Florida Restricts BBL Surgeries

Brazilian Butt lift surgeries have been restricted to 3 BBLs per day, according to the recent emergency mandate. Read along to follow expert BBL Surgeon, Dr. Mark Youssef’s responses as seen on Plastic Surgery Practice to the recent ruling

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Florida BBL News & Responses

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By this time, we’ve all heard about the recent – and – controversial BBL restrictions placed on Flordia Plastic Surgeons.

In a recent podcast episode, board-certified and expert BBL surgeon Dr. Mark Youssef is joined by the Plastic Surgery Practice Co-Chief Editors Alison Werner and Keri Stephens. In the Podcast, Youssef reveals whether or not he believes Florida plastic surgeons have been unfairly treated.

More About Dr. Youssef’s Opinions on Florida’s BBL Restrictions

Youssef, one of the first members of the World Association of Gluteal Surgeons (WAGS) and author of The Art of the Brazilian Butt Lift: Evolve Your Beauty, Empower Your Life, shares his opinion on Florida’s recent mandate limiting the number of BBLs Florida surgeons can perform each day to three and whether he agrees with it.

Lastly, Youssef reveals WAGS statistics regarding BBL safety and why authorities should pay attention to them.

Dr. Mark Youssef is a Diplomate of the American Board of cosmetic surgery and has been for the past six years or so. Learn more about Dr. Mark Youssef and his Brazilian Butt Lift surgery in Los Angeles.

Florida BBL News Restrictions Podcast

PODCAST TRANSCRIPT

Keri Stephens:
Hello. My name is Keri Stephens and I’m joined today by my co-host Alison Werner. We are the co-chief editors of Plastic Surgery Practice. Today, we are joined by Dr. Mark Youssef, a Los Angeles based plastic surgeon and board certified Diplomate of the American Board of Cosmetic Surgery. Dr. Youssef is also one of the pioneers of the Brazilian butt lift and wrote a book in 2019 called The Art of the Brazilian Butt Lift: Evolve Your Beauty, Empower Your Life. It’s a very timely subject as the Florida Board of Medicine recently announced a mandate limiting the number of BBLs Florida plastic surgeons can do each day to three. We wanted to get Dr Youssef’s opinion on the matter and hear his take on BBL safety. Dr. Youssef, thank you for joining us today.

Dr Mark Youssef:
Thank you both for having me. It’s a pleasure to be here.

Alison Werner:
Great. Well, let’s get started. Can you tell us a little bit about your practice?

Dr Mark Youssef:
Yes, of course. So I’ve had my own practice in Los Angeles for the past 18 years. I actually started off as a board certified OB/GYN and went back and did my fellowship training in cosmetic surgery, and now I am a Diplomate of the American Board of cosmetic surgery for the past 16 years or so. We have two locations. We have two surgery centers. One is in Santa Monica, California. The other one is in Ventura county in Oxnard, California. And we have a broad range in ethnicities in our practices and different demographics. So we get to see all types of patients in both locations.

Keri Stephens:
Cool. And as a pioneer in the BBL space, what trends are you seeing regarding your patients and is there a certain demographic that’s coming to you for this procedure? And have you seen any men or is it just mainly women requesting the BBL?

Dr Mark Youssef:
That’s a great question. So we actually look at our statistics, and I’m also part of a group that pools our statistics together and in our practice, as well as mimicking the national average, we’re about 90 to 95% women for this procedure. There’s about three to 4% who are men who do this procedure and about one to 2% of patients who are transgender or in the LGBTQ community for this procedure. But the trend for this procedure has continually risen. In other words, the demand and the number of procedures performed continue to go up. And as you know, this trend started many, many years ago by many influencers that if we look back and talk about people like Jennifer Lopez, and we talk about iconic models and actresses that took the old ‘80s and ‘90s rail thin look that was very popular in models.

Dr Mark Youssef:
When you look at models from the late ‘80s and early ‘90s, and people were emulating these very, very thin women. And then as more and more diversity came about in celebrities, you started to see people like Jennifer Lopez and you started to see people like Kim Kardashian and then the trend followed with people like Nicki Minaj and Beyonce. And then the trend continues with people like Cardi B, so you can actually see the trend evolve and become more and more popular as the years go by. In many years, since 2010 to 2020, you could see almost a 200% increase in the procedures per year, which shows that the influence of social media and television is very, very powerful in shaping what society thinks is beautiful and what society thinks is a nice shape and look for your body.

Alison Werner:
Well, so our main topic today is the Florida Board of Medicine’s mandate that was just issued around the Brazilian butt lift, or gluteal fat grafting procedure. So Dr. Youssef, why did the Florida board issue this mandate?

Dr Mark Youssef:
Okay, so let’s look at it very specifically, because Florida is one of the first and only states to take a very firm stance and put an emergency ruling, which they just did on June 3rd of this year, just a few weeks ago. So the ruling was done for several reasons. It started off with their guidance and emergency ruling in 2019 because of the number of deaths they were seeing in Florida. So all of this came about because the medical board of Florida was very concerned about the number of deaths they were seeing year after year in the state of Florida. So in 2019, they put an emergency ruling that ended up becoming a permanent regulation in Florida that said, all surgeons are required to inject fat or transfer fat into the buttocks above the gluteal muscle, which is basically the subcutaneous space underneath the skin of the buttocks.

Dr Mark Youssef:
And during the ruling a few weeks ago, they quoted several studies that led up to the reasoning for their ruling. So they quoted a 2017 study from the aesthetic surgery journal, which had a survey of 692 surgeons and they had performed 198,857 BBLs, which led to 32 deaths. So basically what we’re going to talk about is the death rate. So the death rate in that study that the medical board quoted was one in 6,200. One in 6,000 people died. They also quoted another more dramatic study by the International Federation of Adipose Therapeutics, it’s also known as IFATS, and their death rate in their study was one in 3000 patients, which to them was alarmingly high. And I do agree that that is alarmingly high. And that’s what led them to the 2019 ruling. So despite the 2019 ruling, the reason why they continued this emergency ruling in 2022 is because the deaths from 2015 to 2022 in Florida were 21 patients.

Dr Mark Youssef:
However, the deaths after the ruling in 2019, just in the last 36 months, were still 10. So just in the last three years, since the emergency ruling, there were 10 deaths. And that was even more alarming to the medical board of Florida because the state had put a halt for almost two months for all elective procedures during COVID, right? So it’s really over a period of about 34 months, they had 10 more deaths after 2019, and they had already seen 21 deaths total. So almost half the deaths that they saw since 2015 were in the last 34 months.

Alison Werner:
So then the original recommendation, which was about where you could place the fat, didn’t do enough to improve or decrease the mortality rate.

Dr Mark Youssef:
Correct. So, because they did not see a decrease in mortality rate, they then felt a few weeks ago that they needed to place more emergency restrictions on the procedure. And so they implemented two emergency rulings. The first one is all surgeons in the state of Florida who are doing BBL surgery, must use ultrasound guidance during the transfer portion of the procedure. And this is basically to help ensure that the cannula that is inserting the fat into the buttocks is always staying above the gluteal muscle layer. So the ultrasound is basically proof “that the cannula never penetrated into any dangerous, deeper levels or deeper veins, which generally lead to the cause of death.” And the general cause of death in most of these BPL patients, if it was from the BBL is fat embolism to the lungs, and the fat embolism is usually from penetrating below the gluteal muscle and fat entering into veins that go directly into the inferior vena cava directly through the heart and directly can clog the lungs.

Dr Mark Youssef:
So that’s basically the mechanism of action for how the patients die from fat embolism. So that was the first ruling they did. The second ruling that they required was that the surgeons in Florida could do no more than three BBLs per day. And their reasoning was by the time you do three surgeries and you have obviously some turnaround time, or you have a little bit of break in between surgeries, that would not exceed a 10 to 11 hour workday in their mind. So these rulings had very, very good intentions and I think their attempt, or maybe some of their testimony they heard prior, or during the hearings prior to this emergency ruling, maybe gave them the impression that physician fatigue could be part of the reason why some of these deaths occurred. So in summary, the two additional rules that they put were ultrasound guidance and documented and kept in the chart for the patient for every BBL procedure, and no more than three procedures in a day for per surgeon.

Alison Werner:
Okay. Well, when we talk about the fatigue, it wasn’t just about the long day. There’s also the physical fatigue that’s related to the type of the technique that’s being used. So what type of technique are you using in your practice?

Dr Mark Youssef:
So a typical BBL in our practice is done, we use something called a micro air harvesting system. So it’s liposuction done by a very fast vibrating oscillating cannula. So after we inject the tumescent fluid, which is basically a numbing fluid that helps numb the area and help loosen the fat cells, this metal straw attached to a motor basically that helps move the cannula back and forth helps gently remove the fat cells and it gets taken into, in our practice, a closed system called the Wells Johnson fat transfer system. So that basically accumulates all of the fat and liquid that’s extracted from the patient. It’s then separated into the more concentrated fat and all the liquid tumescent fluid, blood cells, everything gets discarded out of that sterilely. And then we reinfuse with a pump, the concentrated fat through the Wells Johnson system, back into the buttocks with a different cannula, but also the same system. And that’s not necessarily how every surgeon does it across the country. That’s just how we…

Alison Werner:
Right. In terms of the fatigue then, does that, because I was reading a lot of doctors will use a large volume syringe and that can involve two hand use and that can lead to muscle fatigue. And if you’re doing seven procedures in a day, that could create exhaust fatigue that way.

Dr Mark Youssef:
100%. So a BBL procedure is more physically taxing than other procedures we do. So for example, when you sit down and do an upper eyelid surgery and you’re basically sitting at the head of the patient and you’re making very small cuts and you’re using very small sutures and making very small stitches, you’re not necessarily breaking a sweat. But no matter what technique you do for the liposuction, it is physically taxing on the surgeon. It is very rare that a surgeon does not break a sweat during even just the first half of the procedure, let alone the physical effort needed to push the fat back in.

Dr Mark Youssef:
So whether you are using a syringe to push it in or whether you’re using a cannula to push it in, there is a lot of physical force that’s needed to kind of make the space, create the tunnels, insert the fat, et cetera. So there’s lots of pros and cons to both, and I’m sure if you ask 10 different surgeons, they’ll give you 10 different opinions on, should you use a syringe, should you use a pump? Should you use a cannula? What size cannula should you use? But there are some consensus as to what is safer for the patient.

Keri Stephens:
So how many of these are you doing in a day typically? How many BBLs do you do?

Dr Mark Youssef:
It’s funny that the Florida ruling, even though I don’t necessarily agree with the ruling, I naturally do not book myself more than two to three a day, and that’s just because I physically feel like that’s my limit as to what’s healthy for me and what I can physically do without getting exhausted. But there are surgeons who are a little faster than me, who may be able to do four in the same amount of time that I can do two or three. So I don’t think that three number is magical or I think it’s a little more arbitrary than the medical board might think depending on the type of surgeon.

Alison Werner:
Well, and it doesn’t include them doing a different kind of procedure between those three.

Dr Mark Youssef:
Correct. Correct. So if you’re okay with this, I like to break down the reasoning why I don’t think this Florida ruling is going to necessarily, it may not improve the death rate as much as the board thinks it will. So let’s just take the ultrasound ruling to start. Okay, and by the way, I want to preface this by saying, I think the medical board ruling has very, very good intentions, but I think because it was very hastily come to this conclusion, I don’t think a lot of the afterthought is the reasoning behind these really sound, and is it going to lead to improved death rate? So for example, most plastic and cosmetic surgeons are extremely unfamiliar with ultrasound. And what I mean unfamiliar is interpreting what they’re seeing in live video on the ultrasound.

Dr Mark Youssef:
So if you just took a plastic surgeon and you dragged them into a radiologist’s office and you started asking the plastic surgeon, what is this layer? Is this a vein? Is this an artery? Is this a nerve? Probably a large majority of them would really struggle to interpret what they’re actually seeing. So not only is there a huge amount of training required to even be able to use ultrasound usefully in the practice, but in the beginning, as surgeons are being forced to learn this technology, it may actually be a distraction, and distractions can cause several negative things during a surgery. It can distract the surgeon from the focus of the patient and start focusing on a screen for example, right? It can also prolong the surgery. It can make the amount of anesthesia longer.

Dr Mark Youssef:
It can make the operating room time longer, which has its own risks in it itself. Right? And just the task of training hundreds of surgeons in Florida to use a technology they’re not used to using every day is a very daunting task for many of these physicians. There’s also some ambiguity when the board says use ultrasound and document the ultrasound during the procedure. For example, they want the surgeons to document when they’re injecting fat into the buttocks. But what if the cannula starts to inject in the outer hips? Right? So where there’s no danger zones, there’s no gluteal muscle, there’s no deep veins that can cause pulmonary embolism, is there a required ultrasound there? And we’re talking about just a few inches apart from each other, right? So there are lots of patients and lots of areas where we inject fat that is rounding out the hips or filling in some dips in the hips or the outer buttocks that aren’t necessarily in any danger zones that would even require ultrasound.

Dr Mark Youssef:
So you can see that there’s some ambiguity there in just the geography. And then of course, one of the things that I don’t think the board took into account at all is the logistical nightmare of hundreds of surgeons trying to document, record and store 30 minute to one hour videos in patient’s charts. So just the logistical nightmare and the amount of cloud storage that is going to be required is going to be very cost prohibitive for many practices to be able to record this data and store it. We’re talking a large amount of data.

Keri Stephens:
And then you go into cybersecurity concerns, too.

Dr Mark Youssef:
Exactly. HIPAA violations, where are you going to store this? How are you going to store this? How much is it going to cost to store it? And then on top of that, the cost of the ultrasound itself for the surgeon. So now they’re not only incurring the training cost, but they have to incur the cost of purchasing this new technology too. So there’s several reasons in my mind that I think the ultrasound ruling may not necessarily solve as many problems as it creates. So then let’s take the second ruling, the pros and cons of the second ruling, three BBLs per day. I definitely agree with the premise that surgeons should not be fatigued when they’re doing surgeries, but when you tell a surgeon, you can’t perform more than three BBLs per day, many, many of these procedures I’d say in my practice, a third to a half of the BBLs are being combined with other procedures.

Dr Mark Youssef:
So if I combined a tummy tuck or a breast augmentation with three BBLs, I’m now automatically into a 14 hour day. Right. So limiting it to three BBLs, not talking about combination surgery, not necessarily saying, okay, I’m a surgeon I’m going to get around this rule. I’m going to do two tummy tucks in the morning and then start my three BBLs at 6:00 PM. Right? So again, it is a little more arbitrary than it might look. Right. And again, I’m not sure how deeply the medical board analyzed the 21 deaths that they were looking at. How many of those truly were caused by fatigue? How many of these 21 deaths were truly at the 11th, 12th, 13th, 14th hour of that doctor’s workday. Right. So I think that’s where it really needs to be looked at. And maybe they did.

Dr Mark Youssef:
But I don’t think saying you can do only three BBLs, but let me just do two tummy tucks on that same day, the ruling doesn’t really help stop that either. And then there’s the issue of, if you are limiting surgeons, how does that affect the surgeon’s autonomy? How does that affect the surgeon’s freedom to do certain things? How does it affect the autonomy of surgeons that can do very small BBLs or can do a BBL in 90 minutes or two hours very safely and comfortably for them? Physicians have always been on an honor system. They’ve been on the Hippocratic oath, first, do no harm. They are very good at self-regulating. They’re very good at being paternalistic with patients. And so to start to restrict what physicians can and cannot do, I think is going down a slippery slope if you can imagine.

Dr Mark Youssef:
If I were to tell a general surgeon, I don’t want you to be tired when you’re operating, so I’m going to restrict you to only doing three appendectomies per day, there’d be a massive uproar, right? There’d be a massive uproar. Take any surgery, a cardiothoracic surgeon who’s 20, 30 years into practice and can do three heart surgeries in a day and then they decide, well, we think that’s a little too much, we’re going to restrict heart surgeons to only doing two surgeries per day. So when you think about it in other specialties, it starts to not make sense.

Keri Stephens:
So do you think that these plastic surgeons are being unfairly targeted at all?

Dr Mark Youssef:
I do. I do think something needs to be done, but I don’t think Florida’s really going about it the right way. And so this brings me to the point of why I joined WAGS and I’d like to link this in because it’s very relevant to what I think the solution should be. I joined the World Association of Gluteal Surgeons, I was one of the first members many, many years ago. And this association was put together because amongst my colleagues, there was this understanding that we already knew that there wasn’t specific standard guidelines for BBLs and there wasn’t really any specific training for BBL surgery. And we’re talking very well respected plastic surgery fellowships that have zero cases for these fellows to do in BBL surgery.

Dr Mark Youssef:
Right? The vast majority of plastic surgery fellows will graduate without possibly even doing one procedure, let alone five or 10. Right? So the World Association of Gluteal Surgeons was founded really to create a standard safety guideline and standard of care and recommendations for surgeons who have been doing fat transfer and BBLs for many years. And they came up with six or seven bullet points of basically, if you’re going to do BBLs, these are the following guidelines. And this is what I think Florida should have adopted instead of the three BBL rule and the ultrasound guide rule. Right? So the standard of guidelines that we live by are number one, inject only in superficial planes and never penetrate the gluteal muscle. And I think that was from the 2019 Florida ruling. So that one is very understood.

Dr Mark Youssef:
The dangers come when fat is injected closer to veins that are deeper beneath the gluteal muscles. Number two, always concentrate on the position of the tip, always use technology that allows you to know where the tip of the cannula is, For example, not using flexible cannulas. Always using your non-dominant hand to palpate and guide where the tip of the cannula is. So you can always know where it is. Avoiding bendable cannulas, or cannulas that can actually change position or go too deep, always injecting in motion and not necessarily in one static position that could increase pressure of the fat to enter into a. Discussing the risk of death with every patient in the pre-op and getting their consent for it, and having the patients understand that this is a fairly risky procedure. And then also we’ve agreed that there’s certain cannula sizes, which is the metal straw that inserts the fat, that if you go beneath that size, if it’s too small, it has a higher risk of piercing the muscle.

Dr Mark Youssef:
So counterintuitively, if you use a big rounded blunt tip needle, it’s a lot safer than using a skinny, blunted needle that can actually still pierce between muscle fibers, if that makes sense. So we’ve all agreed that using a four millimeter cannula or larger creates a large safety zone. So going back to the death rates that the Florida ruling a few weeks ago quoted, right, they quoted two studies. One was the 2017 aesthetic surgery journal study that showed a death rate of one in 6,200. And then the IFATs study that showed a death rate of one in 3000, I want to share with you what the WAGS statistics are. And these are 81 surgeons that have performed 95,000 BBLs in the past several years, right? So our death rate amongst the surgeons who follow these strict guidelines, if you take the total death rate, that means everyone who’s died from BBL during these 95,000 procedures, it’s actually one in 9,600, right?

Dr Mark Youssef:
So it’s three times less than the IFATs study. However, if you extract the deaths that were not caused by fat embolism, for example, a patient had an infection, patient died of sepsis, patient had a bowel obstruction or something that was not necessarily related to the fat transfer, it was either an infection or an injury to an organ that was not related to the BBL, for example, puncturing an intestine during the liposuction portion. So that would technically be a death from the liposuction, not the BBL. So if you extract the non BBL related deaths from that one in 6,200 death rate, it actually drops to one in 23,000.

Keri Stephens:
Oh, wow. Okay. Yeah.

Dr Mark Youssef:
So basically, if Florida were to just say, take these guidelines that have been put together by these surgeons that have done 100,000 procedures, I’m talking about the WAGS guidelines I just read to you, if they would’ve just made that the emergency ruling, they would slowly start to see their death rate drop down to that one in 23,000. Right? And that’s why I don’t really think the three BBL limit and the ultrasound, it’s not 100% helpful in bringing death rate down, but the guidelines that we follow as a group and the guidelines that I’ve been following, I’ve never had a death from a BBL. Right? And I’ve been doing this for 18 years. So that should tell you something that these guidelines are probably more powerful and probably more meaningful to a medical board than a couple of these testimonies of, oh my gosh, I think this might be fatigue related or, oh my gosh, I think the ultrasound’s going to solve our problem.

Dr Mark Youssef:
And that those are my thoughts on the ruling. And so when you take a look at real data from surgeons who are properly trained and properly abide by safety guidelines, the death rate is actually much lower than other surgeries. So just for fun, I was looking up prior to our podcast, and you can look these up online, the death rate of liposuction and tummy tucks. So the death rate for liposuction is anywhere from one in 5,000 to one in 6,000.

Keri Stephens:
Okay.

Dr Mark Youssef:
Right? And the death rate for tummy tucks is one in 10,000 to one in 11,000 patients. Right. So we’re talking about the death rate from liposuction being twice as much as a tummy tuck and almost four times the death rate of our WAGS data. And yet no one seems to be doing emergency rulings on liposuction because it’s been around for decades and it’s unfortunately, an accepted number.

Alison Werner:
Do you think part of the reason for the focus of the Florida medical board is the fact that it is such a high visibility procedure, it’s big within the influencer culture and so it’s getting picked up in that regard, and so there’s this need to address it?

Dr Mark Youssef:
Yes. You nailed it on the nose. So when you have a procedure that is very, very relevant in social media and in television, and then when you have the headline being a death of a young, beautiful woman, who’s 25 years old, whether she’s a model in Columbia, whether she’s the girl next door in Miami, Florida, it hits the news very hard, right? These are young, beautiful women who are dying. Right? Nobody talks about the nice little old lady who died from sepsis or infection from her gallbladder surgery in the hospital.

Alison Werner:
Yeah.

Dr Mark Youssef:
So yes. It does get more press because the average age of a BBL is in the early thirties. Right. So our typical patient for a BBL is somewhere between 20 and 50. And so you get a lot of press and you get a lot of media coverage when 20 some year olds are dying, even if it’s in smaller numbers than other surgeries.

Alison Werner:
Right. Well, and also the fact that Florida has, what is it, I read a statistic or was it 28% of the country’s BBL deaths between 2011 and 2016 were in Florida, while Florida only makes up 7% of the US population. So they’ve got to, a vast majority of people are going to Florida for these procedures because it has a reputation of being the place for them, especially for people coming from abroad, or even coming from another part of the US that doesn’t specialize or, so yeah.

Dr Mark Youssef:
Florida does attract medical tourism from other countries. For example, England and the UK did ban the BBL procedure, and one of the closest places to have it done in a place that does it very often is the east coast of the United States, Florida, New York, et cetera. So Florida does get a disproportionate number of BBL patients flocking to it, especially south Florida.

Alison Werner:
So how would you like just-

Dr Mark Youssef:
And also the…

Alison Werner:
Go ahead.

Dr Mark Youssef:
I was going to say, and also, I think there is an ethnic disproportion too. So when we’re talking about trends, when we look at ethnicities that have a higher demand for this procedure, you’re talking about the Latin population, the African American population, there is a large portion of those ethnicities that do live in Florida as well. So their local population has a propensity to want these procedures more than let’s say, Arkansas or South Dakota, where a typical woman that you ask there if they would like their butt larger, they would freak out and run for the hills.

Keri Stephens:
Right.

Alison Werner:
Right. Exactly. I was just going to ask, where do you want to see the WAGS recommendations go?

Dr Mark Youssef:
Well, because the WAGS guidelines have served our group so well, I really think they should eventually be adopted by training centers, fellowships and medical boards. I don’t necessarily believe in overregulating physicians, but I do think that these guidelines should be the basis for training for the procedure. And I really think all of these guidelines go back to the root of the issue, which is surgeons aren’t really getting formal training for this procedure.

Dr Mark Youssef:
So everyone’s learning these procedures at conferences, at colleagues offices, at group events, online, video training, so really we have to go back to the root of the issue is how do we get physicians, especially physicians who are in cosmetic training fellowships, how do we get them formal training in this procedure, enough procedures under their belt for them to feel comfortable and standard safety guidelines for them to follow, really. So I’d like to see these guidelines implemented in official academic training programs, and then eventually be the standard of care that all states follow. It’s proven by our numbers that our death rate is actually very low, well below the rate of liposuction.

Keri Stephens:
No, that’s interesting for sure. And you wrote your book in 2019, and what do you want to convey to your patients? What did you want to convey to your patients in doing so at that time? And what do you want to convey to them now, three years later?

Dr Mark Youssef:
So I initially wrote the book for several reasons. It is one of my expertise, it’s my practice. It’s one of the most highly demanded procedures in my practice. But I really wanted to highlight why the procedure is popular and where did this trend come from? For example, like we talked about earlier, what caused this BBL craze? It almost felt like it came out of nowhere. How did the music industry affect the way we look at women’s bodies? People like, Sir Mix-a-Lot with songs like Baby Got Back, and there’s Sisqo with the thong song, we could go on for [crosstalk 00:35:49] twerking come from and why is it popular? Right. So part of it was a historical journey, so the book walks you through a historical journey of, how did music affect the way we view women’s bodies?

Dr Mark Youssef:
How did celebrities affect the way we look at women’s bodies, especially as celebrities started to become more curvaceous and voluptuous? How does the TV and magazine industry affect our opinions on what is the definition of beauty? I don’t want to get too technical, but part of the book talks about waist to hip ratios and what was an accepted ratio for beauty back in the ‘80s and ‘90s, and what’s accepted now. So for example, your waist to hip ratio, what was considered the most beautiful back in the early nineties was a 0.70. So basically your waist was 70% of the circumference of your hips. Now it’s 0.65, which means narrower waist and wider hips. It is considered the ideal ratio. So you can see the definition is actually changed because we are so influenced by social media, the music industry, the rap industry, the television industry.

Dr Mark Youssef:
And I think that journey is a big reason why I wrote the book. And then of course, the second reason I wrote the book is because I wanted people to know that you’re not stuck with what God gave you genetically. In the past, before BBLs, or even before plastic surgery, whatever you were born with is what you were stuck with. Right? And now it’s very empowering to know that you’re not necessarily stuck with what you were genetically given. If you want to change the shape of your body, if it makes you happy to do so, it’s very empowering to know that you can do something about it now, right? A BBL is a very drastic change in the shape of your body, and it is very empowering. Dr. Miami actually wrote the introduction to the book and he focuses on how beauty is power. Feeling more self confident about yourself is very powerful.

Dr Mark Youssef:
It’s very empowering to people. So part of our job as cosmetic surgeons and part of the ability for patients to choose to have a BBL is the message that I wanted to send in the book is you are empowered to take control of the way you look. And I think that’s the message of the book. And of course the last part of the book is for people who are very interested in having the procedure, it walks them through how to prepare for the procedure, what to expect, what questions to ask your surgeon before you make a decision, all the dos and don’ts and what to expect after the surgery. What’s a typical post-operative course like, and what things to worry about and what things not to worry about. So really, those are the main three or four reasons why I spent two years writing this book, because it is a big passion of mine.

Keri Stephens:
No, this has been so informative, and we really appreciate having you on this. And just thank you so much, Dr. Youssef, it was a pleasure speaking to you today, and I encourage everyone to check out his book. And also be sure to check out The MEDQOR Podcast Network for the next episode of the Plastic Surgery Practice Podcast. And in the meantime, to check up on the latest industry news, please check out plasticsurgerypractice.com. Until next time, take care.

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    Dr. Mark Youssef

    Are You Ready For The Next Step?







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