Anti Aging Secrets with Steven Struck, MD
Beauty Now
Teri Hausman

Episode 1 - Anti Aging Secrets with Steven Struck, MD

Teri interviews Dr. Steven Struck,Stanford-educated, board-certified plastic surgeon from Silicon Valley, CA about the latest in cosmetic surgery procedures. Steven Struck, MD, gets into very helpful detail about face lifts, brow lifts - endoscopic vs. traditional, chin lifts and breast augmentation pros and cons. He also discusses laser liposuction and Fraxel laser treatments. Teri asks him about the options around injectables from Botox and Restylane to Allergan's newest product, Juvederm including covering a new concept called the Brazilian Butt Lift which is where the posterior is filled with injectible product to plump it up without surgery. This show offers the luxury of having an hour-long consultation with an amazingly knowledgeable and articulate surgeon about the many plastic surgery options available. Even better, you will want to listen to it over and over to really understand what's available today in best-of-breed cosmetic surgery practices.



Beauty Now: Episode One

Beauty Now Transcript with Dr. Steven Struck, MD

Teri Struck: Hi, I'm Teri Struck, host of Beauty Now. We’re going to talk about Smart Lipo, Fraxel, FDA approval of silicon implants and endoscopic surgery… and, Brazilian butt lifts.

Teri Struck: I’m Teri Struck, host of Beauty Now. I’m the lucky wife of Dr. Steven Struck, who’s going to be my first guest for my podcast for plastic surgery, beauty, anti-aging and more.
Welcome, Dr. Struck.

Dr. Steven Struck: Thank you.

Teri Struck: Tell us about Fraxel.

Dr. Steven Struck: Well, Fraxel is one of the newest laser technologies in skin resurfacing. I think the main benefits are that it’s extremely effective. And, there are many devices out in this area of non-burning lasers that actually don’t work, and people spend a lot of money on them, and they don’t do anything for them. This one does deliver in making your skin look smoother, softer, and corrects photo-damage.

Teri Struck: So, just tell us a little bit more about if you’re dark skinned, how does that work?

Dr. Steven Struck: Well, Fraxel is a non-burning laser, there are four treatments involved in the process. The process does take some time, about an hour per treatment. You come into the office and we paint your skin blue, you look somewhat like a Smurf, or someone from Blue Man Group. After you’ve numbed for an hour, we partially burn your skin, that’s why it’s called “Fraxel” or “fractional resurfacing”. We’re treating about 20% of your skin surface, and that 20% will grow in new collagen, the pigmentary irregularities in that 20% will be removed and with four treatments we will have treated 80% of your skin and many of the brown spots will be markedly lightened and your pore size should be smaller as well as tighter skin.

Teri Struck: Well, for many of our listeners that’s kind of confusing. How much downtime realistically, if I came in, what would you say to me?

Dr. Steven Struck: The usual downtime is, after treatment you should be red or swollen for overnight, for sure.  If we’re being aggressive with the process, which most people want me to be, it may be two days of redness. It’s enough that you can go to things, you’ve gone to soccer games afterwards and been fine, no one looked at you or laughed so, I think you can go out and do most normal things a day afterwards. If you need to go to a family photo shoot, you would probably want to wait two or three days, but I still think it is a no downtime treatment that you can do most of what you normally do the next day.

Teri Struck: Well, as your wife, I will tell you that you need at least three days downtime. Since you’re so beautiful, you don’t need it. I think it’s an amazing treatment, but you do need three days downtime, for most people. I do have friends that could do it in one day, but tell us more about melasma, and that kind of stuff.

Dr. Steven Struck: Melasma is called a “mask of pregnancy”, you see it often after people have delivered children. It’s that dark mask around the face. It’s an extremely difficult thing to treat, and people have tried bleaching agents, people have tried numerous treatments. The reason that you hear a lot of treatments for melasma is that none of them are really particularly effective. And, Fraxel has shown promise in this area, it doesn’t eliminate the melasma, and I think that would be an unrealistic expectation, and that you as a patient would be unhappy if you expect it to be eliminated, but it will significantly reduce that mask and make your skin look more one-tone, or one-color.

Teri Struck: Right, but if you go back in the sun, it does come back, right?

Dr. Steven Struck: It does return if you spend time in the sun, that’s why we put you on sunscreens and a bleaching agent to maintain the results. Most of my patients that are happy with Fraxel, come back once a year and do one touch up. So they do their series of four treatments, and they follow it up once a year to maintain the result.

Teri Struck: True, and your naughty patients, like me, will go back in the sun, and just get another Fraxel, so that’s perfect. Let’s move on to breast augmentation. A lot of talk about the FDA approval of silicone implants. Tell us more about that.

Dr. Steven Struck: Silicone implants. I think with silicone it’s great that they have been FDA approved again, during that whole time I have been, and numerous doctors have been, on that experiment where we’ve been using them for 20 years, and I believe in most cases, in people who are trim, and have limited amount of breast tissue, are worried about feeling the implant, that a silicone implant is better. I think concerning the risks that people worry about, with Lupis, that has been disproved by the FDA’s protocol, and I don’t think you need to worry about that very much.

Teri Struck: What is your best advice for people that have no breast tissue, size A or B, and they come in and they want DDs.

Dr. Steven Struck: Well, I think there’s really two parts to that question. I think that the best advice for a AA patient who wants to have a breast augmentation is that, that’s the perfect patient for silicone. They have very little breast tissue and very little coverage, so you want the most natural feel in there. The reasons silicone is superior is that it is the most similar to breast tissue in it’s density, so it’s going to feel the most like breast tissue. Trim patient, A-cup breasts, you want silicone under there so that it will feel most natural. The next point with that is you probably want to go under the muscle, because you want more muscle coverage, more breast tissue coverage. The point in a trim patient is to make it feel the most natural as possible.
Now, as far as the idea of going to a DD, they’re probably going to compromise their results with that, because if you push it that large, the skin envelope can only stretch so much, and at that point they run the risk of getting tight and hard and unnatural. So I would probably tell them to go to a C first, and if they really want to go to a DD once their skin’s been stretched, then they can proceed with the second operation.

Teri Struck: I agree. I find that with a lot of my girlfriends is that they have gone too big and then they have to go smaller because they look like hard eggs. Is that because they have saline or because they have silicone or because they have no tissue?

Dr. Steven Struck: I think that with hardness, implant material doesn’t make that big of a difference. There’s never really been any data to show that silicone makes more hardness than saline, than any other product that we’ve ever used. Hardness I think is probably related more to either using too large of an implant, some bleeding into the implant pocket causing scar tissue or some skin bacteria getting into the pocket, which aren’t really causing an infection, they’re simply causing the body to make scar tissue. So I think those are the main reasons perhaps not truly the type of implant material we use.

Teri Struck: And, last about breast augs, is I hear a lot about, what’s above the muscle and what’s below the muscle, and what’s the reason for both?

Dr. Steven Struck: For me, I do mainly below the muscle implants. I think that the coverage of the muscle in addition to the breast tissue gives you the most natural feel, and that’s mostly what people are looking for. The number one problem with implants are hardness and rippling or palpable implant, if you have a muscle on top of that you’re going to have less palpable ripples. Now, the downside to going below the muscle is that sometimes they ride a little bit high, and people don’t like that high appearance, where you look like you can obviously tell that you’ve had a breast augmentation. So what I do is I release a significant portion of the muscle so that two-thirds of the implant is below the muscle and the bottom third peaks out below the muscle, giving you kind of the best of both worlds. You have the below the muscle implant that feels natural, gives you better mammogram, and you have an above the muscle look below so that the implant doesn’t ride too high.

Teri Struck: Ok, let’s move on to tummy tucks. How’s the scar, I mean where’s the scar? I hear that all the time, and actually, I don’t know. I mean, I have a C-section scar, but can you use a C-section scar for a tummy tuck?

Dr. Steven Struck: A C-section scar is part of a tummy tuck incision, it’s larger than a C-section scar, it’s probably half again as long of an incision. I think the main thing with tummy tucks is, when a patient needs a tummy tuck, they don’t care about the scar, because they need a tummy tuck. Where you get in trouble is with someone who’s borderline or not even borderline who tries to convince you that they need a tummy tuck, and if someone doesn’t need one and they get that scar, they’re going to be very unhappy. The scar extends essentially from the hip bone to the pubic hair line, across the pubic hair line and across to the other side. But with that I can remove a piece of skin that is about 7 inches by 12 inches in width, and it makes a significant difference in someone who has hanging skin or stretch marks below the bellybutton.

Teri Struck: So, in that sense you’re trading a scar for the hanging skin?

Dr. Steven Struck: Right. You need to have something to trade. If you don’t have anything to trade for it, you shouldn’t have the scar, but if your trading stretch marks or excess skin it’s probably one of the highest patient satisfaction procedures.

Teri Struck: Let’s talk about the laser lipo, Smart Lipo, I read it in People, everybody’s asking me about it, I don’t know.

Dr. Steven Struck: Being a smart consumer, I’m not surprised you’ve heard of Smart Liposuction. But I do think, it did come out in the last month, and I think that it does have some good benefits to it. The concept is that you place a laser in to the subcutaneous tissues where the fat are and that the laser makes in the fat into a liquid. The liquid is then much easier to remove, much less traumatic to remove, resulting in less bruising and pain, and should result in a smoother result as well, because you’ve liquefied the fat as opposed to just sucking it out with a large canula. I do think that that isn’t a completely new idea, and that ultrasonic liposuction that was prior to this by a few years also liquefies fat and also gives a smoother result. But I am excited to see what the Smart Lipo can do with skin tightening, as that laser bounces underneath the skin, it will also tighten the skin, which I think would be a significant improvement if that’s shown to be true.

Teri Struck: So, now let’s talk about endoscopic versus full-frontal forehead lifts. I know that a lot of my friends are interested in getting their brows raised, but they don’t want that huge scar.

Dr. Steven Struck: Well, the huge scar that you refer to is a scar that goes from ear to ear, and what we do is we remove a large strip of the scalp about 2 inches in width, and we use that strip of scalp that we remove to elevate your brows. So, we’re removing a strip of the scalp, elevating your brows, and that results in the brow lift. The upside to that is that it’s pretty effective, because you’re removing a strip of scalp and that’s raising the eyebrows. The downside is that you’re having a scar which goes from ear to ear, not only the scar, you can lose hair in the scar, and the nerves to the back part of your scalp can all be cut, so you can have pretty large areas of numbness in the back of your scalp as well. So, those are the downsides: numbness, hair-loss and scaring. The upside is, it’s effective. But when you look at an endoscopic browlift, it’s equally effective, and the scars are literally 1/20th the size of a full browlift. They’re very small, we don’t cut those nerves, you don’t have the numbness, you don’t have the hair loss situation and you can still elevate the brow, without all the downsides.

Teri Struck: So, when you do the endoscopic, you use little screws, and tell us what’s in those screws? [laughs]

Dr. Steven Struck: Well, that’s true, and most patients laugh, like you are, when we discuss it. What we have to do, since we’re not taking out all the skin to anchor the skin, we have to have some mechanism of anchoring the skin, and we use a screw, which we place in the outer layer of the skull – it doesn’t go through the skull, your skull is actually very thick, and we can place the screw there, and we use that to suspend everything, as opposed to the other way. Those screws do dissolve, once everything’s in place, the screw dissolves and it goes away, and now the brow’s in it’s new location, with elevated brows, and arched brows.

Teri Struck: I know a lot, but you’re telling me that screws going through the skull, and the skulls thick – are you actually drilling into the skull to do that?

Dr. Steven Struck: Yea, we have a small hand drill that we use during the surgery, and it doesn’t go in very far. The screws are quite small as well. It’s actually a very controlled process, I do them under IV sedation, the patient is still awake and talking to me while I do it,

Teri Struck: I’ve seen beautiful results. I have seen beautiful results. It just seems kind of scary to think about, and the thought of minimal scars is great.
The last thing I think I really want to talk about is your face lifts. Neck lift. You know, define face lift, neck lift, all that kind of stuff.

Dr. Steven Struck: I think the best way to think about that is to divide the face essentially into thirds. One third we already talked about is the brow region. I think the best way to address that is the endoscopic brow lift, less incisions, you can achieve brow elevation without all the hair issues we already mentioned.
Then, you move to the middle third of the face, from the eyes to the mouth, in this region mostly what you hear about are cheeklifts, where we’re trying to suspend cheek fat that’s fallen from up on your cheekbones down to by your mouth, and it gives you that heaviness down low, and a square face. It gives you a squareness to your face and we try to triangulate your face again, create a youthful face, by lifting that cheek fat back up. And finally, we can address the neck, which is usually the most problematic area, by tightening the neck and giving you a more refined neckline.

Teri Struck: I want to talk more about the neck. It’s what all my friends talk about. So, let’s just take a break, for our sponsors, and we’ll get right back to you.


Teri Stuck: Hi, I’m Teri Struck, host of Beauty Now, and I’m so lucky to have my husband, Dr. Steven Struck. Let’s talk more about face lifts.

Dr. Steven Struck: Well, I think we left off with the three thirds of the face. The upper third, middle third, and lower third. And the upper third we’ve already talked about with the brow lifts, endoscopic brow lifts and other ways of elevating the brows. When we addressed the brows, the main thing we want to achieve is an arch to the brow, and you want the arch to be centered over the lateral part of the colored part of your eye. So that’s where I shoot for arching the brow – right above the lateral part of your colored eye brow. I think that’s a good thing you can achieve with a brow lift, you can also weaken some of the frown muscles that give you the frown lines.
Then, as we move down the face, the fat of your cheek tends to fall with time, and it falls forward, forward, forward and it eventually hits some ligaments down by your mouth and creates the jowl or the squareness of the face. And the squarer face tends to be more of a sign of being older of aged, whereas a triangulated face is more of a youthful appearance. With the facelift, we recreate that in the middle third of the face by getting a hold of that fat, elevating it, and resuspending it back up on the cheek where it originally was. You can do that with the Smas facelift – a lot of people have heard of that – S-M-A-S, the Smas, that’s something you’re going to want to know about as a consumer because if you’re going to visit a surgeon, you’re going to want to know are you doing a skin lift, a Smas lift, or whatever kind of lift, because if it’s a skin-only facelift the recovery time will be quick but your results wont really last that long. A Smas lift is where we go a little bit deeper, we get a hold of the deeper tissues, and we create a smooth, underlying foundation by lifting that fat up, and putting it back where it belongs. After we recreate that foundation, we redrape the skin over the top of it, and you have a nice natural youthful looking cheek. So, think of the Smas when you’re asking questions about facelifts.
And then, as we move down into the neck, most people are looking at what you could describe as the turkey-gobbler neck, those two bands that extend out from your neck that most patients I have say that their grandma or their grandpa had and they don’t want to look like their grandma or their grandpa, so… how do we deal with that? The main way we deal with that is we make one incision under the chin, I go down under your chin, I find those two muscles that are giving that turkey banding, and I sew those two together, and then I cut them to weaken them so you don’t have that band under there. Then weave some stitches from ear to ear to further suspend the neck and get rid of that banding. Again, we create your foundation, a youthful foundation with a lifted neck, and then we redrape your skin over the top of it. Most of the work is done from below and then the skin is just redraped to create a natural, youthful appearance.

Teri Struck: How long does that take to heal?

Dr. Steven Struck: With facelifts, a lot of people ask about healing time, the surgical time on that is about three hours – I’d say that you’re in surgery, then you go home, within two weeks you look pretty good, after most facelifts, unless we’re being pretty aggressive with the Smas – the average patient for the average facelift, within a couple weeks looks pretty good. Within a month they look really good. If you’re doing family photos or some big important event, you may want to give it a little longer than a month. But in my patient base, I usually tell people two weeks off work.

Teri Struck: So, you look bruised or swollen or what do you look like?

Dr. Steven Struck: There usually isn’t a whole lot of bruising, with the faces – it’s more that they swell. And gravity pulls that swelling, so let’s say that we’ve addressed all three thirds of the neck – of the face – all that swelling is going to be pulled down by gravity into the neck and you’re going to get a full looking neck afterwards. So, it’s mainly swelling that we’re dealing with. For that reason, we put a strap around your neck for about five days to hold that up, to prevent that swelling from forming or getting set there. So, if we keep the swelling down, that’s the main thing, the bruising is always pretty minimal.

Teri Struck: So, not to get off subject, but I know we talked about Smart Lipo, but now that you’re talking about all these stripes and straps, I just want to know more about lipo. Because I just know that a lot of my friends have had to have garments and things like that for four weeks – is that still true?

Dr. Steven Struck: Yea, with the liposuction, again, we deal with a period of swelling, the maximal period of swelling with any procedure is probably 48 hours afterwards. If you’re dealing with neck liposuction or liposuction associated with the facelift, usually five days of compression is adequate. That’s fine, at that point. I do have some lymphatic drainage techniques and other things we can use to keep the swelling down after that five days. With body work, you’re looking at more like 3 weeks of wearing a garment. The garments are custom-fitted and custom-designed so they don’t really interfere, if people go back to work usually a week after liposuction, they just wear those garments to work and no one can tell they’re there.

Teri Struck: But if you have aggressive lipo, you have to wear one of those garments and it’s, about four weeks, right? Of healing? It’s not like Smart Lipo, or one of these gimmicks?

Dr. Steven Struck: Well, I think it’s more a matter of how much fat you need to remove. The technology, it’s really interesting and people love to talk about it, and you can create a lot of great names like Smart Lipo and LipoSelection or all these names that really catch the consumers eye, I think it’s mostly about, if you’re a big person and we’re doing a big lipo on you, you’re going to be swollen whatever liposuction technique we use on you. And if you’re a smaller person, the swelling is probably going to be less, and you’re not going to be as aggressive with that patient no matter what technique you use and they’re not going to have as much swelling.

Teri Struck: For how many months?

Dr. Steven Struck: Well, in general, I think it’s realistic – when patients come in and  follow up,  I’ve done their surgery and they’re seeing me on their follow up visits, you usually see 80% of the results within 2-3 weeks. So, you’re going to look a lot better 2-3 weeks. But, the final results, and we’re all striving for perfection, to get to that final result it is 6 months, and I usually tell people to wait the whole six months for the results to get finalized, it can even be a little longer than that. But, 80% of the results are there within a couple months.

Teri Struck: Alright, let’s talk about the Restylan face lift, which you know how I feel about that. I believe in Radiance, Botox, all the other fillers. So let’s talk about that. People are talking about Radiance and Restylan.
Dr. Steven Struck: Well, I think with facial aging the main thing is were looking at two things: we’re looking at skin access, wrinkles, and problems of the skin, which are fairly easy to address – you just redrape the skin. But in a lot of those trim patients, who have lost a lot of facial volume, as you age you lose facial fat, some people are extremely trim, they get a thin face, which actually though they are very trim, they look older, because their face is too trim. And the best way to correct that is to add some volume to the face. If you look at the progression of face lifts, nowadays we’re actually using a lot of fillers to keep people looking more youthful. We inject the fat either into the lips, into the nasal-labial folds, into the cheekbones, and all of these areas that will give you more volume and make you actually look more youthful. The Restylan facelift – mainly, we’re injecting the Restylan into the eyelid area, the nasal-labial folds and the cheekbones in order to plump up the face, make them look more youthful, without having had surgery.

Teri Struck: And I know that you are trained in the threadlift, and then you decided not to do them. I’ve seen so much things like on the View and all my friends talking about them, and actually the things that they showed on the View were pretty horrifying – they make a break in your face – do you still believe that? Tell us about the threadlift.

Dr. Steven Struck: I think that as a surgeon, we expect to get A) results for what we do, when people come to see a plastic surgeon, they want to see a result, they may not want to see an overdone result, but they want to see some improvement. And, as a surgeon I have a hard time trying to convince people that something has happened when it hasn’t really happened. And I think that is the main downside to a threadlift is that the results are pretty minimal, often you’re trying to convince the patient that they look a lot better, and I’m just not really comfortable in that environment. So, I stay away from it because I don’t want to spend one-third of my day convincing people that they look better.

Teri Struck: But is it really true that if the threadlift breaks in your face that you can’t get it out of your cheek? Because I did see one horrifying picture, and it’s not that it’s true, but…

Dr. Steven Struck: Well, it kinda is true, the stitches are barb seutchars, that was the whole premise of how it was designed is that they have little hooks coming out of them and the hooks are all the way along the stitch and the hools grab the skin and hold it where you want it to be. So if the stitch breaks, most seutchars that we use are smooth, so it slides right out just like a piece of thread, there’s no barbs or anything, once you cut the knot the stitch comes out. These are barbed and they are hard to remove – I’ve never had to remove one, but removing one would not be easy because you’ve got these barbs throughout, and people who do a lot of them say they’re very difficult to remove. They’re also hard to reposition, if you want to change where they are, if something is a little bit asymmetric, you have to reposition this thread that’s got barbs all over it. Whereas with the Restylan face lift, if someone has something that’s a little bit asymmetric, you just inject a little more Restylan and it evens it out.

Teri Struck: But be honest, I mean, you can’t really inject Restylan to lift your face?

Dr. Steven Struck: You can inject Restylan to give yourself more facial fullness, so in a way it does lift your face, I think that though, the main thing is that in most patients a facelift is a better procedure. I think very few people have the time to come in every three months and spend $2,500 having their face plumped up and then come back in three months later and do the same… If you look at it from a cost analysis, you’re going to spend $5,000 at least every year doing that, so most of your facelift would have been paid for very shortly, and I do think that a facelift delivers much more. If you’re a very young, early facelift patient, you may not even need a facelift, when you’re 35 and 33 and you think you need a facelift, Restylan’s probably the way to go, because it will rejuvenate you without the surgery. But, once someone really needs a facelift, I think the facelift is the way to go.

Teri Struck: See, that’s so confusing, because I’m thinking that Restylan just fills in lines, but you’re talking about a facelift.

Dr. Steven Struck: It does fill in lines, but it’s also a filler. So, if someone has deficient cheeks, you could put a cheek implant in that would fill them in, and you understand that, the implant fills the cheek in. The Restylan’s the same thing – instead of putting an implant in you’re just injecting a bunch of Restylan in there. So it is a different product, and it’s a different concept because you’re using much more of the product, but you’re still doing the same thing. You’re not lifting the skin, you’re lifting the underlying tissue which then makes the skin look more full and tighter.

Teri Struck: Well, I just want to ask you, if somebody came in and they didn’t have much money, and they’re really wrinkled, feeling bad about themselves, feeling down, what would you suggest?

Dr. Steven Struck: Well, I think that’s an interesting question because I think that I would probably suggest something that’s probably more expensive but in the end would deliver much more for them. I think the facelift is going to be a more definitive procedure, they’re going to come in, they’re going to have one thing done, and it’s going to work for them and they’ll be able to stick with it. I think that people who are really making a huge financial sacrifice – if they do something that’s kind of a moderate solution to the problem – they’re not happy, because they feel like ‘Wow, I spent all this, it’s a lot to me, and I didn’t get what I want’, whereas for a few thousand dollars more they could do something that they’re going to be completely satisfied with.

Teri Struck: Let’s take a break and we’ll be back with Dr. Steven Struck.


Teri Struck: Hi, I’m Teri Struck, we’re back and we’re going to talk about fillers with my husband, Dr. Steven Struck. I just want to know honey, what about Juvederm, Botox, Radiance, clarify everything for us.

Dr. Steven Struck: I think you mentioned most of the big names in fillers. Botox has obviously been around for quite some time, it is the number one performed filler for any procedure in plastic surgery. Juvederm is a new filler; Restylan and Radiance – those are the main ones that I use. There are a number of other fillers out there but I think those are the main four – so if you’re thinking about fillers, I would think about one of those four: Botox, Juvederm, Radiance and Restylan. When you look at fillers you need to think about what you’re trying to achieve – it’s funny, patients will come into me and say “I want Botox” and then they’ll show me something that you would clearly use something else on. So, I think that in order to learn what is the best indication, you need to think about what kind of wrinkle you’re dealing with. Most these fillers are all for wrinkles.
A static wrinkle is a wrinkle that’s always there. When you’re looking at someone, they see it. Those can be normally wrinkles around your mouth, a standing wrinkle that’s always there around your mouth and bugs you when you’re looking at it.
Dynamic wrinkles are caused by muscle action or animation of your face. Those are your crows feet lines, frown lines in your face, those are caused by an underlying muscle, so if you think about the cause, then you can think about what the treatment is.
If you’re dealing with a dynamic wrinkle, the crows feat, the frown line, that’s Botox. And the reason for that is that Botox paralyses, or partially paralyses the muscle that causes that wrinkle. If you weaken that muscle, the dynamic action of that muscle is gone, and the wrinkle disappears. We usually use Botox for that reason in the area of the eyes and above. Smile lines or crows feat, frown lines in the forehead, and those are the main areas for Botox.
If you have a static wrinkle, those we have to fill it, it’s not a muscle that’s causing them, it’s a deficiency in soft tissue underneath the wrinkle that causes the wrinkle so you need to fill it. When you get into fillers it’s mostly about how big the particle is. So, if you put a big particle in a big wrinkle, it’s going to last a lot longer. If you put a small particle in, your body, the little Pac-Man guys in your body, that digest the product that we put in, are going to gobble it up faster and the smaller lighter products are going to disappear faster. That’s why some injectibles last longer than other ones. It’s mostly about their particle size. So, if you look at the nasal-labial folds, which are the lines that extend from your nose down to your mouth, those are normally deep in almost everyone. So you want to use a heavy filler in that area, and I use Radiance in that area – it’s probably the heaviest filler, the upside to it is that it last a year and a half. So, you can inject the nasal-labial folds and the patient doesn’t need to come back for a year to a year and a half.

Teri Struck: Right, but you can’t you that in other areas, right? Radiance is very heavy, you shouldn’t use it in your lips, right?

Dr. Steven Struck: That’s true. So if you have a fine line, around the lips, it’s the same thing. If you think about particle size, you put a big particle in a fine line, it’s going to over correct it, and it can give you a lump there that you’re not going to like. So, then you move down the ladder to something like Restylan or Juvederm, which is a thinner product, you can put it directly in a very fine wrinkle, and eliminate that. Now, since it’s a smaller product, it goes away a little  bit quicker. If you’re dealing with lines around your mouth, with Restylan or Juvederm, you looking at 6 months at the longest of recovery time… of lasting time of the product. And what you said about lumpiness is especially true in the lip. In the beginning when Radiance first came out, we injected in the lips, but a good 30% of people were getting significant lumps in the lips, not just little lumps that go away, and we say “just rub that and it will go away”, they were big lumps that didn’t go away right away. So in the lips right away you usually want to use either Restylan or Juvederm.

Teri Struck: Ok, I understand all that. And last want to ask you about Botox in the sense that how come sometimes it goes away in four weeks and sometimes it goes away in 6 months? What I understand – and as a disclaimer my family founded Allergan, but it has nothing to do with it anymore, I wish it did! – but I understand that you can get three people to a bottle and then you see all these disclaimers, Oh, my God, you can get Botox for a hundred bucks, but isn’t it true that physicians can water it down and that’s what it’s all about?

Dr. Steven Struck: Well it’s true that it’s all about the concentration of the Botox that you’re using. And, all physicians water down Botox, because essentially it comes to us dry. I remember one of my friends called me for the first time and he was going to use Botox and he said “Hey, they sent me my vial from Allergan and it’s empty” and it comes to us dry and you look on the bottom of that bottle and there’s a thing of powder in there and that’s the Botox, so we have to dilute it. So, the problem with that is you can dilute it as much as you want to, and the more you dilute it the more patients you can treat, but the less Botox you’re giving each patient. So, if you give someone diluted Botox, then it isn’t going to last that long. That’s just the way it is.

Teri Struck: Right, cause I have a lot of friends that said “Oh, I got it for $199”  and I’m like “Yea, you and 12 other people”. So, if you get it, you get it from a qualified physician who is Allergan approved, so you get two to three people per bottle.

Dr. Steven Struck: That’s in general true. I think that at $199, it’s hard to imagine that you could treat someone without losing money.

Teri Struck: Right, so again. Actually, one of the questions I forgot to ask you is, let’s just talk about that. You want to go to a board-certified physician. And I know that a lot of people just go to these cosmetic physicians, and they get a better deal. And that’s what I’m talking about with Botox and everything else. So, why would you want to go to a board-certified physician as opposed to somebody whose just a cosmetic person?

Dr. Steven Struck: Well, I think with board-certification theres a certain amount of ego, that I’m a board certified surgeon and blah blah blah. But I think there is some importance to having a board-certified person and I think the main thing is a lot of these procedures that we do aren’t extremely complicated. Injecting Restylan or Botox really isn’t that hard to do. But if you’re a board certified plastic surgeon doing it you’re being regulated by a higher governing body that tells you this is right, this is wrong, you can do this, you can’t do that, and they’re in general looking out for the patients best interest. And people who have no governing body above them are not board certified by any board, they do whatever they want to do and there’s really no consequence to that. So I think as a consumer going to a doctor who you don’t really know, at least you can feel comfortable that this person is going to do what’s ethically right in a safe way for me that’s going to deliver a result and isn’t really going to jeopardize my health. When you’re dealing with surgery I think it’s even more important to have the proper certification cause there you’re dealing with an operation that you’re going ot have and if someone has no governing body above them, they just can do whatever anyone – it’s amazing that in the state of California where I practice – anyone can do surgery in their office that has an MD. They don’t have to have any particular training to do it – if they have the guts to set up a practice to do it, and can convince someone to let them do it on them, they’re really not regulated, is to that fact. I think the main thing about when you’re questioning a surgeon is can you do this procedure at the hospital? If a doctor can do it at the hospital, they have to go through all the hoops that you have to go through to get permission at the hospital to do it, they’ve checked him out, they’ve had a residency, they’ve been trained, and they’ve done X number of procedures and the hospital is willing to sign off on them. So even though you don’t need to have your surgery done at the hospital, it can sometimes be a helpful question to say “If I wanted to, could you do my tummy tuck at the hospital?”

Teri Struck: What do you think of all those shows? Extreme Makeover, Dr. 90210, and damn, those girls butt lifts look good, those Brazilian butt lifts?

Dr. Steven Struck: I think in general those shows have been good for our field and good for the consumers. I think that if you probably tracked the statistics of plastic surgery procedures, they’ve gone up quite a bit, since the, mainly Extreme Makeover and Swan show in the beginning, because those were shows that exposed a whole ‘nother subset of the population who thought plastic surgery is only for rich people or plastic surgery is only for people not like me. And then they saw these shows and they thought, Wow, this person is just like me, and so the frequency went way up, I think the frequency went up in men too – men saw men doing these procedures and men started doing it. So those shows were pretty educational, the dramas are what they are, they’re a drama, they’re entertaining…

Teri Struck: But still, those butt lifts?

Dr. Steven Struck: The Brazilian butt lift – I just had a patient ask me about this today, so obviously it’s sticking with a lot of people, and it’s pretty catchy and that was on Extreme Makeover as I remember, and it is a good procedure and there are no real incisions with it because you’re injecting fat into the butt to lift it, that’s what a Brazilian butt lift is mainly designed for, is to fill the butt back in so it doesn’t droop, by injecting fat back in it. You liposuction an area of the body, you inject the fat in there, that lifts the butt and makes it more full, and that’s how it works.

Teri Struck: What about the lift part – I want to know about the lift. I want the lift part.

Dr. Steven Struck: Well, it’s just like the Restylan facelift – where were adding fat to lift the butt, if you really need a butt lift, you have to make a fairly large incision, so for you it wouldn’t be a good idea. For someone who needs there butt lifted, they have to be willing, just like with the tummy tuck like we talked about earlier, to accept the consequences of that which is a fairly large incision, and when it’s worth it, it’s worth it.

Teri Struck: Thank you so much for being our guest today.

Dr. Steven Struck: Alright, thanks for having me.