Face It

Dr. Miami on BBLs, Ozempic & The Risks of Plastic Surgery Abroad

• Face It • Season 1 • Episode 1

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Face It: a new podcast created to cut through the noise of the beauty industry with expert-backed conversations that are actually worth your time.

Dr. Miami
Plastic surgery, BBLs, and the truth behind beauty culture.

Dr. Michael Salzhauer,  better known as Dr. Miami, breaks down how plastic surgery went from taboo to mainstream — and what that shift has meant for beauty standards, patient expectations, and safety.

Intro

SPEAKER_00

And what are the risks of getting a BBL?

SPEAKER_06

Death.

SPEAKER_00

Well, that's a big one.

SPEAKER_06

That's a big one, God forbid.

SPEAKER_00

Beauty standards have never been higher, and plastic surgery is a major reason why.

SPEAKER_06

You know, I call my patients beauty warriors because it really is like going into battle. There's scars, there's bruises.

SPEAKER_00

Did Ozempic change plastic surgery forever?

SPEAKER_06

Forever. Forever. It's really, really hard to lose fat on your arms.

SPEAKER_00

And the only way it goes away is if you suddenly everyone looks perfect, everybody's getting work done, and somehow no one's talking about the risks.

SPEAKER_06

There were many, many deaths, too many deaths, because if you inject the fat in the wrong place, it can travel from those blood vessels to your heart and lungs and kill you.

SPEAKER_00

So why is surgery becoming the new normal? What is a BBL? And is it actually the most dangerous procedure you can get?

SPEAKER_06

In the immediate next 10 years, robots for sure. 15 years, robots will do the surgeries faster, cheaper, better. All the non-invasive procedures are overrated. The laser treatments, the RF stuff. It's a lot of wasted time and money.

SPEAKER_00

Today we're asking the questions that you've always wanted answered. So would you say beauty standards have gotten better or worse?

Meet Dr. Miami

SPEAKER_06

I think it's. I love that. There's no subject off limits. Ask me anything you want. Go ahead.

How beauty standards evolved

SPEAKER_00

You're making my job easy. All right, let's do it. So when you first started practicing, beauty standards were very different. How have you how would you say they've changed?

SPEAKER_06

I mean, when you go back to the 90s, uh, certainly there wasn't the the curvaceous look was not in at the time. It was more kind of a holdover from the 70s and 80s was still in fashion, the kind of boyish uh heroine chic, they called it in the model industry, modeling industry, which is still kind of like that. But in the 2000s and the 2010s, the beauty standards shifted dramatically, almost 180, back to the curvaceous pinup girls of like the 40s and 50s, like more of a Mal Marilyn Monroe type look. And uh, you know, I know you're gonna ask me why. I think it's a combination of hip-hop culture and Kim Kardashian.

SPEAKER_00

Right. That's a big one. Yeah. So would you say beauty standards have gotten better or worse?

SPEAKER_06

You know, beauty's in the eye of the beholder. So I think beauty is beauty. Whatever you like, that's that's beautiful to you. Um, I think I I have a theory that over the course of human history, the curvaceous look was more considered more attractive uh to men. If you look at the older archaeological finds of fertility goddesses, they always have big breasts and they always have big butts. And so I think there is probably an evolutionary reason for that. Um, and you know, if you if you really want to get deep into the subject, I don't know if this is gonna be on topic or not, but I do like talking about this. You know, why do men like women with bigger breasts? Probably because it shows that they're healthy and can nurse infants, right? Um, why do they like big butts? Because it shows they have white hips that can, they probably won't die in childbirth, you know, which was a very common thing 150 years ago. And why do why do men like this this kind of contradiction of big breasts and a flat tummy? Because if there's a flat tummy, there's no baby currently inside that person. So that means that they're they show good signs of fertility, and currently nobody else has put a baby inside her.

SPEAKER_01

Right.

SPEAKER_06

So that is kind of the that's kind of been the beauty ideal for I think millennium.

SPEAKER_01

Yeah.

SPEAKER_06

And I think the more skinny boyish look is probably an anomaly of the, like I said, like the twiggy era, the 70s and 80s. And I think curves are probably gonna be in for a long time with some minor changes.

SPEAKER_00

That's awesome. I like I like the way you explained that. That's great.

SPEAKER_06

Cool.

SPEAKER_00

So, what's the one thing you think everyone should know about plastic surgery?

SPEAKER_06

That it's not like getting a haircut. It's not like you walk in and you walk out fabulous and you can go out to dinner that night. It's it's a process, it's uh it takes courage. You know, I call my patients beauty warriors because it really is like going into battle. There's scars, there's bruises. It's it's not what people on social media tend to make it look easier than it actually is. It's one of the reasons why I started doing the surgeries on Snapchat and social media to show people what it was really like. Um and I think, you know, for some people it turns them off. They're like, oh my God, I'd never do that. But for other people, they're like, oh, now that I see what's behind it, it's not so mysterious, and yeah, I can do it.

SPEAKER_00

We're definitely gonna get more into that because I have a lot of questions about that.

SPEAKER_06

Sure.

Subtle vs dramatic changes

SPEAKER_00

Um, so I was curious, though, can you get plastic surgery without completely changing how you look?

SPEAKER_06

Of course, yeah. Yes. Plastic surgery can be very subtle. There's certain operations that are literally a question of millimeters, like rhinoplasty, for example. It's like literally millimeters of change can make a huge difference. Okay. And sometimes middle millimeters of change can make a subtle, a subtle change that you know you, you, your friends and family might barely notice, but you notice right because it's bothered you.

SPEAKER_01

Yeah.

SPEAKER_06

So you can definitely do plastic surgery without looking like a completely different person.

SPEAKER_01

Right.

SPEAKER_06

But again, what I do is essentially psychiatry with a knife. So if it's a small thing that's bothering you and it can be fixed, nobody else might even notice. But if it helps you, great.

SPEAKER_00

That's awesome. So, what's one cosmetic procedure that you personally would never get?

SPEAKER_06

On myself?

SPEAKER_00

Yeah.

SPEAKER_06

I feel like breast augmentation wouldn't suit me. It would probably feel like, especially with with, you know, my wife would probably have questions.

SPEAKER_00

Yeah, for sure.

SPEAKER_06

Yeah, that's that's the one.

Why did Dr. Miami want to make plastic surgery more open to everyone?

SPEAKER_00

Great answer. So my next question is plastic surgery, it used to be super exclusive.

SPEAKER_06

Yeah.

SPEAKER_00

What made you want to be able to bring this to everyone?

SPEAKER_06

I fell in love with plastic surgery as a field and as an art when I was 19 years old.

SPEAKER_07

Oh wow.

SPEAKER_06

So long time. It's pre-internet, pre-digital cameras.

SPEAKER_07

Yeah.

SPEAKER_06

And what made me uh would made me so attracted to it was seeing a pic uh a book of before and after pictures uh in a plastic surgeon's office that he had had on his table. Like it looked like a wedding album, like those hard plastic wedding albums. And it was the first time in my life that I had seen before and after pictures. And to me, it looked like magic, like Harry Potter wizardry. I was just blown away. Where'd the nose go? How'd the breasts go? Is this the same person?

SPEAKER_03

Right.

SPEAKER_06

And to me, it seemed like I'm like everybody should know about this. Like everybody should know about this. But it was so expensive, and there were so few plastic surgeons, and it wasn't really discussed, even though all the celebrities back then you talked about Marilyn Monroe, all the way back to Marilyn Monroe in the 50s, she had a chin implant and a rhinoplasty. I mean, there's our and those operations weren't revealed until her plastic surgeon died and he left in in his will that those records should be, you know, opened.

SPEAKER_07

Oh wow.

SPEAKER_06

So celebrities have been getting these operations for a long time, just not talking about it.

SPEAKER_00

Yeah.

SPEAKER_06

And again, the price was prohibited. So you're right. It was like definitely more of an exclusive thing.

SPEAKER_00

Very taboo.

SPEAKER_06

Very, you know, yeah, it was one of those things where, like in the 80s, if you saw your plastic surgeon walking down the street, you would cross over so that nobody would know that you knew them.

SPEAKER_01

Yeah.

Cosmetic vs reconstructive surgery

SPEAKER_06

Um, and so yeah, I felt it was kind of a shame, actually. That was my my first thought when I saw what it could do. And then I trained in the 90s and the early 2000s, and I opened my practice and I just thought, gosh, this should, this should be, this should be available for everybody. Yeah. And I wasn't the only one who had that thought because there were a lot more plastic surgeons that were trained in the in the 90s and early 2000s that came out and went straight into cosmetic surgery that into reconstructive surgery. For a long time, plastic surgeons would do half their practice would be reconstructive, some of it would be cosmetic, and it was kind of a mix. There were very few like pure cosmetic surgeons back then.

SPEAKER_00

What's the difference between like um cosmetic versus and reconstruction?

SPEAKER_06

So cosmetic surgery aims to enhance basically what God gave you. Okay. Reconstructive surgery is trying to restore what you had, but was taken away through uh, you know, bad luck, basically, you know, your cancer or accidents and things like that. So it's the two big aspects of plastic surgery. And really all the cosmetic surgeries that were developed in the last century all came as offshoots of reconstructive surgery.

SPEAKER_07

Gotcha.

The future of plastic surgery

SPEAKER_06

So if somebody had their, God forbid, nose blown off in World War I, the techniques used to reconstruct the nose were then adopted to take a regular healthy person's nose and make it look better. And same thing with everything else. The the breast augmentations, the implants were developed as a response to breast cancer, as trying to find an easier way to reconstruct the breast without using flaps and tissues and things like that. So, but again, once you see what it can do for people, and I personally had a nose job and a chin implant and lipo. And so, like I like I said, I fell in love with the whole concept. Yeah. You know, if you think about it, right, for thousands of years, like if you were born and your ears were big and stuck out, or if you had a big nose or you had uh your breasts were small, like you were basically stuck, or even if you had like a mole on your face you didn't like, yeah, you were basically stuck forever. Yeah, you'd be that the mole girl or the big ear guy, you know, and that was it. You know, nothing you could do about it. And you could be a great person, but that would like be your defining features um until plastic surgery. And so the last hundred years. Now, you know, we have a lot of uh techniques to kind of make you feel better about the things that bother you. And I think the future is gonna be even crazier. Totally. Even crazier, yeah.

SPEAKER_00

What do you what do you think the future of plastic surgery is?

SPEAKER_06

The future is gonna be it's gonna it's gonna involve robots, I think, at first. Um, but then I think it's also gonna evolve. If I had to like make a guess, like in the next hundred years, I think there's gonna be genetic uh treatments and like more uh more of the that kind of treatment where it's like maybe you take a pill and your breasts grow. That's crazy to the size you want.

SPEAKER_00

Right.

SPEAKER_06

Yeah, I think that's I think that's potential down the road, but in the immediate next 10 years, robots for sure, 15 years, robots will do the surgeries faster, cheaper, better. So, like, you know, my my dream if I live long enough to see it, because I'm sort of at the tail end of my career now, would be to see robots doing plastic surgery much, much cheaper, much, much faster, much, much better, so that every girl or guy that wants plastic surgery can get it becomes more available. Yeah, kind of like Invisalign.

SPEAKER_00

Yeah.

SPEAKER_06

You know?

SPEAKER_00

That's awesome.

SPEAKER_06

Just walk in and the robot examines you, and the doctor presses the button and that's it.

SPEAKER_00

Well, well, we heard it here first, so we'll say that you you called it. Oh, that's it.

SPEAKER_06

I'm I I mean I I know it's gonna happen. I mean if we don't blow ourselves up, it's gonna happen. Yeah.

SPEAKER_00

But assuming let's hope not.

SPEAKER_06

Yeah, assuming. Yeah.

SPEAKER_00

Okay, so what's one procedure that you think is overrated?

Overrated vs underrated procedures

SPEAKER_06

Overrated, I think all the all the non-invasive procedures are overrated. When I say non-invasive, I mean the laser treatments, the RF stuff, um the laser uh external laser to remove fat, all those.

SPEAKER_00

Interesting.

SPEAKER_06

All those stuff. It's I I see so many people that you know have tried it and wasted money and it's yeah, yeah.

SPEAKER_00

It's just like you opt for that option, but it's probably a thing.

SPEAKER_06

It's not great. It's a lot of wasted time and money. And uh so that's definitely overrated. Um yeah, the it's all the non-invasive stuff is basically if it sounds too good to be true, yeah, it's probably not true. Yeah, yeah.

SPEAKER_00

So what's one procedure that you think is underrated?

SPEAKER_06

Um, arm lipo. A lot of bang for your buck.

SPEAKER_00

Really?

SPEAKER_06

Arm lipo, a lot of bang for your buck. Wouldn't you agree? A lot of bang for your buck. There's so arm lipo, the the reason that you get a lot of bang for your buck is because it's really, really hard to lose fat on your arms. So, like men almost never put fat on their arms.

SPEAKER_07

Yeah.

SPEAKER_06

Like men they're just we're designed to have muscle on our arms and no fat. Women store fat on their arms. And the only way it goes away is if you become like anorexic, you know, like if you develop an eating disorder or like start taking heroin. Like that's the last place your fat will go.

SPEAKER_07

Yeah.

SPEAKER_06

And so it's frustrating to women, especially if they if they live in colder climates where they have to like put on sleeves and it's like tight, or even in warmer climates where they show their arms a lot. Um, they end up going to the gym to try to work out the fat in their arms. It doesn't work like that. You know, you can't spot lose fat from a specific area. In fact, the opposite happens. You start to work out your arms more and they just get bigger because the muscle grows. So now you have the bigger muscle and fat on top of it laughing at you.

SPEAKER_02

Yeah.

SPEAKER_06

And so you never so, but like in literally 30 minutes of arm lipo, you'll have skinny model arms.

SPEAKER_00

Wow.

SPEAKER_06

With a tiny little incision on your elbow. So I think that's the the most underrated.

SPEAKER_00

Okay, good to know. I I love that. I didn't even realize like that was an option.

SPEAKER_06

Oh, it's an option, yeah.

SPEAKER_00

Okay. So I want to talk a little bit about social media. Okay. That was your big rise to fame. So I think everyone wants to know how were you able to film and post your BBL surgeries to Snapchat?

SPEAKER_06

So we we didn't, nobody told us not to. Perfect. That was it. And nobody told us not to.

SPEAKER_00

Yeah.

SPEAKER_06

Um, we always obviously, even from I was in any at that stage when I went on to Snapchat, I was already posting before and after pictures on Instagram, which was considered like extremely revolutionary, you know. And so we had the patients signing consent forms for social media. Then when Snapchat came out, we just added Snapchat on there. Some of the patients didn't even know what Snapchat was. You know, I barely knew what Snapchat was. But the first patient that I that I did Snapchat for was 19, and she knew what Snapchat was. She was so excited to be on Snapchat. That's awesome. So excited. Um, yeah, and then, you know, and I I really it's a shame that I can't post it on Snapchat anymore because uh, you know, the the corporate people, we have four million followers that I would love to keep showing surgeries, but a few years ago in the middle of the corner, they called and said that they're trying to be more kid friendly and that you know this kind of to content is not great. So they just limit the posts, which is interesting. Yeah. So instead I do the surgeries. If you want to see live surgery, I'll put it on Telegram.

SPEAKER_00

Ooh, love that.

SPEAKER_06

Just go to Dr. Miami Telegram, it's completely uncensored. But in the beginning, Snapchat was uncensored. There was no, nobody told us not to. That's what we did it.

SPEAKER_01

Right.

SPEAKER_06

And like I said before, people were uh either super turned off and like I'm never doing that to myself, or they were like, wow, it's not that bad. I like seeing behind the scenes.

SPEAKER_02

Yeah.

SPEAKER_06

And the best part of the Snapchat era was that now when I go to medical schools or even people that just come in the office, they're like, I want you to know that I became a doctor, or I became a nurse, or I became an anesthesiologist because I watched your Snapchat.

SPEAKER_00

Oh, that's so rewarding.

SPEAKER_06

I know, that makes me feel really good. Yeah, that's awesome.

SPEAKER_00

I feel like also, like going back to what we were talking about, where plastic surgery was like kind of taboo, not really spoken about, like it really allowed people to see what goes on. Like what is plastic surgery?

SPEAKER_06

And they could tell now because now, like I would say halfway through 2017. So we started in 2014, 2015. By 2017, people could pick out BBLs, they could pick out nose jobs, they could pick out breast augmentation, they couldn't, they were much harder to fool.

SPEAKER_01

Right.

SPEAKER_06

So, like when Kylie Jenner got her breast implants, people were like, You got breast implants. We see you on social media.

SPEAKER_01

Right.

SPEAKER_06

You know, social media has has a big had a big influence on making plastic surgery more acceptable because people were not able to hide the and make up stories anymore. You know, if in February you're clearly an A cup, you just posted a picture of yourself on a yacht in a bikini.

SPEAKER_01

Yeah.

SPEAKER_06

And then in April, you're a you're a D.

SPEAKER_01

Right.

SPEAKER_06

We know you didn't go through puberty at 22. Right. Something happened between then.

SPEAKER_00

Right.

SPEAKER_06

And, you know, once you put the pieces together, it's obvious.

SPEAKER_00

Yeah. Well, on this topic, how do you think social media has affected plastic surgery as a whole?

SPEAKER_06

Oh, it's been a huge boon for it. Huge boon. I mean, it was huge. I mean, the numbers just go up and up every every single year.

SPEAKER_07

Yeah.

SPEAKER_06

Even through corona. Like, even through corona, we had more people doing plastic surgery in 2021, 2022 than in any year before.

SPEAKER_00

Wow. That's awesome.

SPEAKER_06

Yeah, it was crazy.

SPEAKER_00

I feel like too in so, like kind of what you said, like with social media, you can't really hide it anymore. But I think people are also more open about it now. There's even like trends on TikTok where people are like comparing, like where it's showing what breast um implants they have and the sizes and all of that. So like it's nice that people I think they go hand in hand. Yeah.

SPEAKER_06

I think it's that the fact that you can't hide it, you might as well own it.

SPEAKER_00

Own it. Exactly.

SPEAKER_06

You know, and it also inspires other people.

SPEAKER_00

Exactly. That's why it's nice when like celebrities, influencers, they're honest about the work they got done because then people feel more comfortable to go ahead and talk about it, do it themselves, you know.

The Ozempic effect on plastic surgery

SPEAKER_06

The big, you know, the robots are coming in 10 years, but the big trend that's going to be in the next five is the massive weight loss patients from GLP1s.

SPEAKER_00

Yeah. I definitely want to get into that. Yeah.

SPEAKER_06

I mean, that is and that that is, and again, it's a it's a huge boon for plastic surgeons. Especially with the new tablets that are coming out. So right now you have to give yourself give yourself a shot every week, you know, for Munjaro, uh, you know, Zetbound, Wagobi, all that stuff. And if you haven't heard about these and you're watching this podcast, go Google GLP1s, Wagobi, Ozempic, Munjaro, Zetbound. These are amazing drugs. If you've ever had a weight problem, or even if you're like, and I you don't have to be massively overweight to take these drugs. People are taking them, you know, just to lose five or 10 pounds, which is fine. They're healthy, they control your blood sugar. There's some other benefits to it in terms of cancer prevention and heart disease. So I'm a big believer in them. But when those, uh when that medicine is gonna be put into pill form in the next year or two, you're gonna see thousand hundreds of thousands of people losing massive amounts of weight. And when you lose weight, you need plastic surgery.

SPEAKER_00

Yeah.

SPEAKER_06

If you lose more than 50 pounds, chances are you're gonna need plastic surgery to tighten things up yeah.

SPEAKER_00

Well, that's what I wanted to ask. Like, did Ozempic change plastic surgery forever?

SPEAKER_06

Forever. Forever. Forever.

SPEAKER_00

Do you also think, like, maybe in the sense where now people aren't going for plastic surgery because of Ozempic?

SPEAKER_06

No, the opposite. Uh so here's the thing: plastic surgery is not for weight loss. Never has been.

SPEAKER_03

Okay.

SPEAKER_06

It's always been for body contouring. And people who are overweight and go for liposuction are making a big mistake because liposuction is not for weight loss. Once you get down to your goal weight or near your goal weight, liposuction is great for contouring like small areas or love handles, that little bit of fat in your armpit over here, the back of your arms, like we talked about, it's not for weight loss. So the fact that people can lose weight now, essentially without diet and exercise. I mean, it is a kind of a diet, but it's without having to like really put in the effort they had to before. Right. And uh GLP ones also quiet like the your food obsession in your brain. It quiets the food talk in your head, it makes it a lot easier. You don't have to go for gastric sleep, gastric bypass, all those other operations that you needed to do to lose 50 pounds typically. Um, so once everybody kind of gets back to their goal weight, now you're in the zone for plastic surgery. Now you look great in clothes, but out of clothes, things are loose. Your breasts have fallen, maybe you have extra skin here and there. And that's when plastic surgery is really appropriate.

Liposuction myths explained

SPEAKER_00

Gotcha. So when it comes to what what was the surgery that people that you said people come for to they think it's to lose weight, but it's not.

SPEAKER_06

Liposuction. Liposuction is not for weight loss.

SPEAKER_00

Okay. So but do people lose weight after getting liposuction?

SPEAKER_06

As whatever you take out is out. But you but typically you don't take more than a few liters of fat, which could be a few pounds.

SPEAKER_00

Right.

SPEAKER_06

Let's say you let's say you take out six pounds of fat, which is a lot of fat. Okay.

SPEAKER_00

So you're removing fat in the removing fat with liposuction.

SPEAKER_06

Yeah, liposuction, just for for those who don't know, it's it's an operation where we make little incisions, we put in fluid, and then we have these metal tubes attached to basically a vacuum cleaner and suck out the fat. So it doesn't get rid of the skin if it's loose. It doesn't tighten the skin really. It just removes the fat from those areas, which is great for contouring.

SPEAKER_00

Right.

SPEAKER_06

Okay. But you can if you're overweight, let's say you're 50 pounds overweight, you can go in and people do and and and have in the past gone in for liposuction thinking, oh, this is gonna make Me skinny. Not really. You can you maybe you can lose five pounds, ten pounds. You're not going to lose 50 pounds in liposuction.

SPEAKER_03

Right.

SPEAKER_06

You know, and you're going to end up if you do too much liposuction and you haven't controlled your weight, when you do inevitably gain more weight, it goes to weird areas like your face, your earlobes, your hands, your arms, place anywhere that wasn't liposuctioned now is more of a propensity to gain fat back.

SPEAKER_00

Gotcha. Okay, that's interesting. I didn't know all that. Thanks for sharing. So I want to go back to social media a little bit. I'm curious. Once you became famous, how did it affect your clinic?

SPEAKER_06

Oh, it was like trying to drink out of a fire hydrant.

SPEAKER_00

What does that mean?

SPEAKER_06

You ever tried to take a drink out of a fire hydrant?

SPEAKER_00

Not yet.

SPEAKER_06

Okay. A fire hydrant are those things at the side of the road that the fire truck hooks up to. Yeah. And they put out water like a jet.

SPEAKER_07

Yeah.

SPEAKER_06

So we had so many inquiries. At one point in 2016, we ran the clinic as almost like a club in that people would come in the morning. That's it. They would line up and get a wristband. Okay. Kid you not. We saw we didn't make any appointments. We just had walk-ins and people would just line up in the morning. People would come literally from the airport with their bags. Okay. I'm like, I'm getting in with this guy. And they would wait in line and then we would call them when their numbers came. And we would just, I mean, it was crazy.

SPEAKER_00

That's a great opportunity for people, though. I love that you did that.

SPEAKER_06

Oh, it was great. We had so much, and it was fun too. It was the Snapchat Snapchat J's were so much fun.

SPEAKER_00

Yeah. Oh, I love that.

SPEAKER_06

They were great.

SPEAKER_00

Um, so would you say your social media persona is the same as your doctor persona?

SPEAKER_06

Uh it's similar, but like the social media persona is like me, but the volume turned all the way up like to 11. Right. You know, like so it's me, but just the volume turned up a little bit higher. Um, yeah. This is this is, you know, this is this is the the wacky personality side that you kind of bury when you go through your medical training.

SPEAKER_00

Yeah.

SPEAKER_06

And then you kind of uncover it, you dig it up like a treasure chest eventually when your practice is okay. Yeah. Yeah.

SPEAKER_00

But you probably probably makes patients feel so like comfortable and warm.

SPEAKER_06

And I what the best part about social media from a doctor's perspective is that the patients get to know you before they meet you in person. So you're you they they like, and especially with the Snapchat era and all that stuff, I would introduce my family was on it. Like they knew me. Like they they see me every morning, they see me go to work. They they know, like they know me.

SPEAKER_00

That's awesome, you know.

SPEAKER_06

And so when they come in, it's like you're meeting a friend. And really, that's the kind of doctor-patient relationship that I like to encourage, you know, where it's like you, you know, I I don't like the the old school paternalistic doctor, I'm the doctor, and I will tell you what you need and what you know. I prefer it be a dialogue, yeah. And just more just like human to human. And I think that is especially important after surgery when you're recovering. Yeah.

Has social media raised beauty standards to an unrealistic level?

SPEAKER_00

Agreed. So do you think that social media has raised beauty standards to an unrealistic level?

SPEAKER_06

Um I think the filters more than the plastic surgery.

SPEAKER_00

Yeah. Would you say people commit to the other thing?

SPEAKER_06

I think the filters, I think they have people need to be realistic. Yeah. You know? Um But yeah, I mean, I would I would say that the filters have done that more than anything else. However, the techniques and the availability of plastic surgery has made it more realistic than ever to achieve or come close to achieving the things that you want to.

SPEAKER_00

Yeah. Have people ever come in and like asked to look like a filter?

SPEAKER_06

All the time.

SPEAKER_00

Yeah. And it's is it doable or depends.

SPEAKER_06

Yeah. Depends what they're asking for. Yeah. A lot of times with the noses, it is.

SPEAKER_00

That's true.

SPEAKER_06

With with the filters with the noses, that's that's the most accurate. Um, because it's either making the nose, you know, more narrow or changing the angle of the tip. So like I encourage patients to do their own photoshopping on their noses and then bring that in. And then I can tell that most of the time it's realistic. Sometimes it isn't, but most of the time it is.

SPEAKER_02

Yeah.

SPEAKER_06

Because when you when you Photoshop your own face, you understand, okay, I'm working with this, right? These parameters. And also the nose is just part of the picture. You have your eyes, you have your mouth, you have, you know, it's not like, you know, yeah, it's a fit into the frame. And by photoshopping it, you can kind of get an idea of what it's gonna look like.

SPEAKER_00

Okay. So I want to talk about different plastic surgery trends. So I kind of have questions like all over the board for you.

SPEAKER_06

Go for it.

SPEAKER_00

To start off, what are the new and hot plastic surgery trends?

SPEAKER_06

So the trend is the smaller BBLs for sure. The 2016 ginormous, make it as big as possible, booty. That's out. Perfect. Um, so smaller their BBLs are still very popular, super popular. They're just, you know, more under the radar, fill in the hip dips. We call them skinny BBLs. Okay. That's super hot. The other newer, hotter operation is the Rib X, which basically we instead of removing ribs to make your waist smaller, we just kind of break them and crack them inward. And that can take like two inches off your waistline, which is but it it it works really well in in patients that are skinny but are kind of square and don't have much of a torso, like they don't have much of a definition of their hip.

SPEAKER_03

Right.

SPEAKER_06

It can make a big difference.

SPEAKER_03

Oh wow. Okay. It's kind of cool.

SPEAKER_06

And it's a little incision in the back and it takes an hour, it's a quick operation. The only downside to that is you have to wear a corset for six weeks. You can't really work out for six weeks.

SPEAKER_00

Yeah.

SPEAKER_06

It does kind of hinder your social life for six weeks, but after that.

SPEAKER_00

Yeah, because the ribs probably have to heal. They have to heal, yeah.

SPEAKER_06

It's basically imagine like you broke your finger and someone set it, but instead of setting it straight, they set it like bent.

SPEAKER_00

Right.

SPEAKER_06

So it heals that way. Yeah.

SPEAKER_00

Okay. So how common is it for women to come in wanting plastic surgery after having kids?

SPEAKER_06

Very common.

SPEAKER_00

Very common. And what's the most common procedure that they're typically looking for after having a child?

SPEAKER_06

Usually tummy tugs. Tummy tugs is the biggest one because, you know, probably I would say at least 70% of women after they have a baby or two or three, they have stretch marks in the lower abdomen. The skin has been stretched out. It never really gets back to the way it was before the babies.

SPEAKER_01

Right.

SPEAKER_06

And there's no exercise in the gym to make to make it go back that way. Either the muscles have been separated from the uterus growing and kind of pushing the muscles out and apart, and that needs to be fixed surgically to be sewn together. Um, or the skin has stretch marks and it's been loose, and no matter how much you work out, it's never gonna get tight. So the only answer for that is a tummy tuck. And uh, you know, I encourage women, you know, what what's frustrating for me is a lot of times women will will try for years on their own, and then finally, out of frustration, they'll come to the plastic surgeon. I think it's better to just get an opinion before you before you start trying, you know, for five years, get an opinion from an expert that might tell you, okay, it's not gonna happen on your own, you need surgery. Or the opposite. Yeah, I know this can this part can be fixed, you just it's a little extra fat, your skin is tight, go for it. You know, that way the earlier you do the plastic surgeries in general for everybody, I would say, the more years of benefit you get out of it. You know?

SPEAKER_00

Yeah. And if you are postpartum, though, would you say, like, if you're gonna do a tummy talk, wait till you've had your last kid?

SPEAKER_06

Yeah, for sure. The exception is this, okay. They're there it's it's kind of bimodal. Like there's a group of women that have babies very, very young, let's say at their late teens, early 20s, and then they're single. They find themselves they find themselves single in their mid-20s, let's say. And for those women where they're kind of looking to have a second family afterwards, I would recommend doing the tummy tuck first. Then get out there, find you know, your partner, have more kids, and then come back for it. And I know I've had patients do three tummy tucks or four tummy tucks. There's no limit to how many tummy tucks you can do.

SPEAKER_01

Right.

SPEAKER_06

You know, but again, if you're single and ready to mingle, I wouldn't necessarily say, okay, I'm gonna wait till I have my last kid, because again, you're part of your you know, how you get out there is by feeling confident about your body. And if you don't feel confident about your body, we're looking for a partner that might, you know, hurt your chances.

Why implants are being removed

SPEAKER_00

Yeah. That's all another trend. Flat chests are back in.

SPEAKER_06

I wouldn't I don't think flat chests are back in. I I I disagree. Um, I think the I again, I disagree. There there's there is a trend towards smaller breast augmentations.

SPEAKER_03

Okay.

SPEAKER_06

But um rarely do I have women come in and say, you know, make me flat.

SPEAKER_01

Right.

SPEAKER_06

You know what I mean? Like when it at that point, then I'll know flat chests are in.

SPEAKER_01

Right. Okay.

SPEAKER_06

So even patients that are being reduced, and there's a lot of women, obviously, you know, that have big breasts and that they're just too much on their back or shoulders or they interfere with the what they want to wear, they never say make me flat. Very rarely do they say make me flat. They say, Okay, I want to be a C cub, I want to be B cub. But I'll let you know when they start coming in and say, make me flat, I'll be like, okay, flat must be in.

SPEAKER_00

Flat must be in.

SPEAKER_06

Flat must be in.

SPEAKER_00

There is a trend though that women are taking their breast implants out. That's true.

SPEAKER_06

That's true. So uh two reasons. Um one is because they've they've like kind of achieved their purpose for them. You know, like you, you're maybe you're 18, 19, 20, you you get breast implants, you live your life, you get married, you have kids, and now, okay, I don't need big breasts when I'm 40 or late 30s. I don't need it anymore. That's probably the majority. They've had them, they they're just done. They're like, okay, they I had my fun or they served their purpose. Breasts basically are two things. They they if they're either to, you know, breastfeed kids or they're just basically ornamental. Okay. You don't walk on them like a butt, you don't, they don't, you don't blow them like a nose. You like they're basically just there for ornament. So if you're done having kids and you don't want big ornaments, you can make them smaller, and that's kind of what people are doing. The second thing is um sometimes patients have uh like vague symptoms that they feel are related to the breast implants. There's something called breast implant illness, which is thankfully very rare. And they just want to like, you know what, uh, I haven't been feeling well. I I don't know if it's the implants or not, but let's just take them out just to be safe. And we do that too. But that's that's rare. Most of the time, it's just they've they've done they they're done having big boobs, they enjoyed it, and now they want to have their old boobs back more or less.

SPEAKER_02

Yeah.

SPEAKER_06

But it's not without consequences because you do most of the time, especially if you were like an A cup and you went to a C or a D, when you take the implants out, the breasts are now deflated and they need to be lifted. And so you end up having scars to fix like lift them up.

SPEAKER_00

Right. So you can breastfeed with breast implants. Oh, yeah, for sure. Okay, yeah.

SPEAKER_06

And also with the breast reduction, too.

SPEAKER_00

Oh, okay.

SPEAKER_06

Yeah. Most women that have breast reductions or breast implants that want to breastfeed can breastfeed.

SPEAKER_03

Okay.

SPEAKER_06

Some women can't breastfeed either, with when they whether they have implants or not. You know, it's not every not every woman can breastfeed.

SPEAKER_00

Right.

SPEAKER_06

Yeah.

Most regretted procedures

SPEAKER_00

Um, okay. Next question. Are nose jobs the number one regretted procedure?

SPEAKER_06

Uh no.

SPEAKER_00

No? What is?

SPEAKER_06

I don't think so. The number one regretted procedure. I try not to do procedures that are regretted.

SPEAKER_00

No, of course.

SPEAKER_06

Yeah, but like if I had to Statistically, though, what would you say? Statistically, huh? That's a that's a really good question. Um I would probably say facelifts.

SPEAKER_00

That's a good one. I was just thinking something with the face because it's the first thing you notice, you know.

SPEAKER_06

Super expensive. Um, and then secondly, they never quite achieve what the patient really is looking for, which is a time machine. So, like if you're 60 years old or 65 and you get a facelift, you don't you want to look 30, you want to be 35, but you really won't. You're gonna look like a 65-year-old with a facelift. You know what I mean? Like you're still gonna be 65, you're still gonna maybe you'll look 10 years younger at 55 or 50. But you you never get the you know, the the dream result, exactly like you want. Whereas if somebody's had a big nose their whole life and now they have a cute little nose, it's it's amazing. Yeah, you know, or if someone has small breasts and they have big breasts, it's amazing. So very little regret there because it's something that they never had and you're giving it to them. Whereas trying to restore something like youth is really difficult to make people like super happy about. That's not to say that rhinoplasty is perfect, because probably at least 10 to 15% of all rhinoplasties get revised at some point.

SPEAKER_02

Yeah.

SPEAKER_06

But needing to revise something to make it like more perfect is not the same thing as regretting. You know what I mean?

SPEAKER_00

Yeah. No, that makes sense. Yeah. So speaking of facelifts, I feel like everyone's talking about this and or this 9D facelift.

Non-surgical vs real results

SPEAKER_06

So I think that's a falls into the category of a lot of hype.

SPEAKER_00

Okay.

SPEAKER_06

The 9D is like just non-invasive uh RF. Anything with energy devices is never gonna be as good as actual surgery with steel.

SPEAKER_03

Okay.

SPEAKER_06

Because oh, it's not invasive, it just, you know, uses energy to heat the collagen. Can it give you some results? Absolutely. Can you give you what a facelift does? No way.

SPEAKER_07

Ah, okay. Yeah.

SPEAKER_06

Now the deep lane facelifts and the more invasive facelifts that the techniques are getting more and more aggressive, those work great. Like uh Kylie Jenner's mom. What's her name?

SPEAKER_00

Chris Jenner.

SPEAKER_06

Chris. Sorry, Chris, I forgot your name.

SPEAKER_00

Um, she looks amazing.

SPEAKER_06

She does, she does. That's a deep plane facelift. It's that's a real surgery, super expensive, super, you know, you need to be super skillful to pull it off. Right. And long recovery. Yeah.

SPEAKER_00

What about Lindsay Lohan?

SPEAKER_06

I haven't seen her facelift. It looks good.

SPEAKER_00

Oh, she looks amazing.

SPEAKER_06

I was about 20 something years ago, I got this crazy voicemail on my um my voicemail from Lindsay Lohan's dad cursing me out just randomly.

SPEAKER_00

You're not the first person I've heard say that. Weirdly enough. Weirdly enough, yes. Really? Yes.

SPEAKER_06

He was I mean, I'm like, I didn't even know the guy. And he calls me up. You know what it's like to have a daughter. Anyway, yeah, he's a weird, weird dude. Is he is he still around? I'm not sure. I don't know. I think he lived up in Boca or someplace. He he was he was down here somewhere because uh the the the area code was not what I thought it would be.

SPEAKER_00

Did you like post something about her or I must have said something?

SPEAKER_06

This is pre- this is pre-Fook, pre-social media.

SPEAKER_00

Yeah.

SPEAKER_06

This was like in a magazine or something. You know, they ask sometimes they'll ask an opinion like what do you think of would Botox be good for this celebrity or something? Something silly like that.

SPEAKER_02

Yeah.

SPEAKER_06

It was like People magazine or something, and then Lindsay Lohan's dad just rips me a new one.

SPEAKER_00

Oh wow. Yeah. Okay.

SPEAKER_06

Yeah.

Smoking and surgery risks

SPEAKER_00

I'll show you the pictures after. Okay. Um, okay, so another question. Why should patients not vape after getting surgery?

SPEAKER_06

Yeah. Well, first of all, um, the nicotine does it depends what you're vaping. You know, if it's just vape with flavor or something, but if the nicotine can constrict the blood vessels, and anytime you're you have surgery, you want good blood flow to all the areas of the wounds and scars and things like that. So that's that's the big reason.

SPEAKER_00

Okay. And is it only before or is it also after?

SPEAKER_06

Before and after.

SPEAKER_00

Before and after.

SPEAKER_06

Yeah, yeah. Before because it's you're going to surgery, you want to make sure your your blood is clean, everything's good. And afterwards, because of the constriction of the blood vessels, it can also raise your blood pressure too, which you don't want to do.

Why are so many celebrities going to Korea for plastic surgery?

SPEAKER_00

Okay. My next question is I feel like there's something going on with plastic surgery that maybe you know that we don't know. Okay. But why are so many celebrities going to Korea for plastic surgery?

SPEAKER_06

Oh, Korea is, you may not know this, but Korea is the plastic surgery capital of the world in terms of per capita. Okay. There are more plastic surgeons per capita in Korea than in any other country. Oh, wow. Not Brazil, not America, not those are basically the big ones. Not Brazil or America.

SPEAKER_02

Yeah.

SPEAKER_06

You know, and so yeah, they're and they're now they mainly do facial work.

SPEAKER_03

Okay.

SPEAKER_06

In Korea. That's their main specialty. They have been doing it for decades. It they have fantastic surgeons there. Yeah, and if I yeah, so that's why. That's it. It's not something that people generally know, but if you're a plastic surgeon, you know that per capita in South Korea, they do a ton of plastic surgery, and there's a ton of plastic surgeons.

SPEAKER_00

It's like a hot spot.

SPEAKER_06

Oh yeah, but for 20 years. It's not like just last year's.

SPEAKER_00

Uh, okay. So what's a trending cosmetic procedure that you refuse to do?

SPEAKER_06

Uh, I don't like doing the well, I don't do eyes. I know the fox eyes thing is is popular. I don't do that. Okay. And I'm not sure that I don't know. I'm not sure that's such a great idea for everybody who does it. Yeah. And then the other thing is the lip lift where you cut a little uh you cut a little, you cut skin underneath the nose to lift up the upper lip.

SPEAKER_00

Oh, interesting. I haven't heard of that one.

SPEAKER_06

Oh, it's big. Yeah, if you look uh butterfly lip lift, you'll say I mean it works. It's just that the scar sometimes is not worth it.

SPEAKER_00

And it's supposed to do what for your upper lip?

SPEAKER_06

It gives you really nice, like Angelina Jolie lips. It just does this by cutting a little um butterfly shape. Yeah.

SPEAKER_00

So it kind of makes it more full too, because you're yeah, yeah, yeah. It turns it up. Yeah, it turns it up. Interesting.

SPEAKER_06

Yeah.

SPEAKER_00

What celebrity trend has had the biggest influence on the procedures people ask for?

SPEAKER_06

Uh Kim Kardashian. Yeah. For sure. She's the biggest influence in the last 20 years.

SPEAKER_00

I feel like that's an obvious one.

SPEAKER_06

Yeah. That's it. Yeah.

What is a BBL?

SPEAKER_00

Yeah. Okay. So I want to get into a little bit about BBLs.

SPEAKER_06

Okay.

SPEAKER_00

Because I feel like that's your bread and butter. Yeah. So what is it?

SPEAKER_06

It has been. Yeah.

SPEAKER_00

Yeah. What exactly is a BBL?

SPEAKER_06

Although I do a lot of noses, I do a lot of noses lately. Yeah. A lot of and a lot of mummy makeovers. And then all this weight loss surgery, the skin removal, is I'm telling you, there are not enough plastic surgeons on earth to handle all the skin loss surgery that's coming down the pipeline. Yeah. So let's talk about BBLs. Okay. What's the question?

SPEAKER_00

What exactly is BBL?

SPEAKER_06

So it's called a Brazilian butt lift, even though I don't think it was really, it's not really a lift and it's not really wasn't really invented in Brazil, but that's what they call it. Um it's a fat transfer where you take fat from areas of the body you don't like, like your love handles, your arms, your tummy, wherever you want, don't want it. And then you put it in your butt.

SPEAKER_07

Oh, wow.

SPEAKER_06

Inject it under the skin into the butt. And it's it's an amazing operation because it does two things. It gets rid of the fat from the places you don't want it, like your waist. So it makes your waist smaller. It curves out your lower back, like Kim Kardashian, you know, that famous picture of her holding a, I don't know, martini glass or something. Right. Um, and then it can fill in the areas that you can never fill in in the gym. Like if you have hip dips, right? If you're just not born curvy in that way, kind of square, there's no muscle that you can grow in the gym to give yourself curves there.

SPEAKER_02

Yeah.

SPEAKER_06

There's there are fat pockets there that some people are born with. And if you're not born with those fat pockets, you won't have it. So putting fat in those areas can make a really big change in your in your shape. So when you wear a tight dress, your silhouette looks more like an hourglass and less square.

SPEAKER_00

Yeah.

SPEAKER_06

Um, and that was made possible by the BBL. And there's really no other operation that can do that.

SPEAKER_00

I didn't realize, like you're kind of getting a two-in-one deal, right? You're taking something from somewhere and adding it somewhere else. That's awesome.

SPEAKER_06

And the ideal patients are not like very heavy, they're like have slightly maybe five to ten pounds extra fat, which is perfect, in the right places, like your love handles and your tummy where you want to get rid of it, or your arms, and then you put it in the place you do want it, and it's a home run.

SPEAKER_00

Yeah, love that. Would you say the Kardashians are the reason why BBL started trending?

SPEAKER_06

Yeah.

SPEAKER_00

Totally.

SPEAKER_06

Although, again, like I said before, I think evolutionarily speaking, I think curvy bodies have always been the beauty standard for humans.

SPEAKER_00

Yeah.

SPEAKER_06

For evolutionary reasons.

SPEAKER_00

And what are the risks of getting a BBL?

SPEAKER_06

Death.

SPEAKER_00

Well, that's a big one.

The real risks of BBLs

SPEAKER_06

That's a big one, God forbid. No one's ever died in my practice. I should say that off the bat. Um, but the BBL operation, because it grew in popularity so quickly in the two 2010s, the demand outstripped the supply of surgeons that could do it safely. Let's put it that way. And so there were many, many deaths, too many deaths. There still are too many deaths. Right. Because if you inject the fat in the wrong place, if you inject it in into the muscle or into a blood vessel that you're not supposed to, it can travel from those blood vessels to your heart and lungs and kill you. And that's where the BBL deaths come from. And that's why I got this reputation as the most dangerous procedure. But it's kind of like saying a car is the most dangerous thing you can machine on earth, but not really. It's if you don't drive right, or if you're drunk and you drive, yeah, it's terribly dangerous. But if you know what you're doing, it's fine.

SPEAKER_02

Yeah.

SPEAKER_06

You know, a gun is the most dangerous procedure because that's meant to kill. But the BBL, if you have an experienced person, um, I have, you know, in in 2019, I started an organization called the World Association of Gluteal Surgeons, got about three, four hundred guys together from all over the world to try to improve the safety standards that we're all that's awesome. We all know what to do and what not to do. Yeah. But still, it's 400 out of like thousands of people that do VVL. So we can't, we can't educate everybody, but it's gotten a lot safer because we've got the word out, you know, don't inject into the, don't inject into the muscle. These are very technical things, but basically where you put the fat and the types of instruments you use are important. Now in the state of Florida, we have a law. When you inject the fat, you have to use an ultrasound to make sure you're in the right plane.

SPEAKER_00

Oh, nice.

SPEAKER_06

So you can see that you're going in the right place. So that's that's only in Florida. No other state has that law.

SPEAKER_00

That's awesome. Even though, like, like you said, it is more so about like who's doing it and the and how they're doing it, yeah. Right. Is statistically, is it considered the most dangerous?

SPEAKER_06

It is now it's it now now because of the education, it was, but now because of the education in the last three years, the risk of death is about the same as a tummy tuck, which is small, not zero.

SPEAKER_00

Okay.

SPEAKER_06

But small.

Who is most at risk of complications during a BBL?

SPEAKER_00

So who would you say is most at risk of complications when getting a BBL?

SPEAKER_06

So if you are obese, okay, if you're overweight, you know, all these operations, you should have your BMI under 35. Possible. Okay. And under 30, ideal. I mean, you can calculate online. You can go to BMI calculator, put your height and weight in, it'll tell you. So if the the heavier you are, the higher risk you are for all sorts of complications. If you're a smoker, you're at a higher risk for complication. If you have diabetes, you're at a higher they're mainly medical things that make you and then of course if you are going to a surgeon that doesn't have experience or has a bad reputation, you know, in life, like in surgery, like in many things in life, you get what you pay for.

SPEAKER_07

Yeah.

SPEAKER_06

Now you don't want to overpay, obviously. You know, there are places that can really rip you off, but you need to like balance that out. And of course. Yeah. And and, you know, when you talk about going to other countries for surgery, there are pros and cons to it. Um, you know, there are some great nose surgeons in Turkey. There are also some terrible ones. Right. And so you need to like make sure that the person you're going to is safe. When you go to another country for surgery, if you don't know the language, if something goes wrong, you can be really screwed. Um, but there are great surgeons in Colombia, there are great surgeons in Brazil, there are great surgeons in the Dominican Republic. But you have to make sure that you're going to one of the great surgeons and not like somebody who's not great. Right. And it's just cheap.

SPEAKER_00

Yeah. I want to get more into that, but before we do, have you ever had to turn a patient away?

SPEAKER_06

All the time.

SPEAKER_00

Yeah.

SPEAKER_06

I turn patients away all the time, mainly for either psychological reasons or uh health reasons.

SPEAKER_03

Yeah.

SPEAKER_06

Yeah.

SPEAKER_03

Okay.

SPEAKER_06

But when we have a thing on our website when you're filling out the form, if you don't re meet our criteria, we don't even, you know, we we we we reg, you know, we send you to other people to get those problems fixed first before we even talk about plastic surgery.

SPEAKER_00

Yeah. Okay.

SPEAKER_06

Yeah.

SPEAKER_00

So why do people go overseas for plastic surgery?

SPEAKER_06

It's cheaper, that's all.

SPEAKER_00

And is it is it dangerous to go overseas for plastic surgery?

SPEAKER_06

It can be. It can be. So the main things I see from overseas are people just not doing their homework and ending up in the wrong hands.

SPEAKER_02

Yeah.

SPEAKER_06

Uh also not realizing that when you get to a foreign country, if something goes wrong, you're kind of screwed. You know, you're really, you know, it's because it's cheaper.

SPEAKER_03

So Right.

SPEAKER_06

I've sorry I've heard all kinds of horror stories about going to Mexico and other places, not just Mexico, Dominican Republic. And I've heard surgeries that go great in those places too. So it really depends where you go. Now, when you come back, if you do their surgery out of the country, it's really hard to get any other surgeons to want to help you if you have a problem. I mean, I'm I'm I'm happy to do what I can, but I'm just saying most of the time you're really struggling. And typically overseas surgeons, once you're out of the their country, they don't really pay attention to what's going on.

SPEAKER_00

Right.

SPEAKER_06

Yeah.

SPEAKER_00

Is there also like in different countries maybe different criteria or schooling? For sure. 100%. Yeah.

SPEAKER_06

Nobody's schooling as is as rigorous as the United States. The United the board certification in the United States is accepted everywhere in the world. And in the United States, we only accept board certification from very few countries like Canada and England. Like we don't accept board certification from other countries. Right. If you come as a plastic surgeon from another country, typically you'll have to do your entire training over again. Yeah. And not just in plastic surgery in all specialties. Yeah.

SPEAKER_00

Okay. Would you say patient deaths are more likely to happen if the surgery is cheaper?

SPEAKER_06

Yes. That's that's true. Yeah. I think that's a true statement. Yeah.

SPEAKER_00

And how often are you fixing botched BBLs that people got from like a cheap surgeon?

SPEAKER_06

So I generally try to avoid doing uh revision surgeries for those things. I won't say I don't do any, but I tried I there are people that specialize in that that I refer patients to. Gotcha. And a lot of times it's not even BBLs, it's like the cheap version of BBLs, injecting silicone or I don't know, what they inject, some crazy substances into people's butts in like the back of a salon. Those can lead not only to death but really serious complications down the road. And those patients need serious surgery to reconstruct them, including like major scars where they peel down the skin and they really, you know, core out all the stuff that they put in there.

SPEAKER_02

Yeah.

SPEAKER_06

And then try to reconstruct it. And that's not what I do as a special as a subspecialty, but there are people that do that. Right. So when patients come to me with those issues, I send them to the right person.

SPEAKER_00

Right. So people will get BBLs like instead of taking fat from somewhere, they'll have like silicone.

SPEAKER_06

Injected, yeah. Interesting. Yeah. And that's super not recommended. Yeah.

SPEAKER_00

Okay. So can you undo a BBL or is it permanent?

SPEAKER_06

Yeah, you can no, you can do it. You can do it. Yeah, I just just, in fact, I've had a bunch of pay, I'd say maybe five patients in the last year that I did their BBLs in 2016, 2017, and they had babies, gained weight, whatever, their butt's just too big. We just suck it out. Take out the fat. That's it. And they're super happy.

SPEAKER_00

So why are people removing their BBLs other than that?

SPEAKER_06

That's it. Either they gained weight and it went all to their butt. Remember, the fat cells don't know they've been moved. So when you gain weight after a BBL, the first five, 10, 15 pounds goes right to your butt.

SPEAKER_03

Okay.

SPEAKER_06

And I've had patients either gain weight, get pregnant, and their butts are huge, which is, you know, great if you like that. But if you're not, you just suck out the fat.

Ranking surgery risks

SPEAKER_00

Yeah. Okay. Awesome. So I want to play a little game.

SPEAKER_06

Okay.

SPEAKER_00

So I have a list of different surgeries, and I kind of want you to rank them one to 10 of like the risk level.

SPEAKER_06

The risk level. Okay. Yeah.

SPEAKER_00

So let's say I say BBL and you'll say like four out of 10 or something like that.

SPEAKER_06

Okay. They're all I say this. All the plastic surgery I do, the risk level is very small.

SPEAKER_03

Okay.

SPEAKER_06

So, and risk, like I said, it's kind of like driving a car. Yeah. You know, if I'm driving the car, it might have some risk level. You know, whereas if Alex is driving the car, it might have another risk level.

SPEAKER_01

Right.

SPEAKER_06

She's actually a better driver than me. But I'm just saying, like that, like it really depends. So it's hard to say for the procedure what the risk level is.

SPEAKER_00

Okay.

SPEAKER_06

If you don't have other info. But I'll go for it. Go. Yeah. I'll play along.

SPEAKER_00

Go for it. And if you have anything to add, you can as much as you want. Okay. From one to 10, what's the risk level of BBLs?

SPEAKER_06

Yeah, he's laughing too. It's it's hard to say, like in my practice, the risk level is almost zero. Like dying. It's like zero.

SPEAKER_03

But like statistically speaking.

SPEAKER_06

I would say so the let's put it this way: the riskiest are BBLs and tummy tucks. Those are the riskiest.

SPEAKER_03

Okay.

SPEAKER_06

Um, still very small, but I would say the mortality rate for those is about one in 12,000 or one in 15,000, which is small.

SPEAKER_01

Yeah.

SPEAKER_06

You know, less than riding a motorcycle or crossing the street or something like that. Um, even less, those and those are the riskiest. The least risky surgery is probably, I would say, uh rhinoplasty.

SPEAKER_00

Okay. What about the fox eye lifts? Because you said you wouldn't do that.

SPEAKER_06

When you say risky, when you're saying about death, you're talking about like complication, like blindness. Yeah. Yeah. So yeah, anytime you you touch the eyes, you could go blind. That's a risk that you don't have with an with a rhinoplasty.

SPEAKER_01

Yeah.

SPEAKER_06

Okay. Um, so yeah, anytime you do eye surgery, there's a risk of blindness. It's small, but not zero. Um, and then uh you have, you know, breast augmentation is pretty safe, very rare, but not impossible.

SPEAKER_01

Yeah.

SPEAKER_06

And most of the risks from those less dangerous operations comes from anesthesia, not from the surgery itself. So, like the risk of somebody dying, a young healthy person dying from general anesthesia in an elective procedure is like maybe one in 400,000. Gotcha. Extremely small, but not zero.

SPEAKER_01

Yeah.

SPEAKER_06

Now, that's assuming you're going to a safe place and you're paying for an anesthesia person that knows what they're doing, et cetera. But if you start to cut corners, what could be a safe procedure, your risk could go way, way up.

SPEAKER_00

Yeah. See, but this is good for people to know because a lot of people that aren't informed on plastic surgery think that these are major surgeries with high risk and it's really dangerous.

SPEAKER_06

No, no, no, no, no. No, elective plastic surgery in a safe place, and you'll know if it's safe by how much you pay. Okay. I want and I won't say that rule holds 100%. But in general, if you're paying$3,000 for breast augmentation and the implants, like legitimate implants that are made in the USA, cost$1,000. So the anesthesia costs, and you haven't have to have a professional anesthesia person and a nurse and all that stuff.

SPEAKER_00

Yeah, it probably shouldn't be$3,000.

SPEAKER_06

Yeah, it probably shouldn't be$3,000.

SPEAKER_00

Right.

SPEAKER_06

You know, it's it probably shouldn't be$3,000.

SPEAKER_00

Right.

SPEAKER_06

It's your body. Yeah. You know what I mean? Yeah. I would recommend to just save up till you can afford to do it safely rather than kind of roll the dice.

SPEAKER_07

Yeah.

SPEAKER_06

Now, the other thing like goes back to the robots we talked about before. In the future, there will be safe, cheap breast augmentation. Safe, cheap BBL, safe, cheap lipos, safe, cheap tummy tucks done by robots for maybe$2,000. I mean, it's possible, you know, but as of now, with the cost of things, with humans having to do it, um, every aspect of it, it's gonna cost more.

Advice before getting surgery

SPEAKER_00

Yeah, of course. What's one thing you tell someone that's looking to get their first plastic surgery?

SPEAKER_06

Um, so I would say do your homework, look at before and after pictures. I think that's the most important thing. If you go to a website and there's not a lot of before and after pictures, or the guy's doesn't seem like he's been in practice very long, be careful.

SPEAKER_07

Yeah.

SPEAKER_06

That's the main thing. And and and don't look at the degrees on the wall because they're not what does the surgery. You know what I'm saying? Like that is important for any surgery, even brain surgery, whatever it is, the credentials are not what makes the surgeon. It's the experience of the actual surgery. It's not called plastic book learning, it's called plastic surgery. Totally. So you want people who are experiencing the thing. It's kind of like if you got on a plane and the guy has a pilot's license, but he's only flown a hundred hours. You know, in any in any serious overseas, you know, commercial airline, there'll be one pilot that has like 5,000 hours. Right. And then a co-pilot that has like a couple hundred. Okay. But, you know, when you look for a surgeon, and I'm not saying this just because I'm old, okay? I'm just saying there are young surgeons that have a lot of experience. There are. They've been very busy. They went to a busy practice from their from the beginning, and they could be five years in and have literally 5,000 surgeries under their belt. And there are doctors that can be out for 20 years and they just do other operations, reconstructive surgery, whatever, and only have, you know, 500 procedures of the thing that you're trying to do or 200. That's not that's not good.

SPEAKER_00

Right.

SPEAKER_06

You know, you want someone who's been doing the same operation over and over again, basically for years and years as much as possible. And you want to see the actual before and after pictures because there are some surgeons. I don't want I don't talk bad about, I'm not talking bad about sp a specific surgeon. I'm just saying in general, if you're not good after doing a hundred, you you at least to a certain level, you probably will never be good even if you do a thousand.

SPEAKER_03

Right.

SPEAKER_06

You know, there there are different levels of talent, and you can see it in plastic surgery more obviously as a layperson than let's say if you're a general surgeon, how do you know if someone took out a gallbladder? Great, you know.

SPEAKER_01

Great.

SPEAKER_06

But with plastic surgery, you see the before and after pictures.

SPEAKER_01

Yeah.

SPEAKER_06

Look at them, judge them, you know, be critical. How's that belly button look? How do the nipples look right? You know? And if they don't put a lot of before and after pictures up, and I don't just mean like on the table pictures that you'll see on social media, I mean like six months out, a year out, whatever, a a good amount of, you know, then question.

SPEAKER_07

Yeah.

SPEAKER_06

You know?

SPEAKER_07

Yeah.

SPEAKER_06

And it should be in the procedure you want. If you want a nose job and the guy only has two nose job pictures on his website, careful.

First surgery fears explained

SPEAKER_00

Right. What would you say to someone who wants plastic surgery but they're just nervous to undergo the process?

SPEAKER_06

I mean, there's first time's always the hardest.

SPEAKER_00

Yeah.

SPEAKER_06

You know, it I would say this surgery is easier than most people think in general. Like the anesthesia never having if you never had general anesthesia, it's not what people think it is. It's not like taking a nap. It it's it's the medicine they give you within seconds, it knocks you out. And then you don't have any memory at all. No matter how many hours you're asleep, whether it's an hour or 10 hours, you just open your eyes a second later and it's done.

SPEAKER_01

Right.

SPEAKER_06

So there's no like intervening, people are worried that I'm gonna wake up in the middle of it or I'm gonna feel something, or I'm gonna be no. It's like literally one second, and it's like men in black, they just erase your memory.

SPEAKER_01

Right.

SPEAKER_06

And so I think once you realize that, you know, it's it's it's it's less fearful, I think. Less, less, less, uh, less anxiety inducing. There is pain afterwards, but we do give you pain medication. So people worry about the pain a lot.

SPEAKER_02

Yeah.

SPEAKER_06

Um, just know that millions of people have done it and been fine. You know, I think you just focus on that. It's kind of like when you go on a roller coaster or something. It looks dangerous, but you know, thousands of people are doing it, so it's probably okay.

SPEAKER_00

Yeah.

SPEAKER_06

Yeah.

SPEAKER_00

Awesome. Okay. I want to play one more game. It's gonna be myth or fact.

SPEAKER_01

Okay.

SPEAKER_00

So I'm just gonna read you a line and you can tell me if it's a myth or a fact.

SPEAKER_01

Okay.

Myth or Fact about plastic surgery

SPEAKER_00

Okay. You actually covered some of these, which is fine. But we'll we'll do it again.

SPEAKER_05

All right, good.

SPEAKER_00

Myth or fact. Liposuction helps you lose weight.

SPEAKER_05

Myth.

SPEAKER_00

Myth or fact. Breast implants are toxic.

SPEAKER_05

Myth.

SPEAKER_00

Myth or fact. BBLs go away if you lose weight.

SPEAKER_06

Fact. But they don't go away in the way you think. They like you just you have the same shape but smaller.

SPEAKER_00

Oh, okay. Yeah. That's interesting.

SPEAKER_06

Each fat cell shrinks a little bit when you lose weight.

SPEAKER_00

Right.

SPEAKER_06

And it gets bigger when you gain weight.

SPEAKER_00

True.

SPEAKER_06

But since you have the fat cells in areas you didn't have it before, you still have the shape which gets smaller. It doesn't go away.

SPEAKER_00

That's that's an interesting question. So the fat cells that you're taking, let's say, from your arm to move into your brain.

SPEAKER_06

They don't know. They've been moved.

SPEAKER_00

Okay, so they work the same way, which is in a different part of the body. Yeah, exactly.

SPEAKER_06

And which is great because like a lot of women, let's say they always gain weight like in their tummy, in this one little spot. You take those cells, you put them in your butt. Now, when you gain weight in the future, it goes to your butt and not there.

SPEAKER_00

Interesting. Okay. That simplified it. That makes sense.

SPEAKER_06

Yeah.

SPEAKER_00

Okay. Myth or fact. Rhinoplasty can make your breathing worse.

SPEAKER_06

Yes, that's true. But hopefully not. I mean, hopefully the person doing the rhinoplasty is paying attention to the airway. The interesting thing about like breathing through your nose, it's very, very subjective. It's really, really hard, even with all the sophisticated equipment we have to measure airway flow through your nose. Turns out that if you like open your nostrils up, like if you, if someone would take like a, I don't know, like a drill or something and just open up your nostrils completely. So there was no bone and it's just air flowing through, you would actually get the sensation that you're not getting enough air. Because the complicated part is that the air needs to have some resistance along the turbinates and the lining and spin around for you to get the feeling that you're getting enough air. And also it also warms it and uh and uh you know takes out little dust particles and things like that. So some people say, okay, I I can't breathe through my nose. There's and there may be some obvious blockage, like a bone going in or the septons pushed over, and then you you clean that out, and now they there's a bigger hole, like where you couldn't put a Q-tip, now you can put you know a whole finger. And they may still have the sensation of not getting enough air. So again, it's it's tricky.

SPEAKER_07

Yeah.

SPEAKER_06

Okay. But in general, what when you go in for rhinoplasty, you're also supposed to pay attention to make sure that the airway is open.

SPEAKER_01

Right.

SPEAKER_06

With that said, a lot of times you get a rhinoplasty to make the nose smaller. And if you're making the nose smaller, everything's gonna get smaller, right? Including the airway to some degree.

SPEAKER_00

Right. Now I'm like paying extra attention to my my breathing.

SPEAKER_06

But it's it's it's an extremely subjective thing. Um the you know, the the only way you know you could really screw it up is if somehow you know the airway is like closed completely. Yeah. Then you're then you're screwed.

SPEAKER_00

I have a question about rhinoplasty.

SPEAKER_06

Sure.

SPEAKER_00

Is there there is like a less um invasive way to get a nose job that's like almost like just shaving down a certain part or something?

SPEAKER_06

There's all there's there's a spectrum of how invasive it can be. There's even non-surgical nose jobs where you just inject filler, you know, which is basically making the nose bigger in order to hide a bump. So for example, if someone has a bump over here, if you put filler above the bump, and then the nose from the side looks straight, but it's a bigger nose.

SPEAKER_00

Gotcha.

SPEAKER_06

Sometimes you can put a little filler down here and that will bring out the calumella and it'll make like the nose look like it's turned up a little more.

SPEAKER_00

I see.

SPEAKER_06

So you can do that with filler. It's temporary, but that's what's called a non-surgical nose job. But as far as like actual surgery, there's a lot of very there's a lot of variation as far as how invasive you can be.

SPEAKER_00

Yeah. Do you always have to break the nose when doing a nose job? No, no.

SPEAKER_06

You don't always. Okay. Most of the time I do, but not always.

SPEAKER_00

Yeah. Yeah. Depends on like what they do. Yeah, on the width.

SPEAKER_06

Yeah, exactly. When it needs to be done. If the nose is narrow, you don't need to break it.

SPEAKER_00

Gotcha. Okay. Myth or fact. Facelifts last forever.

SPEAKER_06

That's a myth for sure.

SPEAKER_00

So, what could happen to a facelift?

SPEAKER_06

Five to ten years. Gravity keeps going. It just resets the clock.

SPEAKER_00

Yeah.

SPEAKER_06

Yeah. And you know, if you smoke or if you go out in the sun a lot, yeah, it won't last as long.

SPEAKER_00

Do you see a lot of people that return to redo their facelift?

SPEAKER_06

Well, I don't do a lot of facelifts in the last 20 years, but uh the first couple years in practice I did. And yeah, they they come back to redo. The secret to Hollywood stars is that they'll do their facelift over every five years. Uh they'll start, they'll get their first facelift like in their early 40s, and then they'll just keep re-tucking and tucking and tucking every five years. So you see like Demi Moore, you see like all these stars that look great, they're like 60 years old.

SPEAKER_01

Right.

SPEAKER_06

And they kind of look like they haven't aged since they were 40. It's because they just keep doing the little tucks.

SPEAKER_00

Right.

SPEAKER_06

But if they don't keep tucking, then they age like everybody else.

SPEAKER_00

Yeah. Okay. Myther facts. Buckle fat removal makes you look old later on.

SPEAKER_06

Yes, yes. Um, so what happens is as you age, part of the aging process is that you lose fat in your face. And so you look kind of more gaunt and like things kind of fall. So by not having fat in your cheeks, you might look old younger. Now that's the caveat is if you have thick skin, it doesn't really make a difference. It's only women who have like thinner skin, fairer skin, that you'll notice it uh more.

SPEAKER_00

Okay. Buckle fat removal is when you remove fat from the body.

SPEAKER_06

Yeah, cheat. Yeah, like do this. Does that.

SPEAKER_00

Okay.

SPEAKER_06

Which is great as long as if you have nice thick, you know, skin or your cheeks are full. It's great to have a nice kind of gaunt model, yeah. Defined look. But as you get older, like 40s and 50s, and your skin starts to thin out and things start to fall, now it's just you just look gaunt. You know, like I see.

SPEAKER_00

Yeah. Interesting.

SPEAKER_06

Yeah.

SPEAKER_00

Okay. Myth or fact. BBLs smell bad during recovery. Myth. Myth? Yeah. I I've been seeing that online. I was so curious.

SPEAKER_06

That's a myth.

unknown

Yeah.

SPEAKER_00

Myth or fact. Fillers can replace a facelift.

SPEAKER_06

Uh half.

SPEAKER_00

Half.

SPEAKER_06

So it can definitely it can't replace a facelift, but it can push it off.

SPEAKER_00

Okay.

SPEAKER_06

So it can you can fillers are more temporary, right? Yeah, they're temporary, but they can push it off.

SPEAKER_00

Okay.

SPEAKER_06

If you if you need a facelift, you're gonna eventually need a facelift.

SPEAKER_00

Yeah.

SPEAKER_06

It can't replace it, but he can push it off a couple years. Gotcha.

Final thoughts & patient story

SPEAKER_00

Okay. Before we finish, I want to read you a testimonial from one of your patients.

SPEAKER_02

Okay.

SPEAKER_00

Okay. This isn't just cosmetic surgery, it's a full experience. I was nervous at first, but Dr. Miami took the time to answer all my questions, walk me through every step, and reassured me with both compassion and expertise. You can tell he genuinely cares about his patients, not just the results, but their whole journey. The surgical outcome exceeded my expectations. Natural, beautifully done, and tailored to my body. I appreciated how honest he was about what would work best for me, and he delivered exactly what we discussed. His attention to detail is unmatched, and the post-op care instructions were clear and thorough. I feel like myself again, only better. Thank you, Dr. Miami, for helping me reclaim my confidence with grace. How does that make you feel?

SPEAKER_06

Well, words of affirmation are is my love language. So that makes me feel really good, actually. Yeah, yeah. It's kind of what I it's kind of why I do this. That's awesome. Yeah, I'm like um, yeah. Yeah, I like I don't do it for the money. I mean, obviously, I have to support my family and stuff, but like that is the reason I do it. Yeah. It makes it feel really great. And you know, it's a great ego stroke. And um no, because I and I tell people, like I tell my fellow, we're in the happiness business.

SPEAKER_07

Yeah.

Closing

SPEAKER_06

Like if I change the way you look and I I love it, and who cares? You know, I did it, you you if you don't like it, if it doesn't make you happier, then I failed. You know, and I took your money for nothing. You know, if if you're not happier afterwards, right. And so I feel bad about that. So I always try to make sure that I that everybody leaves happy. Um, and that's what I do. I say I do psychiatry with a knife. You know, I work on people's self-esteem, and obviously she's happy and that makes me happy. So yeah.

SPEAKER_00

Yeah. Psychiatry with a knife. I like it.

SPEAKER_06

Psychiatry with a knife. That's what we do.

SPEAKER_00

That's awesome.

SPEAKER_06

Yeah.

SPEAKER_00

Okay. Well, this has been so amazing. Thank you for having me. It's been awesome just learning all about plastic surgery, learning about how you began and your practice and how you rose to fame on social media. If you want to let our viewers know, like where they can find you, where they can find your practice.

SPEAKER_06

Just Google Dr. Miami. Very simple. Google Dr. Miami or go to the realdrmiami.com. I'm not hard to find. Um, don't keep me a secret.

SPEAKER_00

Awesome. Um, so this has been Face It, where we get real about what works and what doesn't.

SPEAKER_06

Thank you. Thank you. Great pleasure of being here.