00:00:00.000did you get into this so the reason why i decided to become a a plastic surgeon was it happened to
00:00:07.160me in grade school so when i was in grade school there was a girl in my class who had a cleft lip
00:00:12.420and palate deformity and she was on my bus room and kids would torture her it was unfortunate but
00:00:19.480especially back then because you know now we're very focused on anti-bullying and like you can't
00:00:23.580get away with the behavior that used to happen when i was a kid but people would throw things
00:00:28.180at her they would you know alter you know nobody would go near her they would you know it was
00:00:33.820because she had a facial disfigurement unfortunately and i was her friend i used to sit on the bus
00:00:38.780with her and the thing is that she had surgery during the time that i knew her and as her
00:00:44.820appearance started to morph and become more normalized people started to respond to her
00:00:49.680differently. And I thought that was a very powerful way. Welcome to episode 142 of the
00:01:00.100Michaela Peterson podcast. I'm Michaela Peterson. I'm backstage at one of dad's show in Denver.
00:01:07.580As you can see, this episode covers plastic surgery, the real secret to staying young.
00:01:14.620I mean, there's also sleeping right and diet, hello, low carb, and sneaky tricks like NAD.
00:01:21.660But if you see a 70-year-old and they look like they're 50, it's plastic surgery.
00:01:27.360Dr. Andrew Giacono is a world-renowned facial plastic surgeon based in New York City, author and creator of MADE, a minimally invasive hybrid facelift, the secret behind celebrities' ability to never age.
00:01:42.220I've always found plastic surgery fascinating.
00:01:44.620If you look younger, do you feel younger? If you feel younger, do you live longer?
00:01:49.580I don't know. Andrew's the founder of the New York Centre for Facial Plastic and Laser Surgery
00:01:54.700and the co-founder of TAI, a non-profit organization that helps children in third
00:01:59.800world countries get free plastic surgery for things like hair lifts, life-changing surgeries.
00:02:05.800He's been named one of America's top plastic surgeons by Harper's Bazaar,
00:02:09.340the Consumers Research Council of America, and Super Doctors. He starred in the TV show
00:02:14.760Facing Trauma as a volunteer surgeon for victims of abuse. Dr. Giacono has been featured on Good
00:02:21.120Morning America, Anderson, and CNN, to name a few, as well as many publications like the
00:02:26.240Huffington Post and GQ. His main clients are lawyers and CEOs in New York, as well as celebrities
00:02:32.100and the average person who knows about this stuff. We talked about the ramifications of social media,
00:02:37.960the type of person who does plastic surgery the dangers the morality and more i hope you enjoy
00:02:44.100this conversation this episode was sponsored by paleo valley we need collagen it's like the glue
00:02:50.760that holds our body together we're talking about plastic surgery in this episode but i did mention
00:02:55.580diet is playing an important role in aging after we hit 20 we begin to produce less and less
00:03:01.560collagen a simple way to get a good dose of collagen is paleo valley's bone broth protein
00:03:06.900something I can actually eat. It's made in a pesticide-free environment and made from 100%
00:03:12.400grass-fed bones, not hides like a lot of other products. It's also delicious. You can add it to
00:03:18.560smoothies, baked dishes, your coffee, or just mix it with hot water and a bit of salt, like me.
00:03:24.720Adding collagen to your diet will not replace a facelift, but it certainly won't hurt. I absolutely
00:03:30.500love it. It's kind of like coffee. If you haven't tasted coffee in years, it's great and is on sale
00:03:35.740now at paleovalley.com with code MP for 15% off your first order. That's paleovalley.com
00:03:43.300code MP for 15% off. I hope you enjoy this episode. Dr. Andrew Giacono, welcome to my
00:03:53.140podcast. Thanks for having me. I'm super excited to talk to you. Yeah, this is going to be
00:03:58.700fun. I think, I think what you do is something everybody should know about. So before we get
00:04:02.980started, can you give a brief background about who you are and what it is you do? Sure. So my
00:04:09.160name is Andrew Giacono. I'm a facial plastic and reconstructive surgeon, and I practice on Park
00:04:14.280Avenue in New York City. And I specialize in facial aesthetic surgery. So things that are
00:04:20.760to enhance people's appearance, both aesthetically to make them achieve their, you know, their goals
00:04:26.900for their beauty, but also to rejuvenate the facial appearance to make people look younger.
00:04:31.720and as i get older this becomes more important to me
00:04:35.600okay so i want to cover a bunch of things i want to cover like what you do and then how many people
00:04:43.200actually do this kind of thing because i think people don't talk about it and then some of the
00:04:47.780ethics behind plastic surgery so that's what we're going to kind of get into um so first off
00:04:55.480yeah how many what percentage of your clients do you think are women versus men like how
00:05:01.980how frequent do men come in yeah i mean at this point it's changed a lot so i think that you know
00:05:08.100the modern era and how aware we are of our appearance and that's been obviously accelerated
00:05:12.780by you know digital cameras you know our social media presence you know using uh you know digital
00:05:20.000platforms to be able to communicate and work men have embraced plastic surgery at rates that i've
00:05:25.600never seen before i've been doing this over 20 years and i would say that 20 years ago that males
00:05:31.540comprised about 10 of my practice but today it's fully a third so that's a lot you know it's one
00:05:37.560of every three people that i operate on are male patients yeah wow okay again it's not surprising
00:05:44.860because everybody wants to put their best face forward.
00:05:47.780And the reality is, is that our face is our calling card.
00:05:51.660You know, in the modern era, before somebody even meets you, they Google you.
00:14:32.880It's only when you have the distortion and the classic look that comes with, you know, more antiquated facelift surgery or plastic surgery that it gets a big alarm.
00:14:42.980So I give people these excuses all the time.
00:14:45.100I'm like, yeah, just tell people that you did these three things, you know, or that you had a little bit of Botox or you had some, you know, intense pulse light therapy treatment in your dermatologist's office.
00:14:53.140It totally throws people off because they're not really looking at surgery.
00:14:57.680They're looking at somebody who looks good and healthy and youthful and they want to know what your secret is.
00:15:02.700but they don't think it's surgery. They think it's lifestyle choices.
00:15:06.440Okay. So what are the, what are the downsides here? Like, is, is this type of thing super
00:15:12.560invasive? Is it dangerous? Do you need to go under general anesthetic?
00:15:16.960No. So we don't use general anesthesia. At least I don't. A lot of surgeons do,
00:15:20.420but we do something called twilight sedation, which is where you get a little IV and they
00:15:23.560give you some medicine that just makes you kind of sleep, but you're not paralyzed with
00:15:27.920the tube of your lungs breathing gas. So it's not something where it's like a heavy anesthesia.
00:15:31.900that's very risky. Obviously, all surgery has risks, so it's not risk-free. But the thing is,
00:15:37.720is that when you're with an experienced practitioner, your risk of having a
00:15:40.680significant complication from surgery is probably less than 1%. And even then, those problems,
00:15:46.280if you have one, can be managed and remedied. It may require another surgery, but nothing is
00:15:52.860risk-free. But it's not super risky. We obviously have advanced our techniques. We have advanced
00:15:59.240instrumentation that keeps people safe. And if you can do it with less anesthesia and you can
00:16:04.160do it in a more minimally invasive way, which we do, you know, old procedures had huge incisions
00:16:09.180all around the face, you know, they said peel everything off and it was a bigger deal. Now we
00:16:14.480can work through smaller incisions, you know, with our technology and we can do it in a less
00:16:19.440aggressive and less invasive way that's less risky, but also makes people look more natural.
00:16:24.420the downside is it's surgery you know it's not risk-free there is a recovery you know it's not
00:16:30.580comfortable you know after surgery there's pain involved you know it's it's scary you know and
00:16:36.760you know that's the truth but when you get to that point where you have a resolve about what you what
00:16:41.920you want for your appearance and how you want to project your appearance to the world you know
00:16:46.900people kind of accept those things and they get through it and you know after a couple weeks it's
00:16:51.260like it's not that big a deal and then you get to enjoy the benefits of it for a very long time
00:16:56.400interesting okay are there techniques for anti-aging that aren't surgical that you could
00:17:05.280recommend like does botox botox works do fillers work are there lasers that can resurface skin like
00:17:11.380does anything else work are there creams yeah there's lots of stuff for sure good skincare is
00:17:17.280always wonderful and important. But from a skincare perspective, the most important thing
00:17:21.000from my perspective, and I don't prescribe skincare and I have good dermatology colleagues
00:17:24.620and work in cosmetic dermatology that I refer to. But the primary thing that I think that's
00:17:29.900important is you should be on to some kind of a retin-A or a vitamin A derivative. And those
00:17:34.760are skin creams. Retinol is like an example of it, but retinol is not that strong. But prescriptive
00:17:40.800retin-A thickens the collagen laser of your skin and it prevents aging. It actually supports
00:17:45.800thickness of the skin and the protein layers that's tend to thin out as we get older so that's
00:17:50.800a really important thing to do and it's something that people should do throughout their life
00:17:54.380because it definitely will help minimize how much the skin falls and wrinkles so that's one thing
00:17:58.880Botox is wonderful because when you put Botox in if you're not flexing your face all the time you
00:18:04.040don't develop lines and wrinkles in the forehead around the eyes it helps support the brows so it
00:18:08.600prevents aging so Botox even though it could be costly over a very long period of your life
00:18:13.520because if you started younger, say in your mid to late thirties, and you continued on with it
00:18:18.120for a long time, it gets expensive. But is it worth? Yes, it is. Fillers, you have to be very
00:18:24.400careful with. And I talk about this a lot and lecture all over the world about it. The problem1.00
00:18:29.020with fillers is they create something called a tissue expansion effect. And what that means is
00:18:34.320as you put filler in, you stretch the tissues out. When you stretch the tissues out, it's like a
00:18:40.220pregnant women, when they have a pregnant belly, they lose the pregnant belly. There's a lot of0.99
00:18:43.980skin that develops and it hangs. So a lot of women get tummy tucks because the skin has been so1.00
00:18:49.440stretched out after pregnancy. Similarly with fillers, if you overdo fillers, you will stretch1.00
00:18:54.660your face out. And if you do that, it'll actually make it drop more quickly. So one of the big
00:18:59.980problems that I deal with in my practice is women who started fillers too young because they thought1.00
00:19:05.080they were preventing their aging, but they stretched their face out. So they need a facelift1.00
00:19:09.400much younger than they probably would have sometimes by even a decade. So fillers are good
00:19:16.560when done with small quantities with an even hand. But when you start blowing things up too much,
00:19:23.640unfortunately, this can be a significant problem.
00:19:27.880Wow. That's something people should really know about because there you go on Instagram and it's
00:19:32.220like, oh, do the, you know, Kylie Jenner package or something. And it's easy to market and it's
00:19:37.800simple it's not surgery it's just a couple of injections and sometimes it can look really good
00:19:42.920but the problem is is how frequently you do it and how much you do it one time
00:19:47.840because it can look good the first time and the second time but sometimes after people doing it
00:19:52.240the fourth fifth or sixth time as they continue to age they're putting more and more stuff in to
00:19:56.920try to recreate the same effect but our aging face doesn't recreate the same effect with the
00:20:01.440injections that it did say five years ago seven years ago so people try to use more to get what
00:20:06.360they used to get but then they only do is they stretch their face out okay and you mentioned
00:20:12.300something about fat grafting so what's the difference between that and just having a face
00:20:17.860lift so fat grafting is just like using filler it's just using your own body fat so the thing
00:20:23.260is is that any place where you can use filler you can do something more permanent with fat
00:20:27.920similarly fat can cause the same problems that fillers can so it has to be done evenly and not
00:20:34.280too much but the other problem is is that if you put a lot of fat in the face it can weigh the face
00:20:40.680down because it has more weight than filler does so similarly with time and age fat grafting tends
00:20:46.340to drag the face down because it's like strapping two weights into the face so all these things are
00:20:51.780a matter of degree but it's more common for me not to do fat grafting in younger patients and
00:20:58.540here's the reason why fat is a hormonally active tissue so when women go through changes and start
00:21:06.580to have hormonal changes as they age a lot of women start to gain a little bit of weight and
00:21:12.220it's not because they're not trying hard but it's a lot easier to stay thin when you're 20 than when0.93
00:21:17.080you are when you're in your minute to late 40s right for everybody the problem is that the fat
00:21:21.940that you put in the face acts like the fat from your belly so if you start to put weight on in
00:21:27.380your body because your metabolism has changed guess what happens to the fat in your face0.98
00:21:31.560it grows so what i see is i see a lot of women who are fat grafting in their 30s
00:21:37.480whose faces now are getting big and distortive and they weren't like that when they were younger
00:21:42.920because the fat was one size but as they put weight on the fat in the face grows like as if
00:21:49.220it was in the belly because it grows it behaves like where it came from not where it was placed
00:21:55.240so the face gets very distorted so for me fat grafting i prefer to use it in patients who are
00:22:01.200older who have already been through some of those metabolic changes versus trying to use it as a
00:22:06.680substitute for fillers fillers can be dissolved away fat cannot so when you have a problem with
00:22:12.720fat grafting it becomes a big surgical problem that a lot of people would prefer to avoid and
00:22:18.600you learn these this is the thing when you do so much of this and i've done so many thousands of
00:22:23.140surgeries, I've made a lot of mistakes and I've learned from those mistakes over the years.
00:22:27.880That's what happens. That's what good surgeons do. So as a result, I know how to avoid more of
00:22:34.340those problems for my patients. And I know who the right patients are to direct to what treatment
00:22:38.960is in what amounts at what time in their life. That's wild that you can graft belly fat or
00:22:46.780something like that. And then it'll gain weight like belly fat. That's crazy. I bet people didn't0.93
00:22:51.100expect that that's where it came from it doesn't change its character we're using it to like
00:22:57.300resupplement but it has the character of where it came from wow okay that's very cool okay so
00:23:06.320now that we have a bit of a background about all this actually no one question first so you said
00:23:12.320facelifts used to be a lot scarier than they are and you used to end up with just like scars
00:23:17.980everywhere yeah very visible scars and very long incision lines so you it would be very very hard
00:23:24.960to camouflage at least the surgery you know you'd have to kind of wear your hair down and hide
00:23:29.640everything as much as you could and if you ever had to go and get your hair cut or jump in a pool
00:23:32.960everybody would see these horrible scars everywhere which is not fun nobody wants i mean even if you
00:23:38.720look good you don't want to have a visible telltale sign anywhere you don't you don't want your face
00:23:43.340to look normal but you also don't want to have you know visible scars that tell everybody where
00:23:47.360you've been and what you've done so what's the difference between that and now like how come
00:23:53.060there are so many older celebrities that are in their 60s that look absolutely fantastic and they
00:23:58.240don't look like they have any scars or people can't tell otherwise they'd be you know all over
00:24:02.440the magazines because they've had good surgery you know there are there are lots of great surgeons
00:24:07.540out there when somebody's at like an award show and everybody's like holy crap what happened to
00:24:12.360that person knows they had you know not a great procedure and they probably had a technique and
00:24:18.800you know an approach that was you know used decades ago but that still happens a lot you
00:24:24.520know there's a good and high percentage of patients who go to doctors who have those techniques and
00:24:30.060then there are more evolved techniques and unfortunately probably a smaller percentage
00:24:34.420of surgeons are educated and capable with those techniques but those are the people that you see
00:24:39.880who are six years old and a celebrity and you're like, she looks great. Like you don't say, Oh my
00:24:43.960God, she looks X age. You just like, look at her and you can't even perceive her age because she
00:24:47.800just looks fantastic. That's the beauty of the plastic surgery. I've always wondered if there
00:24:54.100was any correlation between looking younger and, and age length, age span. I don't know if,
00:25:00.520if, or lifespan, I don't know if they've done any studies on that, but I've talked to people
00:25:04.720who've had procedures done, who've looked, who look now 15 years younger and they say they feel
00:25:10.100younger too. Yeah, I definitely think that there's health benefits, but I think it's because
00:25:16.840when people look better and they're more prideful of their appearance, they tend to lead healthier
00:25:23.280lifestyles. So people who have a better, more youthful looking face will often exercise more.
00:25:29.440they'll eat more you know more carefully because they want this to match this so i think that it
00:25:36.760sets in motion habits that make people live a longer and potentially healthier life for sure
00:25:42.980so that's where i think the link is i don't think it's generated in the brain i think it's generated
00:25:48.560by habit that's just reinforces better habits and i've seen it over and over again i do a
00:25:54.100procedure on a patient and then i see them six months later they've lost 25 pounds they look
00:25:57.980fantastic because they're like, well, this looks great. Like before, you know, my body wasn't my
00:26:04.420concern because my face really didn't look great. Now this looks fantastic. And now my body becomes
00:26:08.840my concern, you know, because I want all to look great together. So that's where I think that comes
00:26:14.360in. Okay. That's very interesting. And then how do you feel about the ethics of, of how popular
00:26:22.760it's become to surgically enhance yourself and like i guess the costs associated with that and
00:26:28.960whether or not certain people can't afford them richer people can't afford it and i don't know
00:26:34.220the morality yeah i mean you know it's a very hard thing to you know i mean i guess it really
00:26:44.860comes down to your to your politics in a lot of ways right i mean if you're more of an egalitarian
00:26:50.040you get tweaked by it because you feel like it's unfair that people who have more money have access
00:26:55.080to this because the truth is unfortunately is that because we judge a book by it by its cover
00:27:00.520when people are more youthful more attractive their lives tend to be better and i know that
00:27:04.560firsthand they get more job opportunities they have better relationships they have more confidence
00:27:09.640it builds a positive spin on their life and it's it's effective for sure and it's not the reason
00:27:17.100why people do surgery, but lots of things evolve in a very positive way when somebody suddenly
00:27:22.680looks 20 years younger. Like if you're 60 years old, people tend to think of you differently,
00:27:27.920how effective you are in your workplace, how friendly you are. People, as they get older,
00:27:33.360they look sad, they look angry, they look less approachable. People avoid you. You go out in
00:27:38.600public and you look 40, all of a sudden the whole world seems to open up. So it's not fair that
00:27:46.100people who have more means get that so i think that if you're more of that camp then i think
00:27:52.180you haven't you have you feel like there's an ethical uh dilemma there i don't really think
00:27:57.700that's the case you know for me um there are ways for people to have surgery and you don't have to
00:28:03.380have a ton of money you know there are lots of options for surgeons surgeons charge different
00:28:08.020prices there's ways to finance surgery just like you would a car you know buy a hyundai
00:28:15.940and i would tell you that you can probably get a pretty good surgeon if you finance the cost
00:28:21.540of a hyundai and i would arguably say that you know the the value to the person in terms of
00:28:27.460quality of life is probably more valuable than a hyundai depending on where you are and what
00:28:32.980you're trying to achieve so there's ways of getting it done you don't have to be ultra rich
00:28:38.580in order to be have to be able to have plastic surgery and you know the the question is is that
00:28:43.780why do you know why does it matter so much and should we value appearance as much as we do
00:28:50.340and that's the hard part you know because for me i have four children you know and the thing is is
00:28:57.300that as a parent it's not like i think everybody should have a type of face i don't think everybody
00:29:02.100should have perfect balance symmetry and beauty there's a lot of beauty in not having all those
00:29:07.880things um but you know it's like trying to tame the beast at this point because of our our our
00:29:17.600our visualization of beautiful people and youthful people and how it's you know pushed on us it
00:29:25.700really is and we're sponsored eggs that pop up all the time you know everywhere we go you know
00:29:30.740we're aspiring to look a certain way there's a celebrity we are in a lot of this all this
00:29:34.860constant visual imagery and that it's not great you know because it makes us feel inadequate it
00:29:40.480makes us feel less than you know and unfortunately it creates a certain dysphoria that drives people
00:29:47.360to have plastic surgery but unfortunately i don't think it's plastic surgery that's driving it
00:29:52.700it's not surgeons like me who are creating the need or want it to happen but we're serving
00:29:58.840you know we're giving we're providing a service to help people manage the modern era and i don't
00:30:06.960like it even though it's what i do for a living right so it's what i do and i love doing it and
00:30:12.140i make people happy doing it i think it's an unfortunate side effect of the society we live
00:30:18.380in and one of the big things for me when it comes to that is i feel like social media companies need
00:30:25.440to be held responsible for their behavior and that's something that i know right now
00:30:30.420is very much important because the truth is is that if social media companies are held
00:30:37.260accountable for their behavior you can't sue a social media company so if they do horrible
00:30:44.780about ourselves there's no recourse but what they do is they manipulate content they drive it in
00:30:51.500front of us. They make people feel horrible. There's tons of studies that show that the number
00:30:57.100of younger people who are adolescents and young adults who feel inadequate, who have poor self
00:31:02.300image and body image because of social media, it is a problem. And the thing is, is that they
00:31:07.840curate content and they know how to drive it to you to stay, keep you linked onto their platform.
00:31:16.280And they manipulate the hell out of everybody. And it actually creates the desire for these
00:31:21.240things more than it would exist if we didn't have these things around. So for me, the real ethical
00:31:26.260transgression is not in wanting to do plastic surgery or executing it. I feel like the platforms
00:31:32.680and the way we get information today is so manipulated that it's targeting us in order to
00:31:38.960make us feel like we need to be other than who we are. And that's what frustrates me. Because as a
00:31:44.540father, I don't want my children to feel like they're not adequate, that their body type isn't
00:31:49.540good enough, that their face isn't beautiful enough, because there's beauty in all shapes
00:31:54.180and sizes, but it makes us feel that way.
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00:32:52.520in case that needed clarification or use code tmpp at checkout if you like this content please
00:33:00.160remember to hit subscribe I saw I don't remember where it was it might have been a country that
00:33:05.980said they were going to make editing your photos illegal right I can't remember where that's
00:33:11.220happening, but, um, I've seen, I've seen the impact of social media on my cousins. I have a
00:33:15.900couple of teenage girl cousins and it's rough because every single person that they follow
00:33:22.680edits their photos in ways that humans can't really look and they feel ugly. Yeah. Yeah. But,
00:33:29.100but you know, what's so funny, these people have plastic surgery, so they've had plastic surgery
00:33:33.800and then they're editing their photos on top of plastic surgery. So it, it, it absolutely is the
00:33:39.500case because you feel like, well, what's wrong with me? All these people look flawless. Shouldn't
00:33:45.160I look that way? Because obviously there's a certain, you know, worship that we have for our,
00:33:50.880you know, for, you know, the people we look up to, you know, it's, you know, it's in all fields and
00:33:56.520it's in all ages, you know, maybe a younger person looks up to, excuse me, a, you know,
00:34:02.740a famous person, you know, I look up to my, you know, my heroes in my, in my professional world,
00:34:08.540you know the people that are the giants and the people that i learned from you know who made a
00:34:13.500lot of advances in my field so we all look up to people but the generation definitely looks up to
00:34:18.380people who are more beautiful and more you know archetypal or you know or are the best in terms
00:34:24.620of their appearance and it's really unfortunate but everybody seems to manipulate their their
00:34:30.860images and it's so funny because you look at these magazines sometimes and they always have
00:34:35.420like little arrows showing where you can see like the edges of a photo looking all like you know
00:34:41.820janky and like good you know the person sitting there and their waist looks this thin but then
00:34:46.540you see like the bricks like having distorted pattern around them because they just crushed
00:34:50.220the pixels so it's like sometimes it's really goofy and obvious but again you know getting
00:34:57.180bombarded with that imagery over and over again really wears away your brain and makes you feel
00:35:01.740inadequate. Yes, a bit of a pickle. It's definitely a bit of a pickle.
00:35:09.320Yeah, but it's a pickle, but I think it's a pickle that can be solved,
00:35:13.140you know, because once these companies are held accountable for their behavior,
00:35:16.980they will change their behavior. Because if you can imagine the financial downside of a class
00:35:22.420action lawsuit of tens of thousands of families who had children who wound up with mental illness
00:35:27.220or suicide it would be in the number of trillions of dollars but the thing is is that right now
00:35:32.820there is no repercussions they can do whatever they want whenever they want and there's nothing
00:35:38.420you can say about it so once that happens i think that they'll be more responsible with what they do
00:35:44.580and they can even enact policies where can you know and come on we have such technology
00:35:49.540they should have the ability to use technology to make sure that those kind of images are not
00:35:53.220allowed to be posted like that's a possibility why should that be allowed you know if we know
00:36:00.480it's causing significant pervasive public mental health problems which it does why don't we hold
00:36:07.360people accountable to make a difference we should that's a very good idea that's a that's a very good
00:36:16.400idea i don't know why that wouldn't have been i guess everything is so new social media is so new
00:36:21.580It hasn't been around long enough for people to...
00:36:25.440Yeah, but I think that the reason why is at the end of the day is that all of these companies, all they really want, they're not concerned with ethics.
00:36:34.180They want more eyes, more volume, more clicks, and more ability to then, because of the volume of traffic, be able to sell advertising.