Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person, because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome to Meet the Doctor. My guest is Dr. Brannon Claytor. He's a plastic surgeon in the Philly area based in Bryn Mawr, Pennsylvania. Welcome to the show.

Dr. Claytor (00:42):
So excited to be here Eva.

Eva Sheie (00:44):
Tell us about yourself as if we're a patient who's considering coming to see you.

Dr. Claytor (00:49):
Well, our philosophy is to help patients understand what's frustrating them, and then listen to them closely evaluate them, and then give them their options. Go over different things that we can do. I love talking about what I call the aesthetic ladder, and it comes from our core training in plastic surgery, which we generally call that the reconstructive ladder. And it's a principle that's used to really make things simple for the patients to understand. And so I'm very visual and so we don't have that here, but imagine me moving my hands around a lot.

Eva Sheie (01:34):
Easy to imagine.

Dr. Claytor (01:35):
<laugh> because I do it all the time, simulating a ladder. And I say to the patients, on one side of the ladder is what we do. And on the other side of the ladder is the results in what you see. And down at the bottom of the ladder you're talking about a Botox or maybe a little bit of a filler. And they, they may have come in with complaints of jowling and facial aging and, and really just being uncomfortable with how they look when they look in the mirror. You know, this doesn't represent who I really feel. And so our whole philosophy is first meeting the patients, going through everything, listening to what their concerns are, taking good photographs, and then we sit down with them and then I show them their photographs. Cuz many times patients don't actually know what they look like with the exception of the zoom time that we have or the morning mirror time.

(02:26)
The majority of the times patients vision of themselves comes from what they see in other people's eyes and where they see other people's eyes going to. And they're like, people are always looking at my neck. I don't know what it looks like, but I'm not happy with that. I want them to look at me in my eyes. So we'll show 'em their pictures and I'll say, okay, what troubles you? And they, a hundred percent of the time they go, Ugh, can't believe I look like that. And, and I'm like, well, that's okay. Let's address what you don't like and let's apply it to the ladder. So, and as you work higher and higher up the ladder, there may be some low energy heating devices that you might be able to do. There may be a little CO2 laser type things, some microneedling as you move up higher, maybe now you're talking about some percutaneous techniques of liposuctioning move up a little bit higher.

(03:15)
And now you're talking about percutaneous lasers and heat energy. Any one of these that you can bring in to get some skin tightening. Maybe you're talking about some of these new modalities, uh, my elevate where you're doing these threads to lift and contour the neck is all percutaneous, sort of no incisions, very fast recovery. And then you start moving up higher and higher. Now you're talking about making incisions around the ear. How do you, how do you gain access to those deep structures? And how much do you want to have done once you are now working underneath the skin? Are you just moving skin? Are you releasing retaining ligaments? Are you debunking, are you removing glands from the area under the jaw? How far do these incisions go? And then I will take them all the way to the top and say, these, these things can represent the top of the ladder.

(04:07)
And then I let them participate in the decision. Where do you want to be? Well, I wanna be at the top of the ladder. Okay. Are you willing to have these incisions? No, absolutely not. Okay, good. So you've made a conscious decision to climb down the ladder recognizing that there will be less time and energy and effort putting into achieving those results. But those results will not be as dramatic. And then I will open up the iPad and I've got so many hundreds, if not thousands of patients that I can draw upon that very quickly, we try to come up with two or three or a half dozen patients that look exactly like that person, body habitous, age, skin tone, ethnicity. And we try and zoom that in. And we, we utilize our EMR system with our iPads. And uh, I have a book, you know, and if I can't remember who it is, we'll open up the book and Oh, okay.

(05:01)
That person, yes, yes, yes, yes. And we have to be HIPAA compliant so that as I'm communicating with my staff, um, we're not using patients names in, in front of our, our current patient, but we allow them to see that pre-op, that lovely six month post-op. Then we'll go back in time and show the patient even that patient on one day post-op so that they understand, they see the work that's involved, but they also understand the tremendous results that can be delivered. And then they get to come to me and say, well, I want to go here on the ladder. And I say, great. Okay. And then they'll say, well, you know, if I, if I don't go as high up the ladder, if I start here, do I burn bridges? No, you don't burn bridges. And it helps them understanding that they can come back again five years later if they are more prepared at that time.

(05:57)
But as you're hearing me go through all this, this is not a top-down conversation. This is very much a level playing field where I meet the patient, it goes all the way to me, sitting down and making sure that I am at least at eye level with that patient. I'll even sit on the examining bench with them so that I can get close to them and show them this so that they understand that this is a relationship that we're building here, and that I need to hear and understand what their frustrations are and what their fears are so that I can help educate them as to what we can do.

Eva Sheie (06:37):
I had a major realization this year around how we think about the face and the aging of the face. And part of this is because I have the privilege of listening to smart doctors talk about their work all the time. And so if you know Dr. Larry Bass. 

(06:53)
Yeah, yeah. 

(06:55)
He explained it in a way that I'd never heard before. And it's similar to the ladder, but I think different in one way. So, you know, it was a, it was more of a  before and after explanation that in the old days you used to wait until your face fell and then you'd get a facelift and you'd look 10 years younger when you recovered. And now we've moved to a much more expansive, like treating things along the way method where you just maintain, and I don't like the word pre-juvenation because I just am not a fan of cliches, but I guess where I'm going here is, is there an element of also explaining that sort of expansiveness of the process as they move through this ladder too?

Dr. Claytor (07:37):
There is, but I'll be honest with you, as a plastic surgeon where I spend three days of the week in the operating room, I am generally the end of the road. And there has been a complete explosion, possibly even to the detriment of the medical system that is constantly sucking very good nurses and PAs out of the healthcare system into the aesthetics industry. So these individuals are in these med spas that are almost on every street corner now. So many patients are going to those individuals because it's a very low barrier to entry. But really the end of their treatment options are at the end of a needle as opposed to my, that's where I start. So when I'm explaining to people the aesthetic ladder, many patients either I'm too busy in the operating room because a lot of people look at these as almost impulse things, you know, they come, I I want to have some Botox, I wanna have some filler.

(08:48)
And I certainly do a lot of that, but the majority of my time is spent in the operating room. So this whole concept of preventative treatments are more in the med spas and in the, some of these rejuvenation centers that are popping up all over the place. And again, God bless them and I think they're great, and maybe I should expand my office and grow in that direction because there's a need and people want that and, and they want to go to a trusted source. And unfortunately many times if a patient is looking for that improvement, they may have found themselves further down the pathway and, and really they may have passed the opportunity of that, I don't like to use the word but pre-juvenation, but when they are seeing individuals whose treatment options end at the end of a needle, those algorithms can frequently fall flat. And so yes, there's a lot to that, but that's, by the time they're coming to see me, we're having real conversations about dramatic and substantial and substantive changes.

Eva Sheie (10:01):
I think the, the thinking is really, and the argument I would make is you want the plastic surgeon who can offer you the entire range of options. May not do them all himself 

(10:14)
Yep. 

(10:15)
Or herself, but that, you know, you want the knowledge and the level of expertise coming from the top, even if you don't, aren't ready for surgery. So that you know how to plan what you're going to do as you start to,

Dr. Claytor (10:30):
And, and I do, I, you know, we've, we've had a long history of aestheticians. Uh, more lately we've been more focused on, um, our PAs and nurses as treating individuals. And I spend a lot of time working with them. Julie is my PA and she's phenomenal and does a great job. I have another PA, Maria, who mostly works in the operating room with me, but also has capacity. And we utilize a team approach. And I'm meeting and talking with them almost on a daily basis about the patients. And I always go through their schedule and see the patients that they're seeing and, oh, you're gonna be so seeing so-and-so today. She had a facelift 10 years ago and you're probably doing a good job keeping her moving along. But if she has any questions, and I think her eyelids are really an issue. Oh, okay.

(11:16)
And when she comes in and says, you know, just hit me with the Botox. Well, Julie's smart enough to say, you know what, you're probably ready for your bleph now. And so it, you're absolutely right that that whole gamut, uh, soup to nuts. And that's why I do say the ladder. And we do everything right down to two units of Botox, you know, for the lip flip. But I want to help people understand what their options are, and if they, they want to have that opportunity to look their best and even look potentially better than they were, we have that opportunity. I want to pivot and talk about one thing that has just completely blown my mind and was an amazing patient. She was in her mid fifties, early fifties, and she came in and we, I performed her facelift in, she came back about a month or two later and she said, you know, I didn't realize that I was experiencing ageism.

(12:21)
She said, I didn't realize that people were seeing me a different way than I saw myself. Or they had seen me previously. She said 20 year history in, in high tech and was by her description, and it seemed very validated, one of the better people in the firm. But she continually found herself, and she would describe it as being parked in the corner like grandma during conversations and during meetings and strategy, and who's gonna take the next level? And next thing she knows, she was like, I was being boxed out. I was no longer team leader. I, all these things were going on. And she said, I, I didn't understand. She said, within two months of her facelift, she was back to work probably in three weeks or something very quickly. Didn't tell a soul, didn't tell, uh, anybody at work or anybody beyond her close family.

(13:16)
And she said it was dramatic. She said, I looked the same to all these people. They had no idea what had happened. She said, they referred me in terms that I had not heard in years. And, and it hopefully it's not taken as as inappropriate language, but other coworkers would say, Hey, sunshine, you look great. And she said, you, no one had used that term to describe me and, and adjectives to talk about me in, in 10 or 15 years. And she said, all of a sudden, I'm now team leader and all of a sudden the clients want me to be on the job project. She said within, she followed up again another two or three months. She said, I got two performance reward evaluations that I had not seen in my 20 year history at the practice. And she said, I don't blame other individuals. She said, I harbor no ill will towards my teammates. She said, this was a subconscious, this was an unconscious ageism that was going on. And I only saw it after it had been remedied. She said, I did not really appreciate it ahead of time. And think

Eva Sheie (14:25):
I think women who lose a lot of weight experience this. And it's almost like a switch flips. Like, and I, I like the paper towel analogy. Do you know this one about weight loss? No. When you have a lot of weight to lose, you're like a roll of paper towels. And so if you lose one sheet, no one notices if you lose two. But the smaller the roll gets, the easier it is to see how much smaller it is. 

Dr. Claytor (14:45):
Sure.

Eva Sheie (14:45):
Right. So somewhere in the role of paper towels, when you've hit a certain point, people look at you differently. And it is very obvious, especially men looking at women.

Dr. Claytor (14:56):
Well, I could see that. And, you know, we have, we have a lot of effort that's going into individuals trying to achieve, not necessarily their optimal body weight, but body weights that make them feel more comfortable in their clothes. And, you know, I do a lot of abdominalplasties and I have so many patients who will come in and almost in tears and say, I can finally go to the beach. I, I wanna send you a picture of me in the bikini. I think my greatest photograph that I have is a woman, I think it was in her fifties, and she took a picture of she and her daughter on the beach, and they were both in bikinis. And she said that her mom was jealous of her mother's belly. And she was like, mom, your belly looks so great. And they honestly, they look like sisters from their midsections.

(15:49)
You, you almost couldn't tell them apart. And it is life changing. And when I, they come back in and I ask them how do they feel? They say, look, my confidence has changed, my relationship has changed, my outlook on life has changed. You know, my, my future goals in life have been changed. And so these are things that are, are visceral to people and they are working very hard on. And it's an awkward conversation as to how we get there, because I want to be very delicate in helping people achieve those benchmarks. But when they do, they are very happy.

Eva Sheie (16:28):
Now I wanna pivot on you. Okay. So I learned yesterday that you made an incredible, incredible discovery in the treatment of scars.

Dr. Claytor (16:38):
Yes, I did.

Eva Sheie (16:39):
So tell us about that.

Dr. Claytor (16:42):
Well, this is the one thing that is the common thread amongst all treatments that we do that are in invasive, you know, not these minimally invasive type procedures, but facelifts, tummy tucks, breast augmentations. And so these scars can be very vexing. And there are some populations of patients based on ethnicity that you may expect a, a higher scar burden based on the amount of melanin in the skin. But you know, many times you can't really tell whether or not a patient is gonna have a, a challenging scar. And so over the years, most individuals have just sort of settled into, well, you know, massage it, put some compression on it, use some silicone, and then come and see me in a year. And, and then a year we'll sort of reassess it. And it's effectively a kicking the can down the road. It's a avoidance rather than grappling the problem.

(17:39)
And as I was explaining to you earlier, I'm intolerant of mediocrity and I'm intolerant of the status quo. And so what began for me as a mere observation became an obsession. And that was, a patient came in one day years ago, and the whole microneedling craze started about six years ago. And a patient came into the office and I said, well, you know, I'd, uh, I'd like to see the scar treated. And so I asked the patient to go see my aesthetician, and she came back to me indignant. And she pulled out the packaging insert on the microneedling paperwork for the, uh, device. And she said, do you see right here, Dr. Claytor? It says you should not microneedle a scar until one year maturity. And I thought to myself, I was like, wow. So here I have a aesthetician dictating care based on a product insert based on zero data.

(18:38)
There was no reference. 

(18:38)
Yeah. There was no citation on the paper? 

(18:40)
There was nothing <laugh>. So I called the, and I won't say what company, but I called the company, I was talking to their chief scientist, and, uh, I said, I said, I find this very odd. And he said, well, you know, we feel bad about it, but we thought it was kind of important to be as inclusive as possible. And I said, well, where did you get this information? He said, well, we were presenting at a, at a meeting and a dermatologist got up and made that statement. So we, we put that in there. And I said, so one person's, who you don't even know who it is, unsubstantiated comment at a meeting in a random auditorium now becomes policy. I said, I'm gonna do a research study to set the record straight on what I think we as plastic surgeons feel is the appropriate medical management.

(19:27)
So I went about treating facelifts, tummy tucks, breast augmentations, brachioplasties, and even little, uh, lesion excisions. And it was interesting as I built a protocol, and I I didn't think this out ahead of time, and this was sort of how they, they found, um, what is that material they scraped? They had DuPont, they scraped out of the inside of one of those contig gortex, 

(19:47)
Teflon. 

(19:48)
Teflon, thank you, Teflon. It was a total accident how they found it. And so this was a total accident how this came about because I, I tried to design the study so it would be maximally inclusive so that your onboarding could be at six weeks or at up to four months, but it had to be in that window. And that was just for ease of patients in scheduling with, um, the microneedling treatments. And so we built the whole protocol. We got IRB approval to do it, and we had a questionnaires of evaluating outcomes. And what we found randomly is that there was a bimodal distribution of patients. So about half the patients entered the study at six weeks, and the other half the patient's study entered the study at four months after their surgery. 

Eva Sheie (20:31):
This is kind of, because you, that's when you see people post-op?

Dr. Claytor (20:33):
Well, I just, I, I just tried to make it a big window. Yeah. Because honestly, even six weeks is really early. Yeah. And if you would ask many people, would you feel comfortable microneedling a scar at six weeks? Many people would probably say no. But if you, again, this is where it comes in, it's important that, you know, we as plastic surgeons understand wound healing and we're, we're experts at burn management and chronic wounds and healing wounds. And we understand the physiology and wounds are 80% strong at six weeks and then it tapers off and tapers off and tapers off and, and then, you know, when does it become a hundred percent? It depends on, you know, how many months you wanna go down the road. But the majority of the wound healing is really done by six weeks. So that's, that was sort of my earliest.

(21:14)
But I will tell you, there's some patients that would say, no, I don't want you to do it at six weeks. It's too early. And, and honestly, you might not even be seeing problems at six weeks. They might be developing later. So I made it four months because, okay, well at some point we gotta cut it off. And so I just was trying to make it easy. And so randomly as the study unfolded this, these two groups came out and we did three treatments a month apart, and then we reevaluated it two months afterwards. And the most powerful thing is the patient observer scar scale. And, um, it's not just the, the patient, but it's also an objective provider makes these assessments. So, but the majority of it is the patient making the decision as to whether or not they think they see an improvement. And so of course there was statistical significance that there was improvement. But what was really interesting is when you dug deeper, there was even more improvement when you started earlier. And so this completely flew in the face of contradicting this whole, just leave things alone, don't do anything, you know, see it in a year. And it started, the concept for me of earlier intervention is gonna give you better results, but you, you have to make that conscious decision to intervene earlier. You have to decide to, to get involved earlier.

Eva Sheie (22:33):
So let me, let me distill this. You have a, basically a wound, which is an incision that closed, that's gonna be a scar.

Dr. Claytor (22:41):
Correct.

Eva Sheie (22:42):
And we're using microneedling to create more wounds in the wound.

Dr. Claytor (22:46):
You are 100% correct to understand that. But you need to understand when you go down into the molecular layer about in, down in the cellular layer and the crosstalk communication of what's going on, you need to understand that the biology as it's progressing, we think that wounds heal in a linear fashion. And they do not. There are many factors that can be influencing them that can be continuing to stimulate them in ways that increased collagen buildup and the re-injury with the microneedling. And again, these are studies that need to be done to really bear this out and prove or disprove this. But these re micro injuries are releasing all kinds of these cytokine mediators that are then interacting with this immature healing collagen process. And in many ways can tip the scale so that the, the milieu is more attentive to all the things that we're looking for. Thin, small, slight, not discolored. And it just, it's almost like you're bringing more of the mediators to the source or to the site of wound healing at the time when they need it most.

Eva Sheie (24:18):
The other thought I had was an incision and a microneedling wound are completely different kinds of wounds.

Dr. Claytor (24:26):
Very true. They are both opening access, one on a macro level and the other one on almost a nano level.

Eva Sheie (24:35):
Well, I'm blown away <laugh>, as I know your colleagues all were too, cuz I watched them react to this yesterday and it was fantastic to see. Yeah. So let's kind of, uh, wrap this up with, uh, a little bit about who you are not at work. What do you like to do?

Dr. Claytor (24:52):
Oh,

Eva Sheie (24:53):
Away from the office?

Dr. Claytor (24:53):
I'm building a Shelby Cobra.

Eva Sheie (24:56):
Of course you are. <laugh>,

Dr. Claytor (24:58):
That's a, it's a, there's a kit car company, uh, called Factory Five. And our whole family went out to Oshkosh Air Show cuz I'm also a pilot. And we went out there and we were checking out all these cool airplanes in, uh, in Wisconsin, Oshkosh, Wisconsin. And my oldest son, Ben dragged me over to show this to me. And I, I was, he's like, look, you know, you can, you can build these cars. And I had rebuilt a mgb 32 years ago, so I I very comfortable in the, you know, in the workshop turning a wrench and, um, welding if need be. And so we looked into it and we wound up going to Flint, Michigan to a class, a three day class that we learned how to build the car. That was about a year ago. And we, it's everything is the process. It was almost a one year process to just buy the parts. And there was such backlog. I think everybody was stuck at home covid. So they were, they were a little bit delayed, but we got the car delivered and it's, it's a frame and a fiberglass shell and 40 boxes of parts <laugh>. And so every evening and weekend I'm down there, you know, opening up another box, putting on the brakes, steering column. 

Eva Sheie (26:11):
Are they numbered boxes? Like, open this one next.

Dr. Claytor (26:12):
They are numbered, they're numbered, but I, I am on the phone back with them and, and they're very responsive, but I'm on the phone with 'em probably twice a week, you know, I can't find this bolt. Well, you know, okay, we'll send you a new one. Um, and maybe it's in, it's

Eva Sheie (26:27):
It's like the Charlotte Mason approach to building a car.

Dr. Claytor (26:30):
Well, it's, it's awesome. And then you pick your engine, which engine do you wanna put in it? And it, it goes crazy. But these cars are not very heavy. And so the classic Shelby Cobra, the Carol Shelby really in the sixties had a, uh, 4 27 engine in it, which is like over 500 horsepower. It's just ridiculous. I mean, it, the car just won't even stay on the road. So we are, we're getting a smaller engine, uh, the 3 47, but it's just, oh, good

Eva Sheie (26:59):
<laugh>.

Dr. Claytor (27:00):
It's just, it's a lot of fun. 

Eva Sheie (27:02):
Can you send us a, a progress photo?

Dr. Claytor (27:03):
I sure can. Yeah.

Eva Sheie (27:07):
<laugh>, what will you surprise me with next time you're on the show?

Dr. Claytor (27:11):
I don't know.

Eva Sheie (27:12):
I'm excited to find out. I don't know if someone is interested in learning more about you or reaching out, where should they go online?

Dr. Claytor (27:19):
I think the easiest way for people to connect with us is to go to our website, which is, uh, Claytor Noone Plastic Surgery and Claytor is my name. Noone is n o o n e, uh, stands for Barry Noon,e who was one of the real pioneers in plastic surgery. And I took over his practice. And even though he is retired, we keep his name as a legacy on the, on the practice name. When you go to the website, there are great connectivity ways to connect with Debbie, who's our unbelievable awesome practice administrator, concierge expert. And, and you can either email her with these dear doc connections or, or pick up the phone and, and, and she's gonna help you understand a couple of basic things. One is this stuff that we do, number one and number two give you a ballpark for the what you're thinking.

(28:12)
And that's why we really don't put too many prices on our website cuz it's too confusing and you may get overly excited or you may be disillusioned with some of that economic information. And so she can really help you understand, oh, you've want these three things. Okay, your, your price range is probably here. And honestly I find that that is extremely helpful for the patients to know ahead of time because they're investing time in coming to the office and talking to me and they want to be well informed ahead of time. And so that's probably the, the best pathway forward.

Eva Sheie (28:48):
And, uh, on Instagram.

Dr. Claytor (28:50):
Yep. We have an Instagram page. It's at claytor plastic surgery just for simplicity. We, we just focus down on claytor plastic surgery, but I don't post all the time. I will tell you that I do 98.9% of the posting myself. So if you look and you don't see that I've posted anything for a while, it's probably cuz I've been operating so much, I just haven't had time to get around to it. And I try not to waste other people's times. But I, I will say one thing is that I may not have, you know, a hundred thousand followers, but the followers that we do have, they find it very informative. And I will tell you recently I met another plastic surgeon from a different part of the country and I had treated their relative and he said to me, thank you so much for taking care of my family member.

(29:40)
She feels great and really rep appreciated. And he said, and this guy has 150,000 to million followers. He's like, he's an unbelievable megastar on Instagram. And he said, you know, I really felt like I got to know you cuz of course I went and looked on your Instagram when she told me that you were gonna be her surgeon. And he goes, I really felt that I got to know who you were and I got to, I felt comfortable just by looking at your Instagram page. And, and maybe that's, that's one of the greatest compliments I imagine were the, the greatest input and return and response that we can get out of what we do on there.

Eva Sheie (30:19):
That's what it's all about. I mean, that, that is the best use case for social media.

Dr. Claytor (30:24):
Well, I would love to have a hundred thousand followers, but I'm not so sure that it matters. Um, it doesn't, it it's a, it's a resource that people use to further validate what they're looking for in their experience.

Eva Sheie (30:39):
Thank you again for spending time with us today and it's always my privilege to hear more about what you're doing and I'm so grateful.

Dr. Claytor (30:47):
Well, and I'm grateful to you and I was very excited to have you remind me that I was your very first podcast. 

(30:53)
Mm-hmm. <affirmative> and <laugh>. Yep. 

(30:55)
I'm looking forward to doing more with you.

Eva Sheie (30:57):
Many more.

Dr. Claytor (30:58):
Love it.

Eva Sheie (31:02):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, T H E  A X I S. io.