The Internet of Plastic Surgery Things w/ Dr. Jonathan Sykes

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Welcome to Park Avenue
Plastic Surgery Class,

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a podcast where we explore controversies
and breaking issues in plastic surgery.

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I'm your co-host, Doreen Wu,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator.

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The title of today's episode is
The Internet of Plastic Surgery.

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So Dr. Bass, I think I know
where we're going with this one.

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Plastic surgery is all over the internet.

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We're going to talk about how popular
plastic surgery is and how that has put so

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much information about it
on the internet. Right?

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Well, that's the start of it, Doreen.

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Plastic surgery has grown over the
past two decades in popularity,

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and the public has a tremendous
thirst for stories about it.

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Who's doing it, what's available,
what treatment is best?

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The internet and social media is a
natural forum in the 21st century

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for that information to
be posted and to reside.

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Still, there's more to it
because it doesn't stop there.

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That information that gets
posted impacts search and

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what is put in front of you in newsfeeds
and social media platforms and in

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many, many other ways,
it has a life of its own.

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I think of this as the internet
of plastic surgery analogous to

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the Internet of things.

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The internet of things
represents all the devices,

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sensors,

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and other items out in the world
that are connected to the internet.

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It's a little different
from the internet itself,

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and this allows the
things to be monitored,

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inputting data to the internet,

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and in some cases they can even
be controlled over the internet,

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like controlling your thermostat at home.

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This allows the constant
activity of every surgeon

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and patient, aesthetic
medical product company,

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and the public in general.

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All of these inputs have a huge impact on

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our perception or our view of
reality when it comes to plastic

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surgery. So this is not a one-way street,

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but actually a cyclical process.

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It changes our view of plastic surgery
and what we do when it comes to plastic

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surgery.

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That makes a lot of sense. So where
do we go from here in this analysis?

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Well, I brought someone as a guest
today to join us on the podcast,

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who I know has a lot of
thoughts about this topic.

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Dr. Jon Sykes is a facial
plastic surgeon who was

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the director of facial plastic
surgery at UC Davis for over 30 years,

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past President of the American Academy
of Facial Plastic and Reconstructive

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Surgery. He's

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written hundreds of articles and given
over a thousand lectures, trained many,

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many residents and fellows,

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and is really a master in the technical

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aspects of plastic surgery,

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but also in thinking
about plastic surgery.

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So Dr. Sykes, thank you for joining us.

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Thanks for having me, Dr. Bass.

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Thank you so much for
joining us, Dr. Sykes.

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So I'm from the internet generation,

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which means I grew up with access to the
internet and digital technology from a

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young age, and they've played quite
an important role my entire life.

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The internet is basically my first
go-to for all sources of information.

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What should I know about
what's on there, Dr. Sykes?

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Well, that's a good way to put it, Doreen.

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The internet is information
and it's communication.

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We know that we can communicate through
it, we can gain information through it,

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but the natural thought is that
all the information that we get

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is real. It's honest, it's truthful,

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it's authoritative. But in reality,

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when it comes to plastic surgery,

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I think a lot of what gets
put out there is guised

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as information, and it's really
marketing, we're being marketed to,

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and there's a lot at stake here because
people that are good at doing it make

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a lot of money.

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If I am the perceived biggest
expert in the world because of

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what my internet platform says that I am,

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that makes me a lot of
money. And so people,

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plastic surgeons and injectors
have all realized this and it's

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flavored and biased, everything
that they put out there.

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And it really we're
constantly thinking about not,

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do I do a good job with plastic surgery,

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but how am I going to
look on the internet?

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That's what plastic surgeons are
thinking about all the time because

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marketing in general has taken a
backseat to what they do on the internet.

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So I would start by saying the
information we gain by doing

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our quota research, and I have a coffee
cup that sits in my office that says,

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"don't confuse your 30 minute search
on the internet for a medical degree."

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People think they understand
these things based on what?

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So now I get asked all the time,
and I'm sure Dr. Bass does as well,

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do you do the deep plane lift?

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You do the SMAS lift because they've
read a little bit on the internet where

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someone has said this,
what I'm doing is better,

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and people believe that
because that's all they have.

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So that's where I would start.

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So you used this sort of kinder,

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gentler word marketing,

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but let me use a more direct word.
Most of what you see on the internet,

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not everything, but
most of it is advertise.

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I would agree.

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When you watch a TV commercial
in between your favorite

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show,

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people are trying to sell you something
because we grew up understanding

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that. But

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the same is true of an awful lot
of what you see on the internet.

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And the internet then
becomes the source for even

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things that try to archive or review

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information on a given
subject like a Wikipedia or

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similar will abstract from other sources,

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but also predominantly from the internet.

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And if you're starting with that,

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maybe not validated information,

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it's very hard to get a
valid outcome when you review

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it and summarize it.

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Yeah, I would agree with all that. I mean,

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it starts with the things that we say

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about ourselves that we
are the best in class

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is the top surgeon in the area.

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These are what I would call it's puffery.

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It really is. It's a statement
that can't be challenged.

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We don't know who the best in
New York City is, or the best,

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in my case in Beverly
Hills. We don't know.

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We love it when we're included in
the top 10 of whatever that is.

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But the reality of it is, for
me, that doesn't really matter.

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I know it has no validity,
but to patients, they think
it has all the validity.

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So that's the first.

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But then there's the way that
we talk about a given procedure

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or a technique and the way we brand that,

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we brand it with our name, with
something. He does this lift the install,

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lift the whatever that is,

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and there's the perception that that

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is good. I mean this,
Larry, as much as anybody,

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there was a group that did

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these quick mini lifts in the office,

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and it was all over the United
States called Lifestyle Lift.

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They ultimately went out of business
because they were underperforming.

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But I had people that came into
me and I consider myself an

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expert in facelift surgery,
and they were saying,

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do you do the lifestyle lift? Because
it was branded and marketed, of course.

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So the idea really information
about what that was,

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people didn't know what a
lifestyle lift was per se,

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but it got really well marketed. So
that is what the public is up against.

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And now I believe

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it's become a relatively
double-edged sword.

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We live by the sword
and we die by the sword.

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So some of the sword in this case is

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advertising, as you've mentioned, Larry.

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And so we're up against that
because people get asked to

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perform to that, and we
get asked to match that.

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So that's what I would say. And
it's very confusing to the public.

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It's confusing to the public,

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and most plastic surgeons
have to buy into that to

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stay up with the masses of plastic
surgeons that are doing this kind of

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branding.

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And in that vein, Dr. Sykes,

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can you give me an example of how
the Internet's influence transmits

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directly into the plastic surgery
consultation? How does branding,

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marketing, advertising, how does all of
that play into the consultation itself?

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Well, I think first is what the
individual surgeon does in their

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branding or marketing to get
that patient into their door.

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And that gets them a certain kind
of patient because they're marketing

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to someone and they get that someone,
they get that group of someones.

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So that's number one. But
then we get a lot that ask us,

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do you do this or that? And
can you do this or that?

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Let me show you a picture of this.

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And we're matched up against that
and we have to perform to that.

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And it's quite a different world.

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And there are people who are quite
average at performing plastic

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surgery that are very good at this game,

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and they do well and get
more patients. I personally,

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and I'm not saying this in any way,
to have sour grapes or anything,

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I'm not particularly good at it.

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So I'm really good at surgery and I'm
not particularly good at that game. And

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I've never marketed well, and
I'm not whining about that.

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It's just who I am. It's
just not what I'm good at,

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and I can't make myself good at
that. And a lot of people say,

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well, you don't need to be good at that.

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You need to just surround
yourself with people that are. No,

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I think you actually have to be good at
it because in order to play that game,

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you've got to be good at it because you
can't even analyze the people around you

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that are doing a good job without,

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and some people are just very
natural at that. They're just very,

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it's the way they've been brought
up. And as you mentioned, Doreen,

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you grew up with this, so you would
likely be better at it than I am.

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But my guess is you're not a better
surgeon than I'm just because of how young

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you look and how old I know I am.

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But you probably will be and hopefully
will be someday if that's what you want

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to do. But my point is, I
didn't grow up with that.

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And most of the people that got busy in
plastic surgery in the era where I grew

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up got through the old organic way,
which were patients sending patients.

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But now surgeons don't
even have to wait for that.

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They don't have to wait for that.

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They can make a brand and a persona about

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them in a year or two if they're
quite good at playing this.

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I'll call it a game.

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And I don't mean to say that in
a way that I'm annoyed about it.

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It's just what the world has
become. As you mentioned Doreen,

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it's how you've learned
to do your research,

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how you've learned to
get your communication,

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how you've learned to
get your information.

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It's interesting because I find people who

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hire marketing experts,

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you get very slick material,

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but I find that it's a little generic and

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impersonal compared to the surgeons
I know who just have that knack

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that you were describing.

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They're good at communicating
over the internet.

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I'm good at communicating
in a consultation room,

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face-to-face with a single
person and explaining what I'm

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seeing,

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trying to show the patient that
I've heard what their concerns

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are accurately and

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explaining the rationale for what
I would suggest to address their

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concerns. But there are
other people, I mean,

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this is what we were trained to do.

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And I went into medicine because
I liked science and I like the

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technical aspect of surgery,

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and I wanted to spend my
energy and thoughts pursuing

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that and not marketing, but it
is a different business net.

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And you are on the West Coast in a
place where patients talk a lot more.

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People are not as public about their
plastic surgery on the East Coast.

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And so a lot of patients don't
know where to look to find a good

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plastic surgeon.

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They're not comfortable talking to
their friends about who's good or

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who they might've seen.

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So it ends up the internet is
your ready friend that you can

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ask anonymously.

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And you can do it at any hour of the
day. You can do it at two in the morning.

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You can communicate at two in the morning.

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You can find somebody that
would communicate with you,

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and certainly you can just look at the
information and the information is not

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monitored. So anyone can say
anything about anything that they do.

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They can say there's no
monitor on it at all.

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So I could move in next
door to you, Larry,

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and say, and not having, I lived,
I grew up on the East Coast.

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I was educated on the East Coast,
but I could grow up and say,

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I've trained my whole life
in New York and nobody,

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how would you even challenge that? I mean,

235
00:15:07,161 --> 00:15:09,680
you might come into my office and
say, you're not from New York.

236
00:15:09,860 --> 00:15:11,690
I did grow up in New Jersey,
Larry, as you might know,

237
00:15:13,440 --> 00:15:15,710
but I've lived on the West
Coast for over 30 years,

238
00:15:16,220 --> 00:15:18,920
and I could say that kind
of thing. And I could say,

239
00:15:20,990 --> 00:15:25,130
thought by the masses as the best. I
could think of a flashy way to say it,

240
00:15:25,280 --> 00:15:26,630
as is the best plastic surgeon.

241
00:15:27,290 --> 00:15:30,890
And there would be no challenge to it
because we don't know who the best plastic

242
00:15:30,891 --> 00:15:35,060
surgeon is, so why not just say the
most for yourself? Why not just do that?

243
00:15:36,770 --> 00:15:38,390
So it's an interesting kind of thing

244
00:15:41,270 --> 00:15:43,610
saying that you and I see it all the time.

245
00:15:43,620 --> 00:15:47,840
I just saw an ad literally two minutes
before I opened up this that said,

246
00:15:48,350 --> 00:15:51,200
so-and-so as an injector
was best in class.

247
00:15:51,530 --> 00:15:55,550
What does that even mean best
in class or the best in town?

248
00:15:57,560 --> 00:16:01,640
And even the things that get voted
upon when you say the a hundred best

249
00:16:01,641 --> 00:16:04,790
injectors in the country, I got
voted as one of those. I mean,

250
00:16:04,970 --> 00:16:09,920
how I've been in California, I've
been in Los Angeles only three years,

251
00:16:09,921 --> 00:16:13,700
as you know, I've had my career at
UC Davis and retired from there.

252
00:16:14,900 --> 00:16:18,830
So I bought a house and I opened
an office in Beverly Hills,

253
00:16:19,850 --> 00:16:23,720
and that's a place that advertising
is in, marketing is more important.

254
00:16:24,140 --> 00:16:28,250
I don't know why in Sacramento,
I have the name, but in LA, but

255
00:16:29,780 --> 00:16:33,980
somebody just came out with something
that LA Magazine came out with something.

256
00:16:34,070 --> 00:16:37,220
I was one of the seven best
plastic surgeons in Los Angeles.

257
00:16:37,460 --> 00:16:42,140
How the hell do they know that?
I think I'm a confident guy.

258
00:16:42,141 --> 00:16:45,290
I don't know that. How do they know
that? I mean, that's so ridiculous.

259
00:16:47,840 --> 00:16:50,030
But we love these things and frankly,

260
00:16:50,360 --> 00:16:54,200
there was something secret
inside of me that said,

261
00:16:54,830 --> 00:16:56,120
I'm really glad to hear this.

262
00:16:57,740 --> 00:17:01,130
This is another thing I can put
on my Instagram or on my TikTok.

263
00:17:01,310 --> 00:17:06,260
I just started a TikTok. Larry, I've
never in my life posted an Instagram.

264
00:17:06,261 --> 00:17:10,100
I have a hundred thousand followers. I
don't even know how to post an Instagram.

265
00:17:10,110 --> 00:17:14,120
I don't know how to do it, but I have
an Instagram person, crazy damn thing.

266
00:17:15,050 --> 00:17:19,760
And I'm getting a TikTok person. Now,
TikTok could be gone in six months

267
00:17:21,710 --> 00:17:24,560
and I'm doing these stupid little tiktoks
in my living room. I hate doing that.

268
00:17:24,830 --> 00:17:28,880
I'd rather be writing an article
or resting or it's crazy.

269
00:17:28,881 --> 00:17:33,620
But people spend two hours of their
day working on their marketing.

270
00:17:34,430 --> 00:17:39,050
To me, it's a crazy thing.
It sounds like I'm bitter.

271
00:17:39,051 --> 00:17:43,820
I'm not. I love plastic surgery and
I've had a great job and a great career.

272
00:17:43,821 --> 00:17:47,270
I love it. Actually, I'm
going to work till I'm 80.

273
00:17:47,960 --> 00:17:49,070
I love doing what I do,

274
00:17:49,470 --> 00:17:53,820
but it's really crazy the
way to get busy doing it.

275
00:17:53,821 --> 00:17:57,420
Now that irks me because
I'm not good at that,

276
00:17:57,570 --> 00:18:00,000
and it's okay to not be
good. I'm not good at golf.

277
00:18:01,170 --> 00:18:01,501
Yeah,

278
00:18:01,501 --> 00:18:06,390
it's just that you have to think that
clinical judgment in the technical

279
00:18:06,391 --> 00:18:11,190
prowess has to be at least
a major component of what

280
00:18:11,191 --> 00:18:13,350
makes someone a good surgeon.

281
00:18:13,950 --> 00:18:18,180
I understand that some
of the showmanship and

282
00:18:18,660 --> 00:18:23,550
some of the visibility and some of
the party manners are part of it,

283
00:18:25,230 --> 00:18:27,060
an increasing part of it, but

284
00:18:29,590 --> 00:18:33,720
the core capability to do things safely,

285
00:18:33,721 --> 00:18:38,160
to do things with an extremely low

286
00:18:38,340 --> 00:18:39,780
rate of problems,

287
00:18:39,781 --> 00:18:44,040
given that this is elective
and not medically necessary,

288
00:18:44,550 --> 00:18:47,220
has to factor in there on some level.

289
00:18:47,460 --> 00:18:48,293
I would agree.

290
00:18:48,300 --> 00:18:52,650
I'll tell you one thing
that I'm starting to do,

291
00:18:52,860 --> 00:18:54,390
not to market more,

292
00:18:54,400 --> 00:18:58,410
but because I've always been an
informational guy and an educational guy,

293
00:18:58,411 --> 00:19:02,580
but Doreen will be a little interested
in this just as a consumer and as,

294
00:19:03,360 --> 00:19:07,710
so what I've noticed is an

295
00:19:07,890 --> 00:19:11,550
increasing amount of people who are

296
00:19:12,840 --> 00:19:17,580
doing these funky things with their
photographs because there's such a

297
00:19:17,581 --> 00:19:22,080
pressure to show these bigger
results and that I'm so good.

298
00:19:23,250 --> 00:19:27,900
And so I am starting to show the public

299
00:19:28,590 --> 00:19:32,160
how to look out for these. I'll
give one example, very simple,

300
00:19:32,340 --> 00:19:35,670
and this will go into the bigger
picture of what we're talking about,

301
00:19:35,671 --> 00:19:40,500
which is sort of biasing our
information and our confusing

302
00:19:40,501 --> 00:19:44,580
it so that the public doesn't really
know. So here's a common thing. We see

303
00:19:46,080 --> 00:19:49,890
people that get injected and they
show the before and after. Okay, well,

304
00:19:49,950 --> 00:19:52,680
often a before and after picture of
somebody that's had an injection in their

305
00:19:52,681 --> 00:19:53,820
cheeks doesn't show very much.

306
00:19:54,030 --> 00:19:59,010
If you look right now at my face
and actually at Doreen's face a

307
00:19:59,280 --> 00:20:01,350
little, it's top lighted.

308
00:20:02,910 --> 00:20:04,290
And if you see there's shadow,

309
00:20:04,770 --> 00:20:07,680
there's light on your forehead and
there's a little shadow on your cheeks.

310
00:20:08,580 --> 00:20:13,500
So it's a common thing
for these pre injection

311
00:20:14,280 --> 00:20:18,210
photographs to be top
lighted. And then afterwards,

312
00:20:18,510 --> 00:20:23,070
because we want to see the light
shadow interfaces of the face be even

313
00:20:23,430 --> 00:20:27,270
that we don't have these shadows
and convexity and concavities,

314
00:20:27,930 --> 00:20:29,460
and you are really young Doreen,

315
00:20:29,461 --> 00:20:32,850
but they show a little bit because a
light on top of you that's shining down on

316
00:20:32,851 --> 00:20:36,420
your forehead and it casts a
little shadow on your cheeks.

317
00:20:38,100 --> 00:20:42,720
What they would do with you is inject
a little goo into your face and then

318
00:20:42,721 --> 00:20:45,330
front light your face from the front,

319
00:20:46,140 --> 00:20:51,100
which takes out all the light and shadow
and makes it look like the injection is

320
00:20:51,101 --> 00:20:54,790
better than it is. And we could
do that in lots of different ways.

321
00:20:55,030 --> 00:20:58,990
I could show my neck
before and after this.

322
00:20:59,770 --> 00:21:03,400
I could show lighting that's different.
I could show angles that are different.

323
00:21:03,760 --> 00:21:04,630
And if you're good at doing it,

324
00:21:04,750 --> 00:21:08,950
and now I'm seeing that that has become

325
00:21:09,010 --> 00:21:12,790
accepted and somebody
will put it out there,

326
00:21:12,791 --> 00:21:16,150
put a picture out there before and
after this, excuse my language,

327
00:21:16,510 --> 00:21:21,190
a crappy picture, A shitty
picture. And people will say,

328
00:21:21,250 --> 00:21:22,330
great, great, great.

329
00:21:22,331 --> 00:21:27,310
Everybody's liking and
nobody's saying she's smiling

330
00:21:27,311 --> 00:21:29,650
afterwards. And the light's
different and the position,

331
00:21:29,800 --> 00:21:32,800
their head's different and everything's
different. The makeup's different.

332
00:21:32,810 --> 00:21:33,643
The makeup.

333
00:21:33,970 --> 00:21:34,803
Absolutely. The makeup is,

334
00:21:37,000 --> 00:21:41,920
I have a couple of pictures
that are so wildly and the

335
00:21:42,490 --> 00:21:46,300
surgeon goes, look at this
amazing result. And I say,

336
00:21:46,600 --> 00:21:51,550
I'm thinking to myself, look at this
bullshit result. How much can you lie?

337
00:21:52,510 --> 00:21:55,060
You've got to be better at your surgery
than you are at your photography.

338
00:21:57,100 --> 00:21:58,600
Not necessarily.

339
00:21:58,810 --> 00:22:03,510
But maybe not necessarily. Might
say, Larry. But here's the big thing.

340
00:22:03,510 --> 00:22:08,110
The pressure is on all of us
to do that. What's happened?

341
00:22:08,170 --> 00:22:12,640
That's really the big thing that
comes out of our 25 minute discussion,

342
00:22:12,910 --> 00:22:17,170
that the pressure is on everybody to
look better than they actually are.

343
00:22:17,470 --> 00:22:21,910
We don't show who we are. We show
a better version of what we're, so

344
00:22:24,160 --> 00:22:27,910
we can make the public not aware.

345
00:22:27,911 --> 00:22:32,800
We can confuse the public.
We're biasing the facts,

346
00:22:33,220 --> 00:22:34,900
and it's become the standard.

347
00:22:35,200 --> 00:22:38,230
The biased information
has become the standard.

348
00:22:39,130 --> 00:22:44,020
Well, the noise level is so
high, there's so much posted,

349
00:22:44,021 --> 00:22:45,550
there's so much out there.

350
00:22:46,480 --> 00:22:50,440
It's so aggressive that
for you to stand out,

351
00:22:50,470 --> 00:22:54,730
you have to be ever more outrageous.

352
00:22:55,300 --> 00:23:00,250
You have to show a more stark, obvious,

353
00:23:00,280 --> 00:23:02,020
extreme result.

354
00:23:02,950 --> 00:23:07,540
And so rather than a natural result that

355
00:23:08,710 --> 00:23:12,550
preserves the person's identity,
makes them look better.

356
00:23:13,240 --> 00:23:18,160
You need something that's really stark.

357
00:23:19,090 --> 00:23:21,670
You need the super amazing

358
00:23:25,270 --> 00:23:28,600
weebles fall down, but they get back up.

359
00:23:29,080 --> 00:23:30,370
Brazilian butt lift,

360
00:23:30,371 --> 00:23:34,120
because everybody else is doing

361
00:23:34,720 --> 00:23:38,770
medium. And you've got to do
an extra, extra, extra large.

362
00:23:39,460 --> 00:23:44,260
Let me tell you one thing that I think
of. So I don't know if you know Larry,

363
00:23:44,261 --> 00:23:47,060
but I'm a big stock investor.
It's something I do every day.

364
00:23:47,061 --> 00:23:49,250
I play the stock market
every day, and I constantly,

365
00:23:49,251 --> 00:23:52,130
I make several trades a day.
It's a statistical thing for me.

366
00:23:52,370 --> 00:23:56,720
It's a challenge for me, and I like doing
'em. So I follow Warren Buffett a lot,

367
00:23:57,020 --> 00:23:58,670
and I follow some of his principles a lot.

368
00:23:58,970 --> 00:24:03,050
So he said a thing on TV once that
stood out to me about what we do.

369
00:24:04,250 --> 00:24:07,070
And he said, when you're looking to

370
00:24:08,780 --> 00:24:13,160
get new technologies and new things,
you have to stay ahead of the world.

371
00:24:13,340 --> 00:24:17,150
You have to. So he said, it's like
advertising when you're doing that.

372
00:24:18,740 --> 00:24:22,760
And he called it the tippy toe
phenomenon that were his words.

373
00:24:22,761 --> 00:24:25,310
I remembered it really well. He
called it a tippy toe, he said,

374
00:24:25,460 --> 00:24:28,790
so imagine that you're at a parade and
you're in there with people that are all

375
00:24:28,791 --> 00:24:33,740
your height. You have to stand on your
tippy toes to look different as you said.

376
00:24:34,220 --> 00:24:38,120
Okay? But then what goes on is
everybody's on their tippy toes,

377
00:24:38,840 --> 00:24:41,390
everybody's standing on their
tippy toes. So you need a box.

378
00:24:42,200 --> 00:24:44,540
You need to stand on a
box. You get the idea.

379
00:24:44,541 --> 00:24:47,480
So what's going on for people
is I need to stand out.

380
00:24:47,690 --> 00:24:52,640
It doesn't matter what the hell I do,
but as long as I stand out, it's okay.

381
00:24:52,700 --> 00:24:55,610
It doesn't matter if it's the honest,
doesn't matter if it has integrity,

382
00:24:56,030 --> 00:24:57,800
I've got to stand out.

383
00:24:58,040 --> 00:25:02,750
And there's a little soft pressure
on everybody that does plastic

384
00:25:02,751 --> 00:25:06,530
surgery to stand out, whether it be
calling their technique different,

385
00:25:07,340 --> 00:25:12,140
giving a certain advantage with their
before and afters, any of the above.

386
00:25:12,830 --> 00:25:14,780
So just remember that little thing,

387
00:25:14,781 --> 00:25:18,800
the tippy toe phenomenon that's going on
all the time in everything that all of

388
00:25:18,801 --> 00:25:21,020
us doing, the internet where
we want to be competitive.

389
00:25:21,200 --> 00:25:23,780
But certainly for plastic
surgeons. That's what I would say.

390
00:25:23,781 --> 00:25:25,700
That's sort of the sum up for me.

391
00:25:26,780 --> 00:25:31,220
So Dr. Sykes, how is this likely to
play out going forward? Realistically,

392
00:25:31,230 --> 00:25:32,270
what could be changed?

393
00:25:33,170 --> 00:25:34,003
Well,

394
00:25:34,430 --> 00:25:38,510
the thing that could but
will not be changed is some
monitoring on the internet.

395
00:25:38,511 --> 00:25:41,870
I mean, that's like first
amendment right? Monitoring.

396
00:25:42,530 --> 00:25:44,660
I don't think that's ever
going to happen in the US.

397
00:25:45,170 --> 00:25:48,800
It does happen to some
degree in other countries.

398
00:25:49,160 --> 00:25:53,030
And I'm not saying I like that more
in other countries, but in Australia,

399
00:25:53,031 --> 00:25:57,770
for instance, doctors can't advertise,
I don't believe, or they can't.

400
00:25:57,771 --> 00:26:01,850
They're not really free to advertise.
But we have the freedom to advertise.

401
00:26:01,880 --> 00:26:03,890
But we have a lot of
freedoms in our country,

402
00:26:04,310 --> 00:26:06,740
and I think a lot of our
freedoms are fabulous,

403
00:26:07,070 --> 00:26:11,300
and a lot of them we pay dearly for.
This is one where we're paying dearly.

404
00:26:11,510 --> 00:26:14,960
We're paying dearly because there's a
lack of integrity and a lack of honesty.

405
00:26:14,961 --> 00:26:19,040
But I don't know that there's a way
around that unless we get some internet

406
00:26:19,041 --> 00:26:21,050
police for plastic surgeons
or for other things,

407
00:26:21,060 --> 00:26:22,070
we don't have it for other things.

408
00:26:22,280 --> 00:26:26,600
So anybody can say they're
the best pizza in town.

409
00:26:27,710 --> 00:26:29,150
There's no proof they're the best pizza,

410
00:26:29,390 --> 00:26:31,160
but they can say they're
the best pizza in town.

411
00:26:32,810 --> 00:26:35,240
And there's a lot at
stake for the pizza place,

412
00:26:35,300 --> 00:26:37,220
and there's more at stake
for the plastic surgeon.

413
00:26:38,510 --> 00:26:41,060
Maybe part of it is education,

414
00:26:41,420 --> 00:26:45,060
because if you're an educated consumer,

415
00:26:46,680 --> 00:26:51,480
I mean, I know when I listened to a
lecture by a surgeon and they say,

416
00:26:51,810 --> 00:26:56,700
"I did 300 cases and all excellent results

417
00:26:56,701 --> 00:26:59,100
and complications were zero,

418
00:26:59,370 --> 00:27:04,230
and all the patients were
extremely satisfied." That's the

419
00:27:04,231 --> 00:27:06,660
big one. That never happens.

420
00:27:07,680 --> 00:27:12,360
So when I hear that lecture, I
know there's some baloney going on.

421
00:27:13,260 --> 00:27:17,580
But you look at that because
you are a person that is

422
00:27:17,581 --> 00:27:19,140
scrutinizing what you hear.

423
00:27:20,340 --> 00:27:23,940
But when you're at home at two in
the morning and that's all you have,

424
00:27:24,570 --> 00:27:27,630
and it's the most adverti-, I don't
know that it's easy to scrutinize that.

425
00:27:27,631 --> 00:27:32,610
I don't know that it's so often somebody
shows me some picture and I say,

426
00:27:33,330 --> 00:27:36,450
"I don't actually know how much
better the after is than the before.

427
00:27:36,451 --> 00:27:38,580
Look at the makeup." And then
they'll say, "oh," I said,

428
00:27:38,581 --> 00:27:41,100
"look at the lighting different.
Look in their eyeballs.

429
00:27:41,280 --> 00:27:44,280
Look where the light's coming from.
When you look at their pupils,

430
00:27:44,520 --> 00:27:46,230
where the light's coming from in the room,

431
00:27:46,860 --> 00:27:49,800
there's a light difference between
the beforehand." They'll go, "oh,

432
00:27:50,040 --> 00:27:53,880
that's amazing." But you can't
educate everyone in that way.

433
00:27:54,270 --> 00:27:57,000
That's why I'm actually trying to do
this on the internet right now. I mean,

434
00:27:57,001 --> 00:27:58,290
whoever watches me will see that.

435
00:27:58,291 --> 00:28:02,100
But I'm sort of starting
to show these things

436
00:28:03,860 --> 00:28:07,380
were, I'll say, deception
in plastic surgery,

437
00:28:07,381 --> 00:28:08,880
which I think is happening
a lot in the area.

438
00:28:12,390 --> 00:28:16,470
I get what you're saying, Larry.
It would be if you educate,

439
00:28:16,650 --> 00:28:20,040
but this is filtered material
that's coming through as education,

440
00:28:20,310 --> 00:28:22,560
and the filtering is being
done by each individual,

441
00:28:22,650 --> 00:28:26,580
and they can say whatever they want. So
I don't know what we can do about it.

442
00:28:26,581 --> 00:28:28,140
Doreen, I don't know.

443
00:28:28,141 --> 00:28:32,340
Maybe that's a project for you to
think about how to make this better,

444
00:28:33,270 --> 00:28:37,230
how to make the world more honest. Another
thing to add to my To-do list. Yeah,

445
00:28:37,460 --> 00:28:41,910
yeah, exactly. I don't mean to sound
bitter about this. I love doing what I do.

446
00:28:42,150 --> 00:28:45,240
I want you to know that, and you can
tell that I love doing what I do.

447
00:28:45,690 --> 00:28:47,040
I love talking about it. I love doing it.

448
00:28:48,630 --> 00:28:51,960
Not only is it what individuals are doing,

449
00:28:51,961 --> 00:28:55,980
but the ability of AI and chat

450
00:28:56,280 --> 00:29:01,020
algorithms and things like this to learn

451
00:29:01,290 --> 00:29:02,580
what TikTok does. I mean,

452
00:29:02,610 --> 00:29:07,590
TikTok pushes heavily
towards you based on what

453
00:29:07,591 --> 00:29:09,600
you view, how long you view it,

454
00:29:10,410 --> 00:29:14,010
what other people like you view.

455
00:29:15,960 --> 00:29:20,880
And that feedback cycle is
incredibly psychologically

456
00:29:20,881 --> 00:29:21,900
persuasive,

457
00:29:22,590 --> 00:29:27,150
even addictive based on
certain neurobiological

458
00:29:27,151 --> 00:29:31,200
principles. And so it's like you said,

459
00:29:31,410 --> 00:29:34,410
it's worth a lot of
money because it works,

460
00:29:34,920 --> 00:29:39,870
and we're going to see
it turbo working with

461
00:29:39,871 --> 00:29:41,770
these new modalities

462
00:29:43,680 --> 00:29:48,550
that put us yet a much
further step away from

463
00:29:49,930 --> 00:29:52,450
anything, any ability to validate reality.

464
00:29:53,320 --> 00:29:54,153
I agree.

465
00:29:54,880 --> 00:29:59,320
Definitely. Well, this has been a
riveting discussion so far, Dr. Sykes,

466
00:29:59,321 --> 00:30:02,560
before we wrap up, what takeaways
would you leave our listeners with?

467
00:30:02,890 --> 00:30:06,340
How should they be approaching
their use of internet information?

468
00:30:07,930 --> 00:30:08,763
Well,

469
00:30:09,980 --> 00:30:14,410
I think it's good for the observer to
get information from the internet because

470
00:30:14,411 --> 00:30:18,040
the internet has such readily
available information,

471
00:30:18,370 --> 00:30:21,400
but I think they have to scrutinize
the information that they get.

472
00:30:23,320 --> 00:30:28,270
And that might be looking at before
and after pictures with a jaded look

473
00:30:29,240 --> 00:30:34,000
and a routinizing look, that
lets them judge them not, oh,

474
00:30:34,001 --> 00:30:36,430
wow, look at the big picture of this.

475
00:30:37,510 --> 00:30:39,130
If somebody's going to be really,

476
00:30:39,131 --> 00:30:42,970
really dishonest to me about
their lighting and their
head position and all the

477
00:30:42,971 --> 00:30:46,980
above, maybe that's the person I
don't want is my search. Maybe that's,

478
00:30:48,640 --> 00:30:52,810
and then look at the credentials
of the person. And then lastly,

479
00:30:52,811 --> 00:30:57,100
because we're doing so many
of right before this podcast,

480
00:30:57,460 --> 00:30:59,860
I did a virtual consult
on someone from Texas.

481
00:31:01,540 --> 00:31:04,450
She wasn't in my office. I didn't
get to know her in the same way.

482
00:31:04,690 --> 00:31:07,270
I get to know a person
that I see face-to-face.

483
00:31:08,860 --> 00:31:13,780
And so I didn't get all the same clues
that I might get if she were in the room

484
00:31:13,781 --> 00:31:17,200
with me. And so I have to
make a judgment about her,

485
00:31:17,201 --> 00:31:21,700
and she has to make a judgment
about me. And on the one hand,

486
00:31:21,701 --> 00:31:26,170
there's all this pressure to market. So
they sign up for surgery, they sign up,

487
00:31:27,040 --> 00:31:27,940
and then on the other hand,

488
00:31:28,180 --> 00:31:32,050
we've got making the person happy
and producing what they want.

489
00:31:33,670 --> 00:31:36,250
And that's maybe the topic for
another discussion of ours.

490
00:31:38,950 --> 00:31:42,700
But so I think having some scrutiny
about what you read is really important.

491
00:31:42,850 --> 00:31:45,250
Don't believe everything you read. Read,

492
00:31:45,610 --> 00:31:49,930
but don't believe everything you read
because you're getting marketed to and

493
00:31:50,590 --> 00:31:52,390
advertised to, as Larry said.

494
00:31:54,130 --> 00:31:55,990
Dr. Bass, would you like
to add any takeaways?

495
00:31:57,430 --> 00:31:58,840
In that same vein?

496
00:31:59,050 --> 00:32:03,910
It's really important to understand
what validation there is or

497
00:32:03,911 --> 00:32:07,600
the lack thereof really,
of internet information.

498
00:32:07,601 --> 00:32:12,490
So that means the internet
is really not our best source

499
00:32:12,491 --> 00:32:16,870
for doing your due diligence when you're
trying to get ready to have a procedure

500
00:32:17,170 --> 00:32:18,430
or to pick a surgeon.

501
00:32:19,720 --> 00:32:23,020
So think of the internet
more like entertainment,

502
00:32:23,021 --> 00:32:25,000
not like an encyclopedia.

503
00:32:26,590 --> 00:32:31,210
It's more important to find
a surgeon you can partner

504
00:32:31,211 --> 00:32:34,660
with, have a good working
relationship with,

505
00:32:35,770 --> 00:32:40,460
and doubly so because there
is no one best procedure or

506
00:32:40,461 --> 00:32:45,260
treatment that matches your needs
at whatever stage of aging you're

507
00:32:45,261 --> 00:32:46,094
at.

508
00:32:46,220 --> 00:32:50,720
It's really about what works
well in your selected surgeon's

509
00:32:50,721 --> 00:32:55,370
hands. So as I mentioned at
the beginning of this episode,

510
00:32:55,371 --> 00:32:59,660
the internet of plastic
surgery turns and pivots

511
00:33:00,470 --> 00:33:02,870
based on the material that's input,

512
00:33:03,260 --> 00:33:08,240
the majority of which is
not posted by authoritative

513
00:33:08,241 --> 00:33:09,110
sources.

514
00:33:09,800 --> 00:33:14,150
And that turning and
pivoting of what's presented

515
00:33:14,210 --> 00:33:17,840
deeply influences our
perception of plastic surgery.

516
00:33:17,841 --> 00:33:22,700
So we have to kind of take our
head away from the illusions

517
00:33:22,701 --> 00:33:27,680
and be a little bit realist
to make sensible decisions.

518
00:33:29,750 --> 00:33:34,640
I'd like to thank Dr. Sykes
for joining us and for his very

519
00:33:34,641 --> 00:33:39,530
forthright commentary about
some of what's going on

520
00:33:39,531 --> 00:33:42,950
with marketing and internet in our field.

521
00:33:43,730 --> 00:33:44,061
Thank you,

522
00:33:44,061 --> 00:33:48,020
Dr. Sykes for joining us and contributing
such interesting commentary about how

523
00:33:48,021 --> 00:33:50,180
to be a keen and discerning consumer.

524
00:33:50,990 --> 00:33:54,890
Thanks, Larry, my good friend, and
thanks, Doreen, my soon to be friend.

525
00:33:55,340 --> 00:33:59,030
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.

526
00:33:59,480 --> 00:34:00,980
Follow us on Apple Podcasts,

527
00:34:00,981 --> 00:34:03,080
write a review and share
the show with your friends.

528
00:34:03,470 --> 00:34:06,590
Be sure to join us next time to avoid
missing all the great content that's

529
00:34:06,591 --> 00:34:10,100
coming your way. If you want to
contact us with comments or questions,

530
00:34:10,160 --> 00:34:11,030
we'd love to hear from you.

531
00:34:11,510 --> 00:34:16,100
Send us an email at podcast@drbass.net
or DM us on Instagram at

532
00:34:16,550 --> 00:34:16,640
@drbassnyc.