Ep. 516 The Real Story of Midlife Skin – What’s Changing and What You Can Do About It with Dr. Berry Fairchild
- Cynthia Thurlow
- 5 days ago
- 31 min read
I am honored to connect with board-certified plastic surgeon, Dr. Berry Fairchild, today. Dr. Fairchild blends surgical precision with artistry to create natural, lasting results. Known for her expertise in facial aesthetics and complex breast surgery, she is also deeply committed to philanthropy and ongoing international surgical missions.
In our discussion, we explore how societal expectations shape how women perceive themselves, the complex process of facial aging, and the benefits of a healthy lifestyle in supporting these changes. Dr. Fairchild highlights the essential elements of effective skin care, including hydration and sunscreen, and the use of retinoids, lasers, microneedling, neuromodulators, hyaluronic acid, fillers, and fat transfers, diving into the role of surgery and the value of conversations around various facial and body procedures. She also shares strategies for optimizing post-surgical recovery and how philanthropy has shaped both her personal and professional journeys.
Stay tuned for a truly enlightening conversation with Dr. Berry Fairchild, who is caring and open-minded about listeners’ questions regarding the aging process and ways to address an aging face and body.
IN THIS EPISODE, YOU WILL LEARN:
Facial aging actually starts deep below the skin
How losing even a small amount of weight can alter your facial appearance
Why surgical decisions must always be individualized
The positioning of the eyebrows and the upper eyelid skin can help determine facial expression.
Why you could still consider surgical improvements even after you have had previous eyelid surgery
Deep-plane vs. SMAS-based facelifts
Importance of choosing a plastic surgeon with proven expertise and proper credentials
Some surgeries, like breast reductions, go beyond cosmetic value to relieve pain.
Preparing yourself before having surgery for a faster and smoother recovery
“Retinol and sunscreen are probably the two products that I would add early.”
– Dr. Berry Fairchild
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Connect with Dr. Berry Fairchild
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:28] Today, I had the honor of connecting with Dr. Berry Fairchild. She's a board-certified plastic surgeon and is known for her expertise in facial aesthetics and complex breast surgery. She helps blend surgical precision with artistry to create natural, lasting results. She is also deeply committed to philanthropy and ongoing international surgical missions.
[00:00:52] Today, we spoke about how body image shifts with the aging process as well as the impact of societal expectations, how facial aging impacts midlife women with changes in bone, fat, ligaments, muscle and skin, the impact of a healthy lifestyle and key components of skin care including hydration, sunscreen, etc., the role of retinoids, lasers, microneedling, neuromodulators, hyaluronic acid, fillers, and fat transfers impact the aging face, the role of surgery, the impact of conversations around different types of surgeries, whether it is facial or body surgeries, how to help support your body in a post-surgical recovery timeline including eliminating tobacco and optimizing metabolic flexibility and diabetes control as well as other lifestyle measures.
[00:01:53] Last but not least, how philanthropy has guided Dr. Fairchild's personal and professional timelines. Today is a truly invaluable conversation. I found Dr. Fairchild to be incredibly transparent, kind and open-minded to listeners' questions around the aging process and options to address an aging face and an aging body.
[00:02:20] Well, Dr. Fairchild, I've really been looking forward to this conversation. Welcome to Everyday Wellness.
Dr. Berry Fairchild: [00:02:25] Thank you so much for having me. I'm excited to be here.
Cynthia Thurlow: [00:02:28] Yeah, talk to us about your perceptions as a female plastic surgeon and as a woman. How does body image shift with the aging process? Because I'm sure that you have women that come to you every day, the influence of social media, things that they see with filters. How do societal expectations influence the way women view themselves as ageing?
Dr. Berry Fairchild: [00:02:53] I think it's such an individual process. I don't think everybody has the same body image and I don't think that we're all affected the same way by outside sources or social media. I don't think I can make a blanket statement. But I do think that body image has a lot to do with foundation and youth. I think that people who have like a strong foundation that's built upon things that are not related to physical characteristics tend to weather aging a little bit more favorably.
[00:03:36] It doesn't mean that they're not going to find things that they want to optimize about themselves. It just means that they're more accepting of the process and more confident in the choices that they make.
[00:03:49] I see a lot of people from all walks of life, from all backgrounds, and there's a lot of different perceptions about, like, “What is aging gracefully.” I accept everyone's perception on what graceful aging is. I don't think it's accurate that somebody who wants to alter something about themselves is not graceful. I think there's graceful ways to age without intervention, and I think there's graceful ways to age with intervention. I find that my role is kind of just helping those people who've identified things that they want to optimize in a graceful, elegant way and outlet to do so.
Cynthia Thurlow: [00:04:33] I love that because I think that one of the things I hear from women almost every day, whether it's in programs, people I'm working with individually, or just talking to friends and family, there is definitely this shift that occurs physiologically, anatomically as we are navigating all these hormonal fluctuations, especially that perimenopause transition. I'd love for you to identify if we're looking at bone, fat, ligaments, muscle and skin, like, what do you see that's consistent for most women in terms of the changes that are happening with their faces as they are aging?
[00:05:16] Sure. So, across the board, I think things that can be expected are increased elasticity related to collagen loss in skin. That just means your skin is more relaxed and you develop wrinkles. Then, also, volume loss is a big part of aging. If you look at a more youthful face compared to a face that is a little bit more aged, you'll notice very key characteristic areas that lose fat. We know that fat-- a huge part of aesthetics that's really taken off in the last 10 years with facial rejuvenation is the addition of fat with facelifts and facial rejuvenation surgeries because a face with fat is more youthful. We tend to lose-- we lose fat like in the mid-face, in the temples, even in the lower face. The other thing that happens is loss of bony volume.
[00:06:16] We're all in tune to this idea of bone loss with menopause and with aging, but that also happens in the face. Our bones atrophy. They get smaller. That's why you tend to have a less defined jawline, mid-face and you also start to notice the laxity of the skin because the bone is getting smaller in conjunction with the fat getting smaller and the skin getting more relaxed.
Cynthia Thurlow: [00:06:43] I have a 20-year-old son and I have an 18-year-old son. I used to be able to say, “I have two teenagers.” Now they're not both teenagers anymore, they're young adults. I sometimes will catch myself staring at their skin because you just start to realize like this shift that happens ever so subtly, seemingly. You look at younger people and I'm like, gosh, “Look at their jawline.” Like, I don't think I appreciated my jawline enough until it wasn't as defined or just the plumpness of their skin. I'm always looking at things from two perspectives. It's like, I'm looking at it just from a clinician perspective and then also from the perspective of just wonder and amazement. Oh my gosh. There are things we don't even think about that happen ever so imperceptibly.
[00:07:27] Obviously not for you-- your expertise. Were you particularly artistic as a child or young adult? Because I would imagine as someone that works in plastics, you probably have an artistry eye in terms of when you're looking not just at people, but just about it, probably at anything like the minutiae and level of detail that a surgeon sees is very different than the average person.
Dr. Berry Fairchild: [00:07:52] I agree. Yes, I do tend to be creative and artistic by nature. I'm actually the daughter of an artist and a transplant surgeon. It was the-
Cynthia Thurlow: [00:08:04] Really? [laughs]
Dr. Berry Fairchild: [00:08:06] -direction of art and science and plastic surgery really is the perfect combination of those two things. But surgery and science have always been the creative outlet. Like, I didn't want to draw on paper. I want to create in a more scientific way. It really was a perfect way for me to do that.
Cynthia Thurlow: [00:08:31] Listeners may not know that you actually started as a critical care nurse. This is one of the things I was saying before we started recording. I had Dr. Vonda Wright on a few months ago and we were talking about how she transitioned from nursing to medicine. What was it about the attraction to nursing, at least initially, and then this evolution into going back to med school? I understand your husband's also a physician. Being a two-physician family unit, how did that evolve for you?
Dr. Berry Fairchild: [00:09:03] I grew up with my father, who was going through transplantation training, which is very rigorous. That allowed me to become very comfortable in the hospital setting. I spent a lot of time in the hospital as a young child and it was a very natural segue into working in healthcare in some capacity. But I also had a very real insight into the sacrifices that he made in order to become a surgeon. While the hands-on, technical, artistic part of me really craved the surgery side of things, I needed to prove to myself that I was doing it because I needed to fulfill that void in myself and I wasn't sure, like, as a young girl, I was like, “I don't know, like, am I interested in surgery because my father's a surgeon or is it something that truly comes from within?”
[00:10:02] I thought nursing was a good place to start because of my comfort level. I also very much was drawn to working with people, very empathic. I liked the social interaction part of nursing. So, it was a very natural fit. I started as an ICU nurse, but it was almost instant-- I just kept like-- it was like a draw to the operating room. I'm like, “I have to do it. I have to get there.” It was a great experience. I feel like it was very important for me in my development as a person and a surgeon. But a lot of people ask me, like, if it's a desired route. No, I wouldn't do it, like, [Cynthia laughs] if I knew that I wanted to be a surgeon. I think it's a lot of extra time and work and especially when you're considering things like family planning, I think it adds a layer of complexity, but it worked for me. I'm glad I went that route, but I wouldn't recommend it. [laughs]
Cynthia Thurlow: [00:11:06] For me, I would imagine you probably see all sides. You can see how nursing is an art and science, but also this strong desire, as you stated, to be drawn to surgery and wanting to do more. I would imagine that it adds to the relationships you develop with your patients because you've been able to see things from different areas. I think that one of the things that is super helpful for listeners, irrespective of where they fall on this journey of aging and how they feel about how they're going to navigate aging. What are some of the foundational approaches when you're working with, let's say, 20-somethings, 30-somethings, 40-somethings, foundational perspectives that you think are important for all women to consider, that can make things-- how do I say this? The foundational elements that are going to allow their skin and underlying structures to be as healthy as possible as they're navigating that premenopausal timeline.
Dr. Berry Fairchild: [00:12:04] I think the most basic things that you can do, it sounds cliche, but healthy lifestyle, avoiding things that are going to cause you to age faster, sun protection. I feel like we all have that story like, “Oh, I never protected myself from the sun until I started to age.” I feel like sun protection, hydration, good diet, exercise, weight-bearing exercises, I think we, especially women lifting weights puts stress on your bones, which allows your bones to be stronger as you age. I think that's like a huge preventative measure. There's a lot of physiology and science that goes deeper than that, but from a very basic level, sun protection, healthy diet, and exercise are imperative.
[00:12:58] As you enter that, say 30-year-old range, I think introducing actives into skin care that are science based. There's a lot of data that shows and if you talk to a dermatologist or plastic surgeon, you'll be hard pressed to find one that disagrees that retinoids, retinols, tretinoin thickens your dermis. The strength layer of your skin is the dermis. With addition of that active, you're actively making your dermis thicker, which is going to make it more resistant to aging. Retinol and sunscreen are probably the two products that I would add early.
Cynthia Thurlow: [00:13:42] I think it's so important because I think on a lot of different levels there's so much confusion. Do people use topical products, do they use peptides, do they go to lasers? I certainly have interviewed, you'll be my third plastic surgeon I've interviewed and talking about like, there's so much confusion in the communities in terms of like what is effective, what is not effective. When we're looking at like energy devices, microneedling, lasers. Walk us through, if a woman's coming to you and she's saying, “I'm not ready to do anything surgically”, what do you think are the most helpful procedures to consider that are going to help with improving skin collagen, elastin turnover.
[00:14:29] I know that there's a lot of differing opinions on different types of lasers and things like Morpheus, like radiofrequency and how that can be good/bad. But what is your common approach to these kinds of discussions? Let's just say with women 35 and up, because it's a different population than a younger female.
Dr. Berry Fairchild: [00:14:49] Sure. I'm going to go through the basics of my recommendations, but with the caveat being I feel like everybody with the internet and this mass information availability in AI feels like they should be able to go online and be told without a consultation, without a doctor, exactly how to optimize their skin. But it took literally 20 years of education and practice in order to be able to examine a patient, make recommendations and carry out those recommendations. So, it all has to be viewed within a lens.
[00:15:32] That being said, broad strokes for women who are in their 30s or later and looking for preventative measures, daily skin care with pointed actives is number one. Sun protection, some sort of retinoid and then a tailored program depending on what your concern areas are. Botox, neuromodulators, Dysport, some sort of neuromodulator on a somewhat regular basis serves to prevent deep wrinkle formation, like, we know this. It doesn't have to give you a frozen look. If you're not into Botox, that's fine, but it will slow down the aging process, the formation of static lines in your face. Number three would be some sort of yearly moderate-depth skin resurfacing treatment. That can be in the form of a chemical peel or a laser and that has to be very much tailored. I can't make a blanket statement about this one's good, this one's bad, but the key is moderate depth. If we're looking for actual changes in the quality of skin, we have to penetrate deep enough into the skin, into the dermis in order to make change.
[00:16:58] When we're talking moderate depth, it might be a TCA peel and we're talking like 30, 35% TCA peel, not the one from the Med Spa that's 5%, that's different. CO2 laser is a big workhorse. Something like that once a year is going to reset your skin. The overall benefits of laser therapy, fine lines, pores, texture, tone, pigmentation, overall, just appearance of skin. There is a preventative benefit in terms of skin cancer risk.
[00:17:38] I'm never going to go out there and say, “Oh, it's going to prevent you from getting skin cancer.” But there is a risk reduction associated with moderate depth skin treatments. Then once you have your yearly reset, which I recommend doing in winter or fall because it's easier to stay out of the sun. Maintenance treatments for me include things like microneedling. I think that microneedling is a great adjunct treatment for most people and it's safe for most skin types. It will help with the overall quality of skin.
Cynthia Thurlow: [00:18:12] I think it's so helpful. Like, one of the things that I enjoy about your content is you're always sharing very transparently, like, whether you've done a CO2 laser, you're like, “This is what my skin looks like day to day.” You're always sharing products and I'm delighted to know that we share some of the same products. I use some of those on my skin as well. I think for people-- I started doing ProFractional in my 30s and graduated to CO2 laser last year. I think it's made such an enormous difference in, as you stated, like fine lines, wrinkles. As much as I hated it and I would literally sweat the entire time because it was this, like, Pavlov's dog. Like, I know it's like, a good thing to do, but I hated the entire process.
[00:18:55] Then it was over, and I was like, “I can exhale.” But I think for a lot of people that are doing things to your point that maybe aren't as efficacious, they have to get deep enough. You want a provider that is very experienced. This is where I always say that I think it's fine for some things. If you're getting, like, a facial, I think it's fine to do that at a spa. But, like, you want to be in the hands of someone who actually knows anatomically what is going on with the skin. You want a licensed medical provider. I think that's one thing. Like, keep saying licensed medical provider. Someone who's got advanced training, certainly someone who's very conscientious about what they're doing, and they're doing it often enough that they know who to screen out for, and they know who to screen in for.
[00:19:38] From your perspective, do you find that you get patients who are fearful of even with topical lidocaine and numbing products, people that have a degree-- I just transparently-- I am so easygoing with stuff, but just thinking about [laughs] doing my yearly laser, it gives me a little bit of anxiety.
Dr. Berry Fairchild: [00:19:57] That's fair. That's most people. I freely acknowledge, I think, that I have a weird tolerance of a lot of things. I think some of that is just years of lack of sleep and surgical training. I think maybe that increases my pain threshold. But most people don't enjoy these treatments. But-
Cynthia Thurlow: [00:20:21] the love-hate
Dr. Berry Fairchild: [00:20:22] -you learn to love the results and so you keep doing it. I think that's also why more women do it than men. Although, I do have men who do their lasers and chemical peels, but women just tend to have more pain tolerance.
Cynthia Thurlow: [00:20:41] Jokingly, my husband has said this is the only reason why our human race has gone on is because women tolerate way more than men do. He's a wonderful guy, but he's like, I could not do what you do, so-- [laughs]
Dr. Berry Fairchild: [00:20:53] 100%. They couldn't. From an evolutionary standpoint-- It's not their fault. [Cynthia laughs] Their tolerance is just not-- It's different in general. There's a difference for sure, but I think it's normal. I encourage people to be apprehensive when talking about treatments and surgery because it's a big deal. Everything I do is a big deal. It shouldn't be taken lightly. This isn't a pedicure.
Cynthia Thurlow: [00:21:19] Right.
Dr. Berry Fairchild: [00:21:19] I think that's important. I emphasize the gravity of the things that I do to people. I take it seriously. My patients should take it seriously. I very much value that conversation, that apprehension, the fear. People are nervous the morning of surgery and that's normal, you should be.
Cynthia Thurlow: [00:21:39] Exactly.
Dr. Berry Fairchild: [00:21:41] It's okay. Those are normal emotions.
Cynthia Thurlow: [00:21:44] Absolutely.
Dr. Berry Fairchild: [00:21:46] I'm fortunate enough as a surgeon to be able to offer multiple levels of anesthesia with the procedures that I do. I've had people go under anesthesia for a CO2 laser, which is-- It’s your choice. I can do anything from topical numbing, Valium, ProNox, conscious sedation and general anesthesia. We can make you comfortable. [giggles]
Cynthia Thurlow: [00:22:10] And that’s key. You don't want to go into that and have that the way that I have to work myself up. I'm like, “All right, it's a good and then I just have to suffer through however many minutes to undergo the laser.”
[00:22:21] Let's talk about ways to approach volume and fat loss, because obviously, I feel like the filler discussion has swung to one extreme, and I feel like in many ways, it's swinging back to more subtlety in terms of when you're talking to women about fat loss, volume loss. Walk us through some of the options that are available, whether it's like Restylane, all the way up to a Sculptra and then fat transfer, which, from what I understand, is the most natural way to actually fill that volume loss, plus or minus surgery.
Dr. Berry Fairchild: [00:22:57] Sure. I think it's important, especially we're talking about volumizing the face to understand that we add volume for two reasons. Number one is for aging, which I think everybody thinks is the only reason that we rejuvenate a face, but it's not. The other reason is for beautification. So, things like lip filler aren't necessarily related to aging. It's related to a certain aesthetic and what an individual perceives as beautiful.
[00:23:29] When we're talking about fat replacement or volumization of face, first thing that I do is identify “What is the goal. Is the goal to replace fat that you once had or is the goal to add volume in order to improve your self-confidence or the way that you view certain features that you have?” From the probably most simple to the most complex replacements in volume, number one is going to be a filler. You mentioned Restylane.
[00:24:05] Fillers I classify, hyaluronic acid. There's lots of different brands, there's different cohesivities, G primes of different fillers. That is something that I'm going to figure out based on what you want. The nice thing about HA or hyaluronic acid-based fillers is that you get an immediate result and they're reversible. I think that's nice because say you have a small chin, you want to replace the volume. There's multiple options to augment a chin. We can do fillers, chin augmentation with an implant, sliding genioplasty, back grafting. There's a lot of different ways to do it. But a filler is immediate gratification. It's not permanent. It can be reversed if you hate it.
[00:24:54] There are risks with everything I do, but filler is not without risk. I think we've seen a lot of people overfilled and that's scary. I think that small volumes of filler used in the right hands, in the right candidate for the right goals are very powerful.
[00:25:15] Kind of climbing up the ladder, there's permanent fillers, which is something like Radiesse or Sculptra. Sculptra is going to build collagen. There's a lot of back and forth on the internet about Sculptra as well. The good thing about Sculptra is that once you dilute it, you inject 9 ccs is a vial. I would never like as a surgeon inject 9 cc filler in a face. That's just not my practice. I'm injecting very small volumes.
[00:25:51] But with Sculptra, you're injecting 9 ccs, you're getting volumization of the face. In the next few days, it goes away completely. In the area that you put that product, your body will then build collagen over the subsequent months. Most people are getting multiple Sculptra treatments until they have the volumization that they want. The idea is that it's your own body building collagen.
[00:26:19] The problem is that it's also forming scar tissue. You're putting this product down that's building collagen, but if it's not done in the correct plane of the face, then you have scar tissue that could potentially cause downstream problems and it's not reversible. It is permanent. That's something that's important to understand and it's really important to have an injector that knows the anatomy of the face to prevent permanent problems.
[00:26:55] As a plastic surgeon, the gold standard for facial volumization or replacement in the face would be fat grafting. There's different types of fat grafting, but essentially the process is doing a small volume of liposuction. My most common sites to do liposuction for fat grafting would be thighs and then abdomen. That's a 5 mm incision. I inject local anesthesia into the area, harvest fat, process the fat. You can process fat as either micro fat to build volume, and then nano fat can be injected to optimize skin quality or be used as topical, like PRP, as a glide for microneedling, something like that, to optimize skin.
[00:27:42] Fat grafting is great because it's your own body's cells. You're not going to reject them. They're not going to migrate. You're not going to have those inherent problems that are associated with fillers, but it's more invasive, and it's permanent. The big question people always ask, like, “If I gain weight, is my face going to get fatter?” Yes, yes, but we're not putting-- I've never seen somebody that all of a sudden their face is abnormally plump because of weight gain. But certainly, you're putting more fat cells in the face. What happens with weight gain is fat cells hypertrophy, meaning they get bigger. They don't multiply, they get bigger. If you gain weight, you'll gain weight in harvested fat as well.
Cynthia Thurlow: [00:28:37] It's interesting because I have several friends that have done some facial fat transfer, and then they've gone on to GLP-1. Even with negligible, even if the impetus was not for weight loss per se, they're noticing that they're losing some facial volume. So jokingly, one of them said to me, “I only lost seven pounds and I feel like I look shrunken.” I said, “Well, it's my understanding that those fat cells respond to even subtle changes in weight. It sounds like you're shaking your head,” So it must be your own clinical experience. You're seeing with some of these GLP-1s, you're getting some patients that are getting the untoward side effects, like they're happy with the weight loss, but maybe not happy with the fat loss volume in their face.
Dr. Berry Fairchild: [00:29:20] Right. I think it's similar in all types of weight loss. You look at patients who have lost massive weight from any means, whether it's diet and exercise, gastric bypass, GLP-1s and loss of volume is not favorable in the face, no matter what the means of loss is.
Cynthia Thurlow: [00:29:43] Absolutely.
Dr. Berry Fairchild: [00:29:45] I feel like it's a trade-off, unfortunately. [giggles]
Cynthia Thurlow: [00:29:47] Trying to pick the lesser of two evils, if you will. When women get to a point, they're using good skin care, they're doing yearly laser therapy, plus or minus neuromodulators, fillers, fat grafting. If we're talking about someone north of 40, when does the conversation evolve to surgical options? Whether it's blepharoplasty or facelifts or other types of modalities? Because I feel like these are the conversations that my girlfriends are starting to have. When is the right time to have that conversation for listeners? It may not be right for everyone listening, but I feel like it's a conversation we haven't had on the podcast before and one worth having with you.
Dr. Berry Fairchild: [00:30:28] Sure. I think back to the individualized care and assessment. I think that that's crucial. I think that focusing on age for facial rejuvenation is a mistake. It definitely requires an evaluation by a plastic surgeon. But I would say around, most comers, barring genetics and lifestyle, in your 40s, you're starting to see some changes in the face. At that time, there's a lot of women who benefit, feel good having facial surgery, having a facelift, a neck lift. We're all aging a little bit differently. But things that I think are optimized with surgery, number one, eyebrow position, and some of that is genetic, some of that is aging. Some people come into my office and like “My eyebrows have always been low.”
[00:31:33] I've done eyebrow lifts on people in their late 20s because that's a beautification surgery. Certainly, as we age, I think most people's eyebrows start to descend. I think the eyes are one of the first areas that we notice aging. Most people, it's their upper eyelids. I've had an upper blepharoplasty. It was postpartum that I was just like, “Oh my gosh, I look so tired. I don't feel tired, but I do feel tired, but not as tired as I look.” As a Caucasian woman in my 40s, I think I was about 40 when I had upper blepharoplasty. That was the first thing that I noticed. I felt that my eyebrows were in a good position, but it was a relatively straightforward operation and it was just a skin removal made me feel much better.
[00:32:32] It's important to understand the dynamic between the brows and the eyelids. Some people come in and it's not a skin problem, it's an eyebrow position that creates more skin of the upper eyelids. Sometimes I recommend browlift alone, and then sometimes it's a combination of both where if the brow position is a little bit low and there's some extra skin of the upper eyelid, we might do those together. That's one of the first things that I notice women coming in in late 30s, early 40s, seeking out. More recently the neck and the lower face. I think that this is honestly related to Zoom calls. [laughs]
Cynthia Thurlow: [00:33:18] During pandemic.
Dr. Berry Fairchild: [00:33:20] I think that during the pandemic and now so many people work remotely and they're on the computer all day or they're on their phone looking at creating tech neck and also just making us hyper-aware of our lower face. I've had a lot more women seeking out face and neck lifts in early 40s. I think that if skin laxity, jowling, and nasolabial folds are the concern, that surgical intervention is a conversation that should be had with your surgeon.
Cynthia Thurlow: [00:33:59] If there's someone listening, because I have quite a few girlfriends that had blephs in their late 30s, early 40s, and now they're contemplating whether or not it's the right time to adjust their eyebrow position, have an eyebrow lift plus or minus deep plane facelifts versus SMAS lifts. This is not my area of expertise. I'm just -- the high-level perspective is what I understand. If they've had an overly aggressive upper blepharoplasty, does that negate them being able to get an eyebrow lift in the future? Speaking from generalities, like-- [crosstalk]
Dr. Berry Fairchild: [00:34:38] I think it's overly aggressive. There's a difference between eyebrow skin and eyelid skin. If you take eyelid skin and you don't take eyebrow skin, you should still be able to lift the eyebrow without causing a problem. Certainly that's something that would require an evaluation to determine, but there's a lot of skin that can be recruited in the upper face without causing problems with the upper eyelids. It's hard to lift the brow to the point you can't close your eyes.
Cynthia Thurlow: [00:35:12] If someone's listening and they're interested in different types of facelifts, what has been your experience? What types of facelifts are you offering? Perhaps for listeners, giving them a perspective about how that can be differentiated from the old-school facelifts where, unfortunately there are people even in Hollywood or on TV that have had overly aggressive work done and unfortunately they're then left with a permanent result.
Dr. Berry Fairchild: [00:35:40] Right. I think it's important, it's a big decision. Going back to surgery is a big deal. It's important to choose the surgery, the approach, and your surgeon carefully. In my practice, I do all different types of facelifts. The types of facelifts that I don't like and I'm not doing right now would be skin only or what's called a subcutaneous facelift. I think that perception and the bad connotations that come along with facelifts stemmed from a more traditional approach, which most surgeons have gotten away from. A skin-only or a subcutaneous facelift relies on the skin to hold up the face. A technique that employs a horizontal pull to the face. Now we're really pulling in the vertical or oblique directions, which is a more natural type of lift.
[00:36:46] From a very basic level, if we rely on skin to hold the face and we pull horizontally, you end up looking a little bit scary. It's that kind of windswept look where you see comments about the mouth being very lateralized, joker smile. Those sorts of things come from that very old-school subcutaneous facelift. That's not something that I do in my practice. There is something called a mini lift. I think that a lot of people get confused between mini-lift, endoscopic lift. They're different. These are different surgeries. When we're talking about a mini-lift, it's usually-- that's a skin-only lift. That's going back to that kind of long term-- If we keep lifting the skin, we're going to get to a point where we look not good. But if you have like a little bit of skin that needs to come out, it's fine.
[00:37:44] Again, it's not a surgery that I'm doing in my practice, but it's not going to cause a lot of problems if you just cut out a little skin. The problem being it has no longevity. The skin continues to age and it's just going to be lax in-- the longevity is maybe a year or two. It's a big financial and time investment for something that's doesn't have much longevity. The types of facelifts that are in my practice and that I'm most excited about are the deep plane facelift. There's certain people who are good candidates for SMASectomy, SMAS plication and that just really requires an evaluation, consultation to figure that out.
[00:38:31] I'd say the important thing, so A deep plane just in a very simple term and you elevate skin until you get to a layer of the SMAS which is the superficial muscular aponeurotic system of the face where you're going to enter the SMAS. We usually enter over the parotid gland because that's a safe area where there's not a bunch of facial nerves exposed. Enter beneath the SMAS plane. A deep plane facelifts takes the SMAS dissection all the way to the retaining ligaments of the face, releases those ligaments and then pulls the SMAS layer, sews the fixed and mobile SMAS together in order to get a really natural lift of the face. You still have incisions that go around the ear into the hairline where you cut out skin.
[00:39:23] That's a deep facelift. Starting the same way, you elevate skin, you get to the SMAS where you're going to enter the SMAS and you cut it, but then you're either cutting a strip of it out and sewing it together or you're plicating it like you're not cutting it. You just sew what we call fixed to mobile SMAS. This is mobile SMAS. You sew it to the fixed SMAS and that lifts the face. The nice thing about SMAS-type surgeries is that the recovery and the swelling is much less. People who are camera-facing who are in the public eye may benefit from this type of approach. You get a really beautiful result quickly. The downside is the longevity.
[00:40:15] Everybody wants to hear about Kris Jenner's facelift. [Cynthia laughs] I think she released that she had a SMAS-type facelift, which for somebody who's that much in the public eye, that was probably a great choice for her. She looks great. She might not get 10, 15 years out of it, but she can probably afford to get another facelift. Or I think she's had a couple already. It just has to be tailored to an individual.
Cynthia Thurlow: [00:40:48] I think that's really key.
Dr. Berry Fairchild: [00:40:50] Yeah, I definitely think we can-- Everybody wants to know everything about the type of facelift and go to their surgeon and say, “This is what I want.” But it's really important that your surgeon's helping you to understand the reason that you're a good candidate for a certain type of surgery. Not you convincing your surgeon to do something to your face because you saw it on somebody else because unless you're a twin and you've had exactly the same exposures as that other person, your plan is probably going to be different.
Cynthia Thurlow: [00:41:20] Do you find overall that deep facelifts tend to be much more involved, complicated types of surgeries that you're doing with your patients?
Dr. Berry Fairchild: [00:41:30] Absolutely. I think the most technical type of facelift is going to be a deep plane facelift. There's a traditional open deep plane facelift, which is what I've been talking to about up to now. Probably the newest, most innovative, exciting type of facelift is the endoscopic facelift, which is without the incisions around the ear. That's something that is new to my practice and is still in evolution. I've been doing endoscopic eyebrow lifts for years. I'm now offering it in the mid-face and then in the lower face is kind of the next step in the evolution of that surgery. The nice thing about that is all the incisions are hidden in the hairline behind the ears. It's in the deep plane, though.
Dr. Berry Fairchild: [00:42:24] It is in that area of the face which you have to have an intimate understanding of anatomy. The risk is higher. I think that's important to understand with these more technical operations, they take longer, there's more risk involved, but the outcomes, in my opinion, are far superior and the longevity is much better as well.
Cynthia Thurlow: [00:42:50] I think this is where I would always say to someone, like, “Making sure the person that you're seeing, this is what they're doing with frequency.” If this is the choice that you're doing, making sure it's not the first time this surgeon has done this, making sure that they're actually truly board certified, making sure they actually have the training that they are reporting.
[00:43:13] The other side of things is that I feel like for many women, body surgeries, whether it's breast augmentation, tummy tuck, etc., it seems like those seem to be perhaps more socially acceptable. To me, I see no judgment. I'm like “You do you.” Like I always say, if my girlfriends or family members want to do something, I'm like, “I'm all for it, provided they do their due diligence.”
[00:43:36] Do you find that younger women are coming to you for body work? Like whether it's breast lift, breast augmentation, plus or minus liposuction and/or abdominoplasty, or does the range of ages go to the newly divorced, say menopausal female running the range all the way to the 20, 30, 40-somethings.
Dr. Berry Fairchild: [00:43:58] I find in my practice, I feel like there's a wide age range. I don't see like this influx of young girls seeking body surgery, face surgery. There's certainly outliers, but in general, the young girls that I see in my practice are for breast reductions and otoplasty, which is like--
Cynthia Thurlow : [00:44:25] Ears.
Dr. Berry Fairchild: [00:44:25] I think that as a society, like any woman who has had what's-- the technical term is symptomatic macromastia, which is breasts that literally get in the way of daily life because of back pain, neck pain. I've seen women who've had to have spinal fusions because of the weight of their breasts, chronic rashes, shoulder grooving, those symptoms are-- I mean they're candidates for surgery when they're 15, 16 years old because they literally cannot function in gym class or the social implications of having massive breasts at that age is why we're offering surgery to those girls. It's not because they look good in a bikini.
[00:45:16] I think that people look at cosmetic surgery as this-- it has somewhat of a negative connotation. But I think sometimes it's important to take a step back and consider that these patients, some of them are coming after having gone through quite a bit. I think that if you put yourself in their shoes for a few minutes, you might make the same decision.
Cynthia Thurlow: [00:45:42] I have multiple family members that have had breast reductions and every single one of them has said, “Why didn't I do it sooner?” They just keep putting it off, thinking it's not necessary. For some of these women, it's like the amount of chronic pain that they're dealing with is just unbelievable. I would imagine there's a high patient satisfaction rate with that kind of procedure. [Dr. Fairchild laughs] “Why dint I do it earlier?”
Dr. Berry Fairchild: [00:46:06] I know, I know. I did a breast reduction on a lady who was like late 60s, 70 a few weeks ago and she was just like, “I've just been worrying about everybody else my whole life.” She was just in tears. She's just like, I'm so happy. Like I'm not uncomfortable for the first time in 70 years.
Cynthia Thurlow: [00:46:32] Amazing. When you're talking to patients about the best way to optimize their surgical outcomes, whether they're having facial plastic surgery, they're doing something in terms of bodily plastic surgery, what are some of your like high-level recommendations for them to ensure that they will recover as uneventfully as possible? I know there's no way to ensure no one [giggles] has an issue or a blip, but what are some of your like high-level lifestyle things that you like to discuss with patients?
Dr. Berry Fairchild: [00:47:03] Number one, smoking is like a hard stop for me. I don’t. So, I require people to stop six weeks ahead of time and then maintain that six weeks postoperatively. The reason for that is smoking-- nicotine affects microvasculature, little tiny blood vessels and you're not going to heal if you have a big incision, it'll fall apart. Number one, no smoking. Along with that, talking about microvascular problems, diabetes control like hemoglobin A1c, it's a long-term marker of blood glucose. I require anybody who's pre-diabetic or diabetic, which is not a huge part of my population to have it well controlled going into surgery. For people who are otherwise healthy and non-smoking, I'm a firm believer in the idea of prehabilitation, preventative medicine works better than dealing with things once they're a problem.
[00:48:04] Weight-bearing exercise, lifting weights, eating protein, going into surgery as fit as possible will help you heal on the back end. We've seen that. It's actually something that I studied in medical school in the trauma population and what we saw like huge studies show that patients who had muscle reserve, who had muscle mass and were involved in traumatic injuries and had to have emergency surgery healed faster than their counterparts who had something called sarcopenia or lack of lean muscle in their bodies. I think that extrapolates to all surgical populations. The healthier you are going in, the faster you'll recover.
Cynthia Thurlow: [00:48:53] No and that certainly resonates. We talk so much about sarcopenic obesity, the role of muscle mass, why it's so important for insulin sensitivity, and how that feeds into all these hormonal changes.
[00:49:05] I'd love to kind of round out the conversation talking about how philanthropy is part of your perspective, not only as a female physician, but also as a wife and mother. I know that you're actively involved with a foundation locally that deals with individuals that have suffered from aneurysms or AVMs, but you also do a lot of global mission work, and these are things that I think really speak to you as an individual. I think it makes you far more interesting than a lot of other surgeons that are out there.
Dr. Berry Fairchild: [00:49:36] I think it's important to give back something that's very deeply ingrained in my morals and something that I've always held as a priority. At this point in my life, I am involved in charity organizations, which is great just to use my voice, my platform, to bring resources and funding to those who otherwise wouldn't have it. That is the most simple thing that I can do.
[00:50:09] As far as mission work, I've been honored to be part of Faith in Practice, which is the medical mission trip. We've gone down for a few years in a row to Guatemala, and we do a lot of plastic reconstructive surgery. I don't do cleft lip, which is what most people think of when they're thinking of plastic surgeons on medical mission trips. There is so much reconstruction that needs to be done outside of cleft lip, which is probably the most funded part of mission trips and plastic surgery worldwide. That's not my area of mission work, but we've gone for a few years.
[00:50:51] We operate on anybody who's in need. That reconstruction can be anything from tumor removal of the face with reconstruction, hand surgery, skin grafts, free flaps. We really just do anything that needs to be done. It's been fun. Also, I've had the opportunity to go with my husband. He does spine surgery in the same hospital in Guatemala, while I do reconstructive surgery.
[00:51:22] We've been able to bring our daughter the last two years as well, which is special. I think it's really important to me to show her how the majority of the world lives. I think that we get lost in this bubble and we think with the internet that everybody is privileged and that everybody has resources. I think it's really important for me and for her to see that we're actually very much the minority, that it's our duty to help those that don't have what we have.
Cynthia Thurlow: [00:51:56] I love that. I think it's so important for our children to have perspective, especially when they're growing up, as most children here in the United States are incredibly privileged and there's a whole other element to the world that gives them different perspective. I always say that's like the greatest gift is that my kids have been able to travel quite a bit and they'll come home and they have completely different perceptions of things, having been outside the United States multiple times.
[00:52:23] Well, Dr. Fairchild, I so appreciate your time today. I would love for you to share with listeners how to connect with you outside of the podcast, how to work with you directly, you’re based out of Houston, if they want to work with you specifically or follow you on social media.
Dr. Berry Fairchild: [00:52:38] Absolutely. Thank you so much for your time. This has been lovely. I really enjoyed the conversation. Again, my name's Dr. Berry Fairchild. My Instagram handle is @drberryfairchild. It's B-E-R-R-Y Fairchild, it’s berry like strawberry, [Cynthia laughs] and it's the same handle on TikTok. You can message me directly. I'm also located in Houston. I'm part of My Houston Surgeons, which is a group practice, and I would love to connect with y’all in the future.
Cynthia Thurlow: [00:53:11] One of the things I love about your platform is you talk about things other than surgery. You're very much a girly girl, just like I am. You love to share like clothes, fashion and skincare, and so it just makes you very relatable.
Dr. Berry Fairchild: [00:53:24] Thank you. I really appreciate that. I feel like social media is a double-edged sword, but it's been very powerful for me and also a little bit of a creative outlet. I see the positive in it and I really appreciate the community that we've been able to build there.
Cynthia Thurlow: [00:53:40] Absolutely.
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