S06E103 Navigating Obesity and Plastic Surgery - Today's Choices

Nearly three-quarters of U.S. adults are overweight or obese. The obesity epidemic is a multifaceted challenge fueled by genetics, environment, and lifestyle. Navigating the journey to a sustainable, healthy weight is crucial, especially for those considering the transformative potential of plastic surgery.

Join hosts Dr. Sam Jejurikar @samjejurikar, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic as we dive into the complexities faced by patients with a BMI of 25 to 30 who seek procedures such as tummy tucks and liposuction. The discussion extends to the powerful benefits of lifestyle changes, emphasizing the unglamorous yet essential aspects of stress management, nutrition, and exercise. GLP agonists may play a role, but they are no miracle cure. We aim to provide a thoughtful perspective, encouraging patients to align their aesthetic goals with overall wellness.

Balancing aesthetics with health is a dance of ethics and patient expectations. This episode also tackles the safety and ethical considerations of cosmetic procedures for those with a high BMI, and the role GLP-1 agonists may have in this space.

We bring you firsthand insights into surgical criteria, potential complications, and the crucial adaptations needed in practice, such as updated intake forms related to anesthesia. Our shared commitment is clear: prioritizing patient health while achieving satisfactory surgical outcomes. Listen in as we explore how these medications are reshaping the landscape of cosmetic surgery and what it means for both patients and practitioners.

@sandiegoplasticsurgeon #MedicalPodcast @3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S06E103 Navigating Obesity and Plastic Surgery - Today's Choices

TRANSCRIPT

[00:00:00]

Dr. Sam Jejurikar: Welcome everyone to another edition of Three Plastic Surgeons and a Fourth. Today we are poorly named as we are actually missing one of our plastic surgeons, but uh, I am joined today by Dr. Lawrence Tong from Toronto, Canada, who is at Yorkville Plastic Surgeon. And of course, by our fearless leader, Sam Rhee. Is it a Yorkville plastic surgery?

Dr. Lawrence Tong: First, yes, but you said surgeon. It's fine. No worries.

Dr. Sam Jejurikar: I'm the worst. Sam Rhee, at Bergen Cosmetic. That I do have down pat. And I'm Sam Jejurikar, at Sam Jejurikar. Pretty easy, the two go together. So, and we're missing Dr. Pacella, who will join us, I'm sure, in the relatively near future. And today, we're going to talk about, um, an interesting topic that's definitely Peripherally related to plastic surgery, it's about the [00:01:00] obesity epidemic in the U.

S. Before we get into the meat of it, Dr. Tong is going to read a disclaimer.

Dr. Lawrence Tong: All right. This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care.

Never disregard professional medical advice or delay seeking advice because of something on this show.

Dr. Sam Jejurikar: Okay, so what's prompting us to talk about the obesity epidemic today is a new study that was just published in the medical journal The Lancet, which has gotten a lot of press over the last few days. And it showed that nearly three quarters of U. S. adults are now overweight or obese. which is up from over half, just over half in 1990, which means our population is actually getting fatter.[00:02:00]

Um, this is obviously an alarming trend that has wide reaching implications for healthcare costs, for health in general, um, as obesity is linked to conditions like diabetes, heart disease, and shorter life expectancy. And the study highlights a troubling rise in obesity rates among children with more than a third and now overweight or obese and warns that without intervention.

The number of affected individuals could reach 260 million in the U. S. by the year 2050. Um, the experts are basically saying that the issue is an epidemic driven by genetic, physiologic, and environmental factors, including the prevalence of ultra processed foods and sedentary lifestyles. Um, they say that, that social aspects like food insecurity and income disparity exacerbates this problem, particularly in poor and marginalized communities.

And while we have promising new treatments, specifically GLP 1 agonists that we have talked a lot about [00:03:00] previously on this podcast, Um, and I know they can offer a lot of hope. They're really expensive and right now inaccessible to the masses. So kind of opening up this conversation to, um, to a broader discussion and to this podcast, you know, more specifically about plastic surgery.

Have you guys seen this? Like, do you guys feel like in your, you know, patient populations that you're seeing that patients, you know, that more patients than not are overweight or obese that are coming to you for surgery?

Dr. Sam Rhee: I don't, um, go ahead. I, um, I did for a while and, um, it's, it is prevalent. I, there's no doubt that our society, especially in the United States, um, we as a population are getting heavier and, and, and more obese, uh, that, uh, I don't know what it's like in Canada, Larry, but for us, um, you can go to any large, uh, public setting and [00:04:00] you can really see just how, obese most people are at this point.

For me as a physician, um, I mean I have a couple thoughts. One is, um, as a plastic surgeon that does primarily aesthetic surgery, um, I don't use aesthetic surgery as a means for weight management. And so, um, I think most of my patients at this point know if they're coming in with a very high BMI, um, there's not a lot that I can offer from an aesthetic surgical standpoint that's going to address that.

And I talk to them a lot about not using surgery first to address Aesthetic issues related to weight or being overweight, um, and I'm pretty strict about that. I think I've gotten stricter as I've gotten farther along in my practice career, uh, and also maybe because I don't know where Sal is because he [00:05:00] needs to hear me talk about CrossFit because he always tells me what the first rule of CrossFit is, but I've gotten, um, I'm now pretty heavy into CrossFit as a minority owner of a gym, and I also coach.

I've attended the CrossFit Health Summit. I've learned a lot about what their ethos and philosophy is about fitness and nutrition. And a lot of what I think afflicts CrossFit. Us as Americans today are things that are addressable, not through surgery or maybe even, uh, medical principles, but, um, but other means means that I think we haven't really focused on well as physicians in the United States.

And, uh, I'm happy to talk about that a little bit, but I feel like we're putting the cart before the horse. Every time we talk about GLP drugs or surgery or, um. Other sort of more drastic, in my mind, [00:06:00] measures to address patients who are suffering from chronic disease, such as, you know, chronic diseases related to being obese and overweight or being un aesthetic because they're overweight.

Dr. Lawrence Tong: So, um, when I moved from Michigan to, to Toronto, when I moved from, um, the United States to Canada, I actually did see a fairly marked difference in the number of patients that I saw that were, uh, overweight that dropped fairly dramatically. when I, when I moved to Canada. That's not to say that everybody here is, you know, BMI of 20, but, um, I remember when I was practicing in the States, it was, you know, fairly common for me to operate on patients who were, you know, 200 pounds, and that's something that's actually quite rare now, nowadays, and, um, [00:07:00] you know, I'd be curious to know.

If the, um, epidemic in, in obesity is, um, sort of special to the United States or, um, is it, uh, you know, for Western developed countries, um, as an issue? Uh, I think that what you said, Sam, is, is really correct that there's a misconception sometimes that, uh, plastic surgery can fix obesity. But definitely that is not the case.

There's no surgery in the plastic surgery realm that, um, that can, you know, do enough to, um, make an obese person non obese. And I think that's, that's important. Um, something that I just want to touch on is, um, our viewers and listeners might not know why it is that, um, you know, being overweight. is a [00:08:00] health concern.

And so being overweight causes various medical conditions. One which is very important is type 2 diabetes. That is a metabolic condition where you can't regulate, um, your sugars and that's going to have cascading effects, um, on your kidneys, on your vision, on your blood vessels. Another, um, effect of being obese is, uh, it's a stress on your cardiovascular system.

You'll get high blood pressure. It's bad for your heart. So all of these things, um, basically can lead to more disease. shorter lifespan, poor, poor quality of life. And, uh, as plastic surgeons, we have to look at these things because they, a lot of these things are risk factors for surgery as well. But I [00:09:00] take Sam's point, um,

Dr. Sam Rhee: to

Dr. Lawrence Tong: that, uh, you know, the obesity epidemic is not going to be served by, uh, solved by plastic surgeons.

There are other things, um, that are to be done way before. Um, and, uh, I don't know, Dr. Jejurikar, if you have any other thoughts.

Dr. Sam Jejurikar: Yeah. I mean, I think you guys have both said a lot. I will, uh, the only thing I don't really have a opinion on is. The relative healthiness of Canadians relative to Americans, just because I don't, don't, don't see them, but it sounds like they're thinner than what you're seeing here. Um, Sam said several things that I, that I wanted to sort of expound on. The first thing that I noticed that you said is that you hadn't really noticed that. That your patients were necessarily getting fatter than they were a few years ago. And I would say I feel the same way. Like I actually, I mean, I definitely have [00:10:00] different categories of patients that I see. Those that are, that are, you know, obese in the sense that they have excessive fat.

They're not the majority of my patients. Definitely three quarters of my patients do not fall into the category of being obese. in such physical disarray that we're worried about their health. It's probably 25 percent or less.

Dr. Sam Rhee: Tafiro,

Dr. Sam Jejurikar: Plastic surgery is not a treatment for obesity.

Dr. Sam Rhee: Payette,

Dr. Sam Jejurikar: plastic surgery is not only better for your health, for all the reasons that Dr. Tom said. It actually gets you better results with your plastic surgery as well. Pretty much any plastic surgery, whether it's facial plastic surgery, whether it's body contouring, breast surgery, getting to a weight that you're going to be comfortable living at is going to get better results. But then the final thing was some of the methodologic problems with this study. Um, you know, BMI is a really crude indicator for what our overall [00:11:00] health is. And, you know, Sam, you treat a lot of really muscular patients probably who come to you from the CrossFit world. I mean, your BMI would technically in this study, and you are one of the most fit human beings I've ever met with, you know, with a large amount of muscle and very little fat would actually put you.

in the overweight or obese category because of the amount of muscle mass that you have. And I do think that there is a component of that with At least the population of patients that I'm seeing and that you're seeing that many of my patients weight train or engage in, you know, a lot of active muscle resistance exercises, take testosterone supplementation for building muscle mass.

Um, so I don't, I don't honestly believe like when I look at my patients that I treat now relative to the ones that I did 10 or 15 years ago, I feel like my patients are in better shape. That's why I found this paper to be so interesting and something that I wanted to talk about because I just haven't seen.

Obesity epidemic, at [00:12:00] least in my population of patients,

Dr. Sam Rhee: I think, I think part of that is because I think, especially when I first started my practice, I saw a fair number of obese patients who are looking for liposuction for weight reduction. But I feel like a lot of patients who are now obese and, uh, unhealthy, unhealthily obese, realize liposuction is no longer been, is, is no longer, option.

I think most lay people are starting to realize plastic surgery is not the way to fix weight issues. Um, for a while I saw, and I think a lot of patients will generally realize I need to manage my weight first. And prior to GLP 1, I saw obviously, and I'm sure you did too, a lot of patients who had gastric, you know, bariatric surgery, some sort of gastric bypass procedure where they lost a lot of weight through surgical means.

And I still see a lot of those patients too, [00:13:00] for body contouring, um, mostly because of the excess skin that they've developed after massive weight loss. So, I think some of it is self selection from our patient population. I think they do realize they're not supposed to come see us for weight management, or they don't feel like our, um, techniques will help.

The other thing is, is that we all work in fairly high, income areas. works in Toronto, you work in Dallas, and we have very affluent patients. So, I think a lot of obesity and weight and problems with weight can be correlated to some degree, not always, but some degree to income or demographics of some sort.

And so the people who, um, are probably suffering the most from weight issues are probably not the patients who are going to be able to afford or consider even aesthetic surgery [00:14:00] or other types of, um, expensive procedures to, to help themselves aesthetically. That's what I think.

Dr. Lawrence Tong: I think that, you know, when a, when a patient does come who is, uh, likely, you know, overweight to have, you know, too overweight to have surgery, there, there are a number of things that, uh, we have to, you know, explain to them. And so. Um, what are some of the things that you guys would, would explain as to a patient, you know, why they wouldn't be a good candidate, uh, for surgery?

Dr. Sam Jejurikar: you know, I think let's, let's imagine we're going to talk about body contouring surgery. That seems sort of like a logical extension based on the fact that we're talking about obesity. I think there's a few things. So one, if a patient, obese and not because they're muscular, but obese [00:15:00] because they genuinely have, uh, just too much fat within their body.

The thicker the tissue plane is between their muscle and their skin. Number one, the harder it is to mobilize it and get it as tight. Number two, the greater the distance, these tiny little blood vessels and their microcirculation that they need to heal their tissue, the greater distance it has to travel.

And that's the greater likelihood they're going to have a wound healing complications. Number three, the more intra abdominal deep fat or visceral fat they're going to have, and the worse the results will be. So, so I'll try to explain to patients, let's say I'm seeing a patient who is grossly overweight and their BMI is 35, which, you know, I don't have an absolute cutoff for surgery at 35, but I don't think my results are as good as they are for someone who's going to be 30 or 25.

And I'll explain to them, it would really behoove us to try to figure out ways for you to lose weight prior to surgery to get the desired results you're going to get. More often than not, people [00:16:00] are motivated to do that and between lifestyle modification and GLP 1s at this point, um, we can get some improvement, but every now and then patients will say, I just can't.

I've been on a GLP 1 or for whatever reason I can't. Is there anything you can do? And there are ways that we can modify the surgery to perform it. More safely, the results before and after results are still dramatically different. They're not as good as if they'd lost weight ahead of time.

Dr. Sam Rhee: I mean, I think some of it is, uh, talking about lifestyle as, uh, as Sam said, all the things he, uh, you said Sam about what makes surgery results not as good for obese patients, uh, holds true. Absolutely. They're all things that I say. Similarly. Um, I was just thinking, you know, do you guys still take call like in the ER?

Dr. Sam Jejurikar: No.

Dr. Sam Rhee: See, that's the thing, I don't, neither do I, and I do know my colleagues that are seeing [00:17:00] patients in the hospital are seeing a lot of patients who are extremely obese. I see a lot of, um, case reports, uh, during M& M conferences at my hospitals, which I still attend. and they're doing lower extremity reconstructions, they're doing trauma, they're doing other, uh, fairly complicated surgeries on patients, and it's very routine for them to have very high BMI patients which, which complicates the results of these fairly complex surgeries that they're often doing on patients with issues that are often related in great part to the chronic conditions they have due to obesity.

Um, I think we're operating in a very rarefied space where our, you know, our patient population is not subject to many of these issues. But I feel like if we actually sort of opened up where, you know, and, and we chose that, that's what we [00:18:00] wanted. We didn't, you know, um, that's what I chose at least. I did not want to take call.

I did not want to, to, I wanted more control over my life. I wanted to do more of what I wanted to specialize in. And so. I did not want to do venous stasis ulcers on a patient who smoked a pack a day and was over 250 pounds. Like that, that just wasn't, but there are a lot of plastic surgeons who do. And for those who do, I would say they probably have They're seeing a whole spectrum of issues based on, I think, you know, results which I think are legit and valid from what the Lancet's saying, that we are an obese population and we're just getting more obese.

Dr. Sam Jejurikar: Yeah. So then let's make this topic then a little bit more specific to what we, this podcast is about plastic surgery and aesthetic patients and our listeners who are all going to sort of be in the same rarefied areas. So, [00:19:00] imagine we're talking to a patient who is struggling with weight loss and they are in the overweight category, a BMI of 25 to 30.

We'll talk about this patient first. And they're interested in a tummy tuck and liposuction and they come into your guys office and they'll say, Dr. Tong, Dr. Rhee. I'm struggling to lose more weight. What can you do for me? Will surgery be beneficial to me? How will you respond to this patient? And, and

Dr. Sam Rhee: Well, for me, what I do is, I will say, you're a great candidate for the procedure, but not exactly at this time, right this very second. I will say, like, A lot, I do see a fair number of patients exactly as you described, Sam. And I will say, let's work with you and give you some time to get you to the weight that you want to get to first.

And I will ask them, are you happy at the weight that you're currently at? And I can say pretty much 99 percent of patients will say, no, I'm not happy at this weight that I'm at. And I would say, well, what, what is your [00:20:00] livable everyday manageable weight? Not your weight that you were when you were 21, you know, before you had, Three kids, but the weight that you think you could hold on to from this point forward.

And most of them will name a weight somewhere between 10 and 15 pounds. Maybe, maybe some aggressive patients, maybe 20. And I'll say, great. All right. Um, a lot of what they need is to take a good look at themselves in their lifestyle and figure out what is it that's sort of holding them back from reaching that weight.

And generally there are three main issues that patients I see have that I talk to them about. What's your stress level like? What is your nutrition like? What is your lifestyle like in terms of exercise? Um, and all of those things, they generally will take a hard look at themselves and the ones that are motivated, who really want to achieve the best results in terms of their aesthetic [00:21:00] surgery will start to make some moves on it.

I don't necessarily recommend one thing or another. I don't say CrossFit. I don't say Keto. I don't say Paleo. I don't say, I don't say any of that stuff. I just. Um, I will basically tell them whatever means you feel like works for you, whether you start small or big, you need to start making some, uh, measurable, improvements on and most patients it and and it's not perfect.

I know a lot of patients, um, may find that too difficult, maybe at their stage in their lives, or maybe they just have certain issues in their lives that are holding them back. But a lot of them, surprisingly, I will keep in touch with for a while. A month, two months, three months, and they will actually make big gains in terms of improving their life to the point where they can get, um, to be ideal candidates for surgery.

I will say the GLP agonists have helped for a lot of patients, [00:22:00] um, in conjunction with lifestyle changes, but it's not, um, Um, magic, and I know a lot of patients have had some side effects like intractable nausea and vomiting and other issues, but I feel like all of these things combined can really, there are more options for patients who are considering aesthetic surgery who are in, um, the obese or, or overweight category than, than there were previously, uh, available 10 years ago.

Dr. Lawrence Tong: I think that, I think that when, when I talk to patients in this situation, um, I can usually categorize a patient as someone who's wants this surgery because they sort of want a shortcut to look better and other patients who are truly motivated. And I think that if I go through that same sort of talk that Sam just went through, the patients who are motivated will [00:23:00] actually, you know, um, take something from what I've said, lose weight, come back, and actually have the surgery.

And then, you know, there's, there's a certain number of them who will, who will, Basically, leave and hear what I've said, but not really do anything, and then they'll never end up having the surgery. And I think that those patients might not have had, if they, if they did go through the surgery long term, probably would not have had a good result.

Anyways, you've all had patients where they were a little bit overweight, they went to lose weight, did liposuction on them. And then five years later, they came back and they gained everything back and more. So I think that, um, sometimes you can't help everybody. Um, you try your best, uh, but sometimes you're not gonna be able to, you know, not everybody's going to be able to have cosmetic surgery and have a great result.

It's hard to,

Dr. Sam Jejurikar: just to be clear, we're still talking about [00:24:00] patients whose BMI is 25 to 30? Or are you thinking about a higher number when you're

Dr. Lawrence Tong: uh, uh, yeah, I'm more thinking about a higher number. 25 to 30.

Dr. Sam Jejurikar: To me, it's fairly

Dr. Lawrence Tong: Yeah, exactly. That's,

Dr. Sam Jejurikar: of the patients that I see.

Dr. Lawrence Tong: that's not bad. So maybe I won't be having to talk for 25 to 30. Like 25 is very reasonable.

Dr. Sam Jejurikar: I just wanted to make sure if the, uh, if, if we had changed a little bit in our focus, yeah, I thought Sam's explanation was phenomenal. Yeah, I think that was really, really good. I think, um, again, you know, in that 25 to 30 range, I can't say 99 percent of my patients that they want to lose weight.

To me, it's probably 60 percent want to lose weight from that amount. Um, but, but I agree all the lifestyle modification issues you were talking about were, um, were really appropriate. And I think surgery is really motivating to people. To want to lose that weight too and to make the right changes, even though sometimes we'll offer GLP1 agonist.

People don't necessarily want to do that if they can, feel as though they can do it themselves and kind of get themselves [00:25:00] ready. Um, so then let's turn this around a little bit and make it a more, a more dramatic example. Let's say, now you're seeing a patient who comes to see you. His BMI is between 0. 35 to 40.

So now we're going past overweight and obese to the morbidly obese category. The patient comes to you and says, I'm, I'm really struggling to lose weight. I, I just want to have surgery at this point. I know there's going to be a higher risk. I know my results aren't going to be as good. Will you do my tummy tuck please, Dr.

Rhee? That's

Dr. Sam Rhee: Yeah, I've had those. That's a great example of, um, patients that have, uh, shown up for, I think, all of us. Uh, and over time, I've learned, one, many of those patients will say exactly what you said. I just want to get the results done, uh, the surgery done. And you think they have [00:26:00] realistic expectations, but many of them don't.

They really don't. They really feel like doing the surgery, as, as Larry said, is a quick fix to achieving something that they feel like they can't realistically achieve on their own. And, uh, More times than not, uh, in the past when I've operated on patients who were high BMI said, I'm willing to accept whatever the results are.

I realize they're not going to be as good. Um, we'll go through the whole procedure and be extremely disappointed because they did not achieve even close to what they thought they would want to achieve. And I'm disappointed because my results are not close to what I think they should be. Surgery should help people achieve and it makes no difference if you take someone's waist off four or five inches when they have a 45 inch waist, there's like, or 50 inch waist, there's, it's a drop in the bucket.

And so, um, [00:27:00] doing those types of procedures for those,

Dr. Sam Jejurikar: a, that's a 10 percent drop. That's a 10 percent drop based off of what you just said.

Dr. Sam Rhee: That's,

Dr. Lawrence Tong: It's still pretty.

Dr. Sam Rhee: that it would, it would seem like a lot, right? Until, until the patient's like, I'm still 90 percent the size that I was. So, um, so

Dr. Sam Jejurikar: Okay. Let me make this more complicated. Let's say, cause everything you said is completely accurate, a hundred percent accurate, everything. But let's say the patient, you, you, the patient comes back to see you two more times afterwards. And somehow you are now convinced that they have realistic expectations. Would you do it?

Dr. Sam Rhee: Boy, you're asking, you're asking someone to shut up and just take my money here, right? And I'm a

Dr. Sam Jejurikar: I'm asking, would you?

Dr. Lawrence Tong: All right. This is, this is my take on that. 30, anybody over 35 in my practice doesn't get an operation. Um, I think that's, I think that's [00:28:00] too high. This is cosmetic surgery. This is not somebody who has cancer and you're trying to cure them. This is a procedure to make a patient look better. And I think, if anything, the standard for, uh, the indication for surgery in cosmetic surgery, um, should not, should not be because a patient wants it.

I think that, uh, we are Uh, held to a higher standard when you're doing something that's elective. And so, I would feel that somebody who's 35 to 40 is at high risk of not just having a result that they don't like. I don't really, that's secondary to me. I would be concerned that they're going to have some complication.

That they're going to, you know, have a DVT or blood clot or some anesthetic problem or wound dehiscence or infection. All those things. are significantly higher in that patient population, so they wouldn't be getting an [00:29:00] operation until they lost the weight.

Dr. Sam Rhee: I mean, Larry's, Larry's right at this point. I, I do have a cutoff. Um, I'm a little stricter for most patients. I will go up to 35 for a few, depending on the situation. Like you said, it's, BMI is a very, very, very inaccurate measurement anyway, but I will say a lot of it is, um, What I'm willing to accept my results to be at this point.

Um, I am not someone who just started out in practice. I've been in practice for over 15 years at this point, and everyone that is my patient that is out there with some sort of result is representative of me. And if I don't feel comfortable with whatever that result is, even if the patient. says that they're going to accept that result.

If that's not something that I feel is representative of what I, what I can do or what I should do, as Larry said, it is cosmetic surgery and we do have a responsibility to be Um, [00:30:00] responsible surgeons, regardless as Larry said, what that patient may ask for or demand. Um, it is incumbent on me to provide the best results even if the patient may not realize it.

Dr. Sam Jejurikar: I liked challenging you guys on that one and I agree. Um, it's, you know, ultimately,

Dr. Lawrence Tong: your cutoff is 45 or something.

Dr. Sam Jejurikar: you know, I, I think that, um, I have definitely in the past done tummy tucks on patients whose BMI was between 35 and 40. I'll do a modified version of a tummy tuck. You guys familiar with the Tolua abdominoplasty out of Central America, where essentially it is, I guess the way I think about it as, as, as a modified paniculectomy.

Where you do no undermining of the upper skin flap, you aggressively liposuction everything, you do a neo umbilicoplasty and you just do a transverse [00:31:00] placation in the inframedilocular area, sort of a safer way to do it. And I, and I've gotten results that were okay. Um, you know, that's as, as, as good as I'm going to go with that.

I mean, they were, the patients. Usually we're happy and sometimes didn't have realistic expectations, just like Sam was alluding to earlier. Um, but I think what Sam said, which, um, I'm also not brand new in my practice. I too want to get results that are representative of, of me and I want to be safe and I don't want to do things that are on the edge.

And the fact is, is in the 21st century, in the year 2024, there are ways to lose weight. Even with shortcuts, you guys each use the word shortcut once in a negative, sort of derogatory way. I'll use shortcut in a positive way. In the sense that with GLP 1 agonists in the US, I don't know what it's like in Canada, with their, how readily available they are, it is possible to get your BMI down below 35 to get results that will be better [00:32:00] and you will have a safer operation.

Delaying it for a few months to get down to that place to get better results for surgery and have a safer operation is absolutely the right thing to do. But I don't mind taking shortcuts, even if they don't modify their lifestyle. I'll use GLP 1 agonist if it comes down to it.

Dr. Sam Rhee: I, I sometimes have some issues. I wrestle with the fact that we are working on their aesthetics for sure, but in, in many of these cases, we're not necessarily. helping or improving our patient's health. And that's why I really do like lifestyle modification because I feel like if I can get these patients to live a little bit healthier, in addition to doing what is aesthetically helpful to them, to me, I feel Like, I've done my job as a physician.

I've gotten them to a better place in terms of health and longevity, plus I've increased their self confidence. And so, I don't mind, quote, shortcuts, but I [00:33:00] also really want to make sure it's not necessarily compromising their health or they haven't I want them to learn something a little bit, uh, I'm, you know, about the process of becoming healthier during this whole pandemic.

process in terms of body contouring. I see my patients a lot during this this time and I feel like it's an opportunity for me to help them, um, realize themselves a little bit better and get a little healthier hopefully.

Dr. Lawrence Tong: I think that actually, um, you know, I, I think Sam, you're, you're sort of advocating sort of a more natural way, uh, to lose weight as opposed to using the drugs. But I think that, uh, the, the GLP 1 agonists are going to make a very, very substantial difference in the health of obese people in the long term.

Right now it's still early, so we don't know if there's any sort of long term side effects, but [00:34:00] you know, the studies have shown that diet and exercise is for the most part, not for the most part, for many, many people is very limited and it's not always just willpower, so to speak. A lot of it is, you know, physiologic.

And, uh, I, I think that the GLP 1 agonists are going to make a, you know, a big difference. That's part of the reason why they're so popular in the plastic surgery community. Um, sometimes it's, it's, um, you see people who actually Not that heavy and they're taking them and I think that's where they've maybe gotten a, um, an image that, that there's sort of a shortcut, you know, people who are actually not that, not that heavy taking them.

But I think used in the right manner, they're going to make, they're going to make a big difference and there'll be, there'll be [00:35:00] a, um, very significant in, uh, you know, trying to solve the epidemic of obesity.

Dr. Sam Rhee: you seeing an increase in your practice of patients who are coming to you who are already on GLP agonist, um, to begin with and what kind of a percentage increase are you seeing with that?

Dr. Sam Jejurikar: Well, I mean it was zero a few years ago because they didn't exist, but I'd say that of the total percentage of patients that I'm seeing that are on GLP 1 agonist, 35 40 percent of patients who are coming for body contouring surgery. Um, no, there's, the shortages are kind of over at this point. You know, there's Eli Lilly has come out and said there are no shortages of any, of any doses at this point.

So it's readily available for people to get both these compounded versions and the real medication as well. And so, yeah, I see many patients that are, that are on the medication and, you know, particularly for patients that have insulin resistance and, you know, are pre diabetic or diabetic and all that, just like Larry was saying, there's some health benefits to it.

I mean, I think you're [00:36:00] ultimately, I think you both have the best interest of your patients at heart. You want them to be healthy, not just getting cosmetic surgery. But there's a role, I think, just like Larry was saying, for GLP 1 agonists. In overall health and we are not primary care doctors. Nothing that we do as the aesthetic surgeons delivers any health benefit to our patients with the exception of breast reduction surgery, you know, which has been shown to have some benefit.

But so, you know, ultimately I think, um, you know, Sam, you're, you're, um, you're a purist, maybe Larry and I are willing to take a few more shortcuts. Um, but, but I think we all generally have the same philosophy. Um,

Dr. Lawrence Tong: In my practice it's about 10%, but the reason we see this is because we had to put that in our intake form, you know, are you taking ozempic and similar drugs, because there are implications with anesthesia. So, um, yeah. When we put that on, I started [00:37:00] noticing, you know, maybe about 10 percent of patients are on it.

Dr. Sam Jejurikar: well, I think this has been a great discussion guys. Um, you know, it's always interesting to see where a conversation about something unrelated to plastic surgery, how it ties into plastic surgery. So thanks for the stimulating conversation as always. And until we meet again.