Hello everybody.

I'm Jemma Spake and welcome back to the Psychology of Your Twenties, the podcast where we talk through the biggest changes, moments, and transitions of our twenties and what they mean for our psychology.

Hello everybody, Welcome back to the show.

Welcome back to the podcast.

New listeners, old listeners.

Wherever you are in the world, it is so great to have you here back for another episode as we, of course break down the psychology of our twenties today, I hope you are ready for a big episode, a very long episode, an incredibly interesting episode.

We are talking about the psychology of plastic surgery.

We know that there is this huge intersection between plastic surgery and psychology, between plastic surgery and insecurity, social conditioning, social media, self confidence, and sometimes it stirs up a lot of debate online and in our own conversations.

I've always wanted to do an episode on this, but I'm not an expert, so I thought I would bring on somebody who most certainly is somebody who has decades of experience navigating this industry, navigating the emotions to do with plastic surgery, navigating every single little bit and part of this experience and of this process.

So I'm so excited to have him on board for a super interesting conversation.

Whatever you believe, I just feel like you can learn so much from how he approaches this, what we talk about, the nooks and crannies that we get into.

So without further ado, let's talk about the complex, interesting, incredibly fascinating psychology of plastic surgery.

Doctor Rowdy Robert, and welcome to the show.

Can you introduce yourself to the audience and just tell them a bit about who you are and what you do.

Sure, my name is Roddy Rabon.

I'm a Wards certified plastic surgeon out of Beverly Hills in California in the United States.

I've been a BORD certified plastic surgeon, practicing predominantly i would say, esthetic surgery for over twenty years in this sort of epicenter of Beverly Hills, and I've done I kind of uniquely find myself doing all aspects of plastic surgery.

Usually, the minute you tell someone you do plastic surgery, their next question is, oh, really, okay, great, what do you specialize in?

And I kind of find myself a little bit of a unicorn in that I literally do face those eyelid breasts, bellies, et cetera, etc.

So I do the gamut of plastic surgery.

This is the question I've always wanted to ask a plastic surgeon, which is, how did you find yourself in this industry, slash in this space, like when you went and did your MD or I don't know what the process is in the US.

Did you know you wanted to do plastic surgery or did you just kind of like trip and fall into it.

That's a great question.

The answer is that people go about it in both ways.

Some people know early on.

I would say most sort of find theirselves trip and fall into it.

I always always wanted to do something in design fusion with science, you know.

I actually wanted to be a mechanical engineer for a period of time, and then I wanted to be an architect.

So plastic surgery was the minute I decided.

I went to college at UCLA, which is down the street from my home, and I went in as a biochemistry major just simply because I liked science and science came pretty naturally to me.

But I always knew that I needed to do something in the design aesthetic, creative realm.

But I had a very strong liking towards the sciences, mechanical and civil engineering.

So when you actually really really think about it, plastic surgery is that beautiful fusion.

And then I always loved entrepreneurship.

I love business, I love you know VCS, I love Shark Tank, And then when you think about plastic surgery, it is actually the perfect tricycle.

It's you know, business, medicine, and design all merged into one, and for you to be arguably successful, you need to sort of excel in all three categories.

If you imagine one of those wheels being smaller than the others, you're not going to get very far.

So it was actually the minute I got to undergrad, I knew pretty quickly that I wanted to do something in the medical space.

And the only thing in medicine that allows you this degree of latitude into creative element really is plastic surgery, not orthopedics, not ovgyn, not pediatrics.

So it was plastic surgery or bust.

It's so interesting that you say it's like almost a creative part of medicine, and I feel like when I first hear that, I'm like, wow, that sounds that's like, actually, that sounds strange.

And then I'm like, well, yeah, you are.

You're like sculpting the body and changing it to match someone's vision for how they want to look, which is the fact that they're putting their care in your hands to execute their vision is also pretty amazing.

Like there must be a great deal of trust in that as well for you to have these people come.

To Yeah, I mean I actually take it with great reverence and a certain degree of stress associated with it.

You know.

I think the sign of a great surgeon is one who has a certain degree of humility and fear.

And that fear is you know, you say people are God fearing and that you know, they have respect for something outside of themselves.

And so when people come to you and they say, you know, whether it's a young girl or a young gentleman or an older person or what have you, and there's something about themselves that doesn't is incongruent with the way them see themselves, and they ask you to help them get there, it's a very sizable responsibility, and so I take it as such.

So I have always been in awe with what I get to do on a daily basis, I never take it lightly.

One more icebreak.

A question for you, and I don't know if this is if this is a weird question and you cannot answer it if you don't want to.

What was the first surgery that you performed as a plastic surgeon?

Do you remember?

Of course I do.

I remember it vividly.

So I've been in practice now twenty plus years.

And you know, every pilot, every police officer, every person does has a first of something right the first time a fly plane, and you think to yourself like, okay, but like those other jobs, like who cares if you mess it up?

Who cares if you fuck it up?

But with surgery, the first person is you know, you know it's going to have to is the one who who is your icebreaker.

So the first turger I did actually was a breast augmentation.

And a very dear friend of mine, who I adore and was at my wedding and is still a very close friend of mine, always had great faith in me, and she sent me one of her friends who had had a few kids, and I ended up doing a breast augmentation on her.

And I remember her very very well because she was so sweet and so bubbly.

She had had four children, and yeah, I did.

My first case was a first breast dog and it actually went quite well.

Yeah, she's still sending me patient, so I think it was a success.

Well, that's good.

Moving on to like the actual questions around the nitty gritty of plastic surgery.

One thing I feel like we need to get out of the way slash discuss discuss is the difference between plastic surgery and cosmetic prosages or cosmetic surgery.

I'm of the I feel like I think they're kind of different.

Am I wrong in that?

Or are they quite similar?

So I think you ask a very good question.

If the goal of today's episode is to educate and elevate people's understanding, then you got to understand the alphabet soup, you got to understand the vocabulary, You got to understand the glossary of plastic surgery.

And so, unlike all other fields, plastic surgery is very confusing.

And that's not by accident, because ultimately a lot of it is driven by mating marketing.

You don't get confused when you have an arrhythmia and your heart is not functioning correct, you go to a cardiologist there's no confusion on that.

When you have a ovarian cyst, you go to your obgyn, you're a gynecologist, you're obstetrician.

There's no confusion in that.

But in the area of cosmetics, my god, there are thousands of different providers with all kinds of names and things like that.

So the way it works is as follows.

When you go, at least in the United States, when you go to medical school, you are all equal, and then you have to select a specialty.

You say, Okay, when I'm done with my four years of med school, I'm going to be a again orthopedist, neurologist, psychiatrist, blah blah blah blah blah, And one of those is a plastic surgeon.

There is no cosmetic surgery residency.

There is no just plastic surgery.

There are dermatologists, and there are ear nose and throat doctors, but cosmetic surgery is not a residency.

You then go into being a plastic surgeon, and in your training, which is quite diverse, one of the things that you learn is esthetics, beauty cosmetics, so you'll learn burn surgery, you'll learn reconstructive surgery, with microsurgery, you'll learn hand surgery blah blah blah blah, and one of them is beauty or aesthetics or cosmetic surgery.

Then if when you graduate you decide, you know what I really like cosmetic surgery, I really want to specialize in this in my career, then you will take additional training, but you will be a or certified plastic surgeon who specializes in esthetic surgery, which is what I do.

Then comes, you know, years go by, and then the field of medicine, naturally, like all other businesses, is driven by money.

Non cosmetic things like my gallbladder, my hernia becomes poorer and poorer.

So what that does is it drives people who are not trained in esthetic surgery to then change directions mid mid game and say, you know what, I can do this?

How hard could this be?

And then they then start to take any any, any variety of lessons, whether that be online, watching a friend, going to courses whenever they want, and then overnight they can deem themselves as cosmetic surgeons.

I know that's hard to imagine.

I know it's really like, no, come on.

And so if you go look at cosmetic surgeons and you start to say, okay, well where what is your actual training in you will find out that they were general surgeons, they were obgyns, they were radiologists, they were er physicians, and at some point in their career they decided, I don't want to do a shit anymore, and then they get whatever degree of training which is not very regulated, and then they call themselves cosmetic surgeons.

So the answer is your listeners need to sadly do their home.

Yeah, and I agree with that entirely, And it's so interesting to hear like behind the scenes of like the labels and like you said, the alphabet soup.

I also just think like, if you're going to permanently change the way you look and undergo surgery, it's not something necessarily to skimp on or to cut corners with.

So you like bring up a very interesting point, which is like think this through, and there's multiple sides to think through before I go further in that kind of direction.

You know, we're talking about plastic surgery specifically in our twenties.

Really, I just have to ask how many people are getting plastic surgery in their twenties.

What is the most popular age group that you see that gets gets work done.

So that's very interesting.

So it turns out that every decade has its more common procedures.

I will say more than ever before.

Younger and younger patients are coming in to get surgery.

Why is that social media?

The end?

We've always had young people having surgery.

My sister who's almost sixty, had her nose done thirty some odd years ago.

My mom who's eighty five, had her nose done sixty years ago.

So it wasn't crazy to go to a nose job.

But this idea of Belahadee cat eyes, mini facelifts, lip lifts, I mean, there's an bbl's LiPo fat transfer, rib remodeling.

There's some crazy things that are getting done, and they're getting done younger and younger.

The only reason that is occurring social media.

That being said, you know there's things that have happened at different ages in our life.

So let's start with twenties.

What are the things that people come in commonly for their twenties that are within reason and what are some of the fad things that I think are a little overboard.

If your twenty year old young lady and your breast never really fully developed, and you find that while you love your body, and you think everything about yourself is amazing.

You work out and everything, but you just simply never developed much breast tissue.

Then getting a breast augmentation is not an unreasonable concept, and that happens often in your twenties.

If you were born and you were unlucky and your nose just was crazy out of balance with your face, and you inherited a big nose and otherwise we're a beautiful young lady.

Doesn't seem crazy to alter your nose and get a rhinoclassic That happens in your twenties.

If you were born with a very weak chin just because genetically or mathically you never developed and you have a massive underbyte, it's not crazy to get a small chin implant or an enhancement of your chin to create harmony and balance.

That happens in your twenties.

Conversely, now we're getting people calling about browlifts, but you're twenty.

Lip lifts, facelips, necklifts, rib remodeling, those are some really extreme surgeries that are not we're nevers it really designed or really indicated for young adults.

So I think the question you're going to lead to eventually is where's the line right, and the answer is who knows, and that line is drawn by both surgeon and patient.

But I don't know if that answers your question, but those are often the surgeries that are getting done.

I think it, know, it totally does.

And I feel like this isn't even broader discussion of like what is the point where you get something done because it is a gen you and deep insecurity for you, And then what is the point you get something done with there is genuinely nothing wrong and genuinely nothing that a surgery could actually do, Like you're saying a browlift for someone who is, you know, twenty two or twenty three, And I feel like that's where the entrance of social media has probably greatly, greatly swayed people.

How have you seen face tune or Instagram dysmorphia, dysphoria change how people perceive normal beauty Like you mentioned some of those really extreme procedures.

Are you also seeing younger people coming in for perhaps more surgeries than they need so like repeat people coming in and changing back to a certain way, or you know, redoing their nose or redoing their eyes or redoing their cheeks multiple times in the span of years.

I'm curious to see how you've seen the impact of this even further.

Okay, so we got to start with the psychology of beauty, plain and simple.

This is well before any social media.

This goes back to Cleopatra.

This goes back to the Amazon.

You know, you go to the Amazon right now with a bun in a tribe where no one's seen any human beings outside of the Amazon, and there you're gonna know who the queen of the tribe is.

She's the one with the most beautiful neck and the You know, beauty is not a concept of modern times.

Beauty is something that we know.

There's tons of studies that show that like monkeys will go to the more attractive puppet than the other than the other puppet.

So there is an inherent built in us to desire to you know, it comes from mating, right.

Animals in the wild will go to the more attractive bird or the more attractive flower.

So there is that, and then there is this turbocharged version, this version where you have this sort of innate being in our beings as people, this desire to look good or feel good or present our best, and then you pour gasoline on it and I think that's essentially what social media has done in modern society.

We've had billboards, we have actors and actresses, we had magazines, we had celebrities, we had models.

This has existed for over two hundred years, right, and you know, Oh, I think Merilyn Monroe so beautiful.

Oh my god, look at Grace Kelly.

And it always sort of people admired and wanted to sort of emulate some of these people.

But it was still manageable because those people were those people like, Oh, I really want to go to this place I see in this postcard.

It's a real place, right, you can actually go there.

And then we get into the modern world where manipulation, alteration, fabrication, whether it's AI, face tuned filters, angles and morph, and then reality changes.

And because inherently we are vulnerable, right, We're all vulnerable sixteen seventeen eighteen, Even grown ass adults are immature and have insecurities.

Then you massively, at a very high level, you start bombarding people with images.

Right social media.

You'd see a billboard while driving, Let's say you drive on Sunset Boulevard, You'd see twenty five billboards over five miles.

You now see twenty five images within five seconds.

Yeah, and these images are bombarding you.

Secondly, they are not real.

So you're looking at a destination like, oh my god, look how beautiful these trees and the water.

There is no place.

This island doesn't exist.

It's not a real island.

She doesn't look that way.

No, look at Chris Jenner.

Look at the excitement that Chris Jenner generated with her face lit right, there must be one trillion views or comments.

Well, yes, she looks good.

But the reason she looks so good is she's face tuned every image that's come out over the last six months.

And now that her image, she cannot stay up on it.

People are noticing that she doesn't look as glossy and amazing as she did the first couple of months because she's face tuned everything.

So people are thinking that, wait, you have flawless skin.

No, she doesn't have flawless kin.

She's almost seventy.

She has a good facelift, she looks amazing, but she doesn't have flawless skin.

So what I'm getting at is there's this balance between what is reasonable and what is organic and what is part of humanity.

And then there's this gasoline that you poured on this smoldering part of us, and then it's gotten out of control.

And then what happens is ninety percent of us are subject to being impacted.

And so when you're immature and you're vulnerable, and you're thirteen or twelve or eight or nine or sixteen or seventeen, and almost every human being goes through a little awkward time.

Her voice is changing, their growing hair in places they shouldn't be growing wall whatever.

You look at these images and you get fomo and all this sort of sense of like, oh wow, I'm so far from that.

My god, how ugly am I?

And you're so far from a place that doesn't exist.

And there's an amazing saying is so it creates what sadness, depression, anxiety, And there's a very great saying.

It says that your happiness is based on the delta between where you are and where you think you ought to be.

I'm a repeat that your happiness is based on where you are and where you think you ought to be.

So you are here, I make X, I look like this, this is my wife, And where you think you ought to be is the relativeness of where you think you could be and when where you think you could be should be flawless skin with an amazing boyfriend, living on a boat, driving a rolls Royce blah blah blah, skinny body, big but small waist, then you are far far away from that, which then leads to feeling sad, depressed, anxious.

And then what you do is you chase it.

And that's where we are today.

And so I think that the amount of mental dissatisfaction and sadness amongst insecure people ranging from eight nine all the way up to grown ass adults is so massive, and I really really think social media is to blame.

It's not plastic surgery, it's not the chase to be beauty.

It's the fact that you're creating these alternative universes that will never exist.

It's like porn, it's not real.

Yeah no, So anyways, that's the problem.

Yeah No, I totally agree with you, and I agree with you as someone who has seen that happen to me in my own life, where I've been like, wow, this person is just so amazing.

If I had that, wouldn't all these other things change?

And we know, like psychologically, and I'm sure you know this as well.

Obviously, like with hedonic adaptation, you could have surgery.

It might change your life normally you are actually going to return to a baseline level of happiness.

It's exactly what you were saying about.

You know, Chris Jenna got this surgery and I'm sure for her she was thinking this will be the one that eliminates all insecurity, and yet she still face tunes, and yet there's probably still things she doesn't like.

There's like an inner critic in all of us that social media and the unrealisticness of beauty is really kind of promoting.

This kind of brings me to I think probably one of the more controversial questions of this interview.

We're going to take a short break and then when we return, I'm going to pose it to you, So stay with us.

This is the question I wout to ask.

Can someone be truly body positive and still want to change how they look?

Is there I guess something that surgery can never fix within somebody.

So the answer is, let me get let me make sure I understand the question.

Can somebody truly love themselves as we say today be body positive?

I think I'm amazing and still find benefit from a surgery?

Is that.

What the question is, I think still find benefit from a surgery or still find themselves thinking about a surgery?

Does thinking about a surgery no go ahead?

So the answer is absolutely yes.

So that would equate the ideal patient.

The ideal patient is one who comes to you who is otherwise very happy in their life.

They have stability in their interpersonal relationships.

They come in with a very finite issue, one that can easily be agreed upon, and as a result, the correction or the eradication of that one very as if issue can foresure, and I have now witnessed it for twenty plus years dramatically change, enhance, and improve the quality of life of that person.

So let me give you such examples.

So you see a young lady and they come into your office.

I refer to my four nieces, and they are boss ladies.

Ones in law school, one's a venture capitalists.

They played sports, their soccer, one was valedictorian by all intensive purposes, kicking ass boyfriends, everything, love their moms just a great like great great girls.

Yet because of genetics, while they are beautiful and have great skin and nice teeth and everything, with all fairness, all four of my niece had bad noses, and so these four nieces of mine on their own really disliked their noses.

Every other aspect of their lives were kick ass on ninety percent of whatever.

So we sat down individually and I mentioned them because there's so four different young ladies of all different ranges, and we identified the issues.

We had discussions, and we said, okay, if we alter your nose and create a better harmony, not perfection, not the nose on Angelina and Jolie, or let me see what Margaret, a better looking nose on you?

Would this create a little bit a better appearance and hence make you happier?

And the answer is all four of them, all four of their noses were done at different times in their lives, different ages.

All four of their noses still have flaws, because I'm a critic and I know, and all four of them are over the moon about their noses and had hence moved on and never looked back.

So nothing about the way they love themselves has holistically changed, but that one entity about themselves is significantly improved, which then adds to their overall confidence.

Could they have lived life without it?

Sure?

Had they not had the means, would it have drastically changed their lives.

No, but the fact that they were lucky enough to be able to afford it, have a surgeon who executed it and it ended up being positive has unarguably changed or trajectory of their life.

And I can tell you that ninety five percent of my patients their lives have been massively improved by whatever surgery they did, whether it was a mommy makeover after having multiple kids.

And I can give you the stories behind these people.

So, if you've had three kids, you kick ass, you love your husband, your husband loves you, your children are healthy, you do yoga, you go fix your body, and now your insides match your outsides.

No amount of diet exercise would have changed it.

Right, So these are such examples that connect with stories.

We are very good at isolating.

Ah, you should just love yourself, if your husband should love you.

This is all nonsense.

So the answer your question is when a patient is a good patient, a well qualified patient, and has a stability around themselves and we're fixing a very finite issue, then yes, I do think they can be body positive and yet still have a dramatic improvement in their life.

Mmm.

I find that interesting.

Because I definitely see the point.

But what with with your nieces, like what made them bad?

What made them bad noses?

Or like what made the body of the of the woman who's given birth a bad body?

Like you mentioned that they these women were already in the ninetieth percentile, and this woman already had everything she wanted.

What do you think it was about changing this bad part of them or this I guess you know part of them.

They didn't like that that meant something to them, do you know what I mean?

First question is yeah, yeah, I understand.

The first question is defining bad.

Bad is a relative Paul is a relative term.

Good is a relative term.

I use the word in a very simple fashion, but it's it's it's much more complicated that.

First of all, I'm not the one that tells them it's bad.

So let's be very very clear.

These people come to me, I don't.

They don't come to me and say, hey, doctor Bond, how you doing great?

So what do you think of me?

Go, well, you look pretty good, but your nose is bad.

That's not how this goes.

This is a person who has been dwelling on this subject matter for years, seeks out help, comes to the office and I say, how can I help you?

And they say, well, I'm not so happy about my nose.

What is it about your nose that you dislike?

Well, I don't like this huge hump, I don't like that it's droopy.

I don't like that my tip is massively bulbous.

And that doesn't make it bad.

That makes it bad to them.

There is no such thing as bad.

If that girl or that guy loved those features, then it would be good to them.

So when I say bad or good, it's relative to the way they perceive themselves as to either what they would like and or what they used to be.

So then people who like to people who like to sort of be naysayers like to be like, well, what's wrong with it?

Who says that a hump is bad?

And they like to sort of play that game.

Then I ask you, why did you put on lipstick this morning?

Are you wearing mascara?

Have you done your nails?

Do you cut your short, trim your split ends?

Do you wear perfume?

Do you have jewelry?

Well, why do you do any of those things?

What's wrong with you without perfume?

Why are you shaving?

You under your arms?

So if we want to play that game, everyone will fail because it's not about the actual, absolute meaning.

This is okay, and that's not because all that is is a line in the sand.

Who are you to tell me that I'm allowed to put on mascara, but when I get a tattoo, I've gone too far.

Who are you to tell me that I'm allowed to put botox, but if I get a nose job, it's too far.

No one can say that it's about relativism, and relativism is a dangerous area.

So because no one can make that definition, it's a slippery slope.

Because the person who has had forty seven surgeries can now reverse the argument, like, so, but who said forty seven is bad?

Why is it only two?

But we're talking about mentally stable, healthy individuals who look at themselves and feel, you know what, I don't really love my saggy breasts, and to them it's bad, and then there's people to them it's great.

And what we have to do as a society is make sure that we don't get too far off the spectrum.

And we were doing okay because you know, at the end of the day, we had realistic images of what could be.

But I think the dangerous area, the dangerous waters we're in now, is that things are so accessible.

You can go to Turkey, you can go to downtown, you can go to Miami.

Things have become relatively affordable, even though everybody bitches expensive.

I mean, you could literally go and get a boob job for nothing, and images are endless.

So this is a cocktail or a recipe for a very bad outcome.

Does that answer your question as to what defines the person as a bad nos or what my Nieces felt was a bad nose?

Yeah, it does, and I think it's it's like a very like you said, it's it's incredibly complicated, and I think I think the line some people would draw is that there's a difference between the scar and permanently altering how you look.

Like.

You can take the Mascar off, you can't take the nose job off.

What do you tell people?

What do you tell people with tattoos?

No, I know I would have seen the same thing where it's like.

I mean tattoo tattoo young adults.

Not not really, No, that's a lie.

Those are what people tell themselves.

But tattoos are essentially permanent, even if you remove it, you have the scar of it, and the reality is that again I agree with you, it's all a sense of relativism, and I think it's great to play Devil's advocate because we need to make sure that we find center ground.

Center ground is that we're not far left, we're not far right, whether that's in politics, whether that's in religion, and whether that's in plastic surgical philosophy.

So I do agree that each will find that center area and draw that line.

And yes, for someone, mascaro is reversible, yet a tattoo is not.

For some people, tattoo is not really reversible because I can cover it.

So there's all these versions of the way we sell it to ourselves.

I think the key is and it has been for me because ultimately I'm the gatekeeper, right, I'm the one that is there.

I'm the one that will facilitate this alteration in you.

So I take that responsibily, quite heavily.

And there are many patients over the course of twenty years that I have redirected, readvised, recentered, and refused.

Let's talk about those patients because I think regardless of you know, if you're listening to this, regardless of whether you think plastic surgery is a good idea, you've had it done yourself, or you're one of those people who's like, I would never do that.

I want to go through the psychological process of loving my body as it is.

I think we can all kind of that there is a level where someone seeking out plastic surgery might be a little bit problematic.

Can you tell me when you know, oh, instances where you've been like, this person is probably not a good candidate for plastic surgery.

Great question.

So, first and foremost, my overall philosophy is not that plastic surgery is good for everyone.

As a matter of fact, absolutely it's not good for everyone.

My simple philosophy is that if you are the right candidate, and we've been sort of touching on what that is, and you do a good surgery and you find a good surgeon who collaborates with you.

My experience for twenty plus years is that the overwhelming majority of those patients do well.

That doesn't mean everyone should be doing it.

Conversely, there are absolutely people that shouldn't be doing it that are seeking it and who are those people?

And I tend to be a bit more transparent if you follow me, on social media.

You listen to my podcasts.

Everything in anything that comes out of my mouth is cautionary.

I live and die.

I'm sort of the Howard Stern meets Heraldo uh and the you know, reportive investigator of plastic surgeons.

I'm the guy that everyone keeps sending dms to, like, Hey, should I do this procedure?

This sounds fishy?

No.

So these are the things that would be a concern to me.

Number one is when a patient comes in to you and says how much they dislike something.

They describe it to you in great detail of much how terrible it is, and when you look at them you simply just don't see it, Like I genuinely don't know what you're talking about.

A perfect example is a girl that came in just today who wanted a knows job, a revision knows job, and at the end I said, listen, I have to tell you.

I think your nose looks great.

That has a little bump on it and a little dis But those things are like minor by and large, you look good.

I wouldn't touch it.

So red flag number one is what they see you don't see.

Right.

If my son comes to me who's four years old and says, Papa, Papa, do you see the monster?

And I'm like, I don't know what you're talking about.

Babb blah, you know, I don't see what you see.

Second thing that's a red flag is when they make it seem as though this issue is really the end all be all, it's going to change their lives.

They apply too much emphasis on something.

You can tell that psychologically, they've attached too much value to this item.

Right.

And while I think changing the way you look creates a sense of confidence, which then bleeds into your personal relationships, I cannot tell you the countless number of people who have had surgeries and as a results, have massively kindled their interpersonal relationships with their loved ones, their boyfriends or girlfriends, their husbands, their wives.

But when you're making it sound like this is going to change your life, like you just got you know, I don't know, brain transplant, that's a concern when patients don't track the risks when you talk to them, I explain, you know, I'm very underpromised over deliver kind I'm very like, and then this can happen, and then this can happen, and then you could be paralyzed and then you could die.

Like I'm very much doomsday because I like to push the dooms because if you go through the doomsday conversation, you're still on board.

It means that you know, you understand the real risks.

But when they actually act like nothing, like they don't register it, it's a concern to me that they're not going to follow through.

When they have any type of psychological condition, whether they have borderline disorder, they're very jittery, dismissive, they're very labile in their emotions.

They're crying and then they're excited, they're angry and then they're depressed.

Any type of mood swings I won't do.

And when they're asking for things that are extreme that I just like, Like if you're five foot two and you weigh one hundred and twenty five pounds and you're an a cup and you bring me a photo of some huge star and you're like, I want these massive boobs, it's like and there's no way that's going to happen.

So remember, I don't want to be entangled in a marriage with someone with a bad outcome.

So as much as it is my responsibility to prevent them from doing it.

I don't want to get involved in this with you because you're ultimately going to be a patient who is going to be dissatisfied or unhappy or not have a good outcome.

So I spend a lot of time trying to make sure that I marry the right people, because once I operate on you, you're my forever responsibility.

Right.

It's not like I sold you a bag, a handbag of the mall and you're happy and you return it.

You're like, this bag sucks.

You're like, okay, here, buddy, here's your money back.

Just be well, this is kind of like we're forever tie.

So I am very cautionary about making sure that the patients are have realistic and doable expectations and they're emotionally stable and to be present in that moment.

I want to hone in on the second point you said here, because I think this is interesting and I feel like the listeners will want me to talk about this a bit.

The patient who is like this is gonna be the thing that changes my life.

Why for them would you not operate on that kind of person?

Do you think it's because they like that there's a deeper psychological insecurity going on, or a deeper relationship with their body that like surgery can't fix.

What about that kind of patient would maybe scare you as a as a surgeon.

So listen, every single person has insecurities, period.

So this notion that you know, the person who has insecurities is unstable and you should love your body is nonsense.

Again, I'm not going to allow these terminologies to float around, or at least in my presence, because it just then makes people who actually had surgery and have an amazing outcome feel bad about themselves.

Every single person, myself and clue, my wife, the supermodel, the girl walking down the runway, Victoria secrets has insecurities.

That's part of being human.

It's about being in the center.

It's about that insecurity, being within reason where it doesn't consume you.

It's about that insecurity making sense in reality.

This dimple in my butt makes me a little insecure.

It doesn't mean that I can never be naked in front of anyone again.

Do you see how there's a difference between the two of those.

So everyone that comes to me is fixing an insecurity.

Every single human being that I've operated on doesn't like the thing that they're operating on, whether it's the mole, whether it's the breast, whether it's the nose, it's the eyelet.

That's an insecurity.

Where it becomes a concern is where that insecurity is so grand and it is so you describe it as like as it's altered your entire life, you having an ugly nose or not, or a big nose or nose that doesn't fit your face.

It's not altering your very existence.

It's not preventing you from getting a job, it's not preventing you from finding a good it's not preventing you from having a loving relationship.

It might make you feel happier and you'll be a little more confident, and you'll take a few more pictures, and you'll be a little bit more aggressive in life.

But so it's about appropriateness of that emotion.

So it's kind of like the difference between being scared of dogs and being a little careful around dogs, and then being so scared of dogs that you see is dog across the street and you cross the street to the other side.

So it's the difference between being reasonable and it's making sense and being irrational.

There are irrational fears, and there's irrational emotions, and when the emotion is not congruent with the condition, it's a red flag, right to red flag.

And it's kind of like love bombing someone.

It's like, how could you love me?

You've only met me for two hours?

So when the love doesn't balance out with the reality of our relationship, and it's the same thing when the condition, Now, god forbid, God forbid, you've been burned and your face has been mutilated, and you're telling me it's destroyed your life.

Well, that's a goddamn appropriate discussion.

Hmm.

But the right because the yeah, no, I see what you mean.

Yeah, because the condition warrnts the emotion.

But when you come to my office and you're just flabbergasted and just for clempt and you're just beside yourself, and I ask, okay, well, what's going on.

You're like, this mole, it's just which mole?

This one right here?

Oh okay, what about it?

Well it's just ruined my life and I just can't and my boy, and you're like, okay, this is just this is a problem.

And I you know, I obviously use that as a silly example, but it can be your nose, it can be your breast, it can be anything, but you have to be reasonable about it.

And that's what I mean about emotional stability.

And the truth is most consults that surgeons do is about fifteen minutes.

That's the average.

My console to one hour.

What do you think I'm doing for the additional forty five minutes.

I would just say probably interrogating those full things right, making sure that this person is emotionally ready one hundred percent.

What I'm doing is digging.

I'm digging, I'm having conversation with you.

I'm asking about your profession, what do you do.

I can examine you in five minutes and tell you what surgery you need.

I've been doing this for twenty years.

I don't even need to have a conversation with you.

Just send me your pictures.

But the consult is actually an interview.

It's for you to interview me and like, I don't I like this guy.

He seems cool.

I don't like this guy.

He seems arrogant.

It's that, And then for me to interview you, you don't sound like you're going to be a good patient for me to take care of.

I'm not so sure.

I can make you happy, right, I'm not sure if I can make you happy.

And the problem with what I do that's totally different than every other specialty is what I produce is subjective.

Yeah, when you go get your gallbladder remove, how many patients are unhappy about their gallbladder being removed?

It's out the end unless it's like a side effect.

Yeah, genuinely, right of course if you have a complication.

But I'm saying is there's no variation of out, it's out or it's not right.

But when you do your nose, I have four million permutations.

And while you and I may have a lot of conversation, who on earth can predict what your nose is going to look like?

You go to sleep, you wake up, and you are a different person.

Do you understand how scary that experience is for both of us?

What if you hate it and I think it looks amazing, it's subjective.

You say what is this ugly thing?

And I say, what do you mean?

This is a work of art.

It's disgusting.

I hate it, So you better bet I'm going to spend hours, forty five extra minutes digging to make sure that you and I are going to be a good flash.

And in all the years I've been in practice, I've done a pretty good job.

Of Course, a few people slip through the cracks, yeah, of course, but but by and large, I think it's worked well for me.

Follow up question here, This is so fascinating.

I feel like I'm learning.

I'm learning a lot.

When you have one of those patients who fits all four criteria, well, let's say three of the I guess I think you goay four or five.

Let's say three of the four or five?

What do you what do you say to them?

Do you say, here's a therapist I think you should go see.

Do you say here's a friend of mine.

Do you say give it six months?

Like, what's your protocol for those patients who you're like, this isn't this isn't gonna be a good idea for you?

A great question, And actually that is probably the most challenging console is to go into a room someone's come to see you, they paid you a fee.

You internally realize this is not gonna work, and you have to you have to walk them off the ledge and tiptoe out of the room.

So it depends if they are logical.

I will spend time, and I will spend the energy because I have them and I have captivated their attention, and frankly, they only will respect the voice or the reason of a plastic surgeon, not their mom my mom said the same thing, or my friends.

Those people don't count.

I'm a professional who stands to make money from this.

Remember, my incentive is to make a living.

So if I'm telling you that this is a bad idea, I am foregoing thousands of dollars of benefit.

I don't get an Academy award, I don't get any trophies.

I just lose money.

So if they're rational in that they're logical, I can sense that I could educate them.

Then I will take the time to be like, listen, let me show you a photo, let me draw this, let me do this, let me show you that this is why, that this is that, And occasionally I can walk them back to where they can see that this is a bad idea.

If I find that there's just no getting around it.

I'll never disrespect the patient or ever make them feel bad about what they're saying.

I'll never say you know what, you're crazy, I don't even know what you're talking about that's just never gonna go overwhell.

So I'll often if I don't feel that I can really connect with them and educate them as to why, I'll often tell them that, you know, you have a very complicated situation, and to be honest with you, I don't think I'm skilled enough.

Like I don't think I'm good enough to fix this problem.

In other words, I'm the issue here in terms of skill, then you, because at the end of the day, they're going to go and get it done.

I cannot tell you.

Actually, I can tell you one third of my practice is revisional.

One third of my practice is someone that went somewhere, got it done, and it's a bad outcome.

So I know unfortunately, and that have happened to me thousand times where I've seen patients, I've walked them off the ledge.

I told them it's a bad idea.

Yet they go out one door and into another door and the next guy says, no, no, no, that guy doesn't know what you're talking about.

They do the surgery, and then they come back here and ask me how to fix it.

I'm like, ah, because I have their notes, right, I'm like, I saw you four years ago didn't I tell you not to do your nose?

Didn't I tell you to leave your breast alone?

And so I know a lot of people are they want to hear what they want to hear, and I can only do so much to guide them.

So I would say fifty percent of the patients that are in that category, I can educate them, and I can gradually and slowly reel them back.

And then the other half they're gonna go elsewhere no matter what I tell them.

They're just they're just have a B line to get this done.

And you turn, you look at social media every day, look at how many people have gotten so far bizarre in terms of they look the way they look.

You don't.

Chances are they met someone along the way that said no, and they just said bucket, I'm gonna go somewhere else.

I don't care.

My job is to not per harm them.

That's my first duty.

My first duty is You've come to me, and I'm not going to participate.

I'm not gonna drive you to a bank robbery.

I'm not facie, I'm not your uber driver.

I'm not going to take you to your weird ass destination.

That's a good analogy that's a very good analogy.

I like that we're going to take one more short break and then I want to get to surgery addiction and maybe some advice you have for people in their twenties about surgery.

About your things, I feel like we've been circling the drain on this one.

I think it's come up like in a couple of times, which is surgery addiction.

You said a third of your patients are there for revisions.

People give you a laundry list of things that they want.

We've all seen people who have been I would genuinely say disfigured by plastic surgery.

What's been your experience with that?

And how do you two questions, what's been your experience?

And this being a psychology podcast, what do you think the psychology behind that is?

Okay?

So they represent point one percent of patients.

Let me reiterate body dysmorphia to the term for what you're describing, represents point one percent of the patients out there.

The overwhelming majority of patients are normal, regular folks like you and me.

Have an issue or two that they don't like that they identify a surgeon and go get done.

The fact that they have a bad outcome is not because they are crazy and they have body dysmorphia.

It's because they pick the shitty surgeon.

And the reason they picked the city shitty surgeon is because there are for every one good surgeon, there's fourteen Charlatans running around acting like they're experts.

Now, to address your true quint question is is body dys morphia people These people that look like the cat lady, that look literally unrecognizable, Well, they're fascinating.

That's why they occupy so much of the discussion when it it's a plotic surgery.

I've done one hundred podcasts and every podcaster asked me about body dysmorphia because it's fascinating, like it's a train wreck.

We're all watching like what the hell?

Why does she look like that?

And moreover, who did that to her?

Yeah, So the issue is twofold.

The issue is what's wrong with the person, and the second issue is who would have done that to that person?

So body dysmorphia is a psychological condition, and it's a condition in which you see yourself as different than you really are, much like people who have anorexia and they are not well and they have some degree of paranoia, and they have an underlying true psychological condition.

So they need to be on medication, just like a schizophrenic needs to be on a medication, just like someone who hear voices needs to be on a medication and seek psychological health.

However, because often they're estranged, because often they're isolated.

Often they're just by themselves.

Often they're at the end of their life span in terms of the money they've spent on themselves.

They're usually not at a job with their husband and kids.

Not those people I'm talking about buddismorphia, people who walk around You're like, whoa.

There's no one who can intervene in those people.

So that's not the issue.

The issue is who the hell operated on this lady seventeen times.

Yeah, that's the sick part.

The sick part isn't that they are that she was somebody showed up, She went to somebody's office having had three facelifts, looking literally like a stretched tambourine, and someone said, sure, I'll take your twenty thirty forty fifty grand and do another facelift.

That's the sick part, because that's literally like child abuse.

As far as I'm concerned, it's like elderly abuse.

This person is not well.

So it happens.

I'm lucky and that it doesn't happen in my office.

Occasionally they'll get through the window.

If you call my office and you say I've had four facelifts and I'm thinking something's not right and I want to fifth, we just don't see you.

I'm so sorry.

You know, there's nothing, there's nothing we can do to help you.

We're not going to engage the dialogue.

There is no scenario in which zero where you need five facelifts before fifty.

That's one.

Like that's literally like one every five years.

And it happens.

There's a girl.

There was a girl what is the name of that, And I don't know.

She was like literally or six facelift and she's like fifty, So Faddy, it is more fifth, Thank the Lord.

It's a very small minority.

I think it's an addiction right as well.

Right, you have to treat this as one plea psychological.

One hundred, one hundred percent.

It is the same exact area in the brain that leads to cocaine addiction, alcoholism, gambling, pornography.

It is a impulse.

Two final questions for you.

The first one is, here's your space, is to just address the biggest myth about plastic surgery that you want to address.

And the second one is more specific to our audience, but I'll let you do that one first.

What's the biggest myth that you want to address here about plastic surgery?

So I think I have been blessed over twenty plus years to have been graced with so many amazing interpersonal experiences, thousands of letters and thank you notes and gifts and chocolates and pictures and reviews from people whose lives I've improved.

So I don't like when plastic surgery gets a bad rap, because inherently it's an incredible tool.

That being said, my biggest qualm and my biggest message is that tool is a very very sharp knife.

And if that knife is incore, technically, incorrectly handled, used on the wrong patient, done in the wrong way, can create everlasting damage.

And because of the things we discussed, more damage is being done than ever before, thereby tainting and ruining the beautiful possibilities that a good plastic surgical experience can bring.

So what I say is people are now treating plastic surgery, operating going under anesthesia, like it's literally going and getting extensions.

They have lost their reverence for it, they have lost their fear of it, they have lost their You know, if you were going to do something super significant in your life, you would do a tremendous amount of analysis before.

Plastic surgery is no longer in that category.

It's like a whimsical decision.

And that is my biggest concern for young adults is it's something you feel like you want and the biggest issues at twenty you can't afford it.

So what I see more than ever is that when you're twenty five thousand dollars is a lot of money at twenty, and as a result, when someone good is ten grand and someone mediocre is five grand, you have to have it.

I have to have this now, and you forego what you would normally have done in any other scenario, and you say, ah, how bad could it be?

Because it's getting extensions.

And so a lot of the revisions I do are in people who had surgery as young adults and at that time, aside from the fact that their wisdom hadn't settled in there's a reason why twenty year old people do stupid shit, and sixty year old people are like, God, when I was twenty, what the thing?

Because that's when you are in the military, that's what you get into fights, that's when you go to war, that's when you protest, that's when you are at a certain place in your life that you're conquering things.

You don't make always the best judgment, and the problem is that you don't have the finances to do what's better.

So my biggest advice is save your money.

So if you can't afford the person that you did homework on that's ten grand, don't kid yourself that the four grand three grand guys just as good.

Or I'll go to I don't know, the Bahamas or Turkey or Greece.

I'm saying, be wise, put your mature thinking cap on and just treat it with the reverence that it deserves.

And if you do that, then I hope for you that you will be a part of what I experience in my practice, which is amazing transformative experiences, and that's what it should be.

Ninety nine per cent of plastic surgery should be amazing, like, Wow, this was fucking great.

I'm so happy I did this, And there's just a lot of bad decisions being made.

Yeah, that's great advice.

Now that we have you in the advice giving mood, this is the question that we ask everybody, which is a piece of advice you would have for yourself in your twenties or people in their twenties.

Now that has nothing to do with what we talked about today.

So I think for me personally, one of the things that I probably overdid that I wish I didn't is I spent too much of my young adult worrying about getting where I needed to go in life.

So there are two major paths in life, those that really plan and those that don't plan enough.

And generally the conversation is, hey, you got to have a planned kid like, you can't just let the universe take you where it goes that you're never going to get there.

And that's actually quite true.

But because of my personality, I think I overplanned and overworried and overstreet rest about my destination.

And so I got to where I got in life, which I'm so grateful.

I got married and I had kids a little bit late, and I had a wonderful practice.

Everything about my life is where I always imagined it to be, But I think I worried too much about getting here, and it took a little bit of the fun out of it.

I was all then too worried about making it to my end destination and not enough time not smelling the roses or watching the view, but relaxing a bit.

And so for the type A people who are out there, you can probably release the reins a bit and you'll as long as you're headed in the right direction, you'll probably get to your end destination without having to knuckle grip it all the way there.

I love that advice, and you know what, it's very pertinent because that is the question I get.

The theme of questions I get all the time, which is like how do I know that I'm on the right path?

Like how do I do I know where I'm going?

So I like what you said, like the destination will be there.

You can take a bit of time.

Yeah, I mean you've got to have you've got first of all, if you don't, if you're not on a path, you will make it anywhere.

So you don't know that you're on the right path.

But you need to be on a path, that's first of all.

You have to be in the thing.

You have to be in the game, and that path has to be one that's worthy of traveling, even if it ends up not being the one.

So A, you can't not be on a path, and B pick a path that's worthy of traveling and don't worry about it if it's the path.

If you are on a path and it's a path worthy traveling, the path will present itself.

I want to say thank you so much for coming on the podcast.

Yes can I can I have a moment to plug my podcast?

Yeah?

Absolutely.

I think that if people enjoyed this dialogue, which I hope they did, meaning if you have any interest in cosmetic surgery, which most people find kind of curious or fascinating or whatever, I have an amazing podcast called Plastic Surgery on set.

As from this podcast you can get a gauge of how I communicate information and it really covers everything in plastic surgery, from minor things to major things, to trends to disasters, catastrophes, to patients, to their journeys to experts, to et cetera.

It's called Plastic Surgery on Censored.

You find it all over to place Spotify Apple in the description as well.

Yeah, and and I think that for anybody who wants more of this kind of stuff, you can kind of dig in and do a little deep dive there, and then if they want to follow me or anything, it can always come onto our Instagram and and peruse at doctor roddy Raban, which is dr r A d y r A HbA N.

So we'd love to have some of your twenties.

My dream is to get a hold of all the twenties twenty year old before they do shitty mistakes.

Yeah, that's my goal is to get ahead of it, not to fix it afterwards.

So good on you for having a podcast that is specifically targeting young adults, because often the choices we make in young adulthood are the ones that forever change our lives, and if we can alter them early enough, maybe the trajectory will be better.

I appreciate it.

Well, it was such a pleasure to have you on board.

If you enjoyed this episode, give us a five star review, share it with a friend, and follow us on Instagram at that Psychology podcast if you want to, you know, give any feedback.

If you have any further questions or thoughts about this episode or any other episodes, if you want us to expand on anything we talked about, or if you just want to see behind the scenes, we'd love to have you over there, But until next time, stay safe behind, be gentle to yourself.

We will talk very very soon.