Celebrity plastic surgeon Dr. Marc Mani on Facelifts, Beauty, and the New Rules of Aging in Hollywood

Roxy: 00:00:00

What is the ideal age to have a facelift?

Dr. Mani: 00:00:02

It's a good question, but everybody's different. So saying what's the ideal age Is very similar to asking how old should my home be before I start renovating it.

Roxy: 00:00:10

You're looking at me. It's not going to hurt my feelings. What would you suggest?

Dr. Mani: 00:00:16

I can tell people to sleep on their back when they come in. Really younger. Yeah. You can age gracefully and still have well done surgery.

Roxy: 00:00:23

So who is not a good candidate for a facelift?

Dr. Mani: 00:00:27

Someone that's not at an ideal weight. Someone that's not psychologically healthy, that they, you know, you can tell they're addicted. Someone that's had too much done.

Roxy: 00:00:33

But as a man, do you feel any sort of pressure to look a certain way? Especially like being in midlife, you know?

Dr. Mani: 00:00:41

Yeah, we let them know the price range because my fees are higher than the typical fee and most people understand that you get what you pay for and it's your face. I think the future of beauty is spirituality.

You know, I'm good at correcting the external things, but it's more important to develop the inner beauty first and make sure that that's there.

Roxy: 00:01:04

Today's guest is one of the most sought after facial plastic surgeons in the world. And if you've ever looked in the mirror and wondered, is it too early or too late, this conversation is for you.

Dr. Mark Monte is Beverly Hills based board certified plastic surgeon known globally for his artistry, precision and the kind of natural result that don't scream, I had work done. They whisper, I woke up like this.

He's performed thousands of facelifts, written extensively about beauty, aging and aesthetics and developed techniques that are now considered gold standard in modern facial surgery. In this episode we talk about what actually makes a great facelift today.

The difference between the old school wind tunnel look and the refined work we see now, what to know before you consider surgery and why some of the most common beauty trends might actually be working against you. We also talk about timing, identity and the fine line between wanting to look refreshed and still look like yourself.

If you're curious about what's possible and what's smart when it comes to facial surgery in midlife, this is the episode to listen to. Follow heconicmidlife and redcarpetroxy on social media and send this one to your friend who's been screenshotting jawlines in secret.

Welcome to the iconic midlife. We are so excited to have you here.

Dr. Mani: 00:02:20

Thank you. Thanks for having me.

Roxy: 00:02:22

Thank you. How's Your day going?

Dr. Mani: 00:02:23

It's good. We're very busy. We're some kind of harried, but it worked out well. Good over here.

Roxy: 00:02:29

Good. I know you are quite the in demand plastic surgeon.

And you know, I've been getting so many DMs, so many messages from my followers, from my listeners, and they want to know more about plastic surgery interventions and especially facelifts. So thank you so much for coming and sharing your knowledge.

I know that you're really known for subtle and very just elegant work, not loud and so obvious. So what has changed in the last 10 years as it relates to facial plastic surgery, facelifts? What has been changing?

Dr. Mani: 00:03:08

Well, the typical answer people will give or surgeons will give is that we're making things look more natural. But that's sort of the art of plastic surgery is I've always been an artist. I've been a portrait artist all my life, since I was a kid.

And I think knowing what looks normal is a lot of part of being a good plastic surgeon. And so. But the real answer to your question is the things that have changed, especially lately, are that people are getting tired of fillers.

I'm sort of very anti filler. I don't like hyaluronic acid filler. You know, the companies don't like it when you say that.

But I think what's happening lately is they're starting to realize that they block lymphatic channels and just don't look as natural. But where well done facial rejuvenation surgery can look very natural. So the things that have changed are really two things.

Number one, deep plane surgery has become more popular, which, I mean, I think most people have heard of because it's been popularized by myself and some other surgeons. The deep plane is the plane that gravity acts on. So you're just sort of anatomically reversing what's happened.

And then the other thing that I've been proud to be a leader in is endoscopic work where you don't have a scar in front of the ear or anywhere inside the ear here. And so that's, you know, something that I've developed, started doing and, and have been on the forefront of that.

And it's great because that's a stigma of a facelift having that scar.

Roxy: 00:04:25

Absolutely. And I'm so glad you're bringing up deep plane facelifts because I feel like that is all the rage right now, you know.

So how does a deep plane facelift differ from like maybe the traditional facelifts that we've Seen. I mean, is it also called kind of the ponytail facelift where it's.

Dr. Mani: 00:04:40

Yes. Okay, so that ponytail facelift is a term that's trademarked by another surgeon, Dr. Chachi Ko in Santa Monica.

So, you know, using that term if you're not doing his procedure, or even if you are, is sort of, you know, a violation of his trademark. I know Chachi. I. I love him. He's a brilliant surgeon. We have maybe a different style, but we're both.

We're the two surgeons in the United States that are doing scarless work, and we're teaching other people now. And so. So that's. You know, I don't call mine that, you know, because it's. That's what he. He calls. I call mine scarless lift.

And I've also trademarked that. And so basically, that particularly pertains to an endoscopic procedure without a scar.

But in general, in my case, it's a deep plane lift without a scar. And I was the first surgeon to actually do a full deep plane lift without a scar endoscopically.

But a deep plane lift is sort of what I was getting into earlier, which is that it reverses what gravity has done. Any physical force acts along the path of least resistance. So gravity is going to act along the tissue plane where things are kind of loose.

Your face, by design, has to be loose so you can talk and eat and things like that. So in order to really reverse it and take the clock back to where you were, you don't want to fill.

You don't want to lift the skin and peel the skin off like, you know, surgeons used to do. You want to get into the deep plane, release all the ligaments and all the way up. So that's, you know, the sort of a bird's eye view of how it works.

Roxy: 00:06:05

Yeah, it's really interesting because I remember seeing, you know, grandmothers and mothers of the past sort of have these facelifts where it almost was like their mouths were kind of stretched back. You know, it looked very joker, like, almost. But now it's almost like you're saying it's like almost undetectable. I mean, the work is so good.

It's just. Is it. Because it's just these sort of subtle.

Dr. Mani: 00:06:27

I think the answer to that is not so much that it's the deep plane. It's just that surgeons have gotten better because, like, I can show you pictures of the.

Tord Skoog from Sweden in the: 1960

But having said that, there are more facelift surgeons. You know, we've been able to train more and more and so the work has gotten better.

I think the irony about facelift surgery is that, you know, people think it's, it's a less, it's a mini, it's just less work. It's actually more work to make it look natural because you have to know the facial nerve anatomy cold.

You have to be very comfortable with it, which takes a long time and you have to, you know, release all the ligaments. So it takes, in my case, I only do one a day.

I mean, I spend my time and do it and I think I always say it's not how long it takes, it's how good it looks.

Roxy: 00:07:18

Right.

Dr. Mani: 00:07:18

How long it lasts.

Roxy: 00:07:19

So one a day sounds like a good pace.

Dr. Mani: 00:07:22

You don't want to be number five on the schedule. You know, that's my opinion.

Roxy: 00:07:26

Right.

Dr. Mani: 00:07:26

Too much.

Roxy: 00:07:27

Yes. We'd rather have our surgeons fully invested in us for the day.

Dr. Mani: 00:07:30

Awake and alert.

Roxy: 00:07:31

Yes, exactly. So what is the ideal age to have a facelift? Is it like a number, like an age?

Or is it more like what your facial tissue looks like and what the skin looks like?

Dr. Mani: 00:07:41

Yeah, it's exactly the latter. You know, there's people always ask that question, It's a good question, but everybody's different. So saying what's the ideal age?

Is very similar to asking how old should my home be before I start renovating it. It depends on the bones of the home. It depends on the decor, you know, maybe the style in that case.

But yeah, it's more related to genetics, ethnicity, lifestyle. You know, like Asian people don't age as, as much and so they don't really need it until later in life. And it's a generalization, but it's true.

It has to do with the anatomy and the genetics.

So, but, but in general, you know, now, particularly with the endoscopic work that I'm doing, I will dip even like say a 38 year old woman who's aged particularly quickly or lost a lot of weight, you know, from pregnancy, that happen a lot. And so they maybe, you know, need it earlier.

Where in general, like my average age for a facelift of any kind is about 50, I think in LA, it skews younger. Right. More people do it earlier for better or worse, you know, but, but that's, that's about average.

And, and by the time someone's 65 here in LA, they've typically had at least one facelift, which is sometimes a good thing and sometimes it's a little much, I think.

Roxy: 00:08:52

Is there an age that, where it's too late to get a facelift?

Dr. Mani: 00:08:56

It's more, that would be more related to like health factors. If you know you're, you're 90, I wouldn't put you under anesthesia.

I've done, you know, a good number of people in low 80s as long as they're healthy. So there's not necessarily an age, I think the younger you do it, the longer it lasts because your tissues are stronger.

The older you do it, your tissues are a little weaker. So it won't last as long. But it's not necessarily like a full on contraindication to doing it.

Roxy: 00:09:19

Okay, so it's kind of like your health, like your holistic, like wellness. Yeah, okay.

Dr. Mani: 00:09:24

Yeah.

Roxy: 00:09:25

And what are the things that like, what are some of the mistakes that people are doing when they delay surgery? Let's say they're delaying facelifts, they're using fillers and Botox and kind of all these like non invasive treatments.

Dr. Mani: 00:09:36

Yeah, yeah, that's the mistake. I mean, I won't fault anyone for trying it. What I do fault is the providers who are overfilling people.

You know, we're starting to find that the filler, particularly when you do too much migrates. We found that it lasts a lot longer. I mean, I've known this for 25 years. I've seen, you know, filler in people that's 20 years later.

So if it lasts that long and you keep coming in every six months, then you're sort of being tricked into giving your credit card to someone that's trying to pay for their boat or their rent. You know what I mean? And there are great injectors out there, don't get me wrong. But that, that is exactly what you said.

That's one of the mistakes that people are making.

And then, you know, I feel it's a disservice to patients not to dissolve all the filler before the surgery because if you don't, it's going to block lymphatic channels and it's going to delay the recovery. Plus you're lifting a fil face. And so I have a real, you know, keen eye for what looks natural.

And I don't want any filler in the face when I'm lifting it. If Anything. If they need volume, I'll replace it with fat that comes from their own body.

Roxy: 00:10:32

Okay. So that's, that's a better filling technique.

Dr. Mani: 00:10:35

Much better.

Roxy: 00:10:35

Okay. Because it's each your own natural, it's.

Dr. Mani: 00:10:38

Your own natural tissue. Yeah. The main, the main conundrum we have here in LA is that people don't have enough fat. You know, they'll pinch their skin.

Like I have a lot of fat here, but it's not, I mean, I, I do, but a lot of people here know that's a good thing. Right. And actually fat produces estrogen. So I always. Women don't lean out too much because it's going to affect your hormone cycle or potentially.

Roxy: 00:11:00

Right.

So particularly at this time in our lives, you know, it's like because we are chasing the hormone cycle and you know, things are kind of all over the place. Does that affect getting plastic surgery, like with the hormones shifting and changing?

Dr. Mani: 00:11:15

It does. And I want my patients to be healthy.

I want them to eat, you know, a good anti inflammatory diet, not smoke, which are luckily those are things that people do anyway here. But yes, I have relationships with really good endocrinologists that optimize hormones before surgery. Because you're exactly right.

That's, that is very important to get your system optimized.

Roxy: 00:11:34

Oh, that's interesting. So your hormones should be leveled before.

Dr. Mani: 00:11:37

I mean, you should at least if there's fatigue, tiredness, if, you know, you're going through menopause, which is a good percentage of our patients in facial rejuvenation, you should get that looked into and get it optimized.

Roxy: 00:11:47

Because we live in Los Angeles as well. You know, we look around, we see Hollywood, right. We see the celebrities.

And even though people don't really confirm that they've had facelifts, you know, we can look around and kind of see people, you know, reversing the clock by a few years or looking really refreshed. So do you see that as a Beverly Hills plastic surgeon? Because I'm sure you have a fair share of, you know, celebrity clients.

Do you see that coming in that you see, you know, people doing these sort of little tweaks and.

Dr. Mani: 00:12:17

Yeah, I mean, you know, I'm one of the go to surgeons for a lot of actors, a lot of celebrities. I keep it very private obviously, because it's, it's standard, you know, medical confidentiality is paramount. But. But yes, you do see that.

And I mean I've known for decades that a lot of these people have had facelifts when they're sort of not telling the truth about it, you know, and now it's coming out a little bit more because of some of the ones that have admitted that they've had it. And I think that's good because it destigmatizes the word facelift.

You know, I sort of made a joke with someone that when you say you've had a facel, it's like saying that you a goat, you know, that's not something people want. There's a joke about that. But anyway, that, that it's a stigma. It has been a stigma, but. But it's becoming.

But at the same time, and I'm preparing a video about this for my social media. We take pride. I take pride in the fact that no one has to know. You know, I think it should be invisible.

You know, it shouldn't be a point of pride or, you know, a status symbol. I've had a facelift. Look at my scars. You know, it should be invisible. It's the patient's prerogative whether they want to talk about it or not.

Roxy: 00:13:22

You know, I'm so glad you're bringing up honesty too, because I do think when you're.

And it's an interesting, like, kind of way to think about it is when you're a public person and, you know, you maybe do something like this, it is because, you know, the younger generation, they're looking up to these people and they're, you know, saying, I want to look like this. And, you know, I think feel like you should be kind of honest about that stuff. I mean, I feel like I'm honest. You know, I have never done filler.

I have done botox. I have had a rhinoplasty. I have had an autoplasty. I feel like I'm going through the list, but that's really it.

Other than lasers and things like that. But I do think it's important to be honest because the younger, you know, the younger generation is looking up. What do you think?

Dr. Mani: 00:14:05

I totally agree with you. I mean, I can't force anyone to do it. But, you know, personally, I feel much more comfortable when I'm honest about stuff.

I mean, I want to over share personal details with patients and whatnot. You know, I'm honest about things that I've done. You know, I'm not like obsessed with things. But I've also had a rhinoplasty.

My friend Richard Zumalan did, I think, a great job. My nose just started to get more droopy. Oh, I've had a decent amount of hair Work also. So this afro is not.

It's came from here, but I'm very happy with it. But. And I noticed with you, I mean, if you had had filler, I would have noticed, and it would.

You look natural and your face moves naturally, and that's what the human face is for, to express emotions and. And for identity, obviously. But, you know, I think once you start getting too much of that filler, you go into the. What they call the uncanny valley.

So it's better to be conservative with all that stuff.

Roxy: 00:14:56

It is scary, I have to say, when I see filler face, you know, around, especially in this town, you know, it's just scary.

Dr. Mani: 00:15:03

I can't look at them. They're not allowed in my waiting room. I mean, if someone. I don't mind, you know.

Now the more advanced I've gotten, the more I'm capable of correcting some things, like even overdone surgery, I can make adjustments. The problem is, like, if I'm, you know, if people see that in your waiting room, then they think you did all the work on that patient.

So I've always tried to protect my brand and keep it away from, you know, that kind of malfeasance that you see out there.

Roxy: 00:15:27

That's really interesting. Have you had to turn people down in your practice?

Dr. Mani: 00:15:30

Oh, yeah, all the time. I mean, we screen people before they come in. We let them know the price range because my fees are higher than the typical fee.

And most people understand that you get what you pay for and it's your face and. And. But yeah, we ask for photographs before they come in because I'm not good at, like, being Sometimes not good at being blunt.

And it just pisses people off if you're like, oh, my God, you know what? At the same time, if someone's in front of me and I. They have too much lip filler, I will tell them.

I'm like, that you're a beautiful woman, a beautiful person, but that lip, you. You've got too much filler in your lips because it's just distracting, you know.

Roxy: 00:16:06

It'S also interesting because obviously we talk to a lot of women here on the show, but as a man, do you feel any sort of pressure to look a certain way? Especially like being in midlife, you know?

Dr. Mani: 00:16:17

Yeah, yeah, yeah. I think, you know, for men and women, and increasingly men, you know, this.

People listen to you more when you' look younger with social media, there's a lot of pressure. I don't think it's all good, though.

I don't think that, you know, younger people should be getting filler because they're obsessed with the way a certain celebrity looks and whatnot. But I think that it's.

It's only fair, you know, if women are forced to do it or if women feel that men should be, too, because then the woman looks younger. She wants her mate to look, you know, her partner to look younger, too. It happens a lot.

Roxy: 00:16:48

So if a woman is coming into your practice and she's saying, you know, I want to look refreshed, rested, what are you assessing when you're talking to that patient?

Dr. Mani: 00:16:58

Well, I mean, okay, so if someone comes in and they already look refreshed and rested and young, I'm going to be like, don't do anything. You know, you got. You got to be honest with them.

You know, it's not about me, you know, being aggressive about doing these procedures that they don't need them. But I'm assessing, like, the way the volume of the face, their skin. I mean, I'm also assessing their psychology.

I'm assessing the way they behave, the way they move, are they useful, are they happy? You know, and. But just physically, like, it's basically, you know, sort of skin and then volume and then gravity. Gravity. How much is gravity done?

You know, I'm a big gravity person. I think gravity is what we're fighting. You know, gravity is the mystery of life. It's the source of art, the way we experience time.

It's also the main reason for, I think, why our face ages. So that's the main thing. As a surgeon, that's the main thing I'm looking at is how much gravity is the ravages of gravity, how much it's done.

Roxy: 00:17:48

Tell me about it. These jowls. I'm like. Every time I look in the mirror, I'm just like, you don't have.

Dr. Mani: 00:17:54

I wouldn't call them jowls. I mean, the thing is that when. When you, you know, that's why, like, a lot of times when a patient comes in, I. I make my photos first.

So I'll study their photos so I can sort of more unselfconsciously look at the objective features. Because when you're talking to someone, you don't really.

I mean, at least for me, I see their spirit, I see their personality, but then I want to hone in on those things so I don't really start focusing until they're in the exam chair and kind of talk to them about it. But at the same time, I'm not going to look at them. And say, well, you've got this. You've got jowls.

I want to wait until they tell me what bothers them. Because the happiest patient is going to be the one that you figure out what's bothering them and you correct it.

And then if they give you carte blanche, and then I'll say, yeah, we could do this a little bit. As long as it looks natural, then that's. I think that's all good.

Roxy: 00:18:38

So let's say I'm coming into your practice, I'm coming in for the consult, and I'm sitting in your exam room. You're looking at me. It's not going to hurt my feelings. What would you suggest?

Dr. Mani: 00:18:50

I would suggest that you tell me what you think.

Roxy: 00:18:53

I think that gravity, like you're saying, has started to play a bit of a role in the phase. You know, like, I wouldn't mind a little something a little like tuck, you know, just a little.

Just a little help, like, especially in the lower facial. But then there's also the bless discussion, too.

Dr. Mani: 00:19:10

Yeah.

Roxy: 00:19:11

You know, I've got the bags under the eyes a bit. I've got the hooded eyes, so.

Dr. Mani: 00:19:16

Well, yeah, so that. So I think that. And I do start from the neck down when I'm looking at someone and kind of putting my hands and feeling.

The nice thing about the neck, and in particular your neck, is that a lot of the changes can be reversed by devolumizing using the things underneath the platysma muscle. And that's getting kind of technical. I think a lot of people know what a platisma is in this town. Do you know, like, platysma?

Roxy: 00:19:39

I don't know the scientific word, but.

Dr. Mani: 00:19:40

I definitely know the banding, the one that caused that muscle, that causes the. Right, right. You're like, whatever.

Roxy: 00:19:45

Got it.

Dr. Mani: 00:19:45

Well, yeah, so. So underneath that muscle, there are other muscles that are sort of evolutionary remnants that we can get. We can trim down.

It's very common now to reduce the size of the salivary glands here. And that requires a lot of experience on the part of the surgeon and dexterity. But shaving those down also will be helpful.

And I bet you in your case, it might be. And then just you know, sort of lifting.

And the thing that people need to understand is that the procedure that will correct the neck is the same one that will correct the jowl.

So the neck muscle, once you've tightened it here from down here in the midline, you also have to lift it, and it needs to go vertically so that you're going to correct the lower face and the neck at the same time.

Roxy: 00:20:26

Time.

Dr. Mani: 00:20:26

If you just try to pull the neck muscle back this way without pulling this up, it's going to look weird, you know, and your jowls are going to look worse and just sort of like, you know what I mean? Disharmonious, I guess would be the word.

Roxy: 00:20:37

So is that like, would that be considered like a, like a half like. Or a lower lift?

Dr. Mani: 00:20:41

Right.

Roxy: 00:20:42

Is that the full.

Dr. Mani: 00:20:42

Right. So, so what you just did is something that I'm going to talk about in this video on my Instagram. A lower lift.

Roxy: 00:20:48

Okay.

Dr. Mani: 00:20:49

So people like to say, you know, face tuck or, or something lift or lower lift. But if you use the word face and lift together again, that's where like I a goat.

Roxy: 00:21:02

Terminology is the best.

Dr. Mani: 00:21:03

Yeah, it's a little crass, but it's, but it gets the point across. You know, it's like the source of shame.

Roxy: 00:21:08

Right.

Dr. Mani: 00:21:08

It's changing, but fine.

So lower lift is sort of, you know, I think the whole disconnect is that plastic surgeons consider any procedure where you're lifting this part of the face a facelift, and this is a brow lift. So that's the misconception on the part of the public. But you call it whatever you want.

You just want to do the right operation and you want to lift the muscle. So in most cases, lifting the neck requires lifting the lower face.

Unless you're talking about like a 35 year old who just has like a full neck or something like that.

Roxy: 00:21:36

Oh, interesting. Okay, so what should a woman be asking her plastic surgeon when she goes in for the consult? Are there like key questions she should be asking?

Dr. Mani: 00:21:46

Yeah, I mean, in terms of like, you mean like in terms of qualifications and things like that? Yeah. Well, they should know before they go in, is the surgeon board certified.

Certified by the American Board of Plastic Surgery or the American Board of Facial Plastic Surgery. And I think those are the two core specialties that are qualified to do facelifts. Well, so, but that's just a basic.

They should, then they should already, once they go in the office, they should ideally know someone that that surgeon has worked on.

You know, that's, that's the basis of my practice is referrals, you know, sort of word of mouth, but more direct referrals from patients and their friends. So you should have been referred already before you go in. You should be pretty comfortable going in.

And then it's, and then you, you should know, is the patient, is the doctor artistic? Do they have artistic skills? How do they look at you? How do they. You feel the vibe you get when you come in.

You could ask how many they've done, how many years have you been in practice? And then, you know, it's not just, just and then.

And look at before and after pictures very carefully and if you have critiques of them, tell the surgeon and they'll say, well, if you look closely, you know, this is different or that's different. So those are really important things to do.

Roxy: 00:22:51

Should this person also be asking about like the technique or the procedure, you know, kind of the details of that?

Dr. Mani: 00:22:58

Yes, I think so. What kind of facelift do you do? Do you do deep plane facelift and yeah. What's your technique? How, how long does it take you?

How much and how many do you do? A day or a week? And again, like we were talking about earlier, I think doing five a day is not necessarily a good thing. I mean I do one a day.

I take my time. It's a craft. And the suturing, especially if I do an incision in front of the ear, you know, that takes an hour per side to do it. Right.

Because it's a little microsurgical sutures. So look really closely at photographs. I think if I were a patient I would ideally want to see someone else that they've operated on.

And any good facelift surgeon should have like a battery of patients that they can and give them their phone number that they're willing to talk to. I think that's important.

Roxy: 00:23:40

That's a good point. Good referrals and everything. What are like the no no's like before and after a facelift procedure?

Like yeah, are there certain things you should be doing, should not be doing? So you have like the best possible outcome.

Dr. Mani: 00:23:53

Yeah. Get your weight to a stable weight, an ideal body weight, which thank thankfully in la that's not usually a problem.

And if someone says I need to lose weight, I'll say, I mean, well, how much do you feel like you need to lose? Well, ten pounds. So I'd say lose it beforehand, but only if you know you're going to keep it off. Don't lose it. And then yo, yo, back to your.

Because it just looks, I think it looks kind of weird. If you lose a lot of weight, have a facelift and then you gain weight. It looks kind of bloated and.

And I won't operate on someone that has not gotten to a pretty ideal body weight. I think it's a disservice to them. So it's all, you know, you're investing a lot in your facial appearance.

They should also take it as a step to make sure you're healthy. And then, you know, and then Ozempic is not ideal.

I think, in, you know, Ozempic and the other, you know, medicines that help you lose weight, as long as they're done in moderation. But we've talked about the Ozempic phase. People that are really just withering away. That's not ideal.

And those patients don't do as well after surgery because their structure is not as good.

Roxy: 00:24:50

Yeah, that's really interesting. I didn't realize that the weight, like, really plays apart in the facelift, like how well the results are, because you think maybe five, ten pounds.

It maybe doesn't change things much, but it could, huh?

Dr. Mani: 00:25:03

Yeah, it varies. I mean, everybody loses. And you know this from people. You're looking at people. Some people lose a lot and gain a lot of weight in their face.

Some people don't. So if they're not a face weight gainer, I guess you would say, then it's not as big of a deal.

But if they are, then, yeah, it makes a difference because then when it's kind of like when you dissolve filler also, the face deflates. I want that back in its. Oh, you know, I'm a. If I'm a painter, which I am, I want to paint on a blank canvas.

I don't want to take someone else's painting and paint on it. It's a waste of time, and it won't reflect my style and whatever I've gotten from the patient. So, yeah, it makes a difference. And so when you.

When you lose the weight, your face does fall, but that's what I want.

Roxy: 00:25:39

Okay.

Dr. Mani: 00:25:39

Yeah.

Roxy: 00:25:40

And then after the procedure, are there things that people, like, supplements they should be taking or things they should be doing to kind of maximize, you know, the positive results?

Dr. Mani: 00:25:48

Yeah, yeah. There's supplements that they should not be taking, ones that thin the blood. There's a lot of vitamins, and we have a whole list. List.

We generally ask people to quit the majority of their supplements beforehand because a lot of those can thin the blood. Turmeric. And then obviously, you know, anything that contains aspirin, fish oil, all those things are great for you. But not right before surgery.

Not the few weeks before surgery. Those need to be stopped. And then after surgery, you know, people always ask about, like, glutathione drips and whatnot. Nad.

And I think those are for certain people, those are fine. And to restart them afterwards, I will say that I think people are getting these IVs.

I'm not a huge fan of doing that all the time because if you can drink and eat, you don't really need an iv. But they're pushed on people kind of like filler. And I think it's kind of excessive.

And an IV is not a benign procedure because you can get endocarditis. You can die from an iv, it's very rare. But if you don't need it, you shouldn't do it. I don't think so. Those are things that I would shy away from.

The main thing I think postoperatively that it's really helpful is hyperbaric oxygen therapy. You know, I don't know. Do you know about that?

Roxy: 00:26:51

I do. Where you go into the chamber, Right. And is it readily available? I guess in Los Angeles.

Dr. Mani: 00:26:57

It is in la, yeah. There's several places. You know, we use a place in Century City called Alto. That's fantastic. The people are great. They're medical grade chambers.

You know, the chambers that only go up to 1.5 atmospheres I don't think are worth very much. You know, worth your time. You need to go up to 2 atmospheres to get it, get an effect.

But basically what it does, it kind of super saturates your blood with oxygen. So you're delivering more oxygen to the tissues that are healing. And there's a noticeable decrease in swelling.

And also, like again, when I do an incision here, it just fuses together in like a week where if you don't, it takes a little longer to heal so you can see the effects.

Roxy: 00:27:30

Oh, wow, that's really quick. And then how long after can you resume like exercise and kind of going.

Dr. Mani: 00:27:36

Back to your daily habits? The safe answer is six weeks. But that drives people bananas.

And so I let people start a little earlier, sometimes three weeks, sometimes four weeks, but not full bore. You know, I don't want them going on it to a spin class after two weeks. But they can do things that. And really the main thing is cardio.

Cardio makes you swell more. So when your cardiac output, your heart rate gets higher, your face is going to swell, which is not ideal.

And you know, people in LA have an obsession with exercise. And I know because I do too. You know, I try to stay fit and do my cardio, but I'm used to it.

If you have a procedure done, just stop for whatever the doctor tells you to. It's really important.

Roxy: 00:28:12

So who is not a good candidate for a facelift?

Dr. Mani: 00:28:16

Well, again, someone that's not at an ideal weight. Someone that's not psychologically healthy, that they, you know, you can tell they're addicted, someone that's had too much done.

I, they're not, you know, loud even in my back private entrance.

I, you know, if I can help them, if I can dissolve their filler and if they're not happy with their filler or their procedures and I think I can help them, then I, I, then I like doing that. And then, you know, people that are not, do people have serious medical problems, you know, it's real surgery.

So you have to go into it knowing that this is a major surgery in some ways and have a realistic attitude about that. Smokers also.

Thank God we don't have many smokers here, but like in Europe, the facelift surgeons there, they have smokers and they get, you know, necrosis of the incisions of the, you know, the wound. Happens, you know, pretty regularly. Not as much with a deep plane facelift.

But luckily, like, like the people I've had that are smokers, usually they're like these, you know, Oscar worthy actors, they smoked. It's like, well, I'll have to do a more conservative procedure, but that's, it's pretty rare.

Roxy: 00:29:15

So it changes what you would do.

Dr. Mani: 00:29:16

Yeah, a little bit.

Roxy: 00:29:17

What about all the people that vape though? Because there's a lot of vapers here. Does that also change?

Dr. Mani: 00:29:21

Yeah, vaping is not ideal. It's not as bad as cigarette smoking, but yeah, you don't really find that many. At least I don't people that are like chain vaping.

I don't, I don't know much about vaping, but I know it's like healthier for your body but, but better to avoid it because it's actually the nicotine that constricts small blood vessels that can affect flap survival. I've been fortunate not to have that problem number one, just because I don't operate on smokers, period.

But if they do vape, then I make them quit beforehand, at least a month beforehand and then afterwards also. I think that's important.

Roxy: 00:29:55

It's interesting.

I've seen lately on social media when people get faceless lifts, they tend to do sort of like a three pack where it's like a facelift, a bleph and a CO2 laser, like right after. Is that sort of like the go to now when it comes to.

Dr. Mani: 00:30:10

Well, you know, again, this is an art. And so I, yeah, you, you want to. I, My philosophy is that you should do everything at once because you're Going to be under anesthesia. So I don't.

I don't believe in, like, just piecemeal, but the patient has to be ready for that, and the recovery is a little bit longer.

Roxy: 00:30:25

Okay.

Dr. Mani: 00:30:26

Now, with bluffs, I like doing lower bluffs, and I would do those on a good proportion of the patients I do a facelift on, because I do it without a scar. It's done through the inside. I just reposition that little fat that's causing the bulge, and it's like a home run if someone really needs it.

It's a beautiful thing. And there's no scar with upper blephs. I've come up with a way of doing that also without a scar in certain situations.

In most situations, actually, because I do it endoscopically. And you. What I do is go in with an endoscope and go under the brow and release the orbicularis muscles. That's causing a lot of the bunching.

And then as you lift the brow up a little bit, the upper lid spreads out. So you basically. Like, in your case, I wouldn't do an upper bluff on you. I would do it endoscopically.

Roxy: 00:31:07

Oh, do it back in the hair.

Dr. Mani: 00:31:09

In the hair.

Roxy: 00:31:10

Interesting. More like a brow lift.

Dr. Mani: 00:31:12

It's part of a brow lift. Yeah. Mostly you lift the lateral brow and in the. Because everybody's lateral brow goes down the medial brow. Like, in your case. Yours. Yours is fine.

I wouldn't lift it.

But the lateral brow just out here, and then that way I can get in, you know, with the camera and just release the muscle, and you won't have to have that skin redundancy there at all.

Roxy: 00:31:30

Oh, well, that's good to know. I'm like, oh, my God. I have, like, a list of things.

Dr. Mani: 00:31:34

Scarless is the way to go if you're a candidate.

Roxy: 00:31:36

Yeah, right.

Dr. Mani: 00:31:37

And.

Roxy: 00:31:37

And it seems like, you know, the results are lasting and people are happy.

Dr. Mani: 00:31:41

Yeah, yeah. The way. The way I do it endoscopically, it's again, it's a full deep plane lift.

So I'm not going to do it if I think the result's going to be compromised.

Roxy: 00:31:49

Okay.

Dr. Mani: 00:31:49

And, you know, I've gotten sort of a name for doing this endoscopic work. I've been to 14 countries in the past three years teaching it. I presented live surgery at meetings in Brazil and other countries. So it works.

You're going to find people. Other surgeons will say, no, it doesn't work. Is that. That's because they don't know how to do it. And I don't blame them.

I would do the same thing if I wanted the patient to come to me. But it does work, and it's definitely the future in many ways.

It's not for every patient and not for every surgeon, but it's definitely for younger people. On the relatively younger end of the scale, like you. I would probably do endoscopy.

Roxy: 00:32:21

Okay, good to know. How do you know if you should get a blepharoplasty or a brow lift?

Dr. Mani: 00:32:27

Well, that kind of pertains to what we were just saying. I mean, in my hands, it would be a brow lift where, you know, but the patient has to be okay with having their brow lifted a little bit.

You know, a brow lift, people kind of take these procedures as a rubber stamp. Like, oh, brow lifts are bad because I've seen, you know.

Roxy: 00:32:42

Yes.

Dr. Mani: 00:32:42

I don't want that surprise look. Well, that, again, that's the art of it. Knowing how to lift it in a subtle way. With an endoscopic brow lift, it's hard to over lift the brow.

It can be done, but it's, it's, it's hard. And, but the, the, the way I look at it is I want to see pictures of patients when they were younger.

I want to see what their face looked like when they were younger, because presumably that's kind of what they want to recapture in most of the cases. You know, sometimes they'll say, well, I was too fat or whatever, and you, you know, now they're better. But that, that's what I want to look at.

And in particular, with regard to positioning the brow, I want to make the brow look like, you know, kind of what it used to look like.

Roxy: 00:33:17

You know, we also see a lot of these, this buckle fat removal procedure. Now, is that something that you are a fan of in certain, you know, if it, like, applies or.

Dr. Mani: 00:33:27

Yeah.

Roxy: 00:33:27

Do you think it's done too much?

Dr. Mani: 00:33:29

Well, I think it's. I don't think it's done in my practice. I don't do it too much. I don't, like, push it.

But if someone wants that contour and to accentuate their cheekbones when they're younger, I think it's fine.

And then the caveat is, well, again, like, you already know, I think, think, you know, with buckle fat, you worry about losing facial volume as you get older. Well, facial volume can be replaced. I can use fat transfer. And I have done that. And I have had to do it on people.

I did buckle fat on where they're like, well, I liked it. And. But now I realize I want a little. So I'll just go back and put some fat transfer, and then they look better than ever.

But, like, when I'm doing a facelift, it's not a routine part of my facelift surgery. I happened to do it last week. I was doing an endoscopic facelift, and she wanted it and she needed it. It. So it's fine.

But every face is different, so it's not like something that people should be, you know, like ice cream. Everybody likes ice cream. It doesn't mean it's not for everybody. It's for everybody.

Roxy: 00:34:18

Okay, good to know.

Now, when you're looking around at Hollywood, not your patients, but when you just see people in general, is there anybody that stands out as having really good work done or possibly a really good facelift done?

Dr. Mani: 00:34:29

Yeah, I mean, I think, you know, I don't really like to comment on celebrity and, you know, obviously ones that I've worked on, which are a good number, you know, obviously, the, the one that people are talking about a lot right now is Kris Jenner, you know, and, and. And my friend Steve Levine has been acknowledged by her to have done it. Steve's a brilliant surgeon. He's a really cool guy.

I did live surgery alongside him in Sao Paulo last year. And, and so, you know, he's gotten really popular even before that. Interestingly, he. He does just a smasectomy. He doesn't do a deep plane facelift.

It worked out very well for her, I think. I, I still think that deep plane has gotten a lot of traction for a reason. I think over the past couple decades, it's become popular.

And, you know, I think they. The rumors are that Lindsay Lohan had a facelift. She denies it, which, again, is her prerogative. You know, I think one.

The one thing that I think for sure happened with her is the filler went away because she had filler. She had that lip filler look. The lips weren't moving as naturally. And. And so she got that. So those are two people.

But, yeah, there are a lot of them out there. I mean, you look at. At, you know, Michelle Feifer, people see she's a beauty icon. Angelina Jolie, I think, still looks great. They're not my patients.

And then I'll stop there, because then I'm going to. Next thing you know, they're like, they.

Roxy: 00:35:44

Said he said he got a facelift. Yeah, no, you're right. There's some. There's really good work right now, which is so exciting, I think, for people.

And really, I mean, Ultimately, it's each person's prerogative. Like, you're saying it's like, if you want to do work, do work. If you don't, you don't. But I do have to say the work has gotten so much better.

Dr. Mani: 00:36:02

Yeah. Yeah, I'm glad to hear you say that.

I mean, I think, you know, yeah, I. I look back at my work from the first few years of my practice, and, you know, I was lucky to get a lot of facelift experience in my training.

You know, I went trained at Baylor College of Medicine, which was one of the top three programs in the country, particularly in terms of volume that we did. I had, you know, my own facelift clinic that I, you know, as a resident, and I would.

I was comfortable by that point doing enough of that them that I would. I chose an attending physician or professor who wouldn't show up because he was too busy. So, like, okay, I want to do it on my own.

So I had done 30 or 40 by the time I finished my training. So I look back at my initial work, and in the past, I would say, well, I can't do any better than that. I've always been good at this.

But I try to get better every time now. And that's something that's changed with my philosophy is like, I want to be very critical of my results and get better.

And I think that's part of what's, you know, imparting that philosophy to younger surgeons is what's made us all better.

Roxy: 00:36:54

Better, Absolutely. And for the women listening today, what are three things that they could do at home today that will help their skin age slower?

You know, really kind of preserve what they have.

Dr. Mani: 00:37:07

Yeah, well, use good skin care. I mean, there's no magic bullet for skin care. There's nothing that tight. You know, they go, this facelift in a bottle, that's total.

I think most people know that, you know, a facelift takes all day done correctly, several hours at least, so you can't get it out of a bottle. And. And sleeping on your back is.

Is an important thing because, you know, we spend a third of our lives asleep, and so we spend the rest of our lives fighting gravity.

While you're sleeping, you're either going to let gravity do its thing by sleeping on your side or, God forbid, your stomach, or you're going to lie on your back and let gravity help you by, you know, make keeping your ligaments tight and not stretched. So sleeping on your back as an import is one of the things I would do also. So you Know, not smoking. Keeping your weight stable is also a big deal.

That's, that's really important. Getting plenty of sleep, because that'll help with the eyes and everything. Those are all, you know, good things.

Roxy: 00:37:57

Is there any go to skin care that you're loving right now?

Dr. Mani: 00:38:00

You know, yeah, I like Elastin. I kind of leave the skin care to my, my coordinator. And so all these things change. I'm developing my own brand.

I'm going to call it Moni Mist because Mist is a well, so for skin care, I'll back up. I do autologous stem cell injections where I suck out a little bit of fat. And I do it in the office often. And I do it when I'm doing a facelift.

I'll do it with a facelift. And then you emulsify all the fat cells out. And so what's left are stem cells and other supporting cells, you know, autologous exosomes.

And I just inject them thoroughly throughout the face and neck. And that will help reverse the, you know, regeneratively reverse the changes of aging.

And it helps with sun damage and it lasts, lasts forever in the sense that it's a cellular change. And then we have a skincare line that we recommend afterwards that we require called Deafinage, which is a stem cell activating line.

And it's kind of a medical line that we really like that in particular. But I really think that, you know, you mentioned lasers earlier and things like that. CO2 lasers. I don't like them to excess.

I think if someone like has the, like a desert bearing lizard skin, they live in the Palm Springs, then. Yeah, that works. But for thinner skin, it can thin out the skin over time. Time.

And then they end up kind of looking like a ghost when they're in their 60s and 70s. So you got to be careful about that. But I do like Potenza microneedling. We do that before the mist and then inject the stem cells.

And it's just, it's beautiful.

Roxy: 00:39:21

Okay, so you do the microneedling, then do the stem cells. So it really absorbs into the skin.

Dr. Mani: 00:39:25

Well, it's not exactly. That's. I'm glad you said that because people will do, you know, micro needling and then they'll put prp, most common vampire facial.

It's total horseshit.

Roxy: 00:39:34

Okay.

Dr. Mani: 00:39:34

You know, it's like saying this is not the best analogy, but it's like saying, I'm going to take a boat and put it on top of a geyser and it's going to go into the hole. That's exactly the opposite is going to happen. Maybe a little gets in there.

But what I do instead is the Potenza machine has what's called a fusion tip where you turn the power off and it exerts a positive pressure to push the fluid in. So that's what you have to do. And then in addition to that, I also inject with a little Botox needle, you know, and it takes a while.

It's kind of tedious, but it's worth it. So that. But. And I like microneedling to a degree, but not again, not to excess. Because the, the thing is that you'll hear we were building collagen.

You know, we're going to build your collagen with whatever it is, appeal or whatever. The problem is that, like I can take a cheese grater and grade it on my arm and it's not going to look better. It's going to look like hamburger meat.

But it has built collagen. But it's type 1 and 3 disorganized collagen that you're building. It's just scar tissue issue.

And I honestly feel the same way about these bio stimulator fillers. That's another line of bullshit. It's my opinion.

I'm not going to say that's objectively true, but regenerative means you're taking stem cells and other cells from the patient's own body and you're truly regenerating. So you have to kind of watch out for that marketing stuff.

Roxy: 00:40:44

Okay, that's really good to know. Yeah. Please, can you let us know what we should not be doing procedures that you think are not worth it, the time or the money?

Dr. Mani: 00:40:52

Yeah, I think that thread lifts. Most surgeons will tell you and most patients that have had thread lifts, a waste of time and money. They can have complications.

They can injure facial nerves. I've seen it happen. So that's definitely one that I would say for some reason it's kind of reared its ugly head again after 20 years.

They had them 20 years ago. They were permanent. They still didn't work. Now they're absorbable, so they work even less.

Every now and then I'll meet a patient that was happy with them, but it's pretty rare. And then again, CO2 aggressive ablative lasers do work in some cases.

And I have great dermatologists that I refer to for them them but they are aggressive. So, you know, and also retin a I think is overused. It's kind of addictive.

Because it makes your skin soft and supple, but at the same time, it also will make your skin friable, which means that you can scrape it and it'll start bleeding if you do too much of it. And so that tells. Not most people don't do that, but just in excess. It's not good. And I don't even think it's good at all.

But, you know, I've been a proponent of just doing the stem cell injections. The. I think that's much better.

Roxy: 00:41:53

Oh, interesting. So if a woman has her, you know, retin a at home, should she not. Or use it sparingly kind of a thing?

Dr. Mani: 00:41:59

I mean, I would almost say throw it in the garbage can, in my opinion. I mean, dermatologists would probably disagree with me. But again, you know, they're doing fillers. They recommend those. I don't like those.

But again, you know, I'm a surgeon. I don't recommend surgery for everyone. I think you need to do what's right for. For the patient. But yeah, retin a, I mean, maybe, but just in.

In moderation and real moderation and Are there lasers?

Roxy: 00:42:22

I know CO2 is not, you know, great in your eyes. Are there lasers that are better? You think that maybe.

Dr. Mani: 00:42:27

There are a lot of lasers that I kind of lose. There's picosure and they all. And I have a nurse that Karen Villanueva is one of the world experts in laser treatment.

So I kind of defer to her judgment and I'll have people come in and just. She'll do a consult with them. But yeah, there's certain, like IPL works for the little. And it's pretty mild just for little red spots.

V beam laser works well for vascular issues. And we use V beam a lot. My friend Dan Beruzin is a dermatologist. I refer a lot of people to.

For not only, you know, vascular things in the, you know, spider veins and things like that redness, but also with the scars when they turn red. We sort of. If they turn red, we use the V beam laser. So lasers are very specific for a certain purpose.

There's no kind of catch all laser, you know, for. For everything.

Roxy: 00:43:09

So a lot of people have like red light masks at home. I think red, blue and yellow. Are those good to use pol post surgery for healing?

Dr. Mani: 00:43:18

Yeah, I don't think they make a night and day difference. I think, I think the hyperbaric is your go to. But obviously it's not a laser. But I think they can work.

I think those masks, you know, you Kind of have to try and see if it works. People have a tendency to want to do something to help themselves heal. They don't think they're going to heal without doing something active.

And that's not true. It's just time. You know, the vitamin T, the tincture of time, we call it, takes time. Hyperbaric definitely accelerates the healing curve.

And red light might.

I think the main thing is don't get in like an infrared sun or one that's going to make you sweat because you might get an infection if it's too early, then that your sweat will get bacteria into your incisions. So that's a no no afterwards.

Roxy: 00:43:58

Okay. Oh, that's good to know. Especially in Los Angeles. Like you're saying everyone wants to get back to the gym or like do the infrared song.

Dr. Mani: 00:44:04

Yeah, that's one of the problems of working out too soon. I had back when I did.

I do breast surgery still some, but back when I did more breast surgery, I had a patient that, you know, went to, went to work out and got an infection, you know, worked out too quickly and it was like two weeks after or I had a patient once that got the. Got an Airbnb without air conditioning on the hottest day in recorded history. I told her, you're going to get an infection. Sure enough, she did.

I mean, we handled it with antibiotics, but those are things that you don't think about sometimes if you're a patient that you need to be told about.

Roxy: 00:44:34

And what about cold therapy? Like cold plunges? Like putting your face in an ice bath. What about.

Dr. Mani: 00:44:39

What do you think? Well, yeah, so no, I don't think. I think there's something coming out about cold plunges. And I was happy to hear this because I'm a wimp about that.

I don't want to do it. So I'm glad to hear that. There's something that's not good for you. I forget what it is, but something to research. Definitely not.

After surgery, you can ice yourself, assuming you haven't had fat transfer or stem cells. Ice is okay if you haven't had those things done. So I don't allow much icing just because of that because it'll kill the fat. Transferred fat.

That's one thing to be careful about. About.

Roxy: 00:45:10

So when you're taking fat from the other parts of the body, is it usually like the stomach or the legs?

Dr. Mani: 00:45:14

Yeah, usually.

You know, again, in la, it's like everything because they have a little bit left, you know, but so we usually the flanks, actually, because you know, because your body wall is shaped like a cone, sort of. And so there's more fat here in almost anyone than you would think.

So this is kind of the go to area, you know, and, but the thing is that most people, you know, you, you can't, you can't swing a dead cat in LA without having someone have liposuction or that hitting someone that hasn't had liposuction. So in areas where they've had lipo, you may have to go to other areas like the upper back or places like that, but the flanks are kind of the go to.

Roxy: 00:45:51

That's a go to.

Dr. Mani: 00:45:52

Yeah.

Roxy: 00:45:52

Keep those flanks, ladies. So what advice would you have? Would you give your 25 year old self?

Dr. Mani: 00:46:03

That's a very good question. You really shifted gears there. Now I have to think philosophically.

Roxy: 00:46:07

I know we're taking it out of the plastic surgery.

Dr. Mani: 00:46:11

I would say enjoy the process, which I do now, but like appreciate the privilege of being able to do surgery on people because to me it's kind of a spiritual thing because I see the beauty of the living, glistening protoplasm and I think it's a real privilege and surprise. So it's become something that I've incorporated into my soul that I love being a surgeon.

I will never stop operating and I could retire now, but I love doing it and so I'll keep doing it until I can't. And so I would just say, you know, don't, don't worry as much. I tell that to anyone, things are going to work out.

And then, I mean, I would say to myself, you've chosen the right path. Because I wasn't always sure. But you know, my mother was an artist, my father was a circle surgeon.

So I sort of had the genetic, you know, proclivity.

And at that point the other thing I would say to myself is that do more charity work earlier because I do a lot of it now and I trained in reconstructive surgery and I love that part of it, you know, because I sit around in my office having people come in and bitching about their wrinkles all day, which I don't mind because I know I can help them. And it's more than that. There's a psychology to it. But I.

About 10% of my practice I devote to Face Forward International helping, you know, patients that are victims and sort of survivors of domestic violence incidents. And you know, the staff love it when they come in. And I'm the executive, the chief surgeon of that group along with Dr. Rod Roerick.

In Dallas is a very famous plastic surgeon there. So that's the thing. I'll say. Oh, you're from Dallas? Oh, I'm from Abilene.

Roxy: 00:47:42

Oh, you're kidding.

Dr. Mani: 00:47:43

We haven't talked about this.

Roxy: 00:47:44

Oh my gosh. We're Texans.

Dr. Mani: 00:47:46

Yeah. Yeah.

Roxy: 00:47:47

Do you go back a lot?

Dr. Mani: 00:47:48

No. To Abilene? Yeah, it's in my heart. I love the city I grew up in, but no, I don't go back.

You know, maybe most of my friends moved away, my family moved away, but I love Dallas too. Do you go, do you go back there?

Roxy: 00:48:00

I do. I'm actually getting ready to go next week. So just in time for all that August heat.

Dr. Mani: 00:48:05

Yes. Well, I don't mind the heat. Or I used to not mind the heat. You get kind of wimpy in LA after a while where it's like, oh, God, it's too hot.

But, but yeah, it's. But no. And well, Dallas, it's also a dry heat, as they say. So it's not as bad as places, right, Right.

Roxy: 00:48:18

It's not as bad.

And I find that Dallas is kind of a mini Los Angeles in a lot of ways, you know, as far as, like lifestyle and the way people kind of, you know, live there. Right. It's very glamorous, it's very metropolitan. So it's nice to go back.

But then it's also nice to kind of get away and kind of visit relatives in smaller parts of Texas and see that side of it, because it's not something I see a lot here, you know.

Dr. Mani: 00:48:41

So what, what part of Dallas did you grow up in?

Roxy: 00:48:44

Preston Hall.

Dr. Mani: 00:48:45

Oh, sure.

Roxy: 00:48:45

Preston Hollow area. Yeah.

Dr. Mani: 00:48:46

That's beautiful.

Roxy: 00:48:47

Yeah. So I went to an all girls school there growing up. Yes. School, yes.

Dr. Mani: 00:48:52

The best, probably best private school in Texas, right?

Roxy: 00:48:55

I think so, yeah. I mean, I'm a believer.

Dr. Mani: 00:48:57

Yeah. That's a great school.

Roxy: 00:48:58

Yeah. So it was great.

So it was, you know, great growing up in Texas and having those, you know, Dallas summers and Texas summers and, you know, enjoying being outside and all that good stuff. So.

Dr. Mani: 00:49:10

So how long have you been in la?

Roxy: 00:49:11

So I came to Los Angeles to go to undergrad at USC.

Dr. Mani: 00:49:14

Oh, awesome.

Roxy: 00:49:15

So I've been here a little over 25 years on and off.

Dr. Mani: 00:49:19

Okay.

Roxy: 00:49:20

So I lived in New York for a while and then I came back.

Dr. Mani: 00:49:23

Okay.

Roxy: 00:49:23

So yeah, so it's nice to be there.

Dr. Mani: 00:49:25

And you like LA better than New York?

Roxy: 00:49:27

I do for the day to day, you know, I think it's, it's an easier, you know, just getting around. I Like having a car and, you know, I just feel like it. I can enjoy the days more here.

Dr. Mani: 00:49:38

Yeah.

Roxy: 00:49:38

Whereas New York is great. Like when you're young and single and. And running, you know, out every night, party to party, going to clubs and bars, it's great for that too.

Dr. Mani: 00:49:48

But when you get older. Yes. Well, they say this is an old thing that people haven't heard anymore. But back when I was.

I went to college in Boston at Harvard undergrad, and I went to New York back and forth a lot, and they always said New York is like a shit sandwich. The more dough you have or the more bread you have, the less shit you taste. Oh, it's a grind. Right.

But I mean, I'm getting a New York license because I'm doing. I'm doing live surgery there at a big meeting, and so you have to have a license for that. Okay. And. And.

And I loved it last time I went for this meeting. A friend of mine had into the energy and everything, but, yeah, it's. It's always good to get back to la, I think.

Roxy: 00:50:21

Do you have any favorite places in New York, like your top spots?

Dr. Mani: 00:50:24

I don't go enough to. To have that. There was. There was a place we went for.

For dinner, which was really good, but I just think, you know, new places, they have some great rest. I love, like, haute cuisine, French food. So there's more places there that. For that, but I don't really know particularly what's popular now.

Roxy: 00:50:40

Did you ever go to the late Anthony Bourdain's? He had a French restaurant. Liz.

Dr. Mani: 00:50:45

How?

Roxy: 00:50:45

I don't know.

Dr. Mani: 00:50:46

Yeah, yeah. No, I didn't. Is it still. Still there?

Roxy: 00:50:49

You know, that's a good question. I'm not sure. I'm not sure. But I know he obviously, you know, had a great restaurant. Yeah, he was great. He really was.

Dr. Mani: 00:50:59

Yeah.

Roxy: 00:50:59

Okay. So how are you living iconically right now in the season of life?

Dr. Mani: 00:51:06

I kind of am. I mean, I built a house in Beverly Hills. I'm just overjoyed to have and lucky to have a house that has one of the best views in town.

It's the highest home there, and it's modern. It looks like a museum. And so I just am grateful and blissful every time I go home.

It's kind of a creative space and I'm putting artwork in there now. Now. And I think for me, the most important thing to me, how I'm living is my work with the Survivors and face forward.

It just adds so much dimension and depth and it makes me so Much more appreciative. It makes your problems go away when you see these, you know, these people that have. Their face has been burned by usually by acid burns. And we.

The charity flies them in from overseas and they come in and so, you know, to me, it's just. It's natural people. Oh, it's so great that you're doing that.

For me, it's just sort of automatic because I love doing surgery and I trained in all these aspects of reconstructive surgery and wasn't using them as much. But you can wake me up at three in the morning, I'll go operate without batting an eye. And I love doing it. So it just adds that much more to.

Roxy: 00:52:08

Yeah, feed your practice.

Dr. Mani: 00:52:10

That's the good. A good way to put it.

Roxy: 00:52:11

Yeah, absolutely. Well, on the iconic midlife, we always like to play a game at the end of the episode. So if you're game, we can play a little rapid fire.

Dr. Mani: 00:52:19

Okay.

Roxy: 00:52:21

All right. So the name of this game is refine or rewind. So basically I will say an aesthetic or a trend.

And if you would refine it, you would tweak it and make it better. Or if you rewind it, let it go. Keep it in the past.

Dr. Mani: 00:52:39

So you mean like take it or ditch it. Like, is this a good thing or a bad thing?

Roxy: 00:52:43

Exactly.

Dr. Mani: 00:52:43

Okay, got it.

Roxy: 00:52:44

ontoured cheekbones, a layer.: 2016

Dr. Mani: 00:52:53

Rewind.

Roxy: 00:52:54

Okay. Leave it.

Dr. Mani: 00:52:55

Right. Well, yeah, I mean, I think over anything that when you say over contoured, it sort of means like, that's not what they used to look like.

Throw it away. I mean, that, that conjures filler to me or something that's not. Not natural. So I would say rewind.

Roxy: 00:53:08

Rewind. Okay. The phrase anti aging.

Dr. Mani: 00:53:14

Anti aging is okay. Longevity is. Is, you know, is a. Not a good word. I don't think it's.

Or increasing lifespan is not a good word because we should be increasing health span. We should live more fruitfully and more healthily in the years that we have, but not necessarily 150 years. That's kind of unspiritual, I think, to.

To want to do that. But yeah, anti aging is. Is fine. You know, to try to prevent the ravages of age. That's my job. So I can't say no to that.

Roxy: 00:53:42

Botox before the age of 30.

Dr. Mani: 00:53:45

I would say rewind on that. I mean, I'm not a big fan. I do Boto drives me bananas. Every time I have a patient on the schedule for Botox. And I tell my receptionist, please, no.

But I mean, apparently I'm good at it. I mean, I'm a surgeon, so. And I'm being artistic. I know how to do it symmetrically and whatnot. But yeah, before 30, I mean, come on.

Your face is supposed to be expressive. So just sort of wait until you get like some expression lines that are starting to be etched in and then do it in moderation.

Roxy: 00:54:12

Right? Because, you know, everyone says, oh, I'm doing it preventatively so I don't get. Get wrinkles in the first place.

But you're saying, wait, like, yeah, you're.

Dr. Mani: 00:54:20

Not a sculpture or a mannequin. You know, you're not, you're not trying to. You know what?

You're not, you're not trying to mummify yourself at age 18, you know, or I'm not, anyway, so, yeah, that's too early. And I, I think that, like, a lot of good actors don't want it at all. And you can tell by their expression, they're still expressive.

And so I'm, I'm fine with that. But, you know, conservative botox in the 30s, 30s, late 30s, I think that's fine.

Roxy: 00:54:44

Filler migration correction surgery.

Dr. Mani: 00:54:48

Yeah, that's sort of my wheelhouse. So I would say refine. And that's what I do on a daily basis. I get an MRI on every facelift patient or fat transfer patient.

And I have a radiologist at mink radiology. That's phenomenal. And she gives me a 3D reconstruction, okay. So I can see where people's filler is. It lights up in bright green.

I'll send you a picture of this. And it's animated, so you can see the whole three dimensional reconstruction.

So I have the MRI 3D image in front of me and an ultrasound that I call the filler killer. So I have my ultrasound screen and I have my needle, and I spend four to five sessions on almost every patient dissolving their filler.

And then we typically get an MRI afterwards. So I know as much of it as I can is gone. Filler migration surgery. You. You can't remove filler with surgery. And, you know, you can some, some fillers.

That's the only way, like silicone and whatnot. I try not to get into that because it's freaking impossible. But hyaluronic. Hyaluronic acid filler needs to be dissolved with hyaluronidase.

And it needs to be done not only with an ultrasound, but with the ultrasound in the surgeon's hands and the needle in the other hand. And so you can see the needle go into the filler. That's the only way to do it.

Roxy: 00:55:55

Is there any case that you would actually recommend filler?

Dr. Mani: 00:56:00

Pretty much. No. I mean, I occasionally like when I do a facelift, especially endoscopic. Sometimes I try to keep the incision shorter.

So sometimes you little fine lines that are, you know, that eventually, you know, within a couple weeks, usually fade away. Sometimes I'll put filler in them to kind of pop them out. And my patients will say, wait a minute, I thought you hated filler.

What the hell are you doing to me? And I'll say, we don't have to do it. It's going to go away anyway. But those, that's kind of the only case. And like you, you can do filler.

I, I used to do filler and noses when I did a rhino, when I did the rhinoplasty myself. And there's a little contour thing or something, and I would do it and then it goes away. And as the filler reabsorbs, it goes away way.

The problem is the nose is the number two place where you can go blind with filler. Okay. So, yeah, so the gabella is number one. The nose is number two. The midline of the nose there, certain vessel.

I don't do that anymore because I don't care if it's one in a million. I don't want to make someone go blind. I wouldn't be able to live with myself.

Even though it's like you can't control it, you know, But I think general technique, you probably aren't going to get it, but it's not worth it. Especially because I don't like filler.

Roxy: 00:56:59

Right, Exactly. I know you do hear about those, those fillers, rhinoplasty. So that's kind of a no, right?

Dr. Mani: 00:57:05

Yeah. I mean, for me there are people like, like, you know, Sasha Rifkin, my friend in Westwood does a brilliant job with it.

He does it safely, he's not going to have that problem. But it's not for me.

Roxy: 00:57:15

You know, midlife women being told to age naturally.

Dr. Mani: 00:57:20

Well, okay. And meaning without plastic surgery, I think when you're being told by someone, you should be able to tell yourself what's good for you.

I mean, obviously you take the advice of your friend. Friends. And I think you can, you can age gracefully and still have well done surgery.

And I, I think a lot of times when someone tells you, oh, don't do that, don't, it's because they're jealous because they know you, you know, are able to do it, have the time and the means to do it, or they don't want you to look better. I think that's, you know, can, to be perfectly candid, I think that's one of the reasons a lot of people will tell you not to do things.

But, you know, you have to listen to everybody and you should listen to your surgeon. If you think that they're, they think you look great already, then don't do anything.

Roxy: 00:58:01

Right. The idea that surgery is a last.

Dr. Mani: 00:58:04

Resort is becoming apparent that that's not true. I mean, if it's a. It shouldn't be a last resort, but it shouldn't be a first resort either. It's a very personal choice.

So, you know, you can temporize, you can do. I, I actually really like softwave. It's an ultrasonic skin tightening machine. And did you like it?

Roxy: 00:58:22

Did you see? I liked it. I only did one treatment. I know you have to do a series.

Dr. Mani: 00:58:27

It looked.

Roxy: 00:58:28

Yes, I thought, I thought something.

Dr. Mani: 00:58:30

Yeah. I mean, the less invasive something is, the less you're going to be able to guarantee results.

Even with surgery, we can't guarantee, but I can virtually guarantee they're going to look younger for quite a while. But there's no guarantees with any of this stuff. That's why you have to do your research and your due diligence. But yeah, I like, I like softwave.

I think that's good. And I think there are other things to stave off a facelift.

But I think particularly now with the scarless techniques that I'm doing, it's not a last resort anymore. And the younger you do it, the longer it lasts and the more natural the sort of transition is.

Roxy: 00:59:01

Okay, last one. Fill in the blank though.

Dr. Mani: 00:59:03

Okay.

Roxy: 00:59:03

The future of beauty is blank.

Dr. Mani: 00:59:07

The future of beauty is, is inner beauty and self care. That's just my attitude about it.

I think the future of beauty is, is spirituality and embracing the fact that we live in a world of magic and that, you know, know reality is magic. And understanding that the human phenomenon is a collective phenomenon and that everything we do ultimately contributes to the greater good.

Ideally, this, putting that in perspective, that's what's really beautiful to me. The rest is kind of gravy.

And I think that, you know, I'm good at correcting the external things, but it's more important to develop the inner beauty first and make sure that that's there.

Roxy: 00:59:45

That's such a good point. It's always, you're always thinking about the inside too it's not just about the outside.

Dr. Mani: 00:59:51

That's important. Yeah, very important.

Roxy: 00:59:52

And before we go, I know you're developing a really cool product.

Dr. Mani: 00:59:56

Yes.

Roxy: 00:59:56

That I definitely. We need to share with the audience.

Dr. Mani: 00:59:59

Yeah. Thank you.

Roxy: 01:00:00

For sure.

Dr. Mani: 01:00:01

So this is not for sale yet, but it will be. We're going to launch in the third quarter, fourth quarter. It's the Moni Flow and it's a restorative neck wearable.

I first came up with this idea when I was the chief of the second busiest ER in the country in Houston, Ben Taub Hospital. Which is like Parkland, Right. Dallas.

So we ran it as third year residents and I was so freaking tired that I put on a neck collar and sat like this and fell asleep for three hours. Okay. So I like said one day I'm gonna have, you know, come up with something.

So a few years ago I started working with polyurethane and carved this shape. I have four or five patents on it. And basically this is how it works. Or I can just show you.

So it's like you just lean back and then you can fall asleep on a plane. I mean, I use it all the time at work. Work.

Roxy: 01:00:46

Oh, that's a good one. Let me try that.

Dr. Mani: 01:00:48

Put it on where your neck.

Roxy: 01:00:49

Okay.

Dr. Mani: 01:00:49

Right, exactly right there.

Roxy: 01:00:51

So kind of. Right here. So just kind of like.

Dr. Mani: 01:00:54

And then just imagine yourself, you know, when you're.

Roxy: 01:00:57

Oh yeah, that's good. It holds your neck.

Dr. Mani: 01:00:59

Holds your neck stable.

Roxy: 01:01:00

Yes. Because that's what I find is the problem. You're flopping around and it's.

Dr. Mani: 01:01:04

Right. On an airplane or anything. I mean I, I do a lot of traveling and I go for short international trips and I'm usually, you know, bed type arrangement.

But even then on a, on a domestic flight, you're. You're not. And I sleep like a baby. I mean, I take red eyes with the money flow, so, you know, it's just something I, I believe in.

And we know it's going to do really well and I think people will appreciate it. So this is yours.

Roxy: 01:01:28

Oh, thank you.

Dr. Mani: 01:01:28

Unless you don't want it. I want to give it.

Roxy: 01:01:31

I need to defy that gravity. So.

Dr. Mani: 01:01:32

Yeah, that's the thing. It also helps you sleep on your back, so that's. Do you sleep on your back?

Roxy: 01:01:38

So I'm bad. I sleep on my side. Sides.

Dr. Mani: 01:01:40

I do too.

Roxy: 01:01:40

I mean, it's just the natural, you know, in the middle of the night I try to start on my back, but then I find myself moving around, you know.

Dr. Mani: 01:01:48

Yeah. And then. But now's the time to start. You know, before you start really aging. It's time to start because again, you're pulling everything.

It does help. I can tell people that sleep on their back when they come in really younger. Yeah, yeah.

Roxy: 01:02:01

Less like crow's feet is.

Dr. Mani: 01:02:02

Well, not crow's feet, but just overall deep tissue shoe drooping. They have less of it because their ligaments haven't been strained.

Roxy: 01:02:09

Okay.

Dr. Mani: 01:02:09

And people think it's because the pillow folds your face, which may have something to do with it. But I think we, we underestimate the power of gravity. And that's what's doing it is gravity.

Roxy: 01:02:20

We're always fighting that gravity.

Dr. Mani: 01:02:22

Yeah.

Roxy: 01:02:22

Okay, so Dr. Moni, tell everybody where they can find you. And you know the best, the easiest, quickest way to you.

Dr. Mani: 01:02:29

Well, I think my website is markmani.com it needs updating, but. But it's my name, m a r c-m a n I.com and so you can find contact information on there. My Instagram is also one where I respond.

I have 300,000 followers and it's @ Dr. Markmani, so @Dr. M A R C M A N I. And they can send me messages directly there.

Roxy: 01:02:49

And what is the waiting time to get in with you?

Dr. Mani: 01:02:52

It's, you know, I don't schedule myself out more than six months, but it takes a few weeks usually to get in for consultations and the surgery schedule is booked out for several months. But we have dates that shift around and so we, you know, we work with people on that. I don't have a high volume practice.

I have a boutique style practice. We like to see the patients back and get to know them over the course of their lives. So it's a guy, a little, kind of a family.

Roxy: 01:03:14

That's wonderful, Wonderful. Well, thank you so much for chatting with us today. It was great. Thank you. Thank you. That was Dr. Mark Monte.

And I hope what you heard today was not just his expertise, but reassurance. Because when it comes to facial surgery, it's not about chasing youth.

It's about preserving identity, elevating confidence, and doing it with intention.

If you're thinking about a facelift or just trying to understand what's hype and what's real, revisit this episode, take notes and ask better questions. Dr. Mani's insight is a masterclass in what refined aging actually looks like.

And, and if this episode helped you feel more informed, less intimidated, or just totally fascinated, send it to a friend, tag us on social media and share what stood out to you most. Make sure you follow, rate and comment on Apple Podcasts, Spotify, Amazon Music, or wherever you get your podcasts.

It helps the iconic midlife reach more women who deserve smarter conversations about aging on their own terms. Follow the show, trust your gut and remember, we're not doing midlife quietly, we're doing it iconically.