Looksmaxxing: How Far Is Too Far?

Dr. Chang (00:04):
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. Tell us about what you're watching lately, the Euphoria thing.

Jackie (00:17):
Should we do an intro?

Dr. Chang (00:18):
Yeah, no. Tell me, do the Euphoria intro. It's better like that.

Jackie (00:24):
Okay. Have you-

Dr. Chang (00:25):
I do not do anything with Euphoria.

Jackie (00:27):
Which is so crazy and now it's too late. The last season, I'll be honest.

Dr. Chang (00:32):
It's three seasons, right?

Jackie (00:34):
Yeah.

Dr. Chang (00:34):
It's not that many seasons. Why is it so late?

Jackie (00:37):
Well, because the first two seasons were ... I think the last season was four years ago and then they waited forever. Literally two main characters in real life have died since-

Dr. Chang (00:49):
This is like Game of Thrones. Two years to make a-

Jackie (00:52):
Four.

Dr. Chang (00:52):
Four years to make another season?

Jackie (00:54):
Yes. So then they made this season and I mean I enjoyed it but it wasn't great. A lot of people did not like the finale. I thought it was as good as it could be.

Dr. Chang (01:07):
So it's a finale of-

Jackie (01:08):
It's a finale.

Dr. Chang (01:09):
I really have no idea. So it's a bunch of people that are in high school or something.

Jackie (01:13):
They were in high school. Now they're out of high school. Sydney Sweeney's character is doing OnlyFans. They're messing with the Mexican drug cartel.

Dr. Chang (01:23):
Spoiler alert, by the way, if you haven't seen it.

Jackie (01:25):
Spoiler alert.

Dr. Chang (01:26):
Okay. So they're messing around. And then you said there's a plastic surgery reference at the end.

Jackie (01:30):
Yes. In the finale, some of the girls that work at the strip club are getting plastic surgery and one girl got a BBL and so they show her butt multiple times through the finale and her BBL looks so ridiculous and it just looks-

Dr. Chang (01:50):
It's like the Hollywood prosthetics guys are living it up, making this giant butt.

Jackie (01:55):
Yeah. And it looks rock hard and just not attractive at all. And it's all I could focus on. And then they show this other girl in the back of some car. I can't even remember what exactly was going on. They put all these girls in the back of a van and one of the girls clearly got something done with her face so she's wrapped up in Ace bandages and she has her drains hanging and it was just such a scene.

Dr. Chang (02:19):
And these are young people.

Jackie (02:21):
Young girls. Yeah. And then it just made me think of all these people that just go to Mexico, cross over the border to get these cheap surgeries.

Dr. Chang (02:29):
Well, I mean, that's sort of the trend now is young people going for pretty intense extreme surgeries, whether it's facial reshaping or BBLs or stuff like that. And going to other countries, going to Korea, going to Mexico, going to South America, going to Turkey or Europe and stuff like that.

Jackie (02:50):
Yeah. I feel like Euphoria, one thing they're good at is being up with what's going on in the world, the OnlyFans thing. That was a big part, but it was just-

Dr. Chang (02:58):
Well, they got to make another season before four years because whatever they're planning might be out of fashion.

Jackie (03:03):
No, I think it's done forever now. Because it had a weird ending and everyone's like, "We got to just be done. We got to be done now."

Dr. Chang (03:11):
All right. Welcome to the new set, the little decor for you.

Jackie (03:17):
It looks awesome.

Dr. Chang (03:18):
We're always going for the latest and greatest.

Jackie (03:22):
Yeah.

Dr. Chang (03:22):
Your Dad will be exited to see the Episode. Hey, Dad.

Jackie (03:26):
Hi, Dad. My Dad thought our old set was very boring. I actually-

Dr. Chang (03:31):
Well, we'll have to get feedback from Dad.

Jackie (03:33):
I sent a picture to my mom last night of this and she said, "Wow, you guys are official."

Dr. Chang (03:37):
Upgrading.

Jackie (03:38):
Yeah.

Dr. Chang (03:38):
Upgrading.

Jackie (03:39):
What an upgrade. Some may say we're looksmaxxing.

Dr. Chang (03:43):
Yeah, exactly. Exactly. Tell me about looksmaxxing. We go to China maxing later, but we'll bet they'll look maxing.

Jackie (03:50):
So, okay. There's this guy online being told his nose, jaw, and bones are problems he can fix with a syringe, a hammer, and enough discipline. One of them just live streamed the surgery to prove it. We're talking about where self-improvement curdles into something a surgeon should refuse. So at what point does a patient's wishlist stop being about features and start being a sign that surgery isn't the thing that's going to help them?

Dr. Chang (04:15):
This is crazy because I know it's trending. This guy Clavicular ... We go so deep into this. I don't know anything really about him. He just kind of blew up recently, but there's a whole culture of young men who are really into the aesthetics, into the look, how to become more attractive and masculine, I guess.

Jackie (04:43):
Yeah, definitely masculine.

Dr. Chang (04:45):
So there's a whole culture of this going on in sort of the online and social media world. I don't even know. Why would you call yourself Clavicular? I'm sure there's a whole story about that.

Jackie (04:54):
Yeah. I don't know the backstory on that.

Dr. Chang (04:56):
But maybe that means having good clavicles. He's sexy. I'm not sure. And also, I feel like he's known for talking down to women who he doesn't think are attractive enough to be in his presence and sort of this alpha male behavior to be pushing away women.

Jackie (05:15):
Which I think is just hilarious.

Dr. Chang (05:16):
So that's kind of true, right? I'm not making that up.

Jackie (05:18):
I think, yeah. But it's just so funny because it's like literally look in the mirror. What are you doing? And you have no room to talk about how women look. But okay, you know the comedian, Matt Rife, have you ever seen him?

Dr. Chang (05:31):
No.

Jackie (05:32):
He's another one that he got really popular doing his standup online, TikTok and everything. And then he started doing stuff to his face. I think he had jaw surgery and filler in his jaw. I don't know. Clearly trying to look more masculine, but I feel like it had the opposite effect. Now he just looks weird. And I think it turns you to a point where you're starting to kind of look feminine because you're doing too much with your face.

Dr. Chang (06:00):
Yeah. I think now that men are doing more and more plastic surgery, or at least they're aware of things that contribute to aesthetic features, jawline definition, nasal reshaping, brow bone contouring. I mean, people are aware of this, not only for just men, but we think about some of these aesthetic and cosmetic principles in transgender surgery when we define what makes a male face versus a female face. There's certain enhancements or certain types of goals you try to achieve. So I think that sometimes people are learning about those things. Sometimes they're going a little overboard like what you're talking about. So it's kind of a current topic.

Jackie (06:43):
So we have an anonymous question, okay? I'm 19 and I've been taking testosterone I bought online for a year to look more masculine. Plus I want a jaw implant and maybe rib removal. Every surgeon I email either ignores me or says no. Am I being failed by gatekeepers or are they protecting me from something I can't see? So how do you screen a young patient who wants several aggressive procedures at once?

Dr. Chang (07:08):
I mean, this is a huge problem. I think that especially when you see stuff online, different forms, everybody feels that they've done the research or they've read enough Facebook groups, Reddit threads or Discord servers that they're experts. I've seen people in the thread chats criticizing other people's comments that don't concur with theirs saying, "Why are you an expert?" And really the person behind the keyboards are all, none of them are plastic surgeons or none of them are even in the medical field. So they feel that they are experts and can challenge because they've read a lot. This is a huge problem. A 19 year old doing unregulated testosterone-

Jackie (07:46):
Yeah, buying testosterone online. Scary.

Dr. Chang (07:49):
It's insane. And it's a trend too because people are learning a lot about peptides and stuff like that, and that's very trendy too. When you're 19 years old, you shouldn't need extra hormones or testosterone. You should have a lot of testosterone. And if you don't, you should be under the care of an endocrinologist or somebody who can actually guide you because if you take extra testosterone, it can suppress your original production by your own body. So it could suppress your testicular production of testosterone and testicles could atrophy, you could have no ... I mean, you didn't even know this stuff. He's just pumping himself up. Does he know what dosing he's doing and that kind of stuff? You could have all sorts of things.

Jackie (08:32):
Also, is it even testosterone? Where are you buying it from? Where are they making this?

Dr. Chang (08:36):
Yeah. Is stuck in the strait of Hormuz or is it coming from China with all the tariffs? Yeah, I don't know.

Jackie (08:43):
We don't know.

Dr. Chang (08:44):
So I mean, it's just don't be foolish. Don't be foolish, guys. Don't go to do something wild. But this young man who's doing this, obviously to get to that point, they are pushing an agenda that they have researched themselves instead of letting somebody guide them.

Jackie (09:02):
I think that's a tough thing to hear from patients is the, "I've done my own research." Because you got to say, "Okay, well, where are you doing this research?"

Dr. Chang (09:13):
If I told a patient some fact, I don't know, the sky is purple and they're like, "No, it's blue. I don't think it's purple." But they read online the same fact because they discovered it on their own, they're more likely to say, "Well, I researched this and nobody told me this. I found it on my own and then I'm more likely to believe that's true." It's a weird phenomenon that people react to and I see it all the time, but they're more likely to believe something which may or may not be true but a fact or a piece of information that they discover because they feel that it's more honest.

Jackie (09:54):
That's true.

Dr. Chang (09:55):
So that's kind of wild, but we've seen patients with body dysmorphia or patients that have unrealistic expectations, right?

Jackie (10:03):
Yes.

Dr. Chang (10:03):
We try our best to sort of educate those patients or identify those barriers beforehand though. But how about this? When someone lists five, 10 fixes, I mean, how do you read on whether they're a good candidate? Those are all legitimate things. Have you-

Jackie (10:18):
I think what you should do is look at the list of all of their concerns and compare that to what they actually look like. We're an objective bystander looking at them, look at what they are unhappy with and look at what you can actually tweak and make better and then just have honest conversations with them about things that are like, "Okay, this does not need to be fixed. This is not a problem right now or what you're looking for is just not realistic." So I think you have to chip down on that list of everything that they want to fix.

Dr. Chang (10:54):
Do you have friends or friends of friends that sometimes will say, "Well, I want to do this, this, this, this, " and you kind of have to reign them in a little bit?

Jackie (10:59):
A hundred percent, yeah.

Dr. Chang (11:01):
Oh, you know who you are. Yeah.

Jackie (11:04):
Sometimes you just have to hit them with the truth.

Dr. Chang (11:07):
Yeah. Be like, "That's not that big of a deal."

Jackie (11:10):
Yeah, you don't need to fix this. Save your money.

Dr. Chang (11:13):
Yeah. I think that we say no a lot actually and that's the mark of a good discerning provider.

Jackie (11:20):
I do think you're very good at being honest with people.

Dr. Chang (11:23):
Sometimes I'm too honest.

Jackie (11:25):
Some may say that, but I think that's a good thing though. You're not just someone coming in and you're not just like, "All right, let's do it".

Dr. Chang (11:31):
Well, sometimes the sales reps who want us to push various products that are popular, injectable products, fillers or Botox or things like that are sort of like, "You're the worst salesman ever." And I'm like, "Yeah, I'm not a salesman because I talk people out of stuff all the time." And I think for me, I have to feel that I'm going to make an impact and it's worth it because I don't want people to be disappointed or to have the wrong expectations because that's not fair to them. And also that's also disingenuous to what we do. Anyway, I think that this guy's kind of young in this scenario. Do you have any thoughts about operating on younger patients or bringing on younger patients for procedures?

Jackie (12:14):
I mean, not necessarily. I mean, 19, I'm like, okay, maybe ever since puberty you've been unhappy about something. So I don't think it's out of the question to operate on someone. Someone like this though telling me that they're buying testosterone online, one of the things that I would consider before surgery is I definitely would want labs drawn, like what is this weird testosterone that you're taking doing to your body? So I think that would be really important.

Dr. Chang (12:43):
And what else are you doing to your body? What other things are you taking that you didn't tell us about?

Jackie (12:47):
Exactly, exactly. So I think a good history and physical lab work before we even consider operating on this person, because we may be like, "You need to lay off whatever you're taking for a few months before we do anything."

Dr. Chang (12:59):
Right, right.

Jackie (13:01):
Let's get back to Clavicular.

Dr. Chang (13:03):
I forget what his real name is,

Jackie (13:05):
I don't know his real name. He live streamed a two-hour rhinoplasty performed by a well-known cosmetic surgeon billing it as a-

Dr. Chang (13:12):
Oh, it's Dr. Miami.

Jackie (13:12):
first of it's kind broadcast. It was?

Dr. Chang (13:17):
Yes. It was Dr. Miami.

Jackie (13:21):
He was publicly described years of using testosterone and other substances starting as a teenager, previously promoted bone smashing, striking his own face to remodel it. He was hospitalized earlier this year after a live streamed overdose and has since said he stopped the substances over health and fertility concerns. I mean.

Dr. Chang (13:42):
Oh boy, there's so many things to talk about with this. So I think that live streaming surgery, first of all, with Dr. Miami, he's obviously very famous social media personality. This is very much a publicity move for both of them. They're both big internet stars essentially. But surgery is still serious. Things can happen during surgery and you can have challenges with this operation or even with the safety and success of the surgery. So it's not really a thing that should be live streamed, I think for general public or everybody to see. So this feels like a little bit of a publicity stunt or definitely a publicity stunt. I'm not sure. I don't really follow Dr. Miami, but I'm not sure he's the rhinoplasty surgeon I would-

Jackie (14:37):
That's what I was thinking. I was like-

Dr. Chang (14:38):
I feel like he's a breast and body guy. It's Miami.

Jackie (14:43):
Yeah. I didn't even know he did rhinoplasty.

Dr. Chang (14:45):
Yeah. So then you're like, wait a minute. I mean, I'm sure he can do a rhinoplasty, but we're live streaming this with somebody who can do a rhinoplasty. Anyway, maybe it's a great result. I have no idea, but I doubt it. I'm concerned about this.

Jackie (15:02):
When I first started working in the operating room, I feel like that's when Dr. Miami started getting really big on Snapchat.You could follow him on Snapchat and I would watch all of the livestream surgeries and I was like, "This is so cool. I'd love to work for Dr. Miami." But I also was 22 years old, so not anymore. Now I would not want to work for him. It's a weird line. The patients obviously consent to all the live streaming, but it's just morally should you do it.

Dr. Chang (15:34):
So he's still live streaming.

Jackie (15:36):
Yeah.

Dr. Chang (15:37):
Yeah, that's a little bit of a crazy thing. I know that other platforms don't do it. I also know that doctors have gotten a lot of trouble for live streaming. There's other doctors that used to do that on TikTok or Instagram and now those platforms I think have banned that kind of a thing. So it's definitely very controversial to say the least.

Jackie (15:56):
Right. And frankly, no offense. I love doing rhinoplasties, but I wouldn't say that's the most exciting procedure to watch.

Dr. Chang (16:04):
There's a moment that's exciting and for me, the whole thing's exciting. But for you on the outside, those of you watching home, you'd probably be like, "What is happening here?"

Jackie (16:12):
Right. So I'm like, are they dancing around? Are they doing stuff to make it more exciting for the viewer that shouldn't be done during surgery is what I would imagine. Now I'm going to go watch this live stream maybe.

Dr. Chang (16:24):
Yeah, maybe. It'd be interesting to see what happened.

Jackie (16:28):
So would you operate on someone whose history included self-prescribed hormones in a recent hospitalization?

Dr. Chang (16:33):
I'm more concerned about the bone smashing. If you're punching yourself in the face or whatever you're doing to build your bones up, I would be like, "I am not operating on you. You are mentally gone." That Is crazy.

Jackie (16:45):
Huge red flag.

Dr. Chang (16:46):
I mean, if you said to me, "I'm going to get a cheek implant to get higher cheekbones." Okay, that makes a little bit more sense. You might look ridiculous, but let's say it works. Let's say it works. I'm going to punch myself in the face. It's going to stimulate bone growth. Do you have any control of how the bone grows? No. It could grow up, could grow down, could grow-

Jackie (17:08):
That's why he looks crazy.

Dr. Chang (17:10):
I mean, that's crazy. That's a really foolish thing, I think.

Jackie (17:18):
And then years of testosterone from age 14, where along the way did the medical system have a chance to step in?

Dr. Chang (17:25):
I mean, he's got to have parents that ... He's only 20. He's got to have parents or somebody who cares about him, who's got to try to stop him. I mean, I think the internet has probably gotten to him and he is so addicted to being famous. He's got to do something extreme to keep up. I bet you that's what's going on here.

Jackie (17:42):
Or does he have parents that don't care enough?

Dr. Chang (17:47):
I don't know. I don't know.

Jackie (17:49):
But the medical system stepping in, I'm like, okay, well, maybe he had a need at 14 to be taking testosterone. Who knows?

Dr. Chang (17:56):
I just feel like somebody like this should not have a huge platform because it's just going to influence young people that are impressionable. It's bad. It's bad for people to be finding things on rogue websites and why can you order them when you're just a normal citizen and have no medical degree? Why would you do that?

Jackie (18:20):
And then the surgeons need to have a moral compass and say no to these patients, but these people can just keep looking and looking in doctor shopping until they find someone to say yes.

Dr. Chang (18:30):
I probably have already used this analogy and I always say, Michael Jackson getting 22 rhinoplasties just because if you really want it and you have means and you're famous enough or rich enough, you just say, "I want it. " You'll find something to say Yes.

Jackie (18:44):
Yeah. And so this kid probably just has enough followers that they're like, "Well..."

Dr. Chang (18:49):
Yeah, I know.

Jackie (18:50):
"We'll get attention".

Dr. Chang (18:51):
I know.

Jackie (18:52):
But it's not good attention.

Dr. Chang (18:54):
I guess the question is what should we do to when people are just sort of obsessed with their face and they keep working on it and it's sort of like a project that never ends, how do we approach those kinds of people and guide those patients? What do you think?

Jackie (19:11):
Well, my question was going to be, have you ever told a patient to maybe seek a therapist?

Dr. Chang (19:19):
Yeah. Okay. Sometimes that can be the end.

Jackie (19:21):
I mean, honestly though.

Dr. Chang (19:24):
I have, not very often. We do our best to try to help those patients before we've done surgery or done a treatment to them. So if we can identify that they may have an unrealistic expectation or need some support, we try to help them there first, but occasionally there are patients that we sort of come upon that realization later on. So if we do, it's delicate, right? You tell somebody-

Jackie (19:54):
Yeah. Well, especially because obviously their self-esteem's already a little low, so it's hard to communicate with them.

Dr. Chang (20:01):
Yeah. Often that comes in the form of, "I'm not sure I can help you in this way that you're looking for, but I think that it might be helpful if we engage another professional." So it's more like, "We're going to do this together. I'm going to help you get to this point with somebody who can help explore this with you, explore your thoughts, your feelings, and your ideas." So I think that that is always a helpful thing because some things are not surgical, even though we wish they were.

Jackie (20:36):
So you would not take Clavicular on as a patient.

Dr. Chang (20:40):
It depends how many followers he has at the time. If he increases his following, hit me up. But if you guys want to know more about influencers or pushing the boundaries on some of the newer age technologies or things that are trending like peptides or hormones or things like that, leave a note for us in the comments. We would love to talk about it more and answer all your questions.

Jackie (21:04):
Yeah.

Dr. Chang (21:05):
So until next time.

Jackie (21:07):
See you guys.

Dr. Chang (21:09):
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.