transcript

Speaker 1:
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Speaker 2:
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Speaker 3:
[00:48] I recently had a mom of four have a simple breast lift, and she had gone to two or three plastic surgeons who told her she needed an augmentation. And I said, no, you have ptosis. You had nursed four children. Yeah, you're gonna be a bee cup, but that's gonna match your frame.

Speaker 4:
[01:02] When you discuss the things that you've done, there's always those like little Karens in the background, right?

Speaker 3:
[01:07] There's always gonna be a hater, and it's usually reflective of who that person is and where they are in their life. Shame on you for judging people who've had things done. You know, when I started doing content creation, I was encouraged to talk about celebrities. And I said, I'm only gonna talk about celebrities who have disclosed what they've had done.

Speaker 4:
[01:25] Do you think social media has been more of a positive for the plastic surgery industry or more of a negative? Welcome back everyone to another episode of Scrubs to Stilettos with me, Dr. Nicole Martin.

Speaker 2:
[01:41] And me, Dr. Tiffany Moon.

Speaker 4:
[01:43] I think every person has looked themselves in the mirror at some point in time and thought, I wish I could change this or I don't really like this or considered, you know, a little tweakment or a little plastic surgery at some point. Maybe you haven't pulled the trigger, but everyone's thought about it at some point, I think. No, Tiff?

Speaker 2:
[02:04] Yes, for sure. I think many of us have done a little Botox filler, maybe something a little bit more under the knife, or we're wondering about it for our future. So today we have Dr. Alexis Parcells. She is a friend of mine, also a board certified plastic surgeon that practices in New York and New Jersey. She owns a all female plastic surgery practice called Parcells Plastic Surgery. She also has a skincare line called SUNNIE Skin, and she believes in educating patients, being transparent, and really making sure that the patient is optimized and ready not just from a physical perspective, but from a psychological perspective to go on this roller coaster of plastic surgery. So today, we're going to be talking to her about all the trends in plastic surgery, some pitfalls to avoid, what you should look for if you're looking for a plastic surgeon to do something for your body. And then we asked for listener questions, which you guys had so many, so we chose a few, especially ones that came up over and over again, and we have her sharing her wisdom with us. We are so excited to have her on today.

Speaker 4:
[03:19] Before we dive in, Tiff, do you have a weekly obsession for us?

Speaker 2:
[03:22] Okay, I'm a nerd and I still love to write things, even though not as much now, because everything's digital. This is my favorite pen. It's Inner Gel Liquid Gel, 0.7 millimeter ball metal point in blue, not black. It writes so well, it never skips, it doesn't run, like it doesn't, your hand doesn't like make it smear across the page, and it comes in the kind that has the cap, and it comes in the one that has the clicky. And I just, I really love this pen. Like when I journal or when I write notes, when I'm on a Zoom, I love this pen so much.

Speaker 4:
[03:59] It's so funny because you, I'm very particular about my pens too. I hate the ones that are inky, but are like too inky and the tip is thick, and then it like smudges and it's all over your hands. I'm like, oh, I rather a ballpoint than the smudgy one, but there's nothing like a fine tipped ink pen, right? Like it's just like glides.

Speaker 2:
[04:16] Pencil inner gel.

Speaker 4:
[04:18] Okay. So I have always had like a very prominent malar ligament with like a little natural festoon on the side. Malar ligament is basically like this ligament that goes from your orbit down to your cheek, and as I've, you know, lost weight and aged, I feel like it creates like a dark shadow under my eyes, and I don't know, there's a lot of concealer happening here, but it's something that really bothers me, and I am always looking for a good concealer that hides that dark shadow. I found this one on Instagram. It's this brand called Jones Road, and this is their neutralizer crayon or neutralizer pencil. So Jones Road was actually created a few years ago by Bobby Brown. So Bobby Brown was acquired obviously by a bigger company, and so she kind of like lost control of that line, traditionally called Bobby Brown. So then she was like, you know what, I'm gonna make a new line, and I'm gonna call it Jones Road, and I absolutely love this, because it's a very thin, like, concealer. It almost looks like a crayon. So you can really just draw on the line and have precise application without overloading this. You know, when you put too much concealer, it starts to look cakey, and it makes your skin look older. With this, you can just go right on those lines or the little dark area. So you can really control the application. It's very precise, and this peachy color is perfect for neutralizing the dark shadow.

Speaker 2:
[05:42] Love that.

Speaker 4:
[05:43] It's my new obsession. Go, Bobbi Brown.

Speaker 2:
[05:45] Okay. Well, without further ado, let's welcome to Scrubs to Stilettos, Dr. Alexis Parcells. Hello, Dr. Parcells. Welcome to Scrubs to Stilettos.

Speaker 3:
[05:57] Thanks for having me, ladies.

Speaker 2:
[05:59] Okay. We are gonna jump into the thick of it because we asked our followers and listeners if they had any questions for you, and boy, did they. So we need to get through it.

Speaker 4:
[06:10] We need thousands of questions.

Speaker 2:
[06:12] So many questions.

Speaker 4:
[06:13] So many questions.

Speaker 2:
[06:14] We're gonna take the whole hour. So we're gonna jump right into it with some rapid fire questions. Are you ready?

Speaker 3:
[06:22] Sure.

Speaker 2:
[06:23] Okay. What is one myth about plastic surgery you wish patients would understand better?

Speaker 3:
[06:30] I think probably the biggest myth is that it's inaccessible and that you're not deserving of it. I myself never thought that I would be doing cosmetic, a lot of cosmetic surgery. I was never one of those girls growing up that, you know, felt like I would go and get the boob job or take care of myself with a mommy makeover. But I myself have sort of fallen into this career and I've had a lot of plastic surgery. And I love to talk very openly about what I've had done. My team that I work very closely with is very much the same way. And I think podcasts like this, being open and honest and transparent as moms and women, you know, as we age, just it's accessible and you're deserving of it if it is something you want to do.

Speaker 4:
[07:20] I love that. What is the most requested celebrity feature that you get asked for?

Speaker 3:
[07:28] I think specifically in the breast augmentation space, women come in and they are very particular about what they're looking to emulate. So I'm on the East Coast and so implants tend to be pretty conservative. And so I'll have young women, especially my Manhattan population, they'll come in and they'll say, I want like the Kendall Jenner. So I want like that B cup. I want to go from that A to that B, or I want a fuller look like a Taylor Swift with a C or full C with Alex Earl. So I think they're very particular, that particular demographic with breast augmentations coming in with those inspiration photos.

Speaker 4:
[08:07] So full transparency, I have had two breast augmentations. I did my breast the first time when I was 18, and I did saline implants at that point. And then 12 years later, I felt like I had some rippling here on the side, and I decided to exchange those implants for silicone implants. And I remember looking through like Playboy magazines because the surgeon was like, please bring me photos of what it is that you would like your breast to look for because you might say like, I want a full C, but a full C on my frame may look very different than a full C on someone else's frame. So giving like a bra size, he said wasn't as helpful. So I was like a pervert, you know, because you're looking at naked photos of girls to try to find what I had wanted or what I envisioned my breast looking like. And I remember I landed on Carmen Electra spread from like back in the days. And that's who I went with. Like I went with like a photo of Carmen Electra.

Speaker 3:
[09:14] I'd love that. It's like iconic. I can picture like the photo.

Speaker 4:
[09:22] It was like a winter wonderland photo. Like I almost remember the spread very clearly. But she was petite framed but still had like very perky kind of, you know, if I had to guess maybe like full C size boobs. And that was what I went with.

Speaker 3:
[09:34] It's that's basically what Instagram has turned into. I mean, oftentimes it's not even a celebrity. They'll show me a picture of just a small influencer that they follow, a lifestyle or content creator and say, I feel like I look very similar to her. This is what I'm looking to achieve. And yeah, I even say to patients for my breast reductions, I say, show me the inspiration. Because as a plastic surgeon, it helps me understand where is this person's frame of mind. And if they're completely off, that helps to navigate the conversation and say, these are the reasons why this is not going to work for your body. I'm very against sort of the AI technology. There are technologies that allow you to morph your body into what you want it to look like. But you can make someone who's a stick figure look like a Kardashian. So you have to be very careful with that. But absolutely, it's a super helpful tool to use.

Speaker 2:
[10:30] Okay, what is the most overrated procedure?

Speaker 3:
[10:36] Oh, I mean, like the overfilled face. There's been a lot of filler fatigue, which has been really great to see over the last like two or three years, where people have just had it. We're seeing celebrities dissolve filler, and then just the advent of the advanced facelift, the deep plane facelift is coming out. We're seeing a lot of younger patients elect for something like that, or fat crafting over filler. So that's sort of on the decline, and I think the butt lift is also, thankfully, finally on the decline. Just I think there's more understanding of the life-threatening risks involved with that. It doesn't, it's not necessarily as obvious of a transformation that people want to have. So if they are having a butt lift, it's a much more conservative lift. And we're seeing gravity start to take its toll on those OG butt lifts that were popular 10 to 15 years ago, and those are pretty hard to correct. So I think it's becoming a more conservative procedure, yeah.

Speaker 4:
[11:42] Do you think social media has been more of a positive for the plastic surgery industry or more of a negative?

Speaker 3:
[11:51] I think it's been positive. I think first of all, just debunking misinformation, just saying how it is, is very, very helpful. I think my colleagues, because we are board certified plastic surgeons, trying to help educate the general public on the difference between a board certified plastic surgeon and a cosmetic surgeon and providing that information and resources has made surgery safer. I wish my colleagues would be more prominent on social media. I think initially it was taboo, but now we're seeing a lot more medical creators. And I think patients sharing their journeys and their stories is just the best, because you can write a Google review or you can say something on a forum, but that creator who is bringing their audience, even the micro creators through the stage of their journey, we see in terms of engagement. I recently had a mom of four have a simple breast lift, and she had gone to two or three plastic surgeons who told her she needed an augmentation. I said, no, you have ptosis. You had nursed four children. Yeah, you're going to be a bee cup, but that's going to match your frame. We did a breast lift. She took her community through the entire journey, so many questions, and she said, I had no idea that there were so many women like me who were too afraid to ask the questions but felt safe because they followed her for other things. I think social media has been great.

Speaker 4:
[13:25] Yeah, I love when someone is transparent about the things that they've had done because you can, you know, it's like a safe space and you can feel and relate to them like, okay, I want to fix that. But when people pretend to look a certain way and like it's all natural or I got this really big butt because I've been doing squats at the gym and then they're telling their followers to do squats and buy their exercise program, but that's been a surgically enhanced butt, like that's not fair, right? It's almost false advertising. And so I always appreciate when there's a content creator, a celebrity or whatnot, that's very vocal and open because it does remove a little bit of the taboo from the process.

Speaker 3:
[14:07] I completely agree. And I think, you know, when I started doing content creation, I was encouraged to talk about celebrities. And I said, I'm only going to talk about celebrities who have disclosed what they've had done because we can have a very meaningful conversation because they've opened Pandora's Box and they've shared. And I think that that's very powerful. And I always applaud the celebrities that they do it, who do it, good, bad or indifferent, if they've had a good experience or a bad experience. Like, I think when you own it, then when you say, I've had that procedure, it's your power as opposed to people talking about you behind your back. And I remember very early in my career, I did liposuction on a Pilates instructor and she went and said that it was Pilates and I was, it's not my place, it's a HIPAA violation. Yeah, right, right. That's right, it's ingenuous to say to people, Pilates is going to do this because we now know, like it can and can't do certain things. So just be transparent. I think, you know, the days of hiding for three or four weeks and telling people, you know, you've got some cold or you've been traveling, just own it. It just, people like you more when you are honest and open. And what I have found, even in my experience, having had plastic surgery, I openly talk about everything I've had done, is that it creates like a bond, it creates a kinship. And it's like, I can now trust you. And I appreciate that you've been forthright in your experience. So, I mean, we're all aging, let's just, let's talk about it.

Speaker 4:
[15:40] You know what sucks though, is that because just as much as there are people that appreciate the honesty and the transparency, when you discuss the things that you've done, there's always those like little Karens in the background, right, that want to be like, you should stop telling young girls that they should be, you know, like you're creating insecurities, people should love the skin they're in. And you've always got these people that want to chirp about like the plastic surgery or the things that you do. And I think those are the type of people that discourage the honesty.

Speaker 3:
[16:11] I agree with that. I would say whenever I see those in the comments, what I find so fascinating is that there are other people to jump on top of Karen, which I find really helpful because I don't have to do the dirty work. There are, you know, within the community of my social media, there are followers who are actively engaged and say, that's not what she meant. You're misreading that or shame on you for judging people who've had things done. So I think that that's been really nice to have a supportive community, but there's always gonna be, there's always gonna be a hater. And it's usually reflective of who that person is and where they are in their life. And I think the younger generation, especially like us millennials and Gen Z, we're just not having it. It's becoming, it's almost becoming, I would say like my boomer population, they come in for a consultation and everything you could see the guilt on their face. They're trying to make excuses as to why they're there. They're trying to rationalize it. How am I gonna explain it? How do I justify this in my mind? And then polar opposite is the Gen Z, where I'm like, this is not a dental cleaning, right? So like you get both ends of the spectrum. And yeah, even within the platforms, how it's discussed and TikTok is so different than Facebook. It's just as that generation, that boomer generation gets older and us Gen Z and millennials and even some Gen X, we're owning it more. We're talking about it more. We're calling each other out in terms of authenticity. And I really, really like that about the younger communities.

Speaker 2:
[17:45] Yeah. Earlier, you alluded to the difference between a board certified plastic surgeon, which you are, and some of these cosmetic surgeons, which their credentials are nebulous. And I say, usually if you have to dig for it, it's not a good sign. What are some other tips that you have for our listeners who are looking for a reputable plastic surgeon to go and see? What are some things that they can look for or red flags that they should look for?

Speaker 3:
[18:15] It's a great question. I always say start with your homework, make sure they're a board certified plastic surgeon, to your point. Because cosmetic surgeons, I mean, Dr. Martin and Dr. Moon, you guys can advertise yourselves as cosmetic surgeons. It's a weekend course on liposuction and off you go. It's wild that in the United States, you just need a medical degree to practice surgery without any formal training. So that's where I always say to start is to make their board certified or board eligible in the field of plastic surgery or facial plastics. ENT is able to do facial plastic surgery. Then get on that website, look at their befores and afters, read real patient reviews. You can always call the practice and get information. I think a lot of people are afraid to do that, but that is a great first step. Questions you can ask is, how often does she perform this procedure? What are her risk of complications? If I set up a consultation, can I talk to a patient, a current patient of the practice that has gone through this procedure? I always say to patients or prospective patients, you can travel in the United States. That's not really medical tourism. If you're following a plastic surgeon who does an amazing liposuction, tummy tuck transformation, but they may be a flight away, well, heck, bring your bestie or bring your husband and they can go to the resort or stay at the hotel and help you recover. When patients fly in for surgery, for me, they're usually with me for about four or five days and then they head home. So if you're in love with that particular surgeon, you trust their judgment, you like the way that they talk to patients, get more information. Most plastic surgeons will do virtual consultations cosmetically where we can give you an overview of the procedure and give you general information. It's very commonly done and within the scope of our practice. So you can start there and just get the information and decide if that's right for you.

Speaker 4:
[20:14] You bring up an interesting point. The other day I was on Instagram and there was an anesthesiologist that I trained with that I knew is a board certified anesthesiologist. They were posting a video of them doing liposuction. They had initially transitioned into the injectable space, like the Botox and the fillers and what not. But then I saw them doing some sort of lipoprocedure and I don't know the first thing about doing lipo because I am not a surgeon. I am an anesthesiologist. And there's no way that a one weekend course is going to make me skilled enough to stick a cannula and start like sucking fat out of someone because there's complications. You can puncture a lung, you can puncture an organ, fat embolism, like all sorts of things that you're not ready to deal with in a weekend course. So really being sure that you know the training of the provider that you're going to and their board certification is huge.

Speaker 3:
[21:12] I completely agree. And I think there's also nuance to this because what happens is they start in the med spa space and then they start getting into the devices. And so now there are devices that you could do in office liposuction. And so they advertise it as like a pain free lunchtime procedure. It's not like if you've gone wrong, like this could be catastrophic for us. And second of all, like who wants to be awake for liposuction? That the anxiety of managing an awake patient doing an invasive procedure in an office scares the scares the heck out of me. If there's an emergency, most certified credentialed surgery centers and hospitals are not going to allow this anesthesiologist to have privileges to do liposuction. I saw this initially when I started in practice where GYNs wanted to shadow me in the OR and learn how to do lipo, but they couldn't even get the credential privileges. So if there's an emergency, where does this person have privileges to admit a patient and bring them to the operating room in a situation that could be life threatening? And the answer is they don't. So that's another thing when you call around and say, okay, well, what facilities is this position credentialed at? Is there a surgery center that's accredited? Is there a local hospital? And what you quickly find out is that there's not. And that they either have a relationship with a plastic surgeon that could be financially incentivized, or they're going somewhere that's a little scary. And yeah, that is not where you want to put your time, money and energy when you want to do something nice for yourself. So buyer beware. Yeah.

Speaker 2:
[22:52] Yes. And following up on that, because you mentioned earlier, medical tourism is prevalent. I think it's getting more popular. There are certain countries that people tend to go to, Turkey, Mexico. And I have had complications of patients who did medical tourism and then they come back. There's an infection, there's woundy hissence, it's bad. They're not likely to go back to Turkey to have that problem treated, right? And you kind of don't have any legal ramifications, right? If your surgeon is like in another country. And I don't think people think that far ahead. Like if I had a complication, how would that be handled? If I'm displeased with my results and I'm going to fly there again to have that same surgeon try to fix it, or then I got to find someone in the United States to fix it and now I have scar tissue and it's going to be a redo procedure, all that kind of stuff. Do you have any wisdom to share as it relates to medical tourism other than to not do it?

Speaker 3:
[23:54] Yeah, so when I was in training, I trained in New Jersey and a lot of our rotations were at a level one trauma center in Newark and I'll never forget a patient. She came in, she had had plastic surgery done in the Dominican Republic. She had a massive open wound. And it's so interesting when they fly back to the United States, all of a sudden, the people from that country are no longer accessible. No one is responding to emails, nobody's responding to phone calls. She finally gets someone on the line and they said, go to this place and someone will take care of you. And she drove and it was a warehouse in the Bronx. And she was like, I'm not going in. Like I don't know what's going to happen here. She's WhatsApping back and forth with some care provider in the Dominican Republic. Long story short, she ends up in our emergency room. And the physicians, the plastic surgeons, are upset that they have to take care of this because God knows what she's growing because a lot of people don't realize this, but there are all different sorts of bacterias, fungal infections, viruses that are not common in the United States, flesh-eating bacterias that are prevalent in other countries. So it becomes a massive headache for the plastic surgery team to take care of, and the patient has this emotional breakdown because they spent all this time, money and energy going overseas, and now they have to continue to pay out of pocket or get balance billed. It becomes a financial nightmare to have this complication resolved. Whereas you go and see a credentialed plastic surgeon in the United States, yeah, you're going to pay a little bit more, but you're also not flying to Mexico. You're not spending two weeks there in a recovery house. For all of our cosmetic patients, we make them sign up with something called CosmetiShare, which is cosmetic insurance. In a God forbid situation, even if they don't have medical insurance, they've got their cosmetic insurance. That usually runs patients anywhere from 150 to about $300, depending on the procedure. 100 percent of our patients, we make sign up for this type of insurance. That's interesting.

Speaker 4:
[25:58] I've never heard of that.

Speaker 3:
[26:00] It's a God forbid situation, but in the God forbid situation, you don't have to worry about the financial bill. Exactly.

Speaker 4:
[26:06] I remember being a resident and rotating on the chronic pain service, and we were following up a patient that had butt injections done in another country. I want to say maybe Mexico, I can't remember, so don't quote me on the location. But she thought she was getting fat injections, and they injected some synthetic silicone polymer that was causing necrosis of her glute muscle and the skin, and her skin was just dissolving, and so she had to have a bunch of skin grafts done, and she had wound vacts to cover the defects because the skin was just necrosing away. So this poor woman was in excruciating pain because her skin was just dissolving, and she went to improve her appearance, and now is going to be permanently disfigured as a result of this kind of questionable material being used that's obviously not approved, not safe. So it's definitely scary because you don't always know what you're going to get. And listen, I'm sure there's tons of qualified doctors. This isn't to belittle, you know, physicians in other countries, but you just have to be very, very careful.

Speaker 3:
[27:19] I mean, this happens in New Jersey too.

Speaker 4:
[27:21] Yeah, it can happen in Miami as well.

Speaker 3:
[27:24] Yes, exactly. And to your point, there are very qualified physicians in these countries. I always like to remind patients, the United States did not invent the wheel on plastic surgery. Most of what we've learned in plastic surgery was pioneered in other countries. We're seeing this now where Asia, you can go to Korea and get things over there that the US is 10 years behind in terms of approvals. Okay. So like the pioneering of the procedures is very important. Europe tends to be about five years ahead. And we're pretty conservative here. So it's not to say that they don't know what they're doing. Some of the best surgeons in the world are outside of the United States. It's just a matter of making sure whatever choice you have, you feel very safe in that choice, you feel like they are credentialed up the wazoo, and you've done as much research, and you are prepared for the complication if it does arise. Because even in my healthiest patients, we're practicing medicine. It's an art just as much as it is a science. At the end of the day, things happen, things go south despite everybody's best interest, and you want to make sure you've got that team to keep you together and to get you through the complication. God forbid something happens.

Speaker 2:
[28:42] Yeah. It's just a matter of being educated, I think, and not being like, oh, I'm going to go to this place because it's $4,000 for a tummy tuck, and thinking that it's going to save money. Just making sure that you really are educating yourself about the qualifications of your surgeon and the facility that is going to be taking care of you. Not to mention the anesthesiologist. We haven't even gotten to the anesthesiologist. Who the hell is going to be putting you to sleep in Mexico? You know what I mean? And what are their qualifications? What if you code? What if you have local anesthetic toxicity from your tumescent liposuction? What is going to happen then?

Speaker 3:
[29:18] Oh my gosh, the news stories every couple of months, there's a new story.

Speaker 4:
[29:21] I have something special here in Miami.

Speaker 2:
[29:23] Yeah, yeah, it's on my TikTok as well. What percentage of the time do you say no to a patient? I'm just curious. Let's say you do 100 consults for various procedures. What percentage of those people are you like, you don't need anything. You don't need to see me.

Speaker 3:
[29:42] So we have gotten very aggressive on screening. So I have ninjas in the front and on the sides because the honest truth is that you're not going to hit it out of the ballpark every time. You're not going to be batting a thousand. When we look back on the patients where we feel like it could have been a better experience, because I like to review befores and afters, and I like to hear the noise around the practice. I try not to have an ego about my practice. Oftentimes, a lot of it boils down to patient selection. And so, it's not necessarily always a no, but sometimes it's a not right now. And what I have learned is that once the patient makes it into the operating room, it's your problem as a surgeon. Anything you can do before they make it to the operating room is usually on them and the team. So we want to optimize you as much as we can before we get you to the operating room. And that's not just numbers, you know, your CBC and your CMP and your lab values. That's psychologically. Like, is she messaging us 20 times a day? Did she hang up the phone rudely? Did she treat one member of my staff piss poor and then treated me like a goddess? We're screening all of these things because it's a partnership and you need to have good coping skills. And so, I mean, this fall, I was talking to a young woman who was pre-med and she was in college and she wanted to have her breast reduction and we're going through her preoperative visit and I could tell she was having a lot of anxiety. And I said to her, on a scale of one to ten, like, what's your baseline anxiety? A ten. And I said, OK, how are you going to cope with this operation? And she said to me, I'm actually really anxious about that. I'm trying to figure out a way that I could sleep through the entire recovery because I feel like I'm going to have a mental breakdown and I'm not on any medication. And I canceled her. I said, you are not, no, you're coping skills, we're putting you through controlled trauma. Who's in the support network? How are you going to take care of yourself? And she started going after me in the pre-op visit and I said, listen, you're going to go to medical school and the first rule is do no harm. So if you were in my position and a physician said to you know, you were the physician and the patient came to you with this, what would you do? And she said, I wouldn't do the surgery. I said, so there we go, you know. So yeah, it's all preparation on the front end and especially with before the GLPs, there was a lot of weight loss conversation in terms of I'm close to my goal weight or I'm not close to my goal weight. Now with the GLPs, we're seeing patients really reach that goal weight and stay at the goal weight. So I am very strict about, let's get as close as possible to the goal weight because we know it's really attainable with the GLPs, whereas the diet and exercising can really be a struggle for some patients. So those are also like not right now category, but it's really a psychological, physiological assessment. And then where are we in terms of optimizing your health? Because what I do is elective with the exception of breast reconstruction. And so I want you, I say to patients, we're getting ready for surgeries, if we're getting ready to run a 5K. Like I want you in the best shape of your life heading into the operating room, because that's the best chance of a quick, easy recovery.

Speaker 4:
[33:15] And I love that you take that approach, Dr. Parcells, because I think that there is this mental and emotional side to aesthetics and plastic surgery that enough people don't address, right? Like people just talk about the surgical technique and, oh, they do great work, but there is this anxiety and mental component for patients. And I think it's important for physicians to also screen that, right? Because if you have a patient that's depressed because they look a certain way and they feel a certain way, and then they think that, oh, getting my boobs is going to solve all my mental health problems. And then they get this boob job and they still don't feel good. This is like the patients that start circling the frequent flyers unit and getting a bunch of procedures done. And it's not going to fix their fundamental confidence or insecurity issue. So I do think that it's great that you evaluate that, because they don't hear enough plastic surgeons talking about those issues.

Speaker 3:
[34:08] Yeah, I mean, it becomes a nightmare on the back end when you don't create, the expectations are not aligned. I always say surgery and especially plastic surgery is an emotional roller coaster, and we will ride the roller coaster with you. It takes about three to six months to get off the roller coaster. And nervous is normal and all of these emotional reactions are totally welcomed, just not at us. But we do also, what's also fascinating, and we see this a lot with our breast augmentation patients is this dope immune effect, where they will get their augmentation and they have this dissociation of their breasts from their body. So what used to become, they used to be very self-conscious of something they were very self-conscious of. Now, they can't wait to show everybody. So they will, they will, I mean, bathrooms, public places, they're showing everybody. And they have this high after their augmentation or after their lift, whatever the procedure is. And specifically in the augmentation population, usually after about 18 months to two years, like that settles. And then they'll come back and say, I want to go bigger. And I'll say, no, you look perfect. You want that high again. You were on Cloud 9. You had all of the attention. Everybody, you couldn't wait to show everybody. You have a beautiful result. We're going to keep the result beautiful. Because if we keep going bigger, you're going to look insane. And you wear my work, right? So if you have bad plastic surgery, it's out there in the world for everybody to see. So that's sort of where we draw the line of someone. So you could pay someone else to do it, but it's no longer my work. And I don't recommend it.

Speaker 4:
[35:53] I love that. But there is also like, yes, you know, when you first do your breast, they're like sitting really high and they're very perky because everything is like tight and kind of swollen. And it does take time to get those final results. Like what it looks like week one, week two, even month one, month two, is not what it's going to look like, you know, over time. And then when they start to settle, you kind of miss that higher, more fuller look. So, you know, I get it. But to your point, you're not just going to keep doing surgery to keep that look because then eventually, you're going to look crazy.

Speaker 3:
[36:23] Exactly. And the other thing is that I always say to patients, like, bras and tape are very helpful tools. When you see these beautiful women on the red carpet, you better believe they are duct tape to the nines. And it is totally reasonable to utilize these tools, to have the expectation that your breasts are just going to sit up here or that your abdomen is just going to look perfect in every dress. Like they're wearing the corsets and the shapewear, and these tools are helpful and should be celebrated, you're not going to be a perfect Barbie doll walking around. We've got gravity and the effects of time and gravity, and your body, to your point, is just going to settle right in place.

Speaker 2:
[37:02] That's so funny. I do want to pivot a little bit before we get to the listener questions, because you've built a very successful plastic surgery practice. You have two different places that you practice, right? 103. Okay. Pardon me. Manhattan and New Jersey, and two locations in New Jersey. I wanted to see if you would share with us some of your wisdom, not about surgery, but about building a successful clinical practice. How do you hire people to be on your team, to be the ninjas?

Speaker 4:
[37:41] How did we get the ninjas?

Speaker 2:
[37:42] Yeah, and how do you train them? How do you get rid of someone who's really not vibing with the rest of the staff? Teach us these entrepreneur leadership skills that you've now learned as a result of building your successful clinical practice.

Speaker 3:
[37:59] When I started out, I hired a plastic surgery consultant because I have no business in business. I never took an accounting course. I didn't major study any business courses whatsoever. She gave me great advice. Her name is Amy Anderson and her advice was, you hire the will, not the skill. So you need to find your one or two first hires are going to be the most important hires. My first hire, Rachel, who is now my director of operations, had a background in the skincare and beauty industry as a professional makeup artist, and she ran a skincare and beauty studio on the Upper East Side. She had no plastic surgery background, but she had an amazing skill set in terms of knowing how to talk to patients, being forward-facing, I felt from very early on I could trust her, and she just had good integrity. So I was very slow in expanding my practice. I didn't pay myself for the first 18 months. My husband's an orthopedic surgeon, he's part of a larger group, so he was supporting the family and me while I was building out my practice, but she was my first hire for nine months. I think going slow and taking the time for the foundation is so important. Who are you? What are your values? What are you bringing to the table? What makes you different from any other plastic surgeon? I had incredible support from my husband. I initially was with someone my first two years, and then he fired me during COVID and put in a non-compete, so we had to move. And I was looking to join someone else, and my husband said, you're smart, look around, you can do this, you can figure it out. So being resourceful and building very, very slowly, and then not having an ego, like what can I learn and what can I learn? So I signed up for QuickBooks. I took some basic accounting courses, tutorials. I learned how to very, I talked to some website companies, but ultimately learned how to build out a beautiful website without having to pay a massive infrastructure. During COVID, I asked people straight up 50% off for deals. And a lot of vendors were very nice because everyone was struggling. And so I got some good deals, but I also didn't get a lot of revenue to start. I got a $50,000 line of credit to start my practice from a bank, but no one was giving out big loans. And then I was very, very scrappy. So I would rent office space from a podiatrist two afternoons a week. We would take all the feet down and put all of our...

Speaker 4:
[40:41] It's a great story.

Speaker 3:
[40:42] And then I would be in the operating room and the phone would ring, but Rachel would be doing other things. So I would take the phone. And I remember literally a patient getting on the operating table and I'd be like, Parcells Plastic Surgery, how may I help you? And just those types of things of being scrappy and being honest with patients. We have always come from a place of, this is all about education and you're going to do what's right for you, and we're here to give you good information. Make that consultation time valuable for you. I may not, if I don't feel like I'm the right person for it, let me give you the resources. So yeah, and now with like AI and all of these automated systems, there's so many resources available in terms of like trying to figure it out yourself or using another service where you can find someone who's really good at doing what they do to help your business grow. So just about being scrappy and putting in the time. And when I built my practice, I still had to stay at my original practice for three months after he fired me. So I built my practice like basically in my bathroom during COVID when I wasn't working at the office. I was there, working on my website, working on, I had my sister do my first photo shoot and just people, they pick up on that energy and that authenticity, I think. And then my second hire was a cosmetic patient. And so she could speak to that experience. But again, no medical background, just the will, not the skill to start.

Speaker 4:
[42:14] I think that's such an aspirational and motivating story because so many people want to wait until everything is perfect and you have everything teed up and planned to take that step. The problem is, is that if you wait for everything to be perfect, you're going to be waiting forever. Sometimes you just have to rip the band-aid and make yourself uncomfortable, make sacrifices and push yourself to the limit to achieve what you want. It can be very scary, but then you hear success stories like yours, and that's so inspiring to women and people that are scared to take that leap.

Speaker 3:
[42:49] Absolutely. We all know this as mothers, there's never a good time to start your family, right? It's the same thing with any business. You just have to jump right in and say, I'm going to commit to myself and give it my best shot. And then if it doesn't work out, that was always in the back of my mind. If it doesn't work out, I can say at least I tried, and I gave it my best shot. And so yeah, that was my philosophy going forward. But there's never a good time to do anything. That's life. It's always navigating.

Speaker 2:
[43:19] Well, we want to jump into a little bit of questions from our listeners because we literally had thousands. So we want to make time for that. Are you okay with a few listener questions? Okay, we had a lot of people ask about breast implant illness. It's like such a trend. I didn't know that this was a thing. Danica Patrick is one of the people that talked about her experience. People are saying maybe there's a correlation with autoimmune disease. Give us the whole spiel of that.

Speaker 3:
[43:53] Okay. It's a very interesting history. When breast implants were invented back in the late 60s, early 70s, there were no safety devices. There was no FDA Medical Devices Act. They were very poorly made devices in the 60s and the 70s. It was a very thin shell of silicone around it and it was a very gooey gel and there were very, very high rates of rupture when you look back historically. Women and plastic surgeons back in the 70s and 80s were like, what's going on? Are we damaging our bodies? This feels very unsafe. And then finally, the FDA Medical Devices Act came out in the late 80s, early 90s and they said, okay, we need to study, we need to study breast implants. So in 1992, they actually took silicone gel off the market in order to make sure that it was a safe device, okay? So we currently don't have any implants that are silicone free. Even saline devices are made with the silicone shell. But in 1992, the FDA said, we're pulling silicone gel implants, unless you're part of a clinical trial, you cannot have them. And so from 1992 to 2006, silicone was off the market. So I'm curious, Dr. Martin, when you said you have saline implants, if you had that then placed during the moratorium on silicone. I did.

Speaker 4:
[45:17] So let's, I was born in 1984, and I did them when I was 18. So like 2002, 2003, and there were no silicone options. It was just you get what you get. So it was- That's right.

Speaker 3:
[45:30] Because there was a moratorium. Now fast forward to 2006, and they put silicone back on the market. And the FDA says, we've looked at connective tissue and autoimmune diseases. We can't find any association. We use silicone and other things throughout our bodies, stents, ports, et cetera. Okay, so they put them back on the market. What happens in 2006? We get the advent of Facebook and then eventually Instagram in 2013. And so what's so interesting is that groups of women started getting together in Facebook. And now we have groups with hundreds of thousands of women who say, I still don't feel well, and I think it could be related to my implants. And that is sort of the birth of breast implant illness. It has come from social media. And it's very interesting because around the same time, 2006 is when the texture devices started coming out as well for silicone. And they got put in a lot of women, okay? And so there were concerns about both silicone gel implants as well as texturing devices. And these groups of women start talking and talking and talking, and these groups are ballooning and getting bigger. 2018, Allergan, which is the major manufacturer of textured implants, gets issued by the FDA a voluntary recall of their devices, okay? And so now all these women who have textured devices are freaking out because we now know textured devices can be implicated in a specific type of cancer, a breast implant lymphoma, okay? That's when I came into practice. So my first year in practice was me spent counseling hundreds of women on whether or not your devices can give you cancer. So now we've got the breast implant illness patients and we have the lymphoma patients or potential lymphoma patients. And I think that that was just, you know, the, I can't find the expression, but just, I mean, the amount of interest and concern in implants sort of shot up around 2018. And that's really when we started to do a lot of research, when our society started to do a lot of research on breast implant illness, to be like, what is going on? And so over the last like five to 10 years, we continue to learn more and more. So it's not officially recognized as a diagnosis, as a medical diagnosis. I can't send you, if you identify as having breast implant illness, I can't send you for a blood test. I can't see it on mammogram. We can't send you for a genetic test. I can't say clinically you have breast implant illness. What we do in our practice is we use a survey by the Aesthetic Society to do an intake. And I wanna know, do you have a history of Lyme's disease? Do you have any rheumatologic conditions? When did these things start? Do you have tattoos? It's a huge intake form. And then we like to talk to you about what's going on with your health when you feel like things started. In this group of women who have had breast implant illness or identify as having breast implant illness, when you look at the data, removing the device, taking the implant out has proven to be therapeutic in this group of women. I can't explain it. I don't have the science yet to explain it. Do I hope we learn something? Absolutely. I counsel patients that it's your body. You should have grace for a period in your life where you decided you want to have the implant and now you don't feel well. I will take this device out and I hope you feel better. Most patients do feel better. We're seeing between 80 and 90 percent of patients do feel better. Is it physiologic? Is there a psychological component? Is it a marriage of both? I can't give you hard science to say A plus B equals C. The most amount of drama around this topic is the removal of the scar tissue, the capsule. Because the women who have breast implant illness, a lot of them are adamant that the entire capsule should be removed for therapeutic effect. And our societies say otherwise. And the data shows that whether it's removal of a piece of the capsule, none of the capsule or all of the capsule, there's no statistically significant improvement in symptoms. The removal of the device is, but the capsule, not as much. And there are risks, right? So if your implant's under your muscle, you could get into significant bleeding trying to pull that capsule out, create a hematoma. If it's resting along the rib cage, you could get into the ribs, create a pneumothorax, which can be a life-threatening complication. There have been celebrities who have died from this. So I always say to patients, I'm gonna go in, I'm gonna do an examination of your capsule. Anything that looks diseased comes out. Everything gets sent for cultures, pathology. I take photographs and we monitor you. But it's a very, very, very sensitive topic. And I think this community has felt like dismissed by a lot of plastic surgeons. And ultimately, I see patients who don't identify as having BII but want their implants out. So you do you. It's just, I wish we had a more hard science, but I don't dismiss it completely because who am I to just say it doesn't exist? That to me seems unfair and biased for what the future holds.

Speaker 4:
[50:57] Is there anything, any sort of screening tool or patients with certain conditions that have a higher association or correlation with breast implant illness? Have they found that patients with fibromyalgia or lupus and autoimmune conditions that they have a higher risk of it?

Speaker 3:
[51:14] There's not good data on that. It's a good, it's a good, it should be studied more. You know, and those types of conditions, like, right, like, so when are a lot of women wanting to have their implants out? Sometimes around perimenopause, which can, you know, feel similar. Limes exposure, to your point, fibromyalgia, rheumatologic conditions, lupus. But, you know, as we know, like Lululemon was just served a lawsuit yesterday because all of their, you know, a lot of their clothing is made in plastics and were, you know, in 100 degree Pilates studios and we're eating things that aren't the healthiest. And so, like, to say it's one factor, I think is, it's a hard, it's a hard, you know, thing to figure out. There are so many factors that we're dealing with environmentally that can contribute. But a lot of patients do feel better. And even in those populations, what is interesting is I've had, I've had a handful of patients who did not identify as having breast implants, have their implants out because they were just like, I'm over them. And then all of a sudden, they're like, you know what? I can never eat onions or garlic and now I can. You know what? I could never drive at night and now I can. And I'm like, I can't explain that. That's crazy that, that you can now do these things. I don't have hard science for it. And there are, there are, there is research outside of the United States, which is showing different things as well. But it's not A plus B equals C.

Speaker 4:
[52:42] On the topic of ex-plant, because we did get a lot of questions about ex-planting, when you remove implants, now there's obviously like a filling defect, right? Do you automatically have to do a lift if you do an ex-plant or like a fat transfer? How do you tackle the deflation, I guess, that happens with an ex-plantation?

Speaker 3:
[53:06] So I, so I can, I like to physically do an exam on these patients and I can say to them, like if you're a B cup or more, like great, we can do a lift and you're going to be super happy. You have enough tissue to reshape your breast and we'll give you like a beautiful B cup and you'll be happy. It's really the patients that don't have any tissue, they're all skin and implant, that when I ex-plant them, think about it like a breast implant is just pushing and stretching your skin and your breast tissue. So if you have nothing, you're going to pancake down, you're going to look like a mastectomy patient. Those are the hardest patients to counsel, because we don't want to create more issues than there already are, right? So we want you to feel better, we want you to be back to baseline, but I know I'm going to create a situation which is going to be psychologically just devastating to you by making you look like a mastectomy patient. Fat grafting can be helpful. I'm not a big fan of fat grafting in the sense that what are we actually doing? We're transplanting stem cells, and so when we do a fat grafting operation to the breast, only 50 percent of the fat, 50 to 60 percent survives, and what doesn't survive can turn into calcifications on mammogram and now you're going for biopsies and you're feeling things. And psychologically, like, is that, are we doing a... So it's really those B, A, A cups and smaller that have the hardest time with that. And so I counsel the heck out of them. If they're saline, it's great, because I can say, let me, I'll deflate you in the office and you can walk around with what you're going to look like, and then you can tell me if you still want to just be flat or if we're going to rethink this, but with silicone, it's the hardest conversation to have.

Speaker 4:
[54:58] So interesting. I never thought about that with fat transfer, but yeah, now if you have all these calcifications on mammogram, now you're going down that rabbit hole, which is obviously incredibly stressful and not fun.

Speaker 2:
[55:09] Yeah. And how often are people having to redo their implants? Like I was told when I had a consultation years ago that it was like every 10 years, you have to like exchange them. Is that still a thing or is that from more olden days?

Speaker 3:
[55:23] That's old. The modern day implants are holding up a lot better. We say on average, around 15 to 20 years, they're going to wear out. If you have saline, they're going to deflate. You're going to know it overnight. It's over. So those tend to be more emergent. Let's get on because I can't walk around like this. I have a family wedding. With silicone, the concern is that there'll be a rupture and it'll be a silent rupture. So the rupture will stay within the capsule. If there's a break in the capsule, we'll get what's called an extracapsular rupture. And so then they, and I've seen this, the silicone can be in the breast and then the immune cells pick it up and march it right on up to your lymph nodes. I can't get rid of that. We're not going to be doing a lymph node dissection. So now you're going to be dealing with silicone in your lymph nodes and vastly throughout your breast tissue. So usually when there's an intracapsular rupture, the scar tissue, the capsule will get tight and it will show up as a contracture. And that's usually a sign like, hey, let's exchange them. But if you're like, you know what, I'm 15 years and I don't want to wait, I'd rather just do a quick exchange. Like that's totally reasonable. We also offer ultrasound in our office to have it monitored. We do a handheld ultrasound and we can look for breaks in the shell. But again, even an MRI is not 100%. There have been false positives and negatives where they say it's ruptured, I go in and it's not or vice versa. So you don't really know until you actually see the device. So I say 15, 20 years you're like pushing your luck.

Speaker 4:
[56:51] So you're inviting for someone who's at that 15-year mark, but feels good, they look good, they get their annual mammograms and ultrasounds and everything is fine. Are you recommending patients to have them electively exchanged? Or if you feel fine at 20 years, can you keep pushing your luck? I mean, I'm trying to get close to that 15-year mark.

Speaker 2:
[57:15] Yeah, what number year are you at, Nicole?

Speaker 4:
[57:18] I did them when I was 30 for my 30th birthday and I'm 42. So I'm, you know.

Speaker 2:
[57:26] What are we doing then?

Speaker 4:
[57:27] I don't know, Dr. Parcells, what are we doing because I wasn't thinking about it.

Speaker 3:
[57:31] I'd say to you, find a time in your life where you can have three to four weeks of downtime. With you, it's not a fresh augmentation. So what would happen is usually I make an incision inch and a quarter right underneath the breast fold and it's a quick 30-minute swap. If you like your size and shape, it's a clean swap and then you're just waiting for the incision to heal. So no oceans or pools for three or four weeks. So like that and it's again, half hour to an hour operation max. So you could be preventative in that aspect and then just be like, I have a fresh pair and I'm good to go. But obviously life gets in the way, so it's hard to find that downtime.

Speaker 4:
[58:07] I know. Yeah. The other question we'll start wrapping up, but this question came up so many times. Under the muscle or over the muscle? We got so much of it.

Speaker 3:
[58:19] Oh God. I am a traditionalist. I like what's called a dual plane. So the pectoralis muscle doesn't go all the way down to the fold of the breast. The bottom of the breast goes about two-thirds of the way down. So I like to place my implants, dual plane, so I'll divide the muscle and then place them. If you are really thin, the concern is that you're going to see visible rippling, and nobody wants that. Nobody wants someone to see across the room that they've had a breast implant. So if you're thin, you're probably going to want to have a dual plane. I have seen really great sub-glandular augmentations. The risk of contracture of the scar tissue, the capsular contracture is less if they're placed under the muscle because the gland has bacteria in it. And so if your implant's sitting close, there's theoretically a higher risk of the contracture. If I were to get an augmentation, I'd probably go under the muscle. I mean, that's just who I am.

Speaker 4:
[59:18] Yeah. In case our listeners are asking, I'm under the muscle as well. I get a lot of DMs about how big are your boobs? Are they under the muscle? Oh yeah, like how many PCs?

Speaker 2:
[59:29] It's crazy. People would be asking like the wildest questions.

Speaker 3:
[59:32] I had patients say, I want Dr. Martin's boobs. Just so you know.

Speaker 2:
[59:36] You're someone's inspo, Nikki. Yay.

Speaker 4:
[59:41] I'll put in the show notes all the details. I have to look up my... I know they're Cientra. I know they're high profile. Don't quote me on the size. I want to say 450 and they're under the muscle, but I will circle back and I will put it on Instagram and put it on the show notes for you guys.

Speaker 2:
[59:57] Look at us being transparent about our procedures. Okay, this is just for my personal. Can you tell by looking at someone on the beach if they've had a breast augmentation or you can't tell?

Speaker 3:
[60:09] I mean, I think it depends on what beach.

Speaker 4:
[60:11] Like, Miami.

Speaker 2:
[60:15] There are some beaches where I can tell. If I can tell, then whatever. But like, can you tell by looking is the question.

Speaker 3:
[60:22] I probably, if you were to put like not photos, but women in front of me, I can probably tell. I mean, I do this for a living. But yeah, I mean, the goal is that it's so natural, that it's a did she or didn't she, right? It's the question. Like, she looks so good. Did she or didn't she?

Speaker 4:
[60:41] That's what I wanted people to wonder when I decide to do a facelift. I wanted to be like, she looks so refresh.

Speaker 2:
[60:47] You know who has had a facelift and posted it all over Instagram and I think looks so good? Denise Richards.

Speaker 4:
[60:53] She looks incredible.

Speaker 2:
[60:54] She looks so good. I was like, good for you, girl.

Speaker 4:
[60:58] They did a good job of just making her look like herself, but 15 years ago. They didn't over-tighten, over-pool.

Speaker 2:
[61:04] It's just perfect. I love her so much. Okay. Dr. Parcells, how do we follow you, pimp yourself out, tell us all the things, and for patients that would love to have a consult with you, either in person in the New York, New Jersey area or if they want to have a virtual consult, how do our listeners get in touch with your office?

Speaker 3:
[61:26] So yeah, I'm at Alexis Parcells MD on Facebook, Instagram, TikTok, YouTube, and yeah, you can book right on our website, parcellsplasticsurgery.com. I have two partners, Dr. Christina Pasik and Dr. Kavita Kapadia. We are an all-woman plastic surgery practice. We're one of the few in the country. Dr. Pasik does everything I do, which is breast and body, and Dr. Kapadia is our facial plastic surgeon. So we are soup to nuts, head to toe.

Speaker 2:
[61:54] Okay, we will put all that in the show notes so that everybody can follow you and get in touch with you. Thank you so much for being on Scrubs.

Speaker 4:
[62:03] It was such a fun convo. Alright guys, until next time.

Speaker 2:
[62:07] See you later.

Speaker 3:
[62:08] Thank you, bye guys.