May 20, 2025 • 42 mins
Dr. Douglas Steinbrech joins Dr. Bass to discuss his game-changing concept of body banking. Instead of tossing out fat after liposuction, body banking preserves it and strategically reinjects it into areas like the chest, shoulders, arms, or buttocks to enhance your shape and keep your body in balance.
It’s not just about taking fat away. It’s about sculpting, reshaping, and maximizing what you already have. This technique can also reduce the risk of that frustrating post-lipo “rebound fat,” where your body tries to make up for what was lost by storing fat in all the wrong places.
Hear why fat transfer to the breasts doesn’t always go as planned, and why fat tends to “stick” better in some areas than others.
Drs. Bass and Steinbrech also discuss how body banking may help prevent visceral fat buildup and related health problems, the role age plays in fat graft success, and options for people who don’t have much fat to begin with but still want a sculpted, athletic look.
About Dr. Douglas Steinbrech
Dr. Douglas Steinbrech specializes in minimally invasive aesthetics, blending this approach into both surgical and non-surgical techniques. Named one of America’s Top Plastic Surgeons by the Consumers’ Research Council of America, he’s known as the go-to surgeon for men. Using advanced techniques tailored to the male body, a large portion of Dr. Steinbrech’s practice is dedicated to enhancing natural masculine features.
Learn more about New York plastic surgeon Dr. Douglas Steinbrech
Follow Dr. Steinbrech on Instagram @drsteinbrech
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator and technology innovator.
The title of today'sepisode is "Body Banking:
(00:23):
Why It's Better to KeepIt." Okay. Dr. Bass,
I feel like I need a definitionhere. Can you help me out?
The idea here is that sometimeswe think we want something,
but it may not be as goodan idea as it sounds.
There might be a paradoxical effect thatgives us exactly what we don't want,
(00:45):
and looking at things from a differentpoint of view can sometimes give us some
insight and result in anew approach to things.
So we're talking about body fat here andwhether or not we want to get rid of it
or keep it and why. Andthis started, as I said,
from rethinking the baselinenotion that fat is bad and we
(01:07):
want to get rid of it.
I brought the Innovative Mind thatdeveloped this new approach to explain.
Dr. Douglas Steinbrech is a boardcertified plastic surgeon who trained
at NYU at the Institute ofReconstructive Plastic Surgery,
the same department that I trained in.
He's a master of body contouringand minimally invasive approaches in
(01:31):
plastic surgery.
He's been especially active indefining plastic surgery for men,
including editing the seminaltextbook on the subject,
which is titled MaleAesthetic Plastic Surgery.
He was gracious enough to ask me towrite a chapter in that textbook on cheek
augmentation with implants andfiller. Dr. Steinbrech, welcome.
(01:55):
Hey, thanks so much. I'mreally pleased to be here.
It sounds like it'll be a fun topic.
Welcome back to thepodcast, Dr. Steinbrech.
Thanks.
So Dr. Bass really didn't explain it.
He teased me with that idea thatgetting rid of fat might be bad.
Can you explain body banking furtherand how you came upon the idea?
(02:15):
Yeah,
it was actually kind of anexciting thing because before that,
we touched on this a little bit before,
but what we were doing in the sixtiesand seventies and eighties really,
liposuction came along inthe eighties and nineties,
started in France and then madeits way over to the United States.
(02:35):
But what we were doing is just removingfat. And while we were doing that,
we didn't really think aboutit. People just thought, oh,
being skinnier is better,
but they didn't think about what wouldbe like Dr. Bass sort of mentioned maybe
there's some kind ofparadoxical problem with it.
And what we found after we did more andmore of it is that if you suck out all
(02:58):
the fat, then a couple things can happen.Number one, if you think about it,
it's just all about the numbers. Andif we think about removing fat cells,
first of all,
you have a limited number of fat cellsafter you turn 18. There's a certain
number that we all have in our body andthey just get bigger and smaller sort of
going from grapes toraisins, grapes to raisins.
(03:21):
And every year as you loseweight and gain weight,
they go back and forthfrom grapes to raisins.
So you might imagine if youweigh a hundred pounds wet
and then you bloom up to400 pounds, you'd think, oh,
I made a lot of new fatcells. You really didn't.
You just made largerpreexisting fat cells.
And then when you lost all that weight,
conversely it's the samenumber of fat cells,
(03:42):
but they just all got very small. Soonce you start thinking about that,
you start thinking sort of moving fatcells around your body is sort of like
moving hair cells,hairs around your scalp.
You're not really removing them. Ifyou remove them and put them away,
you're not going to be in as good asshape as if you take them out and put them
(04:04):
somewhere else.And we started thinking that direction.
We started to think aboutthe fat cells as clay.
And I always say it at theend of any of my talks,
we do a lot of talking aroundthe country and around the world.
We just finished our national conferencein Vancouver and then I have to
run off to, I guess CartagenaColombia's next in June,
(04:27):
and then we're doing going toGreece in August and then in
October down to Australia. So a lot ofrunning around talking about this stuff.
But what we've learnedwhen we spread the idea,
and this is what I say to everybody,
is that we need to use these cellsand we need to think about it as clay.
And I tell all the doctors andthe residents coming along,
(04:50):
if you are at this point, if you arethrowing away all your fat, which I don't,
I really only once or twice a yearout of the thousands of cases,
hundreds of thousands of cases that we do,
it's only once or twice a year.And it's a very special instance that we
actually don't do it.
Usually the patients doesn't have fatcells that are large enough at all.
(05:10):
But I do banking for everything becauseI believe that this structural fat,
this structural clay is theclay that helps me get a better
result and helps me get a better resultthan the surgeon that's across the
street. And we have a lot ofplastic surgeons on Park Avenue,
Dr. Bass knows that.And same thing with our
(05:33):
practice in Los Angeles. When Istarted doing the men, really,
we had so many men and we saw thatthere was demand with this that we
started a Beverly Hills officeand then a Chicago office. So
there is a demand for this, and thisis why I like to talk about this.
I like to encourage othersurgeons to do this,
(05:55):
but I really feel bodybanking is important because
for two different reasons.First of all, like I said before,
the clay I can subtract and then add toother areas so I can give the patient a
more artistic athletic resultlike a sculptor is doing.
The sculptor never just takesthe clay and throws in the fat.
(06:16):
But the other real reason isthe second part of the equation,
and that is we're starting to learnabout really what happens to those fat
cells postoperatively. Andas I've been watching this,
and I've been learningabout this, I've developed,
I've looked at a lot of patientsthat we call liposuction cripples.
(06:36):
What are liposuction cripples?Those are gentlemen that have,
or women that they have toomuch time and too much money.
So they spend a lot of theirtime at fancy restaurants and
at fancy plastic surgeonsall over Europe and all over
South America. And when you seethese patients come in for the men,
(06:58):
they've had liposuction fouror five, six different times,
and they all look like they're membersof the same family. All their backs are
like a tiny little waist and then theirbelly is out to here. Well, why is that?
Because those doctors,three or four times,
they keep on sucking the subcutaneous,that's of fat underneath the skin out.
(07:18):
They keep on sucking it out andsucking it out and sucking it out.
But unless the patientafter surgery decreases
their caloric intake or increasestheir caloric burn, guess what?
The fat cells left behind, well,
compensatorily enlarge.
So if I have liposuction and I go inthe restaurant and I'm eating those
(07:41):
same rich sauces and I'm having icecream every the same 10 gallons of
ice cream every night, well,I always tell my patients,
I tell the other doctors those calories,
those carbs from that Netflix ice creamdon't just pass through you. No, no, no.
They're going to swim around the bodyuntil they find fat cells. And that's
(08:01):
where the fat cells storethem. So all those patients,
all those liposuction and cripples,
they're still skinny back here becausethose fat cells have been removed,
but they're nine months pregnantbecause the only cells left over are the
visceral fat cells and theycompensatorily enlarge.
We have a name for that that's calledrebound fat or a funny technical name
called "catch fat,"compensatory atrophic cellular
(08:26):
hypertrophy, which means those cellsin their belly, compensator enlarged,
and also other as inner outerthighs, other undesired errors.
So this is a real philosophy andit's a real scientific medical
phenomenon and that's whywe've been able to use it in,
we've been taking a bad thing,a paradoxically bad thing,
(08:46):
and we've grabbed it andwe've used it for us.
Now we have the power in our hands byusing those fat cells and actually putting
'em into good placesto get a better result.
That makes a lot of sense. Sohow do you use this in practice?
What are the most common applications?
Yeah, so that's where wetake it. I started, this is how we started our journey.
(09:08):
I started, I had a patient and Ijust did straightforward liposuction.
This guy was jacked,
but he just had a little bit of extrafatter around his abs and he was trying to
get his abs really enunciated, tryingto get more definition. So I thought,
this is great. I studied all mybooks and I saw where the linea is,
the transverse inscriptions,the semi liners,
(09:31):
which are the side inscriptions.And so I had everything,
I did all my liposuction and he justdidn't get the projection of his abs that
he wanted.
And I realized I always do all mythinking in the shower because in the
shower, that's when my brain calms down.
And I have this idea that why you sleep?
(09:53):
Your body's trying tosolve all these problems,
but when you wake up with that alarm,
you immediately forget everything.So when you jump in the shower,
the shower technology hasa lot of runs over you.
The things that you're thinkingabout and you're solving.
These problems rise to thesurface and you're shower.
And I get a lot of my ideas whenI'm taking a shower in the morning,
shower technology, and that's whenI got this and I still get them.
(10:15):
That's when I got this idea
that we're going to use structural fatto increase projection in those areas.
So I started putting justa little bit on top of
each little abdominal packetto make those project,
and I took the same patient back. Isaid, listen, I'm going to do this.
I'm going to do this for freebecause I feel like I let you down.
(10:39):
And he was so happy.
He kept on sending me pictures ofhow great he looked at the gym.
We were able to give themthat extra projection.
So what I did is I extended that. Istarted injecting everything, chest,
shoulders traps into thebiceps triceps, forearms,
the glutes, the gluteal augmentation,
(10:59):
that's our body bankingbrady butt lift and
also into the calves in other areas. Soit's really been sort of a revolution.
And I don't miss a drip. Like I said,
rarely do I not do it. And after,
usually it's the wife or the boyfriendthat's against it because they don't
really understand, they haven't readit and they just think all fat is bad.
(11:22):
And once I explained thephilosophy and they get it,
and we even have a whiteboard video on
YouTube that explains two brothers,one brother has body banking,
the other brother has traditionalliposuction and we'll watch after surgery.
The brother that went first,he ends up getting belly fat
(11:45):
and the guy that had body bankingdoesn't get the belly fat and
instead his shoulders getwider after surgery. So
the two twin brothers have dramaticallydifferent physiques and post operative
experience. And let me tellyou, after you've had it,
my guys get so charged up that theywork harder at the gym than they've ever
(12:07):
worked before because theyreally got a great kickstart.
So now we're doing it for all differentareas and the patients are very
happy with it.
This is really intriguing tome. I'm curious to know more.
So what are the most commonages and does utility vary by
age? What do we know about fattake by age and grafting overall?
(12:30):
That's excellent question because thatreally does have something to do with it.
We notice in younger people that more fat
sticks around than in older people,
and it just has to do with senescenceand the quality and the vigor of
those individual cells that we transplantand also blood supply and other things
(12:50):
like that. So younger peopledo have a better take,
which is great. In fact,
this is a fantastic story of amedical student for some reason.
I get a lot of doctors when wedo body, I think they understand,
they completely get the idea about
(13:11):
compensatory atrophic cellularhypertrophy or catch fat.
They completely see themetabolic reasons for it.
But this was a medicalstudent and I did his,
one of my first patients and I tookall the fat out and I put it all
upstairs.
He wanted what we call the triple play.He wanted an lateral posterior deltoid.
He wants the deltoids upper in herchest and he wanted those traps.
(13:34):
And I saw him like sixmonths later and was,
he was a nervous eater.
And so he was in themiddle of finals. I said,
how's things going withyour medical finals?
I think he was like a third orsecond year medical student.
He had physiology and allthat kind of stuff he said,
(13:56):
or introduction to clinical medicine,ICM, but he was all stressed out. I said,
"well, at least you'vehad time to go to the gym.
Your shoulders are huge and your chestlooks great." And he said, "no." He said,
"I haven't had anything. And
he said, I haven't been ableto work out in two months.
(14:19):
And I've been stresseating." He put on 40 pounds.
But because we did the bodybanking in those areas,
he looked massive.And it wasn't from working out,
it was from everything that Ihad transplanted into the muscle.
I have another great story from,
this is another patient thatwent to California when I just,
before I started my California practice,
(14:40):
this is a California guy that flew allthe way to New York so that we could do
put in calf implant or put inglue implants and pec implants.
We'll talk about that at the end.
But I also did a littleliposuction and I was like, "well,
what the heck are we going todo with it?" And he said, "well,
don't throw it away.
You can plug it into thebiceps and the triceps." And
(15:01):
so he came back six monthslater and sure enough,
his chest had healed, chest lookedgreat, the glutes look great.
And I looked at himand I was really angry.
I was really ticked off.And I said,
I just reached out and I felt his biceps.And I said, "I did this great job.
(15:23):
I mean, weren't you happywith the pec implants?
Were you happy with thegluteal implants? I said, why?
It looks like you went somewhere toget calf implants and to get bicep
implants?" And he said,
"no," and this is where thatmoment where you get chills.
And he said, "no, you said that youwere going to put some fat in there,
(15:44):
some cells in there".And it looked fantastic.
And I got these chills becauseit was like, holy moly,
this really works after that.
So that was a eureka moment.
It was a eureka moment. I was like, well,let's just do this. See what happens.
And it worked so much that I was jealous.I thought he went to somebody else.
(16:06):
But it was a great surprise and I stillget chills thinking about it now because
it was such an exciting day.
And that's when I just started doingit for everyone in all these different
areas. So it's a really exciting moment.
Wow, that's really great. Overall,
would you say is this moreuseful for men or for women then?
Or is it more or lessuniversal based on biology?
(16:30):
It's universal, but I'd say, likeI said before, sort of jokingly,
women are interested in four bumps,
but men are interested in two bumps infront, two bumps in back. But women,
men are interested in all sorts of bumpsall over the place. And so for men,
it really works well because we canuse it as a detail sculpting tool,
which you can also do for women, but wecan use it for the shoulders, the traps,
(16:55):
the chest,
all those other areas that we don'tnecessarily think about as much for women.
Now I've got a little bitof a challenging question,
and of course as Americans,a lot of us are overweight,
so there's fat available,
but not everyone walks inoverweight or with a fat
depot that you can access.
(17:16):
So what do you do in patientswho don't have fat to work with
and they want to build a body shape?
Yeah,
this is a significant challengebecause occasionally I come in and we
have in New York, they're all fromChelsea. So these guys are ripped.
They do not have an ounce of faton their body. There ain't none.
(17:41):
And then out in LA, it's inWeHo, it's in West Hollywood.
All the guys down there, they alldo yoga, they all do spin class,
they all hit the weights. A lot ofthem are on just a little bit of test,
not necessarily growth hormone,
but just a little bit of testosteronethat's totally legit that their doctor
gives them just to get theirnatural endogenous testosterone
(18:04):
levels up. So those guys though,they are rip. There is no fat,
there is no depot. And for those people,
they would just bedisappointed if we do it.
And these are a few of the exceptionswhere I don't do it. I do as much as I
can,
but it's not enough to give them thevolume that they want in all those areas.
For those people, what wedo are we use implants.
So it's interesting because everybody,
(18:27):
all the women and all the girlfriendsand all the guys and all their
girlfriends, their wives, their mothers,
they all know that if they want largerbreasts that they can just go get breast
augmentation with the plasticsurgeon. And that is a okay,
because everybody, they look great.
They're fun and it makes them feel good.
(18:48):
That's why they come,makes 'em feel attractive,
gives them more optionsand fit into more things.
But the dudes don't realize thatthey can have that too. So men,
if they don't have fat,
what we can do is we can do augmentationwith a pec implant, bicep implant,
tricep implant, shoulder implants,
even traps. I created abimplants that really are natural
(19:12):
appearing, gluteal implants,quad implants and calf implants.
I don't think I left anything outwhile we also have chin cheek,
jawline implants. So prettymuch all those areas,
if we don't have fat, or even if you do,sometimes you may not have enough fat.
And for those patients, and a lot oftimes, I'll give you a classic example,
(19:35):
had a guy that came infrom, flew all the way in.
He and our buddy flewin from Singapore and
this guy was ripped and I knew thatthere was not going to be a drop.
And I said, we'll seewhen you get into town,
we had planned for both for body bankingand implants. Turns out he had no fat,
(19:56):
but what he needed, hisbiceps, pecs and glutes.
So I was able to putin the gluteal implant
and the bicep implant,
and then he came back to have the pecimplant. So couldn't do those both at the
same time because you want to reston your backside for your pecs,
you want to rest on yourfront side for your glutes.
So the two incisions and thetwo postoperative courses competed with each other,
(20:20):
but we put in his glutesand his biceps. He was very,
very pleased and we wereable to do it without
using any fat. And then the secondstory is a guy that was a bodybuilder,
but he hurt his back and he had a prettysignificant back injury and he wasn't
able to work out with heavyweights and he really missed,
(20:40):
he had a lot of clothes,
he had a lot of just regularpolos and t-shirts and
things, and none of hisshirts he could fit in to.
And in one sitting for him,
I was able to put in pec implant,deltoid implant, bicep implant,
and a forearm implant. And that'sgenerally what we do. We do them in pairs,
(21:01):
we put in all the arms and legs.
We have paired muscles, so bicepstriceps, two heads to the forearms,
two heads to the quads andtwo heads to the calves.
So what we'll do is half of the paired,
so patients might fly in from SouthAmerica and I'll put in a bicep,
one head of the forearm, one head ofthe calf and one head of the quad.
(21:22):
Then they come back and we'llput in the other paired muscle.
And the reason why we do that isto put in a good size implant,
but then allow the swelling to go downso that we can put on a good size implant
on the other side. And we don'trun into problems of having
compromised blood supply because toomuch swelling on both sides of the bone.
(21:43):
But for this gentleman that came inwith a back injury, I was able to,
and he could walk around,he was fine with that.
He just couldn't lift heavy weights.I was able to put a forearm,
a bicep, shoulder and chest,
and then four hours he was back to,
he felt able to get back into theclothes that he used to be wearing.
(22:04):
So silicone implants are a great optionfor those challenging cases when people
don't have their own endogenous fat cells.
Okay, that's great. So you've touchedon this a little bit previously,
but let's dive a bit deeper.
What are the main procedures or attributesthat are targeted in body banking and
men?
For most guys, by the way, wecould do it in face as well.
(22:26):
If men are interested, some of the guysare interested in having more structure.
And while we're taking thefat out of those areas,
a lot of times I'll use itfor jawline augmentation,
we'll use it for cheekbone augmentation,
maybe even some areas that are a littlebit lacking, like the nasolabial folds.
(22:47):
Or even with lips, guys don't wantbig lips. They don't want lips like
Kylie Jenner kind of withlooks like sucked out a bottle or something like that.
They don't want the DSLs. What theywant is though, as men get older,
one of the signs of aging is theirlips lose volume and they get really,
really thin.
And we're not doing any give anybodyduck lips or Kylie Jenner lips.
(23:10):
That's not why we do it,particularly in the men,
because the men don't want to look done.Where we do is just put in a little bit
to bring them back to back 10 years wheretheir lips were a little bit fuller,
a little bit more youthful.
This is an important tinydetail that people forget
about as they get older,their lips thin out.
But the major areas thatwe put in for the guys is
(23:35):
really, they usually wantin a couple different areas.
There are guys that are more upper bodyguys and there are guys that are more
quarterback guys that want tohave bigger glutes, more glutes,
more maybe more projection.
They may even want to have thosebody banking gluteal muscles that
have a sexy concavity on the side andhave good projection or maybe a guy that
(23:58):
kind of wants that roundspeedo kind of backside.
So that's glutes are a big spot.
Another big spot is what I call thetriple play. Triple play for the dudes is
it's all about the upper bodyand it's about the cobra back.
The back is the back are the new abs.
Everything used to be the biceps, thenit was the chest, then it was the abs.
(24:19):
Now it's the back. Every guy, every guy,
and I don't care if you're straightor gay, every guy appreciates a man
that likes a big strong back.
Women love a guy that has a big strongback and that cobra back has wide
shoulders and a slender waist.
So what I do is I end up popping itinto the shoulders, anterior lateral,
(24:40):
posterior deltoids up into the traps,maybe even a little bit into the lats.
And I forgot that's another area thatI can put in silicone implant into that
area. If you have no fat,
but to give you that big wide upperbody is going to make your waist look
smaller. So the guys loveto put it in that area.
(25:00):
Okay, got it. So now for the other half,what are the main procedures for women?
For women? So when wedo body bank in women,
usually most commonly wouldbe going into the gluteal
area.
It doesn't mean we're not talkingabout this Kardashian era or that
there's that pretty girl that
(25:22):
has a huge backside whereshe needs to ask for
two airplane tickets to be able to fit in.
She's got a tiny waist and just a hugeback derrière not necessarily talking
about that for women, what they may want,
and these are even those ladiesout in South Hampton, East Hampton,
and they go to the beaches inConnecticut and out in New Jersey.
(25:47):
They want just something that has alittle bit of more volume so the tissues
aren't falling. So I think in fact,
I will say that the Kardashiansmoved back on how much volume,
it became a race for how big it can getand how small it can get. And that ratio
of how tiny a waist and how bigyou can get your glutes for the
(26:07):
women is going away. We'removing away from the diaper butt.
Women don't want that.
I want that less people areactually having that reversed.
The same people that put itin now are priding themselves.
I'm not one of those people that arepriding themselves on taking it back out.
Look at me while you'rethe person that put it in.
(26:28):
But everyone's movingaway from that. But still,
I get the women that they'revery shapely and they have
their slender and havelittle pockets of fat,
but we want to put in the glutesnot to make them big, no thing,
but to lift any saggyskin. So that's number one.
Number two would be alittle bit in the breast.
(26:49):
Now you have to know with the breastsand not as much for whatever reason,
Dr. Bass will back you up on this.It's not a great site.
And this is something that you haveto know in general about fat grafting,
which a lot of people, even doctors don'tknow. Some areas are, two different.
We're going to planta seed and these seed,
these 10 seeds we're goingto plant in the jungle,
(27:10):
all 10 of them are going to growinto beautiful tropical trees.
These 10 seeds we're going toput in the middle of the desert.
How many of those seeds aregoing to grow? Not a lot. Well,
the same thing holds true forthe different parts of your body.
And it's really about one of the mainfactors is about the hospitality locally,
the milieu of the local recipient site,
(27:30):
which is served somethingthat was not intuitive,
but I can tell you and surgeons thatdo a lot of this know that if you
put the fat cells in the glutes that yourretention is probably going to be 40,
50 or even 60% better than if you putin the breast. So that's the other area
that I was getting to is a lot ofwomen want to put in the breast,
(27:52):
but you have to overcorrect in the breasta great deal to get your final result
because we just haven't cracked the code.
The little secret to have more ofthose cells survive in the breast,
no matter what surgeon does it, nomatter what technique that surgeon uses,
you can throw the cells up onthe ceiling, scrape 'em off,
mix 'em in with potato dust. They're not,
(28:14):
the retention is not going to be as goodin the breast as it is in the buttock
area.
And part of that is theamount of blood supply or the
capacity, like you said, fertile soil.
You can plant a lot of seeds. And in anarid desert, you can only plant a few.
And in fact, the more you putdown to compete for blood supply,
(28:36):
the less fat take you may have versus
putting a staged approachwhere you come back,
the fat that went in the first time isgoing to have biological effects that
amplify the blood supply inthe area and we're coming to
biology in fat.
(28:57):
But by creating someneovascularization new blood
supply, when you come back instage two to graft more fat,
you may succeed better than justputting a whole bunch more in one stage.
And I completely agree with Dr. Bass,
and one example I have is withpatients who have Poland disease,
(29:19):
which is a fascinating genetic diseasewhere they may be missing part of their
pec muscle or all their pec muscle,
an extreme phenotypic expressionmay be missing their entire arm.
More commonly in men sometimes happensin women as well where they're missing an
entire breast or part of it. Forthese patients, I was struggling,
struggling putting in implants byfound because they were not very well
(29:40):
developed. They sometimes didn'thave a developed lymphatic system,
and it was common to get fluid collectionsaround the implant after placing
these,
switched strategy andnow we graft first layer
and the purpose of the, first of all,I say we're going to do three graft,
that's it, or we're notgoing to do it at all.
(30:01):
And it's just some people's expectations.And so first layer is just to get
enough cells, and this is exactlywhat Dr. Bass was just talking about,
just to get enough cells in thereso it gets the skin off the bone.
And then you may develop a little bit of a
lymphatic bridge or developsomething that was lacking.
(30:23):
But really what you do is get some goodvascular supply and you create a space
that you can put in more cells. And thenafter the second and third grafting,
that's where we really seeit. So the first piece,
it's not for the first grafting,
that's to lay the bed and then it's thesecond and the third grafting is where
we see the magic happen.
Okay, that's really interesting.
So far we've mostly focusedon aesthetic features.
(30:46):
What do we know about themetabolic impacts of body banking?
Yeah, I mean, well,
I actually spoke at Columbia
University instead ofthe country a few years
ago,
and they asked me to speak because theywere really interested and they were
doing a grant to the NIH.
(31:07):
And what they're trying to do is they'retrying to look about how can we have
less visceral fat? Becausevis fat, belly fat,
fat behind your abdominal wall isassociated with increased rates
of mortality, of diabetes,
of joint disease,
of high blood pressurecorrelates with heart attacks.
(31:29):
So just all those fat,all those bad things.
So what I was doing is I was taking that
fat out,
but I wasn't throwing it awaybecause if you threw it away,
then you would end up having increased
visceral fat, which could increaseyour chances of all those problems.
(31:53):
So they were actuallyinterested in having me speak,
and I didn't speak to the plastic surgerydepartment who asked me to speak was
the Department of Metabolism. It wasthe diabetes department because they're
trying to figure out how all this visceralfat works and their NIH grants behind
this. So I spoke with them,
it was my honor to be able tospeak as a demo plastic surgeon
(32:14):
to a bunch of really smartypantsmetabolism people. And they got it.
They totally got it. Theyunderstood how this would work.
They understood the math behindit. And in fact, I'm working on,
when you talk about themetabolism, I'm working on
a mathematical formula and this formula is
(32:36):
by how many fat cells do
we suck out, meaning howmany in ccs of fat cells,
and then how much do weneed to increase or decrease
our caloric intake or ourcaloric output based on
how much fat cells we removed.
(32:58):
To be able on the other side of theequation to maintain either your
current body weight or yourcurrent physique. And I think we're going to get it
to the point where we can figure out,if I tell you this is your weight,
this is your height, this is the amountof fat that we took out in terms of CCs,
a certain concentration, this isthe amount that we bank back in,
(33:20):
subtract those and put in your heightand weight and then determine how
much you would need to increase ordecrease in terms of caloric burn or
decrease caloric intake. And I think theones that we do with the body banking,
you're going to find that there's notthat much difference because we've kept
all the cells there. But the problem is,
(33:42):
and this is why I'm making this formula,
is I want to tell the people that don't.
So if you come into my office and youtell me that you're not going to do this,
I'm going to plug in mylittle equation, okay,
this is what you are notgoing to bank it. Okay,
so this is how much we plan to takeout. This is how much you weigh.
This is how tall you areby my calculations, after you've had this surgery,
(34:03):
you have to decrease your caloricintake by 10% or and increase
your burn rate by 15%.
Or you're definitely goingto have visceral fat.
You're definitely going tobecome a lipo second cripple.
You want to change your mind aboutdoing the body banking or not.
So this is really interesting and in alot of ways it parallels what's happened
(34:24):
and what's about to happen withthe GLP-1 medications Ozempic like
medicine. So we started with liposuction,we took fat out and threw it away.
And now we recognize that yourproportion of subcutaneous and
visceral fat changes when you do that.
And not in a good way.With the Ozempic like
(34:48):
medicines, now as FDA goesforward with new products,
they're looking increasinglyat not weight loss,
but fat loss versus muscleloss because we really don't
want to lose muscle. Andthey're looking at, again,
subcutaneous fat loss versus thatvery metabolically active fat
(35:11):
loss. Visceral fat loss,
which is what those medicationsin part target because
of the receptor sensitivity of thevisceral fat to those medications.
So it's interesting that thepharmacologic weight loss
progress in some ways is parallelingwhat's already happened with
(35:34):
surgical body contouring in the recent
past.
Yeah, it's really interesting.
And I think we're going tocontinue in terms of the GLP-1
copycats,
I think we're going to reallyfind out some interesting things
coming forward in termsof both fat metabolism or
(35:57):
interestingly, as a sidebar,
playing around with the molecules tomaybe have an impact on satiating your
desires and other thingssuch as drug abuse or
gambling or other bad habits that peoplemay have. So it's really fascinating,
those medicines.
It's a whole new world for sure.
(36:19):
Absolutely.
This is really interestingoverall. So Dr. Steinbrech,
do you have any thoughts for the future?
What research is going on andwhat's the future for body banking?
Yeah, I think really the future iscontinue to do it in more areas,
to be better about it, to be able,
what we really need to do is controlthose sites to try and help the desert
(36:43):
to grow the tropical treesjust as well as the jungle
does.
And I think that that is really what weneed to do also to be able to predict in
a better way which areasare going to do better.
And to that notion,
I've had patients or other doctors callme in a panic and I've even had to take
care of some of those patients wherethey actually put in too much fat
(37:05):
underneath the,
underneath the lids in younger patientsbecause they are used to operating in
older patients and they underestimatehow much fat survives underneath the
eyelids.
So we need to be better about figuringout how to control it. The other things
that were really interesting, Ialways wanted to do a twin study.
(37:26):
I always wanted to a couple of studies.
One is to
inject the fat from,
or actually to look at twotwins. And with one twin,
we only do liposuction alone. And thenthe other twin, we do the body banking,
sort of like my whiteboard video.
(37:46):
And then we feed them a lot of Pringles,
no, actually some good carbs.And we see the difference.
And I think we would see inthose two identical twins,
I think we would see that the one thatdidn't have body bank would have a lot
more visceral fat after putting on 40pounds. They have to sign up for that.
(38:06):
I can't, I'm not allowed toforce feed them on my own.
They have to do it voluntarily.
But we would see some real difference interms of muscle mass in the areas that
were banked versus the gentlemanwho doesn't get it. Now the problem
is how are you going to find a twin?It's sort of like the aspirin study.
How are you going to sign up people forthe aspirin study and tell them not to
(38:29):
take aspirin after we see thepositive effects of taking
aspirin on strokes and heart attacks.They had to just stop the study.
So how do you find in the twin study,
and there's a place in Ohio wherethey have a twins festival every year,
and I just wanted to zip down there andsee who would sign up for this study.
But we would have to get somebodywho would actually sign up to be a
(38:53):
non body banker knowing that theymay have more visceral fat or they
don't get that good sexy volume,
or they may give visceral fat in thefuture because it's really your insurance
policy to make sure that that doesn'tcome later on as mother nature plays
with those testosterone and estrogenlevels that we talked about before.
(39:14):
Those are really interestingpoints to consider. And Dr. Bass,
would you like to add any takeaways?
So just to review,
Dr. Steinbrech has explainedto us this innovative
concept that he's developed of bodybanking where instead of removing fat
and discarding it,
the fat is removed in aliposuction like process,
(39:36):
but is then placed orbanked in areas that give
us good aesthetic applicationsthat enhance our body
appearance and our body shape,
and help us maintain a stable metabolism.
This is certainly particularlyimportant in the slightly overweight,
(39:58):
slightly beyond the twenties patient
who wants to focus onmaintaining and not gaining
visceral fat.
And the other important thing aboutbody banking compared to other
approaches to body contouring isthat when we were talking about
(40:20):
gluteal fat grafting,
I mean there's a lot of aestheticshapes you can pursue in the gluteal
area depending on youraesthetic goals. Fat banking,
body banking gives you theflexibility to shape the way you
want.
It's a very flexible material to
(40:43):
work with,
and Dr. Steinbeck saidthe clay of the body.
But that shaping flexibility isreally important when you're trying to
fine tune aesthetic goals.
There's some role for this inhow we will control the aging
metabolism that we'relearning more and more about
(41:06):
both as part of plasticsurgery and as part of
endocrine and metabolic medicine.
So I'd like to thank Dr.Steinbrech for again joining us on
the podcast and for taking us throughhis thought process and experience
with this cutting edge approach toaesthetic plastic surgery. Thank you,
(41:29):
Dr. Steinbrech.
Yeah, thanks so much for having me.
It's been really fun hour and Ilike to talk about these things.
It just makes me think of more thingsthan more ideas. So thanks for having me.
Thank you,
Dr. Steinbrech for returning to thepodcast to share this really interesting
innovation with us.
Thank you.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
(41:52):
Follow us on Apple Podcasts,
write a review and sharethe show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you.
Send us an email atpodcast@drbass.net or DM us on
Instagram @drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator and technology innovator.
The title of today'sepisode is "Body Banking:
(00:23):
Why It's Better to KeepIt." Okay. Dr. Bass,
I feel like I need a definitionhere. Can you help me out?
The idea here is that sometimeswe think we want something,
but it may not be as goodan idea as it sounds.
There might be a paradoxical effect thatgives us exactly what we don't want,
(00:45):
and looking at things from a differentpoint of view can sometimes give us some
insight and result in anew approach to things.
So we're talking about body fat here andwhether or not we want to get rid of it
or keep it and why. Andthis started, as I said,
from rethinking the baselinenotion that fat is bad and we
(01:07):
want to get rid of it.
I brought the Innovative Mind thatdeveloped this new approach to explain.
Dr. Douglas Steinbrech is a boardcertified plastic surgeon who trained
at NYU at the Institute ofReconstructive Plastic Surgery,
the same department that I trained in.
He's a master of body contouringand minimally invasive approaches in
(01:31):
plastic surgery.
He's been especially active indefining plastic surgery for men,
including editing the seminaltextbook on the subject,
which is titled MaleAesthetic Plastic Surgery.
He was gracious enough to ask me towrite a chapter in that textbook on cheek
augmentation with implants andfiller. Dr. Steinbrech, welcome.
(01:55):
Hey, thanks so much. I'mreally pleased to be here.
It sounds like it'll be a fun topic.
Welcome back to thepodcast, Dr. Steinbrech.
Thanks.
So Dr. Bass really didn't explain it.
He teased me with that idea thatgetting rid of fat might be bad.
Can you explain body banking furtherand how you came upon the idea?
(02:15):
Yeah,
it was actually kind of anexciting thing because before that,
we touched on this a little bit before,
but what we were doing in the sixtiesand seventies and eighties really,
liposuction came along inthe eighties and nineties,
started in France and then madeits way over to the United States.
(02:35):
But what we were doing is just removingfat. And while we were doing that,
we didn't really think aboutit. People just thought, oh,
being skinnier is better,
but they didn't think about what wouldbe like Dr. Bass sort of mentioned maybe
there's some kind ofparadoxical problem with it.
And what we found after we did more andmore of it is that if you suck out all
(02:58):
the fat, then a couple things can happen.Number one, if you think about it,
it's just all about the numbers. Andif we think about removing fat cells,
first of all,
you have a limited number of fat cellsafter you turn 18. There's a certain
number that we all have in our body andthey just get bigger and smaller sort of
going from grapes toraisins, grapes to raisins.
(03:21):
And every year as you loseweight and gain weight,
they go back and forthfrom grapes to raisins.
So you might imagine if youweigh a hundred pounds wet
and then you bloom up to400 pounds, you'd think, oh,
I made a lot of new fatcells. You really didn't.
You just made largerpreexisting fat cells.
And then when you lost all that weight,
conversely it's the samenumber of fat cells,
(03:42):
but they just all got very small. Soonce you start thinking about that,
you start thinking sort of moving fatcells around your body is sort of like
moving hair cells,hairs around your scalp.
You're not really removing them. Ifyou remove them and put them away,
you're not going to be in as good asshape as if you take them out and put them
(04:04):
somewhere else.And we started thinking that direction.
We started to think aboutthe fat cells as clay.
And I always say it at theend of any of my talks,
we do a lot of talking aroundthe country and around the world.
We just finished our national conferencein Vancouver and then I have to
run off to, I guess CartagenaColombia's next in June,
(04:27):
and then we're doing going toGreece in August and then in
October down to Australia. So a lot ofrunning around talking about this stuff.
But what we've learnedwhen we spread the idea,
and this is what I say to everybody,
is that we need to use these cellsand we need to think about it as clay.
And I tell all the doctors andthe residents coming along,
(04:50):
if you are at this point, if you arethrowing away all your fat, which I don't,
I really only once or twice a yearout of the thousands of cases,
hundreds of thousands of cases that we do,
it's only once or twice a year.And it's a very special instance that we
actually don't do it.
Usually the patients doesn't have fatcells that are large enough at all.
(05:10):
But I do banking for everything becauseI believe that this structural fat,
this structural clay is theclay that helps me get a better
result and helps me get a better resultthan the surgeon that's across the
street. And we have a lot ofplastic surgeons on Park Avenue,
Dr. Bass knows that.And same thing with our
(05:33):
practice in Los Angeles. When Istarted doing the men, really,
we had so many men and we saw thatthere was demand with this that we
started a Beverly Hills officeand then a Chicago office. So
there is a demand for this, and thisis why I like to talk about this.
I like to encourage othersurgeons to do this,
(05:55):
but I really feel bodybanking is important because
for two different reasons.First of all, like I said before,
the clay I can subtract and then add toother areas so I can give the patient a
more artistic athletic resultlike a sculptor is doing.
The sculptor never just takesthe clay and throws in the fat.
(06:16):
But the other real reason isthe second part of the equation,
and that is we're starting to learnabout really what happens to those fat
cells postoperatively. Andas I've been watching this,
and I've been learningabout this, I've developed,
I've looked at a lot of patientsthat we call liposuction cripples.
(06:36):
What are liposuction cripples?Those are gentlemen that have,
or women that they have toomuch time and too much money.
So they spend a lot of theirtime at fancy restaurants and
at fancy plastic surgeonsall over Europe and all over
South America. And when you seethese patients come in for the men,
(06:58):
they've had liposuction fouror five, six different times,
and they all look like they're membersof the same family. All their backs are
like a tiny little waist and then theirbelly is out to here. Well, why is that?
Because those doctors,three or four times,
they keep on sucking the subcutaneous,that's of fat underneath the skin out.
(07:18):
They keep on sucking it out andsucking it out and sucking it out.
But unless the patientafter surgery decreases
their caloric intake or increasestheir caloric burn, guess what?
The fat cells left behind, well,
compensatorily enlarge.
So if I have liposuction and I go inthe restaurant and I'm eating those
(07:41):
same rich sauces and I'm having icecream every the same 10 gallons of
ice cream every night, well,I always tell my patients,
I tell the other doctors those calories,
those carbs from that Netflix ice creamdon't just pass through you. No, no, no.
They're going to swim around the bodyuntil they find fat cells. And that's
(08:01):
where the fat cells storethem. So all those patients,
all those liposuction and cripples,
they're still skinny back here becausethose fat cells have been removed,
but they're nine months pregnantbecause the only cells left over are the
visceral fat cells and theycompensatorily enlarge.
We have a name for that that's calledrebound fat or a funny technical name
called "catch fat,"compensatory atrophic cellular
(08:26):
hypertrophy, which means those cellsin their belly, compensator enlarged,
and also other as inner outerthighs, other undesired errors.
So this is a real philosophy andit's a real scientific medical
phenomenon and that's whywe've been able to use it in,
we've been taking a bad thing,a paradoxically bad thing,
(08:46):
and we've grabbed it andwe've used it for us.
Now we have the power in our hands byusing those fat cells and actually putting
'em into good placesto get a better result.
That makes a lot of sense. Sohow do you use this in practice?
What are the most common applications?
Yeah, so that's where wetake it. I started, this is how we started our journey.
(09:08):
I started, I had a patient and Ijust did straightforward liposuction.
This guy was jacked,
but he just had a little bit of extrafatter around his abs and he was trying to
get his abs really enunciated, tryingto get more definition. So I thought,
this is great. I studied all mybooks and I saw where the linea is,
the transverse inscriptions,the semi liners,
(09:31):
which are the side inscriptions.And so I had everything,
I did all my liposuction and he justdidn't get the projection of his abs that
he wanted.
And I realized I always do all mythinking in the shower because in the
shower, that's when my brain calms down.
And I have this idea that why you sleep?
(09:53):
Your body's trying tosolve all these problems,
but when you wake up with that alarm,
you immediately forget everything.So when you jump in the shower,
the shower technology hasa lot of runs over you.
The things that you're thinkingabout and you're solving.
These problems rise to thesurface and you're shower.
And I get a lot of my ideas whenI'm taking a shower in the morning,
shower technology, and that's whenI got this and I still get them.
(10:15):
That's when I got this idea
that we're going to use structural fatto increase projection in those areas.
So I started putting justa little bit on top of
each little abdominal packetto make those project,
and I took the same patient back. Isaid, listen, I'm going to do this.
I'm going to do this for freebecause I feel like I let you down.
(10:39):
And he was so happy.
He kept on sending me pictures ofhow great he looked at the gym.
We were able to give themthat extra projection.
So what I did is I extended that. Istarted injecting everything, chest,
shoulders traps into thebiceps triceps, forearms,
the glutes, the gluteal augmentation,
(10:59):
that's our body bankingbrady butt lift and
also into the calves in other areas. Soit's really been sort of a revolution.
And I don't miss a drip. Like I said,
rarely do I not do it. And after,
usually it's the wife or the boyfriendthat's against it because they don't
really understand, they haven't readit and they just think all fat is bad.
(11:22):
And once I explained thephilosophy and they get it,
and we even have a whiteboard video on
YouTube that explains two brothers,one brother has body banking,
the other brother has traditionalliposuction and we'll watch after surgery.
The brother that went first,he ends up getting belly fat
(11:45):
and the guy that had body bankingdoesn't get the belly fat and
instead his shoulders getwider after surgery. So
the two twin brothers have dramaticallydifferent physiques and post operative
experience. And let me tellyou, after you've had it,
my guys get so charged up that theywork harder at the gym than they've ever
(12:07):
worked before because theyreally got a great kickstart.
So now we're doing it for all differentareas and the patients are very
happy with it.
This is really intriguing tome. I'm curious to know more.
So what are the most commonages and does utility vary by
age? What do we know about fattake by age and grafting overall?
(12:30):
That's excellent question because thatreally does have something to do with it.
We notice in younger people that more fat
sticks around than in older people,
and it just has to do with senescenceand the quality and the vigor of
those individual cells that we transplantand also blood supply and other things
(12:50):
like that. So younger peopledo have a better take,
which is great. In fact,
this is a fantastic story of amedical student for some reason.
I get a lot of doctors when wedo body, I think they understand,
they completely get the idea about
(13:11):
compensatory atrophic cellularhypertrophy or catch fat.
They completely see themetabolic reasons for it.
But this was a medicalstudent and I did his,
one of my first patients and I tookall the fat out and I put it all
upstairs.
He wanted what we call the triple play.He wanted an lateral posterior deltoid.
He wants the deltoids upper in herchest and he wanted those traps.
(13:34):
And I saw him like sixmonths later and was,
he was a nervous eater.
And so he was in themiddle of finals. I said,
how's things going withyour medical finals?
I think he was like a third orsecond year medical student.
He had physiology and allthat kind of stuff he said,
(13:56):
or introduction to clinical medicine,ICM, but he was all stressed out. I said,
"well, at least you'vehad time to go to the gym.
Your shoulders are huge and your chestlooks great." And he said, "no." He said,
"I haven't had anything. And
he said, I haven't been ableto work out in two months.
(14:19):
And I've been stresseating." He put on 40 pounds.
But because we did the bodybanking in those areas,
he looked massive.And it wasn't from working out,
it was from everything that Ihad transplanted into the muscle.
I have another great story from,
this is another patient thatwent to California when I just,
before I started my California practice,
(14:40):
this is a California guy that flew allthe way to New York so that we could do
put in calf implant or put inglue implants and pec implants.
We'll talk about that at the end.
But I also did a littleliposuction and I was like, "well,
what the heck are we going todo with it?" And he said, "well,
don't throw it away.
You can plug it into thebiceps and the triceps." And
(15:01):
so he came back six monthslater and sure enough,
his chest had healed, chest lookedgreat, the glutes look great.
And I looked at himand I was really angry.
I was really ticked off.And I said,
I just reached out and I felt his biceps.And I said, "I did this great job.
(15:23):
I mean, weren't you happywith the pec implants?
Were you happy with thegluteal implants? I said, why?
It looks like you went somewhere toget calf implants and to get bicep
implants?" And he said,
"no," and this is where thatmoment where you get chills.
And he said, "no, you said that youwere going to put some fat in there,
(15:44):
some cells in there".And it looked fantastic.
And I got these chills becauseit was like, holy moly,
this really works after that.
So that was a eureka moment.
It was a eureka moment. I was like, well,let's just do this. See what happens.
And it worked so much that I was jealous.I thought he went to somebody else.
(16:06):
But it was a great surprise and I stillget chills thinking about it now because
it was such an exciting day.
And that's when I just started doingit for everyone in all these different
areas. So it's a really exciting moment.
Wow, that's really great. Overall,
would you say is this moreuseful for men or for women then?
Or is it more or lessuniversal based on biology?
(16:30):
It's universal, but I'd say, likeI said before, sort of jokingly,
women are interested in four bumps,
but men are interested in two bumps infront, two bumps in back. But women,
men are interested in all sorts of bumpsall over the place. And so for men,
it really works well because we canuse it as a detail sculpting tool,
which you can also do for women, but wecan use it for the shoulders, the traps,
(16:55):
the chest,
all those other areas that we don'tnecessarily think about as much for women.
Now I've got a little bitof a challenging question,
and of course as Americans,a lot of us are overweight,
so there's fat available,
but not everyone walks inoverweight or with a fat
depot that you can access.
(17:16):
So what do you do in patientswho don't have fat to work with
and they want to build a body shape?
Yeah,
this is a significant challengebecause occasionally I come in and we
have in New York, they're all fromChelsea. So these guys are ripped.
They do not have an ounce of faton their body. There ain't none.
(17:41):
And then out in LA, it's inWeHo, it's in West Hollywood.
All the guys down there, they alldo yoga, they all do spin class,
they all hit the weights. A lot ofthem are on just a little bit of test,
not necessarily growth hormone,
but just a little bit of testosteronethat's totally legit that their doctor
gives them just to get theirnatural endogenous testosterone
(18:04):
levels up. So those guys though,they are rip. There is no fat,
there is no depot. And for those people,
they would just bedisappointed if we do it.
And these are a few of the exceptionswhere I don't do it. I do as much as I
can,
but it's not enough to give them thevolume that they want in all those areas.
For those people, what wedo are we use implants.
So it's interesting because everybody,
(18:27):
all the women and all the girlfriendsand all the guys and all their
girlfriends, their wives, their mothers,
they all know that if they want largerbreasts that they can just go get breast
augmentation with the plasticsurgeon. And that is a okay,
because everybody, they look great.
They're fun and it makes them feel good.
(18:48):
That's why they come,makes 'em feel attractive,
gives them more optionsand fit into more things.
But the dudes don't realize thatthey can have that too. So men,
if they don't have fat,
what we can do is we can do augmentationwith a pec implant, bicep implant,
tricep implant, shoulder implants,
even traps. I created abimplants that really are natural
(19:12):
appearing, gluteal implants,quad implants and calf implants.
I don't think I left anything outwhile we also have chin cheek,
jawline implants. So prettymuch all those areas,
if we don't have fat, or even if you do,sometimes you may not have enough fat.
And for those patients, and a lot oftimes, I'll give you a classic example,
(19:35):
had a guy that came infrom, flew all the way in.
He and our buddy flewin from Singapore and
this guy was ripped and I knew thatthere was not going to be a drop.
And I said, we'll seewhen you get into town,
we had planned for both for body bankingand implants. Turns out he had no fat,
(19:56):
but what he needed, hisbiceps, pecs and glutes.
So I was able to putin the gluteal implant
and the bicep implant,
and then he came back to have the pecimplant. So couldn't do those both at the
same time because you want to reston your backside for your pecs,
you want to rest on yourfront side for your glutes.
So the two incisions and thetwo postoperative courses competed with each other,
(20:20):
but we put in his glutesand his biceps. He was very,
very pleased and we wereable to do it without
using any fat. And then the secondstory is a guy that was a bodybuilder,
but he hurt his back and he had a prettysignificant back injury and he wasn't
able to work out with heavyweights and he really missed,
(20:40):
he had a lot of clothes,
he had a lot of just regularpolos and t-shirts and
things, and none of hisshirts he could fit in to.
And in one sitting for him,
I was able to put in pec implant,deltoid implant, bicep implant,
and a forearm implant. And that'sgenerally what we do. We do them in pairs,
(21:01):
we put in all the arms and legs.
We have paired muscles, so bicepstriceps, two heads to the forearms,
two heads to the quads andtwo heads to the calves.
So what we'll do is half of the paired,
so patients might fly in from SouthAmerica and I'll put in a bicep,
one head of the forearm, one head ofthe calf and one head of the quad.
(21:22):
Then they come back and we'llput in the other paired muscle.
And the reason why we do that isto put in a good size implant,
but then allow the swelling to go downso that we can put on a good size implant
on the other side. And we don'trun into problems of having
compromised blood supply because toomuch swelling on both sides of the bone.
(21:43):
But for this gentleman that came inwith a back injury, I was able to,
and he could walk around,he was fine with that.
He just couldn't lift heavy weights.I was able to put a forearm,
a bicep, shoulder and chest,
and then four hours he was back to,
he felt able to get back into theclothes that he used to be wearing.
(22:04):
So silicone implants are a great optionfor those challenging cases when people
don't have their own endogenous fat cells.
Okay, that's great. So you've touchedon this a little bit previously,
but let's dive a bit deeper.
What are the main procedures or attributesthat are targeted in body banking and
men?
For most guys, by the way, wecould do it in face as well.
(22:26):
If men are interested, some of the guysare interested in having more structure.
And while we're taking thefat out of those areas,
a lot of times I'll use itfor jawline augmentation,
we'll use it for cheekbone augmentation,
maybe even some areas that are a littlebit lacking, like the nasolabial folds.
(22:47):
Or even with lips, guys don't wantbig lips. They don't want lips like
Kylie Jenner kind of withlooks like sucked out a bottle or something like that.
They don't want the DSLs. What theywant is though, as men get older,
one of the signs of aging is theirlips lose volume and they get really,
really thin.
And we're not doing any give anybodyduck lips or Kylie Jenner lips.
(23:10):
That's not why we do it,particularly in the men,
because the men don't want to look done.Where we do is just put in a little bit
to bring them back to back 10 years wheretheir lips were a little bit fuller,
a little bit more youthful.
This is an important tinydetail that people forget
about as they get older,their lips thin out.
But the major areas thatwe put in for the guys is
(23:35):
really, they usually wantin a couple different areas.
There are guys that are more upper bodyguys and there are guys that are more
quarterback guys that want tohave bigger glutes, more glutes,
more maybe more projection.
They may even want to have thosebody banking gluteal muscles that
have a sexy concavity on the side andhave good projection or maybe a guy that
(23:58):
kind of wants that roundspeedo kind of backside.
So that's glutes are a big spot.
Another big spot is what I call thetriple play. Triple play for the dudes is
it's all about the upper bodyand it's about the cobra back.
The back is the back are the new abs.
Everything used to be the biceps, thenit was the chest, then it was the abs.
(24:19):
Now it's the back. Every guy, every guy,
and I don't care if you're straightor gay, every guy appreciates a man
that likes a big strong back.
Women love a guy that has a big strongback and that cobra back has wide
shoulders and a slender waist.
So what I do is I end up popping itinto the shoulders, anterior lateral,
(24:40):
posterior deltoids up into the traps,maybe even a little bit into the lats.
And I forgot that's another area thatI can put in silicone implant into that
area. If you have no fat,
but to give you that big wide upperbody is going to make your waist look
smaller. So the guys loveto put it in that area.
(25:00):
Okay, got it. So now for the other half,what are the main procedures for women?
For women? So when wedo body bank in women,
usually most commonly wouldbe going into the gluteal
area.
It doesn't mean we're not talkingabout this Kardashian era or that
there's that pretty girl that
(25:22):
has a huge backside whereshe needs to ask for
two airplane tickets to be able to fit in.
She's got a tiny waist and just a hugeback derrière not necessarily talking
about that for women, what they may want,
and these are even those ladiesout in South Hampton, East Hampton,
and they go to the beaches inConnecticut and out in New Jersey.
(25:47):
They want just something that has alittle bit of more volume so the tissues
aren't falling. So I think in fact,
I will say that the Kardashiansmoved back on how much volume,
it became a race for how big it can getand how small it can get. And that ratio
of how tiny a waist and how bigyou can get your glutes for the
(26:07):
women is going away. We'removing away from the diaper butt.
Women don't want that.
I want that less people areactually having that reversed.
The same people that put itin now are priding themselves.
I'm not one of those people that arepriding themselves on taking it back out.
Look at me while you'rethe person that put it in.
(26:28):
But everyone's movingaway from that. But still,
I get the women that they'revery shapely and they have
their slender and havelittle pockets of fat,
but we want to put in the glutesnot to make them big, no thing,
but to lift any saggyskin. So that's number one.
Number two would be alittle bit in the breast.
(26:49):
Now you have to know with the breastsand not as much for whatever reason,
Dr. Bass will back you up on this.It's not a great site.
And this is something that you haveto know in general about fat grafting,
which a lot of people, even doctors don'tknow. Some areas are, two different.
We're going to planta seed and these seed,
these 10 seeds we're goingto plant in the jungle,
(27:10):
all 10 of them are going to growinto beautiful tropical trees.
These 10 seeds we're going toput in the middle of the desert.
How many of those seeds aregoing to grow? Not a lot. Well,
the same thing holds true forthe different parts of your body.
And it's really about one of the mainfactors is about the hospitality locally,
the milieu of the local recipient site,
(27:30):
which is served somethingthat was not intuitive,
but I can tell you and surgeons thatdo a lot of this know that if you
put the fat cells in the glutes that yourretention is probably going to be 40,
50 or even 60% better than if you putin the breast. So that's the other area
that I was getting to is a lot ofwomen want to put in the breast,
(27:52):
but you have to overcorrect in the breasta great deal to get your final result
because we just haven't cracked the code.
The little secret to have more ofthose cells survive in the breast,
no matter what surgeon does it, nomatter what technique that surgeon uses,
you can throw the cells up onthe ceiling, scrape 'em off,
mix 'em in with potato dust. They're not,
(28:14):
the retention is not going to be as goodin the breast as it is in the buttock
area.
And part of that is theamount of blood supply or the
capacity, like you said, fertile soil.
You can plant a lot of seeds. And in anarid desert, you can only plant a few.
And in fact, the more you putdown to compete for blood supply,
(28:36):
the less fat take you may have versus
putting a staged approachwhere you come back,
the fat that went in the first time isgoing to have biological effects that
amplify the blood supply inthe area and we're coming to
biology in fat.
(28:57):
But by creating someneovascularization new blood
supply, when you come back instage two to graft more fat,
you may succeed better than justputting a whole bunch more in one stage.
And I completely agree with Dr. Bass,
and one example I have is withpatients who have Poland disease,
(29:19):
which is a fascinating genetic diseasewhere they may be missing part of their
pec muscle or all their pec muscle,
an extreme phenotypic expressionmay be missing their entire arm.
More commonly in men sometimes happensin women as well where they're missing an
entire breast or part of it. Forthese patients, I was struggling,
struggling putting in implants byfound because they were not very well
(29:40):
developed. They sometimes didn'thave a developed lymphatic system,
and it was common to get fluid collectionsaround the implant after placing
these,
switched strategy andnow we graft first layer
and the purpose of the, first of all,I say we're going to do three graft,
that's it, or we're notgoing to do it at all.
(30:01):
And it's just some people's expectations.And so first layer is just to get
enough cells, and this is exactlywhat Dr. Bass was just talking about,
just to get enough cells in thereso it gets the skin off the bone.
And then you may develop a little bit of a
lymphatic bridge or developsomething that was lacking.
(30:23):
But really what you do is get some goodvascular supply and you create a space
that you can put in more cells. And thenafter the second and third grafting,
that's where we really seeit. So the first piece,
it's not for the first grafting,
that's to lay the bed and then it's thesecond and the third grafting is where
we see the magic happen.
Okay, that's really interesting.
So far we've mostly focusedon aesthetic features.
(30:46):
What do we know about themetabolic impacts of body banking?
Yeah, I mean, well,
I actually spoke at Columbia
University instead ofthe country a few years
ago,
and they asked me to speak because theywere really interested and they were
doing a grant to the NIH.
(31:07):
And what they're trying to do is they'retrying to look about how can we have
less visceral fat? Becausevis fat, belly fat,
fat behind your abdominal wall isassociated with increased rates
of mortality, of diabetes,
of joint disease,
of high blood pressurecorrelates with heart attacks.
(31:29):
So just all those fat,all those bad things.
So what I was doing is I was taking that
fat out,
but I wasn't throwing it awaybecause if you threw it away,
then you would end up having increased
visceral fat, which could increaseyour chances of all those problems.
(31:53):
So they were actuallyinterested in having me speak,
and I didn't speak to the plastic surgerydepartment who asked me to speak was
the Department of Metabolism. It wasthe diabetes department because they're
trying to figure out how all this visceralfat works and their NIH grants behind
this. So I spoke with them,
it was my honor to be able tospeak as a demo plastic surgeon
(32:14):
to a bunch of really smartypantsmetabolism people. And they got it.
They totally got it. Theyunderstood how this would work.
They understood the math behindit. And in fact, I'm working on,
when you talk about themetabolism, I'm working on
a mathematical formula and this formula is
(32:36):
by how many fat cells do
we suck out, meaning howmany in ccs of fat cells,
and then how much do weneed to increase or decrease
our caloric intake or ourcaloric output based on
how much fat cells we removed.
(32:58):
To be able on the other side of theequation to maintain either your
current body weight or yourcurrent physique. And I think we're going to get it
to the point where we can figure out,if I tell you this is your weight,
this is your height, this is the amountof fat that we took out in terms of CCs,
a certain concentration, this isthe amount that we bank back in,
(33:20):
subtract those and put in your heightand weight and then determine how
much you would need to increase ordecrease in terms of caloric burn or
decrease caloric intake. And I think theones that we do with the body banking,
you're going to find that there's notthat much difference because we've kept
all the cells there. But the problem is,
(33:42):
and this is why I'm making this formula,
is I want to tell the people that don't.
So if you come into my office and youtell me that you're not going to do this,
I'm going to plug in mylittle equation, okay,
this is what you are notgoing to bank it. Okay,
so this is how much we plan to takeout. This is how much you weigh.
This is how tall you areby my calculations, after you've had this surgery,
(34:03):
you have to decrease your caloricintake by 10% or and increase
your burn rate by 15%.
Or you're definitely goingto have visceral fat.
You're definitely going tobecome a lipo second cripple.
You want to change your mind aboutdoing the body banking or not.
So this is really interesting and in alot of ways it parallels what's happened
(34:24):
and what's about to happen withthe GLP-1 medications Ozempic like
medicine. So we started with liposuction,we took fat out and threw it away.
And now we recognize that yourproportion of subcutaneous and
visceral fat changes when you do that.
And not in a good way.With the Ozempic like
(34:48):
medicines, now as FDA goesforward with new products,
they're looking increasinglyat not weight loss,
but fat loss versus muscleloss because we really don't
want to lose muscle. Andthey're looking at, again,
subcutaneous fat loss versus thatvery metabolically active fat
(35:11):
loss. Visceral fat loss,
which is what those medicationsin part target because
of the receptor sensitivity of thevisceral fat to those medications.
So it's interesting that thepharmacologic weight loss
progress in some ways is parallelingwhat's already happened with
(35:34):
surgical body contouring in the recent
past.
Yeah, it's really interesting.
And I think we're going tocontinue in terms of the GLP-1
copycats,
I think we're going to reallyfind out some interesting things
coming forward in termsof both fat metabolism or
(35:57):
interestingly, as a sidebar,
playing around with the molecules tomaybe have an impact on satiating your
desires and other thingssuch as drug abuse or
gambling or other bad habits that peoplemay have. So it's really fascinating,
those medicines.
It's a whole new world for sure.
(36:19):
Absolutely.
This is really interestingoverall. So Dr. Steinbrech,
do you have any thoughts for the future?
What research is going on andwhat's the future for body banking?
Yeah, I think really the future iscontinue to do it in more areas,
to be better about it, to be able,
what we really need to do is controlthose sites to try and help the desert
(36:43):
to grow the tropical treesjust as well as the jungle
does.
And I think that that is really what weneed to do also to be able to predict in
a better way which areasare going to do better.
And to that notion,
I've had patients or other doctors callme in a panic and I've even had to take
care of some of those patients wherethey actually put in too much fat
(37:05):
underneath the,
underneath the lids in younger patientsbecause they are used to operating in
older patients and they underestimatehow much fat survives underneath the
eyelids.
So we need to be better about figuringout how to control it. The other things
that were really interesting, Ialways wanted to do a twin study.
(37:26):
I always wanted to a couple of studies.
One is to
inject the fat from,
or actually to look at twotwins. And with one twin,
we only do liposuction alone. And thenthe other twin, we do the body banking,
sort of like my whiteboard video.
(37:46):
And then we feed them a lot of Pringles,
no, actually some good carbs.And we see the difference.
And I think we would see inthose two identical twins,
I think we would see that the one thatdidn't have body bank would have a lot
more visceral fat after putting on 40pounds. They have to sign up for that.
(38:06):
I can't, I'm not allowed toforce feed them on my own.
They have to do it voluntarily.
But we would see some real difference interms of muscle mass in the areas that
were banked versus the gentlemanwho doesn't get it. Now the problem
is how are you going to find a twin?It's sort of like the aspirin study.
How are you going to sign up people forthe aspirin study and tell them not to
(38:29):
take aspirin after we see thepositive effects of taking
aspirin on strokes and heart attacks.They had to just stop the study.
So how do you find in the twin study,
and there's a place in Ohio wherethey have a twins festival every year,
and I just wanted to zip down there andsee who would sign up for this study.
But we would have to get somebodywho would actually sign up to be a
(38:53):
non body banker knowing that theymay have more visceral fat or they
don't get that good sexy volume,
or they may give visceral fat in thefuture because it's really your insurance
policy to make sure that that doesn'tcome later on as mother nature plays
with those testosterone and estrogenlevels that we talked about before.
(39:14):
Those are really interestingpoints to consider. And Dr. Bass,
would you like to add any takeaways?
So just to review,
Dr. Steinbrech has explainedto us this innovative
concept that he's developed of bodybanking where instead of removing fat
and discarding it,
the fat is removed in aliposuction like process,
(39:36):
but is then placed orbanked in areas that give
us good aesthetic applicationsthat enhance our body
appearance and our body shape,
and help us maintain a stable metabolism.
This is certainly particularlyimportant in the slightly overweight,
(39:58):
slightly beyond the twenties patient
who wants to focus onmaintaining and not gaining
visceral fat.
And the other important thing aboutbody banking compared to other
approaches to body contouring isthat when we were talking about
(40:20):
gluteal fat grafting,
I mean there's a lot of aestheticshapes you can pursue in the gluteal
area depending on youraesthetic goals. Fat banking,
body banking gives you theflexibility to shape the way you
want.
It's a very flexible material to
(40:43):
work with,
and Dr. Steinbeck saidthe clay of the body.
But that shaping flexibility isreally important when you're trying to
fine tune aesthetic goals.
There's some role for this inhow we will control the aging
metabolism that we'relearning more and more about
(41:06):
both as part of plasticsurgery and as part of
endocrine and metabolic medicine.
So I'd like to thank Dr.Steinbrech for again joining us on
the podcast and for taking us throughhis thought process and experience
with this cutting edge approach toaesthetic plastic surgery. Thank you,
(41:29):
Dr. Steinbrech.
Yeah, thanks so much for having me.
It's been really fun hour and Ilike to talk about these things.
It just makes me think of more thingsthan more ideas. So thanks for having me.
Thank you,
Dr. Steinbrech for returning to thepodcast to share this really interesting
innovation with us.
Thank you.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
(41:52):
Follow us on Apple Podcasts,
write a review and sharethe show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you.
Send us an email atpodcast@drbass.net or DM us on
Instagram @drbassnyc.
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