Plastic Surgery Myth Busting: The Truth About Breast Implants, Botox, and Beauty Trends | Dr. Kristy Hamilton

Dr. Gabrielle Lyon: 00:00

Are we being misled about plastic surgery, and what's the real story behind those celebrity transformations? Hi, I'm Dr Gabrielle Lyon, and today we're diving into a topic that's not just reshaping beauty standards, it's reshaping our wallets in 2023 alone, millions of women choose procedures like face lifts, Botox, ex plant surgeries. But what's driving this rise and what's the true cost, health, wise, financial, emotional and physical, of the obsession of perfectionism Joining me today is the incredible Dr Christy Hamilton, a board certified plastic surgeon and a brilliant thought leader in the cosmetic surgery space, to break down the science, debunk the myths and share the future of plastic surgery, from quote cortisol face to minimally invasive treatments. We're covering it all, and yes, we'll even unpack those celebrity before and afters you can't stop talking about. Join me. Dr Kristy Hamilton, welcome

Dr. Kristy Hamilton: 01:18

to the show. Thank you so much. I'm so excited to be here. I wanted

Dr. Gabrielle Lyon: 01:22

to bring you on for a number of reasons. Number one, you are an absolute superstar. You are a female plastic surgeon, which, by the way, there are only, it's only 19% of plastic surgeons are female. And I wanted to have a very honest conversation about what is surgical versus what perhaps men and women are spending their money on that are not I wanted to cover some of the new trends and just really get behind and learn definitely talk about breast plant illness. But before we do all of this, please just frame up a little bit of your training and how you are where you are now.

Dr. Kristy Hamilton: 02:05

So I'm a board certified plastic surgeon in Houston, Texas. I was fortunate to be able to do my medical training in the Texas Medical Center, so training at institutions like MD, Anderson Baylor, some of the premier medical institutions in the world, and so learning reconstructive surgery techniques and then pursuing specialized training in esthetics in Dallas has informed my practice, and now I perform surgery, esthetic plastic surgery only of the face, nose, breast and Body, and I'm so passionate about it, I'm really excited to be here, and I'm excited to demystify many of these questions and topics that patients have.

Dr. Gabrielle Lyon: 02:50

And how long is this surgical training for what you're doing?

Dr. Kristy Hamilton: 02:54

So six years of residency training, so you can either go in through general surgery and then pursue another three years, or you can do six years of plastic surgery training after medical school, so it's 10 years post collegiate and then I went straight into private practice,

Dr. Gabrielle Lyon: 03:11

which that's unusual, isn't it, to just go right into private practice.

Dr. Kristy Hamilton: 03:15

A lot of patient a lot of physicians go work in the academic centers. First, I've always had a really clear vision of what I wanted to achieve, and it became increasingly clear to me that I would need to have my own entity, my own practice, if I was going to be able to do all the things that I wanted to do.

Dr. Gabrielle Lyon: 03:32

What for you is kind of the ultimate vision of where, and obviously this evolves for your practice. But what do you think right now is the vision for what you're doing?

Dr. Kristy Hamilton: 03:44

I want to be able to offer the premier surgical and medical esthetics experience for my patients. We want it to be the most comfortable, easiest recovery, beautiful, natural results. And I want to continue to build my team to do that, and also, increasingly, educate the public so that patients, regardless of where they are internationally, are armed with great information, and hopefully that will help them make great decisions when

Dr. Gabrielle Lyon: 04:14

it comes to plastic surgery. What are the what would you say the top three reasons people come to you for and obviously you do all kinds of things, from nose to face to you, name it, to body, you do it. But I'm sure that there's a through line that happens.

Dr. Kristy Hamilton: 04:29

Certainly, mommy makeovers is a big one. So there's so many changes. I know we're talking about this postpartum that women's bodies go through. They're amazing what we can do, and some of these things can be addressed with lifestyle and changes, and others really require surgery for some women. So that's a major one. Facial rejuvenation in both surgical and non surgical is a significant portion of my practice as well. And finally, I'm really passionate about Ryan. Plasticity as well. So it's in its own category.

Dr. Gabrielle Lyon: 05:01

I think that just starting with a mommy makeover, it's a really big deal. Women's bodies go through a tremendous amount. And you know, to share for me, I when I was younger, I had very large, two large implants for my body. I'm a very small person. I don't think I've ever talked about this publicly, five one, and I chose to get implants post pregnancy. They didn't look so great. I mean, both pregnancies later, and I'm sure a lot of moms can relate. And you know, part of you guys are thinking, Okay, well, that's not healthy all of these there's lots of judgment, and that's not what this podcast is about. It's about understanding that a woman's body, or a person's body is their own. They make choices, and how do we make the most informed choices possible? And I will say that I trust you. Obviously, you are a physician that I see myself, and you did. I don't know if we would call it reconstruction, but it was we swapped out these implants. I actually wanted to take them out completely, but it just wasn't suited for my body. Again. I'm very lean, and I wish that I had done it years earlier. Yeah, with all that being said, when a woman has a baby, there are things like the breast change, that tissue changes. There is skin on the stomach, depending what of the things that you commonly see in a mommy makeover can be done through diet and exercise versus what has to be addressed surgically.

Dr. Kristy Hamilton: 06:41

This is a great question, and I talk about this every day in my practice, so I'm excited to talk about it here. So firstly, we should always be doing both. You should always be trying to optimize your health and wellness prior to this surgery, because one, you're going to have a better esthetic outcome, and also your recovery is going to be exponentially easier if you come in very fit, healthy and well so fat is one that's a big one. You can exercise a lot of that away. I would refer to you for that, but you can change that with fitness and a healthy diet. You can also build muscle back and regain a lot of that tone, but some of which gets, I know, just having had a baby myself, you some people lose a little bit of it. How baby Caroline is now 10 months she's 10 months old. Yeah. So it's been, I understand the journey. I've done it once myself so far. Then there are other things that really you can't do anything about. It may not happen to every woman, and I think that's one of the one of the things I get feedback on is I'll hear women say, Well, I was able to exercise that away. Or I've had four kids, and, you know, I don't have any stretch marks. And I, I always say, I'm so happy for you, totally. I'm so happy that you. And it's usually taller people, maybe smaller babies that, and just good genetics. But if you have, if you're prone to stretch marks, maybe you're a smaller person, and you had a bigger baby that is more force exerted on your body, twins even, and then what we'll see is significant skin excess. When the skin was stretched beyond its end, elasticity, and now it can't snap back. Does it have to

Dr. Gabrielle Lyon: 08:21

do with age? Or it just has to do with part of the baby making process? Agent

Dr. Kristy Hamilton: 08:25

is also a factor too. So we lose, you know, we're at peak collagen at 25 and then after that, that's we start, we start producing less collagen than we're breaking down. So after that, we're in a collagen deficit, unless we're change, making any changes or influencing that in other ways, we're producing less collagen. And so that's why we see our elasticity goes down, the integrity of our skin decreases. And so we're more prone to things like stretch marks, and that's a trend in our society. Women are having babies later and later and later, on average for the first one, and also when the last one is coming. And so our tissues are not necessarily as robust as they were when we were 20 years old. So skin is one. And then once we've seen waited a couple months and seen how much retraction we'll get of those tissues. What's left is left. And even when women are working so hard, they're in the gym, they're eating healthy, they're losing fat. Well, all of that fat actually helps plump the skin. And so if you lose a lot of that in pursuit of getting back to your pre pregnancy body, the skin can look even looser. And so that's really frustrating for women, because they're working hard, and they find that what they see in the mirror is not necessarily reflective of what they're doing and all those lifestyle changes that they have made for themselves. So skin is one. The other thing that I see very commonly a body change is separation of the ATM. Muscles. Or even if you don't have a true separation, which is called a rectus diastasis, we see core stretching. So even if those muscles are together, women will say, you know, I'm back at my back, at my same BMI, same body composition, and yet I see a rectangle in the mirror when it comes to my waist. I used to have more of a feminine figure. Why is that? And that's because their core has stretched. And that is also something that you cannot fix with exercise. You can get those muscles stronger, all those muscles pull apart from the core, where our obliques are, where they connect. When you activate them, they're pulling your abs apart. So we don't have a strong muscle that pushes them or pulls them back together. So that's number two, and then breasts. It's that's just like the ultimate that's just happening, that's just happening. It can they can be bigger. They can be smaller, especially women who breastfed, they might get very, very large and then have the same, same sort of concerns as the abdomen, where there's stretch marks or loss of integrity, or sometimes women come in and say, my baby sucked away all my breast tissue. I used to have really full breaths, and now there's nothing left,

Dr. Gabrielle Lyon: 11:22

and they're right, yeah.

Dr. Kristy Hamilton: 11:26

So so many, so many different things that we see. And so therefore each surgery is tailored to the individual.

Dr. Gabrielle Lyon: 11:31

At what point do we say, okay, you are six months postpartum. You've done diet and exercise. Is it Do women typically, on average, wait a year, two years, three years. How long do you often see people wait?

Dr. Kristy Hamilton: 11:47

I ask patients to get to the point where their body is no longer changing. So we want a point of stability, and we also want to see that they're back as close to peak fitness as they as they can be. So I asked them to do, put in all the work in advance so that they can get as close to their goal as possible, and then my job is to come in and complete the process and do the parts that cannot be done without surgery. When

Dr. Gabrielle Lyon: 12:13

a woman comes in for a mommy maker, and I'm talking about this because, again, I had two babies, and I think that I have a lot of patients that have had children, and you know, one in particular, I'm thinking of, she did everything that she possibly could, and also spent a ton of money on external modalities to address extra skin, extra lotions, none of which worked. And I think that there comes a point in time where it's like, okay, you are pinching, I don't know, an inch and a half or two inches of skin. Is there a cut off where, okay, this is the only way we're addressing this is surgical. So

Dr. Kristy Hamilton: 12:55

if you're pinching anything, I would say that's surgical, anything of significance. So all these creams, even things like lasers, radio frequency, all these energy devices, they're really great at, I would say, cinching the skin and improving the integrity of the skin, which is very important for all the reasons we were talking about before. But if you need structural change, it's only surgery right now. That's the only thing that reliably and reproducibly works every time.

Dr. Gabrielle Lyon: 13:31

Because, you know, and I've asked you about these things, there's things called the J wrapper, plasma, all kinds of and again, I don't know if these are, I mean, obviously they're FDA approved, but I don't know how safe they are. Where they affect the skin. Is there a common procedure that you see women who have had babies come in that they've had it done with the promise of something

Dr. Kristy Hamilton: 13:52

else? Yes. So we see cool sculpting is a big one. So that is with the promise of fat reduction. We see it does work. It does work, just not very well. So you've got a lot of extra fat than liposuction. Or when you say, what are we talking about? Anything? Where you want it, when you take before and afters, you want to actually see a difference. So if you you'll lose after three to six rounds of cool sculpting. And this is multiple hand pieces all the way around the abdomen, half an inch that.

Dr. Gabrielle Lyon: 14:25

Gosh, that's nothing, right? Yep,

Dr. Kristy Hamilton: 14:26

that's and you'll have spent $10,000 in pursuit of that. So those devices, those are great for women who have a spot that they want to address. They have a very specific area, and they're almost there. But if women come in wanting transformations, they're much better off going for the surgical option if they've maxed out their capabilities. Otherwise, when it comes to skin tightening, oftentimes, I'll see women who have had liposuction and they really needed a tummy tuck, and so they may have a great shape, but now the skin is really. The accentuated, because that volume that was kind of plumping everything up is now gone and it looks saggy.

Dr. Gabrielle Lyon: 15:05

And what's the difference between a liposuction procedure and a tummy tuck? That's

Dr. Kristy Hamilton: 15:09

great. Great question. So tummy tuck is going to address the extra skin, is going to zip up your muscles with an internal corset, so that is what helps reestablish the waist, and then I will always do a little bit of lipo contouring on top of that, but it's all about the skin removal that is the most significant component of the surgery, combined with the abdominal muscle repair, liposuction simply removes the fat.

Dr. Gabrielle Lyon: 15:37

When someone is doing abdominal repair. They've had diastasis, their rectus abdominis, their abdominal muscles have separated. There's no exercise that's going to put that back together. Is

Dr. Kristy Hamilton: 15:50

that true? That's correct. So there's one muscle that goes across. Is your transversalis. It is, if you've ever seen it, if you're a surgeon, you've cut through it. It is the wispiest, finest, thinnest little muscle. It's got no strength compared to your abs or your obliques. That's the only one that goes in this direction, and it's just not powerful enough to do very much once you've been stretched.

Dr. Gabrielle Lyon: 16:13

Are women? Do you think misinformed about course correction of those things like skin and diastasis and and those pieces post pregnancy 100% and

Dr. Kristy Hamilton: 16:27

let me be clear, right after pregnancy, you may have a smaller, larger rectus, diastasis. And after the baby comes out, your body is amazing. And some of that may correct on its own, like some things that have been stretched but not terminally stretched, may come back, but once you've stabilized in those first couple months afterwards, that's that's where we are, and after multiple pregnancies, we often see those issues get more pronounced as time goes on. This episode

Dr. Gabrielle Lyon: 16:55

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Dr. Kristy Hamilton: 18:26

Absolutely. I've had patient who was a marathon runner, totally fit individual. Had twins. She came in, no body fat, low BMI, really, really strong, really, really fit. Had so much pain every time she would run, this was a passion of hers, something that gave her joy. And she had essentially quit running because she had so much low back pain from it and pain from her abdominal contents, her intestines pooching out every time she tried to run. And so that was, I mean, obviously we treated her abdomen in an esthetic way, because we wanted to look nice afterwards. But for her, her whole focus was function. She just wanted to have her abs back together so she could exercise without pain. Yeah,

Dr. Gabrielle Lyon: 19:09

and I think there is a lot of stigma in the health and wellness industry about undergoing surgery, and I, quite frankly, I don't think that that should be there. It is choice, right? Choice? There's a lot of opportunity to improve the things that bother you. I will say this never ending pursuit of perfectionism, which some people have, yes, is probably a huge challenge. Yes, do you care? To comment on that?

Dr. Kristy Hamilton: 19:36

I do, and it's something I talk about. I talk about this with patients every day, and so we I'm always want to get to the root. I want to really understand their motivation for seeking surgery. What are their goals? Do they expect something to be perfect? What does perfect mean for them? Because the reality is, little asymmetry is really beautiful. I mean, that's what gives our phase. Is their unique characteristics, and we want to preserve those. But if the bump on your nose is all you can see and you feel like people don't see you for that, then there's something we can do about that. But if you are expecting your face to look like a perfectly filtered Instagram AI generated image, that's not going to happen. So we need to understand what is driving you to do this, and is that something that I can offer to make you happy, but happiness is derived from the inside, so changes on the outside are not going to do that. But if we can do something to give you confidence, to take away an insecurity, then I've seen women go on to apply for those jobs and go for the interview and get back out there and start dating again, and, you know, whatever it is that they're looking for, if we can impart and instill some increased confidence, that's

Dr. Gabrielle Lyon: 20:57

amazing. I think that that's a really great point. And the breasts, the breasts, there's a ton of controversy. I have been approached by a handful of surgeons who do capsuleectomies for breast plant illness, and I really struggled with what they were doing in terms of what the data was showing before we get to that, I'd love to discuss breast implants, and also, from a perspective post baby, that tissue never goes back. Yeah, for me, it was incredibly uncomfortable because they were so they were just too large. I couldn't train it was just Yeah. It really was difficult to manage. And again, I am so thrilled that I took care of it, and I think that it can be very helpful for people without judgment, because again, there's a lot of stigma. Will a woman's breast go back? Where will they'll be if she's planning on having other children. How do we think about the cadence of managing breast augmentation? So

Dr. Kristy Hamilton: 22:08

when we look at breast implants and timing, I think there's two categories of patients. So one is usually women in their early 20s. They've known they've wanted fuller breasts. They don't have it. They went through puberty, they weren't gonna get it naturally, and so we'll do a breast augmentation for them. These women are not imminently having kids. It's not in their plan, anyhow, and so they can go, go ahead, enjoy them, and then have their children. And I tell women, if they are imminently planning on getting pregnant breastfeeding, you should complete that phase of life. Something wrong with pursuing surgery in the midst of that. But every time you probably redo it, you're probably gonna have to redo it. I don't want you to have to do surgery over and over again. So once you're in it, complete it. Breast feed your babies, if that's something that you want to do. And then when you're done, then we can go in and make them larger if they need if you want them larger, make them smaller, if you want them smaller. Most people want them per care and lifted that may require just an implant, or what's called a mastopexy or a breast lift.

Dr. Gabrielle Lyon: 23:11

And when women are coming for breast implants, you've heard of breast plant illness, I think that there's a lot of information out there on it. It seems to be an incredible trend. And I'm not saying that it's again real or not real, but I would love to hear from a board certified plastic surgeon what some of the latest data is, what it is, yes, and things of that nature. So

Dr. Kristy Hamilton: 23:38

I'll start off by saying it is real like this is a very real phenomenon, and I think it's a phenomenon that's been large that had been largely ignored up until the last couple years. So luckily, the esthetic Society of Plastic Surgeons said we are going to put together a task force and get some actual information, because what was happening was women with breast implants were having these fairly vague symptoms. They weren't they weren't things you could find on a blood test. They were things like brain fog, fatigue, anxiety, depression, sleep disturbances, and they had breast implants, and they wondered, Is it because I have breast implants and so very valid question. What happened was these women found each other on social media. They found that they found each other. There was a community on Facebook. And then all of a sudden, okay, it's not just me. There are other women that are also having this question, and we had no data to go back to them with and so when you studied the individual, there was nothing you could really put your finger on or concrete evidence. But yet, there's still this group of women that are having these issues. And so we actually looked at the data, and now, compared to three years ago, we actually can say some things with certainty. And. And we looked at them. So the study has come out in four parts, and it's very, very interesting. So when you hear about on the internet some of some of these surges, and what they're suggesting for patients, they are saying, Okay, your implants are the problem. We need to do a disfiguring cancer operation to you to get rid of your implants, and I'll explain what that means, and then also maybe put you on my proprietary detox program that only I offer. It's very expensive, and that's going to fix you. These women are desperate, you know, so there's they have a real problem, and they're going to go to the person that is purported to be an expert about it. So, and you may have heard about on block capsuleectomy. So what is that? That is what we do for cancer. We take the entire area, in this case, the implant, and the scar tissue around the implant, which is called a capsule, plus some of the normal breast so that there's a margin of tissue. Take it out, close up the patient. It usually scars down really, really horribly and is quite disfiguring. And then tell the patient that they're cured. Here's some pills to detox yourself. And their implants are gone, but then what they don't talk about is that there's a whole other community on Facebook now about the explant regret, and now they have increased depression and anxiety because of how they now look, which was never their goal.

Dr. Gabrielle Lyon: 26:35

When did breast implant illness become a thing? When do you think that people began to talk about it

Dr. Kristy Hamilton: 26:43

with the rise of social media? So I it's not a medically accepted diagnosis. It's more of a descriptor of this constellation of symptoms. And I'd love to talk about the study.

Dr. Gabrielle Lyon: 26:55

I really, I have it pulled up. And so this is, there are a couple relevant papers this. I have one here. I'll just read it. It's current. Evidence shows benefits of implant removal, with or without capsuleectomy, and it seems like there's a series of these. So yes, please, please.

Dr. Kristy Hamilton: 27:12

So one of the most important papers shows that if you just take out the implant, you don't have to take out any of the capsule, any of the scar tissue around the implant, by six months, you see a significant reduction in symptoms for these women. So that's amazing news. So that negates the whole concept of having to do a cancer operation to get relief.

Dr. Gabrielle Lyon: 27:35

When? When did this data become public? All this

Dr. Kristy Hamilton: 27:39

data came out between 2021 and 2024 so this is all very, very recent. Think they started the study in 2018

Dr. Gabrielle Lyon: 27:48

and 2021 is when they started publishing the data. And there are still surgeons after 2021 with published data, doing full capsule epitomes. Yes, what does the Board of Plastic Surgeons

Dr. Kristy Hamilton: 28:03

so about that? There's increased pressure from members of our society, and when people have been publishing about it, saying that, is this really ethical to be presenting yourself as a block cap selected me expert all plus all boar certified plastic surgeons can do that operation. That's not a really special or unique skill to be able to do that. And we do capsule activities all the time for other reasons, but not the specific cancer type of operation. So there's increased pressure to get good information out there. In fact, some of us have been writing and talking about, really the society's need to be more present on social media, be more present in the media at large. Because we are only a few people, plastic surgeons and a small voice in this sea of social media information, some of which is accurate and some of which is not. And we know what trends on social media. It's controversy. It's like your breast implants are killing you. Something is wrong with you that's really, really scary, and patients will go down a rabbit hole of information that's not necessarily coming from very credible sources.

Dr. Gabrielle Lyon: 29:11

Who do you think it has to do with the individuals performing the capsuleectomy? For example, are there board certified plastic surgeons performing cancer capsule ectomies for implants, or do they seem to be other types of surgeons. So if someone is listening, and someone is like, I believe right, because we're acknowledging that it is real that I need to get this implant removed, how can they do their homework and say it's a board certified plastic surgeon, or am I going to a cosmetic surgeon, or am I going to someone who's going to do a full cap select me? How can they be discerning?

Dr. Kristy Hamilton: 29:54

That's a really great question, and I wish I could say it was only cosmetic surgeons or non plastic surgeons. That are doing this, but some of them are board certified plastic surgeons. So one, there's a big difference between a plastic surgeon and a cosmetic surgeon. A cosmetic surgeon is not a real designation. It's more of a self descriptor. A plastic surgeon, there's a real board certification process. You have to go through a plastic surgery residency, you have to get taken written exams, oral examinations, submitted your body of work, demonstrated that you're safe and capable. Cause being a board certified cosmetic surgeon is actually just a club, and you you do have to be a doctor, but you could be a pediatrician, pay $700 and get a reference from two other cosmetic surgeons. So big distinction there. So number one, choose a board certified plastic surgeon. Then within that group, if anyone is saying that you need to have an en bloc cap selecting me, I would say run because of what we know now. And I think it's fine if people were saying that because we didn't have data, but now we do, and it's been years of data, so people should have evolved at this point. And I just want to emphasize the difference between an EN block cap select me, which is that cancer operation, versus a capsule ectomy, which is just removal of that scar. Sometimes that's appropriate if it's hard or uncomfortable for patients contracted or contracted. So there's reasons to do it, but we're talking about that that really disfiguring cancer operation for this. So the study also in four parts, looks at the present. So it is really well crafted study performed in conjunction with the NIH so I love that. And blinded as much as it can be, because surgeons obviously need to know their patients. But for the people analyzing the samples, they were blinded to whether the patient had breast implant illness or not. So they looked at patients that were coming back to have their implants removed because they had bii patients that were coming back to have their implants swapped out just because it was time. And then they looked at women who had never had implants and were having a lift, so didn't need them, didn't want them. So that was so those were two different controls for the study. And then they examined these questions that patients are asking, is it presence of toxins and heavy metals? Is it that there's bacteria in my body and something about the microbiome that's maybe causing these symptoms? Is it the capsule itself? Is there something wrong with the scar tissue around implants and what they and they also examine psychosocial characteristics, so baseline anxiety rates, personality characteristics of women before they had had surgery and then afterwards. And what we found was everyone had heavy metals in their body, or all the groups did. And so if you take that information isolation, you're like, oh my god, I have breast implants. I have breast implant illness, and I have some mercury there that must be the cause. But, oh, wait, one of the women who was having just a breast lift also had mercury. And these are things that are found in our environment. And so what we found was that these are not the underlying cause. One statistically significant finding, though, was that women who develop breast implant illness did have higher baseline anxiety and issues with sleep prior to having surgery. And so I use that information now to tell patients, look, if this is going to be a very anxiety provoking surgery or something that you're nervous about, like, you're wondering, like, if you'll develop it. Maybe breast implants aren't the best for you. Maybe we should think about doing something else, fat transfer. There's other options. Or always keep in mind in our back pocket that we can remove your implants. And within six months, 94% of the women that had the implants removed had a reduction in their symptoms.

Dr. Gabrielle Lyon: 34:04

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Dr. Kristy Hamilton: 36:02

with without having to do regardless of whether a small piece of capsule was removed, no capsule, total capsulectomy, which means all of it, and 68% reduction in overall symptoms. That's incredible. So it's treatable, so you don't have to be out there suffering with this. That data changes everything

Dr. Gabrielle Lyon: 36:28

for breast implant illness. Do we have a mechanism of action? Is there a proposed hypothesis?

Dr. Kristy Hamilton: 36:33

So one of the thoughts is, is this from low grade inflammation? Because whether it's a breast implant or a pacemaker or some other, you know, and a knee replacement, having a splinter, anything in the body, your body is going to wall that off with a capsule, no matter tissue, no matter no matter what, no matter what it is, because it says, This is not self and it needs, it wants, to isolate that. And so we know that surgery causes inflammation, and having a implant in place, perhaps, if it was have having an implant in place causes some level of inflammation. So that's this is this is all experimental, and just my thoughts at this point. We don't have data to support it, but it's an interesting thought that if we had perhaps less inflammatory implants too, is that something that might be helpful? We don't know, because we haven't seen evidence that, you know, significant chronic inflammation, that's that's a that's not this necessarily the source of bii, but we know it causes capsular contracture and other issues women implants. So that's one of the reasons I'm excited.

Dr. Gabrielle Lyon: 37:44

I'm curious as to what these are. Basically what I'm hearing you say is that bii is real. It does not require a full capsuleectomy. It does not require a cancer surgery. An implant can be removed and with six within six to 12 months, symptoms resolve the mechanism of whatever the breast implant illness is a result of is still largely unknown. There is a potential that it is thought to be low grade inflammation, potentially, or maybe it's the individual's reaction with the implant itself, potentially, yeah,

Dr. Kristy Hamilton: 38:25

or it could just be baseline psychosocial characteristics heading in to it. We just don't know. So it's, it's

Dr. Gabrielle Lyon: 38:33

complicated, probably with the our favorite terms, multifactorial, yeah, it would stand to reason that those individuals, which you had mentioned before, who exercise, diet, well, probably keep under inflammation, under wrapped, potentially do better. Is that fair to say? We

Dr. Kristy Hamilton: 38:52

don't. We don't know so, but it's an interesting thought, because we know inflammation causes a lot of problems in general. So if we had implants that were more bio compatible and inherently less inflammatory. It's an interesting thought. Will we see less bii in that subset of women? We don't know yet, these motiva implants,

Dr. Gabrielle Lyon: 39:16

you're the first person in Houston to do a motiva implant. Isn't true.

Dr. Kristy Hamilton: 39:20

Yes, and, and I don't represent the company, I'm just really excited about them. And I'm excited about them because they have really great data. They are the only breast implant that I know of that has a publication in nature and impressive, and it's about the biocompatibility of the surface in animal studies as well as human and so it's Robert Langer's lab out of MIT. So really, this is, this is really compelling. And so they actually looked at how the body responds to the surface of the implant, and they found that with the specific nature. Nano texturing. It's a four micron variation in the surface. These cells of the body that produce scar tissue and collagen, called fibroblasts, were the happiest, is the way I like to describe it to patients. And they produce the least amount of capsule, which is the scar that surrounds the breast implant. And so they're the thinnest capsules that we've seen, and so they've been out for 14 years, and the rest of the world are very popular. They've only been out for a couple of months in the United States. So it's too soon to say, and I no one's done that study as far as I know, but I will be very interested to see how that plays out. Just a hypothesis right

Dr. Gabrielle Lyon: 40:39

now, these have been out for 14 years, though, yes. How are they now just getting to the US because,

Dr. Kristy Hamilton: 40:44

because there's a long story history of breast implants. Oh, yeah, yay. Breast Implants are actually developed in Houston in the 1960s by Dr Corona and Dr gerose. They like you're in the home of the breast implant right now. Very exciting, very, very and you know, they're controversial. Breast Implants always they get a lot of attention. They're kind of sexy. It's a sexy topic to discuss, and I think everyone's got an opinion on them. And so the FDA has a long story history with breast implants, pulling them off the market for thoughts that they cause autoimmune disease, then them coming back on the market when they proved that that wasn't the case. And so we've, we're now with six generation implants now at this one, but they are very, very, very cautious always when they are approving a new device. And so they had to repeat, and this is for any company have to repeat, all of the studies that they've done internationally, regardless of the data. It's the number one implant in Asia, very popular in Europe and South America, and had to reproduce them in the United States. That takes years. So, yeah, we're the last US and China. We were FDA or FDA approving their equivalent organization this past year. You

Dr. Gabrielle Lyon: 42:02

know, it just makes me think. And obviously you don't have to comment on this, but there has to be some financial gain for again, this is just my opinion for keeping something as potentially effective as these implants that have been used for 14 years in other countries. Out of here, I'm sure that there are only a couple companies of breast implants, I don't know, but if I was a betting woman, I would bet that there probably are, and that would really affect business for these other various companies. I

Dr. Kristy Hamilton: 42:30

can't speak to the breast implant companies specifically, but we see it with the neurotoxins like otoxin, Dysport, like if you go to North Korea, there's like 10 plus different neuromodulators available, but we have four in the United States, so maybe

Dr. Gabrielle Lyon: 42:47

it's just very rigid when it comes to cosmetic data and cosmetic procedures.

Dr. Kristy Hamilton: 42:55

I think there's a balance there. Obviously we don't, we don't want to be experimenting on Americans, but we also, if there's something better coming down the pipeline, you'd think we could collaborate with our European colleagues, perhaps to expedite that.

Dr. Gabrielle Lyon: 43:11

Do you think that that will happen? Potentially? No. Okay, fair. Well, that that is very fascinating. And what makes these different, and are they so they're now, FDA approved, yes, and what makes them different? So you said that the surface,

Dr. Kristy Hamilton: 43:27

surface, they've The FDA has created a new category for surface, and so it's the smooth silk technology. So this is considered neither macro textured or like a really gritty texture, nor smooth, and that's what I think, to me, that's the most compelling part of it, is this biocompatibility concept. Then there's also other great aspects about them, that the surface means that it also has a less than 1% rate of capsular contracture, which is, wow, what is a normal can be a lot higher depending on what you read, and you can manipulate data to say whatever you want, but no one's at less than 1% and then a less than 1% rupture rate. So that combination is really tremendous, and so I'm excited to have these and beyond that, from an esthetic perspective, different shapes, different sizes. This one is very natural and most importantly, from a technique perspective, they are designed to go in front of the muscle. You can place them under the muscle too, but that is really nice for women considering breast augmentation surgery, if they're good candidates, because it leads us to the preservation breast augmentation concept. What is that? So this is the thought that we are keeping your muscles completely intact. Thought you'd like this. I care very much about this service, and we are truly just augmenting the gland of the breast, which was always the intention of the operation, but the calves. Contracture rates were so high that plastic surgeons switched to placing them under the muscle, because, for whatever reason, we see less capsular contracture in that space. But that's not the ideal place for a breast implant to go. We don't really want to augment our PEC muscle and cut it in that process. We would like to augment the gland of the breast that's going to give the most natural looking results and also allow patients to be back up and at 'em, exercising, living their lives in a week, as opposed to four.

Dr. Gabrielle Lyon: 45:32

I was gonna ask you, how long does it take for recovery from breast augmentation,

Dr. Kristy Hamilton: 45:37

so full recovery from any surgical procedure, to see everything final. Final final is a year, but I let women get back to full exercise after one week now for breast augmentation, that's why people show me a year. Big difference. I used to say four to six weeks.

Dr. Gabrielle Lyon: 45:51

When you think about the texture, there was some concern about cancer in the past. Is that correct with a texturized Yes, implant, yeah. Can you speak

Dr. Kristy Hamilton: 46:02

to that? Yes, no, real and it's and so now I say macro textured versus nano or micro textured to distinguish between those. But with the macro textured implants, and specifically one company that voluntarily recalled them, we saw a chance of getting a type of lymphoma that's in the capsule around the breast. And so that concept also often gets confused with the bii groove. And so that's what makes the cancer operation even more confusing. But that was something that was only identified in the last couple of years, and so that's why I think it's really important to maintain some humility when you're looking at any of this, because things change, and we we treat implants differently now than we did 10 years ago. So I, in my practice, have never used textured implant, macro textured implants, because of that rare Association, depending on what you read, one in 40,000 women with textured implants may get it. There haven't been cases with smooth implants. There haven't been cases with these, like purely smooth or with the micro texture, nano textured. But you know, we don't know necessarily what the future holds. If I was a breast surgeon that only used textured implants, I maybe would seem one in my entire career, but that's still a little too high, or I would say, for a purely cosmetic surgery. So that's why I choose to use other implants. If someone were to say

Dr. Gabrielle Lyon: 47:40

they for their personal reasons, decide that they want to do a breast augmentation. And we think about this kind of loops back to bii. Do we see an increase in any kind of inflammatory marker like HS, CRP or sed rate with surgery versus implant versus surgery, non cosmetic. So

Dr. Kristy Hamilton: 48:03

not, not statistically significantly. So that's that's been the problem with the bii group, is that we can't run a blood test and look at them and see, oh, like across the board, there's specific biomarkers that always show up for those patients. So that's why it still remains a diagnosis of exclusion. And I would also like to emphasize that if you're having these strange symptoms, don't assume it's your breast implants. There's also been cases of women having lymphoma, like something completely unrelated, lymphoma, cancer, other issues, thyroid disease unrelated to the breast implants, and it was going untreated for years because we were just blaming the device. Wow. And so you still need to be seeing your internist, your primary care doctor, and making sure that you're getting a complete look, and that's on the doctor's that's a doctor's obligation as well. I'm so

Dr. Gabrielle Lyon: 48:59

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Dr. Kristy Hamilton: 51:09

the great, that's a great question. So all surgery, cosmetic or reconstructive, medically necessary versus otherwise, they all have risks, and anyone who tells you otherwise, again, run, but these are, they're safe devices. That's why all breast implants are FDA approved the ones we have in the United States, because we believe them to be safe. Surgery, esthetic surgery, has to be so, so safe. Otherwise it's unacceptable to do it, but there are risks of anything, and so that's something that I always take the time to explain to patients, pain, bleeding, infection, common things, damage to surrounding structures or tissues. Those are all things that could happen. Obviously, they are very, very, very rare, because all my patients are someone's daughter, mother, sister, and you cannot be doing surgery for esthetics if these risks are high. So we do everything we can to keep them very, very low. I tell patients my number one concern always is their health and well being. And then very, very close number two is making everything look beautiful the way that they want.

Dr. Gabrielle Lyon: 52:18

What about from an age perspective? If a woman is 50 years old, 60 or 70 and decides, you know what, I'm planning on living to 120 Yeah, I'm done with these breasts as they are. Yes, I want to go ahead and do either an implant or a face implant, whatever it is, where are we in terms of safety, spectrum and age?

Dr. Kristy Hamilton: 52:38

Yes, so you can completely have a cosmetic surgery, esthetic plastic surgery, as long as you are healthy, and so at a certain age, I may, I may work with a colleague with their internal medicine doctor or family care doctor to make sure that they are optimized and in good health for surgery, but if they get clearance, we can do it. And I'm glad you asked that question, because people have this concept that, like, after a certain point, we showed up, hearing about our appearance, what we look like. My patients who are older, they are they're like, young and vigorous inside. They are like living there. They are living their best lives now. They're traveling. They're doing all of this. And oftentimes their motivation for surgery is that they just want to be treated the way that they feel inside, because they're so healthy, and they feel like they get treated like an older person, and they don't like that so absolutely like at all stages of life. I think women and men want to look their best, feel their best, whatever that means for them. And so yes, I mean, look at, look at the way that J Lo Shakira, all these women look turning 50, and then what 50 look like 40 years ago. Very different. Very, very

Dr. Gabrielle Lyon: 53:51

different. And basically, if someone is 60 or 70, is all about what the what the individual wants. And while surgery has its risks overall. Would you say it's generally pretty safe? Yes, it's

Dr. Kristy Hamilton: 54:06

generally pretty safe, and general anesthesia safer than driving a car, even in Houston. So don't

Dr. Gabrielle Lyon: 54:15

drive in Houston, friends, if you can help it, because A, you will be there forever and be whether people drive on the road is, seems to be optional. Yes, and that that is, it's really good to hear, because we have audience members of all ages. And it is a question that we get a lot, what is related to weight loss? Can I fix this by myself? Will? You know, one thing that I hear a lot about is people, right now have been talking about under their chin. What do you call that? The sub mental is, sorry, no, yes, people will say, Well, I've lost a bunch of weight, and now I have extra skin. Will a laser work? Will this go back to normal? Is that a very frequent. Area that you hear very

Dr. Kristy Hamilton: 55:00

frequent. So people, it's the jowls, the sub mental area This drives specifically women crazy, and the reason for that is a square jaw is masculinizing men. Maybe enjoy a little jowl as time goes on. Women, yes, imagine if you have a really like heart shaped face. He's a younger man, yeah, so maybe more boyish. Okay? And then men look, they look more, you know, it's like the silver fox concept, you know, the George Clooney more square in the jaw. Women don't want to look square in the jaw, and that's what happens as our tissues descend. They don't like it. They feel like it's not, it's more, it's more masculinizing. That natural, the natural aging process is a more masculinizing experience. How

Dr. Gabrielle Lyon: 55:44

would you say when people come to you, is it more focused on breath? I mean, it's all. It's everything. It's breast, it's face, if someone is coming for face, what are some of the common trends right now? Because I've heard of threading, I've heard of fillers, I've heard, uh, there's a salmon bio stimulator. Yes, I have heard just about everything. And I would love from your perspective, because some of those things that you do and some of those things you probably don't do,

Dr. Kristy Hamilton: 56:12

yeah? So whereas the hype some of these things, it's like, what is safe, yeah, what is not safe. So there is no substitute for a well performed facelift when it comes to structurally re, lifting the face back to where it was. So if the issue is laxity of tissues, gravity and descent, there is nothing that comes even close to competing with that.

Dr. Gabrielle Lyon: 56:38

The so one that null is not gonna work. No user is not gonna and

Dr. Kristy Hamilton: 56:42

these things are great, yeah, and they all have their place, but we cannot ask them to do things that they aren't able to do. The only thing that comes close to mimicking that is threads. But I don't do I don't I really don't like those. What are those? So threads are? They literally look like little threads. So they are a type of material that's they used to be permanent threads. Now people will use ones that break down slowly, which, as you can imagine, has its own problems, but basically they're Barb sutures that just you can suspend and just pull back the skin. That works okay if you have a little bit of laxity, once you have a lot, you're just bunching everything up around your ears. So everything we would remove in a facelift is still there. The problem is, is, I've seen them extruding through the skin. So you come in, patients come in, I'm like, don't do it. Don't do it. And they come in, they're like, it's like, that. I like that video. I did. I do so and, like, I did it. I'm so sorry. And I'm like, Oh my gosh, don't be sorry to me. We sorry to your face? Yeah, you have a hole with, like, you know, a thread coming out of your cheek. And if you're going to have surgery later, it complicates things, because now there's all this scar tissue, which can look weird and somewhat irregular in your face for a lot of people. So I don't recommend those. How has that been around before. The rest have been all these things. They've come and gone. They've been around for decades. So those not really, yeah, it's not new. It just falls out of fashion because there are problems, and then people like bring them to use it and reintroduce it like it's new. What's new about them is that they they are the dissolvable ones. But imagine if your suture dissolves faster on

Dr. Gabrielle Lyon: 58:18

one eyed. That sounds horrific,

Dr. Kristy Hamilton: 58:20

yeah. Then what's worse than having saggy skin? Having only saggy skin on one side of your face,

Dr. Gabrielle Lyon: 58:27

so which is your good side? Well, I'll just be shooting and talking to you. Yeah, exists. That's why we're like no, but that so that's been around for a long time. Went out of fashion, came back in. Now it's dissolvable, yeah? What else? And are people still so people are still doing the threads. Some

Dr. Kristy Hamilton: 58:43

people do threads. It's usually, it's usually not plastic surgeons, because if you know how to do face lifts, face lifts are just so much superior. Threads are really expensive, and you do, you do that a couple of times, and you just paid for your facelift, and they last six months.

Dr. Gabrielle Lyon: 58:59

How does someone know when it's time for a face lifter versus because there's other ways to treat skin. I've come to you for, you know, we've done CO two laser, and we've done, I think that that's the primary one that we've done. Yes,

Dr. Kristy Hamilton: 59:13

yeah, loves. So let's think about the components of the face and what we should be addressing if we're trying to really rejuvenate our tissues and what happens during the aging process. So one, no matter what you're doing, we want to have really excellent skin. So that's where your Retinol is known medical grade skincare. And then laser resurfacing is the gold standard, and it's amazing. So laser resurfacing, it burns tiny little drill holes into your skin, InCites wound healing. And when you're doing it, I watch the skin. I call it, I say it cinches. It's not going to surgically tighten, but I watch those little laser dots go and I'm watching it in real time, cinch up the skin. And so conservatively, conservatively. Tighten it. But really it's for the luminosity, the the way that your pores disappear, the texture fine lines and wrinkles it. It addresses something that a facelift, for example, cannot vertical lines around them, interesting that I never

Dr. Gabrielle Lyon: 1:00:15

thought about that. So the facelift is really just structure, this structure, the skin, the the laxity,

Dr. Kristy Hamilton: 1:00:23

laxity and of not just the skin, but of the deeper tissues. And then none of these skin treatments are addressing the deeper tissues of the face. That's where all the support comes in. So that's what I'm addressing in a surgical facelift the skin. I'm just removing the extra and laying it back down, and I'll combine that with something like CO two laser resurfacing, either at the same time or afterwards, or for younger patients, maybe we're just doing laser at first, because we still need to beautify and rejuvenate the canvas. So imagine we do a beautiful facelift on someone who's been a sun worshiper and tanning beds and baby oil, and we've now given them the lightning like the producer, yeah,

Dr. Gabrielle Lyon: 1:01:04

baby oil and sun Ted. And so

Dr. Kristy Hamilton: 1:01:07

now you've created this beautiful structure, and then you have, you know, fine lines and wrinkled texture, leathery texture, and a lot of brown. That is not a harmonious outcome, and that is going to be that's going to stand out, and it's not going to look right to people, to the casual observer, there'll be something about it, whether you are a professional or not, where you're like, This doesn't make sense. The structure looks too good and then, but the skin quality doesn't matter. So that's why we need to make sure that those things are always aligned.

Dr. Gabrielle Lyon: 1:01:39

When do we know it's time? Is there? You know? Because it's interesting. I think that there's this concept that a facelift is only for a more mature individual, 60 and 70. But I I remember when I first heard about facelifts in 40 year olds, yeah, I was thinking, oh my gosh, I can't believe that they're doing that that's so young, yeah? But in fact, when you think about how much money is spent on fillers or all this other stuff, there comes a point where that's not going to fix it. Is that fair and that it is surgical. It doesn't necessarily matter the age.

Dr. Kristy Hamilton: 1:02:14

So there's, you really have to look at the individual, and there's, I mean, there's reasons why you might have a facelift in your 20s imagining, oh, you was a ton of weight. Imagine you just lost 200 pounds. Your face was inflated, and then, just like we were talking about with pregnancy, there's a certain amount of elasticity to the skin, but if it's been over expanded to a certain point, then you have a beautiful 25 year old who feels like they look like they're 50, even though they're gone great collagen, right, right? But the structure is not harmonious with the rest of their life and their age, and they feel like they're not getting treated the way that they should, because they're actually 25 but they look a lot older. So that's that's really when we see very, very young facelifts. But more commonly, what we've seen is that plastic surgery has just gotten so good and that we're not seeing these obvious sequelae of an operation. So now people are like, Well, why do I have to wait until I've got really prominent jowls and my face looks really old? Why not enjoy that sooner? Now that surgery has become so safe and the results have become so good, so there's this concept of undetectable plastic surgery, and that's where we're entering.

Dr. Gabrielle Lyon: 1:03:25

That's it's really interesting is that this idea of natural esthetics with breast implant illness there that's kind of one group. Is there something equivalent to that of the face,

Dr. Kristy Hamilton: 1:03:37

the face, I think, the the push I see, and I love this push because I love fat in natural materials, but we see a lot more patients now opting for fat transfer or similar products and biostimulators in the face, as opposed to filler. So fillers, we when I say that term, I mean the hyaluronic acid fillers, still great products. I've got some in my face. I love it. So what's

Dr. Gabrielle Lyon: 1:04:08

the difference? So there's a filler, yes, and then there's bio stimulators, yes. Is there a different another category? And then I would say natural fillers, which would be fat, okay, natural fillers. And just to round out, before you go into that, because I'm so curious. There's the breast implant illness from an external device. There's also like chin implants, right? And there's all kinds of other things, but we don't see, do we see the same kind of

Dr. Kristy Hamilton: 1:04:36

removal? No, and that's what's that's another reason why this concept is really interesting, and why I think the psychological component is really important, because we don't hear about chin implant associated issues if you don't hear about it with PEC implants. Now, it may just be because there's so many more breast implant that is talked about. But no, that's not so. Thing that really exists in our literature, and it's not something that's talked about. Yeah, that's, it's

Dr. Gabrielle Lyon: 1:05:04

just fascinating, because, again, my job is to bring information that is, it's just not biased and and to help people make really good decisions for themselves and their health. And so I wanted to, I was curious to just really wanted to ask you that question, yes,

Dr. Kristy Hamilton: 1:05:17

thank you. I think it's relevant. I mean, think about like there are all sorts of silicone coated devices that we put in our bodies, but none of them get the attention that breast implants do. Fascinating,

Dr. Gabrielle Lyon: 1:05:28

really fascinating. So the back to the classification of what would they be called, The biostimulators, the natural fillers, and the filler.

Dr. Kristy Hamilton: 1:05:40

So in some ways, it's injectables. Oh, perfect, right? There is, yeah, injectable, and they serve different purposes. So you know, the original one we're all thinking about when we say filler, is the hyaluronic acid filler. So this is a molecule that's in all of our bodies. So it's helps keep our skin hydrated. It draws in water and and we slowly break it down over time and replenish our own. So it's created in a lab, but this is a naturally occurring molecule in our in our all over our body and our faces, and you use it optically as well. Yep, you can. It's in skincare. So, so hyaluronic acid is everywhere. It's the great like humidifier, I would say, and it draws in water. So I like fillers for conservative volume restoration and for sculpting and shaping the face. So for someone who wants to have more cheekbone definition, a sharper jaw line, fuller lips, fuller cheeks, and that could be structure that they once had and would like to come back, or they maybe never had, like more sculpted cheekbones, and they would like those. So we can use those products. I think the issue with them is that they have been widely overused. It's something that I love, but I'm very conservative with in my practice, and when you see overuse, since these are hydrophilic materials that draw in water, that is what leads to that puffy, bloated filler face that we see that's not beautiful and not natural looking, but I would argue that that is More the result of misuse of what's a good tool, as opposed to the tool itself. Do those type of fillers

Dr. Gabrielle Lyon: 1:07:27

like a high is there more than hyaluronic acid within that injectable category? So

Dr. Kristy Hamilton: 1:07:33

there's different ways that the hyaluronic is processed and structured. Almost all of them are mixed in with some lidocaine for comfort during the procedure. But there's different types of cross linking with what it's called of the of the fillers, and that's what gives them their unique characteristics, like how much projection they'll give how soft they are. And we use different ones for different parts of the face. For the lips, obviously, we want something softer, smoother. For if we were augmenting cheekbones, we want something that's a little bit more little bit more robust. Does it dissolve? Does it go away? So not as quickly as we used to think? So we've done studies where you look at patients years after five years after filler, not not having done anything, and it's supposed to be gone. If you look at what the companies tell us, and it's quite clearly still there. And I see it when I'm doing face lifts, too. And patients will say, like I have done anything for years. So it does not break down as quickly as you may think. It varies a little bit person to person, and that's fine as well, and maybe even desirable if you like your filler, but it negates that concept of coming in every three to six months to get it redone. So at a certain point we've done it, it looks good, and we're not doing it for a long time. So

Dr. Gabrielle Lyon: 1:08:48

the hyaluronic acid is that more old school, that conservative restoration would be considered more old school in that way. I

Dr. Kristy Hamilton: 1:08:55

think it's it's just that it's an older product. There's always new fillers coming out. I don't think it's old school. I just think you have to use it in the appropriate in the appropriate place. So, for example, a lot of patients coming in now for volume restoration, if they want that and they need a lot of volume, I'll suggest fat transfer, where we take a little bit from their inner thighs and use that material, as opposed to an off the shelf material to do our volume restoration, but that none of those things are going to lift your face. Okay, so that's different. Thank

Dr. Gabrielle Lyon: 1:09:30

you. To timeline for sponsoring this episode of the show, I will say the sponsors are what allows us to produce these for free. For you, I will say that for health, we set standards, not goals. And one standard that we always set is having healthy skeletal muscle, which includes, of course, robust resistance training. And if I were to pick one supplement to support healthy muscle and mitochondria, that would be Mitchell. Year, mitopure is a precise dose of the post biotic ulythin, a It works by promoting an essential cellular cleanup process that clears out dysfunctional mitochondria. Timeline has done an incredible job at leading first with science to bring the only ulithin, a supplement on the market, clinically tested to target the effects of age related decline. You may feel the difference in improvement in energy levels, better workouts, faster recovery, more endurance and so much more, all of which help you reach your physical standards. We've been using mitopure in our family for the past couple of years, and now we want your family to have it. Timeline is offering 10% off your first order. GO TO timeline.com/lion, that's timeline.com/lion. And I think that that's important to know, because you probably need to if someone again, whether this is natural, not natural, I think beauty is an eye the beholder, and let's say someone is not looking for for perfection, but they want to not necessarily look their age, right? And that's fair. And I think that probably Cleopatra didn't want to write your age. We do it with makeup. We right. And when someone is going for filler, what happens if they don't have a good result as they're fixing it? So

Dr. Kristy Hamilton: 1:11:31

the nice thing about filler, and I'll dissolve it even before taking someone back for a surgical intervention, is that we have agents, enzymes that we can inject, and it does break it down. So while I did say it doesn't naturally completely go away on its own, we do have things that we can inject to get rid of if something goes wrong, if something goes wrong, or if just patients don't want it anymore, or someone who's really enjoyed their fillers, but now we're going to take them back for a face lift, and it's an opportunity to replace some of that volume with fat. While we're tightening everything up, we'll dissolve some of that filler and start fresh

Dr. Gabrielle Lyon: 1:12:05

the natural fat transfer. Yes, is that a surgical where someone has to go under general anesthesia? Is it done in office?

Dr. Kristy Hamilton: 1:12:15

So I do it both. It can be a minimally invasive in office procedure, there's no major incisions. They're just little punctures for needles and small cannulas to go in. So we do it all the time as a standalone awake procedure, and we'll also do it under general anesthesia when we're doing face lifts as well. The

Dr. Gabrielle Lyon: 1:12:36

Fat transfer is that for someone who maybe is not accounted for a facelift, wants more volume, and is it safe?

Dr. Kristy Hamilton: 1:12:45

Very, very so safe. So safe. We don't see vascular events or tissue necrosis or any issues like that with fat. So this the globules are much too large to clog facial arteries, which ain't a

Dr. Gabrielle Lyon: 1:13:00

risk, right? I remember ad, can you touch on that? Because I remember hearing about, again, you always hear stories, yes, of, for example, Sculptra. So Sculptra, I don't know actually what it's made of, but I've heard polio, lactic acid, okay, and there are risks of it potentially clogging an artery. I'll let you talk about because I don't want to scare anyone. Yeah, I'd rather so

Dr. Kristy Hamilton: 1:13:25

this is, this is why it is. It's not about fear mongering. It's about going to people who know what they're doing or experience and then have mature, like, have a plan for what you do if something like that goes wrong, and they're not making phone calls, they're like, they have the dissolving agents on hand or whatnot. Now, filler, you can hyaluronic acid. Filler, you can dissolve agents like Sculptra or radius, for example. You cannot, but we don't typically see issues with those as much and how are those used? So those, those are the biostimulators. Now we've moved into the one of the other categories that you were talking about. So radius is calcium hydroxyapatite. That's a biostimulator. And then Sculptra has polyol, lactic acid, another biostimulator. And these are products that we inject to build collagen. And in the case of radias, also elastin. And so that's some conservative, more natural volume, but just more collagen in your skin. So those have been very popular for patients that don't want to have a product injected, they are going in and then activating your body to help produce good materials. And so they're very popular, more so now than ever. Facelift surgeons don't love them as much because they can make the tissue planes kind of sticky, I guess is the best way to describe it. That's interesting, but we're used to working

Dr. Gabrielle Lyon: 1:14:51

around them. And would that be considered? That would be considered more natural, more natural in

Dr. Kristy Hamilton: 1:14:55

the sense that those materials are, it's not the material themselves. That you're injecting them for. It's for what it does to activate your body to produce its own collagen and elastin. Do some

Dr. Gabrielle Lyon: 1:15:07

individuals respond because there's this idea of bio individuality, right? We have diets that some individuals respond better to this type of nutrition plan. Other individuals respond better to that type of nutrition plan. Are there various biostimulators that individuals respond better to?

Dr. Kristy Hamilton: 1:15:24

Yes, and so it is. It is individualized, and we are relying on your body to produce a sort of reaction. So sculpture, for example, requires an inflammatory response to work. Oh, it does. So if you are immunosuppressed for any reason, it's probably not going to do very much for you. So that's important to know, but that's why, especially with the biosimilars, especially because they can't be removed or dissolved, so to speak. I'm always very conservative with those, because we want to see how the patient responds. The worst thing you can do is over volumize or just overdo someone in general. And these are off the shelf products, so we can build them slowly over time. So

Dr. Gabrielle Lyon: 1:16:01

if somebody has an autoimmune disease, how do they are they candidates for biostimulators or other types of fillers? How would someone think about when I say autoimmune disease, let's say Hashimotos.

Dr. Kristy Hamilton: 1:16:14

So I would choose ones that are not requiring immune response for that person most likely. So radius does not require that the hyaluronic acid fillers don't. Or for people that are really just worried about injecting things into their bodies and how that's going to go if they have fat that they can donate, great candidate for fat transfer. And it is a tiny surgical procedure. It is super, safe. It's semi permanent, so very long lasting, always conservative with it, for the same reason, you can't easily undo it, but that is the most natural way to do something. But not everybody's

Dr. Gabrielle Lyon: 1:16:53

extra fat, right? So that's that, I think it's just really helpful. And are there things that people can do to preserve their tissue so their collagen again, like you said, that there's just this natural aging process, and I'm not talking about sun damage, but are there things that are potentially preventative or looking for better patient outcomes that people can do while they are in midlife? And there might

Dr. Kristy Hamilton: 1:17:20

not be so well, you can always modify your lifestyle. So we'll start with that before we start doing devices. But yes, avoid sugar we know is terrible for your skin, avoiding the sun, starting to wear sunscreen. Your diet is really, really important. So that aside, then we start moving into medical grade Skinner. Let's talk about the stuff that we know has great evidence.

Dr. Gabrielle Lyon: 1:17:42

You're anyone who put me on retina? Yeah? I think, yeah. Great evidence. I need a refill, by the way. I will do it right after this. Okay, good. I need them.

Dr. Kristy Hamilton: 1:17:49

So tretinoin is commonly known as Retin A, that is a topical medication, vitamin A derivative. We know it so well. There's be. It's so much data behind it that it turns over our skin faster. It makes it healthier. It builds. If you use it for a year, you'll have more collagen in your skin than you did before you started it. You use it all over your body. You can use it all over your body. I need I need it. Okay, okay, as you can What about getting into the bloodstream? It does get into the bloodstream. So if you are pregnant or concerning becoming pregnant, you shouldn't be on it. So. But other than that,

Dr. Gabrielle Lyon: 1:18:31

there's all, however, every word do not, I don't know. No. Can they use? Are there different strengths of retinol?

Dr. Kristy Hamilton: 1:18:40

So Retinol is the one that we see more over the counter products, and then tretinoin is much stronger. You don't want the retinol if you can avoid it, well, make no. I mean, so, so retinal is good. Um, tretinoin is also because it's so much stronger, sometimes it's too much for patients, so I'll put them on a medical grade retinol first, perhaps, and then we'll bump up to the prescription strength. But the goal is always to guide patients to prescription so we know that if you use this product, it will thicken all of the good layers of your skin, and the only layer it thins is that most superficial one called the stratum corneum, and that's the scaly as the scaly one that makes your skin look dull and dry, so it makes that thin and thickens everything else. It's amazing.

Dr. Gabrielle Lyon: 1:19:21

Can you put it under your eyes? I will often

Dr. Kristy Hamilton: 1:19:23

have patients do retinol for there, because, again, under

Dr. Gabrielle Lyon: 1:19:29

eye problems, I've been putting all of this stuff under my eye. Okay? So

Dr. Kristy Hamilton: 1:19:33

just using trick, there's a little trick normally. So normally, I want patients to put the retina on first and then apply their other products, moisturizers, whatnot. But for the eye area, you can mix it with a little bit of moisturizer just to make it less potent. Okay, so I've

Dr. Gabrielle Lyon: 1:19:49

been doing so I have been using, um, a company called one skin, which is amazing. I'll give you some okay, I've been putting that on and then so I put on the most potent stuff. I don't know if I'm. Think that's right. I've been operating, I've been using koji pads, okay? I don't exactly

Dr. Kristy Hamilton: 1:20:05

yes, I don't Yes, okay, I'm turning over your skin wrong, writing glass skin.

Dr. Gabrielle Lyon: 1:20:10

Look, which apparently, I don't know, is a real thing. That's not a real thing. So I've been using those pads. And then I will use, depending, sometimes, a vitamin C serum, okay? And then using some plant derived, I don't know, oil, I just, I'm like, loading it on oil. And then I've been putting on one skin. So one skin has a face and under eye, okay? And so this is what is one skin. It is just it has a some kind of peptide in it. So I'm not using so peptide. And this for the day, okay. And then I will put on sunscreen, but you actually put on sunscreen

Dr. Kristy Hamilton: 1:20:42

first, no sunscreen last. Okay, great, yes, yes. Final step, um,

Dr. Gabrielle Lyon: 1:20:47

I'm like killing it now, yes. But then at night, I am putting on so I wash my face, and then I put on the retina. Retina.

Dr. Kristy Hamilton: 1:20:57

Try not try. No one tread. No one great, good. Also put that under my eyes, okay? And just if it's not, if it's not irritating your skin probably

Dr. Gabrielle Lyon: 1:21:06

is. But I'm like, I'm going with it. Just go for it. You look great, so I think you're doing okay, okay? And then I'll put again, and then I'll put one skin on all over, and then maybe I'll put a mask on and then go to sleep. This overall, sounds very good. That'll work. My husband's like, I've been in there for 4010, five minutes. I'm like, Honey, I have 15 steps to do. This is why

Dr. Kristy Hamilton: 1:21:28

the beauty industry is targeted towards women, because we will do the 10 to 14 steps like, I do it skin, I do it too. And a man bar soap.

Dr. Gabrielle Lyon: 1:21:36

I old skin. It is the i It makes me very I'm so offended. I'm like, That is a triple wash, hair conditioner, body wash, and you're using it for your face. Get all in

Dr. Kristy Hamilton: 1:21:49

one. But to the men watching, they're coming for you. They are coming out with all the products, and I think we're gonna talk about that too, especially the Gen Zers. They're coming for you guys. Yeah,

Dr. Gabrielle Lyon: 1:21:58

the mewing. The mewing, okay, what should people be doing for skin in terms of

Dr. Kristy Hamilton: 1:22:06

layering? Is that? Yeah, so you're starting with your active and you're washing your face. Always, if you don't wash your face, it's not going to get in. You want to get rid of that oily layer that without using because

Dr. Gabrielle Lyon: 1:22:14

I don't always wash my I mean, I wash my face, that's not true. But in the morning, I don't wash my face. You should wash

Dr. Kristy Hamilton: 1:22:19

your face, because you put all these, like, thick barriers on overnight, so then how is all that pillow? I am something that, and you've produced some, like, garlic sebum overnight. So you got to, like, start, you got to start clean. We want to get all those products in. That's one of the reasons in the office we're injecting things and needling things in. Because your skin is an incredible barrier, and so we don't, you don't want to give it any more helped to be a barrier. Now

Dr. Gabrielle Lyon: 1:22:41

I thought it was just laying there on my pillow. Okay? Now I have forever changed. I'll be washing my

Dr. Kristy Hamilton: 1:22:46

face. Forever change. Okay? Forever strong, forever to change, marginally

Dr. Gabrielle Lyon: 1:22:49

weak, forever. No wrinkles, okay, yes, the so you wash your face, and then the most potent, yeah, she's not even see you go in the morning. I

Dr. Kristy Hamilton: 1:22:58

like to do it in the morning, and the reason for that is it's helping to undo free, radical damage that we sustain throughout the day. So pollution send damage. You know, we wear sunscreen, but still, we're getting those harmful rays hitting our skin. So I like to do that so it can start working in real time. And then, generally speaking, so active. First, thinner things first, like less viscous serums first, and then you're doing your moisturizers, and finally, your sunscreen. So it's generally like thin to thick, but you're going to want to make sure any prescriptions or any active ingredients, do you want that to be the first to penetrate, and then you're kind of locking everything in.

Dr. Gabrielle Lyon: 1:23:36

And do you have to wait as you layer it so you do the vitamin C, then do you wait? You put a timer. Is it 10 minutes? I will do my vitamin C and then brush my teeth. Okay? No, it does require time a little bit. Okay. You just like, let you have to let it dry. Okay, fair enough. Um, tell me about what's happening for men, because they use the bar soap. I don't even know if match hour what what's happening. So

Dr. Kristy Hamilton: 1:24:00

the the mewing concept is interesting. So men are increasing. So men only represent 10% of the cosmetic plastic surgery, medical esthetics marketplace, but it is a rapidly growing segment. Because, you know, women are already all in we like to do these things. We like beauty. We like cosmetics. We're into it. Men, they are the beauty industry wants. They want you. They want you. They're coming

Dr. Gabrielle Lyon: 1:24:27

or you. My husband is definitely last on the list. I for sure know it Did you brush you brush your

Dr. Kristy Hamilton: 1:24:35

teeth. So I think men pursue these medical esthetic treatments and then surgeries with just different goals than women tweaked. I mean, some of them are the same. They want to appear vigorous and healthy, and a lot of these male patients are peak career, and they don't want people to look at them and. Think that they're old. They want they're like, they're in the C suite. They are like, top of their game, and they want to make sure that their outward appearance matches what their brain is doing and what they're accomplishing. What are they coming

Dr. Gabrielle Lyon: 1:25:13

in for?

Dr. Kristy Hamilton: 1:25:14

So the little things like Botox, they'll come in for Botox or discord. Younger men are increasingly coming in for that too. Bro talks, oh my gosh, bro talk. Bro talks, it sounds better. What? Yes, I like, really like desport for men as well. I love that. And then they will also come in for eyelid surgery. Men hate eye bags under eye bags just as much as women do, and they don't also like the heavy eyelid skin. That's the main thing, the main facial surgery that we had an easy recovery, yeah, much easier than, I would say, body surgery, eyelids, you know, you're looking really good in two weeks and, you know, ready for the boardroom, I guess at four. The other thing that men will do is the neck is also bothers them. So the loose neck, they don't like that either. The turkey gobbler, they come in saying that. And

Dr. Gabrielle Lyon: 1:26:05

just to be clear, lasers don't fix that. That is a structural,

Dr. Kristy Hamilton: 1:26:09

structural thing, structural thing. So we have to address that surgically.

Dr. Gabrielle Lyon: 1:26:13

Do most people get more than one structural procedure for let's say, does it lasts for 10 years, and then someone has to go back in. So you get it at 50, then do you go back at 70?

Dr. Kristy Hamilton: 1:26:26

So we like to say a well done facelift, for example, last 10 years. Now it doesn't mean that you accelerate through aging to where you would have been had you not had any intervention. But, you know, aging continues. The tissues are not the same as they were, but you're not going to then look, you know, if you turn the clock back 10 years, you're not going to accelerate 20 years. If you by the time you get to the tenure, I see,

Dr. Gabrielle Lyon: 1:26:48

would it make sense if you're going to do an intervention that you do it earlier?

Dr. Kristy Hamilton: 1:26:54

I think that's a deeply personal question, and it depends on you. And what's going to bring you joy. Also the severity of the issue, I don't think it makes sense to go and do a whole facelift for someone who has a small, relatively small sign of aging. How

Dr. Gabrielle Lyon: 1:27:12

does one as a plastic surgeon, how do you serve those challenges? Because on one hand, people you know, and I don't know this to be true always, but there some people are probably coming in for this perfectionistic type of viewpoint, yeah. And on the other hand, there is, you know, your body, your choice. How do you balance this

Dr. Kristy Hamilton: 1:27:38

motivations for surgery? So if I when I see people and they are like this, eyelid skin drives me crazy. I just like, I can't do my eyeliner. I can't do my makeup the way I want. It makes me look tired and angry all the time. I'm really happy person like, Great, let's take care of it. If patients are like, coming in and they're like, if I get a breast augmentation, my husband, what maybe won't leave me that you're setting yourself up to have a just a very unsuccessful outcome for yourself and your patient, because that's not gonna, you know, that's not gonna change anything. I'm not gonna be able to do anything there. But we see people who, if they're on TV, they're on radio, and they're coming in wanting to do, maybe radio, less so, but TV, or people who've got a very like face forward profession, making sure that they stay looking great, whatever that means to them, fresh faced, that can literally prolong their career. So a lot of those patients come in wanting to do smaller changes earlier, so that you can't tell that they did anything, and we're doing it earlier, so we're really just kind of preserving their face through time, and that that makes a lot of sense. That's their that's how they, you know, provide for themselves and their family.

Dr. Gabrielle Lyon: 1:28:54

Have you ever had someone come in and say, You know what? I really want this fixed? And you look at them and you go, what you're seeing. I don't see guys. That happens. Okay, yeah. Can you tell me a moment where you had that happen, and how would one even handle that? What? What is that like?

Dr. Kristy Hamilton: 1:29:15

So first of all, I ask the patients to show me in the mirror, see what they're seeing, and then what I will tell them is, like for me, it has to be something noticeable enough that I know by going in and doing a permanent change, a permanent adjustment, that I can make that better. If this asymmetry or concern is so small that I can barely see it doesn't mean it's not real. It just means that I'm not sure that I have a surgical option to present to them where I can make this better than where it currently is. And so that's what it comes down to, like I have to be able to offer the patient surgery, and if I don't feel like I can offer them something that's going to address that, then I won't offer surgery.

Dr. Gabrielle Lyon: 1:29:59

And. You ever been pushed? Yes,

Dr. Kristy Hamilton: 1:30:01

you're the only one. Dr Hamilton, and I was like, Well, I'm not the only plastic surgeon in the world, so you already, you already know that's not true. But they're like, I've researched you and I've chosen you, and it can be someone you really, really like, but you're not. You know, even if you love the patient, you think they're amazing, you're not doing them any favors if you pursue a surgical intervention for something that you don't feel like, I don't feel confident that I can meaningfully improve,

Dr. Gabrielle Lyon: 1:30:25

and is that challenging? Because you're, you know, part is, I don't want to say service industry, but your job, you're providing a service. These are elective, yeah, surgeries. And when you are put in a position where someone's like, Okay, well, I want you to fix this? Yeah, they're very persuasive and very intense. I mean, I have Yes, you know, I can imagine that that happens. Yes are I mean, so prepared.

Dr. Kristy Hamilton: 1:30:49

Yes, I am prepared. So one of the things I love to say is, like, I tell them, I look, I am a surgeon. I love doing surgery. Like it gives me joy. I really, really love it. I love like, that interaction with patients afterwards. I love being able to show them and they're excited about it. We did surgery yesterday for one of my team members, and so we were, like, talking about our retail again, fantastic surgery. And she's so excited. And it's like, it's great. Like, I love that. Like, I live for that moment when patients see it and they're like, so, so excited and so happy. And so I tell them, if like, I want to be basically, want to be able to offer someone surgery if I think I can do something. So if I'm telling you that I don't think that I can do that for you, then please, please listen or please seek other opinions too. And I'm just one person. But if your surgeon is not excited to do your surgery, that's like, something you should you should think about that. If you're like, pushing a surgeon to do something, because if they're not feeling confident about it, there's probably a reason why. So one thing I when patients are like, should I ask any are there any other questions, anything I'm missing in the consultation I should be asking? I'll say one thing I always think you should ask is, am I a good candidate for this procedure, because people are for various reasons, their anatomy, their health, their goals, better or worse, candidates for things. I say that's a question you should always ask, like, does your surgeon think you're an excellent candidate? And if not, why? And if you're still doing it anyways again, why is that what we're pursuing? I don't

Dr. Gabrielle Lyon: 1:32:20

want to go into too much detail, but I do want to ask you about this brings up medical tourism, yes, and I remember a friend of mine telling me a story about an individual that went to a different country and just had a full body it was they went over as a group, and they, instead of going to look at the Leaning Tower of Pisa or wherever it is, they went to all get body lifts, yeah. Is that safe? And then they come home, yeah. They're not there for post operative care, yeah. Is that common? It's

Dr. Kristy Hamilton: 1:32:55

increasingly common because I think plastic surgery in general is becoming increasingly common. People this is, it's more accessible. But also in the United States, with our healthcare system, it's very expensive. And, you know, all these things are much less expensive in other countries. So that's, that's, I think, the leading reason people are pursuing out of the country. What I tell patients, be cautious, the excellent people in Mexico, they're really expensive too. You know, there are excellent plastic surgeons in Mexico, but when we see people going across the border, that's typically not whom they're going to see. And I have out of town patients as well. And so this is something we always talk about. There's certain patients that, if they are coming from out of town or internationally, I insist on them saying for a certain period of time. So most things, if you're going to have a complication or issue or just something requiring care, usually happens in the first month. Some things like a rhinoplasty or breast augmentation, it's really like the first couple days if you're going to have an acute issue requiring care. So we have different lengths of time that we require people to stay in town, depending on what they're having, but it's a real concern. And I've seen patients who've had surgery in gene other issues, and then they come in and I'm like, I can only imagine that their surgeon would love to address this for them, but they can't get in touch with them. They don't, maybe don't even, you know, speak their language very well. And so here they are in Houston, and now they're looking at having a reconstructive breast surgery instead of a cosmetic one. And now it's exponentially more expensive because they've got a really bad problem. Yeah,

Dr. Gabrielle Lyon: 1:34:32

and I can see where that would be really challenging, speaking of before and afters. Yes, I would love to pull up some images, and I would just okay, I'm so curious, just to kind of talk through so we can get a sense of what is natural and what is not okay. Dr Chrissy Hamilton is almost like show and tell this. I thought it's very interesting, because we see people in the public eye. Transform and many questions. For example, Some individuals are younger, and maybe it's puberty, or maybe it's some something else, something else, something else. Yeah. Which one should we start with? I would say probably for the younger viewer or listener, uh, Kylie, yes, what this? So this is Kylie Jenner, and this is a before and after picture. I don't know exactly how long the years have lapsed between the two, but I mean, obviously she's beautiful before.

Dr. Kristy Hamilton: 1:35:34

So, so beautiful. And, you know, there's these, all these women, all these celebrities, they're under a tremendous pressure to look amazing all the time. I don't know why. Sometimes they feel like they can't say what they've done, especially when sometimes it's really, really obvious. So like, obviously Kylie's come clean about lip filler, but and also breast augmentation, I believe. But oftentimes they just don't want to say or they'll say, I think it's almost better to say nothing than it is to say that it's from drinking water and using olive oil and using olive oil and then going through puberty. I was like, boy, if puberty could do this, like me up again. Eye me up again. We'll do all the hormones and all of the angst. But so what we see for her is, you see a in her before photo, a she's beautiful, right? Younger version, I think she's a teenager, pre teen there, and you see a broader nose, you see really beautiful jawline, and, I think specifically, much smaller lips. And then her after photo to me, it looks like she's had a surgical rhinoplasty, which is a nose job, because there's really no way to make your nose significantly smaller, particularly at the tip. And then she's had her lips done as well for the upper third of the face. I don't think she's had surgical intervention there, she looks like she's done non surgical Botox brow lifting, because you can see how much more arched her brow is than it is before. And not in this image specifically, but we've seen unedited images of her cheeks and whatnot, and we see like a little bit of puffiness in that area, and sometimes that's suggestive of some cheek filler. So there's like a ligament between where your eye socket is, the transition from your eyelid to your cheek. And when we see that being tension and some fullness above and below, that can be a sign of cheek fillers, maybe, perhaps not in her case, necessarily, but a little bit too much of that.

Dr. Gabrielle Lyon: 1:37:39

But at this time, nothing, too significant. I would have never even noticed her nose. Yeah, I so they did a great job. And,

Dr. Kristy Hamilton: 1:37:46

yeah, she did a great job. And she's beautiful, and she should do all these things. I make her, make her happy. Tip rhinoplasty are really common, especially in Hollywood. Okay,

Dr. Gabrielle Lyon: 1:37:55

so this is one that I think is interesting. So this is Donatella Versace, and she has been in a public eye for, I don't know, decades and decades from before and after, and really, from 2010 to 2024 it seems like there is significant change, potentially. But you're the expert. What do

Dr. Kristy Hamilton: 1:38:18

you think? Do you when you when you look between the 2010 and 2024 does it look significant to you?

Dr. Gabrielle Lyon: 1:38:23

It looks like there is. Maybe her jaw looks different to me. Maybe her jaw, maybe her cheeks, but that's, that's maybe her nose.

Dr. Kristy Hamilton: 1:38:35

She's been so she's been under scrutiny for potentially having a facelift, especially following Lindsay Lohan's dramatic transformation. So they've been pulling that photo of the two of them together before and supposedly afterwards. One thing I see for sure is just her makeup is so much softer. In the after photo, her nose looks a lot smaller, but that could be from contouring. You can see where the brown lines along the either side of the middle of her nose. And then when we look at her neck, one thing that I'm looking at too is just the what are called platysmal bands, or these are the little lines that pop out when you strain in your neck. And she has those in 2024 as well as 2010 if she had had a facelift and neck lift, those would likely be gone. So I'm actually gonna say for her, I think less likely to have had surgical intervention. I think she just has a much softer, more natural looking makeup artist.

Dr. Gabrielle Lyon: 1:39:32

And that's great, you know, I think it would be very amazing when women are in the public eye and don't necessarily have to go. I mean, listen, I don't care whether ever someone wants to do is totally up to them, and it's for no one to say but Lindsay Lohan, I actually, honestly am not into celebrity stuff. I I just am not. But then, but I know, but then I've heard I don't even. I The team brought it up, and they just said, Oh, this is just, like, this incredible transformation. So what happened with her? Maybe her makeup is just better,

Dr. Kristy Hamilton: 1:40:08

yeah, so Well, definitely. So great makeup and great editing, I think, for all of this and that, that's its own separate things you can do, like, incredible, incredible work. But like, look how refreshed she looks there, and we're skipping the in between where, obviously she had some life challenges. Her skin is absolutely glowing. She looks like she's done laser resurfacing. Her brows look higher her, especially after being puffier with some of the struggles that she had. Look at that jawline. The jaw line is impeccable. She looks brighter. Does that mean there's sharp, it's sleek. She doesn't even have a hint of a jowl. And you can see, even in her, you know, she's still really young on her before photo, but you can see some more of those lines and shadows. She's perfection. I think this is a, what I would call like the undetectable early face lift to look like that, no nasolabial folds, and then her nose looks a little different, too little smaller, tip up. So she probably also had a surgical rhinoplasty, possibly an eye lift as well. She looks fantastic. How

Dr. Gabrielle Lyon: 1:41:14

long would all would do you think that all of those things are done together? They can

Dr. Kristy Hamilton: 1:41:19

be they can be all done together. And oftentimes celebrities will, because they've got one window to go do it all. And they, you know, they don't want to be seen in recovery. It's a little unfair the scrutiny that they're under. Yeah, absolutely.

Dr. Gabrielle Lyon: 1:41:30

And how long if she had all of those things, if she had the the Lower Lift, the nose, the eye, how long would that take to recover? So

Dr. Kristy Hamilton: 1:41:39

to recover so you be so nose is separate because you have to wear like a little cast. But if we're looking at the face, you'd be shocked how good people look even the next day, if they don't have much bruising, if you're lucky, two weeks later, I think they'd be socially appropriate a lot of the time. Four weeks definitely be looking really, really good, especially if they put the hair in front of their ears so that you don't see any evidence of scars. Do you

Dr. Gabrielle Lyon: 1:42:02

think that this stigma, I mean, obviously this is what you do for a profession as a plastic surgeon. Do you think that this stigma has changed?

Dr. Kristy Hamilton: 1:42:09

It has. I mean, we obviously celebrities and famous people have have partaken in plastic surgery for a long time, really now, it's a lot more just normal people that are wanting to look and feel their best. My patients that are having face lifts will say, I want when I look in the mirror, I don't recognize myself, like I see this person, and I'm like, Who is that? It's not me. So they're pursuing surgery to look as good on the outside as they feel they are on the inside and match their like figure. One of my patients, we just did her facelift. She's like, doing she's going to like, dude ranches, riding horses, teaching yoga everywhere. She's amazing. And now she feels like everything's harmonious and imbalanced again. So, ah. And then now we're looking at Demi Moore, so beautiful. And you see her on her show, her new show, she like looks absolutely incredible. In 3d, in active image, three, two, in 60s. Now she, I don't know, but I feel like she must be, because I've she's been a successful actress for such a long time. So Demi Moore, um, most I and my colleagues think that she had a facelift earlier. And so what we see here is the sequelae. And this line from the corner of her mouth to her ears. So it's, it's not a very kind term, but it is a technical term, and we call it Joker lines. And so that is, can be a sign of a facelift. And so what that comes from is when the lower face is pulled too tight, and then the cheeks almost hang over, and then she got a revision facelift, and you have to fix that, right? You have to fix that. So that's like, you're not going to age out of that. It's not going to get better with time. And so then she went and then had if, and now she looks like Demi Moore again. I think this picture, you know, people were like, was it really heavy contouring? Was it just buccal fat removal? I think she probably had her buccal fat removed too at that point. But I'm she looks amazing, and she looks like herself again. So I would call that a revision, facelift. One

Dr. Gabrielle Lyon: 1:44:06

more, one more. Let's see, do you want to pick your your next favorite?

Dr. Kristy Hamilton: 1:44:12

Do we want to do body? Yeah, yes, yes,

Dr. Gabrielle Lyon: 1:44:15

but I don't know if we have a

Dr. Kristy Hamilton: 1:44:17

body. We've got Taylor and we've got Ken. Kendall is breast. That's it. You pick

Dr. Gabrielle Lyon: 1:44:24

or whatever you want. Let's do Taylor Okay, this one, yeah, okay, our last and final um celebrity, Taylor Swift, the beautiful

Dr. Kristy Hamilton: 1:44:35

Taylor Swift. I lived in Nashville when she was living in Nashville, and so we would run into each Well, I would run into her at restaurants. She doesn't know who I am amazing, but she was very lovely over in I was in college, and she was just a musician. So what we see for her is two things I believe that she's had done. One is that she used to have these, like, really dreamy. Bedroom eyes like very sleepy looking. Now she's much brighter eyed, so she looks like she's had upper eye lip buffer, plastic. That's a surgery that a lot of people do in their 30s, just to look brighter and more awake. And then also, we see that her cleavage has changed and she had very small breasts before, and now they're a little bit fuller. We don't see that she's really gained significant weight. And so that's most likely a small volume breast augmentation, or the ballerina breasts. And so we see this is very common in in my practice, we see women that just don't have much breast tissue. They want to feel a little bit more womanly. Just fill out their bathing suit tops. They don't want something enormous, and a really tiny implant can achieve that and look very balanced and beautiful.

Dr. Gabrielle Lyon: 1:45:48

Could someone do that with fat? So

Dr. Kristy Hamilton: 1:45:50

first of all, you have to have fat to move, and you have to have enough tissue to receive as graft. But if you had fat that you were willing to donate esthetically from some other part of your body, then a smaller breast is a more realistic way to that you could build with fat, as opposed to an implant.

Dr. Gabrielle Lyon: 1:46:10

I see, well, Dr Christy Hamilton, I think you are a fantastic human, an amazing surgeon and really an innovator, and I know that we're going to be seeing so much more of you, and you also are accepting patients, yes, and

Dr. Kristy Hamilton: 1:46:25

your practice is called Dr Christy Hamilton, plastic surgery,

Dr. Gabrielle Lyon: 1:46:30

and we, we will link everything. I think that you are truly phenomenal. Thank you so much for coming on the show. Thank you

Dr. Kristy Hamilton: 1:46:35

so much. It was a pleasure and honor. You.