Episode 49: Dr. Toby Mayer: Explains Neck, Nose, Arms , Lifts and Lipo For Beauty Now Part 2

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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!

Part 2 of a 2-part podcast.

Transcript

Woman: This program is brought to you by PersonalLifeMedia.com.

[musical interlude]

Teri Struck: I'm Teri Struck, host of “Beauty Now,” a weekly podcast that features experts who share their knowledge on lasers, lifts, lipo, hair, lashes, skin, breast augs, vaginal rejuvenation, cellulite, and much, much more. Today, we're going to get to the arms, and so many women or/and men calling me about arms. What can they do about their arms. Today, we're very, very lucky to welcome back Dr. Toby Mayer, an expert in his field, a Beverly Hills plastic surgeon. You couldn’t get much better than this.

[musical interlude]

Teri Struck: Welcome back, Dr. Mayer.

Toby Mayer: I'm glad to be back, Teri.

Teri Struck: Thanks for being with us. I have so many emails and women asking me about those bat wing things behind their arms. Saggy skin on their arms, saggy skin after weight loss. Then, just as women get older, the sun damage and all that. Arms really show your age. What can women do?

Toby Mayer: Well, we can lump these all into a one giant category. We say, when we have too much skin because what's inside the skin is getting smaller while the skin, because of gravity, is getting larger, and if you combine that with weight loss. Wherever you have excess skin – arms; the flanks between your rib cage and your hip bone; at the sides, the love handles, extending around to the back; the chest, the back of the chest. Lots of times, women complain about rolls of fat there.

Wherever you have excess skin, there's some muscles – for example, the back of the arms – where you can do exercises to help your triceps. But, eventually, we hit a point where most women do not have this kind of time. They're not professional body builders. Besides toning, there's not a lot else that one can do. If you are going to do surgery where we cut out the skin, because that’s really the only way you can address bat wings.

Teri Struck: So, bat wings are those little fatty things that you see slapping.

Toby Mayer: Yes. When you hold your arm out straight in front of you, it's between the elbow and the shoulder. That little thing that slips back and forth. Women don’t like that because they can have had a face lift and other kinds of surgery and look really good. But, their bat wings is, “Oh, my God. Isn’t there something…can't you just liposuction that?” The answer is, yes, liposuction will help if it's fat, but very often, it's not fat. It's just extra skin, which means that we have to make a scar between the elbow and the armpit.

Teri Struck: That’s a pretty big scar.

Toby Mayer: That’s a big scar. Sometimes, they don’t heal well or they make a very hypertrophic red, sort of angry scar.

Teri Struck: Hypertrophic, for the normal listener here, wouldn’t understand that.

Toby Mayer: That’s [xx] thick, red scar.

Teri Struck: Right. Okay.

Toby Mayer: Not what they consider a fine line, and the surgeon doesn’t always know that. If you close it under tension, it will make a thick scar. If it's close, “Oh, look. If I just pinch it like this, why can't you just take all that off?” Well, the reason that you can't is you have to be able to move it. When you move your arms, you're stretching that and your body will not tolerate stretching. So, it will make the [xx] far wider.

Teri Struck: Oh, I see, what you're saying. That would be what would come to mind is that why couldn’t you just make a tiny little cut underneath by your armpit or something.

Toby Mayer: Then, suction the fat out. You can do that a little bit if someone has a great deal of fat. But remember, if somebody is 20, usually, we don’t have this problem. If you suction fat out when somebody is 20, a) they normally don’t need it; and b) you could do that with a little incision, suction out a little bit of fat. It might improve things 10%-20%, but not what people think it's going to be.

By the time you get to be 50 and beyond, now we're talking about just too much skin. You're going to have to make an incision and remove skin. When a woman hears that there's a trade off, “Oh, I can remove skin. It's going to look a little bit better.” But if I have a scar from my armpit to my elbow on the inside of my arm. But still, that’s going to show if she wears an evening dress or something with short sleeves. Most women will not want to have that done.

Teri Struck: But what if you're a woman – and I'm going to do a show on this – that has lost quite a bit of weight, like the lap band surgery. I'm sure, you did the body lift and the big, hanging skin. So, that would be a trade off.

Toby Mayer: Yes. It's always, and I'm glad you phrase it that way. Anytime you have excess skin – face, you need a face lift. You can't do like a little operation, make a little incision. Where is the extra skin [xx] go if you just pull it up? You're just going to move a pleat from one place to another. So, the same thing is true with massive weight loss that people have rolls of skin. Now, we're talking about large incision is going, virtually, around the body to remove the excess skin. There's no way you're going to remove it, it's not just fat. Now, once they’ve lost the weight, it's just rolls of skin.

Teri Struck: So, when people…let's just say they've lost a hundred pounds and they’ve got the big hanging skin. Of course, their arms, they're going to want to do that surgery then from the elbow. It is going to look way better than just hanging skin, which we've seen on “Extreme Makeover” or one of those shows, and it's pretty sad. But, on the other hand, they're really happy that they're skinny, so that’s good.

Toby Mayer: So, there you have it, you said it yourself. When the trade off is favorable, massive amounts of skin versus the scar, good. Go ahead and have it done. But, a lot of women that I see are just, you know, your average 50 to 60-year-old or beyond, and they have bat wings. They don’t have massive weight lost, and the trade off is not going to be beneficial for them

Teri Struck: Even really skinny people, you can see they get the bat wings. I had dinner with somebody that just had to asked me about arms. Her skin is starting to fall off her…what about you're forearms? Her problem was that she was very, very thin. That means she needs to gain weight.

Toby Mayer: Yes, there you go. Go eat a lot.

Teri Struck: Exactly. [xx], I'll tell you why my arms look good.

Toby Mayer: Yes. You know, it's funny. I have one patient that I've known for, probably, 25 years. Every year, she asks me, “Is there something you can do for me?” Now, she's almost 60, and she has a little bit of excess fat, but she doesn’t need like a regular lift. I mean, if you ask people by aging, what's she looks like, she looks like 40 years old. So, she is at the very, very top of the bell shape curve. The fullness of the fat gives her a [xx] smooth texture so she doesn’t have wrinkles.

Teri Struck: But, you're talking of face. I have another girlfriend who’s turning 60, and she, for the first time in her life, is getting a little bit of a pot belly. Are 60 year olds, are they candidates for lipo?

Toby Mayer: Yes, they are if. Think of it this way. The abdominal wall holds your stomach in and all your organs. If that is absolutely flat, which is virtually is not in anyone that’s 60 unless they're in the gym all week. When they relax, if there's a convexity to their abdominal wall and there's just skin around it without that fat layer, all of that fat is inside. Like men would have “beer belly.” So they say, “Oh, can't you suction out the fat?” I say, “No.” The fat isn’t on the outside, it's on the inside.

Teri Struck: On the inside of the muscles, right?

Toby Mayer: Right. Inside, around your organs, and your abdominal cavity versus being on the outside between the muscle and skin.

Teri Struck: Is that possible to lose? I mean, when you get the fat inside your muscles, is that just a question of losing weight?

Toby Mayer: Yes. Okay. The only way you can treat a so called “beer belly,”…and sometimes I see women who have both. Because they’ve had child bearing, they have a convexity to their abdomen.

Teri Struck: When you say convexity, explain that first.

Toby Mayer: It's a bulge, it bulges out. It's not flat, it's not what people call a flat stomach. No matter how many sit-ups they do, because of child bearing, this got stretched so you'd only get it back so far, and some people are luckier than others. But, even after child bearing, if there's fat between the muscle wall and the skin, then we can do a liposuction no matter what the age is. If they have excess skin when you're done with the liposuction, then you have to do some sort of a modified tummy tuck or a full tummy tuck.

Teri Struck: When you say modified, that would be like not doing the belly button. Correct?

Toby Mayer: Correct, yes. Modified carries a lot less risk than a full tummy tuck. Full tummy tucks, you're separating the skin from the pubic bone all the way up to the ribs. When you put your hand underneath there and push it back and forth from side to side, that’s a full tummy tuck and you're making a new belly button. A modified is where you're just removing the excess skin at the bottom, right above the pubic bone.

Teri Struck: So, the full tummy tuck is pretty much when you have that real hanging skin and you really can't just do that without doing the belly button.

Toby Mayer: Right.

Teri Struck: You're pulling the belly button down.

Toby Mayer: Right. But most women, probably, will do as well with a modified without taking the risk of a pulmonary embolism.

Teri Struck: That’s the [xx] thing about having a C section, because then you could do it through that. Right?

Toby Mayer: Absolutely. We just take out the old scar and make a new one. Most women might have a little bit of fullness above the belly button. I told them, “If that is not going to bother you after I do the liposuction, it might still be a little crapy. But we can take out the pleat at the bottom, is that going to make you happy?” If they say yes, great, no problem. But if the answer is no, then they're going to need the full tummy tuck.

Teri Struck: You just brought up a really good point – “Is that going to make you happy?” Everybody is different, and, you know, listeners, I've said this on almost every show. What will make you happy, and I think that is what we're talking about trade off. So, we're trying to learn about scars and scars on your body for the trade off of looking good or how you're going to want to feel. It's not about what other people think about you.

Toby Mayer: Yes, exactly. Once you understand what are the advantages and disadvantages of any procedure as well as…If you go to a surgeon and he tells you only one way of doing something, that doesn’t give you enough information. You need to know what's the pros and cons and different ways. What I might want for you might be different than what you want for you. So, you need to know those things, and you need to be able to evaluate what you see because there's so much misinformation.

Teri Struck: I know. Nip tuck is really fun to watch, but it's just doesn’t represent reality. Except for the part where they say, “What don’t you like about yourself?” because that’s probably what you say. Now, how do you approach somebody that comes in and they have – this is an example – a huge [xx] nose. Then, assuming that’s what they're going to want, then they're like, “See, this little mole here.”

Toby Mayer: Yes. What I do is I put them in front of a mirror and I never suppose what someone’s going to want. I hand them a pointer, which is what I call the Armani Q-tip. I say, “Point out to me what bothers you.”

Teri Struck: That’s good. I like that.

Toby Mayer: That’s all I say.

Teri Struck: We're going to have to take a break. We're already at break time where I want to thank our sponsors. I'm Teri Struck of PersonalLifeMedia.com, and we're talking with Dr. Toby Mayer. All you want to know about plastic surgery. We'll be right back.

[podcast break]

Teri Struck: I'm Teri Struck, host of “Beauty Now,” a weekly podcast and we're talking with Dr. Toby Mayer from Beverly Hills. He sees all the stars, but more importantly, he's an expert in his field, and that’s why we're talking to him. Welcome back, Dr. Mayer.

Toby Mayer: I'm glad to be back. Teri.

Teri Struck: We're just talking about scars, we're talking about sagging skin. Now, I want to ask you about lipo. There's so many different procedures out there. Now, you see smart lipo, you see, wrong lipo, you see vapor[sp] lipo. What can our listeners know that would help them about what would sit for them?

Toby Mayer: Unfortunately, in today’s world, marketing creates what we call catchy little names that really don’t mean a lot. So, people have the weekend facelift to the smart lipo. All of these terms really don’t mean a lot because we don’t use those as plastic surgeons, we don’t use terms like that. When you're doing liposuction, think of this as a gigantic piece of a solid block of cheese. Now, we're going to make holes in it and remove the fat until it's going to become Swiss cheese and collapse and draw in. Now, we have a smaller area because we've removed that amount of fat.

The question is, “Well, how do you remove the fat?” Well, the difference is in the skill of the surgeon. It's not which method you use. What you use to [xx] or you put somebody to sleep. That’s just depends on the way the surgeon does it. Usually, dermatologists are going to do this under local, plastic surgeons are very often doing multiple procedures so they're going to do it with the patient asleep. It doesn’t make any [xx].

Teri Struck: Local, my gosh. I mean, always have to spend the money and go to sleep. That just sounds so painful.

Toby Mayer: Yes. What they show you is the person lying there after they’ve had the injections. Of course, then, it doesn’t hurt. But while they got the injections, it doesn’t feel too good.

Teri Struck: I can imagine. I'm not a huge baby.

Toby Mayer: As you said, “My wife is going to sleep, period.”

Teri Struck: Yes, I'm going to sleep. Right.

Toby Mayer: Yes. So, the real question is, we've been doing liposuction since within a month of the time I came to this country, and that was almost 30 years ago. The difference and the changes have been, virtually, all marketing because the [xx] says, “Well, we use a special laser that melts the fat.” I want to be able to feel the skin to know what I'm leaving, not exactly what I'm taking out. I want to know how much fat is left in the skin.

Teri Struck: That is because you see lumpy…

Toby Mayer: Oh, yes. I see patients who’ve had, “Oh, yes, my doctor did the vapor, laser sound high tech.” Then they have a [xx] that are left. The only advantage really of the laser is the surgeon doesn’t have to “work so hard.” So, you're not going to save yourself more than 60 seconds and you're going to pass that money on to the consumer for the laser machine that you're using just for marketing.

Teri Struck: And, potentially, have a complication.

Toby Mayer: Yes. The only complication that I've had in 30 years of liposuction is if I leave too much. I get to a certain point where I tell the patient before surgery, I said, “If we get close to the line, do you care if you have any crapiness?” This is for women who don’t have massive amounts that they need removed. She says, “Oh, no, no. I don’t want any crapiness whatsoever. I'm going to leave a little bit more.” If she says, “I don’t care about crapiness. I want to look really good in clothes,” then I'll push it. But if it's a choice that I make with her or him, that what are their goals, not what's my goals. I've had nurses that had worked for me that worked for other plastic surgeons and they’ve had bad results. I had to go back and put fat in [xx] that were created by the previous surgeon.

Teri Struck: Does that work when you do that?

Toby Mayer: It sure does. It's not the kind of thing that you're adding clay to a sculpture. It's not that way, it's not that precise. You have to overcorrect a little bit. But, when liposuction first came in, you know, we had bottles of fat. I said, “Oh, geez, we're taking this out, there should be some places where we can put it back in.” So, we developed a way of concentrating the fat and then putting it back in. In those days, as it is up until now, people say, “Oh, this doesn’t work. I tried it.” I said, “How did you do it?” They told me how they did it. I said, “Well, if I did it that way, it wouldn’t work for me either.” But my first three patients, I put it in [xx] that they had some bad surgery. I [xx] send someone else, and I put it in, and I made them all wait one year. On all three of those patients, I had to go back and remove fat.

Teri Struck: That’s good. That’s really good.

Toby Mayer: I took pictures, so I showed. Not only does it work, it can work too well if you put in too much. So, it's my procedure of choice for lips, which I really like, and for filling out people that have very, very thin faces. But, you can only do so much with fat.

Teri Struck: Fat in the lips looks so good.

Toby Mayer: Yes. It doesn’t change the texture because that’s why soft lips are soft lips. It's nice, and the only difficulty you have with that in the lips is trying to get in as much as you would like. If you try to put in too much, it's going to squeeze into the tissue in a place you don’t want it.

Teri Struck: That’s not right. But does that last in the lips?

Toby Mayer: Once again, I make sure I take pictures. Essentially, what you have at about three or four months is what you'll have forever. I mean, that fat is going to age when you're 60, you get it done when you're 40. When you're 60, all the fat in your body is aging. But the fat that is in there, and that result will last forever. That’s why I use it for hands, I use it for chest, with women that have real, hollow chests, and that works beautifully.

Teri Struck: So, you can inject fat into hands.

Toby Mayer: Into hands for women that have bony hands and into the central chest between the breast where it's real bony. But you have to have a woman who has enough fat in order to do that.

Teri Struck: That’s hard when they have a bony chest [xx], isn’t it?

Toby Mayer: Yes. Very often, those women are really, really thin. You might get out a syringe full enough to do lips, but that’s about it. I've had models come in who say, “Oh, I'm so massively fat. Oh, my thighs, there's just plenty of fat there.” Then, when I look at their fat, my nurse looks at me, “I'm going to club this woman to death.”

Teri Struck: I know. I know people like that. Forget it, let's club them. They're not allowed to come in there and get lipo.

Toby Mayer: So, a patient have to understand that all the things that they read about, they have to remove the marketing from it. There's a commercial on now for skin that sort of the same way that we see at liposuction where you have these models. You can't just call it lotion anymore, it has to be a serum.

Teri Struck: A serum, right. Of course.

Toby Mayer: Serum, however that means. Serum is what left over when blood clots.

Teri Struck: I know. I know.

Toby Mayer: I'm sure, it's not that. But, they show a model with make-up, with light on her face, and she's going, “Oh, I'm 43.” Great. You want to tell me how good your product works? Take off all your make up, get a HD kind of picture of your face, do half with this “serum,” and don’t do anything to the other half. Let's take a picture in six months, and then if it works, great!

Teri Struck: The same concept is I love those ads where they have some little squirt bottles and they're like, “Better than botox.” Quite frankly, it's not better than botox. It's completely different. A botox is completely different because it paralyzes your muscles, it doesn’t fill in the little wrinkles. So, the whole ad is wrong, and that’s exactly right. It's so misleading, and I want to tell all the young people today, please don’t be looking up at these girls like they're so perfect because they're airbrushed.

Toby Mayer: Yes. If you saw them in real life the same day, you'd go, “Oh, my God!”

Teri Struck: In Los Angeles, you can see them the same day and you do do that. You're like, “I feel so much better.”

Toby Mayer: Yes, yes. You'll say, “Oh, geez, I saw her last night on the “Tonight Show,” but I just saw her today in Beverly Hills. Oh, my God! She looked years older! What happened?”

Teri Struck: It's so true. I saw in Melrose Place when Melrose Place was popular is that the [xx] next to me was this one of the ones I thought was just so, so pretty. She's pretty, but she looks totally normal in real life.

Toby Mayer: That’s the difference. I mean, somebody who's great looking as Angelina Jolie got a fall apart when she's 60? No, but you ask yourself this question. God does not take 60 year olds and make them wrinkle-free and look perfect. So, when you see that in a movie, you'd go, “Gee, God must have selected out just the actresses that are pretty not to age like the rest of us.”

Teri Struck: Just Angelina.

Toby Mayer: That’s not true.

Teri Struck: I know, and Jennifer is looking darn good, too. Jennifer Aniston, she looks very good.

Toby Mayer: Well, remember, patients like these, as soon as they start to get cracks, they're going to get fillers and botox. Once they have saggy skin, they're going to go get a facelift. When you look at Laura Bush, people think, “Do you think she's not had surgery?” There's a picture of her about a year or two ago and she's got saggy browse, I mean, a bad neck, jowls. All of a sudden, we see her at the Inauguration, and you go, “Ah, this is a different looking woman! Gee, I wonder what happened?”

Teri Struck: Exactly, and I think, that’s the thing, it's a personal choice. I'd personally choose to get fillers and botox and keep myself up, but I want to do it in a natural way. That’s why we have doctors like you to contain us.

Toby Mayer: Yes, yes. That’s exactly right. If you go to a good doctor, he’ll say, “No, no, no. Don’t do this now. The disadvantages are too great. Now, I'll tell you when you need it and I'll get your money then. But I don’t want it now.”

Teri Struck: That’s a really good doctor. When you go in and you say, if you are getting obsessed or something that you go in and you say, “I want this.” He’ll be like, “Are you crazy? You don’t need that now.” Sometimes, you just need that reassurance.

Toby Mayer: Yes, yes. He says, “Look, I'm going to take care of you and I know what you want. I agree with you, but if what you want carries too much of a downside, you're about to make a big mistake.” More than 30 years ago, I saw a woman – I'd only been in practice for a couple of years – and she was an actress. She had some hyperpigmentation of her upper lip and just a little bit and a couple of little wrinkles. She wanted to get a procedure done. I said, “No, just collagen, and that’s all because if we do anything else, you could end up with a real mismatch in your color.” She said, “Oh, okay.” Then, she went to another plastic surgeon who did what she wanted. She came back and told me how terrible he was. I looked at her upper lip, now she has to constantly wear make up forever.

Teri Struck: That is such good advice. My husband, he's a plastic surgeon as well. I mean, that is really good. Listen to your doctor and you'll have a problem if you're going to go find somebody. I'm sorry, Michael Jackson, but you're an example of this. If you're going too far and it's a really qualified great doctor like Dr. Toby Mayer says, “Don’t do it,” then do it. You need to find somebody board certified plastic and reconstructive surgery or a dermatologist if it's just for skin. I totally advocate going to the doctors that’s trained in their fields.

My husband did the same thing. He turned down this really skinny friend of mine. She's a very, very good friend and she's very, very thin. She wanted lipo, and he said, “No.” Just what you're saying on this show, she went to somebody else and her skin hung. She already had a tummy tuck and nothing that they could do for her.

Toby Mayer: Yes, and remember, women are not supposed to have a six pack. I don’t know who started this, like, “Oh, women are supposed to have a six pack.” No, they're not supposed to have a six pack.

Teri Struck: That’s a relief, thank you.

Toby Mayer: Yes. You're supposed to have a little convexity between the navel and the pubic bone. It shouldn’t be absolutely flat. There's supposed to be little bit of a rounding there, and that’s the way a normal woman looks. They're the soft, cuddly ones, not the hard-as-a-board ones. Those are the men that are supposed to be that way.

Teri Struck: Right, because men get the six packs. So, the message is please, please like rein in on yourselves. Ask your doctor and make sure you don’t do too much stuff to yourself. That looks terrible.

Toby Mayer: Right, and also body type. Not all women are ectomorphs or women who are real skinny. They're not Angelina Jolie, they're going to be a little bit more full figured. I don’t mean fat when I say that, I mean they're a little bit more bulky. That’s them, and that’s normal. So, people shouldn’t say, “Oh, here we have this size 2 that we want everybody to be.” Women should understand that all of that marketing is to drive them to get something done. When you need it, get a good surgeon who’ll tell you, “Yes, you need it,” But if he says don’t, don’t.

Teri Struck: Stop, and if you think you do, then talk to somebody.

Toby Mayer: Yes, get another opinion.

Teri Struck: Get some professional advice.

Toby Mayer: Yes.

Teri Struck: Another opinion, if you're going to a really great surgeon, look at their pictures and all that. But really, we need to do a show on this is body dismorphic, which is when people just go too far. That’s when people look like freaks. So, I think, the aim of this show is to make you look naturally beautiful.

End of the show already, we're going to have to do another show. We’re with Dr. Toby Mayer. Listen to Part 1, too. He's got a lot of great advice on plastic surgery and all different types of procedures.

If you'd like a copy of today transcripts, go to PersonalLifeMedia.com. If you have any show ideas, questions, and concerns, email me at Teri@PersonalLifeMedia.com. We're going to link Dr. Toby Mayer’s website to ours, so you can hear the podcast, you can get transcripts, and you can find Dr. Mayer or another qualified surgeon in your area.

Thank you so much, again, for being with us, Dr. Mayer. It was a pleasure and we'll have you back.

Toby Mayer: The pleasure was mine, Teri.

Woman: Find more great shows like this on PersonalLifeMedia.com.

Song Credit: You Had A Little Work Done by Mark Winter.