Decades of Face: The Forties, The Support Decade

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Welcome to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your cohost, Doreen Wu.

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I'm excited to be here
with Dr. Lawrence Bass,

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Park Avenue plastic surgeon
educator and technology innovator.

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The title of today's episode is Decades
of Face: Forties, The Support Decade.

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Dr. Bass,

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we are progressing along in
our series Decades of Face.

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We're up to the forties now.

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Certainly a time when many of us are
noticing a lot more aging changes in the

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face and giving more thought
to getting some work done.

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That's right. We're definitely beginning
to ramp up with the need to actively

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manage the face before it gets
away from us. At this stage,

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it becomes important to
have a regular beauty plan.

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And we'll come back to
that. But first, Dr. Bass,

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can you review the concept of
the series Decades of Face?

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Sure.

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There are certain typical
changes at certain stages of

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chronological age and
certain typical fixes that

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work well.

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We're breaking this down by
decade in individual episodes,

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summarizing what happens at
that stage of aging. Now,

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you as an individual may not
show all the changes or quite

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the degree of severity at a given decade,

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but you almost certainly will
follow the progression of changes

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as you age, which shows much
less variation person to person.

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What are some of these characteristic
changes that show up in the forties?

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Well, starting with the skin itself,
skin is considerably less elastic.

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It's starting to look duller
and rougher. It's thinner.

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There's less ground substance material,

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that's the hyaluronic acid in
the skin and some other things,

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and there's less collagen
and the organization of the

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collagen and the elastin is
starting to deteriorate. Also,

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volume loss progresses at first.

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It helped create a more sculpted look
compared to the baby face that many of us

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have in our twenties.

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So in our thirties we
may have our best look,

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a little more angular, but as volume loss

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progresses by the forties,

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it's definitely too much and it starts
to degrade our appearance and produce

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obvious signs of aging.

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And examples of this are
deepening of the nasolabial fold.

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Much more distinctive
volume loss in the cheeks,

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the production of a marionette
line aligned from the
corner of the mouth down to

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the jawline, and sometimes
even early jowling.

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There are also a lot of
changes in the eyelids,

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which are almost universally
present in people in their forties,

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at least to some degree in the
upper eyelid. This means some

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hooding and excess of
skin in the lower eyelid,

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some bulging fat that creates the
appearance of a bag under the eye

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and crepiness in that lower eyelid skin.

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Just little lines and
irregularities that degrade the

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smoothness of that skin in appearance.

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There's also some deepening of the tear
trough or the demarcation line between

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the eyelid skin and the cheek.

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Skin forties can also start
to show some skin laxity

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at in the early stage,

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and some individuals will show
some muscle banding in the

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neck.

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Given that most people start exhibiting
these signs of aging by the time they

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hit their forties. What is the typical
beauty plan for those in this decade?

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It starts with some good
medicated skin products,

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things that that have
retinoid or growth factor,

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some skin medication, not just a
product that protects the skin,

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but a product that helps
improve the biology of the skin.

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Botox and fillers are almost
universally part of the beauty plan

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in the forties.

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And energy based treatments as
needed for whatever skin changes

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have become prominent. Pigment
irregularity, age spots,

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redness acne,

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rosacea may start to show at this age,

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texture changes in the
skin and early wrinkling.

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And there are also energy based
treatments for skin laxity,

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Things like Ultherapy and
others that take the mild skin

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laxity of a 40 year old and
just give that little drop

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of tighten up by pushing
the skin with energy.

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It's not a replacement for
a facelift or a neck lift,

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but when the laxity is very minimal,

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this can be a really good way to
hold it in check. In the forties,

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we see a really big uptick
in Botox and fillers.

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So we said from twenties to
thirties there was a huge jump,

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but it jumps again about three
times as much use in the forties

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as in the thirties and
a big increase in more

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aggressive laser treatments like
recovery based laser resurfacing

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or laser peels for wrinkles.

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And why is the beauty plan
more essential at this stage?

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Well, you want to try to put
together a good basic plan.

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Not going overboard,

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but doing a few things
periodically to maintain the

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skin and chase the most visible features.

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Experience has shown the difference
between having a beauty plan

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and having nothing is often a decade delay

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before surgical interventions are
needed to correct facial aging.

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And even sometimes approaching
two decades of delay before

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surgical intervention, that's a big deal.

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Speaking of surgical interventions,
what are the big items in this decade?

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So again,

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looking at the American Society of
Plastic Surgeons statistics which

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breaks down utilization of
different procedures by age.

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Eyelid surgery is the
top of the list for face

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procedures. And as I said,

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almost everyone has moderate or
worse aging changes at this point.

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So that's a very popular procedure and
there are a lot of reasons for that.

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Again, it's, it's a prominent
feature in aging at this point.

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The surgeries have very
little recovery and give

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a very durable result that may
last a decade or even two decades.

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So that's a great procedure
with a big impact on facial

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appearance.

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And since people spend about 70%
of the time when they're talking

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to you, looking at your eyes
or the area around the eyes,

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anything you do to approve
appearance in that area has a

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big impact on how you're perceived.

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Facelift is starting to be used by some

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individuals who are either
aging poorly or taking a very

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aggressive approach, but
these are often mini lifts,

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which are more age appropriate
at this stage than for

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later in the game.

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And sometimes there's just a portion
of the face that's showing laxity,

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and that's really where a
mini lift is appropriate.

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Because it addresses and focuses
on the area where the trouble

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is located.

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There are also a bunch of
more minimal procedures for

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facial and neck laxity problems.

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And for contouring these areas,

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liposuction of the neck and
procedures that chase neck

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banding by either surgically
repairing the muscle,

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sewing it back together,
called a platysmaplasty,

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or things like the
trampoline platysmaplasty

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which goes by the brand name,

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MyEllevate that divides some of
the muscle bands and suspends

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the submental tissues
to sharpen the cervical

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mental angle,

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the angle between the jawline and the neck

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and sharpen jawline
definition a little bit.

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And then there are things like
thread lifts again for mild laxity

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in the brow, the cheek,

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the jawline or the neck without the

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magnitude of intervention
of an open surgery.

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Does this mean that everyone is going to
be slated for surgery in their forties

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if they want to look their best?

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The good news is not necessarily,

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It depends in part on how you're
aging and in part on how much

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maintenance and prevention you've
built into your beauty plan.

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Predictably,

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people who are doing a lot of little
maintenance treatments stay looking good

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longer without surgery.

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More and more as we get modern
advances, new techniques,

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new treatments,

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we're able to avoid neck and face

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procedures during the forties.

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If you've had a good
plan of care over time,

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this is less true for the eyelids,

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which is more dependent on surgery
once the aging changes start to

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show.

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Before you conclude Dr. Bass,

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can you share some important takeaways
for our listeners about the forties

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decade?

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Don't just play catch when some feature
on your face looks really bad or

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prominent. Make a
prospective plan of care.

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It's okay to do a little bit or a
lot depending on your preferences,

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but you'll be so much better off
if you're at least doing something.

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We all walk around with a mental image
of ourselves based on how we looked in

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our twenties. And the sad
news is that in our forties,

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especially the later half, we
definitely no longer look the same.

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We may think we do,
but trust me, we don't.

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And others see right away that
we're no longer a 20 something,

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that we're a 40 something headed into
middle age and no longer a young adult.

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Finally,

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this is the time to take a few
steps to keep looking good rather

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than descending into a very worn
out aging look that has to be

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corrected with bigger interventions.

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I could not agree more regular maintenance
treatments in our forties can go a

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long way in keeping us looking youthful
and allowing us to stay ahead of the

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curve. Thank you, Dr. Bass for sharing
your insight and expertise with us.

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And thank you to our listeners for joining
us today to hear about how having a

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beauty plan can help you stay
looking younger for longer.

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I hope you found this episode as
fascinating and informative as I did.

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If you think of other exciting
developments or trends
in plastic surgery that

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you would like us to discuss
in an upcoming episode,

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please reach out via email or
Instagram. We'll see you next time.

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This is Doreen Wu thanking you for joining
Dr. Bass and me for this discussion

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of antiaging treatments in your forties.

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Be sure to tune in next time and don't
forget to subscribe to our podcast to

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stay up to date with all of the exciting
content that is coming your way.

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Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

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Class podcast with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The commentary in this
podcast represents opinion.

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This podcast does not
present medical advice,

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but rather general information about
plastic surgery that does not necessarily

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relate to the specific conditions
of any individual patient.

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No doctor patient relationship
is established by listening
to or participating

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in this podcast.

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Consult your physician to advise you
about your individual healthcare.

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If you enjoyed this episode,

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please share it with your friends and
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