Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level, through optimizing the way you look, move, perform, feel, and connect. Well, this week's OR Diary is something that's spanned a couple of patients for me this week, and it's a story, more. In some sense, a story or a tale as all this time mixed with what kind of carries into the most modern thing that we do in face lifting. What I mean by that is it's kind of a sad story in some sense. It is the importance of body image during our childhood development, essentially. And the story is it's a patient that I did surgery on today who told me a really sad story and that she has always had some body image issues from her dad, really. And she said, even when her dad was 100 years old, still alive, he was still making comments about her appearance as a very grown adult woman. And the real story about this is I had seen this particular patient about a year and a half ago for all revisions surgeries in her eyes. A lot of revisions. And she was in kind of a bad spot and we got her into kind of a great spot. We had talked about revising her face and neck and things like that at the time, but sort of the juice wasn't worth the squeeze maybe then. And she didn't really tell me anything about this history that she had. I just knew that she was in a bad spot. We got her into a good spot. And as we were kind of communicating and follow about that, she started picking my brain a little bit more about her face and neck. And I'm trying to tell her like, I don't know that there's a lot there to do. And it was interesting. And when I saw her in person, I've already known her. We have a very trusted relationship at this point. We had a really great outcome the first time. And now here we are during procedure number two. And she feels comfortable and open enough with me to kind of share this history that she had had with her father that was traumatizing to her in some sense. And forever shaped her, she's a beautiful woman and forever shaped her view of herself. And she never really had confidence in it. And she quite vulnerably told me that she was praying that this procedure would sort of relieve that for her. Because the first procedure that we had done a year and a half prior maybe gave her her first ever glimpse that there was maybe some relief in this. And it was interesting because I'm telling her, I can't fix that for you. I can't no matter what our outcome is here. I can't relieve that burden that you have. And she knew that very introspectively and insightful knew that and was doing her deep work in other places to get around that. But also knowing that this was sort of like her last little missing degree, almost erasing the past where she was chasing this image that she could never achieve and essentially ended up in a bad spot from those other procedures. And finally realizing that she could get back to a normal look, a good spot with me. And even in this conversation about revising her face and her neck, the thing that we had elected not to do the first time, she, just because there wasn't a ton of change, it was a very difficult way to get her back to normal. Because she had very tight, very pulled, would call like a lateral sweep, quite a bit of work to fix that. She was just really looking for some normalcy so that she could wrap her head around this body image and this other deep work she's doing and these traumas from her father. And so, I quite literally, on the operating room table, we had a moment in our entire team, everybody in the room knew this and we felt the gravity. And we almost had our own little prayer moment of silence right about before we were about to start working. Very typical for me, I'll often, as my patients are going to sleep, be sitting with them, hands on their shoulders, kind of like going through my own mindful time with them. But it was quite literal in this sense. And I had had another patient earlier in the week who mentioned something along these lines, but in a much softer way, she's like, I grew up in LA and everybody in LA is F-DEP. What she meant is there is no normal body image in LA and she was referring to growing up in that environment, which wasn't heard directly getting feedback from her father as much as just being in this global environment where everybody has some distortion and there's different standards of beauty and body image things. And she acknowledged that as an adult woman as well, that even that time frame really shaped her. And so, this is very heavy as a father, a father of two daughters. And it's a very interesting sort of thing to think about in months ago, interestingly with these exact same two patients actually, months ago, I did a little post where I had had a consult day, a follow-up day, where I'd been virtually with a bunch of people. And three people that single day had mentioned to me that they had images of their neck that they didn't like. And you know, arrest in a normal time and in regular photos didn't bother them too much. But in very certain angles and positions, they were finding images of their neck that they didn't like. And that day was just sort of motivated and recorded a little video because I'd have three in the same day about, you know, you could give me any 40-year-old person, give me the most beautiful 40-year-old woman that you know, give me a camera in 10 seconds and I will find an image of their neck that we don't like. And so, which is very true. I can find something unflattering, positionally, camera wise, angle light, all those things. And my point at the time was just to say that we shouldn't be treating just camera angles and images because, you know, you might be one of these patients in particular at an image where she was chopping vegetables like this and didn't like what her neck looked like in that image. And so, it's very interesting for that time when I recorded that video with these two exact patients or two of the three when we came in and they were all had previous surgery, mind you. And the previous surgery left them in a spot that they were like kind of happy, but they also thought there was more that they could get. And both of them adhered to that really well. And there were things that we could improve, but, you know, it was sort of this idea of like, well, we can improve it, but is the juice worth the squeeze? Should we do that? Basically just treating photos instead of treating what's happening in real life. But, you know, having this deeper insight with both of these patients, you know, I realize there's so much more to it. It's not just the neck angles in those particular photos that there's always this deeper aspect to it about what our baseline body image is. Interestingly, where that came from. How important my role is as a father with my kids. And, you know, it just really makes my brain cascade into all of these other things because I often talk about even the judging the quality, the outcome and the duration of procedures once we do them. Meaning I can do a very beautiful procedure. I can very objectively know what's going to happen with that's going to look like, but the subjective results or the subjective duration of that we get to this nice procedural point. So, the last is very up to my patient, really. Meaning we could get them to a wonderful point where they're 99.9% satisfied and that's a very common scenario and is that patient overall happy or are they focused on the 0.1% because there's a population that can only focus on the 0.1% even when they're 99.9% there. But then also as that procedure ticks on down the road and normal aging starts to happen. Hopefully we've blunted that aging curve. But there will be some changes that add up over time. When does that person determine, subjectively that that procedure has, you know, sort of like needs to be redone or has gone away for some people it's never and for other people it might happen a little bit earlier in the process. And that's very tied to their own subjective experience of where they're at in the world. Even at baseline, I'll see somebody at 51 years old who's ready for surgery, but somebody else in there own that same body in that same place might not be ready for another decade or two. And there's somebody who is ready a decade ago just depending on their own perception of where they're at. So it's really interesting, powerful and insightful for me to always be sort of curious and understanding where some of these things come from. But this was a really poignant, powerful, sad and happy and celebratory reminder almost all at the same time about, you know, almost a trauma of subjective, personal, self-confidence, self-image, very specifically related to this particular patient and me today in her face. And so, you know, procedures done, things went great and she'll be very, very happy and moving forward and I'm just, you know, praying with her that we can relieve this burden in her along with the other deep work that she's doing. So I thought that was a very interesting story for a parent for wherever you're at. A little introspection is to what your own personal body image is and how that can affect where you're at right now. I've never wanted surgery now in the duration of those procedures and the kind of overall satisfaction and outcome over time. If you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery and performance focus care. I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine. Nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here and I will see you on the next episode.