Latest / HKB Uncut | A Cosmetic Surgery Podcast / Where Is Plastic Surgery Headed? The Biggest Procedures of 2026, GLP-1, and the Truth About Facelifts

Transcript

Where Is Plastic Surgery Headed? The Biggest Procedures of 2026, GLP-1, and the Truth About Facelifts · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_01: Coming up on HKB, I mean what top three procedures do you guys see in 2026 right now?
• 0:06
  SPEAKER_02: Number one, breast segmentation is also a big time facelifting practice.
• 0:10
  SPEAKER_02: Yeah, I would say that's very high on the lift.
• 0:12
  SPEAKER_02: Body kind of do it, body kind of doing it.
• 0:19
  SPEAKER_01: I have seen a lot of people with geophones and when they do um lose so much weight their skin on their face size as much as their body.
• 0:26
  SPEAKER_00: How should people go about trying to get to their best state of health and wellness, specifically when it comes to weight and weight loss?
• 0:34
  SPEAKER_02: Yeah, I think rapid weight loss is is not great.
• 0:37
  SPEAKER_02: I think you should do it in a very, you know, slow, progressive fashion, right?
• 0:46
  SPEAKER_01: What top three procedures do you guys see um in 2026 right now?
• 0:52
  SPEAKER_01: And then what do you forecast for 2027?
• 0:56
  SPEAKER_00: So top procedures at HKB for this year so far.
• 1:00
  SPEAKER_00: I'd say man, too many.
• 1:07
  SPEAKER_02: No, number one, breast augmentation.
• 1:09
  SPEAKER_00: Yeah, and I would I would just say, all right, but he said breast augmentation, I would just say it's like breast, so it's like with that, can we say, you know, breast lifting primary, but we're doing we're doing lifting that's also potentially exchanges to downsize.
• 1:22
  SPEAKER_00: That's definitely happening.
• 1:23
  SPEAKER_00: We're doing lots of reductions though, tons of reductions, tons of lifts with implants.
• 1:29
  SPEAKER_00: So I think that it's interesting.
• 1:30
  SPEAKER_00: I think there's more breast surgery happening.
• 1:32
  SPEAKER_00: I really do.
• 1:34
  SPEAKER_00: And I think patients are getting they're getting the breast aesthetic is fundamentally changed, right?
• 1:41
  SPEAKER_00: The desire for it.
• 1:42
  SPEAKER_00: Um, I've done it several patients, you know.
• 1:44
  SPEAKER_00: I don't know about you, but I know it's a little tangent, but breast reduction surgery, you know, people want to be smaller, but man, a lot of them want to be really a lot smaller.
• 1:53
  SPEAKER_00: I've had to actually do secondary breast reductions on some of my patients because you can only take out so much and keep good form.
• 2:00
  SPEAKER_02: But yeah, patients are always trying to figure out what they what the the look and desire that they're looking for.
• 2:05
  SPEAKER_02: And you know, things change, time changes, and they're always adjusting kind of the the look and goals that they ultimately have.
• 2:12
  SPEAKER_02: So I would still think breast surgery is.
• 2:13
  SPEAKER_00: So is that is that the ballerina phenomena, or is ballerina way smaller?
• 2:18
  SPEAKER_02: It's pretty tiny augmentation, but again, everybody wants something slightly different.
• 2:24
  SPEAKER_00: Totally.
• 2:24
  SPEAKER_02: There's there's not a one size fits all what in terms of breast surgery.
• 2:28
  SPEAKER_02: It's like again, when women go get their hair done, they don't want the same thing all the time.
• 2:32
  SPEAKER_00: Yeah.
• 2:33
  SPEAKER_00: We're also a big-time facelifting practice.
• 2:36
  SPEAKER_00: Yeah, I would say that's you know, very high on the list.
• 2:40
  SPEAKER_00: Super high on the list.
• 2:41
  SPEAKER_00: And like, you know, lots of deep lane facelifting.
• 2:45
  SPEAKER_00: And you know, with those, you know, people ask this, and I know we're we're we're jumping around, but real quick, explain what a facelift is.
• 2:52
  SPEAKER_00: Because some of my patients are like, are we doing a full facelift?
• 2:54
  SPEAKER_00: And they'll go, all this, or are we doing you know, just a neck?
• 2:58
  SPEAKER_00: What is a facelift?
• 3:00
  SPEAKER_02: So again, there are variations with what we term facelift, but in essence, you're making an incision in front of the ear and you're lifting this part of your face, which again is just your face.
• 3:15
  SPEAKER_02: People assume you're doing your brows or your eyes, and that's not the case.
• 3:21
  SPEAKER_02: Um, and if you're doing just a face, you're just concentrating on the face itself.
• 3:27
  SPEAKER_01: Interesting.
• 3:27
  SPEAKER_02: Uh, which is the lower kind of two-thirds of your whole kind of head.
• 3:32
  SPEAKER_02: And it and it's saying which part of the Yeah, it's actually the pretty much the cheek.
• 3:39
  SPEAKER_00: So we should real quick for them to explain.
• 3:41
  SPEAKER_00: There, there's your upper face, right, which is gonna be your forehead, right?
• 3:45
  SPEAKER_00: To your brow.
• 3:47
  SPEAKER_00: And so when you lift your upper face, i.e., you do a brow lift, you're lifting the brow, you're trying to adjust the position of the brow.
• 3:54
  SPEAKER_00: Sometimes patients want the medial brow to be pulled up, which is usually not common, right?
• 3:59
  SPEAKER_00: People don't want to look startled.
• 4:01
  SPEAKER_00: But you see, all these people are talking about this thing right here, kind of that cat eye look, and that's that's a little bit of a brow lift.
• 4:07
  SPEAKER_01: Right.
• 4:08
  SPEAKER_00: So a brow lift is not technically a facelift, but you can do a brow lift with a facelift.
• 4:14
  SPEAKER_00: Bill, what about this?
• 4:15
  SPEAKER_00: Talk to him about the eyelid.
• 4:16
  SPEAKER_02: So, eyelid surgery is slightly different in the fact that you make incisions in areas where you want to hide the scar, and for your upper eyelid, you hide it right where the crease is, and you get rid of all that excess skin that's there.
• 4:30
  SPEAKER_02: Take a little bit of muscle.
• 4:31
  SPEAKER_02: In addition to that, sometimes you have these little fat pockets that kind of protrude out and kind of give you a little uh extra kind of uh fullness in particular areas, and for the upper eyelid, it's usually around this kind of medial part, which is the inside part of your eye, until you ultimately remove a little bit of fat as well with that surgery.
• 4:51
  SPEAKER_02: But again, that's completely different than a facelift.
• 4:55
  SPEAKER_00: So for upper lids, when people get their upper lids done, I mean, Bill, it's important that people know like it's not only like an aesthetic thing, like it's a functional thing.
• 5:01
  SPEAKER_00: Like literally, sometimes people are hooding, it's covering their eyes.
• 5:04
  SPEAKER_00: So, like by getting rid of that, they can see better.
• 5:07
  SPEAKER_00: Women can apply makeup to their eyelids, and they just look refreshed.
• 5:12
  SPEAKER_00: Um, but there's so that's upper lids.
• 5:14
  SPEAKER_00: What about there's another set of lids?
• 5:16
  SPEAKER_02: They're lower lids, and typically there's a couple ways to do that where you hide the scar and just make an incision on the inside of your eyelids.
• 5:23
  SPEAKER_00: That's called transconjunctival.
• 5:25
  SPEAKER_02: Then the most common approach is to make an incision right underneath the lash line.
• 5:30
  SPEAKER_00: Subciliary.
• 5:31
  SPEAKER_02: Um, some surgeons actually make a lower incision, which is called subtarsal uh approach.
• 5:37
  SPEAKER_02: However, you know, that scar is not as hidden as some of the other scars.
• 5:41
  SPEAKER_02: So we prefer uh in our practice to do one of the first two.
• 5:45
  SPEAKER_02: And in essence, we're doing the same thing.
• 5:47
  SPEAKER_02: We're moving a little bit of skin, we're removing a little bit of fat and a little bit of muscle, and we're also tightening the lower eyelid into the right position.
• 5:56
  SPEAKER_00: Yeah, because the dreaded complication is this.
• 5:58
  SPEAKER_00: So you do a lower lid, and somebody has something called ecropion, lid malposition, and then you look like you had operation.
• 6:03
  SPEAKER_00: You can't look like you've had an operation with any of these things.
• 6:06
  SPEAKER_00: You know, it is important from a trend standpoint.
• 6:09
  SPEAKER_00: Again, this, this, this can all be done with a facelift.
• 6:14
  SPEAKER_00: And it's a very common thing to do it.
• 6:16
  SPEAKER_00: And the reason why is like you don't want to look disjointed, like this lower two-thirds of the face looks smoking, and this part looks aged and haggard.
• 6:22
  SPEAKER_02: So that's why you combine it, you know, build sometimes patients are just very adamant.
• 6:26
  SPEAKER_02: They're like, Doc, yeah, I'm just doing my face, I don't want to do anything else, or I'm just doing my eyelids, and you're like, Okay.
• 6:32
  SPEAKER_00: Perfect.
• 6:33
  SPEAKER_00: And and and you can do it, what's the word?
• 6:34
  SPEAKER_00: Sequentially, right?
• 6:35
  SPEAKER_00: You can add to it.
• 6:36
  SPEAKER_00: You know, important piece though, you know, when we when we learn about facial rejuvenation, you know, there's a before it was just pulling tight, right?
• 6:44
  SPEAKER_00: And like that, Joan Rivers, Kenny Rogers, whatever, everybody could tell that person had a face from across the room, scars are horrible, pixie irideformity.
• 6:52
  SPEAKER_00: But that's actually we were missing it because we learned you need to lift, fill, and kind of reposition.
• 6:58
  SPEAKER_00: You know, now talk to talk a little bit about that idea of fill.
• 7:02
  SPEAKER_00: What does that mean?
• 7:03
  SPEAKER_02: So as we age, we lose volume in specific parts of our face.
• 7:08
  SPEAKER_02: You know, the this gaunt appearance, and now everybody's on some version of GLP1.
• 7:12
  SPEAKER_02: For sure, and so that's getting much worse at a much younger age.
• 7:16
  SPEAKER_02: And so, in essence, we got to restore that volume back.
• 7:19
  SPEAKER_02: So, not only is it lifting everything back in the position you ultimately want it to be, you got to restore the volume loss.
• 7:26
  SPEAKER_01: I have seen a lot of people with GLP1s that when they do um lose so much weight, their skin on their face sags as much as their body.
• 7:34
  SPEAKER_01: Is that also can you do a tummy tuck, which is super weird?
• 7:37
  SPEAKER_01: So, tummy tuck and a facelift?
• 7:39
  SPEAKER_00: Yeah, you can do anything.
• 7:40
  SPEAKER_00: It's just about the timing.
• 7:42
  SPEAKER_00: I've I've done them together, but it's all about we don't want people under anesthesia too long.
• 7:46
  SPEAKER_00: Gotcha.
• 7:46
  SPEAKER_00: And even facelifts, I mean, listen, at the end of the day, patients need to know you have options.
• 7:50
  SPEAKER_00: You can do a facelift wide awake under local anesthesia, and it goes great.
• 7:53
  SPEAKER_00: It's more about the patient selection.
• 7:55
  SPEAKER_00: So the thing you were talking about, the Ozempic face, quote unquote, it's a real deal thing.
• 8:00
  SPEAKER_00: Same kind of concepts that happens with massive weight loss.
• 8:03
  SPEAKER_00: It's like if it's like aging accelerated times 10.
• 8:06
  SPEAKER_00: And all those patients can be treated surgically to get back to where they need to.
• 8:10
  SPEAKER_00: Now, just important thing to note though, this is why weight loss in the Ozempic GLP1 thing is an amazing thing, but also it's where we need to like people need to understand there's a way to do this, right?
• 8:20
  SPEAKER_00: And there's a way to do it, not necessarily wrong, but that will 100% you're gonna need to have surgery.
• 8:25
  SPEAKER_00: And I mean, that way is you know, Bill Bill really is pretty passionate about this, thinks that this this revolution is one of the greatest things that's ever happened, but also it needs to be managed properly.
• 8:34
  SPEAKER_00: How should people go about trying to get to their best state of health and wellness, specifically when it comes to weight and weight loss?
• 8:43
  SPEAKER_02: Yeah, I I think rapid weight loss is is not great.
• 8:47
  SPEAKER_02: I think you should do it in a very, you know, slow, progressive fashion, right?
• 8:52
  SPEAKER_02: So you don't want any sudden movements.
• 8:55
  SPEAKER_02: Two I think you have to add strength component to what you're doing because of the muscle wasting it with GLP1s is so real that as soon as you get the sarcopenia, you lose that muscle, the chance of you getting it back, especially in older patients, is practically zero.
• 9:10
  SPEAKER_02: So you really got a strength train and the proper diet nutrition.
• 9:14
  SPEAKER_02: On a cosmetic aesthetic standpoint, with you know facial rejuvenation, I think adding volume in specific areas as you're losing the weight is really important.
• 9:23
  SPEAKER_02: And there's two pathways to do it.
• 9:25
  SPEAKER_02: You can use the common fillers that we talk about, or you can do go down this road of biostimulators, which G is a huge proponent of for sure.
• 9:34
  SPEAKER_00: Yeah, I would say that you know you're hitting the nail on the head.
• 9:37
  SPEAKER_00: First of all, is slow methodical weight loss is better because your face just won't get hit so hard.
• 9:43
  SPEAKER_00: If you have incredible rapid weight loss, you will get gone quick and then there'll be that laxity issue.
• 9:48
  SPEAKER_00: There's things you can do along the way.
• 9:50
  SPEAKER_00: You know, listen, simple is simple sometimes is best.
• 9:53
  SPEAKER_00: High quality skincare, some sort of renewing agent, vitamin C, um, retinols, retinoid acid, retinoic acids.
• 10:01
  SPEAKER_00: Um, but then other things where you can use some energy modalities, laser resurfacing, biostimulators, like you're mentioning, you know, um two main ones in the US are radius and sculptra.
• 10:11
  SPEAKER_00: And then there's also other ones for common platelet-derived growth factor.
• 10:15
  SPEAKER_00: Your own fat is a is a biostimulator, so you can do microfat grafting.
• 10:19
  SPEAKER_00: When we Bill was talking about weight, loss in the face and re-volumization.
• 10:24
  SPEAKER_00: I mean, almost every lower lid that you and I do, and all of our HKB surgeons do, we always add, we're actually removing fat where we don't want and adding microfat graft to the cheeks and the um lateral cheek and the temples, nasal labial folds, not to make the patient fat.
• 10:38
  SPEAKER_00: It's to restore the volume back.
• 10:40
  SPEAKER_00: But every time we do that, I'll be damned that you look at the skin, the skin glows better, the quality of the skin's better.
• 10:46
  SPEAKER_00: And so, you know, adding fat back to the face, you know, if you would have thought about this like 20 years ago before fat grafting was a thing, people think you're just crazy.
• 10:54
  SPEAKER_00: But your own tissue is amazing.
• 10:56
  SPEAKER_00: Now, there is an interesting thing that's available soon.
• 10:59
  SPEAKER_00: What's the there's a product that we can there's synthetic fat, human-derived fat that you can inject in the face that should be commercialized soon.
• 11:05
  SPEAKER_02: Yeah, dermaclay is gonna be on the market pretty soon by the end of the year, beginning of next year, and it'll be great for individuals who do not have a lot of their own body fat to be able to rejuvenate the face and the facial aesthetics.
• 11:16
  SPEAKER_00: All right, so we move from top of the face, and we didn't even talk about hair.
• 11:19
  SPEAKER_00: Hair is an important thing about facial aesthetics, that's another topic.
• 11:22
  SPEAKER_00: You know, Bill, you know, we all know a lot about this, but can't ignore the hair.
• 11:25
  SPEAKER_00: All right, so now we're gonna move to nose.
• 11:28
  SPEAKER_00: Nose is its own topic in and of itself, but you can do a rhinoplasty with a facelift.
• 11:31
  SPEAKER_00: It can be small, it can be a little dorsal, dorsal reduction, it can be something big where you're rejuvenating everything.
• 11:39
  SPEAKER_00: It's an important central piece of your face, could be its own topic completely.
• 11:42
  SPEAKER_00: But one thing we do a lot of, I seem to do a I mean not, I don't know, 25 to 50 percent of the time, central lip lifting and lateral lip lifting.
• 11:51
  SPEAKER_00: And you know, the main reason is that you know, as people get older, it's it's it's interesting.
• 11:54
  SPEAKER_02: You wouldn't think of it, but this thing just well, people assume with a facelift you're gonna change the things around their mouth big time, and you're not right.
• 12:05
  SPEAKER_02: So facelifting does not change perioral region.
• 12:08
  SPEAKER_02: What what we we talk about is this perioral region, and so there is rejuvenation that can occur for that area, like you were talking about.
• 12:16
  SPEAKER_02: There's lifting procedures that can be done or resurfacing because sometimes there's these these these fine lines of wrinkles that you have around the mouth that you're gonna need to resurface to tighten up.
• 12:26
  SPEAKER_00: Great point.
• 12:27
  SPEAKER_00: I will tell you, you know, I I think I've gotten better, but sometimes, you know, patients don't want to be surprised.
• 12:32
  SPEAKER_00: So I've done when I've done uh and our rest of our teams have done, you know, short scar facelift, full facelift, deep lane, placations, massive, whatever it is.
• 12:41
  SPEAKER_00: Sometimes they come back and say, Hey, what happened here?
• 12:44
  SPEAKER_00: Facelift didn't work.
• 12:45
  SPEAKER_00: Facelift worked beautifully, everything is looking amazing, but the issue is that this perioral region still looks aged.
• 12:52
  SPEAKER_00: And you know, walk us through kind of the the treatment algorithm for that area, and obviously it's variable depending on what technology you have, but how do you fix that area without looking odd?
• 13:02
  SPEAKER_02: Again, you mentioned a couple you can do some lip lifting if if the lip is elongated.
• 13:06
  SPEAKER_02: Again, that happens with with a lot of um kind of age the aging process.
• 13:11
  SPEAKER_02: Sometimes it's uh the fact that you don't have uh enough uh uh volume there, and so you need to actually rejuvenate the area with filler.
• 13:20
  SPEAKER_02: Slash, and that filler can be your own filler, which is fat, or you can use a tall, I mean, uh the off-the-shelf stuff like um all the HA fillers that we ultimately have.
• 13:30
  SPEAKER_02: In addition to that, again, I'm a big fan of resurfacing.
• 13:34
  SPEAKER_02: You know, you want to get rid of those fine lines and wrinkles, and you can do that through any of these modalities.
• 13:39
  SPEAKER_02: You can use kind of CO2, you can use erbium, um, you can do a chemical peel, and there's so many different chemicals that you can use to be able to do it, but in essence, they're all doing the same thing.
• 13:49
  SPEAKER_02: You're taking that top layer of skin off, leaving that bottom layer, and everything tightens up around it.
• 13:54
  SPEAKER_02: And a lot of times you do all that combined, and then the third potential option is this microcoring technology where you actually take bits of your skin out and everything tightens around it.
• 14:05
  SPEAKER_00: And there's laser coring also, and then the old school method, tried and true, derma braiding, where you literally just buzz that all off of there, which is we do a little bit less of, but in in right hands, it's it's like a sanding machine.
• 14:16
  SPEAKER_00: It is a dremel on at on on crack.
• 14:19
  SPEAKER_02: Um, so I think it's not my preferred approach.
• 14:22
  SPEAKER_00: But it does work.
• 14:24
  SPEAKER_00: And and I think the main thing we're trying to drive here is that this could technically all be perceived as facelift, but it really is set other individual procedures.
• 14:32
  SPEAKER_00: Now the the It's all part of facial rejuvenation.
• 14:35
  SPEAKER_00: Now the the whole foundation piece is that facelift.
• 14:38
  SPEAKER_00: And when you see a patient, you want to show them typically it's this movement, right?
• 14:41
  SPEAKER_00: And it's important to note that most of the time it's not pulling things back, it's superior oblique.
• 14:46
  SPEAKER_00: And you know, what we're trying to get for patients is they're trying to get this nice angle, show their angle of their jaw, get rid of the jowl that's right here when people get, and then kind of clean up the neck and this to be sharp.
• 14:58
  SPEAKER_00: Yeah, and I you know the thing was clarifying kind of what that movement is like.
• 15:02
  SPEAKER_00: And when someone looks in the mirror, it's not this, it's not pulling back like this to look windswept.
• 15:07
  SPEAKER_00: Windswept, no, no, it's bad.
• 15:09
  SPEAKER_00: Now, the uh the real idea is kind of this superior oblique where you take two fingers, you touch your masseter, which is your muscles along your um your jawline, and you go up like this in oblique orientation towards the kind of you know the root of your hair right here.
• 15:23
  SPEAKER_00: Boom, just pushing up like that.
• 15:24
  SPEAKER_00: And what that does is it gives you that jawline and that neck, and things are nice and snug.
• 15:29
  SPEAKER_00: Um, and to do that, you know, it's it's gonna it's a procedure like we were mentioning where there's incisions, and and Bill mentioned it's in front of your ear.
• 15:36
  SPEAKER_00: So for guys, sometimes we actually go in front of the structure called the tragus because we don't want to put hair on this part of your ear.
• 15:42
  SPEAKER_00: For women, we usually go behind this.
• 15:43
  SPEAKER_00: So at the end of the day, when you're looking at somebody like this, you shouldn't see anything.
• 15:47
  SPEAKER_00: But the idea is lift the skin, lift the deep structures, reposition it, and then put everything back to where when you're you see someone, they should look beautiful and elegant.
• 15:57
  SPEAKER_00: You and I have family members that have had this, we've got close friends that have had it.
• 16:01
  SPEAKER_02: But uh, you know, you you're you're what you're talking about, it's just a facelift, right?
• 16:05
  SPEAKER_02: And oftentimes we don't do just an isolated facelift.
• 16:08
  SPEAKER_02: You were talking about all these other things, but we do it in combination with the neck, um, which is a vast majority when when patients come in, they're like, hey doc, I got this problem, I want to address it.
• 16:19
  SPEAKER_02: And they're talking about, hey, look at this, when I do this, when I bend over, you know, when my chin hits my, you see all that extra stuff that's there.
• 16:28
  SPEAKER_00: I want to get rid of it.
• 16:29
  SPEAKER_00: And and sometimes it's like, hey, I just want to snatch jawline, and they don't really have signs of facial aging.
• 16:34
  SPEAKER_00: And they're actually gonna be gonna be like, oh, you don't need a facelift.
• 16:37
  SPEAKER_00: You need some energy-based liposuction and something to get the skin to recoil back.
• 16:41
  SPEAKER_00: But other times they might need to have a true deep neck lift where you need to debulk the excess soft tissues that are here, debulk some of the potentially the accessory muscles, debulk some of the gland stuff.
• 16:50
  SPEAKER_00: But most people don't need that radical of an approach, but they may.
• 16:53
  SPEAKER_02: How often do you do an isolated just face alone?
• 16:58
  SPEAKER_00: Oh, like uh like just face, no neck?
• 17:00
  SPEAKER_00: Small.
• 17:01
  SPEAKER_00: I'd say out if they were out of the if there were 10 patients, one or two.
• 17:04
  SPEAKER_02: And how often are you doing isolated face to neck and not doing other parts of their facial rejuvenation?
• 17:10
  SPEAKER_02: That's a higher, maybe like double that, maybe like but a vast majority of patients that are coming in, they want kind of the whole gamut.
• 17:18
  SPEAKER_00: You know, they do, and sometimes they don't know what they want.
• 17:20
  SPEAKER_00: And I think that's why you have to have the conversation, you know, what concerns you, what bothers you.
• 17:24
  SPEAKER_00: And um, sometimes they want to do it in a structured fashion.
• 17:27
  SPEAKER_00: They're like, I just I'm just getting into this, and I just want to dress address this.
• 17:31
  SPEAKER_00: And in those people, I sometimes will tell them, and I know our partners will do the same, where you know, you'll you're you're gonna rejuvenate this lower two-thirds, right?
• 17:40
  SPEAKER_00: I say one of the things I always kind of say, well, one of the low-hanging fruits, let's do a laser resurfacing of the whole face at the same time, just so that there's a little shine everywhere, you know.
• 17:48
  SPEAKER_00: Um, and I think we've kind of hit most parts of the face.
• 17:52
  SPEAKER_00: I guess ears is another.
• 17:53
  SPEAKER_00: You could do autoplasty.
• 17:54
  SPEAKER_02: But we we we basically hit them on the you know top two procedures.
• 17:58
  SPEAKER_02: Top two.
• 17:58
  SPEAKER_02: So what does that mean?
• 17:59
  SPEAKER_02: We got one more uh body contouring.
• 18:01
  SPEAKER_02: Body contouring.
• 18:02
  SPEAKER_01: Body contouring in what way?
• 18:04
  SPEAKER_02: So tummy tucks, um, you know, weight loss procedures.
• 18:07
  SPEAKER_00: Both like with with I would say the huge influxes because of the weight loss, but also, you know, our our mothers, you know.
• 18:14
  SPEAKER_00: What people don't realize, this is an important thing, and I just I don't think we verbalized it.
• 18:19
  SPEAKER_00: You know, the mommy makeover, though, the mothers tip it is it is actually the original massive weight loss.
• 18:26
  SPEAKER_00: It just is.
• 18:27
  SPEAKER_00: You know, you think about what happens to a mother, how much weight they gain.
• 18:31
  SPEAKER_00: Some of them are a lot more than others, what it does to the soft tissue envelope, what it does to the musculofascial network.
• 18:36
  SPEAKER_00: So I would, in some ways, they're they're similar.
• 18:39
  SPEAKER_00: Obviously, it causes affects things differently.
• 18:41
  SPEAKER_02: So, you know, we we talk about this body contouring, but what does that really entail?
• 18:46
  SPEAKER_02: It's basically any combination of skin removal anywhere in the body, liposuction, or fat removal anywhere in the body, or some sort of muscle repositioning.
• 18:58
  SPEAKER_02: You know, and and one of the most common body contouring procedures we talk about is a tummy tuck, aka the abdominoplasty, which involves all three.
• 19:08
  SPEAKER_02: We're actually tightening your muscles, your core muscles, we're removing all that excess skin, and we're doing liposuction all at the same time.
• 19:15
  SPEAKER_00: They are, and then the cool thing about the phase that we're in now, too, is that no two patients are the same, and the the spectrum and the level of what needs to be done totally depends on what's what what we're presented with from an anatomic standpoint, but then also from a patient desire standpoint.
• 19:32
  SPEAKER_00: There's so many things you can do, and just because you can doesn't mean you should.
• 19:36
  SPEAKER_00: But at the same time, for a patient, like one of the big things that people ask, I mean, like, I I don't know how many times we've answered this question, but I don't I think there's not many surgeons, and and maybe we haven't done a good job of really explaining what is the difference.
• 19:48
  SPEAKER_00: What's the difference between a mini tummy tuck, a full tummy tuck, an extended tummy tuck, a circumferential tummy tuck, a 360 tummy tuck, a body lift, a reverse abdominal.
• 19:57
  SPEAKER_02: We could talk about tummy tucks, you know, for hours and hours and hours, right?
• 20:01
  SPEAKER_02: And and in essence, all right.
• 20:02
  SPEAKER_02: If we really if we really want to if if we really want to kind of I won't say dumb it down, just kind of put in essence the the length of the incision is usually just determined by how much excess skin a patient has.
• 20:16
  SPEAKER_02: So obviously the more skin, the longer the incision needs to be to remove that skin.
• 20:21
  SPEAKER_02: Hence why in our massive weight loss patients we have to go all the way around.
• 20:27
  SPEAKER_02: And then from a fat removal perspective, it's basically wherever you have excess fat that you don't necessarily want that you can remove to contour your shape the way you ultimately want it.
• 20:39
  SPEAKER_02: Hence why when we do tummy tucks, we typically do the lower back liposuction at the same time because we really want to give those patients that hourglass shape.
• 20:48
  SPEAKER_02: And the beauty of that also is you're gonna give them that little bit of S-curve in that lower back and give them a nice little butt lift all at the same time, which is pretty phenomenal.
• 20:56
  SPEAKER_00: It is, and you know, one of the things too is the numbers don't necessarily mean everything, meaning like high BMI doesn't necessarily mean that they're the ones who are likely gonna benefit more from a circumferential or 360 body lift or a circumferential abdominal plasty, because the truth is some of our low BMI people who've lost a lot of weight, and sometimes the weight loss magnitude is less, but they have tremendous amount of skin laxity.
• 21:20
  SPEAKER_00: So uh, you know, I'm doing more and more circumferential abdominal plasty or extended because when when women are are they really optimized, they've had several kids, whether it be two to six kids, and they're standing and they sit there and they're they're concerned about this phones, but when they're sitting here, they're also concerned about this lateral skin laxity.
• 21:37
  SPEAKER_00: And they feel like their their thighs have dropped a little bit.
• 21:40
  SPEAKER_00: There there's a more cellulite and cottage cheese.
• 21:42
  SPEAKER_00: Now, sorry, I didn't mean to be gross with the the the the the um You're being completely insane.
• 21:48
  SPEAKER_00: No The reason why I said this is because one time I I sometimes in patients when I'm this is a tangible when I tell patients about the idea of a breast reduction and going to areola from this to this to like How big?
• 22:00
  SPEAKER_00: I'm like, well, pepper salami to pepperoni.
• 22:03
  SPEAKER_00: And everybody's like, oh, yeah, I get that.
• 22:04
  SPEAKER_00: But remember, one patient was like, oh, I really am disturbed by that analogy.
• 22:08
  SPEAKER_00: And I'm like, oh God, I'm so sorry.
• 22:09
  SPEAKER_00: Um, so I never meant to be demeaning about it, but it's just so people understand.
• 22:13
  SPEAKER_00: But the thing is what people don't realize, if you do a circumferential tummy tuck or a like extended, you actually pull the lateral thigh and you wipe out that that cottage cheese down there.
• 22:22
  SPEAKER_00: Oh, I meant cellulite.
• 22:24
  SPEAKER_00: Um, so it's a huge change.
• 22:26
  SPEAKER_00: And but the thing is, the scar is longer.
• 22:28
  SPEAKER_00: But the scar and the scar literally is all the way around, but it is within the bikini line.
• 22:32
  SPEAKER_00: And you know what?
• 22:32
  SPEAKER_00: We've been doing this for a long time, but you know, our friend, you know, Ryan in New York, Ryan Neinstein, he does a bunch of these too, and he's kind of really got a lot of uh of traction on it on social media.
• 22:41
  SPEAKER_00: And like you see a lot of those patients similar, like we're talking about.
• 22:44
  SPEAKER_00: There's they're actually low BMI patients, but they have a lot of that laxity.
• 22:47
  SPEAKER_00: So just because like you sometimes can get a better result with a longer incision, but you have to be okay with a longer incision, you know.
• 22:56
  SPEAKER_00: And I think just for patients to understand, like the incision length doesn't necessarily make it less of a procedure either.
• 23:01
  SPEAKER_00: So like picking a full or a mini just because it sounds like less.
• 23:04
  SPEAKER_02: I always get that same thing.
• 23:06
  SPEAKER_02: I want a mini doc, I want a mini.
• 23:08
  SPEAKER_02: Mini doesn't mean mini recovery, right?
• 23:11
  SPEAKER_02: So it's basically the same recovery regardless of which uh how big the incision is.
• 23:15
  SPEAKER_00: You know me, I liked I like a mini, I probably do more minis.
• 23:18
  SPEAKER_00: You you do a fair amount.
• 23:19
  SPEAKER_00: I do more minis for some reason than most do, but it's patient selection.
• 23:23
  SPEAKER_00: Like you can't just do it on everybody.
• 23:24
  SPEAKER_00: And if you do, you have to kind of do a modified approach.
• 23:26
  SPEAKER_00: They're there nuances.
• 23:28
  SPEAKER_00: You can do a hybrid where you have to you can resect a little bit down low, a little bit above.
• 23:32
  SPEAKER_00: Um, but it is fun.
• 23:33
  SPEAKER_00: You know, when you ask one of the things we ask our um our scrubs, who are people who assist us in the operating room, as well as other individuals in the or what's your favorite cases?
• 23:42
  SPEAKER_00: So many of them, they love the abdominal plasty because it's just like you're dealing with so many things of such a dramatic change.
• 23:48
  SPEAKER_02: Big change, huge, huge big, big, big changes.
• 23:51
  SPEAKER_02: So I'll say, you know, those are our top three things that we do collectively as a uh as a practice.
• 23:57
  SPEAKER_02: And do I see those trends changing on 27?
• 23:59
  SPEAKER_00: I think more more of them.
• 24:01
  SPEAKER_00: More more of that.
• 24:01
  SPEAKER_02: I would say I still think it'll be the top three.
• 24:04
  SPEAKER_02: I mean um without a doubt.
• 24:07
  SPEAKER_02: I mean, yeah, there'll be more and more patients on GLP once uh as you see kind of the trends going, more and more will be on it.
• 24:15
  SPEAKER_02: So I think this the skin removal phenomenon is gonna be a pretty big deal in 27 and it's gonna encompass the whole body.
• 24:24
  SPEAKER_02: So that's face and and and body for that matter.
• 24:28
  SPEAKER_00: And there and you know, I think what's the future hold past that?
• 24:32
  SPEAKER_00: I think you know, a lot of people use buzzwords about regenerative and you know things of that nature.
• 24:37
  SPEAKER_00: I think that there's gonna be, you know, new things coming that will be more towards that, kind of stem cell related, etc., where you can upregulate what you already do.
• 24:47
  SPEAKER_00: Um and that'll be very exciting to see how that affects things.
• 24:49
  SPEAKER_00: I think we're gonna get better at scar modulation, we're gonna get better at using your own soft tissue volume to get you where you need to be.
• 24:56
  SPEAKER_00: One day we won't have implants and we can get people's breasts bigger without them, but we're we're a ways away, but maybe in your and my lifetime.
• 25:04
  SPEAKER_00: And that's that's kind of fun and exciting.
• 25:06
  SPEAKER_02: I think the biggest for us at HKB for 27 is gonna be comprehensive care.
• 25:10
  SPEAKER_02: And what I mean by that is we're gonna be able to take care of you from inside and out, all over, to make sure make sure you're the best version of you from a health standpoint, from a wellness standpoint, longevity, and aesthetics.
• 25:25
  SPEAKER_02: And that's gonna be our biggest focus.
• 25:28
  SPEAKER_02: We appreciate you listening.
• 25:29
  SPEAKER_02: If you like any of the the content, please subscribe, tell your friends, post it, share.
• 25:35
  SPEAKER_02: Thanks for being a part of the best plastic surgery podcast out there today.
• 25:40
  SPEAKER_00: Always a pleasure to get to share uh our thoughts and uh concepts with you.
• 25:45
  SPEAKER_00: Got any ideas or criticisms?
• 25:47
  SPEAKER_00: Don't tell us.
• 25:47
  SPEAKER_00: I'm kidding.
• 25:48
  SPEAKER_00: Let us know, and we'd love to discuss them more.
• 25:51
  SPEAKER_02: More more, Dr.
• 25:52
  SPEAKER_02: K, Les, Dr.
• 25:53
  SPEAKER_02: B.
• 25:55
  SPEAKER_01: Mark Jasmine.
• 25:56
  SPEAKER_01: Hello.