Body Banking: Why It's Better to Keep It w/ Dr. Douglas Steinbrech

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The title of today's
episode is "Body Banking:

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Why It's Better to Keep
It." Okay. Dr. Bass,

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I feel like I need a definition
here. Can you help me out?

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The idea here is that sometimes
we think we want something,

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but it may not be as good
an idea as it sounds.

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There might be a paradoxical effect that
gives us exactly what we don't want,

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and looking at things from a different
point of view can sometimes give us some

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insight and result in a
new approach to things.

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So we're talking about body fat here and
whether or not we want to get rid of it

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or keep it and why. And
this started, as I said,

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from rethinking the baseline
notion that fat is bad and we

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want to get rid of it.

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I brought the Innovative Mind that
developed this new approach to explain.

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Dr. Douglas Steinbrech is a board
certified plastic surgeon who trained

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at NYU at the Institute of
Reconstructive Plastic Surgery,

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the same department that I trained in.

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He's a master of body contouring
and minimally invasive approaches in

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plastic surgery.

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He's been especially active in
defining plastic surgery for men,

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including editing the seminal
textbook on the subject,

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which is titled Male
Aesthetic Plastic Surgery.

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He was gracious enough to ask me to
write a chapter in that textbook on cheek

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augmentation with implants and
filler. Dr. Steinbrech, welcome.

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Hey, thanks so much. I'm
really pleased to be here.

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It sounds like it'll be a fun topic.

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Welcome back to the
podcast, Dr. Steinbrech.

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Thanks.

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So Dr. Bass really didn't explain it.

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He teased me with that idea that
getting rid of fat might be bad.

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Can you explain body banking further
and how you came upon the idea?

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Yeah,

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it was actually kind of an
exciting thing because before that,

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we touched on this a little bit before,

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but what we were doing in the sixties
and seventies and eighties really,

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liposuction came along in
the eighties and nineties,

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started in France and then made
its way over to the United States.

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But what we were doing is just removing
fat. And while we were doing that,

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we didn't really think about
it. People just thought, oh,

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being skinnier is better,

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but they didn't think about what would
be like Dr. Bass sort of mentioned maybe

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there's some kind of
paradoxical problem with it.

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And what we found after we did more and
more of it is that if you suck out all

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the fat, then a couple things can happen.
Number one, if you think about it,

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it's just all about the numbers. And
if we think about removing fat cells,

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first of all,

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you have a limited number of fat cells
after you turn 18. There's a certain

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number that we all have in our body and
they just get bigger and smaller sort of

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going from grapes to
raisins, grapes to raisins.

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And every year as you lose
weight and gain weight,

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they go back and forth
from grapes to raisins.

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So you might imagine if you
weigh a hundred pounds wet

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and then you bloom up to
400 pounds, you'd think, oh,

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I made a lot of new fat
cells. You really didn't.

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You just made larger
preexisting fat cells.

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And then when you lost all that weight,

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conversely it's the same
number of fat cells,

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but they just all got very small. So
once you start thinking about that,

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you start thinking sort of moving fat
cells around your body is sort of like

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moving hair cells,
hairs around your scalp.

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You're not really removing them. If
you remove them and put them away,

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you're not going to be in as good as
shape as if you take them out and put them

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somewhere else.
And we started thinking that direction.

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We started to think about
the fat cells as clay.

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And I always say it at the
end of any of my talks,

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we do a lot of talking around
the country and around the world.

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We just finished our national conference
in Vancouver and then I have to

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run off to, I guess Cartagena
Colombia's next in June,

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and then we're doing going to
Greece in August and then in

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October down to Australia. So a lot of
running around talking about this stuff.

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But what we've learned
when we spread the idea,

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and this is what I say to everybody,

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is that we need to use these cells
and we need to think about it as clay.

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And I tell all the doctors and
the residents coming along,

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if you are at this point, if you are
throwing away all your fat, which I don't,

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I really only once or twice a year
out of the thousands of cases,

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hundreds of thousands of cases that we do,

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it's only once or twice a year.
And it's a very special instance that we

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actually don't do it.

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Usually the patients doesn't have fat
cells that are large enough at all.

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But I do banking for everything because
I believe that this structural fat,

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this structural clay is the
clay that helps me get a better

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result and helps me get a better result
than the surgeon that's across the

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street. And we have a lot of
plastic surgeons on Park Avenue,

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Dr. Bass knows that.
And same thing with our

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practice in Los Angeles. When I
started doing the men, really,

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we had so many men and we saw that
there was demand with this that we

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started a Beverly Hills office
and then a Chicago office. So

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there is a demand for this, and this
is why I like to talk about this.

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I like to encourage other
surgeons to do this,

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but I really feel body
banking is important because

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for two different reasons.
First of all, like I said before,

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the clay I can subtract and then add to
other areas so I can give the patient a

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more artistic athletic result
like a sculptor is doing.

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The sculptor never just takes
the clay and throws in the fat.

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But the other real reason is
the second part of the equation,

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and that is we're starting to learn
about really what happens to those fat

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cells postoperatively. And
as I've been watching this,

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and I've been learning
about this, I've developed,

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I've looked at a lot of patients
that we call liposuction cripples.

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What are liposuction cripples?
Those are gentlemen that have,

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or women that they have too
much time and too much money.

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So they spend a lot of their
time at fancy restaurants and

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at fancy plastic surgeons
all over Europe and all over

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South America. And when you see
these patients come in for the men,

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they've had liposuction four
or five, six different times,

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and they all look like they're members
of the same family. All their backs are

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like a tiny little waist and then their
belly is out to here. Well, why is that?

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Because those doctors,
three or four times,

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they keep on sucking the subcutaneous,
that's of fat underneath the skin out.

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They keep on sucking it out and
sucking it out and sucking it out.

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But unless the patient
after surgery decreases

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their caloric intake or increases
their caloric burn, guess what?

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The fat cells left behind, well,

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compensatorily enlarge.

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So if I have liposuction and I go in
the restaurant and I'm eating those

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same rich sauces and I'm having ice
cream every the same 10 gallons of

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ice cream every night, well,
I always tell my patients,

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I tell the other doctors those calories,

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those carbs from that Netflix ice cream
don't just pass through you. No, no, no.

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They're going to swim around the body
until they find fat cells. And that's

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where the fat cells store
them. So all those patients,

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all those liposuction and cripples,

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they're still skinny back here because
those fat cells have been removed,

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but they're nine months pregnant
because the only cells left over are the

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visceral fat cells and they
compensatorily enlarge.

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We have a name for that that's called
rebound fat or a funny technical name

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called "catch fat,"
compensatory atrophic cellular

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hypertrophy, which means those cells
in their belly, compensator enlarged,

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and also other as inner outer
thighs, other undesired errors.

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So this is a real philosophy and
it's a real scientific medical

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phenomenon and that's why
we've been able to use it in,

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we've been taking a bad thing,
a paradoxically bad thing,

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and we've grabbed it and
we've used it for us.

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Now we have the power in our hands by
using those fat cells and actually putting

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'em into good places
to get a better result.

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That makes a lot of sense. So
how do you use this in practice?

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What are the most common applications?

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Yeah, so that's where we
take it. I started, this is
how we started our journey.

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I started, I had a patient and I
just did straightforward liposuction.

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This guy was jacked,

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but he just had a little bit of extra
fatter around his abs and he was trying to

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get his abs really enunciated, trying
to get more definition. So I thought,

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this is great. I studied all my
books and I saw where the linea is,

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the transverse inscriptions,
the semi liners,

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which are the side inscriptions.
And so I had everything,

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I did all my liposuction and he just
didn't get the projection of his abs that

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he wanted.

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And I realized I always do all my
thinking in the shower because in the

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shower, that's when my brain calms down.

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And I have this idea that why you sleep?

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Your body's trying to
solve all these problems,

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but when you wake up with that alarm,

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you immediately forget everything.
So when you jump in the shower,

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the shower technology has
a lot of runs over you.

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The things that you're thinking
about and you're solving.

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These problems rise to the
surface and you're shower.

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And I get a lot of my ideas when
I'm taking a shower in the morning,

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shower technology, and that's when
I got this and I still get them.

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That's when I got this idea

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that we're going to use structural fat
to increase projection in those areas.

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So I started putting just
a little bit on top of

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each little abdominal packet
to make those project,

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and I took the same patient back. I
said, listen, I'm going to do this.

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I'm going to do this for free
because I feel like I let you down.

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And he was so happy.

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He kept on sending me pictures of
how great he looked at the gym.

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We were able to give them
that extra projection.

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So what I did is I extended that. I
started injecting everything, chest,

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shoulders traps into the
biceps triceps, forearms,

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the glutes, the gluteal augmentation,

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that's our body banking
brady butt lift and

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also into the calves in other areas. So
it's really been sort of a revolution.

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And I don't miss a drip. Like I said,

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rarely do I not do it. And after,

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usually it's the wife or the boyfriend
that's against it because they don't

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really understand, they haven't read
it and they just think all fat is bad.

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And once I explained the
philosophy and they get it,

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and we even have a whiteboard video on

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YouTube that explains two brothers,
one brother has body banking,

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the other brother has traditional
liposuction and we'll watch after surgery.

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The brother that went first,
he ends up getting belly fat

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and the guy that had body banking
doesn't get the belly fat and

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instead his shoulders get
wider after surgery. So

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the two twin brothers have dramatically
different physiques and post operative

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experience. And let me tell
you, after you've had it,

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my guys get so charged up that they
work harder at the gym than they've ever

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worked before because they
really got a great kickstart.

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So now we're doing it for all different
areas and the patients are very

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happy with it.

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This is really intriguing to
me. I'm curious to know more.

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So what are the most common
ages and does utility vary by

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age? What do we know about fat
take by age and grafting overall?

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That's excellent question because that
really does have something to do with it.

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We notice in younger people that more fat

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sticks around than in older people,

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and it just has to do with senescence
and the quality and the vigor of

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those individual cells that we transplant
and also blood supply and other things

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like that. So younger people
do have a better take,

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which is great. In fact,

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this is a fantastic story of a
medical student for some reason.

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I get a lot of doctors when we
do body, I think they understand,

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they completely get the idea about

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compensatory atrophic cellular
hypertrophy or catch fat.

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They completely see the
metabolic reasons for it.

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But this was a medical
student and I did his,

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one of my first patients and I took
all the fat out and I put it all

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upstairs.

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He wanted what we call the triple play.
He wanted an lateral posterior deltoid.

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He wants the deltoids upper in her
chest and he wanted those traps.

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And I saw him like six
months later and was,

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he was a nervous eater.

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And so he was in the
middle of finals. I said,

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how's things going with
your medical finals?

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I think he was like a third or
second year medical student.

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He had physiology and all
that kind of stuff he said,

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or introduction to clinical medicine,
ICM, but he was all stressed out. I said,

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00:14:01,210 --> 00:14:04,570
"well, at least you've
had time to go to the gym.

224
00:14:04,720 --> 00:14:08,920
Your shoulders are huge and your chest
looks great." And he said, "no." He said,

225
00:14:09,250 --> 00:14:13,150
"I haven't had anything. And

226
00:14:14,800 --> 00:14:19,540
he said, I haven't been able
to work out in two months.

227
00:14:19,930 --> 00:14:23,200
And I've been stress
eating." He put on 40 pounds.

228
00:14:23,440 --> 00:14:25,510
But because we did the body
banking in those areas,

229
00:14:25,510 --> 00:14:28,540
he looked massive.
And it wasn't from working out,

230
00:14:28,540 --> 00:14:31,510
it was from everything that I
had transplanted into the muscle.

231
00:14:31,720 --> 00:14:33,370
I have another great story from,

232
00:14:33,400 --> 00:14:37,660
this is another patient that
went to California when I just,

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00:14:37,690 --> 00:14:39,850
before I started my California practice,

234
00:14:40,180 --> 00:14:43,720
this is a California guy that flew all
the way to New York so that we could do

235
00:14:44,770 --> 00:14:48,220
put in calf implant or put in
glue implants and pec implants.

236
00:14:48,220 --> 00:14:49,540
We'll talk about that at the end.

237
00:14:50,020 --> 00:14:53,030
But I also did a little
liposuction and I was like, "well,

238
00:14:53,030 --> 00:14:54,980
what the heck are we going to
do with it?" And he said, "well,

239
00:14:55,490 --> 00:14:56,210
don't throw it away.

240
00:14:56,210 --> 00:15:01,100
You can plug it into the
biceps and the triceps." And

241
00:15:01,100 --> 00:15:05,930
so he came back six months
later and sure enough,

242
00:15:06,410 --> 00:15:10,370
his chest had healed, chest looked
great, the glutes look great.

243
00:15:10,430 --> 00:15:13,010
And I looked at him
and I was really angry.

244
00:15:13,490 --> 00:15:18,020
I was really ticked off.
And I said,

245
00:15:18,620 --> 00:15:23,540
I just reached out and I felt his biceps.
And I said, "I did this great job.

246
00:15:23,540 --> 00:15:26,630
I mean, weren't you happy
with the pec implants?

247
00:15:26,630 --> 00:15:29,540
Were you happy with the
gluteal implants? I said, why?

248
00:15:30,560 --> 00:15:34,700
It looks like you went somewhere to
get calf implants and to get bicep

249
00:15:34,700 --> 00:15:36,170
implants?" And he said,

250
00:15:36,170 --> 00:15:40,550
"no," and this is where that
moment where you get chills.

251
00:15:41,090 --> 00:15:44,990
And he said, "no, you said that you
were going to put some fat in there,

252
00:15:44,990 --> 00:15:48,800
some cells in there".
And it looked fantastic.

253
00:15:48,800 --> 00:15:53,210
And I got these chills because
it was like, holy moly,

254
00:15:53,210 --> 00:15:55,160
this really works after that.

255
00:15:55,160 --> 00:15:56,990
So that was a eureka moment.

256
00:15:57,200 --> 00:16:01,370
It was a eureka moment. I was like, well,
let's just do this. See what happens.

257
00:16:01,700 --> 00:16:05,840
And it worked so much that I was jealous.
I thought he went to somebody else.

258
00:16:06,710 --> 00:16:10,880
But it was a great surprise and I still
get chills thinking about it now because

259
00:16:10,880 --> 00:16:12,530
it was such an exciting day.

260
00:16:12,950 --> 00:16:16,760
And that's when I just started doing
it for everyone in all these different

261
00:16:16,760 --> 00:16:19,250
areas. So it's a really exciting moment.

262
00:16:20,120 --> 00:16:23,360
Wow, that's really great. Overall,

263
00:16:23,360 --> 00:16:26,600
would you say is this more
useful for men or for women then?

264
00:16:26,600 --> 00:16:30,050
Or is it more or less
universal based on biology?

265
00:16:30,770 --> 00:16:34,730
It's universal, but I'd say, like
I said before, sort of jokingly,

266
00:16:34,940 --> 00:16:36,380
women are interested in four bumps,

267
00:16:36,380 --> 00:16:40,820
but men are interested in two bumps in
front, two bumps in back. But women,

268
00:16:41,090 --> 00:16:45,860
men are interested in all sorts of bumps
all over the place. And so for men,

269
00:16:45,860 --> 00:16:50,330
it really works well because we can
use it as a detail sculpting tool,

270
00:16:50,330 --> 00:16:55,100
which you can also do for women, but we
can use it for the shoulders, the traps,

271
00:16:55,100 --> 00:16:55,880
the chest,

272
00:16:55,880 --> 00:17:00,590
all those other areas that we don't
necessarily think about as much for women.

273
00:17:01,130 --> 00:17:04,700
Now I've got a little bit
of a challenging question,

274
00:17:04,700 --> 00:17:07,820
and of course as Americans,
a lot of us are overweight,

275
00:17:07,820 --> 00:17:09,740
so there's fat available,

276
00:17:09,740 --> 00:17:14,270
but not everyone walks in
overweight or with a fat

277
00:17:14,300 --> 00:17:16,070
depot that you can access.

278
00:17:16,730 --> 00:17:21,650
So what do you do in patients
who don't have fat to work with

279
00:17:21,710 --> 00:17:24,050
and they want to build a body shape?

280
00:17:25,250 --> 00:17:26,083
Yeah,

281
00:17:26,480 --> 00:17:31,340
this is a significant challenge
because occasionally I come in and we

282
00:17:31,340 --> 00:17:35,960
have in New York, they're all from
Chelsea. So these guys are ripped.

283
00:17:36,200 --> 00:17:40,550
They do not have an ounce of fat
on their body. There ain't none.

284
00:17:41,030 --> 00:17:44,000
And then out in LA, it's in
WeHo, it's in West Hollywood.

285
00:17:44,360 --> 00:17:48,740
All the guys down there, they all
do yoga, they all do spin class,

286
00:17:49,050 --> 00:17:52,740
they all hit the weights. A lot of
them are on just a little bit of test,

287
00:17:52,740 --> 00:17:54,540
not necessarily growth hormone,

288
00:17:54,540 --> 00:17:59,220
but just a little bit of testosterone
that's totally legit that their doctor

289
00:18:00,060 --> 00:18:04,800
gives them just to get their
natural endogenous testosterone

290
00:18:04,800 --> 00:18:09,180
levels up. So those guys though,
they are rip. There is no fat,

291
00:18:09,180 --> 00:18:11,190
there is no depot. And for those people,

292
00:18:11,820 --> 00:18:13,380
they would just be
disappointed if we do it.

293
00:18:13,380 --> 00:18:16,800
And these are a few of the exceptions
where I don't do it. I do as much as I

294
00:18:16,800 --> 00:18:17,130
can,

295
00:18:17,130 --> 00:18:20,310
but it's not enough to give them the
volume that they want in all those areas.

296
00:18:20,700 --> 00:18:23,730
For those people, what we
do are we use implants.

297
00:18:24,030 --> 00:18:27,090
So it's interesting because everybody,

298
00:18:27,330 --> 00:18:30,270
all the women and all the girlfriends
and all the guys and all their

299
00:18:30,270 --> 00:18:32,970
girlfriends, their wives, their mothers,

300
00:18:33,270 --> 00:18:38,160
they all know that if they want larger
breasts that they can just go get breast

301
00:18:38,160 --> 00:18:42,090
augmentation with the plastic
surgeon. And that is a okay,

302
00:18:42,510 --> 00:18:44,220
because everybody, they look great.

303
00:18:44,220 --> 00:18:48,390
They're fun and it makes them feel good.

304
00:18:48,510 --> 00:18:50,940
That's why they come,
makes 'em feel attractive,

305
00:18:50,940 --> 00:18:53,280
gives them more options
and fit into more things.

306
00:18:53,640 --> 00:18:57,720
But the dudes don't realize that
they can have that too. So men,

307
00:18:57,720 --> 00:18:59,430
if they don't have fat,

308
00:19:00,870 --> 00:19:05,130
what we can do is we can do augmentation
with a pec implant, bicep implant,

309
00:19:05,330 --> 00:19:08,070
tricep implant, shoulder implants,

310
00:19:08,070 --> 00:19:12,930
even traps. I created ab
implants that really are natural

311
00:19:12,930 --> 00:19:17,880
appearing, gluteal implants,
quad implants and calf implants.

312
00:19:17,880 --> 00:19:21,270
I don't think I left anything out
while we also have chin cheek,

313
00:19:21,330 --> 00:19:25,290
jawline implants. So pretty
much all those areas,

314
00:19:25,290 --> 00:19:29,850
if we don't have fat, or even if you do,
sometimes you may not have enough fat.

315
00:19:30,240 --> 00:19:34,620
And for those patients, and a lot of
times, I'll give you a classic example,

316
00:19:35,010 --> 00:19:39,960
had a guy that came in
from, flew all the way in.

317
00:19:40,380 --> 00:19:45,300
He and our buddy flew
in from Singapore and

318
00:19:45,960 --> 00:19:50,160
this guy was ripped and I knew that
there was not going to be a drop.

319
00:19:50,160 --> 00:19:51,840
And I said, we'll see
when you get into town,

320
00:19:51,840 --> 00:19:56,430
we had planned for both for body banking
and implants. Turns out he had no fat,

321
00:19:56,450 --> 00:20:00,600
but what he needed, his
biceps, pecs and glutes.

322
00:20:00,600 --> 00:20:02,610
So I was able to put
in the gluteal implant

323
00:20:04,770 --> 00:20:05,670
and the bicep implant,

324
00:20:05,670 --> 00:20:08,790
and then he came back to have the pec
implant. So couldn't do those both at the

325
00:20:08,790 --> 00:20:12,510
same time because you want to rest
on your backside for your pecs,

326
00:20:12,510 --> 00:20:15,930
you want to rest on your
front side for your glutes.

327
00:20:15,930 --> 00:20:19,590
So the two incisions and the
two postoperative courses
competed with each other,

328
00:20:20,100 --> 00:20:22,950
but we put in his glutes
and his biceps. He was very,

329
00:20:22,980 --> 00:20:25,500
very pleased and we were
able to do it without

330
00:20:27,720 --> 00:20:32,310
using any fat. And then the second
story is a guy that was a bodybuilder,

331
00:20:32,310 --> 00:20:37,020
but he hurt his back and he had a pretty
significant back injury and he wasn't

332
00:20:37,020 --> 00:20:40,650
able to work out with heavy
weights and he really missed,

333
00:20:40,650 --> 00:20:41,490
he had a lot of clothes,

334
00:20:41,490 --> 00:20:46,170
he had a lot of just regular
polos and t-shirts and

335
00:20:46,170 --> 00:20:49,030
things, and none of his
shirts he could fit in to.

336
00:20:49,030 --> 00:20:51,250
And in one sitting for him,

337
00:20:51,670 --> 00:20:56,260
I was able to put in pec implant,
deltoid implant, bicep implant,

338
00:20:56,290 --> 00:21:00,580
and a forearm implant. And that's
generally what we do. We do them in pairs,

339
00:21:01,420 --> 00:21:06,040
we put in all the arms and legs.

340
00:21:06,040 --> 00:21:09,070
We have paired muscles, so biceps
triceps, two heads to the forearms,

341
00:21:09,430 --> 00:21:12,790
two heads to the quads and
two heads to the calves.

342
00:21:13,120 --> 00:21:14,950
So what we'll do is half of the paired,

343
00:21:14,950 --> 00:21:18,610
so patients might fly in from South
America and I'll put in a bicep,

344
00:21:18,610 --> 00:21:22,060
one head of the forearm, one head of
the calf and one head of the quad.

345
00:21:22,060 --> 00:21:24,640
Then they come back and we'll
put in the other paired muscle.

346
00:21:24,640 --> 00:21:28,360
And the reason why we do that is
to put in a good size implant,

347
00:21:28,780 --> 00:21:33,340
but then allow the swelling to go down
so that we can put on a good size implant

348
00:21:33,340 --> 00:21:37,720
on the other side. And we don't
run into problems of having

349
00:21:38,350 --> 00:21:41,890
compromised blood supply because too
much swelling on both sides of the bone.

350
00:21:43,240 --> 00:21:47,890
But for this gentleman that came in
with a back injury, I was able to,

351
00:21:47,980 --> 00:21:49,480
and he could walk around,
he was fine with that.

352
00:21:49,480 --> 00:21:53,860
He just couldn't lift heavy weights.
I was able to put a forearm,

353
00:21:53,860 --> 00:21:56,470
a bicep, shoulder and chest,

354
00:21:56,470 --> 00:21:58,990
and then four hours he was back to,

355
00:21:58,990 --> 00:22:03,520
he felt able to get back into the
clothes that he used to be wearing.

356
00:22:04,360 --> 00:22:07,960
So silicone implants are a great option
for those challenging cases when people

357
00:22:07,960 --> 00:22:09,940
don't have their own endogenous fat cells.

358
00:22:11,020 --> 00:22:15,550
Okay, that's great. So you've touched
on this a little bit previously,

359
00:22:15,550 --> 00:22:17,260
but let's dive a bit deeper.

360
00:22:17,260 --> 00:22:21,700
What are the main procedures or attributes
that are targeted in body banking and

361
00:22:21,700 --> 00:22:22,533
men?

362
00:22:22,900 --> 00:22:25,840
For most guys, by the way, we
could do it in face as well.

363
00:22:26,740 --> 00:22:31,210
If men are interested, some of the guys
are interested in having more structure.

364
00:22:31,570 --> 00:22:34,600
And while we're taking the
fat out of those areas,

365
00:22:34,900 --> 00:22:38,920
a lot of times I'll use it
for jawline augmentation,

366
00:22:39,700 --> 00:22:42,190
we'll use it for cheekbone augmentation,

367
00:22:42,430 --> 00:22:47,380
maybe even some areas that are a little
bit lacking, like the nasolabial folds.

368
00:22:47,440 --> 00:22:51,610
Or even with lips, guys don't want
big lips. They don't want lips like

369
00:22:53,170 --> 00:22:57,430
Kylie Jenner kind of with
looks like sucked out a
bottle or something like that.

370
00:22:57,430 --> 00:23:02,140
They don't want the DSLs. What they
want is though, as men get older,

371
00:23:02,140 --> 00:23:06,130
one of the signs of aging is their
lips lose volume and they get really,

372
00:23:06,130 --> 00:23:07,000
really thin.

373
00:23:07,330 --> 00:23:10,630
And we're not doing any give anybody
duck lips or Kylie Jenner lips.

374
00:23:10,630 --> 00:23:12,220
That's not why we do it,
particularly in the men,

375
00:23:12,250 --> 00:23:16,060
because the men don't want to look done.
Where we do is just put in a little bit

376
00:23:16,060 --> 00:23:20,800
to bring them back to back 10 years where
their lips were a little bit fuller,

377
00:23:21,100 --> 00:23:22,390
a little bit more youthful.

378
00:23:22,390 --> 00:23:27,310
This is an important tiny
detail that people forget

379
00:23:27,310 --> 00:23:29,470
about as they get older,
their lips thin out.

380
00:23:30,340 --> 00:23:35,320
But the major areas that
we put in for the guys is

381
00:23:35,320 --> 00:23:38,620
really, they usually want
in a couple different areas.

382
00:23:38,620 --> 00:23:41,650
There are guys that are more upper body
guys and there are guys that are more

383
00:23:41,650 --> 00:23:46,010
quarterback guys that want to
have bigger glutes, more glutes,

384
00:23:46,610 --> 00:23:48,140
more maybe more projection.

385
00:23:48,140 --> 00:23:53,090
They may even want to have those
body banking gluteal muscles that

386
00:23:53,360 --> 00:23:58,160
have a sexy concavity on the side and
have good projection or maybe a guy that

387
00:23:58,220 --> 00:24:01,910
kind of wants that round
speedo kind of backside.

388
00:24:01,910 --> 00:24:04,310
So that's glutes are a big spot.

389
00:24:04,850 --> 00:24:09,590
Another big spot is what I call the
triple play. Triple play for the dudes is

390
00:24:09,590 --> 00:24:12,140
it's all about the upper body
and it's about the cobra back.

391
00:24:12,530 --> 00:24:16,190
The back is the back are the new abs.

392
00:24:16,670 --> 00:24:19,760
Everything used to be the biceps, then
it was the chest, then it was the abs.

393
00:24:19,760 --> 00:24:22,190
Now it's the back. Every guy, every guy,

394
00:24:22,190 --> 00:24:25,640
and I don't care if you're straight
or gay, every guy appreciates a man

395
00:24:27,260 --> 00:24:29,390
that likes a big strong back.

396
00:24:29,390 --> 00:24:33,890
Women love a guy that has a big strong
back and that cobra back has wide

397
00:24:33,890 --> 00:24:35,810
shoulders and a slender waist.

398
00:24:35,810 --> 00:24:40,250
So what I do is I end up popping it
into the shoulders, anterior lateral,

399
00:24:40,250 --> 00:24:45,140
posterior deltoids up into the traps,
maybe even a little bit into the lats.

400
00:24:45,140 --> 00:24:49,340
And I forgot that's another area that
I can put in silicone implant into that

401
00:24:49,340 --> 00:24:50,360
area. If you have no fat,

402
00:24:50,840 --> 00:24:55,340
but to give you that big wide upper
body is going to make your waist look

403
00:24:55,340 --> 00:24:59,210
smaller. So the guys love
to put it in that area.

404
00:25:00,290 --> 00:25:05,090
Okay, got it. So now for the other half,
what are the main procedures for women?

405
00:25:05,810 --> 00:25:08,720
For women? So when we
do body bank in women,

406
00:25:08,720 --> 00:25:13,460
usually most commonly would
be going into the gluteal

407
00:25:13,460 --> 00:25:14,150
area.

408
00:25:14,150 --> 00:25:19,010
It doesn't mean we're not talking
about this Kardashian era or that

409
00:25:19,010 --> 00:25:20,840
there's that pretty girl that

410
00:25:22,580 --> 00:25:27,170
has a huge backside where
she needs to ask for

411
00:25:27,170 --> 00:25:30,290
two airplane tickets to be able to fit in.

412
00:25:30,500 --> 00:25:35,210
She's got a tiny waist and just a huge
back derrière not necessarily talking

413
00:25:35,210 --> 00:25:37,130
about that for women, what they may want,

414
00:25:37,490 --> 00:25:41,390
and these are even those ladies
out in South Hampton, East Hampton,

415
00:25:42,440 --> 00:25:47,330
and they go to the beaches in
Connecticut and out in New Jersey.

416
00:25:47,330 --> 00:25:51,110
They want just something that has a
little bit of more volume so the tissues

417
00:25:51,110 --> 00:25:53,960
aren't falling. So I think in fact,

418
00:25:53,960 --> 00:25:58,670
I will say that the Kardashians
moved back on how much volume,

419
00:25:58,670 --> 00:26:02,900
it became a race for how big it can get
and how small it can get. And that ratio

420
00:26:02,900 --> 00:26:07,760
of how tiny a waist and how big
you can get your glutes for the

421
00:26:07,760 --> 00:26:11,510
women is going away. We're
moving away from the diaper butt.

422
00:26:12,470 --> 00:26:14,630
Women don't want that.

423
00:26:14,720 --> 00:26:17,390
I want that less people are
actually having that reversed.

424
00:26:17,660 --> 00:26:21,110
The same people that put it
in now are priding themselves.

425
00:26:21,680 --> 00:26:25,040
I'm not one of those people that are
priding themselves on taking it back out.

426
00:26:25,070 --> 00:26:26,960
Look at me while you're
the person that put it in.

427
00:26:28,010 --> 00:26:30,710
But everyone's moving
away from that. But still,

428
00:26:30,920 --> 00:26:34,880
I get the women that they're
very shapely and they have

429
00:26:35,780 --> 00:26:39,380
their slender and have
little pockets of fat,

430
00:26:39,770 --> 00:26:43,860
but we want to put in the glutes
not to make them big, no thing,

431
00:26:44,100 --> 00:26:47,430
but to lift any saggy
skin. So that's number one.

432
00:26:47,430 --> 00:26:49,170
Number two would be a
little bit in the breast.

433
00:26:49,170 --> 00:26:52,920
Now you have to know with the breasts
and not as much for whatever reason,

434
00:26:52,920 --> 00:26:56,370
Dr. Bass will back you up on this.
It's not a great site.

435
00:26:56,370 --> 00:26:59,250
And this is something that you have
to know in general about fat grafting,

436
00:26:59,250 --> 00:27:02,940
which a lot of people, even doctors don't
know. Some areas are, two different.

437
00:27:04,110 --> 00:27:06,480
We're going to plant
a seed and these seed,

438
00:27:07,620 --> 00:27:10,080
these 10 seeds we're going
to plant in the jungle,

439
00:27:10,290 --> 00:27:12,990
all 10 of them are going to grow
into beautiful tropical trees.

440
00:27:13,350 --> 00:27:16,740
These 10 seeds we're going to
put in the middle of the desert.

441
00:27:17,010 --> 00:27:19,440
How many of those seeds are
going to grow? Not a lot. Well,

442
00:27:19,440 --> 00:27:22,050
the same thing holds true for
the different parts of your body.

443
00:27:22,050 --> 00:27:27,030
And it's really about one of the main
factors is about the hospitality locally,

444
00:27:27,690 --> 00:27:30,570
the milieu of the local recipient site,

445
00:27:30,630 --> 00:27:34,440
which is served something
that was not intuitive,

446
00:27:34,770 --> 00:27:39,570
but I can tell you and surgeons that
do a lot of this know that if you

447
00:27:39,570 --> 00:27:44,250
put the fat cells in the glutes that your
retention is probably going to be 40,

448
00:27:44,250 --> 00:27:48,660
50 or even 60% better than if you put
in the breast. So that's the other area

449
00:27:48,660 --> 00:27:52,380
that I was getting to is a lot of
women want to put in the breast,

450
00:27:52,380 --> 00:27:55,800
but you have to overcorrect in the breast
a great deal to get your final result

451
00:27:56,250 --> 00:27:58,710
because we just haven't cracked the code.

452
00:27:59,430 --> 00:28:02,970
The little secret to have more of
those cells survive in the breast,

453
00:28:02,970 --> 00:28:07,200
no matter what surgeon does it, no
matter what technique that surgeon uses,

454
00:28:07,560 --> 00:28:11,100
you can throw the cells up on
the ceiling, scrape 'em off,

455
00:28:11,100 --> 00:28:14,670
mix 'em in with potato dust. They're not,

456
00:28:14,670 --> 00:28:19,140
the retention is not going to be as good
in the breast as it is in the buttock

457
00:28:19,140 --> 00:28:19,800
area.

458
00:28:19,800 --> 00:28:23,700
And part of that is the
amount of blood supply or the

459
00:28:23,700 --> 00:28:27,360
capacity, like you said, fertile soil.

460
00:28:27,360 --> 00:28:32,070
You can plant a lot of seeds. And in an
arid desert, you can only plant a few.

461
00:28:32,070 --> 00:28:36,810
And in fact, the more you put
down to compete for blood supply,

462
00:28:36,840 --> 00:28:40,890
the less fat take you may have versus

463
00:28:41,280 --> 00:28:45,450
putting a staged approach
where you come back,

464
00:28:45,930 --> 00:28:50,520
the fat that went in the first time is
going to have biological effects that

465
00:28:50,520 --> 00:28:54,750
amplify the blood supply in
the area and we're coming to

466
00:28:54,750 --> 00:28:56,400
biology in fat.

467
00:28:57,030 --> 00:29:01,770
But by creating some
neovascularization new blood

468
00:29:01,770 --> 00:29:05,280
supply, when you come back in
stage two to graft more fat,

469
00:29:05,670 --> 00:29:10,530
you may succeed better than just
putting a whole bunch more in one stage.

470
00:29:11,520 --> 00:29:14,430
And I completely agree with Dr. Bass,

471
00:29:14,430 --> 00:29:19,350
and one example I have is with
patients who have Poland disease,

472
00:29:19,350 --> 00:29:23,070
which is a fascinating genetic disease
where they may be missing part of their

473
00:29:23,070 --> 00:29:24,870
pec muscle or all their pec muscle,

474
00:29:25,320 --> 00:29:29,430
an extreme phenotypic expression
may be missing their entire arm.

475
00:29:29,430 --> 00:29:33,030
More commonly in men sometimes happens
in women as well where they're missing an

476
00:29:33,030 --> 00:29:37,500
entire breast or part of it. For
these patients, I was struggling,

477
00:29:37,500 --> 00:29:40,710
struggling putting in implants by
found because they were not very well

478
00:29:40,710 --> 00:29:45,160
developed. They sometimes didn't
have a developed lymphatic system,

479
00:29:45,160 --> 00:29:49,300
and it was common to get fluid collections
around the implant after placing

480
00:29:49,300 --> 00:29:50,020
these,

481
00:29:50,020 --> 00:29:54,490
switched strategy and
now we graft first layer

482
00:29:54,880 --> 00:29:59,110
and the purpose of the, first of all,
I say we're going to do three graft,

483
00:29:59,290 --> 00:30:01,030
that's it, or we're not
going to do it at all.

484
00:30:01,540 --> 00:30:06,310
And it's just some people's expectations.
And so first layer is just to get

485
00:30:06,310 --> 00:30:09,610
enough cells, and this is exactly
what Dr. Bass was just talking about,

486
00:30:09,610 --> 00:30:14,500
just to get enough cells in there
so it gets the skin off the bone.

487
00:30:14,890 --> 00:30:19,240
And then you may develop a little bit of a

488
00:30:19,240 --> 00:30:22,750
lymphatic bridge or develop
something that was lacking.

489
00:30:23,110 --> 00:30:26,920
But really what you do is get some good
vascular supply and you create a space

490
00:30:26,920 --> 00:30:31,480
that you can put in more cells. And then
after the second and third grafting,

491
00:30:31,480 --> 00:30:33,550
that's where we really see
it. So the first piece,

492
00:30:33,550 --> 00:30:34,780
it's not for the first grafting,

493
00:30:34,930 --> 00:30:38,290
that's to lay the bed and then it's the
second and the third grafting is where

494
00:30:38,290 --> 00:30:39,340
we see the magic happen.

495
00:30:40,450 --> 00:30:42,400
Okay, that's really interesting.

496
00:30:43,000 --> 00:30:46,540
So far we've mostly focused
on aesthetic features.

497
00:30:46,570 --> 00:30:49,510
What do we know about the
metabolic impacts of body banking?

498
00:30:50,050 --> 00:30:52,090
Yeah, I mean, well,

499
00:30:52,510 --> 00:30:56,560
I actually spoke at Columbia

500
00:30:57,250 --> 00:31:02,050
University instead of
the country a few years

501
00:31:02,050 --> 00:31:02,380
ago,

502
00:31:02,380 --> 00:31:05,110
and they asked me to speak because they
were really interested and they were

503
00:31:05,110 --> 00:31:07,330
doing a grant to the NIH.

504
00:31:07,780 --> 00:31:12,280
And what they're trying to do is they're
trying to look about how can we have

505
00:31:12,280 --> 00:31:15,220
less visceral fat? Because
vis fat, belly fat,

506
00:31:15,220 --> 00:31:20,020
fat behind your abdominal wall is
associated with increased rates

507
00:31:20,350 --> 00:31:24,400
of mortality, of diabetes,

508
00:31:24,700 --> 00:31:25,990
of joint disease,

509
00:31:26,290 --> 00:31:29,980
of high blood pressure
correlates with heart attacks.

510
00:31:29,980 --> 00:31:32,620
So just all those fat,
all those bad things.

511
00:31:33,700 --> 00:31:37,840
So what I was doing is I was taking that

512
00:31:38,650 --> 00:31:39,520
fat out,

513
00:31:40,660 --> 00:31:43,810
but I wasn't throwing it away
because if you threw it away,

514
00:31:44,260 --> 00:31:47,590
then you would end up having increased

515
00:31:49,240 --> 00:31:52,660
visceral fat, which could increase
your chances of all those problems.

516
00:31:53,020 --> 00:31:55,240
So they were actually
interested in having me speak,

517
00:31:55,240 --> 00:31:58,990
and I didn't speak to the plastic surgery
department who asked me to speak was

518
00:31:58,990 --> 00:32:03,100
the Department of Metabolism. It was
the diabetes department because they're

519
00:32:03,100 --> 00:32:08,020
trying to figure out how all this visceral
fat works and their NIH grants behind

520
00:32:08,020 --> 00:32:09,250
this. So I spoke with them,

521
00:32:09,250 --> 00:32:13,870
it was my honor to be able to
speak as a demo plastic surgeon

522
00:32:14,170 --> 00:32:19,030
to a bunch of really smartypants
metabolism people. And they got it.

523
00:32:19,090 --> 00:32:22,540
They totally got it. They
understood how this would work.

524
00:32:22,540 --> 00:32:26,590
They understood the math behind
it. And in fact, I'm working on,

525
00:32:26,920 --> 00:32:30,220
when you talk about the
metabolism, I'm working on

526
00:32:32,080 --> 00:32:35,650
a mathematical formula and this formula is

527
00:32:36,460 --> 00:32:41,000
by how many fat cells do

528
00:32:41,000 --> 00:32:45,470
we suck out, meaning how
many in ccs of fat cells,

529
00:32:45,890 --> 00:32:50,840
and then how much do we
need to increase or decrease

530
00:32:51,170 --> 00:32:56,060
our caloric intake or our
caloric output based on

531
00:32:56,060 --> 00:32:58,670
how much fat cells we removed.

532
00:32:58,910 --> 00:33:03,590
To be able on the other side of the
equation to maintain either your

533
00:33:03,590 --> 00:33:07,460
current body weight or your
current physique. And I
think we're going to get it

534
00:33:07,460 --> 00:33:11,870
to the point where we can figure out,
if I tell you this is your weight,

535
00:33:11,930 --> 00:33:16,910
this is your height, this is the amount
of fat that we took out in terms of CCs,

536
00:33:16,910 --> 00:33:20,570
a certain concentration, this is
the amount that we bank back in,

537
00:33:20,750 --> 00:33:25,580
subtract those and put in your height
and weight and then determine how

538
00:33:25,580 --> 00:33:30,020
much you would need to increase or
decrease in terms of caloric burn or

539
00:33:30,650 --> 00:33:35,630
decrease caloric intake. And I think the
ones that we do with the body banking,

540
00:33:35,630 --> 00:33:38,750
you're going to find that there's not
that much difference because we've kept

541
00:33:39,140 --> 00:33:41,360
all the cells there. But the problem is,

542
00:33:42,140 --> 00:33:44,420
and this is why I'm making this formula,

543
00:33:44,660 --> 00:33:46,460
is I want to tell the people that don't.

544
00:33:46,820 --> 00:33:50,090
So if you come into my office and you
tell me that you're not going to do this,

545
00:33:50,360 --> 00:33:52,760
I'm going to plug in my
little equation, okay,

546
00:33:53,150 --> 00:33:55,820
this is what you are not
going to bank it. Okay,

547
00:33:55,880 --> 00:33:59,180
so this is how much we plan to take
out. This is how much you weigh.

548
00:33:59,180 --> 00:34:03,020
This is how tall you are
by my calculations, after
you've had this surgery,

549
00:34:03,020 --> 00:34:07,820
you have to decrease your caloric
intake by 10% or and increase

550
00:34:07,820 --> 00:34:10,490
your burn rate by 15%.

551
00:34:10,700 --> 00:34:13,130
Or you're definitely going
to have visceral fat.

552
00:34:13,130 --> 00:34:15,080
You're definitely going to
become a lipo second cripple.

553
00:34:15,080 --> 00:34:17,960
You want to change your mind about
doing the body banking or not.

554
00:34:19,310 --> 00:34:23,960
So this is really interesting and in a
lot of ways it parallels what's happened

555
00:34:24,800 --> 00:34:29,660
and what's about to happen with
the GLP-1 medications Ozempic like

556
00:34:29,660 --> 00:34:33,530
medicine. So we started with liposuction,
we took fat out and threw it away.

557
00:34:33,980 --> 00:34:38,840
And now we recognize that your
proportion of subcutaneous and

558
00:34:38,840 --> 00:34:42,920
visceral fat changes when you do that.

559
00:34:43,700 --> 00:34:48,410
And not in a good way.
With the Ozempic like

560
00:34:48,410 --> 00:34:53,030
medicines, now as FDA goes
forward with new products,

561
00:34:53,030 --> 00:34:57,770
they're looking increasingly
at not weight loss,

562
00:34:57,800 --> 00:35:02,690
but fat loss versus muscle
loss because we really don't

563
00:35:02,690 --> 00:35:06,950
want to lose muscle. And
they're looking at, again,

564
00:35:06,950 --> 00:35:11,480
subcutaneous fat loss versus that
very metabolically active fat

565
00:35:11,480 --> 00:35:13,730
loss. Visceral fat loss,

566
00:35:14,120 --> 00:35:19,100
which is what those medications
in part target because

567
00:35:19,100 --> 00:35:24,050
of the receptor sensitivity of the
visceral fat to those medications.

568
00:35:24,350 --> 00:35:28,850
So it's interesting that the
pharmacologic weight loss

569
00:35:29,390 --> 00:35:34,130
progress in some ways is paralleling
what's already happened with

570
00:35:34,130 --> 00:35:38,460
surgical body contouring in the recent

571
00:35:38,460 --> 00:35:39,293
past.

572
00:35:39,600 --> 00:35:41,490
Yeah, it's really interesting.

573
00:35:41,490 --> 00:35:44,970
And I think we're going to
continue in terms of the GLP-1

574
00:35:47,760 --> 00:35:48,420
copycats,

575
00:35:48,420 --> 00:35:53,190
I think we're going to really
find out some interesting things

576
00:35:53,190 --> 00:35:56,820
coming forward in terms
of both fat metabolism or

577
00:35:57,510 --> 00:35:59,880
interestingly, as a sidebar,

578
00:36:01,950 --> 00:36:06,420
playing around with the molecules to
maybe have an impact on satiating your

579
00:36:06,420 --> 00:36:08,730
desires and other things
such as drug abuse or

580
00:36:10,740 --> 00:36:15,120
gambling or other bad habits that people
may have. So it's really fascinating,

581
00:36:16,320 --> 00:36:17,190
those medicines.

582
00:36:17,280 --> 00:36:19,110
It's a whole new world for sure.

583
00:36:19,770 --> 00:36:20,603
Absolutely.

584
00:36:20,910 --> 00:36:24,300
This is really interesting
overall. So Dr. Steinbrech,

585
00:36:24,450 --> 00:36:26,220
do you have any thoughts for the future?

586
00:36:26,220 --> 00:36:29,940
What research is going on and
what's the future for body banking?

587
00:36:30,420 --> 00:36:34,410
Yeah, I think really the future is
continue to do it in more areas,

588
00:36:34,470 --> 00:36:37,680
to be better about it, to be able,

589
00:36:38,340 --> 00:36:42,810
what we really need to do is control
those sites to try and help the desert

590
00:36:43,230 --> 00:36:47,640
to grow the tropical trees
just as well as the jungle

591
00:36:47,730 --> 00:36:48,360
does.

592
00:36:48,360 --> 00:36:52,740
And I think that that is really what we
need to do also to be able to predict in

593
00:36:52,740 --> 00:36:56,490
a better way which areas
are going to do better.

594
00:36:56,490 --> 00:36:58,320
And to that notion,

595
00:36:58,320 --> 00:37:03,000
I've had patients or other doctors call
me in a panic and I've even had to take

596
00:37:03,000 --> 00:37:05,910
care of some of those patients where
they actually put in too much fat

597
00:37:05,910 --> 00:37:07,500
underneath the,

598
00:37:07,830 --> 00:37:12,330
underneath the lids in younger patients
because they are used to operating in

599
00:37:12,390 --> 00:37:17,340
older patients and they underestimate
how much fat survives underneath the

600
00:37:17,340 --> 00:37:18,090
eyelids.

601
00:37:18,090 --> 00:37:22,350
So we need to be better about figuring
out how to control it. The other things

602
00:37:22,350 --> 00:37:26,070
that were really interesting, I
always wanted to do a twin study.

603
00:37:26,100 --> 00:37:30,540
I always wanted to a couple of studies.

604
00:37:30,540 --> 00:37:31,590
One is to

605
00:37:33,210 --> 00:37:35,580
inject the fat from,

606
00:37:36,300 --> 00:37:40,080
or actually to look at two
twins. And with one twin,

607
00:37:40,080 --> 00:37:44,190
we only do liposuction alone. And then
the other twin, we do the body banking,

608
00:37:44,190 --> 00:37:45,840
sort of like my whiteboard video.

609
00:37:46,260 --> 00:37:50,940
And then we feed them a lot of Pringles,

610
00:37:51,720 --> 00:37:55,170
no, actually some good carbs.
And we see the difference.

611
00:37:55,200 --> 00:37:58,920
And I think we would see in
those two identical twins,

612
00:37:59,520 --> 00:38:02,670
I think we would see that the one that
didn't have body bank would have a lot

613
00:38:02,670 --> 00:38:06,990
more visceral fat after putting on 40
pounds. They have to sign up for that.

614
00:38:06,990 --> 00:38:10,620
I can't, I'm not allowed to
force feed them on my own.

615
00:38:10,620 --> 00:38:12,480
They have to do it voluntarily.

616
00:38:13,560 --> 00:38:18,300
But we would see some real difference in
terms of muscle mass in the areas that

617
00:38:18,300 --> 00:38:22,530
were banked versus the gentleman
who doesn't get it. Now the problem

618
00:38:23,280 --> 00:38:25,800
is how are you going to find a twin?
It's sort of like the aspirin study.

619
00:38:25,800 --> 00:38:29,730
How are you going to sign up people for
the aspirin study and tell them not to

620
00:38:29,730 --> 00:38:34,440
take aspirin after we see the
positive effects of taking

621
00:38:34,440 --> 00:38:37,870
aspirin on strokes and heart attacks.
They had to just stop the study.

622
00:38:37,870 --> 00:38:39,820
So how do you find in the twin study,

623
00:38:40,090 --> 00:38:43,990
and there's a place in Ohio where
they have a twins festival every year,

624
00:38:43,990 --> 00:38:47,140
and I just wanted to zip down there and
see who would sign up for this study.

625
00:38:48,700 --> 00:38:53,290
But we would have to get somebody
who would actually sign up to be a

626
00:38:53,290 --> 00:38:58,210
non body banker knowing that they
may have more visceral fat or they

627
00:38:58,210 --> 00:39:00,130
don't get that good sexy volume,

628
00:39:01,120 --> 00:39:05,080
or they may give visceral fat in the
future because it's really your insurance

629
00:39:05,080 --> 00:39:09,940
policy to make sure that that doesn't
come later on as mother nature plays

630
00:39:09,940 --> 00:39:13,090
with those testosterone and estrogen
levels that we talked about before.

631
00:39:14,170 --> 00:39:18,010
Those are really interesting
points to consider. And Dr. Bass,

632
00:39:18,010 --> 00:39:19,540
would you like to add any takeaways?

633
00:39:20,140 --> 00:39:21,250
So just to review,

634
00:39:21,250 --> 00:39:26,050
Dr. Steinbrech has explained
to us this innovative

635
00:39:26,050 --> 00:39:30,940
concept that he's developed of body
banking where instead of removing fat

636
00:39:30,940 --> 00:39:32,140
and discarding it,

637
00:39:32,830 --> 00:39:36,100
the fat is removed in a
liposuction like process,

638
00:39:36,670 --> 00:39:41,470
but is then placed or
banked in areas that give

639
00:39:41,470 --> 00:39:46,030
us good aesthetic applications
that enhance our body

640
00:39:46,030 --> 00:39:47,770
appearance and our body shape,

641
00:39:48,550 --> 00:39:52,480
and help us maintain a stable metabolism.

642
00:39:53,830 --> 00:39:58,630
This is certainly particularly
important in the slightly overweight,

643
00:39:58,870 --> 00:40:02,560
slightly beyond the twenties patient

644
00:40:03,820 --> 00:40:08,380
who wants to focus on
maintaining and not gaining

645
00:40:08,380 --> 00:40:09,670
visceral fat.

646
00:40:10,270 --> 00:40:15,250
And the other important thing about
body banking compared to other

647
00:40:15,250 --> 00:40:19,960
approaches to body contouring is
that when we were talking about

648
00:40:20,830 --> 00:40:22,390
gluteal fat grafting,

649
00:40:22,420 --> 00:40:27,070
I mean there's a lot of aesthetic
shapes you can pursue in the gluteal

650
00:40:27,070 --> 00:40:31,690
area depending on your
aesthetic goals. Fat banking,

651
00:40:31,870 --> 00:40:36,790
body banking gives you the
flexibility to shape the way you

652
00:40:36,790 --> 00:40:37,623
want.

653
00:40:38,110 --> 00:40:43,000
It's a very flexible material to

654
00:40:43,000 --> 00:40:43,833
work with,

655
00:40:44,800 --> 00:40:49,360
and Dr. Steinbeck said
the clay of the body.

656
00:40:49,750 --> 00:40:54,580
But that shaping flexibility is
really important when you're trying to

657
00:40:54,580 --> 00:40:56,680
fine tune aesthetic goals.

658
00:40:58,030 --> 00:41:02,080
There's some role for this in
how we will control the aging

659
00:41:02,080 --> 00:41:06,520
metabolism that we're
learning more and more about

660
00:41:06,820 --> 00:41:11,110
both as part of plastic
surgery and as part of

661
00:41:11,650 --> 00:41:13,750
endocrine and metabolic medicine.

662
00:41:16,120 --> 00:41:21,100
So I'd like to thank Dr.
Steinbrech for again joining us on

663
00:41:21,100 --> 00:41:25,720
the podcast and for taking us through
his thought process and experience

664
00:41:26,140 --> 00:41:29,950
with this cutting edge approach to
aesthetic plastic surgery. Thank you,

665
00:41:29,950 --> 00:41:30,880
Dr. Steinbrech.

666
00:41:31,240 --> 00:41:32,590
Yeah, thanks so much for having me.

667
00:41:32,590 --> 00:41:36,500
It's been really fun hour and I
like to talk about these things.

668
00:41:36,650 --> 00:41:40,640
It just makes me think of more things
than more ideas. So thanks for having me.

669
00:41:41,360 --> 00:41:41,720
Thank you,

670
00:41:41,720 --> 00:41:45,410
Dr. Steinbrech for returning to the
podcast to share this really interesting

671
00:41:45,410 --> 00:41:46,760
innovation with us.

672
00:41:46,770 --> 00:41:47,603
Thank you.

673
00:41:47,700 --> 00:41:52,130
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

674
00:41:52,190 --> 00:41:54,080
Follow us on Apple Podcasts,

675
00:41:54,170 --> 00:41:56,390
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