Well with Arielle Lorre - 417: The Birkin of Bodies: Mommy Makeovers, Menopause, GLP-1’s & the Art of Enhancement with Dr. Ryan Neinstein

Episode Date: October 20, 2025

Dr. Ryan Neinstein is one of the most sought-after plastic surgeons in the world, known for his meticulous artistry, innovative techniques, and unwavering commitment to excellence. In this high-energy conversation, we dive into everything from how he screens patients for surgical readiness to the psychology of enhancement versus transformation. Dr. Neinstein breaks down the evolution of the “Birkin of Bodies,” the nuances of mommy makeovers, and how menopause reshapes the body (and what can actually be done about it). We also discuss GLP-1’s impact on surgical outcomes, the truth about minimally invasive techniques and why trends in cosmetic surgery can be dangerous. Plus, he shares his approach to creating “ballerina arms,” the difference between removing fat and tightening skin, and the most gratifying surgeries of his career.Dr. Neinstein was ranked #1 Tummy Tuck Surgeon in America by his peers, follow him on Instagram @drneinstein to learn more about his practice. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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The following podcast is a dear media production. This is well. a podcast about wellness in all its forms. I'm Ariel Lori, and each week I'm sharing unfiltered conversations with people shaping how we feel, live, and look. Come for the substance, stay for the honesty, and leave with the tools to be well, inside and out. I hope that you are ready for a fun, high-energy, passionate conversation about surgery and aesthetics, but also things that you don't typically here in episodes that I do with plastic surgeons. So I am talking to Dr. Ryan Ninstein,

and this conversation to me was so fascinating. He's one of the most sought-after plastic surgeons in the world. He's known for meticulous artistry, innovative techniques. There were articles about him in The New York Post, an airmail, about how he basically delivers the burkin of bodies. And that is something that you don't forget. So we are diving into everything from how he screens patients for surgical readiness, which I found to be really interesting. And also the psychology of enhancement versus transformation, because there is definitely a difference. And he actually had an interesting perspective where he said, you know, he's screening patients for any kind of red flags, but they're also screening him. So it's kind of a mutual relationship.

that you are entering with your surgeon, and I had never thought about it that way. We are, of course, talking about mommy makeovers and how things like menopause, how GLP-1s, weight loss, reshape the body, and what can actually be done about it. And his typical patient is actually somebody who's very health conscious. They probably work out. They take care of themselves. And at some point, whether it's after having children, whether it's after losing a lot of weight, whether it's because somebody is taking a medication, they have excess skin, all of those things just don't move the needle enough. So, you know, he really looks at these surgeries as empowering and really life-altering for people in the best way. And something that he said in the episode that

I really appreciated was that for anybody else, you know, when somebody comes in, it's just a Tuesday. But for them, it is the biggest day in their patient's life. It's the biggest day in the lives of the loved ones of the patients. And so they really treat every single case as their Super Bowl. And that is definitely something that you want if you are embarking on any kind of surgical journey. So it is no wonder Dr. Ninstein was ranked the number one tummy tuck surgeon in America by his peers. Definitely go follow him on Instagram at Dr. Ninstein to learn more about his practice and see his amazing before and afters. And please enjoy this conversation. Doey.

The do is good. You're Dewey and I look like George Hamilton of plastic surgery here. I would tell you. Well, this is fun. Welcome to New York. Thanks for having me. Actually excited to be here.

Nice to see you in person. I was so worried I was going to be doing this virtually, but this is so much better. I have a rule. I don't do any virtual anymore. I like that rule. just feel like you get a completely different conversation. You're sitting face to face with somebody, the energy, the rapport, all of that, the quality is better. Well, as a surgeon,

you know, we work from work. So not really a work from home kind of job. Exactly. Yeah, yeah. Hopefully not. Okay. So I like to start my episodes now with like a little bit of lightning round. Okay. So let's start there. I feel like I know the answer to this one because of your social media. But what's the first thing you do when you wake up? Me? Yeah? Read. I get, I turn the audio book on immediately. It's like me turning my brain on. And I think like the body follows the brain and it's kind of like a top down thing. I get up and I start reading. And it's an audio thing. And it just, it really gets me rolling. And, you know, now I wake up about four and, you know, no alarm. I just pop up. And I always have a book going. And as I'm getting ready to go to the gym, it's audio book time and just get me thinking. And just get me thinking. And and get, you know, that machinery working. What are you reading?

So one of the things I'm doing recently is I'm going back. You know, there's so many books, people who read a lot. You read all these books. But then there are certain books that just have more meaning. And I find when you go back, like a few years later, it has even more meaning because you're different. The book stays the same. The lessons stay the same.

The book is different. And right now I'm reading ego is the enemy from Ryan Holiday. Yeah. Friend of the pod. Friend of the pod. And I just got his new book, the new one coming out, signed by him and a more fatsy medallion. But I've read that book probably three times at three different stages in my life. And each time it has, you know, different meaning.

So, you know, that's one of the books. I actually just gave it away to someone. We had a visiting surgeon today. And she asked me for a book from my bookshelf. And I gave her, I signed it. Sorry, Ryan. The other Ryan signed it. And I gave her a copy of Ego is the enemy.

And I said, this is the kind of book that will help guide you not. just in your professional career, but in your life. Yeah, I think everybody should read that book. Your ego is not your amigo, as we say. That's a good one. Favorite skincare product that you personally use. Avino for kids. What? I am the guy. Men are so lucky. Can I just say? I'm like, I wash my body with the shampoo that like my wife has. Yeah. And I swear like I have a five year old and a three-year-old and like the avino hypoallergenic kids moisturizer is just like head to toe like it is I don't need anything else like I don't know it's like wash your body with shampoo and then avino for kids and you're

Gucci in my books we were in Santerbury so much I know about skincare I am a real surgeon I am a pure cutter but men are so lucky so we were in Santropay a couple months ago and I was showering after my boyfriend and I'm like there's only like one thing in here It's like a body wash, shampoo hybrid. And I'm like, and I know that he washed his face with that too. Yeah. And he has beautiful, glowing skin, so much collagen, elasticity. Like, it's not fair.

Meanwhile, I have 11 products just to keep things like semi-okay. What is the most common misconception about plastic surgery? I think the most common misconception about plastic surgery is that it's going to make you a happy person. I think people who are happy become happier, but people who are unhappy for something else in their life are not going to find happiness through plastic surgery. I might argue. I'm sure this is circumstantial, but if they're unhappy, it might make them unhappier. Because at least there's a little bit of hope that maybe this is going to move the needle a little bit. And then when it doesn't, you realize, oh, shit.

What I mean is if there's a problem in your job, in your marriage, it's not going to fix it. Plastic surgery is not going to fix it. Yeah. And that's something you get better at screening. And you're actually doing someone a service, not, you know, it's not a negative when you say, hey, I don't think this is right for you right now. How much screening do you have to do now? But the consultation, you know, both parties, you know, I'm kind of a one-trick pony.

When people come to me, they, you know, all I do is mommy makeovers. That's what they're there for. But we're both kind of interviewing each other because we're entering, you know, it's like a marriage once you, So both parties really want to be committed to this and you're getting to know each other. So, you know, we're each looking for red flags, me and the patient. Again, not necessarily negative. Just, you know, it's a jigsaw puzzle of personalities and you want them to fit because post-op, you know, usually everything's fine. But if it goes awry, you want to make sure you're going to be able to work through troubles together collectively and move it forward.

What are some red flags that you look for? and have you noticed a change in people's perception of themselves with the rise of social media? So I actually am lucky. And I think because we share a lot of who I am and what we do, I get a lot of people that kind of fall into, you know, the avatar of who I want to treat. You know, it's, I really get moms who are frustrated. They take great care of themselves. But the extra skin, the loose skin, the stretched muscles, plus or minus weight. loss plus or minus menopause are just interfering with them enjoying their life. And luckily,

because we're constantly sharing that, we do get, you know, the people that fit into that. Again, when I'm meeting with patients, the things I'm looking for, you know, obviously, you know, it's easy to say someone who wants an unrealistic expectation, which is actually just kind of a bad sentence because obviously we're all striving for perfection. You know, going for perfection is unrealistic. But if you go for perfection, you might catch excellence along the way. And that's really the goal. But people who show you a picture and say something like, hey, I have to look like that. I mean, I don't really need to see the picture because I know you're never going to look like that. When someone says, hey, this is what I like, that gives me a sense of what, you know,

their aesthetic. And we want to make sure I share their aesthetic philosophy. And then motivations, too. Again, you want to look at all the things going on their life. If they recently had a breakup, A lot of, you know, it's relationship-based. People see us sometimes. Me and my boyfriend aren't getting along. Me and my husband aren't getting along. My marriage, this. And like I try to say, plastic surgery is not going to be the solution to that.

But when I'm meeting with a patient, you know, I'm really looking for a match in personalities, shared values, aesthetic philosophy, someone I want to spend time with. I think social media has relatively all been positive. And you're going to get the energy back that you put out. So it's just me and my phone being authentic. So I kind of get more authentic people. It's not produced. It's not edited.

So we're not getting a contrived version of me. It just this is me. This is me running around seeing patients doing my thing. So if you like it, come on down. Yeah. That's something that I think a lot of people probably appreciate about you. And I mean, there's so many doctors on social media. And this is something that I talk to with everybody who comes on my show.

It's like, how does the laymen who doesn't know anything about anything and doesn't have access to whatever? Referral network. Exactly. How do they make a decision? Because there are a lot of people on social media. And I was talking to my previous guest about this as well, where it's like, oh, they look amazing. Before and afters are great. Okay, they have a few hundred thousand followers.

And then I find out like, oh, they're not even like a board certified plastic surgeon. I think authenticity in this world is something we're all searching for and we all connect with. Like we gravitate towards like, you know, whenever I meet patients, they're always like, oh, you're exactly like you are on your social. I'm like, it would be really hard to fake it like every day. You know, it's like, this is just me like at four in the morning. Like, I can't really. There's no production team there.

Not an actor. It's just me trying to be quiet so I don't wake my wife and kids up. Like, that's why I'm speaking quietly in the morning. And what's new, what's really been great. And I think this is more this year. Patients, by the way, full pay patients are now openly sharing their journey. There's no collaboration. There's no being paid.

These are people who pay full price. And they're just like, hey, a lot of them, the story they tell me is I learned a lot from another woman who shared her journey. And I want to pay it forward because this is something I've thought about for five or six years. And I see all your posts and everything looks amazing. But like, I wanted to hear it. from an actual patient.

You know, there's people on my Instagram right now who are like recovering and they're sharing like daily and they're answering people's questions and, you know, really helps people get a true sense. When I say something, it's marketing. If you're a patient and say it, it's truth. No matter if we're saying the same thing. Like, you know, it just, that's the way the world is.

I say it, it's marketing. You say it authentically, it's truth. And this new shift of full pay, they have no incentive. There's nothing. them to do anything. They're not getting anything from it. That's really authentic. And that's helped a lot of people. Yeah. And I was going to say that's marketing you couldn't even pay for. Like, I mean, you could. But like, that's what everybody would hope to have. You know, that kind of

testimonial. Yeah. I mean, listen, you have to create something of such value. Yeah. That someone wants to share. Yeah. And that's not easy. People ask me all the time at conferences and stuff. I'm like, what's the secret? What's the gimmick? It's like really hard work. Like I get up at 4 in the morning. I'm really dedicated. I'm hyper-focused.

And like everything we do, you know, our COO Mitch is here. Like anything, every question that comes to me, the answer is no. Like it's like someone opens my door, no. And it's like the answer. Why? Because behind every no is a more meaningful yes. And literally, unless someone comes to me saying, I'm going to make the operation better or the patient experience better, like I don't want to hear it.

because that's the only thing I'm thinking about it. Yeah. And if you do that for a decade, you know, you can make a real meaningful impact. But most people don't want to do that. Yeah. They want a shortcut, right? You know, one of the things I realized in life, and I think I heard, I can't remember who I heard it, probably hormosy because I hear a lot.

But like, there's a big lag time from when you start acting like a winner to when you start feeling like a winner. And most people aren't willing to. to wait that time, you know, because I've been getting up at four in the morning and working 16 hour days for like a decade. And like the first six years, nobody cared. Nobody came. You know, very few people came. And but I didn't give up. And, you know, when I tell people, that's the deal. Do the same thing. And it's probably going to take you six years or so. They look at me like I am a crazy person. Like, are you willing, you know, I think that statement of, you know, there's just a huge

lag time between acting like a winner and being a winner and feeling like a winner. And very few people are willing to do that because it's just loneliness for a long time. And you're trying to wonder, is it just going to pay off at some point? Self doubt. Yeah. That's where like the grit and resilience comes in. It doesn't matter what you do. Yeah. Just take a long time. Whatever people think it's like going to take longer. I think Bill Gates said like people overestimate what they can do in a year and they underestimate what they can do it a decade. Like you got to think in decades, not in years. So if we're looking at your last decade in the first six years, you felt like you were just kind of grinding and grinding and grinding. And then I would assume that you started feeling like you were

progressing, making strides, whatever, in the last three, four years. That's also when you had kids, right? Because last time you were on my podcast was like three years ago. So it's interesting that I had one kid. Yeah, now I have another kid. Okay. So. So, that kind of coincides around that same time. Do you think that experience impacted how you were showing up at work or vice versa? When I think of the last decade, you know, when it started me and my coordinator Bella alone, like in a dental office, to now a staff of over 50 with their own surgery center in two locations. I feel like at the beginning, it was about the destination, meaning like I really would think about like what I wanted to be. And then kind of halfway through is about the journey, kind of accumulating people. accumulating, you know, office space and everything to get to that destination.

And now that I'm like, you know, near the end of this decade, it's not about the destination. It's not about the journey. It's about the people in my life. It is about the people in the office. It is about the people at home. And it is about helping people grow at work because people, just like since the last time I saw you, I've had a child. I have a lot of people who came to work for me single who are now married with kids.

So now this is a lot more than just like you're the new nurse. It's like you're part of the family now. Like we have almost zero churn. People, unless they're like moving, they don't leave. So, you know, I take that responsibility seriously. And then at home it's about the people too. It's about, you know, cultivating and watching these relationships with your kids, watching them grow and maintaining the relationship with your wife.

Definitely not easy. But how do you balance that? Because you've said that you can have it all, but not at the same time. Yeah. I agree with that. You can have it all, but you can't have it all at the same time. So it really comes down to your partner and it's one of the most important things. You and your partner have to be really on the same page.

And even if you agree, it's still hard when, you know, my wife knows that like, somewhere between 10 and 20 years of our life together, like, I'm all in on this, you know. And there's benefits for the family. But like the negative is I can't. work part-time as a surgeon. My days are 12 to 16 hours. Like I can't really get home for 5 o'clock dinner. I'm not going to make a lot of things I want to go to. That is a sacrifice. And it's like, we're going to do that for a while because then they'll be at a point where I'm going to be much more involved at a different stage. But you have to have open communication and agree upon it.

Because I've seen this before where, you know, I'm sure it's the same in any field. but I've seen it in surgery where you have a surgeon who's, you know, gung-ho wants to go hard, and the partner is like, no thank you. And then you have a real problem. Which way are you going to go? You're going to be disappointed either way. So the foundation is agreeing on timelines. And partners got to let you go, like let you do your thing.

If you want, like pursuing excellence is just pain. Yeah. Like it's just there's no way. around it. If anyone tells you that they're going to work this hard and everything's rosy, you know, they're just, it's nonsense. Yeah. But is that something that you guys established from the beginning? Yeah. I mean, when did you and Lauren first meet? Were you in med school? Was it before, after? No, it was at the end of my training. Okay. And, you know, she knew early where I wanted to go and what I was willing to do to get there. Got it. And it probably if, you know, she chose me over the

that, you know, because it's not her ideal choice. She'd love for me to be more at home with her and the kids. Yeah. But that at this stage, that's not happening. Okay. Let's talk about the work because you are known for being the guy for body work, right? Like the burkin of bodies, essentially. Yeah, the New York Post a few years ago wrote an article. And like, we all, our sphincters get tight when you see and someone calls you and says you're in the post. But luckily that day was a good day. Yeah. And the posts wrote an article that said, you know, we do the Birken body.

And associations are real. Like, people get that. You know, I didn't come up with that term. That, you know, the post. And then Air Mail recently interviewed people and they're like, that's the Birken body. And that's what it sticks. And, you know, people understand associations. So when they say, Ninstein, they think that's the Birken body.

that's what these moms want, you know, they get it. It's just like, they don't really know what a tummy tuck is. They don't really know what a mommy makeover is, but you know what they want, Birken body. Yeah, yeah. They want the Birken body. It's really simple. They're like, it's like Pavlovian.

They're like, you're the guy. Just do that. Just make me look like that. How do you walk the line between enhancement and changing, right? So, you know, I really like the mommy makeover. because they have a real problem. There's no gimmick. There's no fad.

It is a timeless procedure. Like, when you have extra skin after babies, like, you're stuck with it the rest of your life. And if you take care of yourself, like, it sucks that you can't wear anything showing your tummy the rest of your life. Never comfortable going to the beach. Your muscles are separated, which they almost all are, and you have a pooch.

Like, you have to suck in or wear spanks the rest of your life. Like, these are real problems. Like, it really interferes. with their quality of life. It's not subjective. No. And there's no like, hey, what's new? It's like nothing's new.

People have been having kids for a long time, and this is the consequence of it. And now there's a solution. So you don't have to hide your body after 34 for the rest of your life. And it works. And my job is to fix all the things from pregnancy, weight loss,

and menopause and make it look like six months later, I was never there. You know, that's what I do. And I am dealing with extra skin, separated muscles, and stuck on fat. And I am taking it all apart and putting it back together and blending it and making sure there's harmony. And that's all I do.

You know, the average classic surgeon in America probably takes like 90 minutes to do a time you talk. It takes me five hours. And trust me, I'm not a slow surgeon. I'm just doing a lot more because when you do this all day, every day, I just really understand what people truly want. what people want in 2025, what moms want, is not what they wanted in 1992 when like the traditional tummy tuck was really, you know. What's the difference?

Is it? And again, there's a lot of amazing surgeons who do, you know, great work. But we see, you know, when I see revisions, which are half my cases, they're not from Tijuana. They're from Park Avenue of Beverly Hills. And they're like, I had a tummy tuck. And the guys, they said there's nothing wrong with it. I'm like, I know there's nothing wrong with it. but like, this is, let me show you what we're doing now.

You know, traditional tummy talk is just in the, it's basically just treats the front of your body. And the other thing is the muscle repairs kind of was traditionally up and down, remove skin in the front of your body. What we know now, when people have babies, they're like this and they're like this, okay? Which means you got to repair the muscle up and down and left and right. The other thing we know now is women also care about the sides of their body and the back of their body, Not just their butt, but they're back. So if they're loosey-goosey in the front and they're loosey-goosey on the side,

you should treat all that because they don't care if you have four more inches of scar, but the result is a thousand times more dynamic. And, you know, we do buttock reshaping on almost everyone now, where I'm lifting the outer thigh to smooth the cellulite. I lift the butt. I reshape it. You know, a lot of them are longer and deflated. We shorten it and plump it up.

But like, you know, they also want the Pilates instructor butt, not, you know, it's better, not bigger. So now we're doing, you know, almost we do extended tux, circumferential tux, buttock reshaping, thigh lifting, multi-vector muscle repairs on everyone. And at the same time, making sure they have a beautiful natural belly button. So when someone sees you at the pool, they just say she looks great. Not that she had a great tummy tuck, great plastic surgery, just that she looks great. Because that's the dead giveaway. Right? The belly button. Yeah.

Yeah. So it's circumferential tuck. That's all the way around. All the way around. Extended is what? Just depends. It's around the corner. Okay. So that's getting the sides. Because they want, okay. The traditional tuck, just remove skin in the front, does a little lip on the sides. People don't want their waist thinner and looser. You know what they want? Tight. Everything. Tight. I know. That's right. Listen, the patients that come, they're like, they're like, I don't see people. I know you're going to think I'm nuts.

And a lot of people, they don't care about scars. They're like, I've seen your scars. They fade. My patients who have five kids, four kids, three kids, they wear string bikinis. You know why? Because a year later, that scar's gone. And they have a flat tummy. They have a narrow waist.

And they got a perky butt. They wear whatever they want for the rest of their life. These surgeries don't need maintenance. They don't need oil changes. They last. They don't, you know, you don't get a second one. You know, I wish they did, but they don't. These are like, these are good surgeries to get.

They want it all tight and they want it all to look good. Like, you know, it's a dead giveaway. Now, like, the cases come in. I'm just, I don't even need to like talk to it. I see what they had. I can tell who did their operation. I'm like, you had a traditional talk and I get it. Let me guess.

You don't like your waist. You don't like your butt. You don't like your back. You don't like your thighs. Correct. All right. And the muscle repair, you know, is never tight enough in the right factor.

Interesting. There's not a lot of people who spend this much time and energy, literally a decade, on one operation. Yeah. But I do because people keep having kids, so moms aren't going anywhere.

You'll never be out of a job. Moms aren't going anywhere. You have the ultimate job security. Correct. As long as people will be having kids. Although I did see in some country that they said that they now have robots that can carry babies, so I don't know.

Well, we'll do robots. Mommy makeovers. I mean, listen, I get mommy makeovers and people who have surrogates. They're like, I still want a mommy makeover. I'm like, all right, whatever. Yeah, okay. So anybody can get this. You don't have to be a mom, right?

Correct. Who is the ideal candidate? Listen, given the GLP ones. Oh, yeah. Huge. It was like before, you know, when we came out of the pandemic, I was like, everyone's going to be fat. And then everyone was thin.

And I was like, what a second? Oops. Something's new here. Okay. So everything changed when the OZEP. fix and everything came out. Before OZempec, I maybe once a year I would do a tummy talk on someone who didn't have kids. I do it once a week. Wow. I do a couple hundred a year. I do young people in their 20s who lost a lot of weight. I do a ton of women in their 40s who, you know, really

working hard and like, you know, OZempeg helped them lose 40, 50 pounds. I see a lot of people after menopause who like menopause made them a little loose and then ozepic made them really loose again never had kids so young people middle age old age all at the end of the day or have just loose skin so listen there's no diet there's no exercise you can never eat again to a plank for a year it's not gonna go anywhere there's no toys it's all nonsense at the germ office like none of that's going to do anything you got hanging skin yeah just cut it off no lasers no no tightening no nothing we tightened by cutting and pasting. But there is technology, though.

Correct. When you do the cutting and the pasting and the lipo and the transfer, I mean, what about, like, Jplasma? Do you do J Plasma? You know, it's not for loose skin. You know, we cut it out. I cut it out. You know, it's your patient population. You know, here's the deal.

And maybe I see a lot of type A women, but it's binary in surgery. You win or you lose, okay? And, like, I have yet to meet a mom happy with 30. percent of her skin removed or 30 percent of her looseness gone. You're either tight or you're not. You know, that's why I don't do minis. Don't do anything mini. What's a mini? Like a mini tuck. We don't do those because we don't even see them. Like they come to our office. We're like, we just tell them the phone. We don't do that. Like look at the results. I show lots of like people who had minis elsewhere. We convert them. You know, it's really like a minimal scar. Yeah, short scar below

the belly button. I'm like, yeah, you had like 20% of your skin removed. 10% of your problem solves. I've yet to meet anyone who's really satisfied with that. I'm not saying it is like a forbidden operation. I'm just saying I'm not going to do it. I play to win. And if I believe if you're going to have the cost, the risk and the downtime,

you've got to come out better on the other side. Because even a mini, you still have risk. Like infection, bleeding, blood clots. Like these are real. Like the, you know, when I'm seeing patients,

especially in revisions, you know, in my mind, it's just this like balance, like pros and cons. It's got to be like this. Like the upside's got to far outweigh the downside. If they start getting close at all, I'm out. You know, people, if someone says I'll only do a miss, I'm not doing it because I don't see the benefit of weighing the risks. Yeah.

I feel like we did go through this era. Maybe it was more in like facial aesthetics, but where it was mini less invasive. Yeah, like minimalist. And now it's changing a lot and you're seeing people be. more open about procedures that they've done, be more forthcoming and transparent. And I think there is more education and more people like yourself who are speaking about, you know, the pros versus the cons. Yeah. You know, when I look at the best surgeons and the kind of people I admire, they do traditional operations. Yeah. Yeah. They do facelifts. They do breast lifts. They do tummy tucks. Yeah.

No name to it. No gimmick. I was going to say the name. They don't have a name. The naming is ridiculous. They just do classic operation. They do two things. They do a classic operation. Three things. You do a classic operation. They probably hyper-focused. That's all they do.

And then they take really good care of their patients after. That's it. There's nothing more to it. You know, breasts are falling on the floor. We lift them up. Tummy, stretched, loose skin, tuck it. Face falls, lift it. People now realize the difference between minimally invasive, less invasive.

It's just the paradigm. It's just so far from real surgery. And the costs, you know, that stuff still costs a lot. And it damages your tissues. You know, maybe it damages it in the right way. But, like, I think people just really want real results. And, like, they'd rather have one big operation to be done with it than play with stuff. You know, we still see people.

I see cool sculpting complications. Complications from all this type of stuff. And they're all, every time, like, why didn't I just come to you first? Yeah. But I get it. if you could get surgical results without having surgery, I mean, who wouldn't want that? You would be out of a job. Correct.

Let's talk arms. Because you're also known for your arms. I love them. The ballerina arms. Yeah. I used to think like flowers or diamonds was like the way to a woman's heart. It's like, no, just give them skinny arms. Yeah.

They're all, they will love you forever. I said something to my boyfriend about it the other day because I was telling him that you were coming on. And I said, he does the best arms. I really want to get arm light up with him. And he said, what? would you want your arms to be skinned? I'm like, you don't get it. It's a female thing for sure. I mean, you get it as well. But what is it with women in their arms? The funny thing is, you know, I hear a lot of like, you know, the husband, and I'm one of them

too, because like my wife will say she wants something. I'm like, you don't need that. I'm like supposed to be on the other side. Yeah, yeah. But I was a joke. And somehow this, like, a lot of the times, like, the partner or husband will come to the console and be like, I love her the way she is. I'm like, listen, man, if you're like, private part was, looking weird after pregnancy. Like, you'd fix it. Yeah. Even if she's like, I like you're weird.

Yeah. You'd be like, great. I'm still going to fix it. Yeah. It's true. He's like, all right, I get it. Yeah. Do it.

Do they got on board with the arms though? Because I feel like that. Most, listen, they're on board. They're like, listen, I love her the way she is. Yeah. But if this is going to make her happy, let's do it. Because she's trying all this stuff in the gym and she's miserable. You know, we went to St.

Barts last week and she couldn't, you know, wouldn't go to the beach. Like, ridiculous. Yeah. Yeah, yeah. Okay, so let's talk about ballerina arms because I get so many questions from people on Instagram. More than anything. Really? Yeah, we do a lot. I do them two ways. If I'm just doing arms, I like to do them under local because I can like really twist and turn the person. And, you know, I make a bunch of little pokes in the armpit and then kind of hidden in the elbow. And the real key when you're sculpting arms is to go all the way around. You know, traditionally they just did the bottom of the arm. Like you really got to get, especially where that deltoid meets that tricep, there's like a little. There's just, I don't care who you are. There's a chunk of fat there. Where?

On the other side, the back here. Oh, what is this? This drives me nuts. That is your deltoid. I know. What can I do about my deltoid? That is an essential muscle for movement of your upper extremity. But, you know, what's nice about these procedures are you can make arms go from big to small and you can make small to tight.

So we see a lot of people with, you know, thinner arms that just need a little bit of that stuck off. on fat removed to give them that contour they like. And it might seem a little gimmicky or ridiculous. But you know what? Like I get people who are like, I don't feel comfortable showing my arms and pictures. And now like at my wedding, like I was so excited to take my wedding pictures. It's a big thing. Being a woman, it's a big thing.

Yeah. Arms. And I think men just don't understand. Like you guys have other hangups. I get it. I get it. I get it. Because it's your job.

Every day. Yeah, yeah, yeah. You know, you'll see women who come and, you know, they're always high. their arms and then you do their arms and they're like always showing them off and they're like they love it because it changes the way they interact with the world. So what do you do though for somebody if they're already thin and you do lipo? What do you do about excess skin? Because you're not cutting it off in that. So I mean this is like you really need to go to someone who really knows what they're doing. So you know when someone sees you for anything you're trying to see it's like

do you have extra fat? Do you have extra skin? Do you have both? Are we going to remove one, the other or both? So you're playing this game. Younger people is more fat removal alone. with a little bit of the Renovion and Vaser, we're going to melt the fat, we're going to tighten the skin. As you get a little older, we're less aggressive with the fat removal, kind of a reduction because you don't want to take too much fat because then you'll really loosen the skin. So you're trying to make the arms smaller,

not necessarily as sculpted. And then all my 65-year-old plus patients from Palm Beach, they're just like cut it all off, Doc. Really? Yeah. And where does the scar go for that? So it goes between, like, it's hidden on the inside of your arm. So like in a conversational,

from the front, the side in the back, you can't see it. Like, only if you're doing the YMCA. But, like, they fade. But I'm telling you, I do it for massive weight loss patients. Yeah, we do both arms at the same time. I don't know. Yeah, we do both arms. What is that elbow?

Elbow surgery, right? If you do elbow skin where you do one at a time because you have to bend here. Yeah, we don't really do that. But we definitely do both arms at the same times. That reminds me with a dumb and dumber skit where they're like, when nobody walks, when he goes to the gas station and he's like, nice, nice ski. They're both yours?

Yeah. That's going to be the clip for this podcast. That question reminded me of the dumb and dumber scene. Oh my God. That's what happened. I don't even know if the age group watches. Yeah. Dumb and dumber.

If you haven't seen it, go see it. Yeah. You kids. Great movie for the kids. Okay. You were saying cut it all off. Yeah. Those inside your arms.

They don't care. They don't care. Yeah. You know, when I look at my patient group, all their kind of vibe is the same, you know, A type. They're into family. They want the best out of life. But they kind of fall into this like 35 plus or minus a few years, 55. It's like they just have their kids and they're like, let's get this done now.

I don't want to wait. And then there's like those who are, I'm really busy. And then they kind of fall in that 55 plus category. And the first thing they say literally when I see them in the morning, after surgery is why did I wait so long? Like I missed 20 years of like walking out of my house with low leggings in a sports bra and wearing bikinis or just, you know, I see a lot of corporate women too who's not about bikinis. And they, what I really like, they tell me like when they're at work, they think about work. They're not thinking about their body or what someone is thinking

about their body. Like they're engaged. They're really dialed in. I hear that a lot from moms. In the corporate world, they say when they're at work and they're speaking, they really have, they're really focused. And before they would think a lot about how they look. And then I also hear moms just like, I don't think about how I look or what, you know, I don't spend an hour in my closet in the morning. And like there's no pile of clothes on the ground,

trying everything on to see how I'm going to negotiate my body today. They just grab whatever they want, put it on and walk out the door. Very empowering. I think people don't realize that. I mean, there's a lot of people who want to just be naysayers and say that any kind of plastic surgery is just, just vanity and blah, blah, blah. But, like, it really is so transformative and so empowering.

You know, people ask me why I don't do faith. I'm like, body is ice cream. It's bubble gum. You know, like, you can do a perfect facelift. Someone may not like their face. Like, nobody comes back. They flat tummy, narrow waist, perky bum. Everyone's happy.

Yeah. Nobody's like, I don't like my awesome body. Like, that's not a thing. There's also, like, you know, I don't do noses or anything. Like, there's a lot of discussion about what are we going to look? It's like, I know. You want to fly. tummy like I get it right very straightforward right yeah yeah I also there's not much to talk about

it's like hot bod right yeah say less okay bye yeah I got you like here's the 10,000 before and after you want to look like them right yeah got you let's do this I also feel like as a patient and this isn't to detract from any surgeon who does both but I feel like if I'm going to somebody for my body I want them to only do body if I go to someone for my face I I want them to only do face. I want them to be so obsessive about the thing that they do. That that's all that they think about when they come to work. Versus like, oh, I'm doing like,

for instance, the belly button and boobs at 12. Let me tell you about like the tummy tuck belly button. People always ask me what I do. I'm like, I have a thousand different moves because I see 10,000 different bodies. I have amassed a huge toolbox. And I just am able to get the rest. right tool for that patient. And if I literally didn't do that every single day of my life, you can't amass the tools.

And there are so many, if there's, say, a hundred moves in a tummy tuck, I don't know, 20 or 30 of them are going to be like, I know nobody else is doing that move. Like, because there's no way they've seen that before. And they don't know how to predict what the move is going to do in the long run. but because I've seen it, I know and I just know what to do to get the patient where they want to go. And that empowers me. Like, I like being great, but also never feeling like I know everything. Like I'm always evolving, always changing.

Like I never like, you know, as soon as you think you know everything, that's the precise moment of your downfall. Yeah, I agree. That's it. Game over. Yeah. So I know that a lot of the patients that come to you have tried everything. with their diet and exercise and oftentimes they lead really healthy lifestyles

and it doesn't move the needle. When you have excess skin, you have excess skin. Correct. But how much does that affect the result and the result moving forward? I mean, where does diet and nutrition come into all of this? The better you are, the better you take care of yourself. Yeah, the better you take care of yourself,

listen, I'm going to do like everything I can in the operating room. We want people to be as optimized as they can before. But like when I do my thing and then you have like a runway of taking care of yourself. And it doesn't mean you have to be an Olympiad. Like, go to Pilates three times a week, like, eat healthy, like, I don't know, 17 meals a week, like, gee, four meals or whatever. I promise you, you'll look better than you've ever looked.

You see these women, they have four or five kids, and you've never seen people with better bodies because we've taken away all the restrictions that take good care of themselves. But I also see people who need what I do to kickstart. Like, they're so frustrated, you know, that they've gone to the gym. They can't feel their core. They don't see any results. They're just stuck and miserable. So I do my thing and then all of a sudden, then it clicks. Like, you can actually go to the gym and you see the results. So not everyone comes in like super thin, super fit. A lot of people need what I do as an inflection point in their life. Yeah. And I'm sure it motivates them a lot.

Nothing is more motivating than change. Yeah. They made a big investment. They're going to protect it. Yeah. You would hope so. Yeah. What trends do you see coming in your industry? So what I see, and I'm going to say, we grow reflecting what patients want. And I think you're going to see more hospitality. Like we focus on the experience. Like, you know, most times you have surgery with a surgeon and then you're sent home and you kind of, that's it. Our patients stay at the plaza or one of our partner hotels.

The room's all done up. we have a partnership. The surgeon visits you every day. You have a nurse practitioner who's like dedicated to you on a text chain. You have private nursing. Flowers brought to the rooms. Massages in the rooms. Private chef.

We're creating a whole experience. You've had the kids. You've done it all. Like get pampered while you're having your major operation. You want to surgery now. I want to. Correct. I want a chef and flowers.

Who the heck wants to be cut in half and sent home? What partner? I wouldn't want to take. care of my wife after the time of that. Like plastic surgery is glamorous, but at the beginning, it's disgusting. Yeah. Yeah. I feel like also the patients love it. Men don't do well with it. No. Like what are you going to give them the instruct? Like, it's like giving you the instructions to like a plane and say to fly it. No, this is caught. I do complicated surgery. This is no joke. It's a little terrifying. That's why we have this whole system and our nurses have protocols that we've

established, like hourly checks. They're not just there to be your friend. They are checking. everything vitals, medications. Like, we are ready to rock here. Yeah. And that's how we get, not just the predictable results, but that's how patients who wouldn't have done this elsewhere, they want not just the luxury experience, they want peace of mind safety. And the partners are usually at work or taking care of the kids.

I'm not taking a week off. My wife has surgery. Like, no chance. I don't want to take a minute off. Yeah. Someone else deal with that. Yeah. I'll pick her up in a week.

I wouldn't want my boyfriend taking care of me either. Correct. I don't want him dealing with that. And we are continuously, like, how do we keep improving the experience? What do people want? And I really think that will permeate out into more surgeons, you know, but it's a big deal. I have over 50 staff. We have 30 aftercare nurses.

These relationships with hotels and all these vendors are stuff. These are living, breathing relationships. It's dynamic. I mean, this is a lot of work. If your doctor has, like, two people in the office, it's not much they can do. You need 50 to deliver the care and experience that people are looking for now. Everything people want now is experiential. I'm not going to a restaurant anymore unless there's like a reason to go.

If I can order it at home, like you better give me a good reason to go out for it. Yeah. Anything with travel, like I kind of like my apartment. It's like, give me a reason to go somewhere. It better be really exciting. Yeah. So I think it's the same. And that's why, you know, last week you did someone from Hong Kong.

We did someone from Australia. someone from London, someone from Paris, Dallas. A third of my patients are from Miami. All the New Yorkers, they want, you know, surgery in New York. But, you know, they're willing to travel for surgery, especially when there's an experience. Yeah, like I said, you're selling it to me. I'm like, ooh, what can I do to get this experience? Well, I was fine something.

Yeah, yeah, yeah. Well, since you have such a discerning eye for others, has it affected how you look at yourself at all? No, I use a veno kids. Yeah, yeah. Circling back on my body. that. No. To me, as I get older, staying physically fit and disciplined is like just absolutely essential and becomes more important. You know, I work out way more now than I did a few years ago. You know, you got to be like rigorous with the body, you know, so it doesn't like disappoint the mind.

Like if you want to do what we do, patients also like they want their surgeon to look like this guy can get through this operation. Yeah, that's true. It's not like you got to be a bodybuilding. but they're like, they know that if you're getting up at 4 in the morning, you're going to bed early. They know if you're working out every day. Like, you can handle this. You're also disciplined. And if you're like a very disciplined person, it's unlikely that you're like a pot's in

the operating room. I don't know anyone who's like disciplined in everything except for their job, you know. Yeah. Like, you know, so that carries through and that gives patients a lot of confidence. They want to see someone dialed in. Yeah. These are big surgeries. Like it's got to be, you know, every day is our Super Bowl.

I love the respect that you have for it. I mean, it's, it really comes out. We talk about it all the time in the office. Like, I know it's Tuesday to you guys. This is the biggest day in her life. Yeah. This is the biggest day in her husband's life, her kids' life. Like, game on.

And that starts from the top and goes down. Like, if you have a less say fair attitude from the leader like me, like you'll have that throughout. My team, like, everyone's up early in the gym. They're like, I don't want to be left out. I'm up early. I'm reading. I'm dialed in. Like, anyone who doesn't match that, I mean, they're gone.

Yeah. Very inspiring. You're inspiring me to be better too. I just think surgery is one of those jobs. It's like a pilot. Like you got to be on every day. Yeah, yeah. Yeah. And it's not for everybody. It's physical and mental. Like, you got to be sure. Yeah. But I like the intensity. People who like me, like they want to show up every day and it be really important. Every day of my life is really important. High stakes. Yeah. Yeah. I get that. I think more it's like important. Not like high stakes like we're gambling. But like I like the intensity. I like being at work. You can't kind of not like operating. You're all in or out. I'm sure there are people who kind of like it, but, you know. What's your favorite surgery of the surgeries that you do? Tommy talk?

The mommy, yeah. It's just so satisfying, gratifying. You know you win every time. Like you're like, this woman's going to be happy the rest of her life. She's a flat, tummy, narrow waist, perky bump. Ballerina arms, maybe. Valerie on top. Berkin body, you know.

It just, it works. Yeah. And we never stop getting better. You know, this year, my operations are different than last year. Never stops. You know, I have my network of surgeons around the world that are like similar-minded. And we just never stop trying to push the envelope safely. And it all reflects what patients are asking for.

Yeah. People five years ago didn't ask, you know, 50-year-old women didn't ask about their butt five years ago. Now, every single one is like Pilates instructor butt. Mm-hmm. Say less. Yeah. So we have to like work, figure out those operations if it's possible and then make them predictable and safe. Yeah.

And then adjust the whole experience, recovery, aftercare around that. That's why there's so many moving parts. Amazing. Well, where can everybody find you? Where can they follow you? Above Bergdorke. Goodman uptown here in New York, but online at Dr. Knightstein on Instagram. I'll be there up early, running around, doing my thing, checking all my patients and making moms. obviously we make them look great, but really we give them confidence.

They're just so happy. They just engage with the world on their terms. Yeah, I love that. Thank you. You're welcome. Thanks for having me. I hope you enjoyed that episode. If you liked the episode and if you like the show in general, please take a second to rate, review, and subscribe.

It goes such a long way in supporting the show. Follow the show over on Instagram at well.pod. You can also follow my personal Instagram at Ariel Lurie. always sharing great clips from the episodes, and we also have full episodes on YouTube as well if you want to watch in entirety. Thanks for listening. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.