. And then, also the complications of general anesthesia, or airway problems and so forth are not in they're not not present with local anesthesia. So, so I think that the and the other one I think is really great is that patients can actually walk out of the operating room if they want to, we usually use a wheelchair but but they're capable of, you know, getting up and they're more clear and more together and the number of times after general anesthesia where we're, we're sort of still last and you're still out of it that night, even the next day is something that we see with general anesthesia. So, so local anesthesia just has a number of positive benefits that that outweigh the general anesthesia aspect. And but again, it can't be done. If the surgeon is just doing it four or five times a year. It's really something you're doing repeatedly with a great team, and you get it done real well, efficiently and the patients benefit from it. With that lower risk, I believe.

Dr. Javad Sajan  15:21

And I know you've been taking care of thousands of patients, and you must have so many stories that come to mind. Can you share with us a story of a patient you've done under local that really stands out to you?

Dr. David Santos  15:33

Well, I think that, that you'll probably, approximately 70% or maybe 75% of our patients are women. And, and, you know, I think that one of the main things that we see is, we want to feel good about ourselves. We want to feel good about where we are in, in the in the world and so many of my patients, you know just say things like, preoperatively they'll say things like, you know, "I, I want to matter more. I want to be part of the conversation." This one lady that that I remember her saying that she walks into a room and she feels invisible because people don't pay attention to her don't look at her don't think that she's, you know, just that older person in the room. But I do have one patient that I always think of that, approximately 65, and we did a procedure on her and she had a great result and so forth. And so a couple weeks, like a month after the procedure, she goes off from here, Seattle all the way to San Diego with the girls and have a girl's trip. And she just had her procedure done. And so the girls did what the girls do and she got asked out by a young man and so they went out to for a for dinner. This this you know, management in San Diego, they're sitting talking and so forth, and and eventually came to well by the way, "How old are you?" And she says, "Well, I'm, I'm 65." And, he says, "Well, I'm, you know, 40." So, uh, so you know, and so it was kind of a surprise, but it's not to say that, that, that we get away with it that way all the time, but it's just to say that you can, you can make a change in your life that that makes a difference. And, and, and I have another gentleman who, who, you know, worked in a factory and all the all the men in the factory were in their 30s and 40s, and so forth. And he was, you know, in his 60s, 65. And he wasn't part of the niche part of the boys club. He was sort of the old guy, you know, that, you know, sort of separate from the group and so he you know, he had something done. You look better and it gave him more confidence and, you know, he wanted to be more part of the boys group. So, there's various, various stories. I mean, many, many stories about impacting your life. Whether it's dating or in the workplace, or just, you know, feeling better about yourself.

Dr. Javad Sajan  18:06

What do you think motivates people the most to seek out a facelift?

Dr. David Santos  18:12

Well, I think that one of the things I see commonly, two things I'll see commonly. One is that they're, you know, see their themselves in a profile or a picture that was taken and look at the picture and look at themselves, or look in the mirror and just simply say, that isn't me. And they feel, you know, much younger than they're looking. And, and so they, it comes to a head, they just say, "I gotta do something about this." "I just don't--I'm not this person that I see in the mirror." And let's, let's, let's make a difference there. And so that's one thing that's very common. And one thing that we, you know, make make a huge difference on the before and after pictures, people you know, after a month after the surgery, they look at They just say, "This is phenomenal. This is great." The other one I see is just just individuals who are younger, you know, in their 40s and you know, 50 or around 50. And you think well, that's not somebody who needs a facelift and I've seen it more and more where somebody comes in and says, "Well, I don't you know, I still look okay but I want to look better." And those individuals are real surprising to me because wasn't something I'd seen back in the you know, 15 years ago, 20 years ago, but more and more is coming to a head, maybe it's because of Instagram. Or maybe because their friends are looking good. They want to keep up with them. But we're seeing folks in their in their 40s, women in their 40s, and you can get a little oomph there, a little tightening, a little lift. You can see that before and after. And it just it just can sometimes blow you away.

Dr. Javad Sajan  19:57

Do you think people taking more selfies is leading them to get more facelift surgery?

Dr. David Santos  20:01

No. So, you know, I think that the main thing that I see really is when I mentioned first. Which is, which is, you know, they see themselves in a picture at a wedding, or, you know, maybe an Instagram. And they look at that they say, "This just isn't me." So that's, that's someone in their 50s, mid 50s, 60s, and so forth. And that's a big one. That's a traditionally a big one in and probably the most common patient that I've seen is is that story. But, but in terms of Instagram has influenced a lot of other things. And it really is huge. And the big one that you'll see of course, or we've seen, of course is the is the Kardashian lips. And so people come in and they want the Kardashian lips and so forth. So there's that's a real influence that we've seen quite often but yeah, so right.

Dr. Javad Sajan  20:57

And, Dr. Santos, and I do facelifts differently. The only way I do them is with general anesthesia. And that's the way I was trained is the way I'm the most comfortable in. I think the way you do it is really impressive. New. It's cutting edge and it's innovative. And, I, for a lot of patients that I've seen in their 60s and 70s. What I'm noticing now more and more is they don't want anesthesia. They prefer to do to under local because they perceive as lower risk factors. And that's what I see too. As far as the ambitions of people. They don't feel like themselves. And they don't feel like themselves because they don't see themselves in the mirror. So when people are having a facelift done by you, do you see this change back and how they perceive themselves? Are they feeling more like themselves?

Dr. David Santos  21:43

Well, I think what they really come to say once things have healed up is that that looks more like me. And that's really what we really want to do. And the number one thing on the list here is to be natural, of course. We don't want to look different. We want to look like, you. Like, me. You know, and that's just a huge, huge aspect. Nobody wants--I mean, there's always the discussion about the Hollywood bad results before and after, and so forth. That's, that's actually a rare, a rarity. It's not what we see we, we see natural, we want natural, we want to look like, like who we are. And, and, and that's what we see time and time again. And I always tell patients beforehand, we're working on looking natural. We're not looking at tightening things up so it looks, looks like it's windswept or anything like that. We're trying to get it to a point where it looks natural, but looks like you. And so if you really look at it in terms of before and afters, I can't tell patients, this is going to give you 10 years, but what we see in general is 10 years to 15 years. Rarely, we'll see 20 years but we have seen that.

Dr. Javad Sajan  22:01

Mm hmm.

Dr. David Santos  22:57

And, I mean the minimum is eight years difference. And that's what we're trying to do is you know, you and I are aging all of us age. We can't, we can't change that. That's just part of the ballgame. But what we can do is take us right now, and back up eight years, 10 years, and 15 years. Let's back it up. And still, because we still have the bone structure of the jaw, the cheeks, you know, the neck, the neck structures that's still there, that's still us. It's just this soft tissue in the fat and the laxity in the just the sagging that's occurred. We're going to remedy that. And so by remedying that, restoring that to its normal, normal, youthful position, then we're going to get you back we're going to get, you know, the unnatural and natural is just really what we really focus on. But we're trying to get, get, get things to look like you. So we really don't it's extremely rare for somebody say, "Well, it doesn't look like me." It really is. You know what, what, who you are what you what you used to look like.

Dr. Javad Sajan  24:03

Yeah. David, how long does a facelift last that you do?

Dr. David Santos  24:06

So, this is a common question everybody asks, "How long does it you know going to, to last? The way I look at it, well, the things I always say to patients is, if you had a twin sister or twin brother, and you had it done and they didn't, then of course, you're going to look better than they are today and this month and this this year, but but essentially the result, the change is a permanent change. And so you will always look better than your twin sibling. You know, 10 years from now, 20 years from now, 30, 40 years from now. Indeed, I have some patients where I have some twin patients, you know, one who had it done, the other who hasn't. And you can see this change over time. So that that's the concept. So we're moving backwards in time today when we do the procedures and we look better today. But of course we can't stop the aging process. And, but but essentially, this is a permanent change. But we still age. The end of the number of times that somebody at 10 years or 15 years says, "Hey, I had this done, but you know, I want to have, you know, have it done again." Yes, that happens a repeat procedure, but it's really less than than 8%, 5% of individuals. So, once you have one lift, usually you're not going to get a second one, or want a second one. But there is a small aliquot of patients that say, "Hey, yes, let's let's do some some more" because they just, they want to get that, get that tightening back again.

Dr. Javad Sajan  25:40

So, it sounds to me like you're setting the clock back, 10 years ish, something like that. But then the clock keeps ticking is that would that be a good way? Right, right, right. Right. Right. Right. And, you know, we we're not going to we don't aspire to be 70 years old and look 40 but we do aspire to be 70 and look 55, 60 and that that's that's a reasonable desire to reasonable expectation. And we see it all the time. And, and, so often I'll see patients that I haven't seen in a year or so they come in, and I walk into the room and I look at him and ask myself, "Well, how old is this individual?" And generally, when you when you when you inspect it, it generally is at least 10 years younger than you might think just just looking at their appearance. When you do facelifts under local aside from the anesthesia risks, are there any extra risks for the procedure itself?

Dr. David Santos  26:38

Yeah, so there's always risks with all surgeries, as we know. And the things that the way I break it down is that certainly we have the common risks that that just you know, happen as swelling, bruising, discomfort and that sort of thing. And occasionally, we'll have some bleeding problems that we have to remedy and occasionally we'll have an infection that we have to remedy or bump and lumps and so forth. So these are common, you know, they're, we remedy them in short order, but after a week or two, you know, these things have taken care of themselves.

Dr. Javad Sajan  27:13

I know everyone's different, everybody has different risk factors. But on average, how often do little complications or little bumps come up when you get a facelift done? 

Dr. David Santos  27:22

Yeah. So, I think of it as common, you know, and that's okay. As long as it's temporary, temporary, in the, in the realm of one week, two weeks, three weeks, and, and no more than a month. And so, that's, that's just part of the ballgame, when we sort of, you know, tolerate that. And so I always tell my patients to, if they could just be patient, for you know, a week, 10 days, that these things will will smooth themselves out and that's, that's a better way of looking at it. If you want perfection after day or two, that's that's a real challenge. The real important thing in terms of real bad permanent complications, those are really rare. And, you know they're, they're those are things we just have to mention. It's like driving in a car, the odds of you driving home and having a bad accident is really low. And same thing with with permanent bad problems with with facelift surgery. So really just focus on these, these minor things, temporary things temporary temporary. They happen we deal with them. And, in short order, they're they're they're taken care of.

Dr. Javad Sajan  28:26

How long is the recovery from a facelift that you do?

Dr. David Santos  28:28

Yeah, so one of the main things we look at is that patients will ask is, "When can I get back to my social situation? When can I go back to work? When can I you know, go to the store? When can I just present myself? I don't want to stay indoors forever." And the day that the number we always give is about 10, 10 days. We should be in over 90% of individuals should be presentable. Not completely healed, but presentable. Where, where where you're not noticed where you're not, sort of, you know, where somebody can see that you've had something done. So, at 10 days, you should be able to get out maybe with your hair in front of your ears or maybe with a little bit of makeup on, but you should be presentable at that time. But before then, on occasion, you know, I've had a patient that was looking great at four days, but generally, you know, you need about 10 days. But in terms of completely healing, you know, it takes some time for it to completely heal. And, and we can be patient with that, because it's not something that really, we notice, but, you know, we can feel some firmness in the face and neck afterwards that takes a while to recover. Those aren't things that we really have a good deal of worry about. The thing we really look at is when can we get out? When can we be social? When can we get back to life? We don't want to stay indoors forever. And in the majority of patients, it's 10 days.

Dr. Javad Sajan  29:56

Have you seen more facelifts requested now that we've had the shut downs and lock ins?

Dr. David Santos  30:02

Yeah, so one of the things that people have said recently with this COVID thing is, "I want to get it done now because I can wear the mask and just hide everything." So, but yeah, I think that, you know, more and more people of course are working from home, and they're able to, you know, take care of themselves at home, can wear the mask, they've got the time. And so we certainly see a lot of that today, for sure.

Dr. Javad Sajan  30:28

I'm sure you've seen a wide range of results and complications from yourself and other doctors. Can you share a complication that you've seen that has been pretty dramatic? Either one that you had yourself or you saw from someone else?

Dr. David Santos  30:44

Well, I'll tell you one, one interesting, maybe crazy story is a physician in another state that I was overseeing. He, he did a procedure on a patient and gave gave the patient lots of normal instructions. And, the patient was sort of out of town. And so went to a local hotel, and was dropped off had her caregiver, you know, taking care of her and so forth. But she was inspired that evening and said, "Well, you know, I think I can drive home" and so got, got in the car and tried to drive home, but was pulled over and because she had medications on board was arrested. So, you know--

Dr. Javad Sajan  31:26

She went to jail with a fresh facelift. 

Dr. David Santos  31:28

Yeah. But you know, it doesn't matter the reason if you're driving, you know, under the influence, then that's, that's reasonably to, to be arrested. The thing is, we have very, very important and detailed instructions afterwards. Obviously, let's take care of ourselves. Obviously, let's don't drive in the same day. But, and, so we do get in trouble on an occasion when those instructions aren't abided by. I have one patient who, who was an avid golfer and so three, four days after the facelift, went out golfed and so forth. And came in on the fifth day with, with lots and lots of swelling as you'd expect. And another lady who was gardening, she had to get her gardening done. It was springtime, and there's lots of gardening to do. So three, four days later, she after the procedure, she's out gardening, bending over, and she came back in with lots and lots of swelling. So, so the overwhelming majority of concerns and complications can be avoided. And we just do the right thing and instructions are pretty the--it's a challenge because one of the instructions is for the first week, do a lot of nothing. 

Dr. Javad Sajan  32:42

Mh mmm.

Dr. David Santos  32:42

That's a challenge for people. And we have usually wear a wrap for whole week. I had one patient, just like recently, who, you know, decided just didn't want to wear the wrap. And so three days afterwards, he came in with a little bit more swelling after three days, and we really worked hard to try to remedy that. But if you abide by the instructions, a lot of these things are avoided. And those are obvious ones there and so forth. But.

Dr. Javad Sajan  33:09

I had a patient I did a facelift on who had a really wild complication. Really sad story, actually. So this was an African American woman. I did a facelift on and one of my instructions after surgeries, I don't like heat packs. I don't like hot packs on the face because people are sometimes numb as you know. And sometimes in within the first 10 days of surgery, they might not feel what's on their face. 

Dr. David Santos  33:33

Right, right.

Dr. Javad Sajan  33:34

So, I had this woman who put a hot pack on her face. It was clearly written on our instructions, don't do that. She fell asleep with it. 

Dr. David Santos  33:41

Right, right. 

Dr. Javad Sajan  33:41

She woke up with a severe burn on her face.

Dr. David Santos  33:44

Right, right. Right, right. So I've had one patient too. We have a little bit of numbness around the ears and so she did her, her hair, curled her hair. And didn't feel it under the ear and had a slight burn on her oracle, or ear. So, you know, there's a whole number of instructions. And if you just abide by them, then so many of these things are avoided. Again, the common things will happen and we just don't even get too concerned about them. Like I mentioned, the swelling and bruising, sometimes bleeding, sometimes infection, sometimes bumps and lumps, asymmetry and those sort of things. And those are remedied in a short order. They're temporary. We fix those, but, you know, bad permanent complications, those are small, those that are at low risk that's less than 1%. You know, you know, patients who smoke. Now, there's a lot of surgeons that say, "No, I'm not going to operate on somebody who smokes." And, and so, that's, that's, that's wise. And I think that that is a high percentage of physicians will will say that or, you know, make sure that they stopped smoking. But they're, you know, and so that provides an increased risk. Your medical history provides increased risk for healing problems. So, diabetes and cardiac disease and pulmonary disease and smoking all increase our risk for healing concerns, or double the rate of healing, and so forth. And so we were very cognizant of that and caution and, and are careful with those sort of situations. But, but I certainly have, have finessed those situations in so much as to treat the, you know, to do facelifts on those individuals. But it's tailored based on on the degree of medical compromise and based on their desires and so forth. So, so plenty of individuals are not candidates for a facelift. But with the right thought process going into it, many patients can still have facelift surgery, even though they have medical problems or even even smoking.

Dr. Javad Sajan  35:53

One of the common questions I get from patients is why do celebrities look so weird as they get older. Not all of them, some of them. And, the patient's tell me, "These people have the best doctors available. They have all the money they could want. Yet they still look really weird like Sylvester Stallone, Steve Wynn, Glen Campbell." David, tell me why do you think they look so funny?

Dr. David Santos  36:16

Well, I think that what's interesting is that I've observed a lot of surgeons a lot of plastic surgeons. And, and, on the whole plastic surgeons are good surgeons, are good people. They're smart, they're sharp. They got the board certification and so forth. But, but with facelift surgery, I think that good good facelift surgery is performed by less than 40% of the average plastic surgeons. And, there's a whole number of reasons for that. And just because you have a big name doesn't mean that you're a really good surgeon. Just because you've got a big office doesn't mean you're a big surgeon. I think there's there's a lot that goes into a really good facelift surgeon and I could I can name, you know, 100 doctors that have observed. And I can tell you that two or three of them that I have observed are really, really good. And they're the people other than myself that I would refer, you know, family member to, or what have you. But but it's really less than 40% that can, that can really get the job done. And so and so in what do we need, we need, we need natural appearance we and and, and that's just something that you need the experience, but you also need the, I don't know, the, the the know how and the the genetics to to provide that sort of result. And so, so there's plenty of instances where the surgeon might be board certified, might be somewhat experienced, but just can't get it done. As an example, I think there is a correlation between the time the amount of time it takes to do the procedure, and the potential success. And not to say that you know, somebody who rushes through, I don't, I rarely see somebody just rushing through and just getting it done just to be quick. But I do think that there's many instances where I've seen surgeries done in four hours and five hours. And the result is they're just just, you know, not getting the job done efficiently. And the result isn't as good. But, but I've got to, you know, many doctors I've seen that just are so efficient, so good, getting it done well, and they can get it done in an hour and get it done in two hours, two and a half hours and have great results. So, so you know, not all surgeons are created equal. And when you get a good surgeon, then you should have a great result 99.9% of the time.

Dr. Javad Sajan  38:46

So, if I'm a patient looking for a facelift, all qualifications being equal, how do I tell who's going to do the right job for me or who's going to be terrible?

Dr. David Santos  38:55

Go to church and pray I think. Now, you know, so I think I think that you've got to have several examples in front of you friends and family, they've had something done, and nurses and so forth. And other doctors who've said, "This guy's really good or this, this woman is really good." But just because they've got a nice, nice, you know, office or something just isn't enough. And so I think you really have to do some good homework and recommendations from from a number of sources, patients, nurses, other doctors, and, and then when you walk into the room and you talk to the physician, you need to feel real comfortable with them. And then you have to do what I've done before when I have gone to other medical professionals. I asked the question, "Well, how many of these have you do you do a year?" And when when someone says "Well, I do a lot or something, or I do 10 or do 20." That's, that's when you want to rethink things. When somebody looks up and says "I do about 50 or 100 of these a year or 200 of these a year, and my results are excellent." Then, that's, that's a person you might feel more comfortable with. So the volume not always is, is the most important thing, but it's oftentimes is very important. So, you know, somebody says they do five, or--and this is true for almost any procedure--you know, just do four or five a year, that's not enough.

Dr. Javad Sajan  40:33

So, it sounds like one of the most important factors, not the most, all qualifications being equal, is how many is that doctor doing? And you want to go to somebody who's high volume. And do you have patients or let's say someone's asking for a referral. I mean, because you can't do it for whatever reason. Do you have them look at the before and afters? How important are those?

Dr. David Santos  40:56

Well, before and afters are important. But it's you go online, you go to the internet, you go to the website. All the best results are on their, their website or on their Instagram and so forth. So that's helpful. And if they have a lot of pictures, that's helpful too. But again, I think I think goes back to having confidence in the surgeon when you talk with them. Having great conversations with other individuals who know about their abilities, including patients, including nurses and other doctors. And, and, I think those are I think those are real important aspects. But just because they got good before and afters I you know, everybody's got one or two good good results. But, we want to know about the the last hundred patients how good we were results and all those hundred patients.

Dr. Javad Sajan  41:46

Do you think it's right for physicians who don't do high volume procedures like facelifts for them to be even be allowed to do them?

Dr. David Santos  41:55

There's plenty of surgeries where you don't really have to have high volume to do well you know? And, I think that it's under the judgment of the surgeon as to you know whether that's appropriate or not. But but I think when it comes to things like rhinoplasty and facelift, I think you really need to be someone who does a lot because it's your face and sometimes if there's a poor technical treatment of these of, of these areas, the results can be, you know, challenging for a long time. And, there's so much we can do in terms of revision facelift, revision rhinoplasty. But, but you just don't want to have to go there. So I think I think that facelift and rhinoplasty are specific surgeries, that you really want to have a surgeon that does it a lot. There's other surgeries when it doesn't, it's not that big of a deal. You know, may ask you your opinion about liposuction?

Dr. Javad Sajan  42:55

Mm hmm.

Dr. David Santos  42:55

I think that that that's not really required that you do a lot of that. I think you can do pretty decent, pretty decent job just doing simple liposuction. For the average surgeon, I think my guess is and maybe you can disagree with me or not, but 80% or 90% of plastic surgeons do a pretty decent job at liposuction because I think it's a simple procedure. But, when we talk about facelift, as I mentioned, I think it's only 40% of surgeons. That's my guess. That's my estimate. That's my opinion. I don't have a study that shows that it's a hard thing to really look at, but that's my opinion. And so, yes, I think that you want to have somebody who does a lot of it, and who's been successful at it.

Dr. Javad Sajan  43:38

I really, I agree with you in the fact that whatever you're going to do. You have to do a lot of it. Right? For example, liposuction, we can talk about that for hours, but that's a procedure that has changed so much. Right? When it first started, people were just removing fat with the big tube. Liposuction is today for the true liposculpture surgeon is so different. Now, when people come, just to give you, you know, some insight, just like facelifts, the goal is really to sculpt the body, not just remove volume. And the people that are removing just volume are not the people who are doing the real high end liposuction that patients nowadays see. 

Dr. David Santos  44:15

Right. Right. Right.

Dr. Javad Sajan  44:17

 There's so much to it. And the only way you get there is you got to do a lot of it. And I agree with you, you need basic certifications, you need education. I also feel that anybody can pass the test. Right? Which is how you get these certifications, oftentimes, but not anybody can do a great case. And, from what you said about high volume really resonates in what I believe. You need that and I think it's true in any trade any profession. Wouldn't you say so?

Dr. David Santos  44:43

There's this study that I read a while back ago that just just essentially blew me away. It was this hospital in Canada, whereby the surgery is strictly a herniorrhaphy hospital. And so all of the surgeons there, that's all they do. They just do herniorrhaphies. They said, "Well, that's just a simple procedure, who cares?" Well, their numbers beat numbers elsewhere by a mile. In other words, their, their revision rate is like half what it would be in any other hospital there. The time that they do the surgery is half as long as as the average general surgeon and complication rate as well. So it's, it's it's the volume and such as a surgeon you think well, the surgeon is really good because that's all he does is herniorrhaphy. It's the team too. You've got these nurses and and assistants that are that are helping you they're doing the same. They're becoming experts themselves. And they are providing that that that little bit that provides a better result. Less complications, less revision rates, and so forth. So the team is part of it as well, not just the surgeon. In fact, if I was to go out and do a facelift at a local hospital then I'd have to use the the nurses and assistants that the hospital has to teach them everything that needs to be done and what about the equipment so forth. So it takes me twice as long to do. The team is part of that equation too as well. And that's an important aspect too. But, definitely volume is important. Definitely experience. Definitely certification. All those things are important. I think there's some some genetics to it too. I think you need to be someone who can't because I've seen the opposite where where the physician is just our surgeon is just fumbling around. Not a lot, but enough to to to notice. Enough for me to say I don't think I want to send my mom and my sister to this person.

Dr. Javad Sajan  46:41

Absolutely. David, I'm totally with you on that. David, you've shared so many amazing insights with us. When you think about facelifts and reflect back on your career, if there was one insight, piece of information that you would want to share with people who are thinking of getting this done, what would you tell them?

Dr. David Santos  47:00

I think that there's plenty of misconceptions about facelift surgery and that comes from Hollywood, right? Because the only exposure that most individuals have over the years has been, you know that bad facelift from the actress and an actor and so forth. And so we we perceive it as expensive, as only for the the Hollywood elite. And it's risky because we could end up looking like you know, one of those bad results. But the truth of the matter is, it's not that expensive, it is really safe. If you get someone who does this a lot, you're in good hands. Somebody with good experience, then you're in good hands. And, and there's more people that that have had it done that you might imagine. You've probably had, I mean, the average person probably has friends or family that's had that have had it done. And they don't know about it because it's so natural appearing. So, so natural is is the commonplace when you're talking about a good facility, a good surgeon. And the abnormalities and bad results that you see in Hollywood are really the rarity, I think.

Dr. Javad Sajan  48:10

Absolutely. I absolutely agree with you. David, thank you so much for coming on the show today. I have learned a lot from you. And I know our listeners have too. I'm honored to have you as a friend and a confidant and someone who I also often seek advice from in my career.

Dr. David Santos  48:26

Great to be here. I love the music. And love, love talking with you.

Dr. Javad Sajan  48:31

Where can patients find you if they want to get in touch with you? You can find a lot of good information, before and afters, and some entertainment on Instagram @drdavidsantos. But also website is facialbeauty.com as well. That's awesome. Thanks for listening to the Plastic Surgeon Podcast and tune in next week for my guest, who's going to have an amazing patient story. Catch us on all social media @realdrseattle and watch me on Snapchat. Bam what!