Male Plastic Surgery 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 Male Plastic Surgery.

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We know women love to think
about beauty, but what about men?

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Are they part of the explosion
in plastic surgery as well?

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To bottom line it? The
answer is definitely yes.

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Both the numbers of procedures and
the percentage of procedures in

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men is growing, but it's still
a small minority of the total,

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according to The Aesthetic
Society statistics as well
as those from the American

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Society of Plastic Surgeons,

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the percentage was around
five to 6% in 2022.

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That's the last year for which
statistics are available.

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Still, this small number really
understates the importance of

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appearance to men.

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Men don't think about personal
beauty exactly the same way as women,

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but they are still very concerned with
their and the image they project to

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others. Appearance is a huge part of that.

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That makes sense. So what can
you tell me about this Dr. Bass?

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Well, let me turn to our
guest to discuss this issue.

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Today we have with us
Dr. Douglas Steinbrech.

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He's a board certified plastic surgeon
who trained at the Institute of

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Reconstructive Plastic Surgery
at NYU where I trained.

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And he is really a
master of body contouring

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and minimally evasive
approaches in 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 entitled

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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. Dr. Steinbrech, welcome.

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Thank you. It's a pleasure to
be here. Thanks for having me.

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I think it's a great topic.
Topic I'm a big fan of.

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Welcome Dr. Steinbrech. So
let's get right into it.

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What are the aesthetic issues
that men pursue most often?

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Yeah, it's really a variety of things,

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but what I see a lot is with aging,
it's a couple of things for face,

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the men are concerned with
their neck and really the

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jawline or the jaws and the point of,

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as Dr. Bass said, the point of where
the cheek is when it comes to body,

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they're more concerned about being fit.

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We're currently in a wave where
we're inundated with Instagram

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and media and everyone's watching
everyone and everyone's actually putting

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everything that they have on
the internet or on their phone.

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And so people are seeing a lot
more, they're comparing a lot more.

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They're seeing a lot more skin.

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So this has sort of shifted
people's interest in fitness and an

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interest in looking good.
So from a body perspective,

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a lot of men are coming in
asking for improved body

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contour.

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They're interested in more dramatic

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fit appearance, and particularly
in those areas that are stubborn,

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everybody's going back to the gym,

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but the areas that the
gym can't quite cover,

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that's where we come in.

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And then the other thing that we could
talk about later is how much massive

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weight loss and even
moderately weight loss with

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GLP-1 copy cats

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or Ozempic and these sort
of weight loss drugs,

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how much that's really shifting the
landscape in terms of body contouring

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for men.

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Okay, that's really interesting. You
touched on this a bit in that answer,

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but separate from what men are
actually looking to address,

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are there differences in how most men
approach or think about plastic surgery

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compared to most women?

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Yeah, I think men, they're interested in,

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like I said before,

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they're interested in looking like they
used to look when they had more time

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to invest at the gym and
before there were changes

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with their genetics. And
that's what we see a lot.

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We see a lot that men want to be back
where they were when they were in

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their twenties before the
testosterone change went down a little

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bit and before work and
family responsibilities

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really came into play. The other
thing is about how men and women,

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and when I say any of these
things I try not to generalize,

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and I'm definitely
trying not to be sexist,

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I just find that people have
different approaches and a lot of

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times men tend to not want to chaperone.

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They tend to want to do
the research, look online,

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see who looks like they
specialize in this area,

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and sort of like they know that they
know that they've done well this year and

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they know that they want to go out and
if they do really well at work that

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they're going to get themselves
that BMW or the Mercedes. They walk

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into the Mercedes shop knowing
that this is what they want.

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And so instead of shopping around to
a bunch of different car lots, they

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know where they want to be.

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So they've already done the research
when they've come to me and instead of

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asking a lot of questions and comparing
what I say to another doctor and going

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up and down Park Avenue,

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they usually feel like they've done their
research and they treat me more like a

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consultant. They hire me for my expertise,

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for my ideas of what I have. They
listen to what I have to say,

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and then they

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usually allow me to execute their
plan. So from that standpoint,

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I really enjoy working with men because,
and a lot of women are this way too.

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Again, I don't want to generalize
it, I don't want to be sexist,

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but I just find a lot
of men when they come,

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they've already made their decision.

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It's just where they want to know what
is the best way and they seek my advice

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as an advisor. As a consultant.

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Got it. Okay.

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So if we look at procedures that
men are specifically focused on,

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what are some of the differences in how
those procedures need to be performed?

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Yeah, so well,

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one of the things is
for women, we see a lot.

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I always say women are
interested in four bumps,

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which means two bumps in front and two
bumps in the back in general, again,

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this is in general we
just want to have fun,

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but men are interested in
a lot of different bunks.
So it could be a six pack,

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an eight pack delts, anterior
lateral, posterior delts traps,

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chest biceps, calves, triceps.
So all of these areas,

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and we accomplished those in
a couple of different ways.

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One is using your own,
I call it body banking.

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It's using your own
cells, your own fat cells,

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taking them out of the bad areas and
then moving them into good areas.

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So that's what we call body banking.

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It's taking all those cells
and transplanting it into
a good aesthetic area.

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So by subtraction and then
addition, we can completely,

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like a artist uses clay
to create a more artistic

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or athletic result.
I could do the same thing with my clay,

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which is a patient's own
cells, their own fat cells.

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So we find it does a couple of
different things, first of all,

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it gives them a better artistic result.

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Then just throwing the fat
and putting it in a bucket,

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I think that's a complete waste of time.

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You wouldn't imagine a clay sculptor just

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removing the clay and throwing
it away. That's complete waste.

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He takes some and then he adds it
to other areas. So that's what I do.

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But then the second thing about it
is we're just starting to understand

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a couple of the rules
or the dynamics of fact

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grafting or lipo cell
transfer and what it means.

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So I've kind of studied this
and I've looked at this,

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and what we find is that if patients
just have liposuction and they throw away

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the fat,

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that they can get what we call
rebound fat. So that's fat

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showing up in other
undesirable for our locations.

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So let's say if you have a dude
that comes in and you do lipo,

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I used to do this all the time.
I used to do all the liposuction,

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really make his abs look great,
really make his flanks look great,

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throw the throw away the fat,

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and then they would come back and if
they didn't increase the caloric burn

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or decrease the caloric intake,

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they're still getting excess
corid excess calories and they're

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developing, they're feeding those
fat cells. Well, guess what,

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if I didn't bank any fat
cells on the outside,

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then then it's going to come back.
If I threw it all in the bucket,

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the only fat cells left over are
visceral fat cells. That's belly fat,

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fat inside behind your
abdominal wall. I see it.

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So when they come back nine months
later, after they're all healed,

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they come back nine months
pregnant. Now that we get smarter,

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now that we bank things, I
bank things in your shoulders,

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trots chest into the glutes, into
the calves, wherever we put it,

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they can relax with their diet. Maybe
they can have bread with dinner,

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right? Can you imagine or even
have dessert? You don't have to

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live a life without pleasure. And now
when they do it, the doctor sent to do it,

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they get more upper volume
cleavage or upper chests volume,

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their traps pop and their shoulders
widen. So this is what our patients find,

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and they're really, really not only happy
about their abs, improving their abs,

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but now they have all this great volume
and other desired errors and they look

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great at the beach, at the pool,

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but they also look great
playing golf with a pull-on.

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And as you get older,

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mother nature plays a couple of
tricks on you. She turns down for men,

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she turns down the testosterone, she turns
up the estrogen. So as she does this,

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as you move into your forties, fifties,
sixties, seventies, and as this happens,

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instead of all those fat cells getting
larger around your belly or inside your

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belly, if you had liposuction,
what happens is it increases
in size relatively.

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There is the got banked,
the desires that we put in.

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So I always tell my patients to write
me a thank you note in 25 years if I'm

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still around.

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But we immediately had people
a year or two that are really,

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really pleased. And so that's
the other advantage of it.

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I think that's a really important point.

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Liposuction started as this
treatment for people back 40,

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50 years ago who were ideal
body weight with very focal

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areas of extra fat.

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And if you do liposuction
on someone like that,

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a 25-year-old with a teeny bit of fat in
the love handle area or something like

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that, that's great,

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but we've really,

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really broadened the application
to people who are older,

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people who are not obese. It's
not a treatment for obesity,

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but for people who are overweight,
which is almost all of us Americans.

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And when you're treating that population,

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the fate of the body when you take
the fat away becomes different

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as Dr. Steinbrech described,

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because that visceral fat is
more metabolically active,

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it's bad fat,

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and if you're in a weight gaining stage of

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life, unless you radically
alter your lifestyle,

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then liposuctioning out subcutaneous fat,

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which is not as metabolically
active and consequential in a bad

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way for you,

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is more likely to get you in trouble where

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taking that fat and putting it
someplace where you need it is

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protective and aesthetically useful.
So it's a win-win, isn't it, Doug?

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Absolutely.

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And just for the women out there that
are listening and not believing this

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before we did BBLs or now we say gluteal
augmentation or a buttock augmentation

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but we say Brazilian butt
lifts. Before we did that,

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Dr. Bass and I used to just do liposuction
on women and then we do a tummy

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tuck and I would do my very
best to suck out all the fat,

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but we threw it in the bucket.
We didn't know any better.

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We never put in the
glutes or anybody cells.

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What happen is the patients
really wouldn't be great
about going to the gym and

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wouldn't be really great about
decreasing their post caloric

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intake. And so they would get this
rebound fiber, what I call catch fat,

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compensatory atrophic
cellular hypertrophy,

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which just means cells in other
areas compensator enlarge,

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unless you do change how much you take
in or how much you put out. But what

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would happen is six months later,

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I would have these women come in and
they would look like a truck because

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what I took out, we didn't bank anywhere
else. I didn't put in the glutes.

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We didn't really do BBLs then, we just
threw all the fat away. And they would

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come back looking

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like Spongebob Squarepants and they would
have a lot of visceral fat almost like

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they were pregnant.

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You'd have an unhappy patient
and an unhappy puffing.

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But now to illustrate the point,

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everyone sucks it out and they put even
maybe less than a couple of years ago,

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but puts something somewhere else.

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And usually it's in the buttock for
women and now they come back six months.

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"You're a genius doctor. You're a
genius." The husband is in love with you.

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The patients are in love with you
because guess what? They went home.

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00:14:30,190 --> 00:14:34,180
They did not change how much they ate.
They did not change how much they burn,

228
00:14:34,450 --> 00:14:36,280
but instead of coming
back as visceral fat,

229
00:14:36,280 --> 00:14:41,260
it came back in their backside
and the husbands otherwise were

230
00:14:41,500 --> 00:14:45,760
in love with you. So that just
further illustrates the point.

231
00:14:46,690 --> 00:14:50,770
This is a really interesting discussion.
I hadn't thought of any of this before.

232
00:14:51,230 --> 00:14:53,990
Is this just a different
aesthetic endpoint then,

233
00:14:53,990 --> 00:14:55,910
or are the actual techniques different?

234
00:14:56,660 --> 00:14:58,220
The techniques are different as well.

235
00:14:58,220 --> 00:15:02,930
And also the philosophy is different
and the postoperative care is

236
00:15:02,930 --> 00:15:06,500
different. And I'll tell
you why. Postoperatively.

237
00:15:07,790 --> 00:15:09,260
Well, also preoperatively,

238
00:15:09,260 --> 00:15:14,060
I put people on a slightly elevated
carbohydrate diet so that their

239
00:15:14,060 --> 00:15:17,570
cells are a little bit larger so that
more of them survive the transfer

240
00:15:18,860 --> 00:15:20,870
postoperatively. And then postoperatively,

241
00:15:21,770 --> 00:15:25,910
we keep them on a high carb diet and a
high protein diet for really high carb

242
00:15:25,910 --> 00:15:29,870
diet for 28 days to make sure all those
less cells that we put in their new

243
00:15:29,870 --> 00:15:31,730
location actually survive.

244
00:15:32,030 --> 00:15:35,510
Because we really don't want someone to
be in starvation mode because your body

245
00:15:35,540 --> 00:15:37,790
prioritizes the most important thing.

246
00:15:37,790 --> 00:15:40,670
What's going to be the most
important thing to heal up,

247
00:15:40,850 --> 00:15:45,320
not to keep any exogenous
fat cells or transplant.

248
00:15:45,440 --> 00:15:47,210
It's really not your body's priority.

249
00:15:47,210 --> 00:15:51,530
Your priority is heal up the surgery that
just got done. So we want to give them

250
00:15:51,530 --> 00:15:56,360
extra carbs to keep everything there.
And that's really sort of a change.

251
00:15:56,360 --> 00:16:00,980
A lot of times surgeons don't
stress or emphasize or higher

252
00:16:00,980 --> 00:16:05,210
carbohydrates postoperatively, and it's
saying to get to patients to do it,

253
00:16:05,240 --> 00:16:08,330
they came to have
liposuction to get lighter,

254
00:16:08,720 --> 00:16:12,380
to really tell people
that you need to do this,

255
00:16:12,380 --> 00:16:15,740
that that's something that you have
to massage with patients as well.

256
00:16:16,070 --> 00:16:21,050
And the other thing about what
I do is a lot of postoperative

257
00:16:21,050 --> 00:16:25,490
molding. We use a lot
more foam with procedures

258
00:16:26,660 --> 00:16:30,650
and we spend extra time
really talking about

259
00:16:31,280 --> 00:16:34,250
compression wear to make sure
everything heals as easily as possible,

260
00:16:34,250 --> 00:16:37,550
as polished as possible,
but also to make sure that

261
00:16:39,260 --> 00:16:43,070
the transition zones from what we've
subtracted to what we've added,

262
00:16:43,070 --> 00:16:47,630
our nice and smooth, our aesthetic, our
mixed sense, and our natural appearing.

263
00:16:48,230 --> 00:16:50,480
So then where the
techniques are different,

264
00:16:50,480 --> 00:16:52,940
does that mean that the
instruments are different as well?

265
00:16:53,360 --> 00:16:54,193
Yeah. Well,

266
00:16:54,200 --> 00:16:58,460
one thing that I have and I've
developed is a scar abdominal healing.

267
00:16:59,000 --> 00:17:03,500
And you may see summer
when you go to the beach

268
00:17:04,370 --> 00:17:05,300
or the pool,

269
00:17:05,300 --> 00:17:09,830
you may see some guys that have had
abdominal sculpting or abdominal etching

270
00:17:10,340 --> 00:17:14,570
and their abs, their stomach
looks like a tic-tac toe board,

271
00:17:15,500 --> 00:17:19,610
and they have six different incisions
right on the skin, right visible,

272
00:17:19,910 --> 00:17:23,720
God forbid if they were a
little bit darker complected,

273
00:17:23,720 --> 00:17:28,430
maybe we call it Fitzpatrick scale and
it's scaled from lightness to darkness.

274
00:17:28,700 --> 00:17:33,560
But if it might be a patient
that may be a patient of color

275
00:17:33,800 --> 00:17:35,390
or a patient of a thicker dermis,

276
00:17:35,690 --> 00:17:39,650
one of these guys that may be Latino
or black can have problems with

277
00:17:39,650 --> 00:17:43,610
hypertrophic scarring or keloids.
Those are those bad scars.

278
00:17:44,030 --> 00:17:48,500
So if you are giving them a scar that's
right on their abdomen and it scars

279
00:17:48,500 --> 00:17:52,380
poorly, sometimes they look ritualistic,

280
00:17:52,860 --> 00:17:56,130
they're going to have scars that
obviously show that they've had abdominal

281
00:17:56,130 --> 00:17:59,100
sculpt.
So I tell everyone that we need to have,

282
00:17:59,190 --> 00:18:03,660
and I have curved cannulas
so that I can hit all the

283
00:18:03,660 --> 00:18:07,620
points from two small incisions underneath
your swimsuit or through the belly

284
00:18:07,620 --> 00:18:10,200
button or a little nick through
the nipple that nobody ever sees.

285
00:18:10,560 --> 00:18:14,340
So I can hit all those sites
without any scars on your abdomen.

286
00:18:14,370 --> 00:18:17,160
So we developed this in 2017,

287
00:18:17,160 --> 00:18:20,340
it's called scarless abdominal

288
00:18:23,040 --> 00:18:26,400
sculpting, and I always
tell the residents,

289
00:18:26,400 --> 00:18:28,230
and I tell when I'm speaking,

290
00:18:28,260 --> 00:18:31,680
I have to speak in Cartagena
next down in Columbia,

291
00:18:31,680 --> 00:18:36,540
and then we're going Greece and then
Australia. So when I talk to people,

292
00:18:36,600 --> 00:18:38,250
I had these conferences,

293
00:18:41,790 --> 00:18:46,440
I always tell patients I've never had
to apologize for an incision that I did

294
00:18:46,440 --> 00:18:50,340
not make. Right. If you don't make
the incision, you don't need to do it.

295
00:18:50,340 --> 00:18:54,510
And frequently I'm at a conference and
I'll talk about this and I'll sort of

296
00:18:54,510 --> 00:18:56,970
beat on people about this,
stop making these incisions.

297
00:18:57,360 --> 00:18:59,550
We have the tools of the
technologist not to have that.

298
00:18:59,560 --> 00:19:03,960
And then the next doctor that gets up
and gives his abdominal sculpting talk

299
00:19:03,960 --> 00:19:07,200
showed make sure there's incisions I
just told everyone in the audience not to

300
00:19:07,200 --> 00:19:10,530
make. So it's kind of tricky.

301
00:19:10,830 --> 00:19:15,420
Yeah, I think that's a lesson
from the whole field of minimally

302
00:19:15,420 --> 00:19:19,350
invasive surgery and
plastic surgery as well,

303
00:19:19,950 --> 00:19:24,270
that the smaller the incision is,
the further away the incision is,

304
00:19:24,510 --> 00:19:29,310
the more it becomes critical to
have exactly the right instrument

305
00:19:29,730 --> 00:19:32,430
that empowers you to
do what you need to do.

306
00:19:33,750 --> 00:19:36,900
And if you try to do it with
just a conventional instrument,

307
00:19:36,900 --> 00:19:39,600
you try to struggle, you're
not in the right position,

308
00:19:39,600 --> 00:19:41,730
the instrument's not configured properly.

309
00:19:42,150 --> 00:19:46,050
So that contribution that
you made of developing

310
00:19:46,050 --> 00:19:50,760
instrumentation that enables
this whole process was really

311
00:19:50,760 --> 00:19:55,650
one of the tremendous steps up for
accomplishing this in a way that keeps the

312
00:19:55,650 --> 00:20:00,510
entire abdominal area looking
great instead of a jigsaw

313
00:20:00,510 --> 00:20:03,150
puzzle of a bunch of little
incisions, as you're saying.

314
00:20:03,690 --> 00:20:08,460
And I've always tried to tilt
towards the absolute minimum of

315
00:20:08,460 --> 00:20:11,580
liposuction incisions of
fat grafting incisions,

316
00:20:11,820 --> 00:20:16,590
and there are some surgeons that go
with very short cannulas and make

317
00:20:16,590 --> 00:20:20,490
many incisions every four inches or so.

318
00:20:20,490 --> 00:20:24,690
And I've just never understood that
approach. So I think you're right on.

319
00:20:25,740 --> 00:20:30,060
Yeah, frankly, that's one of the problems
with a lot of these new technologies.

320
00:20:30,810 --> 00:20:33,060
The companies are more
interested in making money,

321
00:20:33,060 --> 00:20:35,040
so they make all the probes very short,

322
00:20:35,430 --> 00:20:40,020
so they can't use the body in prob for
the neck group or anything like that.

323
00:20:40,380 --> 00:20:44,340
And by making them short, inherently
people just have to make more incisions,

324
00:20:44,340 --> 00:20:48,610
which means more scars.
The patient, unfortunately,

325
00:20:49,240 --> 00:20:53,530
I dare say that for the
company sometimes the

326
00:20:53,860 --> 00:20:56,170
priority isn't the patient
or the patient's scars.

327
00:20:56,170 --> 00:21:00,370
The priority is how many of these things
can they sell sometimes, unfortunately.

328
00:21:00,580 --> 00:21:02,320
Yeah. I mean that's the thing.

329
00:21:03,400 --> 00:21:07,900
We often use a few different
liposuction cannulas in terms of what

330
00:21:08,770 --> 00:21:10,210
the apertures look like,

331
00:21:10,210 --> 00:21:15,070
the holes that actually shear off
the fat or in terms of the curve

332
00:21:15,070 --> 00:21:18,520
of the cannula or the length
of the cannula or the diameter.

333
00:21:18,940 --> 00:21:23,650
And as soon as you go to
an energy based technology,

334
00:21:24,130 --> 00:21:26,950
either applicator or cannula,

335
00:21:27,520 --> 00:21:32,230
you can't really buy more than one
for a case, which means by definition,

336
00:21:32,230 --> 00:21:37,000
you're using one disposable
cannula rather than

337
00:21:37,000 --> 00:21:38,110
your, I mean,

338
00:21:38,110 --> 00:21:42,490
I've had a lot of cannulas for 20 years
and we just put them in the sterilizer.

339
00:21:42,490 --> 00:21:45,490
They're steel, they get
cooked, they're sterile,

340
00:21:45,490 --> 00:21:48,340
and we use them and use them and use them.

341
00:21:48,610 --> 00:21:53,590
But I can pull on that family
of cannulas for whatever exactly

342
00:21:53,590 --> 00:21:58,330
I need in that instant to
get the shaping I want,

343
00:21:59,110 --> 00:22:03,280
which you lose when you
transition to a single cannula

344
00:22:03,280 --> 00:22:07,540
approach. Right. That's an interesting
point. I didn't think of that.

345
00:22:08,230 --> 00:22:12,910
So I'd like to kind of focus
in a different direction

346
00:22:12,910 --> 00:22:13,960
from body,

347
00:22:14,290 --> 00:22:18,700
and you mentioned that neck and jawline
are one of the big things for men

348
00:22:18,700 --> 00:22:20,590
because it does give them a worn,

349
00:22:20,590 --> 00:22:24,040
tired outlook and nobody
wants to look that way,

350
00:22:24,670 --> 00:22:29,500
especially if you don't feel that way.
But this is also a procedure of course,

351
00:22:29,500 --> 00:22:31,720
that women do commonly.

352
00:22:32,620 --> 00:22:37,090
How do you approach facelift
or neck lifting for men?

353
00:22:37,840 --> 00:22:39,340
How are your incisions different?

354
00:22:39,340 --> 00:22:43,270
How is it different what you're doing
underneath with your connective tissue

355
00:22:43,270 --> 00:22:46,690
layers? What's your
thought process for this?

356
00:22:46,960 --> 00:22:49,720
Sure. Well, men are a little
bit different than women.

357
00:22:49,720 --> 00:22:53,320
And neither for men or women do.

358
00:22:53,320 --> 00:22:58,240
I like to do the old fashioned
surgeons really in the

359
00:22:58,240 --> 00:22:59,530
sixties, seventies, and eighties,

360
00:22:59,530 --> 00:23:04,090
which was kind of wait until everything
falls apart and then they get these Park

361
00:23:04,420 --> 00:23:09,400
Avenue matriarchs and they put
their foot up on the table and pull

362
00:23:09,400 --> 00:23:12,550
as much as they can. So that
patient is very wind swept.

363
00:23:12,550 --> 00:23:16,750
So a couple of things that we do
for the men is men would rather

364
00:23:17,080 --> 00:23:20,890
have A, not look feminized
and B, not look overdone

365
00:23:22,910 --> 00:23:27,400
or look like they did have surgery.
So for the men, they'd rather,

366
00:23:27,400 --> 00:23:30,490
and this is one thing I remember,

367
00:23:30,490 --> 00:23:33,670
I had this lady from Texas when
I started out my practice, "doc,

368
00:23:33,820 --> 00:23:38,710
I want to be pulled so tight
that I only have one line and I

369
00:23:38,710 --> 00:23:42,910
want to be sitting on it." And
I just thought it, first of all,

370
00:23:42,910 --> 00:23:46,760
it was very clever, but men
don't want that. And for men,

371
00:23:46,760 --> 00:23:50,150
what we want is I always talk
about something that looks,

372
00:23:50,570 --> 00:23:54,320
some lines are character and there's
nothing that looks more artificial for me

373
00:23:54,320 --> 00:23:58,490
than to see a man that doesn't have one
single wrinkle, one single anything.

374
00:24:01,010 --> 00:24:05,060
I think that a few lines
here or there are sexy.

375
00:24:05,570 --> 00:24:08,450
We just don't want to look
old or older than our age.

376
00:24:08,600 --> 00:24:12,620
So number one priority for men rather,

377
00:24:12,620 --> 00:24:15,860
they'd rather have less done.
And I always tell my patients,

378
00:24:15,860 --> 00:24:17,480
I get in the same sig with them,

379
00:24:17,810 --> 00:24:21,680
you come to me because you want to stay
looking masculine and you don't want to

380
00:24:21,680 --> 00:24:25,100
look like you had surgery and want to
look like you don't look like an alien or

381
00:24:25,100 --> 00:24:27,320
a woman. So for my guys,

382
00:24:27,320 --> 00:24:30,020
I know I say if there's anything
that you're going to be displeased,

383
00:24:30,020 --> 00:24:32,870
it's because there's a little, you
wanted this to be completely gone.

384
00:24:32,870 --> 00:24:34,760
I never say gone. In my practice,

385
00:24:34,760 --> 00:24:38,240
I always say improve after I speak with
'em and they realize that they don't

386
00:24:38,240 --> 00:24:42,440
want to look overdone or over pulled,
God forbid. They do understand that,

387
00:24:42,440 --> 00:24:46,340
and it's about setting those expectations
that makes 'em happy. In terms of

388
00:24:46,340 --> 00:24:51,050
technical differences for the women,
what we do is we take their skin,

389
00:24:51,050 --> 00:24:55,670
we put it all the way behind the dragus,
behind and into the ear. For the men,

390
00:24:55,700 --> 00:24:58,010
I don't do that because
they have hair bearing.

391
00:24:58,010 --> 00:25:01,730
They have that beard or bring it right
up to that little line that everyone has.

392
00:25:01,730 --> 00:25:04,310
We call pretragal that it
has in front of the ears.

393
00:25:04,310 --> 00:25:08,720
But what I do is I do something different.
What I do is I make sure I see some,

394
00:25:08,720 --> 00:25:12,620
and in fact, I went to a laser show,

395
00:25:12,620 --> 00:25:15,680
I don't want to get too specific
because it's going to reveal the person,

396
00:25:16,130 --> 00:25:20,630
but really fantastic lasers vice
president could have gone to

397
00:25:20,630 --> 00:25:22,550
anyone that he wanted to,

398
00:25:22,550 --> 00:25:26,240
but I could see when he had his facelift
with incision, went straight down,

399
00:25:26,240 --> 00:25:31,130
it was about a half inch in front of the
ear and then came back dead giveaway of

400
00:25:31,130 --> 00:25:32,330
someone who's had surgery,

401
00:25:32,330 --> 00:25:36,830
is a poor match.
There was a straight line. What I do,

402
00:25:36,830 --> 00:25:41,150
what I do is different is I make sure I
go around each and individual and most

403
00:25:41,150 --> 00:25:42,590
good plastic surgeons do this,

404
00:25:42,590 --> 00:25:47,150
but I still do see some guys when I go
out to South Anthem and go to dinner and

405
00:25:47,150 --> 00:25:50,720
I see the guy at the club that has
an incision that came straight down.

406
00:25:51,110 --> 00:25:54,170
So we always blended in with the
natural structures of the ear.

407
00:25:54,200 --> 00:25:58,520
When my mother was putting together
wallpaper in the dining room,

408
00:25:59,510 --> 00:26:00,710
her floral wallpaper,

409
00:26:00,710 --> 00:26:05,540
she would painstakingly cut
around every fruit and every

410
00:26:05,540 --> 00:26:09,260
flower so that there were no seams in
that wallpaper. And I did the same thing.

411
00:26:09,260 --> 00:26:13,490
So you don't see it in men. The
other thing with men for the neck,

412
00:26:13,520 --> 00:26:16,100
we start with injectables.

413
00:26:16,400 --> 00:26:20,150
So we can go a long way with
even removal of fat with

414
00:26:21,090 --> 00:26:25,850
Kybella, and that's just an injectable.
Or I can do liposuction

415
00:26:27,440 --> 00:26:29,450
with neck fat, which is radial frequency.

416
00:26:29,450 --> 00:26:34,430
Next step up from that is we make an
incision and bring the platysma muscles

417
00:26:34,430 --> 00:26:36,560
together, with a platysmaplasty,

418
00:26:36,560 --> 00:26:40,220
redrape the skin along with remove
of fat and tightening of the skin.

419
00:26:40,220 --> 00:26:44,940
Next step of that is short scar neck lift.

420
00:26:45,300 --> 00:26:47,910
It just comes around the ear
and that improves the neck,

421
00:26:47,910 --> 00:26:50,070
but won't take care of the jawline.

422
00:26:50,640 --> 00:26:55,590
If we really want to take care of
the jawline from a non-invasive

423
00:26:55,590 --> 00:26:58,920
way or an injectable way, I can do
what I call my male model makeover,

424
00:26:58,920 --> 00:27:02,280
which is more into the cheek
bone, more along the jawline.

425
00:27:02,550 --> 00:27:06,240
Have a special way that I do it to make
sure that you don't look like a mobster

426
00:27:06,630 --> 00:27:10,800
with which you've seen several people do
because they're injecting in the wrong

427
00:27:10,800 --> 00:27:11,633
place,

428
00:27:12,480 --> 00:27:16,740
but I inject it a certain way
so they have a more stronger,

429
00:27:16,740 --> 00:27:20,970
more defined jawline.
And then when it comes to surgery,

430
00:27:20,970 --> 00:27:23,400
if we want to improve the
jawline in the cheekbone,

431
00:27:23,880 --> 00:27:28,110
a little bit of the nasal label
fold is do a full neck and phase

432
00:27:28,740 --> 00:27:32,820
for the gall. So that's pretty
much the entire realm. Oh,

433
00:27:32,820 --> 00:27:36,840
one more thing is what I sort
of call is the Clint Eastwood

434
00:27:38,460 --> 00:27:41,730
neck work, which is somebody that says,

435
00:27:41,730 --> 00:27:44,490
we have a lot of guys that come
in in their sixties, seventies,

436
00:27:44,490 --> 00:27:48,750
maybe even eighties, who say, "doc,
just get rid of the Turkey neck.

437
00:27:48,750 --> 00:27:53,640
Get rid of the Turkey neck." And for
those people, I can do it under local.

438
00:27:53,850 --> 00:27:56,280
We can remove the skin directly.

439
00:27:56,280 --> 00:28:00,270
But the reason why I say Clint Eastwood
is because it's got to be a certain

440
00:28:00,270 --> 00:28:03,240
patient that says weathered skin,

441
00:28:03,240 --> 00:28:05,580
a lot of natural sun aging,

442
00:28:06,450 --> 00:28:07,620
a lot of creases,

443
00:28:07,620 --> 00:28:12,480
crevices and crags so that
when you do directly size

444
00:28:12,480 --> 00:28:17,160
that the resulting scar
can hide quite well

445
00:28:17,520 --> 00:28:19,020
under that weathered skin.

446
00:28:19,020 --> 00:28:22,710
But it's really not something that we
do and a younger person or a person that

447
00:28:22,710 --> 00:28:25,260
doesn't have a lot of
skin damage, that's it.

448
00:28:25,590 --> 00:28:28,050
Yeah. So there's this
big range of options,

449
00:28:28,530 --> 00:28:32,280
and I think those are all
really important points. I mean,

450
00:28:32,280 --> 00:28:37,050
one thing about face and neck
operations is they're not just

451
00:28:37,050 --> 00:28:40,380
loose skin operations,
they're shaping operations.

452
00:28:40,590 --> 00:28:42,120
And so by definition,

453
00:28:42,120 --> 00:28:45,690
a male face shape is different
from a female face shape,

454
00:28:46,350 --> 00:28:47,250
and it's really,

455
00:28:47,250 --> 00:28:52,140
really important to reinforce the
maleness of the shape in a man

456
00:28:52,830 --> 00:28:57,210
and not feminize the face or the eyelids.

457
00:28:57,270 --> 00:29:02,130
And I see that all the time from people
who just have one approach and one

458
00:29:02,130 --> 00:29:04,650
approach isn't even good for one gender.

459
00:29:04,650 --> 00:29:09,360
You obviously have to customize
your approach based on what's

460
00:29:09,420 --> 00:29:12,930
going on in that individual
patient stage of aging.

461
00:29:13,290 --> 00:29:18,210
But it's really important to do that with
the goal of reinforcing a male facial

462
00:29:18,210 --> 00:29:19,043
shape.

463
00:29:19,320 --> 00:29:24,270
And that incision location and
tailoring in is just part of that

464
00:29:24,270 --> 00:29:28,920
good plastic surgery training that
we got at NYU and Summer watched me

465
00:29:28,920 --> 00:29:33,210
making that kind of incision
last week on a very nice

466
00:29:33,210 --> 00:29:38,070
77-year-old gentleman who
still works full time. And

467
00:29:38,070 --> 00:29:42,700
that kind of incision works
better than trying to pull that

468
00:29:42,700 --> 00:29:46,090
thickened weathered cheek
skin over the tragus,

469
00:29:46,090 --> 00:29:50,650
the little button in front of the
ear that's going to look poorly

470
00:29:50,650 --> 00:29:55,450
matched and not hiding the
incision right in the crease in

471
00:29:55,450 --> 00:30:00,160
front because you're worried about
the hair bearing and non hair bearing

472
00:30:00,160 --> 00:30:04,420
areas of the face, likewise is
going to leave you with a giveaway,

473
00:30:04,960 --> 00:30:08,770
which is essentially avoidable.

474
00:30:09,310 --> 00:30:13,870
So these technical details really make
a critical difference in preserving

475
00:30:14,290 --> 00:30:17,980
a natural look, which is
always the goal for men.

476
00:30:18,520 --> 00:30:23,050
I think you said a mouthful when you
said that because that is a hundred

477
00:30:23,050 --> 00:30:24,940
percent what the job is about.

478
00:30:25,900 --> 00:30:30,460
If a man comes out looking
natural, younger, fresh, or rested,

479
00:30:30,970 --> 00:30:32,500
then it's a success.

480
00:30:32,530 --> 00:30:36,850
And if you make any kind of alteration,

481
00:30:36,940 --> 00:30:39,520
it's really a bad day.

482
00:30:40,450 --> 00:30:43,750
Absolutely. Couldn't agree anymore.

483
00:30:43,780 --> 00:30:47,290
The other thing I would
touch on is the support

484
00:30:48,430 --> 00:30:51,040
and bony support,

485
00:30:51,050 --> 00:30:54,520
and that's the other thing that we have
to think about because just like you

486
00:30:54,520 --> 00:30:57,940
said, this is just not just loose
skin surgery. If it was loose skin,

487
00:30:57,940 --> 00:31:02,050
you would just bring it up.
And the problem is men age.

488
00:31:03,100 --> 00:31:06,820
I always tell my patients
when they're in their teens,

489
00:31:07,210 --> 00:31:11,830
one of the reasons why guys look so
great in their early twenties is they

490
00:31:12,940 --> 00:31:15,460
may stop growing when they're 18, 19, 20,

491
00:31:15,460 --> 00:31:18,820
but the jawline continues
to grow until around your

492
00:31:18,820 --> 00:31:23,590
27th birthday is it starts to

493
00:31:23,590 --> 00:31:27,490
recede. So if you took the mandible,

494
00:31:27,490 --> 00:31:32,470
the skull mandible from
a 27-year-old and then

495
00:31:32,470 --> 00:31:35,290
a 72-year-old, we're going
to flip the numbers there,

496
00:31:35,680 --> 00:31:40,060
you're going to see a lot of
resorption of that bony area.

497
00:31:40,360 --> 00:31:44,800
So if you bring up the
skin and you've lost a

498
00:31:44,800 --> 00:31:47,020
significant amount of your mandible,

499
00:31:47,020 --> 00:31:49,780
the actual actual bony
push in the mandible,

500
00:31:49,810 --> 00:31:53,590
you're not going to look right. You're
going to look forrshortened and lack

501
00:31:53,590 --> 00:31:56,440
projection, and you're going
to lose that masculinity,

502
00:31:56,500 --> 00:31:59,440
and you're not going to look like you
looked in those pictures that you brought

503
00:32:00,040 --> 00:32:02,020
from 20, 30, 40 years ago.

504
00:32:02,020 --> 00:32:06,280
So one of the things that
we do have to do is replace,

505
00:32:07,240 --> 00:32:11,530
but what we need to do
is we need to recreate

506
00:32:12,310 --> 00:32:15,100
that extra fullness, and I can do that

507
00:32:16,930 --> 00:32:20,350
during the neck lift or facelift.
Usually after is better,

508
00:32:20,350 --> 00:32:23,170
we reset the tissues after
the reset and healed.

509
00:32:23,590 --> 00:32:28,360
I go back in and I give that extra
volume of that bone with injectables.

510
00:32:28,360 --> 00:32:33,190
I can do it with fat or I can
do it with hyaluronic acid,

511
00:32:33,190 --> 00:32:34,810
which are injectables off the shelf.

512
00:32:35,110 --> 00:32:39,590
And that not only makes a patient
have a more chisel, more masculine,

513
00:32:39,920 --> 00:32:41,270
more defined jawline,

514
00:32:41,840 --> 00:32:46,070
catches a light and throws a shadow
that gives that really straight,

515
00:32:46,340 --> 00:32:47,840
strong masculine look.

516
00:32:47,900 --> 00:32:52,790
But it also makes you look more like you
looked like when you were 27 years old

517
00:32:52,790 --> 00:32:57,770
because we recreated your jawline
you had when you were 27 years

518
00:32:57,770 --> 00:32:59,000
old, so you look younger as well.

519
00:33:00,440 --> 00:33:03,830
Wow. That was a lot of small
details that I hadn't considered,

520
00:33:03,830 --> 00:33:07,700
but are clearly really important when
considering plastic surgery for men.

521
00:33:08,030 --> 00:33:11,180
So as we prepare to wrap up
this episode, Dr. Steinbrech,

522
00:33:11,690 --> 00:33:13,910
what takeaways do you want
to share with our listeners?

523
00:33:14,270 --> 00:33:17,870
I think the key thing is when you're
looking for men's plastic surgery,

524
00:33:17,870 --> 00:33:21,320
what you want to do is do your
research, right? You want to go to,

525
00:33:21,500 --> 00:33:26,480
anybody can, a lot of people do,
they buy the Google terms for male

526
00:33:28,100 --> 00:33:32,540
plastic surgery, New York's best
male plastic surgeon, or they'll say,

527
00:33:32,540 --> 00:33:37,010
Phoenix best male plastic surgeon.
But then when you go to the website,

528
00:33:37,010 --> 00:33:40,190
it's nothing but orchids and
butterflies, right? And then really,

529
00:33:40,190 --> 00:33:44,090
it's when you go to the gallery and
you're trying to find one man in their

530
00:33:44,090 --> 00:33:46,130
gallery of their before and after photos,

531
00:33:46,130 --> 00:33:50,270
and all you see are hundreds
of breast augmentations,

532
00:33:50,270 --> 00:33:52,520
and you're really not looking
for a breast augmentation.

533
00:33:52,880 --> 00:33:54,770
So it's to do your research.

534
00:33:55,160 --> 00:33:59,210
And then the other thing is to also
make sure that they're a member of,

535
00:33:59,210 --> 00:34:02,570
they're board certified
in plastic surgery.

536
00:34:02,570 --> 00:34:04,640
And even higher than that,

537
00:34:04,640 --> 00:34:08,180
a higher level is that they're a
member of The Aesthetic Society.

538
00:34:09,560 --> 00:34:12,230
So those I think are
really important things

539
00:34:13,890 --> 00:34:16,790
when you're choosing your plastic
surgery for male plastic surgery.

540
00:34:17,480 --> 00:34:19,370
And what are your takeaways, Dr. Bass?

541
00:34:20,000 --> 00:34:23,150
Well, we've talked about some of
these things before on the podcast,

542
00:34:23,150 --> 00:34:27,350
but the way plastic surgery
procedures are done, the parameters,

543
00:34:27,380 --> 00:34:31,820
the measurements and metrics are
different for men and for women.

544
00:34:32,450 --> 00:34:36,890
We've kind of scratched the surface here
talking about body banking and talking

545
00:34:36,890 --> 00:34:39,440
about face and neck shape,

546
00:34:39,950 --> 00:34:44,630
but for every procedure, it's going
to be different for men and women,

547
00:34:45,620 --> 00:34:50,330
the aesthetic interests of
men and women go head to toe,

548
00:34:50,600 --> 00:34:55,340
but there are certain aesthetic issues
that are more commonly of concern

549
00:34:55,340 --> 00:34:56,510
based on gender.

550
00:34:57,260 --> 00:35:01,850
We're limiting the discussion in this
episode to individuals that identify in

551
00:35:01,850 --> 00:35:06,350
one of these two simple
baskets of men or women.

552
00:35:07,160 --> 00:35:10,430
But we must acknowledge,
as Dr. Steinbrech did,

553
00:35:10,760 --> 00:35:15,650
that there are individuals that don't
fit into one of these simple categories

554
00:35:15,650 --> 00:35:19,190
based on how they identify or
based on their aesthetic goals.

555
00:35:19,550 --> 00:35:20,510
So for that reason,

556
00:35:20,510 --> 00:35:25,040
it's really important for patients in
their surgeons to discuss the aesthetic

557
00:35:25,040 --> 00:35:27,800
goals and the aesthetic

558
00:35:29,300 --> 00:35:33,980
sense of beauty ahead of time
to come closest to producing the

559
00:35:33,980 --> 00:35:37,250
patient's vision of beauty in reality.

560
00:35:38,850 --> 00:35:39,600
In summary,

561
00:35:39,600 --> 00:35:44,250
men are definitely interested in plastic
surgery and increasingly interested.

562
00:35:44,250 --> 00:35:48,240
The procedures have improved
to match men's needs,

563
00:35:48,240 --> 00:35:52,890
and that's in part due to excellent
instruction in how to customize these

564
00:35:52,890 --> 00:35:57,870
procedures for men from leaders
in male plastic surgery like

565
00:35:57,870 --> 00:35:58,830
Dr. Steinbrech,

566
00:36:00,510 --> 00:36:05,280
there are a lot of subtle features
and some very obvious features that

567
00:36:05,280 --> 00:36:06,810
say male or female,

568
00:36:07,110 --> 00:36:11,820
and it's critical to understand
both the big and little features and

569
00:36:11,820 --> 00:36:16,140
build them into your plastic
surgery procedures if you want a

570
00:36:16,140 --> 00:36:19,200
nuanced natural looking result.

571
00:36:20,400 --> 00:36:23,910
So I'd like to thank Dr.
Steinbrech for joining us today.

572
00:36:23,910 --> 00:36:26,730
It's been a lot of fun to talk
through this topic with you.

573
00:36:28,170 --> 00:36:31,570
Absolutely. Thank you for having
me. I really, really enjoyed it.

574
00:36:31,570 --> 00:36:32,690
Some great questions,

575
00:36:33,430 --> 00:36:37,860
and I really hope that people go
out there and explore it more.

576
00:36:38,370 --> 00:36:42,540
Thank you, Dr. Steinbrech for sharing
your extensive expertise in this area.

577
00:36:43,620 --> 00:36:47,730
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

578
00:36:47,760 --> 00:36:49,680
Follow us on Apple Podcasts,

579
00:36:49,710 --> 00:36:51,960
write a review and share
the show with your friends.

580
00:36:52,140 --> 00:36:55,650
Be sure to join us next time to avoid
missing all the great content that is

581
00:36:55,650 --> 00:36:59,190
coming your way. If you want to
contact us with comments or questions,

582
00:36:59,190 --> 00:37:00,420
we'd love to hear from you,

583
00:37:00,510 --> 00:37:05,160
send us an email at
podcast@drbass.net or DM us on

584
00:37:05,160 --> 00:37:07,680
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