What’s Changing the Game in Male Body Contouring

Keri Stephens:

Hi, my name is Keri Stephens, and I’m the co-chief editor of Plastic Surgery practice, part of the MEDQOR Podcast Network. Today I’m joined by Dr. Darren Smith, a New York-based plastic surgeon who provides cosmetic enhancements such as breast augmentation, liposuction, and tummy tucks. Dr. Smith recently wrote an article for PSP about the role of energy in male body contouring, and we wanted to learn more about the process. Dr. Smith, thank you for joining me today.

Darren Smith:

My pleasure to be here.

Keri Stephens:

Absolutely. And just to start, can you talk about your background and about your practice?

Darren Smith:

Absolutely. So my interest in plastic surgery really began with my dad. He’s now a retired orthopedic surgeon. And when I was in high school, I joined him to watch in the operating room, and he plated some bone or something. I didn’t know what it was at the time, but there was this big piece of metal, and they could not get the wound closed over it. And so they called in a plastic surgeon, and he closed the wound, and it was like magic. And I decided I wanted to be the magician. And that’s what got me into plastic surgery.

Darren Smith:

And from there, I initially had a focus on the anatomy of the face and skull. I was fascinated by craniofacial surgery. So I did a fellowship in craniofacial surgery. And then I really took a special interest in the aesthetic end of things, and how we could really make people happier, and feel better about themselves, and address any insecurities that they may have with some of the treatments that we could provide. So I did an aesthetic surgery fellowship.

Darren Smith:

So now I am privileged to own a practice on the Upper East Side of Manhattan in New York city, where we’re dedicated to aesthetic surgery of the face, breast, and body.

Keri Stephens:

That’s awesome. Okay. And so, in the article, you wrote about the role of energy in male body contouring. And can you please explain the different components of body contouring?

Darren Smith:

For sure. So I think that, at its core, body contouring encompasses any procedure that is designed to change the shape of the body. And, in general, we’re going to be either adding volume to an area or subtracting volume to an area. It’s more common to subtract volume than to add volume. And the way that we subtract volume is either through noninvasive or minimally invasive techniques. Noninvasive things would be things like Emsculpt Neo or CoolSculpting, and minimally invasive techniques are things like liposuction.

Darren Smith:

On the other end of that spectrum are the classic invasive techniques like tummy tucks, and arm lifts, and thigh lifts. And essentially, whenever we remove volume, when we remove fat from an area, that’s one piece of things. The other piece is what do we do with the skin envelope? So if we remove too much fat for the skin to be able to handle it, you’re going to see signs of skin laxity. It won’t be able to contract enough to give you the result that you’re looking for. It’s almost like deflating a balloon.

Darren Smith:

So the example that I always give patients is, if you have a spectrum where on one end of it you have a 20 year old woman who’s never had kids, she’s never smoked, and on the other end of that spectrum is a 90 year old woman who’s had seven kids, she’s smoked all her life. The 20 year old is going to have better skin elasticity. If we do a little liposuction, her skin’s going to snap back, and you’re never going to know it happened. But if you take the 90 year old and do that liposuction, you’re going to have this loose hanging, maybe pruny-looking skin. And every patient is somewhere on that continuum. And classically, if you were to take someone and do something to remove fat, say liposuction, and they did not have good skin contraction, you’d be obligated to do something more invasive and cut the extra skin out. That’s exactly what a tummy tuck is. It’s a way of regrading the skin envelope to better fit the volume contour that you’ve achieved.

Darren Smith:

What energy has allowed us to do is treat more people within the minimally invasive realm. So now, if you have someone with moderate skin laxity, and you do some liposuction, in the past they would’ve likely had some visible waviness or hanging skin, what have you. Now we can take one of several energy-based devices and use that to tighten the skin. So you can actually avoid doing an abdominalplasty in somebody. And this is… I use the example of a pregnant woman, but the… Or I’m sorry, of an older woman. But you could say the exact same thing and use men for the example.

Darren Smith:

And the reason that I think that this is… That energy based devices are particularly germane to male body contouring, is that while the number of men that are seeking out cosmetic procedures is certainly increasing, I do think there’s still a taboo around this stuff, and men are likely to be more reticent to have a cosmetic procedure performed. And I think that the less that they have to do, the more likely they’re going to be to feel comfortable with the option. It’s much easier to go someplace and feel comfortable having a little liposuction than it is to go and have a whole abdominalplasty.

Darren Smith:

So if there’s a man that has some fatty excess, and some loose skin, in the past, I would’ve said, “Hey you’re really going to need abdominalplasty to see the result that you want,” they’re going to look at me like I have three heads. They’re not going to get an abdominalplasty. It’s pretty rare for men to get abdominalplasties. But now, if I say, “Hey, I can really get rid of the extra fat, and I can also tighten your skin envelope with another minimally invasive procedure and get you a pretty nice outcome without having to perform a full abdominalplasty,” then you’re going to have a lot of guys jumping into the line. And I think it opens up a whole world of possibilities.

Keri Stephens:

Do you think this taboo is still decreasing, though? Because you mentioned it now, and you actually mention in your article, too, about the male taboo for plastic surgery. Do you think it is decreasing? And what do you think will take for it to decrease?

Darren Smith:

First of all, I think plastic surgery, and aesthetic procedures and treatments as a whole, is something that’s becoming a lot more mainstream. And I think that, first, it’s starting with women. I think that the taboo for women is now maybe, I wouldn’t say nonexistent, but a lot less than it was 10 years ago. Plastic surgery used to be a secret. Nobody wants you to know they had their nose done, or their breasts done, or a tummy tuck, whatever. Now, people are going around saying, “Oh, I has my nose done by so-and-so.” It’s actually, it’s kind of become a status symbol.

Darren Smith:

So I think it’s something people are discussing very openly. And I think there will be a trickle down effect, and from… To have the same thing happening with men over time. I think that as it becomes more of a mainstream acceptable topic to talk about, maybe even something that people are bragging about, then I think that taboo is going to continue to fade. And certainly as there is more talk about it in the media, or if you have male celebrities being open about what they’re doing, then yeah, I think that’s going to really knock out the taboo as well. And the big, the fuel on this fire, obviously,

Darren Smith:

Is social media. It’s so easy now for people to share what they’re doing and talk about it and interact with their fan base, or with their friend circle. I do think that the stage is set for that taboo to continue to decline.

Keri Stephens:

Are you seeing more male patients? And especially, again, with the rise of the energy-based devices?

Darren Smith:

Yeah. We’re seeing a lot more male patients. I think, when I started my practice about five years ago, I’d say that our practice was about 20% male. At this point, I think it’s probably 35% male. So it’s still predominantly female, but we’re definitely seeing a significant rise in the number of men in our practice.

Keri Stephens:

Yeah. We’ve been hearing that a lot. In a lot of podcasts, a lot of the plastic surgeons have been talking about how their… The demographics is changing a bit in the plastic surgery, among plastic surgery patients. And, like you said, I do think social media is playing such a role where people are talking about this. These conversations, like you said, were secrets for before.

Keri Stephens:

But, okay. So back to the energy-based devices. So your article mentions the BodyTite body contouring method. What exactly is it? And how is it advancing the aesthetic sector?

Darren Smith:

Yeah. So BodyTite, to me, is the most powerful minimally invasive body contouring device there is, outside of liposuction itself. BodyTite uses, and I’ll just say, I have absolutely no relationship with the company that makes the device, which is InMode. I just like it a lot, so I use it a lot, and I talk about it a lot. It’s a bipolar radio frequency device. And it essentially consists of a very thin wand that goes through a standard liposuction incision and stays under the skin. Then there’s a larger piece that stays outside the skin and you sandwich the skin you’re treating between those two pieces. And each of those wands is a pole that transmits radio frequency energy. So you’re essentially transmitting this energy between the two poles across the skin. The skin is treated almost like a resistor. So heat is generated, and that heat tightens the skin by causing collagen and elastin production.

Darren Smith:

It also actually functions to tighten the fibro-septal network that is connecting the skin to the deeper soft tissues. So you really get this nice global shrinkage of the soft tissues to showcase the contour that you are able to achieve by removing some fat with liposuction.

Darren Smith:

The other point that I’ll make is the other device that people talk about a lot in this space is J Plasma, which is unipolar radio frequency energy. So that’s a device that just was under the skin and it shoots out radiofrequency energy in the form of plasma. I’ve never really liked that device. I think that you’re at risk for having more problems with it, because it gets very hot very quickly, and the energy is not really directed. It kind of goes everywhere. So, whereas with the BodyTite, you’re just shooting energy between these two poles that are actually measuring the temperature in real time to keep you in a safe range, with the J Plasma device, you certainly don’t have directional control, and the energy’s going everywhere from the tip of the device. And the temperature control is not nearly as precise, either.

Darren Smith:

And actually, a few months ago, the FDA issued a warning about using the J Plasma device for skin tightening, because they were seeing some real issues with it. There were burns, there were even a couple cases of muscle breakdown and rhabdomyolysis where the system is getting overloaded with muscle breakdown products, and people were getting pretty sick from it. Now these are all very rare things, and I’m not trying to paint an unfair picture. And there are certainly complications that are possible with the BodyTite device, too. But in a head-to-head, when you’re talking about elective procedures, I’m always going to choose the safer approach. And I really do like the BodyTite for that reason.

Keri Stephens:

Interest- Yeah. Okay. And let’s also talk about noninvasive male body contouring methods. So what devices and techniques are you currently having the most success with?

Darren Smith:

Yeah. So, for a long time, the gold standard in noninvasive body contour was CoolSculpting, which uses cryolipolysis to kill fat cells. And, in theory, it works nicely. Over the past few months, there’s been this uptick in reporting of an unusual side effect of CoolSculpting, which is paradoxical adipose hyperplasia, which is where the fat actually grows instead of shrinks, after Linda Evangelista came out and reported that she had this happen. So now a lot more people are aware of it.

Darren Smith:

So I actually don’t offer CoolSculpting. When I finished my fellowship, I was recruited into the practice of someone who does a lot of CoolSculpting, so I saw for what it was. I never really loved it and I never decided to offer it in my own practice. And then I certainly have had that decision reinforced by this whole recent thing that’s been going on with this uptick in paradoxical adipose hyperplasia cases.

Darren Smith:

So what I really like for noninvasive body contouring in men, again, no relationship with the whatsoever, it’s just what I’ve researched and what I use and that I think it works well for a lot of people, is a device called Emsculpt Neo. And Emsculpt Neo combines radiofrequency energy and electromagnetic energy to provide, or to achieve, body contouring. And the radio frequency energy generates heat that destroys fat. And the electromagnetic energy pulses, the muscles to make them do these, the company calls them supramaximal muscle contractions, which is just a fancy way of saying they make your muscle pull really hard. And so in a 30 minute session of this, you’re going to do the equivalent of 24,000 muscle contractions. On average, there’s a 25% increase in muscle mass and a 30% decrease in fat volume over the course of four 30-minute treatment sessions.

Darren Smith:

And the other nice thing about the device is the radio frequency energy actually also heats skin, so it tightens skin. So it’s this triple-threat approach between tightening skin, killing fat, and building muscle that is really nice. Now, again, it’s not a magic bullet. The machine does not work miracles. You’re not going to take a large person and suddenly make them a very small person with a six pack. What I like to think of it as, it brings you to the next level. So if you’re a little bigger than you want to be, and you do Emsculpt Neo, you’ll probably lose some abdominal fat and you’ll look a little more fit.

Darren Smith:

On the other hand, if you’re already pretty fit, maybe you don’t see a six pack yet, and you do Emsculpt Neo, maybe you’ll start to see a six pack. Or if you’re someone who’s fortunate enough to have a six pack and you do Emsculpt Neo, then it’s really going to make that six pack pop. So it’s all about this incremental improvement. And that’s what I think that device is really nice for, and you can use it almost anywhere on the body.

Keri Stephens:

That’s interesting, definitely. So, as a last question, what excites you most in the aesthetics field right now? And in the body contouring segment of it, in particular?

Darren Smith:

Yeah, I think that there are new devices coming out so frequently, and some of them are just totally crazy, but some of them are pretty cool. And what excites me is just the amount of thought and energy that’s going into this space. And every so often something comes out and you’re just like, “Wow.” I really think that we’re rapidly evolving, and I think we’re going to be able to continue to achieve more excellent results with less intervention as time goes on.

Darren Smith:

And the other caveat I want to give is I would never say that these devices can replace surgery. You’re not going to get a tummy tuck-like result with BodyTite, and certainly not with Emsculpt Neo, but they’re a way of taking someone who maybe would be satisfied with a slightly less dramatic result, but doesn’t want the downtime, and gives them an option to have one of these procedures in a way they couldn’t achieve that before. So I think, as the technology advances and we’re able to do them more and more, we’ll be able to amp that pattern up of being able to help people that want to see a change, but don’t want to have surgery, or want to have only minimally invasive surgery without a lot of downtime. And they’re going to be able to see some really nice changes as time goes on.

Keri Stephens:

No, that’s great. Well, thank you so much, Dr. Smith. It was a real pleasure speaking to you today. And I encourage everyone to check him out on Instagram @nycplasticsdoc.

Keri Stephens:

And 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 out on the latest industry news, please check out surgerypractice.com. Until next time, take care.