Episode 57: Dr.Toby Mayer: facial implants, Chin and Cheeks

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Dr. Toby Mayer, a top Beverly Hills surgeon tells us how a new chin will improve your looks and help with anti aging if you were shorted in that department. It can balance your face and make a larger nose seem in proportion and may prolong a face lift. Our faces lose fat as we get older. Dr. Mayer tells us how cheek implants if done correctly can make a huge difference. A rarely discussed topic is broken down and if you are thinking of facial surgery then this podcast has tons of information for you. Dr. Mayer is renowned and Beauty Now gets all we need to know if considering this little talked about surgery.

Transcript

Teri Struck: I’m Teri Struck, host of Beauty Now, the weekly podcast that brings you the latest in cosmetic surgery, breast augs, lasers, lifts, Brazilian butt lift, neck lifts, noses, lashes, hair, diet, training, and much, much more. Today we’re going to talk about facial implants; cheek, chin, lip and all of it. We’ve got back expert top plastic surgeon Dr. Toby Mayer. Welcome back Dr. Mayer.

Dr. Toby Mayer: Well it’s glad to be back.

Teri Struck: Thank you for joining us today. We want to know all about chin implants, cheek implants. Lets start. What’s the standard procedure for chin and jaw enhancement surgery?

Dr. Toby Mayer: Well the most common way of augmenting chins or cheeks, people who when they’re born they really don’t develop strong cheeks or a strong chin, gives them a certain look in their faces out of balanced. So we want to be able to just restore the appearance of the bone, the way it is when we know it’s in good proportion, and the way we do that is by putting in solid silicon implants which are like rubber, and they’ve been used for, oh, probably 45-50 years and caused no problem other than an occasional infection where you have to remove the implant.

Teri Struck: So it’s silicon and not gortex. Is there other materials that are used?

Dr. Toby Mayer: There are other materials that are used, but they usually have a disadvantage. For example, if you get an infection with a textured implant they’re a little bit harder to remove, where silicon can just be slid out, treat the infection and then put it back in.

Teri Struck: How common is an infection?

Dr. Toby Mayer: In, I would say, about one in five hundred with chin implants or cheek implants. They’re both made out of the same material, and we like them for chins and cheeks because you can get them in different shapes and you can get them in different sizes so that you don’t want to make the cheeks too big or the chin stick out too far or be too low. So those can be fixed right to the bone so that they don’t move, they don’t shift around and they look just like bone and they feel just like bone.

Teri Struck: How is the cheek implant implanted?

Dr. Toby Mayer: The cheek implant is uses implanted through the mouth through an incision just above the gum and the upper jaw. And they can be either put into an exact pocket over the cheek, and sometimes we will actually fix them to the bone, and that way the incision is closed in the mouth. There’s no incision; somebody has that done on Thursday they can be back at work on Monday. Pretty much the same thing with chin, but chin can be done either through the mouth or through a small one-inch incision in the crease under the chin. We prefer the one under the chin, other surgeons prefer the one in the mouth. There’s a little bit higher risk of infection when you go through the mouth I think than when you go under the chin.

Teri Struck: So what happens when you get an infection?

Dr. Toby Mayer: It, the body will, it takes much less bacteria to cause an infection if there’s an implant than if you did the same operation and didn’t put an implant in the head and neck it is very rare that you’d ever have an infection. But when you put an implant it takes fewer bacteria to do that, and all you do if it gets red and swollen is you just open up the incision, slide out the implant, let it heal, and it’ll heal right away once the implant is removed, and then you wait a month or two and put it back in.

Teri Struck: Well that doesn’t sound bad. What about if an overly long or prominent chin, what do you do?

Dr. Toby Mayer: Well if, it depends on what’s happening with occlusion, their bite. If their bite is normal and they have a prominent chin, the chin can be shaved down, the bony part. So it can be taken down with a, like a file and that can be contoured to make it asymmetrical and more balanced. That is much rarer than chins that are too small and need to be made larger.

Teri Struck: And you can actually see, you know, when you’re walking around that there’s people with, that really need a chin.

Dr. Toby Mayer: Yes. And in our society if you show people pictures of people who have a receded chin, they, people tend to say that they look dumb or stupid because their, the chin is receded so far. If the chin is receded so far and they also have an occlusal problem, then you have to break the jaws and reset them in a normal position. But if the occlusion is normal then that’s not needed and people would prefer just an implant rather than having their jaws wired for a couple of months.

Teri Struck: Now to do that you would need to go to an oral surgeon as well, right?

Dr. Toby Mayer: Yes, an oral or muscular facial surgeon. Ear, nose and throat or oral surgery usually does those particular operations when they deal with occlusion.

Teri Struck: And pretty much the patient can see what kind of, you know, surgeon… If it’s just that you want a small chin, you can go to a surgeon like yourself, a board certified surgeon.

Dr. Toby Mayer: And if you’re, if I see a patient who has a very bad occlusal problem I’m going to send them to an oral surgeon and say, “You need to get this fixed”, and he can fix your chin at the same time. Other patients, by far the vast majority, is we see patients where I’m doing a nasal surgery but the chin is so receded it makes the nose look very, very prominent, and I say if I bring your chin out then your face will have better balance and I remove less from the nose. But you don’t take a nose down to match a chin, you bring a chin out and then deal with the nasal surgery.

Teri Struck: Mostly do you recommend this to people or do they actually see it and ask you for it?

Dr. Toby Mayer: I would say about two-thirds don’t ask for it, one-third do. The two-thirds aren’t aware of that ‘til I show them on a profile and show them where their chin should be, and I can put my hand underneath the chin and just bring the tissue forward and they go, “Oh yeah, that looks, yeah, that looks a lot better…”

Teri Struck: And so then it becomes their idea, ‘cause I know it… Isn’t it difficult with a patients, and they’ll come in with this huge nose and they’ll say, “Look at this little mole right here”, you know, ‘cause you can’t really say that as a surgeon, can you?

Dr. Toby Mayer: You know, it depends on the age of the person. If, what I don’t… We’re not in the sales business, we don’t try to sell somebody something…

Teri Struck: Right.

Dr. Toby Mayer: but you do want them to be aware of what is available, and if it doesn’t by, if somebody has a big mole on the front of their face and they don’t mention it, well obviously it doesn’t bother them cosmetically. So, you know, there’s no reason to bring it up. It’s like, “What are you doing with that ugly mole on your face?”

Teri Struck: I know.

Dr. Toby Mayer: So, you know….

Teri Struck: It’s not like Nip/Tuck where they say, “Tell us about yourself.”

Dr. Toby Mayer: No.

Teri Struck: “You’re going to do this to yourself”, that’s not reality.

Dr. Toby Mayer: No, no, and… But if somebody has, say, a large nose and they’re fifty years old and you’re talking about doing other cosmetic surgery, I’ll just say, “Does your nose bother you?” And if they say…

Teri Struck: Right.

Dr. Toby Mayer: they say, “No, I’m very happy with my nose”, I just go right on.

Teri Struck: And then you say, “Well we’re very unhappy with your nose.”

Dr. Toby Mayer: Yeah. No, you never should do something because the surgeon wants you to do it. It should be something that…

Teri Struck: To make you happy.

Dr. Toby Mayer: Yeah, makes you happy and not your husband or your children or vice versa. You want the person to, who’s having this done to be happy afterward. That’s the point of the surgery, and if it doesn’t bother them before… We have sort of an issue with people that want to do, you know, forty things to someone, and, you know, they might meet two or three and only one bothers them, then just have the one done.

Teri Struck: And that’s the healthiest attitude, I think. Don’t you?

Dr. Toby Mayer: Yeah, because it’s, you can’t, if someone has unrealistic expectations, you can’t fix that. I have patients who they have bald, a huge nose, no chin, I mean not an overall great look, and they’ll bring in a picture of Tom Cruise, and you go, “Whoa, whoa, whoa, wait a minute. If I could do that I’ve found my own religion.”

Teri Struck: Yeah, you’d be a magician not a physician.

Dr. Toby Mayer: Right.

Teri Struck: What about the turkey gobble neck, can that be corrected with a chin implant?

Dr. Toby Mayer: Actually no. It could be, you know, get it a little bit of improvement if you have a receded chin, but it doesn’t, it doesn’t stretch the skin forward. For all of the things that patients hear about the kind of facelifts that have a catchy title to them, they’re usually just a mini lift, that’s all it means. And they don’t do a lot for the neck, and they won’t do much for a turkey gobbler because you have to separate the skin, you have to do a full facelift to get that skin loose from what’s underneath to be able to remove it ‘cause that’s the mechanical problem. The skull and muscle and fat of the face is getting smaller, smaller, smaller every year. The skin is getting bigger, bigger, bigger every year, so you have to remove skin. And if there’s a substantial amount of skin, then you have to do a full facelift. If somebody’s 40 years old and they’ve got a pinch of skin in front of their ear, then you can do a mini lift by whatever name it’s called.

Teri Struck: And it would be good if you have a sagging neck to do it at the same time so you won’t have to go back in for more surgery.

Dr. Toby Mayer: Right, yeah. And, you know, patients know that, you know, I tell them, “This is an al a carte menu, you get to pick how many of these things you want. You’re going to get a break on the cost and you only have one recovery period if you do them together.” But you can separate every one of them. There’s so…

Teri Struck: And again, I mean I think we touched based on it last show was it just, you really need to research your surgeons, and what you’re saying too is don’t sell them on too many procedures. That’s how you get into trouble too.

Dr. Toby Mayer: Yeah, a, you know, if it sounds too good to be true it is too good to be true, patients should know that. But I see patients who I tell them the truth, they go to see someone else who tells them just what they want to hear, and I’ve already told them, “If you do this, you’re going to be unhappy.” And then they come back and want me to fix it…

Teri Struck: Mm hmm.

Dr. Toby Mayer: And then it’s much, much more harder, and the same thing is true with noses. There’s some noses, you know, I can get them just where I want them and other noses that are real fatty thick skinned, you can’t make a little tiny normal petite nose out of that. You just can’t do that. And if you look at a lot of actresses, people never notice their nose. Catherine Zeta Jones has a very, very wide tip. Renee Zellweger, they all don’t look like, they all don’t have a nose like Julia Roberts. So there’s a wide range of normal.

Teri Struck: That’s so true, and you’ve got to find what works for you. Lets talk pain; how painful is this?

Dr. Toby Mayer: You know, of all the procedures that we do, these are real low pain procedures. Most facial surgery should be what I call almost pain-free because a) we give them medicine, b)… For example, noses, half the people don’t take anything. The other half take one pain pill and they go, “What was the worst, what word would you use to describe your surgery?”, they don’t say painful, they say it was uncomfortable because they’re breathing through their mouth overnight. The day after surgery, any of these surgeries that we’ve talked about, including a facelift. Those people don’t take any pain medicine…

Teri Struck: Mm hmm.

Dr. Toby Mayer: It’s just a little sore. Patients with facelifts have sore ears, that’s the most common complaint, and then we give them the medicine, they say, “I took a pain pill and it went away.” So…

Teri Struck: And usually you do general for this, correct?

Dr. Toby Mayer: Pretty much, because I don’t, I think… an anesthetist monitors the patient. The surgeon should never do the anesthesia if they’re doing, if they’re giving the patient anything other than local, like the dentist.

Teri Struck: Right.

Dr. Toby Mayer: So then you should have someone else there that looks after you, the patient, to make sure everything is okay.

Teri Struck: A professional.

Dr. Toby Mayer: Right.

Teri Struck: An anesthesiologist.

Dr. Toby Mayer: Right. And the way that you secure a safe surgery, there’s some people that’ll do, I know that they have high tolerance for pain and they put a spike through their cheek and they would go, “Oh yeah, that tingles a bit.” And, whereas other patients, you know, if you just start to do anything they’re so uncomfortable in that setting. You know, we’re set up to do both, so I don’t care, but we do the majority under general or light general. But in any case, even when it’s for head and neck surgery because we’re using local anesthesia we carry them very lightly, so five minutes after I’m finished they’re awake.

Teri Struck: Well that’s good then, ‘cause that’s safer, right?

Dr. Toby Mayer: Yeah, it’s safer and it’s more comfortable for the patients. When I was in training 30 years ago, you know, we had patients that were, you know, you tore out ten o’clock at night and they’re still zonked.

Teri Struck: That’s the old days, right?

Dr. Toby Mayer: Correct.

Teri  Struck: Now they have good things for nausea and all that kind of stuff.

Dr. Toby Mayer: Yeah, you know, and we don’t see as much nausea because of newer drugs than we used to. It used to be, to me that nausea was a bigger problem than pain and actually in a lot of ways it still is. I mean, I personally would rather have more discomfort than have any nausea. So we make sure that they have medicine for that, and certain patients are very prone to nausea because of higher histories of surgeries they’ve had and they’ve had nausea with it, and so we hit them very hard with anti-nausea medication.

Teri Struck: And a good thing to mention to your anesthesiologist if you do get nauseous from the past. We’re going to have to take a little break to thank our sponsors. We’re with Dr. Toby Mayer. We’ll be right back.

Teri Struck: This is Teri Struck, host of Beauty Now. We’re talking with Dr. Toby Mayer, and we’ve been talking about cheek and chin implants today. Welcome back Dr. Mayer.

Dr. Toby Mayer: Well, nice to be back.

Teri Struck: Well we just talked about all the different types of cheek and chin implants that you can do. Lets talk more about the complications.

Dr. Toby Mayer: Well I always like to discuss Teri the complications that go with all procedures, because very often on the news it’s not discussed and they make it sound like it’s just wonderful and people just heal right away and it’s, has no problems, and all surgery, when you’re having surgery, has problems, the question is are they minor problems? Are they major problems? So with accomplished surgeons who know how to do implants, you should have very few complications. The one that we can’t always control is infection, which we’ve talked about. The others would be a injury to a nerve, and that should be quite rare because once again, surgeons who do this surgery know where the nerves are, you identify them and therefore you don’t cut them. But short of that, the most common complication probably above that is just inappropriate sizing. We see patients who have huge, huge cheek implants, the chin implants are too big, and that’s the surgeons preference. So the patients, as I always tell them, the most important thing of cosmetic surgery is picking your surgeon. If you don’t like the look of what he does, if it’s, to you it’s too overdone, don’t go to that surgeon. Go with a surgeon who likes what you do. I have patients who come in they’re pulled tight as a drum. They look like Joan Rivers and they’re pulled way back and they want me to do further surgery, and I say, “Well I won’t do that ‘cause you’re pulled too tight already, but here’s three surgeons and any one of the three will try to pull you tighter…”

Teri Struck: And that’s always a big thing. What can you do? Lets just say a woman has gone in and had huge cheek implants put in and then they look terrible, can you correct that?

Dr. Toby Mayer: Yeah, you take them out and put smaller ones in. It’s a little bit harder to do because now the pocket size is much larger so you have to actually fix those implants very carefully where you want to. It’s a much easier problem if they were put in too small and you want to make them larger, but that’s rare.

Teri Struck: And how can you see up there as a surgeon, I’m just saying, how can you see what you’re doing? Do you have…

Dr. Toby Mayer: We have little, surgeons have little tiny eyeballs and we look, we have good lighting and, it’s the first rule of all surgeries, exposure. So we have the special lights and magnification that we need to see where we’re going to be. And…

Teri Struck: So I mean, do you, I mean put it up their mouths and you can see up there?

Dr. Toby Mayer: Yup, mm hmm. You put it in the mouth, you made an incision in the gum, and you’ve just lifted off, the tissue off the cheekbone and there’s the cheekbone. And you know where the nerves are, you’ve identified those and you can put your implant in.

Teri Struck: and that’s really, you said something about, you know, damaging the nerve, that’s very scary. How often does that happen?

Dr. Toby Mayer: Well I’ve been doing this for 30 years and never had it happen, so most surgeons are going to be like that. Is it possible? Yes, extremely rare.

Teri Struck: And what happens when it damages that…

Dr. Toby Mayer: Some good surgeons…

Teri Struck: I mean is that safe for them?

Dr. Toby Mayer: If a nerve is just stretched it will usually regain its function. If it’s actually cut then you may not regain function of what that nerve is, and on facelifts the most common one you see is the one where the little nerve that controls the corner of the mouth is cut and the mouth then droops on that side. There’s a famous female comedienne who I think had that unfortunate experience. But that’s, you need to pick your surgeons carefully, and it’s sort of the nature of the person, you know. A guy that’s going to fix my carpets, I want him to be a perfectionistic personality, and if he isn’t and he’s sort of like, “Oh, ho, ho”, and very flippant, I, you know, that’s great for if you want to listen to somebody socially at a party, but not to operate on me.

Teri Struck: Especially your face. I mean that’s for life and that…

Dr. Toby Mayer: Anywhere, I don’t want a guy like that…

Teri Struck: Well that’s true. I mean your body, your face…

Dr. Toby Mayer: I don’t want a guy like that taking off a bunion because a bunion…

Teri Struck: So true.

Dr. Toby Mayer: can hurt. That’s what you look for, and, you know, I look for that in life. I mean people who are like that, have that personality, are often a little difficult to live with because they do have a perfectionistic personality, but that’s what you want in a surgeon.

Teri Struck: Definitely.

Dr. Toby Mayer: My wife will tell me, “You’re only washing glasses honey.” Yeah, but we have to wash them very nicely.

Teri Struck: Like you do. Yes, you do.

Dr. Toby Mayer: Uh huh.

Teri Struck: But as, we’ve talked about that on every show, and I’ like to touch on it again, is that you do need to choose somebody that’s board certified in plastic surgery if you’re going to have surgery on your body or your face…

Dr. Toby Mayer: But remember also, and there’s a lot of doctors on television that are not board certified…

Teri Struck: The…

Dr. Toby Mayer: So…

Teri Struck: I know one very famous one. So why aren’t they board certified? Is that because the board will not take them?

Dr. Toby Mayer: No, that’s because you have to pass an exam…

Teri Struck: Well I know you have to pass an exam, but so… But lets just say does the board, you know, support these TV shows?

Dr. Toby Mayer: It isn’t usually, that usually, the certification comes long before the TV show.

Teri Struck: Oh, right. Okay.

Dr. Toby Mayer: So the, you know, when you finish your residency you take a board exam, and believe me, the board exam is like the lowest common denominator. So in the bell shaped curve, just ‘cause you pass that exam, you know, that gets you lets say to the top two-thirds. What you need is that person, I would rather have a person who’s conscientious and has that attention to detail and knows when something has been fixed right to best of their ability and when it hasn’t. And if they don’t have that kind of a personality they’ll never be a good surgeon…

Teri Struck: And they don’t try to sell you on too much too. That’s another really good point. Watch out for the salesmen.. There are surgeons like that that are brilliant, but that try to sell you everything.

Dr. Toby Mayer: Yeah, but you can’t be, you can’t really be brilliant if you’re trying to sell somebody everything because it’s not about you.

Teri Struck: Well you have to remember, the average person, like myself, really do think surgeons are brilliant regardless if they’re board certified. I mean, I’ve actually spoken to so many friends that have gone to an internist that went to a weekend course to get, you know, to be able to do breast augs, and I’m like, “No, you don’t do that, ‘cause you hear they’re going to give a better deal.”

Dr. Toby Mayer: Right.

Teri Struck: And that’s my point.

Dr. Toby Mayer: Yeah. You should never ever, ever shop price. That’s…

Teri Struck: With your body.

Dr. Toby Mayer: Yeah. It’s pretty much…

Teri Struck: Your life.

Dr. Toby Mayer: It’s true pretty much, yeah with your life.

Teri Struck: Your life.

Dr. Toby Mayer: And we don’t because what someone says, you know, someone says, “Well, you know, if a facelift is whatever, eight thousand dollars, will you do if for five?” I say, “You want me to do just five thousand dollars worth of work?”

Teri Struck: Exactly.

Dr. Toby Mayer: “Is that it?”, you know. And you think this other person is going to do it for five is going to do… See, because these are terms, like you say; ‘facelift’ or some euphemism for facelift. Somebody puts their little hip name on it and you go, “Oh, this is something different.” No, that’s a mini life. You’re not going to get the same thing as a full facelift.

Teri Struck: And that’s actually a question… If you’re listening, the lifestyle lift is a mini lift, right? You don’t do all that…

Dr. Toby Mayer: Yes.

Teri Struck: detail work and it’s going to fall again.

Dr. Toby Mayer: Yes. And especially, especially in the neck. If someone just needs a little mini lift and they’re 40, that’s one thing. A woman come in 70 and, you know, you could take out enough skin to, you know, to make a couch, a chair, a matching outfit.

Teri Struck: Now, now.

Dr. Toby Mayer: I mean, you know, some people just, no… I mean it’s just a fact that some people have a lot of skin, and when you say “I’m just going to do this little thing…”, ‘cause remember, no matter what the mini lift is, and for that matter a whole facelift, those, a lot of full facelifts can be out in front of the public one week later with a full facelift. Not all of them because it depends on bruising.

Teri Struck: Right.

Dr. Toby Mayer: So when you go, if you’re only going in front of the ear you could hide that with your hair, that’s a mini lift but you aren’t getting much for that. If you do the whole neck, then some of the bruising in the neck may show.

Teri Struck: So you have to weigh the costs and also your needs. So what you’re saying, if you’re a younger person you don’t need much that might be beneficial. But if you’re older and/or you have more work to do, don’t skimp with a mini lift ‘cause it’s going to fall again.

Dr. Toby Mayer: Yeah. People are, they’re being penny wise and pound foolish. It’s like, I have patients who I tell them, I say, “Look, you can keep paying me for all of these fillers and Botox, but over ten years you’re going to be so far behind that… I don’t care, I’m going to make money either way. I’ll probably make more money doing fillers on you than I would if I did surgery on you…”

Teri Struck: Right, but it doesn’t on sagging skin…

Dr. Toby Mayer: Yeah, there you go.

Teri Struck: That’s a really good point. The fillers will fill in your lines, even after a facelift you probably need a touch-up of fillers, but yes, the sagging skin needs to be pulled.

Dr. Toby Mayer: There you go. And, remember, and we doctors, we always use that word too, the saggy skin needs to be pulled. It really isn’t pulled. What we’re doing is we’re re-draping the skin after its been separated, lifting it to where it was 10-15 years ago, trimming off the extra. There’s not so much of a pull. If you put too much tension on the skin, especially once you get past 60-65, you’ve lost the elasticity and then people will really get that pulled look. So that’s where…

Teri Struck: Which looks terrible, yeah.

Dr. Toby Mayer: Yeah. That’s where the skill comes in, and patients who come to see me, they don’t like the pulled look.

Teri Struck: Nobody does.

Dr. Toby Mayer: Well, I… Joan Rivers says she’s very happy with her work, and patients like…

Teri Struck: It might look good ten years from now, but we don’t know.

Dr. Toby Mayer: Well, you know…

Teri Struck: Hopefully.

Dr. Toby Mayer: They…

Teri Struck: For her sake.

Dr. Toby Mayer: Yeah, well she’s happy, and that’s, you know, for her surgeon, I mean that’s the kind of work that he likes, the two of them made that decision jointly. It wasn’t like she ended up that way because of some bad plastic surgery. No, that was plastic surgery by his and her design, and…

Teri Struck: Well that’s the name we want, because we want to know, and it’s not really fair we don’t get to know who did that so you don’t get too much skin taken out, ‘cause you can never put it back in.

Dr. Toby Mayer: Yeah, exactly, and… But, you know, you can do that pretty much by, you know… Patients look at the noses that I did and they say, “Oh you do very natural noses.” I said, “Yeah”, and my friend, his noses for me don’t look natural. But…

Teri Struck: Noses are very hard to do too. This is what I’ve realized knowing a bunch of surgeons now, that, Dr. Toby Mayer, if you need your nose done I would fly down to LA and do that because you are one of the surgeons, top surgeons for noses that I’ve heard of, and you cannot mess up with your nose, and a lot of surgeons are just not good at it.

Dr. Toby Mayer: Yeah, and…

Teri Struck: Even if they’re good at other things. They might be great at other things, but noses are hard to do.

Dr. Toby Mayer: Right, exactly. Noses make us humble. And when you’ve been doing noses for as long as I’ve been doing noses, there’s, you know,  if you’re a perfectionist you’re always going to say, “Oh, I wish this was just a little, this was a little different or that was a little different”, but you’re dealing with human tissue that varies from person to person. And what you do with experience is you know which kinds of skin vary how much, so you make a better educated guess than you did when you were starting out.

Teri Struck: We have one minute left. Lets talk really quick about what is the best, in your opinion, best implant for lips, if there is any.

Dr. Toby Mayer: So, yeah, there’s, for me there’s only two implants that I use in lips. I use Juvederm for the lip roll. That’s where the white meets the red. And in women, when they’re, you know, in their 20’s they have that gorgeous little, it’s like a little part that sticks out, and you can augment that if you don’t overdo it and it looks great. Women are just thrilled with that one. But if you want to make fuller lips there’s only two ways of making lips look fuller. One, my favorite implants are that of still fat, and I’ve used it for 30 years, I got tired of other surgeons saying, “Oh, I tried it, it doesn’t work”, so I took one hand, I put fat in it, the other hand no fat, waited two years, no question that the fat lasts forever. So it does last. Lips, you have a little bit more of a problem because you can only get in so much, even though we concentrate it, and then you also have a problem that even after absorption, you know, you want to get at least a 20 percent bump and most patients will get that. The other thing is they have to be able to tolerate looking a little bit like a duck for about three weeks. So for three weeks they go, “Is it going to go down? Is it going to go down?” And then they go, “It won’t go down anymore, will it?”

Teri Struck: Oh no, ‘cause they love it.

Dr. Toby Mayer: They love it. The only other…

Teri Struck: Real quick, can you take out fat in the office or does that have to go in, do you have to go into surgery center?

Dr. Toby Mayer: No. That can be done in the office.

Teri Struck: That can be done in the office.

Dr. Toby Mayer: Yeah.

Teri Struck: Okay, well you know what, we’re out of time. Thank you once again for being with us Dr. Toby Mayer. We’re going to link Dr. Toby Mayer’s website to our website, personallifemedia.com. If you’d like transcripts of today’s show, please go to personallifemedia.com. We’re going to get transcripts for you, we can have Dr. Toby Mayer linked up so you can get all of you questions answered by him. His office is in Beverly Hills. Thank you once again for being with us today.

Dr. Toby Mayer: Well thank you Teri. It was very, very enjoyable. I hope your listeners got some good information from it.

Teri Struck: I know they did. You’re one of the best. Thank you so much. If you guys have any personal questions for me, email me at t-e-r-i @personallifemedia.com (teri@personallifemedia.com). Thanks for listening today.