Continuing the discussion on how you can affect your results, Drs. Kortesis and Bharti take us through all the things you can do to get the best results possible out of your procedure.
Just because you get a facelift doesn’t mean you stop taking care of your skin there. By taking a few simple steps before and after surgery, you open the doors to an incredible transformation.
Get the inside info on being as prepared as possible, healing quickly, and maintaining results.
Hear part 1 of this series, “How to Ruin Your Results”
Speaker 1 (00:03):
You’re listening to Dr. Bill Kortesis and Dr. Gaurav Bharti on It’s Complicated, the podcast that uncomplicates the mental and physical aspects of life and the aesthetic surgery to help anyone committed to achieving their personal best.
Dr. Bharti (00:20):
So last time we were chatting about, you know, we had one topic about what to do to mess up your results and things you shouldn’t do. And I think that was received really well by people and we wanted to kind of revisit it but in a different way, right Bill?
Dr. Kortesis (00:36):
Yep. It, we got a lot of positive feedback and it was very informative for our patients, which I love. But let’s, let’s spin it a little bit. Let’s talk about the good things cuz a lot of patients do this and they do it really, really well. And it’s amazing when they do do it because the results are amplified and everybody wants to know, “All right, what do I need to do? Do I go out and buy a cream? Do I go and do this? Do I do that? What do I need to do if I’m gonna do something to make it better?”
Dr. Bharti (01:04):
You know, I think first and foremost we gotta make this simple and figure out what it is is gonna make things better. We talked about before, one is follow the instructions. What would you say the next couple things are?
Dr. Kortesis (01:18):
Follow the instructions. Follow the instructions. One and two and three.
Dr. Bharti (01:23):
Mm-hmm <affirmative>. All right. So now we’ve gone through that. A lot of the things that I think people come in for and they think that plastic surgery or aesthetic interventions are going to be the one stop shop, solve everything when the truth is there are actually things that patients can be doing before they have anything done. And I think that’s probably one of the big places that we should start is what to do before you have an intervention. So let’s say somebody comes in and sees you and they’re interested in a mommy makeover, they uh, just had their last kid and they’re still breastfeeding. Talk me through what, what has to happen before that patient is ready for an intervention? What do they need to do?
Dr. Kortesis (02:08):
One of the things we talk about is appropriate weight when patients have surgery and what is that? What is that weight number? Where do they need to be? Do they need to lose weight? Do they need to gain weight? And we don’t want to do surgery on anyone that is fluctuating if you’re losing or gaining or things are not stable, it’s not a really good time for us to intervene. So post-baby, the body’s changing things are happening, things are going back to to where they were. They’re going back to their immune normal, then mommy is losing weight and we don’t want to do anything when things are in flux. Cuz if you do that, guess what? Things are gonna continue to change even afterwards. So in my eyes, one of the mainstays is to make sure things are as stable as stable can be before you end up doing surgical intervention.
Dr. Bharti (03:00):
Yeah and I think that that brings up an important point. Two things. Number one, from a standpoint of a weight number, we could care less. And I think that you gotta really understand that. You have to be really careful about that. Like we don’t care about what a patient’s actual weight is and it needs to be at their ideal body weight. And what I mean by that is it’s not a calculated thing that we do, it’s something that where they can live at and stay at. And that’s important cuz then when you do an intervention and they don’t have a dramatic fluctuation, especially on the upside, people have body contour and they go up and wait, it really can be pretty devastating. And so we want to try to avoid that and from a standpoint of after pregnancy, you wanna make sure that the body has actually had a chance to rebound and recoil back to where it needs to be. And so some of those things are gonna be like they need to be off of breastfeeding, they need, their breasts needs to get back to where they need to be at baseline. So that’s usually like six months after breastfeeding and then their weight takes some time to go away and you want it to be stable so that you can get the best aesthetic result basically where you can kind of get ’em, you know, flatter, tighter and more shapely. And so even though they want to get it done asap, it’s important to be stable.
Dr. Kortesis (04:11):
Yeah, I got, people always ask can you do a tummy tuck at the same time as a C-section? You don’t really want to, right? Cause I mean could we? Yeah but you don’t really want to, you want things to stabilize before you get down that road of doing any long-term surgical intervention.
Dr. Bharti (04:26):
And then the other thing is gonna be too, is you gotta make sure your house is ready. It’s important to not hurry into these things. And so there are things that you gotta do. You know, you gotta have help during and after the recovery. You need to have potentially a recliner. You need to have a way to help yourself get up the stairs. You need to have childcare, you need to have uh, special clothes, you need to have, you know, shirts that have buttons on ’em so that you can have easy access. Who is actually gonna be caring for you when you have all these kiddos. I think those are important things to plan before. So surgery is not just about finding your surgeon, picking a date, it’s also about getting ready before, during, and after.
Dr. Kortesis (05:03):
And part of that is are you medically optimized? Right? Have you had a physical lately? Have you had blood work? Have you gone to see your OB to make sure everything’s okay? So that’s the other part, right? Like if we’re gonna go into this, things wanna be stable, you wanna be medically optimized, we wanna make sure that you’re going into this as best prepared as possible and part of that is your overall health. But let’s take it to the next step. Alright G, they’ve had the surgery, you’re talking about mommy makeover, now you’re talking about you know what we need to do. How can they make that mommy makeover better? What are the things post-op that patients can do? They’ve followed all their instructions, they did everything. They were ready to go, they followed her to a T and they’re like, now doc, I wanna make this better. What do I do?
Dr. Bharti (05:51):
So the mommy makeover for patients when they come in, let’s say they’re fully recovered, we’re talking like they’re six weeks out and they just wanna know, now what do I do? And I think the biggest thing is gonna be they need to re enter into kind of normal lifestyle. Now that does not mean you get to go to do a CrossFit challenge and you’re doing like the hardest, most intense workout of day one. You know it’s gonna be a progressive entry. And when we talk about that, there’s some specific things. So we’ll talk about, let’s say a big body case. You know, where we did breast work and uh, abdomen work and we did muscle repair. Those patients don’t need to go to the gym and start doing crunches. Those patients don’t need to go to the gym and start doing leg raises trying to work their abs and core.
They need to start with something small. And this is gonna be all during the recovery cuz they’re gonna be going on long walks, you know, throughout the entire recovery process. But one of the things that I always say to ’em, and I don’t, and I think you do the same thing, Bill, is like they can start activating their core. And uh, one of the ideas that they can walk around and I always tell patients is like the getting ready for battle pose where like somebody’s gonna slug you in the stomach and you’re kind of bracing yourself. They can walk with that kind of muscle intensity and that actually helps them find and and reconfigure their core. And as they start feeling better and better, you keep adding and introducing more and more activity. Now here’s the deal, if a patient never worked out before and they kind of like, well I didn’t, I mean I kind of don’t work out. I think that’s the time when patients can need to be awoken to say that, you know, you made this huge investment. If you just add a fraction bit more to what you were doing from before, you’re gonna take this result that’s good and you’re gonna make it great and if you do a little bit more, you’re gonna make it exceptional. Now, you know, describe kind of what that means, bill for patients to kind of get to that exceptional result.
Dr. Kortesis (07:39):
It is so amazing when you see this patient post-op I, I’ll just go and paint the picture. You’ve done a great surgery, everything went flawlessly in recovery. She healed really well and then afterwards the patient took it to the next level. They worked out, they watched what they ate, they hydrated appropriately. And you see them back 3, 6, 9 months later and you’re like, holy moly, this is absolutely amazing. And they’re like, thanks doc, you did all this. And I was like, no, we’re a team. I did my part, you do your part. And that’s how we get to this next level of exceptional results. And so part of that is you have to take ownership into that part of your life and to to your point, maintain the investment that you just did. And if you work out cardio three or four days a week, you watch what you eat, you drink plenty of water and it is amazing the aftermath of what you can achieve.
Dr. Bharti (08:39):
Yeah. You know, and I think it’s really important to understand if you have like a, a major surgical intervention that uh, you know, reconfigures your body and you want to continue to protect that investment, it is really important to do everything that you can from a dietary standpoint and from a lifestyle standpoint. And one of the ways that you can do that is you get everybody on board. I tell ’em if you’re going to start being healthier, your whole house has to be healthy. Even your kids having to be healthy, otherwise it’s going to break down. It’s like someone who’s a smoker and you happen to stop smoking before surgery and their spouse continues to smoke through it, it it’s gonna be a failure. Like they’re gonna smoke again. And so everybody has to be on board. So just because like a wife or a husband is getting a procedure, it’s, it’s like the whole family’s going through a change and they all have to be involved in it.
So I think that’s a really important piece and from a planning standpoint that everybody really needs to plan and be a part of this and make it something that’s sustainable. Diets, I’m not a big dieting fan, I think they always fail or they’re fads and people are just on ’em for six weeks, three months. So like this is like a lifestyle change. You’ve gotta do something that’s going to be sustainable. So I think that that’s the only way you do this and and my typical recommendation is that patients just need to eat real food. They need to avoid sugar drinks, try to just drink water and then be as active as possible. We were made to move. You should be moving all the damn time. You should rarely be sedentary. You should rarely be sitting, spend most of your day up and moving when you’re awake. And usually that’s gonna be enough.
And then the people who wanna be more intense can do more. Obviously we get patients who are like these fitness freaks and they are incredible and they get back to it and they just boom snap back. But the ones who were kind of not super active and they do this and then they take it to the next level. I mean it’s such a dramatic thing and I think we owe it to them to really lay that out to ’em. And if they are just willing to put forth that effort, oh it’s just amazing. I always say it’s like carrot cake is yummy on its own, but carrot cake with icing is even better. And so by doing the extra stuff, by taking care of yourself, you really just like create this incredible thing that everybody ends up getting just overwhelmed by how incredible the change is.
Dr. Kortesis (10:59):
You know, you were talking about a healthy diet. One of the things I’d tell my patients is, uh, in terms of what you eat of like you said, avoid the sugars, but I say avoid all processed food and kind of stay on the outside aisles of the grocery store. You know, anything on the inside you really don’t want much of, if you get to the fresh fruits, vegetables, meats, seafood, you’re a-okay anything on the inside you want to stay away from. Just keep it really simple.
Dr. Bharti (11:26):
Yeah. You know, and there’s interesting stuff. So we were, we were talking about a lot of body stuff or mommy makeovers and the truth is it’s anything. So it’s like whether we’re doing a facelift, where we’re doing eyelid lift, whether we’re doing surgery on other parts of the body, whether it be liposuctioning et cetera, there are things that need to be done for every and all of those places. Let’s talk about facial rejuvenation for example. Just cuz you do a big intervention doesn’t mean that you’re done there. Like it doesn’t just stop there. You know, you have to do things like avoid the sun when you’re in the sun. Wear sunblock, sunscreen, this is all of us, whether you’re black, white, doesn’t matter what color you are, you need to be hydrated, you need to hydrate your skin, you need to take care of your skin, morning and night.
Wash it, use a moisturizer, morning night. Doesn’t matter if you’re a guy or a girl. All these things have to be done. And sometimes patients don’t realize that or they’re not educated in that. That simple act can really help prevent accelerated aging to reoccur. In addition to that, you know, you, we can do other things. So when you heal, you come back, you start taking care of yourself again. You start, you know, a strong skin regimen. All those things help. And one thing that we forget, and this is really important piece, is that a lot of people take good care of their skin, their facial skin, especially females. Now just imagine if you did that same kind of skincare to your neck and dece or if you did that same kind of skincare to the back of your hands, all of a sudden you have healthier looking vital skin. And so I think that that’s really important and people kind of forget that. Now the problem is that all that costs money and it requires time and effort. But for those who have it, it really is amazing. Now there are ways to achieve it and still not break the bank. Um, and I think that’s why it’s important for patients to be aware of that. And if you make those small incremental reinvestments, then hopefully you don’t have to have a have to have a big surgical intervention again in the future.
Dr. Kortesis (13:18):
You know, surgery is fantastic, right? And I always say facial surgery, you kind of turn back the clock a little bit, but you wanna maintain that length of time for things to get back to where they were or if they ever do you want to get to a new baseline and then start from there and you said it best. Avoid sun exposure, sunscreen when you’re out there, make sure you’re on great medical skin care. But the other part of this is, you know, with, with a facelift and eyelid lifting, we sort of set the foundation where it needs to be, but it doesn’t do anything to the textural stuff, the outside stuff. And it’s like building a home. When you build a home, you have to set the foundation appropriately, but then you have to put the facade on, you have to put the windows on and you have to make sure you wash those windows periodically. And so I really believe in going to get a, a distinct facial periodically, uh, you know, in our practice we use the HydraFacial and I think it’s a fantastic device that kind of helps clean the skin very, very rigorously, more than you do at home. And then potentially doing microneedling or small chemical peel or um, resurfacing with a light CO2 laser every few years. All that stuff helps to clean the facade and keep it as fresh as possible and to maintain those long-term results.
Dr. Bharti (14:33):
Yeah, definitely. And one of the other things that you have to think about from an after standpoint is from a recovery standpoint and what can we else can we do? Cuz one of the things that people ask us about is scars, for example, bill. What, what should people be doing for their scars? How do you make them have invisible scars?
Dr. Kortesis (14:52):
I think the first thing we do is to make sure we keep paper tape on the incisions for an extended period of time. That pressure on that incision helps to avoid the scar spreading a little bit. So not only are you getting the, uh, inability of that scar to stretch in wider, but we don’t want it to stretch to be able to form a hypertrophic or a keloid. The other thing you do after an extended period of time, the taping is to actually use, uh, silicone tape or silicone based scar cream. We found, at least in the literature, that that has been the only thing that’s been beneficial for mitigation of, of scars long term. In addition to that, like you mentioned, avoid sun exposure. You don’t want to take that, that scar out in the sun and you don’t wanna put any excessive tension on it. You don’t wanna start movement on that area right away. You wanna stop that movement because again, a movement will end up stretching that scar.
Dr. Bharti (15:46):
Yep. And I think the biggest thing too is, you know, we try to lay it out that like, listen, you’re gonna have a scar. The chances of it being truly invisible, unlikely, but it’s going to really blend into the background. You’ll be less aware and hopefully unaware of it long term and time. So this takes about year, year and a half sometimes, but there are other things that we can do and patients can do. So you mentioned all those therapies, Bill and I completely agree. And the other thing I would recommend would be aggressive massage along with it, which you kind of mentioned, but it’s really valuable. It’s incredible that what mechanical massage can do and keep a scar flat. Patients just need to know that those scars are gonna turn a little red after that and that’s normal and it’s okay. And then if they need to have laser therapies like a CO2 laser for texture or a light laser to pull out the color, they can definitely do that. But I’ll tell you that it’s amazing what time does though, isn’t it? Like when you, you just kind of give it time, give it time, give it time and it gets better. You know, this is, this is a side note Bill, but a thing our listeners would enjoy to hearing this is, who gets a a worse scar? Who develops a bad thick scar? A kid or an old, old elderly person?
Dr. Kortesis (16:59):
It’s amazing. The, the middle-aged population tends to scar worse than the ones on the opposites and the spectrum. So kids do extremely well, elderly people do extremely well. Um, it’s just kind of middle-aged population that sometimes can scar poorly.
Dr. Bharti (17:15):
And it’s funny because what patients need to realize is actually, for example, in the elderly patients, their wound healing is actually impaired. So they actually don’t form collagen like you do in your prime. So that’s the reason why their scars are thin. So a thick scar, your body is actually forming a tremendous amount of collagen and it’s actually almost over depositing. So it’s interesting that you actually want to minimize it from a standpoint of having a proliferative scar. So it’s kind of a little bit of an interesting phenomena.
Dr. Kortesis (17:46):
And that’s why like you, you mentioned earlier, why turn red before they get better? It’s like as the scar progresses and you get more and more collagen, you know, at two to three months they look really bad and it’s because your body’s producing a lot of collagen and then it changes from one type of collagen to another and the scar starts to fade and that’s what you’ll see. They look amazing and then all of a sudden they’re like, oh my god, they’re red, what’s going on? And then they start to fade again.
Dr. Bharti (18:11):
Yeah. And so, you know, it’s, it’s funny. So the true learning point that we’re, we just actually said both and without actually saying it, is that it takes time. So the best thing you can do acutely when you’re having an issue with a scar and it’s, and it’s a normal wound healing time frame, is let it do its thing because it’s going to change, improve, and mature over time. So that’s a, that’s an interesting, um, discussion from a standpoint of scar, from a standpoint of do, do patients need to have lasers done on their scar? Do they need to have like CO2 or BBL or IPL treatments on their scar bill?
Dr. Kortesis (18:44):
I sometimes, yes. And I, what I would tell you is, you hit the nail in the head. Sometimes we intervene too fast because we wanna appease the patient we want to help, but in all reality, it’s probably best that we just wait. You know, the longer we wait to intervene, the ultimately better it, it is. Sometimes you need to intervene early. If you see something that’s a little hypertrophic or you’re developing a keloid, heck yeah, dive in, go ahead and treat that immediately. But otherwise wait, you know, they use these scars typically take a year or two years to mature.
Dr. Bharti (19:19):
You know, the title of this was How to Make Your Results Even Better. And I think one of the things to make your results even better is I think patients, when they’re totally satisfied, they feel like their results are amazing. And so what I’m getting at is sometimes there might be something they’re not totally content with, or something really small that bothers ’em and they may think that they can’t tell us, or, or we are gonna be offended by that. And so I will say in that situation, the way you make your results better is you, you have to have trust in your providers. You have to have trust in us and you gotta let us know because at the end of the day, we want to know, I’m almost positive every other surgeon wants to know and we do wanna make you happy. And so if there’s something that we can do, modify or tweak, we’re gonna do it.
Dr. Kortesis (20:09):
Man, that’s a really good point, G cuz in the, I think it stems from the initial consult, the more we get to know exactly what they want, the ultimately better the results are gonna, they’re gonna be. You know, how many times have you seen a patient, they’re like, “Doc, I’m ready for my breast augmentation, this is what I wanna do”. And they’re like, “I want a very natural result. I don’t want anything big. I I’m already a B cup, I may want to go to a small C”. And then they, you get to talking to them, talk to them, and then you see a picture and you’re like, “Oh, that’s not natural my friend”. And so that’s part of the process is really trying to figure out exactly what they’re they’re looking for. Because if if, if you’re not on the same page guaranteed, you’re not gonna end up with a really good result.
Segue into the next part of this is like, how do you make your results better? And you were saying, you know, you wanna have this rapport and, and this ability to have this conversation with a patient. That can’t happen if they don’t follow up. Too many times we don’t see our patients back and follow up and they’re like, okay, I think they’re satisfied enough, or who knows why. But I think it’s very important to follow up with your plastic surgeon. Don’t hesitate to come in and every plastic surgeon wants to see their patients in follow up to make sure that all is well.
Speaker 1 (21:32):
Links to learn more about anything mentioned on today’s show are available in the show notes. To learn more about Dr. Bill Kortesis and Dr. Gaurav Bharti and the entire team of HKB Cosmetic Surgery, just go to hkbsurgery.com or follow HKB on Instagram @hkbcosmeticsurgery. Subscribe to our newsletter for key takeaways from each episode, links to any resources we discuss, and promo codes or giveaways from HKB and our partners. If this show has helped you in any way, if you learn something, write a review on Apple Podcast and share the podcast with a friend. Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more. It’s Complicated is a production of The Axis.