Latest / HKB Uncut | A Cosmetic Surgery Podcast / 15. Cosmetic Surgery Myths | Fat Grafting, Recovery, BBLs, and More

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15. Cosmetic Surgery Myths | Fat Grafting, Recovery, BBLs, and More · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_00: We're gonna bust up myths about plastic surgery today.
• 0:02
  SPEAKER_01: Are there myths?
• 0:03
  SPEAKER_00: A lot of myths.
• 0:04
  SPEAKER_00: Some of the myths are real, though.
• 0:05
  SPEAKER_00: Some are not.
• 0:06
  SPEAKER_01: Let's dive in.
• 0:11
  SPEAKER_01: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
• 0:15
  SPEAKER_00: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance and what you need to know before you book a procedure.
• 0:26
  SPEAKER_00: I'm Dr.
• 0:26
  SPEAKER_00: Bill Cortesis.
• 0:27
  SPEAKER_00: And I'm Gorov Bahardi.
• 0:29
  SPEAKER_00: We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
• 0:37
  SPEAKER_01: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you.
• 0:46
  SPEAKER_01: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.
• 0:58
  SPEAKER_00: This is Gorov Baharty here.
• 1:00
  SPEAKER_01: Bill Cortesis.
• 1:01
  SPEAKER_00: We're super excited to talk to you today about what we love and hate about plastic surgery.
• 1:05
  SPEAKER_00: But today we're going to talk to you about some myths and whether or not it all.
• 1:11
  SPEAKER_00: So here's what we're doing today.
• 1:12
  SPEAKER_00: We're actually we have a myth bag.
• 1:14
  SPEAKER_01: All right.
• 1:14
  SPEAKER_01: First myth fat transfer is risk-free because it's your own fat.
• 1:19
  SPEAKER_00: Depends how we explain this.
• 1:21
  SPEAKER_00: So I would say nothing's risk-free.
• 1:23
  SPEAKER_00: Um everything that we do in surgery has a potential risk.
• 1:27
  SPEAKER_00: So it's all it's all legit things.
• 1:29
  SPEAKER_00: But the idea of using your own tissue to volumize or redistribute something where you don't want it to where you do want it, I think makes a lot of sense.
• 1:37
  SPEAKER_00: We do a ton of fat grafting, all of our surgeons do, and in general, it's very well tolerated.
• 1:42
  SPEAKER_00: Um maybe it's important to talk about what the risks are.
• 1:45
  SPEAKER_00: What are some risks that you would you know correlate with fat grafting?
• 1:48
  SPEAKER_01: I I think the biggest one is the fact that not all the fat survives.
• 1:52
  SPEAKER_01: Right.
• 1:52
  SPEAKER_00: So you So that's that's called take, like the fat take.
• 1:55
  SPEAKER_01: So you know, everybody's like, oh, what percentage actually takes?
• 1:57
  SPEAKER_01: And you know, there's no true actual percentage.
• 2:00
  SPEAKER_01: What we safely can tell patients is hey, we're gonna do this procedure, we're gonna put fat.
• 2:05
  SPEAKER_01: The benefit of it is you're gonna actually take fat from a part of your body you don't really want and put it into an area that you do want, which is absolutely fantastic to be able to do both.
• 2:14
  SPEAKER_01: Because again, if you're doing breast surgery, you're doing kind of fat grafting of the buttocks, you can actually contour the area surrounding the fat grafting part to make it look better, which is really pretty amazing for patients.
• 2:26
  SPEAKER_01: But the downside is again, not all the fat that we put into that area is gonna absolutely take.
• 2:32
  SPEAKER_01: So, how do you how do you describe to patients what that take rate really is?
• 2:36
  SPEAKER_00: Yeah, I think that's a hard thing, and I think it's variable.
• 2:38
  SPEAKER_00: It depends on the patient's donor side, depends on the patient's recipient side, depends on where you're injecting, depends on how much you're injecting, depends on the amount of fluid that's in the fat craft you're injecting.
• 2:47
  SPEAKER_00: So the truth is it's a little variable.
• 2:49
  SPEAKER_00: The way that I would describe it is that it is like um when we're doing fat grafting, for example, for breast, and we're doing like a breast lift, and then we're gonna do some fat grafting, like the breast lift is gonna do its thing.
• 2:59
  SPEAKER_00: It's gonna look amazing.
• 3:00
  SPEAKER_00: The fat grafting is gonna just be like icing on that carrot kick.
• 3:03
  SPEAKER_00: Carrot kick good by itself, with the icing, it's a little bit better.
• 3:07
  SPEAKER_00: So the myths that we want to debunk for fat crafting are number one, you know, that it has no risk.
• 3:13
  SPEAKER_00: It does have risk.
• 3:14
  SPEAKER_00: One of the risks is what we're talking about inadequate correction of the deformity, meaning you can you can get it and you're like, oh, I wish I had some more.
• 3:20
  SPEAKER_00: So that's one.
• 3:20
  SPEAKER_00: The other is overcorrection.
• 3:22
  SPEAKER_00: You put too much in.
• 3:23
  SPEAKER_00: Usually it doesn't happen because we don't overcorrect too much, right?
• 3:27
  SPEAKER_01: But to that point though, oftentimes we're doing bilateral cases with fat grafting, breast, face, hands, buttocks.
• 3:36
  SPEAKER_00: You can get a symmetrical take on each side.
• 3:39
  SPEAKER_00: Yeah.
• 3:40
  SPEAKER_00: Unfortunately, people ask patients ask me that how often is it?
• 3:42
  SPEAKER_00: And I was like, it's usually not very often.
• 3:44
  SPEAKER_00: I haven't really seen it.
• 3:45
  SPEAKER_00: You can get lumps or bumps with fat grafting, you can get oil cysts.
• 3:49
  SPEAKER_00: So we always use purified fat.
• 3:50
  SPEAKER_00: We highly recommend it to all the surgeons that we teach people in our organization and we speak nationally.
• 3:55
  SPEAKER_00: And so the idea is you get rid of damaged cells, you get rid of free fatty acid and oils so that what you're injecting is more consistent and you're not overcorrecting.
• 4:05
  SPEAKER_00: So we're like, we don't do ultra-high volume fat grafting because we haven't found the need to do that.
• 4:08
  SPEAKER_01: So is all fat grafting equal then?
• 4:10
  SPEAKER_01: So I mean again, you if somebody goes to a place in California or Florida versus us, how can patients understand uh that fat grafting technique and what they're doing?
• 4:23
  SPEAKER_01: What questions should patients ask?
• 4:25
  SPEAKER_00: Yeah, it's just it's just it depends.
• 4:26
  SPEAKER_00: I would say that the when we go and lecture other surgeons and then we talk about fat grafting, they ask us what's our take rate.
• 4:32
  SPEAKER_00: I say, well, here's my take rate.
• 4:34
  SPEAKER_00: Your take rate's gonna be a little different because you're gonna have your own technical ability of how you're gonna utilize the fat, how you're gonna purify the fat, and where you're gonna place it, how you're gonna place it.
• 4:42
  SPEAKER_00: So I think that's the key is like plastic surgery is an art, fat grafting is an art.
• 4:47
  SPEAKER_00: And so there is a little bit of the um the methodology and the way that that pro procedure is done that can dictate what the outcome is gonna be and also potentially how risky it's gonna be.
• 4:57
  SPEAKER_00: You're right.
• 4:58
  SPEAKER_00: Yep.
• 4:59
  SPEAKER_00: Uh Brazilian butt lift is the same everywhere.
• 5:01
  SPEAKER_00: Technique doesn't matter.
• 5:03
  SPEAKER_00: Oh, I like this one.
• 5:04
  SPEAKER_01: It's the most common reason for catastrophes in in the state of Florida.
• 5:09
  SPEAKER_01: However, the key with BBLs, and I agree with you, G, I you know, it is not the same everywhere.
• 5:16
  SPEAKER_01: And the point with with BBLs is really about what you're trying to accomplish.
• 5:22
  SPEAKER_01: For us, and it's been our motto for a long time, it's about shaping more than volumizing.
• 5:28
  SPEAKER_01: I think a lot of places, especially in Florida, they just want big, big, big, big, go as big as you can, put as much fat in there as possible.
• 5:36
  SPEAKER_01: Hence why we have all those issues with with fat grafting and and the the problems associated within the buttocks.
• 5:42
  SPEAKER_01: Um for us, it's more about shaping.
• 5:45
  SPEAKER_01: And that's the beauty of I think fat grafting the buttocks.
• 5:48
  SPEAKER_01: And even though it's called a BBL, I I don't necessarily talk to my patients about it being a BBL.
• 5:55
  SPEAKER_01: How do you refer to it?
• 5:56
  SPEAKER_00: I think we want to debunk it.
• 5:58
  SPEAKER_00: We don't even use that term here at HKB.
• 6:00
  SPEAKER_00: It is a silly term.
• 6:01
  SPEAKER_00: It's silly how we propagate it, silly how social media propagated it.
• 6:05
  SPEAKER_00: We don't do that.
• 6:06
  SPEAKER_00: It doesn't make any sense.
• 6:07
  SPEAKER_00: It actually doesn't make any sense with what you said.
• 6:09
  SPEAKER_00: There's no butt lifting happening.
• 6:11
  SPEAKER_00: You're doing circumferential trunk liposuctioning and you're doing some fat crafting.
• 6:14
  SPEAKER_00: So what you're doing is you're getting rid of where you don't want excess and you're adding that excess where you have less.
• 6:19
  SPEAKER_00: So you're shifting volumes.
• 6:21
  SPEAKER_00: And I think that's really what we're doing all the time.
• 6:22
  SPEAKER_00: And like, you don't need to do ultra-high volume.
• 6:25
  SPEAKER_00: I mean, on almost every single abdominal plasty kind of mommy makeover that we do, we are doing some form of fat crafting, but it's it's small volume.
• 6:32
  SPEAKER_00: And like these patients, like, well, do I need to, can I sit on it?
• 6:34
  SPEAKER_00: Can I sleep on it?
• 6:35
  SPEAKER_00: Do I have to get a special pillow?
• 6:36
  SPEAKER_00: You know, all these things.
• 6:37
  SPEAKER_00: And it's like, no, we're just doing volume redistribution.
• 6:40
  SPEAKER_00: So, what typical volumes are you placing?
• 6:42
  SPEAKER_00: Man, anywhere from uh something that's as low as 50cc each side to as high as several hundred cc's.
• 6:49
  SPEAKER_01: Can you make a difference with that 50cc?
• 6:50
  SPEAKER_00: Oh, yeah, it's it's you can make a massive difference.
• 6:52
  SPEAKER_00: And like the idea here is just like these are subtle refinements.
• 6:56
  SPEAKER_00: What people don't realize is like what we're doing in aesthetic and we like to call it restorative surgery is that we are we're refining what a patient has.
• 7:03
  SPEAKER_00: We're not necessarily trying to always radically change somebody.
• 7:06
  SPEAKER_00: Sometimes you got to radically change certain things if that's their desire and it's gonna get the right outcome.
• 7:10
  SPEAKER_01: But most of the time we're really just you know, you're refining what they already have.
• 7:13
  SPEAKER_01: So, what should patients ask for when they come in to see us?
• 7:16
  SPEAKER_01: Should they ask for the BBL?
• 7:18
  SPEAKER_00: They can ask for it.
• 7:19
  SPEAKER_00: I mean if they I would tell patients that they they should explain verbally what their concerns are, what they want to achieve.
• 7:25
  SPEAKER_00: Because like us building rapport with our patients and knowing what they want, we'll help them get what they want.
• 7:30
  SPEAKER_00: There's there's plenty of people who go into um one trick pony shops uh some of these sweatshops, and like everybody's getting BBLs when like in truth the patient might need, yeah, they might need some liposuction.
• 7:41
  SPEAKER_00: Really, what they need is an abdominal plasty, muscle placation, and small volume fat grafting of the buttock, and that's how you're gonna get the waist definition.
• 7:47
  SPEAKER_00: Or maybe they need rib remodeling.
• 7:48
  SPEAKER_00: There's all kinds of things that patients can get to get the result they're actually looking for, versus having a you know massively filled uh buttocks that's gonna need secondary interventions, and now people are getting, you know, having to get buttock lifts or having to give liposuction to the butt, then they have loose skin they have to deal with.
• 8:03
  SPEAKER_00: So, like people need to really think about what they're doing before they do it.
• 8:07
  SPEAKER_01: People don't talk about weight gain or weight loss after fat crafting.
• 8:12
  SPEAKER_01: And if you're talking about BBLs and you're putting fat into the buttocks, and then all of a sudden you gain all this weight, guess what?
• 8:18
  SPEAKER_01: Those fat cells are gonna get bigger and heavier, and you're gonna it's gonna lead to you know buttocks descent.
• 8:24
  SPEAKER_01: So large volumes isn't always the answer, right?
• 8:27
  SPEAKER_01: And that's why we really believe in shaping.
• 8:30
  SPEAKER_01: Uh it's literally all about kind of shaping.
• 8:32
  SPEAKER_01: And so for us, whenever we do liposuction, we ask the patient if they want to repurpose the fat and put it into an area that they ultimately want versus just throwing it away.
• 8:41
  SPEAKER_01: And it's ultimately their decision if they want to, because we can put it anywhere hands, buttocks, and we're gonna start we're gonna start saving that fat, meaning we're gonna actually be able to bank that fat.
• 8:50
  SPEAKER_00: So if they want to get any procedure, we can keep it.
• 8:52
  SPEAKER_00: And when they want to have you know, volume added to their chest or volume added to their butt or volume added to their you know hands or their um hip dips, we can keep that and not have to do a secondary procedure.
• 9:02
  SPEAKER_00: So I think it's a great innovation that we're working with the company on right now, which I think will be really valuable.
• 9:06
  SPEAKER_00: What if somebody's skinny and they're like, I don't have any fat, dog, what can you do?
• 9:12
  SPEAKER_00: So sometimes we can go hunting, meaning that you have to go to multiple areas of the body and you can chase, you can find little bits of fat.
• 9:18
  SPEAKER_00: So even on a really skinny, I always call them really scrawny, lean, amazing women or guys, you can find some fat.
• 9:24
  SPEAKER_00: Um but in the situations where you know you can't find it or they don't want to have a procedure to actually procure or get the fat, because when you get fat, it's liposuctioning.
• 9:33
  SPEAKER_00: Yeah.
• 9:34
  SPEAKER_00: You're doing liposuctioning.
• 9:35
  SPEAKER_00: There are other options, and there are other things that are available on the market now where we can actually use you know allographed fat, which means fat that's from other humans that's been treated and all the DNA or immunogenic material has been removed.
• 9:49
  SPEAKER_00: And so you literally have off-the-shelf fat that we can use.
• 9:51
  SPEAKER_00: It's a little bit costly, but it's a game changer.
• 9:54
  SPEAKER_01: It's really it's a it's an absolute game changer for folks who don't have any subcutaneous fat whatsoever.
• 10:00
  SPEAKER_00: Yeah, I think it's exciting, and I think it gets into the subject, you know, we'll we can go talk on and on about this, which we will in, I think, future episodes about, you know, the aesthetic and regenerative space where, you know, we're not now just relying on prosthetic devices like implants, artificial materials.
• 10:16
  SPEAKER_00: We're actually using real constructs that are actually gonna either become, you know, native tissue and not have any maintenance, or or promoting your own um cellular structure to kind of proliferate and get you the result that you want without actually having anything artificial inside of you.
• 10:32
  SPEAKER_00: So that's super exciting.
• 10:34
  SPEAKER_00: What you got next?
• 10:35
  SPEAKER_01: Gee, you're gonna absolutely love this one.
• 10:37
  SPEAKER_01: Oh you can't work with two surgeons at once.
• 10:41
  SPEAKER_01: It's unsafe.
• 10:43
  SPEAKER_00: You can't work with two surgeons at once, it's unsafe.
• 10:46
  SPEAKER_00: That's simply false.
• 10:47
  SPEAKER_00: That's false on on so many levels.
• 10:50
  SPEAKER_00: But, but, but, but I think that um in the right setting, that is an ideal situation.
• 10:56
  SPEAKER_00: Um, you know, at our at our flagship location, you know, we have a fellowship program.
• 11:00
  SPEAKER_00: What a fellowship program is we have um fellows that are spending time with us for extra training in aesthetic surgery that have already completed their fellowship.
• 11:08
  SPEAKER_00: I'm sorry, they're their training in plastic surgery.
• 11:10
  SPEAKER_00: So they've done six years at least.
• 11:12
  SPEAKER_00: Some of them have done by nine years, and then they spend another year here to refine their aesthetic surgical techniques.
• 11:17
  SPEAKER_00: So they're operating with us typically side by side, kind of assisting us.
• 11:21
  SPEAKER_00: And what people don't realize in plastic surgery, in any surgery, when you do surgery, you got to have help.
• 11:25
  SPEAKER_00: And so that help is all the OR team.
• 11:27
  SPEAKER_00: You have to have a circulator that's an RN, you have to have a RN or sorry, a nurse scrub in there with you who helps you, and they're like your first assist.
• 11:35
  SPEAKER_00: So a lot of times they're helping doing things during the surgery, cutting things, helping close things, doing things that are involved.
• 11:40
  SPEAKER_00: Here, we're lucky enough to where we actually have other plastic surgeons that are assisting us to do these things.
• 11:45
  SPEAKER_00: In many situations, we'll tackle two things at once.
• 11:48
  SPEAKER_00: So one of our other surgeons will handle one area and we'll handle another area.
• 11:51
  SPEAKER_00: So you have two teams that are taking care of a patient.
• 11:54
  SPEAKER_00: What's the value in that?
• 11:56
  SPEAKER_00: Shorter surgical times, um, you know, more efficient.
• 11:59
  SPEAKER_00: And um, when you have shorter surgical times and more efficient, patients get cold less, complications are less.
• 12:06
  SPEAKER_00: And so you can do it and it can work well, but they have to be a well-organized machine and team.
• 12:11
  SPEAKER_00: Like you have to almost have to have like a huddle before to game plan it and how to handle.
• 12:14
  SPEAKER_00: But like, Bill, you've always taught me this, and so did Tunstead.
• 12:18
  SPEAKER_00: It's like we're better together.
• 12:18
  SPEAKER_00: So we actually get, we feel like we do better when we uh work as a collective and um utilize each other's techniques.
• 12:26
  SPEAKER_01: I think we're all about expertise, right?
• 12:27
  SPEAKER_01: It's like I think they're experts for certain parts of the body, certain things that we ultimately do.
• 12:32
  SPEAKER_01: And so for us, it's like, hey, let's have the expert do that part.
• 12:36
  SPEAKER_01: You want somebody who does a lot of facelifts, you want somebody who does a lot of rhinoplastas or a lot of breast lifting, right?
• 12:41
  SPEAKER_01: And so for us, you can have that here.
• 12:44
  SPEAKER_01: You can have that facelift and that breast surgery all together because you have two surgeons working with you to get you your goal efficiently, safe, quickly, so that they're not under anesthesia for extremely long time.
• 12:57
  SPEAKER_01: And that's kind of the HKB way.
• 12:58
  SPEAKER_01: So I agree with you.
• 12:59
  SPEAKER_00: It's also and and I would say, but and also other is like sometimes you we deal with really technically difficult stuff.
• 13:04
  SPEAKER_00: So I'm like, I I want you to help me on a case, or I need like uh Rich Cow to help me on a case, or I need to uh do a case with Dr.
• 13:11
  SPEAKER_00: Cleban or Brett Baker or whoever, like and you like you'll do cases too with you know other surgeons in like like Rick Rosen, and and then our our counterparts in our other location will do the same thing.
• 13:20
  SPEAKER_00: So sometimes you need that little backup.
• 13:23
  SPEAKER_00: It's like you need a little bit of support, or it's just that from a technical standpoint you can enhance what you're offering a patient.
• 13:28
  SPEAKER_01: So I think some cases are very difficult, right?
• 13:31
  SPEAKER_01: And you you need that extra support and help to figure out what to do and how to do it.
• 13:35
  SPEAKER_01: Luckily, here we have experts in the field that can do that.
• 13:39
  SPEAKER_01: Fat will never come back after liposuction.
• 13:42
  SPEAKER_01: Fat will never come back after liposuction.
• 13:46
  SPEAKER_01: True and false.
• 13:47
  SPEAKER_01: So I'll say the areas you subtract fat from, those cells are gone.
• 13:52
  SPEAKER_01: And they're gone forever.
• 13:54
  SPEAKER_01: Now I think that that's pretty common knowledge in in our world.
• 13:58
  SPEAKER_01: However, if a patient ends up gaining weight, guess what?
• 14:03
  SPEAKER_01: The remaining fat cells get bigger.
• 14:05
  SPEAKER_01: And so if you're really taking somebody down really thin and you get you remove all their excess abdominal fat in the subcutaneous plane and they end up gaining weight, they end up gaining it elsewhere.
• 14:17
  SPEAKER_01: Arms, back, buttocks, breast, you name it, they gain it.
• 14:22
  SPEAKER_01: So for us, when we talk to patients about this, it's really important to maintain body weight after any body contouring surgery.
• 14:29
  SPEAKER_01: So wellness is a huge component of everything we do.
• 14:32
  SPEAKER_01: And if patients end up going down that road of trying to gain weight, post-body contouring, it could lead to just disastrous outcomes.
• 14:40
  SPEAKER_01: Have you seen patients, you know, five to ten years out after having a lot of lipo done, what ends up looking like if they gain 15, 20 pounds?
• 14:47
  SPEAKER_00: It's a disaster.
• 14:48
  SPEAKER_00: I would I would say that, and there's there's a little bit of a tolerance.
• 14:52
  SPEAKER_00: So I think the biggest thing is when you remove fat from the body, that fat cell is gone forever.
• 14:57
  SPEAKER_00: So Bill, you mentioned that.
• 14:59
  SPEAKER_00: But if you eat a bunch of cheeseburgers afterwards and you have 10 fat cells that are left over in your tummy, 20 fat cells everywhere else, all those fat cells are going to get bigger.
• 15:10
  SPEAKER_00: So that's the thing is your fat cells can hypertrophy, and then you'll you'll you'll accumulate fat in a weird distribution.
• 15:15
  SPEAKER_00: So you'll get massive deposition wherever there's a higher concentration of fat cells, and you'll get a same amount of deposition where there's less, but it just won't be as much.
• 15:22
  SPEAKER_00: So you'll have this weird asymmetry.
• 15:24
  SPEAKER_00: So I think it's really important, and we always tell patients, like, this is not weight loss surgery.
• 15:28
  SPEAKER_00: This is just kind of kind of refining what you have.
• 15:31
  SPEAKER_00: I'll use that word a lot in every single thing I talk to patients about, but they they need to maintain.
• 15:36
  SPEAKER_00: And so there's a there's like a delta it'll tolerate, like you could tolerate like a five-pound, 10-pound swing, but once it starts getting more, then people start looking funny, and like people will start accumulating fat in their viscera.
• 15:47
  SPEAKER_00: So like they'll get fat around their organs and get a huge pot belly, and when you pinch their abdomen, it'll be paper thin.
• 15:53
  SPEAKER_00: So you can't do that.
• 15:55
  SPEAKER_00: You just gotta you gotta make sure to adopt a healthy and active lifestyle.
• 15:58
  SPEAKER_00: So that's why we tell patients 70% of the outcome is on us, 30% is going to be on you with regards to how you are behave, you know, after this and kind of how what level you maintain to.
• 16:09
  SPEAKER_00: But to truthfully, most of our patients are pretty motivated, they've done a lot of diligence.
• 16:13
  SPEAKER_00: And like if they just crank it up maybe a couple percent points, maybe five percent, I mean it's remarkable what happens.
• 16:18
  SPEAKER_00: So I think we just wanted patients to know that you know, liposuction is a great tool.
• 16:23
  SPEAKER_00: If you can combine that with the right plan and um lifestyle, oh my god, it's it's it's dramatic.
• 16:29
  SPEAKER_01: I love lipo for targeted areas.
• 16:32
  SPEAKER_01: You know, I I don't you know, when I first started, I used to do these full body lipo cases, they turned out great, but then I saw the disastrous outcomes when they gained a lot of weight.
• 16:40
  SPEAKER_01: So now I tend to do it for more targeted areas in combination with you know GLP1s, wellness, um, kind of stuff.
• 16:49
  SPEAKER_01: My preference is always always excisional surgery.
• 16:52
  SPEAKER_01: If I could do excisional surgery all day long over liposuction, it works way better.
• 16:58
  SPEAKER_01: What do you tell patients in regards to that?
• 17:00
  SPEAKER_00: Oh, you know, I think I you know, listen, at the end of the day, I'm a surgeon, cold steel always wins.
• 17:05
  SPEAKER_00: I like to cut and close, but also I hate scars.
• 17:08
  SPEAKER_00: Patients hate scars also.
• 17:10
  SPEAKER_00: And so what we have done is you're we're always trying to add new things, and I think we're gonna get more and more things going forward.
• 17:16
  SPEAKER_00: But what I what what I'm talking about is when you can do different kinds of liposuctioning, and we've always done this, you know, Joe Huntsted, our mentor, and Bill, you know, they showed me kind of how multimodal energy liposuction works, and what that means is you use things like um uh ultrasound assisted liposuction with mechanical liposuction, like power-assisted liposuction, and then combine some sort of energy modality where you either deposit RF energy or RF helium-based energy.
• 17:41
  SPEAKER_00: And what we've done is you can get, you can get a result where there's skin laxity afterwards, but you can kind of have less laxity and maybe not have to cut out the tissue.
• 17:50
  SPEAKER_00: But there is no doubt removing the tissue, cutting it out is the most dramatic change.
• 17:55
  SPEAKER_00: And in the in the age of, and we're gonna be talking about this going forward, in the age of massive weight loss, in the age of GLP1 inhibitors, widespread use, there's a lot of skin laxity around.
• 18:05
  SPEAKER_00: There's still a lot of fat around, too.
• 18:07
  SPEAKER_00: And so we are we're figuring out ways where you can basically just best kind of combine surgery, traditional approaches with technology and energy so that you can get the result you want, but still not have a bunch of scar.
• 18:19
  SPEAKER_01: Some of the best targeted areas for lipo, neck, does really well.
• 18:25
  SPEAKER_01: You know, limited downtime patients do really well.
• 18:27
  SPEAKER_01: Arms, surprisingly, very limited downtime, huge results, you know, short recovery, short surgery.
• 18:34
  SPEAKER_01: Lower back really can ultimately contour the patient really well, highlight their buttocks area, abdomen, another great place.
• 18:43
  SPEAKER_01: Area that I'm reluctant to do a lot of liposuction is the thighs.
• 18:47
  SPEAKER_01: I think the patient's skin doesn't bounce back as well as in other areas.
• 18:51
  SPEAKER_00: It's uh it's definitely you don't oh don't take out too much, utilize energy to your benefit and select patients appropriately.
• 18:59
  SPEAKER_00: And um, it can be done very effectively.
• 19:01
  SPEAKER_00: But I'll tell you what, we do do a lot of them.
• 19:03
  SPEAKER_00: We'll have to talk about just revisionary work.
• 19:05
  SPEAKER_00: I've done a lot of thigh lipo revisionary work.
• 19:07
  SPEAKER_01: All right, the next question you should be able to jump back into normal life immediately after surgery.
• 19:13
  SPEAKER_01: Cosmetic after all.
• 19:15
  SPEAKER_00: Well, obviously anybody who knows anything knows that's a silly, preposterous concept.
• 19:21
  SPEAKER_00: But there are new things that we are doing to help people recover faster and quicker.
• 19:26
  SPEAKER_00: You know, we like the idea of rapid recovery, we like the idea of minimal disruption, and what I mean by that is modifying the techniques that we're doing so that you can kind of get back to your normal thing quicker.
• 19:38
  SPEAKER_00: The reason why we have patients refrain from getting back to absolute normal daily life immediately afterwards is that tissues need to heal, incisions need to heal, and if they push it too hard, they can disrupt that.
• 19:49
  SPEAKER_00: They could cause things to literally tear, they could cause things to bleed, they can cause fluid collections, or they could be under some medications, they could fall and get hurt.
• 19:58
  SPEAKER_00: So the truth is you have to be cautious, but that doesn't mean you need to be bedbound.
• 20:02
  SPEAKER_00: It's been shown that you know, not moving, not taking deep breaths, not walking around is probably the most dangerous thing you could do after surgery.
• 20:10
  SPEAKER_00: So for us, like even when we people get huge surgical interventions, like a circumferential body lift, breast lift, fat crafting, um, on and on, those patients in our hands are walked around that night of surgery.
• 20:24
  SPEAKER_00: They have to be able to void by themselves in the morning.
• 20:26
  SPEAKER_00: I mean, so we want people up and moving and doing things, but there's the right, the right amount of activity and the the least amount.
• 20:32
  SPEAKER_00: It also depends on what you get done.
• 20:34
  SPEAKER_00: You know, like Bill was mentioning earlier, if you get like something like uh under your chin lipo, you can pretty much do practically everything afterwards.
• 20:41
  SPEAKER_00: If you're getting a minimal disruption preserve, breast enhancement, you're probably gonna be able to do most things that same night or the next day.
• 20:48
  SPEAKER_00: Versus if you're getting, you know, total capsulectomy, um, implant exchange, breast lift, and may have a drain, you know, you're gonna have a little bit of a longer, you know, period.
• 20:57
  SPEAKER_00: So it depends on what you're doing.
• 21:00
  SPEAKER_00: Um, I think you need to listen to your surgeon.
• 21:02
  SPEAKER_00: All of us actually will probably have a slightly different instruction on things.
• 21:05
  SPEAKER_00: And I think it is important to make sure you understand those concepts because you just don't want to have an issue, but you always need to actually make sure that you're moving and grooving and like your body is like, you know, not in a state of like kind of like stasis.
• 21:18
  SPEAKER_00: You know, it'd be interesting.
• 21:19
  SPEAKER_00: Tell tell patients what stasis is and why stasis is so dangerous.
• 21:23
  SPEAKER_01: Yeah, ultimately you don't want to just sit there because what ends up happening if you sit there, your blood's not flowing, and then all of a sudden, theoretically, you can get a blood clot.
• 21:32
  SPEAKER_01: And a blood clot can be very dangerous.
• 21:33
  SPEAKER_01: So we really want to avoid any of that stuff.
• 21:36
  SPEAKER_01: And like I think you hit the nail on the head, G.
• 21:38
  SPEAKER_01: We want to we really want patients to get back to normal as fast as possible.
• 21:42
  SPEAKER_01: I mean, there's no real real reason for us to say, hey, we want you to chill out for the next three months.
• 21:47
  SPEAKER_01: Now, again, we do want them to heal, but ultimately our goal is to get them back to their normal life ASAP.
• 21:53
  SPEAKER_01: And then again, it really depended on the procedure that we do and the surgery we do is uh in regards to what they're down to.
• 22:00
  SPEAKER_01: Time's gonna end up being.
• 22:01
  SPEAKER_00: Alright, here's a really good one.
• 22:03
  SPEAKER_00: You can always tell that you've had plastic surgery.
• 22:06
  SPEAKER_01: I think as a trained plastic surgeon, I think a lot of times we can really see what's going on.
• 22:12
  SPEAKER_01: Um, however, the goal with any great plastic surgery is to avoid any of the signs that somebody's had that procedure.
• 22:21
  SPEAKER_01: And I always say the best plastic surgery goes unnoticed, right?
• 22:24
  SPEAKER_01: You want people to look at you and go, wow, you look great.
• 22:27
  SPEAKER_01: What have you been doing?
• 22:28
  SPEAKER_01: And that is a that is the best compliment of all.
• 22:31
  SPEAKER_01: So we really want to hide scars as best we can.
• 22:34
  SPEAKER_01: We want to minimize the visibility of any of any signs that anybody's had that procedure done.
• 22:40
  SPEAKER_01: You know, and there's a lot of ways we can ultimately do that.
• 22:42
  SPEAKER_01: But yeah, a lot of it is well hidden.
• 22:45
  SPEAKER_00: Yeah.
• 22:45
  SPEAKER_00: And I'd say, you know, this is a it's a real renaissance period for aesthetic surgery and longevity wellness in the US and worldwide, because at the end of the day, people want to look as good as they feel, and I think we're able to empower them to kind of get that.
• 23:01
  SPEAKER_00: And so we're we're acting earlier.
• 23:02
  SPEAKER_00: We're doing, we're actually the pendulum is shifting to where we're doing more surgical interventions, especially on the face, because this idea of trying to get a lifted, filled, youthful look by just pumping it full of filler, pumping it full of other products, freezing the muscles, when in truth what we really want to do is we have to reposition and reorganize the face, re-volumize the face, for example, in the way that it was when it was youthful.
• 23:24
  SPEAKER_00: And so actually, surgical interventions tend to have the most elegant, soft, rested, natural look.
• 23:31
  SPEAKER_00: And it's the same thing with body procedures that we're approaching, bigger surgical interventions.
• 23:36
  SPEAKER_00: For example, if you're gonna do like a mini tummy tuck on someone who thinks who really needs to have a full tummy tuck, and actually when you go to see them, you're like, oh, actually, you're gonna do better with an extended tummy tuck.
• 23:45
  SPEAKER_00: And the truth is if we can do a circumventual tummy tuck, we can actually get rid of all the excess that you don't like, get you the contours that you want, so that when they're wearing a bikini, they actually do look better, they look more athletic, and they look less operated on.
• 23:56
  SPEAKER_00: Sometimes doing half of a procedure will make you look more operated on.
• 24:00
  SPEAKER_00: So it's an interesting paradox, but there's no doubt that the work that we're doing now can be very under the radar, can be very elegant and natural.
• 24:08
  SPEAKER_00: Every once in a while, somebody may want a little more.
• 24:10
  SPEAKER_00: Someone might might want more oomph.
• 24:12
  SPEAKER_01: There are a lot of patients that come in, they want everybody to know they've had plastic surgery.
• 24:15
  SPEAKER_01: Which is not there's nothing wrong with that either, right?
• 24:17
  SPEAKER_01: It's to each their own.
• 24:18
  SPEAKER_01: We really want to cater uh to that patient and give them exactly what they're they're they're going for.
• 24:23
  SPEAKER_01: You know, some patients that are like, hey, I want everybody and my brother to know that I've had a breast augmentation.
• 24:28
  SPEAKER_01: Bigger's better, right?
• 24:29
  SPEAKER_01: Or, you know, I want as much fat and contour in my midsection off as possible.
• 24:34
  SPEAKER_01: We can do that, right?
• 24:36
  SPEAKER_01: Our goal is to really help that patient and kind of give them their ultimate best results.
• 24:40
  SPEAKER_00: Yeah, and like us to not be an all-plaster, don't be one trick ponies, don't push one thing to your patients.
• 24:47
  SPEAKER_00: Like, do the things that your patients need and help them understand if they don't need that or if they should consider something else so that they can have a result that they're that's timeless for them.
• 24:57
  SPEAKER_01: All right, G.
• 24:58
  SPEAKER_01: You can't work out again after a tummy tuck or muscle repair.
• 25:02
  SPEAKER_01: No more ab crunches.
• 25:04
  SPEAKER_00: I would say in general, that myth is that is a myth and it's false because you will be able to work out and you'll probably be able to work out like you haven't been able to work out in a long time, like work out like you did before you had kids and had that muscle repair if you were a mother.
• 25:17
  SPEAKER_00: Sometimes there are situations where men get muscle repair too, so people need to understand that.
• 25:21
  SPEAKER_00: Um, I would tell you there's a couple of things, and I'd love to hear what your algorithm is.
• 25:25
  SPEAKER_00: I'm sure all surgeons differ on this, but uh when I approach a patient and they've had an abdominal plasty, typically I don't want them kind of going to the gym doing high-intensity stuff at least a month.
• 25:35
  SPEAKER_00: And usually by a month, we start them up.
• 25:36
  SPEAKER_00: We start them doing things, but I tell them to engage that core secondarily.
• 25:40
  SPEAKER_00: And what I mean by that is they can activate that core, but they can, I don't want them doing crunches.
• 25:45
  SPEAKER_00: Actually, I tell my patients, you're never going to do crunches ever again, because the motion of a crunch is almost like a it's a lot of pressure and it's like an outward pressure.
• 25:52
  SPEAKER_00: Instead, what I try to get them to do is first look in the mirror, flex that core, and sometimes it's weird because you they don't know how to actually activate the core.
• 26:00
  SPEAKER_00: And really, like, and you can talk about this because you remember we went to that one trainer that we were with that functional training, you work on like your pelvis tilt and how it should, you have to like adjust the position of your pelvis, activate your core.
• 26:10
  SPEAKER_00: And one of the simpler ways to activate their core that I tell them is like, you know, after like a month or two months, you know, they can start doing like planks, they can start doing things, and that's a great way to activate your core so where your rectus muscles are retracting and being pulled closer to the spine.
• 26:24
  SPEAKER_00: I mean, what's your algorithm?
• 26:25
  SPEAKER_01: I'm gonna go ahead and tell you every female that comes to see me for a tummy tuck already activates their core better than anybody else.
• 26:31
  SPEAKER_01: Have you had I mean, literally, I have to find out if they have a diastasis, but I'm like, relax, relax, because everyone's pulling them in.
• 26:39
  SPEAKER_01: And then finally, when they relax, I'm like, oh, there it is.
• 26:41
  SPEAKER_01: Right.
• 26:42
  SPEAKER_01: So they understand that that m that movement pattern that you're talking about.
• 26:46
  SPEAKER_01: Yeah, we don't want them applying pressure to that to that repair that you did, but we want to get them back to doing all their normal stuff.
• 26:53
  SPEAKER_01: Again, same way when we're talking about breast augmentation underneath the muscle, we don't need patients to do and activate that pec anymore, but you need it for core stability.
• 27:03
  SPEAKER_01: Hence the same thing for the abdomen.
• 27:05
  SPEAKER_01: You need those big muscle groups, rectus muscles, your pectoralis muscles for core stability, yeah, versus actually utilizing them to hypertrophy or get big again.
• 27:16
  SPEAKER_00: And what's interesting is um but patients afterwards they didn't even realize how weak their core was.
• 27:23
  SPEAKER_00: And when you do this, even on people who are pretty trim, like listen, Bill, we've taken care of people who are high profile, massive trainers, mega following that you would never know that were shredded out when we do this procedure.
• 27:35
  SPEAKER_00: I mean, it's like a game change.
• 27:37
  SPEAKER_00: I mean, they're they they have restoration of kind of like maybe some aches, like lower back kind of pain can be alleviated.
• 27:43
  SPEAKER_00: Their core is just simply stronger, they can do different moves and workout.
• 27:46
  SPEAKER_00: Sometimes they'll have some genital urinary changes too, where like their little incontinence issues change.
• 27:51
  SPEAKER_00: And we I I can't tell you the exact reason, but it's probably just the the nature of what what the abdominal contents are and then fixing that musculofascial network.
• 27:58
  SPEAKER_01: So there's some functional benefits, you know, muscle placation, not just the cosmetic appearance.
• 28:03
  SPEAKER_01: Right, right.
• 28:04
  SPEAKER_00: They're extra extra benefit from and I think that's a that's one, you know, it's not we haven't talked about, but like that's the best thing about most of the stuff that we do is like there obviously are things that we do that are aesthetically um valuable to a patient, but there are a ton of things that we do that are functionally enhancing and then also sometimes sensually enhancing too for people, you know, with things like intimacy and intercourse, and like it's it's awesome when you can combine all that stuff.
• 28:27
  SPEAKER_00: I mean, that kind of stuff's what gets us, you know, yeah.
• 28:29
  SPEAKER_01: Patients can actually go back and do activities in the gym that they weren't able to do before because of this, which is pretty amazing.
• 28:36
  SPEAKER_00: Awesome.
• 28:36
  SPEAKER_00: So I think we're um we'll wrap up that episode.
• 28:39
  SPEAKER_00: That was a really fun episode.
• 28:40
  SPEAKER_00: Um, if you guys like this episode, our listeners, please um uh give us some feedback.
• 28:45
  SPEAKER_00: And if there's any ideas uh that you would like us to discuss, send them our way.
• 28:50
  SPEAKER_01: We'd love to hear about them.
• 28:51
  SPEAKER_00: Yeah, DM us on Instagram or um drop some comments on our uh YouTube.
• 28:56
  SPEAKER_00: And we will see you guys on the next episode.
• 28:58
  SPEAKER_01: One of the myths I have is that is real hair or not?
• 29:01
  SPEAKER_00: Look at it, look at it.
• 29:02
  SPEAKER_00: Hold on.
• 29:03
  SPEAKER_00: Looks like a or is it a wig?
• 29:05
  SPEAKER_00: You'll never know.
• 29:06
  SPEAKER_00: You'll never know.
• 29:11
  SPEAKER_01: Thank you for listening to HKB Uncut.
• 29:13
  SPEAKER_01: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
• 29:18
  SPEAKER_00: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.