10 Things You’re Wrong About in Cosmetic Surgery

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Kirstin (00:09):
Hey, Dr. Koehler.

Dr. Koehler (00:10):
Hey Kirstin.

Kirstin (00:12):
Okay, we're doing a fun one today.

Dr. Koehler (00:13):
Alright. Why is it fun?

Kirstin (00:16):
Because I said it's fun. This is my idea actually, I think.

Dr. Koehler (00:21):
Okay.

Kirstin (00:22):
We are doing Myth Busters Cosmetic Surgery edition.

Dr. Koehler (00:26):
Okay.

Kirstin (00:27):
This might not have been my idea, but I'm going to claim it.

Dr. Koehler (00:30):
Alright,

Kirstin (00:30):
So myth number one.

Dr. Koehler (00:34):
Okay.

Kirstin (00:34):
Liposuction is good for weight loss.

Dr. Koehler (00:37):
Yeah. Have you ever heard me say that?

Kirstin (00:40):
Never. Never. You hate that?

Dr. Koehler (00:43):
No. Yes, I don't hate it, but definitely it's one of those bothersome things when you have people that are clearly overweight that come to you to get liposuction, and the goal is for them to lose weight and yeah, you lose a little bit. Whatever we take off, you're going to lose, but it's always much less than the person thinks it's going to be. It's a tool to contour areas, so trouble areas. So for women, saddlebags, love handles, maybe a little abdomen or upper arms. There's lots of areas we can contour, but it's to contour. So if you've got a big outer thigh, we're not trying to give you, and you can't shrink wrap something. That's another thing. Sometimes people come in, they're like, my entire upper thigh is big. I'm like, well, we're really just contouring. We can't just circumferentially liposuction your whole thigh and give you a skinny thigh. That just doesn't work that way anyhow. No, no, no. It's not a weight loss procedure. It's not.

Kirstin (01:56):
What about just substituting a little lipo for diet and exercise? Just like here and there?

Dr. Koehler (02:00):
Yeah. No.

Kirstin (02:02):
Okay.

Dr. Koehler (02:02):
It's a great tool and you can be a little bit overweight and still get liposuction, but it's a contouring thing. So it's for people with stable weight with a problem area, and sometimes if somebody's really fit and they told a family member that they're going to get liposuction, they might go, oh my God, but you're crazy. You look great, blah, blah, blah. But they may look great, but they may just have a contour thing that really bothers them and that is the perfect candidate for liposuction. It's not because it's not weight loss. It's like, oh. But that reaction that people have, if somebody's like a normal weight and they say they're going to get liposuction, that's why they get that weird reaction from their friends is because everybody in their head's like, oh, trying to get suck off that weight. And that's just not what it's for.

Kirstin (02:50):
Okay, what about number two? Breast implants need to be replaced every 10 years.

Dr. Koehler (02:56):
And go up a hundred ccs.

Kirstin (03:01):
Yes. We go up a size every time.

Dr. Koehler (03:05):
Yeah, no, the short answer is no. But there's a longer story here. The silicone implants when they first came out, and of course even now after 10 years, we know the incidence of leakage does go up over time. They eventually can leak. They're not permanent devices. They were never meant to be one and done. So for sure, after 10 years, if you haven't been, you had better be maybe checking to see that they're leaking, so that if they are, you can have 'em replaced. Now, saline, on the other hand, if it's leaking, it goes flat because your body reabsorbs that water so you'll know. So if you have a saline implant and it's soft and it looks good, then you're good to go. You don't have to replace 'em in 10 years, but realize that you make it wake up one morning and we get these phone calls all the time.

(03:55):
They're like, oh my God, I need to see Dr. Koehler this week. They've had their implants for 15 years and they woke up the next day and now one of 'em is completely flat and they want to be on the schedule like yesterday. But it's fine. Usually breast aug replacements or something that you can work in fairly quickly. But silicone on the other hand, you need to do imaging. So you don't necessarily have to replace them in 10 years, but you should be getting imaging done. At least a screening ultrasound or an MRI. MRI is more expensive, not covered by your insurance, but every couple of years you should be getting 'em checked with a screening ultrasound.

Kirstin (04:34):
The next one is, if it's non-surgical, there's no risk.

Dr. Koehler (04:39):
Yeah, I mean, there's a part truth to that. Non-surgical stuff in general is lower risk, but also lower reward. So that's the benefit of nonsurgical stuff. But no, risk is not true. There's always risks. You can die from too much water. If you were to drink too much water, you can, anything in excess or in the wrong situation can be harmful. So for instance, there are reported cases of blindness after filler from injecting it into certain arteries around the eye. There can be skin necrosis if a filler is injected into an artery and you can lose skin. And these are things that that's why you want to have an experienced injector or if these things do occur that they actually know how to handle them and handle them properly and quickly. Nothing is ever no risk, but I definitely say the non-surgical stuff is not high risk, but research it before you do it. I mean, certainly these things are rare, but they do occasionally happen.

Kirstin (05:47):
Okay. What about number four? You can't breastfeed with breast implants.

Dr. Koehler (05:54):
You can. There's about, I don't know what the current data is, there was a study that I looked at years ago when they were looking at women that got breast reductions before having kids and their ability to breastfeed. And in that particular study, and they matched those patients based off of their body mass index and whatnot. One group didn't have any surgery, and then there were some other groups that had surgery with different techniques, and then they compared that to the group of women who breastfed had no surgery, and about a third of the women couldn't breastfeed regardless of not having any surgery at all. So I don't know if that's maybe last data, it's 20%, I don't know. But let's just say there's a significant percentage of women, whether it's from mastitis or they have inverted nipples or they have issues. There could be a lot of different reasons.

(06:45):
The baby just isn't latching on. Unsuccessful breastfeeding occurs in a proportion anyhow. But just to finish the story on the breast reduction part, actually a significant number, it was statistically almost the same as not having any surgery at all, that most of those women could go on to breastfeed, but small study. With implants, if we're putting them under the muscle, we really are not touching hardly any of the gland, and absolutely you should be able to breastfeed, but if you can't, there are all those other reasons that you might not have been able to breastfeed without implants.

Kirstin (07:21):
Yeah. Okay. Myth number five is cosmetic surgery is just for women.

Dr. Koehler (07:26):
Yeah,

Kirstin (07:29):
Whatever. We see men all the time, literally every day.

Dr. Koehler (07:35):
Yeah, no, definitely the male patients are fewer. Yeah. Men are choosing different procedures. They tend to be things like liposuctioning of love handles, gynecomastia, fullness in the male chest, chin implants, noses, eyelids. So they're doing some things and a lot of times it's stuff that, again, they're not looking for perfection. They're looking for normal. So men that get gynecomastia where they have almost breast tissue in, men guys don't want that. They want to just have a normal chest. So that's what we're doing, trying to correct it. Love handles, nobody loves love handles. You got to get rid of those things. So stuff like that.

Kirstin (08:16):
All right. How about only vain people get cosmetic surgery?

Dr. Koehler (08:21):
Yeah, no, that's something that I actually, I think I do this for a living, and I know, I dunno if I know, but when my kids were younger and they're all grown up now, but when they were younger, I guess I just didn't want my kids, first of all, I don't want my kids to have a complex, they're not good enough and they should have to have something done. I mean, just especially because their dad does this, should they be concerned about their body and all that kind of stuff. And I'm like, that's the last thing that I want. But also doing what you come to realize is we make big differences in people's lives, and it's not about achieving some kind of perfect body image. It's like if you see some of these people who've lost weight and they're just trying to look, they just want to look normal.

(09:11):
They want to look good. Actually, they've gone through a lot of, they've done, whether it's diet, exercise, maybe it's some surgery or medications that they've assisted along the way, but they got to a point and it was a journey for them, and now they just want to look their best. And so that's what we try to do. Same thing with mommy makeovers. It's like they've gone through multiple pregnancies, they've dedicated their waking hours to taking care of children, and now they don't feel like they used to before kids. And they're not looking to be bikini models. They're just like, I just want to feel good when I get dressed and go out. And so is it vanity? Well, sure, but getting your hair done is vanity. Do we have any issues with that? I know surgery is not like hair. There's risks involved, but it's the same principle.

(10:01):
You get your nails done and your hair done to feel good about yourself. To me, as long as the risks are reasonable and we're all on understanding, I think there is a place. Again, surgery should never be taken lightly, and we have to always weigh the risks. Is it just a vanity thing? I don't think so. I mean, I think there's a component of that, but I think feeling good about yourself, especially something that you can't change. If you've got loose skin from weight loss, you've already been working, you're working out all the time, well, you can work out some more. It's not going to tighten the skin. That's not going to happen. So anyhow, for the people that are down on people getting cosmetic surgery, sometimes, I don't know if it's just a jealousy thing or you know what, most of the time it's just a complete lack of understanding. They don't know what these people have gone through. And you always say, maybe walk in their shoes for a little while because sometimes there's a lot more to the story and you just don't know. So if you don't know, keep your mouth shut.

Kirstin (11:04):
Then shush.

Dr. Koehler (11:05):
Yes.

Kirstin (11:05):
Yeah. Okay. Number seven is you can pick any nose you want.

Dr. Koehler (11:10):
Well, you can show me any nose you want, but that may not be what you get because you can't just pick one off the shelf and install it. It is, you've got, nose surgery is one of those things where you can actually have two noses that may externally look actually quite similar, but be very different because of the size of the nasal bones, the strength of the cartilages, the size of the cartilages, the thickness of the skin. And so two people can have a hump on their nose or something like that, and yet they can be very different surgically. And so depending on the circumstances. So I always like when people say, well, this is what I'd like my nose to look. It helps me because then I can go, that's actually achievable. I think we can get you close to that. Or sometimes I'm like, no, no, no, no.

(12:01):
We can't get that. It's not possible because your nose also serves a purpose and you've got to breathe through it. And there's limitations and some of those limitations, the skin, I can't change your skin. We can try to thin it out sometimes, but the thickness of the skin, and some people, they are really deficient in the strength of their cartilages. And so even to achieve some of their goals, we have to do a lot more dramatic things like rib grafts or other things. So I guess the important thing is no, it's not like you can draw a picture and it's not a piece of clay. You can't mold it like a piece of clay. But showing pictures is helpful. Definitely good for the communication between you and your doctor. Yeah, it's not, show me a picture and I'll give you that.

Kirstin (12:47):
Okay. Not a magician.

Dr. Koehler (12:50):
Well, I've been told that.

Kirstin (12:52):
Somewhat a magician. Okay. How about number eight is you'll look fake if you get work done.

Dr. Koehler (13:01):
Some people do.

Kirstin (13:03):
Yeah,

Dr. Koehler (13:04):
Some people do.

Kirstin (13:05):
I already told you when they put me in the incinerator, when I die, I want just to be plastic left.

Dr. Koehler (13:15):
You want to be all plastic.

Kirstin (13:16):
It'll still look like person.

Dr. Koehler (13:17):
The opposite of the bionic man, just implant.

Kirstin (13:19):
Yeah.

Dr. Koehler (13:21):
Yeah, no, some people go for fake. If somebody comes in for breast implants, and if somebody says, listen, I want something tasteful appropriate for my size, I don't really want it to look super fake, whatever. I mean, we can find you that, but if you tell me that and then we're looking at 800 cc, high profile implants, I'm going to be like, well, what you just told me and what we're doing right now are not the same thing. So there's a lot of things that go into it. But same thing with looking fake with a facelift. If you say, tighten my skin as tight as you can get it, well guess what? If I do that, you're going to look fake. It's not going to look normal. I think again, having communication with your doctor, what you're trying to achieve, the results, in my mind, we're going for more or less natural.

(14:14):
And you can definitely, I mean, when it comes to breast implant size, I mean that's a taste thing, right? Some women like smaller boobs. Some women like bigger boobs and bigger is going to a lot of times look faker. So that's fine. But you can't say fake and natural in this, like I want natural looking boobs. But give me the big ones because they're giveaway, right? If you are five, four and a hundred pounds and you choose really big implants, you weren't born with those. So some things I'm okay with. If somebody's wanting a bigger implant, that's a personal choice. I'm not here to judge or whatever you want to get is fine. But there are certain things, like you said, pull my face tight as you can get it. I don't care if it looks fake. I'm not doing that because my name's on that. And I just have, to me, there's certain things I'm like, no, I'm not doing that. Or you see some of these things, people get these cat eye things done or whatever it is. I'm like, that's a fad. I'm not doing that weird stuff.

Kirstin (15:19):
Okay, number nine is scars mean it was a bad surgery?

Dr. Koehler (15:26):
No scars mean it was surgery. That was surgery. Yeah. Can't do it without scars. You can do small scars, but typically all surgery has some kind of an incision. But if they're bad, bad scars can be from multiple factors. There are the unknown things like just genetically your body and how it reacts. Because a keloid scar is an abnormal reaction to a surgical or a trauma to the skin. Whereas a hypertrophic scar is just a thickened scar and it's an abnormal reaction to, but it doesn't grow beyond the boundaries of the incision. So keloids are like, you get your ears pierced, and if you've ever seen anybody, it looks like they got a golf ball hanging off their ear lobe. That's just scar tissue and it's a keloid. Those are incredibly difficult to treat. So genetics, it can be from poor surgical technique. So if a scar got infected, that will oftentimes, it can result in a poor scar, not always, but it can using suture that your body, sometimes people are more reactive to a certain suture.

(16:40):
I don't want to say allergic, that's putting probably not the right word, but your body may have more of an inflammatory response to a typical suture than let's say somebody else. So you want a surgeon that uses a good brand of suture. They're not just buying cheap suture from some weird place overseas. I mean, we try to use the best stuff and we have our own little scar management protocol that we go over with patients and talk to 'em about. And some of the materials and things that we use, we're always looking to try to make our scars look better. We try to hide them. So the positioning of scars is important, and then what we do surgically is important. And then what you do after surgery to manage those scars is also important. And there are other things, if a scar is not healing, ideally there's injections, there's some nonsurgical therapies that we can do. There's things that can be done. So if you're a bad healer, bring that up ahead of time and we can have some discussions.

Kirstin (17:37):
Yeah. Alright. Our last one.

Dr. Koehler (17:40):
Okay,

Kirstin (17:40):
Number 10.

Dr. Koehler (17:42):
This is the best one?

Kirstin (17:44):
This is the best one

Dr. Koehler (17:45):
Of the myths. This is the best one. Okay. What is it?

Kirstin (17:48):
Cosmetic surgery is only for the rich.

Dr. Koehler (17:53):
And famous.

Kirstin (17:54):
Oh my gosh. I was thinking that. I was thinking that. I didn't say it though.

Dr. Koehler (17:59):
No, it's for everyone.

Kirstin (18:01):
For everyone,

Dr. Koehler (18:02):
Yes. There's an expense that goes along with surgery. Surgery is not inexpensive, but it's certainly much more affordable than I think people think. It's where your priorities are. Right? And it depends. It depends on, I mean, it's not, like I say, it's not inexpensive, but if you were going to spend a certain amount of money towards, I dunno, a car or something like that, but this is your body. Your body. So you wouldn't expect to say, okay, well for $500, please operate on me. You wouldn't, somebody, you said, paint my car for $500, the entire car. I don't know if you'd get the paint job you're looking for. So I don't think you'd be too happy. But anyhow, the point is, is that there is financing for those people that need it. My caution to anybody though is that, listen, if it's not in your budget, don't get your financial situation in a difficult spot to have cosmetic surgery. But yes, there is financing. There's ways to go about that, but I think it's for really anybody.

Kirstin (19:09):
Okay. Anything to add?

Dr. Koehler (19:13):
I got nothing.

Kirstin (19:14):
You got nothing? I think so. Dr. Koehler ran out of words?

Dr. Koehler (19:18):
No, I just, if you got to give me a topic and then I can go. I can go more.

Kirstin (19:21):
That's all I got.

Dr. Koehler (19:23):
Alright.

Kirstin (19:24):
All right. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at Alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks Dr. Koehler.

Dr. Koehler (19:35):
Thanks, Kirstin.

Kirstin (19:36):
Get back to making Alabama beautiful.

Dr. Koehler (19:38):
All right, I'm on it.

Announcer (19:42):
I got a question for Dr. Koehler? Leave us a voicemail at Alabamathebeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you'd like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.