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Dr. Shah:
Hi, this is Dr. Anil Shah and you're listening to masters of beauty.
Dr. Shah:
So I'm really excited about our episode today. I have Dr. David Shafer from New York city who is renowned in a lot of areas. We're going to talk about one area in particular, that's hot and upcoming and that's male enhancement, male enhancement. For those of you don't know is when you add filler to a man's penis and the goal over here is to make it bigger. Yes, that's a real thing. We actually do that in my office. And one of the founders of this procedure is Dr. David Schaefer. He's been doing this for years, so we're going to gain some valuable insights, what it means to have filler placed in a man's penis. What does it feel like? What are some of the side effects we're going to hear all from his perspective, lots of valuable information over here. Hope you guys really enjoy this podcast.
Dr. Shah:
This is Dr. David Shafer, a double board certified plastic surgeon, by both the American board of plastic surgery, also American board of surgery and all areas of cosmetic surgery, a true pioneer in many areas, uh, been a national peer trainer for Botox, dermal fillers and noninvasive surgical procedures to achieve natural looking results. this has resulted in them being pure nominated as a castle Connolly top doctor specialized. He was trained and , completed a world-class fellowship for face breast and body. Um, and, uh, he has been featured in the media for many things, including most recently, I think a test to hashtag resting face injections and hashtag resting growth face. So I think you do a lot of interesting things and we wanted to focus on just a couple of you if that's okay. Sure. That's great. Uh, so, uh, I saw that first of all, resting face in rusty bro phase. Uh, those have gone viral the last couple of weeks. Uh, let's explain kind of the synthesis of that, where that came from.
Dr. David Shafer:
Yeah. I mean, people come in and we get, we put Botox fillers and address some of their issues, but to give a name to a constellation of symptoms that patients has, I think makes it more identifiable for people. So when you say resting face or resting bro phase, people immediately understand what you're talking about. And people come out of the woodwork saying, Hey, I have met too. My mom has that. She gave it to me. I, my friend has that my sister has that, that kind of thing. And it also kind of breaks down that barrier. So the patient feels a little bit more comfortable asking him about having a procedure. What can I do about it? And in terms of the media, they could grab onto that headline. And the basically it went from there.
Dr. Shah:
Amazing, amazing. And for our audience who doesn't know, that's going to be the downturn smile, a little bit of the heavy brows of anything else in your RBF from
Dr. David Shafer:
Those are the main things. And the one thing that I had described with patients is we use Botox to block the action of muscles and the FDA, um, approved versions of it are for around the crow's feet between the eyebrows and the forehead and or all you see using Botox fillers reasons. But we can use Botox as a tool in other places of the body, such as the lower face and use the mechanism of action that we know to make a positive effect. So people are they're resting face or resting bro face. Their depressor muscles are stronger than their elevator muscles. So if we weekend the frowning myself, then the smiling muscles take over and you have more of a resting neutral lip or smiling lift, which can be very helpful for people.
Dr. Shah:
Amazing, amazing. And we see that and that's like something that almost everyone will have at some point. And, uh, it's that, uh, mirror reaction we have when we see someone with an angry face, we tend to mirror that we see someone with a smiling face, that baby, usually we're smiling at them when they smile back.
Dr. David Shafer:
Definitely cool. Yeah. It's something too, is it's an addition to other things people might have. So, um, you know, when people come in that they have a wrinkle here or a wrinkle there, but now it's, you know, being able to address the lower face as well. I think it's very helpful
Dr. Shah:
And we're going to work our way a little bit lower in the body to something you're really famous for as well, this SWAG procedure for male enhancement. So, uh, where did that originate? When did you start that? And let's talk about some of that, those foundations of that.
Dr. David Shafer:
Sure. So I've been doing dermal fillers since I started practice. And when I started practice is the same year the stock market crashed. So even though I'm a board certified plastic surgeon, I really got into the dermal fillers, Botox, or other treatments that are low price point quicker recovery that more patients could could have during that time. And so I've built up a huge injection practice and then also a surgical practice about 50 50 right now. And the techniques you use for fillers, just like we just talked about Botox, you can use the same techniques and other parts of the body. And so one day when I was injecting a woman's face, the boyfriend who is sitting in the room jokingly said, Hey, can I put this stuff in my penis? And a light went off and I, you know, I thought, you know, why not? It's part of the body, there's the different skin layers. Uh, we can use a cannula, which we use now on the face that makes it very safe. And so I told them if you want to be the Guinea pig, we'll try it on you and see how it works. Kinda, it all kind of went from there. Perfect.
Dr. Shah:
Um, and it's interesting that a filler in that area. So when someone comes in, first of all, the first barrier to get them in, do they usually come in and say, you know, I'm interested in this or is there a significant other that's calling them in? what's your ratio of patients coming in for, for, for male enhancement?
Dr. David Shafer:
Yeah. They come in for all different reasons, and it's not like most other procedures that we do in an office. If you do Botox on somebody, then their friends, their family member sees them. They recommend it to somebody else. This isn't something that a guy does and then goes and tells everybody at the gym or at home that he did it. So, you know, each person is coming in because they've researched on the internet. They've had some experienced for awhile about it. So, so most people are kind of the awkwardness about their penis, their size. So it's kind of thing. Sometimes you do get, the wife brings the husband and we had, I get a lot of out of twon patients. And so somebody flew in from out of the country with their husband. He thought they were coming to my office for her. And then in the office, she, that she announced at home why they're at the office. So, yeah, he was agreeable. So maybe he had thought about it in the past, but, uh, you know, people come in for all different reasons, whether it's for themselves, for their partner, but what, you know, one discussion with patients is to make sure that they want to do it, but they're not being forced to do it. You know, we talk about that with patients, for any procedure, you want to do it for your own reasons and not feel pressured into doing anything
Dr. Shah:
Amazing. And what, what filler did you start off with and then what fillers have you evolved into?
Dr. David Shafer:
Yeah, so, you know, I use a lot of the Juvederm family of products and I wanted a product that was thick, that would last a long time. And so I started doing it with Voluma and that's the one I've stuck with patients like that. It has a two year duration, um, you know, low complication is a hyaluronic acid, so we're able to melt it. So if there's any issue with symmetry or any other issues, you can mouth, it, there's other products available on the market that are either semi-permanent or permanent. And I try to stay away from those because I always say, if you have a, uh, multiple products, you can, that you can solve anything. If you put a permanent product, then you can get a permanent problem. And, you know, safety is first and foremost, uh, what I'm looking for for patients.
Dr. Shah:
Perfect. Um, and speaking of safety, um, so what's, if someone's coming into your office and they're asking, Hey, guess what, I'm interested in this procedure, but I'm kind of nervous to have something injected down there. Um, how does that conversation go? And what's kind of the, kind of the safety record for this?
Dr. David Shafer:
It's an off-label use for the product. So I tell them about that and discuss the safety studies that have been done for the FDA on the face, longevity compensation rates. So it's kind of things, it's the same set of complications that you could have with any treatment or fill it. Most common complications are, swelling, bruising, very, very low likelihood of nodule, formation, those kinds of things. So you have the discussion. I also go through with every patient, I have a chart of the anatomy. We looked at the different skin layers where we're putting it, how the nerve block works, all those kinds of things. So that they're completely informed before they have the procedure. And I discussed what I discussed with them about 20% of people will come back within a month or two because they love it. And they just want more. And it's just similar effects that you see, if you do, let's say somebody lifts and then they get positive feedback. They're happy about it. They come back to them a little bit more and they live where they achieved the same thing. But part of my job is to say, no, so if we've done enough, I, you know, I have to be that kind of person to say, you know, we've done enough. If we do more, you know, the risk benefit ratio is not there.
Dr. Shah:
And as far as amount of volume, it's, it's probably a misconception. Cause someone might think that, Hey, guess what? I put one syringe in someone's lips, in a surgical room and someone flips might be a big change for someone in the penis. You might need, maybe five is conservative. I need 10, 15 before they're going to see that visual impact that they're going to want and maybe, um, their partner.
Dr. David Shafer:
And guys coming off shapes, and just like, breast are all shapes and sizes. We put them inside breast implants, guys spread out at different sizes. And so how much effect you're going to get for a certain number of syringes depends on the ratio of how you're starting with and how much you're putting in. But yeah, five syringes is nothing you needed to put at least 10 syringes and sometimes up to 20 at a time. And I have people with up to 60, 70 syringes in there. So it's, um, you know, it's a significant amount of syringes, but when you think about it, each five syringes is one tablespoon. So it's a lot of packaging and a lot of opening syringes, but the actual amount in there isn't as significant as you would think the problem is the cost. So it is not a cheap procedure because, uh, doctor, the cost for us for this product is a premium product is a premium cost. So it, you know, it's not something that that's just a couple of thousand dollars and say, um, you know, more involved procedures for patients.
Dr. Shah:
But I would think that dollar for dollar, for many men who are thinking about this, I mean, how many times can you do something, have this done and not have to worry about it? I mean, to me, that seems like an amazing, I mean, that's the whole point of plastics, right? You do something so you don't have to think about it and it becomes your way.
Dr. David Shafer:
You know, the number of emails I get from guys and messages from them, how it changed their life, they feel better. Their sex life is better. They feel more confident at the gym, whatever the reason is, why they, why they want to do it. It is fantastic.
Dr. Shah:
Um, so talking about this, um, kind of talking about how it's going to feel for both the male and, um, and again, their partner. So, um, what would, what does it feel like in real life, someone doing this? Is this going to feel, um, similar to like a normal penis? Is it going to feel a little bit different texture wise?
Dr. David Shafer:
Yeah. That's the way I describe it as kind of like you gained weight. So the, uh, the penis becomes obese, so it's a little kind of full, the skin is thicker. Um, and especially in the flacid state, and then in the erectile state, the erection happens like normal and the skin grows with, and the filler grows with it. So, um, it's kind of, if you imagine just that it's a thicker layer around the erection. I ask every patient, you know, how the effects did it work out well, did your partner like, uh, and you know, the vast majority of people would say it was fantastic. My erection is still as hard as it was. It's now just thicker. My partner noticed the difference right away. So it's not something where they're coming back and saying, it's gooshy. It doesn't form, you know, those kinds of things there's constraints,
Dr. Shah:
Any issues with them, we're in condoms. Cause it seems like, you know, if you're, especially, if we're going towards, and this is kind of like, you know, normal breasts will over time, there's, there's like a normal breast versus you, you do press on the face guy, but, um, for penises, when we're going, not just regular size, I'm thinking we're probably going maybe even like maybe supersize, which, which is what my guys probably want. Um, how about condoms? Condoms?
Dr. David Shafer:
No. And actually that's come back and they'll say even the Magnum condom doesn't fit. And then there's actually an, I didn't even know this until I started doing this procedure. There's actually some companies, especially in Europe and the UK that makes custom size condoms. And there's actually, we have a link to it on our, on our website. You download a PDF and there's special measurements you need to take. And then, uh, I think there's about 80 different sizes that they have for length and width and finding one that is comfortable for them.
Dr. Shah:
They probably say we have another Doctor Schaffer patient.
Dr. David Shafer:
I'm sure. Yeah.
Dr. Shah:
There you go. Uh, well, that's amazing. Um, and so just to get a little bit technical with this, so when you're putting it in, you're using Cannula versus needle, um, the reason for cannula is probably, is it vascular? It also smooth texture.
Dr. David Shafer:
Yeah, definitely. So other fillers started out and we just injected them with needles. And the advantage is it goes in very easily. You just poke the needle through and put the product. The disadvantage with a needlle is the length of it to start with. And then I'll show a sharp on the end. So you're putting it through the skin and you can cause bruising, you can go into a different layer that you weren't intending it to go into, but with a cannula, that's a long blunt needle for people who haven't seen them before. And we use a little introducer, which, uh, pokes through the scan and then we just slide the cannula right in. And once you're in the right layer, it's very to slide the cannula around and circumferentially go around the penis or wherever you're injecting the face and, um, slide that slide the product in. So it gives you a degree of safety, but it also there's different lengths of the cannula. So you can reach areas that you may not be able to reach with the needle as well.
Dr. Shah:
And technically speaking, where do you want that layer to be? Do you want to be just below the skin or do you want to be just that little bit later?
Dr. David Shafer:
Uh, a little bit deeper than right below the sskin. And so when you're putting in cannula and you don't, you don't want to see the actual cannula that's through the skin and for people to do a lot of injecting when you're doing this, this superficial line on the lips or superficial line and the nasal labial fold, you almost kind of see the needle a little bit through the skin, but when you're doing it in the penis doing a little bit deeper and it's actually pretty amazing, it's the candidate that just slides right into that layer. And it's a nice open a layer where you can post a cannula. There are some issues. And for instance, if a guy's circumcised or not circumcised, so if you're circumcised, it gives you a nice end point of where the filler is going to go. But also that skin is scarred down.
Dr. David Shafer:
So it doesn't expand as much. Right. But right. But between the glans the end of the penis and the shaft of the penis. So sometimes you can get a little gap where it doesn't expand as much. Cause the filler can't go in there. Sometimes it's secondarily at their next visit. We can go in there and try to break those adhesions up a little bit, to get that area to expand. And then on the other side, you have guys that are circumcised and then you really need to make sure you're getting the filler into their correcte layer and not putting it into the fourth skin and making a constriction of the foreskin
Dr. Shah:
Do you have any issues with trying to, with uncircumcised men trying to put the foreskin back on them? Or is that just sort of an experience thing saying, Hey, guess what I've done?
Dr. David Shafer:
Yeah. It seems to work well, if you get, if you get too much filler though in the actual foreskin though, it can make it tight or just can't get it around the head. So you do have to be careful about that. I also put filler in the head. It's not as effective as in the shaft, the tissue different, but you can enhance the crown around the, around the plans and then also a little bit into the lens itself. But, uh, again, um, you want to make sure there's a good ratio. You don't wanna have a smile head and a large shaft. You get the pigs in a blanket kind of look. And so you really want to make sure that you maintain those proportions.
Dr. Shah:
Do you go circumferentially around or you go just the seventy-five percent?
Dr. David Shafer:
Yeah, definitely. So I got about 270 degrees around. So, um, and then you, you don't want to put too much on the anterior surface because it makes it look almost like a elephant tracks. So you really you're putting the majority of it. I'm a lateral side.
Dr. Shah:
Amazing, amazing. Um, so, uh, I mean, this is, I think, I mean, you you've been doing this for, for quite a while. Do you think, um, what do you think is the barrier to more men doing this? Cause it sounds like the downsides, again, I don't want to put, but it sounds like the downsides are pretty limited based on studies, based on some of the studies done throughout Asia, um, and using fillers, which is some of the safest things you can put in your body. Uh, so it sounds like the downsides are limited. Um, what do you think is this barrier to ultimately get more, just become the breast implants?
Dr. David Shafer:
Yeah, I mean, there's a couple of barriers. One of them is cost, but, um, that's determined, you know, we've put our pricing right on the website. So, you know, before you come in, but you know, and man, I, as accustomed to going to the post surgery office women, more, a higher percentage come in for their Botox. They fillers their breast implants like protection year, over year, men, more men are coming in. So that barrier is going away. And again, like I mentioned earlier, it's not a procedure that you're telling your friends about. It's very, it's very rare to get a patient come in. Cause they said their friend, uh, this other friend, they recommended them to come in with w what you do see with other procedures in other populations. But, uh, I think men, especially men were a concern. It's been a lot of times going on the internet at night and looking for different things.
Dr. David Shafer:
And I found that the men that come in they've they've researched it really well. And, and I think they're very serious and methodical about how they're thinking about it. And they've looked at the risks and benefits. They've looked at permanent fillers . So they come in very informed and have very good questions for me. And usually if a person gets to the point, they're already in the office and made a, um, contemplation and they're ready to have the procedure because they're kind of half and plated, it researched all the risks and benefits ahead of time. It's not something where you come in, you do a consultation and then they don't look at so usually we'll book the consultation and the procedure all, all at the same time.
Dr. Shah:
Um, is it painful for men? So if someone's coming into your office and says, I want to get this done, I want to have 20 syringes. I know I want to do this. Um, what can I do afterwards? Is this going to be a painful day for,
Dr. David Shafer:
Yeah. And I tell them every single guy, when they get up off the table, when we're done says that wasn't as bad as I thought. So, I mean, it's definitely a sensitive area, sensitive topic for, for guys. We have our protocol that we, we put some numbing cream and we use a tiny little Botox needle just to do a nerve block and then go ahead and do the, um, do the product. And the product has numbing medication in it as well. So it's really not as bad as you can think. Most guys sit there playing on their phone and not even paying attention while we do it. And then they're like, oh, you're done already. And then, uh, and then we're done. So it is a weird sensation. They describe having it numb to you. You have this kind of constant sensation of your penis. And if it's not, if all of a sudden this numb, it's kind of a weird sensation for them, but, but definitely not a painful experience
Dr. Shah:
When can they work out and when can they
Dr. David Shafer:
Resume? You know, I tell people to wait about a week for sexual activity working out. I mean, gym wise, they could go the same day, the next day. There's no restrictions for that. I do have the patients massage to the area. And the example I give is the filler several little cohesive property to them. And they kind of want to stay together. And the example is when you make pizza, anybody who's made pizza though, and you kind of press it on the table. And if you keep pushing it, it fits funded to come back to the center. So while the filler is settling and you really want to massage it to keep spreading it out, smoothing it out while it, while it's settling in. So I do have them work on that a lot. The other issue is, uh, you know, the difference between a shower and a grower, the best candidate is somebody who is a shower because of the penis is pretty much out.
Dr. David Shafer:
And you're just filling the various of it. If somebody is a grower, then there's a dynamic issue after the injection. So you put the injections in and then if it shrinks down and turtles in a little bit, then the stand and the filler telescopes down itself a little bit and can cause some time to issues. So somebody like that, you might do a little bit of filler Ellen, come back a couple weeks later, do a little bit more is the weight of the filet hubs, the peanuts, hang out a little bit farther. You can get a nice effect for them as well.
Dr. Shah:
Amazing, uh, other things in maintenance. So someone says they come in for 20 syringes. Uh, they do Voluma. Um, when will they come back again, typically in your office and then how many syringes will they go back and get 20 again? Or they do less as they maintain that?
Dr. David Shafer:
Yeah, definitely. We usually see patients one or two times within the first month or two and, you know, just adding more volume or tweaking the calm tour, those kinds of things. And then even though the product lasts two years, that doesn't mean you don't have to come back for two years. And the example I give is when you fill your gas tank with gas, you drive maybe 150 miles, and now you have half a tank. So you put half as much gas as you put the FaceTime and it gets, it gets through the way you're going. So the first time we're kind of filling up the tank and then every year kind of tapping off the tank with about half as many syringes as you had the first time.
Dr. Shah:
And that makes sense. And I think fillers last longer than I think all of us probably probably know. And I think, for example, someone with lips, maybe we think it lasts six months, but there's some patients I have two years out, three years out where they haven't, they haven't needed filler. So I think it's in some patients in some areas it's just
Dr. David Shafer:
Definitely, yeah. And some patients, some patients, uh, you get a very nice, um, longevity of it and other people have to come more often. I think it's just the natural metabolism in our bodies. You know, the enzyme we used, the mouse at the higher entities is natural in the body as well. And people may have different concentrations of it, different reaction with the body, all this kind of things can affect the longevity of the filler.
Dr. Shah:
Amazing, amazing stuff. And I think this, um, this is groundbreaking year 2019. I bet you in what, maybe one year, two years, three years, but they won't be groundbreaking, but what you've done for the last years, you know, kind of a promoting this procedure and B kind of being one of the four runners is both, um, super brave. Uh, but also it kind of a true Testament to your talent. So, um, and I think that there's probably lots of men actually, and their partners who are, who are thankful for what you do. Um, and you're super busy. So thanks for being on here and, uh, amazing talking to you again,
Speaker 1:
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