On this episode of The Natural Plastic Surgeon…
Dr.B. Everyone is Dr. Barrett. We're here with episode 34 of the natural plastic surgery podcast. We have Bitter Betty here, also known as Sarah, and she is a trans woman with an incredible story to tell. Recently, you went viral on the TikTok video, which I think we should play for our listeners and viewers. Just briefly, with your permission, if we could do this,
BB: Yeah, go for it, let's do it.
Tik Tok video: Gather round children. And let me tell you a nice little bedtime story. I transitioned in a time long before trans women were being put on the cover of magazines and whatnot. There were no trans pop stars, and we weren't put on TV. And given our shows, in those dark days, health care for trans procedures was nonexistent, so very few trans women could afford them. Now, this is the perfect place to let you know that I grew up in the projects and the trailer parks of backwoods Tennessee and I have spent my life struggling to get out of that kind of poverty. So, I was one of those trans women who could not afford the trans surgeries out there. It didn't help that no one would hire us if we were the slightest bit "clock-able," especially in the Bible Belt where I'm from, and let's be real. I'm not trying to fool anyone with this Tina Belcher voice. So many of us, myself included, had to resort to black-market procedures to transition. We would waltz into seedy motel rooms and let whoever pump us with God knows what; of course, we were told it was medical-grade silicone. Of course. Countless trans women have been left deformed or even dead from these procedures. So I'm very lucky to have lived through it. This is the person that pumped my entire body. This could have been me. I've spent the past decade trying to raise awareness about discrimination against trans women so that future generations of trans women won't have to have lips like mine. But go ahead and laugh at my janky lips. I can take it. God knows I've dealt with worse monsters than you.
Dr.B. This is something that you shared. Now you're also on AMC, Dragula.
Dr.B. okay, you're a contestant on there. You can't tell us what happened.
BB. Well, I've already been eliminated.
Dr.B. Oh, okay.
BB. Yeah, the show is almost over.
02:40 TikTok videos
Dr.B. well, that's exciting. Well, alright, so, you know, I'm a plastic surgeon, and you've had some procedures, and you kind of talk about this. It's a long TikTok, and you know, I'm on Tik Tok a lot as well. You kind of go into some things, and maybe we can, we can just sort of talk about that. What made you kind of want to do that video and
BB. it was just your response to someone, you know, some troll trolling about my lips, or whatever. So I decided to tell the story of how my lips got so messed up.
Dr.B. Yeah. Well, tell us to tell us what, like.
BB. So I grew up in the drag world in the late 90s, early 2000s. And
Dr.B. in Tennessee
BB. yeah, in Tennessee.
Dr.B. Okay. And so I'm from Virginia. So I know a little bit about Tennessee. And I know what it's like in some of these really poor areas. I actually kind of grew up in a blue-collar family. And you know, we lost our house when I was younger, and so forth. And so we had some similar struggles with poverty, I don't think anywhere near what you had to go through. But it's kind of funny when people say you live in the projects, and you're white, or you're trans, you're just like, oh, okay, that doesn't quite make sense.
BB. See, a lot of people commented that the projects don't exist in places like Tennessee.
BB. And I'm like, No, I promise they do in the backwoods.
Dr.B. Right, exactly. So I think that's pretty credible. Anyway, good. Tell us more.
04:00 drag world
BB. Yeah. So in the drag world, there are a lot of trans women because back in the day, a lot of places a lot of trans women could not get hired. People didn't want us, you know, representing their businesses.
BB: And so a lot of us had to resort to either sex work or drag, drag, if we were lucky, we could make a pretty nice little living in the drag world. And I was one of those lucky ones.
BB. However, in the drag world, you know, hyper-femininity is sort of sought after. And so if you're a trans woman in that industry, you want like the perfect hourglass figure, and BBL’s didn't exist back then. So a lot of girls would get back alley silicone,
Dr.B. right. And so to back up, you know, a lot of people don't realize this, but I guess 15% of the trans community is below the poverty line.
Dr.B. so it's, you know, it's not, it's not an easy thing. And you're, you're kind of in the struggle, and especially, it's not until recently that insurance has even started to consider some of these things. So
BB: no, there was not any insurance that would cover anything.
BB. nothing. So yeah, I mean, it was a pretty common thing in my scene that we call ourselves the dolls. The dolls would get everything pumped: leg, hips, boobs, face, all of that.
05:30 first experience with injections
Dr.B. Tell us that first experience that you had. Where was this? And what area did you get injected?
BB. The first thing I got done was my lips because it was one of the cheaper things.
Dr.B. And then how much would this typically cost? We're not encouraging people to do this, by the way, but
BB. I honestly don't remember the exact cost. But like for my lips, I want to say it was maybe like 50 or 100 bucks.
BB. really, really cheap.
BB. And I went and got that done with my drag mother.
05:50 drag mother
Dr.B. And now what's a drag mother?
BB: My drag mother is sort of a drag queen who takes you under her wing and teaches you the business and just helps you out. But she was also a trans woman. Gorgeous trans woman. And yeah, she took me to get my lips done and introduced me to what we called them silicone artists. That did it. And I developed a relationship with her. And over the course of the next few years, I kept going back and getting more done.
Dr.B. was this in like a medical office?
BB. No, no, no, it was in a hotel room.
Dr.B. Oh my gosh.
BB. Yeah. And actually, she lived in Florida, and I lived in Tennessee. So it was like a 12-hour drive. But I would often drive 12 hours to Florida to get work done like a daze and not even a nice hotel.
Dr.B. Yeah. Okay, so you walk in there, and it's your first time getting it to tell us about the experience and what did they use? And
06.50 first-time silicone injections
BB. she did numb, she did numb my lips. I do remember that she numbed them. I don't remember how to be honest. I don't know if it was topical or an injection. Because when she did my body later in later years, she always numbed with that injection of some sort.
BB. Um, but yeah, she numbed my lips and then and then, you know, put the needle on each side and pulled it out and injected the silicone as she was pulling it out, I guess.
Dr.B. Okay, so, was this, what did the silicone look like, was it?
BB. It was just a clear liquid?
BB. Yeah, very clear liquid. She had it actually in a plastic cup covered with a napkin?
Dr.B. Yeah. Does she wear gloves?
BB. She did wear gloves.
Dr.B. Okay. Okay. Did she clean the area before?
BB. She did. She did do that, at least.
Dr.B. And did she have any medical background?
BB. It was said that she had that she was a nurse that she had a nurse's license. But I don't think that ever ended up being the case because she did end up killing someone after years after I had finished welling to her. Yeah. And it all came out that she did not have any sort of medical training.
Dr.B. Oh my goodness.
Dr.B. That's so tragic.
Dr.B. All right. So we the lips were injected. It wasn't so painful. You kind of go home. Were you happy with her like him?
BB: it hurt like hell.
Dr.B. Oh, it did. Okay. All right. Yeah,
BB. that numbing cream did nothing.
BB. Um, but yeah, and then I went home, and everything was, you know, fine. I guess they, I noticed they weren't even okay, like that. But I think I didn't know anything of it. Those are my options. So I dealt with it.
BB. Was it horrible?
BB. Yes, it was; it could have been worse. But yeah, over the course of the next few years, I ended up going back, and the next thing I got done was my butt and hips. And I always swore that I would never get the silicone injection in my boobs. I was like, I'll wait, and maybe someday I'll be able to afford implants.
BB. And but after going so many times to get my button hips done and later my, I got my cheeks, my chin, my forehead, all kinds of stuff in my face done too, it just kind of became less scary. The more you did it, I guess so. So eventually, I caved and got my boobs done, too.
09:20 complications after injections
Dr.B. Did you have any complications with any of these?
BB. So far, no. I do have; actually, I do have on my butt I have a couple of dark spots.
BB. on the edges of my butt.
BB. where she pumped that
BB. Yeah, I don't. I've heard that from where it's too shallow, maybe.
09:40 silicone injections
Dr.B. Maybe. I know, it's not something that I do. But, you see, it's interesting. The medical industry has done injection of medical-grade silicone in the past.
Dr.B. typically, its microdroplets actually, when we first started doing breast augmentation. That's something that was experimented with, and what they realized is that for some people, the silicone injection is acceptable in large amounts. But, there's a high percentage of people, though about a third of people sometimes develop a horrible reaction to it. It can get infected, and once it's infected, it can be a death sentence.
BB. Yeah, I think that's what happened to the girl that ended up dying. And that was that's happened a lot over the years too, you know, queens in the industry and stuff.
BB. So yeah. But I know that it did use to be legal in the 80s, like doctors would do.
Dr.B. It's still legal. Like, technically, I could do it if I wanted to use it. There are some doctors that still do it. But they do a very microdroplet technique, like on the nose or in the face. And it's like, you got to be very careful because if you do too much, it could become a problem. So yeah, I think he's a Dr. Cutler who does it. But, I mean, these people had an experience when it was very common back in the day that none of the newer doctors have ever gotten trained on it. And so we shy away from it because we hear all the horror stories of it.
BB. Yeah, there was; actually, there was a book written by a nurse of a doctor who did it back in the 80s.
BB. and it was called the champagne slipper. And she was a trans woman herself, I believe. And she, as I said, she was the nurse of one of the doctors, so she assisted him with it a lot. And the book is about a lot of her patients that were trans women and drag queens and stuff that
Dr.B. what's the name of the book?
BB. It's called the champagne slipper.
Dr.B. Champagne slipper Okay, to check that out.
BB. Yeah, it's really good.
11:40 Infection issues
Dr.B. Okay. You know, it's all, it's all great until you run into a problem, right? And so it's just you're relying on the human body like resiliency to kind of deal with it. And kind of, not really, you know, silicon as a whole is pretty inert. But it's just that if you get bacteria and other things mixed in with it, your body can't clear it because it's kind of this inert-like foreign substance that doesn't get cleared easily. So that's why we don't use it now. It's interesting. I have seen a lot of trans patients, and I do a lot of trans breast augmentations and breast augmentations. And, and sometimes Brazilian Butt Lifts, which I know wasn't around when we had to do. And so I had one patient recently; she admitted to me that she had already gotten some silicone there. And she wanted me to do a BBL on top, and I said, Look, I can't do that. Because if I did, I make an incision, and then I put fat there, it can increase your risk of infection.
Dr.B. I'm just encouraging her not to get any more done. And
BB. yeah, that's one thing that I still worry about is possibly getting infected or anything like that. But, like when, especially when COVID had, I was like, Who knows how anything could react with whatever's in my body.
BB. Yeah. Because I mean, we don't even know that. It's, it's, it's medical-grade silicone.
BB. we, that was part of the risk you took, then you just, you know, kind of went to people who were well known, I guess. And she had been well known for a decade or two. But yeah, she eventually, though, did end up killing someone.
Dr.B. Yeah, that's awful. I can't imagine that.
Dr.B. Yeah, I mean, and that's the thing. It's, it's, it's, it's a challenging situation. Because here, you know, here you are, when you're younger, and for many trans people trying to transition I mean, tell us to tell us what that's like, and then you're financially strapped, but you are like completely, you know, cross against what you feel like you should be
Dr.B. and then you have no means to kind of feel like to kind of express yourself on the outside and make changes that are more in line with what you want, right feel.
BB. well, fortunately, as I said, I'm sort of in I was in a lucky situation, as far as trans women went back then because I was a drag queen by profession.
BB. And we were, you know, more accepted and even revered in the drag world at the time. A lot of the most well-known drag queens were trans women. And so I was fortunate as far as that went, I did have a place to express myself and friends who accepted it and whatnot.
BB. but not everyone was that lucky, of course.
14:25 advice to young trans persons
Dr.B. Yeah. I mean, what would you say? What would be your advice to a young trans person to, you know, that that's thinking about doing these things or wants to make changes to their body, but can't reasonably afford them right to do the proper way.
BB. It's such a tricky thing. It's such a hard thing to approach, especially if they can't afford it, because I mean, it's one of those things that you'll do anything to get it to happen. But, still, I would just encourage them to hold off on it like start with hormones and and and let them have time to take effect because they take years to see full results from them.
15:00 hormone therapy
Dr.B. and how expensive is hormone therapy?
BB. Um, I don't. Even back then. I mean, this is the early two, very early 2000s. Even back then, I think insurance would pay for it sometimes like I. When I started, I was able, I did have insurance at the time, and I was able to go to a doctor, but I knew more than the doctor about hormones or hormone replacement therapy at the time. And so I had to bring her stuff that I printed offline, about doses and things like that.
Dr.B. And that happens a lot. All my trans patients, almost all of them are very educated. And they're
BB. Oh, yeah. Yeah. Luckily, I had the internet back then; it was the early days of the internet. So but there were some, like trends, forums, and stuff that had older trans women that ran them and, you know, gave the information out. So we'd print it off and take it to our doctors. Nowadays, I think it's a lot easier. I feel more doctors know about hormone replacement therapy.
Dr.B. Yeah, I always kind of a rule of thumb. You know, for my patients, I always ask that they be on for at least six months before considering a breast augmentation because it allows us to do the sizing a little more accurately. And it also allows for more natural coverage,
BB. I would say. So I didn't get any work done until I was on hormones for many years. I think I was on hormones for maybe five years. And I mean, I had pretty great boobs beforehand, too. So yeah, I would say wait as long as you can.
BB. Yeah. Especially if you can't afford to get, real stuff done. Just wait, let the hormones take effect.
16:40 resources for a trans person
Dr.B. Okay. What resources are there for a young trans person or new trans person who's thinking about transitioning?
BB. Let's see, and I know nowadays that there's something called crap. I forget the name. No, no
Dr.B. we have some
BB. Oh, I know what it is. Plume, there's something called plume where you can get hormones online, like legally with a doctor and everything they FaceTime you and yeah, it's like 100 bucks a month, I think which is still, you know, not affordable for everybody. But it's not as bad as it used to be.
BB. And if you're thinking about getting hormones from, like, a foreign online company, plume might be just as cheap.
BB. Yeah. So look into that if you are looking into transitioning.
17:35 her career
Dr.B. Great. Alright, so let's tell us about your career now. I guess, do you still do drag and
BB. I do.
BB. I just came off that reality shows that Boulais brothers Dragula season four, and so yeah, I've been traveling quite a bit from that.
BB. So yeah, and then I also went through a time when I wasn't getting as many bookings and stuff, so I created my own little like wigs styling business for drag queens, so I've done a lot of wigs for a lot of famous people. I've done wigs for sia, and yeah.
Dr.B. wow. Do you have a link to the website?
Dr.B. Alright, so you, I have to check that out. I have. I have some haters. You probably have some haters.
Dr.B. How do you deal with that? What kind of criticism do you get?
BB. You know what? I try just to ignore it. One thing I love about TikTok is that whenever those trolls comment, you can respond with a video. It kind of takes power out of their hand.
BB. It's back in yours. Right. I liken it to drag queens getting heckled at a club.
Dr.B. Uh huh.
BB. They've got the mic. Never forget that the drag queen has the mic.
BB. And that's sort of how it works online.
Dr.B. That's great.
BB. Or on Tik Tok. Rather,
Dr.B. I know it's kind of a kind of, it turns it gives you great content, right? Cuz then you can just sort of turn it around and either use it against them or make them feel kind of foolish.
BB. That's what went viral for me.
BB. I mean, like, 50,000 plus followers.
Dr.B. That's incredible.
19:10 raising awareness
Dr.B. What other is, Do you consider that kind of like, now something you're trying to do is raise awareness? Is this kind of a, you know, goal? What would you say is some of your aspirations now for is raising awareness, one of those.
BB. I've always wanted to, you know, be a voice for trans women and, you know, help the younger generation when with things that they need and whatnot. Yeah, I would say that. That's something that interests me.
BB. Yeah. And if I can, if I can help people, you know, not make the same mistakes I did. Because like I said, I'm lucky that I haven't had any issues, but also, it's a constant fear that my silicone could turn on me at any minute.
Dr.B. I know.
BB. Yeah, it can migrate into a major organ and just kill me. So it's, it's scary. It's not something to be taken lightly.
Dr.B. I've got a couple of statistics, half percent of US adults identify as transgender. Do you think that's
BB. half of what
Dr.B. half percent of US adults identify as transgender.
BB. That's what I've heard.
Dr.B. And then transgender females are usually identified at higher rates than transgender males.
BB. Although I, back in my day, terrifying trend finding trans men was, I mean, almost them, I never really saw any for years. And now they're everywhere. I feel like that might be changing. I mean, it's trans men also a lot harder to clock. Because once testosterone enters your body, and the effects that happen, it's kind of your reversal or whatever. And there, and they charge you more.
BB. they do voice
BB. since their voice, it gives them facial hair and all that. So it kind of makes them a little less clockable than us.
BB. Like, my voice is so deep because I testosterone got ahold of my body as a teenager. So like, there's no reversing that, you know, like, like physically altering, like, making an effort to change my voice and one, so which I'm not going to do. Some girls do but
21:20 procedures done
Dr.B. tells us what tells us. What would you mind sharing what procedures you have had done?
BB. Yeah, so I had my lips done. And I had my lips done a couple of times, because like I said, the first time, they were a little lumpy.
BB. And she was like, Oh, I can fix it. I can fix it. And it didn't help much. So I've had my lips done, my forehead pumped my cheeks, my chin. My boobs are done quite a few times, and my hips have done quite a few times.
Dr.B. and you're happy with how it looks.
BB. I'm happy with how it looks; as I said, there are some dark spots that I would rather not have. But yeah, I'm not. I'm not upset with it. I've seen some really bad things like silicone harden in the body.
BB. turns blue and black and everything else.
Dr.B. Yeah. I trained at the LA County Hospital here in Los Angeles. And so we had regular, we had sis women and trans women who got silicone injections come in with kind of disaster situation where it gets infected. And you know, we'd have people in the ICU for weeks, if not months, because we were debriding parts of their buttocks, or it would slide down their legs into their calves and other areas that migrate. It could be pretty devastating once it gets infected. And it tracks through you get septic you can die.
Dr.B. So, you know, I know we talk about. Yes, it does look good for some people, but it is a great risk. And so, for those of you out there listening, please don't take this as an endorsement. Oh, yeah. It is. It's tragic. And once it's done, I mean, we only get one body. And you don't want to do this because it could catch up to you.
BB. Yeah, yeah
Dr.B. does not for you and anybody else but um.
BB. like I said, I've heard of it hardening like 10-15 years down the road and things you might look real cute when you're young, but then you look real crazy when you get older.
BB. So that's again another fear of mine.
23:20 insurance coverage
Dr.B. And then the other thing is also when I get some patients that have had silicone injected, it's almost like I want to help them, but I know how hard it is, and so sometimes I know they don't have the financial means to kind of pay for all these treatments. And so we try to get insurance involved, or we're trying to get charity cases involved. But it's not any it's not fixable most of the time and typically what we can do is kind of like micro expression of the silicone to try to get it out and but even then we worry about it getting infected and so a lot of times you don't even touch it.
BB. Yeah, I've heard that it can be scraped out, but you can never get all of it out, and it's very dangerous, right?
Dr.B. You can't get it all out, and then you're left with like a deformity, right.
BB. It's very, very hard to get insurances to cover it too because it's so, I guess, dangerous or whatnot. I just had a friend of mine that I worked with for many years she had huge silicone breasts, and they were hard as raw and blue, and she managed to get it scraped out and have implants put in.
Dr.B. oh wow
BB: it's that there's still so many granules on top of the implants that she's so she's … Yeah, it didn't do well even when she did get it scraped out, it still kind of was messy.
Dr.B. Wow. Well, at least you didn't get an infection. I meant this the other day, you know, it's like my advice to people. It's always man if you go into somebody's garage to get a medical procedure done. Don't do it. Going into a hotel is not a good idea if you go into a hotel room. But, yeah, the procedure and you know we've I've seen heard stories of people get, you know, Home Depot, silicone injector to buttocks, and it travels straight to … And it travels straight to your heart, and they die.
BB: Yeah, yeah.
Dr.B. With an embolism which
BB. I've heard of people getting pumped with, like, see mint.
BB. And it just Yeah, crazy, crazy stories.
Dr.B. It's awful.
BB. But yeah, I mean, we used to a lot of us would throw pumping parties to where a lot of the Queen's and the trans women would, you know, go to someone's house, they'd bring a silicone artist to their house or whatever. And yeah, so it kind of made everyone feel a little safer and better, but it's not like,
BB. anything could happen.
Dr.B. Well, yeah, we kind of we, you know, the same thing with like Botox parties and filler parties. It's not the best place to do that kind of stuff, but yeah, but Well, good. Well, you know, looking forward in your career or is there any upcoming moves that you're you're planning on or anything that you were
25:55 plans for the future
BB. just traveling this year
BB. You know
Dr.B. when you travel? Are you doing show?
BB. Yeah. Traveling, doing shows. With with with the Dragula fame.
Dr.B. Okay, wonderful. I'm a board-certified plastic surgeon. And so I'm qualified to do silicone injections, but I would never do them because it's just I think they're too risky. But do you have any questions for me as a plastic surgeon?
BB. Yeah. So is there? Would you say that there's a sort of so many years later that you would consider if nothing's happened, that you would consider things being okay? Or do you think things could have been 40 years down the road and
26:45 Antibiotic prophylaxis
Dr.B. things can happen 40 years down the road. And it's funny because you know, when even when we do regular silicone implants, there's a suggestion to take antibiotics every time you go to the dentist.
Dr.B. Yes. Because you could introduce bacteria into your bloodstream. And that bacteria travels, that bacteria can travel to the surface of the implant, right? Not as big of a deal if you have an implant as in silicone cases, but when the silicone is so spread out throughout the body, that's where the bacteria can kind of really just totally migrate and spread and become a massive infection.
Dr.B. So you know, I think that's, that's
BB. how I react and lots
Dr.B. Yeah, it's a great question. You know, maybe I think when you get any procedure done, you just want to be clear with your dentist or your doctor that you have some liquid silicone in your body. They suggest antibiotic prophylaxis, I don't think it's a bad idea. I hate antibiotics in general. I believe they are bad for us and our gut. Believe it or not, our gut produces more than 95% of the serotonin that makes us, you know, our it connects to our brain and produces happiness. So every time you do and, but if you're going to do it, make sure you do a probiotic with it. Okay. So I mean, I would just encourage you to be as healthy as you possibly can.
Dr.B. And then if you're going to get a procedure, make sure to let them know, even if it's at the dentist, that maybe you should get some
BB. that's a really good advice.
BB. I wish I had known that when I had my wisdom teeth taken out a few years ago.
Dr.B. Well, maybe I just got lucky. I have an amazing immune system.
BB. I’m one lucky heifer.
Dr.B. Yeah. Wonderful. It's been great having you on the show. Your tag on TikTok is bitter betty?
BB. missbitterbetty miss
Dr.B. miss bitter Betty. So you guys want to check that out? And why is it bitter Betty, why you have that name?
BB. This is a little story behind that. You know, other drag reality shows have been around for about 15 years. And they were very open about not allowing trans women to compete in them. And yeah, for many years, they only just recently started in the past two or three years.
Dr.B. Oh, I didn't know that.
BB. Yeah. And I was very, very vocal about that aloud mouth. And I was not happy about it, very vocal about it. And not necessarily the nicest person about it, either. I was fighting for my existence in my career field. And a lot. A lot of people said, Oh, well, you just sound better. You just sound better. So I said, alright, I'll show you bitter and became bitter Betty.
Dr.B. That's great. That's a great story. Well, bitter Betty. Is there anything else you want to chat about? On the podcast, on the show?
BB. I can’t think of anything.
Dr.B. Yeah, well, good. Well, I thank you. I mean, it helped educate me, and I think some of our listeners and yeah, hopefully having me it's hopefully somebody out there, you know, kind of uses this information to make a smart decision.
Dr.B. So thank you so much.
BB. Thank you. Oh, my God, I learned. Excuse me, I learned so much.
Dr.B. antiobitics, right.
Dr.B. just be careful.
BB. I'm going to remember that one.
Dr.B. All right, good. And of course, if there's ever anything you need from me, let me know.
BB. Awesome. Thank you.
Dr.B. My pleasure.