 a life you love with Tony G. I am beyond honored today. I have Dr. John Yosef on my show today, and this is going to be such an eye-opening interview. Dr. John Yosef is, well I wrote it down just so I would not forget because I'm so honored to have him up, and just a little bit nervous. Dr. John Yosef is a world-renowned plastic surgeon with national awards as well as patients from around the world. He's a leader in discovery in new procedures and has more than 20 years, more than 20 years of research on facial aging and facial reconstruction. Hi Dr. Yosef, welcome to the show. Thank you so much for having me. It's a pleasure. Absolutely my honor, trust me on this one. So the first question I ask every guest is when did you know you wanted to be in the medical field? What started you down this road? You know it's a funny thing is that I've always, as long as I can remember, wanted to be in medicine. Maybe it was my mother who drilled that into me, but you know she, I don't know if it was that, but I was always interested in anatomy and kind of always knew I was going to do medicine. And so that was, I don't think there was a real question about, I didn't really want to be a fireman. It was always wanting to go into medicine. Maybe as I said, maybe that was my mother, but that's where it went. Well thank goodness for her, right? And when did you know you wanted to take that into plastic and reconstructive and work in that area? What was the... Well that's an interesting, I kind of always knew I liked surgery. I was very technically oriented and detail oriented. And I was always the artsy person in medical school, so my friends thought I should do plastic surgery. And it just so happened I was in Connecticut doing general surgery. I liked surgery. And then my friend was here at the Medical College of Wisconsin and said, well he was rotating through the plastic surgery department and said that they did all these great new things and I should come and interview. And so I came out here and they were doing new things in microsurgery and microsurgical reconstruction and hand surgery and all this. And really that technical detail really interested me. And so I applied and I was out here. I did my residency out here and then stayed on to do a hand and micro fellowship. And then they asked me to stay on and teach plastic surgery. So after that I joined the faculty. And then you know for some reason as I did different things when you're in the academic field you're publishing about things. And I had published about different hand issues and breast reconstruction. And as I was progressing it came to facial aging because I didn't really agree with what people were saying. And so I thought I'd go into that field. And that kind of starts your clinical practice. And when you're publishing about that we won a national award about paper in the early 90s about facial aging and what was happening with the face over time. And then it kind of started me interesting enough started me to be interested in you know if I know how it ages how can I put it back together so it looks natural if I was doing a cosmetic procedure such as facial reconstruction or facial rejuvenation. And then I started on publishing that about how to do what I call my mid-face lift. And then recently in December of last year I published my my technique for neck lifts. And so it just kind of goes on from there. And one thing that I know is recently you were invited to speak and teach in two very prominent locations for two very prominent sets of people. I would like you to explain a little bit about that because that's quite a cool. Yeah you know it was actually I was it I got an email and I was going to delete it but it was from a person in Russia and said he'd like he's read my paper on the neck lift and like me to come and give that discussion. And it was in St. Petersburg Russia and amazing city and great people and the conference was great. And so there were a lot of international speakers from around the world and we were giving talks on the face and facial aging and I gave my talks on different aspects of facial aging and my neck lift. And then after that I was invited to go speak at the Israeli National Conference. So invited to go to Tel Aviv and spent some time there and gave talks on what we well our experience in microsurgery that was beyond just facial aging and as well as facial aging and just great travel. It was wonderful. Both places were beautiful. How amazing. What incredible experiences. It is such a beautiful to be able to visit those places but then to be able to teach what you're so passionate about at the same time. It's wonderful and you know what you learn a lot from those places. I mean you learn from other lecturers and you learn from people that you're teaching and so it's always a great experience. Absolutely. Now I need to ask you what's the difference between plastic surgery and reconstructive surgery. Let's get that out of the way before we start talking about the face and what we can do with it. Well you know the term plastics comes from the Greek term plástico which means to mold or to change and so it's all plastic surgery but there is a distinction between cosmetic surgery and reconstructive surgery and cosmetic surgery is the change of something that's already normal that's there and doesn't really need to be changed per se and reconstructive surgery is building things back up a traumatic injury something that is a functional problem and so there is a difference between cosmetic surgery and reconstructive surgery and we do both. Most plastic surgeons do both things and I think that it's surprising this is one reason I really like plastic surgery is because you could do all different kinds of areas in the body you could do you know hand surgery one day and then another day you could be doing a facelift or a facial surgery or facial reconstruction or breast reconstruction so it leaves a lot of area of interest for you to kind of explore on a professional sense so yeah plastic surgeons are not just cosmetic surgeons so keep that in mind. So today you and I are going to be focusing on facial surgery and all the way down to the neck but you will be on again and during those episodes we'll discuss breast augmentations and I can move my hand and body reconstruction so on and so forth but today we're going to focus on the face so my first question to you is I've seen people who have had they've been over surgeryed I'm sure you've seen the specials with the the couple called they're not actually an actual couple but Barbie and Ken and they're trying to look exactly like these dolls and they've had so much surgery you can look at them and you know but sometimes when you look at the average person you can see somebody's had some work done and it doesn't look quite right so what would you say to that? Yeah I mean I can see it right I can see it myself I mean I you know you can kind of point those people out I think that it's it's hard on the public to understand what's going on because they think that you can go to one person and they're going to do a facelift or go to another person and they're going to do a facelift and those two facelifts may be totally different and it's it's surprising to understand how many facelift procedures there are because underneath the incisions and even the incisions can be different I've seen bad scars in bad places that aren't well done but then after the incision you have all these structures in the face and the surgeon or you know he or she may have been trained one way or would really not understand facial surgery surgery because it's hard the face is difficult a lot of important structures there but they can be doing different things and those different things that someone pulls on or changes that position make make the final result look good or look abnormal and it's not really just looking tight that's not the the point of a facial surgery looking good looking natural looking like yourself is really the point of facial surgery and that's why I started studying this why is it that some surgeries look good and others don't and I think that you know from a publication that I did early on in the early 90s you if you understand where things are going with time then if you put them back into that right position it's just logical that if you put the structures back into the right position that someone will look natural if you put them out of position the the observer may not know why that doesn't look right but they know it doesn't look right exactly that makes so much sense now when somebody comes into your office and maybe I know first and foremost I think most people that know me know I love Botox I love fillers even though I haven't had it in a while and I agree that if somebody wants to feel better about themselves we feel so young on the inside and we want to we want that to be apparent on our outside too we want to look as young as we feel we want to look vibrant and healthy and happy and and match the the way we feel on the inside to the outside and when someone comes in your office do you I know you also you do the fillers and you do the surgeries so do you often recommend one way over the other for patients and what's that deciding factor absolutely I think you know you see a patient and you certainly want to discuss the things that bothering them the most and I think you can focus on those areas and I I think that's the that's the good thing about going to a plastic surgeon to do even the other things the injections the Botox the filler because if I only have Botox and filler as my tool then that's all I'm going to offer you but if I understand that listen I have Botox I have filler I have facial resurfacing I have all these things but I also have surgery and I want I tell all my patients I want to be your physician I don't want to be your sales person I want to tell you what's right for you and when it's right for you and if I don't think something's right or it's a timing for that then I'll tell you and I'll guide you through that process so that it doesn't look badly done but I think certainly my goal is to do the least to get the patient where they want to be and sometimes they be patient don't totally understand well what direction do I need to go this is what I want they come in and say well I want filler and I tell them you know that much filler to correct that particular issue you'd be better off having the surgery or someone comes in and says well I want surgery and I say you know you can achieve that with just some little filler you know you're really not ready for surgery yet so you have to have someone that you trust that you're going to go down a journey with I have patients who have come and they say oh you know I had Botox here I had both and filler there and a different person did this and I think that's hard because you know a good clinician is going to learn from some issues if I if I didn't get the Botox in the right place the first time we'll come back and see me so I can correct it and I can we can learn together and go down this road together right I think that's really important I agree and you know having had some of these you know the fillers because I have this very very I have some Native American in me so my skin tends to do that Native American thing and my upper lip tended to get very thin and I love the lip injection for that and going to the right person for these procedures is more important than the procedure themselves and you have Sierra Spa yes where you do some of these procedures the fillers and you also work out of a hospital for the surgeries yes correct and the amount of research that you've spent the amount of time you've spent researching this I mean you've done 20 years of research on what works and what doesn't and if there's if there's one thing that's important to somebody who's looking at making sure their face is done right right that should be it that should be the deciding factor right there somebody who's put who's that passionate and has put that time and effort now I do know you brought some before and after photos that you would like to share and I would love to see these photos because I was able to look through them quickly in the beginning and I'm so excited to hear the stories behind them and what you like some of the work that you did to them so that we can see the difference it makes just a little bit goes such a far away and how natural they look well we know we can you know and as you said we can talk about a lot of things over different sessions but certainly you know facial surgery is not easy and someone who just does an occasional facelift and doesn't study and understand it is not going to have a great result but I think understanding the facial anatomy and understanding you know the procedures the right procedures to do with each individual is so important this first photograph is from paper that I did in the early 90s actually it was a research paper and one of the national awards and what we did it was a huge paper we had anatomic dissections and histological dissections and part of it was to take photographs of individuals in different decades and to see what was happening in their structures and we facial structure we digitize the photographs and if you go to the next photograph you see that this is kind of what's happening um and you can see this person as she's aged and that central structure that midface that cheek pad tends to drop down with time and as it drops away and drops I think because of gravity it tends to become lower and it tends to widen the face and in the lower part of the face but also tends to have the lower lids look longer if I'm if I'm seeing someone's face or if they've had facial surgery I look at their lower lids because if it's done well the lower lids look short again the way she had her lower lids when she was younger and that's a good surgery so and that's what you know if you bring those structures back to the right position then they then they look more natural awesome excellent I have some some examples of that so at the time I um you can go even to the first patient photograph there we go and you can see that that's what happens with time is that the structures go down the lower lids look longer and the lower part of the face looks wider and um you know the face is the the lips are held up by muscles and I just a photograph had painted but the lips are basically held up by muscles while the soft tissue on either side of the lips that's the nasolabial fold that's being held up in position and the soft tissue the cheek pad is dropping down over time so that's what happens we you know um right right we can go to number eight that's uh yeah and that's a patient so that's a patient with a mid-face lift and a face lift you can see her her cheek pads are brought up back to where they were when she was younger and her lower lids look shorter I think that's a natural looking face that's that's amazing the difference in that photo it what's what I love about that photo is as you look at the the one side the face looks a little wider on the bottom and then after the procedure it goes back to that like heart right right if you will right without without adding something or subtracting something just bringing the structures back to where they were how beautiful is that thank you yeah that's such a beautiful and you would never and I don't think you'd know from this after photograph that she had a facial surgery done I would not look at her and say she looks like she's had procedures done I would say on the on the one side she looks tired and like she is overworked but on the other side she looks refreshed and natural right you can you can look at number 11 and you can see that so that's another that's that patiently so before her cheeks are back up into position her neck is done of course all this other things but if you go to the next photograph there's a two years out there she is that's her after surgery but that was her in her 30s and I think if you puff up her hair and put it in black and white that I think she looks close to what she looked like in her 30s without looking like you know she's had a surgical procedure yeah she and again very natural it's her just younger right and then the next photograph now that patient had a surgery seven years prior to that time and then she came to see me she had it somewhere else and came to see me without having had a mid-face lift you can see that it didn't really change her facial structure that first surgery and then bringing the structures back into position made her eyes look better made her lower part of her face look better made her mid-face look more youthful right you can go to the next one you can see where the eyes are different I think it makes a real difference yes yes and the cheeks right I mean that line we get that pronounced line from the the edge of our nose down right that's called the nasolabial fold yeah and then but after the procedure that is so soft and if not right so basically I mean that's you know I think that you know understanding what to do for the patient is really important not everyone needs that there's sometimes you don't need to do a mid-face lift you don't need to you know you need something smaller you need something just in the office you can just do fillers sometimes you can get fillers to help reformat the mid-face if it's not too low if it's too low then it's going to be very difficult I think you've seen some people who've had too much filler to try to correct a problem that shouldn't be corrected with filler right and you know you've got to be able to walk that line I think there is a line between what you can do and what you wanted you know what you do to make someone look natural and I think it's really important to work with a doctor who offers a little bit of everything so that they're not just pushing you or trying to guide you in this one direction that might not be appropriate for you they're open to doing let's do this or this or this and a little bit of that right meaning if you need a little procedure you can we can do a little bit of a procedure but if you if a filler is going to work let's start there and save it that procedure for later on in time absolutely I think I think if you can get away I think if you can look natural with things that are done in the office certainly protecting your skin with sunscreen and and whatever that is I think the less you do you know as you start off you know if you can get a natural look with a filler I always start there or start with Botox or whatever that is and then we go on potentially what doesn't look right is if someone keeps trying to correct a descent issue with fill issue and nowadays a lot of people are doing fat injections into the face and even in New York there's some people talking about that's all they do is fat injections well that doesn't seem to make sense because you know you didn't lose all the fat in your face and so I'm going to just put it back that's not facial aging just it's not all about right fat loss but you can fill the face up to look tight but that's not looking natural and so sometimes it takes a little bit of each thing a little bit of fat injections a little bit of a lift maybe a mid-face lift whatever it is to to make someone look appropriate absolutely and I love that philosophy I love that you are looking at the face and seeing what the person needs and working within those parameters for that person and every single person is different let's move on to some of the procedures that you do I'm very excited to talk about this so first of all let's talk about the lip augmentation so what first explain what is a lip augmentation and what what what does that entail well I do think we lose some volume in the lips with time and with age and I you know we started off trying to put collagen back into the lips and it was all kinds of products we even started off with bovine or bovine collagen we have to test the patients to see if they were allergic to it and but nowadays most of the lip injection is done with something called hyaluronic acid and it's a product that's in our body and somehow either the company extracts it or they make it chemically and then they put it in a medium some type of some type of either sphere or whatever that they collect the hyaluronic acid and that's usually what's injected into the lips and there are different products and they have different connections to each other so some are softer some are some are more fluid some are whatever those products are but most often we're injecting some kind of product with hyaluronic acid in it the problem is that and I think a lot of people have seen this and I get this all the time when I tell my patients that you know you might consider a little bit of lip injection it scares them because they've seen some really bad lip injections and you know it's not fair sometimes to compare someone's bad lip injections for the good lip injections you may not notice on the street so you know if it's done correctly and if you understand the anatomy then I think you know a small amount or a moderate amount depending where each patient goes I like to do it in stages you do a small amount first you know see if the patient likes that and it's certainly important to understand the anatomy so that you have a distinction of the lip itself the red part though you know looking at that person's anatomy and then do it slowly so you do a small injection first and see if the patient likes it and sometimes they want a little bit more I've had patients come back and say I like this I a lot of times they'll they'll go away a little slow and they'll be a little worried but most of the time that comes back down to an appropriate you know if you're careful it comes down to what looks nice on that patient and then if they want to come back they can come back and have a little bit more done to the point I'm there to kind of limit them say well okay you know you can have a little bit more done it will still look natural or to tell them you know I think you we should wait a little bit more because if we do a little bit more it might not look so good that's nice right yeah that's good that you're there to guide them that way because once it's in it lasts for quite a bit of time and you would rather have them come back and get a little bit more than regret having overdone it and maybe never do it again or think that it was a bad experience yeah the funny thing is I see the bad injections tend to last longer than the good injections I don't know what that is but most the most lip injections last for about a year or a year and a half the good thing is you can always inject it away so hyaluronic acid has something called hyaluronidase which if you really didn't like it you could inject it away but that's really rare to do most of the time if you do it correctly it looks nice right so Dr. Yosif there's so much more I want to talk with you about and so many more procedures that you do that I would love to discuss with you now we only have about two minutes left so what I would like you first and foremost to do is tell people if they want to connect with you if they have some questions if they want to come in for a consultation how do they get a whole of you well you can certainly call my office and that's 414-352-2766 you can go on my website drjonyosif.com and there's an email section you can email questions but I think that's really important to go on and to look at an individual surgeon's website and and you know this is an elective if you're really considering surgery it's elective go talk to the person make sure you get a good feeling about how they are looking at you as a patient versus as a customer and I think that's really important absolutely and having it and I I'm not afraid to admit this having had you work on me already you've done some filler around my eye in the past this isn't recent folks don't judge it by now you're very gentle and kind and when somebody is in your office they are your priority and I feel like that is the most important thing and you're never pushing it you're not here's the way I'll say it you're never selling a product you simply want to help the canvas of the person who's sitting in front of you yeah exactly that's really important you're the physician for that person you have to guide them through things you have to be their advocate absolutely absolutely that's my mother talking you see you have to be coming well she must she must be a very good woman because she uh she she taught you very well thank you so if there's one last thing with like maybe a 30 seconds of what you would like to say of why so much have come to you or something you would like to add that you know I think yeah you know I'd be happy to talk to anyone and come and come on in let's talk about your face and talk about issues and you know get an honest objective opinion you know the other thing is to take care of your skin you know sunscreen is the thing that I tell everybody about a broad spectrum sunscreen um is really important just for skin cancers and for protecting from fine lines and so broad spectrum sunscreens usually um you know I'd like them to be not incorporated in the cosmetic but at least that if not you know even in the winter we get a fair amount of sun in wisconsin so protect your skin absolutely I agree I absolutely agree and what we put in our body is just as important as what we uh put on our body I would like to thank you for joining us for this episode of create a like you love and Dr. Yosef thank you so much I'm looking so forward to the next episode thank you Tony I had a great time I appreciate it it's a lot of fun I appreciate your time and your effort in putting this together thank you thank you and we look forward to the next episode have an amazing day thank you