Deep Plane Facelift Explained | Plastic Surgeons' Opinions

[Music] today my guest is uh dr craig foster uh he's a nationally and internationally a well-known plastic surgeon from uh manhattan he has a practice on park avenue and uh dr foster um is an old friend of mine i've known him for 30 years and i'm excited to have him as a guest on the beauty doc today podcast and we're going to discuss new trends and how they fit into the paradigm of treating cosmetic patients and i i really am excited to get his his thoughts about um you know things that where people are there's there's always these uh trends that come and go and i'd like to hear his thoughts about him since he's been around a little while and as a as a as have i uh i'm in the same category so um we're going to start first of all before we begin i i do have to introduce him a little more thoroughly because he is a uh trained as a general plastic surgeon otolaryngologist and dentist he's covered the entire waterfront of of the face from top to bottom and and all those uh particular uh areas of training has added to his uh expertise and ability to analyze a face and treat the patient uh in a comprehensive way so um dr foster i'd like to or i'm going to speak to you as greg and and um today i'd like to talk about um you know what your thoughts are about current trends and in face lifting for instance i know a lot of people uh are touting the deep plane facelift as being the end-all and be-all and i and i'd like to hear what your thoughts are and what your preference is based on your experience well yes i mean they're the deep plane is recently got much more play in the faceless circles however the basic and fundamental anatomy of the of the human face in terms of its relevance for facelift surgery was more or less established in 1969 by tort scoob and it all revolves around the so-called deeper layer in the face called the smash which is an acronym smas for superficial musculoapneurotic system and all that's a mouthful for the average listener because this is gauge to the average listener not to the the medical community right well an average an average listener or a potential patient may get a consult and your doctor may talk about this mass which is which is the layer that's that's assumed importance really since the 70s and most modern um basically all modern facelift techniques to a certain extent revolve around what is to be done with that layer how is it to be approached what are you doing with it so you can either pay attention to this mass layer from superficially or you can go underneath it so-called deep plane so there is a a uh controversy i guess you might say about what is the best way to approach and to deal with this mass a lot of these questions were answered by a so-called twin study that was done several years ago where they took three sets of identical twins and did different procedures on them different approaches superficially on top of this mess underneath this mask they did deep planes they did so-called subperiosteal they did a a panoply of different approaches they had an uninterested observer uh grade or try to detect which procedure had been used six months later once everything had healed there's no difference in the outcome of the facelift procedure depending you know whether or not you're on top of this mass or underneath this mass the important thing was as long as something was done with this mass layer that gave the best and the longest lasting results so i think what it boils down to for most of us is that however you choose to deal with this mass layer is a uh is personal preference what you feel most comfortable with whether you approach this this mass on top and do a mastectomy a lateral mastectomy a just a smash dissection or a plication your results will be comparable with or similar to a subs mass or the so-called deep plane the reason many of us i do not particular i do not in myself use a deep plane approach only because the deep plane approach i i believe brings the facial nerve which is the motor nerve that runs all the muscles in the face into a little more peril i mean you're in the you're in the plane or you're in the level of the face that contains the facial nerve and i think it it it's a little riskier in that it does expose the facial nerve to more potential damage so personally i use a lateral mastectomy and plication procedure and i think uh time has shown that those procedures that are repeatable and deal with this mass layer give the best results whether you approach it from superficially or deep so but you know there's there are those advocates uh of the plane who who believe that this if you do the deep plane it lasts longer you get a more lasting result and maybe you can achieve things uh say like lifting the cheek fat up higher or something like that uh to a greater extent having and and but having said that i think i i appreciate what you're saying because if you go on the deep plane there is a risk of uh of a facial nerve injury and that brings me to the next question do you think that people in new york city is where you practice are willing to uh have this procedure done at a greater risk than people say on the west coast do you think there's a difference between the two do you want to say do i say patient population in new york is somehow different than the patient population in l.a yeah i mean i think in terms of tolerance yeah well i do risk tolerance well my feeling is generally speaking that the northeastern part of the united states the patient population is more conservative now in terms of accepting risk it's all about how it's presented to the patient so it really just depends on what how the doctor is saying what he's saying and even though on the face of it the facial nerve is more at risk in deep plane procedures i'm not so sure it's been shown to be statistically different in other words are the longevity are there are more facial nerve injuries in deep plane as opposed to superficial also i'm not aware of any study that has shown that a deep plane facelift lasts longer than a than a uh any other technique that's used now i mean it'd be very difficult to to show that the only thing you could do is do a deep plane on one side of the face and um you know a smastectomy or placation on the other side of the face well that's what that's where i see the flaw that that twin study that you were referring to they looked at six-month results so we didn't see the results say out in five years to see or three to five years to see if there was recurrent uh banding in the neck or or sagging in the face and and um you know i you know i'm just i don't have a i don't have a uh leaning either way i'm just saying i'm very curious how you view it and i now have a i have a uh understanding of that and i do respect that you know safety first for the patient and and ultimately um it may not make a difference and also you're undermining tissues that um in planes that are normally not undermined and you kind of undoing in a sense natural uh adhesions that uh may not be that beneficial right i mean i think virtually every modern facelift technique calls for disruption of those particular facial ligaments in order to allow more mobilization of the tissue that you're trying to mobilize the fundamentally a facelift operation is an anti-gravity operation so you're trying to mobilize tissues in re reposition them in a uh vertically in a more uh vertical position so without releasing those uh facial ligaments very it would be very difficult to actually reposition these tissues and have them stay in that position for any length of time in terms of banding in the neck there's fundamentally very little difference in the in the dissection in a deep plane in the in the neck as opposed to any of any of these other operations it's all about well lifting up the lateral bore the platysma then how far do you go undermining it and you're doing basically the same thing with almost every every procedure the real difference is the deep plane occur in the cheek well there's a lot of people who you know have focused on the neck in terms of below the platysma muscle which is the neck muscle and again i think it's there's greater risks once you go below the platysma to dissect deep there or even manipulate the celery glands uh which are over here and um so what are your thoughts about doing that for instance there are people who do routinely do salivary gland reduction in order to get more of a extreme uh contour of the neck it's true that one of the persistent problems in facelift surgery and as it pertains to the neck is a large or low position of the salivary glands so-called submandibular glands and you know many procedures have been promoted to reposition tighten or actually reduce the salivary glands my personal opinion is it's that's maybe just a bridge too far the salivary gland and then certainly that location in the neck has a lot of important things going on right around it the marginal mandibular nerve which is the nerve that runs the lower lip actually traverses right over the gland there are major arteries and veins in that area so even though some surgeons are comfortable attacking the gland and and actually doing a reduction which i think is the only particular technique that actually works to alter that area for me as i say it's just like a little bridge too far a little too risky there's too much there's too many important things going on in that little patch of real estate that makes me want it okay well i i you know i'm just throwing it out to you because you know there's there's a lot of hype about different procedures and i and i you know i think that it's easy to jump on the bandwagon because the public may be pushing or heard about these procedures and don't recognize the associated risk when they visit their uh their plastic surgeons and they should know it's a case of a tail wagging the dog i mean the surgeon has to decide for himself what he's most comfortable doing what he feels his expertise or his clinical judgment or his particular surgical skills will lead him to produce the the best and the safest result for the patient so if that includes reducing the salivary gland and they're very competent doing it and they've they've done it and they feel comfortable doing it then more power to them the problem with jumping on the bandwagon and this is usually a problem for you know our younger colleagues who go to meetings and hear these talks about you know these procedures where we're dealing with this problem with the neck and then you think they can go back and and start doing it that may be fraught with a little bit too much risk you know i think mistakes happen in those sort of circumstances so it's easy to be swayed both the public and the surgeon themselves you just have to be careful yeah this is at in in essence you know this is a totally unnecessary operation nobody needs this operation so the idea is to try to deliver the best product in the most in the safest possible way i got it yeah now i'm going to switch subjects a little bit because i know that you're an expert in rhinoplasty and you've operated on people i know and you've done an outstanding job so why r in in general rhinoplasty uh is fraught with complications as well potential complications the recurrent the recurrence of uh rhinoplasty surgery nose surgery by the way i'm sorry i'm using medical terminology cosmetic nose surgery which is not purely cosmetic by the way as you know it has to also have a component of functionality uh and that's where you come into play is in particular that's why i'm particularly interested in your practice because you have ear nose and throat training as well as general plastic surgery training and so you have a perspective from both fields and i really feel that when it comes to functional improvement i think the ear nose and throat doctor is typically more uh attuned to breathing issues than just pure aesthetic issues and and that's why i think your training is so important because you have that dual uh training and so uh where is it that um first of all how does how does how do you feel your uh your ear nose and throat training has reflected on your uh general plastic nasal surgery training in terms of your understanding of the nose and the aesthetics and the limitations well i mean certainly ear nose and throat physicians in training get much more emphasis on nasal function than the general plastic surgery trainees do so they understand more about the septum determinates so-called nasal valves these are all technical i'm sure terms that may be difficult for the public to understand but they all figure in performance of a rhinoplasty operation so functioning cosmesis go hand in hand i do do a lot of secondary rhinoplasties which are rhinoplasties or nasal procedures that have been done before and for one reason or another the patient is unsatisfied with the outcome and they seek a secondary rhinoplasty is i'm gonna i'm gonna interrupt you there is it typically for a cosmetic re redo or is it due to the lack of the ability to breathe uh after they've had their rhinoplasty done is there a 50 50 split there or is it is it uh somehow i would say i would say in close to 100 of the cases both issues come to the fore in other words the typical secondary rhinoplasty patient doesn't like the way their nose looks and they don't like the way their nose works so in the in probably 90 percent of the cases it's really both things that they're that they're complaining about and i usually will counsel them that many times they'll have to make a choice or decision about what's more important to them the function of their nose or the aesthetics of their nose because in reality the cosmetic operation decreases function virtually 100 of the time cosmetic nasal surgery will alter function now does it alter it enough for it to be a problem blessedly no not usually but if you think about what you're doing when you do a cosmetic rhinoplasty you're usually making the nose smaller you may get narrower you're removing tissues cartilage tissues from the tip of the nose that have an important function in breathing so that if you asked sort of average rhinoplasty patient who is otherwise satisfied with their the way their nose looks well what do you think about the way your nose breathes though i'll almost always say well maybe i breathe a little bit less than i used to but i don't care my nose looks better oh so you know when you're approaching when you're approaching a secondary rhinoplasty patient i'll oftentimes tell them look some in some some of these circumstances you have to choose because some of the things that i i could do to make your nose work better will make it look worse i'm going to make it fatter i'm going to make it bigger the tip fatter oh it's better so spreader grafts it widens the bridge of the nose right yeah many of the things that you will do functionally for a certainly for a secondary rhinoplasty revolve around putting things back into the nose rebuilding things which will have an adverse effect potentially from the viewpoint of the patient and that it makes their nose bigger so when asked to choose the vast majority of patients go i want my nose to look better i'm willing to sacrifice some function as long as my nose you correct the thing that is bothering me about the way that my nose looks so there these two things are butting heads a little bit there's there's a little bit of conflict here between the things we do cosmetically for noses and the things that we may do functionally for noses and and do you think there's those so do you think from the get-go when the patient goes in for a primary rhinoplasty prior primary nose job the doctor is really not uh trying is really not um discussing maybe the um the pros and cons so to speak of doing a cosmetic procedure that's going to make them look better and how it may compromise the functionality of the nose in other words do you think right from the start that the functionality comes in comes in conflict with the cosmetic uh aspirations of the patient um i think it does yes and again it all depends on how the consult is conducted right the doctor is discussing with the patient all right so many times i'll see patients that will come in and they'll say i can't breathe out on my nose or i have trouble breathing with my nose and oh by the way i don't like the bump on my nose and my tip is too fat and i'll do an examination an internal examination and i look at their septum which is of course the thing that you're usually focusing on and the septum looks pretty good it's basically pretty straight so i can tell them look i can appreciate that you have a functional issue that you're having problems breathing but it's not a structural problem in other words your symptoms not crooked your turbinates look healthy if i do a septoplasty you make no difference the other thing you have to understand that is if we do a cosmetic rhinoplasty on you you may lose some function so that it is something that you need to be prepared for you need you need to accept as a potential outcome of cosmetic operation on the flip side sometimes i'll ask a patient do you have any trouble breathing and they'll say no my breathing is pretty good i'll look inside their nose and their septum looks like a carnival ride it's all over the place i'll tell them well your septum is is fairly significantly deviated and i can guarantee you that if we do just a cosmetic rhinoplasty on you i will tip you over and having trouble more trouble breathing you will notice it so in those circumstances i'm going to tell them look we need to fix the inside as well as the outside in order to get in order to get an optimal result and can do the general plastic surgeons who do rhinoplasty are they capable of fixing what i call the functionality i'm not i'm not i'm not asking you to throw stones at your colleagues i'm just asking do do they typically know how to treat the functionality and you know with the nasal valves and and and so forth uh you know i'm sure they can do a septoplasty but there may be other issues at play right i think it's all a function of their training yeah most general plastic surgery programs unless they affiliate in some sense within with an ent program their residents are really not getting i don't believe much exposure to an in-depth or sophisticated approach to functionality of the nose when i hear i get secondary rhinoplasties if i get them from ent people i'm going um there's probably not my cartilage left in that septum they probably were in there if i get a consult from a plastic surgeon i'm going oh well i know the septum has probably been untouched oh and will will serve as a bank for anything i need i got it rebuilt yeah to rebuild the nose i see so it's really a function mostly of training the problem with rhinoplasty training in general across the country is in my experience i don't think plastic surgery residents these days get adequate training in nasal uh surgery they rarely do any they probably see some but i don't think they really get adequate training and they don't really have a good understanding i and of the complexities complexities and many of you know my former professors and everything look you have to do two or three hundred noses before you even understand it before before you even you know trying to get predictable repeatable results okay so that's that's an interesting comment because obviously in general plastic surgery residency they're doing breasts and doing you know everything in between and so it's it's hard to be a expert at at the nose unless you get a really in-depth experience i know that you you're how about your dental training what has that brought to your practice in terms of i i'm not saying you're doing teeth but i i've read i've read an article of yours uh that you co-authored with other plastic surgeons um on uh orthognathic surgery in particular the chin yeah and does your dental training uh has it given you insights into the perioral area in terms of of what can be done what can't be done you know i you know i'm just curious because i think that sometimes chin implants don't do the job and i'm just wondering whether or not how often do you do sliding bone operations genioplasties uh to correct a chin projection yeah i think any training or any experience that you've had it could be with ent it could be as an oral surgeon for that for that uh matter always gives anybody a better understanding of what's going on in the head and the head and the neck because that training is usually more extensive than just not just the teeth um i mean i haven't done a sliding genioplasty for years now only because in my view chin implants solve most of the problems of the chin and a chin implant is a reversible operation there's a problem with it you just take the thing out and you're basically back to where you were sliding genioplasties of course they're an important part of orthognathic surgery and there are many guys that do a lot of them and they're they're fine but you know that's a much more invasive and much more destructive potentially uh procedure so if i had somebody that really had an orthodontic problem where a chin implant would not suffice i will usually refer them to a neural surgeon because it's usually not a oral maxillofacial surgeon yeah okay an oral surgeon that does orthognathic surgery because if their chin is that retreated it's never just the chin it's everything it's awful oh it's a mandible and everything that's on the mandible it's the maxilla it's can be the whole thing so if i have something i don't think i can safely or easily solve with the chin implant i usually refer them out to somebody that's doing that that surgery more frequently do you use it do you use any uh only uh synthetic implants like on the on the cheek for instance or do you go do you rely on injectables for to to enhance the midface well both i mean the obvious advantage of an injectable is that it's not surgery i mean it takes a few minutes sitting in a chair the disadvantage of it is you know six months later nine months later it's gone right so it has to has to be repeated uh cheek implants are particularly a little twitchy only because there are two of them in order to achieve symmetry is very difficult to do because we as humans are not symmetrical so there can be some underlying asymmetries that you put a cheek implant in and they come to the fore you see them more also the positioning of the implants while you know if you're expert in the unisr and you you can almost always get cheek plants cheek implants on you know spawn so to speak where they're they're in the exact same positions bilaterally they are they are certainly fundamentally more difficult than a chin implant a chin plant is one thing and if you get a chin implant it's off like this very difficult to even see it but it could ride up though yeah if you get a chin implant it's off like this yeah now you got a problem so cheek implants are certainly more finicky they also i think that cheek implants masculinize feminine faces sample yeah you have to be careful i think you know the one of the fundamental things about certainly facelift surgery is that you're not trying to make any fundamental changes in the way the patient looks you're trying to all you're trying to do is make them look like they did 10 15 years ago you start adding things like cheek implants sometimes fat fat's another thing that's very popular right now yeah you are making a little bit more fundamental change in the way they look which they may or may not appreciate so i use cheek implants i do cheek plants i just find them to be a little more finicky okay so that's interesting because again that's something that that's uh kind of passed off as something simple and and insignificant and almost and yet you're right i think there's asymmetries in the face that that people don't appreciate you know whenever whenever you start thinking like that you're setting yourself up for to get slapped because there you know there are certains that have complications and they're surgeons that don't operate yeah so anybody that does any of this stuff is always going to run into trouble right so there's no operation that's a that's a simple thing every every all they all need to be treated with being serious about them right right and yeah approach it with caution uh lip how about lip lifts what's the story with lip lifts in say new york city do you think that's a popular thing i know in l.a there are young women who are having lip lifts like it's going out of style and i think that maybe they're buying into an aesthetic that is popular in 2020 but maybe in 2030 that aesthetic may no longer be uh you know in in fashion and they're have to live with it so what's your thoughts about that you can say the same thing about rhinoplasty i mean the rhinoplasties that were done in 1970 don't hold up very well you know you have this rhinoplasty done i'll get back to lips but yeah there's the diamond the diamond nose you're 15 years old 16 years old you've got this cute little button nose it's hard to wear that when you're 60. so you know rhinoplasty is is a case in point now lip lifts the unfortunate circumstance i guess or the reality is that they're no good things for lips i mean they're good things for eyelids or good things for noses they're good things for faces they're no good things for lips so you don't like injectables i do simple is always best now injectables like anything can work and work appropriately but they can be overused and certainly all of us have seen people who have had too much of whatever you know put into their lips the reason i like fillers jupiter any of the hyaluronic acid products is that they're reversible i mean if if the patient goes what did you do to me i hate you you know i'll say well okay give me five minutes and i can make it go away yeah the lip lifting procedures themselves it's all about the scar it's all about the scar so if you're making a lip lift where you're making an incision on the lip itself and there are some i'm talking about a bullhorn incision yeah yeah that incision actually if it's done properly is the best thing in terms of a lip lift that you can do now it'll only lift the central third of your lip it won't lift the lateral margins so it's important to tell the patient look this is only going to be kind of the central third maybe a little bit of the central half of your lip and you have to ask them to smile give you a good broad smile so if they give you a good broad smile and you see gum you see gum above their central incisors you got to tell them look if i lift your lip you're going to have a gummy smile yeah you'll be able to get maybe two millimeters maybe three millimeters out of it the cow horn so-called the incision that runs across the base of the nose should heal great if it's done well the problem that i've seen with them is if the guy just does a straight cut across the base of the ring i've seen them where they do a lip lift operation where they basically just made a straight cut across the base of the nose they haven't actually followed all these contours what what following all these contours does is it hides the scar yeah so if there's no free lunch if you make an incision someplace and you create a scar it better be the best one that you can do because the patient in the end what they're going to be looking at is maybe okay maybe my smile i see a little bit more in my teeth what i'm looking at is that scar yeah yeah and if they see it they're going to be unhappy with it so i do lip lifts but selectively yeah selectively so but what do you think about this this idea i'm just going to circle back to this idea that the aesthetic may change how does that factor into your discussion do you do you actually i'm always concerned telling a patient look it may be popular even in the eyelids you know you know there was a time when there's deep sulcus on the upper eyelid deep uh hollowing out of the uh upper eyelid and you know uh lucille ball and and and the actresses of that age right now of course now everybody wants to look like it didn't have anything done except a little uh skin removed so it's it's really this it swings i call it the twiggy effect that hollow look right right twiggy right exactly and that for years you know we were taught we took skin we took muscle we excavated all the fat out of the upper lid and you know he gave them this sculpted so-called upper lid it's much worse than the lower lid if you take too much fat out that looks terrible in the end so if you open up any woman's magazine and you look at all the models that are 16 years old you know they're not old people these models are all young kids and you look at them they've all got fullness yes in their upper lids so eyelid surgery has evolved now so that we're removing i remove certainly less skin than i did i don't remove any muscle anymore and usually i'm not taking all that much fat out i mean there's there's some obvious fat removal that may need to be done particularly on the inner corners of the upper lids but certainly the way things have evolved in upper eyelid surgeries that it's much more conservative you can always go back and take a little bit more out but once it's gone it's gone and so most people do not like that sculpted hollowed out look it makes them look older right right and particularly with lower lids if you've taken too much fat out of lower lids and they get this hollow look it looks bad it makes them look older it's very difficult to fix yeah yeah i mean there are things you can do but it is difficult to fix the lower lid i think you know is it's a pit of vipers bad things happen in lower lid surgery and the more then the more conservative you are in lower lid surgery the better well this fat transfers and fat grafting that's going on that's also trending and uh yeah people are injecting fat everywhere yeah and that's that brings me really to final question about fat because fat to me is also a potentially a dent of horrors because uh you the patient is you're you're grafting fat from say the abdomen take abdominal fat from your belly putting it in your face it's very very popular uh as an adjunct to face lifting or even eyelid surgery and then uh if the if the woman in particular women because their hormones will potentially stimulate that that fat that's not been transferred from the belly to the eyelid or the cheek they could end up being much larger if they gain weight and so again how do you uh balance this uh this desire with uh you know reality if you know what i'm saying yeah well you know the thing about fat it's interesting right to me i mean the thing about fat grafting theoretically makes a lot of sense because certainly one of the things that contributes so much to the appearance of aging is the kind of the loss of the that kind of juicy plumpness that you had you know when you're 20. it just sort of goes away and so the concept of trying to replace it with fat makes makes perfect sense but it's an imperfect operation obviously as all operations are and and the problem that i've seen and i i use fat i mean sometimes you'll have a 70 year old lady who wants to have a facelift and you can pull that skin and you can pull that smash but she needs some volume volume the problem i've had with fat injecting is well i mean you can do it and it looks good but does it hold up so i always tell patients that the typical fat graft patient whatever you see at four months or six months usually is going to be permanent but you can expect to lose a significant portion of what i put in there so i mean you can either over over correct the patient in anticipation of fat loss and then they look like an idiot for six or eight weeks you look like a pumpkin on a fence post most of my patients in new york city are never going to tolerate that you can put in what you think is an appropriate amount of fat to make it look good but you know that in the vast majority of patients you are going to lose a significant percentage of that okay it it it's particularly it can be particularly problematic i believe in lower lids and again it's mostly about fat survival if you get fat survival well most of the time that's going to be a good thing but some of the time it's not a good thing because in lower lids in particular it can look bad and look lumpy yeah it can feel lumpy and getting it out of there is no fun yeah you can do it technically but it but it's a difficult operation yeah so i think fat i think we're on the right path with fat but i think something's gonna it'll be something different it'll have to have to do with stem cells i mean i think stem cells is going to be the future of not just what we do in cosmetic surgery it's going to be the future of medicine well you will be using stem cells to replace hip surgery or heart surgery or any of these things so yeah the real future of medicine and certainly cosmetic stuff in general i think is going to be stem cells so you can get stem cells from adult fat there aren't many of them in there but there are some so you'll see some spectacular results with fat injecting like under scars and things like that and the the supposition or the feeling is it's probably the stem cells in the fat that are doing most of the repair and not the fat not fats basically dead fat dead tissue when you put it in some place so i think they're real so you don't you don't think the fat is is actually surviving you mean or i think some of it is most of it isn't oh i mean there's a lot of different ways to treat everything you know everybody has a way of treating their fat so you confuse it and wash it and do all this stuff i think it's pot luck i think you inject the fat you inject the fat into a into a bed and some of it takes and some of it doesn't i've seen a couple of cases where more took than you wanted and you have to go back in there and you have to reconstruct it say take some of it out but the vast majority of fat patients lose i believe most of what you inject not all of it but have you seen any difference between where you harvested the fat from and and where you placed it it changes things in other words is is the fat from the abdominal fat better than the hip fat or the inner thigh fat uh some people say even buccal fat is is is different some people actually i'm sure they're right the fat is different in different locations but nobody's ever shown anything a series a study of some kind that says abdominal fat is better than that inner eye thought fatter i think it's a matter most of i think logically it's a matter of convenience i mean you go to the donor site that's most convenient now with a lot of fat injecting when you're using large volumes this is another area it's totally different really than the face but when you're doing breast augmentation with fat injection you're doing butt augmentation with fat injection now it becomes a volume issue most girls with small breasts don't have a lot of fat so if you're going to do a fat transfer to a breast and you're going to put 300 cc's of fat in each breast where are you going to get it now it becomes a donor site issue and this all this all reminds me of the free flap craze that we all went through back in the 80s when free flaps first came about and we were taking chunks of tissue off of different parts of the body and putting them you know here hit the third yawn and then all the problems with donor sites started showing up so you know i think there's a real risk of these massive fat transfers of there being significant donor site morbidity interesting thought yeah i i haven't thought of that okay listen i think we're going to wrap it and i want and i want to listen uh greg dr foster uh i i really appreciate your time your thoughts and your insights uh i you know you have you have a lot of experience and you know i talk to younger surgeons and and other people who are insurgents and i think i'm an old guy too so i i i think experience counts and uh you know so but what i'm saying is uh you know in the end you know i think we need you know that's why i'm coming to to ask you your opinion because i i really value the uh your experience over 30 35 years right 35 years yeah something like that and you're gonna have to think about it well i know i've been i'm in practice 35 years myself so but you know i think that uh you know there's a lot of things to measure before you uh cut as they say well experience is always a hard one you always get experience usually your mistakes and your problems give you much more experience more knowledge knowledge then you're and i'm still making mistakes and i'm still learning things it's a never-ending process so you know the concept that well i never have any complications well you obviously don't operate that's right that's right okay thanks again and i appreciate your time and uh and uh your thoughts so all right joel thank you very much stay healthy okay you too bye-bye [Music] you

Channel: Dr. Kopelman

Views: 2,815

Keywords: Deep Plane Facelift, SMAS Facelift, Facelift, Plastic Surgery, Craig Foster, Dr. Kopelman, deep plane facelift complications, mini facelifts

Id: ojjDefL3XGs

Length: 46min 43sec (2803 seconds)

Published: Tue May 10 2022