Under the Influence (with Jo Piazza) - Can Plastic Surgery Keep Up With AI？

00:00:00.000 Hello, Jo here, and you are listening to Under the Influence.

00:00:09.980 Now, I want to start this episode out by saying that you are absolutely perfect the way that

00:00:15.120 you are.

00:00:16.180 And you know what?

00:00:17.160 So am I.

00:00:18.260 I love me.

00:00:19.360 I do.

00:00:20.620 This episode happens to be about feeling like you aren't perfect.

00:00:24.300 And so I think that's an important reminder to tell everyone.

00:00:26.860 because one of the biggest problems with social media, and I've been talking about this a lot

00:00:32.200 on the road for my book, is that it really makes a lot of us feel less than. And that could be

00:00:38.560 about anything. It makes us feel a ton of guilt and shame that we're not being quote-unquote

00:00:42.480 perfect or quote-unquote good mothers. It also makes us feel like our bodies aren't doing the

00:00:48.860 things that bodies are supposed to do. I mean, I get sort of videos of young women with abs of

00:00:54.480 steel every day, telling me that if I just buy their protein powder and their workout course, 1.00

00:00:59.920 that I'm going to look exactly like them. And here's the truth. The truth of it all

00:01:05.000 is that the secret to their abs of steel is youth. I had abs like that when I was young too,

00:01:11.860 and I was not huffing protein and I was not doing their workout. My diet was pretty much

00:01:17.580 parliament lights, beer, cheese, and bad decisions. But bodies look different when we're young. They

00:01:25.240 do. And it is true that Instagram and TikTok have the ability to make us feel bad about our bodies

00:01:29.800 and our faces. And that's getting even worse now that AI face tuning is getting more and more

00:01:37.140 prevalent. AI filters and filler-fueled faces have completely taken over our social media feeds.

00:01:44.160 And I want to know if there's more of this lately, or if I'm just getting served it.

00:01:48.880 So I caught up an expert, like I always do when I don't know something.

00:01:52.320 Today, we're talking to Dr. Jonathan Zelkin.

00:01:55.240 Jonathan's great.

00:01:56.320 He is a board-certified plastic surgeon, and he's kind of an expert right now in what's

00:02:01.620 happening to filtered faces and bodies, and how that's changing our perception of what

00:02:06.540 we could look like. 1.00

00:02:09.240 So today we're going to get into how social media is warping our reality of what women

00:02:14.200 should look like, what's even possible with plastic surgery, and what's just AI BS.

00:02:19.720 We're also going to get into whether or not I should get a boob job, because even though

00:02:24.300 my boobs are fine, they are still like sun-dried tomato flop bangers after nursing three babies, 0.95

00:02:31.160 and some days I'm like, I do want a boob job.

00:02:34.460 I have a ton of questions, and I am not pro or anti-plastic surgery.

00:02:38.900 I talk all the time about getting a nose job 15 years ago and how I loved it.

00:02:43.100 I think everyone should do whatever they want to feel awesome about themselves.

00:02:46.820 But I do want to talk about how social media is, one, making us feel worse, and two, creating

00:02:52.280 these faces that are actually impossible to achieve, even with plastic surgery.

00:02:57.100 So here's Dr. Zelkin.

00:02:59.000 Hi, Jo.

00:02:59.580 How are you?

00:03:00.700 I'm good.

00:03:01.220 I'm great.

00:03:01.640 I'm really excited to have you on today.

00:03:03.640 Because I want to talk about boob jobs, nose jobs, Botox, fillers, and plastic surgery TikTok.

00:03:11.020 Because I am served so many plastic surgery before and after videos right now.

00:03:16.080 And I just, I don't know if my phone is listening when I contemplate getting a boob job or not.

00:03:23.860 But it's everywhere, all over my feed.

00:03:27.140 Are you seeing more and more of this on social media?

00:03:29.340 I am definitely seeing, and I'm going to be upfront with you. I am not a TikTok guy. I'm a little bit older, so I'm still stuck in the Instagram age, but it's all sort of adjacent. This is one thing versus the other.

00:03:44.100 So TikTok is not my specialty, but I am definitely getting a sense that the ethos, you know, is predicting what I'm thinking.

00:03:55.720 It's not even it's not even what I'm saying anymore and my phone picking up on it.

00:03:59.560 It's like what I'm thinking.

00:04:00.800 And my phone has targeted ads for what I'm thinking because it's taking any cues you can get for my search queries and it's predicting what I want next.

00:04:09.660 And it's terrifying and convenient all at the same time.

00:04:12.660 I'm not on TikTok that much.

00:04:15.280 I am on Instagram all the time.

00:04:18.360 What I'm curious about, and my friends who are doctors tell me the same thing,

00:04:22.680 do people come into your office now showing you things they've seen on social media and say,

00:04:27.540 is this possible?

00:04:29.220 Such a good question.

00:04:30.920 People show me things that they see on social media, but they don't ask me, is this possible?

00:04:35.900 And I think therein lies the problem.

00:04:37.360 I think everybody sees something on social media and assumes it's possible,

00:04:41.520 which puts a tremendous onus on the plastic surgeon community because now we have to sort

00:04:47.660 of compete with what is unobtainable. Well, and I think that we're now obsessed with things that

00:04:54.280 are unobtainable, right? Also because we see so many filters on social media and people can

00:05:00.040 face and body tune all of their images. Are we now a culture that is obsessed with things that

00:05:07.220 are just not possible or maybe not possible without a gazillion dollars? Again, these are

00:05:13.840 very, very good questions. I think we've become fascinated with what we can manipulate and not

00:05:19.420 necessarily what's achievable. And so because of that, and we've been able to manipulate images

00:05:24.840 for 10 years, but it's getting so sophisticated that it's hard to discern between reality and

00:05:30.940 what it's fake. So now the rarer thing is not looking perfect. Anybody can look perfect.

00:05:35.980 The rarer thing is being authentic. And I think authenticity is becoming this really hard to reach gem, this diamond in the rough that we're all searching for, because how can we be authentic and perfect?

00:05:48.780 authentic and yet also perfect. I mean, I think about this so much because

00:05:55.060 I see myself on camera a lot. I do a lot of television interviews and there are certain

00:06:03.320 ways that I want my face to look. I, full confession, and my audience knows this,

00:06:08.200 I had a nose job. God, it had to have been 15 years ago, maybe. I don't even remember what

00:06:14.120 year it was, but I've been married for 10 and it was well before that. And I love my face with my

00:06:19.020 nose job. Maybe I would have loved my face without my nose job. And now I'm considering a boob job

00:06:24.640 because, you know, after nursing three babies, I'm just, they're just sun-dried tomatoes over here.

00:06:31.660 Okay. That's all I'm going to say about them. And at the same time, there's a part of me that's like,

00:06:38.360 why not go full crone? Why not age authentically? Why do you even care about this? But I guess

00:06:44.100 guess if people if all people felt that way you'd be out of business right yeah and yes and i do

00:06:49.300 think for the rest part i mean you're you're sort of walking down a different pathway you're saying

00:06:53.520 i don't feel sexy anymore i want to do something for myself that the world may or may not be aware

00:06:58.740 of this is true this is true because my husband could care less too like he's just like what what

00:07:05.960 what would you even do to them and i'm like it is not for you it is for me mister and so if it's for

00:07:10.680 you, I think it's out of the discussion of today. I don't think AI can even compete in terms of

00:07:14.860 making you feel good about yourself. Now, if you're an influencer and you feel like you look

00:07:19.160 unsexy in dresses and you can't Photoshop cleavage and you want something to make you

00:07:23.480 look naturally enhanced, then that's going to open up the doors of, you know, is this going to be an

00:07:28.320 AI press augmentation versus a real augmentation? Right, exactly. And I think just like you said,

00:07:35.060 you hit the nail right on the head. AI augmentations on screen are now better than ever

00:07:41.180 before. I think even in the past three months, they've gotten better than ever before. So do

00:07:47.500 you ever have to say to people, no, this is just not a thing that is possible for you?

00:07:52.440 I do it all the time. I did it just yesterday. I had a lovely lady. She's probably

00:07:57.080 approaching 80 years old. I did her facelift a few years ago. And now she's coming in

00:08:03.000 and she says, I want an hourglass figure.

00:08:06.320 You know, I want my body to match my face. 0.99

00:08:08.420 And I'm looking at a woman who's relatively thin 0.99

00:08:10.500 and who's built pretty broadly. 1.00

00:08:13.620 I mean, she has almost a barrel chest. 1.00

00:08:15.400 She has a wide abdomen. 1.00

00:08:16.900 She's never had children. 1.00

00:08:17.860 And I'm seeing a lot of what we call visceral fat, 1.00

00:08:20.840 fat that's underneath the muscle layer.

00:08:23.320 And I'm thinking to myself, 0.99

00:08:24.680 there is just no way with her bone structure, 0.99

00:08:27.840 where her muscles basically originate and attached, 0.99

00:08:31.360 that surgery is going to be capable of changing your figure. 0.84

00:08:34.680 Of course, a simple AI app could do it in five seconds.

00:08:38.720 Exactly, exactly.

00:08:40.120 And so how do people take it when you're like,

00:08:42.280 well, AI can do that to you,

00:08:43.640 but you can't look like this in person?

00:08:45.940 So this is what today,

00:08:48.100 I'm hoping we can talk about in depth today

00:08:50.660 because I think this is going to be something

00:08:53.220 that you and I are discovering in real time for your audience.

00:08:56.000 I think plastic surgery may be the passport for people to be authentic and perfect.

00:09:07.280 And it sounds weird.

00:09:08.420 So, I mean, I want to-

00:09:09.320 That sounds a little weird.

00:09:10.160 All right.

00:09:10.360 Explain it to me.

00:09:11.160 Yeah, explain it to me.

00:09:12.060 Unpack that.

00:09:12.860 But I'm here for it.

00:09:13.760 Yeah.

00:09:14.500 Just about five minutes ago, I was telling you that we're getting better and better at

00:09:18.340 detecting AI, even though it's sort of matching us in terms of its advances and sophistication.

00:09:23.220 We're getting to a point where something looks AI because it's too good to be true, right?

00:09:28.540 Yeah, absolutely.

00:09:29.800 So if it's too good to be true and surgery is unable to help you achieve something that's

00:09:35.960 too good to be true, then why don't you just admit to having surgery and let AI do the

00:09:42.200 rest?

00:09:43.120 And that way you have come clean about having surgery.

00:09:46.880 Meanwhile, AI is making you look more perfect than surgery can ever make you look.

00:09:52.320 and there's your passport for perfection and authenticity and that's the holy grail that

00:09:58.380 everybody wants they want to be perfect and authentic 20 years ago it was like you can't

00:10:03.720 talk about getting plastic surgery because you wanted to attribute your genetics or your you

00:10:08.760 know good you know sunscreen and i drink lots of water or i do yoga to how you look but now you

00:10:15.080 know with time we're realizing that we all age regardless and it's no way that lifestyle behaviors

00:10:20.300 and things like that can help you look that good.

00:10:23.140 So then we fell back on photo manipulation for a while.

00:10:26.540 And then photo manipulation got so sophisticated

00:10:29.100 that people are calling us out on that.

00:10:32.060 So why don't we just admit to something?

00:10:33.500 Why don't we give society a token?

00:10:35.360 Why don't we just give, oh yeah, sure, I had plastic surgery.

00:10:37.700 Now look at all of my Photoshop images

00:10:40.060 and acknowledge that I now look this amazing,

00:10:44.180 even though surgery itself can't help me really look this good.

00:10:47.520 Exactly, exactly.

00:10:48.440 Let's back up just a little bit.

00:10:50.300 When you started, plastic surgery was probably still pretty taboo, right?

00:10:56.060 And when I started out as a celebrity journalist, no one wanted to talk about it.

00:11:01.340 Everyone wanted to pretend, like you said, I just drink a lot of water and I have good genes.

00:11:06.300 And then you're like, Jennifer Aniston, that's a new nose.

00:11:08.940 We know, stop gaslighting me.

00:11:12.520 And, you know, Khloe Kardashian, you have a whole new face, a whole different face than you had before.

00:11:21.520 But and I do remember, I mean, you know, the Kardashian clan and the extended Kardashians, they've all started admitting these things.

00:11:29.460 But in the early days of covering them, they constantly denied any plastic surgery, as did almost every celebrity.

00:11:36.080 when I know that the majority of these people are getting very invasive surgery at least once

00:11:43.460 every five years. Yeah, I think the times have changed. You said it best. I mean,

00:11:51.000 25 years ago, the holy grail was to age gracefully, to look amazing. And you've got

00:11:59.200 A-list celebrities from a bygone era who always sort of denied having surgery. I think Jennifer

00:12:05.020 Gray is a great example of that. She downplayed or outright denied having a rhinoplasty until it

00:12:10.760 destroyed her career. And Courtney Cox, who was popular in the 90s, the same thing. She had way

00:12:15.220 too many fillers and she denied it. So, and Madonna, I mean, the list goes on and on and on.

00:12:20.060 We can keep talking about celebrities who are, you know, Gen Xers or older who are denying it

00:12:25.800 because they were raised in an environment that plastic surgery is in fact taboo. And obviously

00:12:30.440 the thing that the tables are turning in real time. What do you think has changed that taboo?

00:12:36.900 I mean, no one did want to talk about it. And now why are people being more open about it than ever

00:12:41.360 before? Is it because of social media, because you kind of can't get away from people constantly

00:12:46.600 scrutinizing it? I think both plastic surgery has become more sophisticated. So when we think

00:12:53.340 of faceless, we think of like John Travolta in Face Off with an incision that goes from ear to

00:12:58.280 ear and you're pulling the face off and pulling it really tight and you're getting these really

00:13:01.860 wide lips and shiny white betty white skin and we think about you know big fat overblown lips and

00:13:09.560 and tiny eyes and we're thinking about like old-fashioned overdone facelifts facelifts

00:13:15.580 i think about john travolta in face face off every time i think about a facelift which is why i i

00:13:21.060 actually kind of want you to tell me what does it what does a real facelift do you don't just take

00:13:24.780 someone's face off like in the movie? You don't take a face off. A modern day facelift has small

00:13:31.700 incisions usually in the temples, somewhere in the brow or temple, and then small, well-concealed

00:13:36.940 hidden incisions, ideally, around the sideburns, behind that little cartilage point in your ear

00:13:43.180 hole, down across your earlobe, and back behind your ear into your hairline. I mean, it's supposed

00:13:48.000 to be a really, really well-concealed incision that, sure, internet sleuths will be able to

00:13:53.880 detect, but through that small access, we don't just pull your skin tight. We do something where

00:14:00.380 we traverse into a deeper layer and pull the deeper layers of tissues tight. That way the 0.84

00:14:06.360 recovery is faster. You don't get as much bruising. You don't get any tension on the skin

00:14:10.560 and you can pull basically the rug out from the carpet beneath it rather than pulling the rug

00:14:18.700 really tight. I don't know how else to describe it, but the result of at least my composite

00:14:23.340 deep plain facelifts now are going to be a lot more concealed and they're going to inspire a lot

00:14:28.960 more speculation. The old fashioned facelifts that frankly I trained doing, it's not that old,

00:14:35.860 they're 20 years old or so. I had incisions that basically were what I just described and you had

00:14:41.520 another one underneath the chin and then you had another one like a barrette that goes from the

00:14:45.860 top of one ear to the top of the other and you pull everything tight. Now we're trying to do more

00:14:51.700 through less. That way there are fewer, there are less stigmata of having facelifts and you can get

00:14:58.600 your cake and eat it too. You can look better without having people know that you had a facelift.

00:15:03.380 How much does the average facelift cost? Oh, I think that's a loaded question.

00:15:09.760 You're in New York City, I'm in the LAOC area. Right, exactly. And I had my nose job in

00:15:15.300 Philadelphia. They did a very good job, but I know that it was half the price of what it was

00:15:19.200 in New York City. Exactly. And then you can also get a facelift in St. Louis, Missouri for $200,000.

00:15:25.040 So the answer is it really varies on really what you're trying to achieve, who's doing the surgery,

00:15:30.500 their qualifications, their geographic location, and their reputation. And I think facelifts for

00:15:36.800 that reason definitely run the spectrum from maybe $15,000 in Mexico. I heard some lady 1.00

00:15:43.560 went to Guadalajara and had this amazing $15,000 facelift to $250,000 or more anywhere from St. 1.00

00:15:51.380 Louis to New York to LA, depending on who you go to. Right, right. A range. It's always a range.

00:15:57.060 Totally. I hear that. Let's take a quick break. And when we get back, I want to talk a little

00:16:04.540 bit about the plastic surgeries that people are completely obsessed with right now. Absolutely.

00:16:13.560 Okay, we are back.

00:16:20.480 Which plastic surgeries are very in vogue?

00:16:23.440 Like, what are people obsessed with right now?

00:16:25.740 I have the sense that everyone is obsessed with the same kinds of things

00:16:29.140 because I see so many faces on social media that look exactly the same.

00:16:35.240 Like, Lauren Sanchez looks exactly the same as every woman in the Trump administration.

00:16:40.860 I think that's very interesting.

00:16:43.100 And you know what? My practice is very face-forward. I'm a board-certified plastic surgeon. I do plastic surgery on the face, breast, body, and even hand from time to time. But my practice is face-forward. So you're right up my alley with this question.

00:16:57.240 I think from a facial standpoint, we are looking at deep, plain facelifts, custom-made facial implants, lip lifts. Blepharoplasty has regained its popularity.

00:17:10.420 What is that? What is that? Blepharoplasty is a fancy term for eyelid lift. And it's either

00:17:18.080 upper eyelids or lower eyelids or both, but that is becoming super popular as well.

00:17:23.340 Huh. What does that do to your face? It does quite a bit. It is one of the

00:17:28.760 longest run, shortest run for the longest slide or low hanging fruit or whatever,

00:17:34.560 whatever analogy you want to use for it, type operations. When we look at a person, when one

00:17:39.720 person gazes at another. They really look between their eyes and their nose and the mouth. There's

00:17:46.140 sort of a triangle, if you will, between the eyes, nose, and mouth that are high yield facial

00:17:52.220 recognition areas. So we can do the best facelift in the world, but if we don't touch your eyes or

00:17:58.340 we don't touch your lips, you might find that you don't look that much different. So I think

00:18:03.140 whether or not we recognize it, society who is starting to, I guess, understand that the more

00:18:10.120 you can do with your upper eyelids, especially high yield, low risk, low expense operations,

00:18:15.920 the better. And cutting off skin from the upper eyelid and tightening it can change your appearance

00:18:20.360 drastically in as little as half an hour and oftentimes awake. Fascinating. That is something

00:18:26.060 that I have never even heard about, really. 0.75

00:18:31.100 Let's talk fillers for a minute

00:18:32.580 because we went through an era of really bad,

00:18:37.140 either bad filler work or people overdoing the filler.

00:18:41.040 I mean, really overdoing.

00:18:42.220 I'm so curious, did people just get addicted to it

00:18:44.720 and not realize what they were doing to their faces?

00:18:47.900 I think so.

00:18:48.820 I think there is a certain psychology

00:18:50.440 of being a filler patient.

00:18:51.980 I think at least when I do lip fillers, for example, on a virgin lip, meaning that they

00:18:58.720 have never had it before there, even, even if I do one syringe and to me, you know, the

00:19:04.000 lips look a little swollen, a little pink, a little bit, you know, a little bit, a little

00:19:08.840 bit fluffy.

00:19:10.200 The, the panic that some patients have when they look at themselves in the mirror, like, 0.98

00:19:15.280 oh my God, I look ridiculous. 0.82

00:19:17.440 And I'm looking at them thinking, you really don't look that much different. 0.99

00:19:21.440 That is a common pattern.

00:19:24.760 I think people look at themselves in the mirror, and when something changes to them that's

00:19:28.480 drastic, even if it's subtle to the outside observer, they magnify it.

00:19:32.780 But then they look at themselves in the mirror or through their iPhone or in some sort of

00:19:38.040 selfie mode on their camera so often that their brain subconsciously normalizes that

00:19:43.160 change, and their brain goes back to yearning for more again.

00:19:46.820 So it's not uncommon for that same patient who is panicking at 1cc to dwell or be remorseful

00:19:54.420 at a week because the swelling's going down and they like the way it looked and they don't

00:19:57.920 want it to go down anymore.

00:19:59.660 And so that same patient will come back and now their new normal is where I left them

00:20:05.060 and they want to be bigger again.

00:20:06.300 And I think you're constantly changing the thermostat when you get fillers to a point

00:20:10.480 where you can look ridiculous to the outside world, but to yourself, this is normal.

00:20:16.480 It's like perfume or cologne. 0.90

00:20:18.780 I mean, some people put cologne on and then they become used to it.

00:20:22.220 And they put more and more on until they smell maybe pretty good to themselves, pretty neutral, pretty mild.

00:20:29.160 But to the outside world, they can be smelled, you know, 10 minutes before they enter a room.

00:20:33.980 We all know people like that.

00:20:35.020 Like every Uber driver I've ever had.

00:20:37.420 Like every Uber driver you've ever had.

00:20:39.940 This is the truth.

00:20:40.920 This is the truth, my friends.

00:20:42.080 And so I don't see the same with Botox as often, I got to say.

00:20:48.320 And I am due for some new Botox, but I had a really bad experience last year on book tour.

00:20:57.160 So I went to a new place that was recommended by my friend who is a television anchor.

00:21:01.500 So I thought they were going to be great.

00:21:02.840 They used Dysport on me for the first time.

00:21:05.840 Okay.

00:21:06.440 And it made me look like a Neanderthal.

00:21:08.480 It pushed my brow into my eyes so that they got very, I'm doing it right now so I sound funny.

00:21:14.580 It got very squishy.

00:21:16.300 And I had Neanderthal face for the beginning of my book tour.

00:21:19.760 Does that even make sense? 0.90

00:21:21.320 It doesn't only make sense, but I have the same exact issue.

00:21:25.620 I have like washboard forehead abs, okay?

00:21:29.260 So I have, and as a plastic surgeon, obviously I have like unlimited access to Botox.

00:21:34.640 Oh my God, that sounds so fun.

00:21:36.440 It sounds fun. But the reality is, as much as I hate having deep wrinkles on my forehead, I hate even more having brows that fall into my eyeball holes and looking like I'm a pretty scary looking dude, I guess. I mean, I'm just an intense looking man. And to have low brows makes my dry East Coast humor that much more accentuated, I think, in the West Coast here where everybody's like, oh, hey, what's going on?

00:22:01.860 Oh, sweetie, that is why I had to leave the West Coast, okay? Because, like, I drop an F-bomb every other sentence. I'm sarcastic. Like, they just could not handle me out there.

00:22:13.160 I miss it out there in New York.

00:22:14.940 I know. I know. It's nice here.

00:22:17.160 So here's what happened. Dysport is a broad, it's like a, it's like a broader reaching.

00:22:22.420 If you want to think of it as like a more dilute agent, it's like rather than a paintbrush,

00:22:27.080 it's like a watercolor. You put a little bit more on, but it's a more blended diffuse treatment.

00:22:32.220 And so it's great for the forehead muscles. I think that the result of your dysport treatment

00:22:39.240 probably has less to do with the fact that it's dysport and not Botox, even though theoretically

00:22:44.920 that could have an effect than the injector and the way they injected your forehead. I think

00:22:50.080 technique will always trump the neurotoxic agent that they use. So that is a technician-dependent

00:22:59.520 outcome. So I would say, don't say I'm never using Discord again, and I have no financial

00:23:04.740 ties to any of these companies. I would say maybe try a different injector. Yeah, I think that's

00:23:12.260 what i'm gonna do i do dial it down just say like i had a really excessive treatment last time

00:23:17.240 i don't want to be frozen can you can you just turn down the dial if you really liked his or

00:23:22.500 her personality and they came highly regarded maybe you just had a little bit too much of a

00:23:26.820 treatment for your brow no i'm i'm agnostic about them i'll try someone new i mean i'm fascinated by

00:23:33.680 by all the aspects of plastic surgery like i said i'm considering a boob job what i've been told

00:23:41.380 is that a boob lift is actually more invasive than a boob job. Is that accurate?

00:23:48.020 No, it's not accurate.

00:23:49.420 Okay, good. People are just lying to me all the time.

00:23:51.880 People aren't lying to you. I mean, look, a breast lift is a lot. It takes more time

00:23:57.220 than a breast augmentation. But what is invasive? I mean, so if invasive means how long it takes on

00:24:04.260 the table, then yes, a breast lift takes three times as much time as a breast augmentation.

00:24:09.180 But a breast augmentation, especially if you're deflated, I don't know if your surgeon's going to go under the muscle or above the muscle, but you, even a short operation, are dissecting down between the muscles of your chest wall and the ribs.

00:24:23.400 And that's way more invasive than a breast lift, which is skin and fat only.

00:24:27.160 So if you're talking about depth of surgery, a breast lift is not as invasive as a breast augmentation.

00:24:33.420 If you're talking about the time it takes to recover, a breast lift is not as invasive as a breast augmentation because when you're releasing muscle, it hurts.

00:24:42.980 You're going to have more downtime.

00:24:44.680 But if you're talking about pure operative time, like I'm going to be under anesthesia for longer, sure, you can argue that a breast lift is more invasive.

00:24:51.940 Okay, that makes sense.

00:24:52.780 That makes sense.

00:24:53.880 If I got implants or if anyone gets implants, do you have to have them removed after a certain period of time?

00:24:59.380 No.

00:25:00.040 Okay.

00:25:00.400 And don't let anybody tell you you do.

00:25:02.140 I've taken out implants that are older than me.

00:25:06.380 I've taken out these like they're called Dow Corning implants from like the 70s.

00:25:12.480 I don't want to reveal how young I am, but I, you know, I have definitely taken out old

00:25:19.340 yellow sticky implants from the Cold War era.

00:25:22.980 And they only came out because this person was 79 years old and it was starting to cause

00:25:29.100 back problems.

00:25:29.880 The implants were gross looking, but they were not causing any harm.

00:25:33.500 So all this, you got to replace them every 10 to 15 years.

00:25:37.080 I mean, I think it's a good rule of thumb for setting expectations.

00:25:40.020 There's a lot of reasons that we do switch them out.

00:25:42.100 If you want to be bigger, if you want to be smaller, if they get encapsulated, that means

00:25:46.040 hard, then you obviously want to take them out.

00:25:48.720 If they have any, if you're concerned about rupture, you want to take them out.

00:25:52.140 So if you're going to look at the population at large that's getting breast augmentation,

00:25:56.280 I would say on average, we swap them out every 10 to 15 years.

00:26:00.220 Sure.

00:26:00.680 But you don't have to.

00:26:01.600 They're perfect and you're healthy and you're fine and you like them and your husband likes

00:26:05.560 them.

00:26:06.060 Why would you do it just for the sake of checking off a box?

00:26:09.700 There's no medical reason.

00:26:11.760 I also don't care if my husband likes them.

00:26:14.320 Good answer.

00:26:15.680 It's just, I mean, it's really just all about me, to be honest, at this point.

00:26:19.920 I'm 44 years old, right?

00:26:21.500 I'm like, no.

00:26:22.300 So am I, Joe.

00:26:22.640 So am I.

00:26:23.200 Oh my gosh, we're the same age.

00:26:24.920 I love it because I always assume everyone is my age.

00:26:26.940 I've reached that age where I'm like, oh, we're the same September 12th.

00:26:30.700 I'm September 2nd, 1980. 0.99

00:26:33.060 Shut your mouth. 0.98

00:26:34.360 I swear to God, I'm getting too much information. 1.00

00:26:37.000 You're not.

00:26:37.880 You're not.

00:26:38.680 Oh, let's take one more quick break.

00:26:41.020 When we get back, I want to talk a little bit about the myths of of plastic surgery.

00:26:46.940 TikTok.

00:26:47.200 I think that people are, like, being sold something by these plastic surgery influencers that is a little bit crazy these days, just so these people can get attention.

00:26:58.040 I can't wait.

00:27:06.600 Okay, we are back.

00:27:08.080 I want to talk about influencers, not just TikTok, but Instagram influencers, the plastic surgery influencers, because I think that they are selling people.

00:27:20.000 We talked earlier about the fantasy, but they're definitely showing things that are that are not possible, that are not real just to game the algorithm.

00:27:27.720 Are you seeing more and more influencers in this space than ever before?

00:27:31.200 I'm seeing fewer influencers and I'm seeing more A-list celebrities in this space.

00:27:40.060 Oh, interesting. Like Kylie Jenner just talked about her boob job, right?

00:27:44.560 Yes.

00:27:46.240 And that was very interesting. That made headlines around the world because people were like, oh my gosh, why would she talk about this?

00:27:53.120 Why would she talk?

00:27:54.020 It's a great question.

00:27:55.360 And I think this is the question that our mutual friend Kate had that made the introduction

00:28:00.460 between you and I.

00:28:01.760 And I've been thinking a lot about it.

00:28:03.500 Why are celebrities all of a sudden talking about their plastic surgery?

00:28:10.580 It's perplexing.

00:28:11.600 Why?

00:28:11.920 Why do you think so?

00:28:13.660 I can only fall back on the same concept of the value of authenticity.

00:28:22.300 Everything in this world is supply and demand.

00:28:25.640 You know, the supply of looking superhuman is much easier to obtain now than ever.

00:28:33.240 But the supply of proving it, of being authentic, is diminishing.

00:28:38.300 So the demand for that is getting so much higher.

00:28:40.680 So perhaps on some spiritual cosmic level, celebrities are weighing out the risks and benefits of saying too much and being authentic.

00:28:49.720 So one of the possibilities is that by coming out about surgery that you've had, you are going to gain wealth in authenticity, and that will be rewarded some way or the other.

00:29:01.020 I don't know how.

00:29:01.740 I'm not that smart, but I think the value of authenticity trumps the value of being naturally blessed or gifted.

00:29:10.400 The other thing is celebrities who are maybe B-listers or C-listers or are maybe losing some steam want to get back into that limelight.

00:29:19.440 And they find that every time they do something, they get onto a news outlet or a media channel that sparks conversation about them again.

00:29:28.080 So I think those would be the two avenues I can think of.

00:29:31.640 Maybe a third one is you're just bragging.

00:29:34.420 Like, you know, I have this surgery from a surgeon who's really hard to get.

00:29:39.940 Check me out, you know.

00:29:41.720 Oh, that's interesting.

00:29:42.640 So like the surgeon as the status symbol these days.

00:29:46.240 Yeah. I mean, I don't want to talk about influencers or celebrities by name, but like Garth Fisher is a plastic surgeon that, you know, was recently announced as doing a breast augmentation on an A-list celebrity or a socialite. And I'll tell you what, Garth Fisher is an amazing brand. He is very well known for his breast surgery. He's been doing it for a long time. And he's one of those plastic surgeons that has not been fraught with controversy.

00:30:10.540 he's been a popular brand in plastic surgery for decades and so yeah i mean if i had a breast

00:30:16.780 augmentation i'd want to be like oh yeah this is a garth fisher breast aug he's hard to get i got

00:30:21.360 him so that's a possibility i haven't even heard of him but i also don't live in this world so it's

00:30:26.520 just like don't go to me i'm not i'm not putting i'm going if i do this i'm going i'm flying there

00:30:30.920 and i'm going to you okay great great job all right great very very close handholding i love

00:30:36.200 this also i need all the handholding um but i just think that's like that's funny to me like

00:30:39.860 i've got a garth fisher breast augmentation like you're wearing i've got the prada i've got the

00:30:45.560 prada of augmentation exactly and there was a guy you know there's a guy who i respect tremendously

00:30:50.660 in new york named andrew jacona who years ago was the was the go-to guy for facelifts and i think

00:30:56.140 something may have happened i just haven't heard his name as much maybe that's by his design who

00:31:00.120 knows maybe he doesn't want to be in the limelight but for whatever reason maybe his star is fading

00:31:04.720 a little bit and somebody else comes up the guy who did chris jenner's facelift for example

00:31:09.160 is the next name that would come up. Do you think that when people are looking to spend a lot of

00:31:16.280 money on things like this, are they Googling who did Kris Jenner's facelift? Absolutely. I think

00:31:22.020 if you hear enough that Kris Jenner had her facelift by this young up-and-coming plastic

00:31:28.660 surgeon in New York City, facelifts are scary. I mean, unlike breast augmentations where you can

00:31:33.160 just kind of revise it under the hood. Facelifts are in your face. In this selfie slash social

00:31:39.920 media slash Zoom forward culture, you know, facelifts are one thing that you can't get

00:31:45.800 wrong. And so going to a name brand has a lot more value than going, for example, to a foreign

00:31:51.360 country. Although a lot of people are still doing it, going to Turkey and other countries

00:31:55.400 because it's less expensive. I think people still place a tremendous value on a recognized name.

00:32:02.120 And if Kris Jenner looks this good and she had her facelift with this surgeon, then the odds of me getting a result that good are higher with that surgeon.

00:32:12.540 I think it's very reasonable to think that, but that logic is unfortunately very flawed.

00:32:18.440 Yeah.

00:32:19.100 I don't know.

00:32:20.320 I don't need Kris Jenner's facelift.

00:32:23.480 I don't even know if I need a facelift.

00:32:24.740 I mean, there are some things that I'm down with aging gracefully with.

00:32:29.900 And then, you know, things like a potential boob job. 0.93

00:32:33.540 I'm like, I just miss my normal boobs. 0.98

00:32:35.420 I liked my boobs before kids. 0.80

00:32:36.800 And I'd like those guys to come back and hang out with me. 0.97

00:32:40.020 Surgery could help you with that.

00:32:41.540 I think it could.

00:32:42.380 I do think it could.

00:32:43.660 I want to flip the interview a little bit.

00:32:46.760 We're talking about influencers, but I see a lot of plastic surgeons feeling the need

00:32:51.360 to be on social media now to increase their brands.

00:32:54.460 Is that a thing?

00:32:55.520 It is unfortunately a thing.

00:32:57.760 And I, I, I am personally really bad at it. And you're going to say, oh no, you're so natural on

00:33:02.840 the, on the microphone. How can you be bad at it? I am really, really bad at it. And I hate it.

00:33:09.600 And that's a strong word. I don't even let my kids use the H word in my house. I don't like

00:33:14.200 that social media is necessary, but it absolutely is. You can't hang in New York. You can't hang

00:33:21.020 in california if you don't have a social media presence so yes i'm i am i'm grateful to be on

00:33:28.960 your podcast i am grateful to have a youtube channel but beyond that it's really hard to

00:33:35.540 gain popularity without being tiktok famous or having a viral result dude don't i know it okay

00:33:42.720 like i don't don't like to use the h word either but i also kind of hate being on social media

00:33:50.660 I'm perfectly good at it, and especially for being an author where this doesn't necessarily come naturally. But it is the only way to sell books these days. It is the only way to make sure my podcast is out there by making myself a kind of social brand and putting myself out there on a daily basis.

00:34:13.800 And it is such a grind.

00:34:16.420 But I do feel like all of us have to constantly be branding.

00:34:21.320 It's like the Glengarry Glen Ross, always be closing.

00:34:23.660 I'm like, I'm always be branding, friends.

00:34:26.220 Always be branding.

00:34:27.300 And maybe what you don't like about it, what you detest about it, is what I detest about it, which is I'm a fast talking.

00:34:34.220 I come across perhaps as arrogant when people first meet me, especially on the West Coast, because I talk a little bit differently.

00:34:39.440 um i do not like promoting myself i will tell you right now i don't either that's the problem i don't

00:34:47.120 like promoting myself humor and i think with social media if you're not promoting yourself

00:34:51.840 or a product then you're not doing it right you know people people don't really care about what

00:34:59.080 you're building or your office looks like you've got to be telling people that you're the best and

00:35:02.760 this is why constantly and it's hard for it's really hard for me to do that it's hard for me

00:35:08.080 to say one certain facelift is so vastly superior to the other. This technology, Morpheus 8, body

00:35:14.500 type, face type, you name it. These are the best technologies. And I think it's got to be even

00:35:18.820 harder in the med spa industry where you're relying on products more than you're relying

00:35:22.960 on yourself. I mean, it's got to be hard to be a salesperson. And I am not a salesperson. I'm a

00:35:27.880 fast talker. I'm a sweet talker. You're a sweet talker. You're a sweet talker. Yeah, I don't like

00:35:33.940 being a salesperson. That's the thing. I like being good at something, which is writing books,

00:35:40.120 but I don't necessarily want to have to be the constant sales and marketing person

00:35:46.120 for those books. It's fun to preach, perhaps, but it's not fun to sell.

00:35:52.580 It's not fun to sell. It is not. But again, my dentist is on social media now and they've built

00:35:58.940 this great brand of, you know, look at our amazing dental work. Look how good we are at

00:36:04.800 teeth whitening. And that's where people's eyeballs are these days. And that's where you

00:36:10.180 have to be. It's really sad. You know, I'm going to talk about a recent event that's pretty

00:36:14.980 sensitive. It happened this week. But around the COVID pandemic era, I hired an in-house

00:36:21.080 videographer to help me build my YouTube channel because I thought that this would be a platform

00:36:25.680 to kind of to educate, to talk about things in plastic surgery, kind of like we're doing here

00:36:31.040 today. And I'm very grateful for this opportunity. And when I first started in 2021 or 2020 with this

00:36:37.440 YouTube channel, I talked a lot about buckle fat pattern removal, facial liposuction and celebrity

00:36:43.800 plastic surgery. And I quickly was rewarded with tens of thousands of subscribers on my YouTube

00:36:51.680 channel. And then I'm like, okay. And I kept this guy in house and I'm like, this has got to be

00:36:56.140 selling something. And then after a few years, I'm like, I just don't want to gab about celebrities

00:37:01.960 anymore. I don't want to speculate. I don't want to gossip anymore. And my message came across that

00:37:06.440 if a celebrity does not admit to plastic surgery and there's no physical evidence for the internet

00:37:11.480 sleuth to find that they've had plastic surgery, then accept that they didn't have it. Just accept

00:37:16.060 them as a human being. And that was sort of my message. And I retired the whole celebrity

00:37:20.080 discussion. I just put it in the back burner and I went directly to talking about biomaterials and

00:37:25.780 facial implants and facelift techniques. And guess what? My YouTube channel died, absolutely died

00:37:32.720 when I went from a gossip to an educator. And it's just a really sad way of sort of portraying

00:37:39.660 what's going on in the world today is the world does not reward education anymore. It rewards

00:37:45.620 this instant gratification. Who did what? You know, how much did this cost type of mentality?

00:37:53.040 And I don't like that. But guess what? If you don't go with the flow, if you don't play the

00:37:58.380 game, you'll get punished for it. So I'm trying in the present moment to try to find new ways

00:38:03.940 to play this game in a way that's self-satisfactory. Yeah. Yeah, I agree. But it is so easy to fall

00:38:11.680 into that gossip kind of hole right because those are the things that perform well on the algorithm

00:38:18.460 and it's not fair it's not right I mean I created gossip magazines for a long time plastic surgery

00:38:23.640 covers did so well and there's one that there's a lot but a lot of covers I regret and I remember

00:38:28.840 one that was Kim Kardashian Kim Kardashian plastic surgery while pregnant oh dear I mean it sold so

00:38:38.300 well. Also, it was true, but just damning and judgmental of a woman when I didn't have to do 1.00

00:38:46.360 that. But that was the edict of capitalism of making a magazine at the time. 0.99

00:38:50.360 Isn't it crazy? And what we have to sacrifice as far as our moral fibers, who we are as good

00:38:55.860 people to try and run a business and survive in this world is it's a shame. It's really a shame.

00:39:02.260 It's a shame. It's a shame. It's it's it's crazy. I have one last question before I let you go.

00:39:06.920 Oh, I'm just getting started, Jo.

00:39:08.360 Oh my gosh, darling.

00:39:09.660 I love it.

00:39:10.600 I have a droopy chin, like, right?

00:39:14.700 Like, you know, I think it's like, there's a little bit of fat in there, but I'm also

00:39:17.920 starting to get jowly.

00:39:19.920 I love that you guys can hear my voice change because I'm like touching it now.

00:39:23.820 What are the fixes for that?

00:39:26.120 I mean, if it's fat, you can liposuction it.

00:39:28.820 If it's fat with a little bit of skin laxity, you can consider doing some radio frequency

00:39:33.580 of your energy-based treatments to tighten the skin while you liposuction. But remember,

00:39:38.440 liposuction is just deflating that pillowcase even further. So eventually, while we're approaching

00:39:44.140 our mid-40s, and your audience might not like what I'm about to say, is we are falling into

00:39:49.060 facelift territory. When you're starting to see the pavement crack, that can be the time to act

00:39:54.680 on it. Modern-day facelifts don't need to be recognizable. You don't need to have the stigma

00:40:00.860 of having a pulled face.

00:40:02.480 You don't need to look different.

00:40:03.740 We can change these small feature problems

00:40:06.900 with aggressive sounding operation

00:40:10.280 that in skilled hands

00:40:12.060 should have a quick recovery

00:40:13.560 and decades,

00:40:15.280 not seven years,

00:40:16.460 but decades of reward.

00:40:19.120 Okay, yeah, that's what I want.

00:40:20.520 That's what I want in like.

00:40:21.360 And I'm also very cool

00:40:22.460 with talking clearly

00:40:23.480 about my plastic surgery.

00:40:26.160 I'm, you know, I'm getting,

00:40:28.180 I'm vaguely vain at this point

00:40:29.860 as I think anyone is. 0.96

00:40:30.860 who puts their face out there in the world because there are male trolls that tell me I am ugly and 0.98

00:40:36.280 homely on a daily basis. And some women, some nasty women. And I just think if this is a thing 1.00

00:40:42.980 that makes you feel confident, you go for it, girl. I think that's what it comes down to.

00:40:48.040 In this world of unpredictability and instability and all of these things, whatever it takes to make

00:40:55.220 you feel good, as long as it's safe and it doesn't hurt you, should be taken seriously. And I know

00:41:00.460 plastic surgery. It sucks to have trained for so long and to jump over the highest yardsticks to

00:41:09.460 get where I am now, only to be the kind of doctor that nobody needs. But the reality is we do make

00:41:15.600 people feel better about themselves. And sometimes even if the physical change isn't there, that

00:41:21.320 mindset, that confidence, that strut is what we're selling as plastic surgeons.

00:41:26.420 I agree. I agree. I mean, I think that confidence, even though I mean, is it necessarily philosophically right that it does come from our outward appearance? It often does. OK. And anything that makes anyone feel good. Yeah. Like I said, I am here for it. Dr. Zalkin, please tell people where they can find you on the Internet. That terrible place where we have to live.

00:41:49.220 the internet's dying is the internet even is that even a thing anymore what is seo why am i paying

00:41:54.680 for seo what is that oh i don't know why you would pay for seo anymore my internet worldwide website

00:42:00.040 is www.zelkenmd.com and my instagram handle is at jonathan zelken md i i don't really know if i

00:42:12.980 have a TikTok channel. I think I might. And my YouTube channel is also at Jonathan Zelkin, MD.

00:42:20.400 Wonderful. I love that. I love that. Thank you so much for being on today, my dear.

00:42:25.220 It's been my pleasure. Thank you, Joe.

00:42:42.980 Thank you.

00:43:12.980 You

Under the Influence (with Jo Piazza) - July 31, 2025

Can Plastic Surgery Keep Up With AI？

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