Frank Relationships: The Plastic Surgeon

Sunday, Apr. 21st 2013 9:53 PM

 

Most of us agree that looks matter, but when exercise won’t do, today’s guest might become your partner in aesthetics. She one of the top plastic surgeons in Atlanta, and she’s going to tell us all about her specialty … on this edition of Frank Relationships.


FRANK RELATIONSHIPS: THE PLASTIC SURGEON
Guests: Dr. Lisa Bootstaylor
Date: April 22, 2013

Frank: Most of us agree that looks matter, but when exercise won’t do, today’s guest might become your partner aesthetics. She’s one of the top plastic surgeons in Atlanta and she’s going to tell us all about her specialty on this edition of Frank Relationships.

Welcome to Frank Relationships, where we provide a candidate fresh and frank look into relationships with goals of acceptance, respect and flexibility. I’m Frank Love and you can find me, my blog and my various social media incarnations at franklove.com.

Relationships have a visual element to them. Most of us want to look good to attract a partner, to keep one and to just shine bright like a diamond. There are a range of efforts that are undertaken to get there. Some of us use exercise, some of us find a tailor and some of us call a surgeon.

Yep, there’s a huge demand for plastic surgery in our community and our guest is here to tell us all about her specialty. She’s a board certified aesthetic surgeon. She lectures, she’s published and she’s helping Atlanta get good looking. She’s Dr. Lisa Bootstaylor. Doc, thanks for joining us.

Dr. Bootstaylor: Thanks Frank. Thanks for having me. I’m very excited about being here.

Frank: What’s the difference between a plastic surgeon and a cosmetic surgeon?

Dr. Bootstaylor: You know, it’s just a play on words. A plastic surgeon is someone who has completed expensive training, has expensive experience in plastic surgery. They do, do some reconstructive surgery, but I would think of a plastic surgeon as a redo doctor. These are doctors that do have problems with plastic surgery or with cosmetic surgery, you’re going to ultimately end up with a plastic surgeon.

A cosmetic surgeon can be any specialty. It can be a podiatrist, which is a foot doctor. It can be thoracic surgeon. It can be a GYN doctor. It can be a family practice doctor and you can see from that long laundry list of people that some of those people hadn’t been trained in surgery at all.

So they’re very good at the one thing that they do, but they’re not good but they may not be good at the complications from that problem. And they may not be able to address your whole body to give you a more aesthetically pleasing appearance and balance.

Plastic surgeons are total body people. A lot of us specialize in certain areas. Cosmetic surgeons can be any specialty.

Frank: What’s your background?

Dr. Bootstaylor: My background is–there’s medical school, then there’s five years of surgery. Within surgery I specialize in plastic surgery, because I knew I wanted to be a plastic surgeon very early on. I was very fortunate to work in New York City where there are some world renowned plastic surgeons and I set in with them, learned from them.

I moved to California for two years. Once again, sometimes things happen to you. I’ve worked with some renowned plastic surgeons out there and met some great African American surgeons who knew there was a deficiency in my field.

So I stand on the shoulders of African American surgeons and Caucasian surgeons who just appreciated my love for the aesthetics of the body. And I’m very academic and I’m always kind of pulling apart issues, trying to put everything back together. And all these surgeons I worked with–Haley Devoss, Claude Organ, William Silver in New York–these are just great people.

And I did my training at Mount Sinai in New York and then University of Pittsburgh, then University of California, San Francisco. So, I’ve been all over. And then I was a bush doctor for awhile in the South Pacific with Doctors without Borders.

Frank: A bush doctor?

Dr. Bootstaylor: And while helping them triage patients who have burn defects and things like that, so I’ve gotten a chance to see the whole world. Work on really difficult cases and because I’ve done all that, I think I really work well on patients who don’t have problems. Just helping them tweak what they have.

Frank: You said a bush doctor.

Dr. Bootstaylor: Yeah, a Bush doctor is–the Republic of Vanuatu is an archipelago of 80 islands and on those 80 islands, they may have injuries or problems and they can’t really get anywhere. So, I went on a boat, went hiking into the bush and carried my medicines on my back, with a group of doctors. We get there, we set up shop, see everybody–triage of people who had medical problems, burns, cleft lips, cleft palates and then bring them back to the major city and operate on them. But when you do all of that expensive training, you know when you finally sit back and you work on aesthetic surgery, you have tremendous experience.

Frank: Tell us about your new recognition by the U.S. News World Report.

Dr. Bootstaylor: Well that’s been really special for me, because everyone knows the U.S. News and World Report, we use it to look at colleges, we use it to evaluate hospitals and unbeknownst to me, I’ve been doing this for 11 years and I got nominated. It’s tier nomination, which is like the doctor’s referral, like who doctors would go to themselves and who the person is the most deserving of a referral. And so I was nominated and I was selected.

Frank: Nice.

Dr. Bootstaylor: I’m the only woman in Georgia and I’m the only African American in Georgia. There are 14 doctors who are recommended on this list. The list consists of about 800 plastic surgeons, about 10 percent are women. And I’m the only woman and I know of only one African American male, Lloyd Gayle, I think right now–

Frank: Congratulations.

Dr. Bootstaylor: Who’s also on the list.

Frank: Do you work–

Dr. Bootstaylor: It’s pretty fantastic.

Frank: Do you every work with a team of surgeons to perform plastic surgery or any type of procedures in the OR?

Dr. Bootstaylor: Yeah, probably the most common procedure, which people don’t know about is, when women have a GYN procedure, what happens is that they can also have abdominoplasty or liposuction at that time.

And so, when you work with a team like that, what’s beneficial is that most of the time when you have a GYN or insurance covered procedure, you’re going to get time off from work, which is usually sick leave, so you don’t have to take vacation leave.

So, it’s very advantageous if you’re having an insurance procedure and you’re getting sick time for people to have plastic surgery at that time.

Frank: What about C-sections?

Dr. Bootstaylor: Usually it’s body contouring, because they go together. Someone’s going to have an incision on their abdomen, the GYN doctor’s going to go in and look at their ovaries and things like that. Usually, I come in afterwards, I make their incision seamless and then I do my body contouring or abdominoplasty and the patient recover from two things: the covered procedure and then also my procedure.

Frank: How do you suggest that the listening audience go about finding a plastic surgeon?

Dr. Bootstaylor: I think the most important thing is that once you’ve decided to have plastic surgery, you have to look for a board certified plastic surgeon or a board certified dermatologist or otolaryngologist, which is an ENT doctor. And the reason I say that, most fields want to say go to a plastic surgeon, go to a dermatologist or facial plastic surgeon. The person has to be board certified, because when they are board certified, they’ve met the highest standard in training. They have the experience. They’re trying to always look for better ways to do what they do.

They go to classes. Just like anyone goes to classes, they’re sharp. And then, after they’ve done that, I want you to make sure that this doctor doesn’t have any outstanding lawsuits or hasn’t been disciplined by the State Board. So you can look that up online. Make sure that the facility that they operate out of is certified. There are three agencies around the country that actually certify these facilities.

You need to make sure that doctor has hospital privileges. This is like a security blanket, like you need to know when you go to sleep that you have everything on lock time. You have dotted your “I’s” crossed your “T’s” and you have created a cocoon for yourself.

Frank: Is there a website–

Dr. Bootstaylor: Make sure the doctor does a lot of what you want them to do for you. Talk to their patients, see two or three people and then compare prices.

If someone’s price is way up there and someone’s prices is way down there, then you know, why is there that distinct differences? Sometimes there are things people do, like I pretty much itemize everything, so people know exactly what I’m doing and then they can kind of line items and drop things. But then, there are some surgeons that just say, “You’re having abdominoplasty.”

You don’t know if it includes liposuction, if it includes moving the belly button. Does it include body contouring of your waistline? You’re not as informed, so when you go through the process of seeing two or three people you learn a lot and then finally once you’ve done your homework, you’re settled. You have your surgery, you heal from your surgery and you’re happy.

Frank: Is there a website that you suggest that the listening can audience check out in order to find out about lawsuits, outstanding lawsuits or even closed lawsuits?

Dr. Bootstaylor: Oh sure. It’s the Federation of State Medical Boards, fsmb.org. And that’s a national that studies and covers all of the doctors and all of the specialties.

Frank: What about–

Dr. Bootstaylor: Of course there’s going to be some lag time between lawsuits. But you can tell if a doctor’s been disciplined that’s also listed.

Frank: Okay.

Dr. Bootstaylor: So, not only are lawsuits important, but also whether the doctor’s been disciplined. Because if the doctor’s been disciplined that means they’re probably stepping out of the standard of here already, so that makes their behavior very risky and usually risky behavior ends up in a lawsuit.

Frank: Okay, so outstanding lawsuits, certified facilities. So, you’re saying the facility is run separately from what the physician’s reputation is. Tell us about the certification of a facility.

Dr. Bootstaylor: Okay, you have the physician who’s just one-armed, they give you their fee. And then there’s going to be facility and anesthesia, so that facility and anesthesia can be covered by the doctor himself or herself, meaning they have an in-office operating facility.

That doctor can also work at an ambulatory surgery center. That means it’s freestanding, not associated with the hospital or not next to a hospital. The doctor also has the third operation of working in a hospital and maybe the hospital has an ambulatory outpatient center.

Each of those centers are certified by three agencies and those agencies are the American Association of Ambulatory Surgery Facilities, The Accreditation Association of the Ambulatory Healthcare and then there’s the Joint Commission of Accreditation of Health Care Organization. But really, you can also go to the ASAP’S website, which is the American Society of Aesthetic Plastic Surgery and they have a lot of information there about these hospital privileges and the surgical facility accreditation society or organization.

Frank: Is it the doctor’s individual responsibility to make sure that everyone on his or her staff, if they’re doing procedures in their office, is up and up, doing a good job, certified or whatever they need to be certified in and that sort of thing?

Dr. Bootstaylor: I really feel that’s true, because you have to think like from the point of view of a doctor. If you have a strong team, you sleep better at night, because they’re reliable. So, no man is an island. When I come to the OR I expect everything to be sterilized, I expect them to know my protocol and to carry it out.

I spend a lot of time teaching new employees when I have to. I don’t have much turnover in my circle, but when there is someone, we spend time together.

There are different ways of teaching and different ways of creating a team, but there’s no “I” in team and I’m very inclusive of my team. So, I feel it is up to the doctor and a really good doctor and good surgeon, we always have a strong team.

So, if you like the office, that’s another thing. When you go to see a plastic surgeon, if the service of the office, the mannerism of the people of the office, really exudes the standards of the doctor, you can get a better feel for that doctor. You know they’re good, they have a lot of attention to detail.

Frank: Okay, let’s talk about your practice a little bit. Do you ever deal with emergency procedures?

Dr. Bootstaylor: Emergency procedures would be procedures usually performed on the outside. There is a complication and they’re emergently sent to the hospital. Recently, in the city, we have had a flurry of ophthalmologists, who have done breast augmentation.

Frank: Ophthalmologists?

Dr. Bootstaylor: Ophthalmologists.

Frank: Okay.

Dr. Bootstaylor: And so, there was one very serious event at North side and then there was one here that I saw, and these because you’re on-call, you go to the emergency room, you take the patient to the operating room, you stop the bleeding and then you manage them post-operatively.

And so, those are usually the emergencies that occur. They’re usually from physicians who aren’t trained extensively in the field of plastic surgery, but they are performing plastic surgery. They have complications and you see them in the emergency room, because the patient is in dire straits.

Emergencies and plastic surgery, I would like to say, I’m a person who is proactive and not reactive. And so, I like to set the patient up to avoid these complications. Additional and extensive training, additional and extensive work-ups when you go to a doctor: past medical history, past surgical history, family history, medications, all those things matter. And if you worked-up, you can avoid a lot of the emergencies. So we don’t have many emergencies in plastic surgery. That’s why we’re not up all night operating between 12:00 P.M. and 6:00 P.M. That’s usually when the emergencies come in.

Frank: What about when someone gets into a car accident and there’s some major issue with their face and that sort of thing? Do you get those types of calls?

Dr. Bootstaylor: Well, I’m an aesthetic plastic surgeon and so usually, if you’re in a car accident and you hurt yourself, if you get facial fractures, skin avulsions, scalp avulsions, whoever’s on call will cover them.

Frank: Okay.

Dr. Bootstaylor: And so, I usually don’t do that. I’m well qualified to do it, but I’ve been doing plastic surgery for 11 years and my practice really doesn’t cover that realm anymore.

Frank: For the listening audience that doesn’t know, would you tell us what an ophthalmologist does?

Dr. Bootstaylor: Well, a board certified ophthalmologist, their region is they’re eye doctors. They’re eye doctors who are certified in ophthalmology that cover the globe itself, which is the eyeball. They cover the area around the eyeball, which is the orbit itself. They cover the retina. They cover the lens. So, they’re multiple sub-specialists. But you to remember, I’ve said, “Eye, eye, eye,” several times. You may say, “Why is it that there is a board certified ophthalmologist doing breast surgery?”

And the reason that occurs, which most people don’t understand, is that most states do not have a specific law about a doctor practicing surgery outside their specialty.

Frank: Okay.

Dr. Bootstaylor: There’s not a law that prevents a doctor for practicing surgery outside their specialty.

Frank: Are you active–

Dr. Bootstaylor: So, if you’re an ophthalmologist, there’s no law that says you can’t practice surgery that is pretty much practiced by plastic surgeons.

Frank: Are you active on the political side of your field?

Dr. Bootstaylor: Oh, I am. I’m a member of the American Society of Plastic Surgery. I’m American Society of Plastic Surgery Ambassador, so we formulate talking points a lot of times if we have to go on radio shows or we’re quoted in newspapers, just trying to talk about the safe plastic surgery.

People maybe level headed, so that’s one. I also lecture extensively around the city and I do a lot of philanthropic work. But I’m very active politically and then, of course, if you’re doing politics, politics, obviously I’m active, because of the Affordable Healthcare Act. I’m very involved in obesity prevention. I run marathons. I’m involved with Black Women Run. I’m a member of that.

Frank: Okay.

Dr. Bootstaylor: That’s pretty much it.

Frank: Alright.

Dr. Bootstaylor: I’m real involved. I have my practice, I have my family life, but I definitely believe in being involved in the community and giving back.

Frank: Let’s jump into those questions that I’m sure the listeners really, really want to hear. Is plastic surgery covered by health insurance?

Dr. Bootstaylor: You know, it is not. It is not and that is one way people sometimes get you to have plastic surgery; People who are not certified in plastic surgery. So, one field that’s blossomed is the bypass surgery field. So, those patients have that surgery, they lose 100 pounds. They still have the skin of a 200 pound person, so they will see that general surgeon and that general surgeon will convince them that they can have a tummy tuck.

But it’s actually just skin that they’re removing below their belly button. When someone says “a tummy tuck,” to be honest, we all know what that means. You want a waist line, you want to be flat, you want to look good in your clothes. And so, in some ways, they’re being disingenuous to those people, because they’re really not discussing the nuances of a tummy tuck.

There are like four different stages or types of tummy tucks you could have. And I’m talking about something we don’t even call a tummy tuck in plastic surgery. They’re talking about a panniculectomy, which is removing the apron of skin that goes from hip to hip that every patient who’s lost more than a hundred pounds has.

Frank: Okay.

Dr. Bootstaylor: So, when a general surgeon says plastic surgery and tummy tuck, they’re really not being honest with the end result.

Frank: Now, I’m sure most of the patients that receive that procedure are happy that the skin is gone at the end of the day. Is there–

Dr. Bootstaylor: Yeah, so that maybe covered by insurance cases, by the way.

Frank: What about a deviated septum? Someone may get a nose job–and that’s Laymen’s terms, a nose job–in the process of getting their deviated septum corrected?

Dr. Bootstaylor: Yes, that also can be covered, but you have to have obstruction, which means difficulty breathing. There are objective tests that you can do that document that. And usually, when patients have a deviated septum and they’re trying to have insurance coverage, I will refer them to three ear, nose and throat doctors that I trust and let them try to go the insurance route to get the deviated septum repaired. And then I like these doctors enough that if they want to go ahead and get their nose reshaped by them, I’m pretty satisfied.

Now of course, if they have thick skin, if they’re real ethnic rhinoplasty, I’ll warn them that the result may not be what they want and that if it’s not what they want, they can come back and see someone like me and then I can give them kind of the end result, by nose–

Frank: What is–

Dr. Bootstaylor: Reshaping surgery they want.

Frank: What is that mean? Real ethnic rhinoplasty?

Dr. Bootstaylor: When you talk about nose reshaping, if you think about the Caucasian population and we all know about a hump in the nose, that’s very common, so they may have a hump. Their nose may be broad for them, and so, a lot of their rhinoplasty are based on hump removal, narrowing the nose itself, like the bridge of the nose or the base of the nose, but they don’t have to have as many procedures as may be people of color have to have to get to their end results.

Frank: Really?

Dr. Bootstaylor: Yeah, because our skin is a little thicker and that’s a good thing, because it keeps us from aging as rapidly as Caucasians, but when you’re talking about plastic surgery when the nose is a little thicker at the tip, most of the people that I see want more definition at the tip of the nose, so I have to de-pad the fat from that area.

They may want the nostrils of their nose not to flare as much or to be a little bit more tailored, so there are hollow incisions I have to make the base of the nose to give them the balance at the bottom of their nose.

I may look at them and see they really don’t have a bridge, so I have to give them a bridge. So rather than removing the hump, I have to give them a bridge.

Frank: Okay.

Dr. Bootstaylor: They may have broad nasal bones and so I have decrease the broadness of their nasal bones. So, for me, when I do a Caucasian rhinoplasty, usually I’m doing two procedures within the nose reshaping surgery. But when I do an ethnic rhinoplasty, I’m usually doing about four procedures, four to five procedures to get the optimum balanced nose for a person of color.

Frank: You’re listening to Frank Relationships. We’re talking with Dr. Lisa Bootstaylor, one of Atlanta’s top aesthetic surgeons about the ABC’s of plastic surgery. Please tell our listeners how they can find you and secure your services.

Dr. Bootstaylor: They can find me at plasticsurgery-atlanta.com. My phone number is 404-240-2804 and I’m in Atlanta.

Frank: Tell me about some of the most requested procedures and the price range.

Dr. Bootstaylor: Yes, the American Society of Aesthetic Plastic Surgery’s meeting right now in New York and our data has been tabulated from 2011 and 2012 and the most common procedures done–and you know there are two, there’s surgery and then there’s also non-invasive procedure.

The most common procedures are liposuction, abdominoplasty, eyelid surgery and rhinoplasty. The most common non-invasive procedures are botulinum toxin, which is Botox or Dysport, followed by fillers, followed by peels and microdermabrasion.

When you talk about price ranges for these things, you’re really talking about procedures that you can find these actual price ranges on the American Society for Aesthetic Plastic Surgery and so an abdominoplasty is about, on average–these are actual average prices for the surgeon’s fee alone. Remember that for surgery you’ve got to have the surgeon, you got to have the facility and the anesthesia. So, just the surgeon’s fee alone is averaging about $5200, for eyelid surgery about $2600, for augmentation surgery about $3600. So, those are the numbers. And then, for a rhinoplasty those numbers are a little bit higher and you’re at $4200.

Frank: What is discussed during the initial consultation? A patient comes to you, sits down, what do you do?
Dr. Bootstaylor: Yeah, when a patient comes to me, they can expect to spend anywhere between 45 minutes to one hour in a doctor’s office or in my office. And most board certified plastic surgeons really focus on this, because we’re really giving you a chance to get exposed to the office and also, go through our before-and-after books, watch some videos to make sure that you’re hearing the terminology that we want you to hear. Then, you meet with me and we talk about your concerns and I try to understand whether the person is happy, are they stable in their life and is this one little thing that’ll just make them a little happier.

We will ask them about my assistance and things. We’ll get an idea of their past medical history, past surgical history, family history, whether they smoke. And what we’re doing is trying to understand if that person is an ideal candidate for plastic surgery, because ideally you want to have elective surgery with no baggage. You don’t want to be smoking, you don’t want to be sick, you want to have that surgery and then bounce back right away.

Frank: So, do you tell them–

Dr. Bootstaylor: You don’t want to have surgery and be struggling to recover, because you’re anemic.

Frank: Do you tell them to stop smoking?

Dr. Bootstaylor: So that’s what happens during the information session. Photographs are taken. Usually, I’ll put the photograph on the monitor and I’ll talk about their nose, because most people, they may see their breast on the screen and they feel like, “Wow, that’s how I look,” and it’s very informative when you see yourself in an objective way on the screen.

There are some imaging techniques that are available on breast implant websites. You can put your height and weight in and do that with patients sometimes. After talking with them, I may open up before-and-after and show them, “This is the patient I think you most look like. I want you to look at this. Do you like that result,” because ethnic rhinoplasty doesn’t allow me to image it, because so many things are going on.

If it’s abdominoplasty, I’ll look at their height and weight and say, “This is a person who has a similar issue as you, I think this is probably a pretty realistic result for you.” And then we talk about whether they agree with what I’ve done and they may want more, they may want less, but it’s a consultation where the patient and I get to know each other and if I provide a service that they want and they like my staff and they trust me–and this should be true for any doctor that you see, not just me. You like their staff, you like the doctor, you like the before-and-afters, you’ve done your do diligence with background checks, then you sign off for surgery.

But the other thing you have to remember, a doctor has the right to also not to operate on someone, so every month I turn away two or three people, because I just feel we’re not a good match. They have unrealistic expectations or I really say, I can give them a better result if they lost 30 pounds. So at that point, there are certain websites that I actually ask

One is called myfitnesspal.com. I really like it. I show them what I do. “This is myfitnesspal.com profile.” People in my office are on like “lose it” (loseit.com) and I encourage them to do it. We’re getting more active on Facebook now and I’m getting more active on myfitnesspal.com. We try to “friend” them and they can see what everybody’s during in the office.

Frank: A lot of people are going to the Dominican Republic now to get plastic surgery done. Tell us about that dynamic, why people are doing it and whether you suggest it.

Dr. Bootstaylor: Yeah, people are doing it, because, once again, they’re very price conscious. Let’s just get down to the nuts and bolts of it. It’s a lot of money. Don’t get me wrong. And they go, because the price is right and the websites make it sound very appealing and enticing. You can be in a beautiful tropic, sipping a margarita and recovering from surgery. It sounds great, but the problem is, and this is a huge problem. I’ve actually seen several people who have complications from this surgery and they cannot find a doctor who will basically, take them on.

Frank: Back in the States?

Dr. Bootstaylor: Back in the States. So when you stateside and you have problems. That’s a problem, a huge problem. And if it’s a major problem, you’re going to end up having plastic surgery in the beautiful tropics and probably end up in a city hospital getting whatever care you can get from whichever plastic surgeon’s on duty there at a teaching hospital.

If you do it and you go to the Dominican Republic, you can just think, you haven’t really made an informed decision. You haven’t done your due diligence and work. Is the person board certified? Have you checked the facility? Once you leave the States all of that is just hearsay.

There’s no credential agency that will absolutely verify that they have what they have. The other thing I have found is that when you go out of the country, there are implantable devices they use that we don’t use in our country, because they haven’t been certified yet. The animal studies haven’t been done. We don’t know if it’s safe.

I’ve taken out a lot of PIP implants using implants that we used in France. They were pulled from the market probably about two years ago.

Frank: What is PIP?

Dr. Bootstaylor: They had a tremendous rate of rupture, tremendous rate.

Frank: What is PIP?

Dr. Bootstaylor: It’s a type of implant. We have silicone implants, we have saline implants, and the PIP implant was from France and there’s the silicone implant. However, they build themselves being just as good as the American companies, but then the capsule was fragile and degenerated rapidly, so the patients developed ruptured implants earlier. So they saved money on the front in going to the Dominican Republican to get their work, but then when they’re back on the state’s side and the implant ruptured, people seek people out like me and then I’ll remove them.

I document everything so that if they want to present their bills to the company, the French company to see if they will offset the bill, they can do that. But they have to have it removed, because any broken implant has to be removed.

Frank: And we’re talking about, I assume, breast implants?

Dr. Bootstaylor: Breast implants, yes. And so, when you leave the shores of America, the facility may not be certified, the doctor may not be certified, the doctor that you meet in that office may not be the doctor that operates on you, may not be the doctor that follows you post-op. All of these gaps in care that you open yourself up to.

Frank: Have you ever partnered with a surgeon in the Dominican Republic or outside of the country in order to facilitate a smooth transition?

Dr. Bootstaylor: I have not done that. I have entertained it, but they would have to contact me for me to decide to do that and my ideal setup would be that I would probably rotate my team down there to make sure there was quality assurance.

You see? So you have to have continuity. Not just the doctor, you have to have a broader group of people, a team to make sure people not in our country are providing the same care. I have entertained it, but it never got off the ground. I think that’s the best way to do it. And then it has to be financially feasible for everyone. The person has to be honest, they have to provide the care that you expect and the compensation has to be so everyone’s happy.

There’s just so many problems, but I think it’s possible if you get a good, good board certified plastic surgeon who lives in the Dominican Republic. Because I’ve trained with people from Turkey and they do some awesome, awesome ethnic rhinoplasties and I’ve benefited from our shared experience. So, I think there are doctors out there abroad who are excellent, but if you’re going to have surgery elsewhere and you come back stateside, there’s a huge void in your care. So, you may not get durable results because of that.

Frank: Do you do any non-invasive procedures?

Dr. Bootstaylor: I do a ton of non-invasive procedures and probably the two that people do all the time are using Botox and facial fillers. And Botox is used to make their face more serene. It eliminates wrinkles in the forehead along the crows feet or along the eye. It eliminates wrinkles also or really a down-turned smile. I use the Botox to turn the smile up.

The fillers also fill in depressions along the nose to the mouth. They fill in depressions along the chin. You can give people augmented cheeks and this is something that you can have done, very little downtime. With the fillers, there are a few of the fillers that are actually reversible and then if you like the filler you can go onto something that’s more semi-permanent. So, it’s a booming industry.

Last year aesthetic procedures increased by three percent, so fillers and Botox are here to stay and they’re a great non-invasive devices. I think they slow the aging process, that’s been my assessment.

Frank: Does Botox wear off?

Dr. Bootstaylor: It does wear off. It wears off in three to six months and there’s that variability, because it is a toxin that is broken down–it actually paralyzes the muscle that causes the wrinkle, so the wrinkle becomes less and less obvious over time.

Most people get Botox every four, three to five months. And then what happens is that muscle that has been paralyzed starts to thin out, so that even if they stopped their Botox for like six months it doesn’t come back as fast–the wrinkle.

Frank: Okay, does the–

Dr. Bootstaylor: Usually people have to get Botox about two to three times the first year then they may start to be able to space out the Botox sessions. So that’s how the Botox is administered. The other thing that people don’t know is that Botox, once you’ve the Botox, it can take three to seven days to see the results.

Frank: Okay. Does the wrinkle that the Botox affects, when it comes back is it worse than it was before?

Dr. Bootstaylor: No. Well, over time it will come back exactly where it was before.

Frank: Okay.

Dr. Bootstaylor: And because we’re always aging, of course the wrinkle will deepen. Other wrinkles will come into that area.

When you look at the forehead and most people have a row of about three to four lines that come across the forehead and there are young people who have it. This is genetic.

My son has it, very attractive young man. He has it and so at some point he may decide to do it. Men usually do Botox in the forehead, because they’re in sales. Everybody’s in sales and they want to have a serene look. They don’t want their feelings to translate to their face.

And you do the Botox in the forehead, because if you don’t do the Botox, first the muscle pulls the skin down, reproducibly and then all of a sudden it becomes–that’s dynamic, the muscles always pulling it down. And then, over time it becomes static, which means it’s always there.

First you start with one line, always there. It’s fine. Over time it deepens, because the muscle is still very strong and then, because as we age, we get more lines, the other lines become more obvious. And the more lines we have on the face, the more that is associated with aging.

That’s why I said these fillers and Botox are here to stay, because they just soften the blow and we’re a generation, where we don’t mind getting older, but we want it to come on slowly. That’s all.

Frank: Facial fillers, do they wear out?

Dr. Bootstaylor: They do wear out, but they’ve been probably in the market strong for at least 10 or 11 years, and the wonderful benefit of these fillers is each time you get the filler your body is stimulated to make its own filler.

Frank: Interesting.

Dr. Bootstaylor: Yeah. That’s awesome, because eventually you’re going to have a more stable result. Now, the only problem with that is that once you start getting fillers, that means you’re aging, so then you may start getting fillers in other areas, but it really depends on your genetics and how fast you’re aging.

Frank: I’m going to ask a loaded question. It’s going to certainly reveal my thoughts and that’s if, you can tell a person has had plastic surgery, is it too much?

Dr. Bootstaylor: I think so. I think there is an aesthetic balance you’re trying to create and when you’re talking to patients, you can tell them, “You know, I think that may be a little too much, too strong. This may be a tattle tale sign of plastic surgery.” So, I kind of introduce it with a suggestion.

Frank: Okay.

Dr. Bootstaylor: And I keep suggesting it. But then some people, really for me, with ethnic rhinoplasties and with facial implants and things or with chin implants, they want a strong chin. They want it.

Frank: So you don’t just give them what they want, you’re actually saying to a patient, “This might be a little bit much.”

Dr. Bootstaylor: Exactly, because once you change one area, it creates an imbalance in another area.

Frank: I’m going to lead us into people with plastic surgery and I’d love to hear your thoughts on what happen with them. Michael Jackson?

Dr. Bootstaylor: Yeah, Michael Jackson is someone who had too much. You know, too much of anything is not good. He had about four to six surgeries on his nose. And really, the first time you do a nose surgery, you’ve got to get like 80 to 90 percent there, because it’s in the center of the face, the skin has a significant component to the healing.

And the second time you go in, which we call them secondary or second time rhinoplasties, you know the supporting structures can be weakened. So, usually when we go back, we’re doing like tip rhinoplasties, we don’t even reconstruct the whole nose, because most of us got 90, 95 percent of what we want.

Frank: Right.

Dr. Bootstaylor: We’ll go back and may be tweak the bottom of the nose to make it maybe a little narrower. We’ll tweak the tip of the nose and end up with a better result.

And then, there are certain people, because their skin is so thick, it’s really unrealistic to hope to get that nose.

Frank: Lil’ Kim?

Dr. Bootstaylor: Yes, yeah. I think there has definitely been plastic surgery there and she’s the result of kind of a lot of plastic surgery. And you talked to me about or people talk to me about addiction to plastic surgery, that’s probably her riff, because we know that age is going to get us and so you want to make changes that will lead to beauty for life and that’s an adage or a phrase that we have in plastic surgery, such that when we do a procedure, we’re adding beauty for life.

So, if you change a lot of things, you’re always going to be kind of running after your tail, like a dog chasing their tail. Always trying to change something and then an extreme person would be Joan Rivers and she’s extreme, because she’s had multiple facelifts, multiple plastic surgeries. And the problem with her, she’s had phases where she’s looked like the joker.

Frank: Yes.

Dr. Bootstaylor: Her eyebrows are pasted up to her forehead and there was nothing she could do about it, because a good plastic surgeon’s say, “Here we are. This is where we are. We have to sit tight for a minute.” So, she had to sit there on national TV with joker eyebrows. I’m sure it was humiliating for her and then she had it redone. Now she looks so much better, but her lips are a little too big. Sometimes it looks like she has duck lips. So, when you start to do a lot of plastic surgery, you’re almost never satisfied.

Frank: I’ve heard the same thing with tattoos, but that’s–

Dr. Bootstaylor: Correct.

Frank: Another story certainly.

Dr. Bootstaylor: That’s a totally another story. That’s another show.

Frank: Patti Labelle?

Dr. Bootstaylor: And too much of anything is no good and I think if you look at your genes, which I tell people. Look at your mom, your dad, your aunts, your uncles. So when you go to those family reunions really see the lay of the land. See where you’re headed and then try to side step it. And then try to side step it. Side step it with lypo, just a little bit of Botox, you’re just holding off what’s going to happen. But it may not happen full force, because you’re aware of it, you see it, you’re being proactive, not reactive. And the more proactive you are, you can alter things, so that finally when you’re 40, you look like you’re 30, when you’re 50, you look like you’re 40. When you’re 60–you can stay 10, 15 years younger, that’s good, because all the contemporaries are not looking as good as you.

Frank: What about Patti Labelle?

Dr. Bootstaylor: Yeah, so she’s kind of rhinoplasty from what I remember exactly, because I haven’t seen her in awhile. I think her nose job definitely improved significantly. Is there any other surgery I’m missing or–

Frank: No, I haven’t seen Patti Labelle in the limelight recently, but I recall it just being a nose job and that was 20 years ago it seems like.

Dr. Bootstaylor: I mean, that’s thing, if you’re 20 years ago, there’s so few African American plastic surgeons around the city, so I’m not really sure who she who did her nose, but there aren’t many people who specialize in kind of ethnic rhinoplasty.

There aren’t many people who kind of–there are people who do it, but there are some people who are better at shaping, creating a better shape abdominoplasty, a better shaped liposuction procedure and it’s more about understanding what is appealing to that culture.

Frank: What about–

Dr. Bootstaylor: And so–go ahead.

Frank: What about one of my favorite guitarists, George Benson?

Dr. Bootstaylor: Yeah, so George Benson. Let me think. Tell me what he had done. I can’t remember off the top of my head.

Frank: Nose job?

Dr. Bootstaylor: You know what I would say? If a plastic surgeon doesn’t obsess over something, it’s a good job. I don’t obsess over his face.

Frank: Nice. And Oprah?

Dr. Bootstaylor: Oprah. Oprah. Oprah, I don’t obsess over her, because she’s got the ethnicity of her nose.

Frank: She has. Yes, she has. Yes.

Dr. Bootstaylor: And I think that’s really important, because the world is global now, there’s no set standard of beauty and you know beauty starts from within, so you should take what you have and just augment it and run with it.

Frank: Exercise?

Dr. Bootstaylor: Oh, exercise. Well that’s huge, because if you have any body contouring procedure. If you think you can get away with that procedure without maintaining your investment, you’re wrong, because remember, what you put in is going to go somewhere on your body.

: So if a doctor operates and chisels out a very nice waist line, you have excellent buttock contour and they don’t go to your hips, they don’t go to your ankles or your knees, when you gain that extra weight, you’re going to get thunder thighs.

Frank: Okay, so–

Dr. Bootstaylor: Yeah, s you really have to be on guard. I always tell people your clothes don’t lie. They start fitting tight, do not go and get stretchy clothes. That’s probably the worse thing we have in America. I think if we wore clothes that had less stretch, we would know immediately when we’re gaining weight. A lot of us wear jumpsuits and things like that. What that allows you to do is slip.

You slip and you don’t get on the scale and problem by the time you identified you slipped, you’re like may be 10, 20 pounds down and it’s hard.

You’ve got to have to eat like a rabbit or not eat and it’s torturous. I think, and from what my personal experience is, the body, once you start trying to lose weight naturally, almost hold it’s breath for three months.

It’s just like, “No, this won’t last. This person is going to eat, because we love fried chicken. It’s going to happen,” and so you have to be diligent. Now you have to cut back the calories and get out there and exercise. And like I mentioned before, there are great apps that really help you be objective about it.

You just kind of log in what you eat that day and then it’ll burn the usual things you eat and it’ll tell you how many calories you had. You punch in your diet throughout the day and then at 5:00 P.M., where a lot of people who have dinner engagements and business meetings, they look at their phone and their phone says, “You’ve got no calories. You don’t have any calories to eat. If you do, you’re going to gain weight.”

And so, I’ve had businessmen tell me, “You know, doc thanks for giving me the app. I go to the gym for an hour and I burn 500 calories. This way I can have a drink and I’ll decide what I want to do and then the next day, I’ll exercise, so that I’m back on course.”

Frank: You’re listening to Frank Relationships. We’re talking with Dr. Lisa Bootstaylor, one of Atlanta’s top Aesthetic surgeons about plastic surgery. Please tell our listeners how they can find you and secure your services.

Dr. Bootstaylor: Sure, you guys can find me at plasticsurgery-atlanta.com and my phone number is 404-240-2804.

Frank: Have you ever told a patient you’re not going to work on them and to go do some sit-ups?

Dr. Bootstaylor: Probably twice a month.

Frank: Okay.

Dr. Bootstaylor: Yeah, you have to remember that when you go to a seasoned doctor, they’re busy. They want you to be happy, so you can spread the word about them or and lastly more importantly, live your life the way you want to live it. If you operate on someone too soon, they’re not ready.

Frank: Okay.

Dr. Bootstaylor: And they’re not going to be happy with their results. They’re going to be slow to heal, maybe not compliant, because they see within two weeks they’re not where they want to be. So then, they may not be as compliant with their care that they need to provide for themselves in order to get the optimum results.

So you have to let people know there are personal trainers that you can recommend them to like I mentioned those apps, but people know they shouldn’t be in my office half the time. Those people, they know.

Now, there risk is finding a cosmetic surgeon who will operate on anything. So, usually they end up giving smart lipo for $2000 times three sessions. So, they’re out $6000 and they’re kind of, maybe if they stay in their right life they see a difference. So, they’re at risk for making those choices. They just have to make sure that if they do get a procedure that they’re just getting one little micro area addressed, but I usually don’t do it, because I just think it’s healthier for them to have someone like me say, “You know what? You need to get healthy.”

I talk about the end consequences. You’re going to get diabetes, hypotension, heart disease. You’re the leader of the family, because 90 percent of my patients are women and I’m like, “Do you want to be around for your kids? You don’t want diabetes.”

Frank: What about–

Dr. Bootstaylor: And if they come from a referring patient or from a group of people that I know, I say, “So and so runs, so and so lives in your neighborhood, why don’t you hook up with her? She goes to this area, Woodward Academy and runs their track, usually every Saturday at 10:00 A.M. or go to active.com. Why don’t you walk from there? Why don’t you walk some of these runs?

Frank: Nice.

Dr. Bootstaylor: I just try to be helpful to them, because you know, they’re really looking for help and that and exercise is such a drag for some people, because they’re so on the other side.

You have to remember, if you really never been in tune with your body, you have to get in tune with it, but if you’re like 50 pounds over that’s a huge obstacle to overcome.

Frank: Yeah.

Dr. Bootstaylor: So, instead of pushing them away, I bring them toward me and we put them on a website or email list and we send them blast, active.com. Dr. Bootstaylor’s going to be on active.com. She’s going to be in the Peachtree Road Race. I was in the mud run probably in October and people loved it. I posted a few pictures on my website about the mud run. There were a ton of pictures, but it was just to make it fun.

Frank: Yeah. Okay. What about these butt surgeries? Butt implants? Do you have any things to say about those? Do you do them? Are they safe? I know there are some of them that are unsafe.

Dr. Bootstaylor: So, usually the problem with the butt augmentation, they’re really in the media. I’m talking about what’s in the media. You can get shots. You can get fat transfer or you can get implants. Those are the three things in the media.

But let me talk about the thing you should not do, because this is the most important and those are actually the silicone injections–the injections into the butt.

When you get injections into the butt, it’s usually by a person who may not be certified, remember? And I didn’t say they are between 50 to 100,000 non-certified doctors, performing surgeries and doing procedures in the country this year.

These are non-certified people, so there’s no real rigid standard up here they have to follow. We know there have been industrial grade silicone injected into butts. We know there’s a woman for fix-a-flat.

Frank: Who?

Dr. Bootstaylor: Remember? Fix-a-flat–there was a woman who had fix-a-flat injected into her butt and that was a huge media bonanza, probably about may be eight months ago.

So, we’ve gone to the extreme with butt injections. There are pumping parties all over the country. There was a pumping party in 2001, where an exotic dancer was injected by a woman into her butt, while she was dancing on the table and then she had consequences, because the silicone she injected, they’re small particles. They went to her lung, she had shortness of breath and had to go to the hospital. So these pumping parties and things like that just have to stop.

Frank: Got it. I’ll let the people know.

Dr. Bootstaylor: Okay, you can not do it, because there are consequences to it. And then lastly, this is the scarier thing, if you need to have that silicone taken out, there’s really no way to get it out.

Frank: And so what happens?

Dr. Bootstaylor: Your butt becomes hard, you develop chronic infections and lastly, if you develop chronic infections then the doctor will have to go in and debris. That means to kind of randomly cut out areas–

Frank: Of your butt?

Dr. Bootstaylor: Exactly.

Frank: Goodnight.

Dr. Bootstaylor: Goodnight.

Frank: What are the–what are the–

Dr. Bootstaylor: The next thing that’s very popular is the Brazilian butt lift and what that is and the safest way to describe it is, fat transfer from an unwanted area in your body. It could be your abdomen, your back, your thighs, your outer thighs. Taking that fat from areas you don’t want and putting it in an area of the butt that you want augmented.

So, when you have these consults–the people who come in and want to have butt augmentation, they feel their clothes don’t fit them well, they feel that when they lost weigh their butt is now sagging or droopy, their butt is too small for their body frame. And if you have fat available on your body, you get that fat moved from that area, it’s processed in the operating room, and then injected back into the butt. And that fairly safe, people are doing it, but once again, because people perceive it as liposuction and now they can charge you an extra fee for the fat transfer, you have to make sure that the doctor’s doing it, board certified, the facility is there.

And you can always have complications from fat transfer and lipo, so they must have privileges at a hospital. They must do that surgery and they must do it to the volume that you like. I’m not someone who makes very big bottoms, because my fear is if you make a very big bottom, this fat lives there, right? So let us say, you are not disciplined enough to lose weight. I would imagine in the next five to 10 years, if people really don’t get on the wagon for health and fitness, their butts are going to grow bigger. And a big butt is great, but a super big butt is not attractive.

Frank: Here, here. I’ve seen–

Dr. Bootstaylor: People have to figure that out. And it is hugely popular, so I like to build a bottom that is complimentary to the person that kind of fits our standard clothes, especially if I know they haven’t really brought into diet and exercise. But there are people in the city of Atlanta, who build bigger bottoms, but I’m just not on that band wagon right now.

Frank: Okay.

Dr. Bootstaylor: Lastly, you can also get buttock implants. These are stable form, solid gel implants that are placed under the muscle of the butt. It’s much more uncomfortable post-operative course for patients. It is a procedure that’s becoming more standardized and done by surgeons throughout the country. I haven’t started doing them yet, because I’m waiting for long-term results.

Frank: Okay.

Dr. Bootstaylor: I want to make sure the complication rate is low. I’m waiting for these five year studies. You can have malposition, you can have chronic pain, you can have a device rupture, so it can still have problems.

We’re still working out the standard, standard of care for buttock implants. But there are people in this city– one guy I trained with in New York, who’s really starting to publish some good data. He’s probably the only person I would send people to right now, but it’s a viable option. The incisions are made in the buttock crease, in the middle or they made underneath the butt, so if it did fail, you can take it out without much of a scar burden to the body.

Frank: And there’s no concern about sitting on the implant too hard and busting it or anything like that?

Dr. Bootstaylor: Well, that’s a different type of a implant. Remember, I said stable form, kind of semi-solid implant.

Frank: I got it. I got it.

Dr. Bootstaylor: Breast implants–totally different type of silicone, different type of device.

Frank: What’s the general age range of your patients? You said 90 percent are women. And what is the age range?

Dr. Bootstaylor: I mean, age range is probably between 20, 30 to 40. Twenty year old women usually are getting breast augmentations.

Frank: Okay.

Dr. Bootstaylor: So, most of the surgery will start child bearing, picking up a little weight, getting settled in life and wanting to erase a few problem areas. And then definitely, after having children women are usually in stable relationships, they’re happy, but they just want to erase the baby damage and there’s really no way to fully erase baby damage without having surgery.

Frank: So, a woman who has a child the stretch marks and the wrinkle–some call it a pouch, you can’t really get rid of that without surgery?

Dr. Bootstaylor: Well, it really depends on the skin elasticity. That’s the snap back quality of the skin. If you have stretch marks, the stretch marks represent kind of like fractures of the skin. Like it’s permanent damage to the skin, it’s lost all of it’s snap back. So, if you have stretch marks, there’s really no way you can lose a lot of weight, your padding, because when you have a baby you have padding that obliterates your waist line. Sometimes you develop a little pooch, so you have a little comforter there, so you go to the gym and get that padding reduced, but you’re still going to be left with the excess skin.

Frank: Got it.

Dr. Bootstaylor: And so, if you’re hoping to sit down and not have a pouch, the only way to do that is to have that pouch removed. You can have the pouch removed and that’s like one type of abdominoplasty. However, an abdominoplasty is really three components. It’s removing that pouch, it’s tightening the muscles, creating an internal corset and then it’s liposuction. And that’s a full erasure of everything, getting you as flat as you can be and getting you close to the baseline you were at before children.

Frank: Alright. You’re listening to Frank Relationships and we’re talking with Dr. Lisa Bootstaylor, one of Atlanta’s top Aesthetic surgeons about plastic surgery. One last time, please tell our listeners how they can find you and secure your services.

Dr. Bootstaylor: Well Frank, they can find me at 404-240-2804 or they can check me out on the website at plasticsurgery-altanta.com. I’m also on Facebook as Lisa Bootstaylor. So, I’m starting to interact with people more now on Facebook, so they can also Facebook me.

Frank: Okay.

Dr. Bootstaylor: And we’re going to get more active on Facebook and just kind of have an interactive dialogue with people, letting them know what they could do.

I hired someone to man that and will help people. One thing I will tell you also, which is something we didn’t talk about, doctors really can’t make recommendations out of their state.

Frank: Okay.

Dr. Bootstaylor: I’m in Georgia, I cannot tell someone–I can tell them digitally, “You look like you’re a at appropriate weight for plastic surgery,” but I can’t call in a prescription or help them if they’re having a problem, because I can’t practice out of my state.

So, that’s been pretty clear now, so now I’m very comfortable now going on Facebook, just understanding the legalities of what I could do, so I can provide the best answers and the best treatment options and suggestions to clients and patients out there.

Frank; Along today’s journey we’ve discussed butt implants, Dominican surgeries and Botox.

I hope you’ve had as much fun as I’ve had talking with Dr. Bootstaylor, about plastic surgery. She’s certainly given me a greater understanding of her field.

As always, it’s my wish for you to walk away for this conversation with a heaping helping of useful information that will help you create a relationship that’s as loving and accepting as possible.

Let us know what you thought of today’s show at facebook/relationshipflove, on Twitter @mrfranklove or at franklove.com. On behalf of my producer Phileta Legette, keep rising. This is Frank Love.

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