Hey, guys. My name is Mavi, and I've spent the last 14 years in the plastic surgery and beauty industry working alongside top board certified plastic surgeons. In that time, I've helped thousands of women in their surgical journey. My passion to educate and help women feel empowered is what led to what we now know as the big Butts no live podcast. Join in on the fun as I talk to plastic surgery experts, friends, and real life patients about all things plastic surgery. Should
be fun. Hey, guys, do I have the episode for you today? I don't even know where to get started. Um, I'm so happy because we have our first Colombian doctor on the show. Columbia canadian. Carlo el dota makeover. He is out of Florida. And you guys, I can't wait for you all to get to know him, get to hear his expertise. I'm going to let him tell you a little bit about himself. And then the topic for today, skinny BBL. Okay, so, hello. That's an amazing intro. And I
love your, uh, energy. I love that sign. I need to get a sign like that. It is epic. So, yeah. Hello. Thank you so much for having me on the podcast. It's really a pleasure. I've listened to a few episodes Julia loves. She actually was listening to your show prior to even us connecting. Uh, so she knew about you, actually. So it's kind of interesting that we connected a little bit about myself as you were kind of talking about already. My dad is from Boulevard, Colombia, and my mom is
from Canada. So I'm a mixture. I went to school, did all my training, grew up in Canada, and then started as a plastic surgeon there in 2017, doing a lot of transgender surgery and body contouring. I was able to move to the US, uh, in Florida in 2020, right before Pandemic. Perfect timing. Perfect timing. Yeah. But things actually went well over Pandemic, as you probably know. Plastic surgery went through the roof booking like crazy. Everyone was, I
guess, online or on podcasts, everything. You know, it and they wanted to spend their money on themselves. So plastic took off. And right now, I'd say the most I do is BBL, because I'm in Florida. It's like, I think the capital of Bbls. A lot of interesting stuff to talk about with the new rules and regulations in Florida. I think Florida leads the nation in BBL, so whatever happens here will probably trickle to other states
eventually. The second thing I do is the mamasita makeover, which I would like to claim credit for. So you guys all know about the mommy makeover that's any operation on the breast and tummy, why they call the mommy makeover, because those are the two areas that a baby affects the most with breastfeeding and with the pregnancy. I like the mamascita. So what? That is because we love Bbls. We love booties, we love nalgas, we love, uh, the
shape of the entire body. And so what I do is, when I have a patient who comes from Mommy Makeover, they usually want a BBL. So a BBL with a tummy and the breast in one procedure has to be a healthy patient. Right. Obviously, three surgeries, and one is a big recovery. That is the mamasita makeover. I love the mamasita Makeover, and I love the take
on it because it's so true. It's not just moms, but it's a lot of moms, but it's just women trying to reclaim their shape and feel better and look better. Yeah. I would love to hear all the new rules that are coming out in Florida. So I haven't really covered them much on the podcast, but I think it's really important for us to talk about it. Yeah. So if you're going to talk BBL, we got to
talk safety. Because if anyone who has been following the history of BBL knows it's a newer operation, I'm talking, like, 20 years ago, no one knew what a BBL was. Five years ago, everyone's talking about a BBL. It really blew up because of how powerful and how amazing the change can be in your shape, and it's your own body's fat. So if you don't know I mean, you're on the podcast. You got to know what a BBL is. But if you don't know it stands for Brazilian Butt Lift. It wasn't
invented in Brazil. What it is, it's a fat transfer from somewhere where you don't want fat. Usually the love handles, the mid section, the abdomen, and you transfer it to where you do want it, which was the lower hips and the buttocks to create that amazing upside down heart hourglass shape that everyone loves. That's a BBL. So why aren't we talking about safety is because initially, because it was a newer procedure, a lot of surgeons were doing it that, number one, didn't
really have training. Number two, even plastic surgeons, it was new to them. So how could you have training for something that hadn't been done before? And the last thing is, because it was so popular, a lot of people who probably shouldn't have been getting a BBL or who probably shouldn't have been doing a BBL were getting Bbls. And this led to a very high fatality rate because of the danger of when you're injecting fat into the wrong place, which is into the muscle or too deep, the
fat can clog. Blood vessels, veins go to the heart. All do all kinds of bad things that can lead to death, which is something we never want to talk about or experience in plastic surgery. But it's a reality. That's what happened with the BBL's. And as you probably know, the increase in medical tourism at the same time. So, over the past 20 years, there's been a huge trend in Americans, Europeans, Canadians traveling to lower income countries where they can get a discount
BBL. We're talking like $2,500 for a BBL. $2,000 in Mexico, Dominican Republic. Colombia is a big place for cheaper Bbls. So you add those two factors, more increased medical tourism, a new procedure, inexperienced surgeons, and you have a real recipe for disaster. So stop me if I'm talking too much here, but this is exactly what we want. You know what I love having? When two people who love talking about the same stuff? These episodes can go on for hours.
Okay, good. Because I feel like, uh, I'm very passionate about this topic. Um, ah, especially safety and VBL. So to get to kind of the summary of what I'm trying to say is you had all these bad factors which led to the American society, the ASPs, the American Society of Plastic Surgeons releasing a statement, I think it was 2018 or 2020 about that. The BBL is risky. Like one in 6000 death rate, which is really high. I'll give you another number. Your tummy talk is about a one in
15,000 or one in 14,000 death rate. So more than twice the risk. And so now, thankfully, with more knowledge, better training, uh, better research on BBL, now we know how to do it safely. And that's why I think Florida is leading the charge. Number one, we have to do with an ultrasound. So when we're putting the fat in, we actually put a device on the skin that shows us where exactly we're putting the fat. So it's not blind, right? If you know where the fat is going, let's risk that it's
going to go in the wrong place. The second thing, and this is kind of something I was not guilty of, but I know some clinics were bad boys and bad girls. They were doing seven, eight Bbls a day. Were they really? Or were they doing them? Uh, you want to really get the details? Someone was doing seven or eight Bbls a day. Yeah, it's a really good point. Who really knows what was going
on in some of these places? But the point is that they did a research study on this and they found that more BBL deaths were occurring on Thursdays and Fridays. And why would that happen? It's not that we're doing more Bbls. It's probably surgeon fatigue or clinic fatigue, or they're getting to the end of the week and they're just doing too many. So now Florida, you're only allowed to do three Bbls in a day? I say only because for me,
they take me. Yeah, that's a lot. It takes me two to 3 hours, depending on the size of the patient. So imagine three a day. That's 9 hours of straight operating turnover time. That's like 12 hours. How exhausting it is to do like your shoulder. You have biceps like crazy and huge, uh, shoulder muscles. But you know what I'm saying? Three is still a lot. But I think that's what I was referring to. Earlier is that the ultrasound rule is mandatory in Florida. The limit on BBL's is
mandatory in Florida. And I think those will lead to a decrease in deaths, which is the most important thing. And so a lot of people disagree with the rules. It's a little bit controversial, but from my standpoint, I think for safety reasons, both those rules make a lot of sense. They make a lot of sense to me, too. And I feel like, um, if they have to make rules to keep us safe, let's just do what we're supposed to do. I've had surgeons on the show who they're like, I
can't imagine doing three BBL a day. There's no way I can. It's too exhausting. By the third one. Who knows what kind of work I'll be doing. My standard is. I do, uh, and a lot of plastic. I know they'll do two to three patients a day max. Because after that it is very true. It's like any other job. You lose your focus. You get fatigued. Your mind wanders. And with this kind of a surgery, you have to be 100% because the stakes are so high. So that's another thing that people
have to understand is safety costs money. If you do eight Bbls in a day, you can charge $2,500 for a BBL. If you're only doing two or three in a day, the price has to go up. So that's another thing. And I think that's why it's so good to have podcasts and to educate, is that if you're paying $2,500 for a BBL, the cost is being cut somewhere. And you have to understand that, right? Maybe they have not, uh, the surgeon or they have assistants doing the whole operation. Or maybe the surgeon is
not even there for most of the operation. Or they're cutting a corner because there's no way that a BBL can cost that much, given how expensive things are in the operating room. Right? Like, even to run? I'm sure you've had surgeons that have told you their costs, but I think it's interesting for consumers to know my operating room costs about $1,000 per hour to run. So I think that's fairly average. Maybe in Beverly Hills it's a little bit higher. And maybe in
Columbia it's a little bit lower. But it's about 1000 /hour. So if you think of BBL takes about 2.5 hours average, that's $2,500 cost. Just to get in there. Just to run the room. Keep the lights on. Right. Because think about the team. That's another interesting thing to think about. It's not just a surgeon. It's me. It's an anesthesiologist or a cRNA has to be present at all times. There's an assistant that helps me. There's a circulating nurse. There's a scrub nurse. There's usually one
or two texts. Those are people who clean the rooms, clean the equipment, and there's a packing nurse. That's about eight people. Right? So you think everyone has to earn a living and then supplies? Right. All the supplies. And the thing about a surgery, you can't reuse most of the stuff. Once something has touched the inside of the body, it's going in the garbage. There are certain instruments you can sterilize, but the
vast majority of things are disposable. The next time you look at plastic surgery, price don't just go, oh, my goodness, this is robbery. It's a luxury service. It's very expensive to do. And I think prices have come down a lot in certain regions, especially in Florida. I can't charge a lot because there's so many competitors nearby that are charging less. But at the end of the day, costs or costs, cost or cost.
And, uh, I tell my girls, when you find a surgeon that you align with, with their safety, how they are with their results, how they are with their post office care, when you find your surgeon, that's it. Whatever they charge, that's just what they charge. And if it's the right one yeah. If he's the right one for you, then he's the right one for you. If it's outside of your budget, then we need to save a little bit more. And that's just how it is. I feel. You get what you pay for.
Yes. A lot of times. Yeah. And we know that they've been cutting corners. I actually had, um, somebody who had some insider information from me ah, aesthetics. And they were telling me, like, the corners that are being cut in their ors single use vials reusing them. The floors. There's nobody cleaning the floors. There's slippery, flat fat all over the place. Sounds like out of a movie. It sounds like a horror movie. Uh, right out of a horror movie. What I've heard is that they don't have enough
staff. People are supposed to be cleaning the rooms, but they're not because they have them doing something else when the next case is getting started. And nobody cleaned the floor. They're still fat. I can imagine I don't know specifics, but you can just imagine from the outside. You don't have to know specifics. If something is too good to be true or the price is, like, so much less than everyone else's, there's a reason for that, and
it's probably not a good reason. It's probably some corners being cut, ultimately. Okay, so with your Colombian style skinny Vvls. So I have so many requests for skinny BBL. It's like the Hot Topic. So first, what's considered a skinny BBL? Who's considered a skinny BBL, and where do you find that fat? Okay, well, I, uh, got good news and bad news. Okay. Good news is, even people who think they're skinny and think they don't have enough fat, they probably do have fat. It's just I will have some
secret locations, which I'm going to tell you. The bad news is, sometimes you really need to be seen in person and evaluated. And I find that the way it's gone as we were talking about with pandemic and the history. Everyone wants online consults now. Everyone wants to stay at home, send me photos. And the problem with skinny girls and what is a skinny girl? I would say a skinny girl. And there's a large variation in what you consider skinny, because it can be skinny fat. You can be
skinny muscular, you can be skin and bones. So there's many varieties of skinny. And my favorite is skinny fat, actually, or, ah, skinny muscular. Those two skin and bones. It's a tough, tough for a BBL. So what is skinny? Let me give you, like, a number. So I would say a BMI from 24 to maybe 19. And that would be, like, your overall medical definition. But remember, that's just a starting point. And there's so much variability because you need fat pinchable fat on your body somewhere that
I can take. So where are these secret locations that I look? So there's three locations that usually even, um, on a skinny girl, I can still find fat inner thigh. So that's if I can pinch a little bit of fat on the inner thigh, even on a BMI 1920, I can sometimes pinch maybe 100, 200 CCS there. The other is the underarm and sometimes the armpits. So people hide fat kind of under their arms. Even skinny girls, I'm m sure some of you
guys know. And the last place and this is the most common place, which is almost 99% on everybody they have fat, is a little ring around the love handles and around the lower abdomen. And this is what we call, um, in Florida, usually the lipo 360 zone, or the waist lipo or the flank lipo, love handle. All these are kind of interchangeable for that circular ring on your hips. Some people call
them the upper hips, your waist, basically. So if I have a skinny person who's, like, another doctor turned me away or I don't have enough fat, I'll say, okay, come into the office or send me a video of, uh, you pinching those three areas. And if you can pinch, pinch an inch is what another, uh, doctor in Canada said to me. If you can pinch an inch, we can do a skinny BBL. And why pinch an inch? Because if you're at home right now and you're pinching and it's less than an inch, it's
probably just skin. There's not enough if you can pinch and it's an inch, there's something in there, then we can lightboard it. Beautiful. Um, okay, so I know this is all the secret sauce. I'm asking you all secret sauce. Do you have a favorite way of processing the fat that you see the most success with? Yes. So this is a little bit of secret sauce. You're right, because as surgeons and scientists, we haven't figured out what the optimal fat processing treatment is. So, for me, I kind of
learned from mendieta. And some of the older, more well known BBL surgeons in Florida. And what they think is the most important is time. So when you take the fat out, do minimal processing, and you put it right back in. And that is kind of the key with fat survival. And if you think about that,
that makes a lot of sense, right? The fat is being removed from its home, its blood supply, and the more you leave it out on the table and do different maneuvers, you're kind of injuring it or you're preventing it from getting back to healing. So what I do when I'm taking the fat out is I take it out, I filter it with gravity so we have to have a shaker on the side table. So if you can imagine, there's all these fat cells and it's shaking, and all the fluid, blood, anything goes
to the bottom, oil rises to the top. And then you have this nice, beautiful yellow liquid, gold we call it, in the middle. I suck off the liquid I don't want and I immediately inject the fat. And if I'm doing a big liposuction okay, this is secret sauce. I don't even know if I can tell you guys. I don't know if I want to say that. Uh, but if I'm doing a big liposuction case and I know the fat is going to be seen there for a
while, I'll do it in stages. So I'll suck, say, a leader, do the BBL, then I'll suck more, maybe add a little bit more, take a little bit more. So that the key, is I'm not like a big life. It's going to be four liters. I don't suck all four liters and then leave it the whole time. And then I literally will I get 500, 100, it's good fat, put it right back into where I want it. And I think that is where I get the most survival. Wow, that is a, um, secret sauce right there. Secret sauce. I love it.
Okay, so then after that, I think the most common question I get about skinny BBL's lipo, and I can't wait to hear what your recommendations, uh, are, or how you are with your patients about foams and boards after surgery. So this is, again, another area where we don't know. We don't have evidence on what is the best answer. What is the most optimal foam, compression, timing, millimeters of mercury? We
don't know. All I know from, again, a lot of experience doing a lot of light bulb and a lot of BBL is some compression is better than no compression. And too much compression can also be a problem because then you get skin healing. So some compression, and usually it's anywhere from six to twelve weeks. And the best compression is, like I said, gentle compression. And that's where
it becomes a balance. Is the FAA the best or should we put faja in foams or some combination to get the best compression for each individual patient. So that's kind of where I'm at now. I'm at a kind of middle of the road approach where I do use foams, I do use the FA Hawk, but I am, um, conservative with them. I'm not too aggressive in
terms of tightness. And after six to eight weeks, when the patient tells me, you know what, when I'm out of my FAA foam, I don't notice too much difference, then I say, okay, now you can wean it. So you may have wanted a m more kind of this is the right answer, but I think no one knows exactly what is the perfect regimen post up. We're still learning. The beauty, uh, for me, of having the show and being able to showcase so many different surgeons
is that I get to hear everybody's opinion. And, uh, what I want my girls, my listeners, is they get to hear other surgeons opinions, and they're able to learn as they're going through their journey about, well, what you're saying can help them later on, not be so worried if they're not in the tight enough, huh? Because they know some compression is better than no compression, and
they're learning. And this is the valuable information that my girls just love, because they're learning for the future, or they're learning for right now. Maybe, uh, they'll see somebody who's having to deal with this, and they're like, hey, there's actually a podcast episode about this with Dr. Jankadlow, and he talks about, uh, phones and fajas. And then an interesting thing is that things change. So when I first graduated in 2017, no one that I knew knew anything about post operative
massage. No one was talking about it. The only reason I knew about it was because of Colombia. And in Colombia, in Brazil especially, they have been doing this since the 90s. They were doing lipo with aggressive massage. They were doing getting incredible results. And so I feel like now everyone talks about massage. So you look at in the space of five years, we've gone from no one talking about massage. That's all anyone talks about. So it is interesting how things can really
change when something works. And I think the same thing as with FA Haas and compression. Everyone's talking about it now. And I think with more people talking about it, more patients getting it, there'll be better research, there'll be better, um, kind, uh, of evidence. And then we'll know exactly, maybe in ten years, 20 years, we'll say, hey, you need this much millimeters of mercury in this zone for this many days. And that'll be like an amazing, like, your dosage of Tylenol will be
your FAA dosage. You know, we'll know it better. So at least the average, though, you're saying six to twelve, and that's really what I've been hearing across the board, six to twelve weeks before you really start to wean yourself off of it. But the foam I haven't talked about foam too much on the show. What is it supposed to do? Why do you all use it? What is the purpose? So foam I think of for a couple of reasons. So foam is to make the contact between the FA hat and the
skin more gentle. So sometimes you have those kind of lines in the FA hall, or the zippers or the straps, or sometimes they use drains, and the foam is just to make this more gentle. And the second reason I use the foam is for areas of high compression. So especially at the very deepest part of the waist, or if I'm doing kind of sometimes on really skinny VLS, I'll do some absculpting, which is I'm just defining those kind
of athletic lines. If you put foam in those lines, it's going to help give a little bit of added compression. And so there's many brands of foam. There's many different types of foam. We use something called toppy foam, which is about a quarter inch to a half inch of thickness. And it's gentle. It's not like those you can think of. Foam can range to a brick where it's like super hard. It's a super kind of squishy where it's like air.
And our foam is kind of in the middle. Again, the same rationale is we want some compression, not too much compression. And it's going to help give added compression under the FAA in those extra kind of contoured areas. Beautiful. So since you already knew about massages from Colombia, I have a question. So what is the I know in Colombia, it's like the day of go get your massage. Yeah, it is. So how do you mesh both here? So I went with the Colombian method almost right
away because it was so funny. So when I was in Toronto, a lot of the massage therapists were like, RMTs or registered massage therapists, and they wouldn't touch my patients for six weeks. And they're like, oh, like, I'm going to lose my license. This is like and so I met a Colombian massage therapist just by chance, instagram. And she was like, no, in Colombia, we do it the day after surgery every day. And I was like, okay,
let's do this. I'll write a doctor's note. I'll write a letter saying, doctor Jan Carlo give permission to do massages. And she was like, that's fine. And then I was getting these incredible results. And a lot of my colleagues were like, when do you start the massaging? The next day? And they're like, you're crazy. I'm like, no, I'm not crazy. I didn't invent this,
okay? And it's kind of the weird thing about being you never want to be first at something because when you're first or early, then people are like, oh, this guy is crazy. This guy doesn't know. But it was like, no, the Colombians and Brazilians do this. You just have to have faith that you're not going to injure anything. And if you really think about it, what is the biggest downsides of liposuction? The biggest downsides is the swelling, the fluid collections. Draining.
Draining the irregularities. Everyone wants a perfectly smooth skin and appearance, but with liposuction, it's rough, right? And you can get small irregularities. So Massaging takes care of all of those problems. You're literally smoothing out the fat, especially in the first few days. You're smoothing out irregularities. You're helping with drainage. It's like all the biggest problems with Lampostion are addressed to me. It's more like, why are you not doing massages? Right?
Because then you're going to have a much higher risk of all of those, uh, kind of downsides. Yeah, absolutely. So when you do your tummy tucks, do you allow them to massage on the tummy tuck, too, or just wear the lipo? It's a great question because with the tummy tucks, the most aggressive lipo is on the sides. I don't do as much aggressive lipo in the middle, but I
still do lipo in the middle. So what I found is we massaged the whole tummy tuck, and this was something, again, from Brazil and Colombia that they were doing with tummy tucks. And it actually made me switch my technique because I had learned drainless tummy talk when I was a plastic surgeon. That's a very good topic, too, right? So I actually learned drainless tummy tuck. And most of the surgeons that I was working with, and they're like, drainless, drainless, drainless. You
don't need a drain. You don't need a drain. You don't need a drain. But then I moved to Florida, and everyone was doing these Colombian Brazilian techniques and with tons of fluid. And they said, if you're going to massage the patient on day one, put a drain, because guess what you can do? You can basically massage out all of their fluid and they're going to recover much faster. And no word of a lie. That's like the exact thing I saw. I was
doing mostly drainless tummy tucks in Canada. I came here, added a drain, more aggressive massage, and my patients, even with a drain, recover faster. In terms of the swelling and the appearance of their abdomen in the first few days, you can almost look like a cookie doll. Like, the stomach just looks lumpy. Yeah, squishy and all. It's ademitis. And squishy is the best word. Whereas when the dolls with the drain and the massage, it's like they really get rid of that fluid fast.
I'm so happy to hear that because if you've heard any of my episodes, you all know I'm totally team drains. So we had an early episode where we were like, okay, well, I had drains during my tummy tuck, and I love drains because of this exact reason. Yeah, I witnessed it with my patients when I would I worked for multiple surgeons, and some of them did drainless, and some of them did with drain.
What. I would tell my girls is like, just because it's drainless doesn't mean there's not fluid accumulating there. Your body has to deal with it. Your body has because they're like, oh, it comes out in your peak. But you still have to go through the process of getting it there. Right. You know, you should do you need like a scoreboard in the background? Team drain, team no drain. And then you can ask them. That's a really good idea. Okay, so today Dr. Jack Gadlow said.
He'S team drain, team Drain for sure. I love that. M, I'm writing this down. Tell us about the different techniques. Okay, so drainless tummy talk versus tummy tuck with a drain. So it's not just pulling out the drain, it makes a drainless tummy tuck. No, a drainless tummy tuck actually is a genius technique where instead of just laying down the skin flap, which was the old tummy tuck technique, where you would do the muscle repair, you take the
skin flap and you'd sew it down in place. They realized that if you just lay this flap down, there's a huge open space that is a potential place to collect fluid. So what they did is as you are laying down the skin flap, you're doing quilting sutures or tacking sutures so that whole flap is packed down. Some surgeons do 20 tacking. I do a line down the middle and basically crisscross on the sides so that I'm eliminating
all that potential space and surgery. We call it dead space because it's an area where fluid can collect. And if you do all that, you're going to have a very little chance, a very small chance of collecting fluid. That's a drainless stomach tuck. Because the surgeons were like, okay, if I'm going to do all this extra work, all this extra suturing, all this extra quilting, let's get rid of the drain genius idea. It is a genius and it
works. But and here's the big butt. If you are doing a tummy tuck with modern aggressive liposuction, because nowadays is not the same tummy tuck they were doing 20 years ago, nowadays there's really a lot of liposuction on the flanks, a lot of contouring. You add in, even with the quilting and the drainless tummy tuck technique. What about the sides? What about the flanks? What about the lipo 360? What about all the areas around the quilting where you've done all this
lipo? You're going to have fluid build up. So that's what technique I do. And I think, uh, I can't claim that I invented this, but I basically, I do the drainless technique with all the quilting and then I place a drain underneath everything. Because I know that my patients, when they come to see me, are getting a week, two weeks straight of massages. And by the end of those two weeks, the vast majority of patients, the drain is ready to come out because they've been milked squeezed like
a lime every day after surgery. So I hope that is kind of if people can visualize drainless versus drain, and then I think both. I think that is beautiful. I had no idea that there was surgeons out there doing that. It was either one way or, uh usually I hear either they do one way or they do the other, but I hadn't heard of this combination of both. And I'm curious to know, do you still see a significant amount of fluid in their drain? Yes. So the drain fluid that we normally see is for
two reasons. Number one, because of the lipo. Remember, with most lipo, we're putting in two liters, three liters of fluid at the time of surgery. That does not come out immediately with the liposuction. Some of it does, but most of it is coming out in the drain in the first couple of days. And the second reason for fluid is that your body doesn't know you had a tummy tuck. Your body just knows it got injured. And how the body heals
is very interesting. It swells. It swells because the blood vessels are injured, the lymphatics are injured, the tissues are injured. And what is our body it's like 95% water. So when structures are injured, they get leaky. The leaky fluid is the swelling. And this leaky fluid is actually what your body needs, because now in that leaking fluid is the cells that will help repair the immune system will come in and make sure there's no infection. So it's actually a very natural
process. So by doing the drainless tummy tuck, you're minimizing the fluid, but it doesn't address that your body is going to be overloaded with fluid. And that's what you were kind of saying, is that you notice or we were kind of saying about how squishy people are when they don't do the, uh, drain. Whereas with the drain, your body is doing all that natural swelling, and then the extra fluid can be massaged right out. Yes, there's a lot in the first few days, but
usually it's very little by two weeks. Now, I will say something, though. Sometimes the drain is very hard to remove because in my patients, especially, I do a lot of weight loss patients, they have tons of loose skin, and sometimes their BMI M is higher, like 31, 32 BMI. I have a max. My Max is 32. But you can imagine when someone has a higher BMI. So that means more room for fluid to collect. They have more injury because there's more fat and more swelling. Then sometimes the drain can be
difficult to remove. It can take three weeks, four weeks. And that's why people are so against the drain. And I get it. Imagine having a drain for a month. It's a bummer. I like I tell my girls, I'm. Like, you know, just accept that this is your buddy and he's going to be with you for the next two to three weeks. But once he's gone, he's gone. And he's not hurting you. He's only helping you. So you just have to make peace with it. And I love it. I call it short term pain, long term
gain. And with this technique, I think in the last two years, I've done hundreds of tummy tucks. I've maybe had two seromas, right? Like build ups, almost nothing. It's amazing, m, because we do both right, and so it can still happen, but much less. That is amazing. Dr. Jenkins, this was so good. I already knew, I already knew the vibes. I already
knew were going to be amazing. But before I let you go, when I was looking you up and I was reading, um, I saw that you co authored a paper on social media and how it affects cosmetic surgery, and I'd love to hear your take on that. So when I did the study, it was almost, like, rare for plastic surgeons to have social media. The reason why is you guys got to remember, surgeons most, they are old, and surgeons take a long time to develop. And so we are kind of like dinosaurs
that we move slowly and we're slow to change. But there's a reason for that, and the reason is safety. We do things that work, and when something new comes along, surgeons don't want to try it because new means potential risk, right? So that's why so many surgeons are set in their ways. And I know on social media, you guys laugh at us like all these dinosaurs, but there's a reason. It's a good reason. It's safety. So surgeons looked at
social media the same way. It's something new, it's something dangerous, and in one way to write, because what do you see in the news? Every once in a while, a doctor will lose their license because they're posting bad stuff or they're doing unsafe things on TikTok or who knows, right? There's all sorts of potential landmines with social media. But I since, again, I'm a little bit younger generation, I was looking at it as a communication
tool. And so what I found in my study was I researched all the plastic surgeons that were listed with the Canadian Plastic Surgery Society, and I found only 50% of them had a social media profile, which I thought was kind of low, considering that if you ask your friends, like 99% of them at that time had a Facebook profile. Now, that's like dinosaur. No one wants a Facebook profile. But that was included. Everything we looked at Facebook, LinkedIn, there was no TikTok
at the time. There was Instagram, and we found there was no profile. And the most active people were actually cosmetic surgeons. So the point of the paper was just to find out what Canadians were doing plastic surgeons, and probably they're very similar to Americans, and that it's kind of a lost opportunity because I feel that social media has been one of the best parts of my practice. I get to show my results, I get to educate, I get people
to see my personality, which is so important. Like you said, you got to choose the surgeon that is kind of on the same wavelength as you, that has the same eye for aesthetics, has the same style that you're looking for, has maybe the personality that you are going to listen to or find good communication with. There's so many variables. So I find social media, like even this podcast, people will hear my voice, they'll hear my thoughts, they'll hear how I answer questions with
you. And they'll be like, you know what, I really like the way that Dr. John Carlo thinks I want to go to him. Or they'll think, you know what, I like his sense of humor. I don't like that he's too jokey. And that's fine. Then maybe there's a surgeon for you out there, right? And that's the good point. And that's, I think, the good point with social media. That they get to know you and by the time they come in, they already know you. They feel like they already know you.
Yeah, that happens a lot. That's where I'm going to do my little plug. Julie and I, we created a Facebook group. It's called Dr. Jancarlos palo. Excellente dals. Ah. And you have to spell those correctly to get in. And what it is, is we have about 6000 members and we do Facebook Live every
Wednesday with question and answers. And I think that's been like a rocket ship because in terms of growth, because I felt like being in Florida is great, but you kind of get lumped in with a lot of the bad actors and then there's a few lots of good plastic surgeons, don't get me wrong. But you know what I mean, where the BBL factories, you get kind of lumped at this. But I felt like with the lives and with the social media, I'm able to say, hey, listen, yes, I'm in Florida, but I do things with
safety. I do things the right way. The board certified. American board certified. Canadian board certified way. And uh, the social media has allowed me to just showcase that, to showcase that's amazing. That and I feel it's so important that we talk about this because you're so right. A lot of plastic surgeons here in the US. Even till now, they might have an Instagram, maybe their practice. There are a lot of plastic, really great, really, uh, good ones, uh, who are not on
social media. And that I tell my girls that all the time. Just because they're not on social media doesn't mean that they don't exist. And also not just because they're on Instagram means that they're good. That is a really good point. That's one of the things I wanted to actually touch on is one of the biggest problems with plastic surgery. And the whole beauty industry is social media because it's not honest. And there's two ways it's not honest.
The results they're showing you are either edited or not realistic for your average patient. And also because a lot of people who have had plastic surgery are dishonest about it. So they have the work. You're like, Why did they look so good? And they're like, oh, yeah, I'm eating broccoli. It's like, you did not eat broccoli to get that BBL. Do you know what I mean? That's not true. It's a skinny tea. I've been drinking tea. Skinny. And I've had that. I will always protect patient
confidentiality. But it is funny when you have patients that they won't tag me. They will not tag me. But you know where they got that booty? You know where they got those ABS? And I'm just like, you know what? She looks good, and I'm happy. And it's true. If you want to tag me, hey, I love it. That'd be great. But it is funny. I actually was having a conversation with one of my girlfriends, and we were talking, she was like, some of the surgeons, like, best results. Nobody
will ever know because they don't tag. They want, um nobody knows that it's not real. And I have to tell you a funny story. So this is the difference between Canadians and Americans, okay? So when I was in Canada, I had a patient. Amazing result. Amazing. Did not want to do social media. Not wanting me post. Okay, no problem. And she was showing me pictures of her bachelorette, uh, party, and she was in a bikini, and she's like, man, all the girls were asking me, like,
what I did on my routine. And she just said, oh, diet and exercise and giggle. And I'm thinking to myself and then I said to her, I'm like, why wouldn't you tell them my name? I'm trying to get some business. I'm brand new. I'm just starting. She's like, no, a girl's got to keep her secret. So I'm like, okay, fine. So that's Canada. The US. Men, they come in, they're filming on the way into the clinic. They're doing, like, a Facebook Live. They're like, Doctor, gee, can you film my butt
from this angle? Can you do this? Tag me. I'll tag you. It's the exact opposite in terms of willingness to share. And I just am always amazed by how conservative some people are and how people want to post things. I'm like, you can't post that. That is scandalous. We're not even allowed to post when you want to post. You know what I mean?
I love it, though. It's refreshing in a way, because I feel like a lot of that stigma that was around plastic surgery and kind of like, oh, you don't want people to know is fading, where it's like, so what? Well, it is and isn't. This is just kind of a general story, but I do think age, the generation of the patient, the culture, like Latinas, um, uh, more Southern floridians. They don't care. They want everything out there. Whereas I feel like more northeast, more conservative. They are like,
no, I don't want it out there. And also the line of work, it is really interesting because I feel like you'd think stay at home moms or moms would be like, they're like, more private. And I feel like people who are more out socially, they're more like, okay, put it out. So it's really interesting. It's really interesting. I would love also to hear, uh, from your point of view, seeing them about their post office glow up when you see them come out.
Okay. That is probably one of the best highlights of my job. So I've had quite a few patients that where they wanted to look better for their daughter's wedding. Or I had a patient who get a divorce or a patient who is getting ready for their own wedding. And the glow up is unreal. Like, just seeing them in their wedding dress. And some of them are funny. What they'll do is take a picture in their dress or presurgery, and then
they'll take a picture post in the same dress. And those are, like, so powerful because they'll be like, this was the dress that I really wanted to wear, and it never looked good. And now look at me. Like, the glow up is for real. But here's the big asterisk. Sometimes it's hell to get there. And that, uh, people don't talk about that enough. The recovery can be tough. And the older you are, the more health issues you have, the bigger the
surgery, the bigger the recovery. So I think the best way to think about it is the first few days after surgery, you feel, like, incredible because you're like, adrenaline rush. You're like, look at this. Boom. And then you kind of realize, oh, now I'm going to swell. It's painful. I got a drain. Uh, there's an opening on this side that's not healing right. And then you kind of realize, I'm not going to look like that instagram model that I
thought I wanted to look like. And then after a few weeks, after all those things, then it's like this. Amazing it's a roller coaster. Because for me, when I came home, I think my realization of, like, oh, this is going to take me a minute. Yes. Because I don't know where it comes from. Maybe it was do you remember that plastic surgery
show? It was called the Swan or something, where they would do a M total makeover, and then they would show, like, on the next scene, the woman walking out was sparkled, and she was perfection. It's like, that took six months. That literally took six months to a year. And it gives this fake impression of when you leave the operating room. Yes, you're going to look tighter. You're going to get what you want, but it's not going to look the way it's going to look until six months. It takes
time. It's like, uh, you're putting a cake in the oven. Yes. You know, the ingredients are there. Yes is there. But it takes time to cook. And that is how your body heals, which I do feel that's probably the biggest let down for some patients. They think they're going to be at their wedding the next week after surgery. And it does not work that way. Absolutely not. I always like to tell my girls, like, planned when I hope they find me, I'm like, let's plan for a year from now. You're going to be
fine. Let's give us a year. We're not, uh, upset, um, with the results. And we're still giving it time. Like, I had a girl recently, she had her implants, and one of them wasn't dropping on time as fast as the other. You know how it goes. And she was starting to get a little anxious about it. And I was like, just give it time. Just give it time. And sure enough, right at the five month mark dropped, uh, she's like, I woke up and it was in place. It was a couple well, I've had.
Patients writing bad reviews, like, five days after surgery. And I'm like, you're writing a bad review about things that will get better at five days. You're absolutely right. You are. You know what I mean? Yeah. Those things that's why the name of the it's like big butts, no lie. Like, you're going to get your big butt. And the no lie is just going to take time. It takes time. And the no lie, it might not be perfect. We have to go through recovery. You got
what we're doing. We got to m make sure we pick the right doctor. Because, uh, the right doctor, especially for BBL. You know what you were mentioning earlier, when doctors who are inexperienced with this procedure choose to do it, the results. Don'T look that, um, great. It could be that problem. And the other thing I think that we haven't really touched on, especially with skinny BBL, is it's a lot of work on the patient's part. My work in the surgery is
about two and a half hours. And my work as your surgeon is communication, giving you the information, kind of guiding you. But after surgery, it's more like a cheerleader. All the hard work comes on the patient, and I think a lot of people don't appreciate that. And you're like, well, what hard work? You got to do the massages. You got to wear the FAA. You got to watch your weight and what you're eating. Right. A skinny BBL, if they're just eating hamburgers after
surgery, they're going to ruin their results. So I feel like the patients who do all those things, they get an even better result than was on the table. And the patients who kind of just blow those requirements, uh, off, don't take care of them, don't go back to the gym, don't really invest in their investment. They get mediocre results. And at the end of the day, it always comes back to me. It's like the people who take care of themselves and they make me look like a
better surgeon. I get the credit for that, so I'm happy. But the ones who don't take care of themselves and they don't do anything, I still get the credit for that discredit for that. And then so usually it's one of those things in between that's like, okay, well, do we need to do a round two? Do we need to do other things to help this
patient get the look that they're looking for? And that's another here, no lies, is that sometimes to get the result that you want, it requires multiple surgeries and a lot of hard work on that person's part in terms of what they need to do to get their body right. You know what I mean? It can't all be the surgeon. It kind of has to be 50. Uh, 50.
It's 50 50. I tell my girls once I like to teach my girls that they have to get all their diet, their eating habits, uh, all of those habits in control and good before surgery. That way after surgery, it's like getting. Back on the bike. You're slowly getting easing your way back in. And it's not like, oh, you're working out, uh, for the first time ever after your surgery.
Yeah. And also what I've noticed, and there's a lot of research to back this up is that the healthier and stronger someone is before surgery, they are going to withstand the stress of surgery much better. And this is, like, shown in study after study. So it's not just eating right. It's not just having a healthy attitude, healthy mind, which are important. It's really having a strong body because your body doesn't know you're getting a tummy tuck. I already said that. It's like, you
injured me. I'm, um, injured. I got hit by a truck. How do I recover from this? So the stronger you are, the easier the recovery. And so I'm always, like, drilling that into my patients. Beautiful. Okay, so I know I've had you on for longer than I was supposed to, but I'm happy about it. Before I let you go, I want you to educate us on what is called the Fluff Fairy. Okay? So, um, the Fluff Ferry is a real ferry,
okay? It's not like the tooth fairy. It's not like your mom putting, like, $5, uh, under your pillow when you're asleep. The fluff. Ferry exists. And this is a great example of patients teaching surgeons, because I never knew about the fluff period until I started doing a lot of Bbls. And I would have patients that I would see the four week, the six week. And some of them would be really disappointed. And they'd be like, my fat
hasn't survived. And I would, uh, just say to them what the textbook says is give it time, give it time, give it time. And then some time. And this varies from patient to patient between the three to six month mark. The fat really finds its home. And this is what is called the fluff period. And I've seen it time and time again. And I think science will catch up again because what my hypothesis is, is that you're doing a transplant. You're taking fat from one part of the body to
another part. It's a transplant. This fat cells is moving from one home to another home. And it takes them a few months to get comfy in the home. They got to redecorate. They got to buy new furniture. They got to put some coat of paint. Like, you get what I'm saying? And so for the fat cells to really be healthy and thrive, it's not on our timeline. We want everything done yesterday. We want to look excellent now, right? So what the fluff period? I think is it's just those fat cells
getting comfortable? And so now, um, I actually use that experience. I say wait for the fluff fairy. And how can you encourage the fluff fairy? Because remember, we're talking about what can a patient do? So number one is the massages. I think the massages really stimulate blood flow. Deep tissue massage also is going to get rid of that extra swelling. So it allows the fat cells to be
more comfortable in the home. And the last thing, and this is super important for skinny BBL, since this is our topic, is you have to feed the fat. You have to feed the fat. And I'll repeat that again, feed the fat. So if you're someone who's already skinny and you are after surgery starving yourself because maybe you're nauseous or you don't feel well or the surgery kind of hit you hard, you need to eat more than you regularly eat. And it's not bad foods. How do we feed the fat?
It's healthy fats, olive oils, avocado, red meat, really good high proteins with healthy fats in it. And this is the one time that a doctor is going to say ice cream, French fries, at least something with some fat is going to really help you. In those first couple of months after. A BBL, I've had a plastic surgery nutritionist on here. And she recommends instead she's like, most people go into like, oh, I don't want to eat
because I don't want to ruin my results. And you really should be like, I need to eat in order to make sure I heal properly and I get the results that I'm looking for. Right? No. And I think nutrition is such a misunderstood topic in plastic surgery. And even she's probably, if she listened to this episode, she's going to be, like you said, ice cream and French fries. You're a bad doctor, and I get it.
But the thing is, in the reality is, after surgery, especially in a skinny BBL, any calories is better than no calories because you're already dealing with someone who's probably maybe eating less than they need. Because if they're really skinny, they're probably either they're not someone who's getting too much nutrition. They're probably someone who's getting a little bit under. And then you go into surgery and they have an increased demand to heal. And if they're not going
to meet that, the butt will fade away. Those fat cells will be like, feed me, and they may die. Or they may just what's called hypoplasia, where the fat cells are in the buttocks, but they're not growing. Right. Like, I did the trance. Imagine the way I think of it and the way it's been explained to me is there's two ways the BBL works. It's not just the number of fat cells, but the size of the fat cells. So imagine in a skinny
person, their fat cells are not that big. So if I transplant 500 of them and 500 survive, we're happy. But if they don't grow or at least fluff out, then what's the difference? They're not going to give you that result you want. And that's where feeding the cells is as important as transferring them, which is the BBL. Whenever we say, oh, it's 50 50, your surgeon is 50% and 50%. This is your 50%.
And I think if a nutritionist is an amazing person to talk to, and if someone who's really serious about their fitness and a skinny BBL, then getting their nutrition in kind of good control prior to surgery so they know, okay, this is how much my macros, my proteins, my fats, and after surgery, I'm going to need this much more. Those people would get incredible results, right? They have. I've had a few girls who are going through this where she puts them on a regimen
prior to surgery. She gets their gut ready. She's getting them ready for everything, all the medications prior to surgery. And then after surgery, she puts them on an anti inflammatory diet with this and that. And my girls who have gone through with the nutritionist as well, are healing. They're telling me this is not bad. I'm doing fine. Everything's great. I'm, um, healing. I have no doubts about that. I think that's amazing. Okay, Dr. Jankablo, so thank you so much for coming
on the show today. You are amazing. Just exactly what I thought. Uh, tell our girls where they can find you. First of all, I'm in Boca Raton, Florida. It's a really nice place to come visit for surgery if you're looking for it. And where you can find is two ways. So we have a really nice Instagram run by my wife. Real plastic surgery. That's all my results. I have my instagram doctor. John Carlo I really post my baby sometimes. So if you just want
the results, go to real plastic surgery. If you want to see more personal stuff, doctor John Carlo and you can find everything there the website quotes and mostly results. And I think the best thing about me is, if you follow, I post every result every day. You can see I post the high BMI, the Instagram, the skinny. So I think, you know how we were talking about social media not being realistic? I'm realistic. That's why I call it real plastic surgery. Whatever I do, I post, of
course, with permission. I think it sets more realistic expectations patients, because you can see where you start is sometimes as important as where you end up, right? Absolutely. Where you are before you go into surgery. And with your weight loss patients, do you recommend that they're at the goal weight before they come into surgery?
Yeah, 100%. So with weight loss, the key for the best result is to be at, uh, your goal weight and to be stable for about a year, sometimes six months of patients really motivated and they're really kind of gung ho. And why is that? Because if someone, as we talked about weight and nutrition and health plays such a huge role in the final result and surgery is expensive, it's time consuming, it's a big investment. You really want to have optimal conditions on your body before
doing surgery. So my weight loss patients know that's why I have a strict cut off. They want to be at their goal weight stable, and that's when they're going to get that razor like salente. Otherwise it might be that they get a sub optimal result and then they need multiple revisions or multiple and then it kind of is, I feel like, not as life changing of a process as if you do it right the first time. Absolutely.
I think you could not have said it better. Doing it right the first time, I think, is kind of like my tagline, do it right the first time. When we do the homework right prior to surgery, we do everything we're supposed to. We find the right surgeon, we're at the right weight. We're doing all of our we're preparing our mind, we're preparing body, we're preparing our support system after surgery. It's a piece of cake because you.
Already did all you yeah, if you plan all those things, I think in my group and in my I would say healthy mind, healthy body, healthy soul. So the healthy mind is kind of all those important support system, positive attitude. And then the healthy body is the nutrition part and the exercise. And healthy soul, I think, is something that is not talked about enough. But if you're not happy before plastic surgery, surgery is not going
to make you happy. If you have depression, mental struggles, struggles at work, struggles with family, plastic surgery is not going to fix those things, or you've had a recent death or something really tragic. Plastic surgery is not going to fix those things. The way to do plastic surgery is fix those things as much as possible. If you need counseling, if you need therapy, if you need family, whatever you need to do to get your mind right, then do the body afterwards. And that's
where I've seen the happiest patients. It's always sad when a patient thinks that the plastic surgery is going to fix all their life problems, which is not the case. Not the case at all. We know that on the show. That's not the case. I tell my girl, Good. You have to do your homework. Uh, the surgery is not going to fix everything, but okay. Dr. Jankadlo, I am so happy I had you on the show today, and we'll have you back on. Uh, you gave us so much juicy information. We talked about too much.
You got to delete this. You got to delete the tapes. You got to delete them. We talked about the drainless tummy tuck technique. We needed that on the show. We hadn't talked about that. So, so much good stuff. I cannot wait to join your Facebook group. I'm going to ask your wife to sit down. You should. You be in such a bad when you get this episode ready, you have to post in there, because they will eat this up. They will love it. The Reza Alex Celente dolls will blow this podcast up, I'm
telling you. Okay. Uh, all right, Dr. Jancadilla. I will let you go. We'll see you guys next week. Bye. I would like to end this episode with a huge thank you to all of our listeners. If you enjoyed this podcast, make sure to subscribe to Big But No Lies podcast and follow us on Instagram at big. Buttsnolispodcast. If you have a topic you want me to cover, please send it to the DM. If you know anyone on their plastic surgery journey, be sure to recommend them the show. You can also visit us
on our website, bigbutnolies.com. You'll see the online surgical recovery store. We're adding new items all the time. If there's something you think I need to have on there, send me a DM. Don't forget to leave us a five star rating on Apple podcast, and don't forget new episodes every Monday. I'll see you then.