Men Really Only Care About Two Things

Dr. Chang (00:00):
This guy needs one of those queer eye for the straight guy makeovers. He could use a little beard trim, maybe a little haircut.

 

Jackie (00:09):
Yeah, we could focus on other things.

 

Dr. Chang (00:11):
We got to give this guy a head to toe makeover, not just a penis makeover. 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. So tell us about your trip.

 

Jackie (00:31):
I went to Chicago, really short trip. My boyfriend was there all week for work and everyone's always like, "Chicago's amazing in the summertime." And I went last summer, but I ended up being very sick. I had ear infection, throat, the whole thing. So I had one solid day. So when he said he was going to Chicago, I was like, "All right, I'm going to go out there." And we got really lucky because the weather was amazing when I was there. And so he was still at work. And so I dropped my stuff off at the hotel and I was like, "Oh, I'm just going to walk around." And we stayed on the Navy pier, so we were out on the water. And I walked a couple blocks and I stumbled upon a little beach.

 

Dr. Chang (01:14):
I mean, I always think that's weird. I don't think of these Midwestern states as having a beach, but they always talk about how big the Great Lakes are.

 

Jackie (01:20):
Well, and then I always saw people talking about the beaches in Chicago and they were like, "Oh, it's just concrete and then water." But no, where I was, it was a legit beach, sand. They had volleyball nets up, people are playing volleyball.

 

Dr. Chang (01:37):
And then the skyline in downtown was in the background?

 

Jackie (01:39):
It was so cool. Yes, it was awesome. There was a beach bar there.

 

Dr. Chang (01:42):
What's the water like? Clear? Are there waves?

 

Jackie (01:45):
There are waves, but there's also, there were a ton of boats out, so I don't know were they creating the waves, but there were waves.

 

Dr. Chang (01:53):
People were in the water?

 

Jackie (01:55):
Everyone's in the water.

 

Dr. Chang (01:56):
Was it-

 

Jackie (01:57):
It felt good.

 

Dr. Chang (01:57):
Warm water or was it freezing?

 

Jackie (02:00):
The second day it was a little cooler, but it was totally fine to get in. And then the second day we were there, I brought a bathing suit. We went to the beach and laid on the beach, got in the water.

 

Dr. Chang (02:11):
It could have been any beach.

 

Jackie (02:13):
Could have been Outer Banks.

 

Dr. Chang (02:14):
Really?

 

Jackie (02:15):
It was really cool.

 

Dr. Chang (02:16):
Interesting.

 

Jackie (02:17):
I know.

 

Dr. Chang (02:18):
Did you see a lot of beach bods out there?

 

Jackie (02:20):
Oh, I saw one lady. I swear to God, she just got to the beach and took her clothes off. She was in a bra and a cloth thong.

 

Dr. Chang (02:32):
Oh, you're saying she wasn't even in a bathing suit?

 

Jackie (02:33):
Correct. Yeah. I literally think she just stumbled upon the beach and was like, "All right, let's just take my clothes off and lay."

 

Dr. Chang (02:40):
Middle of Chicago.

 

Jackie (02:41):
There was a wedding happening.

 

Dr. Chang (02:42):
Wow. I never thought about that.

 

Jackie (02:44):
Me neither.

 

Dr. Chang (02:44):
I've only been there in the wintertime actually, and it's been cold and dark.

 

Jackie (02:49):
Yeah, they say it's terrible, but I was like, "This is amazing."

 

Dr. Chang (02:51):
The food's incredible too. It's very -

 

Jackie (02:52):
I ate so much.

 

Dr. Chang (02:53):
Very delicious but heavy. Kind of heavy.

 

Jackie (02:56):
Oh yeah. I felt disgusting.

 

Dr. Chang (02:59):
But in a good way?

 

Jackie (02:59):
I got the big deep dish. It was delicious. Yeah, it was cool.

 

Dr. Chang (03:03):
Well, although we usually talk about women in their bodies, we're going to talk about men and their bodies today. So welcome back to another episode of Secret Services. I'm Dr. Chang.

 

Jackie (03:11):
And I'm Jackie.

 

Dr. Chang (03:13):
So today on the podcast, we're going to talk a little bit about men and their bodies, but a couple stories landed this week, three of them that have nothing to do with each other and everything to do with the same thing, which is what men will do, pay, endure, and hide when it comes to their bodies. So this started with a man in North Carolina who just booked his penis enlargement procedure. And then we also saw a Swedish triathlete strapped on a bra to go faster in a race. And then we're going to talk a little bit about what Donald Trump went through in 1989 that he has never ever admitted to.

 

Jackie (03:50):
How many men are you seeing coming into the clinic? Do you think there's more than there used to be? Is there a shift in that?

 

Dr. Chang (03:57):
Oh, I definitely think there's more than there used to be. I think that aesthetic treatments, skincare has been demystified a little bit. I think taking care of yourself and looks maxing, as we've talked about before, is real popular trend. I saw Jeremy Lynn, the basketball player. I don't know if he's just joking around doing a little skincare, Korean skincare routine on his Instagram page. It's been very popular seeing some of these Asian K-pop stars with their beauty regimens and stuff. And then there's certainly a lot of men, especially in America, who have a lot of beard grooming and things like that. So there's a lot of stuff out there I think now.

 

Jackie (04:38):
I just started the latest season of The Ultimatum on Netflix, which we could have a whole podcast about. These people are insane. But several of the guys were talking about how they got Botox before the show aired. And I was like, these are pretty. Most of the men are mid - 20s, early 30s, straight men, and they were all getting Botox. And it's like, yeah, you know you're going to be on TV, but you just don't usually hear about that.

 

Dr. Chang (05:08):
Yeah. It's very cultural. I think that there are certain areas where men are more open and talking about it and it's more acceptable to say, "Oh yeah, hey man, I'm going to get Botox." And then the other guy will say hair transplants now are very common to talk about among men.

 

Jackie (05:29):
Barstool Sports, they did this whole segment where everyone in the office took that trip together and they basically vlogged their entire trip. But I mean, think of the male audience that reached and they're like, "Oh, okay. I don't have to feel ashamed that I want to go get a hair transplant or I'm worried about my hairline."

 

Dr. Chang (05:49):
That was very interesting to see. They almost did it as a little gimmick to say if you guys shave each other's heads and haze each other a little bit, but then also get hair transplants to look better. So it's kind of almost new age, like let's get tattoos together, but let's get hair transplants together. But for our practice, I would say we maybe see 10 to 15% male patients. I don't think that's a lot or a little. I think that's probably about average for an average plastic surgery practice. There are plastic surgery practices that I know specialize in men's aesthetics and do a much higher percentage than that, but there are fewer of them than I would say.

 

Jackie (06:28):
Yeah, I would agree. Well, before we get into those crazy stories, we have this little segment. It's classified and this person, "I'm a 40-year-old man and I've been thinking about getting a procedure done. I'm not going to say what it is, but I haven't told anyone."

 

Dr. Chang (06:44):
I know exactly what you're thinking.

 

Jackie (06:46):
I'm not going to say, "But I haven't told anyone, not my wife, not my doctor. I just want to know how common is it for men to come in alone in secret and how do you handle that?"

 

Dr. Chang (06:55):
It's very common for men to come in alone. Secret is hard to tell. I mean, everything is confidential in the medical appointment, so it's not really a secret. We don't really sneak them in through the back door, but we don't really talk about it that much.

 

Jackie (07:09):
We do have patients that they tell us after the surgery, "This person's my ride. They know I had something done. I just don't want them to know what exactly I had done."

 

Dr. Chang (07:20):
Yes, correct. That's usually an awkward thing where we're -

 

Jackie (07:26):
It does put us in a weird -

 

Dr. Chang (07:28):
Tell the caretaker, "Hey, don't worry about the bandages or everything went great, wink, wink." But you can't tell them what you did.

 

Jackie (07:38):
And you can tell some of the caregivers are frustrated and we're honoring our patient's wishes.

 

Dr. Chang (07:45):
Usually a strange relationship between a patient and their mother or patient and their sister or their husband or spouse or girlfriend or boyfriend. It's something like that usually, but it's kind of awkward.

 

Jackie (07:58):
And some stuff people want to hide, but you're like, all right, realistically, if you got a bluff, I feel like more men are getting bluffs. It's like, okay, well, it's on your face. How can we avoid this elephant in the room?

 

Dr. Chang (08:11):
Yeah. I do think that the men are pretty open once we get to surgery, but beforehand they do come in alone. We see a lot of men for facial surgery, a lot of men for body contouring like liposuction and a lot of patients for hair transplant as well. But there's nothing to be secret or ashamed of. I mean, we just kind of talk about what you want to talk about and then we'll talk about what the options are and you can make some decisions independently or go home and talk to your loved ones about it. It's not really tricky or controversial.

 

Jackie (08:43):
Yeah. So this penile enlargement filler, it's a real thing. It is very real. So what does it do? And is $6,000 a reasonable price? What are your thoughts on this?

 

Dr. Chang (08:59):
So fillers are FDA approved generally for the face, but that doesn't mean they can't be used in other parts of the body. That just means that they were cleared for use during the initial study and approval process and for one clinical indication. And then if the company's successful that they try to expand those clinical indications with a second or third study. Using them off-label for other areas of the body are okay if you understand the risks and the principles of how that filler works. It just hasn't gotten the official approval for those things. Penile enlargement with filler would essentially create more volume under the skin of the penis to create more volume, more girth, more size in the penis. But that seems crazy to me because we don't do that in our practice.

 

Jackie (09:53):
I was going to say, do you ever get inquiries regarding it?

 

Dr. Chang (09:57):
We have had some inquiries for sure over the years, but we don't really do filler. And I think that the issue with the penis that's tricky is that the way the penis enlarges during normal erection is blood flow.

 

Jackie (10:16):
I'm like, how does it not cut off the blood flow or something? I just feel like it would be so risky.

 

Dr. Chang (10:23):
Well, that's the scary part in my opinion is there's so much circulation down there. What we're always worried about is the filler getting into the circulation and then causing blockage of circulation because it's not blood, it's filler. And if you block circulation, could the tip of the penis have ischemia? Could you have difficulty getting blood flow that's natural to fill and engorge the corpora and you have a problem then with getting an erection, erectile dysfunction? This is a functional organ that you are trying to make it look better. Frankly, it's not the first thing people are going to see in terms of whether they assess whether you're attractive or not. So that's a kind of risk that I don't think you should take.

 

Jackie (11:05):
I'm just shocked that men would even be interested in this because it's like I have friends who they're done having babies and it's time for their husband to get snipped and they all are so scared about getting a vasectomy. So I'm just like, I can't even imagine all these men being like, "Yes, stab my penis with this syringe multiple times."

 

Dr. Chang (11:26):
I mean, men don't care about a lot of things, but the two things they care about is their penis and their hair, which we're going to talk about. I mean, those are the things that they really care about. You can be like, "Oh, I have 12 inch arms or 20 inch arms or biceps." It's like, okay, or I have a huge grip or I'm very tall. But at the core of men is their masculinity and their youth.

 

Jackie (11:57):
So is there anything that men commonly will lie about or leave out in consultations that you see more so -

 

Dr. Chang (12:03):
About their penis?

 

Jackie (12:04):
Well, no, no, just anything. If they're coming in for a consultation, do you feel like, do they hide things?

 

Dr. Chang (12:10):
Well, I do. Actually, this is a good segue that kind of blends both things. I often talk about patients about side effects of medicines, and one of the medicines is finasteride, which we recommend for many people who have thinning hair. And one of the scary things that people hear about with finasteride is its effects on your testosterone and they often are worried about sex drive libido and erectile function. And so sometimes they're afraid to even mention the word that that's what's hung them. Why haven't you ever tried this? Oh, well, I was worried about side effects. But they won't say, I'm worried about getting an erection or having difficulty with ejaculation, something like that, sexual function. So I will bring it up. I'll say, well, you may have heard this or that, but I think that the incidence of sexual side effects is extremely low. I think that you have no other risk factors for that kind of outcome. I do think that this medicine is a very short-acting medicine, so you could try it and if it doesn't agree with you, you can stop it. So I think that there are -

 

Jackie (13:13):
I was going to say, so if you experience that from finasteride, if you just went off of it, it kind of resolves itself or -

 

Dr. Chang (13:21):
Well, there's a study that shows that men were given placebo and told that it was finasteride, and a certain percentage of them reported erectile dysfunction or -

 

Jackie (13:33):
Because it's in their head.

 

Dr. Chang (13:34):
Yes, because there is a huge amount of psychology behind sexual performance.

 

Jackie (13:39):
Mental.

 

Dr. Chang (13:39):
And particularly for men, the virility and sexuality and masculinity is all tied to that. They're very obsessed with that.

 

Jackie (13:47):
That is pretty crazy.

 

Dr. Chang (13:48):
They're very obsessed with that. But that's why if you have a procedure for male enhancement patients, I'm sure would come to the door.

 

Jackie (13:56):
Yeah. All right. Let me run through these three stories because I know you're itching to talk about them. All right. First, Michael Phillips, 38, North Carolina. He was diagnosed with a micro penis, 0.38 inches. He crowdfunded $11,000 and under 12 hours for enlargement, backed out over risks, got offered a free $20,000 procedure by Beverly Hills doctor and has now booked a filler procedure closer to home. It's weird. My tiny pecker's finally getting a growth spurt. That is the headline.

 

Dr. Chang (14:29):
This poor guy, I don't know. I don't know what. Imagine having. I mean, a micro penis is a very severe deformity, essentially. It's like 0.38, like a third of an inch.

 

Jackie (14:43):
So how much. I mean, if this guy gets filler, it's like -

 

Dr. Chang (14:48):
Right. Okay.That's a good point.

 

Jackie (14:51):
What's that going to do?

 

Dr. Chang (14:52):
This patient needs a phalloplasty, which is what is, the patient needs something more reconstructive surgically if he wants to have more length and more function out of that organ. You're not going to have that by puffing it up with a couple syringes of filler. It's just going to. In fact, I think that if you were swell or

 

Jackie (15:15):
The photo of his pinky.

 

Dr. Chang (15:16):
Of his pinky. That's too big. That pinky's longer.

 

Jackie (15:20):
I was going to say, yeah.

 

Dr. Chang (15:21):
Unless it's just his fingernail.

 

Jackie (15:22):
Oh, probably the fingernail.

 

Dr. Chang (15:24):
I mean, that's like clitoromegaly, not micro penis.

 

Jackie (15:27):
That's what I was thinking.

 

Dr. Chang (15:29):
Anyway, but I think that. Oh my gosh. What I was saying is if you engorge the skin or tissue around, it might just involute and essentially make it look smaller. Let's say we were successful in creating volume around. So I don't know. I think that it might not be the right procedure. And also I think he would probably benefit if his true goal was to have more length or size, that he might need a real phalloplasty, which is a real surgical procedure.

 

Jackie (16:03):
Yes. All right. Second story. When bra doping became the controversy of the Tour de France Femme this week, Swedish triathlete Elias Lundberg decided to test the theory himself. He swapped his chest bottles for a bra during intervals and he found that it was measurably faster. A result in aerodynamics professor says is physically possible. So here he is in his bra.

 

Dr. Chang (16:27):
This man needs breast implants immediately because the rules state. First of all, let's get into science. The science showed there was a study of physics that showed the air drag was less in the cyclists that had more volume in their chest because as they bent over toward the handlebars, it closed off sort of the pocket of the body bending over, which is sort of like a parachute, absorbing a lot of air. So the airflow around the body was more streamlined and you saw less drag. So all that to say, he would do great with a 450 CC moderate profile submuscular silicone gel implant and he would do great, but -

 

Jackie (17:10):
How bad does he want to win?

 

Dr. Chang (17:11):
Yeah. But the rules state that natural breasts or anatomical prosthetics are okay that are surgically placed, but not bra or guarded

 

Jackie (17:25):
Not like a padded bra.

 

Dr. Chang (17:28):
Yes. So you can't wear a padded bra or something like that. So surgery is the way to faster time trial.

 

Jackie (17:36):
It's time for top surgery.

 

Dr. Chang (17:38):
Let's do it. Yeah. So Elias, call us. We'll put you on the podium, my friend.

 

Jackie (17:44):
Yeah, we got you. All right. Number three, Donald Trump reportedly underwent a scalp reduction in 1989. The bald section cut away surrounding scalp stretched and sewn shut. And according to Ivana's sworn divorce deposition, came home in blinding pain. He has never confirmed this. Thoughts?

 

Dr. Chang (18:06):
Yeah. So I looked at this and this is possible for sure. He's got a kind of a strange hairline. He has the swirl and the flip over thing.

 

Jackie (18:15):
I know when I saw this, I was like, "That explains a lot."

 

Dr. Chang (18:18):
Okay. So let's say you're thinning and it's the 80s. Back in those days, there was something called a scalp flap or scalp transposition flap where they would take a long paddle of skin from a different part of your head and take it out and flip it around to cover that bald spot in your scalp. So then you'd get hair there, but then you have a scar on the side or things like that. You kind of twist and rotate things in a position and then the hair might grow not in your normal way. They'd be kind of in the wrong swirl, not really the right cowlick, but then you could coiffed it over or something like that. So that's one option. And that has been largely abandoned, not very common because now we have more minimally invasive transplant techniques, but that scalp flapping was common then.

 

(19:09):
Now, what they said on what he had done was essentially serial excision and tissue expansion. So when you stretch the skin and the scalp that has the hair and then you cut out the bald scalp and you shrink it over to shrink the hole that you made where you cut out the bald area. So that would be painful for sure that when you're stretching the skin so it's looser and then you hog it together to pull it together to kind of essentially get to close the gap.

 

Jackie (19:42):
Have you ever seen this done?

 

Dr. Chang (19:43):
I've done this.

 

Jackie (19:44):
You have?

 

Dr. Chang (19:45):
Not for hair loss. Yeah.

 

Jackie (19:46):
Yeah. Oh, right. For trauma.

 

Dr. Chang (19:48):
Well, I had a patient who had a very bad melanoma, deep melanoma on her scalp. Very young patient, very beautiful young girl who had a deep melanoma though. And the problem is with the deeper melanoma, the more you have to remove peripherally, the hole gets bigger and bigger and bigger. And on an area like your scalp, it's very tight. I remember we typically would do certain flaps and things to try to bring the hair in there, but because we didn't want her to have balding and stretch marks that would cause more alopecia and traction loss, I actually used one of these. It's called a Dermaclose. It has a progressive tension and it ratchets.

 

(20:36):
And unlike the balloon tissue expansion, it caused tissue and skin expansion by stretching with these sort of cleats like a corset and ratchet. So over the course of a series of weeks, we cinched it closer, close, closer. And then when it gets close enough, then you can close the edges together. And so basically brought her hair in toward the middle. And fortunately she did really, really well and it looked great and she didn't have any bald spots. It was a huge success. I think they still use my case on some of their promotional materials, but it's great. But it's a hard thing. I mean, that's a relatively new technology and piece. I think back in the 80s they didn't have that.

 

Jackie (21:15):
Right. So yeah, he reportedly told the surgeon, "I'm going to kill you after the procedure," probably because it was painful as hell.

 

Dr. Chang (21:24):
Yeah, he was pissed. Apparently he was. So this came out, I guess, in the records of his divorce and they were arguing and apparently he pulled some of his wife's hair out as retribution. They were like she was fighting with him and she pulled hair out of her hair, she claims. And so I don't know. I could understand being emotional. But especially if it's your ex-wife or your marriage is on the rocks and you're fighting a lot, I could see it becoming definitely a source of tension and argument. But yeah, so I think that nowadays we have some other ideas that are a little better, but in general, hair restoration with transplant is much less invasive, much less painful than excision and serial closure.

 

Jackie (22:13):
This is so crazy. I was like, does this explain Trump's hair? His hair is such a part of him.

 

Dr. Chang (22:21):
Yeah, it is. The other thing I was noticing in that picture was I was noticing his neck contour. As a young man, it's very similar to as it is as an old man. It's just not in the neck vagina level yet.

 

Jackie (22:34):
I'm shocked he hasn't explored a neck lift.

 

Dr. Chang (22:38):
Yeah. Maybe he's too scared of surgery or anything like that.

 

Jackie (22:41):
Maybe he can't get medically cleared.

 

Dr. Chang (22:43):
He's got this a little bit of. I mean, he's thin, you see definition, but he's got sort of this oblique cervical mental angle. It's a little -

 

Jackie (22:49):
Yeah, that is true.

 

Dr. Chang (22:50):
Kind of genetically like that.

 

Jackie (22:51):
Yeah.

 

Dr. Chang (22:52):
I sent you the neck vagina prosthetic video, right?

 

Jackie (22:55):
You sure did.

 

Dr. Chang (22:57):
There's a thing where you can buy these Trump neck vagina prosthetics. It was crazy. It was very funny. But sometimes the genetics need a little help. We can definitely. And nowadays, actually, facelift and neck lift techniques are even better so that you can create a two-dimensional submandibular angle as well as a cervical angle so you get a little bit more of that L-shape that most people are looking for.

 

Jackie (23:25):
Right. And also, it seems like the commonality between these three stories is secrecy.

 

Dr. Chang (23:33):
Yes. Yes, exactly.

 

Jackie (23:34):
And so as techniques are changing, you can hide that facelift a lot better.

 

Dr. Chang (23:39):
Yeah. Yeah. And I think the men that are interested in all of these things, they're going to expand a little more. And even though secrecy is a big part of it, I think just like the women, it's becoming a little bit more commonplace to discuss it and talk about it. I mean, even the micro penis thing, the guy just went on a couple talk shows, talked about it, and he raised thousands of dollars, tens of thousands of dollars for himself.

 

Jackie (24:08):
For his situation, I'm like, I feel like -

 

Dr. Chang (24:10):
Would you donate?

 

Jackie (24:11):
No. If I knew the person, maybe, because I would legitimately feel bad, but no, I'm not going to donate to Michael.

 

Dr. Chang (24:21):
I thought his name was Michael Phelps right away. In the beginning, and I was like -

 

Jackie (24:24):
Same.

 

Dr. Chang (24:24):
Michael Phillips?

 

Jackie (24:26):
Yeah.

 

Dr. Chang (24:26):
I was like, wait a minute,

 

Jackie (24:27):
But I feel like for him, he already -

 

Dr. Chang (24:29):
All his superpowers.

 

Jackie (24:29):
He clearly has a bad situation, so it's like, might as well just lean into it and own it.

 

Dr. Chang (24:35):
This guy needs one of those queer eye for the straight guy makeovers. He could use a little beard trim, maybe a little haircut.

 

Jackie (24:46):
Yeah, we could focus on other things.

 

Dr. Chang (24:48):
We got to give this guy a head to toe makeover, not just a penis makeover. I think he'll do well with that.

 

Jackie (24:54):
I would agree. I think, like you said, as time goes on, it's a little less taboo, but I don't know about the penis injection. I don't know, will that ever be something that men are just opening?

 

Dr. Chang (25:07):
Honestly, if it's successful, if it's effective, it's safe. It's not something I would poo-poo on as a treatment, but it's got to meet those criteria. We don't want to disappoint anybody and we don't hurt anybody. That's really the big thing.

 

Jackie (25:21):
Well, and then at that point, it's like, why not just go for the full implant?

 

Dr. Chang (25:25):
Yeah. I know nothing about that. There's a guy in town I know who does a lot of penis implants, but.

 

Jackie (25:32):
I've done a few, and it's an interesting.

 

Dr. Chang (25:36):
Actually, I remember my first week of medical school, I was in the anatomy lab and we were dissecting different areas, and we realized our cadaver had a penis implant that had one of those bladders in the scrotum and had the inflatable bladders.

 

Jackie (25:51):
Yeah. You pump it up from the little thing in the scrotum.

 

Dr. Chang (25:56):
You don't have to actually pump it up in the-

 

Jackie (25:59):
But you can.

 

Dr. Chang (26:01):
Okay.

 

Jackie (26:02):
You can.

 

Dr. Chang (26:03):
It's a PG rated podcast.

 

Jackie (26:04):
Sorry.

 

Dr. Chang (26:07):
All right, guys. Well, if you have any more questions about male plastic surgery or any other cosmetic procedures in general, please leave us a comment. We'd love to hear from you, and stay tuned for the next episode next week. 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.