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

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. The title of today's episode is "Body Banking: Why It's Better to Keep It." Okay. Dr. Bass, I feel like I need a definition here. Can you help me out?

Dr. Lawrence Bass (00:31):
The idea here is that sometimes we think we want something, but it may not be as good an idea as it sounds. There might be a paradoxical effect that gives us exactly what we don't want, and looking at things from a different point of view can sometimes give us some insight and result in a new approach to things. So we're talking about body fat here and whether or not we want to get rid of it or keep it and why. And this started, as I said, from rethinking the baseline notion that fat is bad and we want to get rid of it. I brought the Innovative Mind that developed this new approach to explain. Dr. Douglas Steinbrech is a board certified plastic surgeon who trained at NYU at the Institute of Reconstructive Plastic Surgery, the same department that I trained in. He's a master of body contouring and minimally invasive approaches in plastic surgery. He's been especially active in defining plastic surgery for men, including editing the seminal textbook on the subject, which is titled Male Aesthetic Plastic Surgery. He was gracious enough to ask me to write a chapter in that textbook on cheek augmentation with implants and filler. Dr. Steinbrech, welcome.

Douglas Steinbrech (01:55):
Hey, thanks so much. I'm really pleased to be here. It sounds like it'll be a fun topic.

Summer Hardy (02:01):
Welcome back to the podcast, Dr. Steinbrech.

Douglas Steinbrech (02:03):
Thanks.

Summer Hardy (02:04):
So Dr. Bass really didn't explain it. He teased me with that idea that getting rid of fat might be bad. Can you explain body banking further and how you came upon the idea?

Douglas Steinbrech (02:15):
Yeah, it was actually kind of an exciting thing because before that, we touched on this a little bit before, but what we were doing in the sixties and seventies and eighties really, liposuction came along in the eighties and nineties, started in France and then made its way over to the United States. But what we were doing is just removing fat. And while we were doing that, we didn't really think about it. People just thought, oh, being skinnier is better, but they didn't think about what would be like Dr. Bass sort of mentioned maybe there's some kind of paradoxical problem with it. And what we found after we did more and more of it is that if you suck out all the fat, then a couple things can happen. Number one, if you think about it, it's just all about the numbers. And if we think about removing fat cells, first of all, you have a limited number of fat cells after you turn 18.

(03:12):
There's a certain number that we all have in our body and they just get bigger and smaller sort of going from grapes to raisins, grapes to raisins. And every year as you lose weight and gain weight, they go back and forth from grapes to raisins. So you might imagine if you weigh a hundred pounds wet and then you bloom up to 400 pounds, you'd think, oh, I made a lot of new fat cells. You really didn't. You just made larger preexisting fat cells. And then when you lost all that weight, conversely it's the same number of fat cells, but they just all got very small. So once you start thinking about that, you start thinking sort of moving fat cells around your body is sort of like moving hair cells, hairs around your scalp. You're not really removing them. If you remove them and put them away, you're not going to be in as good as shape as if you take them out and put them somewhere else.

(04:05):
And we started thinking that direction. We started to think about the fat cells as clay. And I always say it at the end of any of my talks, we do a lot of talking around the country and around the world. We just finished our national conference in Vancouver and then I have to run off to, I guess Cartagena Colombia's next in June, and then we're doing going to Greece in August and then in October down to Australia. So a lot of running around talking about this stuff. But what we've learned when we spread the idea, and this is what I say to everybody, is that we need to use these cells and we need to think about it as clay. And I tell all the doctors and the residents coming along, if you are at this point, if you are throwing away all your fat, which I don't, I really only once or twice a year out of the thousands of cases, hundreds of thousands of cases that we do, it's only once or twice a year.

(05:03):
And it's a very special instance that we actually don't do it. Usually the patients doesn't have fat cells that are large enough at all. But I do banking for everything because I believe that this structural fat, this structural clay is the clay that helps me get a better result and helps me get a better result than the surgeon that's across the street. And we have a lot of plastic surgeons on Park Avenue, Dr. Bass knows that. And same thing with our practice in Los Angeles. When I started doing the men, really, we had so many men and we saw that there was demand with this that we started a Beverly Hills office and then a Chicago office. So there is a demand for this, and this is why I like to talk about this. I like to encourage other surgeons to do this, but I really feel body banking is important because for two different reasons.

(06:02):
First of all, like I said before, the clay I can subtract and then add to other areas so I can give the patient a more artistic athletic result like a sculptor is doing. The sculptor never just takes the clay and throws in the fat. But the other real reason is the second part of the equation, and that is we're starting to learn about really what happens to those fat cells postoperatively. And as I've been watching this, and I've been learning about this, I've developed, I've looked at a lot of patients that we call liposuction cripples. What are liposuction cripples? Those are gentlemen that have, or women that they have too much time and too much money. So they spend a lot of their time at fancy restaurants and at fancy plastic surgeons all over Europe and all over South America. And when you see these patients come in for the men, they've had liposuction four or five, six different times, and they all look like they're members of the same family.

(07:04):
All their backs are like a tiny little waist and then their belly is out to here. Well, why is that? Because those doctors, three or four times, they keep on sucking the subcutaneous, that's of fat underneath the skin out. They keep on sucking it out and sucking it out and sucking it out. But unless the patient after surgery decreases their caloric intake or increases their caloric burn, guess what? The fat cells left behind, well, compensatorily enlarge. So if I have liposuction and I go in the restaurant and I'm eating those same rich sauces and I'm having ice cream every the same 10 gallons of ice cream every night, well, I always tell my patients, I tell the other doctors those calories, those carbs from that Netflix ice cream don't just pass through you. No, no, no. They're going to swim around the body until they find fat cells.

(08:00):
And that's where the fat cells store them. So all those patients, all those liposuction and cripples, they're still skinny back here because those fat cells have been removed, but they're nine months pregnant because the only cells left over are the visceral fat cells and they compensatorily enlarge. We have a name for that that's called rebound fat or a funny technical name called "catch fat," compensatory atrophic cellular hypertrophy, which means those cells in their belly, compensator enlarged, and also other as inner outer thighs, other undesired errors. So this is a real philosophy and it's a real scientific medical phenomenon and that's why we've been able to use it in, we've been taking a bad thing, a paradoxically bad thing, and we've grabbed it and we've used it for us. Now we have the power in our hands by using those fat cells and actually putting 'em into good places to get a better result.

Summer Hardy (08:58):
That makes a lot of sense. So how do you use this in practice? What are the most common applications?

Douglas Steinbrech (09:04):
Yeah, so that's where we take it. I started, this is how we started our journey. I started, I had a patient and I just did straightforward liposuction. This guy was jacked, but he just had a little bit of extra fatter around his abs and he was trying to get his abs really enunciated, trying to get more definition. So I thought, this is great. I studied all my books and I saw where the linea is, the transverse inscriptions, the semi liners, which are the side inscriptions. And so I had everything, I did all my liposuction and he just didn't get the projection of his abs that he wanted. And I realized I always do all my thinking in the shower because in the shower, that's when my brain calms down. And I have this idea that why you sleep? Your body's trying to solve all these problems, but when you wake up with that alarm, you immediately forget everything.

(09:59):
So when you jump in the shower, the shower technology has a lot of runs over you. The things that you're thinking about and you're solving. These problems rise to the surface and you're shower. And I get a lot of my ideas when I'm taking a shower in the morning, shower technology, and that's when I got this and I still get them. That's when I got this idea that we're going to use structural fat to increase projection in those areas. So I started putting just a little bit on top of each little abdominal packet to make those project, and I took the same patient back. I said, listen, I'm going to do this. I'm going to do this for free because I feel like I let you down. And he was so happy. He kept on sending me pictures of how great he looked at the gym.

(10:46):
We were able to give them that extra projection. So what I did is I extended that. I started injecting everything, chest, shoulders traps into the biceps triceps, forearms, the glutes, the gluteal augmentation, that's our body banking brady butt lift and also into the calves in other areas. So it's really been sort of a revolution. And I don't miss a drip. Like I said, rarely do I not do it. And after, usually it's the wife or the boyfriend that's against it because they don't really understand, they haven't read it and they just think all fat is bad. And once I explained the philosophy and they get it, and we even have a whiteboard video on YouTube that explains two brothers, one brother has body banking, the other brother has traditional liposuction and we'll watch after surgery. The brother that went first, he ends up getting belly fat and the guy that had body banking doesn't get the belly fat and instead his shoulders get wider after surgery. So the two twin brothers have dramatically different physiques and post operative experience. And let me tell you, after you've had it, my guys get so charged up that they work harder at the gym than they've ever worked before because they really got a great kickstart. So now we're doing it for all different areas and the patients are very happy with it.

Summer Hardy (12:17):
This is really intriguing to me. I'm curious to know more. So what are the most common ages and does utility vary by age? What do we know about fat take by age and grafting overall?

Douglas Steinbrech (12:30):
That's excellent question because that really does have something to do with it. We notice in younger people that more fat sticks around than in older people, and it just has to do with senescence and the quality and the vigor of those individual cells that we transplant and also blood supply and other things like that. So younger people do have a better take, which is great. In fact, this is a fantastic story of a medical student for some reason. I get a lot of doctors when we do body, I think they understand, they completely get the idea about compensatory atrophic cellular hypertrophy or catch fat. They completely see the metabolic reasons for it. But this was a medical student and I did his, one of my first patients and I took all the fat out and I put it all upstairs. He wanted what we call the triple play.

(13:28):
He wanted an lateral posterior deltoid. He wants the deltoids upper in her chest and he wanted those traps. And I saw him like six months later and was, he was a nervous eater. And so he was in the middle of finals. I said, how's things going with your medical finals? I think he was like a third or second year medical student. He had physiology and all that kind of stuff he said, or introduction to clinical medicine, ICM, but he was all stressed out. I said, "well, at least you've had time to go to the gym. Your shoulders are huge and your chest looks great." And he said, "no." He said, "I haven't had anything. And he said, I haven't been able to work out in two months. And I've been stress eating." He put on 40 pounds. But because we did the body banking in those areas, he looked massive.

(14:26):
And it wasn't from working out, it was from everything that I had transplanted into the muscle. I have another great story from, this is another patient that went to California when I just, before I started my California practice, this is a California guy that flew all the way to New York so that we could do put in calf implant or put in glue implants and pec implants. We'll talk about that at the end. But I also did a little liposuction and I was like, "well, what the heck are we going to do with it?" And he said, "well, don't throw it away. You can plug it into the biceps and the triceps." And so he came back six months later and sure enough, his chest had healed, chest looked great, the glutes look great. And I looked at him and I was really angry. I was really ticked off.

(15:16):
And I said, I just reached out and I felt his biceps. And I said, "I did this great job. I mean, weren't you happy with the pec implants? Were you happy with the gluteal implants? I said, why? It looks like you went somewhere to get calf implants and to get bicep implants?" And he said, "no," and this is where that moment where you get chills. And he said, "no, you said that you were going to put some fat in there, some cells in there". And it looked fantastic. And I got these chills because it was like, holy moly, this really works after that.

Dr. Lawrence Bass (15:55):
So that was a eureka moment.

Douglas Steinbrech (15:57):
It was a eureka moment. I was like, well, let's just do this. See what happens. And it worked so much that I was jealous. I thought he went to somebody else. But it was a great surprise and I still get chills thinking about it now because it was such an exciting day. And that's when I just started doing it for everyone in all these different areas. So it's a really exciting moment.

Summer Hardy (16:20):
Wow, that's really great. Overall, would you say is this more useful for men or for women then? Or is it more or less universal based on biology?

Douglas Steinbrech (16:30):
It's universal, but I'd say, like I said before, sort of jokingly, women are interested in four bumps, but men are interested in two bumps in front, two bumps in back. But women, men are interested in all sorts of bumps all over the place. And so for men, it really works well because we can use it as a detail sculpting tool, which you can also do for women, but we can use it for the shoulders, the traps, the chest, all those other areas that we don't necessarily think about as much for women.

Dr. Lawrence Bass (17:01):
Now I've got a little bit of a challenging question, and of course as Americans, a lot of us are overweight, so there's fat available, but not everyone walks in overweight or with a fat depot that you can access. So what do you do in patients who don't have fat to work with and they want to build a body shape?

Douglas Steinbrech (17:25):
Yeah, this is a significant challenge because occasionally I come in and we have in New York, they're all from Chelsea. So these guys are ripped. They do not have an ounce of fat on their body. There ain't none. And then out in LA, it's in WeHo, it's in West Hollywood. All the guys down there, they all do yoga, they all do spin class, they all hit the weights. A lot of them are on just a little bit of test, not necessarily growth hormone, but just a little bit of testosterone that's totally legit that their doctor gives them just to get their natural endogenous testosterone levels up. So those guys though, they are rip. There is no fat, there is no depot. And for those people, they would just be disappointed if we do it. And these are a few of the exceptions where I don't do it.

(18:15):
I do as much as I can, but it's not enough to give them the volume that they want in all those areas. For those people, what we do are we use implants. So it's interesting because everybody, all the women and all the girlfriends and all the guys and all their girlfriends, their wives, their mothers, they all know that if they want larger breasts that they can just go get breast augmentation with the plastic surgeon. And that is a okay, because everybody, they look great. They're fun and it makes them feel good. That's why they come, makes 'em feel attractive, gives them more options and fit into more things. But the dudes don't realize that they can have that too. So men, if they don't have fat, what we can do is we can do augmentation with a pec implant, bicep implant, tricep implant, shoulder implants, even traps.

(19:09):
I created ab implants that really are natural appearing, gluteal implants, quad implants and calf implants. I don't think I left anything out while we also have chin cheek, jawline implants. So pretty much all those areas, if we don't have fat, or even if you do, sometimes you may not have enough fat. And for those patients, and a lot of times, I'll give you a classic example, had a guy that came in from, flew all the way in. He and our buddy flew in from Singapore and this guy was ripped and I knew that there was not going to be a drop. And I said, we'll see when you get into town, we had planned for both for body banking and implants. Turns out he had no fat, but what he needed, his biceps, pecs and glutes. So I was able to put in the gluteal implant and the bicep implant, and then he came back to have the pec implant.

(20:07):
So couldn't do those both at the same time because you want to rest on your backside for your pecs, you want to rest on your front side for your glutes. So the two incisions and the two postoperative courses competed with each other, but we put in his glutes and his biceps. He was very, very pleased and we were able to do it without using any fat. And then the second story is a guy that was a bodybuilder, but he hurt his back and he had a pretty significant back injury and he wasn't able to work out with heavy weights and he really missed, he had a lot of clothes, he had a lot of just regular polos and t-shirts and things, and none of his shirts he could fit in to. And in one sitting for him, I was able to put in pec implant, deltoid implant, bicep implant, and a forearm implant.

(20:57):
And that's generally what we do. We do them in pairs, we put in all the arms and legs. We have paired muscles, so biceps triceps, two heads to the forearms, two heads to the quads and two heads to the calves. So what we'll do is half of the paired, so patients might fly in from South America and I'll put in a bicep, one head of the forearm, one head of the calf and one head of the quad. Then they come back and we'll put in the other paired muscle. And the reason why we do that is to put in a good size implant, but then allow the swelling to go down so that we can put on a good size implant on the other side. And we don't run into problems of having compromised blood supply because too much swelling on both sides of the bone. But for this gentleman that came in with a back injury, I was able to, and he could walk around, he was fine with that. He just couldn't lift heavy weights. I was able to put a forearm, a bicep, shoulder and chest, and then four hours he was back to, he felt able to get back into the clothes that he used to be wearing. So silicone implants are a great option for those challenging cases when people don't have their own endogenous fat cells.

Summer Hardy (22:11):
Okay, that's great. So you've touched on this a little bit previously, but let's dive a bit deeper. What are the main procedures or attributes that are targeted in body banking and men?

Douglas Steinbrech (22:22):
For most guys, by the way, we could do it in face as well. If men are interested, some of the guys are interested in having more structure. And while we're taking the fat out of those areas, a lot of times I'll use it for jawline augmentation, we'll use it for cheekbone augmentation, maybe even some areas that are a little bit lacking, like the nasolabial folds. Or even with lips, guys don't want big lips. They don't want lips like Kylie Jenner kind of with looks like sucked out a bottle or something like that. They don't want the DSLs. What they want is though, as men get older, one of the signs of aging is their lips lose volume and they get really, really thin. And we're not doing any give anybody duck lips or Kylie Jenner lips. That's not why we do it, particularly in the men, because the men don't want to look done.

(23:14):
Where we do is just put in a little bit to bring them back to back 10 years where their lips were a little bit fuller, a little bit more youthful. This is an important tiny detail that people forget about as they get older, their lips thin out. But the major areas that we put in for the guys is really, they usually want in a couple different areas. There are guys that are more upper body guys and there are guys that are more quarterback guys that want to have bigger glutes, more glutes, more maybe more projection. They may even want to have those body banking gluteal muscles that have a sexy concavity on the side and have good projection or maybe a guy that kind of wants that round speedo kind of backside. So that's glutes are a big spot. Another big spot is what I call the triple play.

(24:07):
Triple play for the dudes is it's all about the upper body and it's about the cobra back. The back is the back are the new abs. Everything used to be the biceps, then it was the chest, then it was the abs. Now it's the back. Every guy, every guy, and I don't care if you're straight or gay, every guy appreciates a man that likes a big strong back. Women love a guy that has a big strong back and that cobra back has wide shoulders and a slender waist. So what I do is I end up popping it into the shoulders, anterior lateral, posterior deltoids up into the traps, maybe even a little bit into the lats. And I forgot that's another area that I can put in silicone implant into that area. If you have no fat, but to give you that big wide upper body is going to make your waist look smaller. So the guys love to put it in that area.

Summer Hardy (25:00):
Okay, got it. So now for the other half, what are the main procedures for women?

Douglas Steinbrech (25:05):
For women? So when we do body bank in women, usually most commonly would be going into the gluteal area. It doesn't mean we're not talking about this Kardashian era or that there's that pretty girl that has a huge backside where she needs to ask for two airplane tickets to be able to fit in. She's got a tiny waist and just a huge back derrière not necessarily talking about that for women, what they may want, and these are even those ladies out in South Hampton, East Hampton, and they go to the beaches in Connecticut and out in New Jersey. They want just something that has a little bit of more volume so the tissues aren't falling. So I think in fact, I will say that the Kardashians moved back on how much volume, it became a race for how big it can get and how small it can get.

(26:02):
And that ratio of how tiny a waist and how big you can get your glutes for the women is going away. We're moving away from the diaper butt. Women don't want that. I want that less people are actually having that reversed. The same people that put it in now are priding themselves. I'm not one of those people that are priding themselves on taking it back out. Look at me while you're the person that put it in. But everyone's moving away from that. But still, I get the women that they're very shapely and they have their slender and have little pockets of fat, but we want to put in the glutes not to make them big, no thing, but to lift any saggy skin. So that's number one. Number two would be a little bit in the breast. Now you have to know with the breasts and not as much for whatever reason, Dr. Bass will back you up on this.

(26:54):
It's not a great site. And this is something that you have to know in general about fat grafting, which a lot of people, even doctors don't know. Some areas are, two different. We're going to plant a seed and these seed, these 10 seeds we're going to plant in the jungle, all 10 of them are going to grow into beautiful tropical trees. These 10 seeds we're going to put in the middle of the desert. How many of those seeds are going to grow? Not a lot. Well, the same thing holds true for the different parts of your body. And it's really about one of the main factors is about the hospitality locally, the milieu of the local recipient site, which is served something that was not intuitive, but I can tell you and surgeons that do a lot of this know that if you put the fat cells in the glutes that your retention is probably going to be 40, 50 or even 60% better than if you put in the breast.

(27:47):
So that's the other area that I was getting to is a lot of women want to put in the breast, but you have to overcorrect in the breast a great deal to get your final result because we just haven't cracked the code. The little secret to have more of those cells survive in the breast, no matter what surgeon does it, no matter what technique that surgeon uses, you can throw the cells up on the ceiling, scrape 'em off, mix 'em in with potato dust. They're not, the retention is not going to be as good in the breast as it is in the buttock area.

Dr. Lawrence Bass (28:19):
And part of that is the amount of blood supply or the capacity, like you said, fertile soil. You can plant a lot of seeds. And in an arid desert, you can only plant a few. And in fact, the more you put down to compete for blood supply, the less fat take you may have versus putting a staged approach where you come back, the fat that went in the first time is going to have biological effects that amplify the blood supply in the area and we're coming to biology in fat. But by creating some neovascularization new blood supply, when you come back in stage two to graft more fat, you may succeed better than just putting a whole bunch more in one stage.

Douglas Steinbrech (29:11):
And I completely agree with Dr. Bass, and one example I have is with patients who have Poland disease, which is a fascinating genetic disease where they may be missing part of their pec muscle or all their pec muscle, an extreme phenotypic expression may be missing their entire arm. More commonly in men sometimes happens in women as well where they're missing an entire breast or part of it. For these patients, I was struggling, struggling putting in implants by found because they were not very well developed. They sometimes didn't have a developed lymphatic system, and it was common to get fluid collections around the implant after placing these, switched strategy and now we graft first layer and the purpose of the, first of all, I say we're going to do three graft, that's it, or we're not going to do it at all. And it's just some people's expectations.

(30:03):
And so first layer is just to get enough cells, and this is exactly what Dr. Bass was just talking about, just to get enough cells in there so it gets the skin off the bone. And then you may develop a little bit of a lymphatic bridge or develop something that was lacking. But really what you do is get some good vascular supply and you create a space that you can put in more cells. And then after the second and third grafting, that's where we really see it. So the first piece, it's not for the first grafting, that's to lay the bed and then it's the second and the third grafting is where we see the magic happen.

Summer Hardy (30:40):
Okay, that's really interesting. So far we've mostly focused on aesthetic features. What do we know about the metabolic impacts of body banking?

Douglas Steinbrech (30:50):
Yeah, I mean, well, I actually spoke at Columbia University instead of the country a few years ago, and they asked me to speak because they were really interested and they were doing a grant to the NIH. And what they're trying to do is they're trying to look about how can we have less visceral fat? Because vis fat, belly fat, fat behind your abdominal wall is associated with increased rates of mortality, of diabetes, of joint disease, of high blood pressure correlates with heart attacks. So just all those fat, all those bad things. So what I was doing is I was taking that fat out, but I wasn't throwing it away because if you threw it away, then you would end up having increased visceral fat, which could increase your chances of all those problems. So they were actually interested in having me speak, and I didn't speak to the plastic surgery department who asked me to speak was the Department of Metabolism.

(32:00):
It was the diabetes department because they're trying to figure out how all this visceral fat works and their NIH grants behind this. So I spoke with them, it was my honor to be able to speak as a demo plastic surgeon to a bunch of really smartypants metabolism people. And they got it. They totally got it. They understood how this would work. They understood the math behind it. And in fact, I'm working on, when you talk about the metabolism, I'm working on a mathematical formula and this formula is by how many fat cells do we suck out, meaning how many in ccs of fat cells, and then how much do we need to increase or decrease our caloric intake or our caloric output based on how much fat cells we removed. To be able on the other side of the equation to maintain either your current body weight or your current physique.

(33:06):
And I think we're going to get it to the point where we can figure out, if I tell you this is your weight, this is your height, this is the amount of fat that we took out in terms of CCs, a certain concentration, this is the amount that we bank back in, subtract those and put in your height and weight and then determine how much you would need to increase or decrease in terms of caloric burn or decrease caloric intake. And I think the ones that we do with the body banking, you're going to find that there's not that much difference because we've kept all the cells there. But the problem is, and this is why I'm making this formula, is I want to tell the people that don't. So if you come into my office and you tell me that you're not going to do this, I'm going to plug in my little equation, okay, this is what you are not going to bank it. Okay, so this is how much we plan to take out. This is how much you weigh. This is how tall you are by my calculations, after you've had this surgery, you have to decrease your caloric intake by 10% or and increase your burn rate by 15%. Or you're definitely going to have visceral fat. You're definitely going to become a lipo second cripple. You want to change your mind about doing the body banking or not.

Dr. Lawrence Bass (34:19):
So this is really interesting and in a lot of ways it parallels what's happened and what's about to happen with the GLP-1 medications Ozempic like medicine. So we started with liposuction, we took fat out and threw it away. And now we recognize that your proportion of subcutaneous and visceral fat changes when you do that. And not in a good way. With the Ozempic like medicines, now as FDA goes forward with new products, they're looking increasingly at not weight loss, but fat loss versus muscle loss because we really don't want to lose muscle. And they're looking at, again, subcutaneous fat loss versus that very metabolically active fat loss. Visceral fat loss, which is what those medications in part target because of the receptor sensitivity of the visceral fat to those medications. So it's interesting that the pharmacologic weight loss progress in some ways is paralleling what's already happened with surgical body contouring in the recent past.

Douglas Steinbrech (35:39):
Yeah, it's really interesting. And I think we're going to continue in terms of the GLP-1 copycats, I think we're going to really find out some interesting things coming forward in terms of both fat metabolism or interestingly, as a sidebar, playing around with the molecules to maybe have an impact on satiating your desires and other things such as drug abuse or gambling or other bad habits that people may have. So it's really fascinating, those medicines.

Dr. Lawrence Bass (36:17):
It's a whole new world for sure.

Douglas Steinbrech (36:19):
Absolutely.

Summer Hardy (36:20):
This is really interesting overall. So Dr. Steinbrech, do you have any thoughts for the future? What research is going on and what's the future for body banking?

Douglas Steinbrech (36:30):
Yeah, I think really the future is continue to do it in more areas, to be better about it, to be able, what we really need to do is control those sites to try and help the desert to grow the tropical trees just as well as the jungle does. And I think that that is really what we need to do also to be able to predict in a better way which areas are going to do better. And to that notion, I've had patients or other doctors call me in a panic and I've even had to take care of some of those patients where they actually put in too much fat underneath the, underneath the lids in younger patients because they are used to operating in older patients and they underestimate how much fat survives underneath the eyelids. So we need to be better about figuring out how to control it.

(37:21):
The other things that were really interesting, I always wanted to do a twin study. I always wanted to a couple of studies. One is to inject the fat from, or actually to look at two twins. And with one twin, we only do liposuction alone. And then the other twin, we do the body banking, sort of like my whiteboard video. And then we feed them a lot of Pringles, no, actually some good carbs. And we see the difference. And I think we would see in those two identical twins, I think we would see that the one that didn't have body bank would have a lot more visceral fat after putting on 40 pounds. They have to sign up for that. I can't, I'm not allowed to force feed them on my own. They have to do it voluntarily. But we would see some real difference in terms of muscle mass in the areas that were banked versus the gentleman who doesn't get it.

(38:21):
Now the problem is how are you going to find a twin? It's sort of like the aspirin study. How are you going to sign up people for the aspirin study and tell them not to take aspirin after we see the positive effects of taking aspirin on strokes and heart attacks. They had to just stop the study. So how do you find in the twin study, and there's a place in Ohio where they have a twins festival every year, and I just wanted to zip down there and see who would sign up for this study. But we would have to get somebody who would actually sign up to be a non body banker knowing that they may have more visceral fat or they don't get that good sexy volume, or they may give visceral fat in the future because it's really your insurance policy to make sure that that doesn't come later on as mother nature plays with those testosterone and estrogen levels that we talked about before.

Summer Hardy (39:14):
Those are really interesting points to consider. And Dr. Bass, would you like to add any takeaways?

Dr. Lawrence Bass (39:20):
So just to review, Dr. Steinbrech has explained to us this innovative concept that he's developed of body banking where instead of removing fat and discarding it, the fat is removed in a liposuction like process, but is then placed or banked in areas that give us good aesthetic applications that enhance our body appearance and our body shape, and help us maintain a stable metabolism. This is certainly particularly important in the slightly overweight, slightly beyond the twenties patient who wants to focus on maintaining and not gaining visceral fat. And the other important thing about body banking compared to other approaches to body contouring is that when we were talking about gluteal fat grafting, I mean there's a lot of aesthetic shapes you can pursue in the gluteal area depending on your aesthetic goals. Fat banking, body banking gives you the flexibility to shape the way you want. It's a very flexible material to work with, and Dr. Steinbeck said the clay of the body. But that shaping flexibility is really important when you're trying to fine tune aesthetic goals. There's some role for this in how we will control the aging metabolism that we're learning more and more about both as part of plastic surgery and as part of endocrine and metabolic medicine.

(41:16):
So I'd like to thank Dr. Steinbrech for again joining us on the podcast and for taking us through his thought process and experience with this cutting edge approach to aesthetic plastic surgery. Thank you, Dr. Steinbrech.

Douglas Steinbrech (41:31):
Yeah, thanks so much for having me. It's been really fun hour and I like to talk about these things. It just makes me think of more things than more ideas. So thanks for having me.

Summer Hardy (41:41):
Thank you, Dr. Steinbrech for returning to the podcast to share this really interesting innovation with us.

Douglas Steinbrech (41:46):
Thank you.

Summer Hardy (41:47):
Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.