Episode #114 Featuring Dr. Susan Chobanian! The Queen of Rhinoplasty! The PATIENT FIRST Plastic Surgeon, Rejuvenation techniques and advancements, Ethics in cosmetic surgery and more!!

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All right, everybody. Welcome back to the Dylan Jamelli podcast.

So, I am absolutely excited today because this is the first interview,

and I'm well past 100 now where we're going to get into this topic of discussion. And I talked to my guest beforehand. This is something of mega interest to me. This is in my prior life of modeling where I go back into this. And I am really ecstatic to touch on all of this today. And she's a one of a kind in her profession. And we're going to get into all of that.

I noticed right away on her approach and her belief system that she really stands out to me.

“And that's why I wanted her to be my first person to touch on this subject.”

Because this is how it's supposed to be done. So, she is a board-certified cosmetic surgeon, and she's renowned for her expertise in ethnic rhinoplasty. And that's a delicate approach that enhances facial harmony without erasing cultural identity. She's often called the Queen of Rhino Plasty. And rightfully so, and she's known for creating refined natural results

that are going to preserve what makes every face unique. And she's not just about surgery and not only about beauty, but she's about confidence and transformation. And that's one of the things that I absolutely love is that she cares genuinely about how her patients feel afterwards. And so, we're going to get into all that, and I'm going to drain her for information today.

So, my friends, welcome. Dr. Susan Chobanian. Please, to be here. Thank you very much. It's an honor dealing to me too. And I'm so happy you invited me for your podcast. Well, I was very happy to discuss this. As I said, you came extremely highly recommended. And I knew right after I talked to you that this was going to be exactly what I was hoping for.

And I made mention of several things there, and one of those was your approach.

“And that's what really got me excited about this interview. So, I want to get into that.”

But first, I do want to discuss or kind of talk about, you know, what your main goal was for patients.

Has it always been this where how have things changed for you?

Well, you know, the whole practice of plastic surgery has evolved as our society has evolved. I've been in practice for over 25 years, closer to 30 years. And I've done thousands of rhinoplasties, revision rhinoplasties, among other cosmetic plastic surgeries that I do. And the whole concept of rhinoplastie has changed as I've been in practice. Years ago, everybody came in. Everybody wanted to look like the SDL order model.

Karen Graham, she was beautiful despite her nose, not because of her nose. And everybody wanted to look like her, but now, as our society has evolved, the diversity and the concept of inclusion. Everybody wants to maintain their ethnicity. They want to accent improve their ethnic appearance. They want to maintain their identity. But they want to improve their confidence and with they want to succeed.

“I believe that cosmetic plastic surgery is not just about vanity. Patients don't come and”

come to me because they're vain. They come to me because they want to succeed. They have a goal in life. And that's part of my approach that has changed throughout my practice. I talk to the patients more. I want to know more about their lives. I want to know more about their education. I want to know more about what their goals are in life are and what their problems are. So that when I transform them, physically, when they look in the mirror and they like what they see,

Whatever it may be, whatever it may be. I've operated on doctors, lawyers, dentists, showgirls, and just the woman who wants to find the right guy and be a wonderful, successful mother. You know, and I can attest to this because I've been around it for so long and saw it in the industries that I've been in. And I've had a lot of personal struggles myself

with the way I view myself because I've always been put out in front of people heavily criticized

and just the way I looked at myself. And one of the stereotypes is when someone goes in to get plastic surgery or some kind of worked on this, people like to make their little comments and

“digs, but they generally think of those people as vain. And I disagree. I think there are some”

that certainly are, but I think there's some that are just lacking confidence and they're just unhappy because of either being made fun of or just they're just born that way where they just lack that kind of confidence, that's self-confidence. And I think that sometimes it gives them that. And I think you probably see that more than anyone because of the people you're around. Do you feel like that that's accurate? There are a lot of people, it's not just vanity,

there's more to it. No, patients, patients want to feel part of mainstream society. They also, whatever they choose in their profession, whatever they choose in their lifestyle, whatever they choose to accomplish and they're like, they want to stand out. And I think

when I do cosmetic surgery, I help them. I've been in practice long. When I first started practice,

“I always said to myself, I hope I live long enough. I hope my practice progresses long enough”

that I can do the second generation. And I'm very proud to say that I've not only done second generation, I've also done third generation. I have patients, I have patients that come in, I've done the grandmother, the mother, and now I'm doing the teenage granddaughter. And it makes me feel very good. Every day, every week, I get even if you read some of my reviews. Patients that I haven't seen for 10, 15 years respond to say how happy they were that they had the plastic surgery

and that it changed their lives. I hold my patients very close to me. I do a very in-depth consultation, but post operatively, I also follow them very closely. I don't just operate and tell them that that's it. I see my patients every other day for the first week. I see them at least once a week for the first month. And I see them once a month until their healing process is completely finished. And everyone knows in plastic surgery that takes up to a year. I follow all my patients

for at least one year if it's a revision. 40% of all the noses I do have been done somewhere else. And I know that if the patients don't get the result that they like it, they don't like what they're looking at in the mirror, it will diminish their confidence, they will be unhappy. When I do a revision and the patients are happy with what I delivered, okay, that's very gratifying for me because then they just blossom. And those patients I like to follow for even more than a year.

I follow them up to two years and I like to see how their life has changed and succeeded. That's pretty rare. I mean, I'm not saying there's no surgeon that does that there are

some that care. I've met them and I've seen them, but it's not commonplace. Have you always been

that way? Has that always been your concern? Has that something in time has gone? You know, as I started practice, I found out that part of the success, part of my success was to follow these patients and make sure that they got the result that they wanted.

“I think that's the key in all of all of plastic surgery. I agree.”

And make the patients happy. So your main focus then is on the nose, correct? Because I come from an ethnic background. My name will tell you that I'm our Megan. I always grew up and I used to hear my father say a woman without a nose is a woman without a face. He always liked a prominent nose on a woman, but we do other. We do, I do my share of rejuvenation procedures. As I've gotten older, my patient clientele has also gotten older and I do a lot of facelifts.

We have a lot of facial rejuvenation. And we do facial rejuvenation. It's the same thing. We want to maintain the ethnicity. We want to maintain the identity. Patience. I practice in Los Angeles. I practice in Glendale, California. And the patients are very intelligent. They want to maintain their identity. They don't want to change their look. They just want to look refreshed. They want to look a better version of themselves. And with the older patients,

you know, that is one of the areas where my practice has really evolved. Because years ago, you know, you get a 60 year old, 65 year old woman, 70 year old woman,

okay, fine, we got a nice jawline. They're happy. We're happy. And then the procedures evolved. We started doing deep playing facelifts. And then we started doing, you know, to repositioning the musculature and the suph or the fat layers in the face. And that, not terrific. But, okay, Patience, we're happy. I was happy. But the procedures evolved. And now, when we do a facelift, I also like to emphasize the rejuvenation of the patient.

And I've instituted fat grafting. I've been doing fat grafting since the 1980s,

the first ones I did were in 1988. And I used to get pretty good results. But I noticed

something about the fat when on certain patients that were healthy, non-smokers, relatively young, we would not just get a re-structuring of the face or recontour with the fat. But we would get facial rejuvenation, the entire skin. And the research was actually done in Japan, and they found out because stem cells are the most abundant in fat cells. And now I've preferred, you know, and then with the fat grafting, some of it was hit or missed. Sometimes I could get it all to take,

sometimes not. But now my fat grafting technique has really been perfected. I mean, we use stem cells.

I use exosomes. I am micronized the fat. We do macro, micro, and nanofat grafting. And when I do a facelift,

I include the fat grafting. And I get, we get a rejuvenated face that looks very natural. Not artificial. I haven't changed the patient's identity. But it's the texture and quality of the skin, the musculature, the stem cells really do a good job. And then the other thing that I like on

“the rejuvenation cases that we do, whether it be face or body, is I think the peptides, the whole peptide”

therapy. I think the peptides are cutting edge like to add it as sort of, I think patients should be consulted about it in terms of their own individual biohacking. Okay, we need to take charge

of our own, our own health. And the peptides are very, they're naturally existing in our body.

They're composed of amino acids. Five times a week, I get peptide, I do my own peptide injections. And I can deadlift 120. I train, I train three days a week. I'm at the gym at least four days a week. Okay. And every Sunday morning, I run 2.8 to 2.9 miles in 35 minutes. And I'm not, I wasn't born to be an athletic person. I'm not, I'm not model material. You know, I'm not 5.8. 5.10. Okay. And I wasn't meant to, I wasn't built to be athletic, but I want to be healthy.

“And I think that's part of the entire rejuvenation process we also do with plastic surgery.”

Let's get into that a little bit, because you've said that now multiple times, and I understand what you're saying, but some people may not. When we're talking about the rejuvenation side of things, because I think people just think, well, I get the work going to get the base lift, and it's going to be all good and dandy. But there's way more that goes into that. That's not how this works. There's maintenance, there's things that you got to do. We're going to talk about peptides, and I'm going to

get into that. For people listening that are wondering, what, when you say rejuvenation therapy and treatment, what are we talking about? What is going along in this? Well, like I said, years ago, we did the, I mean, even today, I mean, some doctors, they do a facelift, and they think if they get a sharp jawline, and they pull the skin tight enough, that somehow the patient looks younger,

“I really don't think that, I don't think that's the end of it. I think you can do a facelift”

on a 70-year-old woman. She looks like a 70-year-old woman who's had a facelift. You see the facelift scar, okay? So, you know, I use depending on the particular patient and what their needs are. I discuss it, what their problems are, their pain, their arthritis, their diabetes, their hypertension, whatever it may be. I like to take a look at them medically, okay? And then, if it's a cosmetic thing, if there's the three D's of aging, okay, we got deflation, descent, and degeneration. And I think

we have to really, with the fat grafting, I have addressed the deflation. But with the degeneration, I think we have to look a little bit deeper, and it's not only surgical, but we have to use

the practice, I had the very first carbon dioxide laser that they use for skin resurfacing

in the nose. And it was, it wasn't a fractionated CO2. It was a constant pulse CO2. If you shot the, the beam across the room, you could start the wall on fire. I mean, I don't know how the FDA ever approved that device, but they did. And then they came out with the fractionated CO2. And patients would get the fractionated CO2. The carbon dioxide lasers, the ablative quality ablative, quality of those layers, meaning that you were ablating the tissue. I actually felt that

the patients looked older, that somehow it aged the skin. Our new lasers are collagen stimulating. I have infrared, and I use light therapy. We have infrared lasers. We have very gentle

herbium-yag lasers. We can stimulate the collagen, not destroy it, stimulate it, and we've

taken beautiful results. Micro-neudling, with stem cells and exosomes, I've experienced it myself. You get beautiful, beautiful results. And with the patients look rejuvenated. Light therapy,

“I believe in medical grade, light therapy, red, infrared, green, yellow light therapy,”

and it not only treats the superficial layers of the skin, but the patients feel stronger. Their musculature, their pain is resolved. They move better. They move more at like a young patient. Yeah. So, you know, you get the face lift done, but you still need these different modalities to keep up. It's upkeep. It's like you take care of a car, you take care of your body, you view it's constant. I think plastic surgeon cosmetic surgeons in the past have ignored that.

Yeah. Oh, yeah. I've seen it. I've seen it with a lot of people, then they wonder after a few years why they just, it doesn't look good anymore. Whether struggling or unhappy, I can attest because I'm on my, probably my fifth or sixth micro-neudling, I started doing with the PRP injections, and I'm telling you after three, four months, I can tell. You know, it takes a little while, but

“I can tell in a major way. And you should, the exosomes will augment that. Talk about that a little”

because they're, that there's a craze, everybody's talking about, but you know what the problem is,

is not a lot of people tell you what they even are. So, you tell us, well, the exosomes that is an enzyme that tells the stem cell what to do, and what it does is it compliments the stem cell, it augments the stem cell, it pretends she eats the stem cell so that we get better results. We get more results. We stimulate that stem cell to do whatever it's supposed to do next to whatever tissue we put it. All right. So, so if we inject, so if we do the micro-neudling, and then we put

the, the pores will stay open for at least 24 hours. We put the stem cells and the exosomes on top it absorbs. Then I send the patient home with some more of the exosomes, they put it on at night before they go to sleep. They don't wash their face for 48 hours once they watch their face. And the results look good immediately, but three to six months later, they look even better. And that's to also the result that I've seen with my facial fat grafting when I do,

when I do facelifts, the patients look good initially. It works as I as a filler, okay, but six months from the, from the day of surgery, they look better than they did immediately after. Creatine, one of the most proven and studied compounds in existence, yet still, one of the most confusing. Most people think creatine is only for muscle, but creatine is for energy, not caffeine type energy, actual cellular energy. The kind that your body uses for strength,

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these treatments, that a lot of these in a lot of times people, it doesn't work, it doesn't work,

to the patient about life side. Yeah, I mean, even the other day I had a patient, you know,

she's diabetic, she's hypertensive, she was obese, so now she took the mongioro and she got massive weight loss, okay, so she's sitting in my office for, or a facelift, and I look at her file and I look at all the medications and things that she's on, okay, and then she tells me that she also smokes, okay, so we have to, I have to consult this patient about life side changes. I mean, in the 1970s, two doctors at Boston University that had the same last name, I do,

Otto and Otto Machobanian, they did the classic research that was published in the American Journal of Medicine, and it said that diet and exercise can control hypertension and heart disease. I don't know why the medical practitioners have forgotten about that study. I know, the thing, the crazy thing to me is, well, I guess it's not crazy because that's where they're called

general practitioners, but you go in there, they never ask you about your stress levels,

your sleep, you're diet or anything. They run a couple tests, a couple basic tests, and then it's like, here's your medication beyond your way, and that is just not how we fix things at all, and I'm assuming that you take the time and say, hey, if you're not sleeping, if you're highly stressed, if you're drinking, if you're eating like crap, everything we're doing here is not going to

“work. That's why I follow my patients for a year. Okay, I watched their healing process, and”

it is amazing how much variation there is in the healing process. You do the same operation with the same technique, with the same instruments, you do it, and they in different patients heal differently. Yeah, I mean, granted, some people heal better than others, but most of that is going to revolve around the things that I just said, how are you sleeping? How are you eating? Are you training? Are you taking care of yourself? And I guarantee you, even slow healers,

they're going to be a lot more rapid in their recovery, and probably look a hell of a lot better, too, in the long-term. No, I've gotten some very beautiful results with my face lifts, as I and my nose jumps, like I'm the queen of rhinoplasty, but I follow them out, I follow them out, and I monitor their healing process. And if I see that there is some kind of delay, I often ask the patient what's going on in their life, maybe emotional, maybe dietary,

might be stress. I don't know, you know, and maybe lifestyle changes. But these questions and stuff that you asked beforehand, this is what it's so important for your assessment, right? And I'm wondering what is your rundown look like? Because I'm sure that you get patients that tell you, I'm highly stressed, or I drank, or I do this. Do you say, hey, we got a weight to you stop this,

“or I want to change doing this, like, what does the consultation look like in your process?”

You know, my consultation, well, with for the noses, it's a little bit different than with the facelay. Sure. Okay, with the young people, I want to know what's going on in their life, what motivates them, what they don't like about the nose, what they don't like about,

what they see in the mirror. And then I always take the photographs, and I bring the photographs,

I get them printed immediately, and I bring the pictures right back to them. So they can see themselves in pictures, and the young people will tell me exactly what they want. And yeah, especially in Los Angeles, the teenage, the young population, my nose populations between the ages of 16 and 25, most of them. My oldest nose job was on a 76 year old woman from Montebele, but anyway, yeah, and you know, and so I go over the pictures, we draw for them, they see what they're

going to get, and then we compare after the surgery, I compare to see how close I got. All my rental plastics, even my revision rental plastics, I do with a closed technique. Okay, and I feel that I get faster healing, less bruising, and on a teenager, I'm really opposed to putting any kind of permanent scar on the outside of their face. And I go over the pictures, and then after surgery,

“we compare to see how close I can. And over the years, I've perfected the technique. I think close”

rental plastics really lost art, but I've perfected the technique, and I come very close to what I draw, and I can, and I also take after pictures to compare. My older patients, when I do rejuvenation types of surgeries, or whether it be the face, or sometimes the body, I also take pictures, and we go over the pictures, and what they expect, and what they want to look like. But the older

identity. They're afraid of looking strange. They're afraid of looking scared, or frozen, or something

“like that. I perfected, like I said, I perfected my techniques on face lift. I vary it according to”

what needs to be done on a particular face. Men are different than women. You do men, male face

lifts a little bit differently than we do female face lifts. And then I always depending on what

the facial structure is. We always, I like to do the fat grafting, either the nano fat, micro fat, whatever the fat needs. And they're using the stem cells, and the exosomes, we've gotten a rejuvenation that makes them look very natural, makes them look like themselves, but makes them look better. When you said close technique, what does that mean? I do a scarless rhinoplasty. All the surgery is done from the inside of the nose. I operate through the nostrils on the inside,

whether it be for the breathing portion, or the cosmetic portion, or both. And there's no scars on the outside of the nose. I don't put any scars here or here or under the lip. I move through the nostrils on the inside. And it was the original close rhinoplasty was the original technique of rhinoplasty. And then in the 19th, he's someone felt that we should use an open technique where we actually skin the nose. And the open technique of rhinoplasty actually comes from a

cadaver dissection manual on how to disassemble the nose. It's the way you put the scar across the scar across the bottom of the nose. You follow it inside the nose and you actually flip all the skin back. So you're looking, you know, the technique of the operation is that you keep flipping the skin back and forth. And I feel it damages the skin. And I have perfected the technique of scarless internal closed rhinoplasty. Such that, you know, I can, and I have a whole series of

revision rhinoplastys. It has to be over 1,000. They were previously done by an open technique elsewhere. And I revised them with a closed rhinoplasty technique. And we've gotten excellent results. So I'm curious, well, we talked about faceless, but there's different types of treatments like a brow lift, for example, or different things that aren't just a full blown facelift. What I would like you to do is go over different options and then what the difference is like who would be

someone that wants a full blown facelift as opposed to just minor areas of the head or around the eyes?

“When it comes to facelifting procedure, I really feel that you should only address the issues”

that the patient is concerned about or that the face needs. Right. Okay. In my practice, I had a woman come. She was only 38 years old. Someone did a facelift on her and she was very unhappy with the

results. And if you had, if you had come to me the first time around, I would have told her she

would and she didn't need a facelift. Patients after they've had female patients after they had their first baby, the elasticity of the skin is gone. And still come in my office and they'll say I think I need a facelift. You don't need a facelift. We have modalities of treatment that help tighten the skin. They may need may need fat grafting. They may need collagen stimulation with our lasers. We have various lasers. They may need the micronedling with the PRP with the stem cells

and the exosomes. They may need maybe they just need a collagen stimulating filler, which is very easy and inexpensive to do in the office. As an outpatient, no downtime at all. Sometimes they just need a light therapy. I mean, I do yellow light red light infrared blue light. We address that if is it the surface of the skin? Is it the texture of the skin? Is the elasticity of the skin? What does that need? And the facelift patients, I really, you know, are really patients who

have sort of let themselves go and all of a sudden they turn 60, 65, 70. And they look in the mirror and they don't like what they see. They feel, they're usually patients who are very active who feel good and they feel, and they feel much younger than what they see in the mirror.

“So that's why they come to me. So I'm assuming, and I think this is fair to assume that a lot of”

people just come in with this, this is what I want done. And most people would have done research now for you. You seem like the type that would talk people out of things if they don't need it, but there's some searches that will just do whatever that people come in and do. I'm sure of it because I've seen it. So you are much different. You actually care and you're taking the time to go

hey, wait a minute. You don't need all of that. Here's what we can do and here's what you need.

I have a reputation of being very honest when it comes to that. In fact, when I was first in practice,

I turned them around. I turned them away. And you know, I was in Los Angeles and some people in the media caught that. And I was actually featured in a newsweek article back then that addressed the problems with plastic surgery junkies. Okay. In Los Angeles, we have a set of people that are, you know, and they do plastic surgery until the point that they get a complication. And it's very it's very difficult. It's tempting for a lot of doctors, but I would rather see a beautiful result

than to see a complication. And I'm sure there's a lot of complications. There are a lot of

complications walking around. You don't always see them because they're covered up by makeup or

clothes or whatever. But it's very difficult to put the whole done a patient. Yeah. Okay. You

“get, and some patients, I hate to put it this way, but you need to keep them on a real short leash.”

Okay. And, and I tell them, you know, I say, you know, you can go somewhere else. Someone will take your money. But if you get a complication and I have patients, they fly across the world to have, I have patients that have gone, blown across the world to other countries to have plastic surgery. And when they get back, the plane lands at LAX before they come home, before they go home, they come to my office. I've had that happen. Oh my gosh. I've had that

happen to me. And I just, I don't know what to do. And they don't know, you don't know what injection they got, what product they got. I have, you know, and really at a loss of helping some of these people. You know, this is common for every human when we want something we want it.

“We all go through it at some point. But I think that it's very important. And I do this a lot”

with, I've done this for 15 years with people that I need TRT, testosterone replacement therapy. And I'll look at them and go, no, you don't. And I can fix this like this if you just let me. You don't need all of that. And I think that when somebody takes the time to do what you're doing, what I do, you should think about, wow, there's a lot of credibility here, because they can easily make a good amount off of what I want done. Maybe I should listen. Maybe I should

listen, because what would you gain by turning down money? Well, you're gain in the ability to sleep at night and everything and know you're doing well. But that should be enlightening to a

customer like, wow, they actually care. I understand that, but my goal in life when I first started

practice was to operate on the second generation. Yeah. And you're not going to get the second and third generation if you've ruined one or the generation. Okay, not only that, but I was in a situation where the topic came up. And as a physician, when I graduated from medical school, I took a hypocritic oath. And that hypocritic oath was to do the best for each and every patient, irregardless of their background, their race, their color, their creed, their sexual orientation,

whatever it is, when I take care of a patient, I take care of the patient to the best of my ability. And I try to guide them so that they will have no harm. My duty as a physician is to do no harm.

“And that's what my hypocritical oath was all about. And I know that you're a man of faith.”

And I just want to let you know that when hypocrities first wrote that hypocritical oath, before he wrote the oath, he prayed. Okay, he prayed to the God Apollo, which was the God of well-being. He prayed to his God, a sculptious who was the God of medicine and healing. Those were his God. Okay. So, you know, I take that oath very seriously. And even though I do plastic surgery, and I want to deliver good results to the patients. And yes, we all want to be successful.

We want to succeed. Well, I always wanted to succeed in my profession, but I have to do the best

for each and every patient. And I do. People are trusting me with a high level of their life. And so for you to do that says a lot, because you actually understand what somebody's coming to you for. And I don't think that a lot of people do when it comes to money, especially in their professions. And sometimes you need to realize, man, people are really trusting me and taking a leap of faith on something that's going to affect them forever. You know, a lot of my

rental plastics are on teenagers. And there isn't a case that goes by when I see that child lay down

And I'm a mother myself. And I know how difficult it is to give you a child to someone else

“in that situation. But they're all my children. And even, you know, the older patients too,”

they're my mother, they're my sister, they're my aunt, they're my uncle. So, you brought up some other things, you know, some, you know, which I'm very well in forum because I've been doing them for so long. Because when I started modeling, I started getting stuff, you know, Botox and things. Because it was the thing to do so that I didn't have many cracals and everything. So, I've been through the ringer on different types of

fillers and injectables and everything. Do you do a lot of that? Do you believe in those? Do you think that those are better than the actual surgeries? Because I've had different opinions on that. So, I'm curious your thoughts as a, you know, long-term profession. You know, I, I, I, I, I was, I've been injecting Botox since 1993. I do injectables. I have, I have injected all the injectables

“that are approved in this country. There are a lot of injectables that are not approved that some”

people get from other countries or other sources outside of this country. Those I do not use. I think the injectables are, I think they're very good. I think they're very safe. I've been injecting

Botox since 1993. When I first started injecting Botox in Beverly Hills in 1993, we even started

before it got approved by the FDA. And half of the Beverly Hills women were walking around. They look like stroke patients because we really didn't know, you know, the dosage and the, and the placement and we, we didn't understand it. That well. But as time is evolved, I've become very astute at injecting Botox. We have, well, Botox is one brand. We have Xiamen. We have Disport. We have Duval. Okay. We use those. They're trying to come out with a Botox that lasts longer, but we haven't

seen it. And then there's also, you know, the topical, there's the topical peptides that are, they're only 40% effective, though. You produce it topically and it's supposed to relax the muscle.

“And it too works at the neural muscular junction, but they found that, you know, you have to”

use it for many, many weeks or months before you start seeing results. And so far, the study show that it's only like 40% effective, where patients, especially my patient population in Los Angeles, they want an immediate hit of errors. So we, I think, you think for minor corrections, a deep smile line, a little bit of contour deformity, some wrinkles, and the the neural muscular relaxation drugs have, like Botox, have become very popular and preventative for some time.

I just got, was it called Daxify? It was kind of a newer one. And I think it's peptide derived. And it was supposed to be stronger. It hasn't shown me to be any stronger at all. But I did it. I liked D-Sport. I've had Botox since I was 24. I think so. I have a lot of 20 year olds that come in for Botox because it's preventative, especially in California. They're out in the sun. They have a lot of wrinkles. So I, you know, I, and I live in a community. One time I was at a

medical conference and I, one of the, one of the vice presidents of the company that manufacturer Botox, and when he saw my name tag, and he found out that I was from Glendale, California, he said, you know, you, we sell more Botox in Glendale, Burbank, Pasadino, Hollywood, North Hollywood, than any other place in the country. And I said, more than more than New York, he said, yes, I said, more than New Jersey, he said, yes, I said, more than Beverly Hills, he said, yes.

Well, who would have thought? So I'm in the middle of the Botox capital world. Why know, I, I know all about it. So let me ask you this. Are there any long-term side effects from, and I'm not talking about bruising or facial. I'm talking about internally. Is there any long-term side effects from Botox or fillers or anything that you're aware of that people should know about? They're maximum

doses of Botox is 100 units. I never inject anyone with more than 100 units. And most of the time,

I say, well, below that. And I have heard of cases where they have injected, I mean, and it was an unusual case, though. I have heard of cases where patient, if they injected large units, dosage of Botox, that there have been systemic complications. Okay. But the safe, though, I mean, most patients don't get nearly 100 units at one dose in one injection. So my long-term, like I said, I've been injecting Botox in 1993. And I haven't seen any major

complications. I have seen allergic reactions. Yeah. Okay. Some, I have, I've had patients who are

And it usually, it will happen within the first 24 hours. And I'll get a phone call. And they'll say,

every place you inject the Botox on me swelled up. Wow. And then I come into the office. I see them. And we give them, you know, a shot of cortisol or anahistamine. And it goes away within the next 24. Okay. Okay. So I mean, the key is to catch it early. I was, you know, I injected the first injectable we ever had for filler was called collagen. Yeah. And it was actually, it was a bovine. It was derived from cows. And before we could inject the collagen in the face, we had a skin test, the patient,

to make sure they weren't allergic to it. At the time, I was a fellow in plastic surgery. And I was a fellow in plastic surgery. And we were injecting Botox, not Botox. We were injecting collagen to get it approved by the FDA. I wasn't, I wasn't the, I wasn't the research person, but I was the injector. And the company actually came and taught us how to inject it at that time. And it was only for plastic surgeons. They didn't give it to dermatologists. They didn't give it to general practitioners.

They didn't give it to nurses. You had to be a plastic surgeon to inject collagen. And even then, after we got some skin test that were negative, if the patient was an allergic patient, you know, they had asthma attack, all of a sudden, everything that you injected collagen on swelled up. So now we have, then they, they evolved into the, how you're, how your onic acid gels, and how you're onic acid gels work by holding water underneath the skin wherever it's injected.

“And that's how it fills in the lines and contours the faces. There are different types”

for different parts of the body, different parts of the face. We can use under the eyelid. We use one type, the face, the contour. We use a different type. And then there's a collagen stimulating products. Okay. We have, we have it's radius, which has the calcium hydroxyapatite crystal at it.

And then we have the sculptor, which is, um, I would, and I was one of the first doctors in

LED to get sculptor. Scultor is a collagen stimulating product, but it needs to be injected repeatedly in order to get permanent or semi-permanent results. And it's, it was originally developed for patients with lip, what we call lipotistrophy, or people who actually lose the back in their face as they get older, not just shifting, but they lose the fact. And it was, and it worked,

“these work well also. However, fat is my favorite. Okay. Okay. And the fat is my favorite. I think”

I get permanent results, and I get better rejuvenation. And I get stimulation of the stem cells with the fat. And we're at my brain here. So this is what I think that I've used to fill our eyes. I know I used Juvederm. I know I used Veluma. I know I used something called Velour when

it first came out. Didn't like that one. And I think I used Rossell. And so I've used up

you several over the years. Well, that's, that's, you know, I, I hate that there are different manufacturers. The products that you all met and you were all manufactured by Allergan, which is not Alley. Yeah. Okay. But then there's, then there's the, actually the first products that came out were restaling products. Yeah. Restaling was the first, how you're on a gas at gel. That, that superseded collagen with it. And you didn't have to skin test. There was no allergic reaction.

And they're made by a company called Galdurma. Yeah. And Galdurma products. I have those also. Every, in Los Angeles, the patients are very sophisticated. And they, and although you don't like

“Velour, there are a lot of patients who prefer, well, I think, they gave me Velour was a little”

crazy and just went, just out of control. I think it was probably his technique more than the Velour itself at the time. But that's a different story for another day. No, I, you know, I've injected all the products. I have them in my office. And like I said, the patient population in, in Los Angeles is very sophisticated. And they tell me which one works best on home. Sure. They know. I got one more question before we finish with peptides. So just real quickly, because we

rattled off it like we said Botox, de-sport, and we rattled off a few. So what is the difference? Is it a different product? Makeup is it a same mechanism of action between them, but just different consumption of product or what is it for? No, it's the same mechanism. Action is it just a different way that they produced it. Okay. Botox is a film. Okay. And you, all the products have to be diluted with sterile saline. Botox is a film. It needs to be frozen. Okay. It comes

It needs to be refrigerated. Okay. Disport, semen, and Juvo are powders. Okay. Okay. So they're

a little bit different. And they still have to be reconstituted with back to aesthetic saline. But honestly, it's really an individual patient preference or how that particular patient reacts. Some patients get a more prolonged effect with the semen. Allergend doesn't like to, I mean, the Botox people don't like to hear that. But and some people prefer Botox. Some people depending on their facial structure and the way their musculature is, they may get a better result

“from discord because discord has a higher diffusion coefficient. It diffuses more. So if you want to”

cover, if they have a very high forehead, very large forehead, a very big person, big face, you might want to use discord. Okay. Patients, like I said, the Los Angeles patient,

a patient who doesn't know who's never had it before, you know, usually stay with the household

name. Yeah, of course. Okay. But the other ones, but once you see what kind of results they get, if they're happy, unhappy, or they think they can get better results with a different product. The D-Sport for me, it seems like it kicked very quickly for me as opposed to the other ones I've tried, but it just, and because of the way I work out so heavily, they just all don't last that long, but that one wore off too quick for me personally, but man, it works. It works

“fast on me for some reason, really fast, and I like it. It just sucks. You have to pay for it so much.”

Honestly, in my office, they're all the same. I tried it all the same. Yeah. Okay. But yeah, you know, like I said, some, the patient will come in and I'll say, I get better results with D-Sport. Another patient will say, you know, I get better results. I have a patient came in the other day. She wanted Z-Amen because she didn't get a very good result. She thought Botox wore off too soon. And then people, yeah, people, the other thing is, after you do the neural, in general,

muscular injections, they, the neural toxins, you shouldn't exercise for 24 hours. I tell the patients not to exercise for 24 hours, not to do any sunbathing, tanning salon, don't sweat, don't get a facial massage. Okay. Because that's why I go on Fridays because that's my off workout day. But that's a doer. I've burned my lesson. Yeah. Okay. So let's shift

“lastly and out of peptides. So I think most people listening always associate GHKCU peptides with”

skin. I think that's pretty prevalently known now. I want your opinion on that. But then I want your opinion on other options that you think are good ones for what you do and maybe ones that you're just interested in general. Well, you know, there are actually there are six different categories of peptides. But the three that refer to me are the ones that the GHK, the AAs, okay for hair. I love it too. And in fact, I had a patient who had alopecia. Her hair was falling

off. She was a young girl. And years ago, we used to just do a little steroid injection and hope that the hair came back. But I did this, I did this steroid injection, but I complimented it with the AHK and her hair came back full. I was very happy. And my younger son who has hereditary baldness, you know, I'm injecting him. His hair is coming back. Okay, John's getting good results with it. Then we have the peptides that are for for longevity,

for health and longevity. And those are the ones that stimulate the telomere lengthening to preserve the telomeres. And I, you know, take those. I do by sub Q injections five days a week. And then there's the the other ones that for for repair for muscular strength and repair. And I work out about six months ago, you know, I was I was doing a squat with 37 pounds lifting 37 pounds and all of a sudden I hear a pop. And I pulled the muscle in my leg. And sure, I took the did the injections,

lay in the red infrared light. And within six weeks, I was better. I was back to doing my own one now. So, and then there's the other peptides which I don't, you know, there's for cognitive. Okay, if patients have memory problems, there's for immunity. I take the ones for immunity also. I think that's very good. And then there's the peptides for sexual function. And I think, you know,

the first three categories that are mentioned, I, you know, I tried to encourage my patients

to do the sub Q injection. The whole research on peptide is very difficult to do. Okay, because

they were measuring one parameter, one variable, the blood sugar. But when you have multiple

“variables, it's very difficult to dehuman studies. And although we don't have, you know, the research”

on it, I personally use these and we've seen in general good results. What's your stack right now? What are you taking? I take everything. I'm like, I say, I, I, you know, and then I take all my, my dietary supplements. I take my asthazanthin and my effestin. And I can stand on my feet for eight hours a day. I can operate four cases. I started, I get at the surgery center at 637 o'clock. I leave a two o'clock in the afternoon. I finish three, four cases. And then I go to the gym.

By three o'clock, I like to be at the gym. And I did, like I said, I did lift 120. I can pull 35 pounds. Maybe I'm one of the older patients on the workout floor, older persons on the workout floor. That doesn't matter as long as you're there and doing it, that's with matters. Yeah, and I like to run every Sunday morning. And when I, and the other thing is, I also did a video on this.

“When I go grocery shopping, I stay in the periphery of the grocery store. Um, because that's what”

all the healthy stuff is. Not in the middle. No, that's the worst spot. Yeah. And you start with the vegetables. Yes. And then, yeah, that's a good point. And, say away from, you know, process foods. Good point. No way. Now, if you think about everything you said there, it's totally accurate. You go from the produce and vegetables around to the meat counter to the fish counter and then generally the health section, depending on what story you're in, if you're on whole foods,

it's everywhere. Well, hopefully, but yeah, it's always in the parameter. All of the

the garbage is in the middle. Stay in the periphery. Good point. Process frozen foods forget. Yeah, exactly. It's a good. That's a good one. I have never had anybody say that one. So, I tried it, you know, like I said, I love my profession. I love my work. I get up every day. I get up. I dress up. I show up and I never give up. Okay. I try to deliver the best for each and every patient all the time. I mean, how gratifying is it when you can really tell that you've

really just made someone's life really by fixing something that they were really bothered by. And some of these people, here, I mean, it affects, I know firsthand the effect it has when you have a dysmorphier or you see things there. And how gratifying is that to you that you get to do that for so many people? You know, it's, it is. I've been doing it all these years and I continue to do it. And I, and I get the feedback from the patients. I get letters. I get flowers. Again, patients,

they don't have an appointment. They're in the neighborhood. They stop by to say hello.

That's amazing. That is to just say. And I follow my patients through. I lately, you know,

I've had, I've had a lot of success. I mean, I operate on a young man. He passed the bar exam. I operated on a young girl who is an attorney in the district attorney's office. She's a prosecutor. And in Los Angeles, you know, she, she tells me her problem. She's up against a lot of the high profile, high-powered defense attorneys. Okay. And she's got to deal with that. But I, you know, she came to me. She wanted to look better. She looks better. She's more confident. They graduated

from college. They graduated from medical school. They graduated from law school. Or, you know, they made it on stage and Vegas. They're happy. One more question for you. I'm curious. So let's talk about both sides of this. So on the face, left side and the, the no side, does this one have to be put under or can they be awake for that kind of procedure? Well, Jen, it depends on how expensive the procedure is. Okay. If it's going to be a minimal procedure, some of them might do under local

anesthesia. Some of them we can do with IV sedation. And then some of them, if they're going to be prolonged procedures. And I'm going to be there for a while. We do general anesthesia. Yeah. And then recovery time on something like that. I'm sure it's very independent on the extensive, you know,

“work that you have to do. But what is it general? My nose is, I take a bandage is often one week.”

They look pretty good. A few of the patients are still a little bit bruised, but they go back to work or school that puts a makeup on. They look great. Yeah. Facelift, depending on how extensive the facelift is. But even my facelifts, you know, 10 days, two weeks, I see them going back to work. They do okay. They do well. I, you know, like I said, I, I, I try to do whatever needs to be done. And I try to maintain their identity and try to maintain their self confidence. What about

activity levels? Like when you have a facelift or so, I'm sure with the nose, you really got to take it easy. But with the facelift, what about activity level? How long before you can get working out and training and stuff? Most of my patients, they look good in about two weeks,

And then I also have them stay away from things that might cause excessive swelling or bruising.

“I've had some, some patients, they think, I mean, I have them stay away from,”

initially, I have them stay away from Arnika and Bromely because some of those medications break down

cloth. When you have a surgical incision, a cloth is the first stage at healing.

So we don't want to break down the cloth because then we'll get more bruising. If they have continued swelling or bruising, you know, two or three weeks after surgery, then you might want to start some of those medications. But otherwise, they do very well. They get back to work and they get back, you know, I had a patient go back on the, she comes from Palm Springs. Okay,

she comes in for a mini face lift every other year. And I did, when she was in her late 50s,

maybe early 60s, I did a big face lift on her. And she comes in every year just for a little tuck. And I do it under local anesthesia. And then she comes, we take the stitches out in one week and she's back on the golf course on Palm Springs. I love it. Yeah. Well, thank you for all the information. And what was nice was to not only learn about the procedures and all the

facts, which was great, but then to see what kind of person you are on the time of the dedication,

“the effort and the care. That's what I care about the most is the actual care. I'm sure most”

people appreciate that more than anything. The insight, the information is fabulous, but the care. Well, I think it's necessary. Yeah. I think as a physician, it's your duty to be a good doctor, to take care of the patients, follow them through. And then I just love seeing my patients blossom. I love it. And it's succeed. So tell everybody and I'll link all of this in the descriptions and everything. Where are the best places to find you? Set up a consult with you,

all of that. Well, I have a website. I'm on social media. I have Instagram, Facebook. My name is Chobanian. Okay. I'm Susan. I'm in Glendale, California. I'm Dr. Chobanian,

“Susan Chobanian. And I'm very easily easy to find. All you have to do is give me a drinkle or”

contact me through my social media and we'll get back to you right away. Perfect. Well, thank you for coming and seeing me. Thank you for having me. It's a pleasure to see you. Absolutely. You must have been some model in New York. Oh, I was just average. I had a couple lucky days. I think more than luck. It's talent. It was talent. Thank you so much. Well, that wraps up another one. I really, really hope everybody got insight and understanding into the world of plastic

surgery, healing recovery and everything in between. So that being said, stay tuned for plenty more. Come Dylan Jamelli. Sign it off. [Music]