Age Proof
Age Proof: Unlock the Real Fountain of Youth
What if the secret to staying young isn’t a myth, but just hidden in plain sight?
Age Proof is where real science meets real-life results.
Each episode brings you inside conversations with doctors, biohackers, and longevity experts who are redefining what it means to grow older. Together, we unpack breakthrough treatments, debunk outdated health myths, and explore everything from anti-aging supplements to the newest regenerative therapies.
No trends, no shortcuts, just practical, science-backed tools to help you feel better, move better, and stay sharp as you age.
This is Age Proof, where growing older comes with smarter choices and stronger health.
Age Proof
The Truth About BBLs and Plastic Surgery
What do plastic surgeons really think about Brazilian Butt Lifts and cosmetic trends on social media?
In this eye-opening conversation, three surgeons share what makes a good candidate for a BBL, why liposuction artistry often matters more than adding volume, and when cosmetic surgery might not actually be the right choice.
They also pull back the curtain on male procedures like gynecomastia surgery, reveal how weight loss drugs like Ozempic are reshaping their practice, and even connect the dots between America’s weak food regulations and surgical outcomes.
Raw, honest, and packed with insider insights.
This episode is a must-listen for anyone curious about beauty, medicine, and the future of plastic surgery.
All right. So what are you watching video with?
Speaker 2:with the obvious, BBL the girl working on her butt.
Speaker 1:Yeah, showing how to get a butt like that. Yeah, I think our viewers will get to see that. What do you think Looks natural? Huh, yeah, super natural.
Speaker 3:Did she make her head and just put two of them in her ass?
Speaker 2:I don't know. She was legit able to fit peach emojis into her pants dude, like when I was in training in new york, like people used to come in and we had a huge dominican crowd and they used to want to be able to hold a cup on their butt.
Speaker 1:Oh, yeah, oh, that used to be a cup holder. It's called the. Yeah, oh, that's a thing. There used to be a cup holder. It's called the shelf?
Speaker 2:Yeah, it used to be the shelf.
Speaker 1:That's hilarious. I mean, why do you have to wait for it on your airplane?
Speaker 2:when you can't use it Like if you have it on your behind, you can use it whenever Do you have to buy an extra seat, Like how do you, can you even sit comfortably?
Speaker 1:I don't know, actually I haven't thought about it. What if you?
Speaker 2:have like this seat. Well, it's a little longer, but if you have a shorter seat like you know what are you going to do with a cup on your backside.
Speaker 3:I don't know. It's helpful if you're a mom. True, we can just do a procedure.
Speaker 2:Here you go, honey, if we can just do a procedure to install cup holders and bottle holders like a like a one of those batman belts for a mom like just well, you know, you know, they have those belts that you wear on the side, but you could carry your kid on your back instead of on your side with that oh really yeah, like it's a little
Speaker 1:stand on the side Didn't exist when I had my kid, carry your infant. I don't know. I truly love a nice butt, even if it's worked on, if it's proportionally good on the body with good proportions. It's great when it's just Overdone. I don't know if it's just me, because's like just overdone. I don't know if it's just me because I'm a plastic surgeon. You should tell me because you're an eye doctor.
Speaker 3:No, it does not look good.
Speaker 1:Do you ever do that?
Speaker 3:Does this look better or?
Speaker 1:this Right or left.
Speaker 2:Right or left. Maybe when you're checking eyesight you should see which butt they look yeah, yeah, this is this bigger or this or that you can do that.
Speaker 3:Yeah, I usually.
Speaker 2:Yeah, that's what I do in my, but in this video like I I wish you could see the girl's tummy so you could kind of tell. But she's like pretty covered up in the beginning of the video but her legs are a little thicker so you're like, yeah, she probably had a BBL.
Speaker 1:But when she's working out it almost seems like she has cushions in her pants. I couldn't tell. I was just like, eh okay, this looks kind of ridiculous. I personally am more butts than boobs.
Speaker 2:Yeah, I am the same way. It's like Although I do more boobs than butts I know I do too. In New York, I did more butts than boobs.
Speaker 1:Okay, Because I personally, because I'm a butt guy New.
Speaker 3:York was more butts because there's more Latinos.
Speaker 1:Yeah, latinos, not just Dominicans, but Puerto. Ricans.
Speaker 2:It was New York, you got guys getting BBLs done.
Speaker 3:Oh yeah, nowadays you get it.
Speaker 2:I had one person.
Speaker 1:Oh, I had a guy that got glute implants. I don't do butt implants yeah but I came in. It's just like okay, that looks a bit like cartoonish, but if that's what you wanted, you're happy with the way it looks.
Speaker 2:It's fine, but nowadays people are going for more of the natural look than the. That's with every procedure, right.
Speaker 1:So the thing I always say, like for me, when people ask I'm always butt over boobs. Yeah, almost like. Here you go, I'm just going to be a full-fledged asshole. It's like a luxury car. You get a leather seat before you get a heated seat. Nobody has a heated fabric seat. You might have a heated leather seat, so the leather seat. The core thing is the butt, the. The cherry on top is having the heated option yeah I don't get that I'm lost in that one oh
Speaker 3:speaking about cars I actually have a good question that's unrelated to this that I need, okay, personal advice, can we?
Speaker 1:do fat injections into your car?
Speaker 3:my wife just got a car, so what, which car should I get rid of? Volkswagen tiguan 2022 45 000 miles, or tesla 2020 model 3?
Speaker 1:that one's black on black you should get rid of both and get a lamborghini we gotta sell one. Yeah, call it a midlife crisis yeah, yeah, yeah, if you want a plastic surgery standpoint, like well okay well, yeah, you gotta look successful these days.
Speaker 2:That's good for your Instagram. You might get more patients. You're like I'm not making money because I'm driving the Tesla.
Speaker 1:Just do a few videos Jumping on a car.
Speaker 3:I'll take Nez's car, then I'll take her Porsche Cayenne. I'll take her Cayenne.
Speaker 2:But the thing is you got to sit in the back seat with like a laptop and make it seem like someone's chauffeuring you around.
Speaker 1:So makes you more successful, I'll wear a fake mustache I like don't waste time driving.
Speaker 2:I like your work while someone's driving you yeah, that's, that's the point of my life.
Speaker 1:Yeah, it's all about it's all about, uh, image of success.
Speaker 2:Sell both, yeah, so so tyler had a good question. He's, you know, like you go to the gym nowadays like everyone's got a butt and like we're talking about it. I'm like, yeah, they just make better shapewear these days and like they do.
Speaker 1:But I think I think a lot of people actually see the benefits from like squats and those I don't know, the, the humpers, hip thrusts whatever they're called bridges, Like you see people putting like crazy weight and like just humping the air. It's like that looks like a crazy exercise but that actually does help the glutes.
Speaker 2:Yeah, it hurts the pelvis though.
Speaker 1:Yeah, yeah, yeah, yeah, the glutes. Yeah, it hurts the pelvis though. Yeah, yeah, yeah, yeah, but I'm just like every time I say I'm just like, I know I look like a creep, but I take a couple seconds to be like they've really gonna hump that much weight into the air, like this is nuts like.
Speaker 2:I just want to see that done like, and I'm willing to look like a creep to watch this do you think lululemon supports the hip thrust uh?
Speaker 3:of course yeah of course they they support they wouldn't be they wouldn't be selling their product if that wasn't like a primary lawsuit, because they were on their way to making transparent yoga pants like what was it?
Speaker 1:Their yoga pants were technically see-through.
Speaker 2:They're not see-through. I think they are.
Speaker 1:No, there was one line, I think about 10 years ago, where it was just like okay, why are you wearing pants? Like the only reason you wear these pants is to look like you're not wearing pants in certain positions. But they, like people are complaining, like, oh people, see my ass yeah like so you guys didn't hear about this no, it was a nationwide.
Speaker 2:Nowadays it's become more of a butt guy than you guys. That's why I had that car analogy. Nowadays it's become so common everyone like wears that stuff. You're like all right and like I'm like your boyfriend's right there. Do you really need to? Please do it flesh?
Speaker 1:tone Customized flesh tone.
Speaker 2:I wonder what the Ayatollahs would think If they walked around.
Speaker 1:Lululemon.
Speaker 2:They should make an Ayatollah Line for.
Speaker 1:Lululemon yeah, that would be a bed sheet, not form-fitting.
Speaker 2:How about tight spandex for their beards?
Speaker 1:Oh, that's a good one, I don't know. They're careless with their beards.
Speaker 2:They're not like the.
Speaker 1:Sikhs. Sikhs like braid them and tie them down.
Speaker 2:So like, since we're talking about BBL, it's like who's a good candidate for BBL Anybody?
Speaker 1:with a flat butt. Yeah, some people call it the banana butt, some people call it the long back, like the back just extends beyond the buttock.
Speaker 2:SpongeBob SquarePants.
Speaker 1:So if you have fat somewhere and you can move it somewhere else, there you go, easy peasy.
Speaker 3:What does BBL stand for?
Speaker 1:Brazilian butt lift. Did you know that?
Speaker 3:Yeah.
Speaker 1:Do you know the Brazilian eyebrow lift? No, no, it doesn't exist.
Speaker 3:I believe it does. I could have told you a story of how it does exist.
Speaker 1:We put butt cheeks on people's foreheads and that just elevates because of all the volume it elevates there.
Speaker 3:So what do you guys?
Speaker 1:do surgically, you just do liposuction. Yeah, get that fat and inject it in the buttocks.
Speaker 3:Yeah, so from the abdomen, and you just put fat in the belly, that was the thing is a lot of.
Speaker 2:It's the the liposuction artistry that you have yeah, because, like, because like my breast recomb patients. I, I lipo with the same techniques I use for bbls and stuff and a lot of the ladies come out. They're like um, my friends think I had my butt done. What the hell did you do?
Speaker 1:you know, um, and it's just, you're welcome, yeah exactly, they're like I'm sending my friends I'm like yeah, so you, you lipo everywhere, wherever like their problem areas are, so you make that look better.
Speaker 2:You go by the anatomy yeah.
Speaker 1:And a key part is lipo in the lower back and the back itself gives such a better emphasis on the buttocks. That's why I like with our tummy tucks almost all our tummy tucks we do 360 lipo Because even if they don't get a BBL, you shrink down the back. It gives a better emphasis on the buttocks.
Speaker 3:What does 360 lipo mean?
Speaker 2:All the way around. Like Jason once said, we're going to turn this team around All the way around right here right.
Speaker 1:Yeah, we're going to turn this team around 360 degrees, but I want to come up with I'm going to trademark this, Don't steal this from me. I'm going to start selling 720 lipo. I'm going to lipo them on their back, their stomach, and then turn them back around to their back and then to their stomach again. Be like dude. Nobody else does this. 720 lipo.
Speaker 3:And then I'll do 1080. I'll go 1080 I'll go full, tony hawk on you, even though I don't do it, but yeah, that was a great game 1080.
Speaker 1:Uh, snowboarding, snowboarding yeah, that's fun and that that was like an unreal video game where the characters go up and do what one, two, three spins yeah that's a 1080 and then, within like three years, you just have sean white doing 1080s like repeat jumps like, okay, that wasn't, that wasn't so far-fetched.
Speaker 2:Yeah, 1080 lipo, let's go yeah so with the, with the talking about BBL, like last week I had three consults and one day everyone came in. They're like I just want lipo, I just want.
Speaker 1:I'm like, well, like not everyone's suited for lipo. Do you want me to throw this fat out?
Speaker 2:Yeah, so no, it's not even that I'm like. You know all these girls had been pregnant. They're done having kids, but like, like you know you got to have good skin quality to be able to get bbl.
Speaker 1:You can't just.
Speaker 2:You know every people get scared of the incision. I'm like, well, it's either the incision or like just emptying out and the fat from your lower abdomen and then having hanging skin. It's not going to give you the look that you want. You know where we, we can hide those incisions under bikini lines, you know, and like over time that stuff, over a year or so, that scar fades. You know if it's done appropriately. Um, but they have to be willing to accept, yes, scar yeah there's a scar.
Speaker 1:You're not a fetus, but like, but like we can't get rid of their stretch marks.
Speaker 2:People think, like you know, with liposuction if, if you have stretch marks on your abdomen and that skin doesn't bounce back, it's you know, liposuction is not going to work. And even the skin tightening techniques we have, you know, like the radio frequencies, those are even the best stuff on the market.
Speaker 1:No, is not going to get rid of stretch marks.
Speaker 2:No, no, that skin's broken, so we really can't like take that away, you know.
Speaker 3:So stretch marks are a forever thing, basically yeah, unless you cut them out.
Speaker 1:If they're in a portion, like if they're lower belly, where you cut out that tissue for like a tummy tuck. That's, that's easy care. I think you can be pretty preventive with stretch marks, I don't know, like because like stuff like olive oil, like cocoa butter, just taking care of your skin, not gaining too, too much weight with pregnancy for for certain people, there's certain people. I think they're just.
Speaker 2:Genetics leads to weak bonds within their like collagen and elastin, and also how much weight and stuff you gain.
Speaker 1:And yeah, and some people aren't in control of that, so I've seen some people with poor skin quality go through pregnancy and not come out with stretch yeah marks because of the oils cocoa butter um, I don't think there's any studies out there, but like just just lather yourself up during pregnancy but that, but a lot of times.
Speaker 2:They need muscle repair too. Oh, that's yeah.
Speaker 1:I'm just talking strictly about stretch marks and it doesn't matter, like the more you, whether you're going to get surgery after childbirth. Like the better skin care, like the better your outcomes will be.
Speaker 2:Yeah, I was listening to some lectures and they were talking about people that are on ozempic or weight loss and um, and they're going into surgery. Like what, what are you recommending like pre and post-op surgery doing with the ozempic?
Speaker 1:they were talking about competition rates and stuff ideally stop two weeks beforehand and start four weeks after. There's no science behind what I recommend.
Speaker 3:Yeah.
Speaker 1:But that's Because I feel like at the four Like two weeks should be good enough. Where like it. I know they say for surgery one week, for aspiration risk that's if they regurgitate food into their lungs and have complications from being intubated yeah uh, so I just like to do two weeks and I also like to have patients on high protein supplements. Yeah, that time and for four weeks after, because I don't want to suppress their, their food intake, so they can promote that healing.
Speaker 2:But do you, do you think it's dose dependent? So, like I, I, I go different way. So I usually say one week beforehand and then I, I almost start them immediately afterwards. But I think you know, know, I got to look at patients and pour any of those and pick on the wounds.
Speaker 2:Yeah, it works great. Um and like I, I think, like it's okay usually I started a week after, but I, I think if they're on low dose, that's actually, and there there's some parts of it, with diabetics saying, like you know, you almost don't want to stop them oh well, yeah, with diabetics sugars can be much better controlled with it yeah, worse controlled sugars, diabetics.
Speaker 1:Yeah, I shortened that.
Speaker 2:They were saying there's a study that says um higher complication rates with people on ozempic.
Speaker 1:Um like going again dose dependent and timing like yes, of course there will be um and again one of the biggest correlating factors to healing is nutrition, yeah, and if you're, you're suppressing your need to eat yeah and so. So two ways, but the way I think about it, two ways. You're either suppressing the need to eat, so like with ozempic juice, right away you're resulting in worse nutrition, or if you're diabetic, you're already more prone to have those complications anyways.
Speaker 2:So it kind of confounds the Well, I don't think I got to look at the study. I think the diabetics were out of the. You know, I don't think they were used, it was more you do not need to say I need to look at the study.
Speaker 1:You have an opinion about it, just yell it.
Speaker 2:But like I think one of the main things that you gotta look at is like how?
Speaker 1:they gave me autism.
Speaker 2:How they controlled at the age of 43, how they controlled the, how they controlled the patient's diet. You know whether it's going to be the clip that goes viral he's going to be known, the guy he linked. If you've got a vaccine and you're on. Osempic you are fucked. You got long, covid.
Speaker 3:Don't get more vaccine, sorry.
Speaker 2:But like I just think they probably didn't control for the diet, you know, oh yeah, you know, like people on Osempic, like if you're not, going to control for the diet. Oh yeah, oh definitely, you know like people on Ozempic, like if you're not going to control on the diet. They already have a poor diet and they continue to take it. And they're still eating McDonald's after surgery, like you know, they're going to have.
Speaker 1:But there are studies that show that people in general on the GLPs end up eating healthier on the glps, end up eating healthier like. So if they're consuming like 20 of the calories, yeah, those calories are way healthier like.
Speaker 2:Yeah, they're more likely to go eat cucumbers than potato chips yeah, and I wonder, like bmi selection too, you know, and the study like whether you know they looked at you know, like it's a multivariate, like approach they do it, but let's like look it up.
Speaker 1:They do the multivariate approach but there's still like stuff they either can't measure or didn't measure. Like any study can get ripped apart, I'll be glad to do it.
Speaker 3:Why aren't people losing weight? Why are people fat? He people losing weight. Why are people fat? He's asking yeah, why why?
Speaker 2:are people eating sugar dude.
Speaker 1:My favorite is uh listening to eating crap.
Speaker 1:Um no, the best the best takes were about 6 to 12 months ago, watching like cnbc and listening to investment like advice. Because that's when, like it really tells you they have no idea what the hell is going on. Because they're it made sense at the time. They're like oh, this is going to change everything and stock prices for, like, mcdonald's and Coca-Cola are coming down because the stock prices of the GLP-1 drug manufacturers are going up. Then it's like, you know what? Like, people are just not going to want to do this. People like to eat, they like to consume this stuff Like, and they don't want to like. Some people feel like they need to do it, but it's not as revolutionary as everybody made it out to be about 12 to 18 months ago, because they were just like oh, it's going to change people's habits, like mcdonald's, like margins are going to decrease, like go buy cucumber stocks, I don't know.
Speaker 1:But in in the real run, like in the real world, like how many people get on it and just stop at what's it? 50 to 70 percent, oh, and uh glp1 just just stop because they're like I didn't like it. Man, I don't know I I'm, I'm cool with this weight. The same thing with like like weight loss surgery, like gastric bypass.
Speaker 3:Are they happy because they lose a certain amount of weight and then they think that it's good.
Speaker 2:Sometimes they also become uncomfortable with the excess skin.
Speaker 1:They just don't know what to do. Yeah, but a lot of people quit within three months.
Speaker 2:But you know the excess skin patients only like 20% or 30% of massive weight loss patients actually get surgery on their excess skin oh really, yeah, it's very the problem with mass why?
Speaker 1:is being able to afford you also got to look at.
Speaker 2:Yeah, patient demographics on who gets massive weight loss surgery. It's not the higher socioeconomic. Yeah, of course.
Speaker 1:And weight loss surgery has greater than 33% failure rate. Like people eat their way out of a gastric bypass or a gastric sleeve, so, I looked it up.
Speaker 3:What's the failure rate? 33%.
Speaker 2:Over over 33%. I think that's a conservative measure. So, compared with non-GLP-1 controls, I think that's a conservative measure. So, compared with non-GLP-1 controls, glp-1 users have similar postoperative outcomes following body contour and surgery. Wound dehiscence is more prevalent among patients taking GLP-1s for diabetes compared with weight loss. Okay.
Speaker 1:So it's probably the diabetes yeah.
Speaker 3:And then he gets a random story.
Speaker 2:But no, no, they were talking about it at the. It was the aesthetics meeting. It was like a video recorded spring meeting that I went through and like they were talking, like they made it seem like it's.
Speaker 1:But if you got diabetes in the appropriate amount of money, I'm willing to do the surgery.
Speaker 2:Yeah, and the revision Do it in a hyperbaric chamber, yeah.
Speaker 1:Yeah, it's. I don't think, no matter what happens until, like everybody's, like food habits and the industrial complex changes in how they provide and promote certain foods where you're actually going to see a decrease, that's what by now, if it's like this many years into glp, like by next year or in two years, you're finally going to see like the obesity rates stabilize or decrease.
Speaker 1:Because every time they put those stats out it's like, oh, 33% of the US is obese. Next year, 32% is obese. Yeah, so it hasn't really changed. People can eat their way through anything. Yeah, that's why, like underground rails, their way through anything.
Speaker 3:Yeah, that's why, like underground rails, I mean. I mean I think that the difficult part is obviously staying committed to anything for a long period of time, no matter what you know you wake up and you say you want to do glp ones, and you do it for even, say, a year, but then after a year you're done doing it yeah, like I said, most dropout is within three months with before you see any results yeah, because people don't feel good on them sometimes.
Speaker 3:Yeah, you're not and you don't want to ride out the side, especially with not like ruse.
Speaker 1:Ruse went to max dose day one, puking his guts out he just continued that shit.
Speaker 2:The thing is especially with garbage.
Speaker 1:It's like they told me to titrate up and mom's.
Speaker 2:I think one of's he put in his body.
Speaker 3:He's making himself sick. What's going on?
Speaker 2:I think one of the biggest issues is, like with telemedicine and like everyone just ordering it for patients without having a good walkthrough of why they should take it.
Speaker 1:Oh yeah, and like just, some random dose.
Speaker 2:I had a patient today. She's like, yeah, someone gave it to me because I have Hashimoto's, and she's like, but I haven't decided to take it yet, and she came in for like a tummy tuck and you know she was tiny.
Speaker 1:12 months later it's been sitting in my fridge, so I just started taking it.
Speaker 2:She's like should I start taking it before I have a tummy tuck or not? I'm like it's up to you. It's like what goal weight do you want to reach? How far away are you from it? I'm like it's good long term and I started describing like what it's good for and she's like, oh, I never knew any of that stuff yeah I'm like you need to explain why like something like this is good for patients and not just hand it to them for weight it regulates their thyroid hormone too.
Speaker 2:Right yeah, it's anti-inflammatory, it's just better protective good for your good, for your kidneys, heart, everything um and also for your brain overall.
Speaker 1:So better body balance, that's how I just describe it it's. It sets you on a way better path so even if it's just, weight loss, just having that weight loss.
Speaker 1:That's why I like a lot of specialties. Like you go for a spine problem, oh, you need knee replacements. The first thing they tell you is it's just weight loss, just having that weight loss. That's why I like a lot of specialties. Like you go for a spine problem, oh, you need knee replacements. The first thing they tell you is weight loss. And because it just it takes care of a lot of little things that you actually probably won't need surgery for.
Speaker 2:So one of the craziest things I just looked up was you know, europe versus united states food chemical bans. So european unions over 1300 food additives and chemicals are banned or strictly regulated, 1300, 1300. United states fda 11 foods. Approximately 11 foods. Additives are explicitly banned.
Speaker 1:That's right. I'm never going to eu I want my freedom, don't tell me what not to eat.
Speaker 3:I want my craft mac and cheese sauce. Look at these chemicals.
Speaker 1:Craft mac and cheese sauce is definitely the best thing for you, right oh yeah, oh uh, I don't know. I don't know if craft is better than velelveeta.
Speaker 2:Just put some Cheetos in there.
Speaker 1:Nacho cheese isn't technically a cheese Tastes so good though, dude nacho cheese is not technically a cheese. That's where we've gotten to Lucky Charms you got your what is nacho cheese made out? Of? I don't know.
Speaker 3:It's definitely not out of milk clearly they better keep Cheez Whiz in those Ph.
Speaker 2:keep cheese whiz especially if it comes out of the squeeze bottle right, the philly cheese steaks are out if the cheese whiz goes oh yeah, what was that one?
Speaker 1:what are you gonna do?
Speaker 2:oh, this is another, there are over 10 000 chemicals and additives currently allowed in the us food supply drugs, coloring, packaging agents and more more under FDA regulations, many of which haven't been re-evaluated in decades.
Speaker 3:Great so what are you guys doing surgically Bruce?
Speaker 1:with your green slippers and blue scrubs, you look like a cereal additive.
Speaker 2:The European Union restricts this to around 400 permitted additives, so the US list is more than 25 times larger.
Speaker 1:The one thing I will say is how you're going to keep that list up. There's in like, so many different molecules to be able to like. Have an agency to list all those molecules but like but.
Speaker 2:But what's scary is like what's allowed to be. You know like what. You can list your food as organic. It's like. You know fda says, as long as it's organic, this percentage or like, even like grass-fed, like we're.
Speaker 1:You know you're thinking like you're getting these grass-fed milk and like but there's still a lot like one percent, like rat ass, yeah, yeah, no grass-fed just means, if they ate grass at any point in their life.
Speaker 2:Yeah, so they could feed them oats and grains and stuff and like biotics yeah, like, because like there was, there was. There was a video on like grass fed versus grass finish because of, uh, the liver king guy, his protein says like Swedish grass-fed grass-finished and I'm like what the fuck is grass-finished? I hadn't heard of that. Grass all the way through, but like it's grass all the way through where, with grass-fed, it's like any time in their life Grass-finished the last six months of their life.
Speaker 1:Sprinkle that on there.
Speaker 2:Yeah, the last six months of their life they're fed grains and stuff to beef them up.
Speaker 3:Is there anything grass-finished? I haven't seen any product grass-finished.
Speaker 2:I haven't seen grass-finished, but I'm pretty sure it's going to be marketed pretty big pretty soon.
Speaker 1:I want to start my own thing grass all the way through it's like, like god, they just finish with grass.
Speaker 2:Yeah bunch of lazy grass diarrhea.
Speaker 1:Sprinkle grass on them right when they kill them. Yeah, they murder your animals. We take it easy but actually like.
Speaker 2:The other thing is like, you know, I was like why, why do you need halal like this and that? But actually like, when you think about it like halal meats and stuff is actually pretty good because you know they're. They cut the necks and they drain out the blood from the animal, so all the blood's drained out, instead of like shooting them in the head or however they get rid of all the toxins.
Speaker 2:They they keep all that blood in them and like it gets contracted, so they have all the toxins still in them. They're not drained. So when you're eating halal or kosher, that's gonna help with like getting rid of a lot of controversial take.
Speaker 1:I've had more arabic uh restaurant halal meat than Persian halal meat. Yeah, but I do find the Arabs dry out the meat way more.
Speaker 2:Do you think it's that? Or the Persians just toss meat tenderizer? I think the Persians just put so much meat tenderizer on all their meat, just like, and then and then you bite a falafel.
Speaker 1:I don't know about you guys, I bite a falafel.
Speaker 3:I don't know about you guys. I freaking hate falafels. Oh, I always.
Speaker 1:There's some good falafels, but you got to make sure you have water in your hand, dude. I tasted paste when we first moved to the US in the second grade. Put it in my mouth and every time I eat falafel I have that same sensation of eating freaking paste like ah, why did I do that?
Speaker 2:you usually can't eat more than one or half of one.
Speaker 3:Yeah I always get tempted. The place east side pockets in rhode island used to have good.
Speaker 2:No, you know where I had the best falafels I've ever tasted. It's a hookah shop in old town scottsdale that was next to w that place. Really the guy, the guy's like, yeah, the owner. He's like it's my mom's old recipe and his falafel was off beyond that's why, yeah, it's hilarious. They should be called full awfuls, yeah the thing is the you know, making them with a recipe, versus, like, getting the costco restaurant brand and just frying yeah, costco.
Speaker 2:Costco has falafels now hot dogs, slices, I'm sure they have everything. Yeah, they probably have falafel at the outside grill you can like walk up to.
Speaker 1:I'll take two one dollar hot dogs.
Speaker 3:I take a year off my life every time I have a costco hot dog. But man, they taste good.
Speaker 1:Yeah, that's why euros are called euros. It's all made. Majority are made with like um frozen, supposedly lamb meat, so it takes a year off your life they just like put the whole lamb and it grinds it and comes out. I don't know I mean I work, we worked at concession stands yeah, it was just like slabs of like frozen, like lamb strips you throw onto the grill and you just watch. Well, it's a little bit. It says added lamb added lamb flavoring.
Speaker 2:I'm like I don't want that lamb flavoring take that out?
Speaker 1:why do you have to add lamb?
Speaker 2:flavoring. I'm like I don't want that lamb flavoring. Take that out. Why do you have to add lamb flavoring to lamb, Shouldn't?
Speaker 1:this taste like lamb.
Speaker 3:Another illegal ingredient Adding the gaminess to the European unit. What do you guys do surgically for these massive skin weight loss people?
Speaker 1:We cut the excess skin off and close it. Okay, that's the clip.
Speaker 3:Is that it Really? Is there any?
Speaker 2:like. No, it's almost like you know magic moves, Like you're cutting them with a saw in half and sewing them back together. That's pretty much what it ends up being.
Speaker 3:How do you measure it out? You pull it.
Speaker 2:You pull it and measure and make up markings. Yeah, you make your markings.
Speaker 1:You don't want to go too too tight, because then you know you're going to increase the amount of tension on there, but you also don't want to remove too little, so you gain a little more with experience. But it's literally like retracting, aka pulling, yeah, yeah and making the marking.
Speaker 2:And the best results are if their BMI is less than 35 or 33. You want them?
Speaker 1:at that goal.
Speaker 2:weight you want them at that goal weight for like six months or so before operating on them because you don't want them malnourished, otherwise, like you know, you're not going to get great results. And it becomes like art kind of, because you're you know you could like some of the stuff, like the tummy and stuff. You get the basics but with some of these patients you almost have you. You got to think differently because some of the roles some people like when they're obese, they have like eight, ten roles and you're like there's no way of retracting down, so sometimes you have to make an upper incision but the but, the roles.
Speaker 1:The roles are because of the attachments from the skin to the deep fascia so you know you have to like kind of either eliminate those from underneath, like dissect up that far, or just live with some of it yeah, it's the same thing you do with the eyelids, it's just bigger. Yeah, yeah, what do you?
Speaker 3:do for your eyes. Oh yeah, you pull it. Markings are the most important part of all the different ell, different ellipses, yeah.
Speaker 2:Yeah, like with the chest, especially for guys. You have to become a little more creative with what you do, because it's not, you know, for the females. You do your lift and then you do the bra line in the back and it's more.
Speaker 2:Also, I'm going to do two different types of planes, but for the guys, guys, you almost have to take like a pyramid off to kind of decrease that central portion instead of going through the back, and different people carry their weight different, they have excess skin in different locations. So you got to kind of um, you know, and we mark the patients and then, once they're asleep, we take them and we preemptively like staple everything and see whether things come together and what it's going to look like before, like actually doing the procedure.
Speaker 1:What do you do? Okay, not much, that's because hard enough on the lower eyelid that the skin just comes up it's like, okay, natural and nancy pelosi natural nancy natural and then you know how many people I have.
Speaker 3:They always ask. They're, it's always nancy it's always. It's always pelosi or who else do they tell me about? Um, oh yeah, I mean, I mean, you guys get have.
Speaker 2:I said it on this pod, but nancy pelosi looks like she's perpetually seen a jack-in-the-box pop out for like the last 25 years like oh, oh, you got me again, but like it just never well, when her husband's like gets caught with like a naked, with a guy running around with a hammer holding hands well, she probably sees that every day and the cops are like that's an awkward.
Speaker 1:He just got caught once. The hammer is one of the most crazy sex tools I've ever used.
Speaker 2:Dude, there was a guy running around the house attacking him with a hammer.
Speaker 1:They were both naked right. That was so awkward.
Speaker 3:Were they both naked, or was it just the husband that was so awkward? When did this happen? It was like a year ago, two years ago. Come on, dude.
Speaker 1:Open your eyes. You're an eye doctor.
Speaker 2:I think Nancy Pelosi's favoritism died out after that. She had to go into hiding because it was she just had a really bad favoritism.
Speaker 1:It was pretty poor before then.
Speaker 2:Yeah, she was never liked, but I think that like went down the drain ultra fast.
Speaker 1:I don't know. She's just got to start a hedge fund. Yeah, I would invest in it. It's just regular year over year, 80% returns. You invest in that for like three years. You never have to work again. It's like, oh, I'm so good at the stock market, I'm on the Pelosi index. Yeah, how about deporting all these Mexicans? I'm kidding, work again. It's like, oh, I'm so good at the stock market, I'm on the pelosi index. Yeah, how about deporting all these mexicans? I'm kidding, I love mexicans especially the ones that come and sign up for surgery.
Speaker 2:Yeah, actually they're always great, you know what?
Speaker 1:just just just follow my instagram feed and you'll know how much majority majority of my videos are all like my algorithms are pretty much right now. Just feed me Mexican memes Like the last one was like the Rage Against the Machine, played with the slick and mariachi style. It's just nonstop.
Speaker 2:And then like German sends me more, yeah, german sends us. Yeah, german, just totally.
Speaker 1:I can't help it. I'm like don't do it, don't do it, oh crap. I watched the video to the whole length. I know I'm gonna get some more like too, and I'm like no, why did I just hit like?
Speaker 2:and you take, you go to the next reel, it's another mexican reel, and you're like, oh man, it just.
Speaker 3:And I mean my favorite meme is Mexican word of the day.
Speaker 1:Oh, yeah, it's like my favorite. That's old now.
Speaker 3:I know, but it's still awesome Like Mexican word of the day. Juicy, tell me if you see the cops.
Speaker 1:Which ones are there from?
Speaker 2:Namaste.
Speaker 1:It's just great. Namaste has got to have like a hundred of them. I personally like there was this wedding going on and this mariachi band and like getting drawn by a trailer and this fight breaks out and the bride's like getting in the middle of it and the mariachi band just starts playing the theme song for Rocky and they all get in it. It's like it's so good.
Speaker 1:I was just like why have I watched this like 25 times, like now? I went to bed at a good time, being age proof, but except I watched that one clip, like to the point where Sarah got up and was like, can you shut that off?
Speaker 2:It's like shut that off. It's like so all the people make in front of persian, like parents and stuff that they do.
Speaker 1:Do you think anyone else gets that? Nobody, no, no, no way, no way. All I've figured out all of the. There's a lot of comedians that make it big in their own genre or their ethnicity. You've seen it with, like indian uh comedians, yeah, and like I know enough indian people to find that stuff funny. Yeah, but like the it's, it's so niche. There's just, there's just no way. Maybe like little pockets here and there, but there's no way. I think some of our friends would get it from just watching our parents and us be like, oh yeah, seen that happen before, but I think it just serves those niches.
Speaker 3:Yeah, who's the Indian comedian who has the Netflix? I always ask If you want the Netflix special.
Speaker 2:Anyone that meets me they used to ask me oh, have you watched the stand-up? I'm like he's fucking Indian, I'm fucking.
Speaker 1:Iranian. I know we're brown, but no, I'm not brown bro. I'm olive.
Speaker 3:I mean, Aziz is the big one he is, but no, it's Ross.
Speaker 2:No, not Ross, not Ross, what not Ross?
Speaker 3:Not Ross. What was his name? I guess we have gone completely off topic today.
Speaker 1:One of my friends in med school. He was just talking about going to this guy and I thought he was hilarious too. And this friend always wore like pretty, like loud gear, like he'd buy designer but not just designer, but make sure the sign's ultra big, and he was like talking up going to see this guy and I was just like, oh, that's, that's great, you get to go. He's like, yeah, I'm like right in front and the day after the show he comes back. I'm like, hey, how was, how was the show? And he's like, oh, it was great. And then I had to get up and go to the bathroom and he saw my sequined skull on the back of my shirt and he was just like the rest of the stand-up was about me and he's like I couldn't get away from it. And he was like there's at least a good 30 to 40 minutes of him just cracking on him and who he was as a person and what he was wearing.
Speaker 1:He was so disappointed he was just like I can't believe I did that. I saw that coming from a mile away. I know what you're wearing, russell.
Speaker 2:Peters, russell Peters. Yeah, what did I say Pete Ross? Pete Ross is a pretty Indian ring to Peters Russell Peters.
Speaker 1:Yeah, what did I say, pete Ross? Pete Ross is a pretty Indian.
Speaker 2:Yeah, he is.
Speaker 1:It's not a real Indian name but like yeah, everyone would be like oh have you watched that Russell Peters?
Speaker 2:It was either him or that that American guy that made fun of the fucking like terrorist. I forget you like had the puppets and stuff and I'm like terrorist. I forget he like had the puppets and stuff and I'm like why would I watch something that's making fun of? Oh, the ventriloquist, yeah, whatever it was.
Speaker 1:Yeah, I couldn't get into that. That was like the dumbest fucking shit. It was so bad, jeff Dunham, jeff Dunham yeah, fucking Jeff Dunham.
Speaker 2:Have you watched, jeff? I I'm like no. Think of real comedians.
Speaker 3:Yeah, I don't know how that guy got big, I know.
Speaker 2:It was just horrible. It wasn't even funny, Like Russell Peters is funny.
Speaker 1:Yeah, yeah, yeah, but he's Indian, he's not freaking Iranian. Yeah, or you're off-white.
Speaker 2:Yeah Well, I don't even know if he's Indian or Pakistani.
Speaker 1:Nobody does. Yeah, show me your birth certificate.
Speaker 1:It probably says Canadian One of the most underrated Indian American. I always think back to this Mitch Hetberg, just like the most dry comedy in his delivery was a poor guy who passed away when he was under 30. He was like you know, you've got that fancy bread. It's like you open up the first wrap and take the bread out and it's still under another wrap, the dumb lines almost like norm mcdonald's style, but actually with a little more character than norm and um oh. One line that's always stayed with me is like if, if I were to be anything other than a human in life, I would be escalators, Because even if I'm broke, I'm still a set of stairs. This is like I don't know why. It's like burned into my memory Like it's one of my favorite jokes of all time.
Speaker 2:You know what's funny? Like joe rogan does, like this, what's it? Parks and something and he has, like shane gillis ari shaffer and what's it max? No, is it max norman? I don't know or norman, norman, that that guy like. He's pretty much like norm mcdonald yeah it's norman and his name, but they're like a couple of them are on shrooms. I don't know how Ari Schaefer ended up being shirtless in the middle of the show. They have their sunglasses on because they're tripping and they're doing a podcast, but it's freaking hilarious.
Speaker 2:It's just like this they're just sitting around.
Speaker 1:I'm going to watch it.
Speaker 3:Yeah, is that?
Speaker 1:what we're doing next. Yeah, call joe, we need mushrooms they smoke cigar.
Speaker 2:I'm like joe you, you're supposed to be like this health freak and he smokes cigars people follow all his health advice. Yeah, smoke cigars that that probably kills us covet, so he doesn't need vaccination.
Speaker 1:Yeah, that prevents you from having to shove bleach up your butthole.
Speaker 2:Yeah.
Speaker 1:What do you do, Sir? No, don't do that with my light.
Speaker 2:Well, if you cold plunge, it probably gets rid of that bleach in your butthole.
Speaker 1:Oh, cigarette smoke was good for COVID, wasn't?
Speaker 2:it. Yeah, you had less likelihood of getting COVID if you smoked cigarettes.
Speaker 1:It's like, oh yeah you want to get in this body. Fuck you, bitch Wait till you.
Speaker 2:Find out what's inside.
Speaker 1:Some fucking straight nicotine, some tobacco, bunch of fucking additives. Get over here, did you?
Speaker 2:hear his story about the COVID shot, because he's never had the COVID shot. But he went to get it and they told him they ran out and he was going to get Johnson Johnson, which is known to cause the blood clots and stuff. So they were handing him out and he went to get it and they're like oh, we don't have any for you right now. So he's like. He's like that was probably the best thing that ever happened to me, because then I researched and I'm like what the fuck am I about to do?
Speaker 1:My favorite COVID memory amongst my hundreds and hundreds. No, I'm kidding, sarah got COVID. Yeah, ari got COVID, and this is when we were on trauma call. So we're working like 100 hours a week and this is like everything's still like shut down, but we were working. Oh, it was like a war zone. Yeah, it was a straight up war zone, man.
Speaker 2:Everyone's in, like all these suits and you're like should I be walking into this fucking place?
Speaker 1:It was like shortly after I moved here from.
Speaker 2:New.
Speaker 1:Orleans and New Orleans, we legit had one of the tents. New Orleans and New Orleans, we legit had one of the tents. I was like they, freaking ran out of places to put these tents once they had to move them out of Afghanistan. It was just like the helicopters are going to start landing on here. But and it was the drive up testing and looked like I was trying to hide ET from the FBI and go and like just get stabbed in the nose and it looked like I was trying to hide ET from the FBI.
Speaker 1:Yeah, and go and just get stabbed in the nose, the thing. And I'm like, oh yeah, because I hadn't taken any time off and it was like again, 80 to 100 hours a week and I'm like, yes, Sarah got COVID, Ari got COVID. I've been scared to ask for time off. I'm going to get COVID.
Speaker 2:I'm'm gonna take like seven to fourteen days off you guys like you're negative.
Speaker 1:I'm like you're kidding me.
Speaker 3:I've been trying to get covered for the last five days like went back negative again.
Speaker 1:I'm like no way, there's no way they test that's probably because you didn't get the vaccine yet.
Speaker 2:If you had the vaccine, you would have been positive all the other crap in my system fighting off COVID.
Speaker 1:This is before vaccines.
Speaker 2:Yeah, you probably got COVID before. That's why, if you had the vaccine, you'd probably get it.
Speaker 1:No, I think the staff I picked up in the hospital fought off the COVID. It's like nah not happening here buddy Seats taken.
Speaker 2:I got more COVID after I got my vaccine.
Speaker 1:I never got COVID. I got pretty sick a couple times. You never got COVID.
Speaker 2:I think I got like, I got COVID. I never tested positive, but I felt like it was something like COVID.
Speaker 1:Seriously through, like the last five years, knock on wood or whatever. I got COVID, I never tested positive for COVID. I probably have COVID right now.
Speaker 3:I got COVID. I never tested positive for COVID. I got sick once. I probably have COVID right now for my son. Great, and you got near me.
Speaker 1:Yep, I'm there for you. I mean, yeah, we've been sick for like five years ago. I feel better now. It's good I got the vaccine five years ago That'll help me.
Speaker 3:now it's like day five I felt better, and then I felt better and then, like yesterday, it felt terrible.
Speaker 1:I think we just need a new, like rebranding, like we need COVID-25.
Speaker 2:It's probably a different virus.
Speaker 3:That's why I'm sucking down these cough drops.
Speaker 1:Why did COVID not get served at the bar?
Speaker 3:Because it was 19. Because, covid-19, I think our shows. This is our bad joke for me like 8 times probably, I think, our pad's done. Yeah, someone's, someone's done someone's done.
Speaker 1:No, you're actually gonna have to stay here and shoot 30 extra minutes of filler material for our previous episodes and we're just going to get a cardboard cutout.
Speaker 3:Well, you guys have been with guests a bunch.
Speaker 2:So, Ram, do you do agility workouts?
Speaker 1:He used to do functional.
Speaker 2:But not now. I think you need to do it more now than ever before.
Speaker 3:I know I need to do a lot more than I do nothing.
Speaker 1:Well you're technically doing it. When you're running after Saran, I know After.
Speaker 2:Saran, it looks like the crunch. It's so bad for your body, dude.
Speaker 3:My body's falling apart.
Speaker 2:I need to start Dude. Everyone that was watching them was like you're like all of a sudden shooting.
Speaker 1:I'm like that needs dude, that's a good way to like judge, like like nfl prospects, instead of doing the reaction test it's like being able to get, and then it's like why?
Speaker 3:why are you going to sleep? When he goes to sleep, I'm like dude. Are you kidding me? Like how?
Speaker 2:I have to be awake when he's awake yeah, and it's.
Speaker 3:It's like nine o'clock right now and I've been running after that, madman what time do you usually go to?
Speaker 2:sleep when shy does what? When is that? It's usually 8, 39, yeah I try some nights I I stay up a little.
Speaker 3:I want to stay up but I can't. I used to.
Speaker 1:I legit what I do is I and the thing is we're all night people right, we all like when we were growing up, we'd fall asleep at like one.
Speaker 2:Oh yeah, yeah, yeah yeah like right now pam falls asleep at like. It goes to bed at midnight, one o'clock, but I I use that time to lay on the red light mat, which I don't know. I I hugely like recommend that because I think it got rid of my back pain and inflammation.
Speaker 3:What should I be doing for agility training?
Speaker 2:Nothing. Just run after Saran. That's what we were talking about.
Speaker 3:I need to stretch. I know, I don't know.
Speaker 1:That's the thing.
Speaker 2:Anytime I stop stretching, I'm just like yeah, that's why I bought that whole table. Pam's, like what the hell are you doing? More gym equipment.
Speaker 1:That's why you got to get rid of the row machine. We should. I thought he bought something.
Speaker 2:I bought the knees over toes guy. I told you, I told you on Sunday I bought the knees over toes so I can do, norik lunges man that thing, you stretch out my quads.
Speaker 3:Do all three of us have to show up to the surgery center to get a full out gym?
Speaker 2:Yeah, she's like you're not adding anything else.
Speaker 1:I know she's like you're not making it like your office right now.
Speaker 2:I'm like we'll put it on top of the round table.
Speaker 1:When she mentioned like this is where the tonal will go, I was like, oh, we're getting a tonal. I was like is that for us? Or the patients like, so I love it.
Speaker 3:I'll yeah, I'm I'm happy about that too and dude.
Speaker 2:The red light chamber that I'm gonna get is gonna be.
Speaker 3:I'm really happy about the tonal it's great all I can picture is him walking into a red light chamber.
Speaker 1:What's it Right side, fred, is that it Hit me with?
Speaker 2:those laser beams. So that red light bed I sent you, it has PMF, it has ozone therapy. You're getting all these things, does it have anything that works? All of it does.
Speaker 3:The red light itself.
Speaker 1:I think the red light. I don't know about the PRF, our hyperbarics has been off the chain.
Speaker 2:We were thinking of getting a two-person chamber, but I think if we do four, it's like you put three recliners in there, we can fire away.
Speaker 1:People won't feel claustrophobic yeah, you can blast you with this oxygen. You can just go chill like bro. We got all this oxygen in our clinic. It's gonna make you feel good. It's gonna keep you young, which it will. Yeah, it's like we're ready, you come and sign up.
Speaker 2:You can go and do your op notes in there, you can do all your work it all comes back to.
Speaker 1:Oh, that is true, it all comes. That is pretty balling so, oh, you can actually just sit oh yeah, you're just gonna put the thing go on a computer, oh yeah that's, oh, it's a it's like, uh like this size yeah, oh, that's amazing, it's huge. Oh, that's really cool ruse is gonna put the tonal first hyperbaric it's bought.
Speaker 2:No, not yet, not yet. No, it sounds amazing.
Speaker 3:Shortly. That's amazing. Yeah, sit there on your computer in a hyperbaric chamber that is perfect.
Speaker 2:It's gonna have a big tv and, like you, can put recliners in there oh my god, yeah, we're gonna just hang out.
Speaker 3:We'll have the. We should have the pod in the hyperbaric oh yeah, we could.
Speaker 2:I think thing does it, I think Thing does it.
Speaker 1:Yeah, brecca does it, weren't we talking to Thing about it.
Speaker 3:I haven't been back on the pot for like two months now.
Speaker 1:Yeah, thank God, you're just the filler.
Speaker 3:I am Fuck. We can't get a guest. Who are we going to call?
Speaker 1:Rob, sorry to drag you away from your family. I know you don't want to do this.
Speaker 3:You barely ever add anyways. I'm just clueless right now.
Speaker 1:But you joined me with a greige crew.
Speaker 3:Yeah, I got new Father's Day clothes to look like Rodmear.
Speaker 2:Are those Lululemon pants? It's Vori. That's what I said. Look like.
Speaker 3:Rodmear Vori Vori.
Speaker 1:We have to balance it out. We can't all dress like lucky charms, like issues, so with some some of us have to be grinch. I got some new clothes from uh isay miyaki. Yeah, I spent way too much on it, but um, don't worry. No, I got ashland's uh advice on a couple of brands to buy and I was just like oh dude, I can't believe I just spent that much what is it? It's close, it's close.
Speaker 2:Oh, I should have sent this real to you guys like um, so it's on that, like that rap guy that I send you, the Jewish rap guy that I send you every once in a while. So he makes fun of all these people that are influencers and stuff. And this one guy is talking about how he used to and you can tell this guy is just full of bullshit all the time. He's like he used to go to this Chinese restaurant and the the guy would like put the tables away and would teach him Kung Fu. He's like he's like who the fuck does that? No one does that. Like you're not the karate kid.
Speaker 3:We saw that on the karate kid. You're not the fucking karate kid.
Speaker 2:He's not Mr Miyagi. Mr Miyagi doesn't exist. He's in the fucking movie.
Speaker 1:If you do that, you can add 20% to the revenue stream. Imagine PF Chang turning into a dojo after hours. After everybody has diarrhea, they can hang around and fucking scrap you, eat Chinese food, have diarrhea.
Speaker 2:They can hang around and fucking scrap you eat Chinese food, have diarrhea, do some fucking Taekwondo. Well, if you teach them good Kung Fu, then they can go and catch the dogs for you.
Speaker 1:So they bring them back so they can kill it. Is there actual Kung Fu being taught?
Speaker 2:I don't know.
Speaker 1:I feel like it's just used for generic karate and Disney movies. You just teach them like generic karate and Disney movies.
Speaker 2:You just teach them how to go and catch people's dogs, so you they bring them back for your food. So then you got free, free meat, oh my god that's definitely cut to catch a predator.
Speaker 1:I think we're degrading with time and getting more and more racists, but it's cool. Racists. Yeah, racism is in now.
Speaker 2:We're with the in crowd Freedom.
Speaker 1:You gotta go woke or go racist, you only have two choices. What are you looking up? You couldn't wait five minutes for that.
Speaker 3:He's getting yelled at Ten minutes. Let's hit the gynecomastia.
Speaker 1:Gynecomastia.
Speaker 3:Tell me about male boobsia. Yeah, tell me about male boobs you tell me about your male boobs. Do you guys have a story about that? Like somebody that came in.
Speaker 1:Yeah, they've had oh well, so gynecomastia is breast development in males. Happens to some people, naturally a lot of people, after like taking too much testosterone and stuff, unsuper smoking too much weed weed definitely does it, weed gives you male boobs. Yeah, that's why you have them. Some other medications too. A lot of the psych meds do it too.
Speaker 2:Some of it's genetic.
Speaker 1:Yeah, so it's split up into three grades. Grade one is arguably operable. It's pretty much if someone has a problem with it, but those are like the quickest cases. Grade two you have some. It's arbitrary, it's like a subjective classification. And grade three requires the biggest surgery. I've actually recently had a couple like three patients that have had grade three. So they end up with the incisions all the way across the bottom of the chest where the outline of the pecs are, and then you elevate and place the nipple areolar complexes on as a graph.
Speaker 2:You know what I've changed. I I used to do that just straight across. I've changed to like an l-type incision because that gives you the scar, kind of gives you more of an outline of the pec. So I've changed it to an l-type incision and um kind of give it an area so you go here and up, so it kind of give them an accent, so you go here and up, so it kind of Okay, which grade do you do that?
Speaker 1:Grade three Grade three yeah, so.
Speaker 1:It matters Grade two, I've been a little more aggressive with packing more people into my thought process for grade two because of the changes with the like, vaser and the Renovian. You get so much more, especially with the like, vaser and the renuvion. You get so much more, especially with the renuvion. Yeah, you get so much of that skin tightening where there's people that you thought like if you hollow out, remove that breast tissue, it's going to hang low and look weird. Yeah. But now, like you have an option to tighten the skin after you remove that tissue, where, like I've been able to do that more to escape that big scar yeah, and it's all dependent on skin quality, right?
Speaker 2:so if the skin quality permits, you can do it. Some people, their skin quality like, will not get them away. But even then, like with some of the um great twos, you could do like an axillary lift. So you're not exactly removing skin underneath the breast, you're just pulling everything up and repositioning the nipple and removing the excess skin in the axilla. So the scar is hidden even with the removal. Yeah, with the grade ones, you usually can do it in the office. Yeah, caused by multiple different things, um or just and it's probably the most popular thing we do.
Speaker 2:We do sometimes two, three in a week and I sometimes line them up like, yeah, two or three in a day, um, in the office, uh, done under local anesthesia, uh, patients do great. And one of the things is people are like I can finally wear t-shirts again. Yeah, they, they wouldn't wear t-shirts or even like take their shirts off and stuff at the beach or at the gym and stuff so it just builds their confidence.
Speaker 1:I had a patient in his 70s undergo. He had grade three, so he had the full incision and I was like, if it's that bothersome, then he's like, yeah, I don't like it. He saw a few other surgeons and went with me because of my charisma, but he got it done. And he's just like I give all like you, I give all our patients our phone numbers. So I'm like, oh, if anything comes up, he's like, oh, I'm just concerned about this. But oh, man, this is on day two where everything's like swollen and bruised. He's like this is fantastic. He's like I can't believe I waited this long to do it. And it's like every time you hear that like, yeah, I can't wait, I, I can't believe I waited this long to get it done, no matter what procedure is like that really hits home, like I feel good about what I'm doing.
Speaker 2:I think a lot of it has to do with you know, like just the information being out there and people know, because, like people like oh, I never knew there was something out there that you could do about it. Like I have it and I thought my chest, you know, my pec muscles were grown, but it would grow faster than my pec muscles. I have a small amount but like I haven't done anything, like my skin's pretty bad. So if the tissue gets removed.
Speaker 1:Do you find it bothersome? Yeah, If you decide to proceed.
Speaker 2:I know, actually looks plastic surgeon for you.
Speaker 1:If I could do it from on myself, I would do it otherwise I don't trust anyone else yeah so with gynecomastia.
Speaker 2:So like what one thing that could be added on? You know, like some people need a little more refinement in their chest, I do quite a bit of liposuction. I liposuction the area out and then I remove the tissues, and the other thing that could be done is adding some fat back into the pec muscles to make that appear much more youthful and bigger. Um, where it's more masculine and you know it helps with the overall like look of the entire procedure, I think fat grafting is a huge tool into the pec muscle. It.
Speaker 3:It's a great option.
Speaker 1:Yeah, patients out, Even in the breast overlying it to define the pec muscle you get a lot better definition.
Speaker 2:Yeah, some men I've removed pretty much 500-600 gram breasts off of them. They have full female breast tissue. It's just genetic it's their home hormone, especially like obesity. So if you're if you're more obese, you're going to have more estrogen and more likely to produce breast than if. Yeah, if you're someone that's lean not that someone that's lean that can't get the breast tissue Everyone has that breast tissue, but there's something that causes it to develop and get bigger, like for me.
Speaker 2:It's probably from me being overweight. You know like being younger between 8 and I forget.
Speaker 1:I think it's because you walk like a woman 16.
Speaker 2:I was pretty, pretty obese when we moved to the us. I think the diet weights fluctuated yeah, big time. Yeah, like I, you know, during wrestling season I would drop 20 30 pounds and get ripped up. But but that wasn't until, like I was sophomore in high school, where I would drop the weight and get, and then, once I entered college, I gained a lot of weight for football, but then I dropped back down in med school.
Speaker 1:You fluctuated between like what like, 190, 200 up to like three plus.
Speaker 2:Yeah.
Speaker 1:And then back down and back up. Yeah, and back down. Back down, yeah yeah, that's a lot yeah.
Speaker 2:So that's why, like you know, doing longevity and peptides and stuff to just kind of maintain that weight and build muscle and, you know, have the energy and stuff it. And I've tried every diet in the on the planet. Yeah, most recently I'm on the carnivore diet. The problem is you can't try all the diets at once.
Speaker 1:We always talk to patients like plastic surgery doesn't cure underlying issues. Your underlying issues are diet, healthy life. We can probably make you look better, but you're not going to have your ideal outcomes. So there's again matters like if you're not going to have your ideal outcomes. So there's again matters like if you're overweight and how overweight you are, or like healthy living, like liposuction or tummy tuck is not a weight loss surgery. You're going to get some tissue removed, but it's not to like actually lose weight.
Speaker 2:Yeah, and I've changed the way I practice and it's great to have GLP ones and tools that we can use to help these patients to get healthier throughout their life. And then you can do something to change their body, to gain their confidence. Because, like before, you know when I first started, yeah, when you're like all right, I don't have a bmi limit, I do sort of have one, but like not really where you, where you totally know, like complication rates, everything's gonna break apart. Or you know the patient even undergoing anesthesia, it's not safe for them. So those, those are patients that you know we don't want to operate on.
Speaker 2:And then you know, then you're walking the line of, like some of these people that you're in there you're doing a tummy tuck, you're like or like they have so much intra abdominal fat, you're like I'm making you a little less round, but is this the right thing for you? And like I was just getting tired of that. So now I started on a weight loss journey so we can move on to like once they have the excess skin, removing that skin, and they're living a healthier lifestyle, they're overall healthier, they're going to have much less complications, they're going to have better aesthetic results, because if we continue down that path, you know, like I was in New York and some of my attendings are like, well, you don't turn them down.
Speaker 2:You liposuction them like three, four times because allowables yeah, allowable to like five liters per session and then you do the tummy tuck on them. I'm like, you know, like nuts yeah, it's crazy and these people would would get it done. And like there's someone in town that does high BMI patients. But is it the right thing for these patients? It's not it. It usually does not lead these people into a path of losing weight.
Speaker 1:I was actually starting to live on that.
Speaker 2:Yeah, it's you gotta, and it's not by just us. You know, I try to spend time with them and try to describe what they need to do to get into a position to have overall safe surgery and good surgery for them, rather than being like, oh yeah I'll remove all this fat and you're gonna have less fat this before glp1's.
Speaker 1:One study I wanted to do but couldn't organize the numbers, is to see like you still have a decent failure rate for gastric bypass and stuff where people regain the weight even if they lose it. But I wanted to see what percentage would keep it off if they had the weight loss surgery and had the removal of the excess skin and and follow up. It's obviously like going to be biased because the people are motivated enough to lose that weight, to have that surgery, to lose the excess skin, are probably more motivated to keep that weight off. But I think, like just just that process it's a it's
Speaker 2:a hit and miss because I actually started to do that not that exact research, but I started doing research on people that we were doing tummy tucks on because you think about it, you're kind of tightening up the muscles in the midline and they're going to have increased intra-abdominal pressure. They're going to have increased intra-abdominal pressure. They're going to eat less. We were finding like a lot of patients would stop eating as much, but that goes away within three, four months as your muscles relax a little bit and stuff and you know like when we looked at the numbers there wasn't much of a difference.
Speaker 2:You know, some people were gaining weight after procedure.
Speaker 1:I think the thing with with, especially after massive weight loss yeah again, it's your more motivated patients yeah also, if you have some parts with, like excess skin, subcutaneous tissue, yeah, you're.
Speaker 1:You're never going to be fully like over that because it's a part of you, yeah, and you're bound to like get back into habits. And there was a study a couple months ago in one of the top-notch journals that showed that once you gain weight, there's a genetic shift in your cells to want to return to the original amount, like your fat cells specifically. So even if you do whatever it is to lose the weight, and that's why probably people have to stay on GLP-1s or like a low-dose GLP-1 to maintain because your body gets shifted genetically to again want to gain, those fat cells increase the weight. So the one thing that study didn't do is follow up long term. Yeah, because I think if you keep that weight off, like, let's say like instead of one year, like five years, the chances you keep it off is like 90 compared to like, oh, if you drop well, your stomach might be paralyzed from the glp1.
Speaker 1:Yeah true, yeah true, but I mean, I think obviously, the longer you live a certain way have certain habits, the more likely you are to continue.
Speaker 2:But like with some of the long-term follow-up with liposuction patients, so like I tell the liposuction because everyone asks is like you know, when I have liposuction that fat's removed, so it's never going to come back. I'm like, yeah, in those areas that you have liposuction that fat is reduced and you're not going to have those fat cells there On top of it. You're going to have scarring, so it's going to be tough to regain fat in that area. But there's other areas that haven't been liposuctioned.
Speaker 3:So like if I liposuction your upper thigh.
Speaker 2:The fat is going to grow on your lower thigh once you gain weight. If you're going to gain weight, it's going to. You know you're going to gain a little bit in the liposuction areas, but the un-liposuctioned areas are going to grow tremendously worse than the liposuction areas. So overall, these aren't you, you know, weight loss surgeries. They're good for, like someone that has had weight loss and doing it afterwards, um, you know. And for best results. You know, being within a certain bmi. You know bmi less than 30 is perfect, but we I usually, you know 33 is usually my cut off. Yeah, 33 to 35.
Speaker 2:Yeah, or else you there's I cut it below 35 because if you're bmi over, 35.
Speaker 1:It's, it's you. You probably have some underlying issue that you need to take care of. That is not surgery that's gonna make you happy.
Speaker 2:So you're, you're, you're probably already insulin resistant, which, like, is already leading down the wrong path. So you need to get on something to control that and, like, get yourself to a healthier lifestyle because, yeah, like it's just not worth the risk of getting blood clots that go to your lung, and you're at much higher risk when you're running to hire.
Speaker 1:Not just that like just like you're, you're part of a family, you have a lot of people who care about you, yeah, and like it's just significantly decreases your risk for heart disease, stroke, like, even like Alzheimer's cancers. Yeah, so it's not like like it's kind of like just don't be selfish.
Speaker 2:Like take care of yourself, don't be selfish which is weird to say, but that's yeah and you know, there there's people that are out there that are against your glp-1s, you know, even like they're health nuts, but they're, you know they're against glp-1s because it's like cheat code for these people. But, like you know, for some of these people one thing is it's extending their life by controlling their sugars, even if they're eating poorly. But you know, I think overall they decide to eat less poorly than they would if they weren't taking GLP-1.
Speaker 1:Yeah, the studies show that. Yeah, just eat healthier yeah.
Speaker 2:You know, not everyone can stay away from sugars and processed foods. You know, and like work, stress, like all these things factor in with what they eat and like for me, you know I've been pretty regimented on what I eat and stuff. So like I can do that, I stay away from anything processed and and sugars. But like your average Joe isn't able to do that, I'm out.