S04E66 HIGH DEFINITION LIPOSUCTION WITH GUEST DR CHRISTOPHER COSTA

One of the hottest buzzwords in plastic surgery is "high definition" liposuction. But what does that mean, exactly? Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Sam Jejurikar @samjejurikar and Dr. Sam Rhee @bergencosmetic discuss high definition liposuction and more with guest Las Vegas plastic surgeon Dr. Christopher Costa MD @drcosta_platinum.

Dr. Chris Costa is a Nevada native who serves the greater Las Vegas and Henderson area through his private plastic surgery practice, Platinum Plastic Surgery. Board Certified by the American Board of Plastic Surgery, Dr. Costa graduated with a dual Bachelors in Science from the Hawaii Pacific University prior to attending the University of Hawaii, John A. Burns School of Medicine. He also obtained an MPH (Master of Public Health) degree in biostatistics and epidemiology from the Johns Hopkins University. Dr. Costa completed his surgical internship at Beth Israel Deaconess Medical Center, Boston MA and subsequently finished his surgical training as an integrated plastic surgery resident at the UT Southwestern Medical Center in Dallas, Texas. Dr. Costa has been voted Best Of Las Vegas & MYVEGAS Top Doc.

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Transcript

S04E65 HIGH DEFINITION LIPOSUCTION WITH GUEST DR CHRISTOPHER COSTA 

[00:00:00] Dr. Sam Jejurikar: Well, good morning everyone. Welcome to another edition of Three Plastic Surgeons and a microphone. As always, I am joined by Dr. Sam Re and uh, uh, Bergen Bergen County, New Jersey. God in Paramus, New Jersey. Sorry. uh, uh, uh, Dr. Sal Pacella, Malia, California. Who's that San Diego plastic surgeon. And today we have the great fortune of being joined by Dr. 

Chris Costa, who's an incredibly busy aesthetic surgeon in Las Vegas. Um before we get into the meat of the program, uh and we introduce Dr. Costa, 

disclaimer  

[00:00:39] Dr. Salvatore Pacella: All right, here we go. 

show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after pro. Every discussion, always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delay seeking advice because of something in the show. 

[00:01:03] Dr. Sam Jejurikar: Great. So, um, for our listeners, I've had the great pleasure of knowing Dr. Costa for many years, as has Dr. Pacella. Um, I've known, uh, Chris since he was a resident at UT Southwestern. Um, and even back then it was really clear that he had a. Great eye and a great mind for all his things, aesthetic surgery. kept in touch with him over the years and he's shared his philosophy to me, and I've really been struck by his results that I'm seeing online, that are, that are fantastic and so many different procedures, whether it's rhinoplasty, liposuction, body contour, and breast surgery. He seems to be doing great job with all of that stuff. Um but he's had an evolution and he's done some things that that are, that are, um, You know, he, he has different philosophies to things than, than than I do and that many others as well. And, and, but his results speak for themselves. So it's been really, uh, awesome to sort of keep up. So what we've decided would be a great topic for today is high definition liposuction, because every time I'm go onto Chris's social media feed, I see yet another amazing result after another amazing result. And so, Chris, I guess for our listeners out there, uh, first of all, welcome to the show and then second,  

um What is high  

definition liposuction I heard that term being  

banding around a lot  

[00:02:13] Dr. Chris Costa: right? Yeah, no, that's, that's like all the buzz on social media now. I think. Uh, no matter where you turn, everyone's saying Ah, hi def. Hi, Def. Hi Def. So, um, you know, uh, what I classify high definition liposuction is, as you know, it's, we're doing more than removing fat. So, um, the tra from the traditional sense of liposuction where, um, you know, your mom's liposuction from 10, 20 years ago or whatever, it's just like, Uh, the focus really was on volume reduction, right? 

So like, just get the fat out, um, you know, and then you fit into your jeans better. And there's definitely like nothing wrong with that. Um, Where, uh, the, the term high def kind of comes into play is where we are looking more at your natural anatomy and trying to highlight the contours that you already have and just kind of bring 'em out and, um, kind of tell the story, uh, that you are, uh, that you're, you're trying to tell people. 

Um, on the outside, right? So like, like all plastic surgery, but like, , uh, you know, the people who do really, really well are obviously, it's like the people who are in the gym, you know, three to six days a week, and they're just like, you know, they're like, man, I, I just can't get any sort of like, result, you know, just cuz of genetics or whatever it is. 

So, um, uh, I, I just try and help, uh, bring that out for him. And so there's varying degrees, right? Because like, um, the, the person who maybe, uh, Has a BMI of like 20, um, and works out all the, all, all the time. They're going to be maybe coming to me with different expectations than maybe somebody who's had two kids and they just kind of want their old form back. 

You know what I mean? Um, so, uh, so it's, it's always a conversation and there's varying degrees of it. Uh, you know, most of my patients actually come to me ironically saying like, Hey, like. Just, I, I don't want, I don't want like a six packer, anything crazy like that, right? Like they just, people just want to look natural, like , right? 

So, um, so I think, uh, uh, we use high def because it, like, people kind of know now, like, you know what's out there and they know that what that term means. Um, but it's, it's just about like, like all plastic story, whether you're doing rhinoplasty, breast augmentation, like, you know, the, the goal is to make people's heads turn and be like, whoa. 

Like they look, they look awesome. Right. Not necessarily like, . Whoa. That's, that's some plastic surgery like. So, um, so 

always  

the goal, whether we're doing body contouring or tummy tuck or breasts or nose,  

face, you know, for all of us. Right.  

[00:04:51] Dr. Sam Jejurikar: Right what what and I think you hit on a couple  

of really key topics  

Um one natural  

it sounds like 

interested in looking natural and fit as opposed to looking like they have crazy six packs. Um I assume you're talking predominantly about women when you say that.  

Um do you do you  

[00:05:08] Dr. Chris Costa: Yeah. Exactly. You know? Um, so it definitely is different in the male population, but you know, to, to a certain extent, right? Um, uh, like I, I did a, I did a guy, um, in his sixties actually, uh, last week, and he was a physician. He bikes, he's an avid biker and he had two orthopedic injuries like last year. 

Where he was basically kind of, you know, immobilized and not able to like get into shape. And now he was like, man, like I just, you know, I'm 60, whatever. I can't, no matter what I do, like I just can't get any definition back that I had before. And he's like, I'm not trying to like look like Captain America. 

I just want. Kind of my own old form back and somebody who can kind of make it look good without making it look kind of like that Van Gogh painting where it's, you know, kind of amorphous or something like that. So, so, but for the most part, uh, you, you know, probably like the same thing you guys see in your offices. 

Like anytime someone comes in for a breast augmentation, Um, well, you know, I'm in Vegas, so maybe my patients are a little different than your guys'. Right. Like, um, you know, I know, I know my average size breast implant may be a little bit larger than it is in, uh, in Dallas. Um, but, uh, The, you know, the patients that come to me, they're all like, you know, I want, I love your results. 

Just don't make me look like I got two volleyballs in my chest. You know, like, don't, don't do, don't give that plastic surgery look. Um, so, uh, it's, it's the exact same thing with, with lipo and, you know, all that kind of stuff. So I think that's definitely a, uh, you know, something, uh, you know, when you're, when you're trying to learn like a technique in. 

in a new procedure. Uh, you know, the pendulum can shift like too far the other way too, right? Where you are giving the patient something that it, it, it crosses the line of like a natural looking result. Um, and, uh, and now they look over operated or just over resected or, you know, that kind of thing. So, uh, it's definitely tough. 

It's definitely a balance. Um, you know, and it's taken, it's taken a lot. 

it's. totally different from what we, what I learned  

in training. Um, 

[00:07:29] Dr. Sam Jejurikar: Well yeah So let's let's let's 

kind of walk through the process then of a, 

patient who's coming 

consult. 

guys interject as he 

questions as well. So let's say you have three patients that are coming, coming to you. One has a BMI of 20. One has a B M I of 25, 1 has a B M I of 30, they all tell me, Dr. 

Costa, I wanna look athletic and natural. Does your conversation differ with those patients in terms of what the results might look like? Um, or is it the same  

conversation with all three patients 

[00:08:00] Dr. Chris Costa: Uh, yeah, no, I think that's a really, that's a really interesting, because the way you're asking that question, Um, kind of puts a lot into context of, I think a lot of the way, a lot of plastic surgeons think about this and e maybe even patients of like, oh, well if my bi, if my B m I is this versus this versus this, and I know that, that, that's a very like, structural way to think about patients. 

The way I have every single one of my body contouring consoles, as I say, uh, the, the equation to getting you the result you want has three different factors, okay? X, Y, and Z. All right. First factor muscle diastasis. If you have pregnancies, you know, if, if all that is stretched out, you know, I gotta fix it. 

Uh, the second part is gonna be your subcutaneous skin. If you've got, or I'm sorry, your subcutaneous fat, if you've got a lot of fat, that's where we make the little incisions and I can suck it out for you. And then the third part, which I say is, , the most critical part of this whole thing is your skin quality. 

Do you have, you know, excess skin quality, skin damage, um, uh, uh, you know, age of the skin itself, all that kind of stuff. And I tell people I'm like, of all of these factors. Your skin is the, that's the, that's the, the loose cannon. Like I, that's the one I can't predict. Um, that's the one that I, you know, really defines like what type of result we can get you, um, and that kind of thing. 

Now, luckily, , most people are really, really reasonable, right? Like, you know, the, the, the regular plastic surgery patient is just a regular person. It's not somebody who, you know, like, what, what, what, what we see on tv on botched and all this kind of stuff. It's just like people who wanna look better. Like they just, whatever. 

So, um, so a lot of people get that. Um, and so my conversation whether, you know, your V M I is 20 or 30, Really comes down to me like doing an exam and looking at your skin. Right. Um, because I have had patients with BMI A 30 who I can get phenomenal results on. Um, and I've had patients with BMIs a 20 who have three kids, and I just tell 'em, I'm like, look like we have to do a s a skin removal procedure. 

And I think patients really get it when I kind of present it that way. Because if I just say like, look like. , like the liposuction is to treat fat. It doesn't do anything for that third part of the equation, doesn't do anything for your extra skin. So we gotta do a skin procedure if we're gonna treat your extra skin. 

Now, you know, Mo, I, I have, I think one of the things that has really, really helped me, um, move forward is I have a very low threshold to do some sort of skin excision and, um, like I have a lot of tools in my tool belt where. A skin excision doesn't necessarily have to mean it's a full tummy tuck, right? 

It's not like zero to a hundred. It's um, you know, maybe we're just doing a little mini c-section scar size like skin removal to pull that skin tight and, you know, help distribute that fat nice and nice and evenly. Right. Um, one analogy I like is, uh, you know, when we do liposuction, , we leave fat behind, right? 

And, uh, that's the way it should be done. That's the way you keep the tissue nice and healthy. But it's kind of like taking a big bowl, a big heating bowl of potato salad. Okay? So if you just scoop a bunch of potato salad in a bowl, um, it's all chunky and you know, it looks like whatever. , but if you get some Saran wrap, nice and tight, and you just, you, you, you stretch it over that top of, uh, the potato salad, you know, it looks nice and smooth and contoured. 

Right. So I explained that to patients too that like, well, you know, yeah. It just, it just flattens everything out. Right. So, 

I don't know. I, I'm open to suggestions if you got a better idea of, uh, how to, uh,  

[00:11:58] Dr. Sam Jejurikar: I'm just you  

[00:11:59] Dr. Chris Costa: I. Oh, 

I, I, don't even like potato salad, so I you know, macaroni salad. I  

don't know, man. 

[00:12:12] Dr. Sam Jejurikar: That's on  

[00:12:14] Dr. Chris Costa: uh, yeah. Yeah.  

[00:12:15] Dr. Sam Jejurikar: so so yeah I think you're  

total sense in terms of the skin elasticity. 

[00:12:22] Dr. Chris Costa: Well,  

[00:12:22] Dr. Sam Jejurikar: got really bad skin elasticity, you can talk him easily into doing a skin excision. I get it. Someone that's really good 

you're not really that worried about is plastic surgeon.  

if someone's kind of in that middle ground? They're sort of, you know, you can kind of tell their skin's gonna loosen up a little bit, but they're  

coming to you and their skin's 

yet  

until it is there any  

role in your practice for things  

of doing a skin excision to tighten the 

it's  

radio frequency or any other 

[00:12:50] Dr. Chris Costa: Mm-hmm. Yes. So, um, and the, uh, so I think, um, like I said, it all comes down to the skin. So if, if I even have that premonition of the loose skin, uh, I don't, I'm not really sure because Right. Like, like, yeah. Exactly like you said, Sam, there's people on both sides, but most people are like in the middle. Most people have had a kid, most people have some degree of laxy. 

And, and, and so first of all, it's just about like the patient counseling where, where I just tell people like, look like, uh, and, and to answer like I, I promise you, I'm gonna answer your question, but I I really. I really believe, like it's not a one-way conversation of like, this is how I decide it. Um, it's a, it's totally like this. 

It's totally a two-way conversation. That is how you get happy patients for sure, is if you say, all right, here's the deal. You got a little bit of skin. It's kind of loose after I suck your fat out. , I think you may have a little bit of loose skin, but I don't know, cuz I don't know, like everybody's different. 

Your genetics, you know your thing. I, I'm giving you my best guess. If it were me, I would rather do a little bit of a skin excision, pull that skin tight so I, you know, make sure that we get a nice, smooth contour. But if you are like just totally against that and you're okay with having a little bit of loose skin and maybe the contour doesn't look the same or maybe you've got a little bit of, you know, that kind of thing, then I'm okay doing that too. 

And I think, um, that is one thing that like I was not taught in my training and I don't, I don't know if other programs do teach that or not, but like, The way I was taught was like, you really only do liposuction only on people with really, really good skin quality, because those are the only people that are gonna have really good results. 

And, um, you, you know, someone with a B M I of 32, you should never really do liposuction on because like, they're not gonna have a good result. They're gonna end up, you know, with n whatever. And, and I think that that is like something that is just totally wrong, you know, because there are so many people out there who they. 

They, they, they're not necessarily looking for, um, you know, this amazing sculpted super, you know, result, right? They just wanna look better. And if you tell 'em like, Hey, you may have a little bit of loose skin. How do you feel about that? And oh, by the way, like if you do, like, we can always come back and cut it off later if it really, really bugs you. 

A lot of people are like, yeah, that sounds good. Let's do that. Like, uh, you know, and then when they're in my office, um, I'd say it's 50%, get it 50%, uh, you know, end up healing really well. And that's why I say like, I can't even predict it because like, um, sometimes, uh, I'm like, there's this patient's definitely gonna need, you know, a mini tummy tuck or whatever, a modified tummy tuck like with, um, billable transposition, and, um, and, uh, and then they, they just, their skin just heals really, really well. 

So, um, I love radiofrequency microneedling. I'll say that, uh, for those patients where I'm like, Hey, you know, I don't know. . Um, so here's, uh, a little insurance policy that we can do at the same time that will help us maybe get a little bit of skin retraction. And, um, I like incorporating that for those patients, um, if they're interested in doing it, you know, but again, like I just leave it up to the patient. 

I say like, or don't, you know, . Um, it's really up to you. Uh, now if it's very, very obvious the patient needs a tummy tuck, I'm gonna like, um, still tell 'em. I'm gonna still give them the same option. And I think that's also something that's, you know, maybe kind of controversial, maybe not. But again, like, uh, I have a, I can think of a patient who had a B m I plus 35, um, and she just was like, listen, I can't take the time off. 

I can't, you know, I just want to debunk, you know, and, and that's the word I use. I say it like this is gonna be more of a debunking procedure. Right. Um, and. . I'll tell you, man, some of my happiest patients, they're, they're, they really are. And, uh, you know, and we can, we can still highlight some, give them some contour, give them some of that shape back. 

And then those, those girls, those those girls, , like love their results because they have always maybe been kind of like a larger woman, but now they're like a really, really sexy, larger woman, you know? And, um, and, and then maybe they come back in a year and, and they're, they have the time to do the tummy tuck or whatever. 

So I really do think it's like this sliding dynamic. Um, and uh, it's, it's hard to like, You know, create some algorithm in a paper of like, oh yeah, well, BMI here, do this, procedure b i here do this procedure. Because it's, it is really not like, it's, it's, it's really not. It's really like trying to figure out, I, I know we always like, well, what are your goals? 

Like, we tell, we ask the patient, what's your goals? Like, you know, and we try and meet that, but like, I don't know how much of us actually really, really listen to that. Right. Like, if, if I, because, and, and the reason I point that out is, um, When I first, uh, started, like got out on my own, um, I went and I, I worked for Evil Corporate Plastic Surgery. 

Okay. Uh, you know, one of those places that does like liposuction on everybody. Okay. And, um, you know, when, when all you have is a hammer, everything's a nail, right? So every, everyone that walks through the door liposuction, that's all they do. Like, uh, and. , I was, I was told like, Hey, you gotta do liposuction on this guy. 

Hey, you gotta do liposuction on this woman. Um, and I was like, man, this is totally different than what I was trained. This is, this is a really bad thing. Um, you know, this goes against everything I've been taught that I'm supposed to do this patient totally needs, you know, a big, you know, extended tummy tuck with, um, you know, possibly, you know, whatever. 

But, um, but. , we would do this, we would do these liposuction procedures. And again, if you talk to the patients and you kind of tell 'em what to expect down the road, they're extremely happy. Like, like way happier than I could have ever expected. I was like, oh my God, they're gonna hate me. They're, oh, and you know, um, , I also think like, uh, if. 

If you're, if you're not somebody who, uh, who, uh, doesn't personally get, like, care about the, the feelings of others and stuff, like, you're probably not gonna be a good plastic surgeon, but like, you know what I mean? Like, you gotta let your own conscious kind of guide you, right? Like, uh, so I, I try and I'm like, look, I'm just gonna lay it out for you, right? 

Like, , you're still gonna be big after this. You're still gonna have loose skin. Like this is not like, some crazy procedure. And they're like, dude, I don't care. I just wanna like fit into my pants, . You know, and you get, and, and that was a big, like, eye-opening kind of thing for me when I did that because, um, it really did show me that like, it's, it's. 

We spend so much time saying like, this is the right thing for you. This is this. Our science says this is the right procedure. And, and obviously we have to present that to people like, you know, I've done this for a really long time and I can tell you that, uh, this is probably not gonna be the best result. 

But if that person also comes to you and says like, look, well, I can't get. Three weeks off, or two weeks off for a big mommy makeover procedure 

and like, I just really want to get some of this off so I can like, you know, start  

walking again or start, you know, doing some exercise and stuff like that. Like sometimes it's just, that's the catalyst, right? 

Like to really, 

really get that going. 

[00:20:32] Dr. Sam Rhee: Well, be, opposed to presenting the options and letting the patient. understand what those options would result in, and then letting them choose what they know for themselves to be their best result, which, which I think sometimes a lot of plastic surgeons overlook in terms of always trying to achieve what we think be appropriate. Um, one of my questions I had for you, Chris was. The high definition high definition liposuction. So, um, as opposed to say, like you said, your mother's liposuction, what is it that makes it high  

[00:21:18] Dr. Sam Jejurikar: why? Why do you guys keep talking about  

[00:21:20] Dr. Sam Rhee: like you said? Oh, 

[00:21:27] Dr. Salvatore Pacella: We're gonna, we're gonna start with the mom jokes. Nice. 

[00:21:32] Dr. Sam Jejurikar: Sorry  

[00:21:34] Dr. Salvatore Pacella: mom  

is So,  

[00:21:36] Dr. Sam Rhee: It's so, so, um, so if, if we could get on point guys, um, the question is, is like, it picking the right patient, like you said, like a, like a fit 60 year old who's, who's looking to try to get. Back into shape. Is it, doing more aggressive liposuctioning, so you're actually seeing the underlying musculature? Or is it more of a, like a etching where you're sort of working a technique to highlight, um, the ana the anatomy better by a, a specific technique of liposuction.  

[00:22:13] Dr. Chris Costa: absolutely all of the above. Uh, so you know when  

you're saying  

Like  

what, well, what is, Like if someone comes in  

and says,  

am I a candidate for high def  

liposuction? And I think, is that kind of another way to 

rephrase it,  

Sam?  

[00:22:24] Dr. Sam Jejurikar: how like how are like how are you doing it Like how  

[00:22:26] Dr. Chris Costa: Yeah.  

[00:22:26] Dr. Sam Jejurikar: do you  

[00:22:27] Dr. Chris Costa: So, yeah. Um. So it's more, uh, so, uh, ho Hoyos wrote a paper a year or two ago and he just came out with another one that's like kind of similar where he, you know, basically kind of defines like the different degrees of definition. 

And, and the way he kind of structured that paper, I think is, is the way that I kind of talk to a lot of my patients. I don't call people endomorphs or ectomorphs or you know, what I just say like, Number one, everybody coming in my office for liposuction. I'm assuming they're coming in because they've like seen my results and like that's they're, they're coming in cuz they want some degree of definition. 

So, so I, it doesn't matter if I'm doing a. A very obese person. I'm still going to try and get them some highlights in the linear alba, in the semi lines, right? Like, um, I'm still the, the key though is like, you can't just draw 'em on there. Okay? You've got to look at the patient's torso because someone who's got a 40 inch circumference chest, Um, their, their rectus muscles are just gonna be wider. 

And so if you try and paint 'em on there like you would for a, a five foot, two petite Asian woman or something, like, it's, it's gonna, it's not gonna work. Right. So, so again, like highlighting their natural anatomy, um, li I have them literally. , like stand and flex. Like tell, I, I tell 'em, I'm like, flex, like you're trying to show me your abs. 

And, and I just, I push on 'em and I try and feel where, where that is. So, um, it's not like a, it's not like a stencil where you can just like stick it on there and then like draw inside the lines, right? Like, so it's, it's. I think you can do these techniques in every single patient. Now, if, if, uh, to that degree, if a, uh, if a patient who is, let's just say, um, uh, you know, overweight, uh, with some loose skin comes to me and says, I'm looking for a high def result, I'm gonna say, well, number one, like, what do you mean by that? 

right. Um, and have 'em show me some pictures. And again, like when they show me those pictures, a lot of 'em are. They're showing me natural results. You know, they're not showing me like the true high def, etched out six pack, eight pack with the, with the, uh, sarus definition and the external obliques coming off of the ribcage. 

Like, that's, that's like an extreme high def. Right. And that,  

that type of patient tends to be, you know, it's, it's sign, it's kind of self-selecting,  

right? Like that tends to be somebody who's already in shape.  

So  

you  

[00:25:07] Dr. Sam Jejurikar: I can I ask a  

question as you're doing this  

[00:25:08] Dr. Chris Costa: yeah, of course.  

[00:25:09] Dr. Sam Jejurikar: you using traditional lipo energy modalities power  

assisted Like how are, 

you 

these different degrees of definition  

[00:25:21] Dr. Chris Costa: Oh, 

all right.  

all the industry people hate me. Um, , because I, I don't, I don't, I don't believe that this, and, and I think this is super important for your audience to hear. do not associate a result with a device. Okay. Um, whate, whatever that device is out there. Like, you know, we get called, you know, at least a few times a week asking, Hey, do you guys have, uh, oh, I saw Dr. 

Costa's liposuction. Does he use the, the, the x the whatever device, uh, for, you know, does he do X? Like, well, I, I'm not saying any names. Um, You know what I mean? Um, and that, that my, I've had to lit, I've literally had to have hours of conversation coaching my staff of how to navigate that because I, you know, uh, your result is based on, you know, proximal to the instrument. 

Right? So, you know, if you, uh, put me in a pair of Air Jordans and make me play basketball against Michael Jordan, uh, in flip flops, , uh, he's still going to whip me pretty hard, right? Like it doesn't, it's not the device, it's not the shoe. It's uh, it's the, it's the surgeon and, um, and it's, and for the, from the surgeon's standpoint, um, it's again, like if, if, if you're, if you're a surgeon, uh, there's so many people who, like I saw during training and I, I've seen, you know, just out in the community who they go through the steps. 

and then they're done and they never sit there and like critically analyze their own result, um, on the table. Like, it's just like, well, I did it, the fats in the canister we're done. Like, yeah, I got, I got three liters of fat out. Like, what? That's a great endpoint. And at no point are they actually looking at the patient, feeling the patient doing skin pitched tests, like, you know, feeling to make sure that that contour is nice and even right. 

So, um, so do we have those devices? The answer is yes. Uh, and I do use them when appropriate, but I don't necessarily think that, um, Any device actually makes the surgeon. I ironically, uh, . So like, uh, I have two micro errors in my office because I do a lot of awake liposuction. And the reason I have two micro errors is because, 

uh, the piece is interchange, uh, you know, you can take the, the tip off right? 

And I can fit it in my tabletop autoclave. That's the only reason 

have it  

Um, is it's not because  

I feel like it's a better thing. Oh yeah. Yeah. 

[00:28:00] Dr. Salvatore Pacella: how very two-sided. Um, you know, and you mutually decide on So let's say for example, you, think the patient needs a more advanced procedure, full tummy tuck, liposuction, et cetera. 

The patient says, No, I can't take the time off. I'm just gonna do a little bit of skin incision. I'm not going to tighten up the, the rectus muscles. I, I want to do something that you feel is not necessarily the best. You do the procedure  

[00:28:35] Dr. Chris Costa: Yeah.  

[00:28:35] Dr. Salvatore Pacella: and then they're unhappy.  

How do you handle that? 

[00:28:41] Dr. Chris Costa: So again, um, My, uh, my experience has been that most people are like, reasonable and normal. Like most people are normal, right? So I can have an unhappy patient, but if I sit with them and I, you know, and I say like, yeah, remember we talked about all this? Like, like that's the loose skin that I was talking about. 

Um, and remember how you said you couldn't take two weeks off work? Oh, yeah. Yeah. Okay. Okay. Okay. , like most people get it. Like they, they they are, they people are not dumb. Now you yes. You are there. The, the people out there who are just mean, angry people and they're gonna be mad. Yeah. We, we, we, we try not to operate on those people , you know what I mean? 

Um, and I think, uh, I think that's a big key part of it is, uh, it's, it's not. If, if, if in that two-way conver, part of that two-way conversation is, you know, the patient interviewing me, but me interviewing the patient too is like, does this person like get it right? Like if they do not get it, um, if, uh, and, and the way I can tell a patient doesn't get it is because, um, they start trying to negotiate with me, right? 

Like they start saying like, well, uh, . It's like, it's like it's one or the other. It's either we cut the skin off and I get you the best result and we pull it tight, or we just do more of like a debulking procedure and we try and get you smaller and just, you know, one step along the way. Um, well, well, can't you do that and get me the result that I, and like when I have, when I'm having that conversation, I'm like, We lay it out very, very clearly. 

No, it's, it's one or the other. It's not both. And, um, if I feel like they're not getting it, um, I, I, I will then say like, you know, I don't think this is probably the right procedure for you, or, I don't think I can get you this, you know, the results that you want. You should maybe go see somebody else. But the advantage is, um, , I don't know how long your guys consults are. 

I know you guys all do really, really good work. Um, but there is that, that is part of the advantage is, um, I get to interview the patient also and, you know, make sure that they're somebody who, when they do come back and they have that result that like, we're like a hundred percent clear about what, what the goals and expectations were. 

And, and like I said, like most people aren't gonna like come after you because. , uh, most people get it. Like, uh, so  

the, um,  

so when that does happen, uh, let's just say it does happen. Uh, you know, we've, we've laid all the groundwork now to kind of lay that out to 'em and to, um, the other thing that's really nice is like, I have lots of really, really great results on my website. 

But I have some results on my website that I kinda like hide at the bottom. Okay. And the reason I hide 'em, I hide 'em at the bottom. Cause they're not the ones I really wanna highlight, but they are there in case, uh, I have somebody who like, I feel like isn't getting it cuz then I can show 'em, hey, this is somebody who should have gotten a tummy tuck. 

And I really recommended it to 'em. But they decided that like, you know, they just wanna do liposuction, and here they are, and you can see that they're smaller and they have, um, you know, that crepey looking skin now. And it's, you know, and this is their result. But they are super, super happy because 

I gave them, like, we 

that conversation and we talked to him and I said, 

so are you gonna be  

happy if you  

get a  

result like this? Like, and that's how  

I turned it back to the patient,  

you know?  

[00:32:12] Dr. Sam Rhee: I love is, for as to  

[00:32:21] Dr. Sam Jejurikar: yes 

[00:32:21] Dr. Chris Costa: Right,  

[00:32:22] Dr. Sam Rhee: And the farther along you go, you, you figure that out and you, you avoid these situations as best you can to make sure you're a good match with the patient. The second thing I love about your answer is that you are honest. 

don't just put everything that looks glam and awesome on there. You're putting other,  

[00:32:40] Dr. Chris Costa: body shapes. Yeah.  

[00:32:41] Dr. Sam Rhee: other results that. Right. And, and to me  

that's the mark of a, of a real plastic surgeon is someone who's very honest, who can show a variety of results and is not sitting there 

have to like, pretend that everyone is a, a model, an Instagram model. 

That, that comes outta my practice. And I think that that honesty is something that I just thought about myself. Like, you know what? That I could probably take some lessons away from that  

[00:33:09] Dr. Salvatore Pacella: And I think, you know, I think that brings us, 

[00:33:10] Dr. Chris Costa: tell you. Yeah.  

[00:33:11] Dr. Salvatore Pacella: think that brings us to our last question, Chris.  

a very important question, yes or no answer. Okay.  

[00:33:18] Dr. Chris Costa: Okay.  

[00:33:19] Dr. Salvatore Pacella: does what does  

always  

[00:33:25] Dr. Chris Costa: no, ,definitely not .  

Um, you know, I,  

[00:33:33] Dr. Salvatore Pacella: Yes or no.  

[00:33:34] Dr. Chris Costa: but have good  

for sure.  

I,  

it's.  

[00:33:42] Dr. Sam Jejurikar: Chris, we, we really want to thank you for your time. I think you've hit some really big points for our viewers. 

is 

operation. It's the surgeon that determines it. And it's not really how, how big you are, it's all of these various anatomic factors that determine how great of a result you'll get. 

So thanks for illustrating those points. Um, it's been super, 

and we really appreciate  

your time 

[00:34:06] Dr. Salvatore Pacella: Good seeing  

[00:34:07] Dr. Chris Costa: Yeah, thanks. Hopefully my perspective, uh, was refreshing  

a little bit. Um, just a reminder. Yeah. I'm in Las Vegas, Nevada Platinum plastic Surgery. We just  

opened our new office, um, with our new surgery center too. So, uh,  

if you're around, come check us out, 

[00:34:22] Dr. Sam Jejurikar: I I'm totally gonna  

[00:34:23] Dr. Chris Costa: see our new place, man.  

[00:34:24] Dr. Sam Jejurikar: there 

[00:34:25] Dr. Chris Costa: Yeah.  

Very cool. 

[00:34:28] Dr. Sam Rhee: Can't wait. 

[00:34:30] Dr. Chris Costa: All right. 

[00:34:32] Dr. Sam Jejurikar: Chris.  

[00:34:32] Dr. Sam Rhee: you.  

Thank you, Chris.