The Psychology of Plastic Surgery, discussing expectations, realities, disappointment, and the recovery process with Dr. Brandyn Dunn

[Intro] Hey, everyone. I'm Trina Renea, a medically-trained Master Esthetician here in Los Angeles, and I'm sitting with my rockstar co-host, Dr. Vicki Rapaport, a board-certified dermatologist with practices in Beverly Hills and Culver City, Rebecca Gadberry, our resident skincare scientist and regulatory and marketing expert, and Julie Falls, our educated consumer who is here to represent you. 

We are here to help you navigate the sometimes confusing and competitive world of skincare. Our mission is to provide you with insider knowledge on everything from product ingredients to medical procedures, lasers, fillers, and ever-changing trends.

With our expert interviews with chemists, doctors, laser reps and estheticians, you'll be equipped to make informative decisions before investing in potentially expensive treatments. 

It's the Wild West out there, so let's make it easier for you one episode at a time. 

Are you ready to discover the latest and greatest skincare secrets? Tune in and let us be your go-to girls for all things facially conscious. Let's dive in.

01:28 Dr. Vicki Rapaport: Good morning, everybody. During this heat wave in LA, how are you doing?

01:32 Trina Renea: It went from rain to horrible rains to horrible heats.

01:38 Rebecca Gadberry: Oh, gosh, it's not that horrible. Think about what's going on back east and in Death Valley. It's 152 in the Middle East.

01:47 Dr. Vicki Rapaport: 152? I didn't know it could go up that high. I thought 130 in Death Valley was the highest.

01:54 Rebecca Gadberry: In the United States.

01:55 Dr. Vicki Rapaport: I thought that was in the world.

01:56 Rebecca Gadberry: I did too but I was shocked.

01:58 Dr. Vicki Rapaport: Well, welcome to beautiful California, sunny LA then.

02:01 Rebecca Gadberry: I think we need to do an episode about hot skin.

02:07 Trina Renea: Like sexy hot skin or like hot skin like when it sweats?

02:11 Rebecca Gadberry: Well, by the time it plays, it'll have to be sexy hot.

02:14 Dr. Vicki Rapaport: Speaking of hot, new and sexy, today we are talking…

02:17 Rebecca Gadberry: Your voice is.

02:19 Dr. Vicki Rapaport: Besides my voice.

02:19 Rebecca Gadberry: Very sexy.

02:21 Dr. Vicki Rapaport: We are speaking today to hot, new plastic surgeon in Newport Beach, our resident plastic surgeon Dr. Brandyn Dunn. I'm going to give you a little bio on him. 

He is a fellowship-trained facial plastics and reconstructive surgeon. He grew up in Hawaii where he received his Master’s in Public Health and he received his medical degree from the University of Hawaii. 

After medical school, he moved to Southern California where he completed his residency in head and neck surgery at the prestigious University of California in Irvine, where it seems like he loved and stayed, because following his residency, he was selected for a highly-coveted fellowship in facial plastics and reconstructive surgery at the University of Kansas.

Dr. Dunn is passionate about rhinoplasty and aging face surgery and is committed to achieving elegant and natural results.

The reason why we have him on today is because we really want to get down to the psychology of plastic surgery, discussing expectations, realities, disappointments and the recovery process of plastic surgery with Dr. Dunn.

So, welcome, Dr. Dunn.

03:29 Trina Renea: Welcome back.

03:31 Dr. Brandyn Dunn: Hello. Thank you so much for having me back. It's great to be here.

03:35 Rebecca Gadberry: It's great to have you back. We really, really love you. You're such a great person.

03:41 Trina Renea: We really love you.

03:43 Dr. Brandyn Dunn: Thank you.

03:44 Dr. Vicki Rapaport: Instead of always talking about the positives, we kind of want to talk about the potential downsides and the potential disappointments. I guess the first question is can you discuss the expectations of a typical patient who comes to see you for facial plastic surgery?

04:04 Dr. Brandyn Dunn: Yeah. I love that you're talking about this topic. It's something that's not often discussed and I think it's important to delve into the realistic side of plastic surgery. It's not all beauty and glamor.

There is some psychology that goes into it. Actually, a lot of psychology that goes into it. Every patient that comes into the office, I've got two lenses. I'm looking at them from a physical standpoint, evaluating their anatomy, evaluating their skin, their skin quality, their aging, their nose.

Then I also have another lens that I look through and I kind of look at them and see where they're sitting in their life. What's their support system like? Who are they? What is their job? What is their motivation for this procedure that they're coming in for?

So it's extremely important for me to have both of those perspectives, because surgery, and especially cosmetic surgery, this is completely elective. Is, in many ways, transformative or can be transformative. It doesn't just transform your physical side but it also transforms your psychological perspective. 

The expectations that I go through, my big thing is really honing in on realistic expectations for each patient and making sure that they understand what they will be getting into if they decide to move forward with surgery.

05:33 Trina Renea: Do you watch Botched?

05:36 Dr. Brandyn Dunn: I don't. I maybe watched an episode or two.

05:41 Trina Renea: Those are unrealistic expectations in patients.

05:45 Dr. Vicki Rapaport: Well, they always have somebody on the episode with unrealistic expectations. Then they have like the “normal” person. That sounds really judgmental, but you know what I mean. Like, the one that they refused to do.

Do you refuse to do procedures on a lot of patients? What's the percentage?

06:02 Dr. Brandyn Dunn: Not a lot, but I definitely will. I think if I have a concern that a patient is going to be unhappy or a patient is not understanding what is going to be involved in the procedure, then I believe it's in the patient's best interest and my own best interest to refuse a procedure.

And that could be as simple as Botox or fillers, to something much more complicated like a facelift or rhinoplasty. Because I think that anything that we do, it's a verbal contract that we get between each individual. We need to make sure that they are going to be happy. I mean, we're doing this to make people happy and to make people feel comfortable.

06:55 Trina Renea: Can I tell you a quick little story that I experienced about this expectations in a patient? Can I tell you the story?

07:03 Dr. Brandyn Dunn: Of course. Please.

07:08 Trina Renea: I was observing a plastic surgeon one day, very, very big plastic surgeon in Beverly Hills. He was seeing a patient, he was speaking to. I was in the room. She was coming in for a last-minute final consultation before her plastic surgery. It was already scheduled and paid for. It was like $90,000 and was getting a facelift.

She said, “I forgot to tell you,” because he was dissolving a bunch of filler, fixing her lips. She had a few bad nose jobs and he was fixing but also facelift. But she said, “I forgot to tell you that I wanted to know if you could…”, because her nose lift had dropped her upper lip and so her lip went into a frown. So she did filler to try and lift her lip. It did not work and so he was going to dissolve it and try and help her.

But she said, “Could you cut the sides of my lip and sew it up so that I look like I have a smile?”

And he gave her a mirror and pulled her face back how she wanted to do that and said, “Like this?”

And she said, “Yeah.”

And he said, “But you'll look like the Joker. I can't make you look like the Joker permanently.”

She said, “Well, it'd be better than what I have now.”

He was like, “Okay, what's the second thing you wanted to tell me?”

She said, “Well, when I had some brain surgery…” or something, one of her ears wasn't sewn on so they weren't equal. She wanted to know if he could pull her ear up and staple it to her head.

So he stepped out of the room for a second and I was like, “Oh, my God, what in the world was that?”

And he's like, “I think I'm going to have to say no to her surgery. I can't give this. She's never going to be satisfied. She's got a twisted way of thinking.”

So, he had to go back in and tell her he wasn't going to give her her surgery. She cried and broke down. It was crazy. I've never seen anything like that. 

But do you see things like that? Does this happen to most plastic surgeons, these crazy stories?

09:26 Dr. Brandyn Dunn: Yeah. I wouldn't say that I have a story as crazy as that, but I definitely have seen patients like that.

One of the ways that I like to describe it, and I've heard it from many people and it's kind of been passed along, I think, from generation to generation of plastic surgeons, is the 80/20 Rule. Have you guys ever heard that before, the 80/20 Rule?

09:47 Trina Renea: No.

09:50 Dr. Brandyn Dunn: Maybe in other context but not maybe in plastic surgery, but I think it's a great way to have someone psychologically understand and get an idea if they would be happy with the procedure. You can really read people that way.

What the 80/20 Rule is, if you, at your current state, are unhappy with 80% of the photos that is taken of you and happy only with 20% of the photos, then what plastic surgery’s goal is basically to flip that. So, you're going to be happy with 80% of the photos and that's considered a success, and not happy with 20% of the photos.

There's some realistic expectation that there's going to be angles, there's going to be things after surgery that aren't going to be perfect. You have to understand that going into a procedure. I think that's a really easy way to describe to someone whether they are going to be the right person for a procedure. That's kind of a nice, simplified way.

As you can see for someone that's had, like in your story, they're looking for the 99 to 100%. You're just not going to be able to meet that, and so why do that? $90,000 isn't worth the headache that's going to follow you for the rest of your career. 

11:16 Dr. Vicki Rapaport: And also, those patients, sometimes they just don't know how to how to verbalize exactly what you're going to do under the knife but they'll tell you what they want. Like when she said, “Can you staple my ear to my head,” don't you think she just really meant make my ears symmetric. You can then educate her about what you can and can't do.

To me, that doesn't sound, honestly, that crazy, because patients don't know what you're doing under the knife. Even when you describe filler versus Botox.

11:41 Dr. Brandyn Dunn: That’s true.

11:43 Dr. Vicki Rapaport: And the smile, can you make my lips look permanently smiling, I think you just can explain to her that that is not the way your anatomy is going. You can't turn up the corner of the lip with surgery, but you can with a little bit of filler or thread or this or that.

I feel like she could have been better educated, although I get it. He got a weird feeling from her and that's totally fine. But I feel like sometimes these patients don't know how to say…

12:08 Trina Renea: Well, she also looked like a lion already.

12:12 Dr. Vicki Rapaport: She had a lot of procedures, yeah.

12:14 Rebecca Gadberry: The problem is is that somebody out there is going to do it if she keeps looking.

12:18 Dr. Vicki Rapaport: Oh, yeah, they will. I but I do like your 80/20 Rule, because I do feel like patients come in to see me just for their normal skin checks and, “Oh, I had a facelift.” 

“How do you like it,” I ask.

And they say, “Oh, it's great,” or, “Oh, they have to do a redo.” I think to myself, “Well then, was that still a success?” Because they describe to you that it wasn't going to be 100% perfect. Because I think people really do believe that they're going to be 100% perfect and, you're so right, they are not. They're going to need more procedures.

12:47 Trina Renea: But then do those people come back and try and get you to do free stuff on them to fix whatever their mental state is on the procedure?

12:58 Dr. Brandyn Dunn: They can. Honestly, those are the ones that you maybe shouldn't have operated on. And I mean things happen in plastic surgery where you can make improvements and you can do revisions. 

And patients are completely right if they're unsatisfied with certain things. Maybe there was an outcome that was not ideal and you do need to do a revision surgery. You do need to do a second procedure to kind of improve things. That's not completely out of the picture as well and it's not necessarily wrong. 

There are bad surgeons and bad plastic surgery out there and so it can happen where you need to do a second procedure. So, not everything is just accept it the way it is. There's just realistic expectations, I think, that need to be understood.

13:56 Dr. Vicki Rapaport: And the big question to me, I always wonder, although I never ask the patient, do you charge for those re-dos. I guess, obviously, every individual is different, but are those free?

14:07 Trina Renea: Are they?

14:10 Dr. Brandyn Dunn: It depends. It depends on the time frame when it happens and it depends on what exactly they're asking for. 

The reason why plastic surgery is expensive is because you're not just paying for the procedure, you're paying for the post-op care. There's no insurance that’s getting to pay you for your time that you spend and the hours that you spend helping to take out sutures and take out drains and coach them through their healing process, and the phone calls and text messages that you get and the years of followup that you have. And so that single payment is supposed to cover all of your time and all of your energy for all of those procedures.

14:50 Trina Renea: That's so important for people to know.

14:54 Dr. Brandyn Dunn: Yeah. That's why they are expensive. If you have a procedure that's done through insurance, every followup and every procedure that you do afterwards, you're paid through insurance. With cosmetic surgery, that's not the case.

And so if you need a touchup, you need a revision, if there's something typically within the first year, it can be covered within the original fee. We oftentimes, if it's a really complex procedure or there's a high chance that you may need a little touchup, it may be more expensive to include that in the procedure. Oftentimes, I'm pretty explicit. Like, we're going to try to get as much as we can on this first one and we may need a second procedure to kind of refine or touch things up from there. 

So I'd say, generally speaking, if it's the first year, then we won't charge. And every surgeon is different, but I typically don't.

15:54 Trina Renea: And Dr. Dunn works at, what's the place called? SCAR?

16:00 Dr. Brandyn Dunn: It's an acronym. I tell them every day we should make it the No-Scar Center.

16:05 Trina Renea: Right, the SCAR Center.

16:06 Dr. Brandyn Dunn: It's called SCAR Center, it's Skin Cancer and Reconstructive Surgery Center. We also have an Appearance Center side, which is our cosmetic surgery site.

16:15 Trina Renea: It's a pretty impressive facility I saw.

16:18 Rebecca Gadberry: It's down in Newport Beach, isn't it?

16:21 Trina Renea: It is. It's in Newport Beach and it's really cool. It's perfect because you know that they're scar specialists.

16:29 Dr. Brandyn Dunn: We are.

16:28 Trina Renea: So there are going to be really good plastic surgeons in there.

So, what are some of the disappointments that you see across the board? Like, the most common, I should say, disappointments. Is it their expectations?

16:47 Dr. Brandyn Dunn: Yeah. It's a good question. I think the biggest disappointment that people have is I'd say a lot of it falls on the surgeons describing what they can expect afterwards. I think a lot of it comes down to my ability to give an individual an idea of what they're going to look like or what they're going to experience afterwards. And I think if there's a discontinuity between that, then I think that's where disappointments can occur.

The other thing that I will say is mostly in rhinoplasty, we use morphing technology, which is basically taking before images and using computer technology to be able to morph the nose into something that we are trying to achieve.

17:41 Dr. Vicki Rapaport: That’s so cool.

17:42 Trina Renea: I love that.

17:45 Dr. Brandyn Dunn: It's awesome. And the best part about it, it does two things for me. One, it gives me a goal to work towards in surgery. I have it up in the operating room and I have it as an example and say, “This is the ideal image and this is what I want it to look like.”

There's definitely some limitations in the morphing technology, but I'd say, overall, this is kind of what I'm working towards.

Then the other thing that it does is it gives the individual who's coming in for the consultation the ability to see what they may look like. Especially in rhinoplasty, it's a very transformative surgery. Your face is going to look different. Your facial balance and aesthetics and all of these different things will be different after surgery. How you look at yourself in the mirror and see yourself in photos is going to be very different. It takes some understanding and getting used to that.

And so if you can show them an image before, they can either say, “Whoa, that's not what I'm looking for,” or, “That's not anything that I'm… that's very weird. It doesn't fit my face,” or whatever. 

It gives you the ability to have a starting point to have these open discussions so people can kind of start to see what they may look like afterwards.

18:54 Dr. Vicki Rapaport: Will artificial intelligence improve that morphing technology?

18:59 Dr. Brandyn Dunn: Definitely.

19:00 Dr. Vicki Rapaport: I think that could be kind of transformative, it seems.

19:03 Trina Renea: Because you could do it with a facelift, an eye lift and all those kinds of lifts too, right?

19:06 Dr. Brandyn Dunn: Exactly.

19:07 Dr. Vicki Rapaport: Everything-lift.

19:08 Trina Renea: Yeah, everything, to see what you look like.

19:14 Dr. Brandyn Dunn: Yeah, I think that would be extremely helpful. I think about plastic surgery in kind of two different ways. You can have a surgery that is more an augmented, or it changes kind of how you look and how you perceive yourself, which is more like a rhinoplasty where you're changing what you look like before. You kind of look like a different person, versus a transformative, where you're basically returning back to an earlier time in your life. Where, ideally, you look more like what you looked like 5, 10, 15, 20 years ago.

The psychology of those are very different because, one, you're looking at yourself as a completely different person. The other one, you're looking at yourself as, hopefully, what I looked like earlier in life. 

At least that's another thing that I do with my facelift patients or my aging-face patients. I like to see photos of them before to see where their brow position is. You don't want to overcorrect someone's eyebrows if they already have heavier brows. They're going to look at themselves very differently if you do that.

Again, those are like the guiding photos that I use when I'm looking at aging-face patients.

20:25 Trina Renea: Okay. And so the disappointments that you see, the biggest disappointments are what?

20:31 Dr. Brandyn Dunn: I think the biggest disappointment I would say is didn't meet their expectations, so if the change is not as much as they originally hoped. For example, in a rhinoplasty, if their nasal bump didn't come down as much as they were hoping for, if their tip is not raised as much as they were hoping for. 

Early on in rhinoplasty, it takes about a full year for the swelling and everything to go away. So people can be disappointed early on and things can change throughout the healing process. And so kind of coaching them through that process and getting them to a steady state at six months to a year is helpful.

21:16 Trina Renea: It seems that there's a lot of psychology in your job. Do you guys learn that in school?

21:23 Dr. Brandyn Dunn: No. There's not really a course in it, although…

21:27 Trina Renea: There should be.

21:29 Dr. Brandyn Dunn: Yeah, there really should be. There's a lot of articles that are written and there's a lot of research out there that's been done on the psychology of especially plastic surgery, but, no, it's not a full-on course.

21:42 Trina Renea: I mean, because the people coming for plastic surgery are already disappointed with something, that's why they're coming. So then if their image of what they want isn't exactly met, it seems like they're still disappointed. They were disappointed before they came in and then— I mean, to fix somebody perfectly has got to be such a challenge. Perfectly to them in their mind, and everybody's mind is different.

22:09 Dr. Brandyn Dunn: Exactly. When you think of psychology of plastic surgery, traditionally, you think of anxiety, depression, body dysmorphic syndrome or body dysmorphic disorder. Many years ago, there were papers that were, actually, poorly done but they showed that individuals that got plastic surgery had higher percentages of having these psychologic disorders.

As we've gone further and further in our understanding, they found that it's actually more similar to the general population. There are, obviously, some individuals that have these still, but it's more comparable to the general population as plastic surgery is becoming much more accepted.

But the thing that you just described really kind of goes hand in hand with body dysmorphic disorder, which is really the big thing that we are taught. I would say that that's the big thing that we are taught in our training, is to try to identify patients that have this condition. It really is someone that will be unhappy even if there is a change for the better. They will still find something and still will be disappointed.

It's not the client or the patient’s job to identify this. It's really our job to be able to spend the time and figure out who's the right person and who's not.

23:40 Trina Renea: But it's also nice to know that plastic surgery exists for those people who were born with some kind of deformity or like a lump in their nose that makes them insecure. That when that goes away, it must be very satisfying to see their happiness that, “Oh, my God, you fixed it,” or like one eye is lower than the other, or whatever that you can actually— or a lip is dropped. I mean, there's so many things that can happen. Even in a car accident, whatever that you can fix. There's a lot of satisfaction and happiness and joy that comes out on the other side, right?

24:17 Dr. Brandyn Dunn: It's so rewarding. I'd say we're talking about the psychology and we're talking about all of the more difficult patients, but I'd say 95 to 99% of all of my patient are completely, and we said this in the beginning, normal, but they've got realistic expectations. They're like you and I. 

I think they're happy after any procedure that's done. It helps their self-confidence and helps them feel better about themselves. So I'd say most of it's really very positive.

24:50 Trina Renea: And with plastic surgeons, I find that a lot of them specialize in either breasts or noses or face lifts. Are there some plastic surgeons that are like, “I can do it all. I'm your go-to guy.”

25:07 Dr. Brandyn Dunn: There are, yeah. I'd say there's a lot out there that do that. I think some of them are great and incredible at what they do and they can get great results, but I think, traditionally, as you become more focused on a particular area, you refine your results and you get more consistent outcomes. 

I, personally, only focus on the face, and so I think people that have just a particular focus, I think their results tend to be better.

25:46 Trina Renea: Because they're doing them all the time.

25:48 Dr. Brandyn Dunn: Exactly. 

25:50 Trina Renea: And what is the realistic recovery process that people can expect? Because I find that even with doctors who are doing lasers, peels, surgeries, they really sometimes, or a lot of the times, I find that doctors will be like, “Oh, it's three days of downtime. No time at all. It's barely painful.” That type of thing.

Then because I'm an esthetician and they have my cell phone, they're like, “This isn't right. My face…” So, I feel like, a lot of times, doctors aren't upfront about that. But what would you say the realistic recovery process of a facial plastic surgery would be?

26:39 Dr. Brandyn Dunn: I think you have to understand that there's a lot of plastic surgery, again, completely elective. The clinic and the practice is a business. So there's a lot of incentives to try to be able to pay the bills and push things and try to make sure that you don't want to lose clients and you don't want to lose patients, but then you get yourself into some trouble.

I think that's probably where a lot of what you're describing, making it seem like it's not a big deal and just getting people to do things. You have a very expensive laser, you have a very expensive piece of equipment or you've got a lot of staff. The motivations are in the wrong spot.

I'd say, overall, I think it's important to be honest with the patients so that they know and that they're happy, but from a facial plastics perspective, I'd say there's two kinds of categories. For aging face, I'd say most of the healing is done by three to six months. Then for rhinoplasty, it can take up to a year to even a year-and-a-half for the final result. So it's a long process.

27:50 Trina Renea: A long process.

27:51 Dr. Vicki Rapaport: And I would say, just about the realistic expectations, if we don't tell the patients what to expect and they are having trouble and really bombarding us with phone calls, you learn from that one experience never to do that ever again with a patient. Because it's so much better to really let them know what to expect, give them a handout, show them pictures. We do everything. We don't want trouble. We don't want problems.

Maybe if we're a little more lax at the beginning of our career, because we're more desperate to get in patients to do lasers or this or that, we're maybe a little more lax about it, but I think most places who do procedures really prep the patient. There are consents. There are handouts. There's post-care. We give them everything.

28:33 Trina Renea: I went to a med spa, or whatever, and I saw a nurse who gave me this laser, DermaV, I think it was called, or something. She said, “It's for your veins, your little spider veins and it's better than an IPL,” blah, blah, blah. She's like, “Just come in, I'll try it on you.”

And so she did it on me and I left and I swelled up so big, like a balloon. My face looked crazy. I was like it's going to pop. I called her office. The office of course didn't answer. It was after hours. I didn't have any way to get a hold of her. They said call 911 if there's an emergency. Nobody answered the email. I had no connection to her at all and I was like, “What am I supposed to do?”

Luckily, I have Dr. Vicki on speed dial, so she was able to get me some prednisone, but I was like what do you do? Then that person never ever responded.

29:31 Dr. Vicki Rapaport: Shocking.

29:34 Trina Renea: Her office, like two days later, I tried calling again the next day. It was over the weekend so they weren't there. On Monday, they're like, “Are you okay now?” That was their question. I was like, “Oh, my God.”

Then I said, “Can you please have her call me.” She never called me. I mean, this happens all over the place. They don't want to deal with you. They don't want to deal with it. They're like, “Sorry.”

30:02 Dr. Vicki Rapaport: It's so inappropriate, so not okay. If you do a procedure on a Friday, even DermaV, which is very safe, you should still have some kind of way to give the patient an email that you'll check over the weekend. We do that. We check our— and I know everybody does it differently, but that, it doesn’t sound pretty. 

Obviously, you're never going back. You're never going to refer anybody to them. The fact that they didn't even check on you afterwards. We bombard them with calls. We want them to come in, send photos. We're happy to help.

30:28 Trina Renea: I think that’s so important. That’s why you have a good office. I think the communication is where the lacking is. Being realistic about your recovery time and the recovery process, that they explain it to you and they check in with you is such an important part of any office. It's going to keep your patients or not keep your patient.

30:48 Rebecca Gadberry: Shouldn’t the patient ask what kind of followup and where's my emergency phone number if I need one? 

30:53 Trina Renea: They shouldn't have to ask. A lot of times, they don't know to ask.

30:56 Rebecca Gadberry: If it's not offered. No, I mean, that's what this podcast is about. To educate you.

31:00 Trina Renea: Correct. Yes, you should, as a patient, ask for these things. Like, “What if something goes wrong? How do I reach you?’

31:06 Rebecca Gadberry: Yeah, how do I reach you and do you have an after-hour phone number? If they don't offer it, you might wonder whether you want to see that person or not.

31:15 Trina Renea: Do you guys agree with that as doctors? That if somebody asked, “If something goes wrong, how can I reach you,” and you're like, “We don't have an after-hours number,” or during the weekend, that they didn't know. 

31:26 Rebecca Gadberry: What I'm saying is that if this should be the way it is and the doctor doesn't offer it, then maybe you should think twice about going to that doctor rather than just asking if they don't offer it.

31:39 Dr. Vicki Rapaport: And I agree with that, Trina, because we can help them so quickly. We can reassure them. If they need prednisone, if they need wound care, whatever they need. We're the ones to help them versus the internet or their friend. So it is pretty easy for us.

I remember years ago, my husband who's also a doctor, he would give everybody his cell phone. And I thought, “That's a lot of extra work that you're doing for yourself.” His answer was to me, “I can help them so quickly. It's so much easier for me to answer their questions if they have a problem. I'd rather that be the case than for them to have hours and hours hoping for somebody to respond to them, somebody giving them the wrong advice.”

And I thought, “Wow,” that was really honorable of him and I completely agree, because, yeah, it sucks. You don't want patients to have bad outcomes. But when they do, we can help them and we should.

32:32 Dr. Brandyn Dunn: I was going to say the exact same thing. I give my cell phone number for pretty much every cosmetic surgery that I end up doing, because it's significantly easier than them going to their primary care doctor, to the emergency department, asking someone else.

I had one of my patients’ wife text me. “I don't know how to get on the head wrap,” and it's a lot easier for me to walk them through that and talk them through that than having them not wear it for the entire weekend and potentially lead to a poor outcome.

Honestly, most patients are very respective of our time. So they're not calling us and bombarding us. It's very easy for us to trust them.

33:16 Trina Renea: I love that these days, I mean somewhere in my career, I've been in this business 20 years, and doctors used to never give their phone numbers out. These days, I don't know when that changed, doctors always give their numbers out. I think it's great, because, you're right, patients won't bombard you. They'll respect your space, most of them. And they'll just ask you questions if they really need it.

But if they don't have that, then they call the office 800 times over the weekend, like with massive voicemails going, “I need help. Somebody, please call me back.” Like that dramatic fear that's in them. When you could easily, you said, answer it with a sentence in a text.

34:02 Rebecca Gadberry: Or if you go to somebody else, they may screw things up. So, go back to the doctor who did the procedure.

34:08 Trina Renea: Like going to the ER is no good.

34:09 Rebecca Gadberry: No, and looking it up online and asking your girlfriend and any of that. Go back to the person who is doing this.

34:18 Dr. Vicki Rapaport: And also, on the other side of that, if you do go to someone, not ER or Urgent Care, but if they end up going to somebody else, that somebody else is happy to throw you under the bus, because it is bad out there. Dermatologists do it to other dermatologists. I'm sure plastic surgeons do. 

34:35 Dr. Brandyn Dunn: Definitely.

34:35 Dr. Vicki Rapaport: They love to throw you under the bus and degrade you because you weren't available. Really? That's just so uncool. You definitely want to avoid that, because that patient has no confidence in you and they'll definitely never come back.

34:48 Rebecca Gadberry: Right. Not to mention the Yelp reviews. 

34:52 Trina Renea: Oh, yeah, there's Yelp.

Okay. I think that kind of finalizes our— is there anything else, Dr. Dunn that you want to talk about with this psychology of plastic surgery?

35:09 Dr. Brandyn Dunn: I’d just add one comment. It was something that I've kind of been reading about and have heard a little bit about. I feel like the times that we're in is sort of a unique time and maybe get your, guys, opinion on it. But I feel like the term that I've heard is ‘The Cosmetic Surgery Paradox’. I think we may be in a time where this is kind of happening with social media and with influencers, more influencers doing procedures and making plastic surgery and cosmetic surgery more common and aware for the general population. 

We're in a time where people are encouraged to not change themselves and to be who they are and to stay kind of within their lane and to be happy and love themselves. But at the same time, we're also in a time where we're accepting of people having cosmetic surgery and plastic surgery, and changing their nose and getting a deep neck lift or getting breast augmentation.

So it's an interesting time to see these two schools of thoughts kind of working together and the inner play that we have. I guess that's one thing that I've started to notice. I think plastic surgery is becoming extremely common and it's much more prevalent, but I'd be interested to hear what you guys think on that topic.

36:37 Trina Renea: I have an opinion. I think that people should be happy with who they are. Everybody can look different. You can be beautiful inside because of your personality and who you are and really to try and love yourself as you were born, because you don't want to look like everybody else. 

But these days, you can look like everybody else and you can look like whoever you admire that you think is beautiful. You can go in and get these little tweaks here and there with filler and Botox and little plastic surgery here and there. You can make your lips a little bigger and you can make your nose a little smaller, you can make your boobs a little bigger and your butt a little bigger. You can do all kinds of things now.

And it is very common now because of social media and because of these influences that are making it like it's not a big deal. You can change yourself. You can be whoever you want to be. But I think it's more, to me, internal about who you really are inside and not what you look like on the outside. I understand if, like, you have a giant nose and it makes you insecure, but I think all these little tweakings, it is, it's becoming more common. People are a little twisted in their thought process, I feel like.

Everyone seen Barbie? 

37:59 Rebecca Gadberry: I'm seeing it tonight.

37:58 Dr. Vicki Rapaport: I have the nails to match it. I'm seeing it tomorrow.

38:02 Trina Renea: I was at the mall yesterday and there were like old, old, old people going, and there were little kids going, and there were people all in between. And men and everybody was dressed in their pinks. It's the cutest thing.

38:14 Rebecca Gadberry: And everybody's so happy. I'm calling it the Barbie effect.

38:18 Trina Renea: It's bizarre. My 12-year-old daughter and my 50-year-old husband went, and both of them loved the movie. I'm like for them to make a movie that is like…

38:27 Dr. Vicki Rapaport: I think that the director/writer…

38:30 Rebecca Gadberry: Greta Gerwig. She's fabulous.

38:31 Dr. Vicki Rapaport: Unbelievably talented, Margot Robbie, they've been they've been talking about this for months and months and months. I haven't seen it yet. I'm seeing it tomorrow with my pink nails.

38:42 Rebecca Gadberry: You are awesome.

38:43 Dr. Vicki Rapaport: I feel like the Barbie plastic surgery, obviously that was the segue, but I don't think of Barbie as like the small waist and the big boobs. I just think of it as pink and cool and happy and fun.

38:55 Trina Renea: Well, I heard it's very, very inspiring and it's very woman-positive and very funny.

39:07 Dr. Vicki Rapaport: The comment about the two extremes, like the self-acceptance versus changing everything to have the smaller nose and the bigger butt, I agree it's just a personal preference. I love that it's able and available for those people who want it. I love for people who don't want it. I don't know. It's like whatever people want to do is fine with me, as long as it doesn't hurt me. It's not hurting me if you do plastic surgery. It's not hurting me if you don't do plastic surgery. You know what I mean? And don't force your ways on me and do whatever you want. That's how I feel.

39:40 Rebecca Gadberry: I think we should adjust our own attitudes as to how we respond to somebody rather than judging them as to what they do or do not want. It's our bodies. I mean, if you want a tattoo, get a tattoo. If you want a smaller nose or a larger nose, go ahead and do that.

39:56 Trina Renea: It's available now so the kids today are growing up with it's possible to do whatever you want to do and it's not a big deal. Nobody's judging you.

40:08 Rebecca Gadberry: No. People are judging you all the time and that's what the real issue is to me.

40:12 Trina Renea: Well, the next generation won't. Once we all die off, then the judgers will go away.

40:18 Dr. Vicki Rapaport: I hope that's true. The open-mindedness is going to be here because of the new generation. I hope that's true, because that would be great.

40:24 Trina Renea: It would be.

40:27 Dr. Brandyn Dunn: I agree. Stay cool.

40:28 Rebecca Gadberry: I have nothing to say there because I have so much to say.

40:32 Dr. Vicki Rapaport: I love it. We're going to let everybody do what they want to do and just don't be judgmental and don't force your ways on me and that's cool.

40:39 Rebecca Gadberry: Absolutely.

40:39 Trina Renea: Just love yourselves.

40:41 Rebecca Gadberry: Don't be judge-y.

40:42 Dr. Vicki Rapaport: And go see Barbie movie.

40:44 Trina Renea: Go see Barbie. 

40:46 Rebecca Gadberry: I want to do the take away here.

40:48 Trina Renea: Can I just really quick before that? Have you ever had anyone come in and say, “Can you make me look like Barbie?”

40:56 Dr. Brandyn Dunn: I haven't yet. I haven't yet, but now with the movie coming out, I'm sure there's going to be one.

41:02 Dr. Vicki Rapaport: Take away a couple ribs, double-D bras.

41:07 Rebecca Gadberry: So what is the most requested celebrity nose?

41:14 Dr. Brandyn Dunn: The most requested celebrity nose? I don't think people are asking for that as much, at least in my practice. I haven't had as many people asking for that. They know how they want to refine their nose. They will bring in some examples, but most of the time it's just, “I want to do this to my nose,” not necessarily look like this person's nose, which I think it's refreshing. it's nice that people are not trying to make something that they're not. 

41:44 Rebecca Gadberry: Right, because I had read something about it. It was Meghan Markle, and over the last year too. I thought that was interesting, but not in Newport Beach.

41:55 Dr. Brandyn Dunn: Yeah.

41:57 Trina Renea: Maybe in Los Angeles proper, Beverly Hills.

All right. Well, thanks for joining us again Dr. Dunn.

42:04 Dr. Brandyn Dunn: Thank you so much.

42:05 Trina Renea: Of course, we're going to have you back again and again, if you will.

42:09 Dr. Brandyn Dunn: My pleasure. It's been great. Great seeing you all.

42:12 Dr. Vicki Rapaport: Thank you so much. You're wonderful, as always.

42:14 Trina Renea: Happy weekend. Enjoy the heat.

42:16 Dr. Brandyn Dunn: You too.

42:17 Rebecca Gadberry: Take care.

42:18 Dr. Vicki Rapaport: Bye-bye.

42:18 Dr. Brandyn Dunn: You too. Bye.

42:20 Rebecca Gadberry: He's adorable. I wonder if he's going to go see Barbie with his fiancée.

42:25 Trina Renea: She's listening.

42:26 Rebecca Gadberry: I'm sure. Will he wear pink, that's the question?

42:29 Trina Renea: Yes, wear pink.

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