Cosmetic Surgery Questions

Airdate: 1/17/14

Cosmetics Cop Paula Begoun is joined by the Nip/Tuck Coach Michele Garber, author of the e-book Safety First! 10 Golden Rules for Cosmetic Surgery. Hear from an in-the-trenches expert about how to find a great cosmetic surgeon, how to prepare, what to expect during recovery, and which procedures give you the most for your money. Michele explains why you need someone like her to help you navigate the confusing world of cosmetic surgical (and non-surgical) procedures.

Paula Begoun: Hello, I’m Paula Begoun, the Cosmetics Cop, here with co-writer and research director, Bryan Barron. We are the bestselling authors of “Don’t Go to the Cosmetics Counter Without Me.” That’s because we’ve sold millions of books. We’re very proud. We’re here to keep you beautifully informed so you can make the best decisions about everything from skincare to makeup, hair care, Botox, cosmetic surgery. You name it, we’ll discuss it. We’ll tell you the truth and take your questions on our Facebook page and answer as many as we can.
00:00:30 Today we’ll be talking about, well, nipping and tucking and correcting and Botoxing and lasering and just about anything you can imagine.
Bryan Barron: Yes.
Paula Begoun: And we have an interesting expert with us that we’re going to get to in just a few moments here. She calls herself the Nip/Tuck Coach. Her name is Michele Garber. Her website is, of course called the
00:01:01 And what this lovely lady does is help people make decisions about plastic surgery, the kind of doctors to work with, what does it mean, how to do it. How to go about it. She, in person, in the San Francisco area, or even in LA, or just over the phone around the country, the United States, helps women get the best results and -
Bryan Barron: Yeah. She’s a self-described, and I think this is really cool about the service she offers.
00:01:31 She’s a patient advocate, navigating the world of cosmetic corrective procedures, of plastic surgery, and then not only trying to find the right doctor for the procedure you want, and determining what procedure is best for you, but then what happens afterwards?
Paula Begoun: Right.
Bryan Barron: What happens when you’re sent home? What happens when you’re having issues with the recovery or you have questions about recovery but you’re in no position to use a phone and call your doctor and say, help, this is going on.
00:01:59 Michele will step and ease you through that and make sure that if it’s not her that’s actually doing some of the after care that she will find someone certified and qualified that can do that.
Paula Begoun: You know, it’s a remarkable service. I actually think as the Nip/Tuck Coach she’s really the Cosmetic Procedure Cop given that we call ourselves the Cosmetics Cop, Michele definitely qualifies as being a cosmetic corrective procedure/plastic surgery cop.
00:02:30 She knows what works and what doesn’t. You know, I have to say, before we talk to Michele, just from a personal experience when I had my facelift, I made the mistake of having my boyfriend and I, who live together, been together for some time, have him around. I expected him to help take care of me. And the poor guy freaked out. He cried. I mean, the amount of pain I was in. And I was in a lot of pain because I also had a laser, a CO2 deep laser procedure.
00:03:04 I had a lot of things going on at the same time.
Bryan Barron: And he did not want you to have it done.
Paula Begoun: Nope. He didn’t.
Bryan Barron: He was very much against it.
Paula Begoun: Yeah. He loved me the way I was. When he saw me, when I finally was able to talk again and open my eyes, my swollen eyes, he said, “I can’t believe you put yourself through this. I loved you the way you were.”
00:03:27 Yeah. If there was a mistake it was not taken into consideration my boyfriend’s strong reaction. He needed to see me afterwards, because I remember at about the four week point he finally said, “Well, I guess it really does look good.” I should have sent him on vacation! So, Michele, are you there? I was going to…
Michele Garber: I am. I am. And I’ve enjoyed listening to you because everything you said is so right on.
Paula Begoun: You know, we typically start the show with some rant or some rave about some skincare product or something we read in a fashion magazine, but I think what you do is unique and deserves attention because we haven’t run into this before.
00:04:18 And so I want to know everything about what you do and, actually, let’s start this way. Let me just remind everybody that we’re talking to Michele Garber, the Nip/Tuck Coach at She is the cosmetic corrective procedure/plastic surgery cop. She’ll hold your hand and advice how you how to get started, what to do before and after. So, given my story, Michele, about my cosmetic surgery and my boyfriend crying in the corner, seeing me in some much pain, if I had called you before I even started the process, what would you have said to me?
Michele Garber: Leave him home!
Paula Begoun: Leave him home or - no, we live together.
00:05:09 Where would I have sent him?
Michele Garber: Oh, well then go on vacation and don’t have him involved until afterwards. I think men - I had a similar experience on a personal level. And so I can totally relate to that. My husband was adamant, even the night before surgery. He was angry and freaked out. And I actually didn’t tell him until the pre-op.
Paula Begoun: Oh my god. No!
Michele Garber: And what was interesting is I went on the internet at that time and I thought, you know, there must be someone else out there that has an issue of how to talk to their husband about cosmetic surgery.
00:05:49 Because you can counsel people on how to talk to their husbands, but when it comes to your own husband, it’s a little bit different. And I couldn’t find anything online. Like no scenario that was similar. And so it’s a - you know, husbands, like you said, they like you the way you are, and they love you the way you are, boyfriend/significant others, and it’s very difficult for them to see you go through the process because they don’t get it.
Paula Begoun: Right.
Michele Garber: And every time I’ve had work done or I’ve had laser and I look like I stuck my head in the oven…
Paula Begoun: Ha!
Michele Garber: …and they will look at me and say, “Are you crazy? Like you’re sick. There’s something wrong with you. Why would anyone do this to themselves? Why? Why?”
00:06:42 And so I think for -
Paula Begoun: Well, actually let me stop you for a second. So, when people say that to you, what is your response to them when they say you’re crazy and why would you put yourself through that? What do you say back?
Michele Garber: Well, I think, I say it’s a very personal decision. And the reason why - everyone is doing it for a different reason. But obviously the end result is what you’re looking for and you’re looking to feel better about whatever it is that’s bothering you. And how you feel on the inside reflects how you feel on the outside. And how you feel on the outside reflects how you feel on the inside. And no one can understand that except you.
Paula Begoun: Right.
Michele Garber: You know why you’re doing it.
00:07:33 And try to explain that to your girlfriend, or your children, or your significant other, it’s very difficult. So, I think the most important thing is the support. It doesn’t matter if they understand it. It doesn’t matter if they approve of it. That’s not what you need. You need the support. You need the emotional support and the kindness and the understanding of what you’re doing.
00:08:01 It doesn’t matter if they understand it themselves.
Paula Begoun: You know, it’s interesting. The other story I tell about the different procedures I’ve had over the years and the reaction my friends and family have had along the way is they’ll often say to me, “Oh, you don’t need it. Why do you need it? You don’t need it. Look how young you look. What are you doing?”
00:08:26 And my comment always is, back, is, one is that - am I supposed to wait until you go, “Gosh, girl, get yourself to a plastic surgeon and lift that stuff off your neck. I can’t see the back corner of your eye anymore. Come on! Go get those eyes tucked and lifted.” The idea is I’m a preventative - my approach is preventative. Not waiting till it’s so bad that I can’t stand it anymore and I look like those before and after women in the - what is that, Facelift Style?
00:09:01 What’s the…
Bryan Barron: The Lifestyle Lift.
Michele Garber: Oh, the Lifestyle…
Paula Begoun: Right. And those terrible before and afters where the woman looks 90 and then all of a sudden she looks 40 again. I don’t want to be one of those women where I’m like desperate to look young again.
Bryan Barron: Actually, Michele, I take it you’re familiar with the Lifestyle Lift?
Michele Garber: I am. And…
Bryan Barron: We get asked about that from time to time and I totally understand why because it’s advertised as a non-invasive, in and out, minimal downtime. You can go back to your normal activities almost right away. Alternative to a facelift.
Paula Begoun: Are you kidding?
00:09:40 They actually say non…I’m sorry, go on, Michele.
Michele Garber: Well, let me put it this way. The Lifestyle Lift is not what it appears to be. And there’s been a lot of controversy about that. There’s been a lot of legal issues about that. You have to be very careful about before and afters because before and afters, there’s a lot of before and after pictures out there that have been Photoshopped and they’re not accurate, that are marketing gimmicks.
00:10:11 So, when you are considering any type of cosmetic procedure, and especially a facelift, you need to do your homework. And you need to make sure that you’re going to a board certified plastic surgeon. You need to speak to other patients. It’s complicated. There’s a lot involved.
00:10:35 If you go to a center that - and you’re looking at before and after pictures, and you think that you’re going to look like that, you’re asking for trouble. That is not how to choose a procedure. And that is not how to choose a facility.
Paula Begoun: Let me just back up for a second. So, just to be clear, the Lifestyle Lift is absolutely a cut and paste facelift.
00:11:04 It is jaw only. Jaw and neck line only. It is a one-stop shop procedure. They only do the same procedure for everybody.
Bryan Barron: On everybody.
Paula Begoun: You actually never see the -
Michele Garber: It’s a mini-lift. And if I can be so bold and say this, I probably shouldn’t.
Paula Begoun: Oh, yeah, we’re bold. No, be bold. Say anything you want.
Michele Garber: It’s run like a retail shop.
Paula Begoun: It is.
00:11:33 You actually, I -
Michele Garber: And that’s not the place that I would recommend or refer anyone to. People go there and that’s their choice. But, again, it’s surgery.
Paula Begoun: It is surgery.
Michele Garber: It’s not to be taken lightly.
Paula Begoun: When I, so many years ago I thought I was going to do a story on that. And I actually went in and had a consultation.
00:11:59 I did not see the doctor. And I was told that I would not see the doctor until the day of the procedure. I only saw a marketing - I didn’t even see a nurse. I saw a marketing salesperson. I was appalled.
Bryan Barron: It’s still that way. You can go to YouTube and find videos of local news stations that have done like exposés on this system. And they pose as patients. Or they talk to women who have gone through it.
00:12:30 And they say exactly the same thing. I never say a doctor. I never say a nurse. Not until I was there. I felt pressured.
Paula Begoun: And the physician doesn’t -
Michele Garber: Is that smart? Is that smart?
Paula Begoun: No!
Bryan Barron: That’s why we need you, Michele.
Michele Garber: And I’ve had clients that have gone through Lifestyle Lifts and it’s not been pretty.
Paula Begoun: So, the other thing to point out that Michele says over and over again on her website at is that board certified is a big deal, in this area specifically. Not a board certified pediatrician. Not a board.. - Because that’s what I found. And some of these news stories that Bryan is talking about is that the Lifestyle Lift, the physicians are not necessarily derm - they’re not even dermatologists. They’re not even plastic surgeons.
00:13:24 They’re not even ocular surgeons. They’re not even surgeons. They just do this cut and paste procedure without any accreditation in that field whatsoever. So, tell me how you walk through a client. If I call you, I don’t live in the San Francisco area necessarily, and I call you and say I’m thinking of cosmetic surgery. Walk me through what you do, Michele Garber, the Nip/Tuck Coach.
Michele Garber: Well, the first thing that I would do is I would ask you what it is that you’re interested in doing. What kind of procedure. And then I would have you send me/email me a photo if you are not local. And that will give me a little bit of a guideline of what you look like and what some of your needs are.
00:14:15 I’m not a medical doctor, so I don’t give medical advice. And then we’ll talk about what your options are if you are feeling, say you just want to rejuvenate yourself, or if you’re actually looking for a face lift, then we will talk about the different options that are non-surgical and weigh those out. This is going to cost you this, this is going to last for his long. And this is your possible outcome. Versus if you go under the knife, these are these things that now you have to think about when you’re having a facelift and you have to be well informed about it.
00:14:57 So, we’ll go through the different types of facelifts. We’ll see some before and after pictures. We’ll talk about how I vet my physicians that I refer to and questions that you should ask the doctor. And how to choose the right doctor for you. Just because you may want to go to the best doctor in your area, that best doctor may not be - they may be best for your girlfriends, or best that you read online, or best you read in a magazine, but that doesn’t mean that that doctor is the best.
00:15:33 And it also doesn’t mean that that doctor is the best for you. Maybe you have special needs. Maybe you are a little more anxious. You need more hand holding. So, there’s a lot I need to find out about you as a client, and your personality, and what your needs are. You have children. How does your husband, you know? There’s just a lot of different things. And then we can go through the process of giving a referral.
00:16:02 I usually give three doctor referrals. And these are doctors that I have personally vetted myself. And it’s not based on how much TV spots they’ve had or how many - how often they’ve been quoted in glossy magazines or been on Doctor Oz or whatever. That is not how I go about vetting my surgeons that I refer to.
Paula Begoun: So, two things.
00:16:30 One is how do you go about vetting the surgeons or doctors who do cosmetic corrective procedures? And do you recommend physicians all over the country?
Michele Garber: I recommend physicians all over the country. What I do is I get their curriculum vitae. I look at their -
Paula Begoun: I’m sorry, can you explain what CV.
Michele Garber: I look at their CV. So, I look at their backgrounds.
Paula Begoun: Wait. I’m sorry. Just to be clear, because not everybody knows what a CV, a curriculum vitae.
Michele Garber: Oh, so I look at their bio or their resume.
Paula Begoun: Got it.
Michele Garber: I look where they went to school.
00:17:05 I look if they’ve published any articles. I look to see what organizations they belong to. How involved they are. And the different meetings that come up all across the country. You know, are they on any of the boards there. Do they do training for other doctors?
00:17:27 Then I go deeper into how many surgeries they do per month of that particle surgery that you’re interested in. What is their specialty. Are they more face? Are they more body? Again, how many visions do they do? How many revisions of the particular surgery that you’re interested are their revisions? How many are revisions coming from different offices or different practices? Some of their philosophies. I look at the staff. If it’s local I’ll actually visit them. I’ll speak with the staff. I’ll look at the patients in the waiting room.
00:18:02 So, there’s a lot. And I’ll talk to the doctors. So, there’s a lot of work that I do in the background.
Paula Begoun: So, Michele, how do you - do doctors actually tell you how many revisions they have to do? I mean, how do you get that information?
Michele Garber: I ask! I’m very blunt. I ask.
Paula Begoun: And they have - well, they don’t have to tell you.
Michele Garber: Well they don’t have to tell me. No. Of course they don’t have to tell me. But, I ask. I ask these questions because these are things you want to know.
Paula Begoun: Actually, you know something? I never - that is - you know, you would think that that would be a basic thing you would think of.
Bryan Barron: How often do you have to redo?
Paula Begoun: And they do have to redo!
Michele Garber: Well, you know, I wrote - I published an e-book which is called The Ten Golden Rules for Safe Cosmetic Surgery. And it’s really simple, to the point, right onto the point. It’s not rocket science. And it’s common sense. However, the information that I’ve written are things that average consumers never thing about.
00:19:07 Like they don’t think about asking these questions before they sign the dotted line. They don’t ask about even revision policies. You know, they sign the paper, but what are they signing?
Paula Begoun: Revision policy. Boy, you know -
Michele Garber: What if they’re unhappy with the outcome of the surgery? Now, what does that mean?
Paula Begoun: God, that is so significant.
Michele Garber: Does it mean that they’re unhappy because their expectations were too high?
00:19:31 Does it mean that the doctor didn’t deliver what the doctor promised? Does it mean that something happened that is not right, but correctable. Where do you draw the line? Well, you need to understand what constitutes a revision and then what’s the financial obligations of a revision.
Paula Begoun: So, we’re talking to Michele Garber, the Nick - the Nick! The Nip/Tuck Coach a where you can download your free copy of her book called - and it’s not long and involved. It is a very easy -
Michele Garber: No, it’s not long at all. It’s very simple.
Paula Begoun: Called “Safety First.” Dr. David Goodkind on her site, who is a plastic surgeon, has said, “Safety First is amazing.
00:20:23 Not only in content but the presentation. Michele has very succinctly nailed everything the lay person should consider before signing on the dotted line, of which includes…” You know, it’s funny. I love thinking I know all this stuff, but I never asked what happens if things go wrong and what is your responsibility and what is mine. Because let’s say I don’t like it. You didn’t do anything wrong. I just think you didn’t tuck enough or you tucked too much. We disagree, not necessarily that my scar is too thick or…
Bryan Barron: Or the incision made was longer than you thought. You know, he told you half an inch, and you got an inch and a half!
Paula Begoun: And then what does that mean because things happen.
Bryan Barron: And you’re out.
Paula Begoun: Right.
00:21:13 you’re not there to say anything.
Michele Garber: You have no control of the outcome. It’s all in the surgeon’s hand. And there are some patients that are just disgruntled patients that will never be happy with anything. And then there are some patients that have real legitimate issues that have happened after cosmetic surgery.
Paula Begoun: Well, and some of it is the surgeon also needs leeway because when they’re in there in surgery, some of what you’re getting, a cosmetic surgeon or anybody who’s doing corrective cosmetic procedures is their creativity. There is art to this. Not just medicine. Not just medical knowledge. There is art.
00:21:59 And when they’re in there cutting and pasting or lasering or injecting, their skill, their knowledge base is only part of it. Their creativity - they need leeway because - and unfortunately they don’t always tell you that. That once I’m in there, you know, you might need an inch and a half as opposed - I might have to do an incision that’s an inch and a half versus a half an inch because until I get in there I don’t really know.
Bryan Barron: You don’t know.
Paula Begoun: And they don’t necessarily tell you that.
Michele Garber: No, it’s very true. I think communication between the doctor and the patient is really key.
00:22:33 And for a doctor, if you walk into a plastic surgeon’s office and he looks at you and he says, “Ah! Easy case. You know, just sign here. It’s going to be easy. You’re going to be beautiful afterwards.” And, you know what? A lot of consumers just say, Okay.
Paula Begoun: So now have you done a situation for a patient that is out of town, not in the San Francisco area where you’re located, where during my consultation with a surgeon, even one that you have approved of, can I have you on the phone and do a conference call during my pre-surgery, you know, while I’m vetting my cosmetic surgeon?
00:23:16 Can you be on the phone with me?
Bryan Barron: I want you to know the Nip/Tuck Coach is on speakerphone!
Michele Garber: If you need that type of handholding, absolutely. Usually when I work with out of town people, generally a lot of them have very specific - like the know I want a tummy tuck, or I’m not quite sure I want a tummy tuck and maybe it’s just liposuction. And a lot of it is the educational process, because once you walk into a doctor’s office, they are going to tell you what they want you to purchase. And you have to understand, it’s still a business. And if you are interested in, for instance, let’s say laser, and the doctor has two laser machines in his office and he just spent $354,000 for those laser machines, he’s not going to send you to the guy across the hall, or across town for a different laser treatment.
00:24:06 So, you really need to have an understanding of what procedures you are interested in and have done your own homework and your own due diligence so that by the time you actually meet with the doctor you’ve got informed questions to ask. And you know that those questions are going to get answered. And then you can make an informed decision based on those answers.
00:24:32 So, it’s really important, again, I go back to it’s more than just doing your research online. It’s really - you really got to get in there and you’ve got to vet even the people that you’re communicating with online, because I know from stories and people that I’ve spoken to in doctor’s offices, you know, even on some of the message boards - sometimes it’s not the doctors answering those questions. It’s actually marketing people.
Paula Begoun: Right.
Michele Garber: A lot of smoke and mirrors out there.
00:25:05 And it’s important to know - have all the information you possibly can have. And if you need someone by your side, if my clients need me to hold their hand, I am there for them throughout the entire process. Now, because of HIPAA, there are some things that doctors get a little bit worried about. And you have to make sure that you’re compliant with all of the legal medical laws.
Paula Begoun: So, HIPAA is the patient disclosure, what you’re allowed to say about the patient.
Michele Garber: Right. Right.
00:25:45 And there are doctors that are reluctant to have like a third party involved with the surgery process, or the post-op process.
Paula Begoun: Really?
Michele Garber: And I always tell - yes - I’ve run into that here in San Francisco. But I’ve always told my clients that I work with that if they need any post-op, you know, sometimes things happen post-op and you are - consumers are a little bit afraid to talk to their doctors. They’re going through some things and it’s emotional. It can be depressing.
0026:20 They worry about every little scar, ever little wrinkle, every little puff. And doctors basically will say, “Okay, you’re healing fine. You look great. You’re healing fine.” Well, that is sometimes not enough.
Paula Begoun: Right.
Michele Garber: And because I have gotten phone calls from clients post-op where they’re really depressed. “And my doctor thinks I’m crazy and neurotic.” And it’s important to have that communication with the doctor. And if you’re feeling a certain way, you need to pick up the phone and talk to your doctor.
00:26:55 And even if you feel that you’re bothering him, you’ve paid for this. He works for you. You need to have that talk.
Paula Begoun: Right.
Michele Garber: Go to his office. If you have to wait all afternoon to see him, you have to do that if that’s going to make you feel better.
Paula Begoun: Right. That was something that was - despite the fact that I forgot to ask about revision surgery, and I actually did have a revision surgery that they - when something didn’t go right that they did pay for.
00:27:28 I mean, they did - they pick it up. But I hadn’t asked about it. Just like what you said, it didn’t occur to me to ask what happens when I’m not happy or something goes wrong. So, actually, I forgot what I was just going to ask you. But let me ask a different question that I can’t remember. “Safety First: The Ten Golden Rules Before you get Cosmetic Surgery” or any cosmetic procedures. Can you go over briefly some of what’s on that list in your free download of your book, “Safety First,” on
Michele Garber: Yes.
00:28:08 Absolutely. Rule number one. Only go to a board certified plastic surgeon. And people have to understand that all plastic surgeons are cosmetic surgeons, but not all cosmetic surgeons are plastic surgeons. And they really need to understand the difference of the board certifications and that the board certification for a plastic surgeon, his training is very different than a cosmetic surgeon in that the certifications for plastic surgeons - that’s really the only approved of certification.
Paula Begoun: So, wait, I’m sorry. Again, this is -
Michele Garber: It’s a bit confusing.
Paula Begoun: This is why we need.. -
00:28:50 You are the plastic surgery/cosmetic corrective procedure cop, Michele Garber, at What is the difference between being certified cosmetic surgeon versus certified plastic surgeon. What’s the difference? It sounds the same to me.
Michele Garber: It’s not. The training is very different. So, a cosmetic surgeon can have medical training and general surgery training. A cosmetic surgeon can be board certified - he could be a radiologist, a gynecologist and go through a medical specialty in cosmetic work and get then board certified as a cosmetic surgeon, but does not have the same training as a plastic surgeon.
00:29:37 A plastic surgeon has to have at least three years of general surgery training and three years of plastic surgery training. Has to pass a very comprehensive written and oral exam. Adhere to strict codes of medical ethics. And the cosmetic surgeon, I’m not saying that a cosmetic surgeon is unqualified or unskilled, it’s just that they don’t have the same training as a plastic surgeon.
00:30:04 So, again, all cosmetic surgeons and plastic surgeons belong to various medical boards. So, there is a medical board for cosmetic surgery, but it’s not the same as the American Board of Plastic Surgery.
Paula Begoun: Just so I get it, I just want to wrap my brain around this, because this sounds phenomenally important in terms of skill level that you would be getting when someone is cutting and pasting your face back together.
00:30:34 A cosmetic surgeon could be any kind of doctor, could be a pediatrician, who then decides I want to do cosmetic surgery.
Bryan Barron: There’s money to be had here.
Paula Begoun: Yeah. And they pay upfront. And nobody ever - or rarely - dies. It’s relatively popular. Whatever, decides to go into business. They literally just could take a special course.
00:31:02 They don’t have to do this extensive training that a plastic surgeon does in terms of their accreditation?
Michele Garber: So, I’ll try to make this as clear - it’s confusing - as clear as possible.
Paula Begoun: Yes.
Bryan Barron: Okay. So there is the American Board of Cosmetic Surgery which is different than the American Board of Plastic Surgery.
Paula Begoun: Oh, gosh.
00:31:29 Now it just got more complicated. Everybody - wait, wait - Michele Garber, everyone who is listening, because even after you hear Michele say this, you’re still going to have to read it. So, you have to go to and you have to download her book, easy-to-read book called safety first where what she’s about to explain, she has explained there, because right now you just said it, and it is hard to follow.
00:31:57 But I want you to say it one more time about the two different boards, because if you’re asking for board certification, which we all should be doing when we’re looking at a plastic surgeon, we need to understand this difference because it’s a major difference. So, one more time, Michele.
Michele Garber: So, there is the American Board of Cosmetic Surgery, but that is not the same as the American Board of Plastic Surgery. Plastic surgeons are trained exclusively in reconstructive surgery of the face, head, an neck.
00:32:39 In order to be a cosmetic surgeon, you need to be a board certified doctor, but you can be a board certified doctor in other surgical specialties like dermatology, general surgery, obstetrics, ophthalmology. So, you can be certified as a cosmetic surgeon, but you first have to be certified as a medical doctor of another surgical specialty. But your training is different.
Paula Begoun: Radically different.
Michele Garber: A reconstructive surgeon.
Bryan Barron: So, Michele, if I’m a cosmetic surgeon, I’ve gone through all the steps you just described, but I’m not a plastic surgeon, are there procedures that I would not be qualified or authorized to do that a plastic surgeon can do?
00:33:33 Or is it just kind of like cosmetic surgeon, I can do everything a plastic surgeon can do. But, really they’ve had more training and they’re more expert and I’m just kind of, you know, hoping for the best here?
Michele Garber: A plastic surgeon does have more training. And there are some very qualified board certified cosmetic surgeons that do cosmetic surgery. That may be dermatologists and have a lot of training in surgical specialties of dermatology or general surgery. Or E&T surgeons.
00:34:13 They do, I mean, they’re skilled in the head and neck.
Paula Begoun: ET meaning?
Michele Garber: Ear, nose, and throat.
Paula Begoun: Ear, nose, and throat.
Michele Garber: And there’s a lot of plastic surgeons that are double board certified, so they’re board certified as an E&T doctor as well as a facial plastic surgeon .
00:34:32 So, it is confusing and there are websites that an individual can go to like the - And they can get - and that’s the American Society of Plastic Surgery. And they can get a little bit more of an understanding of the different board certifications and what to look for, but it is confusing and it’s going to get more confusing because more and more doctors, medical doctors, are looking to make more money. And are looking to get into the world of cosmetic medicine.
Paula Begoun: So, obviously - well, not obviously necessarily. But if I’m shopping for a plastic surgeon, cosmetic surgeon, which seems to not be the same title now that we are listening to Michele Garber, the Nip/Tuck Coach at
00:35:33 Is that a cosmetic surgeon obviously who was an ear, nose, and throat doctor, or a surgeon, or an ocular surgeon, an eye surgeon, who then decides to go and be trained as a cosmetic surgeon, or plastic surgeon, has the skill set to then merge into that additional field. Whereas if you’re a heart surgeon or, I don’t know what other kinds of - there are all kinds of surgeons.
00:36:01 You know, internal surgeon, whatever other, taking out appendixes, whatever it is you do as surgery.
Bryan Barron: A brain surgeon.
Paula Begoun: And then you decide to become a cosmetic surgeon. Obviously the specialty of already operating on the face puts you leagues ahead of, even though as a heart surgeon you might have been brilliant. Being able to do the face is a whole different area of surgery. Would you say that’s a fair assumption?
Michele Garber: Yes.
00:36:31 I think it’s important to understand what your doctor’s specialty is and what his training has been, or her training.
Paula Begoun: Yeah.
Michele Garber: If they’ve been trained in the head and neck area and they’re double board certified, then that’s an excellent surgeon to go to if you’re going for a facelift. An ocular plastic surgeon, they do eye lifts. I mean, that’s their training.
00:37:03 They have been trained in ophthalmology and the eye area and they’re very skilled at that. So, I’m not saying that cosmetic surgeons are unskilled. What I’m trying to get people to understand is that there’s a difference in training. All plastic surgeons are cosmetic surgeons. All cosmetic surgeons are not plastic surgeons.
Paula Begoun: And what they were doing before they became cosmetic surgeons is incredibly significant in terms of their skill set?
Michele Garber: Right. And a lot of cosmetic surgeons, many of them specialize in non-surgical. They’ll do liposuctions. They’ll do fillers. They’ll do Box.
00:37:49 Yet, some cosmetic surgeons will do breast augmentations and facelifts. And maybe they’re a dermatologist and they’ve been a board certified dermatology for 30 years. So, I’m not saying that they’re not skilled enough. Again...
Paula Begoun: It depends on what they were doing.
Michele Garber: It’s complicated.
Paula Begoun: Michele, we’ve spent a lot of time on just the first safety, “The Ten Golden Rules.”
Michele Garber: Well, that’s the most important.
Paula Begoun: That’s the most important one.
Michele Garber: That I think is really key, is understanding your doctor’s certification. And the second one I have is do your own due diligence. The online world of cosmetic surgery is very deceptive.
Paula Begoun: Say that again.
Michele Garber: Do your own due diligence. The online world of cosmetic surgery is very deceptive.
Paula Begoun: How do you mean?
Michele Garber: When you are online and you’re doing your due diligence online, are those people real?
00:38:48 Are those message board people real? Try and vet them. See if they’ll email you off those message boards.
Paula Begoun: You know, one of the things, I believe I read this in your “Safety First” book, your “Ten Golden Rules on Cosmetic Surgery,” or “Plastic Surgery,” was that sometimes there will be negative comments about a surgeon and that doesn’t necessarily speak to the quality of the surgeon.
00:39:19 Rather, it speaks to a disgruntled woman who for whatever reason can’t ever be happy, or just whatever - that it might not be a legitimate problem. And it also assumes that no other doctor has problems, which of course is a lie. All doctors have some amount of negative outcomes. Not necessarily dangerous, but just where something didn’t go the way they wanted it to, or you wanted it to. And that those negative comments sometimes are irrelevant in terms of the quality of the doctor.
Michele Garber: Yes. And not only that. There are some competitive practiced that are writing reviews that weren’t even patients.
Paula Begoun: Ooh!
Michele Garber: But they’re actually employees.
Bryan Barron: It is wicked out there.
Michele Garber: Or staff from a competitive practice.
Paula Begoun: Ooh!
Michele Garber: That say negative things about a competitive practice.
Bryan Barron: Because they know how much stock consumers, you know, shopping for this type of thing put in those reviews.
Paula Begoun: Oh, how do you like that?
Bryan Barron: They want to hear from someone who has ostensibly gone through it.
Paula Begoun: You know, we’ve said this before for our own work is that often - and we can often tell the criticism we get about our work usually comes from somebody at a cosmetic counter because they haven’t read our book.
00:40:45 We can tell - or seen our site. They know that we criticize the cosmetics industry and we can tell the way they criticize us that they haven’t really read what we’ve said, because we’ve actually said - they’ll say, “Oh, they don’t like anything. They hate all cosmetic products.”
Bryan Barron: Except their own.
Paula Begoun: And obviously you’d only have to pick up our book and look at Beautypedia and notice that we recommend a lot of products that are not our own. And we give lots of products happy, you know, good ratings. So, yeah, it never occurred to me that that could flow over to other areas of critique. So, give me one other golden rule that is your favorite of your Ten Golden Rules in your “Safety First” book that you can download for free on
Michele Garber: Oh, one of my favorites.
Paula Begoun: Yes?
Michele Garber: They’re all so good. Never shop for bargain plastic surgery. I think that’s really important for people to understand that it’s not like buying a pair of designer shoes. You can return those shoes, but you can’t return your face and your body if you don’t like the way it looks.
Paula Begoun: Ha!
Michele Garber: So, you really have to - don’t bid for plastic surgery.
00:41:57 Please, please, please don’t go on those websites and bid. Don’t buy a Groupon. An excellent top doc is not going to advertise on Groupon. He doesn’t need the business. Don’t even get Botox from a Groupon. Bad, bad, bad. Save your dollars. Save your latte money. Save it. It’s a bad decision to buy something because of the price. This is your face and your body.
Paula Begoun: So, Michele, you - Michele Garber, the Nip/Tuck Coach.
00:42:28 You’ve obviously had cosmetic procedures and plastic surgery. Can you walk us through some of the ones you’ve had personally and which ones you thought worked best for you and which ones didn’t? Which ones you would do again? Which ones you wouldn’t?
Michele Garber: Sure. Well, let’s see, I’ve been getting Botox since before it was FDA approved, so I’ve all sorts of experience with Botox. I’ve looked like Dr. Spock. I’ve had injectables. I’ve had duck lips where my husband thought I was a total freak.
Paula Begoun: Oh my gosh.
Michele Garber: You know?
00:43:06 I’ve had allergic reactions to hyaluronic acids.
Paula Begoun: Ah!
Michele Garber: Before some of them were FDA approved fillers. When the doctors said, “There’s no allergic reactions,” and I blew up like a puffer fish.
Paula Begoun: Oh my gosh. Oh my gosh.
Michele Garber: Yeah, it was kind of funny. I mean, it actually looked fun.
00:43:28 I’m not sure what caused that. I think there might have been some formulation. Again, this was off label, before it was FDA approved in the US. And since then I’ve had fillers and I’ve never had a reaction. But that’s been kind of interesting. I’ve had laser - I’ve had different laser treatments. Fractional lasers. Some of them worked. Some of them, I didn’t see much difference. I had Thermage when Thermage came out.
00:44:03 It was extremely painful when it first came on the market. This was several years ago. And I saw no improvement whatsoever from that.
Bryan Barron: Ugh. Bummer.
Paula Begoun: Nothing worse than going through pain and not seeing something better.
Michele Garber: Thermage has gotten better. You know, it’s not for everyone. It really depends on the elasticity of your skin. How old you are.
00:44:29 You know, you have to look at the amount of money that you invest in a lot of non-invasive procedures, how long they’ll last. And if you’re willing to wait the time, the six or nine months for collagen buildup. And is it worth the several thousand dollars or do you want to put your money aside in a piggybank for a face lift? Because in my opinion there is a time of kind of no return when you’re at a point of your age where, you know, none of this stuff is really going to work for you.
00:45:02 Where you - fillers will be fine. And Botox is fine. But some of the other new technologies just may not work because you just don’t have the collagen and elastin anymore. You’re not a 30-year-old. And I don’t think even if you have a facelift, if you’re 60 you’re not going to look 30.
Paula Begoun: Right. Right.
Michele Garber: So, you need to understand that as well.
Paula Begoun: What were the procedures you had, Michele, that you thought given what you wanted were the best bang for your buck?
Michele Garber: Well, I’ve also had a facelift. And I’ve had my eyes done.
00:45:39 And in my case with my face lift, I actually do need a revision.
Paula Begoun: What happened?
Michele Garber: I had a lot of residual elasticity early on in the facelift because it wasn’t pulled tight enough. Now, this could be a whole other conversation of why and the doctor and etc, etc. But things happen. You know, unfortunately it happened to me, but it can happen. Where there is a fine line between too tight and then not tight enough. And then once the doctor goes in there, it’s a judgment call.
00:46:22 And then they don’t know whether you’re going to have a relapse elasticity or not. And in my case it’s just one of those things that happened. So, it could happen to anybody.
Paula Begoun: So, we just have another minute or so with you. Can you sum up your incredible experience and what you do as the Nip/Tuck Coach? What we have been saying is you’re the plastic surgery cop at And your free book on the “Ten Golden Rules of Plastic Surgery,” what you should know.
00:47:03 And absolutely read before just about any procedure you decide to have. Can you kind of sum up what it is you do and what you recommend for us, whether we call you or not?
Michele Garber: Sure. I basically help you navigate the confusing world of cosmetic surgery and cosmetic treatments. And there is a lot of information out there that I help sort through. And a lot of people are busy and they don’t really have the time to do it. And then there are things that people don’t really think about. And they need to really take a look at this process as that there is a lot involved in it.
00:47:42 It’s really not that simple. And if you think it’s simple, that’s great. Then you don’t need me. But, for most people it’s not simple and even after you’ve seen doctors, it’s very confusing. So, to have someone that gives you the support, that has the knowledge, I don’t give medical support but I give the guidance and I can help you sort through the different options. It can help you sort through the doctors. We can talk about what it is that you need and also post-op, to just help you get to a place where you’re feeling good about yourself and you’ve got great communication with your doctor, because anything can happen.
00:48:20 And you’ve got to be prepared. And you’ve got to know you have to be prepared and you’ve got to know what to ask. And you’ve got to know what to look for. And you have to go through this with an open mind. And I think that’s really important and that it’s just going online and making your decision or being blind about it is not the right way to do it, because you’re asking for trouble. And so my whole mission is really safety and education. And I’m very passionate about educating consumers…
Paula Begoun: Oh, yeah are!
Michele Garber: …and to make sure that they have a beautiful experience and they get the best possible results that they can from their surgeries. And they make the right choice that’s right for them.
Bryan Barron: Even if that choice is to not have anything done, right Michele?
Michele Garber: Right. Absolutely.
Bryan Barron: Just because you’re going down that rabbit hole, so to speak, of having a consultation, talking about procedures, getting quotes, getting second opinions, you’re not committed to it.
00:49:26 It’s an information, fact-finding mission, and it’s always your prerogative to say, “Now that I have the information, this is not right for me. Or this is not the right time for me.”
Michele Garber: Absolutely. And I have had that happen with clients. Where they’ve just bowed out and said, “You know what? I’ve heard enough. I am not ready!”
Paula Begoun: I’m not ready. Well, Michele…
Michele Garber: Yeah. And so I’m so grateful that I could help them get to that space so that they’re comfortable with their decision.
Paula Begoun: Right.
00:50:00 They make the best decision - an informed decision.
Michele Garber: If your girlfriend had a great result with the surgeon, it doesn’t mean that surgeon is right for you.
Paula Begoun: Right. Well, Michele Garber, the Nip/Tuck Coach at And where you can download her free “Safety First: Ten Golden Rules of Plastic Surgery” book. Thank you for taking your precious time today and…
Michele Garber: Well, thank you.
Paula Begoun: Your passion is clear.
00:50:26 Your mission in life is clear. And lord knows you’ve helped me. I know you’ve helped Bryan. And our listeners will be grateful and I know they’ll be coming to visit. Michele, thank you for taking your time. Hope to talk to you again soon.
Michele Garber: Thank you so much. I enjoyed it.
Bryan Barron: Thanks Michele.
Paula Begoun: All right. Bye-bye, Michele.
Michele Garber: Thank you.
Paula Begoun: So, this was, wow! Boy, it’s not often I walk away feeling just awed. And so much better informed than when I started.
Bryan Barron: Yeah. It’s not very often. I mean, we love having special guests on this show for that extra perspective.
00:51:00 So it’s not just us talking all the time.
Paula Begoun: Yes!
Bryan Barron: And I think it’s actually good that our listeners know that we do - you know, if we don’t know enough about something, we will reach out to other experts, because it’s all about educating and helping you out.
Paula Begoun: Absolutely. Knowledge. Exactly.
Bryan Barron: But it’s not often we have a special guest were just what you were saying, you walk away thinking, “Okay, that was an eye opener”
Paula Begoun: I did not know that. Wow. That was great.
Bryan Barron: She’s a great resource.
Paula Begoun: So, I’m Paula Begoun, with my better half, Bryan Barron. We are the team for “Don’t Go to the Cosmetics Counter Without Me.” We’re part of the team because it is a whole process. Come visit us at Our articles. Our product reviews. And, of course, Paula’s Choice products are all there for you. Thank you for listening.
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