Did She or Didn’t She? Adele’s New Face

Dr. Jenny (00:00):
People often are able to stop them for three, four months post-op without much of an issue. Now, if they're gaining weight, I say, we can go back on it. I don't want you to gain 40 pounds just because I put some fat in your face.

 

Dr. Chang (00:13):
You are listening to Secret Services, where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang.

 

Dr. Jenny (00:23):
Hi everyone. I'm Dr. Hillary Jenny. I'm Dr. Chang's partner and a plastic surgeon here at Congressional Plastic Surgery, and we have some fantastic guests with us here today. Got Monica.

 

Monica (00:33):
Hi, I'm Monica Thompson. I'm one of the PAs here at the office.

 

Dr. Jenny (00:37):
She also runs our GLP-1 program, and we've got Carey here as well. Welcome back.

 

Carey (00:42):
Hi. Thanks. I'm glad you guys are here.

 

Dr. Jenny (00:43):
Yes. We're going to have a little girl chat time as we take over the podcast. We kicked Dr. Chang out. So what are we talking about today?

 

Carey (00:51):
So a woman goes to a car race with her teenage son. By dinnertime, people who have never met her are explaining what she's had done. There's a real answer to what everyone has seen, and it has almost nothing to do with a scalpel. So basically significant amount of weight loss and what happens to your face when you experience that?

 

Dr. Jenny (01:11):
Lots of things. And we see this all the time. I mean, with our patients who are in our program, other people out there doing GLP-1s, GLP-3s, all sorts of things. So your face is affected like the rest of your body, right? What have you been seeing?

 

Monica (01:23):
I've seen a lot of patients that come into the office hoping to lose a little bit of weight. They found that it slowly starts to creep up over time, and they're just finding it really hard to lose those annoying 10, 15, 20 pounds that they've been trying to lose for quite a long time. So not only they're hoping to lose a little bit of weight maybe in their thighs, the belly, but just kind of all over, they're hoping to slim down a little bit.

 

Dr. Jenny (01:52):
The one place they don't want to lose it though.

 

Monica (01:54):
Is the face.

 

Dr. Jenny (01:54):
Yes, but it's affected like everything else. So we see this all the time. And I think a lot of people always wonder when should I do something about this and what can we even do? So what do you typically tell people when they ask you?

 

Monica (02:08):
So we typically tell patients that we don't want patients to lose weight too quickly. So our program is for six months in the office and three or four pound weight loss per month is an average. We don't like to see any more than that. Patients that lose weight too quickly, it's not a healthy thing to do. And we like to see them every month and monitor them and make sure that they're feeling okay on the medication and then don't have too much of those uncomfortable side effects that you can develop.

 

Dr. Jenny (02:38):
And then when they're kind of nearing the end of their weight loss journey, that's kind of when we can do other things or even a little bit along the way too, right? So one of the things that we do.

 

Carey (02:47):
Well, you're amazing at this, but fat transfer to the face. I absolutely love that. That's obviously the more invasive way to go. But I personally love fat transfer to the face. I think it's amazing results, not only to give you the volume in the face, but your skin. I always say it's like liquid gold for the skin. Your skin just eats it up.

 

Dr. Jenny (03:07):
Absolutely.

 

Carey (03:07):
But if you're not wanting to go the more invasive route, we do have a bunch of different fillers here at the office that you can add to the face to help build, kind of fill in the areas that have kind of de-puffed or deflated throughout the last couple months.

 

Dr. Jenny (03:24):
For sure. So on the operative standpoint, adding fat to the face, sometimes people also need a full-on facelift. So that is another thing that we're doing. That I would say wait until you're at the end of your weight loss journey because we don't want to be intervening and then you lose more weight, you get more recurrence without sagging. But we can add volume with fat. We can also add volume with filler. Filler is going to be a little less downtime, but also a little bit less volume kind of added with that. We have volumizing fillers, but we also have skin beef, which we like as well. And so that can add just a little bit of boost in hydration to the skin. So all of those things can be helpful.

 

Carey (03:59):
So this is a woman who said, "I've lost 62 pounds on tirzepatide and I love every part of it except my face. My mother asked me last month if I was sick. I want to do something about it, but I'm scared that if I start filling now and keep losing, I'll end up looking like the exact people I make fun of." What's the right order? And we've kind of talked about this, but how do you kind of talk to someone who is a little apprehensive about filler especially? I mean, I just feel like filler has kind of gotten such a bad rap over the years. Everyone's saying that they're dissolving their filler. But yeah, how do you help with anti-aging, but then also -

 

Dr. Jenny (04:40):
Not making things worse.

 

Carey (04:41):
Right.

 

Dr. Jenny (04:42):
Yeah. Yeah. It's a fine balance. And we definitely see some people who've gone over on the other side of things, the Mar-a-Lago face kind of side of things, which we don't really promote here. But I say sort of filler is a good temporizing thing. It's something that you can do while you're in the process of losing your weight. I like really tasteful filler. I mean, I've had filler in my face. I think it can look natural. At least I think I look natural. Don't tell me if not, but I think it can be done very well. And when we think long-term though, we are typically often thinking more fat transfer facelift. So get your filler, feel more confident in yourself, particularly when you're in the middle of your weight loss journey. It's not really going to burn any bridges. If you're using a hyaluronic acid filler, we may end up dissolving that down the road once you're done with your weight loss and you say, "Hey, I really want a more permanent change." That's when we're looking for the fat, which I love.

 

(05:28):
And then maybe even a facelift as well if you had a lot of sagging and drooping and you really need things lifted in addition to just the volume added.

 

Carey (05:35):
I feel like, especially for the GLP-1 drugs, obviously you can lose weight quickly. And also not just the GLP-1 drug, but the lap band and stuff like that. And I find that it's not so much the face that looks gone, but everyone kind of talks about their little turkey neck. Yes. Is there anything you could do? Obviously surgical's the way to go, but in office things that you think are effective.

 

Dr. Jenny (06:04):
That's what everyone wants. If we had a great answer to the turkey neck that was non-invasive, we would have. I mean, it's just below solving world hunger I think for people. It'd be the absolute biggest innovation in the aesthetic world. I mean, I think there's less invasive things are going to have less impressive results. It doesn't mean it's zero. So I feel like I talked to a lot of people about Morpheus8, which I think you're also talking to people about as well. Get a little bit of skin tightening, but nothing's really going to get rid of that gobbler other than surgically addressing it.

 

Carey (06:32):
Yeah.

 

Dr. Jenny (06:33):
I will say, I think people on these GLP meds get more significant loss of volume and facial changes and people who lose weight just through diet and exercise alone. Have you also been seeing that?

 

Monica (06:42):
Yeah, I have seen that a fair amount. And usually if they've been on their program for even longer than six months, they start to really kind of bring it up in the office about the lower face and the neck and just what the plan will be once they're off of the medication. Because not only do they feel great about weighing a little bit less and looking a little better in their clothing, but now they want to feel better in their face too.

 

Dr. Jenny (07:05):
They want to look good everywhere, don't we all?

 

Monica (07:06):
Yeah, we do.

 

Carey (07:08):
All right. So Adele attended the British Grand Prix on July 5th with her son. Her significant public appearance in nearly two years. Photographs set off, days of speculation with commenters blaming bad medical decisions. Doctors quoted in the coverage pointed to her documented 100 pound weight loss, which changes facial proportions on its own. She has said since 2015 that she doesn't want plastic surgery. So I can actually speak firsthand about this. After college, I was definitely a little pretty. I was going to say a little heavier, but I was significantly heavier back in the day. And it just obviously like lifestyle changes, working out, finding what's right for you. But we joke about, there's this picture that goes around the office and we call it Fat Carey because my face looks so -

 

Dr. Jenny (08:08):
I can't imagine it.

 

Carey (08:09):
Oh, I'll have to fix it. It's a terrible picture. I'm in Nantucket. I'm burnt to a crisp.

 

Dr. Jenny (08:14):
Of course.

 

Carey (08:15):
I just look ridiculous. And yeah, I think Dr. Chang made a sticker out of it. Yeah. And we call it Fat Carey. And my face is just so puffy. My nose looks bigger. My eyes look smaller. And it's funny because last year we had a photographer come to the office who had done our website photos years ago. And he asked me, he's like, "Did you get a nose job?" And I was like, "No, just lost a lot of weight." But I think too, yeah, people think when you lose weight, they're like, "Oh, she's had something done." When really, nope, it's my nose. It just has less fat, I guess.

 

Dr. Jenny (08:53):
And it honestly goes both ways because sometimes people have had something done and people just think they lost weight. We see that a lot when people are getting face and necklift to address the gobbler. People are like, "Oh, you look like you lost weight," when really he was getting something done. So I think it's funny. I think these discussions are always interesting to me because I have a love-hate relationship with it. The plastic surgeon in me does look at these people online and I'm like, "What did they do? Did they do? I don't think they did." And then the woman in me is like, "Why are we constantly critiquing women's bodies and finding a reason for why they look the way they do?"

 

(09:22):
So I struggle with this a little bit, but I do think in general, the internet loves to jump to surgery, particularly for celebrities. And they do kind of lose their ability to have an anonymous aspect, their anonymity. They kind of lose that because they're in the public eye and I don't think we give them as much grace because we assume they've done something. Whereas your average person you meet, it's more likely you think that they've lost weight rather than maybe they did actually have something done.

 

Carey (09:47):
Yeah. There's this doctor that's on TikTok and she basically has side-by-side photos of celebrities five years ago, 10 years ago. And she kind of starts from the top and breaks it down. And it's so interesting what she says when they've obviously have a fuller face. She's basically like, "The filler's overdone. They have way too much in their cheeks. It's making their eyes look too heavy." So basically she's kind of breaking it down. And you tend to get harsher reviews on people who have fuller faces, but for the celebrities that have lost weight, she kind of is a little bit more kinder. I don't know. It's very funny. But the one thing that she always talks about, and again, obviously fat is all over your face. And I always find it so satisfied when we're doing an upper bleph and a nice little fat pocket comes out.

 

Dr. Jenny (10:42):
That little fat is beautiful.

 

Carey (10:43):
Yes. But she says, she's like, they've had an upper bluff and their eyes are hollow, but I'm like, did they have an upper bluff or did they just lose a lot of weight?

 

Dr. Jenny (10:51):
Did they just age? Yeah. I've lost volume in my upper eyelids just through time. And I look at myself and I'm like, I definitely know I'm going to be gone at some point. It won't have been from an upper bleph. It'll just be age. Losing that volume, we lose volume in our faces as we age. So that in combination with weight loss can produce some of these really dramatic changes that people often chalk up to surgery. But especially if you're losing this weight quickly in combination with aging, it can change a lot.

 

Carey (11:14):
Yeah. Yep.

 

Dr. Jenny (11:15):
Okay. So we've talked about what rapid weight loss, including through GLP medications can do, but what's kind of the endpoint when people have lost their weight, we're thinking about doing some interventions to address some of the changes they've seen, what's their long-term course going to look like?

 

Monica (11:31):
So for some patients that have lost a fair amount of weight and they're so worried about gaining it back again, we will discuss a maintenance program where it's a very, very, very small amount of GLP-1 where they will take that for an additional six months just so that they are able to see how they're able to tolerate going back to their lifestyles that they were doing before they were on their GLP-1s to see if they gain any weight back. I will say that for the patients in our office, we've had a lot of patients come through here and we have not had many patients go back onto the medication after they've gone off of it. Most patients are thrilled that they've lost the weight. They've worked really hard. They have purchased new clothes and they want to wear the new clothes that they've bought. So they haven't really gained weight back.

 

Dr. Jenny (12:18):
That's great because I think there's a lot of thought that once you get on these meds, you're kind of on them for life. And maybe that's true for some people at even a diminished dose, but for a lot of people, it sounds like they can be happy without it. So that's awesome that we can see more of a sustainable change.

 

Monica (12:31):
Yeah. Yeah. We've been really thrilled with the results here for our patients in the office.

 

Dr. Jenny (12:35):
What have you been seeing for side effects, things that you're monitoring for as you handle this patient?

 

Monica (12:39):
So the most common side effects that we hear about are a little nausea, a little fatigue, a little heartburn. There can be some constipation or a little loose stool. Those are probably the most common side effects that we hear about for fatigue. We do offer B12 shots if they need them. They can have that once a month. But most of our patients have done very well on these medications. They're not on doses that are so extremely high that the side effects have been bad.

 

Dr. Jenny (13:09):
That's good. Yeah. I think the last thing I would want to say in terms of things I wish everyone knew was GLP-1s and surgery, because I feel like we get these questions a lot. I get these questions a lot with my patients too, especially since I do so much with fat transfer and how are you really handling your GLP? And so I think these drugs are newer, and so how we handle them has shifted in terms of before your surgery. Now I think we're typically having people stop the week before, so they skip a dose and then we're doing clear liquid diets the day before. So that's kind of where we landed with that. And then the question that I get a lot in terms of fat transfer is how are you going to handle your GLP-1 after?

 

(13:45):
And I feel like for me, that's been a moving target. And you're probably having some of these conversations with these patients too. But I like you, if you can, to stay off your meds for about three, four months after the surgery. Because I do think, and this is not study, this is just my philosophy and scientific brain kind of working, but I think that if you're in this weight loss mode where your body is not trying to hang onto fat, I think it's not going to hang onto the fat that I'm adding. And so I think as much as we can get a holiday, and to your point, people often are able to stop them for three, four months post-op without much of an issue. Now, if they're gaining weight, I say, we can go back on it. I don't want you to gain 40 pounds just because I put some fat in your face. But I think oftentimes we're able to kind of handle that pretty well.

 

Carey (14:26):
Yeah. Yeah. I just remember you talking to a patient one time after surgery and you were like, no, I want you to feed the fat. Don't starve yourself because yeah, it's like all your hard work just down the drain.

 

Dr. Jenny (14:36):
Down the drain. You want to feed the fat. Give it a good home.

 

Carey (14:39):
So it's safe to say we kind of have decided that okay, it's extreme weight loss or volume loss in the face isn't always such a bad thing, but when it's that extreme sick looking aesthetic -

 

Dr. Jenny (14:54):
Maybe not so much then. And if you're having that - Come see us.

 

Carey (14:57):
Yeah. We have a lot of solutions for you.

 

Dr. Jenny (14:59):
Got a lot of tricks up our sleeve.

 

Monica (15:01):
Love to see you.

 

Dr. Jenny (15:02):
Yes.

 

Carey (15:02):
Well, this was fun. A little girl chat.

 

Dr. Jenny (15:05):
Little girl chat. Let me have coffee next time.

 

Carey (15:07):
Yeah, exactly. All right.

 

Dr. Jenny (15:08):
Thanks for joining us.

 

Carey (15:09):
Thank you.

 

Dr. Jenny (15:09):
Join us next time we take over the podcast.

 

Carey (15:11):
Yeah. Bye.

 

Dr. Chang (15:14):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @congressionalpsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.