Transcript of 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!! New

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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 Rhinoplasty. 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 of that and I'm going to drain her for information today.

So My friends, welcome Dr. Susan Chobanian.

Pleased to be here. Thank you very much. It's an honor, Dylan, to meet you, 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 discuss or kind of talk about, you know, what your main goal was for patients? Has it always been this way, or 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 rhinoplasty has changed as I've been in practice. Years ago, everybody came in, everybody wanted to look like the Estée Lauder 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 they want to succeed. I believe that cosmetic plastic surgery is not just about vanity. Patients don't come to me, 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 I wanna 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, they have unusual confidence that helps them succeed in life, 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 work done is 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 self-confidence. And I think that sometimes it, 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, that a lot of people are, it's not just vanity, there's, 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, in their lifestyle, whatever they choose to accomplish in their life, they want to stand out. And I think when I do cosmetic surgery, I help them. I've been in practice long. I, when I first started practice, I always said to myself, I hope I live long enough, or I hope my practice progresses long enough that I can do the second generation. And I'm very proud to say that I've 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, 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 postoperatively, 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, if 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've 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 2 years and I like to see how their life has changed and succeeded.

And 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? Is that something that time has gone?

You know, as, 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, 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 Armenian. 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 we do a lot of facelifts without a lot of facial rejuvenation. And we do facial rejuvenation. It's same thing. We want to maintain the ethnicity. We want to maintain the identity. Patients— 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 I, you know, you get a 60-year-old, 65-year-old woman, 70-year-old woman, and you do a facelift and you lifted this. We used to just lift the skin. Okay. And we say, okay, fine.

We got a nice jawline. They're happy. We're happy. And then the procedures evolved. We started doing deep plane facelifts, and then we started doing, you know, repositioning the musculature and the soufflé, the fat layers in the face. And that not terrific, but okay. Patients were 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, nonsmokers, relatively young, we would not just get a re— restructuring 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 profi— I, you know, and then with the fat grafting, some of it was hit or miss. 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 micronize the fat. We do macro, micro, and nano fat 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, 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, are cutting edge. I 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. 5 times a week I get peptide. I do my own peptide injections. And I, you know, I can deadlift 120. I train, I, 4 days, I go, I train 3 days a week. I'm at the gym at least 4 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 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 done, I get the facelift, 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, what is going along?

And like I said, years ago, we did, 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 pulled 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, we, I use depending on the particular patient and what their needs are. I discuss it, what their problems are, their, 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, if it's a cosmetic thing, if they, you know, there's the 3 Ds 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 other therapies to complement, augment our surgical procedures.

I love— I like— I, I— and evolution of the practice. I had the very first carbon dioxide laser that they used for skin resurfacing in the '90s, and it was— it wasn't a fractionated CO2, it was a constant pulse CO2. If you shot 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 lasers, meaning that you were, 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 erbium YAG lasers. We can stimulate the collagen, not destroy it, stimulate it. And we've gotten beautiful results. Microneedling with, with stem cells and exosomes. I've experienced it myself. You get beautiful, beautiful results and the patients look rejuvenated. Light therapy. I, 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 like a young patient.

Yeah. So, you know, you get the facelift 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've used constant—

I think plastic surgeons, 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, why they're struggling or unhappy. I can attest because I'm on my probably my 5th or 6th microneedling. I started doing with the PRP injections, and I'm telling you, after 3, 4 months, I could tell, you know, it takes a little while, but I can tell in a major way.

And you should— the exosomes will will augment that.

Talk about that a little bit, because that is 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 complements the stem cell, it augments the stem cell, it potentiates the stem cell so that we get better results, we get more results, we stimulate that stem cell to to, 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 microneedling and then we put this, 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 wash their face and the results look good immediately, But 3 to 6 months later, they look even better. And that's 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 a— as a filler. Okay. But 6 months from the— from the day of surgery, they look better than they did immediately after.

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Go to qualialife.com/dylan for 50% off and use my code Dylan for an additional 15% off. That's qualialife.com/dylan and use my code Dylan. Thank you to Qualia for sponsoring this episode. We have to stress patience, right? Because this stuff doesn't fix itself overnight, these treatments. That, you know, a lot of these, and a lot of times people, oh, it doesn't work, it doesn't work. And it's like, you gotta understand, this takes time.

Well, it's, it's, you know, and then you have to talk to the patient about lifestyle.

Yeah.

Oh yeah. I mean, even the other day I had a patient, you know, she's diabetic, she's hypertensive, she was obese. Now she took the Mounjaro and she got massive weight loss. Okay. So she's sitting in my office for, for 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 counsel this patient about lifestyle changes. I mean, in the '70s, two doctors at Boston University that have the same last name as I do, Ara and Aram Chobanian, 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— the medical practitioners have forgotten about that study.

I know the crazy thing to me is— well, I guess it's not crazy because that's why they're called general practitioners. But you go in there, they never ask you about your stress levels, your sleep, your diet, or anything. They run a couple of tests. A couple basic tests and then it's like, here's your medication, be on 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 watch 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, 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 are going to be a lot more rapid in their recovery and probably look a hell of a lot better too in the long term. With—

no, I've gotten some very beautiful results with my facelifts as I— and my nose jobs. Like, I'm, 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 why it's so important for your assessment, right? And then, and I'm, I'm wondering, what does your rundown look like? Because I, I'm sure that you get patients that tell you, I'm highly stressed, or drink or I do this, do you say, hey, we got to wait till you stop this, or I need you— you might want to change doing this? Like, what does the consultation look like in your process?

You know, my consultation, well, with, with— for the noses, it's a little bit different than with the facelift.

Sure.

Okay. With the, with the young people, I, 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, especially in Los Angeles. The teenage, the young population, my nose population is between the ages of 16 and 25, most of them. My oldest nose job was on a 76-year-old woman from Montebello. 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, all my rhinoplasties, even my revision rhinoplasties, 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 came. And over the years, I've perfected the technique. I think closed rhinoplasty is really a lost art, but I've perfected the technique, and I come very close to what I draw. And I can, and we, I also take after pictures to compare. On my older patients, when I do rejuvenation types of surgeries, 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 patient who comes for a facelift is, you know, I think they really want to maintain their idea— identity. They're afraid of looking strange. They're afraid of looking scared. Or frozen or something like that. I perfected my— like I said, I perfected my techniques in facelift. I vary it according to what needs to be done on a particular face. Men are different than women. We do men— male facelifts a little bit differently than we do female facelifts. 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 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 closed technique, what does that mean?

I put— 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, outside of the nose. I don't put any scars here or here or under the lip. I work through the nostrils on the inside. And it was the original, closed rhinoplasty was the original technique of rhinoplasty. And then in the 1980s, 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 dissect the nose. Is where you put the scar across the— you put the scar across the bottom of the nose, you follow it inside the nose, and you actually flip all the skin back.

Yeah.

So you're looking, you know, the technique of the operation is that you, you keep flipping the skin back and forth, and it— 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 rhinoplasties. It has to be over 1,000. They were previously done by an open technique elsewhere, and I revise them with a closed rhinoplasty technique, and we've gotten excellent results.

So I'm curious. Well, we talked about facelifts, 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, 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 face lifting 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 she had come to me the first time around, I would've told her she wouldn't, 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 they'll 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 microneedling with the PRP, with these 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. Uh, sometimes they just need a light therapy. I mean, I do yellow light, red light, infrared, blue light. We address the— if— is it the surface of the skin? Is it the texture of the skin?

Is the elasticity density of the skin, what does that need. And the facelift patients are 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, 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 surgeons that'll just do whatever that people come in and do. I'm sure of it, cuz 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, 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 used— patients used to come to me for forehead lifts and facelifts, and I didn't think they needed it. I turned them around. I turned them away. And, you know, I was, 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, they do plastic surgery until the point that they get a complication. And it's very, it's very, 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, 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, right? But it's very difficult to put the hold on a patient.

Yeah.

Okay. 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, flown 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 to me.

Oh my gosh.

I've had that happen to me and I just, I don't know what to do. I, and they don't know, they don't know what injection they got, what product they got. I have, you know, I'm 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. 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 could 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 gaining 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, I understand that, but my goal in life when I first started practice was to operate on the second generation. Yeah. And you, you're not gonna get the second and third generation if you've ruined one of the generations.

Exactly.

Okay. Not only that, but I was in a situation where the, the topic came up and as a physician, When I graduated from medical school, I took a Hippocratic oath, and that Hippocratic 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, 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 Hippocratic oath was all about. And I know that you're a man of faith. And I just want to let you know that when Hippocrates first wrote that Hippocratic oath, before he wrote the oath, he prayed. OK? He prayed to the god, Apollo, which was the god of well-being. He prayed to his god, Asclepius, who was the god of medicine and healing. Those were his gods. Okay. So, you know, I take, I take that, that oath very seriously. And I, 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. And I do.

People are trusting you 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, and I don't think that a lot of people do when, when it comes to money, especially in their professions. And sometimes you need to realize, man, people are really trusting in me and taking a leap of faith on something that's gonna affect them forever.

You know, a lot of my rhinoplasties are on teenagers, and there isn't, there isn't a case that goes by when I see that child lay down on that operating table, I don't ever forget that that's someone's baby.

That's good.

And I'm a mother myself.

Yeah.

And I know how difficult it is to give your child to someone else in that situation, but they're all my children. And, and, and even, you know, the older patients too, they're my mother, they're my sister, they're my aunt, they're uncle. I take care of him.

You brought up some other things, you know, some which I'm very well informed 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 any crinkles and everything. So I've been through the wringer 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, I've had differing opinions on that, so I'm curious your thoughts as a you know, long-term professional?

You know, 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 didn't understand it that well. But as time has evolved, I've become very astute at injecting Botox. We have Well, Botox is one brand. We have Xeomin, we have Dysport, we have Jeuveau. 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 use it topically and it's supposed to relax the muscle, and it too works at the neuromuscular junction. But they found that, you know, you have to use it for many many weeks or months before you start seeing results. And the— and so far the studies show that it's only like 40% effective where patients, especially my patient population in Los Angeles, they want an immediate hit. Okay. So we— I think, I think for minor corrections, a deep smile line, a little bit of contour deformity, some wrinkles, and the neuromuscular relaxation drugs have, like Botox, have become very popular and preventative.

Mm-hmm.

For some reason.

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 and it hasn't shown me to be any stronger at all. But I did get it. I, I like Dysport. 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 they're, it's preventative. Yeah. Especially in California, they're out in the sun. Oh yeah, I have a lot of wrinkles. So I, you know, I, I, I, I, and I live in a community. Um, one time I was at a medical conference and I, one of the, the, one of the vice presidents of the company that manufactured 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, Pasadena, 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?

I'm in the middle of the Botox capital of the world. I know, 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?

Their maximum dosage of Botox is 100 units. I never inject anyone with more than 100 units, and most of the time I stay 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 unit dosage of Botox, that there have been systemic complications. Okay. But, but the safe dose— 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 since 1993 and I haven't seen any major complications. I have seen allergic reactions.

Yeah.

Okay. Some— I have— I've had— I've had patients who are allergic to Botox, but they won't be allergic to Dysport or Xeomin.

Yeah.

And that has happened. And it usually will happen within the first 24 hours. And I'll get a phone call and they'll say, every place you injected 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 cortisone or antihistamine, 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 to 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 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 tests that were negative, if the patient was an allergic patient, you know, if 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 hyaluronic, hyaluronic acid gels. And hyaluronic 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 the collagen stimulating products. Okay. We have, we have its Radiesse, which has the calcium hydroxylapatite crystal in it. And then we have the Sculptra, which is— I would— and I was one of the first doctors in L.A. to get Sculptra. Sculptra is a collagen stimulating product, but it needs to be injected repeatedly in order to get permanent or semi-permanent results. And it was originally developed for patients with what we call lipodystrophy, or people who actually lose the fat in their face as they get older, not just shifting, but they lose the fat in their face. And it was— and it worked. These work well also. However, fat is my favorite. Okay. Okay. 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.

I'm racking my brain here. So this is what I think that I've used filler-wise. I know I used Juvederm. I know I used Voluma. I know I used something called Velour when it first came out. Didn't like that one. And I think I used Restylane. So I've used, I've used several. Over the years?

Well, that's, that's, you know, I hate that there are different manufacturers. The products that you all met were all manufactured by Allergan, which is now Allergan.

Yeah.

Okay. But then there's, then there's the, the actually the first products that came out were Restylane products.

Yeah.

Restylane was the first hyaluronic acid gel that, that superseded collagen and you didn't have to skin test. There was no allergic reaction. And they're made by a company called Galderma.

Yeah.

And Galderma 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 the guy that 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 the office. And like I said, the patient population in, in Los Angeles is very sophisticated. They tell me which one works best on them.

I'm sure they know. I got one more question before we finish with peptides. So just real quickly, because we rattled off like we said, Botox, Dysport, and we rattled off a few. So what is the difference there? 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?

No, it's the same mechanism of action. It's 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 frozen. It needs to be— stay frozen. After it's reconstituted with bacteriostatic saline, it needs to be refrigerated.

Mm-hmm.

Okay. Dysport, Xeomin, and Juvo are, are powders.

Oh, okay.

Okay. So they're a little bit different and they still have to be reconstituted with bacteriostatic saline.

Mm-hmm.

But honestly, it's really an individual patient preference or how that particular patient reacts.

Mm-hmm.

Some patients get a more prolonged effect with Xeomin. Allergen doesn't like to hear— 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 Dysport. Yeah, because Dysport 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 Dysport. Okay. Patients, like I said, the Los Angeles patient, a 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, we try different products.

The Dysport for me, it seems like it kicked very quickly for me as opposed to the other ones I've tried, but it And because of the way I work out so heavily, it just— 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 that you have to pay for it so much.

Honestly, in my office, they're all the same. Yeah, I charge all the same.

Yeah.

Okay. But yeah, you know, like I said, some— the patient will come in and they'll say, I get better results with Dysport. Another patient will say, you know, I get better results. I have a patient came in the other day, she wanted Xeomin. Yeah, because she didn't get a a good result with, she thought Botox wore off too soon. And then people, yeah, people, the other thing is after you do the neuro inject, neuromuscular injections, the, the neurotoxins, you shouldn't exercise for 24 hours.

Yeah.

I tell the patients not to exercise for 24 hours, not to do any sunbathing.

Yep.

Tanning salon, don't sweat, don't get a facial, 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 learned my lesson. Yeah. Um, okay, so let's shift lastly now to peptides. So I think most people listening always associate GHK-CU 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— there are actually— there are 6 different categories of peptides, but the 3 that refer to me are the ones that the GHK, the age, okay, for hair. I love it too. And in fact, I had— I had a patient who had alopecia. Her hair was falling out. 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, I did this, I did the steroid injection, but I complemented it with the AHK and her hair came back full.

Did it really?

I was very happy. And my younger son who has hereditary baldness, you know, I'm injecting him. His hair is coming back. Oh, okay. So I'm getting good results with it. Then we have the peptides that are for, um, for longevity. For health and longevity. And those are the ones that stimulate the telomere lengthening to preserve the telomeres. And I, I, you know, take those. I do my sub-q injections 5 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 6 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 enough, I took the— did the injections, lay in the red infrared light, and within 6 weeks I was better. I was back to doing my own work. 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 3 categories that are mentioned, I, you know, I try to encourage my patients to do the sub-q injection. The whole research on peptide is very difficult to do, OK, because unlike Ozempic, where you're just measuring the blood, you know, Ozempic, we got that peptide because They were measuring one parameter, one variable, the blood sugar. But when you have multiple variables, it's very difficult to do human 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?

You know, Mike, Terry, I take everything. I'm like I say, I, I, I, I, you know, And, and then I take all my, my dietary supplements. I take my astaxanthin and my efestin, and I can stand on my feet for 8 hours a day. I can operate 4 cases. I start it, I get at the surgery center at 6:30, 7 o'clock. I leave at 2 o'clock in the afternoon. I finish 3, 4 cases and then I go to the gym by 3 o'clock. I like to be at the gym and I did. I did. Like I said, I deadlift 120. I can pull 35 pounds. Maybe I'm one of the older patients on the workout floor, older persons on the workout floor.

Doesn't matter as long as you're there and doing it. That's what 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 because that's where 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 you, yes, that's a good point.

And stay away from, you know, processed 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, the fish counter, and then generally the health section, depending on what store you're in. If you're in 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.

Processed frozen foods, forget.

No. Yeah, exactly. That's a good, that's a good one. I've never had anybody say that one.

So I try to, 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 you. I know firsthand the effect it has when you have a dysmorphia 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, I get Patients, if they don't have an appointment, they're in the neighborhood, they stop by to say hello.

That's amazing. That has to just—

and I follow my patients through. Lately, you know, I've had, had a lot of success. I mean, I operated 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, 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 in Vegas. Yeah. They're happy.

One, one more question for you. I'm curious. So let's talk about both sides of this. So on the facelift side and the the nose side. Does, does one have to be put under, or can they be awake for that kind of procedure?

Well, it depends on how extensive the procedure is, okay? If it's going to be a minimal procedure, some of them I 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 variant depending on the, the extensive of, you know, work that you have to do. But what is a general—

my nose is, I take the bandages off in 1 week. They look pretty good. A few of the patients are still a little bit bruised, but they go back to work or school. They put some makeup on, they look great.

Yeah.

Okay. Facelift, depending on how extensive the facelift is, but even my facelifts, you know, 10 days, 2 weeks, I see them going back to work. They do okay. That's great. They do well. 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, I'm sure with the nose you really gotta take it easy, but with the facelift, what, 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 2 weeks, but I don't want them to exercise for like 4 week. But, yeah. And so I don't want the face to swell up. And then I also have them stay away from things that might cause excessive swelling or bruising. I've had some pa— some patients, they think, I mean, I have them stay away from, initially I have them stay away from Arnica and Bromelain because some of those medications break down clot. When you have a surgical incision, A clot is the first stage in healing. So we don't want to break down the clot because then we'll get more bruising. If they have continued swelling or bruising, you know, 2 or 3 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're, 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 facelift every other year. And I did— when she was in her late 50s, maybe early 60s, I did a big facelift 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 in Palm Springs.

I love it.

Yeah.

Well, thank you for all of 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 and the, the time and the dedication, the effort and the care. That's what I care about the most is the actual care. And 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 succeed.

So tell everybody, and I'll link all of this in the descriptions and everything, what are the best places to find you, set up a consult with you, all all of that?

Well, I'm— 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. Susan Chobanian, and I'm very easily— easy to find. All you have to do is give me a jingle 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 of 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 to come. Dylan Gemelli. Signing off.