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The Weirdest Requests Plastic Surgeons Get & Is GLP-1 Good or Bad? · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_04: Coming up on HKB, I'm what is the most ridiculous cosmetic surgery request you've ever received?
• 0:07
  SPEAKER_00: Penis enlargement.
• 0:08
  SPEAKER_00: Shaft.
• 0:09
  SPEAKER_01: They call that shaft graft.
• 0:11
  unknown: It happens.
• 0:11
  SPEAKER_03: A lot of guys do anytime.
• 0:13
  SPEAKER_01: But the GLP one thing is amazing.
• 0:15
  SPEAKER_01: You know, Bill, you know a lot more about it because it's leading to I think it's gonna get so refined.
• 0:20
  SPEAKER_01: And it's gonna be-read this right now, right now GLPs are still like a it's like a big ass gun for like a small target.
• 0:26
  SPEAKER_02: But but but if you look at the studies, cardioprotective, renal protective, potentially prevents Alzheimer's and dementia.
• 0:34
  SPEAKER_02: There was one study that said potentially, potentially could decrease the risk of cancer.
• 0:42
  SPEAKER_04: What is the most ridiculous cosmetic surgery request you've ever received?
• 0:49
  SPEAKER_02: Oh, these are gonna be great.
• 0:51
  SPEAKER_02: Love this.
• 0:52
  SPEAKER_02: We've been practicing a long time, so there's some really crazy requests.
• 0:57
  SPEAKER_01: Uh one of 'em, one of my crazy requests was toe fat grafting.
• 1:04
  SPEAKER_04: True, yeah, that makes sense.
• 1:06
  SPEAKER_01: What about your toe shortening procedure?
• 1:09
  SPEAKER_01: I did get a toe shortening procedure because apparently I was the toe guy.
• 1:18
  SPEAKER_04: Okay.
• 1:20
  SPEAKER_02: Penis enlargement.
• 1:22
  SPEAKER_00: Shaft, they call that shaft graft.
• 1:25
  SPEAKER_02: Yeah, it happens.
• 1:26
  SPEAKER_03: A lot of guys do it.
• 1:27
  SPEAKER_03: What are you talking about?
• 1:28
  SPEAKER_01: But you have some random guy in the backyard.
• 1:30
  SPEAKER_01: Is that okay?
• 1:31
  SPEAKER_01: Yeah, he's just checking out the landscaping.
• 1:33
  SPEAKER_01: That's okay.
• 1:34
  SPEAKER_01: He's awesome.
• 1:35
  SPEAKER_01: That's my boy.
• 1:37
  SPEAKER_04: Okay.
• 1:39
  SPEAKER_02: Um, anywhere you can think you can have a piercing, I've had it asked to be removed, replaced, redone anywhere in the body.
• 1:51
  SPEAKER_02: Yep.
• 1:53
  SPEAKER_02: I've been asked to make elf ears.
• 1:57
  SPEAKER_04: Okay.
• 1:58
  SPEAKER_04: That's a little, yeah.
• 2:00
  SPEAKER_00: So did you do it?
• 2:01
  SPEAKER_00: Nope.
• 2:03
  SPEAKER_02: You scared?
• 2:04
  SPEAKER_02: Not scared of anything.
• 2:06
  SPEAKER_02: However, I'm not an elf ear expert.
• 2:10
  SPEAKER_01: Mm-hmm.
• 2:12
  SPEAKER_04: I'm assuming you rejected those requests.
• 2:15
  SPEAKER_04: How did you go about rejecting them and saying, hey, like how do you know that I rejected them?
• 2:21
  SPEAKER_04: Did you do a toe surgery?
• 2:24
  SPEAKER_01: Oh, you will never know.
• 2:25
  SPEAKER_01: When I need to reject a thing, it's uh, you know, I typically just want them to see an expert, you know, someone who's I I think the key is just to be open and honest with them.
• 2:36
  SPEAKER_02: You know, it's like if this is somebody you don't do a lot of, you know, you say you know, yeah, only I'd say, like, um I'm gonna be real here.
• 2:44
  SPEAKER_01: So I I have a a patient of mine who had uh a lot of facial surgery done.
• 2:49
  SPEAKER_01: And um she looked she just looked really operated on, like like not good, you know, and you could see it across the room.
• 2:56
  SPEAKER_01: She walks in, I remember my my team was like, Oh, this lady, you're gonna you're gonna be able to tell you you don't want to touch this lady, you don't want to help this lady, you don't want to get anywhere near this lady.
• 3:04
  SPEAKER_01: Um she had a lot of surgery, a lot.
• 3:09
  SPEAKER_01: And you know, just some things that just were not, you know, very elegant and aesthetic, and just looked overdone, operated on, and I got to talk to her, and incredibly smart, kind woman, um lives on her own, but just a professional, like doing great, and she wanted to look better, and she just she was unhappy with where she was, and um just didn't know what her options were.
• 3:31
  SPEAKER_01: And I did operate on her and did actually several things on her, and um she looks uh way more you know, elegant, natural, less operated upon.
• 3:43
  SPEAKER_01: She still has some of the stigmata of like what she had initially, but like she's really happy, and she's actually one of our team and staff's favorite, f more favorite patients.
• 3:53
  SPEAKER_01: And um, so there's times when you like see something, you're like, oh, stay away, but like you know, you gotta figure it out, you gotta understand what's going on, like because we can really help people.
• 4:02
  SPEAKER_01: Like, I know like a lot of what we do is cosmetic and aesthetic, but we really do change people's lives, and sometimes you gotta listen and just figure like, oh man, which shows you like I think you you brought a key point here, is just to prevent judgment.
• 4:17
  SPEAKER_02: Yeah, it's like, and I think that's a problem in society as a whole, is like we're we're constantly judging all the time, and you're doing it without having any knowledge of the patient, who they are, what they're not, you're basically you're looking at somebody and creating this judgment already, just based on looks and without really understanding the nuances behind it all.
• 4:38
  SPEAKER_02: So I think to your point, I think if we can help people and you can do it safely, we're all in favor of helping.
• 4:44
  SPEAKER_02: But if you can't or the risks greatly outweigh the the rewards, then you you sort of pun it and say, I'm not doing this, and I don't think it's the right decision for you for X, Y, and Z reasons.
• 4:56
  SPEAKER_01: What about like uh breast size implants?
• 5:00
  SPEAKER_01: Biggest thing you've ever done.
• 5:02
  SPEAKER_02: Uh over a thousand cc's.
• 5:03
  SPEAKER_01: Yeah.
• 5:07
  SPEAKER_02: Um I've asked I've been asked to stack implants before.
• 5:11
  SPEAKER_04: Can you do that?
• 5:12
  SPEAKER_02: What does that mean?
• 5:12
  SPEAKER_02: To put multiple implants in one patient.
• 5:16
  SPEAKER_02: Um I've I said no to that.
• 5:18
  SPEAKER_02: Um but yeah, 2,000 cc's, they they want to go bigger again.
• 5:23
  SPEAKER_02: You have to understand what can safely be done versus what can't be done safely, and understand the reasons why they want to do it.
• 5:31
  SPEAKER_01: Yeah.
• 5:32
  SPEAKER_01: And you know, it's also the other thing is like think about what happens if you don't like that or if it you decide to change your mind in the future.
• 5:40
  SPEAKER_01: How do you undo or move move forward from that?
• 5:44
  SPEAKER_01: And I think that's the and then that that goes that goes to the surgeon.
• 5:47
  SPEAKER_01: If the person's gonna do it, they've gotta make sure to explain to him what's gonna happen.
• 5:51
  SPEAKER_01: Like, case in point, like I don't know about you, but when you see someone who's gonna get breast, you know, surgery, we go back to implants, I mean, we look them in the eye and tell them, hey, this is not a one and done procedure.
• 6:04
  SPEAKER_01: And there's some of our surgeons say, hey, if it ain't broke, don't fix it.
• 6:06
  SPEAKER_01: I'm sorry, if it ain't broke, don't fix it.
• 6:08
  SPEAKER_01: Like they say that, and it's fine, but like listen, I mean, it's like you're taking someone who's young, you're putting a device in there that is a device that is walled off and that your body recognizes is not you, and then the expectation is that you could leave that in there for 20, 30 years while the body's changing like crazy.
• 6:27
  SPEAKER_01: You know, I I say that, you know, it's uh it's up to us to tell them, hey, you're probably gonna need some maintenance, you're probably gonna have an exchange.
• 6:33
  SPEAKER_01: I and I s my personal recommendation, I'd love to hear yours, because I've seen some stuff on social where some people say that some surgeons are so horrible, all they would care about is money, and they're telling people that you need to swap these out at 10 years.
• 6:43
  SPEAKER_01: Well, I'm one of those people because I think your body's changing so much.
• 6:47
  SPEAKER_01: It's not saying you have to, I'm saying you should really think about it because like only one cell in your body doesn't renew or and change, that's your cartilage.
• 6:53
  SPEAKER_01: Everything else is new, and your body's facing this device.
• 6:56
  SPEAKER_01: I mean, what's your approach on this?
• 6:58
  SPEAKER_02: I I I take a very personalized approach because again, if they have saline implants and they've been in 10 years and there's there's tiny and there's been no issue.
• 7:07
  SPEAKER_02: I you know, talk to the patient about the rupture rates, but if they're happy, there's no real reason, you know, for a saline implant that's tiny, that's doing well to exchange them at 10 years.
• 7:17
  SPEAKER_04: Is there a difference between bigger CCs and smaller CCs when it comes to having to go in again?
• 7:25
  SPEAKER_02: Uh yeah, the not about going in per se, but about the fact that if it is a bigger implant, it's gonna have a greater impact on the soft tissue of the breast long term.
• 7:36
  SPEAKER_01: So, you know, bigger potentially could have more problems stretching things out, right?
• 7:41
  SPEAKER_01: You know, thinning things out.
• 7:42
  SPEAKER_01: Um so I think I my my big thing is like we don't want to lose patients to follow up.
• 7:46
  SPEAKER_01: And like this is everything.
• 7:47
  SPEAKER_01: Like, so if you get any procedure you get, they say, well, is this permanent?
• 7:50
  SPEAKER_01: Am I good?
• 7:51
  SPEAKER_01: Am I ever gonna have to do anything?
• 7:52
  SPEAKER_01: Oh, there's nothing we do that's permanent.
• 7:54
  SPEAKER_01: There's nothing that we use permanent, right?
• 7:55
  SPEAKER_01: It all needs attention, maintenance, potentially some secondary, tertiary procedure.
• 8:00
  SPEAKER_02: That's why we see all our breast patients back yearly to make sure.
• 8:03
  SPEAKER_01: I mean, we see everybody back yearly.
• 8:04
  SPEAKER_01: I mean, at the end of the day, I think if you if you set foot in our in our office and you end up doing something, we we want to take care of you for the long haul because you're gonna change, things are gonna change.
• 8:14
  SPEAKER_01: There could be something that comes up, but more than anything, like I think our goal is like we think you deserve to have a great result for your whole life.
• 8:22
  SPEAKER_01: And it's one of those, I think this is one of the things where I like what happened, like in the facial side where people are getting you know facial procedures, facelifting earlier.
• 8:30
  SPEAKER_01: It's not to look like you've had surgery, it's actually just to look like yourself, kind of all the time.
• 8:36
  SPEAKER_02: So, yeah, the body changes and we just got to keep keep track of any other crazy asks or procedures.
• 8:42
  SPEAKER_02: I'm trying to think of all the things I've ever been asked.
• 8:45
  SPEAKER_04: On the trauma.
• 8:46
  SPEAKER_01: You know, I will I would say the crazy things we've seen.
• 8:49
  SPEAKER_01: You know, we have seen some people who when this stall stuff was first starting, the weight loss kind of uh revolution has always been there.
• 8:58
  SPEAKER_01: So HKB has always done massive weight loss patients, and we fortunately have dealt with this so we know how to manage it, where to put incisions.
• 9:04
  SPEAKER_01: Like it's important where you put incisions.
• 9:06
  SPEAKER_01: We've seen some people who've come into our office for second opinions, where like I I can't understand how it could have ever been thought that resecting in this pattern or putting an incision here would make sense, and like they're the most crazy locations where the incisions were just on display, like like the front part of front part of a thigh, you know, like obliquely on the abdomen.
• 9:33
  SPEAKER_02: And I think that those are things that are kind of unfortunate, so you need to make sure to do your homework and make sure that whoever is taking care of you the places where individuals got silicone injected in different places buttocks, face, oh right, those are irreversible.
• 9:49
  SPEAKER_01: Um very difficult.
• 9:50
  SPEAKER_01: I did a case recently.
• 9:52
  SPEAKER_01: I'm like, so it's it's very difficult because that silicone dissects into the soft tissues, and then what happens is it turns hard and firm and it changes the tissue forever.
• 10:02
  SPEAKER_01: So the only way you can't suction it out.
• 10:04
  SPEAKER_01: We've done some cases where we try to suction out and try to debulk it for a patient, but you gotta cut all of that out.
• 10:08
  SPEAKER_01: Yeah, you can't get rid of it.
• 10:09
  SPEAKER_01: Some women have to get mastectomies afterwards and then have reconstruction.
• 10:13
  SPEAKER_01: People who've got in their butts, I mean, you literally have to resect a fair amount of the soft tissue envelope.
• 10:19
  SPEAKER_01: And and these poor, poor patients, you know.
• 10:21
  SPEAKER_01: I mean, it's these are these some of them are really, you know, elegant, you know, well-to-do people that just were sold a bill of goods and they just didn't know.
• 10:29
  SPEAKER_02: You know, fat grafting as well.
• 10:31
  SPEAKER_02: I we talk about all the great things about fat grafting, but there's a lot of bad things about fat grafting, and one of which is weight gain post-fat grafting can be pretty horrendous.
• 10:45
  SPEAKER_02: So all that fat you transfer can you can gain weight, you know, even in the face, you can get big, swollen.
• 10:52
  SPEAKER_02: So you gotta be very careful in regards to that that massive um buttocks contouring with fat grafting, and used people used to put these huge volumes in.
• 11:03
  SPEAKER_01: You're seeing it now, right?
• 11:04
  SPEAKER_01: I mean, this whole thing is shifted back.
• 11:06
  SPEAKER_01: I mean, the pendulum is doing this, so like I think maybe that's one of those things where I think or excessive liposuction can really create problems long term.
• 11:17
  SPEAKER_02: So liposuction is not a weight loss procedure.
• 11:21
  SPEAKER_02: No way.
• 11:22
  SPEAKER_02: People assume it is, but it's not a weight loss procedure.
• 11:25
  SPEAKER_04: So when it comes to weight loss procedures, like I'm assuming it's GOP1.
• 11:30
  SPEAKER_04: Is that a good thing or a bad thing?
• 11:32
  SPEAKER_04: Like, do you recommend GOP1s if someone is going to be looking to lose weight?
• 11:38
  SPEAKER_01: I I we have Bill and I have the same opinion, but we have different, like maybe slightly different kind of thoughts on it.
• 11:45
  SPEAKER_01: I um I don't love the idea of everybody having to take a medication to prevent them from eating, and and because I think what happens if something happened, that medication disappears, that dependency on it, when there is a fundamental overarching issue, and that is our generalized approach to health and food source in the United States, and you know, you know, making it affordable for people to get high-quality real food that's not synthesized, that doesn't have hormones, that doesn't have dangerous elements in it that could be carcinogenic.
• 12:18
  SPEAKER_01: Uh, and then comparing where we have in the US to the other other you know developed nations, like it's it's backwards.
• 12:23
  SPEAKER_01: And like when I go on vacation and I'm traveling and I feel amazing and I'm doing all the things I'm not supposed to do, and my labs are all fully normalized, and then I come home and I get my labs checked, and there's not a bit of inflammation, and then I'm here for a month and it's all back.
• 12:36
  SPEAKER_01: That's that that to me is, I think, the real fundamental problem.
• 12:38
  SPEAKER_01: So we're not addressing what needs to happen, but there are so many people.
• 12:41
  SPEAKER_01: I I'm gonna talk in out of one year out of the other because typical G-Speak right here.
• 12:46
  SPEAKER_01: It's G-Speak because like there are people who need this stuff.
• 12:48
  SPEAKER_01: The problem is I also see people who don't need to be on GLP once that are that are low BMI already and they're taking it and then they're becoming gaunt.
• 12:56
  SPEAKER_01: And I just think that's kind of silly.
• 12:58
  SPEAKER_01: Um, I think we should do you know things that you know things should be data driven.
• 13:04
  SPEAKER_01: You know, it's almost like when you run a good organization, it should be KPI driven, you should be data, you should adjust what you're doing and move forward.
• 13:09
  SPEAKER_01: The same thing should happen with with these types of things.
• 13:11
  SPEAKER_02: The medications are revolutionary, though.
• 13:13
  SPEAKER_02: Let's just put it out there, call spade a spade, it's revolutionary, it's changing the game for all these folks.
• 13:19
  SPEAKER_02: So it's a it's a great, it's a great class of medications that are really gonna help with longevity in the US.
• 13:26
  SPEAKER_02: But you you're right, it's just one piece of the puzzle, and there's a bigger kind of overarching problem that patients really got to go into.
• 13:33
  SPEAKER_02: So is it good and bad?
• 13:35
  SPEAKER_02: It's both.
• 13:35
  SPEAKER_02: They just gotta do the right thing.
• 13:37
  SPEAKER_01: I agree, and like I'd be honest, like most people are in medicine and healthcare, like, well, you really listen to people, most of them say the best medicine is when you can be on no medicine.
• 13:45
  SPEAKER_01: So I'm just saying, like, we have to also remember that and think that way.
• 13:49
  SPEAKER_01: But like nutrition, nutrition's huge.
• 13:52
  SPEAKER_01: But then, and the next is physical activity, and you know, you know, being out there and being outside and like you know, good, you know, um, good exposure to the air and like touching things that are alive, all these things are really important relationships, being happy, interacting.
• 14:06
  SPEAKER_01: And so like we have this cool dawn of age where like all right, you got all this stuff that can help make you feel better, you got all this technology, you can just chill at home, be on your phone, do everything through AI, get 20 different tasks done, and like blah blah blah blah.
• 14:17
  SPEAKER_01: But there's also this like you need to like experience life a bit, and like that's one of the fun things about what we do as aesthetic surgeons, like we get to experience it with people all day long.
• 14:27
  SPEAKER_01: And like when we have our clinics, we see you know anywhere from 20 to 60 patients.
• 14:32
  SPEAKER_01: It's cool because we're interacting with people.
• 14:34
  SPEAKER_01: We don't even we take that for granted.
• 14:35
  SPEAKER_01: You know, some people don't have that.
• 14:37
  SPEAKER_01: Um GL but the GLP one thing is amazing.
• 14:40
  SPEAKER_01: You know, Bill, you know a lot more about it because it's leading to, I think it's gonna get so refined.
• 14:45
  SPEAKER_01: And it's gonna be right now.
• 14:46
  SPEAKER_01: If you read this right now, right now, GLPs are still like a it's like a big ass gun for like a small target.
• 14:51
  SPEAKER_02: But but but if you look at the studies, it's cardioprotective, renal protective, potentially prevents Alzheimer's and dementia.
• 14:59
  SPEAKER_02: There was one study that said potentially, potentially could decrease the risk of cancer in certain patient populations and certain types of cancer.
• 15:07
  SPEAKER_01: But the crazy thing is there are also things like back in the day were like aspirin to it was good for this, this, this, and this, and like coffee is good for this, this, this, and this.
• 15:13
  SPEAKER_01: So sometimes some of these things are like a little overblown.
• 15:17
  SPEAKER_01: I mean, if it was that amazing of a wonder drug, you know, your body is endogenously producing this stuff too, right?
• 15:24
  SPEAKER_01: I mean, that's the other thing, too.
• 15:25
  SPEAKER_01: It is being produced, right?
• 15:26
  SPEAKER_01: We all have GLP, you know, being secreted.
• 15:29
  SPEAKER_02: But that being said, though, it does do the things that it's supposed to do.
• 15:34
  SPEAKER_02: Now, will there be some negative sequelae of it long term?
• 15:38
  SPEAKER_02: Potentially.
• 15:39
  SPEAKER_01: It doesn't seem to be that much, though.
• 15:42
  SPEAKER_01: Right, right now it's but it is not going anywhere.
• 15:45
  SPEAKER_01: It's not going anywhere.
• 15:46
  SPEAKER_01: It's gonna be continue to be mainstay.
• 15:48
  SPEAKER_01: You know, the interesting thing is like what I don't know enough about, which uh we should learn, is like what's happening, like kind of OUS, because it's very big in the US, is some places OUS, but like other places it's not blown up as much.
• 15:59
  SPEAKER_02: Well, I think to your point about nutrition, the diet uh you know, outside the US is way better than inside the US.
• 16:06
  SPEAKER_02: Interesting physical activity is way better.
• 16:09
  SPEAKER_02: Um, you know, there's not a McDonald's on every corner that everybody, you know.
• 16:13
  SPEAKER_02: Again, I think it goes back to you mentioned affordability of high quality foods.
• 16:19
  SPEAKER_02: You know, if you come from a low-income family, it is very disadvantageous for you to go eat healthy because it is so costly.
• 16:29
  SPEAKER_02: So costly.
• 16:30
  SPEAKER_02: You know, try to eat organic, trying to eat healthy foods, fresh foods, it's very expensive.
• 16:36
  SPEAKER_02: Where you can go to one of these fast food restaurants and feed your whole family for cheap.
• 16:42
  SPEAKER_01: It's crazy.
• 16:43
  SPEAKER_02: So it's tough.
• 16:45
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• 16:47
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• 16:53
  SPEAKER_02: Thanks for being a part of the best plastic surgery podcast out there today.
• 16:58
  SPEAKER_01: Always a pleasure to get to share uh our thoughts and uh concepts with you.
• 17:02
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• 17:05
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• 17:06
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• 17:09
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• 17:10
  SPEAKER_02: Dr.
• 17:10
  SPEAKER_02: K let's Dr.
• 17:11
  SPEAKER_02: B.
• 17:13
  SPEAKER_04: Mark Jasmine, hello.