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 is 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 back to Meet the Doctor. My guest today is Sarah Saxon. She's a facial plastic surgeon in Austin where I am, and I'm so happy to see you today. Thank you for joining me.

Dr. Saxon (00:40):
Thank you for having me.

Eva Sheie (00:43):
So let's start with where you are, because I actually, before I pressed record, learned that you just moved, well, sort of just.

Dr. Saxon (00:49):
It did, yeah. So my office used to be in downtown Austin up until about a year and a half ago, and we completely outgrew the space and I had to make the decision to expand or I'd just be hopping around to different offices every five years. So in the meantime, we subleased a space up north in Austin until my new office was done, which is in Dripping Springs, just about,

Eva Sheie (01:19):
Which is known for what? Dripping is known for something really special, isn't it?

Dr. Saxon (01:23):
Yeah, there are a lot of distilleries and wineries out here. So a lot of people actually come out here for weddings and bachelorette parties and bachelor parties, and the very beginning of the Hill country, I guess some people like to think of Dripping Springs as, so it's nice. I moved out here during Covid. Before that I was downtown in a high rise and just needed a little extra space, and I found a house on two acres and it was nice and peaceful. And actually the vast majority of my patients come in from out of town. So it didn't really matter where I was, to be honest. And I have another satellite location in Dallas, so I go there once a month and life is good. We just moved into the new office about two months ago, and it's gotten really busy. There's really no other plastic surgeon out here.

Eva Sheie (02:17):
No, there isn't. You're not far from me. I think I'm about maybe 10 minutes from there.

Dr. Saxon (02:22):
Oh, really?

Eva Sheie (02:23):
I live in construction zone.

Dr. Saxon (02:26):
In the Y?

Eva Sheie (02:27):
Yeah, exactly. That's right where I am.

Dr. Saxon (02:29):
Yeah.

Eva Sheie (02:30):
So is the office visible from the highway? Is it easy to spot? Is it tucked away? Give us a visual.

Dr. Saxon (02:39):
It's just off the highway. If you can imagine, Austin, just past Belterra, there's a new office development where you can see one of the buildings is a Fuse workspace, and then you just go right down the hill and it's right there. It's one of the bigger buildings in the complex. I decided it was necessary to open a surgery center there. So that's the second phase of construction. So it's a 10,000 square foot building pretty big. So we've just opened the clinic there, but not the surgery center yet.

Eva Sheie (03:10):
So we come out there to see you for consultations, non-surgical, all the ordinary stuff. But you're still doing surgery in a surgery center somewhere else for now?

Dr. Saxon (03:20):
I do. Yeah. Right now I do surgery at a surgery center close to downtown called Pinnacle Surgery Center. It's off of 38th Street, right near all the major hospitals. So like I said, I get a lot of patients coming in from out of town, so they just come in and stay a week and have their surgery here. Even my Dallas patients come in to Austin to have surgery and then they can go back home after that.

Eva Sheie (03:46):
So if everyone's coming from out of town, or not everyone, but a big chunk of people, how are they finding you and what are they finding you for?

Dr. Saxon (03:55):
Yeah, so I am a facial plastic surgeon, but even within facial plastic surgery, I am very highly specialized. So I focus on facial feminization for the face. I do aging face as well, facelifts, I do rhinoplasty. I do just about everything. But in addition to that, I do cranioplasty, so brow bone reduction, jaw contouring, adam's apple reduction. A part of facial feminization is also hairline lowering and lip lifts. So I get patients from all over that come to me for that. Apparently a lot of my hairline lowering patients find me on Reddit because there are a few threads on Reddit that a lot of my patients are on, and just word of mouth. I've had my practice here in Austin about seven years now. So I've been in practice long enough to where I have enough patients out there talking to each other. So

Eva Sheie (04:49):
I met a patient of yours once, several years ago. It's been a while now. And she actually came to you because she wanted her face to look more feminine, and I thought that was a really interesting take because I think when we hear facial feminization, we're thinking about transgender patients most of the time. But that skillset that you have is also really helpful to women too.

Dr. Saxon (05:13):
It is. I treat women with more masculine facial features all the time, and that's something that I'm really trying to promote because, so we're just at the cusp of it becoming more known. And in the next five years, I really think it's going to be more mainstream, but we're just not quite there yet.

Eva Sheie (05:35):
Hairline lowering is also a big part of that. So everyone knows the old joke about having a fivehead, right? So really what you're doing is fivehead surgery.

Dr. Saxon (05:43):
Right. Yeah.

Eva Sheie (05:46):
How does the hairline impact the way that we perceive the way our own face looks?

Dr. Saxon (05:53):
So if you have a high hairline, what I find that patients say is they're just constantly thinking about it. And so it can change the balance. So you want the ratio of the different thirds of the face to be about equal. So you're kind of throwing things out of balance in that way. So by lowering the hairline, oftentimes I'm also rounding off the sides of the hairline, which is a more feminine feature, and raising the brows. So it all kind of goes hand in hand and also makes the face look younger as well. So I think you can do it in a way that looks really natural. A lot of surgeons don't round off the hairline like I do, and that's why people come to me for it as well as just the things that I do to promote healing.

Eva Sheie (06:48):
Is the recovery pretty gnarly or is it pretty, what does it look like? Gnarly's not usually a word I use with recovery, I'm sorry.

Dr. Saxon (06:57):
I don't think it's bad for most people. Pain is an interesting thing that can be very subjective. I do long-acting nerve blocks for everyone with regional anesthesia. Most of my patients are just on Tylenol and ibuprofen afterwards with no narcotics. Occasionally I do have someone that's a little more sensitive and needs some narcotic pain medicine. But in general, after about two to three days, they're wanting to get out and about in town. They have a head wrap on, but they can throw on a hat, and most people don't know they've had surgery.

Eva Sheie (07:33):
Wow. Two or three days. Really?

Dr. Saxon (07:36):
Yeah.

Eva Sheie (07:37):
Yeah. Well, that's not terrible. How many times have you done this now? Are you

Dr. Saxon (07:43):
Hundreds.

Eva Sheie (07:43):
Hundreds, I'm sure.

Dr. Saxon (07:44):
Yeah.

Eva Sheie (07:46):
Is there something that these patients say to you afterward where they made it to the other side?

Dr. Saxon (07:54):
Well, at first it can be a little shocking because you're not used to seeing your face fresh, and that's with any surgery, so you have to get used to it. And then about at the one month mark, most people are like, you know what? I just don't even think about it anymore.

Eva Sheie (08:11):
They are looking at themselves in the mirror for a different reason now. It's sort of losing weight, which is how I can relate to it now, is I don't hate looking in the mirror. I enjoy it and I'm surprised by it, and it makes me feel differently than it used to. And I think that's just sort of true of all aesthetics is that that's what we're going for.

Dr. Saxon (08:30):
It's a good feeling. A small subset of patients get something called shock hair loss, and so their hair thins a little bit, and that can take months to get better, and that's the exception. So that can take a while for them to get back to a place where they're feeling confident again. But most of the time around a month, they're feeling like their whole life has changed at that point. They don't have to worry about their hairstyles or going swimming or going on roller coasters. All of those examples told to me before.

Eva Sheie (09:05):
That shock loss thing that happens. That's kind of like what happens after you have a baby, isn't it?

Dr. Saxon (09:10):
You can have that, yeah. We saw it after Covid as well, because even any viral illness can cause it.

Eva Sheie (09:18):
Wow. That I had not heard. Do you treat hair loss too?

Dr. Saxon (09:24):
I do some. I don't do hair graft. I have a couple of surgeons in Texas that I'll send patients to for that. I do PRF injections for hair loss. We have some exosomes in the office that we can use for that. And then of course, we carry nutrafol in the office too. So if someone wants to take supplements while they're healing, they can. But in my training, I was never trained to do hair graft, and it's just not, if I'm not the best at it, I don't want to take it on.

Eva Sheie (09:56):
Makes sense.

Dr. Saxon (09:57):
Yeah.

Eva Sheie (09:58):
We all like to do what we're good at.

Dr. Saxon (10:00):
Yeah.

Eva Sheie (10:01):
Along with these two really big categories that you focus on, so you're doing facial feminization and hairline lowering, do they usually come together or are they usually separate, or is it just all over the place?

Dr. Saxon (10:16):
Well, facial feminization is interesting because basically any procedure in facial plastic surgery can be part of facial feminization surgery. Part of looking feminine is also looking young and helping with skin texture, how the light reflects off the face, and then of course bone structure. So in a way, I think of everything that I do as part of facial feminization, but we know based on studies that we've done that the upper third of the face makes the biggest impact as far as looking feminine or not. And so hairline lowering can be a part of that, but oftentimes if I'm trying to feminize the face even more, I'm including cranioplasty or brow bone reduction with the hairline lowering just to remove the shadowing and hooding over the eyes.

Eva Sheie (11:06):
Does the upper third also have that same impact on how old we look, or is it a different part of the face?

Dr. Saxon (11:12):
I think so too because as we get older, we also look more masculine. So women who are in their sixties who have never done anything or seventies, they start to look more masculine with time. And so most of the procedures we're doing are also feminizing the face. The main exceptions are procedures that we do that widen the jaw, or I think a lot of injectables that we do actually masculinize the face. So if you're getting injections that are too heavy in the glabella and it drops the brows, that can masculinize the face a lot.

Eva Sheie (11:49):
Let's go to fillers for a second. The other day I was curious and went to Google Trends and I looked at lip injections, and what I'm always doing is trying to figure out which word gets Googled more than another word. So that's what I was actually looking for. But what I noticed was when I switched to the five-year trend, that lip injections and lip filler has steadily declined in a very noticeable way over five years, the last five years. Have you seen that have seen a trend down in the number of people asking for filler, or is it maybe just wanting less filler than they did five years ago? What's going on there?

Dr. Saxon (12:28):
Yeah. What I'm seeing, and I've never really done a lot of filler as far as HA filler in my office, but I've always really liked biostimulatory fillers. And I think finally the trends are catching up with that. More people are asking for Sculptra or Radiesse or I do a lot of Easygel, so using PRF to form a gel and add volume in that way, especially in Austin. Dallas is a little bit different than Austin.

Eva Sheie (12:58):
They like their fillers more in Dallas?

Dr. Saxon (13:00):
Yes, very much so.

Eva Sheie (13:03):
If we come to your Austin office, we get granola bars, and if we come to your Dallas office, we get, uh, something else.

Dr. Saxon (13:15):
Yeah, I've always attracted patients that want lip lifts over just doing filler. And I think there's a little bit of confusion there because a lip lift doesn't necessarily take the place of lip filler. So for some patients, I will recommend doing some augmentation along with a lip lift.

Eva Sheie (13:37):
The lip lift is like one of those shockingly powerful procedures that's really small and huge impact. And so for anybody who's listening who maybe doesn't know what the lip lift is, can you give us a little overview?

Dr. Saxon (13:52):
Yeah. So a lip lift has actually been around for a long time, but things trend, so they come and go. So really in the last five years, it's become more popular. We make an incision just under the nose and the crease that hides in a shadow there, and you remove a strip of skin to shorten the distance between the nose and the upper lip, and that exposes the teeth a little bit more. It can slightly make the lip look more full if you already have some volume to your lip, but if you don't have really any volume, sometimes that's limited. Our upper lip gets longer as we get older because we lose collagen and elastin. So I call it a facelift for the mouth.

Eva Sheie (14:36):
I had a friend who I worked with at RealSelf, and she had one, and I remember being stunned first that I'd never even heard of it, but then at how unbelievably beautiful she looked. And she was already beautiful, but it just added some really special, I don't know. You can describe it better than I can probably. It was amazing.

Dr. Saxon (15:00):
It's one of those things that most people won't know that you've had it done, but they'll notice it change if it's done right.

Eva Sheie (15:07):
Yeah. What happens when it's not done right?

Dr. Saxon (15:09):
It can go south pretty easily. I know just from photos that I see online, some that I've seen, they lift the lip a little too much in the midline and not laterally, and it can look almost like a rabbit lip sort of situation, and it's not good. So I've had to revise some that were done elsewhere before. I've had patients come in that maybe the sutures, the deeper sutures incorporated the muscle, and so they couldn't really move their mouth normally, almost like a cleft lip aesthetic. I don't know how it was done, but as soon as I went in and clipped those stitches in the muscle, they went back to having normal motion. So it can be done poorly, but by and large, most people have a really good outcome and really love that procedure. So

Eva Sheie (16:05):
Do you find that a lot of people seek your help for revision? Is that something you do?

Dr. Saxon (16:11):
Yeah, I do a lot of revision surgery, both in the hairline for rhinoplasty, for lip lifts, jaw contouring. There are some days that most of my patients are coming to me for revision work, and I think it's because the procedures that I do have been around for a while, but I did my fellowship particularly to train in them. But they've just become popular just in the last few years. So it's easy to go to a conference and see a talk on it or read a couple of articles and start trying to dip your toes into a new procedure. But it takes a while of a learning curve when you're trying to perform a new procedure.

Eva Sheie (16:52):
Where was this fellowship that you did?

Dr. Saxon (16:55):
I did my fellowship with Dr. Jeff Spiegel in Boston, in Boston Medical Center, and then he had a private office in Chestnut Hill just outside of Boston where we saw all of our cosmetic patients. He's considered the pioneer of facial feminization surgery, so it existed before him, but he improved upon the techniques early on in his career, and since then, has trained many other surgeons to do what he does. So there are a handful of us out there busy doing facial feminization that he trained.

Eva Sheie (17:28):
How did you get from Boston to Austin?

Dr. Saxon (17:31):
Well, I'm from Texas from a tiny town, Carthage.

Eva Sheie (17:35):
You got back here as fast as you could.

Dr. Saxon (17:37):
I did. Actually, the year that I was in Boston was the worst winter on record, so

Eva Sheie (17:43):
Oh no.

Dr. Saxon (17:44):
I was ready.

Eva Sheie (17:46):
Go home, Sarah, go.

Dr. Saxon (17:49):
Yeah. My mom at the time actually was diagnosed with pulmonary fibrosis, and so she was on the lung transplant list at UT Southwestern in Dallas. And when they offered me a position there, I decided I couldn't really turn that down just to be where my mom was. And I was there for two years, and then my mom did end up passing away there, and that was about the time that I decided I just needed a change and a little burnt out from academia, and I just wanted a change of venue and start fresh. So I didn't want to join a group because I had my own ideas of how I wanted to run a practice and marketing and things like that. So I decided I did want to stay in Texas because I love Texas, and I had recently been to Austin for a bachelorette party actually.

Eva Sheie (18:47):
The wedding capital of the world.

Dr. Saxon (18:48):
Yeah. I hadn't been here for a while. I went to medical school in San Antonio, so we used to come up here all the time on weekends. And when I came to Austin around that time, I forgot how much I loved it. And so when it came time to decide where I wanted to put my practice, that's basically how I did it.

Eva Sheie (19:09):
I'm so glad you did. I feel so lucky that you're here.

Dr. Saxon (19:12):
Yeah. The rest is history. But I did keep a lot of patients in Dallas, which is why I now continue to have a satellite office up there. I go there once a month and see patients.

Eva Sheie (19:26):
And is there stuff you like to do in Dallas that you can't do in Austin? Every time I go to Dallas, I make sure I go to,

Dr. Saxon (19:33):
Oh gosh. It's always a quick trip, but I do love all the art museums there. And we have music here in Austin too, but I think a lot of the bigger venue concerts are there. I saw Taylor Swift there in Dallas.

Eva Sheie (19:49):
Are you a swifty?

Dr. Saxon (19:50):
Yes.

Eva Sheie (19:52):
Oh, awesome. I'm a swifty by default. I have a 6-year-old and a 4-year-old, and they're just getting into it, and they have these songs memorized already. My 4-year-old, she just turned four like two weeks ago. This morning on the way to dance camp, she said, mom, can you play bad blood? Yeah. And then she sits in the back and lip syncs, but she doesn't really know the words. She just moves her mouth.

Dr. Saxon (20:23):
That's so cute.

Eva Sheie (20:25):
She's really funny. Yeah.

Dr. Saxon (20:26):
Yeah. One thing I do love about Dallas is the shopping. That's a lot better than Austin I think.

Eva Sheie (20:32):
It is a lot better. Yeah. Yeah. A lot more choices, a lot more, I think Places to go shopping. Here in Austin, we've got like 1.5 places to go.

Dr. Saxon (20:43):
It's true. It's very true.

Eva Sheie (20:44):
And they're both terrible to park at and hard to get to.

Dr. Saxon (20:49):
We'll catch up.

Eva Sheie (20:50):
Sad. So sad. Poor us.

Dr. Saxon (20:53):
Yes.

Eva Sheie (20:56):
What else do you like to do when you're not working? I'm sure you work a ton.

Dr. Saxon (21:00):
I do work a lot. Lately, and I would've never thought I would've gotten into this, but I've gotten into gardening a lot. So my house out here in Dripping came with a really big raised garden, so I've planted the whole thing and we've built more raised gardens. I have a drip system that's on a timer, so I don't have to worry about getting home to water it. I've gone down the YouTube rabbit hole of how to suspend tomato plants and use trellises. And I think it's really peaceful going outside in the morning and checking on the plants and pruning, and. I don't know why, but that's the last year that's what I've done a lot. It's been so hot in the summer though, that even though I love being outdoors, I don't get outside this time of year as much as I want to, just because you have to be in the water if you're outside.

Eva Sheie (21:58):
Yep. You do. If someone's listening today and they want to find out more about you, where do you suggest that they look for you online?

Dr. Saxon (22:06):
Well, the primary way is our website, saxonmd.com. I'm also on YouTube and Instagram @Saxon md.

Eva Sheie (22:16):
That's great. Thank you so much for sharing yourself with us today.

Dr. Saxon (22:19):
Yeah.

Eva Sheie (22:19):
It's really nice getting to know you better.

Dr. Saxon (22:22):
Nice to meet you too.

Eva Sheie (22:28):
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 MeettheDoctorpodcast.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.