BBLs, Facelifts, and Fillers with Dr. Rady Rahban

One of the key elements is to not find a surgeon who necessarily will do well, but find a surgeon who you feel comfortable if things don't go well.

BBLs, they seem like they're the big risky one.

BBL is Brazilian butt lift. We're gonna take all the fat that we took outta your body and put it back in your butt. I need as much fat as I can get. So the liposuction done to do BBLs is the most aggressive liposuction you can have. That's why they're so deadly.

Which procedure do people regret most often and why?

Liposuction. I can do it under local, any asshole can do it, and every human being is a candidate. Liposuction is way overdone and overused and too aggressive. That's the number one thing people regret.

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To try Qualia Vitamin C+, go to qualialife.com/virginwellness and use the code VIRGINWELLNESS at checkout for an extra 15% off. That's Qualia Vitamin C+ at qualialife.com/virginwellness with code VIRGINWELLNESS to start getting vitamin C right. Hey, I'm JJ Virgin, PhD dropout, out, sorry mom, turned 4-time New York Times bestselling author. As a certified nutrition specialist, Fitness Hall of Famer, and globally recognized leader in health, I'm driven to keep asking the tough questions and use my podcast to simplify the science of health into actionable strategies that help you thrive. I'd also love to hear your thoughts on the show. And here's the fun part. When you send me your review, I'll reply to you using my on-demand virtual me. That's right. My team and I created a virtual JJ packed with my books, speeches, and wisdom so I can personally connect with you. Here's how you do it. Subscribe and leave an honest review of the podcast. Take a screenshot of your review. Text it to 813-565-2627. That's 813-565-2627. 6, 2, 7. My virtual JJ will reply directly. And trust me, this will make your day. So subscribe now at SubscribeToJJ.com and text me your review. Let's keep thriving together. Why are some surgeries exploding in popularity while others quietly destroy lives? Why do some people look amazing after procedures while others look strange, swollen, and are frankly regretful. And what actually works? What's dangerous? And what does nobody tell you about before you sign up? If you've been following me, you know I had a facelift last year. We'll be talking about that and some of the things that have come up from it because we're in a place in a time when plastic surgery has never been more normalized, but also— more misunderstood. From Ozempic face to mommy makeovers, facelifts at younger ages. Hello, 20s. Breast implant fears and the deadly rise of BBLs. Yes, we're talking about those too. Women are being sold a lot of promises with very little truth. Today, Dr. Radi Robin is back and is here to pull back the curtain on what's hype, what's risk, and what actually works. And what every woman needs to know before making a decision. And I'm gonna put all of his information, including his awesome podcast, Plastic Surgery Uncensored, his social media handles. You can get that all at jjvirgin.com/dr, R-A-D-Y for Dr. Radi. I'll be right back with Dr. Radi. Stay with me. And we're back.

I'm so excited.

For part 2. Well, if you're gonna come all the way out to Tampa from Beverly Hills, I'm going to get everything outta you. I love it. That's all I have to say, Dr. Radi. So we are gonna dive in. What I'm calling this is the truth about plastic surgery nobody says out loud. So we're gonna have fun here, right, Stu? Yep, yep.

This is right up my alley.

All right, so overall, is plastic surgery safer today or is it just better marketing? And I know how much you love marketing.

Yeah, exactly. I was like, makes me nauseous. No, it is 1,000 times safer today than it's ever been. Anesthesia is 1,000 times better. The machines, the medications, our monitors. I've always been, but some, we're better at selecting patients. We're a little more critical, like, "Oh, you have a murmur. Oh, you have an arrhythmia. Go get it checked out." So that's better. And then the techniques have been refined, just like anything else.

And I would assume that most of the bad outcomes, I might be totally wrong here, so, would be from non-board-certified plastics, or is it?

So the answer is no. There are plenty of board-certified plastic surgeons that are, terrible and should have their license taken away. And there are some non-board-certified, non-plastic surgeons that are reasonably decent. But when you look at things, you look at things for trends and probability. And the probability is that if something goes really sideways, it's often— more often, usually— someone who's poorly trained and unscrupulous, which is parallel universe of plastic surgeons who are non-board-certified. But unfortunately, you know, just like there's bad pilots and bad cops and bad priests, they're going to be bad plastic surgeons, even though they're sort of board certified.

That's why you must do your homework.

Yes.

So BBLs.

Yes.

What are they? And they seem like they're the big risky one.

Yeah.

Are they?

So BBL is Brazilian butt lift. Which, as the name denotes, originated predominantly out of Brazil because of their aesthetic preferences, which is fuller, rounder, bigger butts. And essentially the idea is a Brazilian butt lift means that we are adding volume, fat, to your butt, which, as it fills it, makes it lifted, right? So as we put volume in your butt, it— because it swells up, it gets bigger, it quote unquote lifts it. Okay, got it. So the basic principle is we're going to liposuction your body, and it's usually everywhere. Well, that's what they refer to as lipo 360. I hate all these terms, but we'll use them because that's what you're going to hear. We're going to take all the fat that we took out of your body, put it in canisters, prep it, wash it, clean it, put it in syringes, and put it back in your butt. Okay, sounds pretty good.

But—

But— so number one is, what could possibly be wrong with taking fat from all over my body? This is like the best surgery I've ever heard in my life. It's a win-win. Negative. In order for you to make any type of appreciable change in your butt, meaning I spent a shit ton of money, I went under anesthesia, yada yada yada, I look at my butt, wow, that's better. You need a lot of volume because a butt, even if you're a tiny person, is a big-ass space. When I want to fill your lips, I need 5 CCs at the most. When I want to fill your butt, I need hundreds of CCs. Even if you're like, no, no, no, I don't want to be Kim Kardashian. No, no, no, I'm not talking Just a tiny change requires a lot of volume. Just like if I throw a penny into an ocean, it disappears. So number one, you need a lot of fat. Okay, I'm following. What's the problem? I got a ton of fat. No, you don't. And so what they do is, whereas if you came in and said, hey, Dr. Iman, could you lipo my arms and my belly and my back? First of all, I almost never do lipo, which is unheard of because 99% of lipo leaves you loose skin, irregular dents, divots, looks like shit.

I've seen the worst from lipo.

No, you look, looks like shit. So I do it incredibly rarely. Incredibly sparingly. But if you came in to me and you said, hey, Dr. Urban, I think I have a little bit of stubborn fat here, I work out a lot. JJ, I would be lipoing you with your love handle in mind, meaning I am looking at your love handle and going, that looks good, we're done. But when I'm lipoing you for fat for your butt, I don't give a shit what the donor sites look like.

Oh.

I need as much fat as I can get. So the liposuction done, To do BBLs is the most aggressive liposuction you can have, meaning every area we lipo— we, them— they go to the— to 10. They lipo your arms, they take every amount of fat out, your upper back, your lower back, your abdomen, your inner thighs. Okay. And initially everyone's like, wow, this looks great. And then of course, 2 years later, now is the fallout. Loose skin, a bunch of dents, irregularities, etc. So we've now stolen from Paul. Who's poor, and we gave it to Peter. Now, what's the butt with the butt part? Okay, we inject the fat in there, and if you inject a little bit of fat, you're fine because you're injecting a small amount of fat and the butt can handle it. But where all the deaths occurred— because BBLs are the most deadliest procedure we've ever had in plastic surgery— is they were putting in hundreds, 800, 900 cc's of fat into each buttock.

And what was that in pounds?

I don't know what it is in pounds, but in volume, it's like an entire canister in each butt. So an 800cc implant is the size of, let's say, cantaloupe. Wow. It's a lot of volume. Remember, these people have already their own butts, and usually the people going for the biggest butts already have a big butt.

Right. I've seen some of these and they look—

Well, you're in Florida, so. So it's funny. Small butts, women who are fit want small butts. Large butts, people who already have a lot want a lot. At any rate, when they were putting a lot in, they were putting it in, they ran outta space. So they started penetrating into the muscle. And then that's when you got what's called a fat emboli. Most people know about a pulmonary embolus, blood clot shoots outta your leg, goes through your heart and straight into your lung, kills an area in your lungs, you drop dead. Okay. Well, now instead of blood traveling and doing that, fat is traveling. And then they did autopsies on these people. They found a bunch of fat in their lungs and their heart.

Wow.

So BBLs, that's why they're so deadly, because the deaths that were associated with the emboli and also all the damage from removing the fat. But they're still popular.

Are they popular?

They're popular in a subset of the world, meaning there are individuals in whom that is their aesthetic.

And Kim Kardashian, is that butt real?

No, of course it's not real because you don't— you don't need to be a— you don't need to be a rocket scientist. You just follow her. You follow her photos. She's been in the— she's been in the press since she was 20 or 19 with Paris Hilton. So her butt grows. I'm sure it's a combination of things. You can add fat, which I'm sure she had a BBL done. You can then add— back in the day it was called Sculptra. Sculptra was this sort of in-between filler. It wasn't the HA like Juvederm, but it was something in between. And it was very expensive. But if you had money, you could use it and then you could always add a small implant. So those things are all the combination of things, which then takes me to— ta-da! The newest, greatest thing, which I actually think might be another one of these revolutionary things. Have you heard of Alloclay?

No.

Okay, this is perfect.

Is this for butts?

This is for wherever. So listen. Wow. Unfortunately, the leaner, fitter, older you get, the more fat you lose.

Correct?

Yeah. And in your—

I mean, I couldn't, I couldn't do lipo to put it in anything because I got nothing for them to get. We tried to even get it for stem cells.

Correct.

Bruise.

Correct. So the areas on your body in which you don't want fat, you're loving it. Ripped delts, ripped biceps, flat abdomen. Awesome. Breasts need fat. Faces need fat, butts need fat. Not everyone's butt, but a lot of people even don't have the anatomy that even if they do 4,000 donkey kicks or whatever, they're not gonna develop the glute mass. So for the thin patients, which is a tremendous part of my practice, 'cause I live in LA and I have a lot of fit moms that are yoga, Pilates, da da da da, they had no, I don't do BBLs, but they have no recourse. Well, here comes a new product. So there is now something called Allaclay. It's cadaver fat. It's a donor. When you need a heart transplant, where do you get it from? A donor. And a lung transplant? A donor. Well, now that donor also, they take the abdominal wall. And this company, Tiger, has a proprietary method which works where they remove all the cellular DNA.

Mm-hmm.

All these patients have been screened for every genetic and bacteria and whatever disease. And then they create syringes full of this fat scaffolding, and it comes pre-filled, pre-ready to go. And I now, and I've done many of these cases, I'm able to very eloquently add volume in an otherwise fit, lean person from a syringe that I order. It's been a game changer in that I have such a fit, lean world, and before you couldn't take fat from anywhere.

Well, okay, wow.

See, I knew that would blow your mind. Look at that, you're like, your wheels are turning.

I remember early on when people were doing fat to face and you had to overfill it a bit because some of it would die. Is this the same situation?

Right, correct. So once you take fat out of the body, yours, from a cadaver, from wherever, it's dead. The fat that just came out of you 35 seconds ago is now dead. It's disconnected from you. And then you put it back. And the whole principle behind fat transfer is once it goes in your body, it needs to be put into soil. Just like a seed comes alive because of imbibition. The stuff kind of seeps into it until it gets roots. So fat goes into your butt or your face or your breast, and then the surrounding fat starts to kind of like touch it and hold it and then give it blood supply. The reason people ran in trouble is that a certain percentage of the fat dies, and that fat dies because number one, it's sitting next to dead fat. So you can't just go overfilling it because most of the fat's sitting next to a neighbor who's dead. Your dead neighbor's not helping you.

Like zombies.

Yeah, two, your body starts to absorb it. Like your metabolic rate is higher than say somebody else's metabolic rate. So it is true that in general, anytime you transfer a fat, whether it's yours or this cadaver version, a percentage of it will go away.

And do we know how much?

Right now, it's been around for a few years in data. It's been around market-wise probably a year. The philosophy is about the same amount, a little, you know, let's say 50 to 75% of it remains. Like any product, there's a learning curve. It's a new product. Whatever it was, Botox was a new product. Juvederm was a new product. I don't overdo anything ever. I never overcorrect anything because I'd much rather you come back and say, oh my God, I'm so happy with that. I wish it was a little more than— what do I do with this now? How do I get it out? That's the case with breast implants, everything for that matter. I just thought it's a very interesting thing because as a fit, lean person, you're not— you're not immune to wanting some volume. And this is the new world revolution, you know, amazing, holy shit kind of a thing.

Will this last longer than the fillers for your face?

So they have now in the process of formulating a facial version of it. So it's called Alaclay. And Alaclay, when you look at it, you can go on my Instagram or whatever, I have many posts on it. It's kind of fibrous and it's a little thick. So it's great for breasts and it's great for butts. But not face. But not for face yet. So they're coming out with soon in the next 6 months where they're gonna process it smoother because anything that goes in your face should be like called nano fat. It should be like paste. Back in the day, 15, 20 years ago, it was too clumpy. They didn't know that the size of the fat globule should be smaller. That's why people were getting all the lumps and bumps under their eyes. Today, that should never happen. So yes, eventually they'll get it soft enough to put in the face.

But here's something for someone who, let's say, is getting a— hasn't— having a mastectomy, had breast implant illness, and now they have an option.

Sure. Its indications are the same as fat transfer. The only problem with putting it in the breasts or places where there isn't a lot of fat is you have to do it incrementally. You can't, you know, the biggest mistake most plastic surgeons make and patients is they just wanna be done with things. So we want all your money at once and you wanna do the surgery at once. Well, this particular thing is a layered process.

Mm-hmm.

You put a little bit, it survives. You put a little more, it survives because you're putting it in an area that doesn't have a lot. The butt has a lot of fat in it. The breast that you've explanted or mastectomized doesn't have a lot of fat. Needless to say, I thought you'd like that. And it segued nicely to your BBL.

It does. And well, if someone's layering it though, it's not like a big surgery, it sounds like.

No, no. You can even do it under local.

That's amazing.

Yeah, it's pretty, it's pretty cool.

What about a Zempik face? Is it a real thing?

Sure.

But I mean, is it a Zempik face or is it aging or is it just losing weight? I mean, what is it?

So Zempik face is 90% of it is I just lost a ton of weight. I don't care if you lose it from, I became a gym rat, I became a vegan, I got a gastric sleeve. I don't care how you lose the weight. Ozempic happens to be one of them. Once you waste away and you've lost 100 pounds, you are going to lose fat.

Fat.

And you're going to lose it in your face. The reason why it's so shocking is you lose it in such a speed that the photos are juxtaposing. So it's not that, oh, what if I lost it gradually? You'd still lose 100 pounds. When you get to 100 pounds less, your face is 100 pounds less full. So the difference is you got these celebrities and they're, you know, I don't know, 6 months earlier they were on concert or tour or wherever and you're like, oh, okay, whatever. Look at Adele. And then all of a sudden, 6 months later, you look at, you know, the Osbournes and you're like, oh my God. And then the last part is they don't know when to shut it off. They pass point.

Yeah.

You know, you're like, how could too much gold be bad? How can you have too much money? So how can you be too thin? And you are too thin. There is a component which I think we'll find out. There's some muscle wasting component, muscle atrophy. There's some concepts of bone atrophy. I don't know. It's early. The science isn't there. In other words, is there— in addition to I lost 100 pounds, did I lose some muscle mass and did I lose some bone? Aside from the fact that I'm just doing nothing.

I think so. There was an interesting study just came out. It was a mouse study, but it was looking at the muscle the muscle loss and what they looked at, what they found was a lot of what they're seeing is muscle loss, 'cause they're looking at fat-free mass instead of skeletal muscle, because they're just predicting skeletal muscle from fat-free mass and making these, you know, accusations on Ozempic, but it's actually was a shrinkage of the liver by 20%, because they're losing so much liver fat and it's looking at like it's fat-free mass, but it's not. A lot of these things aren't impacting bone and they're really minimally impacting muscle. It's probably just—

Yeah, I think the drugs are amazing and I'll tell you why. I think that like anything, we're still trying to get our hand around how to use it. It's the same as filler. Xempic is filler in that it's an amazing new advancement of health. And in 90% of people, it's awesome. In 10% of people, it's being used incorrectly, just like filler was. And now filler got a bad rap and we love to jump on things and undo things.

Did filler get a bad rap?

Well, filler right now, when you tell a patient filler, there's sort of this notion that pillow face and all this. Yeah, it does have a bad rap. I can tell you that overwhelmingly, if you speak to any one of your injectors, like these nurses that are out there who make a living off of this, I don't make a living off of this. They're telling you they're down by 70, 80%.

Really?

Yeah, because people have, you know, they just follow the trends and they're not paying attention that the filler isn't the problem. You're just getting overfilled. So if a patient comes to me and she's like a 36-year-old girl who's beautiful and everything's great, she's super lean, works out, She's a little hollow in the midface. She doesn't need a facelift. You just need, like, a little bit of filler in your face. You look stunning. That's the indication. And that's always been the indication. It just wasn't for the 49-year-old who needed a facelift, and you just kept filling her. And now she looks like— I refer to it as koi fish, like the sides get so big. So I think that Ozempic or all the GLPs are phenomenal because overall we have a massive epidemic of obesity and morbid obesity.

So, you know, I've been in the weight loss industry for 40 years. And there's this chart that we would always use when we were at clinical conferences, and it was showing how the states were going from, you know, they would go blue to red, and it was not Democrat, Republican. It was like, you know, fit. It was like, how obese are you getting?

Sure.

To morbidly obese. And it's like, they started out light blue, and now they're all like, it's all red. Even Colorado is falling. So you're like, oh my gosh, 70% now overweight or obese, 40% obese. And we're, it reminds me of out in the, the fitness world, everyone's concerned about overtraining and cortisol. I go, you know what? 30% of the people are actually even meeting the guidelines for what the CDC says to do, which are too low. And you're worried about the 1% that might be out there overtraining and their stress response. Like, I'm not.

And the thing about it is that is the case with everything. Things that are good are good predominantly, well over 90%. And things that are good, everything, everything you can mention to me, anything you bring up, I can find 10% that I could kind of be like, well, but. And the reality is that you can't punish the 90% for the 10%. You just have to learn to manage that 10%. And the same is true of everything that comes out. And all of a sudden now people like to jump on the anti-Ozempic phase.

I've been pro-GLP-1 since they came out.

Amazing.

And I just think they're dosed wrong. I think they're one of the most amazing things. I think they're a longevity drug. So what separates a natural facelift from someone who looks, like they got some work done.

It's not a switch, it's a slide, it's a, it's a dial. So when I'm doing a facelift, I literally open up the face, I go in, whether you do something to the SMAS— I'm not going to worry about the details right now. The bottom line is at some juncture I'm lifting and pulling, right? Anyone who says otherwise, because they don't like to use the word pull, because pull has been associated with bad, so now we, we re-elevate, we suspend, we release— they love all these Fucking words. It makes me crazy because it's just garbage. The reality is at some point we're pulling on things because we're re-lifting things.

Yeah.

Right. How much do I pull?

Do I pull a little?

Do I pull a little more? How about now? How about now? And the answer is that's the nuance of a good versus great versus bad surgeon. So every face anatomy structure, laxity requires a pull. So if a patient is younger, less laxity, less falling, you pull a little less. If a patient has fallen more, you pull a little bit more. So to answer your question, what makes for a natural facelift is one in which the surgeon figured out what was the right amount of re-elevation or pulling. And I use the word pull loosely to make that face look good. So turn the dial up. It's easy. Every surgery we do, we can turn up the dial. So, okay, I do your facelift, and instead of pulling a centimeter and a half, I pull 2.5 centimeters. Now I'm standing in front of you. Your nasolabial folds are fully pulled out. The corner of your mouth looks a little tugged, and your chin looks a little pointy. And when you turn, you have a— it's a little bit stiff. And the sides of your mouth get flattened, right? The sort of telltale signs. So every surgery— I do a ton of noses— as you turn, as you scoop down the hump, wow, that looks good. That's not looking good. That looks terrible. Oh my God. As I turn up the lift, the nose, oh, that's cute. Oh, that, that's a pig. As I remove skin from your eyelids, as I pull up your eyebrows, as I enhance your breasts. So, for example, breast aug, what makes it natural? What makes it natural is you're 5'2". 112 pounds and you're an A cup and you should be a full B and that looks natural. What if I want to be a small D? Then you will not look natural. The end.

So when you're doing these, having just done this and she did it all under local, are they pulling and testing? Like, how do you do it?

So what you do is you make an incision. 99% of surgeries are the same. So we make an incision normally in front of the ear, but within the ear. And behind the ear. Whether it extends into the hair and whether it extends into the hairline depends on the laxity that you have. But the gist of it, the approach, the entry point is right in the line of the ear and behind it. Then we open up the skin and we march forward, and then we get to the muscle layer. And what we do with the muscle layer, which they refer to as SMAS, S-M-A-S, or whatever, is each surgeon's preference, training, call. Mm-hmm. But something should be done to that layer because the old school facelifts was just pulling on the skin. And the reason why that doesn't work is you're pulling on the item that is most likely to relax, to be overpulled, etc. Skin doesn't hold well. It's not a strong tissue and it's really not the thing that's moved. If you look at my face, which at 52, I'm, I'm starting to have this sort of looseness here. Well, it turns out by anatomy, that's the whole muscle, the whole tissue as a unit. It has moved as a composite. They get up to the muscle. I like to do a deep plane, doesn't matter, which means I like to open that muscle and then go underneath it. The guy, I think, in New York that did Kris Jenner's did what's called a SMASectomy and would remove some, but something has to happen to that layer. So let's just, for the sake of argument, do the technique that I do. I go under that muscle. I release all the things that are holding it. We have ligaments and they anchor to the bone. They— and that's why when you see people who age, they, they age, they avalanche, but they're tethered in places, right? It doesn't just all slide down. There's like an anchor point in certain areas. Those are the sort of the pillars. Those don't move, but everything else just slides right past it. And when you do a reversal of that, you gotta go in, find those pillars, release them. Don't damage the nerves so that you can smile. That's the whole point. And then this now composite, which means skin, fat, and this sort of SMAS layer are one piece of paper. The muscles are below and the nerves are below. We don't wanna talk about those. We don't wanna see them. And then I can literally pull. And when I pull, I'm looking at your mouth, I'm looking at the corner of your nose, and I'm looking at the corner of your jaw, and I'm down in your neck. I'm looking at the turkey neck. And when I pull this sheet of paper exactly like a bed sheet, and I look forward, I can see what's happening. And if I pull a little, I correct it mildly. And if I pull a lot, whoa, that doesn't look good. And then I or him or her needs to decide what's the right amount of salt to put in this recipe.

Now, I know we talked about this last time, but I just want to drive this point home and talk a little bit more about it. It sounds like it is better to do small amounts over time, like to have that facelift and then maybe 10 years later have a— have an update on it.

So what works for you and your budget is you and your budget. Like, I can't afford it now. I don't want it. It's too severe for me. I'm not ready. I feel like— what? Fine. When you're 59 and you look in the mirror and one day you're like, oh, I can't take this anymore. Fine. But from an aesthetic standpoint, which is I'd like to look my very best for as many years as I can within reason, then yes, because somewhere in your mid-40s to 50s, somewhere between 45 and 53, 99% of people, even the one who's like a unicorn, has changed. And if you go and you are, you, you were a 10 and now you're a 7, we can make you into a 9 again. And it's just 2, it's like a notch, notch, notch. Oh my God. No one will know cuz you went from 7 to 9. You look so well rested. Then you go live your life again. It took you 45 years to go from 10 to 7. Mm-hmm. Remember that 45 years to go from 10 to 7. I put you back to 9. So in 15 years, you're gonna go back to a 7. Why it took 45 years the first time and only 15? Because you're now a 45-year-old tissue.

Mm-hmm.

So it's accelerating, but you're not gonna go— in 15 years, you go back to a 7, and then we notch it to 2 again, and we go back to 9. So yes, if you wanna look your very best so that when you're 65 and you look natural and good, yes, Yes, that is ideally the way to do it.

Years ago, when I was living in Palm Springs, I was on the Dr. Phil show every week doing his weight loss challenges, and we had the 100+ pound weight losses.

Sure.

That's where my buddy, Dr. Larry Copeland, came in and did some—

Body contouring.

Body contouring, because we literally had 2 people that lost 100 pounds, and you can imagine what that looked like. What do you do there for someone? Because that is a thing, and it's becoming more of a thing now GLP-1s?

Yeah, probably the single greatest spike in my practice, second to facelifts, is body contouring, right? So what that means basically is I've lost 100 or more pounds, what do I do? Well, first of all, it doesn't matter who you are, doesn't matter what age you are, doesn't matter what ethnicity you are, and it doesn't matter how you lost it. Once you lose 100 pounds or more, you will have loose skin everywhere. So what I like to do with those patients— I recently did a gal, she's a lawyer, she's 30 She was 400 pounds. She's now 185. It's 200-some-odd pounds. So first thing I like to do, 'cause I'm very much about planning, I have an economic plan for my family. I do financial managing and budgeting. So they come in and I wanna make sure they're not overwhelmed because the reality is unlike you who went in and said, listen, it's time for me to do my face. It was like brow and eyelid and face. But when— or I'm here to do my breast. But when you go in after losing 100, 150, 200 pounds, it's your whole body and it's very overwhelming. And a lot of them are bummed out because they kind of weren't ready because they thought, listen, the Holy Grail, I lost 200 pounds, I can't believe I did it. And you just assumed that you would get over the rainbow and it would just be like, it would be heaven. And then you're there and you're like, wow, this is even worse. Why is this even worse? Because now Everyone looks at me with clothes on, they think I look amazing, but internally I have this secret. And it's a very interesting phenomenon.

Yeah.

Furthermore, they look at themselves in the mirror and they're still fat. They look in the mirror and they see all this loose skin. And I have had hundreds and hundreds of patients tell me, "I still need to lose another 100 pounds." I'm like, "No, you don't. As a matter of fact, you're too hollow right now. Look at all this, this is all skin." So first thing we like to do is I like to, what I call it, the wishlist. Tell me the things that bother you in terms of priority. The first thing that you would do if you could only afford it. Tell me the second thing you would do. Tell me the third thing you would do. So there are 6 areas that everyone changes. One, the neck and face. If you are 35 and younger, you'll be okay. It won't, it won't be perfect, but you'll, you'll be fine. If you're 35 and older, you, you'll have some loose skin in your neck. The second is the breasts. Man-an or woman, it doesn't matter. Women have breasts that become saggy and lose volume. Men have gynecomastia. The next is the arms. They refer to them as their bat wings, but they have loose arms that then start to, aside from looking bad, physically restrain you from doing things. Next is your upper trunk, which is all the loose skin in your upper back, around your bra, that whole area. Next is your lower trunk, which is the main event, which is all the loose skin on your abdomen and love handles and your buttock and thighs. And last is your inner thighs. That affects everybody. What we then do is we create a plan. We look at them, we prioritize what bothers them, we look at their financials because this is a very expensive endeavor, and then we plan. So one of two things will happen. You'll either— Mm-hmm. Do a single event, single surgery, and you'll go away because it's—

You can do that all in one surgery?

Negative. I'll tell you my plan, my thing. So either you'll do your single surgery and fix the items that you can afford and then you'll disappear, or you fix your whole body gradually. So 99.99% of surgeons who do body contouring do so with a team. How do they in Formula One change 4 tires in under 3 seconds. There's 12 people who change your tires. So 99.9% of surgeons bring in a team, and that team involves people you've never met, you never consulted, you don't know who they are. They could be other doctors, they could be techs, they can be nurse PAs, or they can be, um, nurse practitioners. What that means is I have decided to go see Dr. Smith, and I'm gonna do my arms, my thighs, and my breasts. He says he's gonna be done in 7 hours. Sutures. Okay? So you go to sleep, and while you're asleep— this is not make-believe, this is reality— someone's operating, sewing on your right, closing your right arm. Someone's closing your left arm.

Oh no, two different people doing—

Of course. You think Dr. Smith's gonna do arms, thighs, legs in one by himself? That's not gonna happen. 99.999% of body contouring is done with multiple people. Not your facelift, not your rhinoplasty, not your breast aug, but this is hundreds and hundreds and hundreds of sutures. So I am unusual. For 21 years, thousands of patients, I've sewn every single patient closed myself. Not a single stitch has been placed by a tech, a physician assistant. And in plastic surgery, that's actually unheard of because when you do arm lifts, thigh lifts, breast lifts, I'm talking miles and miles of sutures, 3 layers, everything.

So these are sutures that are going to show too. Oh, for sure. I mean, these are the most important.

But patients don't know. It. And what happens is you come in and you're unhappy, and you obviously want as much done as possible. You don't want to keep doing this shit. They want to book as much as they can. They're not going to delay things when you're there saying, hey, can I have these two purses? No, why don't you buy one purse and just see if you like it and come? Are you kidding me? Yes, you can have these two purses. So patients want it done, doctors want it done, they go and do it. No one tells you otherwise because it's not illegal. So I do it. In phases because I'm the rate limiter. So I do phase 1, phase 2, and phase 3. If the patient wants it all done by me, that's the only way I can. I can only do 8 to 10 hours of operating. So what we do is we divide it. So most patients who have lost a ton of weight, who've planned about it, take about a year and we do 3 phases. And in each phase we do about 8 to 10 hours of close, like skin removal, and we'll remove 10 to 20 pounds. Wow. 10 to 20 pounds.

Biggest red flags when choosing a surgeon.

So I have 6. One is you go into the office and you don't see the surgeon, you see the consultant. Who is the consultant? Oh, whoever. Someone comes in, "Hi, nice to meet you. So tell me what brings you in here?" And you do all this, "Where's the doctor?" So a lot of surgeons to expedite the process have you meet with some type of consult. Two, when there's some type of pressure that, "Listen, if you book your surgery today," 'Blah, blah, blah, blah, blah,' or, 'We only have one spot left.' No one who's reputable should pressure you into doing surgery. Next, when you talk to them about their team, they don't have specifics. So, '21 years I've been in practice. 18 of them I have the same anesthesiologist. I've operated on my mom, my wife, my sister, my mother-in-law, my aunt, and my 4 nieces, and these are the 2 that took care of them.' To me, that's a winning team. And when you work with the same people, you end up having a better outcome. So you should want to know who their team is. Most times, you just— whoever's the doc du jour will be there. So you want to know the team. I think that when you specifically— you should ask about follow-ups. Okay, I paid you a lot of money. You did the surgery. Awesome. Who do I see and when do I see them and how many times? And my wife had 6 spine surgeries in total. She saw 3 different spine surgeons, 0 times. It was their PA, and she saw them at 3 months. Every patient I've operated on in 21 years, I've seen at 1 week, at 2 weeks, at 6 weeks, and 1 year. Not my MA, not my nurse, me. So you want to make sure that you and the person who operated on you are seeing each other, not when there's a complication, because normally it's like, we don't need to see you until there's an issue. No, no, that person doesn't know there's an issue.

Right.

You operated on me, you took my money. You should see me. And then I am a big, big stickler about this. You should ask them who is going to close me. You wouldn't think like, what do you mean who's gonna close me? What do you mean? I came and saw this guy in New York, he's the shit. I mean, his price is 4 times more than everybody else. But did you ask him? I didn't. Why would I have to? Did you ask him? Not who's in the room, not who's helping you, not who's your assistant, not who's your— who other than you places sutures? Very famous facial plastics guys do facelifts, and because they do 2 in a day, which is a lot, they leave the room and let the junior, the fellow, the tech, the whoever close the facelift after they've done a few key sutures.

Oh boy.

Wow. So those are red flags to me. And a dirty office is a dirty surgeon.

Well, dirty office? Come on.

Well, dirty meaning like disorganized, discombobulated. You know what I mean? Like you want to give them grace, like they're having a bad day. No, no, I don't have that grace. It's a bad sign.

Yeah. No, that's— yeah. Okay. Which procedure do people regret most often and why?

Liposuction, liposuction, liposuction, liposuction.

I didn't realize liposuction's still being done.

Oh, it's the number one procedure done in the US. Number one procedure in the US. Why? I can do it under local. Any asshole can do it. There's 1,000 variations of it that they market as minimal, tickle me lipo, laser lipo, limited lipo, lipo with a cannula. There's a, it's so, and every human being is a candidate 'cause every human being, even you, I have a, this one area.

I have nowhere on me that I want, like.

So the average person has something, just a little. I'm happy, just this little area. Oh, that's so funny. And it's advertised as right under getting Botox, like it's nothing. And who does it? Every single low-lying provider thinks they can do it. In other words, I do rhinoplasties. 90% of plastic surgeons, plastic surgeons don't do rhinoplasty. They don't wanna even deal with it. Just too complicated, too much headache for a little money. Liposuction, every asshole is doing it.

Wow. Well, I'll tell you, the reason I said I don't have anywhere I wanna do it is because when I had stem cells for my knee, they used my fat, right? And they took it off my flanks.

Yeah, clocked.

Okay, so they take it off my flanks. I am bruised for a month. Month. I'm like, it looks weird. I'm like, and they just took a little bit. Yeah.

Like a little bit. Yeah. So as I told you in the previous episode, so I didn't even elaborate why, what's wrong with lipo. Number one, I promise you, I guarantee you, I assure you that after 12 to 18 months you will have some loose skin unless you are super thick-skinned, which most of us are not. If you are Caucasian or thin or dry or freckly or you've had a few kids, Forget about it. Secondly, in addition to loose skin, you will have a divot, a dent, some kind of weird contour something. And third, 99% of the liposuction cannula sites are visible from 100 feet away, which defeated the purpose.

Wow.

You know how many cannula sites I've revised? I saw a super, super famous person in my office the other day who had a whole bunch of surgeries before I met her. Arguably, ton of them were shitty. And they did something to her butt. I don't know. And the liposuction cannula sites literally look like pockmarks, like chicken pockmarks. And I was like, oh my God. So I just think liposuction is way overdone and overused and too aggressive. That's the number one thing people regret.

Yeah, I've seen it in clients and it's— it just looks like they have cellulite now.

Yep. And there's zero fixing it.

Wow.

You get a capsular contracture in your breast, I can take out the capsule, put a new implant in. I can't fix this. I can't like, oh, put the fat back. What fat? What do you mean? What are you talking about? No, the only way to do it is like if you do it in your abdomen, I have to do a tummy tuck. If you do, like, you understand what I mean? I gotta remove now this issue. It's, it's, it's a catastrophe.

Most underrated procedure.

Chinog.

Hmm.

I love noses. And as a result, if you love noses, you gotta love chins. It turns out that if you look at 100 supermodels, men and women, Asian, Black, uh, Latina, Latino, whatever. All of them, all 100, will have a strong jaw. Not all of them will have the same nose. Not all of them will have the same eyes. Not all of them will have the same eyebrows, cuz we're varied, right? Ethnic. No one will have a weak jaw or weak chin. Strong jaws in men and women is incredibly attractive. I think it's something to do with our, um, teleologic, you know, it means it, it evokes a sense of strength. Mm-hmm. And why we're attracted to it. But in, in 30 minutes, I can put a small chin implant instead of any kind of filler or mushy stuff. Your jaw is going to become 1,000 times better. I teach the course for this, uh, for this, uh, procedure, and it's like we say, for the unit time, the transformation is like no other surgery.

Wow. Okay. Which procedure gives the best natural-looking result when done well?

All of them. Because it's just the truth. Like, if I took a little bit of eyelid skin, you're like, "Oh, wow, that looks so good." If I do a little, very subtle brow lift, "Oh, wow, you look so fresh." I actually think all of them, when done eloquently, can lead to beautiful results. Botox, done just a touch of it, ah, so nice. So I just think all procedures have the potential to be beautiful, and all procedures That's not true. Not all of them. Liposuction is very hard. Even if you're an amazing surgeon, the technique is flawed. Lip lifts, even then, lip lifts, cutting underneath the lip and lifting it, very tricky. Sometimes no matter how good you are, you don't get a good result. But most of them can lead to good looking results.

I love the way you literally talk like you're a chef.

Yeah, I love it. Yeah.

What's one thing every woman should know before booking a procedure?

I mean, I'm a big, big, big, big believer that you're never going to educate yourself enough and that you must ultimately rely on the expertise of your surgeon. Look, I hire lawyers and I hire accountants, right? I consider myself a reasonably bright person. I've never once guided, advised, suggested, maybe, but I've never really ever intervened in my lawyer's guidance of my case. I've seldom ever say anything to my accountant. Why? Not because I'm not smart, not because I don't have it. I could never know enough to tell you. I am relying on my ability to select the right person, and that person as a professional will guide me. It's not to suggest I never ask questions or I don't inquire, but what I'm trying to say is you can never educate yourself enough to know what you don't know, to then ask so you're protected. Your only job is to make sure you found someone that you can trust. Then you have to rely on them.

So we've got to do our research. Final one. What's one procedure you would never have done on yourself?

Me personally?

Mm-hmm.

My nose. Even though my nose is hardly anything to write home about, and even though rhinoplasty is a significant part of my practice. I think that it would change the way I look so much. And because I'm such a critical person, I wouldn't— I would be tortured for the rest of my life. And I actually use myself as the example during the consults because unlike facelifts that are somewhat flawed, breast dogs are flawed, you know, ear pinning is flawed, but noses, there's a unique way in which we view them. Mm-hmm. Once we've done them, where we're highly critical and we can't be uncritical. And because I have a microscope as a brain, I would be so tortured by every irregularity that I would see that I would probably just end up losing my mind. So I'm going to stick with this Middle Eastern schnoz that smells really well. Yeah, I had a lady— you know, you have, you have all the haters, right? You're on social media. And someone's like, "I can't believe you're doing rhinoplasties and you haven't done your own nose. Who are you to be doing noses with that thing?" You know what I mean?

And I was just like— Wow.

What an angry person.

People are a trip, aren't they?

Well, they need to find something to make themselves feel better. They're gonna find something.

I was just like, "Would you say that to me in person? That's just a mean thing you just said to me, woman." Thank you for plowing on over here.

Yeah, well, I appreciate it.

You flew all the way over here. I super appreciate it.

I did. My staff said to do so. They said—

Ah, good. Smart.

They said, they said, JJ is her show and she's fantastic. And I think at the end of the day, if you have a message, your message is meaningless if someone doesn't hear it. Right. It's kind of the idea that if a tree falls and no one's there, did it make a noise? Right. So I have made it a lifelong mission to do plastic surgery, to enjoy plastic surgery, but to sort of take the information and repurpose it in a way that can be digested and explain it so people have good outcomes. As a result of my podcast, The Plastic Surgery Uncensored Show. And so if I don't get on to megaphones and you have a megaphone, then I'm— it's just, it just dies with me. So anytime I have an opportunity to be on a show like yours and you are open-minded to have someone on, because a lot of people will reach out and like, oh no, we don't want to breach the subject.

Hmm.

Because they think it's taboo. And they think that, oh, if their listenership, like you're all about empowerment, and to them that plastic surgery is not empowerment. You see what I'm saying? You see the other side. So I'm grateful that you had me on and you allowed me to come and chat with you.

Yeah, it was fantastic. And for everybody listening, we'll put all your handles and your podcast. I listened to a bunch of the different ones you did on other people's too. You're a riot. So jjvirgin.com/dradi. So D-R-R-A-D-Y.

R-A-H-B-A-N. And so, but we're just going to do Dr.

Rady so they don't have to spell your last name.

Okay. As long as it links to my— Yeah.

It's going to link to all that stuff.

Okay.

Because you got a weird spelling name.

Yeah. Well, you know, these damn fucking foreigners.

You know, it's like, I was like, doctor, how do I say his name?

Yeah. Yeah.

For the record, it's Dr. Rady Raban.

Come and check out our podcast, Plastic Surgery Uncensored. If you like this and this information, I have a lot of guests on and they're almost always my patients. One of the key elements is to not find a surgeon who necessarily will do well, but find a surgeon who you feel comfortable if things don't go well. Remember, surgery is wonderful in the 90, 95, 97% of times, but there are 3%, 1%, 2% where it doesn't go as planned. And the question is, what happens then? I'm not doing you any favors, it's my obligation. And I think that's the thing that people are, uh, maybe not fully grasping. That's what you wanna look for, is that feeling that this person will take care of you take care of.

Well, I'm glad you're getting that out there.

Yeah, it's very good.

Thanks for having me. Thank you.

It's been a pleasure.

Be sure to join me next time for more tools, tips, and techniques you can use to look and feel your best and be built to last. Also, I'd love to connect with you and hear your thoughts on the podcast. Here's how. First, subscribe to the podcast and and leave an honest review. Second, take a screenshot of your review. And third, text to 2-813-565-2627. That's 813-565-2627. When you do, I'll reply using my brand new Virtual JJ. It's my on-demand virtual self built from my books, and years of experience so I can interact with you directly. You'll make my day and I can't wait to hear from you. Thanks for tuning in and I'll catch you on the next episode. Hey, JJ here. And just a reminder that the Well Beyond 40 Podcast offers health, wellness, fitness, and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional because of something you may have heard on the show or read in our show notes. The use of any information provided on the show is solely at your own risk.