Cutting edge medicine: Dr. Deepak Dugar & Dr. Jeff Toll

DR. MIKE MORENO: All right, guys, well, welcome to another edition, and I’m excited about this edition, there’s not enough time to ask all the questions I have of my next two guests, but welcome to Wellness, Inc. where we try to, you know, break it down, make everybody understand what’s going on in the world of medicine because it’s too much, too fast. I’m an old guy. I’ve been doing this for twenty-four years. I can’t handle anymore. I know my two guests are probably quite a bit younger than me.

So, without further ado, let me bring on these two rock stars. Dr. Deepak Dugar is a Beverly Hills board certified plastic surgeon specializing in rhinoplasty, and we’re going to talk a little bit more about his special technique. This guy is a rock star, and he’s behind some of the prettiest and most natural looking noses you see on celebrities and social media, which is everywhere. His appearances on CBS daytime talk show The Doctors TV News. This guy is always bringing the cutting-edge stuff to all the popular print magazines. You’re going to know this guy and his partner, friend, colleague all the above, right? Dr. Jeff Toll is an internist, so now we’re speaking my language, because I’m a primary care guy. Family Med he’s an internist, also in LA, specialize in concierge medicine. We’re going to talk about that and telehealth. This guy, also his Rolodex of celebrity clients is quite vast. I can’t wait to get into concierge medicine. It’s been around a while, but it’s evolved and changed a lot. So, gentlemen, welcome.

DR. DEEPAK AND DR. TOLL: Thank you for having us.

DR. MIKE MORENO: So there’s a ton to get to. I’m going to start with you, Dr. Dugar, but Dr. Toll go ahead and feel free to keep your friend in line here. I’m going to ask questions if he deviates from and starts to tell me stuff that’s not accurate I want you to like, break us up and talk, but we’re going to get to you and then Dr. Dugar, you’re going to be doing the same thing. All right. So, first of all, Dr. Dugar, you have a really unique practice that’s dedicated to this type of rhinoplasty called scarless nose surgery. Let’s talk a bit about that.

DR. DEEPAK DUGAR: That’s right, so I focus my entire practice on one procedure because I love the idea of mastery. I’ve always been obsessed with mastery when it came to shots, when it came to fighters, when it came to cooking anything, I just love the idea of mastery. So, for me, as a surgeon, especially, I love the idea of being really good at what I do rather than being mediocre at a bunch of surgeries, so I decided I’m going to do one, and it’s worked out really well.

DR. MIKE MORENO: Well, tell us about this technique, because this is interesting, and this is what I can’t wait to talk to my buddy about because he practices in Beverly Hills, as I said, and now I can have some common ground to talk to him about other than the other stuff.

DR. DEEPAK DUGAR: Absolutely.So, nose jobs are typically done through what’s called an open approach, you make a small cut at the base of the nose, lift up the hood of the nose and you’re able to take apart the entire nose, much akin to rebuilding a house from scratch. Versus what I do is called closed rhinoplasty, where everything is done from inside the nostrils. We finesse the nose, much akin to remodeling a house to just make the nose a little bit of the softer, smaller, prettier version, but leaves the roots intact.

DR. MIKE MORENO: Gotcha, so less painful?

DR. DEEPAK DUGAR: Way less painful.

DR. MIKE MORENO: Less recovery time?

DR. DEEPAK DUGAR: Yep, seven days back to life.

DR. MIKE MORENO: I’m in. Seven days?

DR. DEEPAK DUGAR: Seven days.

DR. MIKE MORENO: Did you hear that everybody? Seven days. That’s a week. We’ve taken vacations a lot longer than that. That’s amazing because when I think about years ago when you know, I was, you know, 20 plus years ago, this is way, way different than it was. They’d stick you up in a hotel for like a month and you’d like to stay there, and you couldn’t leave. So, seven days, it’s amazing and is it more natural looking, right?

DR. DEEPAK DUGAR: That’s the whole goal of what I do. Scarless nose, it’s not about whether I make a cut or don’t make a cut outside the nose. It’s the philosophy. I think people are way better looking then they think they are. Most of my patients; I actually turned down about 30 to 40 percent of my patients.

DR. MIKE MORENO: I love that part of you. That’s amazing. My friend always says I’m changing lives and it’s so true, you are changing lives. It’s a huge thing and we’re going to talk about that in a little bit. Teenagers make up a large part of your practice.

DR. DEEPAK DUGAR: Yes, a large part.

DR. MIKE MORENO: A lot of people may be thinking, Oh, you know, these people are too young and this and that. How do you approach that? I mean, let’s say I bring my daughter in and I say, Hey, you know, you know, she’s bugging me about this, that and the other, how would you approach a patient like that?

DR. DEEPAK DUGAR: Yeah, great question. Teenagers are the most common, because when you’re a kid, the number one thing you look at is your face and how your facial features are evolving. Your body is still evolving every day. Your facial features kind of get to their maximum growth potential around age 13, 14, 15, 16-ish for most teenagers. So, the nose is something that usually when you’re younger, you think about. As you get older, you think about less. The number one plastic surgery procedure for age 13-20 is the nose. Number one procedure from 20-30 is the breast, and number two becomes nose. As you go older, the nose starts dropping down the list. So, nose the young man’s sport, young patient sport. 16-30 is really the demographic for noses, and the reason it seems really young, I get it, but it’s kind of like peak performance. Peak performance living and enhancement. There’s some 16-year-olds who have tutors, and there’s some who don’t. Some 16-year-olds who have swim coaches. There are some who don’t.

DR. MIKE MORENO: Yeah, I mean, it’s the center of the face, so it makes you or breaks you and then we become so focused on it, especially now. We’re going to talk about the whole COVID thing, everybody is staring at themselves in a zoom or whatever, but it’s amazing. Tell me, and this is really fascinating, and I know we could talk forever on this, but tell us a little bit about Mia Khalifa’s nose, and first of all, tell us about Mia Khalifa, explain the whole story.

DR. DEEPAK DUGAR: She is an absolute sweetheart. She’s one of the sweetest, nicest, most gentle hearts and has been through so much in her lifetime and really put such a deep purpose to her pain. A lot of people have been through what she’s been through would probably just be addicted to drugs and alcohol and living a very subpar, mediocre life. Instead, she decided to take a path of complete, independent freedom, and she literally looks at herself as a beacon of hope for young children that, hey, don’t make the same mistakes. Not about going into the industry, but if you do, don’t become powerless the way she did. She’s really inspiring for the young kids, and she has a huge following. Twenty-two million people on Instagram, almost the same number on Tik Tok, and this whole Gen Z group has really taken her as like their hero. They love her.

DR. MIKE MORENO: How did you meet her?

DR. DEEPAK DUGAR: So a friend of hers got her nose done by me, and then she is the one who referred Mia. Mia has always been insecure about her nose. She has a big nose, it’s part of her Lebanese ethnic heritage, and she was always insecure about it. She had seen a couple of consults from some very prominent plastic surgeons in Beverly Hills who always wanted to completely reconstruct and give her this tiny little nose because it technically looks better, but she didn’t want that. She wanted to have the same nose just a little bit smaller. When she learned about me and what we do with Scarlett’s nose, she was sold. As soon as we met, we were two kindred spirits and had a great relationship.

DR. MIKE MORENO: This culture, like I was saying earlier, we’re constantly looking at ourselves. This pandemic has just changed the world in so many ways. It’s crazy. So, let’s go on to Dr. Toll. Let’s talk this pandemic because this has changed everybody’s life, and I know that it’s changed a lot. Dr. Toll, you’re a concierge doctor, Good Life Medical Services, is that right?

DR. JEFF TOLL: My practice is just my name, Jeff Toll, MD.

DR. MIKE MORENO: Ok.

DR. JEFF TOLL: I have a second company since the pandemic started that’s really focused on COVID testing, making COVID testing readily available timely with timely results, and that that business is called Good Life Medical Services.

DR. MIKE MORENO: So you definitely are the definition of pivoting on a dime.

DR. JEFF TOLL: Well.

DR. MIKE MORENO: He’s shaking his head.

DR. JEFF TOLL: What concierge medicine means is we are doctors who are a little more readily available for our patients, so instead of seeing 20 or 30 patients a day, we’re seeing more like five or six patients a day where we’re able to have time with our patients, establish really great relationships and just have time to sort of solve all their medical needs. When it’s not the pandemic, that means we’re being very proactive about people’s health, putting them into wellness programs, getting everything from their physical to mental health on point so that they can run their businesses and do whatever they’re doing

DR. MIKE MORENO: Right.

DR. JEFF TOLL: When the pandemic struck. All of my patients wanted to be able to know they could get testing immediately with results the next day for them self and their family and their businesses. That became something I started working on very early on in the process. Then we sort of were able to scale it now to the point where we’re doing hundreds of tests per day on the individual people in the public. We have a drive through in West Hollywood, another one in Newport Beach. We’re able to get people results in about twenty-four hours, sometimes 48 hours. A lot of businesses are now using us to reopen in a much safer way than they were able to when the first reopen happened. I have a lot of warehouses, productions, like commercials, TV where we’re testing the whole business once a week, twice a week, three times a week. I feel like we were able to solve a problem that the government really wasn’t able to solve and being able to get timely testing was easy to get results.

DR. MIKE MORENO: I mean, that’s really been a huge key in terms of containing this thing. We’re not going to stop this and as I said, I’ve been doing family medicine for 24 years now, so I’ve been around a little bit. What I try to tell people early on is like, Listen, we’re not going to put this out. This is not like a fire that we’re going to put out. We can contain it much like the wildfire anywhere else. It’s about containment and minimizing damage, but there’s a lot of confusion about testing. I think a lot of it is just social media and a lot of it is just the news. I don’t think I’ve ever seen more people so fixated on the news. I think a lot of it is fear. I think the fear of the unknown, but you got to know the source of the information. What do you think about the testing and the confusion and accuracy? I mean, give me your thoughts on that.

DR. JEFF TOLL: I totally agree it’s so confusing. There’s so many different tests. There’s PCR tests and antibody tests, there’s rapid tests and even within each of those categories, there’s multiple different companies that make them. Multiple different places you can go for them. Part of what I’ve tried to do is be honest about what are the right tests that we should be doing and that is the only option we’re selling. Online you can find people willing to sell you these fingers prick fake tests that they’re buying overseas. What’s unfortunate is people or companies taking advantage of the pandemic to offer services that aren’t really helpful. So, in terms of what are the tests mean and what are the different ones? So, the PCR test, which a lot of people hear about, is the one that goes up and tickles your brain. That’s really just a swab.

DR. MIKE MORENO: Nasal swab.

DR. JEFF TOLL: That’s right.A nasal swab. What we’re looking for is the genetic material of the virus itself. We’re testing is that virus present in your body at the moment we’re swabbing. That’s the most accurate test that we have to see if the virus is there.

DR. MIKE MORENO: I think before you go to that, I’m sorry to interrupt you, but I think the confusing thing about that test is, first of all, it’s technique based, right? If you don’t really get up there to where the colonization is, to where the source is, you may get a false negative, and I think the other confusing part of this is that you may get positive results that doesn’t necessarily mean you’re infectious or that you’re spreading virus, so talk a little bit about technique and where the confusion is with that.

DR. JEFF TOLL: Those are both great questions. In terms of technique, the virus is most likely to be up high up in the nasal passages, which is why we use that long swab.There’s been a few studies out of different countries comparing swabbing up high there, as opposed to lower in the nasal passages, just sort of in the nose part versus in the back of the throat. It’s thought to be something like 80 percent likely to get it up in the highest part, 60 percent in the lower nasal passages and maybe like 40 to 50 percent in the back of the throat.

So, a lot of people who will go to a physician will say, Hey, I have nasal problems, or I have sinus problems, please don’t swab me up there and I’ll tell them, Listen, I can swab you lower, and we can send that sample, but we may have this thing called a sampling error, which is that you really, truly have the infection, but we don’t pick it up on a sample because we’re swabbing the wrong place.

DR. MIKE MORENO: Gotcha. So false negative in a sense?

DR. JEFF TOLL: So the test itself, typically when we hear – yes, so the test itself is accurate, so the test isn’t a false negative, it’s a sampling error. We’re not picking up the genetic material of the virus and thus you get a negative test. So yes, that would be considered a false negative.

DR. MIKE MORENO: Yeah, and you know, and I tell my patients to I say, listen, it is, it’s not like they’re just going to go barely inside the nose. It needs to get up there. As you said, you’ve got to tickle the brain. Obviously, we’re not tapping on the brain.

DR. JEFF TOLL: You’re only fooling yourself. If you want to just have them swab down low, that’s fine, but you just have to know that the test is going to be less accurate.

DR. MIKE MORENO: Not a great confidence interval.

DR. JEFF TOLL: The other side being, I think you were mentioning the potential of a false positive.

DR. MIKE MORENO: Right, people who are actually shedding virus versus not.

DR. JEFF TOLL: So there’s two things that I would call a false positive. One would be where we swab you and there’s actually nothing there and you get a positive result, that’s a false positive. What we have with this PCR test is also something where this PCR thing – we’re looking for the genetic material of the virus so you can pick up the RNA of the virus. What we can’t tell is, is that virus still alive in your body or are these just dead fragments of the virus that you had a week ago or two weeks ago or three weeks ago?

There is the possibility where we see in the news, we read about people who have tested positive a month after their infection. And the question is, are they truly infected again or are these just dead fragments that are positive? So, a lot of times, I’ve been testing a lot of movies and TV shows where we’ll get someone in the crew positive and then we wait until they test negative in order to go back out onto the set, but the problem is, we don’t know when they’re truly not infectious anymore. So, to be safe, we’re quarantining them until they swab negative, but they may actually be negative prior to that. It’s difficult.

DR. MIKE MORENO: Yeah. And you said that in those sentences, there are so many “maybes”, “may”. The bottom line is to call it novel is an understatement. It is about as new as it can get. I mean, we talk these days now, when we talk about new, we talk about things that have been around three or four years. There’s a lot of unknowns and all your points are really valid, and they’re spot on. The problem is like in a month from now, what we’re talking about may not even be valid anymore. It’s so frustrating for people.

DR. JEFF TOLL: So down the pike there’s these rapid antigen tests that we’re doing, that are in the White House, for example, they’re able to do these tests where you get a result in about six to 12 minutes and there’s slightly less accurate, but the problem is the companies aren’t able to produce enough test kits to make this readily available worldwide.

I think one point I always try to get to is that as much as the testing is helpful, it’s only really helpful if the turnaround time is fast enough for people to quarantine. If you have to wait a week for a result, there’s no point of taking the test in the first place. In my opinion, the countries that beat COVID, when we’re talking about South Korea and New Zealand, these are countries that beat COVID with masks, testing with fast turnaround time and contact tracing.

DR. MIKE MORENO: Right.

DR. JEFF TOLL: That this country is spending so much money testing people where results come back seven days later that are essentially useless tests.

DR. MIKE MORENO: Right. No, you’re exactly.

DR. JEFF TOLL: It’s not making this go away, so the way we mitigate the spread, which we’re not doing, is being diligent with the mask wearing and the quarantine and that’s what we’re not doing in our country. We have too many freedoms.

DR. MIKE MORENO: Listen, we can get into this all day. We could spend hours on this. I just tell people, just do what you’re supposed to do. That’s what I leave it at. We all know around maybe what, seven or eight, nine years old, right from wrong. I know that, you know, robbing a bank is a bad idea. I know that driving one hundred and fifty miles an hour on the freeway is a bad idea. So, I don’t do that. You know, and here’s another thing I’m interested to see your thought on this.

So, one of the things I tell my patients is this because there are a lot of patients. There are a lot of people in general all over. They say, Well, you know, the mask doesn’t do anything. Ok, that’s your opinion. So, I say to them, all right, so let me give you a situation. I’m going to put you in a small room, four feet square room with four people who are known COVID positive, who are known actively shedding virus COVID positive. Now I’m going to give you a choice. You can wear a mask or not. What do you think you would like to do? And what is their answer? One hundred percent of the time? Well, of course, I’m going to wear a mask. OK, and I leave it at that. So that’s the process, and you’re absolutely right. Just do what we’re supposed to do, and I think we’re going to be way ahead of this thing.

DR. JEFF TOLL: And I think I’m missing part of that question would also be to add, would you prefer that those other three people are wearing masks?

DR. MIKE MORENO: That’s good. Can I add that? I’m giving you full credit, of course, but you’re absolutely right.

DR. JEFF TOLL: The point is, if everyone wears it, the sick person doesn’t spread it as easily and then the other person has even less. These are not perfect. These are not 100 percent effective, but the point is all we need is that every day there are less people with the virus than the day before and then the next day, less people with that day before, then eventually it ends, but the way we’re doing it now without the mass is, we’re going up. We’re going up, up, up and it’s never going to go away.

DR. MIKE MORENO: Right, so Dr. Dugar, let me ask you this. One percent seems like a small amount, right? One percent. But if I told you that I’m going to put your name in a hat with ninety-nine other names, so you get a one in one hundred chance of winning a billion, billion with a B billion dollars. You only have a one percent chance would you want to get in that contest? Or you’d be like, Yeah, it’s only one percent. Don’t even bother me.

DR. DEEPAK DUGAR: No, we’re getting in that contest.

DR. MIKE MORENO: Exactly, you know, and that’s the point. I don’t care how limited or minimal it protects you. One percent is better than zero percent. I want skin in the game. I want anything I can get to protect us from this. Bottom line is this kills people.

DR. DEEPAK DUGAR: Yeah, I mean, do you want your food servers to wear gloves? I mean, most of the bacteria won’t get on the burger.

DR. MIKE MORENO: Right, exactly. We can go on and on about this, so let’s switch gears a little bit. There’s no such thing as virtual surgery yet.

DR. DEEPAK DUGAR: Yet.

DR. MIKE MORENO: Right? Yeah, I’m sure it’s going to happen. I’ll probably be long gone by then, but you know, you’ll be right in the thick of it. So, what has this whole pandemic done to your practice?

DR. DEEPAK DUGAR: Wow. So, for the first two months, March, April, it really became we have to do something from home, there was no practice. We were completely shut down, so we completely strategize and digitalized our entire practice. We went online and we did consult every single day and I was busier than ever just doing online, consult all of March and April and into May. So that was amazing. We reached out to all our patients. We let everyone know that we’re doing digital. We’re available. I was doing sometimes 10 to 20 a day. Then as soon as the restrictions were lifted and we’re able to come back to work, we went slowly on purpose, we want to look around and make sure the neighbors aren’t dying from going to work and to realize that everyone’s doing OK.

We look back and end of May, June, July, August. It’s been so busy, and I’ll tell you the truth. People are taking advantage. You know, God bless the people who don’t have the means that are sick and dealing with bad things right now, but the people who do have the means and are just kind of bored sitting at home, if you have thought about plastic surgery before, it’s never been a better time because before the problem was, Hey, I want to get my nose done, but I don’t know what I’m going to do it now.

DR. MIKE MORENO: Right.

DR. DEEPAK DUGAR: Now it’s like, I want to get my nose done and can I do it tomorrow?

DR. MIKE MORENO: Right now and then I’m assuming you’ve probably because I know my buddy, his whole office, the whole, you know, the way it runs now in terms of sanitation and hygiene, you must have spent a lot of money and effort, and I can’t even imagine, I mean, tell us some of the things that people can feel comfortable about when they come in to see you.

DR. DEEPAK DUGAR: Ok, well, one thing is that all the staff are wearing KN95’s. The surgeons are wearing what we call P100’s. These are the respirators that we wear when we do surgery.

DR. MIKE MORENO: That’s no joke.

DR. DEEPAK DUGAR: Every single patient is being tested prior to surgery, and I would say this is not even just a plug for my buddy, but-

DR. MIKE MORENO: I was going to say, you got a guy right next to you that helps you with that.

DR. DEEPAK DUGAR: He’s testing my patience, and the results do come back in twenty-four hours, it’s quite amazing. Dr. Toll has created amazing testing machine. It’s all PCR, real tests we don’t do any of the blood antibody tests. We’re doing real PCR tests, so every single patient has to be tested. The staff is routinely tested. I test myself once a week, so we are being as diligent as possible to make sure that we provide the safest environment. Everyone’s temperature screened. Everyone signs Covid consents. Everyone’s mask mandatory.

DR. MIKE MORENO: Right. I’ve heard, too, I know there’s people using ultraviolet light as a cleansing.

DR. DEEPAK DUGAR: We have that as well; we have an ultraviolet machine that cleans the rooms between patients.

DR. MIKE MORENO: Right. Listen, you got your buddy right next to you. He should be able to give you a little bit of a deal on all these tests. I mean come on, Dr. Toll, don’t hold out this is your buddy. It’s really incredible that we’ve had to do to ensure the safety of our patients. People need to seek their care. You cannot disregard care because of fear.

You need to care for your diabetics, your hypertension. I mean, all of these people that I see, and I know Dr. Toll you can attest to this. People are afraid, but that doesn’t mean, when you looked at the ER’s over the last several months, there’s no magic that suddenly the incidence of chest pain and heart attacks and strokes just stopped happening. These things were happening, but there were a lot of things that were missed, so letting people know that we’ve created a safe environment and we are proceeding with caution, whether it’s having a rhinoplasty, or your nose done or going in to get your blood pressure checked or your sugar, whatever it is just yet, people need to. I think a big message in this whole thing is recognize that the medical community, I think far and wide, maybe this doesn’t speak for everybody at far why we are doing everything we can to ensure their safety.

DR. DEEPAK DUGAR: Agreed. I have a buddy who’s a radiation oncologist, and he was telling me that when they went back to work full time and everyone kind of started coming again, they have never seen this much incidence of stage four cancer.

DR. MIKE MORENO: Breaks my heart.

DR. DEEPAK DUGAR: Patients who had stage cancer just delayed going to the doctor for two months. Then all of a sudden now they have lung mass, brain mass that they wouldn’t have had had they followed their regimen properly.

DR. MIKE MORENO: Right.

DR. DEEPAK DUGAR: So I could not agree more. Please go see your doctors. Ninety nine percent are following the rules and regulations and doing exactly what they need to protect your safety.

DR. MIKE MORENO: Yeah, and I think that’s the biggest thing that really is, you know, when you look at disease rates, more morbidity mortality and you look at deaths annually from things, you know, every year it’s upwards. I mean, you probably know this doctor told what six seven hundred thousand people a year die from cardiovascular disease. This is the one year that it’s not going to get first place. But I guarantee you it’ll be right behind it and it’ll be next year where it’s going to go back to number one.

And you know, Dr. Dugar you talk about cancer, you talk about all of these things, these diseases are present. They’re here, they’ve been here for years. They’re not going away. Suddenly, this stupid COVID thing pops in and just, you know, has its moment. But I will tell you, these other disease entities and the morbidity and mortality related to them is going to come back. I hope people just embrace the fact that taking care of yourself and doing these things, as you guys are mentioning, is super important.

DR. JEFF TOLL: Yeah, I’ve really tried to get this really in my patients minds to that they’re uncontrolled diabetes is just as dangerous to you as COVID, potentially.

DR. MIKE MORENO: Right.

DR. JEFF TOLL: Especially because COVID is a theoretical risk. There’s a there’s a risk whenever you drive a car of getting in a car accident, there’s a risk. A lot of things have a potential risk. But we know your diabetes, if you don’t control it, is definitely a risk.

DR. MIKE MORENO: Right.

DR. JEFF TOLL: At least in my practice. I’ve tried to make this an easy process for them. So, we’ve hired a whole bunch of phlebotomists that are going to people’s homes to draw blood in the backyard.

DR. MIKE MORENO: Great.

DR. JEFF TOLL: And then pairing that with a virtual visit so that they don’t have to leave their home for the elderly or for diabetics. All things like this to make it just easier on them. I think this has been a real big opportunity for us to explore what in medicine doesn’t work. I think one of the one things the government did that was good in this whole thing was to say that virtual visits should be reimbursed for the doctors, the same as regular visits to allow.

DR. MIKE MORENO: Hallelujah. Yes.

DR. JEFF TOLL: Why should an eighty-five-year-old who’s had a stroke who doesn’t drive anymore, could actually call their doctor and say, Hey, I’m having a little chest pain. What should I do instead of the Oh, doctor can’t see you unless you come in? I mean, it’s crazy how the old system was working.

DR. MIKE MORENO: Well, you know, we learned, to use that term I used earlier, we really pivoted on a dime on this. We went from 10 percent virtual and 90 percent face to face to the opposite almost overnight. Now, and I don’t think that that’s obviously sustainable, nor should it be, but I think somewhere 50/50, 60/40 is a sweet spot.

DR. JEFF TOLL: Yeah. It depends. It depends on the specialty, you know, as an internist I definitely want to examine someone once a year and listen to their heart. Then they need an EKG and some things like that, but for a blood pressure follow up check, there’s so many devices out there. There are bluetooth blood pressure cuffs, you can get EKGs at home. So, if people have their mind to making the system different, we’re doing it in my practice, I know other colleagues that are doing it in their practices, but I think in 10 years from now, medicine is going to look very, very different than it looks now. I think this was a big opportunity impetus for us to change our practices.

DR. DEEPAK DUGAR: Yeah, even with cosmetics, I’m doing just as many virtual consults as they do in person now.

DR. MIKE MORENO: Ok, so let me ask you, so now that since you brought it up, Dr. Dugar, going back to the virtual consults now, obviously I know that with age is when, I told you I’m knocking on fifty-two, when or maybe has it happened already, has the tip of my nose started to change? Talk a little bit about this? Because again, this is not something we could do virtually. You can look at it, but let’s hear a little bit about this.

DR. DEEPAK DUGAR: Great question, so as you age, there’s this big myth, everyone thinks that as you get older, your nose grows. Right, that your nose ears grows.

DR. MIKE MORENO: You’re right.

DR. DEEPAK DUGAR: Yeah. So, what it is not that they grow OK, it’s that everything like your breast, your arms, your legs, everything’s gravity dependent and so heavier parts of your body will always fall prey to gravity, including your nose. The tip of your nose does have a predilection to fall as we get older, especially if you already had a dependent tip. If you didn’t have a dependent tip, then it might not fall that much. We see this a lot, especially in older celebrities, as they continue filming and doing their movies or TV shows. They look at their stuff and they say, Dude my nose does not look the same. So, they’ll come in and we’ll do little, tiny things. Sometimes they can’t do surgery, so we do a technique that I love doing called a nose lift. Well, inject a little bit of filler, a little bit of Botox at the base of the nose. The filler acts like a plumping graph, which is a surgical term for a support beam to lift up and the Botox decreases the muscular activity of the special muscle that pulls our nose down. So, by releasing that muscle and giving some support with the filler we can in one two minutes create a little bit of a lift to the older nose.

DR. MIKE MORENO: So we’re like retrofitting a building for earthquakes.

DR. DEEPAK DUGAR: That’s exactly right. And it’s going to be temporary, just like that retrofitting.

DR. MIKE MORENO: That’s right, well, if you’re in California, you’ll know exactly what that means. How much is genetics in terms of your know, I have my father’s nose. And you know, you can’t see it because I’m looking at you straight on. But if you see my profile, you’d be like, Oh man. So how much does genetics, and I mean, we can’t really genetically manipulate ourselves, again another “yet” it’s going to happen I’m sure, but how much of it is genetics and what do you do?

DR. DEEPAK DUGAR: Yeah, I think about 80 percent of our cases are genetic and then 20 percent is based on environmental factors. So, trauma, even when you’re a kid, having a deviated septum in the inside of your nose can literally come from when you’re a four-month-old learning how to crawl and you fall in your face and you cry, your mom gives you milk and then it’s all over, right? But that little micro fracture that happened in the septum now makes your septum grow two centimeters left than it should be. So little micro fractures like that, or you’re 16 and you get hit in the face playing basketball or volleyball. These little things can cause trauma as and micro traumas that cause things to bend in ways they’re not supposed to. But I would say 80 percent are probably genetic, 20 percent environmental.

DR. MIKE MORENO: So like you guys, remember The Brady Bunch, right?

DR. DEEPAK DUGAR: Yeah.

DR. MIKE MORENO: So, Marcia, Marcia, Marcia, when she gets hit with the ball. It’s safe to say she had a deviated septum moving forward.

DR. DEEPAK DUGAR: Absolutely, and a lot of girls get hit on purpose to get their nose job.

DR. MIKE MORENO: So she could come to see you and correct that.

DR. DEEPAK DUGAR: Yes.

DR. MIKE MORENO: So let’s go back to, this COVID thing is just beating us all down, it’s like everywhere we look, but I want to talk a little bit about hope. What do we think? Both of you guys, I’m sure, have opinions. Where are we going with this? What do you guys think? And I get it. We’re not going to like, put this in stone and we’re not going to hold you to it. This is all conjecture. I think even Dr. Fauci’s words are conjecture, and they evolve and everything changes. It’s like liquid, right? It’s constantly evolving. What do you guys think?

DR. JEFF TOLL: Well, I would say, as far as how does this end, it seems like our only real way out in this country, at least, is a vaccine coming or herd immunity. It’s sort of one or the other. The vaccine is the artificial way that you create herd immunity and herd immunity means when there’s enough people in the population who can’t get it anymore, it slows down the spread to a point where each day there’s less people who had it than the day before until it goes to zero.

DR. MIKE MORENO: It’s like when you were a kid and you had like chicken pox and your mom would send you to your buddy’s house and say, go hang out with them so you would get chicken pox because it’s better as a kid than to have it as an adult. You don’t have all the complications or as much, I should say.

DR. JEFF TOLL: And so one of the reasons why other infections like the flu are seasonal is because some people had it the year before. Some people had the vaccine, so that slows down the spread enough that it sort of peters out at the end of the winter each year, whereas this no one had immunity to, so it just continues to spread. I think we don’t really have a true sense of how many people in various areas have had it. The testing is getting better, it’s getting cheaper, the turnaround times getting better. There’s going to be more rapid tests coming down the pike. If I was the government, what I would do is spend much more of the money that they’re spending on testing rather than all this other stuff that’s not helping. So as much as we want to give these people who have lost their jobs six hundred dollars a week, I think it would be make more sense to test people six days a week and let them work.

DR. MIKE MORENO: It’s a great point. It’s a really great point, I’ve never heard it put that way, but it’s a great point. I mean, I think of the days where, well, a couple of things like, first of all, how many of us have like gone out with friends and like someone’s sniffling and congestion and you’re like, oh yeah, I’m just getting over a cold that ain’t happening anymore. Right? So, the days of like, yeah, just got a little cold. Don’t worry about it. Those days are over, right?

DR. JEFF TOLL: I think for a while, I do think it’s going to go away once we really do have a vaccine, assuming American people are willing to take it, which is a whole other thing.

DR. MIKE MORENO: Yeah, that’s a weeklong, that’s like a retreat discussion about that we can go on about. You know, the other thing is really like, you talk about herd immunity and you know, vaccines, but how long does your immunity last?

DR. DEEPAK DUGAR: Yeah, well, that’s so important because no one’s talking about the data in terms of once people get it, what are their reinfection rates right now? We’re not really looking at those details as closely as we should be. Who are the type of people getting it and what were their environmental factors that caused them to get it? We’re not looking at all the socioeconomic data. People who wear a mask every day go to work around people who wear masks and go home and stay around a masked environment. Are they getting it? The mask data. So, I think the data is just not being looked at deep enough.

DR. MIKE MORENO: Yeah, here’s what I think, the one thing I’ve been saying to so many of my colleagues for months, and I’m starting to get confident that I’m actually right and I’m curious what you guys say. I think we are going to have the nicest, kindest flu season ever.

DR. DEEPAK DUGAR AND JEFF TOLL: Yeah.

DR. MIKE MORENO: And that’s without the vaccine. Now we have a vaccine, which, you know, the average vaccine rates are probably, I don’t know, 40 percent if that if you’re lucky, right? But I think there’s going to be a fear factor. People who are on the fence, I mean, there’s going to be those non vaccine people, I get it and whatever, but there are people on the fence who are going to be like, you know what, I’m going to get it. But beyond that, it’s the hygiene. It’s the hand-washing. It’s the masks, it’s the, I’m not going out if I have a sore throat. I think our flu season and if you look at Australia’s numbers so far because you know they’re having their flu season or just wrapping it up, their numbers have been vastly low in terms of influenza, I think. I mean, call me crazy, but I my mom has been telling me to wash my hands since I was a little kid. And, you know, cover your face when you speak, or you sneeze. All of these things people are actually doing now I think it’s going to translate into not only helping eradicate or at least control COVID, but I think we’re going to create a better environment for the upcoming flu season. What do you guys think?

DR. DEEPAK DUGAR: I hope you’re right.

DR. JEFF TOLL: I think that that definitely makes sense, but again, that’s assuming that people actually do it. You’re giving them credit for doing it if they’re not doing because we know in the countries where they did it, like Australia, the rates go down. In the US, the U.S. is really the only place where you see two hundred and fifty thousand bikers meeting up altogether.

DR. MIKE MORENO: I know.

DR. JEFF TOLL: This doesn’t happen in other countries. The only countries who have levels that we have are countries that are so poor and uneducated where they literally can’t distance. They can’t afford mass. We’re talking about India, Brazil, where there’s people packed in multiple family members in one home. The sad thing is, we don’t really think about in America, there’s two societies. There’s there are people who are living like they live in Brazil, where there’s three families in one small place and they can’t afford mass. They’re not as educated and those are the people that are getting COVID and spreading COVID.

DR. MIKE MORENO: Well, you know, so I was born in this country, but my father is from Mexico. I’m Mexican, I speak Spanish fluently and I will tell you the Latino population has gotten pummeled by this and it’s for exactly what you just said. They’re the people who work in these very tight environments. They’re on top of each other. They’re in factories, they’re in kitchens, they’re out in, you know, outside working in the agriculture area. You look at the San Joaquin Valley where I grew up, these people are getting really just hammered by this.

There is also the socioeconomic elements. I mean, there are so many things to me that makes sense as to why this population is being affected like this. I don’t know. I mean, I would just say, I hope people just do what they’re supposed to do at the end of the day. I’m curious what your guys just take. I tell people there’s five things you got to do, Covid or not. Flu or not, general wellness. You got it. You’ve got to move and stay active. You’ve got to drink plenty of water. You have to avoid smoking. And if you do smoke, always be trying to quit. You have to follow a sustainable, likable, doable diet that’s healthy and balanced.

Above all, you have to manage your stress. You have to respect your stressed. Understand what stress is in your life. Have your coping mechanisms. People do not respect stress, and I think that that is a big, big hit on your immune system.

DR. JEFF TOLL: Yeah, I think on our podcast, Modern Prescription, one of the things we talk about, our modern prescription is that how connected the mental health part is with the physical health. People always want, what’s my crash diet I can get in one day, what’s my exercise to lose this weight in one day instead of sustainable practices for your mind and your body to sleep better, to eat better, to feel better?

I think one of the things we have in common, whether we’re talking about your physical appearance or your physical health, we both want to make people feel good and feel healthier and feel good about themselves and live a better lifestyle. I think he calls himself a psychiatrist with a scalpel, I’ve always loved that. So, what’s your take?

DR. MIKE MORENO: Closing thoughts. Let’s hear it.

DR. DEEPAK DUGAR: That’s where me and Dr. Toll on Modern Prescription really blend well because he looks at medicine and I look at surgery as a sword that should be wielded with a lot of responsibility. You don’t just dole it out. So, we treat patients holistically. That’s what I loved about Dr. Toll, is that he’s very similar to me, that we are real doctors, just like you are Dr. Mike. We care about our patients. We don’t just want to get them in and out and use our weapon. If we don’t have to use the sword, if he doesn’t have to prescribe a pill and I don’t have to do a surgery, it’s even better. So, our whole thing is a holistic wellness and that’s what you promote, and that’s what we love to be on the show today.

DR. MIKE MORENO: So you guys mentioned it, but I want to make sure everybody gets this message. Modern Prescription. Where can we find you guys, Dr. Toll and Dr. Dugar? I’m going to track you guys down because I’m up in L.A. I love you guys. I love your philosophy. I love the way you approach this. I think medicine is a beautiful thing. It’s not about money. It’s about resting at night knowing that you’re changing lives. Whether that’s changing the nose or whether it’s fixing someone’s blood pressure. It is infectious in that that person’s wellness really translates to the wellness of their friends and their family, and that’s why we do this job. I think it’s important. So how do we find you guys tell us about Modern Prescription? Where do we where do we find you guys?

DR. DEEPAK DUGAR: Our Modern Prescription you can find as we’re streaming on all platforms, Spotify, Apple Podcasts and as well on YouTube. You can watch the whole video if you just want to see what you want to hear. Yeah, it’s an important part of our last episode to delve into the hair we talked about as hair tips because I shampoo twice a day. He told me he doesn’t shampoo even twice a week, sometimes.

DR. MIKE MORENO: One of these guys.

DR. DEEPAK DUGAR: Look at his hair versus mine, so he knows what he’s talking about.

DR. MIKE MORENO: Listen, you guys have been a real treat, it’s been a ton of fun and I really want to thank you guys. You know so much to learn. We could just the time goes so quick, but I really appreciate you guys taking time to spend with us.

DR. DEEPAK DUGAR and DR. JEFF TOLL: Thank you. Thank you for having us.

DR. JEFF TOLL: And to your listeners, if anyone wants to follow us on Instagram, both of us, have a lot of interesting stuff to talk about there too. So, I’m Jeff Toll, M.D.

DR. DEEPAK DUGAR: And I’m Deepak Dugar MD, on Instagram. Thank you so much.

DR. MIKE MORENO: Awesome, thanks, guys. That’s it, guys, that’s it, everybody. That was a great, great show. A lot of great stuff. I could go on forever. I just love these guys philosophy. Thanks for spending some time with us. We talked a little plastic surgery, we talked a little COVID, we talked a little health and wellness. All the important stuff. Have a great day. Don’t forget, subscribe, download and listen to Wellness, Inc with me, Dr. Mike. Have a great day, everybody. Thanks, gentlemen. See you soon.

The Wellness, Inc. with Dr. Mike Moreno podcast is for informational and entertainment purposes only and is not intended as a replacement or substitution for any professional, medical, financial, legal, or other advice, diagnosis, or treatment. This podcast does not constitute the practice of medicine or any other professional service. The use of any information provided during this podcast is at the listeners own risk for medical or other advice appropriate to your specific situation, please consult a physician or other trained professional. Thank you.

About This Episode:

On this episode of Wellness, Inc. Dr Mike Moreno has a conversation with world famous plastic surgeon Dr. Deepak Dugar and internist Dr Jeff Toll about the newest information and cutting edge techniques in the medical field.

Dr. Dugar is responsible for many of the prettiest noses in Hollywood and he shares techniques you may never have heard of including the nose lift and scarless nose surgery.

Dr. Jeff Toll offers important information on Covid testing and herd immunity, concierge medicine, and how tele-health may be the way of the future.

Dr. Mike shares his expert advice and lays out the five things you need to do to stay healthy!

Hi Listeners, Wellness, Inc. with Dr. Mike Moreno podcast will be on hiatus next week, will be turning on Dec. 2nd! Thank you, Happy Thanksgiving!

Connect with Dr. Deepak Dugar:

https://www.instagram.com/deepakdugarmd/
https://www.scarlessnose.com/
https://www.facebook.com/ScarlessNose/
https://twitter.com/deepakdugarmd

Connect with Dr. Jeff Toll
https://www.instagram.com/jefftollmd/
https://www.goodlifemedicalservices.com/
https://www.facebook.com/jefftollMD/