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Josh (03:59.898)
Dr. Sheila Nazarian. Thanks so much for joining us.

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Dr. Sheila Nazarian (04:16.098)
Thanks so much for the opportunity. I'm excited to chat.

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Josh (04:19.158)
Likewise, so Sheila, everybody's kind of got their villain origin story. Um, not that you're a villain per se, but I'd love to learn a bit more about you and what actually got you into plastics in the first place.

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Dr. Sheila Nazarian (04:31.626)
Yeah, so even as a young kid, I think I was always doing like arts and craft stuff like, you know, my family escaped from Iran and I made my own suitcase out of duct tape and paper bags. I was always doing these little projects and my mom would just be like, what are you doing? Go outside, shoot a ball, you know, but she used to call me a motahaseh karayi bi khodi, which means the expert in useless things.

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But I think it really helped me become an artist first. And then I was really good at math and science. And so my father was a pathologist, he was a physician. I said, what includes all of this stuff? I did wood shop in the fourth grade. I loved hammers and drawing out a blueprint and then sort of making the thing with my hands. So I said, maybe I'll do orthopedic surgery. So I started following around an orthopedic surgeon and.

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realized it wasn't as creative as I'd hoped. It was very cookie cutter. Like you would literally put a plate on and cut around it and then the piece would fit right in. So I wanted something a little bit more creative. I was talking to one of my friends about it. He said, why don't you do plastic surgery? It sounds like it's right up your alley. He introduced me to a plastic surgeon who became my mentor and I never looked back. I think it's the perfect blend of art and science. And I just really technically liked it. I think that being a surgeon and

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you know, a plastic surgeon with what they make it out to be on TV is kind of fun. And it was a little bit exciting too. But really, I just really liked the technical and artistic aspects of the job. And now with my practice that I've sort of built, I get to meet really cool people. And I think now in my job, it's not as creative because I've done every procedure a gazillion times. So it's not like.

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even though I'm making little slight adjustments based on someone's particular anatomy, I'm not thinking as much. I'm not tapping my creative juices as much. So really I've looked through other avenues to fulfill that creative side, whether it's marketing or social media or I'm sitting in my closet right now. My podcast is called The Closet. I love fashion. And so I think that I've always had that creative side. I think it's just kind of shifted throughout the years.

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Josh (06:42.651)
Hmm.

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So creativity, I mean, you make it sound so simple. Like I just decided I'd get mentored and become a plastic surgeon, sort of just negating the 15 years of school and training and education. It does sound easy, but I can imagine it was a very arduous task to get here.

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Dr. Sheila Nazarian (06:46.114)
So.

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Dr. Sheila Nazarian (06:55.703)
Yeah.

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Dr. Sheila Nazarian (06:59.886)
It was very difficult. I have, you know, I met my husband three months before I had to make the decision of where I would say like yes to, it's called the rank list. And he had just graduated from neurosurgery and two fellowships. So he was finally home after 14 years. And he basically told me we either get engaged tonight and you only rank Los Angeles or we don't get engaged and you rank all the places you interviewed. Now getting accepted into plastic surgery is back and forth.

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one of the top two most difficult residencies to match into. And so I had to make that decision having met this guy three months ago, right? But I decided to choose family over job and I ended up only ranking LA. Thank God I matched into my number one program. So that worked out, but it was a huge risk. Everybody thought I was nuts, but thank God. I always say that year I matched in life and I matched in career.

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So that's difficult. And then during my residency, we had to do three years of general surgery and three years of plastic surgery training. I did it in Los Angeles at the LA County Hospital mainly. And I had three pregnancies as well during that time, which made me even more exhausted. We were working 80 hours a week, every third night in the hospital, but got through, have three great kids. Actually, my anniversary with my husband is in three days and we'll be married 18 years.

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So I know it's kind of crazy. I can't even believe it. But yeah, it was tough.

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Josh (08:22.498)
Wow.

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Josh (08:28.526)
That's amazing. So I gotta ask, I mean, we often think, or I'd like to think I have an idea of what the most common surgeries that you do are, but what are the most common procedures?

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Dr. Sheila Nazarian (08:41.446)
I have a full blown surgical suite. I have 30 lasers and devices in the spa. So really, and also skincare, I think, is a very overlooked topic. I always say, it's kind of like you do a facelift on someone. It's like making a bed. So you can pull the sheets and tighten the sheets and tuck them in.

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But if it's wrinkled and dirty sheets, no one wants to sleep in that bed. So you really have to take a very four dimensional look at aging. And if you do, people end up looking very natural. So again, you can't pull someone's lower face and not fix their eyelids or not take, you know, soften wrinkles or get rid of sun damage. Otherwise people are gonna say, that doesn't make sense. And then people know you've had something done. The whole like idea is to make people look natural, no stigmata of surgery. Nobody knows you did anything. They're just like, why does this person keep looking younger and younger?

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That's the goal. So very quickly, I had to sort of do all things for all people so that they look normal and everything makes sense. And no one's questioning if they've had something done. That's how our practice is built. My hashtag is naturalbynazarian. You know, like, I think that's what people want, thank God, these days, most of them, if they're sane. And I only wanna deal with sane patients. So it's sort of like, you know, what you put out there is what you attract.

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Josh (09:53.11)
they're saying that's the operative word.

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Dr. Sheila Nazarian (09:59.83)
So I put out Sanity and I attract really cool patients that I learn a lot from. But yeah, I think the major thing that we're known for is facelifts, mommy makeovers, including labiaplasty, vaginal rejuvenation. For a while I went on the doctor show for buccal fat removal and that was a whirlwind of buccal fat pad removals.

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Josh (10:05.062)
That's awesome.

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Dr. Sheila Nazarian (10:28.534)
But yeah, I think what most of our patients do, 70% of my patients don't even live in California, they're flying in. So what they do is they fly into California for two weeks and we literally do a head to toe overhaul, whether that's surgical, minimally invasive, lasers and injectables and skincare. And then they fly home and tell their friends they did a juice cleanse in Joshua Tree and no one knows they had surgery or anything else done. That's kind of, we call it the Nazarian special.

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So really it's not about what is the thing that I think nationally in America, a liposuction and breast augmentation fight for number one and two as far as most common procedures. But in my practice, it's really I give all the patients information and then let them choose what their priority is at that time and it could be one thing, it could be all the things.

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Josh (11:18.39)
Now obviously prepping for surgery isn't easy. And with most of America being pre-diabetic or diabetic or obese, there's a lot of illness and chronic inflammation people are dealing with. So you mentioned that you do a pre-surgical protocol for every single one of your patients. What does that look like and how do you find that impacts both the surgery and the success rate as well as the recovery?

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Dr. Sheila Nazarian (11:41.154)
I have to start out with like, you know, you want to sleep well at night as a physician. You don't want to be too hungry. You don't want to be greedy. And so if a patient is not a great specimen or optimized as well as possible for surgery, you don't take them to surgery. This is not adverse appendix. This is not open heart surgery. This is elective, you know, cosmetic, aesthetic surgery.

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Now that doesn't mean I haven't operated on syndromic people. That doesn't mean I haven't done work after cancers. But you want that person optimized. So we start off by looking at their weight and seeing if we need to put them on a weight management program first. I think that there is diet, exercise, there's now the semi-glutides, which have been amazing, amazing. I cannot tell you.

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As a woman who's over 40 and I've never had to worry about my weight ever if anything I was drinking like four shakes a day to try to gain weight and Might when I was younger because I was getting teased for being too skinny When I hit 40 after three kids I could smell food and gain weight and it became Impossible to lose it and you think you're and you're just basically hungry all the time But it is that insulin resistance. It is that changes that are real

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once you hit 40 and I've heard 50 and I've heard even worse 60. So having the help of the, you know, Ozempics and the Monjaro's has been a game changer in my practice and has saved a lot of people from needing as much surgery, which is fantastic. So I think that those have been a great help. So if a patient needs to lose weight, we, we help them, you know, plug them into that first to help them, you know, get to the point where they are the safest they can possibly be.

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before we do anything to them. That's number one. Number two, as far as the protocols go, and I have to tell you, I was very resistant. I was that typical, you know, Western doctor mentality that LED lights don't do anything and Arnica is BS and like all of this stuff. But in speaking internationally and visiting different countries and seeing what their protocols are, I actually do compound Arnica, bromelain, and vitamin K.

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Dr. Sheila Nazarian (14:02.366)
And for non-facial surgeries, I have them start that two weeks before. And for facial surgeries, I have them start that a month before. The other thing that I start them on is protein. So I love the Premier Protein drinks. They're at Costco, they're at Target. They're very easily, you can find it online. 30 grams of protein, one gram of sugar and vitamins.

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I'll tell you the number one reason why someone doesn't heal well is low protein levels. So we check their prealbumin, which gives us a snapshot right now of their protein levels. We check their albumin to make sure that over time they've had consistently normal protein levels. Patients think after surgery, oh, now I can diet. I feel so much cuter. I feel so good. I'm going to like do this. And they decrease their protein levels and their caloric intake in general. They were healing perfectly. In two weeks, they start to get little tiny openings.

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Josh (14:32.73)
Hmm.

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Dr. Sheila Nazarian (14:57.718)
because they started dieting or they'd lower their protein levels. So it's not just about doing the best job that I can in the operating room. Things like hyperbaric oxygen, lymphatic massage, huge, totally thought that was BS. Totally thought not necessary. Now I won't even liposuction someone if they say I'm not going to get lymphatic massage. I always say I'm 80% of the result. The things you do before and after the surgery are 20% of your result. And if you're making that

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monetary and time commitment to undergo this procedure, we want to get the best result ever. And so all of these little things like the arnica-bromley vitamin K, scar therapy starts at two weeks. At two weeks, we also start giving them turmeric because turmeric is anti-inflammatory, but it's a blood thinner. So we don't want to give it before or immediately after surgery. But two weeks after we throw in turmeric so that swelling continues to dissipate more quickly. So it's just all of these little things, you know.

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Collagen. Yeah, you know all of these little things that really helps someone heal safely and quickly and So I've had patients come to me and be like my friends had tummy tucks and they were like out for three months What the heck I literally took like three pain pills and I was out of bed the next day making myself breakfast like, you know, so those are the kinds of Conversations that we want our patients having with their friends, right? We want to say I don't know what you guys are talking about. It was smooth sailing

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You know, those are the things that we want to change the conversation, not just in my practice, but industry wide.

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Josh (16:31.514)
Have you ever had somebody come in and imagine you do a medical history, got to go through due diligence, not only for good practice, but liability reasons. But somebody who comes in who complains of chronic gut dysfunction, be it IBS, IBD like Crohn's colitis or some other kind of GI dysfunction. What's the correlation you've seen between gut issues and being able to actually handle surgery and recover from surgery?

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Dr. Sheila Nazarian (16:39.222)
Yeah, exactly.

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Dr. Sheila Nazarian (16:57.014)
Well, I think the gut issues in my aspect of the world is really, are you able to absorb nutrients? I think, again, going back to the protein, like zinc is necessary for collagen cross-linking, vitamin C is necessary for collagen cross-linking, and it's not just the gut issue patients, also get the people that have had gastric bypass. Lots of issues, right? So that's why I think now gastric sleeve.

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is a little bit more because you're not bypassing half of the intestines. Because the intestines, I don't know if your audience knows, but like the first foot absorbs certain vitamins. The second three feet absorbs another set of vitamins. So if you bypass half of your intestines, now it becomes very difficult for those particular vitamins to be absorbed. The hair starts falling out, there's skin changes, you know, there's, there's issues. Same with, I had a patient that had a colitis so bad, they had to remove a large part of her large intestine.

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and she has a lot of diarrhea, a lot of just liquid stools. So for her it's different challenges and for those patients we really want to get into like adjusting the plan. You know we don't want to do big surgeries all at once like the Nazarian special we talked about. Maybe it's about breaking it up and seeing how they do with a smaller surgery first. How do they heal from that? Is it prolonged? And I'll tell you Josh, it's not just those people that have issues, vegans. In California we have a ton of vegans.

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and they heal slower. I hate to say it. It's like blasphemy to say it in Los Angeles where I'm at. I don't care how much lentils you eat. I don't care whatever. They have slower healing. They're the ones that get those little tiny openings. No matter how much vitamins or lentils or beans or whatever they're eating, they will not heal as well. So we talk about that beforehand and what to expect. And I've even had some vegans tell me, you know what?

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Josh (18:26.914)
Science is science though.

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Dr. Sheila Nazarian (18:49.986)
hearing what you're saying, I believe you, I've had my friends go through this, they've experienced that, I'm gonna have some meat before and after my surgery. And that's up to them, but it's about really setting the expectation, right? It's about setting those expectations, letting them know what to expect. There's a saying in my line of work that if you let them know beforehand, it's education, if you let them know after hand, it's an excuse. So I try to educate as much as I can beforehand.

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Josh (19:17.05)
So are there requirements you put somebody through in the way of holistic practice? Now you mentioned some of the creams that you use, and you talked about going through lymphatic or the education side. Are there requirements that you have in your protocols? Like you must eat X amount of food or calories or diet or track your food, or you must not have these health conditions or I will not operate on you. What is that screening process like in that pre-surgical requirement for you?

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Dr. Sheila Nazarian (19:42.794)
Yeah, so we have certain lab work that we check. We require EKGs on all of our patients to check their heart. If they're 40 and above, they have to get a screening mammogram just to make sure we have a baseline mammogram before I touch their breasts. They have to go to their primary care doctor and get a clearance for surgery. So that person's reviewing their exam. If they need an echocardiogram, it's being ordered. If they need a chest x-ray, it's being ordered. So we kind of run them through the wringer on that end. But on my end, again, it's really about

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tanking them up with protein and arnica bromelain vitamin K so that they're not bruising, they're not bleeding, they're not swelling. And I've got to tell you, once we started that protocol for facelifts, for example, the downtime went from a month to two weeks. I mean, it is significant. They were starting to get compliments at two weeks rather than hiding for a month.

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Josh (20:25.094)
Wow.

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Josh (20:32.91)
That's wild. It really goes to show that, again, the conventional practice, like you said, you weren't really a believer till you saw it yourself, but there's so much in the way of nutrition and plant medicine, of course, in combination. I'm a big fan of integrated medicine. So I don't know if you know this, I specialize in inflammatory bowel disease. So I just, Crohn's and colitis is really all I do. Sometimes severe IBS, I get asked about, but we're dealing with this, there's so much more to it.

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Dr. Sheila Nazarian (20:46.946)
safe.

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Josh (20:59.842)
It's such a well-rounded, holistic practice. And I think people don't really understand the power of integrative medicine. Sometimes it's necessary to have these pharmaceutical drugs or other protocols in addition to herbs and supplements and vitamins just to get the body to maintain control. And I love that you're really there, especially being at the level that you're playing at. It speaks volumes to integrative medicine.

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Dr. Sheila Nazarian (21:23.33)
Well, you have to like, you have to know your patient too. Like I had another patient that had severe bowel disease that had a lot of bleeding. And you know, you have to be aware of that anemia. And actually I did a pretty intense thigh liposuction, a thigh debulking. She was very thin woman, but just un-proportionately large, large thighs. But we had to make sure her blood level was at a certain level before we would go into that operation. And sure enough, even after the operation, as she typically would get,

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you know, she was bleeding from her inflammatory bowel disease. But thank God that we made sure she was at a good level so that we were able to get her successfully and uneventfully through, you know, not just the surgery, but also her typical bouts and really looping in their, their physicians too. You know, you're not operating in a, in a bubble, right? Really having those conversations with the person that was managing her, you know, her GI doctor.

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and making sure that they knew what was going to happen, what the expected fluid shifts are from the numbing medication, how much blood loss is typically involved in that kind of operation. So really working in tandem with the whole team to make sure that everyone's on board and aware and knows what's going to happen so that we can get a positive outcome for that patient.

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Josh (22:43.851)
Let's shift gears a minute here, Sheila, because we often talk about the microbiome, right? It's often associated with the gut. But I think a little known fact is that there are bacteria everywhere. They outnumber the cells in your body 10 to 1. In those bacteria, there are viruses which outnumber the bacteria 45 to 1. Like we're not even really our own cells in DNA. We're just a bunch of bugs. That's all we really are. Walking sac, skin sac filled with bugs. And so what role...

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Dr. Sheila Nazarian (22:44.206)
Thanks for watching.

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Josh (23:10.79)
do you see the microbiome of the skin or general skin health playing in some of these operations? Maybe not just the facelifts or skin surgery, but some of these deeper surgeries that you find yourself performing like liposuction and others.

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Dr. Sheila Nazarian (23:25.486)
I always tell people, it would be so funny, like, you know, when they're taking care of their wound after surgery, like, let's just say tummy tuck because everybody knows what that scar looks like. Can be located in better locations, lower versus higher, but everyone knows what that, what we're talking about. So for example, when I'm putting antibiotic whitening, we have them put antibiotic whitening on those wounds for the first two weeks before we start scar therapy. And they're always like, do I need a sterile glove? Like, you know, all this stuff. And I'm like, no, your bacteria on your hand is on your skin, it's already on the wound. You don't need to, you know.

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Darryl would love to do that, everyone's so scared. Or for example, in certain cultures, they're afraid to get wounds wet because growing up their grandparents or parents told them you don't get water on this. Whereas decreasing the bad bacteria count on surgical wounds is something you do wanna do. So starting two days after any surgery, I have them get in the shower and use a gentle soap on their fingers to wash their wounds.

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But yeah, I think it's always funny how people kind of view bacteria. You know, there's bad bacteria, but there's actually helpful bacteria. In the vaginal microbiome, for example, we want good bacteria. We want the good, you know, microbiome. That's what keeps sugar levels normal down there and prevents yeast infections. That's what keeps you moist, you know? So it's just very interesting how people view bacteria as always like this evil thing. Same with the skin.

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There's newer technology starting about five, six years ago, a lot of the skincare companies started talking about optimizing the microbiome of the skin. So they would put ingredients on the skin that would interact with the bacteria on the skin to make it penetrate deeper, to make the delivery better. So, which was really cool. And recently there's a new product line out that uses a ocean bacteria that it's kind of used as a break.

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You know, it's great for acne patients. I have a friend, a dermatologist in New York, who said once she started using this line with her acne patients, she doesn't have to prescribe antibiotics anymore for their acne. And as you know, and as I know with my teenage daughter, you know, she was put on antibiotics, a low dose for her acne, totally messed up her gut. And that was literally a one to two year issue that we finally have gotten over. And I didn't know what was causing it. We didn't know why this happened.

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Josh (25:36.902)
Mm-hmm.

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Dr. Sheila Nazarian (25:46.782)
But they're like, is she on, you know, I took her to finally a specialist and like, is she on antibiotics for her acne? Yes. Oh, we see this all the time. Crap. I didn't know that, you know? So again, I think this whole acne got, it's more common than no everyone knows. But anyways, getting back to this new technology of the skincare. So this bacteria when it's activated, so it's actually a probiotic, you put it on your hand, then it's activated and you put it on your face.

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and it uses, it interacts and normalizes the bacteria in the microbiome of the skin. So if you're acne prone, it kills that bacteria, it overtakes that bacteria that causes acne. If you're very oily, it normalizes that and just makes you normal hydrated. If you're dry, it makes you just normal hydrated. So now we're using this in our practice to give people like, not just for acne patients, but to just everyone. We just need to take a break.

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And the way I like to say it is, I don't know if you've ever used a shampoo for a while, your hair kind of gets used to it, you switch to a new one, all of a sudden your hair is amazing and then you can go back to that old one and it's amazing again. So it's kind of like, I think of it and I explain it to my patients is you're turning on different circuit breakers. Your body gets used to this circuit breaker, turn this circuit breaker on and then turn this circuit breaker back on. So I would call it a little bit of a skin cycling or a skin break.

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Josh (26:52.622)
Mm-hmm.

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Dr. Sheila Nazarian (27:09.642)
where we take you off the retinol, we take you off of the antioxidants, we take you off of the glycolic acids and all of those things, put you on a six to eight week break to normalize the bacteria on your skin, and then we go back to the anti-aging things. And then when you do go back, it's effective again. Like you don't feel like your skin got used to that.

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Josh (27:34.11)
Interesting. And so you had mentioned this comes from an ocean bacteria. Now where are they finding it? Is it algae based? Is it in like the sea life?

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Dr. Sheila Nazarian (27:42.374)
I think it is algae based. There's actually a whole book on it. So this just came out. So I'm you know learning about it. I put my son on it. My husband like even loves their sunscreen. Like I've never seen someone obsessed with a sunscreen, but we're all these are like it's really exciting for us Josh because for skincare, the industry, there's always been like peptides, retinol, vitamin C or other antioxidants,

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That's been basically what we've been working with. Now, can we make the retinol more tolerable? Sure. Can we bring in antioxidants other than vitamin C? Yes, now we have resveratrol and vitamin B. But it wasn't really a groundbreaking new technology until this skincare line has recently been introduced a few months ago.

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So I'm still learning about it. I'm trying it on my, you know, my family members, my staff in conversation with these, this is exciting stuff. And it's been 10 years in the making by the way. So the guy who made it as a PhD studied this bacteria for 10 years before even introducing it as a product.

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Josh (28:39.416)
Sure, sure.

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Josh (28:54.422)
Wow. Now I'm curious. Obviously we're not sponsored by them and you and I have no affiliation with them. But what is the name of this product?

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Dr. Sheila Nazarian (28:59.446)
No.

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Dr. Sheila Nazarian (29:02.634)
It's called BioJu. Yeah. We have it on our website. I'm gonna plug my website too. It's called theskinspot.com. So theskinspot.com. And we try to curate stuff that works. And stuff that actually has research behind it. Because I don't know if you've been on like these websites, but there's like 2000 sunscreens.

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Josh (29:04.43)
Biojewel. I'm going to look that up myself because I'm very curious.

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Josh (29:10.31)
Please.

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Josh (29:18.49)
Hmm.

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Josh (29:27.362)
Oh, sure. Yeah.

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Dr. Sheila Nazarian (29:27.506)
I just want to know about the 10 best sunscreen. What additional things they do. Does it also have antioxidants in it? Does it also moisturize so it's good for winter? So we've tried to curate it down to things that are actually medical grade, have scientific data behind them, and from each line we only bring in the hero products. So I don't want every single skew from this line. I only want the stuff that's really cool and different and that works and that I've tried and I like.

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So that's sort of the basis for the site. Because skincare can be really confusing.

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Josh (29:59.434)
I'm going to make sure I put that. Yeah, it's amazing. I mean, I'm going to make sure I put that in the show notes and I'll make sure I link your site for that as well. That's incredible. So let's talk briefly here about anti-aging. Obviously aging is something that is sort of faux pas, especially today. People don't want to age. They do want to age. They want to age gracefully. And early aging is something we're seeing more and more with, especially with sick people who maybe have inflammatory conditions, diabetes, fatty liver.

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Dr. Sheila Nazarian (30:05.399)
Thank you.

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Dr. Sheila Nazarian (30:10.402)
Thank you.

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Josh (30:28.058)
gut issues, especially we see a lot of early aging and the breakdown. Can you walk us through why that happens? Why the skin appears to age and what it is we can do about it?

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Dr. Sheila Nazarian (30:38.222)
So skin aging, you know, estrogen has a lot of effect on skin aging and as estrogen levels go down for whatever reason, you know, the hormonal just in general, low estrogen's bad, high estrogen's bad. So, you know, for example, overweight patients, we see that, you know, testosterone is made into estrogen in the fat cells and that can cause breakouts, that can cause inflammatory conditions.

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low estrogen levels lead to dry skin and wrinkled skin and a loss of elastin and you see that in the like postmenopausal. Also there's like post androgenic too, men see it too. So yeah, so it's almost like this balance has to be there. Being obese has certain negative side effects and I'll tell you I've seen it in my patients that we put on weight loss programs. They'll come in with

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Josh (31:20.609)
Andropause, yeah.

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Dr. Sheila Nazarian (31:36.062)
rosacea, inflammatory, kind of red, just inflamed skin, when they lose the weight it goes away. It's crazy. You know, and we have them on the right products to anti-age and like makeup. There's also a skincare line called Emapel that mimics estrogen in the skin. It doesn't get absorbed. So our patients that are like, you know, had estrogen-positive breast cancers, for example,

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Dr. Sheila Nazarian (32:05.93)
There's really cool things, but it's almost like you need to be in this balanced, healthy state, and your skin is like a mirror of that.

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Josh (32:17.152)
So these estrogen mimicers, do they not have the same negative effects as you would find in xenoestrogens?

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Dr. Sheila Nazarian (32:17.774)
Thanks for watching!

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Dr. Sheila Nazarian (32:23.594)
No, they don't get absorbed into the body, into the bloodstream. They stay at the skin.

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Josh (32:29.986)
So it just reacts with the skin as if it were estrogen and then that's it, there's no absorption. That's amazing. I mean, especially considering the skin is the largest organ in the body and it's one of the main detoxers or absorbers. I often tell my patients, especially when they're using certain chemicals, chemical-based shampoos, all the parabens and endocrine disruptors, if you're using fragrances, if you're using shampoos and creams and all these things, if you're gonna put it on your skin, you may as well put it in your mouth.

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Dr. Sheila Nazarian (32:34.262)
That's it. Exactly.

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Josh (32:58.414)
but you're saying these particular creams, it's totally fine. Fascinating.

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Dr. Sheila Nazarian (33:01.998)
Totally fine. Yeah, because that was the number one question I asked too. Especially in my patient population where there's breast cancer reconstruction and things like that, they can't be on estrogen. So we're looking for things to help them without the negative effects of estrogen. We even have a laser for the vaginal wall that through the laser, we create some more regular microbiome, we create some more regular receptors and increases.

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moisture because our patients that are you know can't be on estrogen post menopausal they'll describe sexual intercourse as like knives. I had one of my first patients the cutest couple she was a breast cancer survivor they came in her husband was holding her hand and they said they haven't been able to have intercourse for two years just because they can't it's so dry it's so painful down there we did three laser treatments on the vaginal wall and they were back to normal I mean that's amazing so always you know we have to take considerations each patient

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We want to have something for everybody and something safe for everyone. So we're always looking at those things too.

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Josh (34:07.502)
Well, that's amazing. I mean, there's so much that we look at the way especially hormones, right? Low estrogen causes dry skin can also cause vaginal dryness and a lot of that. And so these lasers, are they doing anything in particular to the hormonal profile? Is it just the tissue? Like, what are you guys doing to manage that?

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Dr. Sheila Nazarian (34:22.59)
It's at the tissue level and I'm not like, I don't have like the paper in front of me, but I just remember going to this talk, I think it was like 10 years ago, where the guy, his name's Rob, he did the actual studies on it. He showed us biopsies with stains that actually will stain for glycogen, that will actually stain for the receptors. And you're actually up regulating the receptors to produce normal microbiome, normal.

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Josh (34:27.75)
to it.

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Dr. Sheila Nazarian (34:49.038)
types of sugar levels in the vaginal cavity to promote good bacteria, not like vaginosis, not overgrowth of bad bacteria, not creating a lack of bacteria, like a yeast will populate. So it's about creating a normal milieu in whether it's the skin or whether it's the vaginal mucosa, but it's really fascinating and they weren't even expecting that by the way. They were just trying to tighten the tissue to give a better sexual experience.

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But their patients were coming in saying, oh my God, it's more normal down there. It's more pink. It's more moisture. Like, you know, all of those things and they started then looking into it.

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Josh (35:26.85)
Interesting, maybe it's more of a circulatory issue on top of cellular regeneration or rejuvenation. Bacteria I find fascinating. I find light in its photobiomodulation, all these things, just absolutely incredible. And as a little sidebar, a little hack for you, if you ever get patients who come in dealing with UTI prone or they have a lot of yeast infections, so I see a lot of those, I see a lot of UTIs, especially in my line of work, because we're doing a lot of detoxing, lymphatic drainage, liver detoxing, cellular detoxing.

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Dr. Sheila Nazarian (35:51.374)
Mm-hmm.

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Josh (35:55.714)
and cleaning things out, which of course go to the blood, go to the kidneys and out we go and now we have UTIs. And so what I actually have them do, there's a probiotic I'm a big fan of. It's got two particular strains. It's a lactobacillus, reuteri and rhamnosus. And it'll have them put coconut oil on a tampon and just put this one capsule, this gut, it's an oral-based gut probiotic on the tampon, insert, leave overnight, and then that UTI is gone in the morning. And so it's just bacteria.

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Dr. Sheila Nazarian (36:01.025)
Mm-hmm.

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Josh (36:23.046)
fighting bacteria and it's all about these balances, all it really is. Yeah, shoot.

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Dr. Sheila Nazarian (36:25.538)
Josh, I have a question for you actually. And this is like a thing that I found works. And I don't know if it's like the dumbest thing ever. Plain yogurt for a yeast infection. Yay or nay, what says Josh?

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Josh (36:39.942)
All right, interesting question. Not one I've been asked actually ever. So I'm gonna work through this one as my best guess. We're talking plain yogurt. Are we talking topical? Are you talking insertion? What are you doing with it?

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Dr. Sheila Nazarian (36:49.843)
insertion and topical.

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Josh (36:52.566)
I think there's something to be said. So there are lactobacillus, there's different, there's obviously dozens and dozens, or if not hundreds of strains even not explored. Hundreds, yeah. I mean, there are literally, there are one to 2000 different species in your gut alone, seven to 9,000 strains in every area of your body has its own microbiome, right? Vaginal, oral, and your hair on your nails and your skin, it's everywhere. And so if we take a look at what type of bacteria is actually being used to culture that yogurt, theoretically,

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Dr. Sheila Nazarian (36:59.638)
Hundreds, thousands, yeah.

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Josh (37:20.686)
whether it's typically their lactobacillus strain of some kind, it's highly likely, be it a rhamnosus or a rotary or whatever else, it might actually work. My only concern, oh, it does work, not questionably, like it does work.

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Dr. Sheila Nazarian (37:32.726)
It does work. In my non-study, non-controlled experience, once, but with a lot of people too, I just tell them if they're like, oh, I suffer from yeast infections all the time, can you write me for, you know, diflucan? Can you write me for this? I'll say, yeah, I can, but you might wanna try this in the future. It's positive feedback.

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Josh (37:41.322)
You can be honest, is this personal experience? Yeah, and it did work.

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Josh (37:53.019)
Mm.

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Josh (38:00.398)
That's really interesting. So I'm just trying to look it up right now. I mean, it is lactobacillus. Can't find which one in particular, which bacterial culture, but I'm sure there's a million common ones. That's really, really interesting. My only concern obviously would be pasteurized yogurt versus raw milk, whatever has been used, pasteurized versus raw. The quality, yep.

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Dr. Sheila Nazarian (38:25.486)
Okay, go ahead.

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Josh (38:26.65)
Anyways, sometimes I have to like close my door, I leave it open, there's a garbage truck in construction, like guys, but so yeah, it really would come down to the strain that's in the yogurt, whether it's raw versus pasteurized and what's in it. My concern of course would be if there is poor clearance, there's a lot of dryness, you're not getting a lot of clearance or good mucosal production, that it might get stuck and deal with fermentation and of course rancidity, which would lead to other issues. But theoretically,

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It sounds like it's great and clearly in practice, which I find fascinating. I'm not sure I'm comfortable recommending that to my clients or not.

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Dr. Sheila Nazarian (39:01.374)
It's so funny, half the things I say to my patients, just based off of talking to my patients over time who are just very intelligent, out of the box thinkers, which is why they're successful and cool. For example, five years ago, I was telling my patients, I'm like, please don't ever tell your primary care doctor I said this, but after 40, no cardio, just heavy weights. Just do heavy weights and walk. That's all you need to do.

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Now, everyone's saying that. I'm like, see, I freaking knew it. So I just didn't want them to go tell their doctor and be like, my plastic surgeon said not to do cardio. Now it's like all the research is showing over 40, it's really about muscle mass. It's really about those heavy weights and less about cardio, which just drains all the sugar out of your blood, makes you want a bowl of pasta and you just get fatter.

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Josh (39:35.918)
Hahaha

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Josh (39:42.273)
Oh it is?

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Dr. Sheila Nazarian (39:51.598)
So I just think it's funny these little things that you know you notice then the research starts coming in and you're like I knew it.

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Josh (39:59.211)
Mm-hmm. Well, I do love a good sidebar. There was actually a cardiologist. I have to pull up the study. You can look it up, cardiologist. If you Googled something along the lines of cardiologist, doesn't run, only does weights, and he actually did a study on himself because he had a heart attack. He was a marathon runner. And he found all this information and evidence that actually went to short burst, high intensity, if anything, 15, 30 seconds max, and then long rest periods.

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which I mean, I think that's how humans were designed, right? Originally to chase down a saber tooth tiger or gazelle and eat it, which is really what we do. But it's incredible when we look at the science behind it, the rejuvenation, the longevity, strength training and resistance training is the fountain of youth. It's incredible.

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Dr. Sheila Nazarian (40:23.18)
Right.

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Dr. Sheila Nazarian (40:39.618)
It is. It is. Did you see that new study that just came out that they looked at people that led a mostly sedentary lifestyle and then started becoming active? Then they looked at people that kind of in middle age started to being more active. Then they looked at people that have been active their whole life. And actually the people that have been active their whole life had the highest risk of inflammatory heart problems. You totally expect the opposite, right?

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Josh (41:07.834)
That's why, no, is that gonna be, I haven't seen the study yet, no, that's bizarre. Is that due to?

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Dr. Sheila Nazarian (41:12.254)
You have to look it up. I was like, what the heck? Because you're not supposed to like, do that, I feel like, you know? And it just, I don't know, I'm a person that like never got that high from exercising. Like my friends are like, I have to work out every morning. I feel so good after I do that. And I'm like, work out an extra hour for me, please, because I'll be, I don't know, answering emails instead or something. But it just, you know, those types of studies, I'm just like, hmm, like...

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Josh (41:23.334)
Hmm.

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Dr. Sheila Nazarian (41:38.23)
That's interesting, you know, maybe we're not built to, you know, kill ourselves running or, you know, doing those things.

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Josh (41:38.415)
Hmm.

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Josh (41:45.826)
Well, the good news is you don't need to exercise. I'll put in a good word, I know a surgeon at Spa26 who can take care of you.

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Dr. Sheila Nazarian (41:53.17)
No, but literally for me, I think always it just hurt. It hurt to run. It didn't feel good. I never got that runner's high. I wish I did. But for me, lifting weights was always the thing that kind of gave me. It was easy. I could be sitting here doing a podcast with you and have, you know, 15-pound weights and be doing bicep curls or have weights around my ankles and be doing leg extensions. Like it was always something that was easier for me to fit into my lifestyle. And it's just funny.

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That it's kind of like what my body needed was what was best for my body. And sometimes really it's about just listening, listening to your body.

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Josh (42:26.294)
Intuitive exercising, you know, I'm curious to see the extrapolation of the data because the first thing I would guess on a study like that, just having not read it myself, would be that we are always in these anabolic phases, right? We're always in the build, go train, go eat, increase the protein, increase the food, increase the calories, go lift, rest, recover, go lift. But very rarely are we actually getting into fasted states. Very rarely are we getting into these states of depletion where our body has to increase all of its autophagy and the AMPK and

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these mTOR molecules and all this to keep you healthy, young, stimulate growth hormone. We're not seeing that as much. And so I guess I would wonder, these people in a lifetime of activity, is it because we have so much access to a surplus of food and nutrients on an ongoing basis, we never have to stimulate these rejuvenative processes, these anti-inflammatory innate processes in our bodies?

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Dr. Sheila Nazarian (43:18.122)
These rest periods, these, yeah. I'm all about the rest periods.

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Josh (43:20.394)
Yeah. I'm, I'm an advocate for fasting. Yes. Yes, we are. Resting is huge. I could use one of those today.

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Dr. Sheila Nazarian (43:29.782)
I'm not always the best at it, but I feel like I'm always mentally running, but at least, you know, rest spirits for the body.

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Josh (43:36.73)
Well, that's actually an interesting conversation I'd love to tap into here. I mean, obviously you are very well known, you're an international speaker, you've got, was it one and a half million social media followers, you've been on TV, you've got your clinic, you've got all these, you've got kids. So obviously there's a lot of stress. You're overdue. That's right. I just took my dog in the other day, actually for dental surgery. He had a slab fracture, so he split the tooth in half right up into the gum. He's got these little

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Dr. Sheila Nazarian (43:53.627)
Well, I'm gonna go take a nap.

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Dr. Sheila Nazarian (44:01.994)
Oh yeah. Mm-hmm. My dog has that too.

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Josh (44:06.758)
Oh, poor pup. Well, we had we just got the tooth extracted. It's got this little bag, these syringes, little opiates. So make sure I send you some in the mail to help with your nap. It's a good little he's 10 pounds. You might need more than one syringe. Yeah. So obviously being as busy as you are, all the stress, the go go, whether it's a you stress, like good stress or distress, that go has got to take its toll. Like how do you see that impacting your health?

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Dr. Sheila Nazarian (44:19.23)
Yeah.

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Josh (44:35.066)
the aging protocols and processes, inflammation, what do you do to manage it?

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Dr. Sheila Nazarian (44:40.722)
I think it's all perspective, you know, like my family escaped from Iran while being shot at by border police. My mom passed away when I was 16. I think, you know, at my residency, being pregnant three times, working 80 hours a week. So I think it's all about perspective. And

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Yes, I have a lot to do. I'm really grateful for that. I'm really grateful that I have the opportunity to have to be able to do all of these things and to be in America and to have freedom of speech and to be able to have a platform to announce what I think and have people want to listen. I'm just really, I think I just am really grateful. And I think I burned the candle at both ends because I realized what a huge opportunity I've been given my family left everything a very comfortable life in Iran.

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to bring us to America just to give their daughters a chance at success. I mean, you see everything happening in Iran and what they're doing to the women and the oppression and the women fighting for their lives literally and giving up their lives to have the freedoms they once used to have. So I don't take any of that lightly and I don't take it for granted. I fully realize that the world that my parents were able to create for us.

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is a huge opportunity and it's not to be wasted. So I'm just trying to do as much things as I can and to fulfill all aspects of things that make me feel whole and fulfilled. Because I'll tell you, if I was just to, went through all this training, came out and they told me, okay, go in your office and just start making money. And that's what I thought, like literally two years after practice, I was burned out. I was like, this is it?

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I liked being collaborative in the university setting. I liked struggling with friends like we were in boot camp. I liked learning and growing, but once you graduate from that, and that's been your goal for 33 years, I graduated when I was 33 years old, that story and that world that you'd created in your brain that you'd been striving for, you get there and you're like, I need more. And in surgery, they...

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Dr. Sheila Nazarian (46:50.786)
kind of taught you shouldn't want more. You know, we took the opportunity to train you. We gave you this gift. Now go die with a scalpel in your hand, you know? But for me, I liked my kids. I liked my family. I liked traveling. I liked fashion. I liked business. I liked social media. I liked marketing. I thought it was creative. And initially, my colleagues really looked down upon that. They really were resistant to it. There was a lot of...

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Josh (46:58.298)
Hmm.

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Dr. Sheila Nazarian (47:18.946)
talking behind my back, there was a lot of that. But I think they learned for me that you have to fulfill all aspects of yourself so that you are a better doctor and a better mother and a more fulfilled human and not depressed and not burnt out. So yes, I do a lot, but I do a lot because it makes me happy. And I think that it all comes down to

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Josh (47:42.598)
Hmm.

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Dr. Sheila Nazarian (47:45.226)
Everybody has a different tolerance for stress. Everybody else has a different tolerance for juggling. For me, I had a high capacity and it made me happy. And so that's why I did it.

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Josh (47:57.218)
Well, we know where you get your high from and it's not running. So at least we dialed that one in. So I do have one last question for you, Sheila. Obviously going through in plastic surgery, there's a large part about vanity and self-confidence and self-respect and how we even view ourselves.

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Dr. Sheila Nazarian (48:04.225)
That's what I only got from running.

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Josh (48:19.13)
There are dozens and dozens of study, probably hundreds of studies of people who are put in situations where they're made to feel more self-confident and they end up experiencing more success or better social outcomes, all this. Are these hurdles that you deal with your clients? Do you do any kind of mental, emotional coaching or any addressing of those whatsoever? Oh, good.

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Dr. Sheila Nazarian (48:37.166)
Absolutely. I always say I'm like a therapist with a needle or a therapist with a knife. I think with the older patients, you know, they really have a struggle. They're like, I shouldn't be spending this money on myself. I should be spending it on kids, right, or my kids or something like that. Or I don't even deserve the time to recover, you know, I'm all I have to do things for others. So I always tell them do you want your daughters to feel that way?

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Josh (48:41.606)
I'm going to go to bed.

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Dr. Sheila Nazarian (49:02.494)
And they're like, no. And I'm like, well, you have to model that. You have to model that you matter. And I think it's really about shifting the perception of plastic surgery away from vanity and really making it a part of self-care. The way, if you look better, you do better. And people feel that around you, especially women. We do so much for others. If you have a happy woman in your household, that has ripple effects to the whole household.

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Josh (49:28.678)
I'm going to go to bed.

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Dr. Sheila Nazarian (49:29.394)
So it's really about you know you can't exercise your breasts back up you can't Exercise or eat your diastasis after childbirth and make it go away like you know There's certain things that I say every 10 years you need kind of a tune-up your car requires maintenance your house requires maintenance You know everything requires maintenance, so why not us? And I always say if it's safe you're healthy, and it's gonna be safe Why not?

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If it's going to make you feel better, if it's something you think about more than three times a week, imagine taking that mental energy and putting it towards something more productive. Like just fix it and move on and go enjoy the more important things.

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Josh (50:12.55)
Obviously getting tuned up and cleaning things out. I look on a holistic level. I mean, even on a basic level for inflammatory disease, like we deworm pets every one to two years. And most of the pets in America aren't even eating raw food. They're eating kibble and bagged food, but we still deworm and de-parasite cleanse. And that's a tune up of sorts that we should be doing for ourselves. But that's things we take plants or you do cleanses or you promote liver detoxification or emphatic drainage. But there's a lot of people then who would argue

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and rightfully so that plastic surgery is not natural, it shouldn't be a tune up that you need. What's your opinion on that and what would your response be?

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Dr. Sheila Nazarian (50:51.566)
I'm trying to think, okay, let's say you go to the store and you buy a pair of pants that makes your butt look really good.

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Do you need to go buy another color? Did you need those pants in the first place where you naked to begin with? No, but it makes you feel better. It makes you more confident. It puts a smile on your face. It makes you glow a little brighter. There's, to me, you know, again, like if you're a really unhealthy specimen of a human, do not get plastic surgery. Like work on that first, you know? You're not even gonna get a good result probably. But if you are, you know, taking care of yourself, you're healthy, you're...

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But life changes have made you not shine as brightly. Like I had a consult yesterday with a patient, she was in her 60s, so funny, so outgoing, and her skin was literally falling off her face. So she's like, I need this to reflect how I feel on the inside. I don't want people to look at me and think I'm sad. I don't want people to look at me and think I'm angry because of these lines on my face. Her brows had dropped, so she looked really just tired.

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Josh (51:49.21)
Cool.

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Dr. Sheila Nazarian (51:58.542)
She's like, I'm not tired, I'm not angry, and I'm not sad. And people ask me all the time, what's wrong? That sucks. That's gonna have an effect on your emotional wellbeing. That's, you know, and if it's something that's safe and easy and you're in the hands of a skilled physician, why not? Why not? Life's short. Why have to be asked what's wrong every five seconds by people around you?

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Josh (52:27.358)
A little enhancement goes a long way. I mean, if I'm buying jeans, it better make my butt look good. You know what I mean? Like that's, that's what I'm going to go shopping for.

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Dr. Sheila Nazarian (52:28.636)
And I love you guys. All right. That's it.

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Dr. Sheila Nazarian (52:36.554)
I don't know, maybe not the best analogy, but you know.

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Josh (52:39.55)
No, I did the job that definitely I think is gonna hammer at home. I think that's the only way people buy pants. Like if I go to the store and I'm buying pants, my wife's coming with me. I'm like, how do I look? She makes me do a spin. I got to look good. Right. Yeah, absolutely. If I know those jeans are making me look saggy, I'm not even, I don't see behind me, I don't see my own butt, but I'd rather know, you know? Yeah. I think it's a great analogy. So last question for you, Sheila, is there any pre

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Dr. Sheila Nazarian (52:44.59)
I'm going to go to bed.

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Dr. Sheila Nazarian (52:49.27)
Yeah, let's see.

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Dr. Sheila Nazarian (53:00.692)
Exactly.

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Josh (53:06.094)
consulting or coaching you do on that emotional side. You mentioned you're a therapist with a scalpel. What does that look like for somebody coming in? Do you do prep work for them? Do you do any kind of courses or is it just a quick chat, checklist and get things in and out?

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Dr. Sheila Nazarian (53:20.766)
We do have a screening questionnaire with every intake form that does screen for, you know, depression or is anyone forcing you to do this or, you know, are you doing this for someone else? We do screen for those things because we want to make sure that we have a person that's ready to receive happiness. You know, if I'm doing a virtual consult and I like to do virtual consults and in-person consults, if that person doesn't smile the entire time that we're talking, that's a red flag. Maybe, you know, it's not time.

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Um, weight loss patients. I've noticed that when that skin comes off, it takes them two years to mentally catch up with their new body, to actually look in the mirror and not see a fat person. So I always get a therapist involved for those two years because it helps them kind of come to terms with their new look and their new body. Like sometimes they'll come in a year after surgery and they're a size, they went from a size 20 with a skin removal, they're now a size eight.

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and they're still wearing a size 20. So really it's person by person. The way I like to give an analogy on this one, it's like a comedian, they have to read the room. I have to read the room too. So if I walk in and that person needs a friend, I'm their friend. If that person needs a leader, I'm a leader. If that person needs a cousin, I'm a cousin. If they need a sister, I'm a sister. So it's really about reading the room and filling the right role that person needs to get through their procedure.

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and after that.

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Josh (54:54.702)
I love it. And that to me is a holistic approach. You're really dealing with more than just the body. And we often see, particularly in medicine, when it comes to intervention, surgical intervention, that's required for life saving. We're looking at organ removal, all these bits. We see them all the time with hysterectomies. Just hormones aren't balanced. Let's just cut it out, which is horrible. We're not looking at the holistic picture. It really sounds like as a practitioner, you really are looking at the whole person, not just like a slab of meat on a table.

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Dr. Sheila Nazarian (55:25.622)
Yeah, because you're not gonna get a good, I mean, again, you wanna get that person leaving and not just saying, you know, yeah, my stomach looks good, but that was a horrible experience, horrible bedside manner. This is not spine surgery where they're gonna accept horrible bedside manner for the most skilled person that's not gonna paralyze them. There's a lot of choices, and it's an elective surgery. There's a lot of choices.

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Josh (55:47.434)
Hmm. Yeah.

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Dr. Sheila Nazarian (55:52.546)
in plastic surgeons. There's 31 plastic surgeons just in my building alone. So you really want to give them that experience and take good care so that they, you know, when they're reflecting back, they're not just, you know, they remember how you made them feel, not just how you made them look.

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Josh (56:13.71)
Well, that is a fantastic place to wrap up a conversation. One more question, Sheila. This is my ending question for every episode. Is there anything we haven't touched on, talked about, or gone over that you'd like to say or mention to any of the listeners?

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Dr. Sheila Nazarian (56:29.602)
Hmm.

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Josh (56:30.656)
Open book, whatever you want.

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Dr. Sheila Nazarian (56:34.206)
I just think it's about allowing yourself and giving yourself permission to like live your best life. And I think that whether it's about starting a new venture or talking to someone new or learning a new skill or you know body modification, I think it's really just about giving yourself permission to explore new things.

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and not being held back by taboo or dogma. And just thinking outside the box and allowing yourself to do so. I think that, you know, that's the takeaway I get from this episode.

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Josh (57:18.926)
I appreciate that. Thank you so much, Sheila. It's been an absolute pleasure. This isn't an episode that I'd say is pretty typical of our series because, you know, we've met with researchers and celebrity doctors who specialize in the fields of nutrition or microbiome and research. And I think this has just been such a unique take on things and the connection, even just not plastic surgery, but tissue healing as a general. I think it's really going to shed some light on the importance of

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diet and prep and health and a holistic perspective. So I really appreciate you taking all of your time, your expertise and your experience and just cramming it into this last hour with me and for our listeners. So thanks so much for being here.

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Dr. Sheila Nazarian (57:58.018)
Thanks for the opportunity. I really enjoyed the talk.