I sat down with plastic surgeon Dr. Dahlia Rice to uncover why the beauty industry's biggest lies are keeping you from aging on your own terms.

This conversation explored the evolution of plastic surgery from dramatic transformations to natural, undetectable enhancements. The discussion covered how celebrity influence, particularly Kris Jenner's recent facelift, has normalized conversations about aesthetic procedures while highlighting the shift toward subtlety over obvious results.

A major focus was the reality of dermal fillers contrary to marketing claims about 12-16 month dissolution, many patients retain fillers for years due to individual metabolism differences. This has led to overfilled appearances and the need for ultrasound guided dissolution techniques.

The conversation highlighted practical anti-aging strategies, particularly upper eyelid surgery as a high impact, low downtime procedure that can dramatically improve appearance without looking artificial. Fat transfer emerged as a game changing technique that provides natural volume while improving skin quality through growth factors.

The discussion addressed modern challenges like "Ozempic face" from rapid weight loss and the limitations of non-surgical skin tightening. We also discussed the importance of rejecting societal pressure around aging and aesthetic choices, framing these decisions as personal autonomy rather than vanity.

Throughout, the conversation challenged stigmas in both plastic surgery and women's health, advocating for patients to address what bothers them rather than suffering in silence. The overarching message was about empowering women to make choices that improve their quality of life without shame or judgment.

Highlights:

• Celebrity influence on plastic surgery trends (Kris Jenner's facelift analysis).
• The shift from "overfilled" to natural aesthetics in modern plastic surgery.
• Breast reconstruction for cancer survivors and body image.
• Filler dissolution and the truth about how long they really last.
• AI filters vs. realistic surgical expectations.
• Ozempic face/body and massive weight loss surgery.
• Small procedures with big impact (upper eyelids, lip lifts).

If this episode gave you new perspective on aging and body autonomy, help other women find this conversation by subscribing to the channel and leaving a review on Apple Podcasts. Your reviews help more women discover these important discussions about taking control of their healthcare choices.

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GSM Collective

Hey all, it's me, Dr. Smeena Raman, gyno girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs and Hormone. I'm Dr. Smeena Raman. Today I have a very special guest and friend that I cannot wait to talk to you, talk with her to you. But if we think about it, from Beverly Hills reality TV to Instagram feeds everywhere, Kris Jenner has made plastic surgery a kitchen table conversation, and she's not the only one changing the game.

Perfect.

My guest today is Dr. Dahlia Rice, a board certified plastic surgeon and the founder of DMR Aesthetics in Chicago. She brings an incredible depth of training and experience to her work earning her medical degree at Rush Medical College here in Chicago and completing her general surgery training in Michigan State, as well as going through a very highly competitive integrated plastic surgery residency at the University of Rochester Medical Center.

Before that, she built a rock solid academic foundation and getting a master's in biomedical science with a concentration in neurology and bachelor's in biology focused on anatomy, both from Colorado State University. Over the years, she's honed her skills in everything from face lifts and blepharoplasty to breast augmentation, tummy tucks, chin liposuction, and labialplasty. Dr. Rice is passionate about helping women look and feel their best.

whether through subtle refinements or transformative surgeries, always with the safety, artistry and empowerment at the forefront. Today we'll talk about celebrity influence, the latest innovations in surgical techniques, the controversies making headlines and how plastic surgery intersects with aging, sexual health and self advocacy. I'm here to educate so you can advocate. So let's get into it. Hey Dahlia, so nice of you to join me today. Thank you. I know you're so busy. thank you.

Hi.

Thank you. Thank you for taking the time to have me on the show. I'm super excited.

This is gonna be great. Dolly and I met just about a year ago, right? We've become friends ever since. So I think it was just like, was it through social media? No, it was that much.

Yeah.

It was through, yeah, through friends and a publicist, Everybody kept hearing about your name, because I was new in town and everyone's like, my God, you gotta meet Dr. Ramon, she's amazing. And they were 100 % right.

Yeah.

And she comes in with some beautiful purple, full outfits and beautiful bag and just like what you would expect from your plastic surgeon to VH. you don't want to come in a plastic surgeon and say, they're a little crunchy.

I'm very, very fashionable.

Truth.

Disheveled, exactly. Yes, exactly. And I think art, know, people who are into artistry-based things, like they love fashion too. It's another form of expression and creativity. yeah, I think, especially as women, like that's something that we very much, you know, use to express ourselves.

Yeah, absolutely. I love it.

Yeah. Well, let's just start there. What drew you into plastics and like what keeps you passionate?

Good question. So actually this is my second career. I first started doing autopsies before I came to medical school. I was in Colorado at the time and I was still trying to figure out what I wanted to do. I loved anatomy and so I was a pathologist assistant and I was doing autopsies and after a couple of years, the forensic pathologist I worked with was like, Dahlia, it's time for you to go to med school. Like really? So I said, okay.

No, I didn't.

So interesting.

wow, I'm just thinking like, that's you in my background, like, criminal justice.

My family is like not educated. So I never really got that like guidance for med school. And so I applied and once I got in, I thought that I wanted to do forensic pathology. And really it was the anatomy that I loved, the variety. And so when I started to get exposed to plastic surgery in medical school, it's kind of hard because it's not a normal rotation you go on. I decided to do an externship. had to try to find people along the way.

And I basically was able to kind of explore it that way. Really when I kind of opened my eyes to it, because I think like society likes to think that's all we do is boobs and butts. But when I started looking at all the reconstructive stuff, we did facial reanimation, which was insane. We worked on babies, we worked on older patients, men, women, and really a lot of the surgeries were pretty positive. Like patients would come in, they were very excited, very happy about the changes that were gonna happen.

Yeah.

And so that really kind of made me realize that that's kind of the vibe I want to bring in. I love to make people happy. And so for me, having patients that are excited to see me, excited about changes that make them feel good, that's really what really kind of drove me into that field. I love working with women. And so in plastics, we do a lot of that, obviously. And so...

Yeah.

did a lot of breast reconstruction for some years and now I've transferred, opened up my own practice about a year and a half ago doing primarily cosmetic-based surgery. But I do a lot of transgender surgeries as well and other things that really kind of fulfill my, you know, palette of the variety that I really enjoy.

Yeah, I mean, that so is that how you kind of define success? Because like, I feel like plastic surgeons or you guys are like perfectionist, you know, you're always like the details. mean, just like even working with you, I just see how much detail you put into everything and you're so meticulous. I mean, I've sent a number of my own patients to you and they come back and I'm like, damn, you look good. What happened to you? And you're like, I did it.

Yes.

Thank you. Thank you. And that's the thing. I think it's important to know the details matter, you know, and honoring someone's own anatomy. I'm not trying to change that person's looks. I'm trying to obviously listen to what they're telling me that they don't like and then giving them realistic options about what they can and cannot do. And also just in general, like, you know, trying to figure out, you know, is this really what they're asking?

and really kind of getting those little fine tuning of things makes all the difference because that really can set apart a good result from a great result.

Absolutely. I mean, I think you and I are both in a field that gets dismissed and or thought of as a luxury, right? Like sex, good sex life is thought of as a luxury. Sexual pain is discounted. know, people that have like persistent genital arousal disorders, these things that are really this debilitating for patients are discounted. Insurances don't want to cover it because it's not a real thing. This is something that maybe you should get psych for instead, you know, and

Yes.

Yeah.

Right.

Same, know, even with all of like menopause and transformations and midlife and all these things, it's so much about like what is considered like an almost ancillary where for so many people it's life transformative. Wouldn't you say?

Yeah, or even the shaming, right? In your field, my field, there's a lot of shaming. The families, like, why are you doing this? You you don't need to do that. You're beautiful the way you are. Or, you know, providers will gaslight people, right? You know, they're coming in with pain and real problems, sexual health issues. And they're kind of taught, like, that they shouldn't really say anything because they are made to feel like they're crazy or that they're wrong for wanting these things. And I think that that

Yeah.

you know, very much speaks a lot to us as women in society because that is pretty much the crux of how we've been raised in society is to be small, to be happy, to sort of like look your best, but we don't want you to do surgery, plastic surgery, because that's taboo. You just need to naturally be beautiful. then, you know, and everyone's preference is totally different.

Yeah. Yeah, yeah, yeah. It's not a whole, it's impossible to be a woman Barbie speech, right? Like, really are.

Right, exactly. 100%. But I think, know, aesthetics and what people enjoy and what people find bothersome about themselves is so unique and different and personal. And some people will come in and say, Dr. Rice, what do you think? Like, what do you think? Tell me what I need to have done. And I always say, like, I don't like to answer that question because it's not my job to tell you what I think is, you know, a flaw is your job to tell me what you don't.

you know, like about your features, what are the things that you used to like, what are the things that you want to develop more? And so I really make people kind of focus on that. And because a lot of times I'll be like, well, this, this, this, this. And I'm like, no, pick one, this, two, that, three. And so really getting people to hone in on the very specific things that are bothering them. And that I think, especially as we're in our forties,

Yeah. Yeah.

and we start to hit that phase of where there's that rapid aging phase where you wake up one day and you're like, I don't even recognize this face anymore. And at that point, people start to freak out and they just don't really know what to do or where to start even because there's so much fear mongering out there as well.

Yeah. Yeah. Yeah. Yeah. I mean, not to mention the fact that we're not allowed to age, Like, you're bad. You gain weight. You lose your sexual desire. It's like, what the hell? How are we supposed to even function sometimes? And so it's just, we're going to talk a little bit about aging in a second. But you're mentioning just the whole idea of

Exactly.

It's so true.

you know, what we're allowed to, like we accept women suffering much more in this society, almost like a norm, like it's acceptable for women to snor. I mean, think about, you say you do a lot of breast recon, think about, you know, the pink elephant in the room as my friend Corrine Men says, the patients who have had breast cancer who are now survivors, who are years out, they don't get, you know, the therapies they need, they don't get the sexual education or attention they need. But tell me a little bit about the breast stuff, right? Because I feel like,

Right?

Correct.

So many of them are like, your breasts are, that's body image is huge, right? For sexual function, how you feel about yourself and your day-to-day ability to cope even sometimes. And so.

Huge.

Absolutely. mean, one of the first things we do is put a bra on, right? So it's very much ingrained in our lives as women.

Right.

And so how do you go through kind of talking to a patient who's maybe, I mean, because we could talk about it if you want, like all the new things, because I think people used to use expanders or maybe they still do, and now they can go straight into mastectomy plus, right? But maybe you can give us a little history around that if you want, but I think that's such a huge factor, right? Because a lot of women feel like, is nipple sparing better? Is it not? Like where's?

Mm-hmm.

Yeah.

Yeah.

Where are all the data and the feelings around how patients experience it? What have you seen in your practice? And what do you think the most important things to consider for people that are breast cancer survivors listening and maybe wondering?

Yeah, I think that's a great question. Because I think a lot of breast cancer survivors and breast cancer patients are very much in a similar boat to all the other things that we experience as women. They're taught, you know, they come in, well, I don't like this. Well, you should be happy with what you have. You should see you have good reconstruction. You should Yeah, I saved your life. You should be happy. You should see a bad reconstruction. And it's literally little stuff like dog ears or a little bit of some asymmetry like

You should be happier live. Yeah.

Yeah.

Yeah. Yeah.

stuff that's totally fixable that can really make the person accept their reconstruction as their own body. I call it their survivor body. And so then you have to learn to relove a new form of yourself because it's not the old person anymore, right? This is a new body that has survived cancer and that's a really beautiful thing. And that will continue to age and change over time. What we're finding is that a lot of these, especially insurance companies are giving a lot of pushback for

revision stuff or making things more symmetric or doing things to help kind of improve the overall aesthetic and feel of these breast reconstruction patients. And I think that there has been so much more technical based things that have advanced in these areas of last five, 10 years to be able to offer more nipple sparing mastectomies, to be able to offer really well done flaps that are borrowed from your own body, some tissue to use and make a breast out of.

It's even from those patients I hear people say like, well, I feel guilty doing this for myself. And it's like, girl, you just had breast cancer. Like you went through all the things. Like you shouldn't feel guilty for this. Like, but they view it as like, well it makes me vain. And I'm like, no, this does not. It makes you whole as a person and you have to be able to, you know, look at yourself in the mirror and say like, yeah, hell yeah. I made it through cancer. This is my uniform, my warrior body. This is the one that took me through that.

Yeah, yeah, Yeah, get some new ones.

Yeah.

And it's not the same, but even when we change in life, our bodies are not the same. You know, go through menopause, it's not the same. You're going through babies, it's not the same. Each time you have a baby, it changes weight gain, weight loss. And so we're constantly scrutinizes women over our bodies. And I think this is just a great example, again, of how all the different varieties are out there breast reconstruction. Some people don't offer every single one of them. So a lot of times patients don't even know the options fully. And then additionally,

Yeah.

they're often kind of told like once they're done, you're good to go. You don't really need anything else like except for some maintenance stuff. But to me, that was something that I really felt that people left those patients in the dark about, you know, they just kind of were had to accept the pains because they had a lot of scar tissue pain to capsular contractures, other issues that come with other surgeries. A lot of times they would just essentially be told like

Yeah.

this is good enough and you should be happy with where you're at, even though they're wearing like a bra that is not the same cup, you know, the cup sizes are completely different. I had one patient cut a bra and sew two different bras together to make her breast fit. Like the fact that she went to those lengths tells us how much, you know, you know, breast reconstruction is just not really something that people are allowed to take seriously sometimes. And that's really unfortunate considering, you know, on the flip side, how much,

Yeah.

Bye.

We're not done.

how the lengths that we go through for men having reconstruction. And I remember when I was in my training, we were talking about vaginal reconstruction for a woman that had a cancer, erectile cancer that invaded into her vaginal wall. And we were doing reconstruction on her and we were talking about vaginal reconstruction. And I clearly remember one of my attendings say, she doesn't need that. It's just a vagina, basically. Let's like sew it up and call it a day. And I'm thinking, what?

Nah.

I know,

What? Like that's how they think, right? And so it's just like the concept, we have to change the mindset of what it is to be a woman, why it's not okay for us to suffer in silence and how to advocate for ourselves in a way that people hear us and or find doctors that will listen to you, which is one of the reasons why I absolutely adore you.

So yeah, no, no, and you know what's interesting? Cause when I, when I did, I remember doing my urogynecology rotation and we were doing this procedure called a copal plysis, which was like for older women who had like severe prolapse and you basically sealed up their vagina, right? So, and it's like, okay, yeah, maybe they are like, but you know, this day and age, we should be able and

and allowed to have patients have great sex throughout their life. I mean, I have 70 year olds, 80 year olds coming in, new boyfriends, know, somebody passed away in their life, you new girl, whatever it is, right? And they're like, just fix my vagina. I'm like, let's go, you know? Yeah.

Yeah.

Totally.

Yeah, let's do this exactly. Let's get that girl running. Because I think that's the thing too, is that when you feel confident in your body and you feel confident knowing that you can still enjoy your life and still enjoy your sexual health, that looks different for everybody, right? Some people want to look good naked. Other people want to look good with their clothes on. But ultimately, at the end of the day, I think that everybody wants to take care of themselves, right? And if we view it as self-care and maintenance.

Yeah.

then it's not as much stigmatized. And so I get a lot of men who will ask me about skincare and be like, well, that's for women and that's, you know, this and that. And I'm like, no one is gonna look at you and say taking care of your skin is a terrible thing. You know, it's all maintenance. And if you change the wording, so I changed the wording a lot to maintenance because like Botox, fillers, skincare stuff, like it's all maintenance to maintain your own natural beauty, your own natural.

Right.

Yeah.

look that you want to achieve.

Yeah, absolutely. No, it's so interesting because I think that, you know, you're right. There's just so much shame around wanting to do it even. Like I oftentimes patients won't even tell me they've had like a breast aug and I'm doing their breast exam. Like, it feels like you have some saline or you know, yeah, I totally forgot to tell you doctor, but I did this when I was 18. I'm so, you know, I'm so regretful. Yeah.

Absolutely.

Yes.

Yeah, well, I've had, I have people who try to hide it from their entire families. Like, oh, I'm going to pretend I'm going to work today and I'm going to go get surgery and then I'm going to come back. It's like, and people even going through breast cancer reconstruction and surgeries, they didn't want to tell their family. They felt like they were a burden to the family if they brought up that they wanted to do these things. And so it's super interesting to hear people tell me that because, you know, I'm like, well, this is your body. You get to make those decisions and it's, shouldn't feel guilty for wanting.

Right?

the things that you want. There's nothing, you there's no shame in that.

Yeah, absolutely. I think one thing that's helped is obviously like, social media has been pretty...

outstanding, I think, for lot of surgeons because the before and afters are so compelling, right? Like, I feel like when people post before and afters, and then also just like celebrity and like pop culture in general has really opened up the conversations. Like, I haven't had so many friends tell me like, I'm, it's kind of like that, you know, back in the day when you had, when Harry met Sally and she's like the orgasm thing where I'll have what she's having. So many friends are like, I'll have what Kris Jenner is having because she looks good. So

Yes.

Yes.

Right. She looks good and she looks very natural. We have changed things so significantly over the last 10, 15 years in plastic surgery world, focusing more on natural aesthetics, natural anatomical boundaries, really honoring that. And then also like an undetectable era of plastic surgery where people can have plastic surgery and you may or may not even know it. Whereas people are scared of those things because they are scared to look like, you know, crazy people. And so, you know, that's, I spend a lot of time reassuring patients. Yeah.

Yeah.

Yeah.

Yeah.

No.

Yeah.

Right. We've all seen the bot ones, right? You see the bot, I mean, there was a whole show on it, Like botched or whatever. But like, you know, get scared about some of those things because people do look so different or they look so like not good really. You know, they look kind of like, you know, too fake, too whatever. And so, but she, everyone like agrees that she just looks like she turned the clock back, right? Like she.

Exactly.

Yes.

Right.

Yeah, which has been interesting because I have a lot of people who reach out to me and be like, what do think they had done? What do you think this person had done? And that's interesting. So I think the thing that's super interesting about her facelift in general and why people are making waves about it is, you know, there was a lot of talk about did she have a deep plane facelift? Did she have her, you know, SMAS, you know, a traditional facelift because there's many different varieties of facelifts. And the surgeon that she chose, you know, doesn't really do a lot of deep plane facelifts. So there is a theory that

That's how this works.

No.

She probably had a regular facelift, you know, where we do what we call a SMASectomy, where we kind of pull that area up instead of going into the deep plane of the face. So that might be part of the reason why. But also if you look at all the other things, you look at her skin, you look at her lips, you look at how before she had, you know, these like deep lines around her lips, like smokers lines. And so what we don't know or what we didn't get the hint of is that she's clearly had a lot of adjunct procedures with.

Yeah.

right? And this is the time in plastic surgery where we're starting to see the rise of these little subtle things that we're doing that are really changing the game. It takes a good facelift to a great facelift. And those are typically fat transfer at the same time, or fat transfer around the same time. So doing fat transfer to replace volume, because the facelift will help the face, lower face and the neck. But when we're looking at volume loss in general,

you know, around the eye area, especially like we lose a lot of volume up in here. We lose a lot of volume around the eyes. And so really kind of focusing on everything. I think that Christian are also probably had a lip lift with hers. but then also the, a lot of these adjunct things, laser treatments, skin treatments, you know, really great skincare. But I think a lot of what we're seeing is these added on things that are

necessarily something you point your finger at and say, she did this or she did that. But it creates this general softness, naturalness to the final result. And it creates a more harmonious look, which is what most patients want.

Yeah.

Yeah, absolutely. Yeah, no, that's true. I think that, um, do you think that like when these celebrities come out and admit like, you know, you have all these people that like there's theories about whether or not they took those in bag or GLP, you know, and so, um, but they're not coming forth and saying it because of, you know, stigmas or whatever. But when they do come out to admit that they've had these procedures publicly, um, do you think it creates like more pressure for women or do you feel like it empowered? I guess it could probably be both, but what do think?

I think it's double edged sword because a lot of people are like, well, she looked better before. Like you always have the group of people that are like that. Well, this person looked better before and I said, well, maybe, but also like it doesn't really matter what I think or you think as long as they're happy. And you know, that's ultimately at the end of the day, the person that matters the most is the person who had the surgery. And so I think it does empower women somewhat to be like, you know what, maybe I do want to make, maybe I do want to do something, but then they hear about these price tags of these, of some of these things because facelifts can run.

Yeah.

Yeah.

Yeah.

$150,000 to $300,000, right? And so people see that and they're like, whoa, maybe not. Or they get nervous and anxious again about the whole process of everything and looking fake. And so I think there is a component where we are allowing people now, as women, we feel more confident and comfortable having procedures, having plastic surgery, talking about it. And really, I think a lot of the millennial generation push for that. We weren't gonna go down quiet.

Right. Yeah.

Yeah. Yeah.

We weren't gonna go down like our parents did. Like, you if you have menopause, go out to the pasture and die, right? It was not happening. We are not going down like that. And so from our standpoint, we really push for a lot of changes in the aesthetic industry that give us a more natural aesthetic and also allows us to not necessarily have big surgeries. Like we don't want big results like they used to have like huge transformative results. We want little things along the way that are gonna help preserve our beauty that we're looking for.

No.

without having to be like, people come out and be like, whoa, this person's totally different looking, right? You want somebody who's not really gonna be able to tell what they had done to the point where they're asking, what did you have done exactly? And I think a lot of these adjunct things, that's when we start seeing that. When I do my facelifts and I add fat transfer with that and maybe just an upper eyelid surgery with it, like people stop these patients and are like, what did you have done exactly? Cause it looks...

What have you got done?

Exactly. It's always a pressure. Yeah, yeah, yeah.

So natural, but yet they can't quite put their finger on exactly what this person had done. Kind of similar to Christiana, right? She looks great. We can't figure out what it is exactly. We have some suspicions, but these other little things added to it kind of really helped create a more cohesive look.

Yeah.

Yeah, no, that's true too. I think that's always the best. Like even the patients I've sent to you and then come back, I'm like, wait, you look different, like really like you just look more bright or more like,

Yes.

Yes, and people get terrified. I don't want someone to see me. I don't want to go out in public. And I'm like, I promise you, no one's looking at you like you are. And no one's going to notice these things like you do.

Yeah.

Yeah, yeah, that's true. Other celebrities that have gotten negative press, like Monica from Kourtney Cox, right? She got a lot of negative press around her fillers for a while and she got them dissolved. Let's talk a little bit about the filler industry. I feel like it's changed a lot. People aren't going from fillers as much.

Yeah.

Right.

Yeah, correct. think there was a huge rise. So there was a huge rise in the use of fillers. And that's when we started to see everyone kind of having more of a pillow face, being overfilled, you know, all these things. And I think a lot of that came with the fact that we didn't have a lot of other options for tools, right? And so whenever I talking to people and we're talking about different injectors and stuff, you know, you have to have somebody who has all the tools in their toolbox so that, you know, you're, you know, not every

person is going to need the same thing. And not every person is going to need the same regimen that the other person has. And you really have to look at someone's anatomy and ask, okay, well, what is it specific about their anatomy that they're telling me they don't like? And how do we fix that in a way that has more natural look to it rather than trying to just blow up that area? And I think that, again, it comes down with technical skills, right? We have a lot of people in the industry out there that...

are not as technically advanced as other people, right? And that's okay, because it takes time to get there. But you can't really be very good at it if you don't necessarily understand how the aging process works and how the anatomy really plays into a huge part of that.

Yeah.

Absolutely. mean, I was at 2012 or something. I had an interest in some of that. And so I took like, you know, some medical aesthetic courses at the Academy of Medical, whatever it was, and I did it for a very short period of time because I realized like, I'm not going to be good at it unless I do a huge volume of this. And it wasn't something that I felt like was something I enjoyed. At some point I was like, I enjoyed doing it.

Right.

Yeah, because it's stressful because the patients are very, you know, it's their face, like, it has to be perfect. You you want to make sure symmetry is there. It's hard. It is hard. And you have to also be able to hear what the patient's telling you and be able to tell them like, yes, this is going to work or no, this is not going to work or you know what, we've gone too far here, we need to fully dissolve this and start all over again. And that's hard for patients to hear. But that's the reality of it is

Yeah.

Yeah. Yeah.

you know, sometimes what they're looking for is not in conjunction with a very simple in-office procedure of using filler, right? And so I see a lot of these patients that become overfilled. I do a lot of ultrasound guided filler dissolving. And so that really helps me identify where the pockets of filler are because over time they can form granulomas. They can be hiding in areas that we didn't expect them to, cause they can migrate.

Yeah.

And in general, they can also infiltrate it through the tissues. And so that can really change a lot of the patient's appearance, making them appear that puffiness. It can clog the lymphatics in the face, causing a lot of puffiness around the eyes. It can also cause issues with lymphatic blockage around the lip area, causing lots of swelling and abnormal deformities from hardness from the granulomas, because those can sometimes surface to the skin. I think the things that we're learning too is that fillers don't

Yeah.

Yeah.

They don't go away like we thought they would. know, we are always told in the industry, they're within 12 to 16 months, they're gone two years, whatever, whatever. I mean, we're, seeing a lot of variety of patients. And I think a lot of this speaks to people's own metabolic genetic makeup, right? Because I see some people come in who had fillers had them in years ago, still have it. I see some people who've had filler six months ago, looks like they've had nothing. And so really break the, how people break down the products makes a big difference.

Thank you.

Yeah.

And not only that, but just like technique wise, you know, if you're really looking at somebody's face and they're like, well, I don't like my smile lines. Well, the answer isn't necessarily to just fill that one line and call it a day because then you lose the cohesivity of the face. The more you add to one spot, looks like another spot's further away. And so trying to get that into balance is not so easy sometimes, but also for the most part, people are pretty open to understanding the idea of facial balancing and how important that is overall.

Yeah.

Mm.

I like to tell people in general that you can expect like multiple different avenues, but there's about three main arms. There's going to be like the, skincare regimen stuff, which is tone, texture of the skin. And that should not be discounted by any means. Cause that really is the canvas that you're working with. Then the fillers and Botox are going to be volume replacement, neural modulation for wrinkles. And then last category obviously is surgery and people are always like, my God, surgery. But I'm going to talk about a couple of little procedures that can be done. That can be super.

Yeah.

Powerful that don't necessarily put you down really heavy but can really make a big big difference for you overall like people as we start to get towards this late 30s and on like When do you do what you know, and that's always the question that I get asked. So when am I supposed to start doing this? When am I supposed to start doing that and I tell people right away Trenton Owen 100 % right away immediately

Yeah.

Yeah. Yeah. Yeah. Absolutely. And then what else? Like, what are the little procedures that you think make a difference, you know, with each decade of life in terms of that? mean, know people start with Botox, right?

Yeah, I mean, from a surgical standpoint, Botox for sure. think a lot of this is, you know, comfort level too. Someone can come in, they've never been exposed to any of it before. So starting them off slowly, I think is super important so that you can build upon it so that you don't, they don't forget what they look like. They don't get that like, you know, kind of body dysmorphia where there's like small changes over time and then you change how you view yourself over time or what you think you can obtain.

And so that drift that can happen is real. And I think that there's a lot of value to doing things in segments because then people can really also give a lot of feedback. Yes, I like this. No, I didn't. And so sometimes starting people off with Botox, skincare regimen and a little bit of filler can make a bit, can really go a long way. And again, we used to do larger volumes of filler years ago, just like.

Yeah.

tons of it. And that's how we got overfilled, right? And then we kind of backed off. We're like, okay, you don't need that much, maybe a little bit here, a little bit there, a little bit there and like learning how to break that up. so whenever I'm talking to my patients and I'm talking to them about they've never had anything done, what can I do? Usually these are people who are either or they've had Botox one or two other times. And they said, well, I really didn't like it because it made my eyelids feel super heavy. You know, and they're in their early 40s or something like that. I tell people look, yes.

balance.

Botox is gonna feel heavy because now you have laxity in your upper eyelids. And if you had hooded eyes to begin with, then the cat's out of the bag already, right? Any kind of lid space we lose definitely creates problems with Botox to make it feel very heavy. So I truly believe that a lot of people, depending on your genetics, some people need upper eyelids done in their late 30s or 40s or sometimes into their 50s, depending on how their skin is.

Right.

But that really makes a big difference for people as far as not even just necessarily from an aesthetic standpoint for the brightness looking around the eyes and then it makes your Botox less heavy, of course, because you don't have as much of extra lid space. But really in general, like it makes people feel like they can do big results with a very small procedure because it's done in the office under local, downtime is like a few days. Sutures come out at day five. Like it's amazing how fast it heals. It is amazing.

Yeah, that's amazing. Yeah.

But the results look incredible and not to a point where people are gonna be like, something's changed. It's more along the lines of like, did you sleep well last night? Like they can't quite figure it out, right? Exactly. And so that upper eyelids are huge for people in our age range, going through menopause, going through those, know, cause really, you know, in some of those genetics, right? Some people genetically have lower eyelid bags. You can't fix that with filler really. We used to try, it doesn't.

Yes.

Yeah. Yeah. You don't get tired usually.

Yeah.

do a great job. And so those people need surgery to get that fixed. I mean, that's a little bit bigger surgery to do your lower eyelids versus uppers, but uppers can be done in the office in like half an hour, hour, super easy, very quick. You don't need general anesthesia for it. And the results on that is a big deal.

Yeah. Yeah.

You're just basically, and what are you basically doing when you do that?

Yeah, so essentially, you know, this line, natural line is called the lid crease where it's where you're when you open your eyes, you can look at straight ahead and you can see some of that extra skin that wants to lay over top of it, kind of this little stuff here, right? And so taking a slip of that. And then also what I like to do, especially for my female patients, I don't do this for my male patients because it makes more of like a cat eye look, but it will pull. do a little bit of a wing out here. So I pull the incision out a little bit and that pulls up.

Yeah. Yeah. Yeah.

there's always this like little fold that happens at the end of the corner of the eye and you're trying to do makeup and it's just so annoying because you're putting more makeup on it, more makeup on next thing you know your makeup looks like it's going down here. And so getting rid of that little fold to bring that up really helps bring that corner of the eyelid up. And in general, even with facelifts, we resuspend this lower part of the face can really help resuspend the lower eyelid in general. And because we lose the shape of the eye over time.

It becomes less almond shaped, more oval shape or more circular where we get more show on the lower part of the eye. But even as we get older and the heaviness of the lids, you lose some of the clearance of the pupil. And so what that happens is a lot of that's from ptosis could be from the muscle, but also extra skin plays into that too. My patients oftentimes will tell me like, I cannot believe how much better I can see. Things are so much brighter.

Yeah.

by the end of the day, they don't feel as heavy. Like you don't feel like you're like, you know, trying to lift your eyeballs up because it's just like, you know, the old like loony tunes where you're trying to like keep your eyes open. And that can really make a big difference for people for a small cost. It's, know, as far as bang for buck, like that is a very powerful surgery. Additionally, the other things that can be really powerful is an upper lip lift. So basically reestablishing the distance from the base of the nose to the upper lip. As we get older that

Yeah.

elongates. Now some people it elongates more than others. People who have more thinner upper lips tend to have more in turn of their like vermilion border or this like kind of red color in the lip. It will turn in more and then it looks very flat. So we get a blunted effect of this of the upper lip. It becomes more smooth. We don't get as much of the definition of the column, but it also lengthens over time. And so bringing that back up into position can help with showing the teeth better. One.

but also it can help prevent needing to overfill with fillers. Because if you honor someone's anatomy and their natural anatomy, if you put fillers in them, it looks insane. You're just blowing up the lip when the reality is they might just need a little bit of a hike. And then you're doing something, again, this is in the office under local, like very small downtime, but that really makes a huge difference for patients. Those tiny little procedures can restore a lot of the...

Yeah, yeah.

especially kind of in the main areas where people can see, right? Because the nose, the lips, the eyes, those are the areas that people are always looking at and can converse with, right? And in the lip, you know, if you have a cut in your lip and there's a one millimeter difference where they put the two edges together, the human eye can see that at a conversation distance. It's crazy, one millimeter, right? You're like, what? But that's how powerful the mid face is for our conversation and how we talk and interact with people.

Yeah.

That's so funny, huh? Wow. Yeah.

Yeah.

Yeah.

And so that those two procedures in combination with you know, fillers Botox and skincare stuff can make a really really big difference and can really bridge people a lot over time till they're ready to maybe get a facelift or maybe not.

Yeah. Until the face look up. Yeah. Oh, that's so cool. What do you think about like, because now we're in this like AI world that we live in and you know, people are coming in with their AI filters and they want to look a certain way. Like what, how do you even manage those expectations?

Yeah, and I think that that is true, right? And we're also in like the social media selfie world where everybody wants to look like a specific person or they have a vibe that they want. You know, and sometimes I tell, I'm very honest with my patients and I'm like, this is beautiful look, but it's not real. It's not real. And when it's not real, it's not necessarily going to be real for you. And have you thought about maybe this variation of that or that variation of it?

Yeah. Yeah.

Yeah.

The other thing is too, is that we have software systems that will change your face for you to give you an idea of a result. And there's a lot of scrutiny with those softwares. mean, obviously we use them, helps us have a visual representation, but it can set unrealistic expectations for patients because they're expecting what this AI rendered version of them looks like. And maybe that's not how everybody feels different. Maybe that's not how it's going to end up looking at the end of the day. And that can really bother patients a lot.

Yeah.

Yeah.

Yeah.

And I really tell people, really encourage them to look at themselves and view themselves in a way like, okay, what is it that you love about yourself? Let's talk about that. What are the things that are your favorite features? And then, you know, we don't want to change that, right? And so if we don't want to change that, we don't want to go down this route of computerized, like what they think you should look like. And then we run into an era of how everybody starts to kind of morph to look the same, right?

Yeah.

similar lips, similar this, like they all look like cookie cutters of each other. And that's not the focus of beauty. Like beauty is unique. Beauty is what is also a feeling, right? You don't have to be necessarily the most beautiful woman in the world, but maybe your personality is what makes you that, right?

Yeah.

Right, absolutely. I agree with that 100%. I mean, do you get a lot of younger patients then, like teenagers and stuff that want like either Botox, fillers, or you know, even...

I get probably people in their 20s that are looking at baby Botox. And for some people, that's not a bad thing. And other people, I discourage them. It really just depends on the patient. The patient's anatomy again, because some patients that have thinner skin, white people have very thin skin. And so they start to develop pretty significant wrinkles, crow's feets. By the time they're in their late 20s sometimes even. And so what do you do in those situations? know, prevention Botox is what we like to call it. Yep, exactly.

Yeah. Yeah.

Yeah, they cut the ends and everything.

Honestly, like some people are about that and other people are not. I don't push it on people. I tell people though, like, look, if you have static wrinkles, meaning that you're not making that face, but yet you have those lines, that's usually the sign that's a good time to start Botox. You don't want it to be really deep. Cause I have a lot of like men who come in and they're like really, really deep. I want to get this to go away. And I'm like, the cat's out of the bag on that one, buddy. Like we're going to do our best to soften it, but really it's hard to get rid of the very, very deep wrinkles.

because that's at a deeper process of the skin that we need to get to. really, so I think that when I tell people that they get frustrated about those things, but they also recognize that, okay, well, maybe this is something that I need to be okay with. This gives some character to me, but also at the same time, like it's not making it completely go away and that's okay too. So they learn to love those little things that they originally came in saying that they didn't.

Do you get a lot more people because of like, you know, people are now we have such great treatments for like chronic conditions like obesity and inflammatory conditions. know the GLPs help with inflammation, obesity, cardio protective, all of things. But now you have people with all this extra skin and you know, all of it. Are you getting more of that as well? And.

Absolutely. mean, for sure. Ozempic has really changed these, they call them Ozempic face, Ozempic bodies. And it really has changed the game a lot because, and it's happening at younger ages too, right? Cause people are losing massive amounts of weight and they have a lot of laxity in the skin and you can't really fix that. So my massive weight, I did a lot of massive weight loss patients. When I was in my training, I had a mentor that specialized in massive weight loss and did his fellowship at one of the only ones in the country. And so,

you know, those patient population have been through some significant stressors, significant body dysmorphia in their life. Now they're coming out with almost looks like a body suit that they have on and they don't like it. So some people will gain weight back because they don't like the way their face looks. And it's true in general that as the thinner we are when we're older, we look older than if we have a little bit of some fullness to our face. And so, you know, with the rise of that,

Yeah. Yeah. Yeah.

women who are losing a lot weight and like they start looking especially unfortunately like I think in the Caucasian populations because the more that you

Yes, yes, and that, it compromises the soft tissue integrity and those tissues just don't hold up as well. And the skin does not like to snap back like it used to. And also depends how many times they've yo-yoed. It depends on their skin type. It depends on their whatever, right? But I do see a lot of that. And I think people are always a little bit disappointed that we don't have enough non-surgical skin tightening options out there. They're just not great. And I tell people, look, if they have 10 different devices for one thing, it's because they all suck.

Yeah, exactly. Right, like a freak, whatever.

in different ways. They don't work, right? Otherwise, yes. Right, exactly. I mean, if there's 10 ways, there's all these different ways to do it. It's like buying eye cream, like there's a million of them because they're all terrible. Like none of them really work great. Like let's be honest about that. And so I think that that really speaks to those things. And I think people finally come to the realization that they're going to need surgery. And so they end up doing

I'll get him off.

and such.

facelift, neck lift, we do their breasts, their arms, their legs. I I end up operating on these people year after year. They'll come in, get $60,000 worth of surgery every year. And then next year, it's another section of their body, another section of their face or whatever, until they're getting to the point where they're like, I'm happy now with all this extra skin resection. And some people need some of it, some places and others don't. It's really genetics like plays a big role into that too.

Yeah. Yeah.

Yeah.

Yeah, it's so funny because I mean these surgeries are long, right? Like, I mean, I have another one IVFS in California is a plastic surgeon. She's like, Oh, I just had a 12 hour surgery.

Yes.

Yes, yeah, body surgeries, especially when you're doing multiple things, because it can save people money by doing stuff all together, but they can be quite long and it can be really hard on the body too. And so, you know, obviously making sure the patient's safe for surgery and that they understand what they're getting into is super important as well.

Right.

But in terms of the aging thing, isn't this a common, I I tell my patients too, like at some point you have to choose between your ass and your face. Like, if you lose too much weight, your face is gonna look, you know, whatever, older. If you keep a little ass, keep a little fat, you know, you might look young.

Yes.

It's true, although we've gotten so much better with fat transfers and things like that, which we've been doing over many, many years. Actually, when I was doing research between my undergrad and my master's, I was doing research on fat injections for different various like veterinary ailments. And I didn't really appreciate that until now. And as much as I'm doing fat transfer, we did a lot of fat transfer to the breast and we're doing fat transfer to the buttocks, but really fat transfer to the face is...

No.

the new thing now, it's really gonna change the game. We're finding ways to make it more consistent. There's new products coming out that are gonna be shelf stable fat transfer. So catarheric fat that's been decellularized so that they can take those cells and use that without having to have a donor site to harvest from. And so really restoring a lot of that youthful contours with fat is really gonna give you a very, very natural look.

Okay.

That's so interesting because like a lot of people aren't getting implants anymore, right? They're getting more.

Right, right. And I do all, a lot of times I'll do breast lifts with fat transfer instead of breast augmentation. Or even with a breast augmentation, if it's a very thin patient, but they don't want the implant under the muscle, we can put a little bit of fat over top of it to make it have a smoother transition so that they're not getting that step off and we're not disrupting the muscle. And so some of these newer techniques that we have coming out like placement of the implants in a subfascial plane just underneath the pec.

Yeah.

Yeah.

muscle fascia, but keeping the muscle intact has been huge game changers for people because now you're not really disrupting their own anatomy significantly, but you're still able to give them what they're looking for. then you basically, what I like to tell patients is when we're doing fat transfer stuff, this is primarily like, you know, if you're looking at a painting and the painting has very defined edges, you're gonna, your eye is gonna go to that where the sharpness is. If you want a smooth transition,

The body does that with fat and I think that that's the best way to do it too. And it can be the face, it can be everywhere on the body really. Hands, back of the hands too, because people don't like the back of their hands as they get older, right? And so fat transfer into the back of the hands can help restore some of that lost volume. But other things that we're recognizing about fat transfer is that how much it is actually significantly changing the skin as well. It's not even just volume replacement. It has so many good growth factors in it, has your natural

Really?

Yeah.

exosomes, natural growth factors, and these things are really changing the texture and the tone of the skin as well. It really does a beautiful job restoring that elastin and collagen and things like that that are naturally lost over time.

That's so interesting. Well, mean, Dahlia, I can just ask you tons of questions, but I have to be cognizant of our time, my god, that's so good. OK, I want to start this new thing that I want to do for part of my closing. So I like to call my listeners part of the Vagilante Nation. know, because every podcast has like their gang or their group. So I'm like, I'm a Vagilante as a guy and a girl. So my listeners are the Vagilante Nation.

Yeah, no problem.

Yeah, of course. I love that.

Love that. I love that.

So I'm coming up with this thing called a vaginal anti-virtue. So it's the one truth that Dr. Dahlia Rice wants every woman to hear loud and clear. what's your verdict?

Do what makes you happy. Do what is that you love. Don't let anybody else tell you that you should or should not do something. If something bothers you, fix it. If you're doing this all the time in the mirror, fix it. You only live one life and you wanna be able to enjoy your life the way you wanna enjoy your life. And as much as we want to not really believe it to be true, as we age, women can sometimes disappear in society. And that can...

Hmm.

Yeah. You only live.

and visit us.

Right, exactly. And that can be really hard and especially in very public facing careers or just in general with your interactions with people because people, we read each other's faces. And if you have this look of like anger on your face, just because you're, you have a lot of laxity, then that can make people feel pretty self-conscious about it or not want to take pictures or not want to do these things. I tell people, look, if you're a change, if you're not taking pictures, if you're changing your face in the picture to a certain way every single time, fix what it is you don't like.

Yeah.

to address the condition.

Yeah, yeah, that's really good. Yeah. It's so interesting because I think, yeah, we do like we, we give us, we don't allow ourselves to do some of these things that we should. And it's really, you know, you're right. We only live one life and, and, you know, why is everyone else to judge what we're doing? That makes you happy and it's safe. can get good results with someone like Dr. Dahlia Rice. Thank you so much Dahlia for joining us today and pulling back the curtain on the world.

It's okay.

Right.

Absolutely.

That's right.

Thank you.

plastic surgery. If this episode gave you some new perspective, share it with someone who's here at your body, your choice, your voice, that's the Vagilante way. So anyway, I want to thank you again. I'm here just to really help people learn and educate them so they can advocate for themselves. I appreciate it.

Yes.

Yeah, thank you so much. I appreciate you taking the time to bring me on here. I always love chatting with you. We could talk all day long about all the things. I know I'm like, okay, we need to our own podcast again after this. Because honestly, like so many different, so many interesting things coming out that really crisscross into our fields. Because, you know, I mean, like your field and my field are like two hands that are holding and who's taking care of this midlife population? Who? We are.

I know. I have so many other questions.

We found it! my god, I'm so s-

Absolutely, we are. And who's getting the fame for it if we're talking about sex or for, you know, plastic surgery is like such a shameful thing to get, right? Like, oh my God, we should do one. Maybe we'll do a series of them and see.

You know, and that's important.

Yes. Because again, like dissolving that stigma, empowering people to do what it is that they love. Like we don't need to live our lives by what other people are telling us we can and cannot do. You wouldn't have somebody tell you what kind of car you're going to buy or, you know, where you're going to go on vacation. And, you know, you know that, I mean, obviously people feel stressed and guilty about those things as well.

But you know, even just normal everyday things, you know, like, you're just gonna do the things that are good for you. And that's one thing I love about our age range. Like when you hit your 40s, like your will to care about what other people think starts dissolving during perimenopause. And I'm like, ride that train because this is how it should be. You deserve these things. If that's what you want, yeah, exactly.

Yeah.

Yeah.

Yeah. No. Yeah. I mean, why people pivot. Right. That's why people pivot. This article just came out in the USA today about men of divorce. They actually interviewed me for it. like, it's like, you know, I can say people have very little time for broke for bullshit. Yeah.

exactly as they should, you know, and not only that, but like, as women were told what to do, how to wear, what we should wear, how we should act, constantly minimized, constantly gaslighted, you know, at some point in time, you know, the woman has to decide for themselves what it is that they want, rather than someone telling them what they want.

Yeah. Yeah. Yeah.

Yes. Right. And we already have insurance in our exam rooms. have politicians trying to dictate women's care. And so at some point, it's like, That's why both of us have stepped outside of the insurance company, which we should talk about that on a separate episode. I'm going to have you come back. We will try it. Yeah.

Right.

Yes, because they...

We could talk a lot about that for sure.

We should do in person like we said, because we both are in Chicago, I got to figure out what we'll set up and then I'll get you in person.

Yes. I would love that because I think especially the insurance stuff we could go on and on about it. It's prevalent. It's the dark. It's the dark force in all of doctors lives and it's it's just making things impossible. That's obviously one of the reasons why I went into private practice while you're going into concierge because they're making it nearly impossible for us to take good care of our patients, which is really sad.

Yeah, it's important.

Yeah. Right.

Absolutely. Absolutely. They're dictating the care that they have no business doing. So I think we should. We'll talk offline. We should do a series. That would be so much. Okay. Well, you so much. Yes, you too. And you guys should like and subscribe to my channel and I'll see you next week.

100%.

Yeah, absolutely. Well, thanks, Dr. Rahman. I appreciate it again.