Speaker 1 (00:07):
You're listening to the LA Jolla Cosmetic Podcast.

Monique (00:14):
Welcome everyone to the LA Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today we have a very interesting episode when it comes to a cosmetic procedure, like the one we're going to discuss today, the BBL or Brazilian butt lift. It's our mission to help you sort through the crazy stuff that's out there, especially on social media and get you the information that you need to know. So we're going to let you in on a bit of the crazy stuff in a moment, but before we do, if you're new to this podcast or to LA Jolla Cosmetic, we have been known for over 30 years as the safe place to have your cosmetic surgery. We work really hard to show you proof of that through our commitment to patient satisfaction and our reviews, but also through communications like this podcast and education. To help with this important mission, my guest today is Dr. Luke. Swistun. Welcome back, Dr. Swistun.

Dr. Swistun (01:15):
Thank you. Good morning.

Monique (01:18):
Good morning. So, if you could help us understand for people who might not know what is a BBL and what's the goal of the surgery.

Dr. Swistun (01:27):
Sure. So a BBL, as you already said, stands for Brazilian butt lift, and I'm not sure if that actually originated in Brazil, this procedure, I mean, but that's just kind of the name that it's known for and what it essentially entails is just redistributing the patient's fat. It involves liposuction, which basically removes fat from the areas where the patient may not want it, which is typically the waist and the abdomen. And then it, we actually inject that same fat, the patient's fat into the other areas where the patient might want it, might want a little bit more volume, such as the buttock. And also we, a lot of times blend into the hips and that essentially enhances their hourglass figure, which is that sought after shape that most women want. And that's essentially the crux of it.

Monique (02:13):
So before we go too far into the procedure itself, let's go back to the crazy part that I mentioned at the moment. You really can't talk about BBL without talking about safety, because you don't have to go very far on Google or Tik Tok or Instagram to find a little controversy. This week, there were two major articles with provocative headlines, both use the word dangerous right in the headline. One was in the New York Times titled "Why is a Brazilian Butt Lift Dangerous?" And another in Vox called "How the Brazilian Butt Lift, One of the World's Most Dangerous Plastic Surgery Procedures, Went Mainstream." So what's been happening with safety in the terms of this procedure in particular.

Dr. Swistun (02:59):
Excellent question.

Dr. Swistun (02:59):
And I applaud you for addressing safety first and foremost, because ultimately this is an elective procedure, just like pretty much anything we do with aesthetic plastic surgery. These are surgeries that patients don't necessarily even have to have. So safety is paramount, and obviously there are risks with any surgery that we're ever going to do, but we want to keep those risks to a minimum. And in this particular case, technique has a lot to do with the safety. And we'll discuss that in a second. But with regards to safety about this procedure, the trend in the United States definitely doesn't follow the rest of the world. And the good reason for that is because most of these procedures in the United States are done by board certified plastic surgeons. And you know, the good reason for the plastic surgery board is that we really keep ourselves in check as far as what's appropriate and what's not appropriate to do.

Dr. Swistun (03:46):
And there's very rigorous testing examinations and things like that that we undergo as residents in training. For instance, while you're training, there's an annual test that we have to at least get a passing score. We're scored against all of our peers. And then ultimately before we actually ever get board certified, there are two tests that we get. There's a written test, which is very extensive, takes all day. And then there's an oral test where you actually sit in front of other plastic surgeons who are very senior to you. And they critique patients that you have operated on for the last year and uh nitpick every single detail, why did you do this? Why was this decision made versus that one? And then you have to sort of defend your choices based on your patients. And then there's other cases that they will give you that are basically completely hypothetical.

Dr. Swistun (04:30):
And they want to see how you think on the spot and how you would handle these very complex, different situations. And they're all very complex. It's not as straightforward. None of these are straightforward cases. These are solely like worst case scenarios. And how would you deal with them? So a very rigorous process for an American plastic surgeon to become board certified. And I think that is a big benefit of going to a board certified plastic surgeon, because you really get that standard of care when you see a board certified plastic surgeon in this country. And I think that's also directly related to the lower risk rates in this country.

Monique (05:01):
So, in these articles, they talk about people actually dying from the procedure, what would cause death in these cases?

Dr. Swistun (05:13):
Yeah, so you're right. So the articles do mention that the fact that these particular procedures that are associated with the highest death rates of any plastic surgery procedure that we do, which I believe they quoted as one to two per 6,000, which to me is obviously unacceptable because nobody should be dying from a plastic surgery procedure. And the very common link that we found with this is that it has to do directly with the technique. In other countries, in order to gain a lot of volume during fat transfer, specifically in the buttocks, the surgeon actually takes the fat that they liposuctioned out and in order to enhance the buttocks, they inject it into the muscle instead of the fat that rests above the muscle, the benefit that other surgeons and other countries see in this is that they can get a much bigger enhancement because you can inject more fat into the entire buttock area because they'll use the muscle as well as the tissues outside of the muscle.

Dr. Swistun (06:08):
But the risk is that, you know, the muscle in the buttock has very, very large veins. And those veins communicate directly with the vena cava, which then goes right into the heart. And if any fat gets injected accidentally into the buttock veins, the fat will travel up the vena cava through the heart and into the lung vessels. And that can clog up the lung vessels and can basically kill the patient on the spot in the worst case scenario. Sometimes if a very little amount of fat gets into the venous circulation, almost nothing happens. Patient doesn't even know it, but if enough fat gets into the veins and then into the lungs, then that can be catastrophic. So that is the specific reason that was identified, why the death rates are higher in this procedure more than in any other. So the solution from the American board of plastic surgery is that we simply do not inject the fat into the muscle area.

Dr. Swistun (07:04):
We basically keep our injection above the muscle, which is essentially under the skin and into the fat above the muscle. But we do not violate the muscle. We do not go any deeper than that. And that basically avoids the entire dangerous aspect of this surgery. This is very, very highly emphasized on the boards. When I was taking my boards, I actually had a case of my own that I have done. And they obviously nitpicked that one and then basically asked me a lot of questions. How did you do it? Where did you inject the fat? How much fat did you inject and how do you know that you were above the muscle as opposed to inside the muscle and there's appropriate techniques that we need to be aware of to make sure that we're doing this correctly. But again, very, very highly emphasized. And I think partly because of the fact that the procedure is rising in popularity in the United States and the board knows that a lot more plastic surgeons are going to be doing it. So they really want to make sure that we know what we're doing. And then all of the plastic surgeons are on the same page on this.

Monique (08:02):
Okay. So based on what you've said is that maybe why somebody should not travel outside of the United States to get this procedure. That might be it for a lot of reasons, it's safer here in the United States.

Dr. Swistun (08:16):
That's a great reason. I mean, I don't know the standard of care in other countries because I haven't trained there, I haven't practiced there and I haven't operated there. But, if a family member asked me for advice on this procedure, I would definitely tell them to stay in the United States and go to a board certified plastic surgeon in order to get it done, because that is the surgical population that I know will follow the correct standard. In other countries, there's lots of good results that we see come back from other countries, but you just don't know. The standard of care may be different or the patient may have had the procedure and sort of gotten away with it as in a, you know, maybe they did go into the muscle and then she did on bigger enhancement. And she, you know, in that particular case, the fat did not get into the veins and everything went well, but it is a risk basically. It's a little bit of a gamble every time that you stray away from.

Monique (09:09):
Yeah. And I would think based on after surgery, you've got a lot of post-op care. And if you're in another country and things aren't going quite right, or you've got a lot of traveling to do...I mean even just traveling. If you're going from Turkey to San Diego, you know, that's in itself sort of a risk right?

Dr. Swistun (09:28):
Absolutely. Absolutely. So the travel itself is a little bit of a risk depending on how long your flight is, just because you're immobile. And there's a specific time frame after surgery, any surgery that we do want to keep the circulation going in the lungs to prevent blood clots and stuff like that. And some people have a concern about getting on a plane and having to sit for a long time. But the aftercare is obviously another big point. There's lots of patients that travel outside. And I have seen patients who traveled away from this country and then gotten back into San Diego. And they came into my office when I worked in a different office, just specifically with complications and with concerns and questions. Hey, is this swelling appropriate? Is this bruising appropriate? This drain is looking like this, is this infected? Things that are normal postoperative concerns that you should have a plastic surgeon available for in order to address appropriately. If that's just not there, then you don't know if you're recovering well, if there is a complication, you may not be aware of it until it's too late and you wind up in an emergency room or something else. So.

Monique (10:32):
Yeah. And I think, you know, you might wonder, or people might say, well, why would you go out of the country for the surgery? I think a lot of it comes down to price. And would you say the main population who is interested in a BBL tend to be on the younger side and if they're on the younger side then they're more price sensitive?

Dr. Swistun (10:52):
No, I'm not sure. Honestly, I've seen actually patients from all kinds of age groups be interested in this procedure. It's got its benefits for slightly older patients as well, which we can talk about, but I'm sure price is always a factor across the board for younger or older patients. Another reason that I have heard by other patients that have traveled outside of the country is that they think that they will get a better result in Brazil or a better result in another country because they are more liberal there as in, like, they will put more fat into my buttock, therefore I will have a bigger butt in a different country. Whereas, here they're a little bit more conservative and that's, again, the reason for that is because exactly what we already did addressed is a yeah, you're right. There may be a doctor that will put more fat in there. And maybe they'll go under the muscle in order to augment the buttock. But that is the risk that comes with that procedure, that larger augmentation is that the risk of a complication increases significantly.

Monique (11:48):
Good. Well, I'm glad we kind of confronted that topic head-on because you know, it is important to think about safety, obviously. All of us want to have a great result, but you also want to have a really safe experience. So let's help everybody kind of visualize what's the BBL all about. So how much excess weight do you need to have for a BBL to be a success?

Dr. Swistun (12:15):
So, honestly not much. I mean, what the procedure actually does is basically redistributes fat from again, as I mentioned before, from the areas where you don't want them and into the areas that you want, and there are plenty of patients who are on the thin side, you know, BMI of 23, 24, 25, which is a perfectly normal weight, but they just have a little bit of a problem area in a certain part of their body. It's usually the abdomen, like I said, or maybe the hips. And they would rather get rid of that. And maybe they would want a little bit of an enhancement in their buttocks. And then there are patients who are much bigger, who basically are a little bit overweight. And then the problem area is a lot more obvious and they want that removed. And if, because we have extra fat, we can sort of round out other areas.

Dr. Swistun (12:59):
In most cases, actually, patients don't look for a bigger butt like the Kim Kardashian look is exaggerated and very uncommonly sought after at least in my practice. Not a lot of people say they want that look. And in fact, most people say they don't want that look. Some of my patients actually came up with interesting words for that is, uh, you know, I want to look natural, but I don't want to look exaggerated, which is level one of Kim Kardashian or scandalous, which is like beyond Kim Kardashian. And those are also results that are out there, and the patients are very clear about that. It's like, I don't want to look scandalous. I don't want to look exaggerated. I just want to look natural, but I have a flat spot here in my buttock that I'd like to round out. And I have a little bit of a belly on the front that I'd like to get rid of.

Dr. Swistun (13:41):
Can we do something? And that is the most common scenario by far. And that is also the realm within which I practice most of the time. It actually sort of translates to the older population to answer the question that you asked before, is this usually a procedure that our younger patients seek? The answer is no, because as we age, there are certain areas where we lose fat, certain desirable areas where fat goes away from, which is sort of the outer part of the buttocks, kind of flattens out a little bit. So you lose that roundness. And then there's other areas that we sort of gain weight in, which is usually the flanks and the anterior, the front abdomen that tends to happen with aging a little bit more. So there's lots of women who I see in their forties or fifties who basically say like, this is, you know, no matter how much I exercise, no matter what I do this shape just doesn't go away. I'm losing fat where I want it. And I'm gaining fat where I don't can we do something about it? And that is another very common scenario. And again, the goal is not really to enlarge her butt too much, but just kind of bring them down to where they were 20 years ago.

Monique (14:42):
Yeah. So it's sort of like, in the article they used a quote, it said it's like moving money from your checking to your savings account.

Dr. Swistun (14:49):
Yeah. I remember reading that. I wasn't sure what the analogy states.

Monique (14:53):
From one to the other, you know, you move the fat from where you don't want it saved to where you do want it saved.

Dr. Swistun (15:00):
Yeah, yeah. That's, that's, that's actually a reasonable analogy. So basically what you're doing here is the way to think about it is this. Everyone is born with all the fat cells that they're ever going to have and they live in certain areas in your body. And when you gain weight, the fat cells simply get bigger. And then when you lose weight, the fat cells simply get smaller. So in this case, what we're doing is we're removing a large portion of fat cells from the area where you don't want them. And we're putting them back into the area where you do want them so that after the procedure, your proportions essentially change. After you heal from this procedure, the question is, can you still gain weight or lose weight? Of course you can, but you will gain proportionately more in the buttocks after we augment that and you will gain proportionately less in your waist. So in essence, you age a little bit more gracefully without the common pitfalls that most people face with the flattening of the areas that should be round and the rounding out of the areas that should be flat, we sort of kind of reset the clock on that and redistribute the fat so that as you go through life afterwards, the volumes maintain in favorable ways.

Monique (16:07):
Yeah. And you have that new, great shape. So along with changing the shape of the buttocks, are you contouring other parts of the body? Like you mentioned, where you most normally take fat from the abdomen maybe, or the, the flanks you're kind of reshaping that area to correct?

Dr. Swistun (16:26):
Correct. So everyone's got their different problem areas. You know, patients come in with different focuses. This is the area that bothers me by far, the most common ones are, you know what you already mentioned, the abdomen and the flanks. A lot of times, it's the upper back though. Sometimes it's the arms that are just a little bit too heavy. And then some patients have kind of a square shape where they're not very curvaceous, so to speak and they really want that. So everyone's a little bit different. We analyze everybody very individually and everyone is their own sort of masterpiece, so to speak. It's basically the way I look at it, but each one is individual and each one is different. And in my opinion, again, the procedure involves two different things. It's liposuctioning. And then the fat grafting. The liposuctioning part, I think is 80% of the result.

Dr. Swistun (17:10):
And that patients typically have really nice curves already. They're just hidden underneath other areas of fat, that sort of mask their true natural curvaceous shape. And what I do is I unmask that with the liposuction. So, you know, really carving in the waist, the street word for this is snatching the waist. I don't know where that came from, but a lot of patients use it now. So I have to. But to snatch their waist and really make the waist as thin as possible, will unmask the curves that they already have... The buttock projection that they already have that is otherwise not really pronounced. So to me, the liposuction is 80% of the result. The fat grafting is the other 20%. That's like the cherry on top. It's like, everything's already nicely exposed. If you want just a little bit more roundness in certain areas, maybe a little bit more projection on the buttock, a little bit projection on the hips to make it a little bit more hourglass shaped.

Dr. Swistun (18:01):
Maybe you had that 20 years ago, but now you lost it. Let's put that back in there. That's the fat grafting part. And then the two in combination add up to a really nice long-term result in the end. Other areas can definitely be augmented. The buttock is kind of the most common area people know about. But I typically blend into the upper hips as well to enhance the hourglass figure for patients who kind of were kind of square most of their lives. This is again, a patient term, I'm not... I don't want to use that as the term that I've invented, but they just come in, I'm square, you know, can you make me more round? We can augment their hips as well. We can just fat graft to the outer thighs and outer hips and give them a little bit more of an hourglass curvature down there. A little bit more volume in the hips while we snatch their waist. Again.

Monique (18:46):
It's really interesting. I never really thought about the fact that you're putting the fat in a place other than the buttocks for a BBL.

Dr. Swistun (18:53):
Absolutely. Another area that's very common is the breasts. You can actually fat graft the breast as well. And that's a whole other discussion and it's got its own set of questions and answers that we definitely need to touch on, but that's a very common area. And then finally, also the face, you know, as we age, we also lose volume from the face. There are certain predictable changes that happen due to that, due to volume loss, fat loss from the face and augmenting that with fat, your own fat, as opposed to fillers is also a really good idea if the fat is already available, if you're already doing the procedure.

Monique (19:24):
Now, how much of the fat stays like a year later, is there, could you say kind of a percentage of how much fat would still be there from right after surgery?

Dr. Swistun (19:35):
Yeah. Depending on the articles you read, I think the number is quoted anywhere between 30% to 70%. I just say 50% of the fat, just in that. I basically tell the patients that like everybody's a little bit different and it also does depend on the vasculature of the area we're injecting into. So, you know, the landing zone, so to speak, where I put the fat needs to be vascularized, there needs to be a lot of blood flow in that area for the fat to take. And that's just a little bit of an unpredictable thing. But in general, about 50% of the fat will stay. So for that reason, we actually over-correct a little bit. You know, if a patient is going for a certain look and we know that in the long-term, they want a certain look, then I will actually over-correct if I can safely, I will inject a little bit more into a certain area because I know that about half of it will go away in four to six months, but the other half that will stay is, you know, once a vascularizes, it's there for life.

Monique (20:27):
And what are the alternatives? I mean, couldn't you just get buttock implants or is that something that people do anymore or is that an option?

Dr. Swistun (20:38):
They do. So it is an option. That's not an option I recommend. It's not a surgery that I do. I'm familiar with how to do it. The reason I don't do it is because buttock implants are quoted with very, very high complication rates in the short-term and in the long-term, you know, higher than most plastic surgeries that we do. I think it has to do with the fact that there is a foreign object that is in the buttock, which is an area that you sit on. So they're always exposed to pressures and different forces and eventually stretch the area that they live in. And eventually they can migrate, move around and get infected and things like that. So I believe that there's some literature that quotes long-term rates of buttock implants, long-term complication rates as high as like 70 to 80%, if you take the entire lifespan. So if at some point they have to come out there, they're typically not considered a forever product. They're a temporary solution, I suppose, if you will, especially with that high complication rate in the long-term.

Monique (21:33):
So not a good alternative. So Dr. Swiston where are the incisions for this procedure?

Dr. Swistun (21:40):
Now, the short answer to that question is that they kind of are where they need to be, because I don't like to compromise the result, the three-dimensional shape of the patient just by incision placement. And the incisions are very, very small and they heal up almost scarlessly. There are very few that are invisible places. Most of them are sort of close to where clothes would be hiding them anyway. But one other thing that I actually like to do with incisions is I like to make them asymmetric. And to me that is actually masks that somebody had a procedure. If you think of it this way, you know, people have sort of moles and marks on their skin sort of throughout their body that are not symmetric. And nobody's eye is really drawn to those. But if I'm on a beach and I see someone who has two little scars in the lower abdomen, and then two little scars in the upper back, and two little scars that are exactly in the same places on both sides. I know from far away that they had liposuction, those are the giveaways. But if you just vary the scar placement by an inch, up on one side and an inch down on the other, they look like moles that were removed or nothing at all. Your eye basically doesn't travel to that. So that's another thing I think about if I can do that, if I can make them asymmetric, I think that's a benefit.

Monique (22:49):
And how big is it like a line or is it more of a puncture?

Dr. Swistun (22:53):
It is just a quarter of an inch to a half an inch, depending on where on the body. Really, it's a very small knife that is made to puncture the skin and typically it heals like a fine line.

Monique (23:05):
So what does somebody look like immediately after this procedure?

Dr. Swistun (23:10):
Swollen? So I actually found my patients look at, you know, 48 hours after the surgery, you are going to be the biggest that you're ever going to be because the surgical swelling from the trauma of surgery is there. And all of the fat that we grafted into an area is also there. So it's going to look big. It's going to look exaggerated. It's not what you want. And we know that and we'll just have to let you recover and let the swelling go away. But you know, all the areas that we address swell, so everything that, you know, if I liposuction the waist, the remaining skin and that area is also going to be swollen. So it's going to be thicker than the final result. The buttock that's grafted is also going to be pronounced, remarkably swollen. So after about four to six weeks or so, the surgical swelling goes away.

Dr. Swistun (23:57):
So patients feel a lot better. You know, things calm down a little bit and the waist is starting to get really, really tight. And about four to six months after their surgery all of the fat that did not survive about 50% of the fat that we predicted is also going to get reabsorbed. So four to six months from after the surgery is typically when the patient sees their final result. Realistically, I'd probably wait a whole year to get the final, final result. Cause there's still some residual swelling hanging around, but you know, four to six months after it's a pretty good estimate of what they're going to look like.

Monique (24:29):
And so do they wear a compression garment like with traditional liposuction?

Dr. Swistun (24:34):
Yes, they can. That, that really helps early on. I believe massaging is also very, very important because it serves two purposes. Early on, you really want to get a lot of that extra fluid out. I do use drains for this procedure. That's another thing that post-op recovery patients have to deal with a little bit. But early on massaging really helps to get all that extra fluid out of there and into the drains and out of the body. And then later on, after the drains come out, massaging the areas that were treated also really helps because it'll give us a smoother contour in the end. It basically smooths out all the scar tissue that's forming and kind of redistributes the remaining tissues underneath for a most optimal, smooth result.

Monique (25:13):
You mentioned drains, how long do the drains stay in?

Dr. Swistun (25:15):
Typically one to two weeks occasionally longer. Uh, it really just depends on how much volume was removed, how big the patient was to begin with. But you know, the drains really help evacuate all that extra fluid. The way to think about it again is we're creating this empty space where the fat used to be. We are separating the skin away from the body and the empty space where the fat used to be now needs to heal down and be obliterated. So a drain will, especially if we leave it on suction, will kind of provide a little bit of negative pressure to suck those two tissues together so that they heal. And in addition, remove any excess fluid. That just takes time. So typically I look for the drainage output and once the drain output reaches a certain level, then we can remove it because I know beyond that level, the body can kind of reabsorb, but it is different for everyone.

Monique (26:01):
Hmm. I hear that you have to avoid sitting after this procedure. How is that even possible?

Dr. Swistun (26:08):
There's ways. You know, sitting as it's kind of a generalization. I typically tell patients that they need to be aware of where the fat graft was placed and we want to avoid pressure on that area. So sometimes sitting is actually okay, depending on what we grafted. So if we grafted the hips or the upper buttock, then you can sit on the lower buttock and everything is going to be okay. If we grafted the entire buttock, including the lower part, then there are pillows out there that you can sit on, which basically sort of go more under your thighs and they leave the buttock sort of out in the air and that avoids putting direct pressure on the fat grafted area. But the reason for that is again, because once you graft the fat, the critical two weeks immediately after the graft does that, that fat needs to survive.

Dr. Swistun (26:50):
So it needs to find blood supply in the immediate area where it was grafted into. And any pressure of that graft will sort of squeeze out the blood flow and not allow the fat to revascularize. Once patients understand that they can, they find really creative solutions of how to avoid that, depending on where their fat is grafted. There are some that sort of float themselves. They have like a La-Z-Boy and they'll just put, you know, they want to sleep on their back, so they'll put a lot of pillows underneath their lower back and upper back, and then underneath their knees. And they'll sort of like float the buttock in the air almost throughout the night. The easy solution is just to sleep on your stomach. You know, some people are not stomach sleepers. So we find other ways.

Monique (27:32):
I actually talked with a patient recently who said, you can rent a La-Z-Boy after surgery and this patient had looked into it and he thought, well, buying one for this, post-op isn't necessarily the bright way to go, but you can rent it. So I thought that was really clever. The things you learn. So why is quantity of procedures not necessarily a representation of quality?

Dr. Swistun (28:02):
In my opinion, this procedure is more artistic than any other procedure in plastic surgery that we do because it really involves sculpting the patients. And that takes time. And, you know, there's another way of doing the same procedure where you just go through the motions. You know, liposuction the waist, and then fat graft into the buttock. You're done. Next. Liposuction the waist, fat graft buttock. Done. To me, it's more than that. And again, it's analyzing every patient as an individual and really tailoring the result to them. And I think that takes a little bit of time. And I think for that reason, just because someone claims that they do many, many, many of these in any given month or a year, that doesn't necessarily represent the result or their artistic eye, so to speak. It may, and they may be very good at it,

Dr. Swistun (28:46):
But that is a decision that I would leave up to the patient. I would advise the patient that, uh, you know, first of all, look at their before and after results. But second of all, meet the surgeon. Let the surgeon tell you what their goals are for you and make sure that they explain them well and see how much time they take explaining them. If they're just explaining a very routine procedure that they've explained a million times, and it takes two minutes, that's probably different than analyzing your body very thoroughly and taking their time and saying like, this is what we're going to do for you. This is what's possible. And this is what's not. And what do you think? If it's a two way exchange and you feel really comfortable with the exchange... That you're really, really on the same page with that surgeon, I think that speaks volumes.

Monique (29:25):
So what's a consultation like for a BBL or like walk us through the process.

Dr. Swistun (29:32):
Sure. So I will typically meet with the patient and we'll talk about goals specifically, what do they want to achieve? What's the problem area? What's the, you know, that they have too much fat in and what's the area that they would want to augment. Everyone's different, like I mentioned. A lot of times they'll bring pictures of what they like off the internet. And that's something where we basically use it as a point of discussion. It's like, this is a picture where we can discuss goals, but this is not certainly not something that I can duplicate. I can't make you look like another person, but I like to be in your mind to see what you're thinking so that we sort of aim towards a certain result. And maybe towards that result that you brought in. A lot of patients just bring pictures of themselves when they were younger.

Dr. Swistun (30:13):
Can I go back to what I was 20 years ago? This is what I looked like. And we discuss that. And that's a very common point of discussion. After we have the goals sort of set up, then I do a physical examination to see how close we can get to achieving the goal. If they don't have a lot of fat, then you know, the fat grafting may not be that successful just because again, only half of it survives whenever we liposuction out, some of that is not even usable anyway. So it's always a discussion about how realistic it is based on their physical examination. And after that, another thing that I really like to do is do a Vectra analysis of them. So there is a three-dimensional scanner that we have that we actually can scan their entire body into and then the patient, and I can look at it on the screen together and we can actually manipulate the volumes in certain areas.

Dr. Swistun (31:01):
And I can give them an idea of like, okay, if we do the liposuction, this is what your waist is going to look like afterwards, based on my exam. And, uh, if we do have fat grafting, this is what the buttock is going to look like afterwards. And then we can compare the before and afters right on the screen. These are again, approximations. These serve to me as tools for discussion, for communication with the patient so that the patient can sort of have input in there and say like, oh, I'd like a little bit more volume here, but a little bit less volume there. And we can make those changes. And it really puts me in their head and makes sure that I'm thinking what they're thinking when I'm in the operating room and they're on the table asleep. And, um, you know, basically doing their procedure.

Monique (31:40):
It sounds like a really cool tool to be able to imagine. Because you know, looking at other patients before and after that's helpful, but it's not you.

Dr. Swistun (31:52):
I think that's the one thing that's distinguishing between this procedure. Each one is very, very individualized.

Monique (31:58):
So where can I find information about you and about the procedure?

Dr. Swistun (32:05):
We are online? We have a website, I believe there's some before and after photos of the surgeries that I did. And as well as the other surgeons in this practice. I think there's a descriptive page on our website as well, for Brazilian butt lift specifically. My own Instagram also has a lot of examples of what I’ve...the work I've done in the past.

Monique (32:25):
I think it was at the end of 2019, we wrote a blog post about... Sort of about the safety and helping educate people. And we have the links for that, and the articles that we talked about in the show notes, and as far pricing goes, you know, we publish everything on our website. And so when you look up BBL and look at the procedure page, it has a range there. We can help with financing, there's a whole page about financing and you can read about that. And in terms of first steps, it would really be getting in contact with us, either call, text, email on our website, we have a little pop-up text function, so that's really convenient. So those are all ways to get in touch with us. So thank you, Dr. Swistun. This was a really informative episode. I hope all of you listening got your questions answered. And certainly the next step, if it's something you're thinking about having done, or you just want to know the possibilities, have a consultation and, you know, see what the possibilities are. So thank you again, Dr. Swistun. This was a wonderful episode. We appreciate you coming on.

Dr. Swistun (33:36):
Thank you for having me.

Speaker 1 (33:43):
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