Pushing the limits of what's possible in plastic surgery [Matthew Nykiel, MD & Mark Epstein, MD]

Eva Sheie (00:00):
You're listening to Where Before Meets After. What's on the horizon. I heard yesterday that there's some really interesting things happening with fat in terms of products that are filler that are made from fat.

Dr. Nykiel (00:13):
Were you talking my boy, Dr. Johnny Franco? Was he in here talking about that product?

Eva Sheie (00:18):
I think it was Adam Clay.

Dr. Epstein (00:22):
AlloClae?

Eva Sheie (00:22):
Yeah. AlloClae.

Dr. Epstein (00:22):
Yeah, AlloClae is a product by Tiger Medical and what they do is they take cadaveric fat, they process it and it looks like fat, like you're ready to inject it and it comes in syringes. It's sterile, it's not immunogenic. It totally safe to inject, but the advantage to it is if you have small areas to augment, you can use this as an alternative to doing a surgical procedure where you have to use liposuction to harvest fat and then process it and then inject it. So for small areas, it's easier on the patient and may even be cost-effective

Dr. Nykiel (00:55):
In the problem. We're trying to body balance people. Either we have too much fat or we have too little fat, and sometimes if we're really strapped for fat, this is a great option because there have been times where you say, if we're trying to target, maybe get a rounder hip, get rounder hip dip. I don't think implants are a great option for that. And there'd be many times where we just said, look, in the US we really don't have a good option for you. I wish I could offer you something, but it's just not here yet. And now it seems that that is at least becoming more of an option. I think the important point about AlloClae too is just to point out it is FDA research approved. We're actually going to be one of the people that going to be able to offer it early also, but we have that conversation with people too. Hey, this is FDA research approved, so when people ask you what are the negatives that could happen, I just very honestly and bluntly say, that's why we're testing it. You're giving me that look, right? It's a little bit of a moment.

Eva Sheie (01:44):
It's early.

Dr. Nykiel (01:44):
Yeah, yeah. It's a little bit of a moment. You sort step back and you're like, oh, wait a minute. That's why I'm getting this tested on me. Do I want to go through that? And some people just like giving a risk. Do you put all the money down on black on roulette or do you not? Do you let it ride or not?

Eva Sheie (01:58):
I'm so old, I had a friend get Restylane in her lips before I even had heard the word Restylane. So I mean what year was that? 2003?

Dr. Epstein (02:06):
Yeah, well go back to about 1965 or so. It was a very brave woman who got

Eva Sheie (02:11):
Breast implant

Dr. Epstein (02:12):
The breast implant.

Eva Sheie (02:13):
Lindsey.

Dr. Epstein (02:13):
Yeah, that's right.

Eva Sheie (02:14):
I've written about her many times.

Dr. Nykiel (02:15):
Crazy, right?

Eva Sheie (02:16):
She's one of my heroes.

Dr. Nykiel (02:18):
I stop and I think about that and it's just so interesting. Then you think there are businesses that will fly you up into a plane and push you out of there with a parachute on and you sign up for it. So it's just amazing the will of human beings to try things that could potentially have very adverse complications and we are all better because of it pretty well.

Dr. Epstein (02:38):
But the thing is to do it in a controlled and safe fashion.

Dr. Nykiel (02:40):
There is one other thing on the horizon I think for body contouring and that is sort of the next level. And if we think about this skin, we've been removing it. Fat, we've been liposuctioning it now we've been giving it back. Muscles, we've been figuring out ways to augment it either by adding a little bit of fat in or putting implants in, and so next portion in trying to body balance is actually the bones. And there have been some developments or there's been some work again mainly out of South America and Central America of seeing can you safely, and that's the key word, reposition or basically control break people's ribs to reshape them and it's ongoing. I don't think you could give it the thumbs up that it's fully been vetted a hundred percent. I'd say it's been looked at pretty heavily for the past, say two years, three years. And again, you've got some people willing to pioneer in that space and you've got people willing to be tested on in that space.

Dr. Epstein (03:33):
This is a revisiting of an older idea where people would actually remove lower ribs, the entire lower rib, which is a radical procedure and not a benign procedure.

Dr. Nykiel (03:44):
That was the main issue is that there was severe consequences, cuz you could frequently get into lungs except your ribs have very important structures behind them. I mean obviously, but that was the issue with it.

Dr. Epstein (03:55):
As plastic surgeons, we do procedures with great frequency and skill, but we also are very well trained as surgeons to know what lies on the other side of where we're working. You're doing a breast augmentation, you're doing a capsulectomy, you got to know not how to get into the chest, things like that. We're very trained for this and we know what to do if things happen as well.

Eva Sheie (04:19):
Where is that headed? Where are we going with the rib thing?

Dr. Nykiel (04:22):
I don't know. I have been going to the talks throughout the world and it is seeming that as the individuals are doing them more and more, it's becoming a more reproducible and safer procedure, but love to hear Mark's opinion too. But there is that point where you say like, well, each time we push that envelope and we start doing on bigger and bigger changes, the negative to that is there's just bigger and bigger possibilities for complications that are much more grave, and I think that's kind of where we're at right now. I think that's sort of the general consensus of this is just, Hey, wait a minute. I get it. You've gotten it now to a point that's pretty, that's reproducible and seems to be relatively safe based on clear data.

Dr. Epstein (05:00):
Yeah, it's risk and benefit and you have to see how you can do it in a safe manner that you can teach to other surgeons who can reliably do it safely. If you just have a handful of surgeons who do it well and do it safely and other people are doing it and getting into trouble, then it's not a good operation.

Dr. Nykiel (05:18):
I'd like to piggyback off that because I think the other issue slash concern is there appears to be a learning curve with it, right? Like anything life, there's learning curves, anything we do, the question is just what are the negative complications during that learning curve? I think that's really where we're at right now with the rib remodeling restructuring, is just how are we going to be able to get people to learn and educate in a way that we can avoid these major complications during the learning curve. What would you say? That's fair, Mark?

Dr. Epstein (05:47):
Yeah, definitely. Absolutely.

Eva Sheie (05:49):
Alright, give me your Instagram, your website, and where to find you.

Dr. Epstein (05:52):
Epsteinplasticsurgery.com and our Instagram, DR.mark MARK Epstein. You can find me on Long Island in Hauppauge. It's in Suffolk County

Dr. Nykiel (06:03):
And I am a SoCal plastic surgeon. Matt Nykiel in Newport Beach.

Eva Sheie (06:07):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.