5 Years, 5 Surgeons, 5 Moments: The Best of the La Jolla Cosmetic Podcast

Announcer (00:00):
You're listening to the La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:05):
Hi everyone. I'm Monique Ramsey and welcome back to the La Jolla Cosmetic Podcast. This episode is going to be a little bit different. Five years ago, we sat down with our founder, Marie Olesen, for our very first episode and I really had no idea what we were starting. 230 something episodes later, here we are. So to mark five years, I went back through the archives and pulled five of my favorite moments, one from each of our surgeons. It's a countdown. So we're starting at number five and working our way to number one. And then I have one more thing for you at the end, the actual greatest moment in the five years of this show. You'll want to stick around for that. So all right, let's get into it.

Dr. Johan Brahme (00:53):
When we do a brow lift and I do a lot of brow lifts and I think it's a wonderful operation on women, not on men. It is an incredibly feminizing operation. And see, he looks surprised.

Monique Ramsey (01:13):
He does.

Dr. Johan Brahme (01:14):
He looks surprised. And when I evaluate a brow lift and I talk to my patients who are considering brow lifts, we divide the eyebrow into three regions, the inner region, the middle region, and the outer region. And if the inner region is down, you look angry. And if the outer region is down, you look tired. And the middle region, you don't really want to change because if you elevate the middle region, you look surprised. And he looks a little surprised here. He does. So maybe he was surprised that he got the award.

Monique Ramsey (01:58):
That was Dr. Brahme earlier this year breaking down what actually happened to Jim Carrey's face and why brow lifts on men are almost always a bad idea. Coming in at number four, our facial plastic surgeon, Dr. Kirsten Riedler, and a moment that has absolutely nothing to do with surgery and somehow everything to do with surgery. Take a listen. If your surgical results were a cookie, what kind would they be? Crisp and classic or soft in a little spic?

Dr. Kiersten Riedler (02:31):
I'd say soft with the little spice because-

Monique Ramsey (02:36):
And why?

Dr. Kiersten Riedler (02:37):
Well, because to be crisp and classic, I don't know. I feel like that's how people think of gingerbread, but nobody likes that kind of gingerbread. And maybe the same thing with facial plastic surgery, it's kind of harsh and done is not really what most patients want and what I try to deliver. So I think soft with a little spice is more like soft, natural, beautiful results.

Monique Ramsey (03:08):
Well, we are going to put in the show notes some information about if you're thinking about having any facial plastic surgery, which really is she does everything really from the clavicle up. So that's if you want to think about if it's a breast lift, it's not going to be Dr. Riedler, but if it's your ears, your nose, a face, eyes, brow, fat transfer to the face I think you'll see, we'll put in the show notes links to her gallery because you'll just see how natural her results are. And I think that your point about it's not done or overdone. Some things seem extreme and yeah, you want a noticeable difference to rewind the clock, but you don't want to be screaming like, "Hey, everybody, look what I had."

Dr. Kiersten Riedler (04:01):
You want to look better without people knowing why.

Monique Ramsey (04:06):
Soft with a little spice. That's Dr. Riedler in a nutshell. So number three is from our podcast with Dr. Diana Breister. And it's one of those moments that reminded me why we make this podcast because patients come to us with things that they're embarrassed to even bring up with their gynecologist. So sometimes the best part of plastic surgery isn't what you see, it's what you finally don't have to think about anymore.

Dr. Diana Breister (04:35):
After about three to four weeks when the tissue has settled down, they are absolutely thrilled. They basically walk into the office just almost with a skip in their step. There is a change. They feel more confident. It's almost like a sigh of relief. They're like, "Oh my God, I'm so happy. I'm so happy that's gone." It really emanates from their whole presence a lot, which is kind of strange, but it's true. We are a function of how we feel about ourselves. And if that's just a source of a little ick that you don't really like, once that's fixed, even though you're not showing that to anybody, it doesn't matter because you just feel better. And that I think is the number one reason why I'm actually in this field is just to help women feel the very best they can.

Monique Ramsey (05:37):
Dr. Breister on why women walk back into her office with a skip in their step. Number two takes us into a little different territory. Dr. Luke Swistun has been our breast implant removal specialist since day one and last year he sat down with his wife, Dr. Dominica Swistun, a clinical psychologist and sleep specialist to talk about something that doesn't really get talked about anywhere else, which is what happens to women mentally after they've had their implants removed. The story he tells, I think, about this story all the time.

Dr. Luke Swistun (06:18):
The simplest example is a very extreme situation where a very young patient presented to my clinic to remove her implants specifically because of anxiety. She basically developed intractable anxiety after her augmentation. Now, looking back, this is sort of the perfect storm patient, so to speak. She's young, she's very thin, she's very tall, and she wanted to go really big. So she went with 600 cc implants under the muscle, which are large implants under the muscle, which will feel very tight. And then because she was very thin, she was really feeling that pressure. And she actually already had, she said that she already had some preexisting generalized anxiety disorder, noth very serious. There was talk of maybe treating her for it, but her psychologist or psychiatrist rather at the time never really recommended treatment yet. "Hey, just watch it. Here's some rescue techniques. When you start feeling panicky, take some deep breaths, calm down and here's some Xanax for breakthrough panic attacks in case you need it."

(07:15):
After her augmentation, she said this basically just completely get out of control. She woke up after surgery in recovery and immediately had a panic attack. She was like, " Oh my God, this is so tight. I can't breathe. I can't breathe. "The staff called the doctor over and the doctor examined her and was like, " You fine, you're fine. These are just large implants. You're going to adjust to them, get used to them. "And she literally told me she never did, that never really happened. They always felt tight. They always felt heavy. They always felt like she was closed in and claustrophobic and she couldn't breathe. And this affected her life very quickly, very significantly. She went from a normal functioning person to completely disabled in about six months. She saw two psychiatrists. She was maxed out on SSRIs with a short period of time.

(07:57):
She had a lot of Xanax on hand and she was using three to four pills every single day just to get through the day because of how many panic attacks were getting triggered in her life. And within six months, she was unfold disability from work for intractable panic attacks. That was decided diagnosis. And she basically made the observations like, " Look, I can't live like this. I didn't have it this severe before I had an augmentation and I love my implants. I love my result, but I cannot live like this. "So she presented to our clinic nine months after her original augmentation. So she didn't even last a year with those implants and her symptoms got so severe, she basically said," Can you just get them out? "So we went ahead and did that. And by the way, no other symptoms, no chest, shoulder, back pain, nothing else, just anxiety.

(08:40):
That was literally the only reason she wanted to remove them. And when we removed them, she woke up after surgery in my recovery room and she was like, " Oh my God, back to normal. I can breathe again. I can feel like I'm so much lighter and stuff like that. So it was an immediate improvement in her physiology or in how she felt. Then obviously we have a very strong follow-up with our patients. So I saw her two days after the surgery, a week after the surgery, three weeks after the surgery, three months, six months, and every single time at every single milestone, she was like, "I'm back to normal. No panic attacks and things like that. " The biggest milestone was at the six month mark after we explanted where she basically comes back and says, "Well, I'm down to one of my original psychologist and he's actually weaning down my SSRI dose.

(09:26):
I think we're going to get off of it next month. So I won't be on that medication anymore. I'm fine. Here's my full bottle of Xanax. I have not used any of these since we explanted. You can see the expiration or the refill date. I haven't refilled these. I was using three to four a day with my implants and I haven't used them since we explanted at all. I'm basically back to normal and back at work. I'm normally functional.

Monique Ramsey (09:51):
Okay. That was Dr. Luke Swistun telling the story of a young woman whose entire life turned around the day her implants came out and we've made it to number one. Of every moment of five years of this podcast, this is the one I think every single person considering plastic surgery anywhere in the country, not just here, needs to hear. It's from Dr. Hector Salazar, one question that tells you whether the surgeon sitting across from you is the real deal.

Dr. Hector Salazar (10:25):
It's funny because one question that it's key for patients that they're not sure if their surgeon is the real deal. The one and only question would be, for instance, we're going to do a breast augmentation. So you would ask the surgeon, Dr. Salazar, you're telling me we're going to do a breast augmentation. If I would ask you to do this breast augmentation that you're going to do in your surgery center, do you have privileges at a hospital to do this surgery? Meaning, could you do my surgery at a hospital? Are you privileged by Scripps, by Sharp, by Kaiser to get that surgery done at that hospital? And that question differentiates a oral maxillofacial surgeon placing implants because that person would never, ever be privileged at a hospital where things are very much regulated to be able to put breast implants in. And believe it or not, that happens.

(11:26):
So that question is can you do my tummy tuck? Do you have privileges to do it at the hospital? If that doctor is a OB/GYN doing tummy tucks, that doctor would never have privileges at a hospital to do a tummy tuck because that's out of the area of his expertise. So I think if there's one question to ask at the end of any consultation, say, "Doc, what are you going to do? The surgery that you're planning, can you execute that surgery at a hospital if we would need to? Are you privileged at a hospital?" And then if you still have your doubts, if you ask me, "Can you give me a letter stating that? " I would and I'll be very happy to do it because I can.

Monique Ramsey (12:13):
That's it. That's the question. If you remember nothing else from this episode, remember that question. But here's the thing. When I went back through the archive for this list, there was one moment that I couldn't put on the top five because honestly, it didn't belong on a list. It belongs at the end. And when I started this podcast back in 2021, the very first guest was Marie Olesen. She's been at the heart of La Jolla Cosmetics since the beginning and on episode 100, she came back and she brought her husband, our founder, Dr. Merrel Olesen with her. And I asked them how it all started and here's what they said.

Marie Olesen (12:56):
Well, I remember a couple stories. One is that cosmetic patients in 1988 were still embarrassed and sort of wondering if they were doing the right thing. And so someone came in to talk about having her eyes done and she was sitting in a waiting room with sick people and she came in and Merrel came home and told me that she said, "I wanted to have my eyes done, but sitting in your lobby with all these sick people, I need to get a life." And so that was a problem. And then when it came, you have to give a fee estimate. So they had to go into a bullpen of secretaries and four people were overhearing whatever the patient was going to have and the patient was reluctant about having it. And so their need for privacy was much greater than it is now. Those are just two examples.

(13:59):
I would say the third is that there wasn't a real consensus in plastic surgery nationwide that the cosmetic patient was a legitimate patient. In other words, someone who's sick deserved the care of these esteemed and highly trained specialists, but the person who was being driven by emotional needs or appearance was somehow second class and he saw all that and felt it was wrong and wanted to get into an environment where he could take care of patients in the way that he felt they needed to be taken care of.

Monique Ramsey (14:47):
That was Marie Oleson in 2023 on our 100th episode, telling the story of a patient in 1988 who said, "I need to get a life." And the husband who decided that that patient deserved better. Five years of this podcast and almost 40 years at LJCSC, that's still the whole reason why we're here. Thank you for listening and to every patient, every surgeon, every guest, every team member who's shown up for this show, thank you. We've got plenty more coming and we'll see you next Tuesday.

Announcer (15:22):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I- 5 San Diego Freeway in the XiMed building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @LJCSC. The La Jolla Cosmetic Podcast is a production of the Axis, T-H-E-A-X-I-S.io.