Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Hello. And today on Meet the Doctor, my guest is Dan Gould. He is a plastic surgeon in Beverly Hills and I am so proud to have you here today. Dr. Gould, welcome. Tell us about yourself.

Dr. Gould (00:45):
Great. Thanks for having me. I'm excited to be here and kind of chat a little bit. Basically, I'm a board certified plastic surgeon, uh, like you said in Beverly Hills specializing in a few key surgical procedures, but basically just allowing patients to recognize better the person they see in the mirror, to feel more comfortable in their own skin. And most of the procedures that I do focus around those types of situations.

Eva Sheie (01:09):
What are the procedures that you focus on? I know most of you can do most things, but in Beverly Hills, everybody super specializes.

Dr. Gould (01:17):
That's such a good point. Yeah, I think to be successful in a market where there's a lot of subspecialization, you have to have maybe, well, let's say two or three things that you're good at. Because we all know the old adage, you know, they say master of none. So jack of all trades, master of none. But they forget the second part, which is still always better than a master of one, right? So you want to be good at maybe two or three things. So in my practice, I'm well known for deep plane face and neck lift. That's something that I publish papers on, give talks on around the country, including at the upcoming ASAPS meeting in Miami in a couple of weeks and in the upcoming official plastic meeting in San Diego. But I also do a very unique style of abdominoplasty called a drainless tummy tuck.

Dr. Gould (01:58):
I've written some articles on that, including one recently where I described it as a painless drain list tummy tuck because we're utilizing a new approach to pain control than making it a much more comfortable procedure and not like what you've heard of, you know, not like your mother's tuck. And then the last thing that I'm known for is complex breast surgery. Because if you think about it, the ideal patient in my practice is the same patient for all these procedures, essentially women between the ages of 35 and 65. And you know, in my practice, women who need facelift have had breast implants and maybe they're on their third or fourth breast surgery and we're tuning things up, taking implants out, getting 'em ready so that they don't need additional surgeries the rest of their life or dealing with complicated situations including breast revision surgery, which I do a lot of in order to fix disasters and to improve the quality of people's lives.

Eva Sheie (02:46):
Let's go through those kind of one by one because face and body are really different.

Dr. Gould (02:52):
That's true. Face and body are quite different, but the surgical approaches can be very similar. Meaning if you're doing good plastic surgery, you're taking tension off, you're going into the deeper layers and you're re you're restoring the natural anatomy that's there in my fellowship. So I'm fellowship trained by the top kind of fellowship for cosmetic surgery. I worked with a bunch of different surgeons that were doing everything from complex revision rhinoplasty to face, neck lift and abdominoplasty complex breast surgery. And I think given that I'm fellowship trained by a special group of surgeons in Los Angeles who are really the experts in those things, I definitely had the experience coming out of fellowship to do face and body. There are some surgeons who just do face because they're ENTs, they're ear noses and throat doctors who train in head and neck surgery. And so they don't really feel comfortable going outside of that um, region.

Dr. Gould (03:40):
And then there are plastic surgeons who specialize in breast and body because that's really what they did in their fellowship. Or maybe they didn't do a fellowship or maybe in a residency they did a lot of that and they feel comfortable in it. But when you've got fellowship training at the top kind of place where you're doing it all, that's when you need to take advantage of it and kind of go forward with the same approaches. Now after that, I started working in an office for the first year and a half for really almost two years with a surgeon who was very senior. He was in his late sixties, you know, and most of his patients were at the age where they needed facelift and revision breast surgery. And that's why I got all the experience I did at such a young age doing. And he brought me in very specifically to treat those patients doing facelift, doing um, complex breast surgery.

Dr. Gould (04:22):
And in that first year alone, I did something like 200 or 300 facial rejuvenation procedures, which is extremely rare as somebody that early in their practice. But it's all because of the setup and the situation. And that's why in my practice today I do what I do is because early exposure and, and kind of defining the practice that I want, but I've been very systematically and purposefully collecting those types of, um, patients and procedures cuz I want to have an office full of those types of patients. I want people who are experienced, thoughtful, and have the energy and the downtime to be able to go through procedures like this. I like patients who, like I said, wanna look better and not different. They want to recognize a person they see in the mirror and they fully understand what they're getting themselves into. Maybe they've had surgery before, it's not their first time.

Dr. Gould (05:05):
You know, um, i, I don't wanna practice where I'm doing necessarily Brazilian butt lift or rhinoplasty and high volumes where you're really taking a patient and changing the way they look dramatically, making them look quite different and sometimes not better, you know, but usually quite different. So those, that's just kind of an active thought process about what I want my practice to be like, who I want in my doors and who I feel like I resonate with. And the truth is, patients seek you out. So these, you know, I get along well with people who are looking to rejuvenate their face and those are the patients that seek me out and that's really why I wound up where we are.

Eva Sheie (05:39):
When I was younger, I worked with a lot of well known plastic surgery consulting people. Yep. And there used to be this sort of well known, you know, consulting problem that you couldn't sell facelifts if the surgeon was really young. Like people just wouldn't go to a young surgeon for a facelift because

Dr. Gould (05:59):
Yeah,

Eva Sheie (05:59):
That patient is much older. But I think the angle that you're taking is remarkable in the sense that, you know, you're focusing really on a specific demographic and age of patient and the things that that patient needs the most.

Dr. Gould (06:12):
Right. I'm focusing on my patient and my customer and saying, Hey, what do they need? And then I'm gonna provide those resources. My goal is to be the best experience for the patient at all times. So the first question I ask is, what kind of patients do I want? And the second question is, what do they need? And if I can just answer those two questions and can I provide it? So three questions, then I know that I can succeed in an environment that's very difficult and very complicated and very competitive. Now let's be honest, you can't do great unless you can do great surgery. You have to be able to provide the outcomes and the results. And I think that not everyone provides the same outcomes and results, but I think it's wrong to think that just because a surgeon is old, they know how to do a facelift.

Dr. Gould (06:56):
That's quite dumb. I mean, honestly like if the surgeon's been doing breast surgery for 20 years and all of a sudden they just turned 60, now all of a sudden you can go to them for a facelift. I mean, what's changed in the last 20 years? They weren't learning how to do a facelift that whole time. They probably have no, no clue how to do it, honestly. And if they have been really well known for one thing, like breast surgery or tummy surgery, then I think that would be the thing that I would go to them for. You know, I think it's, it's wrong to say, well he did my breast, now I'm gonna go back to him to do my face. No, you should go to the person who's doing that in high volumes, or at least not even in high volumes, but at least with a good concept of how to do it with great results. And an and is also in a leadership role and an educational position because that means that they know inherently what they're doing. And then also I would just say that sometimes you can find somebody who can do one or two things, but usually, like I said, they're, they're somebody who's targeting their practice, they're servicing that age group, you know, and usually the reason why it's usually older surgeons that are doing faces is because they're practices aged with them. Not necessarily because they're amazing or great at that procedure.

Eva Sheie (08:02):
But to your point, isn't the deep plane technique relatively new in terms of facelifts? You know, on a continuum of time,

Dr. Gould (08:10):
Arguably no. Uh, in the 1960s and seventies, Dr. Hammer was really one of the pioneers at advancing the early technique. And the very first facelifts were really just skin removal. But Peyronie and Skoog were the ones who had identified the SMAS as a layer in the face that you could manipulate and tighten. And that was long time ago. But in the sixties and seventies they started saying, can we go into the deeper layer and not just tighten the fascia, not just tighten the skin but go in the deeper layer, release the tension and re-drape it. And Hammer really liked that technique when he kind of pioneered its use. And then there was this huge dispute in the nineties and two thousands about what happened because he stopped operating and everyone said that he said that he stopped doing it and that he was doing, gone back to doing SMAS style lifts.

Dr. Gould (08:55):
But the people that were saying this were all the SMAS lift surgeons, they were saying no. Even Hammer stopped doing it, went back, said he had too many complications, wasn't worth it, results weren't that great. But recently Hammer was interviewed by Dr. Jacono, this was in 2019 or I wanna say 2018. And in this long conversation that he had, which he actually posted on his Instagram, Hammer said, no, I never stopped doing a deep plane. I love the deep plane until I stop practice and I continue to do it. And this is all a bunch of nonsense. And the truth is that there's a group of surgeons that know how to do it, that do it and great get great results. And the group of surgeons who don't know how to do it, know how to do something else and the results are okay. And I think that surgeons get intimidated when you start using a new language and you start saying, this approach is better than that approach.

Dr. Gould (09:37):
And people say it's a marketing term to say deep plane facelift and whatever. And that's just a poor understanding of what's actually happening during the surgery. Or an inability to adapt and recognize and and develop new techniques or an inability to want to change what you're doing in your own practice, which I think is the most common thing. I think that the bottom line is this deep plane face and neck lift is not a new approach. However, it has been re-approached by Jacono and a few other surgeons and has been adopted wildly by the ENTs and facial plastic surgeons widely by those people. And in in the right hands, I think it can provide the best and most natural result because of the principles. And I just say, what's the, what are the basic principles of plastic surgery release tension, right? And reapproximate the native to native natural results. So if you can do that with a deep plane, then it probably is the best thing. Well, as opposed to a SMAS where you're gonna cut the fascia, you're gonna tighten it, you're gonna reposition it like canal style flap where you take it and pull it behind the ear to tighten things in different vectors. That's just so complicated. Why not just release all the tension, put it back where it belongs and put it back into place.

Eva Sheie (10:44):
I'm flattered that you think I know how to do facelifts. I don't

Dr. Gould (10:48):
<laugh>

Eva Sheie (10:49):
<laugh>. So for anyone who's listening who's like me, will you give us like the, the shortest of elevator pitches on how each one works and how they're different?

Dr. Gould (10:58):
So most original and like least effective is just cutting skin out. So taking the loose skin that's in front of the ear or behind the ear making incision, pulling the skin tight and closing it doesn't work because skin stretches, skin will always stretch back. And so within the fir initially looks great a year later looks like not great. And remember there was this whole lifestyle lift that came out in the nineties and two thousands. Where did it go? How come it doesn't exist anymore? Because,

Eva Sheie (11:25):
Because RealSelf took 'em down.

Dr. Gould (11:27):
Correct. And because it was terrible, results were bad and patients didn't like it. And all it took was a little transparency to realize, hey, it's not the right thing to do this. So facelift 2.0 is SMAS style elevation. So going below the skin, separating skin from what's below it and then taking that deeper layer or the SMAS, removing a small portion and tightening it or making an incision in the SMAS and pulling it behind the ear or making incision in the patisma and the SMAS and deepening the jawline. And by and large, this was the dominant and still is probably the dominant facial rejuvenation procedure practiced by most plastic surgeons in the United States today. Now what are some of the issues with it? Well, you're not disconnecting that SMAS from what's deeper, the connections between the bone and the other soft tissues to the SMAS.

Dr. Gould (12:15):
And so you can't really re-drape it. You can't really, there are limits to how far you can lift it, pull it, tighten it, and you're using a stitch to tighten it. You're, you're adding some tension across it that may not be a native tension or a normal shape. And over time things will change. Now people say that it's safer because you're not going deeper where the nerves are, but if you look at all the studies and science on it, it's the same rate, if not a higher rate of nerve injury because you're not looking below, you're just putting a stitch in. So you could be grabbing it with that stitch. And they also say that if you look at the studies on how often it is before they need uh, revision around the country, it's five to eight years for revision after SMAS style lift.

Dr. Gould (12:54):
And then in facelift 3.0, which is the deep plane, it's more like 13 to 16 years. Now a deep plane lift is different because you make an incision go down below the skin, then you make an incision into the SMAS, you go deeper to the connective tissue layer, the layer that supports the fat, the skin and all the other compartments of the face. And by going deeper than that layer, you're in the same plane as where the nerves are, where all the soft tissues are, where the connective kind of regions are. And by releasing the tension in that layer, everything is kind of relaxed and can move freely. That's what allows you to have the biggest vertical vector of uh, anti-aging in the midface. And that's what gives you the best vector with regards to the neck and chin. And I think that's what provides the best results.

Dr. Gould (13:38):
So that's facelift 3.0. So 1.0 skin only, 2.0 is SMAS modification and the variations on that, and 3.0 is deep plane. And I think that most deep plane surgeons would agree with that analogy and would say that you do get better kind of release. Now are the rates of complications different? Slightly, but in the literature that's out there, you know, the risk of nerve injury and all these things is actually lower or equivalent with deep plane. So I don't really think that there's any one way to say one is better, safer or should be the thing that we should be doing other than to say just look at the results. And some people that don't do a deep plane have excellent results that do a SMAS only. Excellent results, great quality surgery and they're doing their own kind of variation. And that's where it gets complicated cuz plastic surgery is not just about the technique, it's about the surgeon, right? So you know, you can get great results with technology that's different. It doesn't mean one's better or one's worse, it just means that you, you know, you both got to the same place with a different route. So those are the different approaches and um, a little bit of commentary on what's good and what's better or you know, maybe what's different in different in facelift today.

Eva Sheie (14:45):
Now I have this impression that you have written and published more papers than most and there's always been a serious academic side to your work. Is that accurate?

Dr. Gould (14:56):
Uh, definitely. I mean I, you know, I'm an MD PhD and the PhD is in tissue engineering bioengineering at Rice University and

Eva Sheie (15:02):
Oh, I went there too. Did you know that we both went to Rice?

Dr. Gould (15:05):
Well there you go. Fellow owls <laugh> in the same place. So, and I would just say that even from undergraduate institution I had interest in, in science and research, I decided to do an MD PhD to explore that further. And I did a lot of publications on tissue engineering and the science of, of that process during medical school and the PhD. And then in residency I applied that same work ethic and knowledge of how to publish and explored questions asking what do plastic surgeons and what do the general public wanna know about plastic surgery? And I published over 140 articles on in plastic surgery during that time when most people can barely stay awake long enough to drive home. I was up late operating and then writing articles. And I think that that just shows you that I'm one of those kind of people who always looks at questions and says, I really wanna know the answer.

Dr. Gould (15:53):
You know, as opposed to just letting it go. I'm gonna explore the answer and make sure that I'm doing the right thing because I wanna improve the quality of care for the patients and I wanna speak from a position of knowledge and be able to answer the question reasonably but also give all the data to the patients almost to the point where it's too much information. Like you said earlier, I'm not, you act like I know how to do a face with, well I don't know what you know, but I know that if I give you a little bit more than what you need that you can take what you need from it in the conversation and the consultation. But I also like getting up on stage and having debates with other surgeons. I like furthering the science of plastic surgery. I truly believe in my heart, unless you're writing papers and publishing and contributing back, you are not a plastic surgeon cuz plastic surgery is about changing the way that people look.

Dr. Gould (16:38):
But it's also about furthering the science of surgery in general. Like, you know, the first transplant was done by a plastic surgeon. You know, plastic surgery is a specialty of innovation. We've created all these new surgical techniques and approaches that then we hand off to other surgical specialties and they do um, that's why, you know, facial plastics, I mean microsurgery to do reconstruction, the head and neck that was plastic surgeons and then they gave it back to the ENTs and now facial plastic surgeons has been created as its own specialty focused on cancer reconstruction and cosmetic. But that all has come out of plastic surgery. So we do these things knowing that, that we have to contribute and improve it. And in my mind, unless you're doing that, you're not really a plastic surgeon. So I've been, like you said, been focused on publications and I've, I've written over 140 peer reviewed publications.

Dr. Gould (17:22):
I'm the editor of the Aesthetic Surgery Journal and probably the youngest and first that had it before he was board certified. And I'm also, I give talks so I've given probably over 600 total abstracts around the country in the last like nine years or something like that. So I think that this is a big part of who I am and this is why patients seek me out. I mean people come in and they say, I read your article about inverted nipple repair and that's why I'm here. Or you know, I found you online and I saw these things and I realized this guy is pretty, you know, this guy knows what he's talking about with relationship to this thing. And let's face it, like you said, if you're gonna go to a young surgeon, they better have some chops. So if you're gonna come to me for a facelift, you're gonna wanna see that I've written articles with 250 patients or 300 patients and that it was several years ago. And then I've, I've explored the topic, it's not just me saying, yeah, look at my results, it's me saying I've got great results but I've also written articles, I've given the talks, I'm on the panels, you know, I'm at the meetings.

Eva Sheie (18:14):
So there's a certain relentlessness to your approach.

Dr. Gould (18:17):
Yep.

Eva Sheie (18:17):
You dial it up to 11.

Dr. Gould (18:20):
Always in life in general, I do that in everything including the aftercare. Like I'm, I'm there the night of the next morning checking on patients. I'm not even gonna let a very small, like a wound complication occur. You know, even very small things like wound healing not being perfect. I realize how big of a deal it is for patients and it's kind of funny to me because sometimes I see very small things and I'm like, this is not a big deal and I know it's gonna be fine in like a week or two, but it can really affect the patient. They can be like, oh my gosh, is this little pimple gonna ruin my result? And we both have a little bit of a laugh but initially they're scared. They do actually think it could be a big deal. And later when it's a year later, like I just suggested on the phone with a patient who I did a procedure and she had a like a reaction to microneedling and she was really freaked out about it cuz her surgery was awesome and this thing that we did extra was like the thing she was worried about.

Dr. Gould (19:08):
I prescribed her a topical medication, she'd seen some injectors and they said we've never seen this before. What is this? Gave her a topical medicine. She used it, she said six days later it was gone. I told her, I was like, yeah, you know it's funny how the little things, the little things can derail your experience. Not the big things. Obviously if you had had an infection and your implants had to come out or your face fell apart, that would be a big deal. But even little things like, like you know, little postoperative things can make a big difference and I don't let any of that go. I'm all over it from start to finish.

Eva Sheie (19:36):
So you're the editor of the A S J now?

Dr. Gould (19:39):
I'm a contributing editor.

Eva Sheie (19:40):
Contributing editor.

Dr. Gould (19:41):
There's like an editor-in-chief that is Jeff Kenkel and previously it was Foad Nahai, he's just retiring. Kenkel was the editor of Aesthetic Surgery Open. So they have like an open forum, uh, journal that's more of like an open access and he's moving into the chief role in the main journal. And meanwhile I'm a contributing editor for the open access journal and the main journal and also like an ambassador for social media for both as well. But you know, there's a limited amount of space on that masthead. It's mostly people who are kind of expert in something. I do a lot of articles on social media and on crowdsourcing looking at what the public's perception is of plastic surgery. And so they send me articles on those types of things and on facelift and a few other types of procedures.

Eva Sheie (20:22):
What are you researching today? Like what, what's on the horizon? What do you wanna study next?

Dr. Gould (20:27):
Well I just submitted a great article with my buddy Ben Talley on the Crevasse technique, which is this new approach that we use in the neck to really deepen the jawline as much as possible and got some great reviewer feedback from that. They're looking at accepting it with minor revisions at this point I'm gonna be addressing those. I just finished another study on crowdsourcing looking at breast reconstruction and how to improve the outcomes of oncoplastic surgery. And that's a really fantastic study because it really shows us what we can do to achieve the best possible breast results and how we educate patients and doctors towards that effect. And then I've got a few other studies that I'm doing that are really looking at the intersection between artificial intelligence and plastic surgery and looking forward to say, you know, we know where we came from, we know what's happening right now, where are we gonna be in two, three years and how do we utilize it to our advantage and really protect patients from weird and bad outcomes, but also how do we use it to improve education and transparency in cosmetic surgery. So those are just a few things that I'm looking at. And then I've got one or two other little pet projects that are really looking at um, devices, technologies, and other hot applications in plastic surgery.

Eva Sheie (21:37):
Devices is a good segue back to a question I wanted to ask you earlier. There's a trend toward not preventing the facelift altogether but using non-surgical to delay the need for the facelift.

Dr. Gould (21:50):
Yeah, the buzzword is pre-juvenation.

Eva Sheie (21:52):
Pre-juvenation. I'm gonna try not to use buzzwords too much, but <laugh>, that is the word.

Dr. Gould (21:57):
Preventative aging. And I think that it is a good trend because it helps to prepare patients for the concepts of aging. They ask what can I do to prevent a facelift? What they're really asking is how does aging occur and why does it occur and what are the things I can do to prepare myself for that process? Right? And the truth is then you can really have a discussion about what aging is, the loss of collagen, the loss of volume, ptosis to kind of sagging and hanging of the skin and the loss of bone. We usually approach it from that triumvirate. That's like the discussion that Val Lambros had in his groundbreaking articles. And Bill Little who was one of the first innovators behind fat grafting to the face cuz they were saying, hey, it's not just about lifting it, it's about adding volume. So we know we need volume, fat, and bone.

Dr. Gould (22:45):
We know that we need to lift, that's the surgical facelift. But nowadays we're looking at the molecular level, we're looking at the changes that are occurring in the genetics of the skin and in the soft tissues. And we have a treatment rate of frequency, micro needling, which can go deep to the skin, give heat via rate of frequency energy and trigger genetic changes in the expression of heat shock proteins, which then remodel and change the collagen in that level. That can thicken the skin. It can't necessarily tighten it, it's not like tightening in the X and Y dimension. It's more like the Z dimension where it doesn't move around as much. So the skin is like shrink wrapped down, but it's not like actually physically making it smaller in the X and Y dimensions. But radiofrequency, NewLink can thicken the skin, can improve collagen deposition and can change what's going on.

Dr. Gould (23:34):
And then there are additional topical medicines that can cause the turnover of elastin, which is the stretchiness of the skin. So we have different approaches for that. And now with exosomes, which are essentially vesicles that are secreted by stem cells, so they're not stem cells and a lot of argument about that, A lot of people are saying, oh, it's basically stem cells, it's not stem cells, it's exosomes are vesicles which are secreted by stem cells, which contain growth factors in other sequences that stimulate improvement in the quality of skin that's around or that's treated. So now with the combination of exosomes new treatments that change the genetics of the skin itself and uh, nano fat P R P and other things that are derived from the patient themselves, we can really make some dramatic changes. Not just in the way things look but also in the genetic expression and the quality of the skin that's there.

Dr. Gould (24:24):
Now the three things that have been clinically shown to stop aging or to reduce aging, there's only three by my count. Number one is topical sunscreen blocking.

Eva Sheie (24:35):
I knew you were gonna say that.

Dr. Gould (24:37):
Yeah. Blocking the radiation from the sun. Everyone's like coming in the office like, all right, what's the newest, hottest thing? And I'm like, have you heard of this stuff called sunscreen? It's like duh. And everyone's like, oh yeah, yeah I use sunscreen. I'm like, really? Is it in your bag? Is it in your car? Is it on your face right now? The answer is no. People are not using sunscreen. Dermatologists will tell you this. It's like their, it's like the bane of their existence. It's like how come we aren't using sunscreen? Why? Because you gotta remember to put it on every day.

Eva Sheie (25:03):
You've seen that photo of the lady who only put sunscreen on her face and not her neck.

Dr. Gould (25:08):
Yeah, <laugh> and the neck is all like <laugh>. Yeah. And that's a common problem. And in in medical terms we call it poikiloderma. But there's aging that occurs right here because they put sunscreen on and then there was maybe a little, and there's a shadow here underneath the chin, but laterally underneath the jawline there's an area where the sun always goes and they get this like streak of sun damage or in aging. Yeah. So sunscreen number one. Number two, topical vitamin A based treatment. So retinol, tretinoin, whatever you want to use, you pick your poison but it's a vitamin A, it stimulates the skin cells to go from the basement membrane to the surface and to fall off. And that improves collagen, improves skin wrinkly-ness and texture. We know that that works too by accelerating skin turnover. Again you gotta use it and people don't like using it cuz it makes their skin kind of itchy and red and it takes them a while to get used to it.

Dr. Gould (25:58):
And we say okay, we'll cycle it, use it every third night but then get to the point we're using it every night. And people who use it well and all the time, like their skin looks like porcelain after a couple years of using it. And there are some people that I know in my practice have been using it for 10, 20 years and their skin looks immaculate. They are not aging. It looks wonderful. So if you can just do those two things now you're at 66%. Now what's the third thing? And this is the most controversial. I love it because every time I bring it up people are like, no you're wrong. Oral collagen supplementation. So there are many doctors who say it does nothing because when you eat it, it's digested dissolves. It's not in the form of collagen. And I would just say that just proves that there are many doctors that don't read.

Dr. Gould (26:43):
If they were reading they would know that there's science on this. They would read the literature, right? And if your doctors don't read, that's not a good thing. That's dumb. Okay, so read the literature. It's really simple. March 21st in uh, 2021 there is a systematic review in meta-analysis that looked at every article on oral collagen supplementation. And definitively this was published in the Journal of Dermatology is like a pretty well known journal, very good impact factor. And definitively what did it find? Well without a shadow doubt, by 90 days everyone who takes oral collagen supplementation has better looking skin. How? Why? I don't know, maybe it gets dissolved in the stomach and breaks down and it doesn't get transported of course across the gut as collagen. But the basic building blocks may be influential or may be necessary in rebuilding the collagen in your skin. That for sure is a fact, right?

Dr. Gould (27:33):
We know that we, the collagen in our skin came from amino acids and peptides that came from what we ate now. Or maybe it's through signaling, maybe it's by having it in your gut, it changes the way that your body produces it in the skin. We don't really know all the pathways for how it works, but we do know that it works. So I would just argue that if someone tells you oral collagen supplementation doesn't work, they're just not reading the literature that's out there. It's really straightforward and it's new literature. 2021 was only two years ago so they're just not reading frequently enough. So back to the low hanging fruit, the three things that we can do to really prevent aging, topical sunscreen, topical vitamin A and oral collagen. If you just do those three things, it's not expensive. The total cost of that should be somewhere around 30 bucks to 40 bucks a month. The topical like vitamin A derivatives, I prescribe them for my patients via compounding pharmacy. So it's inexpensive and I like to add to it like hyaluronic acid to prevent the itchy burning stuff, turmeric to reduce the inflammation. A few other kind of tricks but I would say it should not be super expensive. All it requires is that they do it every day. If you do those things, they look great.

Eva Sheie (28:38):
So the collagen supplementation is something like Vital Proteins, like those products?

Dr. Gould (28:43):
Yeah, I mean the truth is everyone always asks me what's the best one, right? I tell 'em there's, within the nutrition supplementation world, there's basically two signs that a product is good if you turn the bottle over and it says G L P or G M P, that means that it's got good laboratory or good manufacturing practices. And that's like a rubber stamp saying this has been examined by a group that says that this is pretty safe and pretty good.

Eva Sheie (29:07):
It is what it is, what it says it is.

Dr. Gould (29:08):
It is probably what it is. We don't know for sure because there's no FDA regulation. The FDA is the federal group that says if you don't put what's on there on the label, then we're gonna sue you and find you and you're gonna go out of business. And it's a nutrition supplement so it's not regulated. But I would say that G N P, G L P usually means uh, company that's worth a couple million to a couple hundred million dollars. They're doing business for a long time, they're not looking to, you know, off their patients and run away. So those companies would include Vital Proteins, which has a good approach to collagen synthesis and manufacturing. And they have different sources. So they have a beef based one, they have a fish based or a marine based one and then they have another one that's kind of like a blend, the beauty blend.

Dr. Gould (29:49):
And then I also like Nutrafol. Uh, Nutrafol has a collagen supplement and I really like it because it's got a few things in it that also help the hair out. And it's optimized for patients that are doing it for hair restoration. So it's bioavailable and it's also perfect for in conjugation with their other vitamins. And it's branded right, it looks right, it's priced right, it's like 38 bucks. So it fits well into the paradigm of treatment that I'm using for my patients. And it's the company that's worth a, a good amount of money. You know, they're not screwing around with their production, they're doing a good a good job. Those are the two big ones. And then there's a handful of other ones. There's another company called Heal Fast that, full disclosure, I'm on the medical board for. They don't pay me anything, I don't get any royalties or anything like that.

Dr. Gould (30:31):
But we sit down as a group and say, what are the things that have been clinically shown to make a difference in terms of wound healing before and after surgery? And then those are the things that are in their supplement for surgery. But then they have another supplement that's for anti-aging and that supplement contains collagen that's bioavailable in high amounts but also a few other things. And I actually take that one cuz it's easy and it's a pill in the morning. But those are the three that I usually recommend. There's a handful of other ones. And if a patient pulls it up and I look at it and I look for the labeling, I'll say, yeah, it's a good one. Or you know, this one, uh, this one that's like Uncle Joe's collagen bone broth. So I probably don't wanna do that one <laugh>. That might not be the right choice.

Eva Sheie (31:06):
What about sunscreen? What, what are your favorites there?

Dr. Gould (31:10):
I like topical sunscreens that are natural barriers to sun. So I like, you know, metals like zinc and a few other types of Yeah, and the reason why is because those things don't just degrade like the chemical components do when they're hit with a a solar radiation, they continue to absorb it and they don't go away over time. So they're effective over time. They don't, you don't have to reapply 'em as often. Color Science is a brush on product that's essentially like, like a makeup. I mean it's like a base layer or a foundation layer of makeup. And I like that one cuz it simplifies a patient's life and it's actually a better quality pigment than what's found in a lot of makeups that are out there. So, and a lot of foundations that are out there. So I like that product. I also like Elastin. They've got a hydrogen tint which has a, a natural barrier product. But basically any sunscreen, Elta, whatever that's got a barrier in it that's going to block the solar radiation. That's not a chemical, not a pba, not something that breaks down over time and doesn't cause irritation. And sometimes a little bit of an inflammatory response.

Eva Sheie (32:12):
There is so much to you and so much knowledge and it, not just knowledge but backed up. You know, I said earlier you're dialed up to 11 on everything.

Dr. Gould (32:22):
Well I get asked a lot of the same questions all the time. So I have a lot of science built in. Now if you start asking me questions about like gender reassignment surgery, I'm probably not gonna be able to answer them with as much authority, but with a little bit.

Eva Sheie (32:33):
What about opera?

Dr. Gould (32:35):
I know very little about opera other than I, other than I've been Austria to the opera there, that was actually pretty nice. So

Eva Sheie (32:42):
What do you like to do away from work? Probably don't do much outside of work, but I'm hoping that you do.

Dr. Gould (32:48):
Listen, I'm very conflicted because I grew up fly fishing. I spent a lot of time fishing in, in medical school and doing a lot of other things. Like I had a lot of other hobbies nowadays for me, the main thing is it, and it's cuz I'm at that critical phase in my development and my career and in my job where a hundred percent of my passion has to go towards what I'm doing. This isn't a job for me. It really is a way of life. It really is a passion. It's not, I don't look at coming to work every day and say, oh God, I gotta go to work at nine o'clock. I'm looking forward to every moment with each of my patients, even the ones that are unhappy. Everyone has them. And I'm looking forward to those moments to figure out what's motivating my patients, where the successes are, where the failures are, how I can improve the quality of results over time.

Dr. Gould (33:38):
I go home and I read articles on how to make face look better. You know, because I want it to be better. I, I have arguments and discussions with other doctors about brainless tummy tuck, about convincing them to start doing these things to improve the quality of the results because I'm passionate about it. So I'm conflicted because in the last three to four years, a lot of my hobbies have kind of disappeared. But I think that's because the main thing is the main thing and it's it, and for me, I'm a hundred percent committed to it. I still, I go to the gym, you know, three, four times a week. I keep my body in shape. But honestly I used to do that cuz I like being strong. I was bench pressing like 405 pounds. I was really big. I had big muscles, I looked good. Nowadays I do it because I wanna be fit in the operating room. I'm doing a totally different workout. I've changed my workout to be more postural squats, you know, lower body stuff, deadlifting flexibility, all these things because I have to move patients. I have to be able to stand for a long period of time. I have to be able to do liposuction at an angle. In doing a facelift, I would be able to hold a retractor and bend my body in certain ways. So I've

Eva Sheie (34:36):
You'll be able to stand when you're 50 and 55 and 60 and 65 too.

Dr. Gould (34:39):
Right. And, and I want to be able to do that over time. And so the workout I do nowadays is really focused around surgery. It's, everything's changed to adapt to make the main thing better. And the things that I, you know, like reading and things like that, the things that I do, the other hobbies, they all kind of revolve back around that, you know, like I'm reading books about being a better leader, but it's also that I can be a better surgeon in my office. You know? So I'm conflicted. I mean, I, it'd be wrong if I'd be alive if I told you, you know, I'm a great polka dancer or you know, something stupid. You know, like I play the trombone on the weekends. It's like, no, I'm, I'm fully focused on being the best facelift surgeon. That's really what I'm focused on. The best tummy tuck surgeon and just the best doctor taking care of the patients, optimizing the results and making sure that they're getting the best care. That's really what I'm focused on.

Eva Sheie (35:27):
I was gonna ask you next, what, what would you like listeners to take away from listening to the podcast, but I think you just told me what you want them to take away.

Dr. Gould (35:36):
Yeah, I mean, I think that listeners are always looking for information and knowledge and a lot of them want to know about my practice, but they also wanna know about surgery in general and how to pick the right surgeon, how to pick the right doctor, how to get the right surgical result really. And I think that at the end of the day, um, the most important thing is resonating with your doctor. So finding someone who you feel like you can trust, you can talk to, and that's gonna take care of you over time. Because let's face it, every surgeon has complications. Every surgeon has three great results, three mediocre results, and three not great results. It's all about what they do with the three that are not good or mediocre. How do they improve those results over time? How do they make that number smaller?

Dr. Gould (36:22):
And how do they help patients who are unhappy with the result? Do they do revisions? What's their policy about that? That's really important. How do they hold the patient's hand through the process? Some surgeons are amazing and they, you, you meet 'em, you like 'em, you see in the morning of, you see 'em three months later or maybe never again. And maybe you're happy cuz the results are phenomenal. You know, that's some aren't. And how do you deal with those situations? For me, I really enjoy talking to my patients. I really enjoy being around them. They bring me great joy. They bring me the energy that keeps me going forward and the inspiration to do what I'm doing. So I lean into that and I nurture that and I'm the right doctor for most patients because of that. Because I, I combine surgical skill and patient care.

Dr. Gould (37:03):
But that doesn't mean that there's not a better fit for patients out there somewhere. Maybe a better fit for them or that maybe the surgeon that they're with isn't a good fit or isn't gonna deliver them good results. So I think for me, I think that thing that I want patients to know is that for me, the most important thing is the quality of the care. It's not just about surgical result, actually. Number one is safety, you know, making sure that that they're safe, uh, during the surgery. Number two is the quality of the result. And number three is the experience. But I think that those are the really the critical things that people want to know and don't get wrapped up in the nonsense. You know, like there's a lot of celebrity surgeries, celebrity surgeons, people that are out there kind of marketing themselves as being famous because they operated on a famous person.

Dr. Gould (37:45):
And the truth is like, that's the least important thing. I mean, if they're great, they are operating on celebrities. But you know, the truth is that's not what made them great. That's not what makes their results great. So be thoughtful about that. Don't get wrapped up in that nonsense. Just cuz someone has a show on TV doesn't mean that they're, you know, a good human being or a great doctor. You know, you gotta, you gotta interview those people. You gotta interview your doctor. You gotta have trust. Get a referral from someone who had surgery from them. Learn about it that way. Look at the reviews. Know that there are all kinds of different reviews online, but look at the reviews. RealSelf is a great platform to evaluate real reviews from patients who've had actual surgery from those patients. And to say, Hey, does this sound like the kind of experience that I want to have?

Eva Sheie (38:26):
Where can we find you online?

Dr. Gould (38:28):
Oh, so I'm in a few different places. I've developed the platform online in social media on Instagram and TikTok and RealSelf and LinkedIn and a few other new kind of emerging markets and a little bit on Twitter. But what I would tell you is that like each of those is a different taste for what you're gonna see in my practice. So Instagram is really showing you before and after results and experience, like what you'll experience as a patient. Whereas TikTok is more commentary and conversation about plastic surgery. And then I also have the website, Dr. Gould plastic surgery.com, where you can see videos and things like that and before and afters and more information about me. And then YouTube. I have a lot of videos that really describe each of the procedures with very succinct clarity, talking to you about what to expect before, during, and after surgery.

Dr. Gould (39:16):
And that's a good place to look at if you wanna know more about what it is that makes me different. The go, you know, the plastic surgery experience that I'm providing and the types of procedures that I'm doing. But I would say those are all good places to start. And then of course, you know, you look online at Google, at Yelp, at RealSelf, at the other places where patients talk about their experience and show their results. And those are good places to see what my practice is like from an outsider's perspective. But, you know, I'm always innovating. I just start, I just joined, um, I mean, I'm a member on Clubhouse, which is like a chatroom thing. And I just joined Lemonade, which is a new social media platform that I hadn't heard about until very recently. And I'm always experimenting and trying to find ways to kind of connect with new audiences in these other platforms. So I'm sure that whatever comes after TikTok is dissolved, <laugh>, I'll be in that platform as well. Or maybe when Twitter is dissolved as well, who knows what's gonna happen over the next couple of years. But I think that, um, I like to leverage the, the scale that you can achieve on in social media and online to really give people clarity, a little bit of transparency around plastic surgery and a little bit more realistic approach to what's gonna happen once you're, you know, going under the knife.

Eva Sheie (40:27):
Thank you for sharing so much of yourself with us today.

Dr. Gould (40:30):
Yeah, well I appreciate you taking the time because everyone has a concept for what their practice is, how it's structured, and what they wanna project into the world. But it's only when you have a discussion that you can really highlight that. And we all try to put what we put out there as like a scripted version of, of what we want in social media and on our websites and all these other areas, but it's only when you have an open discussion that you can really kind of put texture to it so it's not just, um, and I hate to use the word or it's organic, but it really is a little bit more gritty, a little bit more kind of real feeling when you have a discussion about it.

Eva Sheie (41:02):
That's what it's all about.

Dr. Gould (41:03):
Yep.

Eva Sheie (41:09):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet The Doctor podcast. Check the show notes for links, including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor Made With Love in Austin, Texas and is a production of The Axis , t h e a x i s.io.