Do Lasers, Fillers, or Threads Affect Future Facelift Surgery? A Plastic Surgeon’s Perspective with Dr. Ben Talei

[Intro] Hey, everyone. Welcome back to Facially Conscious with myself, Trina Renea, Esthetician, Dr. Vicki Rapaport, Dermatologist, and our fabulous, overly-educated consumer, Julie Falls. 

We are gathered here together with you to talk about this crazy world of esthetics. It's confusing out there in this big, wide world. That's why we are here to help explain it to you all, subject by subject. We will be your go-to girls. And from our perspective, without giving medical advice, we will keep things facially conscious. 

Let's get started!

00:55 Julie Falls: Hello, and welcome to Facially Conscious, where we talk about all things skin. Today's episode is a very special one. We're going to be talking to the one and only Dr. Ben Talei. I personally met Ben in 2017 when I was in the market for a little work myself. I'm so happy with my results. I gush every single day when I talk about this man. And I have so much respect for him as a practitioner and as a truly lovely human being. So we're going to be talking all about his wonderful Cupid Lifts, his AuraLyft, and everything else that he has made so special.

Dr. Vicki, you want to tell us a little bit about Dr. Talei’s background? 

01:43 Dr. Vicki Rapaport: Yes, I'm happy to share his training, his expertise. Dr. Talei did medical school at UC San Diego, and then he proceeded to do his residency in Head and Neck Surgery at Cornell. He went on to do a fellowship in facial plastics. 

He initially planned to dedicate his life to be a brilliant Head and Neck Cancer Surgeon, however, the stress of dealing with cancer day in and day out made him cry daily. So he decided to shift gears and move toward the reconstruction portion of it and focus on the reconstructive and cosmetic surgery where he could change people's lives on a daily basis. 

In 2014, he set up practice in Beverly Hills. He was working 16-hour days, six days a week, to grow into quite a force in Beverly Hills. And yes, he is known for his Cupid Lip Lift and he has a passion project called Cupid Lips On Sunset, which is going to be opening shortly. It's going to be a one-stop shop for anything related to all things lips. 

So, welcome, Dr. Talei.

02:55 Trina Reneá : Welcome. 

02:55 Dr. Ben Talei: Thank you. Thanks, Vicki. Thanks, Julie. Thank you. Thank you. 

02:59 Trina Reneá : How are you today?

03:01 Dr. Ben Talei: Great. You guys have already said so many nice things about me, so it's a flattering morning. 

03:07 Julie Falls: Very well deserved. 

03:08 Dr. Vicki Rapaport: Well, you're right. You are our first plastic surgeon guest, and we have so many questions for you. But my most burning question as the dermatologist is all the things that we do as injectors, as dermatologists, as nurse practitioners, injecting fillers and Botox and doing thread lifts, how does that affect a patient's future if they want to do plastic surgery? Can you tell us, is it a terrible thing to do for years, or can really well-seasoned plastic surgeons kind of get around all that stuff? 

03:50 Dr. Ben Talei: There's a short and long to that answer. I'll go the long way. It's really about how tastefully everything is done and I'd say how smart the injector is who's doing this kind of stuff, or the heat treatments or anything like that. Every time we inject the face with a needle or with a substance, put radiofrequency into it, any kind of energy, we're torturing the face to some extent. And it could be a delicate amount of torture. It could be a pretty harsh amount of torture in the case of lasers and radiofrequency and things like that. 

And we use all these things to our benefit, but what we're doing, in many cases, is upsetting the face or denaturing proteins in hopes that they're going to regenerate and form new proteins, new collagen, new elastin, new hyaluronic acid, all this kind of stuff. We put in materials like Sculptra that are going to be collagen-forming, which is a euphemism for scar tissue formation. We do this kind of stuff with risk, but we also know it benefits us. 

But the more things are repeated in a more aggressive fashion, the face starts to change character and it becomes a little more dense internally. Let's say we're doing repeat treatments of Sculptra over and over and over again, and we're doing Ulthera, and we're doing Thermage, and we're doing CO2 lasers, all this kind of stuff. It really changes the soft tissue quality inside the face irreversibly. So it does turn a little more dense. 

And in those cases, it doesn't mean that you can't do surgery. It just makes it a little bit more of a complex obstacle course for a surgeon to go in and get the full result. Whereas a less-seasoned surgeon would go into a face that's been tortured multiple times and they might not be able to get through the whole thing. So they stop halfway and they give you a half result versus somebody who's really experienced can get through that whole obstacle course of scar tissue formation or threads or whatever has happened. 

But very few things make it impossible to do surgery. The exceptions to that would be a face that is incredibly overfilled with temporary or permanent substances, permanent substances being silicone, Bellafill, Artefill, and fat. The temporary fillers, also if there's way too much place that expands the face out so much that the tissues are just permanently damaged, and you can't ever get a good result anymore because it's damaged tissue. Now, if someone is doing tasteful filler, it doesn't do anything. It just looks beautiful and nice and volumizes. That's really the taste of the practitioner. And if you have a dysmorphic practitioner, you're going to end up with problems in the patient that are hard to fix. 

06:29 Dr. Vicki Rapaport: I got it. Makes a lot of sense. 

06:31 Trina Reneá : I have a question. When you're talking about these fillers, is it for a patient who's looking to get fillers? Do you think it would be better if they're planning on a future possible facelift if they would get a more hyaluronic acid filler rather than a Sculptra or Radiesse or something like that, if they're deciding to do fillers? 

06:55 Dr. Ben Talei: In the world of the injectables, I always advise strongly against the permanent ones. The permanent ones are silicone, Artefill, Bellafill. They're extremely reactive and they're perpetuating. So they'll just keep forming scar tissue in the face forever, inevitably. 

Within the temporary realm of what we consider dermal fillers versus volumizers, we have hyaluronic acids, which is a sugar gel that we inject, versus Radiesse, which is a calcium hydroxylapatite paste, a bony mineral paste. And then you have the volumizer, which is Sculptra. Most people don't understand the difference between them. 

Sculptra is a diffuse volumizer. So what you do is you spread out a particle inside of the middle layer of the face that we call the SMAS, or the fat. What happens is your body starts to react to it and starts to form scar tissue. So the volume that you're getting is not from what you injected. It's from the irritation that forms around what you injected. You formed little tiny granules, which we call granulomas. They're grayish in color. They're kind of the same shape as fat cells so they really do mimic fat nicely. That's why we use Sculptra, although it is a little more firm than fat. 

If you're trying to discreetly go and volumize a single area or to really get under the dermis to pop something out, now you're using the other injectable fillers. The hyaluronic acids are great because Injectables are not predictable. There's nothing predictable about an injectable. You can inject it one direction, it goes the other direction. It can change its quality over two, three years. 

So it's really nice to use these hyaluronic acid fillers because let's say something unpredictable happens, it's an easy fix. That's why I like them. You can just dissolve it and fix it. Now, if you overexpanded somebody to a giant balloon, then yeah, you can never fix that. But for other common problems, you can fix it. 

Radiesse, I don't love so much because it has no definitive advantage over the other types of fillers. It does theoretically. Theoretically, you could say we're forming collagen in the skin. But again, it's a bit of a misunderstanding. It's scar tissue formation. 

And Radiesse, I'd say like eight years ago, was one of the longer acting ones. But then Voluma and all these other ones came out. Radiesse as a paste is fine for use on the bone, but then if you use it in soft tissues, you're going to form little calcium nodules that stay there permanently. And if you do that superficially in a thin skin area like the under eye, you're kind of screwed. 

I personally just stick to, again, sorry for the long answer, but I stick to the hyaluronic acid gels myself. I don't see much of a benefit to the Radiesse. And then Sculptra, every once in a while, I'll send somebody who's really gaunt, and that's the perfect person for Sculptra. It was originally intended for HIV lipodystrophy, which is people with HIV, they get fat loss on one side of the face more than the other and they don't have fat to inject, so you just inject the Sculptra. 

10:01 Trina Reneá : But with the hyaluronic fillers, you don't see problems with facelifts when you go in? No?

10:08 Dr. Ben Talei: No, no. Only if it's overexpanded. And then it's a problem of never getting the patient happy because they've been overexpanded. You can't lift them that high because they have such high volume in their face, and their tissues are leaking out this stuff. It's soaking the muscles so they don't smile properly. 

10:23 Trina Reneá : Oh, my God. That sounds just horrible. 

10:25 Dr. Ben Talei: Yeah, but that's overfilling. That's bad. And it's not just injectables that are bad. Surgery is bad, too. You have people who overoperate. They don't know how to operate. They make people look fake and weird. This is all, again, a matter of good taste, dysmorphia within the doctor, and skill. Probably 10% of practitioners, I think, are skilled, and I would let them touch my face. 90%, I would never let them touch my face. 

10:51 Dr. Vicki Rapaport: I agree. Same with PAs and NPs and dermatologists. Can we talk about the famous lip lift?

11:01 Dr. Ben Talei: Yeah, of course.

11:02 Dr. Vicki Rapaport: I mean, I know that there are two definitions. There's a lip lift that we can do with Botox and there's the lip lift you can do with surgery. I think it's an amazing procedure. I've always, always loved it. I recommend it to patients all the time. I honestly didn't realize that you coined the term or you were like the expert, so I want to hear all about it from you. I'm super stoked to start to send patients to you for it. 

11:26 Dr. Ben Talei: Thank you. So the different ways to lift the lip are either pretty much surgical or non-surgical. Non-surgically, you're doing Botox and fillers and you have something called a non-surgical lip lift, which is coined by Steve Harris in London. That's just putting dots of filler in the lip to it give a tiny bit of eversion. It's an appearance of lifting. It's not actually lifting anything.

Then there's the lip flip, which is Botox placed along the vermilion border. You imagine someone's pursing their lips. They kind of hold it tight down and then you release with some Botox above the vermilion and it rolls up the tiniest bit. And the second you go overboard with that, people can't kiss or suck on straws. So you have to be very judicious with the amount that's done there.

And then we have the surgical lip lift. The surgical lip lifts, there's the one that you do from under the nose. There's ones that you do from under the nose that go into the nose. There's ones that you do directly cutting across the entire vermilion or just the corner. So anything that lifts the lip, you call a lip lift. 

Now, the kind that really is the most popular or most useful is called the subnasal lip lift, which means that you're lifting the lip from under the nose. This started back in 1971 with Cardoso and Sperli. They talked about it in a conference and it kind of gained some popularity back then. But they saw that it would scar a lot so they could only really do it on older, like, thin skin white people. 

That's what it was used for, 67-year-olds, you're white and you have a longer upper lip. You can do an incision at the base, use that to shorten the lip, which lengthens over time and make the face look a little younger, more balanced. And if you look at the teeth, you get more incisive display on the teeth. 

I fixed the problem of just doing it on old white ladies by figuring out the same thing that we figured out with the facelift, which is in facelifting, they used to do SMAS plication or skin-only. They would really just pull the skin or lift the skin and pull on the muscle. This caused a lot of strange appearance in the face and a lot of tension, a lot of scarring. So they kept coming up with ways to hide the scarring rather than just changing the surgery. 

And we formed this thing called a deep plane facelift, which means we're actually disconnecting the middle glide layer of the face where there's no natural connection. We're disconnecting it, rolling it over, putting it back down, which means there's no word “pulling”. There's no tightening. That doesn't exist anymore with the way that I do a facelift. There's no pulling-tightening so that people don't look pulled and tight. 

And with the lip, I did the same thing. I said, “You know what? Let me do a deep plane.” So I found the deep plane. The anatomy was never described properly, so I'm the first one who described the anatomy of it. And I showed that if you release the SMAS layer over the muscle, you can pick it up, roll it over, put it back down. Now you have a deep plane lip lift or a modified upper lip lift. 

And again, I described the anatomy of where to attach things, because there are very few good descriptors of the anatomy of the lip. My first paper was an 823-patient series called the modified upper lip lift, which is a 823-patient series of deep plane release and suspension. And then my new paper, or more recently in the Aesthetic Surgery Journal, is called the Cupid Lift. That is a deep plane design, meaning it's showing people how to draw it out and where to actually lift, how to lift, and how to ascertain the best model for each patient. There's an algorithm now. 

And I formed the algorithm because I've taught hundreds of people, but very few could repeat what I did. That means I'm a failure of a teacher. It doesn't mean that they're idiots. It means I don't know how to teach it, right? Or else, more would have gotten it. So I came up with this whole algorithm just to teach other doctors. I figured out these numbers and mathematically how to actually design a lip, which is cool. 

I'm not a mathematical person. I love math. I'm just not a mathematical person when it comes to the face. I think the face is more of you eyeball it and you really got to understand it. But in this case, math came in handy. 

15:18 Dr. Vicki Rapaport: Well, and I think for the listeners, it's such a great youthful treatment. What they need to understand is when you look at a baby, the distance between the lower part of the nose, which is called the columella, and the top of the lip is very short. The baby, their upper lip practically touches their nose. And as we get older, the saying “long in the tooth” is the distance increases as we get older, the distance between your upper lip and the lower part of your nose really elongates. 

So when he does this amazing Cupid Lift, it makes us look more youthful because we look a lot more like the baby version of ourselves. 

15:52 Trina Reneá : But does it stay that way, like forever? Or is it a temporary 10-year thing? 

16:00 Dr. Ben Talei: Aging face surgeries, like a facelift or upper eyelids, brow lift, they usually last about 10 years. You age out of it towards seven years, eight years, and then by 10 years, you're like, “Okay, I'm ready to do it again.”

The lip lift, you're taking such a large proportion of the height that it's unlikely for most patients that they would need to do another one, unless they live another 40 years past it, then maybe I can imagine that. And there are patients here and there that couldn't be lifted that much. And maybe 20 years later, they grow some back and you lift it again. 

So you would assume it's fairly permanent, but not for everybody. 

16:33 Trina Reneá : And how long are they in surgery? Is this a day in and out situation? 

16:39 Dr. Ben Talei: Yeah, you come in, I tell them it's just like a dental procedure. You come in, we numb you up, takes about an hour. And you leave with stitches in and you have the stitches in for five days. First week, you look ridiculous. Next week, you look halfway ridiculous. Third week, you look like you're starting to get to normal volume on the lip, but it's stiff. So you go back to life, but you have a stiff lip. 

And then usually by two, three months, that softens up. In three months, I say if you stand in front of your twin sister, your twin sister wouldn't realize you did it. And I've done twins, and trust me, they don't even realize. You're only 20% healed at three months, and you keep healing for over the course of a year to three years, which is how the body heals. 

17:14 Trina Reneá : Okay. And what does something like this cost someone? Do they have to come to Beverly Hills to get it done? 

17:21 Julie Falls: If they want it done properly, yes. 

17:25 Dr. Ben Talei: Yes, so the Cupid Lift, currently, I'm the only one who does it. But I'm teaching people and setting up centers here and there. In my practice, if I do it, I think it's like $15,000 or something. If my colleague does it or at the Cupid Center, it's five. So five is the standard rate around the country and five is what we chose for that. The more expensive practitioners than me charge like 20 to 30, but those are very few people. And it doesn't really mean you're getting better work. It's just some people charge more, some people charge less. 

17:53 Trina Reneá : So the people in your clinic that are charging $5,000 compared to your $15,000, you completely trust 100% with your patients?

18:02 Dr. Ben Talei: Yeah, there's not one person who works with me that I don't trust fully. I would go to them myself, including my nurse practitioner, Jen, who I hired to take over. I used to do 20 to 40 injections a day every day on patients. So six days a week, I was injecting 20 to 40 people. It was killing my life.

And I had real trouble delegating it to somebody else because I don't trust anybody to do anything, unless they can do it exactly as I do. So I brought her on and fully trust her and handed it over. 

And now with the Cupid Lips, it's not that I just train them and show them how to do it and send them off, I'm training them for a while then I watch them operate. Then they watch me operate again. Then I go watch them operate again. And then I say, “Okay, you got it,” and then they go.

18:02 Trina Reneá : That's exactly how I work with estheticians. I train them and train them and train them, and then they have to work on me. Then I have to work on them. Then they have to work on me to be perfect. 

18:56 Dr. Ben Talei: Yeah. Quality control. That's the problem with a lot of these companies that have opened up and try to replicate things is there's no quality control. They just want to make money. So their goal or their definition of success is how many people they get in the door and how fast they can do things. 

For me, it's going to be how well can people replicate my results, and I'm going to be watching it and making sure they can. 

19:20 Julie Falls: Speaking of replicate, I believe at one point you told me there were really just three surgeons in this country who do the actual facelift that you do. I was in your waiting room once, and there was a woman in there. She was a week out from your AuraLyft. I think she did a brow lift and something else. And she worked for a very well-known plastic surgeon in L.A. She didn't go to him where she wouldn't have to pay anything. She went to you.

I mean, your results are astonishing. And I'm wondering, are you teaching your technique to more and more doctors? Are more people going to be doing what you do? 

19:59 Dr. Ben Talei: Yeah, absolutely. Any day you come by my operating room, there's at least two to three surgeons watching. Now, they have to come back enough times to really learn how to do it because the anatomy is a little complex, but the surgery is easy once you get the anatomy. Other than that, I have fellows that we teach and I have residents. I have residents from here in Los Angeles and I have from Mexico. I'm a professor in Monterrey, Mexico and in Mexico City. They send their residents for one month at a time. I'm part of one of their rotations. So they come rotate with me and they learn.

So I'm trying to teach as many people as possible, as much as I can, in addition to giving conferences, which every month I'm at least at one conference, giving five to six lectures, live surgery courses, you name it. And part of the growth of the Cupid Lips Center is that we're going to be a teaching center with an online compendium called the Cupid Compendium, which is a compendium video library of different surgeons and different injectors showing their techniques. So we're going to have an online library.

Because injectors, especially, are always hungry for education, and they don't know where to get it. They can't just get it from the one person they're working with. They have to really learn. So it's hard for them to get it. This will make it a lot easier. 

21:18 Trina Reneá : That's great. I love to hear that.

21:20 Julie Falls: Yeah.

21:22 Dr. Vicki Rapaport: Well, that's part of the reason why we have him on the show is because not only is he skilled, but he is interested in teaching the next generation, which is what medicine is all about. Honestly, you know, the narcissistic plastic surgeon who just wants to keep everybody for himself or herself is not the plastic surgeon that we would have on the show. 

So we love everything that you just said. I love that you're educating and teaching and that you have injectors and surgeons that you work along with and that you totally trust, like you said, with your own face. Because you can't do surgery on your own face. 

21:54 Dr. Ben Talei: No, no, no. And you got to trust somebody at some point. It's nice to be in the part of the world that we all teach each other, because the ones who teach learn more. I'm better than other surgeons because I teach. It's not just because I'm smart. It's because I teach. As you teach, you have discussions and you talk to people and people teach you things. 

22:14 Dr. Vicki Rapaport: Absolutely true. 

22:16 Dr. Ben Talei: A good amount of plastic surgeons, even though we're in this academic world, are very competitive and secretive. But competition is for the mediocre. There are always going to be mediocre surgeons who are going to feel that they need to be competitive and secretive because they have no true value. Their only way to stay successful is to keep secrets and market. It's really just more marketing and branding than becoming good at surgery. 

The greatest surgeons have no secrets. It's an open-door policy. They want to teach everyone everything. Realistically, you owe it to everybody because somebody taught you. 

22:54 Dr. Vicki Rapaport: That's right. 

22:56 Dr. Ben Talei: I didn't go invent surgery. Somebody taught me. Many, many people taught me and they took time out of their lives and they sacrificed time to teach me. Imagine how offensive it is to those people who taught me if I go keep their secrets like I made it up and it's my own. It's offensive. 

23:12 Dr. Vicki Rapaport: And then it just goes to better patient care, right, In general. Medicine in general has gotten better and better. Medications are better. Surgery is better. It's all about improving the patient care, less downtime, all that stuff. 

23:24 Trina Reneá : I do the same thing in aesthetics. I train estheticians. In fact, I'm going to do a training right after this today, but I have to give back to the community because I learned from Dr. Vicki. Also, I take classes every month, if I can, at least four times a year. And I give back to the estheticians that are learning in school now because they need it and they don't have that postgraduate training that you guys get, which is great in your field. But our field doesn't get that, so I also give back. I agree with all that. 

I also have a question about your lip lift. If somebody has jowls and you lift that lip, what's going to happen with the jowls? 

24:13 Dr. Ben Talei: That is something that is it's multifactorial when we're looking at the jowl. Because when we're looking at the corner of the mouth towards the jowl, there's the jowls, which is that hanging jowl that everybody has. And then in front of it is the pre-jowl fold. And below it, the pre-jowl sulcus. 

So there's a shadow that forms. On some patients, that shadow is exaggerated because they have what we call angular depression, which means the corner of the mouth is pulling down tight. And if the corner of the mouth is sitting lower than the rest of the lip and pulling down tight, that needs to be treated with either facelifting or Botox. It takes the weight off the side of the face and you can Botox those to relax it. 

And in fact, if you were to do a central lip lift, subnasal lip lift, you may exaggerate that downturn. 

25:00 Trina Reneá : That's what I was thinking.

25:02 Dr. Ben Talei: Yeah. So you may exaggerate that downturn. That's a matter of really kind of a skilled assessment and trying to figure out what you can get away with without exaggerating it. Or do I do a big corner lift, where you make an incision on the side of the mouth to neutralize a down-pointed corner? 

All these things. work together. There's the muscles that pull it down. There's the drooping that's happened, which is the jowl. There's the corner of the mouth that's coming down. And you have to figure out how to balance these things without exaggerating one. 

25:32 Julie Falls: What kind of pain do people experience after they do the lip lift? Is it painful, the recovery?

25:39 Dr. Ben Talei: Not for most people. For most people, they have a little bit of burning as the medication wears off for about 20 minutes, where it's just the anesthetic going away. And then I'd say 97% to 99% of patients don't have any pain at all. Maybe if they have a little aching, they take Tylenol. 

There is a small subset of patients who they're hypersensitive to pain. They're usually the more anxious patient. Anxiety really does affect pain levels because your perception of pain is really amplified. Those patients have pain. They're shocked that they have pain and surprised every time. It's the biggest deal in the world for them. But that's how their bodies are wired. So it is a bigger response. 

Imagine you're asleep and a mosquito bites you. You don't even feel it. If you're awake and you're staring at the mosquito and they get on you, even before they touch your skin, you feel it. You're batting them off. That's how your sensation and pain and all that stuff works. It depends on your level of sensitivity and your level of anxiety. It completely, completely changes. If you're asleep, sedated, no anxiety. You don't even feel pain. 

26:48 Trina Reneá : Right. Another thing we wanted to ask you on this episode was about threading. It's very popular. It's made a comeback. It's better, I guess, now. I'm hearing about it a lot more from my clients and asking questions about it.

And when I started doing some investigating, you came up because you had a little talk about it on Instagram. I just want to know your thoughts. I know that if it's done well and not too deep or something, then it's okay. But then sometimes, if they do it too many times or if it's a bad person, somebody not good doing it, then it can affect a facelift. Can you tell us a little bit about that? 

27:38 Dr. Ben Talei: Yeah. So the main problem with threads is that most practitioners are very limited. By limited, I mean, they're just not that smart. And it's hard to explain to somebody who's not that smart that you can use a product or you can use a device, but it's bad in 70% of ways, good in 30%. And you have to know how to use that 30%. But they just want to tell their patients that it's all good, or else they wouldn't be doing it. But that doesn't make sense. 

So that's the big problem with threads and injectables and things like that is that practitioners don't know how to limit themselves because they think that to do something, in their minds, they have to convince themselves and the patient that it's all healthy and all good. 

And that's why when they describe Sculptra, they could just say, “Listen, I'm forming scar tissue granules in your face.” And that's the reality of it. “I can use it to benefit you.” But instead they say, “I'm helping stimulate collagen production.” It's a twisted way of telling someone something. That is not going to benefit them anyway. 

With threads, that's the problem, is that people don't realize the limitations of threads. Threads have been around for 20 years. They've been around in different types of threads. Now they're collagen-stimulating threads, which means scar tissue-forming threads or fibroplastic threads, different types of suture material. 

So the things that threads are good for, there's two ways to think about it. So there's one procedure called MyEllevate, which is a procedure developed by Dr. Greg Mueller and it's an internal type of neck lift that's done with threads, but it's not the way you think about it. He actually uses a device to enter the suture back and forth. He can do myotomies on the muscle to release it and then he can tack it up. And you get this really cool internal neck lift without ever opening somebody. That's a cool way to use threads. 

The other is how most people use threads, which is to try to stiffen up somewhere on the face or the neck. Now, they call it lifting, but that makes no logical sense. For something to lift, it has to go from down to up and, realistically, these don't do that. They just contract things and stiffen things, which can give the appearance of a lift. 

So threads in the midface, if you were to ever use them, may enhance the effect of fillers or something that you're doing on somebody who wants a non-surgical intervention. The places it doesn't work, which is just asinine, is in the lip, for example. And I'm like the lip specialist, so I can get pretty aggressive with describing it. I don't have to be diplomatic. I know for a fact it cannot benefit the lip. And nobody knows in the world more about lips than I do. It doesn't exist. And I'm telling you it can't benefit the lip. But some doctors still do it because they think it forms collagen, but they don't even know the anatomy. So they don't know where it's forming collagen, but it's forming collagen. 

So threads are overdone in that respect where they put them on places where it's not going to help because they're imagining things rather than just being practical and realistic. You want your doctor to live in the real world and tell you physically, “Here's what I'm doing. I'm not lifting you. I'm tightening you or contracting this area. It's going to give the appearance of a lift. It's going to last you usually about anywhere from two months to nine months. And I have to give you a big range because I don't know how long it's going to last.” 

And the patient says, okay. I think that is a responsible way to do threads on somebody. Not, “Hey, come back, and it forms collagen and it's healthy, and let me do this every six months for the rest of your life, because, in my mind, I've envisioned that this is a healthy treatment.” 

So if you overdo threads, then again, just like overdoing Sculptra or overdoing any kind of filler, you start to change the soft tissue quality in your face and it does start to get more rigid. And let's say you do fillers in the future, it won't go where you want it to go because you have scar tissue in there, and it always escapes to the path of least resistance. So it becomes unpredictable doing fillers. 

So again, with everything else, it's about doing it with taste and being realistic about it because we're medical professionals. We don't have the comfort of just playing with a dollhouse and doing whatever we want. We're playing with people's faces. So we have to just explain to people rationally and realistically the limitations of this stuff and really find limits for ourselves, not just keep doing it because we think it's good for people. 

31:54 Dr. Vicki Rapaport: And in my experience in our office, Vicki Chen is my PA and she's the one who does the threads in my office. But what I have experienced with the patients is that they love it and it actually prepares them for future surgery because they love it so much. They just can't believe how beautiful it looks. But he's absolutely right. It does not last very long. 

And I hear Vicki Chen doing her consult. She's so straightforward. She never even says 12 months. She says it lasts maybe up to nine months, like three to nine months. And they're really, really happy with it. If they want to continue to do it, that's fine. But it is important to kind of let them know it's not going to be a forever solution. You may indeed need surgery in the future if you like those results and you want them to last longer. 

32:40 Trina Reneá : Yeah. So if somebody were to get threads, let's say, in their cheek area, and they were to do it, let's say, once a year, like how many times is too many times to then be like, “Okay, now I'm ready for a facelift.” And you have all this scar tissue under there possibly that has formed from the multiple times that they've done it. Could they do it 10 times and then go for a facelift or is it per practitioner? 

33:14 Dr. Ben Talei: So it's per patient. You'll never know the answer to this. I'll never know the answer to this. Some patients could do it a hundred times and their bodies won't react in a negative way, or roughly two and it won't change the tissue quality at all. But when it does, it's not reversible. 

I just like to veer on the side of caution. If somebody said, “I'm going to do threads once a year for three years,” I'd say, “Totally fine. I don't see any problem with that at all.” And I don't see where a problem could arise from that, unless you're the rare person that has some kind of weird fibroplastic reaction. So I say that's totally fine. 

If somebody says, “I want to do it every six months for the next 10 years, I'd say, “Well, you can, but most likely you're going to just develop firm soft tissues at some point and your face is not going to move the same and it'll start changing.” You know, you're doing it excessively. 

So I think something like once a year for three years. I can't imagine what would go wrong with that. 

34:08 Trina Reneá : And then if you see this patient, let's say, who's done a lot of threads, can you tell before going under their skin, or can you feel it before opening up their skin and going, “Oh, this person has a lot of scar tissue. I can't work on this.”

34:26 Dr. Ben Talei: Yeah, but it's usually not from the threads. Threads don't cause that much scar tissue. Realistically, the problem is that somebody who's had threads has also tried a ton of other things. So they have filler, a bunch of different kind of filler in their face. They've done 20 different types of heat treatments, heat-based therapies. They've done Ulthera 10 times, which kind of microwaves the tissues a little bit. So it's a combination. 

So when they say they've had threads and you see these kind of soft tissue changes, I know in my head it's not just threads. Threads didn't do that. It's every bit of every treatment they've had that cumulatively has changed their soft tissue quality. It doesn't stop me from doing a surgery in most cases. I just know that my hand is going to hurt more. That's all.

35:08 Dr. Vicki Rapaport: I love that. 

35:10 Trina Reneá : And are you good with all the lasers and stuff out there, like for the skin?

35:13 Julie Falls: Yeah. If we have time, I wanted to ask him to tell us, because he did love this treatment called Profound. So I'm curious if you still love it and if you could tell us a little bit about it before we go. Do we have time? 

35:27 Dr. Ben Talei: Yeah, of course. So in the world of heat treatments, you have lasers and radiofrequency and ultrasound. Ultrasound is Ultherapy, which is one of the most popular devices that's out there. I always try to explain in the plastic surgery world, think about the way people look at plastics. The reputation is pretty bad. So if you talk to somebody about plastic surgery, they're worried about looking plastic. The reason is that the majority of practitioners, the way they do things is wrong. And that's the bottom line. It's just not done well.

So when things are exceedingly popular or a filler type is exceedingly popular, you have to put that in perspective saying, well, the most popular is probably the worst. That's how I start in my mind looking at things. It's not true but it's a good way to approach to, as a practitioner, to just say, “Okay, I'm not going to just jump into it because everybody's doing it.”

36:17 Trina Reneá : Right. The trending thing. 

36:19 Dr. Ben Talei: Yeah. It's usually the wrong thing. So you just have to be cautious. 

Now with heat-based therapies, I love heat-based therapies. My second fellowship was in birthmarks and lasers. I really got into the physics of it. I do love lasers and know a lot about them. I don't think lasers are safe for everybody. I don't think lasers are a healthy thing to keep doing to somebody, but I do think they're a lifesaver. There's gentle ones like Clear and Brilliant that are exceedingly rare that they would ever cause a problem versus like a CO2. You really got to know what you're doing. Or a Fraxel, I'm a little more lenient with that one.

But they're life-changing for people because you can really clean up the sun damage that's occurred over time. Knowing that, you're also burning their face. So you have potential problems that can come from these things. 

And with radiofrequency, similarly, there are ones that you can overdo it and there are ones that just don't do anything. In the world of tightening, real skin tightening, the best one that I've ever seen, hands down, by far, and it's not arguable, it is Profound for the face. 

So Profound radiofrequency by Syneron Candela is a true bipolar radiofrequency. It tightens up the skin where maybe you diminish about 30% of shadows or something like that. It has a week of downtime, so it's more downtime than the others. 

Second best would be probably Morpheus, because it's a little versatile. You can go superficial to deep. You just have to know how to control it. 

And then Profound is coming out with a new one that's going to be a little bit better than that, which is going to be awesome to use. And then you have all the fluff ones, which are for pores and stuff like that in the radiofrequency realm.

There are magnetic-type devices that are coming out now, which help with muscle stimulation and tone under the skin. That's kind of cool and are not going to be harmful.

So I like the ones that make a big difference but have really low risk. That, for me, is Profound, Morpheus. Whereas things like Renuvion and FaceTite, you really got to do it on the right patient. It's a patient who has some fat under the skin and you do want to diminish the fat at the same time as tightening up the skin. 

So FaceTite and Renuvion, those kinds of things, or J-Plasma, they're better for people who have a little bit of fat under the skin and you really want to diminish the volume. 

38:30 Trina Reneá : And Profound is what type of technology is that one?

38:35 Dr. Ben Talei: It's bipolar injectable radiofrequency, which means you put in pairs of needles and they pass electricity to each other versus dispersing it everywhere. That's a very controlled type of radiofrequency. That helps produce elastin, hyaluronic acid, and collagen. 

Whereas if you're looking at just CO2 laser, it's mainly just collagen reformation and heat contracture. 

38:55 Julie Falls: With Profound, is it more invasive? Do you have to go in with the cannula or no? 

38:59 Dr. Ben Talei: No cannula, it's percutaneous needles. So you have to numb the face from face to neck, and you poke them in the face with a bunch of needles. That's how it goes.

39:07 Julie Falls: Okay. 

39:09 Trina Reneá : And then the radiofrequency is at the end of the needles?

39:13 Dr. Ben Talei: Exactly. The way radiofrequency works is you take energy from the wall, a plug, puts it into a machine, converts it into a different type of energy we call radio frequency. That's the energy that you pass into the skin over the skin or under the skin.

39:29 Trina Reneá : Right. So you don't get surface burning. It's underneath the skin. Just like the... 

39:37 Dr. Ben Talei: Exactly. 

39:37 Trina Reneá : I understand. So it's on the same realm as the Morpheus and any of the radiofrequency devices. You just prefer the Profound over others. 

39:47 Dr. Ben Talei: Yeah, the mode of energy deposition is very different. 

39:51 Trina Reneá : And how much does that one cost? 

39:54 Dr. Ben Talei: Most people charge about $4,000 to $5,000 for it. But it's a single treatment versus doing Morpheus four times at $1,500 each. This is like you do it once, you have swelling for a week, but then the results are going to be more substantial for actual skin tightening. 

Now, if you're looking at pores and acne and that kind of stuff, then you're going to use Morpheus because you can go to one millimeter depth, one and a half, and control it a little bit more for that. 

40:21 Trina Reneá : Got it. Okay. Awesome. Anybody have more questions? 

40:26 Dr. Vicki Rapaport: Yes, I would like to ask Ben a question, which is the future of plastic surgery. Can you give us like a scoop of what's to come besides the amazing Cupid Lip lift? 

40:40 Dr. Ben Talei: Yeah. There's a lot that we're doing with regenerative medicine and healing people. So the healing of surgery is going to be getting a lot better. And cosmetics, we're going to be able to do things that are just less risky with bigger changes. That's definitely coming down the pipeline. You see it every day with all the devices. 

The other big turn in plastic surgery happened about five, six years ago when social media really took off. So social media really has only been popularized since 2013 and 2014. Since that time, plastic surgery has improved dramatically because we, as practitioners, no longer just look at what's published in the medical journals and what's allowed to be seen or what people allow to be published. We see what individual practitioners do in their own social media. They teach it before it even gets published. Now, it's not peer-reviewed but it gives you ideas. 

And the other thing is the plastic surgeons who aren't so good can't hide anymore. They can't just say, “This is the procedure I do. This is why I do it,” and stand by it for 20 years with no evolution. Now they have to compete with everybody else saying all these other practitioners are showing their results. They're proving without a study by their photos, they're proving that a deep plane facelift is better. And they proved it because my facelift results are so much better than this other guy's facelift results. And they see it, the proof is in the pudding, right? You see the actual art of it and the results. 

And so now, they can't hide behind it anymore because a patient is going to see my results and see their results and say, “Doctor, why aren't you doing this?” And after a hundred times of hearing that, the doctor is going to be forced to go change his ways. This is the nice thing about social media. 

42:12 Trina Reneá : Right. So better plastic surgery.

42:15 Dr. Ben Talei: 100%. 

42:15 Dr. Vicki Rapaport: I love that. 

42:17 Dr. Ben Talei: More realistic, more natural, bigger results. Everything is getting better. And if you look at the results in the past seven years, you'll see they are dramatically better and have evolved dramatically more than they used to in the past 50 years. 

42:31 Trina Reneá : Right. Well, we're happy that you're on the scene and that you're helping teach other doctors how to do things better and that you are so passionate about it. We really appreciate all that you do, so thank you very much. 

42:44 Dr. Ben Talei: Of course. My pleasure. It's my pleasure speaking to all of you. 

42:47 Julie Falls: Thank you so much. Have a wonderful boating weekend. 

42:48 Dr. Vicki Rapaport: Yes, go. And wear your sunscreen, please.

42:51 Trina Reneá : Don't forget your sunscreen. 

42:52 Dr. Ben Talei: Yes. You got it. I used to never burn. Then I moved to New York, moved back to L.A. and now I burn. 

42:58 Trina Reneá : Oh, no. 

43:01 Julie Falls: Your pigments have changed. 

43:03 Trina Reneá : Well, we would love to have you back again with more questions. 

43:05 Julie Falls: Yeah, maybe next time with Jenn Hollander, who we are thinking about having too. We'd love to have her. She's awesome. 

43:10 Dr. Ben Talei: Yeah, it'd be a pleasure. 

43:11 Julie Falls: Yes. 

43:13 Trina Reneá : Thank you. 

43:13 Dr. Vicki Rapaport: Okay, Dr. Talei, thank you so much. You're wonderful. Appreciate everything. 

43:17 Dr. Ben Talei: My pleasure. Take care. 

43:19 Trina Reneá : Bye.

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