The Internet of Plastic Surgery Things w/ Dr. Jonathan Sykes

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, a podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is The Internet of Plastic Surgery. So Dr. Bass, I think I know where we're going with this one. Plastic surgery is all over the internet. We're going to talk about how popular plastic surgery is and how that has put so much information about it on the internet. Right?

Dr. Lawrence Bass (00:39):
Well, that's the start of it, Doreen. Plastic surgery has grown over the past two decades in popularity, and the public has a tremendous thirst for stories about it. Who's doing it, what's available, what treatment is best? The internet and social media is a natural forum in the 21st century for that information to be posted and to reside. Still, there's more to it because it doesn't stop there. That information that gets posted impacts search and what is put in front of you in newsfeeds and social media platforms and in many, many other ways, it has a life of its own. I think of this as the internet of plastic surgery analogous to the Internet of things. The internet of things represents all the devices, sensors, and other items out in the world that are connected to the internet. It's a little different from the internet itself, and this allows the things to be monitored, inputting data to the internet, and in some cases they can even be controlled over the internet, like controlling your thermostat at home. This allows the constant activity of every surgeon and patient, aesthetic medical product company, and the public in general. All of these inputs have a huge impact on our perception or our view of reality when it comes to plastic surgery. So this is not a one-way street, but actually a cyclical process. It changes our view of plastic surgery and what we do when it comes to plastic surgery.

Doreen Wu (02:33):
That makes a lot of sense. So where do we go from here in this analysis?

Dr. Lawrence Bass (02:38):
Well, I brought someone as a guest today to join us on the podcast, who I know has a lot of thoughts about this topic. Dr. Jon Sykes is a facial plastic surgeon who was the director of facial plastic surgery at UC Davis for over 30 years, past President of the American Academy of Facial Plastic and Reconstructive Surgery. He's written hundreds of articles and given over a thousand lectures, trained many, many residents and fellows, and is really a master in the technical aspects of plastic surgery, but also in thinking about plastic surgery. So Dr. Sykes, thank you for joining us.

Dr. Jon Sykes (03:27):
Thanks for having me, Dr. Bass.

Doreen Wu (03:30):
Thank you so much for joining us, Dr. Sykes. So I'm from the internet generation, which means I grew up with access to the internet and digital technology from a young age, and they've played quite an important role my entire life. The internet is basically my first go-to for all sources of information. What should I know about what's on there, Dr. Sykes?

Dr. Jon Sykes (03:50):
Well, that's a good way to put it, Doreen. The internet is information and it's communication. We know that we can communicate through it, we can gain information through it, but the natural thought is that all the information that we get is real. It's honest, it's truthful, it's authoritative. But in reality, when it comes to plastic surgery, I think a lot of what gets put out there is guised as information, and it's really marketing, we're being marketed to, and there's a lot at stake here because people that are good at doing it make a lot of money. If I am the perceived biggest expert in the world because of what my internet platform says that I am, that makes me a lot of money. And so people, plastic surgeons and injectors have all realized this and it's flavored and biased, everything that they put out there.

(04:59):
And it really we're constantly thinking about not, do I do a good job with plastic surgery, but how am I going to look on the internet? That's what plastic surgeons are thinking about all the time because marketing in general has taken a backseat to what they do on the internet. So I would start by saying the information we gain by doing our quota research, and I have a coffee cup that sits in my office that says, "don't confuse your 30 minute search on the internet for a medical degree." People think they understand these things based on what? So now I get asked all the time, and I'm sure Dr. Bass does as well, do you do the deep plane lift? You do the SMAS lift because they've read a little bit on the internet where someone has said this, what I'm doing is better, and people believe that because that's all they have. So that's where I would start.

Dr. Lawrence Bass (06:02):
So you used this sort of kinder, gentler word marketing, but let me use a more direct word. Most of what you see on the internet, not everything, but most of it is advertise.

Dr. Jon Sykes (06:18):
I would agree.

Dr. Lawrence Bass (06:19):
When you watch a TV commercial in between your favorite show, people are trying to sell you something because we grew up understanding that. But the same is true of an awful lot of what you see on the internet. And the internet then becomes the source for even things that try to archive or review information on a given subject like a Wikipedia or similar will abstract from other sources, but also predominantly from the internet. And if you're starting with that, maybe not validated information, it's very hard to get a valid outcome when you review it and summarize it.

Dr. Jon Sykes (07:16):
Yeah, I would agree with all that. I mean, it starts with the things that we say about ourselves that we are the best in class is the top surgeon in the area. These are what I would call it's puffery. It really is. It's a statement that can't be challenged. We don't know who the best in New York City is, or the best, in my case in Beverly Hills. We don't know. We love it when we're included in the top 10 of whatever that is. But the reality of it is, for me, that doesn't really matter. I know it has no validity, but to patients, they think it has all the validity. So that's the first. But then there's the way that we talk about a given procedure or a technique and the way we brand that, we brand it with our name, with something. He does this lift the install, lift the whatever that is, and there's the perception that that is good.

(08:24):
I mean this, Larry, as much as anybody, there was a group that did these quick mini lifts in the office, and it was all over the United States called Lifestyle Lift. They ultimately went out of business because they were underperforming. But I had people that came into me and I consider myself an expert in facelift surgery, and they were saying, do you do the lifestyle lift? Because it was branded and marketed, of course. So the idea really information about what that was, people didn't know what a lifestyle lift was per se, but it got really well marketed. So that is what the public is up against. And now I believe it's become a relatively double-edged sword. We live by the sword and we die by the sword. So some of the sword in this case is advertising, as you've mentioned, Larry. And so we're up against that because people get asked to perform to that, and we get asked to match that. So that's what I would say. And it's very confusing to the public. It's confusing to the public, and most plastic surgeons have to buy into that to stay up with the masses of plastic surgeons that are doing this kind of branding.

Doreen Wu (09:51):
And in that vein, Dr. Sykes, can you give me an example of how the Internet's influence transmits directly into the plastic surgery consultation? How does branding, marketing, advertising, how does all of that play into the consultation itself?

Dr. Jon Sykes (10:06):
Well, I think first is what the individual surgeon does in their branding or marketing to get that patient into their door. And that gets them a certain kind of patient because they're marketing to someone and they get that someone, they get that group of someones. So that's number one. But then we get a lot that ask us, do you do this or that? And can you do this or that? Let me show you a picture of this. And we're matched up against that and we have to perform to that. And it's quite a different world. And there are people who are quite average at performing plastic surgery that are very good at this game, and they do well and get more patients. I personally, and I'm not saying this in any way, to have sour grapes or anything, I'm not particularly good at it. So I'm really good at surgery and I'm not particularly good at that game.

(11:08):
And I've never marketed well, and I'm not whining about that. It's just who I am. It's just not what I'm good at, and I can't make myself good at that. And a lot of people say, well, you don't need to be good at that. You need to just surround yourself with people that are. No, I think you actually have to be good at it because in order to play that game, you've got to be good at it because you can't even analyze the people around you that are doing a good job without, and some people are just very natural at that. They're just very, it's the way they've been brought up. And as you mentioned, Doreen, you grew up with this, so you would likely be better at it than I am. But my guess is you're not a better surgeon than I'm just because of how young you look and how old I know I am.

(11:58):
But you probably will be and hopefully will be someday if that's what you want to do. But my point is, I didn't grow up with that. And most of the people that got busy in plastic surgery in the era where I grew up got through the old organic way, which were patients sending patients. But now surgeons don't even have to wait for that. They don't have to wait for that. They can make a brand and a persona about them in a year or two if they're quite good at playing this. I'll call it a game. And I don't mean to say that in a way that I'm annoyed about it. It's just what the world has become. As you mentioned Doreen, it's how you've learned to do your research, how you've learned to get your communication, how you've learned to get your information.

Dr. Lawrence Bass (12:45):
It's interesting because I find people who hire marketing experts, you get very slick material, but I find that it's a little generic and impersonal compared to the surgeons I know who just have that knack that you were describing. They're good at communicating over the internet. I'm good at communicating in a consultation room, face-to-face with a single person and explaining what I'm seeing, trying to show the patient that I've heard what their concerns are accurately and explaining the rationale for what I would suggest to address their concerns. But there are other people, I mean, this is what we were trained to do. And I went into medicine because I liked science and I like the technical aspect of surgery, and I wanted to spend my energy and thoughts pursuing that and not marketing, but it is a different business net. And you are on the West Coast in a place where patients talk a lot more. People are not as public about their plastic surgery on the East Coast. And so a lot of patients don't know where to look to find a good plastic surgeon. They're not comfortable talking to their friends about who's good or who they might've seen. So it ends up the internet is your ready friend that you can ask anonymously.

Dr. Jon Sykes (14:27):
And you can do it at any hour of the day. You can do it at two in the morning. You can communicate at two in the morning. You can find somebody that would communicate with you, and certainly you can just look at the information and the information is not monitored. So anyone can say anything about anything that they do. They can say there's no monitor on it at all. So I could move in next door to you, Larry, and say, and not having, I lived, I grew up on the East Coast. I was educated on the East Coast, but I could grow up and say, I've trained my whole life in New York and nobody, how would you even challenge that? I mean, you might come into my office and say, you're not from New York. I did grow up in New Jersey, Larry, as you might know, but I've lived on the West Coast for over 30 years, and I could say that kind of thing.

(15:17):
And I could say, thought by the masses as the best. I could think of a flashy way to say it, as is the best plastic surgeon. And there would be no challenge to it because we don't know who the best plastic surgeon is, so why not just say the most for yourself? Why not just do that? So it's an interesting kind of thing saying that you and I see it all the time. I just saw an ad literally two minutes before I opened up this that said, so-and-so as an injector was best in class. What does that even mean best in class or the best in town? And even the things that get voted upon when you say the a hundred best injectors in the country, I got voted as one of those. I mean, how I've been in California, I've been in Los Angeles only three years, as you know, I've had my career at UC Davis and retired from there. So I bought a house and I opened an office in Beverly Hills, and that's a place that advertising is in, marketing is more important. I don't know why in Sacramento, I have the name, but in LA, but somebody just came out with something that LA Magazine came out with something. I was one of the seven best plastic surgeons in Los Angeles. How the hell do they know that? I think I'm a confident guy. I don't know that. How do they know that? I mean, that's so ridiculous.

(16:47):
But we love these things and frankly, there was something secret inside of me that said, I'm really glad to hear this. This is another thing I can put on my Instagram or on my TikTok. I just started a TikTok. Larry, I've never in my life posted an Instagram. I have a hundred thousand followers. I don't even know how to post an Instagram. I don't know how to do it, but I have an Instagram person, crazy damn thing. And I'm getting a TikTok person. Now, TikTok could be gone in six months and I'm doing these stupid little tiktoks in my living room. I hate doing that. I'd rather be writing an article or resting or it's crazy. But people spend two hours of their day working on their marketing. To me, it's a crazy thing. It sounds like I'm bitter. I'm not. I love plastic surgery and I've had a great job and a great career. I love it. Actually, I'm going to work till I'm 80. I love doing what I do, but it's really crazy the way to get busy doing it. Now that irks me because I'm not good at that, and it's okay to not be good. I'm not good at golf.

Dr. Lawrence Bass (18:01):
Yeah, it's just that you have to think that clinical judgment in the technical prowess has to be at least a major component of what makes someone a good surgeon. I understand that some of the showmanship and some of the visibility and some of the party manners are part of it, an increasing part of it, but the core capability to do things safely, to do things with an extremely low rate of problems, given that this is elective and not medically necessary, has to factor in there on some level.

Dr. Jon Sykes (18:47):
I would agree. I'll tell you one thing that I'm starting to do, not to market more, but because I've always been an informational guy and an educational guy, but Doreen will be a little interested in this just as a consumer and as, so what I've noticed is an increasing amount of people who are doing these funky things with their photographs because there's such a pressure to show these bigger results and that I'm so good. And so I am starting to show the public how to look out for these. I'll give one example, very simple, and this will go into the bigger picture of what we're talking about, which is sort of biasing our information and our confusing it so that the public doesn't really know. So here's a common thing. We see people that get injected and they show the before and after. Okay, well, often a before and after picture of somebody that's had an injection in their cheeks doesn't show very much.

(19:54):
If you look right now at my face and actually at Doreen's face a little, it's top lighted. And if you see there's shadow, there's light on your forehead and there's a little shadow on your cheeks. So it's a common thing for these pre injection photographs to be top lighted. And then afterwards, because we want to see the light shadow interfaces of the face be even that we don't have these shadows and convexity and concavities, and you are really young Doreen, but they show a little bit because a light on top of you that's shining down on your forehead and it casts a little shadow on your cheeks. What they would do with you is inject a little goo into your face and then front light your face from the front, which takes out all the light and shadow and makes it look like the injection is better than it is.

(20:53):
And we could do that in lots of different ways. I could show my neck before and after this. I could show lighting that's different. I could show angles that are different. And if you're good at doing it, and now I'm seeing that that has become accepted and somebody will put it out there, put a picture out there before and after this, excuse my language, a crappy picture, A shitty picture. And people will say, great, great, great. Everybody's liking and nobody's saying she's smiling afterwards. And the light's different and the position, their head's different and everything's different. The makeup's different.

Dr. Lawrence Bass (21:32):
The makeup.

Dr. Jon Sykes (21:33):
Absolutely. The makeup is, I have a couple of pictures that are so wildly and the surgeon goes, look at this amazing result. And I say, I'm thinking to myself, look at this bullshit result. How much can you lie? You've got to be better at your surgery than you are at your photography.

Dr. Lawrence Bass (21:57):
Not necessarily,

Dr. Jon Sykes (21:58):
But maybe not necessarily. Might say, Larry. But here's the big thing. The pressure is on all of us to do that. What's happened? That's really the big thing that comes out of our 25 minute discussion, that the pressure is on everybody to look better than they actually are. We don't show who we are. We show a better version of what we're, so we can make the public not aware. We can confuse the public. We're biasing the facts, and it's become the standard. The biased information has become the standard.

Dr. Lawrence Bass (22:38):
Well, the noise level is so high, there's so much posted, there's so much out there. It's so aggressive that for you to stand out, you have to be ever more outrageous. You have to show a more stark, obvious, extreme result. And so rather than a natural result that preserves the person's identity, makes them look better. You need something that's really stark. You need the super amazing weebles fall down, but they get back up. Brazilian butt lift, because everybody else is doing medium. And you've got to do an extra, extra, extra large.

Dr. Jon Sykes (23:39):
Let me tell you one thing that I think of. So I don't know if you know Larry, but I'm a big stock investor. It's something I do every day. I play the stock market every day, and I constantly, I make several trades a day. It's a statistical thing for me. It's a challenge for me, and I like doing 'em. So I follow Warren Buffett a lot, and I follow some of his principles a lot. So he said a thing on TV once that stood out to me about what we do. And he said, when you're looking to get new technologies and new things, you have to stay ahead of the world. You have to. So he said, it's like advertising when you're doing that. And he called it the tippy toe phenomenon that were his words. I remembered it really well. He called it a tippy toe, he said, so imagine that you're at a parade and you're in there with people that are all your height.

(24:29):
You have to stand on your tippy toes to look different as you said. Okay? But then what goes on is everybody's on their tippy toes, everybody's standing on their tippy toes. So you need a box. You need to stand on a box. You get the idea. So what's going on for people is I need to stand out. It doesn't matter what the hell I do, but as long as I stand out, it's okay. It doesn't matter if it's the honest, doesn't matter if it has integrity, I've got to stand out. And there's a little soft pressure on everybody that does plastic surgery to stand out, whether it be calling their technique different, giving a certain advantage with their before and afters, any of the above. So just remember that little thing, the tippy toe phenomenon that's going on all the time in everything that all of us doing, the internet where we want to be competitive. But certainly for plastic surgeons. That's what I would say. That's sort of the sum up for me.

Doreen Wu (25:26):
So Dr. Sykes, how is this likely to play out going forward? Realistically, what could be changed?

Dr. Jon Sykes (25:33):
Well, the thing that could but will not be changed is some monitoring on the internet. I mean, that's like first amendment right? Monitoring. I don't think that's ever going to happen in the US. It does happen to some degree in other countries. And I'm not saying I like that more in other countries, but in Australia, for instance, doctors can't advertise, I don't believe, or they can't. They're not really free to advertise. But we have the freedom to advertise. But we have a lot of freedoms in our country, and I think a lot of our freedoms are fabulous, and a lot of them we pay dearly for. This is one where we're paying dearly. We're paying dearly because there's a lack of integrity and a lack of honesty. But I don't know that there's a way around that unless we get some internet police for plastic surgeons or for other things, we don't have it for other things. So anybody can say they're the best pizza in town. There's no proof they're the best pizza, but they can say they're the best pizza in town. And there's a lot at stake for the pizza place, and there's more at stake for the plastic surgeon.

Dr. Lawrence Bass (26:38):
Maybe part of it is education, because if you're an educated consumer, I mean, I know when I listened to a lecture by a surgeon and they say, "I did 300 cases and all excellent results and complications were zero, and all the patients were extremely satisfied." That's the big one. That never happens. So when I hear that lecture, I know there's some baloney going on.

Dr. Jon Sykes (27:13):
But you look at that because you are a person that is scrutinizing what you hear. But when you're at home at two in the morning and that's all you have, and it's the most adverti-, I don't know that it's easy to scrutinize that. I don't know that it's so often somebody shows me some picture and I say, "I don't actually know how much better the after is than the before. Look at the makeup." And then they'll say, "oh," I said, "look at the lighting different. Look in their eyeballs. Look where the light's coming from. When you look at their pupils, where the light's coming from in the room, there's a light difference between the beforehand." They'll go, "oh, that's amazing." But you can't educate everyone in that way. That's why I'm actually trying to do this on the internet right now. I mean, whoever watches me will see that. But I'm sort of starting to show these things were, I'll say, deception in plastic surgery, which I think is happening a lot in the area.

(28:12):
I get what you're saying, Larry. It would be if you educate, but this is filtered material that's coming through as education, and the filtering is being done by each individual, and they can say whatever they want. So I don't know what we can do about it. Doreen, I don't know. Maybe that's a project for you to think about how to make this better, how to make the world more honest.

(28:34):
Another thing to add to my To-do list.

(28:37):
Yeah, yeah, exactly. I don't mean to sound bitter about this. I love doing what I do. I want you to know that, and you can tell that I love doing what I do. I love talking about it. I love doing it.

Dr. Lawrence Bass (28:48):
Not only is it what individuals are doing, but the ability of AI and chat algorithms and things like this to learn what TikTok does. I mean, TikTok pushes heavily towards you based on what you view, how long you view it, what other people like you view. And that feedback cycle is incredibly psychologically persuasive, even addictive based on certain neurobiological principles. And so it's like you said, it's worth a lot of money because it works, and we're going to see it turbo working with these new modalities that put us yet a much further step away from anything, any ability to validate reality.

Dr. Jon Sykes (29:53):
I agree.

Doreen Wu (29:54):
Definitely. Well, this has been a riveting discussion so far, Dr. Sykes, before we wrap up, what takeaways would you leave our listeners with? How should they be approaching their use of internet information?

Dr. Jon Sykes (30:07):
Well, I think it's good for the observer to get information from the internet because the internet has such readily available information, but I think they have to scrutinize the information that they get. And that might be looking at before and after pictures with a jaded look and a routinizing look, that lets them judge them not, oh, wow, look at the big picture of this. If somebody's going to be really, really dishonest to me about their lighting and their head position and all the above, maybe that's the person I don't want is my search. Maybe that's, and then look at the credentials of the person. And then lastly, because we're doing so many of right before this podcast, I did a virtual consult on someone from Texas. She wasn't in my office. I didn't get to know her in the same way. I get to know a person that I see face-to-face. And so I didn't get all the same clues that I might get if she were in the room with me. And so I have to make a judgment about her, and she has to make a judgment about me. And on the one hand, there's all this pressure to market. So they sign up for surgery, they sign up, and then on the other hand, we've got making the person happy and producing what they want. And that's maybe the topic for another discussion of ours.

(31:38):
But so I think having some scrutiny about what you read is really important. Don't believe everything you read. Read, but don't believe everything you read because you're getting marketed to and advertised to, as Larry said.

Doreen Wu (31:54):
Dr. Bass, would you like to add any takeaways?

Dr. Lawrence Bass (31:57):
In that same vein? It's really important to understand what validation there is or the lack thereof really, of internet information. So that means the internet is really not our best source for doing your due diligence when you're trying to get ready to have a procedure or to pick a surgeon. So think of the internet more like entertainment, not like an encyclopedia. It's more important to find a surgeon you can partner with, have a good working relationship with, and doubly so because there is no one best procedure or treatment that matches your needs at whatever stage of aging you're at. It's really about what works well in your selected surgeon's hands. So as I mentioned at the beginning of this episode, the internet of plastic surgery turns and pivots based on the material that's input, the majority of which is not posted by authoritative sources. And that turning and pivoting of what's presented deeply influences our perception of plastic surgery. So we have to kind of take our head away from the illusions and be a little bit realist to make sensible decisions. I'd like to thank Dr. Sykes for joining us and for his very forthright commentary about some of what's going on with marketing and internet in our field.

Doreen Wu (33:43):
Thank you, Dr. Sykes for joining us and contributing such interesting commentary about how to be a keen and discerning consumer.

Dr. Jon Sykes (33:50):
Thanks, Larry, my good friend, and thanks, Doreen, my soon to be friend.

Doreen Wu (33:55):
Thank you for listening to the Park Avenue Plastic Surgery Class Podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram at @drbassnyc.