Daniel Suissa, M.D., FRCS

00:00 – Introduction

• Welcome and episode overview
• Guest introduction: Dr. Daniel Suissa, plastic surgeon with practices in Miami and California

01:49 – Dr. Suissa’s Background & Journey into Body Sculpting

• Discussion of how Dr. Suissa found his specialty in body sculpting
• Training background: University of Toronto fellowship, Yale fellowship
• Career path: Connecticut → California (6 years in Beverly Hills) → Miami (4.5 years)
• Philosophy: Standing on shoulders of giants while seeking incremental improvements through trial and error

03:20 – Training & Geographic Journey

• Canadian medical training and fellowship experience
• Second fellowship at Yale as entry into US practice
• Opening of Sculpt clinic in California
• Move to Florida and expansion of practice

04:52 – Miami as a Plastic Surgery Hub

• Discussion of Miami’s reputation in cosmetic surgery
• Impact of social media on widespread demand for cosmetic procedures
• Concern about the pendulum swinging too far with young patients

05:48 – Social Media’s Impact on Cosmetic Surgery

• Rise of cosmetic procedures driven by social media
• Concerns about patients (especially young women) wanting too much too soon
• Discussion of procedures becoming commonplace in early 20s rather than later in life

06:30 – Comparing Canadian vs US Markets

• Canada’s more conservative approach to cosmetic surgery
• Historical lag time in adopting new trends and technologies
• Recent convergence: Canada has largely caught up to US demand

08:02 – Patient Expectations & Surgical Philosophy

• “The greatest enemy of good is better” – when patients want too much refinement
• Importance of patient education for realistic expectations
• Distinction between surgical success from surgeon’s vs patient’s perspective

09:36 – Managing Patient Expectations

• Quote: “If you’re not okay with your worst day in court, don’t do it”
• “A surgeon without complications is a surgeon who doesn’t operate”
• Balancing realistic risk discussions with not scaring patients away
• Difference between necessary surgery (cardiac) vs elective cosmetic procedures

11:35 – When Surgery is Appropriate

• Philosophy on patient autonomy in cosmetic decisions
• Criteria for proceeding: reasonable request, not dangerous, proportionate risks, achievable outcomes, well-informed patient
• Importance of full disclosure about risks and complications

12:34 – Age Trends in Cosmetic Procedures

• “Baby Botox” age dropping from 28-30 to 20-22
• Discussion of dynamic vs static wrinkles
• Concerns about complex facelifts in early-to-mid 30s patients
• Historical approach: waiting longer for first facelift to allow for potential second procedure

14:10 – Patient Selection & Red Flags

• Importance of understanding patient goals
• Example: “I want to reduce pain” vs “I want to run ultra marathons”
• Identifying unrealistic expectations that guarantee dissatisfaction
• Patients seeking surgery to save relationships or fix life problems

15:31 – Recognizing Problematic Cases

• Body Dysmorphic Disorder (BDD) recognition and appropriate referral
• Distinguishing psychological pain from life circumstances
• Sometimes surgery does help life situations, sometimes it doesn’t
• Case examples: post-divorce situations, body changes after children

16:45 – Surgery as Positive Intervention

• Balance between helping by doing and helping by not doing
• Complexity of determining when cosmetic surgery will genuinely improve quality of life
• Long-term follow-up success stories

20:00 – Function vs Form in Surgery

• Lower extremity surgery: primarily function over form
• Plastic surgery: primarily form over function
• Exception: hand procedures balancing both elements
• Psychological impact of visible scars

21:01 – The Psychology of Scarring

• Scars used metaphorically for psychological trauma
• Personal embarrassment vs others’ perception of scars
• Medical scars as “battle scars” vs cosmetic procedure scars
• Location matters: breast scars vs facial scars

23:05 – Minimizing Scars in Body Sculpting

• Obsession with tiny incision sites
• Techniques: hiding scars in creases, protecting from cannula friction
• Post-operative care: silicone patches, sun protection for 18 months
• Goal: minimal evidence of surgical intervention

25:00 – Facelift Scar Management

• Anatomy of facial aging: jowls and natural attachment points
• Why incisions go behind the ear into hairline
• Trade-off: longer scar path for less visible result
• SMAS (muscular fascia) techniques for deeper tissue manipulation

25:36 – Breast Surgery Scar Considerations

• Breast scars less visible than facial but still significant concern
• Impact on patient confidence during intimacy
• Circular and anchor scar patterns in breast lifts
• Patient decisions to avoid lifts by adding volume instead

26:55 – Endoscopic & Alternative Approaches

• Historical: endoscopic breast augmentation through belly button
• Transaxillary (armpit) approach
• Limitations based on patient anatomy and breast characteristics
• Fat transfer as alternative to traditional incision patterns

27:38 – Fat Transfer vs Implants Overview

• Transition away from implants toward fat transfer
• Acknowledgment that implants still have place for certain patients
• Not all patients are candidates for fat transfer
• Goal: avoiding scars while minimizing complications

28:51 – Biohacker Movement & Implant Removal

• Growing trend of women removing breast implants
• Concerns about immune response and infection risk
• Fat transfer as solution avoiding foreign body complications

29:01 – Breast Implants: Types & Evolution

• Basic structure: silicone bag containing saline or silicone
• Evolution from soft silicone to cohesive “gummy bear” implants
• Medical grade materials and safety considerations

30:00 – Implant Complications: Ruptures

• Saline implant ruptures: obvious deflation, body absorbs liquid
• Silicone rupture complications: leaking into capsule
• Challenges of removing ruptured silicone implants
• Development of highly cohesive gels to prevent leakage

31:42 – Breast Implant Illness (BII)

• New recognized condition not present during Dr. Suissa’s training
• Silent ruptures requiring MRI monitoring every 2-3 years
• Recognition that silicone bag itself (not just contents) can affect patients
• Symptoms: headaches, autoimmune symptoms, fatigue

32:42 – BII Impact & Patient Decisions

• Not all women affected, but significant subset experience symptoms
• Difficulty detecting symptoms leading to delayed recognition
• Now confirmed by large medical studies
• Patients choosing explantation and fat transfer as alternative

33:07 – Advantages of Fat Transfer

• Lower overall complication rate compared to implants
• Can develop lumps (calcifications) but generally less problematic
• Main limitation: requires adequate donor fat
• Not suitable for very thin or athletic patients with minimal body fat

34:06 – Patient Selection for Procedures

• Medicine doesn’t offer one-size-fits-all solutions
• Individual patient assessment crucial
• Matching procedure to patient anatomy and goals

35:04 – Historical Context: Dow Corning Litigation

• Major billion-dollar verdict in Houston, Texas
• Anecdote: simultaneous implant placement and removal at same hospital
• Humorous dynamic between surgeons performing opposite procedures

36:06 – Modern Body Sculpting Innovations

• Focus on minimizing incision trauma
• Perfectionistic attention to cannula movement and tissue effects
• Progressive refinement of techniques

36:59 – Evolution of Liposuction Technology

• Analogy: like evolution from first iPhone to latest model
• Major leaps vs incremental improvements
• Comparison to development of cars and airplanes

37:27 – History of Liposuction

• Origins: 1960s France with primitive techniques
• Sharp cannulas without bleeding control
• Early procedures: bloody, dangerous, limited scope
• Dr. Klein’s major contribution: awake/tumescent liposuction

38:28 – Tumescent Liposuction Breakthrough

• Dr. Klein as “father of awake liposuction”
• Plastic surgery’s experimental nature (first kidney transplant by plastic surgeon)
• Acknowledgment of multiple innovators contributing to advancement

39:07 – Tumescent Solution Components

1. Lidocaine – numbing agent (familiar from minor procedures)
2. Epinephrine – natural adrenaline causing vasoconstriction
3. Sodium bicarbonate – baking soda to buffer pH

40:52 – How Tumescent Solution Works

• pH buffering eliminates injection sting
• Faster lidocaine action at proper pH
• Epinephrine closes blood vessels serving dual purpose:
  • Extends lidocaine duration in fat
  • Prevents rapid absorption into bloodstream
• Allows dramatically increased safe lidocaine doses

41:21 – Safety of Higher Lidocaine Doses

• Traditional limit: 5-7 mg/kg
• Tumescent technique: safely up to 50+ mg/kg
• Factors enabling safety:
  • Dilution in large volume
  • Injection into poorly vascularized fat (not muscle)
  • Vasoconstriction from epinephrine
• Millions of safe procedures over 30-40 years

42:26 – Incremental Improvements at Sculpt

• Smaller instruments to reduce trauma
• Challenge: maintaining adequate flow with smaller cannulas
• Solution: custom cannulas with more suction holes
• Medical-grade friction-reducing coatings (technology from other industries)

43:40 – Vibratory Technology Innovation

• Air-powered vibrating cannula machines
• Dr. Suissa’s background: psychology degree, studied under Ronald Melzack
• Application of Gate Control Theory of Pain to liposuction

45:06 – Gate Control Theory Explained (Melzack & Wall)

• Nerves have limited information capacity (like internet bandwidth)
• Spinal cord acts as gateway for sensory information to brain
• Vibration at specific frequencies “congests” pain signal transmission
• Combined with numbing solution and light sedation for optimal comfort
• Some patients even experience ticklish sensations during procedure

48:08 – Vibration vs Ultrasound Emulsification

• Clarification: vibratory cannula different from ultrasonic fat liquefaction
• Ultrasound machines use specific frequency to liquefy fat without nerve damage
• Potential complications: skin burns
• Vibratory benefits:
  • Pain reduction via gate control
  • Smoother, more even fat removal
  • “Fanning” effect for better results

48:37 – Skin Tightening Claims

• Skepticism about skin tightening from vibration or ultrasound
• Use of plasma flame technology for subdermal heating
• Modest, temporary collagen stimulation
• Reality: aging and gravity continue regardless of technique

Key Takeaways

1. Patient Education is Paramount – Managing expectations through thorough education leads to better outcomes and patient satisfaction
2. No Perfect Procedure – Every technique has trade-offs; success lies in matching the right procedure to the right patient
3. Evolution of Safety – Tumescent liposuction transformed the field by enabling awake procedures with dramatically improved safety profiles
4. Incremental Innovation Matters – Small refinements in technique and equipment compound to create superior results
5. Psychological Considerations – Recognizing Body Dysmorphic Disorder and unrealistic expectations is crucial for ethical practice
6. Fat Transfer Advantages – Growing preference for autologous fat over implants due to lower complication rates and avoidance of foreign body reactions
7. Social Media Impact – Increasing demand for procedures at younger ages requires careful ethical consideration and patient counseling
8. Multidisciplinary Knowledge – Application of pain theory (Gate Control) from psychology/neuroscience to improve surgical techniques

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Special Offer: Save 15% Using Code “SBPOD” At Checkout