The Only Good Reason to Bring Us a Photo of Your Mom

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.

Jackie (00:13):
Hi, welcome. I'm Jackie.

Dr. Chang (00:15):
I'm Dr. Chang. So what's going on? So spring is here.

Jackie (00:20):
Spring has sprung. So I was thinking we need to talk about this Reddit thread that I saw that went viral. Three generations of the most famous faces in the world side by side. This will all make sense at the end. Dr. Chang, have you ever had a patient point to a photo of their mother and say, "This is what I want?"

Dr. Chang (00:40):
Actually, more commonly, people say, "This is my mom and I see this happening to me. Please tell me how to stop it from happening." That's the more common comment I get actually.

Jackie (00:51):
I could see that. So we have an anonymous patient question. Okay. It says, "My mom had incredible cheekbones and a defined jaw when she was my age. I'm 34 and I just look softer. Is there anything I can do to look more like she did?"

Dr. Chang (01:06):
Well, I mean, that's a great question. The thing is that people that have strong genetic features, things that are inherited from their grandmother, their mother, those things are usually conserved. So you see those carried through. Physical features, of course, your medical history and things like that. Of course, you have two parents, right? So some of it's mom, some of his dad, some of

Jackie (01:29):
Thanks, dad.

Dr. Chang (01:30):
Yeah. I got dad's nose or I got mom's eyes or something like that. But I think that obviously if it's your biological mother, you have a good chance of inheriting a lot of the features that they have and then you have more to work with if you're trying to look like your parents.

Jackie (01:47):
I'll say when I look back at my parents' wedding photos, my mom was so skinny. I feel like everyone back in the day was just way skinnier.

Dr. Chang (01:55):
Crazy skinny.

Jackie (01:56):
Right. So I'm like, I think you have to also look at it through that lens. It was a different time.

Dr. Chang (02:02):
Right. I think what we view as overweight or attractive was totally different back in 20, 30, 40 years ago. And if you compare those figures and even facial features, I mean, if you were just thinner in general, your facial features are going to be different.

Jackie (02:22):
Yeah, definitely.

Dr. Chang (02:22):
You have different definition and different things, but there's other things. You've obviously seen the memes when they say, "Oh, well, this is what the 50s look like in 1985." And you know the Golden Girls and then you see J-Lo next to Bea Arthur.

Jackie (02:37):
Yeah. And you're like, "They're the same age."

Dr. Chang (02:39):
Yeah. Okay. And you're like, "Wow, she had a super glow up." So it is a little different.

Jackie (02:44):
Right. So when a patient says they want to look like a family member, what do you hear as a surgeon and how do you translate that into a surgical conversation?

Dr. Chang (02:53):
Yeah. I think more commonly we get the question of, well, could I look like I used to look at my wedding picture 20 years ago or 30 years ago?

Jackie (03:02):
Yes.

Dr. Chang (03:03):
Right. That's a pretty common-

Jackie (03:04):
I see a lot of people with an old photo of them and be like, "Bring me back to this. "

Dr. Chang (03:10):
Right. But in any event, the facial structure, the genetics are conserved a little bit. So I think that you start to see how do you bring somebody back given the structure. And I think as a craniofacial surgeon, and you know this because you were in craniofacial surgery, so that is skeletal surgery of the face. And it's a subset and a specialty of plastic surgery. With my background in that and my training in that, and you did a lot of work with a couple big craniofacial surgeons here in DC, that is to me, the foundation of facial structure. The bones of the face are what everything lay on. And so it's really the foundation.

Jackie (03:51):
That's a good point. I think that the craniofacial cosmetic surgery is definitely lesser known. I don't think people talk about it on social media or anything like that.

Dr. Chang (04:02):
I think that's true. I think that people kind of dabble in it. If you see a lot of things about Asian plastic surgery, jaw contouring, transgender surgery is becoming more well known. People know about brow bone shaving and V-line jaw contouring. I think more people are learning about it, but it is a much bigger deal. Usually we would do that stuff for jaw deformities or if you had a trauma and your face was smashed in a car accident or something, you rebuild the brow and the forehead and the skull or you had birth defects for sure.

(04:38):
But yeah, so I think that getting back to it, the foundation of the facial skeleton is super powerful for changing your face and facial proportions. And then, so if you're starting that way and you have a family member that you're trying to copy a certain look or you'd want to enhance a look that they had, I think you're already starting at a pretty good place if you have similar bone structure.

Jackie (05:01):
That's true. So what procedures would address the softness, like that girl, the anonymous patient question. She said she just looks softer. What would you advise or what things could you do to address that?

Dr. Chang (05:14):
Well, I always think that popping a picture is dangerous.

Jackie (05:18):
Yes.

Dr. Chang (05:18):
Right? Because the picture can ... You could have taken 10 pictures and that was the best one or have it be a day when you were feeling skinny or looking great, had a good tan .

Jackie (05:30):
That is true.

Dr. Chang (05:31):
I mean, the number of pictures we take to find one good one on our phone has got to be 10 to one.

Jackie (05:36):
Yeah. Or you're looking in the mirror and then you take a photo and you're like, "I don't look anything like that. "

Dr. Chang (05:41):
Right, exactly. Or, "I hate the photo, deleted them all".

Jackie (05:44):
Yeah.

Dr. Chang (05:45):
So I think that that's always tough to judge against, but softness can be things as we do see with younger people, a little fluffierness or fullness of the face is very common. It's not chubbiness or not the same as filler, but a little bit of volume, less gaunt, less thinned out. I think people that look a little bit older ... We talked about Ryan Seacrest one time, right?

Jackie (06:12):
Oh, yeah.

Dr. Chang (06:13):
Right. I mean, he's gotten older. Everybody's gotten older, but I think when you start to see too much-

Jackie (06:19):
He's lost the softness all around.

Dr. Chang (06:21):
Too much definition. Yeah. It looks aged.

Jackie (06:25):
So you just have to have a real conversation with the patient, like this photo, you're not going to achieve copy and paste of what you're trying to get.

Dr. Chang (06:35):
Sure. Exactly. And then also, are you comparing your relative or your mother at 30 and you're 50 or 45? I mean, you're not putting a fair comparison.

Jackie (06:47):
Right. So there was a Reddit post that went viral with a photo collage. I'm going to butcher her name, Marcheline Bertrand, Angelina Jolie's mom.

Dr. Chang (06:58):
Oh yeah, Yeah. I saw this.

Jackie (06:59):
Next to Angelina and then next to Angelina's daughter, Vivienne. And the internet is losing their mind over the bone structure. I mean, the photos-

Dr. Chang (07:08):
I saw this.

Jackie (07:09):
... next to each other.

Dr. Chang (07:10):
It's incredible.

Jackie (07:11):
It's crazy. I really thought it was three photos of Angeline and Jolie.

Dr. Chang (07:14):
Well, it's crazy. They're all strikingly beautiful, but also very similar. It's a very incredible demonstration of the features that have been conserved throughout each generation of woman there. And what's interesting to me, when Angelina Jolie became famous, they were like, "Oh yeah, she's John Voigt's daughter." I was like, "They look nothing alike."

Jackie (07:42):
I was shocked when I found that out. Yeah. Very different.

Dr. Chang (07:45):
And they never spoke of her mom. I guess her mother died a little earlier in her mid- 50s.

Jackie (07:50):
Yeah, she died at 56.

Dr. Chang (07:52):
But when you look at that, you see her face is very, very similar to her mother's face and it's extremely impressive. So I think that she does have striking features. I mean, Angeline Jolie is very beautiful, but doesn't look like any other beautiful celebrity. She's very distinctive, I think.

Jackie (08:10):
Did you see the most recent photos of her? She was on a red carpet or something.

Dr. Chang (08:16):
No.

Jackie (08:16):
And everyone was seeing, just like the Jim Carrey thing, they were saying she was cloned.

Dr. Chang (08:21):
Oh, I might've seen it, but I didn't see the commentary about it. I might've just sort of seen, oh, celebrity on the red carpet or something like that. So yeah, tell me about it.

Jackie (08:30):
She did look a little different. To me, I thought she just looked a little more sunken in and then something was up with the eyes. I don't know necessarily if it was a bleph or what, but she did look a little different.

Dr. Chang (08:44):
I mean, she is a bit older than the last time we've seen her in the public eye. So she had all this action, all this sort of political stuff and movies and all this other stuff, then had sort of this private breakup with Brad Pitt and they're fighting over the kids or splitting their assets or whatever they're doing. And then so she's been kind of out of the public eye for a while, but then maybe it's just she aged too.

Jackie (09:08):
That's what I was thinking. I mean, she looks a little gaunt.

Dr. Chang (09:16):
She's giving me a little Mary Kate and Ashley Olson kind of, don't you think? Maybe it's the cherry red lipstick. It's like really red.

Jackie (09:25):
So I feel like one of the most sought after things about her is her cheekbones and I mean, they're really prominent there.

Dr. Chang (09:35):
I mean, she has crazy genetics. So I think that for the listeners out there, it's important to think about her neckline and I don't know if her mother was a model or something or an actress, but she looks like a model.

Jackie (09:48):
She looks like one. Yeah.

Dr. Chang (09:50):
The one thing about Angelina Jolie's jaw and neck structure is her neck is very long, very vertical. And she's got a high hyoid position where everybody hates what hangs down below their neck. So her muscles and the floor of the mouth structure is very tight and sunken up into this very strong jawline. Like that is just her gift. She is just genetically gifted that way and it looks beautiful, but she's always going to win. Even if she's older and loosens up a little bit, it's just never going to be the same as somebody who's got a fuller neck, lower bone position and lower angle of the soft tissue. It's a very specific and special thing.

Jackie (10:35):
Yeah, that's a good point. Something that I never even noticed with her, but that's true. So what if I came in and I was like, "I want her neck." What would you advise?

Dr. Chang (10:46):
Well, we have to recreate that, right? So actually for a while, a lot of people were asking about jawline enhancement and still do. So I always phrase this as this is an addition and subtraction problem. We need to build the bone structure to define the jawline and bone, or we need to subtract the fullness to create negative space to give you definition. So those two concepts have to be balanced and it depends on where you start. So if you're building bone, you can build it with filler or build it with a jaw implant, or you can even do jaw surgery, like we were talking about before, and reshape the bone a little bit to get either more definition or softer definition and things like that. And then the other question is the subtraction. Do you dissolve some fat and fullness with medications such as Kybella?

Jackie (11:42):
Oh yeah.

Dr. Chang (11:42):
Could you do liposuction under the chin to reduce fat? Can you do some non-invasive things like CoolSculpting or Ultherapy or things that provide energy to shrink that area? And then more popularly now is sort of getting in there and doing deep neckwork and reducing some of the deeper fat, reducing some of the gland sagging, tightening some of the muscles there. So surgically, that's how you would approach a lot of these things, addition versus subtraction or some combination of them. So that's probably the best way to sort of enhance your look, but you're never going to take somebody else's jawline and put them on your face.

Jackie (12:24):
Right.

Dr. Chang (12:25):
You can't do that.

Jackie (12:26):
There were a lot of people in the comments just saying that some people are just structurally privileged.

Dr. Chang (12:32):
Yeah. Well, yeah, if that's your idea of a 10, which I think that from an aesthetic standpoint, it's what we define as a good ideal. Yeah. I mean, yeah, we'll call that privileged.

Jackie (12:44):
Yeah, definitely.

Dr. Chang (12:45):
For sure.

Jackie (12:47):
Is there anything in this photo of the three of them that you'd say that's the procedure people are trying to buy? That's what everyone's looking for.

Dr. Chang (12:57):
I do think people like Angelina Jolie's lips-

Jackie (13:01):
I was going to say her lips- All of them have great lips.

Dr. Chang (13:06):
Yeah. She's thin, at least in these photos, they're thin, but not ... They don't have really pencil thin lips. They've got kind of still the plump lip thing going on. So that had driven a lot of the lip filler, lip fat grafting, lip implant trend for a while. It's very attractive to have that fullness.

Jackie (13:29):
She was like the OG, Kylie Jenner lip.

Dr. Chang (13:31):
Yeah, yeah, exactly. And as you said, the contouring of the cheeks and that jaw interface is very distinctive. I always thought her eyes were very distinctive, but I never thought they were ... I don't know, they were distinctive, but I wouldn't have like, "Oh, well, everybody wants to have eyes like that. " They're kind of like her signature, I don't know, almost like darker or deep set eye a little bit, but I'm not sure that would look good in everybody.

Jackie (13:58):
Right. I would agree.

Dr. Chang (14:00):
I don't look at that classically and say, "Oh, you see those eyes on everybody and they will-"

Jackie (14:04):
That's true.

Dr. Chang (14:05):
I think she's just special to be able to pull that off. But yeah, I mean, this goes through to lots of things. I think that we see things, I see mother-daughter combinations come in talking about their nose or breast. Breast happens all the time. How many times do we see a patient that comes in for a breast reduction and the mother said, "Oh no, I had a breast reduction when I was her age. It was the best thing I ever did and I'm here to support my daughter through that and that kind of thing."

Jackie (14:35):
That's true.

Dr. Chang (14:36):
I think it's pretty common. You'll see a lot of these things, not just in the face.

Jackie (14:42):
And we love a supportive family member that comes in. That's always nice to see.

Dr. Chang (14:48):
Yeah, yeah. Sometimes it's very helpful to have people ... Well, if they've been through it, It's a huge thing because-

Jackie (14:54):
It's a huge help.

Dr. Chang (14:55):
They had a positive experience and they're also supporting their child or their family member through trying to cheer them on. I mean, that's a huge thing because I think a lot of people are worried about being judged by their family and friends.

Jackie (15:10):
Yeah, definitely. It's great, especially if the mom is in the pre-op area with them, they're with them the whole time. That's always nice. And then managing expectations for post-op care, that's super helpful too.

Dr. Chang (15:26):
I think that's totally valuable for the patients. And for us too, I mean, it's much easier to talk to somebody who's going to be your support and try to help them through it than somebody who's sort of grumbling along the way and be like, "Oh, now I got to take care of this".

Jackie (15:40):
Yeah, absolutely.

Dr. Chang (15:42):
This kid who's been difficult or something like that.

Jackie (15:47):
So if someone were to come in asking to look like a picture of their mom, helpful or no?

Dr. Chang (15:57):
It's helpful. I guess it's helpful in the sense that we can ... It depends how far off the picture is from where they're at.

Jackie (16:04):
Yeah.

Dr. Chang (16:06):
It's always a good starting place.

Jackie (16:07):
I was going to say a good conversation starter and then you can talk about the reality.

Dr. Chang (16:13):
Yeah. I think pictures actually are a nice way to communicate because we're both looking at the same thing instead of just imagining like, Oh, what will the result look like?

Jackie (16:22):
Yeah.

Dr. Chang (16:23):
But that being said, you also have to say, "Well, that picture isn't exactly you. " Somebody comes in with breast pictures and say, Oh, these are nose pictures." We're like, "Oh, here's Natalie Portman's nose. I want to look like this. " Or, "Here's Sydney's Sweeney's breast. I want to look like this. " It's like, "Well, you're not Sydney Sweeney and you didn't have Natalie Portman's facial feature, so these things are not going to necessarily fit on you."

Jackie (16:46):
Right. Yeah. Just because we're changing one thing, there's still the whole picture.

Dr. Chang (16:50):
I had a male patient bring in Natalie Portman's nose one time.

Jackie (16:54):
What?

Dr. Chang (16:55):
He's half African American and he was showing me pictures of these Caucasian and Western European noses. And I was like, I mean, they're pretty noses, man, but I'm not sure we're going to get there.

Jackie (17:13):
That's hilarious.

(17:15):
Natalie Portman is also so tiny. She's just a tiny little girl. Yeah.

Dr. Chang (17:19):
She's probably five feet standing straight up.

Jackie (17:25):
That's so funny.

Dr. Chang (17:27):
So I think that pictures are helpful, but we got to also make sure they're somewhat in the range of realistic.

Jackie (17:35):
Good starting point, good talking points, but just got to understand the reality.

Dr. Chang (17:41):
Yeah, for sure.

Jackie (17:42):
So bring your pictures, but be smart about it.

Dr. Chang (17:45):
Yeah. If you have questions or want to have these kinds of discussions and let us know in the comments, we'd love to talk more with you either individually or on the show and feel free to reach out or follow us and subscribe and keep us in mind.

Jackie (18:02):
All right. Well, I guess we got to go see some patients, right?

Dr. Chang (18:06):
We got to run.

Jackie (18:07):
All right. Thanks guys.

Dr. Chang (18:10):
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.