Episode 46: Dr. Toby Mayer: Explains Neck, Nose, Arms , Lifts and Lipo For Beauty Now Part 1
Dr. Toby Mayer, a prominent and world renowned plastic surgeon, who boasts many celebrity clients informs our Beauty Now listeners how to look natural and real after surgery. How can we keep our arms from having bat wings? What are the different kinds of lipo? Where are the scars for a neck lift and more on rhinoplasty? Look natural and listen to almost any fix for what bothers you about you. Dr. Toby Mayer shares his wealth of knowledge, Free. How do stars always look ageless? Good to know. Look your best and feel good while doing it. Parts one and two have it all!
Teri Hausman: I’m Teri Struck, host of Beauty Now, a weekly podcast that brings you the latest in all things beauty. We have featured lasers, lifts, breast augs, vaginal rejuvenation, face, neck, lashes, hair, skin, make-up and all things anti-aging. Today we have esteemed plastic surgeon Dr. Toby Mayer from Beverly Hills. Yes, he’s doctor to the stars but he’s here today to give us free advice on what’s the right thing to do and the wrong thing to do when you want to look like Jennifer Aniston and maybe you need a lot more work than she did.
Dr. Toby Mayer: …but once that skin is gone, I can’t ever make that person look as good as I could have in the beginning. Because the skin is gone. If I lift their brows up, they won’t be able to close their eyes.
People are trying to get a quick fix, you know. Oh, the weekend face lift; oh they’re just going to take a laser to do it. And I always ask them where, or the other current one where they are using a wire and they lift it up – where does the skin go? If he’s only making a one inch incision, what happens to the skin?
I’ll tell you the other one, for your listeners, that’s really important is this incision that goes in the hair, in the temple, where someone is pulling back on the temple and that creates an unnatural look because you’re moving a woman’s temporal hair line back. And that really will age them. If you’ve removed the woman’s best hair because that operation was very popular about 30 years ago.
Teri Hausman: Welcome Dr. Mayer, thank you for being with us today.
Dr. Toby Mayer: Well thank you Teri, it’s very nice being here with you. Hopefully we can give all your listeners some good information.
Teri Hausman: Well I think you know, today, and in today’s economy, I wanted to give you an opportunity to tell our listeners when they see a picture of Angelina Jolie and they want to bring it in to you and they want to look like that, what’s your advice?
Dr. Toby Mayer: Well first of all I tell them you can never look like that person because everyone has different skin, head, hair – there’s so many variables. But it gives us an idea, we like patients to bring in pictures because it give an idea of what they like. Sometimes they’ll bring us in pictures of people that are overdone and very overdone and then we say, “Well this person has a pinched hip. If you saw her in real life you wouldn’t want that.” And sometimes we’re asked, “Oh, how does Angelina Jolie look like that my God!” Well, she’s 33 years old and like most of the stars they are photographed with flash blubs and they have so much light on their face that Mother Teresa would look 20 years old if you put that much light on her face.
Teri Hausman: Bring on the light!
Dr. Toby Mayer: Yeah, if we could only walk around with that light all day long. Wouldn’t that be nice?
Teri Hausman: I know! Bring on the light.
Dr. Toby Mayer: Yeah. Sometimes the pictures are airbrushed, if they are in a magazine, done for an ad for example. When you see these pictures of Andy Mcdowell, once again if it’s in a print ad, obviously they can be airbrushed. On television there is so much light on their face that you – you can’t have a person that’s 50 years old and have no lines on their face because you…
Teri Hausman: Why not? [laughs]
Dr. Toby Mayer: Because you just don’t see that in real life. You can improve it…
Teri Hausman: Right. And how do we improve that Dr. Mayer? Let’s just say there’s a 50 year old and she wants, she’s got lines on her face, where do you start?
Dr. Toby Mayer: Well, whenever I see a patient I always start at the top and work my way down. I tell them that, you know, in the case of the consultation they might as well hear what’s on the a la carte menu for them…
Teri Hausman: Right.
Dr. Toby Mayer: …and the different ways, something to be done. Like “How can I correct my tired eyes?” Well it may not be an eyelid surgery, it may be a forehead lift. But I give them the advantage or the disadvantage for different ways of doing it. I may have my preference, but sometimes I’ll say to someone, “You know, your eyebrows are really giving you your lines because your forehead is sagging and we can kill many birds with one stone here because you don’t need your eyelids done.” And I go on to my little spiel and when I’m done they’ll say, “Well great, I understood what you said, I just want to get my eyelids done.”
Teri Hausman: Right and I think that’s because it’s really difficult to hear about a brow lift. I think that women are afraid of it. I actually had to learn about that myself. My husband’s a plastic surgeon and just taking the weight, taking your finger and pushing up your brow makes such a big difference. And I know what you’re saying and I think that people have to get the idea that it’s not that big or horrific a surgery. Why don’t you explain a little bit about what you do with the brow lift?
Dr. Toby Mayer: With a brow lift, there’s two kinds of brow lifts that we do. One is where the person has a low hairline. That’s only about 10% to 15% of patients. If they have a low hairline you can make all the incisions in the hair and do everything you have to do. But the average person, the other 85%, have a high hairline. If you make incisions in, back in their hair and then lift their forehead up you’re going to lift their hairline. Very often these patients want to have hairline remain the same or lowered. So we invented an operation many years ago, more than 20 years ago, where we make an irregular incision along the hairline, we bury the hair, do everything we have to do and lower the hairline at the same time we lift the eyebrows. And in most patients, when you lift the eyebrows you’ve sheared the upper eyelid skin excess that they have so you’ve killed many birds with one stone but it does sound a lot worse than you say, “Oh, I’m going to just snip a little bit of skin off your eyelid.” That sounds better. But once that skin is gone I can’t make that person ever look as good as I could have in the beginning because the skin is gone. If I lift their brows up they won’t be able to close their eyes.
Teri Hausman: Right and I always say, but I don’t remember who I heard it from, but it’s true that you can always take more skin out but you can never put it back in. So that’s how sometimes people look freaky right?
Dr. Toby Mayer: Yeah. And remember when you see a person, a famous person, there’s many from Joan Rivers to Michael Jackson where you say, “Gee, this person doesn’t look the same anymore. They look different, not better, but different. That’s a choice; that’s a surgeon who did that.
Teri Hausman: Right.
Dr. Toby Mayer: It didn’t just happen because oh, they had some untoward event because almost all facial plastic surgery has very, very low complication rate. But when you see these people who look like they’re face are wind-blown, they’ve been in a tunnel with the wind blowing, or their eyes, their eyebrows are pulled up at the side really high, they look surprised – that’s just bad surgery.
Teri Hausman: And that you know, that is such good advice listeners. I mean really hear what Dr. Mayer is saying. Make sure you get a conservative surgeon because I would rather spend 10 more thousand dollars saving up again to have more taken out than have too much done and you look terrible.
Dr. Toby Mayer: Yeah and very often the patient comes in and they will say, we start talking about a brow lift and they will pull out at the side of their eyebrow and pull up toward the temple. And I say, well gravity doesn’t work that way. If you do that, that’s the way Kabuki dancers put on make-up to make themselves look evil.
Teri Hausman: [laughs]
Dr. Toby Mayer: If you see this, a lot of celebrities have, have this pulled eyebrow up. That’s bad surgery. Gravity doesn’t work to the side it works straight up to the top of your head.
Teri Hausman: And I know one actress that, I know her personally so I won’t say her name but I, she’s a gorgeous girl but her eyebrows are so darn high. They look so strange now. And she was so popular in the 80’s and early 90’s and so… I mean is that what you’re talking about, even when they’re just pulled way, way up?
Dr. Toby Mayer: Yeah you shouldn’t, here’s a little tip-off which I’m sure scares her still: the result they should be after is not “Oh my God what happened to her?”
Teri Hausman: Exactly.
Dr. Toby Mayer: That’s not what you want. What you want is someone who thinks that you look that way because you went to Hawaii, that you had your hair color-changed, etc. Not because you look pulled. So…
Teri Hausman: How can, you know, a normal person, I mean I think that as a regular person and not a doctor you’re so trusting and especially if they have decent credentials you’re so trusting of them. How do you know that they’re not going to do that to you? And then you go on and you say, “Oh, I want to look this…”
Dr. Toby Mayer: I am so glad you asked that question because that really is the key to patients not getting into trouble. I don’t care about my credentials, I don’t care about any of that other stuff. Don’t, don’t pay attention to that. Obviously you want someone who is board certified…
Teri Hausman: Right.
Dr. Toby Mayer: But that, that’s like the lowest standard that you could have. What is really the essence of what the person does is: show me your patients. I’ll show them a live patient. We have enough people coming through here, I’ll say, “Here, you want to see a brow lift? Walk in that room I did a brow lift on that woman. I made this scar all the way across her forehead, you can’t see it, and she’ll tell you what her experience is.”
Teri Hausman: Exactly because you know, shouldn’t patients even be wary of just pictures? Because you don’t know where the doctor got those pictures.
Dr. Toby Mayer: Yeah you can, unfortunately now with the Photoshop you can do too much. I’ve had, I’ve had my pictures lifted off my website and used by another surgeon in another country.
Teri Hausman: Oh right, right. And that’s what’s scary because you don’t know. I mean that’s the thing that you really do need to see a patient and ask for patient referrals.
Dr. Toby Mayer: Most of the time there, you know, the good, the hallmark of a good salesman, conman, is he makes you think what you want to hear. You want to make sure that, I don’t care how good the person sounds. You’re not, you don’t want to go to dinner with this guy, you want this guy to have in his brain – he’s doing it for himself, he’s not doing it for you. That’s the way he is…
Teri Hausman: Right. And even now I think, now people need to be even more careful with the economy down, you know, ask for a payment plan or you know, work with the doctor but get the doctor that you want. You don’t want to mess up your face. I’ve seen too many people – you don’t get another face.
Dr. Toby Mayer: Yeah. I had a patient of mine, recently, who decided she wouldn’t drive an extra 15 miles, because I had operated on her 25 years ago and she had a great result. She came to see me but there was another guy that she saw and she said, you know, he’s only 15 miles away. She went to him and nine months later I had to redo everything: forehead lift, facelift, everything. That’s a lot of money to pay twice.
Teri Hausman: And that is such a huge point. A redo – I would even fly to another state fly to someone who is a really, really good surgeon. Because that’s not something you want to skimp on. Save your money, pay for it how you have to pay for it but don’t skimp on your face.
Dr. Toby Mayer: Yeah and for example, the most difficult operation that we do as plastic surgeons, other than reconstruction, burn reconstruction, trauma reconstruction is reconstruction of bad nose jobs.
Teri Hausman: You know you were recommended, I just wanted to tell you, by another great doctor that I did a podcast with for noses. So I know that you are well-known for your noses. And that’s actually why I was looking for a specific nose doctor because you have to be so good at noses. I mean go ahead, say what you’re going to say.
Dr. Toby Mayer: Yeah, people think that or they’ll say, “Oh, are you a good artist?” and I say, “No, I’m an average artist.” If I was a great artist I wouldn’t be doing plastic surgery. But what you have to be is a good architect engineer. You have to know how to make it because half of the noses I do are revisions, they’ve been done before they get here. And they’ve taken too much. Now I have to go figure out how to rebuild this nose and make it into what you want it to be. And for a doctor to have wonderful pictures and drawings – that, that’s an illustrator doing that. You want to see what did this doctor do and once again I’ll always, if a patient says to me, “Well can I talk to somebody that you’ve done?” Sure, here’s three people, call all three of them. You know, a doctor who does good work should not have any qualms about you seeing his work in other people with a similar problem to you.
Teri Hausman: Especially noses. I have seen so many bad nose jobs that it’s just a tragedy. We can use Michael Jackson as an example. I mean it’s who did his last nose job? I mean come on. I mean who didn’t say no at that point because he’s a star.
Dr. Toby Mayer: Yeah well years ago I was sitting at a wedding at a table with about eight women and my wife was sitting next to me and I said, I bet you this guy did this nose job to somebody sitting next to her and sure enough he had. And I told her how unfortunate because there were half a dozen women at that table who really could have benefitted from having their nose done.
Teri Hausman: Right.
Dr. Toby Mayer: Yet they looked at this woman who looked “done” and they were probably thinking, “Well, if that’s my choice, I’m going to leave it the way it is.” And if that was their only choice I would agree with them but there is another choice that they don’t see. Because when I do work that’s really, really good, those people don’t tell anybody. They…
Teri Hausman: Well that’s the thing; you really have to go to a nose specialist. I mean and conversely, you know, you think because a plastic surgeon, and this happened to a friend of mine, he’s good in a lot of other areas but just not noses. Noses are not his thing. And she went to him for the nose and I actually took off her bandaging and gasped. Because this was 15 years ago and then she ended up having to have it redone several times by different people. So that was when I learned you don’t just refer a good plastic surgeon who can do noses, you have to go to what you’re saying: somebody who knows the engineering and the architecture of noses. Like you do. You’re highly recommended so…
Dr. Toby Mayer: Thank you.
Teri Hausman:…we’ll recommend you for noses too.
Dr. Toby Mayer: Thank you. You know if somebody has a little…all plastic surgeons may have to do some little touch-up because this person makes a little bit more scar, but it’s like, put in a little bit of local anaesthetic and trim a little thing. But that’s, that’s, we’re not talking about that. Because that…
Teri Hausman: Right, no, we’re not talking about…we’re talking about the big picture.
Dr. Toby Mayer: Yeah, you look at it and you go, “Oh my God is that, that nose, it’s pinched or it’s scooped or it’s a piggy nose” and you go, Oh my God.
Teri Hausman: That’s bad, that’s the worst. And we’re going to have to take a break, I love talking to you, hold on for one second. This is Teri Struck, personallifemedia.com, we’re talking with Dr. Toby Mayer and we’ll be right back.
Teri Hausman: This is Teri Struck, I’m back, personallifemedia.com and I’m talking with Dr. Toby Mayer, a board certified plastic surgeon from Beverly Hills. Beverly Hills, surgeon to the stars, and he’s giving us all great tips today. Welcome back Dr. Mayer.
Dr. Toby Mayer: Hi Teri. Glad to be back again.
Teri Hausman: We were just talking about noses and how important it is to go to the right doctor. I mean, not only the right doctor but I mean there’s great plastic surgeons like I was saying, and they can do fabulous eyes, fabulous neck, whatever, but when it comes to your nose, that is right on your face and, you know, there’s been so many disasters.
Dr. Toby Mayer: Yeah, because a facelift, unless you overdo it, and people are trying to get a quick fix. You know, oh the weekend facelift. Oh they’re just going to take a laser to do it. And I always ask them where, or the other one where they’re using a wire and they lift it up – where does the skin go? If he’s only making a one inch incision what happens to the skin? And they go “Uhhh” and the answer is: you’ve got to make an incision big enough to remove skin because that’s the problem in facial aging. You know if you have excess fat, the fat can be suctioned if you’re in your 20’s, but by the time you get to be in 40’s to 50’s if you suction the fat out the skin is just going to sag. And even if you try to jack it up, now you’ve moved the extra skin from under the jaw-line to up above the jaw-line with like a pleat. And unfortunately we see a bunch of those because that particular procedure has had a renaissance this year and every year we see some new revolutionary procedure that’s supposed to be easy, simple, yet it only takes a weekend. And you say yeah, it’s called a facelift, just a plain facelift.
Teri Hausman: And I did a show on that, the Lifestyle Lift, and the guy was really honest. I think with Dr. Ducono if people want to check that out, that basically they’re not doing all the work that you’d normally do with a facelift. So that’s not going to last and it’s pretty much a waste of money.
Dr. Toby Mayer: Yes absolutely, it’s when any of these types of lifts because you’re not actually removing skin as we age the glove is the skin of the face. The skull and the muscles is the hand inside the glove. The hand is getting smaller, the glove is getting larger. So you can’t correct it by doing little tiny things. It doesn’t mean if someone is 30 that you couldn’t improve them a little bit by doing that but at 30 most people don’t need a facelift.
Teri Hausman: Right they’re not sagging like that, right. I mean so I really think it’s good advice and I think this what you’re saying, correct me if I’m wrong, that if you are sagging and you’re in your late 40’s, 50’s, you know, 60’s even 70’s, 80’s that you should go for the full face lifts. Because you’re going to be spending I don’t know how much on a Lifestyle Lift, probably $10,000 and it’s just going to go down the drain again.
Dr. Toby Mayer: Right, you’re spending a half to two thirds as much for something that a year later…I was just speaking in Atlanta and a woman came up to me and she had bad scars around her ears because she’d had a Lifestyle Lift and she said, “Oh this is a waste of money and look at my neck! My neck looks just the same as it did before.” And I went, “Yeah well if it sounds too good to be true, it’s too good to be true.
Teri Hausman: And is that because they don’t do the intensive work that you do on a facelift? Like say it takes you five, six hours to do a facelift and they’re going to do this in an hour because they don’t do the stitching underneath the skin.
Dr. Toby Mayer: Correct. And they don’t adjust the muscle. It won’t take five or six hours; I mean a good surgeon should be able to finish a facelift in roughly between two to three hours taking out muscle, repositioning the muscle the correct way and then removing skin without creating a pulled look. But that takes time and then you have to stitch it so that the scar doesn’t spread. Otherwise the woman looks good the day afterword but you look at her a month later and her scars are a quarter of an inch around her ear. And she says, “Oh my God, now what am I going to do?”
Teri Hausman: Well what is your best advice for getting rid of that little turkey neck thing underneath your chin? Like I mean I see people with neck lifts and then that comes back a year later. What…
Dr. Toby Mayer: Ahh! It comes back because that little muscle keeps moving. So years ago we used to sew them together and we said, Gee, you know what? The guy that I was a fellow with, that’s what he did and I thought, Geez when I was a fellow, this just doesn’t work. You’re kidding yourself. So we just started cutting them out. And that’s what we do. You have to actually cut out that muscle, sew it together in the middle so that it forms a sling underneath the jaw and then you have to tighten it at the other end too. Because when someone is lying down having a facelift, you have a lot of the excess that’s at the back of their neck. Because when we look at a facelift and you said, “Listen, I really want to get the best neck possible” well ideally we just take a wedge, like a dart in sewing, we take a wedge out of the back of your neck.
Teri Hausman: Yeah, good idea.
Dr. Toby Mayer: Yeah people would go, “Uh, wait a minute.” But won’t that be…
Teri Hausman: I never heard of that. That’s, that’s what I was thinking, why wouldn’t they do that?
Dr. Toby Mayer: Yeah, that’s just a bad scar. I do it for actresses who are in a much older age group. They’re in their late 60’s, 70’s and there’s no way I can give them a good neck. Most of them, what they do is they just use tape when they’re making the movie. They tape the skin back, their hair wig covers it and you don’t see it. And then when they are done shooting that day they take the tape off and back comes their saggy neck.
Teri Hausman: Oh that’s so sad! So that’s not what we want, we want permanent. So what’s your best advice for…
Dr. Toby Mayer: The best advice is you need a full facelift and the more banding and excess skin someone has in their neck, the lower you have to go into the hairline behind the ear. So you have to come down that hairline into the, almost, not to the midline but almost and then you have to be very careful the way you reconstruct that line. You have to bury the hair, so the hair grows through the line otherwise you’d see that scar.
Teri Hausman: Right. And the scars are, for our listeners, behind the ear?
Dr. Toby Mayer: They’re inside the ear in the front…
Teri Hausman: OK.
Dr. Toby Mayer: And then on the back side of the ear on the back and then down the hairline. If you go into the hair you can hide the line but if you’re pulling up you’re going to raise the hairline. So there’s a lot of women that I have to redo their hair because the guys pull their hair up so much that they now have a big step behind the ear with no hair.
Teri Hausman: See, there’s so many important things that you’re saying and this is what, pretty much every show I say, do your research on your doctor, do your research on what they know and what they don’t know. It doesn’t matter, I mean I see a lot of board certified surgeons that actually don’t really follow up on…
Dr. Toby Mayer: Right. And I’ll tell you the other one for your listeners that’s really important. It’s this incision that goes in the hair, in the temple, where someone is pulling back on the temple. And that creates the most unnatural look. Because then you’re moving a woman’s temporal hairline back and that really will age them. You’ve removed the woman’s best hair because that operation was very popular about 30 years ago. And the problem was that you’re, we did a lot of hair work so I was constantly replacing a woman’s hair because it had been removed. So you can’t make that incision across the top of the head or the one in the temple. So we developed an operation where the only thing I remove when I do a forehead lift and a facelift is bald skin. I never remove any of a woman’s hair.
Teri Hausman: That’s good because I’ve seen that on women. You know their big scar on their head and that’s really sad…
Dr. Toby Mayer: Yeah they have to wear bangs.
Teri Hausman: They don’t do it the correct way.
Dr. Toby Mayer: Yeah and they have to wear bangs after that all the time. And you see more of those now with endoscopic forehead lifts because if you’re doing a good endoscopic forehead lift on a woman with a high hairline you’re going to pull her hairline back too far. Or as a woman said to me, she said, “Look at my hairline! Do you think this is pulled back a little bit?” I said, “No, but I bet your surgeon did.” And she said, “Yeah, that’s what he told me!” She says, “This is not a little bit!”
Teri Hausman: And that’s another good point that you just brought up. You can’t really count on the surgeon for saying oh, yeah I did that, you know. Or, I mean hopefully a good surgeon will, a really good honest surgeon will say, “We can correct or improve upon that.”
Dr. Toby Mayer: Yeah and he’ll say, “Look, if I do this, this is what’s going to happen and I’m going to lift your forehead this much. Does this bother you?”
Teri Hausman: I only have one more minute, I’m going to have to do another show with you. I want to ask you really quick: I get a lot of mail and questions about the skin on women’s arms.
Dr. Toby Mayer: [laughs]
Teri Hausman: How can, as we get older….
Dr. Toby Mayer: Old, yeah, that’s one of my favorites too.
Teri Hausman: Think you’ve just got to cover that…we’re going to have do another show on just arms, but I…
Dr. Toby Mayer: Yeah we call that bat wings.
Teri Hausman: Yeah what can they do about that?
Dr. Toby Mayer: Bat wings. Yeah, OK, so the best, there’s only a few things a woman can do. If they’re young, you can suction a little bit of fat, it will only improve it 10-20%. If they have actual skin hanging and you liposuction more, the skin is just going to hang more and the only good operation for what we call full bat wings is to make an incision essentially from your elbow to your armpit and remove the skin.
Teri Hausman: And that’s a pretty nasty scar right there.
Dr. Toby Mayer: Yeah, that’s a pretty nasty scar.
Teri Hausman: So you’ve got it. What about doing push-ups?
Dr. Toby Mayer: No, well, anything for triceps will firm that area especially in a younger person but you do get to, back to what we said before, the problem is the hand inside the glove is getting smaller, the glove is getting larger. And how do we stop the glove from getting larger? As I tell patients, I said, “I can stop, I can reset the clock, I can’t stop it.”
Teri Hausman: Right, and that’s such good advice. And so my advice on that one: Do your weights, weightlifting and everything and work in conjunction with your doctor. And if you do have it you’ve got to have the trade-off: whether you want the scars or do you want to get an improved look. It’s a trade-off because I mean some people are happier with the scars. So that’s, we’re going to have you back because I can’t even believe we’re running out of time. That went so fast and I actually want to do another show with you on arms completely because I have so many people asking what we can do about our arms.
Dr. Toby Mayer: Any time.
Teri Hausman: Thank you so much, you were a pleasure today and I can’t believe we’re out of time. I’m going to have you back for round two so listeners stay tuned. And if you want to find Dr. Toby Mayer out of Beverly Hills, go to personallifemedia.com and we’re going to link our website to his and you can get a transcript of today’s show by going to personallifemedia.com. And Dr. Toby Mayer we have so much more to talk to you about, we’ll have you back.
Dr. Toby Mayer: Thank you very much Teri.
Teri Hausman: Thanks again, buh-bye.
[song: You Had A Little Work Done by Mark Winter (http://www.mark-winter.com)]
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