Well with Arielle Lorre - 121: The Truth About Lipo, BBL + Other Body Procedures with Dr. William Rahal

Episode Date: July 21, 2021

In this episode I’m talking to Dr. William Rahal, a board certified plastic surgeon in Beverly Hills who specializes in breast augmentation, 360 lipo, and BBL. We discuss what these procedures are and how common they have become; how social media is affecting the popularity of body procedures; the prevalence of lipo and BBL among public figures; why celebrities lie and mislead the public regarding the work they’ve had done; how we can both love ourselves and get enhancements; what can go wrong with an inexperienced or unethical provider; the best treatments for cellulite and skin tightening, and so much more.    www.helloned.com/BLONDE for 15% off your first one-time order or 20% off your first subscription plus free shipping www.get-base.com/blondefiles for 20% off your first month of membership www.blublox.com/BLONDE for 15% off your order plus free shipping www.sakara.com/BLONDEFILES for 20% off your first order   Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The following podcast is a dear media production. Hey, welcome to the Blond Files podcast. I'm your host, Ariel Lori, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits. I know there is so much information out there, so I'm here to help you navigate it all and live your best life. Thanks for listening.

Let's get into it. Hi, everybody. Welcome to the show. Today I'm talking to Dr. William Rahal. He is a board certified plastic surgeon in Beverly Hills, who specializes in 360 lipo and BBL. That is Brazilian butt lift. Dr. Rahal's signature technique in Brazilian butt lifts is to use 360 degree liposuction

around the body to ensure a beautiful hourglass figure for all of his patients. So at face value, this may seem like an episode about, of course, lipo and BBL. But we get into some really interesting discussions, including the mental phenomenon of always wanting more, no matter what your surgical outcome is. We also talk a lot about how misleading people like the Kardashians and the Hadid's and other public figures who allegedly have had surgery, how misleading it is when it comes to the work that they've had done. You will hear his take on it about halfway through. It's really interesting. And we also talk a lot about the emotional part of having surgery. He has a pretty refreshing attitude about his patient's attitudes going into surgery,

and he's very straightforward. He explicitly says, if I think you're trying to fix something internal with this surgery, I'm going to tell you to go to therapy. And I think so often people are trying to fix an internal thing with an external solution. So people are probably not expecting to hear. that coming from their potential surgeon, but somebody has to say it. So we also talk a lot about procedures that I have done. We talk about what can go wrong with BBLs, like the girl from Newport Beach who died last year, which was very sad. And then at the end, we talk about best treatments for concerns like loose skin and cellulite and answer some of your questions. So make sure to stay tuned for that. And with that, enjoy Dr. William Rahal. All right, welcome Dr. Rahal.

so excited to chat with you today. Thank you, Ariel. It's good to be here. So to start, why don't you just tell the listeners if they're not familiar with you in your work, what you do, what your specialty is, and all of that? I'm a board certified plastic surgeon in Beverly Hills, and I specialize in 360 LIPO with fat transfer to the buttock, also known as BBL, right? The infamous BBL. And that's what I do most of that in combination with other body contouring procedures, skin tightening breastwork.

You explain to everybody just before we dive into everything exactly what the BBL is. I'm sure most people are familiar, but just in case there's a subset of people who either don't live in L.A. or Miami or where it's really popular. Right, right. For those who don't live in the geography where it's an essential service. Yeah. Los Angeles and Miami. So 360 lipo-v-BL, it's really two things are happening. One is lipo or liposuction, which is a pretty dramatic procedure to really bring in your waist,

create a tight waistline, take out all the fat from your back. So the 360 lipo is a very, like I said, comprehensive approach to just take all the fat out. Top to bottom, right, it's all out. Tiny waste. That's the take home. Then the fat transfer. So, you know, and I found that it's almost universal. that my patients, women, even men, it's kind of they all want to look good in clothing,

have a small way. So that's part one. Part two is now what do we do with the fat, right? What do we do with the precious fat? And this is where it gets interesting. So, you know, this is where there's more, I think, diversity, depending on culture, ethnicity, age, in terms of what people want to do with the fat. So we inject some of it in the buttock underneath the skin. And, and, you know, and, you And we expand the buttock, we make the buttock bigger. But what's not talked about as much as the hips. So I think, you know, BBL is kind of not the best name. You say it's a Brazilian butt lift.

And it's not a great name because, number one, it really didn't come out of Brazil. Two, it doesn't lift you. And three, it's not just about your butt. It's also about your hips. So to summarize, we take out all the fat. You get a tiny waistline. We build up your buttock. We give you more projection.

And then plus or minus we do the hips. But like I said, I think the hips are not talked about a lot, but it's, I mean, it's major. It's a game changer. And a lot of what I do is not only the buttock, but how much do you want to expand your hips? How curvy do you want to be? And when I say hips, I'm talking about from the top all the way down past the mid thigh. So you go pretty low with these transfers to really kind of build up an hourglass, that lower body, so that you look curvier from the front. It's all about that visual, Ariel, you know, that curvy from the front, that silhouette from,

the front, that's what it's about. So I'm curious how long you've been doing this and how you have seen the trend change or take off in the past few years because, I mean, I remember like years ago when Kim Kardashian was first getting famous. And I can't remember what show she went on, but they did the x-ray or the ultrasound or whatever of her butt. And she said, no, no injections or no implants. And everybody was like, oh, okay. And at that time, it was like such a novel thing. seemed like she was so unique in having this. I mean, of course, hers is huge too. But at the time, it didn't seem like it was as common as it is now. So how long have you been doing this? Were you doing it before it became more mainstream? And how have you seen it take off for change in

the last few years? Yeah, I think to your point, you're right. I think, you know, Kim Kay, for better or for worse, you know, definitely was one of the trendsetters. I've been doing this for about six years. I moved to LA from New York City in 2015, and I really started doing this in 2016, so about five, five and a half years. And, you know, it's interesting. What I've noticed is just how universal the appeal is. So while, you know, Instagram may glorify or Kim Kay may glorify like a certain genre person, you would say, you know, a certain age or demographic or look, the reality is that, like I said, the appeal is universal. I get anywhere from 18. to 68, 69 year olds.

I get, you know, moms of four, a young girl just finery. I mean, you name it. Transgender is huge. Transgender feminization. So I think the trend I've seen is that it's not just this thing for like young girls who don't have kids who like, hey, I want to have a bigger button and be on Instagram. I think that's kind of like the cliche that's popularized on social media.

You know, what I see is that, like I said, it's ubiquitous. all ages, all demos, all ethnicities. They all come in and they, I'm not saying they all want the same thing, but there's this universal appeal to being curvy or to having an hourglass or to having a small waist with some variance, like I said, in the hips. So like I said, I think the trend is that it's just getting bigger. I see everyone kind of wants it. And it's really interesting, like I said, to see all different ages,

ethnicities come in and request it. Yeah, and there are different types, right? So there's like a skinny BBL. There's an athletic BBL. And I think when people hear BBL or think of it, they think of like the extreme, the Kim Kardashian or other public figures that may have done this. So can you describe some of the different types and how it can really be individualized? Sure.

I think it's a great question. And I think part of to answer your question is I always use 3D imaging. So anyone who comes into my office, regardless of what they're asking for, how old they are, they're starting weight, it's first thing we do is scan them. We get a 3D picture and then we literally have an image. If you see that big screen on the back, you know, I can even pull one up if you really want later. We can do that. But so you get scanned. And then what we do is we talk about like, hey, like you said, what do you want, right?

Like, what are you going for? and the waist and the back is like I said, it's pretty standard. Just take out all the fat ring in the waist. And then where it gets interesting is like, to your point on your question is, what are we doing with the buttock? What are we doing with the hips? How much of a transfer? How much are we augmented?

How much expansion? The key words expansion. How much expansion do we really want? So let's break it down. You can get this like petite, I call them yoga moms. So you get the yoga moms that come in. And they're just looking to fill in the hip dip a little bit. So they're just basically looking for like an asian.

shape, athletic built. A lot of time the yoga moms do not want to look curvier from the front. They want to maintain the curve from the back. So really, the main work is on the back. Fill in the hip dip a little bit just so it fills in, but it doesn't project out too much. And then no work from the front. That's a yoga mom. Then you get the average girl who comes in and says, I want to look curvier from the front. I want to have some pretty good size from the back. And that's what we get a little bit more intense on the hip expansion. And we go pretty low. base of the buttock and it gets interesting too they have different shapes you know the heart shape is very popular which is like a bottom heavy butt with a point of maximum projections on the bottom and then it

curves up and there's people who want and these are you know colloquial terms they're not you know medical terms but we got an idea then there's people who want more of like a bubble butt and you know it's interesting what really determines these shapes aerial is the point of maximum projection meaning where is it the widest from behind and if you look at you know 10 girls and you look at their pictures from behind you say well where is it projecting the most is it at the base or at the bottom and then it comes up or is the point of maximum in projection at the mid-buttock so it kind of flares out and then comes back in then we say well what are we doing with the front of the thigh are we changing the way the person looks when you're staring at themselves in the mirror hip-wise

or are we leaving that alone i call it front curves you know do you want front curves you want to look for front. So those are kind of, you know, the topics of discussion where we're filling in the hip dip. How much? Are we going for this yoga mom? Are we just doing, you know, get as curvy as possible? Or are we heart shape, not heart shape? I mean, it's amazing. People, patients walk in and they got some app. I don't, I don't know what kind of app it is, right? But they're like, Doc, this is how I, this is how I'm worth myself. Can you do it? So they're very sophisticated. You know, they're like, They're like drawing on themselves, moving the arrow around, building it up. And they're like, here you go.

How much do you think that has contributed to the popularity? The fact that like the filters and the facetune and the Photoshop and everything, like you can manipulate your body, you know, with the touch of a button on your phone. And you can see what you could look like. I mean, do you think that that's contributed to the popularity at all? Yeah. I always say we live and die by the sword. social media is the sort you know it's the modern day church everyone's on there so absolutely it's

contributed and i say live and die because it yes it's enhanced the popularity of the procedure there's no doubt about it but it also creates some challenges as a surgeon because you have to spend a lot of time explaining to people hey this isn't real you know this has been photoshop let me explain why it's not so half of my time is spent with them and the other half sometimes if they have these pictures, they're saying, well, let me explain why this, what you're seeing on the internet is a Photoshop picture. I'm pretty good at telling them, you know, I could pick it out.

But a lot of this stuff on Instagram, a lot of these girls that, you know, they're glorified or, you know, the inspo picks, I mean, there's no, there's Photoshop, there's no way around it, or they've had two or three procedures, which I tell them too, because, you know, there's a whole other world area if you start talking about round twos. that's a whole right

what are round two is round two is what happens when a round one gets buck greed and comes back for round so round two so round two is basically a patient who comes already had a BBL

and they want more volume because there's only so much expansion and size you can get from one procedure so they come back for round two so sometimes you're like you know you get a petite patient low weight who comes in with this

I want this doctor you know, that looks like a round two. It looks like they Photoshop this a little bit. They took the shadowing out. I can tell the light is off here. So, you know, that's, that's. So yeah, you're right. It popularizes it.

It's definitely enhanced it. But I think as plastic surgeons, it's given us, we have to be a little bit more cognizant and a little bit more aware of this stuff and explain it to them. You know, hey, this is, this is not one surgery. This is not real. Some of this is, yeah, some of this isn't real. If you are anything like me, you may have tried everything to improve certain health issues or symptoms that you're experiencing.

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blue light, go to blue blocks today and get free shipping worldwide and 15% off with the code blonde, that's B-L-O-N-D-E, or go to blueblocks.com, Blonde. That's B-L-U-B-L-O-X.com slash B-L-O-N-D-E. I'm Sheney Grimes Beach. And I'm Annalin McCord. After years spent playing best friends on screen on 902.10. And fighting like hell behind the scenes. Ah, yes. How could I forget? We made it out of our time in Young Hollywood on a show that shared names with the most

iconic zip code in the world. Bonded for life, but not without a shit ton of baggage in tow. Now we are back together letting it all hang out on our new podcast, Zip. Tune in and UnZip with us and our brilliant guests every Wednesday, wherever you listen to podcasts. So I got fat transfer to my face in April. And I'm curious if the BBL experience is similar to that in that I first put it in and I was like, holy shit, this is crazy. I look absolutely insane. And then I went down and I was like, oh, I actually miss that swelling. And then you kind of are like riding this wave of fluctuation. So obviously when you're putting fat in your butt and your hips, whatever,

you're using so much more than you would in your face. I mean, that was such a small amount. But how long until it settles? And what is that healing experience like? Yeah. Well, I hope you're doing well from your procedure. And it's settled to a place that you're satisfied with. I love it now.

It's subtle. Good. So it's a similar experience. I tell my patients, look, I just tell them straight up. It's going to be tremendous. I mean, just get ready for it. The first week is going to be really big. Have fun with it. Take some pictures. Have fun with it. You're going to like the size. You know, it may be a little scary. Like you said, for the significant other, may freak out. You know, I always say I'll walk him off the ledge if he freaks out. Don't worry. Just have them calling me. It will settle because of the swelling. You also lose,

as you're aware, you lose a percentage of fat as time goes on. There's three mechanisms. You know, if you're interested in the science, there's three mechanisms for losing volume. One is that anytime they inject fat in your face or the buttock, there's a very small aqueous component or water component. So automatically, some water gets absorbed. It's not pure, pure, pure fat. In the face, it is more pure than in the buttock. In the buttock, there's probably 15% water that's being injected with the fat. Two, fat cells get smaller. So as you take fat and you put it from your tummy to your buttock, some of those adipocyte, some of those cells actually contract and get a little smaller because the blood supply

is tenuous and they survive, but they shrink. And then the third mechanism for losing volume is apoptosis or cell death or, hey, they die, they shrink and they kind of go away. So on average, I think in face, your retention is going to be a little. little bit higher because it's more of a small volume augmentation and it's more purified. While in the buttock, it's a higher volume, less processed or purified, you're going to lose about 30% to 40%. I tell everyone one month volume stable. So I say have fun with it for a couple of weeks. At a month, your volume is going to be stable. Average patient wishes they had 10% more, but I think

that's just a human thing. I call it Buck Reed. It's just humans. You know, We always want like 10% more. I get it. Yeah. And I know like with the face too, there's diffuse swelling and factors like that. So you get used to seeing it like that and you look like a baby. I mean, and then some of that goes away. But I think that that happens with every procedure.

I'm very open about what I've done. I've had rhinoplasty. I had a brow lift. I've done things over the years. And I think just the nature of it is to like it, but to all. always want a little different, no matter what it is, which is really hard because it's a slippery slope when it comes to doing these procedures on your body, especially when you can do anything now. You can fix anything. And it's like once you have a little taste of that,

I think obviously, you know, you can kind of run with it. Yeah. I mean, do you wish she had 10% more? Yes. Every day. I drive my surgeon. It's also a friend of mine. I think I drive him crazy. Sorry. Can I ask who your surgeon is in Florida? Dr. Mascaro. Oh, Miguel? Yeah.

I actually know him. And I'll, my fiancé went to him for a procedure. She's very open about it too. Yeah. And, you know, she could obviously go anywhere. And she saw some guys in L.A. for a facial procedure. And she ended up going down to him and I spoke to him.

And he's a really cool guy and very down to him. I liked him a lot. Dr. Muscarry, he's good. Yeah, he's great. So, yes, I drive him insane with the pictures. And, like, I actually went back there and I got some stem cells. So we did that in the face. Like, I can't remember what it was called, but he said it was basically like PRP, but like on steroids.

And we did that. PRF? PRF? I'm not sure. I don't even. I'm like, just do everything. Something in there. It'll be all right.

Yeah. Exactly. So I'm curious. you were saying, like, I didn't know about the yoga moms. This is amazing. How common are these procedures, especially in public figures, do you think? I think in public figures, it's a lot more common than you think. Because what I would argue is that with a round one, you know, round one look is people look at you and damn, wow, nice body.

Round two is who's your surgeon. Right. Right? So a lot of the people that public figures that we know, the Kardashians are always that like, right, the kind of the staple image that we think of. But those are round two results for the most part, right? Kim. And they're not my patients. I don't say like, you know, I'm not coming from a place that disclaimer. I'm not their doctor. But when I look at it, in my professional opinion, it's a round two, round three. There's no way you can get that kind of volume from one. So I think there's a lot of people out there. You know, you'd be surprised too in the fitness. And, industry, you know, and I'm not going to get into the philosophical argument of you're cheating or not cheating, but there's a lot of physique competitors, a lot of fitness competitors who are very dedicated, and it's a whole other subgroup of people that are in the gym, working out hard, they're doing the most that they can. But just little stubborn pockets, hey, let's just kind of fill it in, let's do a little touch-up, little finesse work. So there's a lot of public figures walking around.

There's, like I said, a lot of yoga moms. There's fitness people. I think it's, like I said, it's ubiquitous. It's everywhere. Because one surgery, it's like, damn, you look good. It's not, whoa, what did you go do to yourself? Right. It's a whole different book.

Yeah, I mean, I don't know if you saw, I think it was Kylie Jenner, who has been posting a lot of, like, TikToks and Instagram, Snapchat of, like, second workout of the day and Kim doing it too. And I think it does send such a misleading message, especially to, like, young fans who don't know that this stuff exists or don't believe that like their idol would ever do this. And I have this debate a lot. I've had a lot of surgeons on my show. And, you know, I don't know what the solution is because I feel like if these public figures came out and said, like Kylie Jenner, for example, yes, I had a BBL, you know, allegedly I'm not saying she did.

Or two or three or whatever. Exactly. Exactly. Right. Then are like the, 12, 13, 14 year olds going to want to do that too? Or would they realize that this doesn't just happen from doing two workouts a day and, you know, wait for this to happen to them when they hit puberty too? I'm not sure what the right solution is. Yeah, I don't know if there is a right answer because there's so many variables that go into play, especially if you're talking about an adolescent population, which is very impressionable, right? So a 12 to 13 population versus a 25 year old is very different. I think from the celebrity or public figure point of view, I think it has to be an organic decision. So I kind of respect their privacy and their need to maybe keep certain things

private. At the same time, I understand the counter argument where they are, you know, for better or for worse, you are a public figure and people look up to you. So it's important to have some ownership over what things are and what they're not. And that's in the wrong message across. I don't have kids, but, you know, as a 12 or 13 year old, if I had a child, and they knew that their role model had two surgeries. I think that I personally, if it was my kid, I wouldn't have a problem with it. I'd say, look, it's something people do.

You have a healthy discussion with them and just tell them this is something that people do. There's a lot you could do on your own. They shouldn't discourage you from working out. But it's very different. You know, you can never get a surgical result from working out. So it's misleading for everyone to think that you can work yourself out into a 360 BBL result.

It's just not possible. Forget it. So I think they can coexist. I think you can have a very healthy relationship with who you are organically trained. Most of my patients are active. They're in the gym. They're doing all the right stuff.

And at the same time, have an organic, healthy relationship with the idea of an enhancement. So I do think those two can coexist in a healthy way and they're not mutually exclusive. I do too. And this is another thing, that I kind of debate with my guests a lot is where is the line? How can you love yourself

and also want to change things about yourself? And I see it as like, for me at least, I came from a place of like just wanting to enhance certain things, not change how I look or any of that. And, you know, I agree. I think that they can coexist. I think it just really depends on what your motives are. And, you know, obviously it's different if you're like completely changing everything about yourself. Yeah, I think that's a great point where you brought up because now you're talking about the soul and the spirit of a person. And that's, that's powerful. I mean, you know, I have told my patients. I have sat in rooms and talked to people. And after talk, I talked to all my patients for about an hour the first time I meet with them. And I, there's been

times where I say that and I say, hey, you know what? I don't think you love yourself. Like, you have had a lot of traumas and I'm empathetic towards the traumas that you're, you know, that you're sharing with me and thank you for sharing them. But if I'm sitting here and I don't think you love yourself, believe me when I tell you, the surgery is not going to change. It's not going to change how you feel about yourself and you're still going to have, you're going to walk around with the same traumas, you know, the same beliefs. You're going to experience the world the same way that you are now. So this is not going to cure, right, all the stuff you're going through. And I'll tell them you have to be in therapy or you have to get some personal help. So I think you're right.

you could love yourself and feel that love for yourself and be a very joyous, grateful person. And at the same time, say, hey, you know, my come from, what's your come from? Your come from is still one of love, peace, and joy. And hey, you want to do a little soul enhancement or something wrong with that. But if your come from is very unhealthy and you don't love yourself and you're traumatized and you have some stuff that you have to work through, then you're right. It doesn't matter what you do. You're still not going to love yourself.

and maybe some of those people have a proclivity to do too much and keep going and going because no one tells them, no one stops them. Right. No one takes the time to say, look, there's some unresolved traumas. And, you know, this is, right, changing that is not going to fix those things. I bet they're not expecting that when they go in for their BBL consult. No, they're not expecting the Dr. Rahal deep dive. It's such an important distinction, though, because I think,

If you go into it, expecting that you're going to feel differently about yourself after. And sure, you can feel more confident and, like, what you see in the mirror and all of that, that's one thing. But if you're expecting the external change to change the inside, like you're going to be chasing it forever. Yeah, I agree. And it's such a subtle line, Ariel. It's, you know, it's an I don't know. I don't know, I would, I don't know who's who, but I can, you know, I can pick out some of the extremes. Mm-hmm.

You know, and point him out and say, hey, you're not ready for this. but you're right. I wholeheartedly. I tell everyone, you got to love yourself first organically. If you don't, that's cool too, but we got to get you some help. Right. So you can get to a healthier place with who you are. So who is a good candidate for these procedures? Obviously, emotional health needs to be on point. But going back to my experience with the fat transfer, I'm a petite person. I have a healthy BMI, but Dr. Miscarro initially was a little concerned that he wasn't going to be able to get fat.

I reassured him. I have plenty of it. But if you are really petite and you want to get this done and you don't have the BMI or the body fat to support the procedure, I mean, what are the options? Yeah, well, I mean, I'm going to, maybe I'm going to change your life right now. Shock you. For me, everyone's a candidate. I mean, everyone's a candidate.

BMI 18, 19, so you name it. and I can always find fat. Now, the question is, how much do we have, right? But you could take like a BMI 18 physique bodybuilder, right? One of these girls who are very, very lean, I can always find certain pockets of fat, back of the arm, waist, hip roll, inner thigh. So I can harvest 6,700 cc's and just about anyone. And is not going to give them a very dramatic result?

No. But it'll fill in the hip dip. So the question is, you know, for me, that question is not, are you a candidate? or not, the question is, what are you trying to get? And you're right. If you're very small and you walk in and say, look, I want this massive change, then the conversations will gain weight or we can use injectables like Renuva to get you where you want to be. But anyone's a candidate, you know? Interesting. I had no idea. I can, like I said, I do this on very, very small patients and it's no problem. It's just a conversation. You guys know I'm all about nourishing my body with the most

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Hello ned.com, H-E-L-L-O-N-E-D dot com slash blonde, B-L-O-N-D-E, for 15% off your first one-time order or 20% off your first subscription order plus free shipping. In terms of, like, post-operative care, are there any ways that somebody can ensure that they retain a lot of the fat? Also, how is the pain? What are, I mean, should people be doing lymph massage, all of that? There's a lot, yeah, there's a lot of debate on this stuff. The pain, let's just say you're going to be uncomfortable. I tell you, it's going to be annoying for like three to five days.

Plan a week that you're really uncomfortable. Two weeks, you're back to work, back to gym. One month, you have a stable result. You can go out in public. You could photograph at a month. Three months, you're there. Post, I like hyperbarics a lot. Ariel, I'm a big fan of hyperbaric therapy.

So hyperbarics for the listeners. you go into a chamber, it increases your plasma, your blood levels of oxygen. And I think this does a lot for swelling, inflammation, pain, and it helps you keep more fat. I think lymphatic massages help with swelling and inflammation, so that's a good tool. I've actually been experimenting with cryo. I've been sending some of my patients to cryo, like post-op lipos. Make sure anyone listening to this, I don't want them to go and like jump into a cryo chamber a day three. Oh, Dr. Rall said it's okay.

You got to make sure you're not. draining anymore because it'll freeze. And the, you know, if you're draining a little bit, so you've got to be careful with that. But cryo helps. I like to start him at two weeks. So I think all these tools, all these modalities help. My favorite is hyperbarics. My second favorite is lymphatics. My third is cryo. There's some new cool stuff out in lymphatics. There's actually these contactless massages. You may have seen them. One of them is called a balancer pro. It's cool because in the post-COVID or COVID era we're in, having a contactless massage, like a body suit you're going to, is actually pretty practical.

It's nice because it standardizes the treatment to area. What I have found is patients, when I struggle with quality control, right, I have patients from all over the country, outside the country. It's like they fly back to their home state and it's like who's going to do their lymphatics. I mean, I have no idea, like who, right, who's out there. But these medical grade devices are actually really good in that their FDA approved, their medical grade, they have their medical licensure. And it's standardized, right?

You jump into the suit, you go up to a certain degree of pressure, and it's cookie cutter. So I really have liked these newer methods of doing lymphatic dringe that I find to be a little bit more reliable and predictable in terms of the treatment that's being offered. I've seen some pretty gnarly, like post-lipo massage videos. I don't know if it's on TikTok or Instagram, but it looks a little, a little scary, not going to lie. Yeah, they shouldn't hurt. That's another pearl of mine.

Like, I tell people, look, if you're like, if you're like in pain, they don't know what they're doing, just walk out. It shouldn't hurt. It should be a soft massage. You should be soothing. It shouldn't be hurt or gnarly to use your word. Okay. So what about exercise after this procedure?

So, like, again, to use the Kardashian-Gener example, the two workouts a day. At what point might you lose some of the result that you've gotten through surgery? Or do you not really have to worry about it unless you lose like a massive amount of weight? Yeah. I have my patients start at two weeks. I think strength training for your gluteus for your buttoe muscle is paramount. So I say go for it, lunges, squats, anything that builds up your glutes, it's great. You can start at two weeks.

In terms of losing your result, I get a lot of questions about this. And we got to kind of say, let's take it. take a step back and kind of understand fat loss and how that works. It's a calorie thing, right? You probably know there's calories in calories out. So training is part of the equation because when you train and you work out, there's calorie expenditure, but you got to take a step back and say, well, what's your calorie input? So as long as your calories are good and adequate, even if you're training, you shouldn't lose weight. Now, what I would tell someone after is don't go, don't keto, don't go into some restrictive calorie phase, don't intermittent fast, right?

Like two weeks after your surgery goes, yeah, if you go down to 800 calories and start working out, it's not, oh my God, I worked out, I lost my buttock. It's well, you're working out, you're burning calories, you're not eating, so your body's burning fat is fuel. So in general, my advice for post-up is don't calorie restrict for six weeks. Do strength training for your buttock. once you're at six to 12 weeks and your volume is stable, if you want a calorie restrict and just overall lose a little weight, you're okay. But remember, just, you know, exercise is one part of the equation.

I followed the feed the fat plan after I did mine. The first month, I was like, this is amazing. And I just, I mean, I ate probably not more, maybe a little more calorie dense than I normally would and was definitely a little puffier than I am normally. but I was trying to hold on to everything. Yeah, no, I agree. I think your calories should be,

if I could have it my way, I would say about 10 or 15% surplus while you're healing, because when you're healing, it's catabolic. You need nutrients. Your body's breaking down the nutrients that it's intaking. So yes, 10 or 15% calorie surplus is a good idea. So, you know, feed the butt, you know, or do it for the cause, however you want.

Feed the fat. Okay, so we've talked about all the amazing parts of BBL and LIPO and these procedures. What should people be cognizant of going into it? What are some of the things that can go wrong? I know that there have been some kind of famous cases. I know there was a girl on Newport Beach who died recently. I think she had like an embolism on like her second BBL or something like that. She went to South America. So what are some of the dangers of the procedure if somebody is in the wrong hands? Yeah, and it's sad that this stuff is still happening. And it's interesting because we have to go a little bit into some history.

If you go back to like 2017, which is not long ago. So in 2017, if you would go to these plastic surgery meetings and we would talk about, right, bought fat transfer, it would always come up. Can you inject fat in the muscle? And in 2017, you would have a bunch of people yelling at each other at a meeting. And half of the people would be yelling, you can't do it. And the other half would be yelling. You could do it, but you can only do it in this area.

So my point is, before 2018, there is not a consensus of where the fact could be injected. And it was a thought, it was thought that it can be injected safely in the muscle, but it has to be outside of what's called the danger zone. Let's move on, 2018. We got a little bit fancier. We did some cataveric studies actually at a UT Southwestern in Texas, and we said, wait a second, if we inject fat in the muscle, it doesn't matter where it always ends up in the wrong place. And the wrong place is behind the muscle where these big veins sit. So what we found out is that as pressure builds up from the fat being injected into the muscle, that pressure build up actually.

tears the vein. It's a shearing effect. And when the veins tear, fat can siphon in to the blood vessel. And then once it's in that blood vessel, it goes up and it embolizes. So when this, when this information came out in 2018, it was like, I'd say it's very black and white. It's dogmatic. You can't inject fat into the muscle. Like I said, before 2018, there's, oh, no, you just, their surgeons are injecting wrong. They're pointing in the wrong place. They can you has to be bigger. There was all this nonsense we were making up trying to justify like why it was happening. But then we figured it out. So it should be interesting, Ariel, to see there should be a huge decline in cases. It should be zero because now we know from 2018 forward, we know we have that

luxury of knowing that you cannot inject fat inside the muscle. That's a big no-no. It's lethal. So you say, well, why is it still happening? Right? That's that's a million dollar question. Well, why is it still happened? Why have this girl Cano, right, who I'm very familiar with that case. I got a phone call about it. You know, why is she, why did this happen?

So I can't speak for other surgeons, but I can tell you my hypothesis, right? I can guess. One, you could have a surgeon who is not board certified, doesn't know. what he's doing, makes a mistake, and just is reckless. So one, you can have someone who's reckless and just makes a mistake. Two, this is even worse. And I think this is what happens in some places. Again, I'm not saying this happened where that patient went, but maybe this happens in some places is that I think in other countries, they're a little bit more lax on the rules. And surgeons are a little bit more, let's say, loose. And they'll inject fat into the muscle.

and you say, well, why would anyone do that? It doesn't make sense. You go, well, it's one thing and one thing only is volume. So why would anyone keep doing this? Volume, volume, volume. When you inject fat below the skin, the expansion is limited. There's only so much you can get in. So you limit the expansion because the space is finite.

There's only so much you can fill. Let's say, let's just call it 600 Cc's fit underneath the skin. Okay? You go deep into the muscle. Now, whoa, there's so much more space. and we can get these huge butts. So again, why would this happen? Either people just are unethical and they're just, they want to just make bigger buttocks

because that's just the draw. To draw people in, too, they're just reckless. They don't know what they're doing. But any ethical surgeon who's board certified who knows what he's doing is going to keep it sub-Q, he's going to keep it safe and he's going to keep his patient safe because that's paramount in what we do. You know, Hippocratic oath, Ariel, first do no harm. right first do no harm so for anyone listening yeah unfortunately the stuff is still happening

it's all related to intramuscular injection of fat it should never happen it should be a zero event five six years ago it was happening more because we didn't know better and that's the truth but now we know better so if anybody is considering this they should make sure their surgeon is not going to do it under the muscle, right? That's it. The moral of the story. The moral of the story is go to someone who's board certified, trusted, who does this a lot, and you feel comfortable with that.

They're not going to be doing that. Okay. Let's get to some listener questions here. We have a couple minutes. I got a lot of questions about cellulite. Everyone wants to know, what is the best treatment for cellulite? Can LIPO help this? why is there not a more effective treatment?

So cellulite is, it's, you know, I call it the icing on the cake, right? If we can get that fixed, then the BBL just takes it to a next level, right? Surface issue. The cause of cellulite are dense bands that kind of pull in and they pull in from the dermis below the skin down to fascia. So, okay, so you got these dimplings. Thanks, Doc, I get it, but just fix it for me, right? That's all I want to. I just want you to say.

So there's three or four treatment modalities we use right now, and they all have the same mechanism. It's to release the bands. Those tight bands are dimpling in. Let's release them. You could do it mechanically with the cannula. It doesn't work very well with the BBL. So let's just say that's not so good.

Two, there's Salfina, which is an older tool that was out. They used like a fork. So sharp release of the bands didn't work so well. Morpheus, there was a self. a body piece that I have, a deeper one. There's like a black handle. There's a blue handle. The blue is actually deeper. It goes eight millimeters. I've used, so you try radio frequency release. That's what Morpheus is, right? So let's try to zap it. I've had, I've used it a lot. I was one of the first people, docs who had it here because I have a lot of patients who have

cellulite. It worked a little bit, 20, 30 percent improvement. So not a game changer, but helps. The last one now, Ariel's Quo. Quo's an enzymatic release of the bands, right? we went from mechanical to sharp to radio frequency. Now we're using enzymes, right? It's a common theme. How do we break up these things as the dimpling? So now we're using enzymatic release. It's called collagenase, which is not a new product. Collagenase has been around forever, but it's a new application for the product. I think the jury's still out. So for the listeners is, yes, it's a tough problem. We have a lot of toys. They all help a little bit, 20, 30%, but at least in my hands, I think that that's the best I can offer someone to some improvement, but not complete

correction. I think I don't know anyone out there, someone's out there telling you, you can get complete correction. Please call me because I'd love to, I'd love to know what, how they're doing it. I like your honesty. Yeah. I think they'll appreciate that. How effective are less invasive treatments like cool sculpting? Yeah, it's, it's just a whole other world. You know, you got to ask yourself, what are your needs and are my needs going to be met by this tool or this treatment so you'll never look you'll never ever look like a surgical patient from a non-surgical tool so if you want to have a real tiny waist enhanced buttock all that stuff and that's a surgical look you need surgery if you're like well yeah you know I just want to go in for an hour I'll give it a couple tries I just

want to have a little bit shaved down a couple millimeters. Maybe I notice it. Maybe I don't. If I don't notice it, I'm not going to get mad at the doctor. Then try cool scoping. But don't expect, like I said, don't expect a surgical outcome from a non-surgical treatment. Great advice. Okay. So you mentioned obviously you do lipo all over. How do you then tighten after? I almost always use Renuvion. It's very seldom that I don't. So all my 360 BBLs have baser and Renovion, which are two additional technologies that I use just about in everyone. Renovion is radio frequency energy. It's a plasma energy. It works by tightening the collagen below the skin. I think this technology actually works very, very well. I've been using

it for three and a half years now, close to 400 surgeries and very satisfied patients. So right after we're done our lipo, we go back in through the same incisions, we tighten the skin using radio frequency plasma energy, it heats up the tissue and cools it real fast and then everything tightens up. So that's my favorite. I've used them all. I've used that in mode, body tight, you know, you name it. But Nuvion is the one where I've had at least the best results for. And no, I'm not, no disclosures. I'm not on like, you know, I'm not under payroll. Will results last if somebody has bad genetics? Yeah, that's kind of a real open question.

I don't know what bad genetics means, but results are going to last. Well, let's just talk about if results last and why if they don't last, right? So results always last as long as you take care of yourself. So if we do a 360 fat transfer together, you maintain your weight, you don't eat excess calories, then there's no reason why you won't maintain the results. Now, what happens over time is we all age and, you know, we can take the clock back, but we can't stop it, right? So the clock is ticking and as we age or collagen or elasticity, all that stuff starts to move. So over 10 or 15 years, over the long term, you are going to notice change in how you look,

but it's not because you had a fat transfer or lipos, just because these changes are occurring that we can't stop. So the skin will sag, right? Your but your buttock will fall a little bit. But like I said, these are just age-appropriate skin changes that are unopolesoles. avoidable. Mascaro calls it the conveyor belt of time. Yeah. It doesn't stop.

Yeah, we're all in the same belt. Don't worry. No one's left behind. Yeah, you know what's unfair, though? Men start to get better at like 40, 40 to like 60 in some cases. Whereas women, it's like, I'm in my mid-30s and I feel like, I mean, I feel like it's just kind of down now, if I'm being honest. Yeah, I will, I mean, skin starts to change at 32.

So at 32, you start to really notice the degradation in college and breakdown in college and Elastin, things start to change a little bit. You know, whether you say it's, you know, it's for the worst. I mean, that's, you know, that's belief, you know, we can argue either way. But you're right. I'm working on my mindset. That's good. Okay, well, I guess to close, I'm just curious where you think all of this is going.

Do you see trends changing post-pandemic? We didn't really talk about that. Where do you see trends going? What do you think is going to stay? Yeah. Yeah, I think that, like I said, I think that the appeal, it's almost like a universal appeal. You know, we'll kind of end the way we started, you know, in that poetic. Like the appeal for an hourglass silhouette, a small waist, it's just looking or feeling better in clothing, Ariel.

I mean, I've had people tell me, you know, some stories. It's like, oh, when I went to Neiman or Bloomingdale's wherever, I wouldn't even, I wouldn't change. I wouldn't change at the place because I was embarrassed. And now, Dr. Rahal, like, you've given me a second life. I can go, I can go to Neiman's or Blumies. and I feel comfortable changing in public. So, you know, that idea of feeling and looking better in clothing, like I said, it's not going to go anywhere.

It's a human need, and I'm very privileged and blessed to be able to provide it for patients. Yes, there's some cultural and I think ethnic subtleties in terms of the degree of hip expansion and how curve are you want to be and you want around to. So you're right. Those are trends, and I think that at some point it'll fade. that really maybe overdone looks. But there's always going to be a small subgroup of people who are extreme and want that, right? So like I said, but I think it's here to stay.

I think, you know, small waste, liposuction, contouring, feeling better in clothing, that part of the procedure is not going anywhere. And it's a big value at, like you said, as long as the patient has the emotional maturity and their soul and their spirit is in a right place, then I think it's a huge value at it. And it's really life-changing. Well, I love that you take all of that into consideration, too. So where can everybody find you? Yeah, I'm in Beverly Hills, California.

Instagram is probably our most robust channel right now. So Dr. D.R. William Rahal is the handle. You can find me there. We're on YouTube. We're very active on social media platforms. And we always, you know, we're always here to help. Thank you. Thank you.

Thanks for your time, Ariel. I hope you enjoyed that episode. If you liked it, and if you like the show in general, please take a second to rate, review, and subscribe. It goes a long way, and it's actually the best way to support the show. Also, if you want to see more about each episode, you can head over to The Blonde Files podcast on Instagram. I'm always posting about each episode there or over on my personal page at Area Lorry. Thank you.