S05E112 The Price of Beauty: Tragic Lessons from Ana Bárbara Buhr Buldrini's Case with Guest Dr. Lawrence Tong

In this episode of Botox and Burpees, host Sam Rhee invites Dr. Lawrence Tong, a renowned plastic surgeon from Toronto, to discuss the tragic passing of 31-year-old Brazilian influencer Ana Bárbara Buhr Buldrini @anabmusi following cosmetic surgeries traveling from Mozambique to Istanbul, Turkey.

They explore how the transactional nature of trading surgical procedures for social media exposure potentially compromised standard safety protocols from allegedly partying with the surgeon before surgery to operating late at night and possibly ignoring basic safety measures like NPO status.

The conversation delves deep into what makes cosmetic surgery safe – proper patient preparation, medication disclosure, facility standards, and the risks of multiple procedures. Both surgeons emphasize that while excellent doctors exist worldwide, patients must conduct thorough due diligence when seeking treatment abroad.

Whether you're considering cosmetic surgery at home or abroad, this episode provides vital information to help you make informed decisions that prioritize safety over cost. Remember - if a surgical deal seems too good to be true, corners are likely being cut somewhere, and the price may ultimately be your safety.

#BotoxAndBurpees #MedicalPodcast #PlasticSurgery #PatientSafety #MedicalTourism #SurgerySafety #CosmeticSurgery #HealthAndWellness #PlasticSurgeons #SurgeryStories @botoxandburpeespodcast

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S05E112 The Price of Beauty: Tragic Lessons from Ana Bárbara Buhr Buldrini's Case with Guest Dr. Lawrence Tong

Transcript

[00:00:00]

Sam Rhee: Hello and welcome to another episode of Botox and Burpees. I'm your host, Sam Ree, and I have with me special guest Dr. Lawrence Tong from Toronto, Canada. Uh, what's your Instagram handle again, Larry

Lawrence Tong: At Yorkville Plastic Surgery.

Sam Rhee: at Yorkville Plastic Surgery, uh, one of the most talented plastic surgeons I know trained with him at University of Michigan.

He's, uh, killing it for all facets of plastic surgery. And as I mentioned in our previous episode, uh, our. Esteemed podcast, three plastic surgeons and a fourth is currently on hiatus. So I thought I'd bring Larry on Botox and burpees so we could talk about, um, a very tragic story that just recently happened.

There was a 31-year-old, uh, influencer, Anna Barbara bore. I. Bini who died after a series of cosmetic procedures in Turkey. And she, her circumstances in terms of [00:01:00] her passing is, is pretty tragic. And I think that there's a lot that we can learn both as surgeons and patients in terms of unpacking this to make sure that, um, our patients are safe and that plastic surgeons are following best practices in terms of, of what they do.

Um, so. Before we get into it, Larry, if you could give us our disclaimer.

Lawrence Tong: My pleasure. So this show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment. After appropriate discussion, always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care.

Never disregard professional medical advice or delay seeking advice because of something on this show.

Sam Rhee: So tell us about, uh, the circumstances with Anna Barbara

Lawrence Tong: All right, so. Uh, Barbara Baldini is a, was a 31-year-old female influencer, uh, from Brazil. And, uh, she and her husband had, uh, traveled to Istanbul, Turkey [00:02:00] to have a series of cosmetic, uh, procedures with the understanding that she would be promoting the hospital where she was having the surgery. Uh, it's reported that the surgeries that she underwent were breast augmentation, rhinoplasty, and liposuction, although they did not.

Um. To elucidate, uh, how much liposuction was done, which might be important. Uh, the surgery occurred on, uh, June 15th, and it's reported that this occurred hours after her and her husband had quote unquote partied with the, with the surgeon who was performing the, the procedure. Um, the husband states that the procedure ended at 11:00 PM which is in my opinion, sort of late the end surgery.

Um, and the assistant said she was told him that she was recovering. Uh, from anesthesia and showed him, showed him a photo of her recovering. But then sadly, one hour later, the surgeon came out and told him that her heart was beating slowly while another, so, [00:03:00] uh, surgeon told him that she had died. Uh, it's reported that she had died of, uh, cardiac arrest.

And, uh, obviously the husband is, uh, uh, very upset about this and he's saying that she was not, uh, prepared. Uh, adequately, uh, for the surgery. Uh, one of the things that he noted was that, uh, she was not NPO, which means she had still been ingesting, uh, food prior to surgery and that, uh, her surgery had been moved up actually two days earlier, uh, than was scheduled because of quote unquote, uh, scheduling issues.

So there are. Um, pertinent topics, uh, that we should discuss, but it is important to note that we do not know the entire story and the, and all the facts about, uh, what happened. So some things are unclear, uh, but this discussion, uh, is, uh, around important topics, uh, surrounding the tragedy, um, how things [00:04:00] should ideally take place and, uh, you know, what are the particular, um, issues regarding, um, having surgery.

I. In, in a foreign country, um, having, um, social media mixed in, uh, with the aspect of, uh, having surgery and, uh, safety, uh, in surgery. So, um, I'll start off with, um, talking about the fact that, um, she had a, a cardiac arrest. Uh, that's, that's how it's been reported in, in the news. There has not been further information, uh, about that, but there are, you know.

Uh, tragically times when this, uh, can occur. And so as a patient, you might be wondering, well, you know, what can I do to, um, minimize that risk? Because it, you know, with all surgery there's gonna be, uh, the potential for complications. There's no way to, to get around it. But there are [00:05:00] things that can be done to, you know, minimize, uh, the risk.

Um, and there are things that, uh, the surgeon is responsible for, but there are also things. That the patient, uh, has some responsibility in as well.

Sam Rhee: Absolutely.

Lawrence Tong: Yep.

Sam Rhee: Uh, and you mentioned, uh, there are always risks associated potentially with surgery and choosing the right people that you feel comfortable with to. Perform your anesthesia to perform your surgery, uh, plays a large part of it. And that's something that we might talk about in terms of how, like the, you know, how she traveled, how she chose this particular, um, group or surgeon.

Uh, but you're right, there are things that patients can do also to make sure that they stay safe, uh, in their, in, during the procedure as well as after. So what are some of the things that people, uh, should know about in terms of. Trying to stay safe.

Lawrence Tong: So one of [00:06:00] the things, um, that, um, you know, every patient is told before they have surgery and, and if our viewers have ever had surgery, they, they, they probably told you nothing to eat or drink after midnight. Uh, that, that's, uh, often referred to as NPO after midnight. And there's a reason for that and that the reason for that is because, um, when you are put under general anesthesia, um, you should have an empty stomach.

Um, if you've eaten just before you have anesthesia and you have food in your stomach, the risk is that, um, you might, um, you might aspirate. Aspiration means the food from the stomach. Um, comes up, uh, through your esophagus and then goes back down into your lungs, which can cause pneumonia, and you can, and you can die from that.

So that is a very basic thing that every surgeon will instruct you to do. And so it's important if an, uh, if a surgeon instructs you to not eat or drink after a certain time [00:07:00] period, you should really, uh, follow that advice because that is very, very important. And in general, unless it's an emergency, if we know about.

A, a patient who's, who's eaten, who's eight or, or drank before surgery, we will, you know, we will cancel their case for that day because the safety aspect is, is that important?

Sam Rhee: Absolutely. I, I have known people who have. I not been truthful about that. And they put themselves at enormous risk because those stomach contents, if they go into your trachea, into your lungs, it's very acidic. This stuff is all filled with your stomach acid. And you're gonna have huge problems, as you mentioned, with pneumonia, with lung damage, uh, potentially death.

Uh, and if you wonder, well, how about trauma surgery or some. Si situation where people are not, um, without empty stomachs. Well then the anesthesiologist perform. Um, a slightly [00:08:00] riskier type of procedure called r rapid sequence intubation, where they are trying to minimize that risk of people aspirating stomach contents into their lungs.

So that's something that I haven't, I, I mean, I can't remember the last time I saw a rapid sequence intubation. I think it was probably residency on the general surgery service on trauma. Like that's sort of what. Uh, and that's not a, that's not a great situation to be in. Um, how do you

Lawrence Tong: that is not something that you should be doing in a cosmetic practice.

Sam Rhee: That is exactly

Lawrence Tong: in that, in that situation. So any kind of, you know, intubation should have the proper, um, protocol in place and, and having the steps in place, uh, before doing the surgery. So I think that if, if, if it's true that that patient did not, um, follow NPO, um, before the surgery, I, I would not have done that surgery.

Sam Rhee: What else?

Lawrence Tong: Um, so [00:09:00] related to that is actually, you know, some, uh, the drugs that you take that a patient might take. So, uh, one of them is, uh, ozempic. So Ozempic is very popular, especially, uh, amongst the cosmetic surgery, uh, population. And one of the things that Ozempic does is it slows down gastric emptying. That means the rate at which food leaves your, your GI system is slowed down a lot.

And if you are taking ozempic, even if you have stopped eating the night before, that is generally not enough time to minimize your risk of aspiration. So some people are on Ozempic and because it's to the point where it's so commonplace, they might not even mention that they're taking it or they're maybe taking a, a, um, ozempic sort of copycat and, and they don't think it's.

You know, really like taking a drug. So if you are on Ozempic, you definitely, definitely need to tell your surgeon that [00:10:00] you are on it because we usually stop that, uh, medication about two or even three weeks before a patient goes under general anesthesia.

Sam Rhee: Yeah, and there's so many variations now. There's zep bound, Manjaro, you name it. Like there are so many different GLP one type agonists that, like you said, and they, and a lot of them are just. Intermittent injections. They're not daily pills or anything, so people might even forget that this is quote, a drug that might affect their procedure.

And you're right, I probably see now, I don't know. What would you say? I would say maybe for my body contouring, I would say at least a third of those patients are on some sort of, or have tried a GLP one agonist.

Lawrence Tong: Yeah, I would, I don't know if the number's that high in my practice, but it is, it is somewhere, maybe in my practice around 10 or 15%, something like that. So it's not, it's not unusual at all.

Sam Rhee: Yeah.

Lawrence Tong: Um, another drug that patients may be taking, which may they may not disclose to the physicians is the use of [00:11:00] diuretics.

So diuretics is a, is a, is a medication that you take to get rid of, uh, fluid, um, in your body. And it is primarily used for, uh, patients with high blood pressure or heart disease, but patients also take it to make themselves look thinner so that, that they don't look so quote unquote bloated and. Um, using that medication messes with your, uh, fluid balance and, and can mess with your, uh, electrolyte imbalance.

So it's also very important to inform your physician if you are, you know, taking, uh, that kind of medication. Um, and there are other kinds of drugs that are, um, not pharmaceuticals, but recreational drugs that are important for, for you to tell your doctors such as, you know, if you use cocaine that is. A very high risk thing to take if, if you're having, uh, surgery, um, in the near future.

Sam Rhee: Yeah. Um, it's [00:12:00] funny, uh, we have several menstrual cramping medications in our household. Uh, mainly because, not for me, uh, but for, but for other members of my household, uh, like my daughter and I looked at the ingredients and a lot of them contain diuretics. So not only do they. Contains some sort of like pain medication for menstrual cramping, but they also do, they have these me, these pretty powerful, uh, water, um, you know, uh, treatments to address water retention.

And so people might not even think a midol or a pampering or something like that is a real medication. But yes, definitely you gotta let your surgeon know because if you're dehydrated and you go into a procedure, that could definitely advert. Adversely affect, um, your system.

Lawrence Tong: Yes. And then the last thing is, uh, your general medical history. It, it's actually pretty common that patients don't [00:13:00] tell me. What cosmetic procedures they've had when they, when they come in. And then when I look at them, I can, you know, when I examine them, I can tell 'em and I have to ask 'em, okay, did you have this done?

You know, they have a scar or, or something like that, which makes it obvious. So, uh, having prior surgery affects how, how your, uh, surgeon may approach, uh, any future surgery, especially if it's in the same area. So I, I think that's important because in general it's not gonna be as easy the second or third time as it was.

Uh, the first time. And, and you should, you know, for your own safety and interest, you should tell your surgeon if you've had surgery before in the, in those particular areas. And in addition to that, if you have any other medical conditions, especially, uh, related to your lungs or your heart or, um, you know, strokes or history of, um, anesthetic complications or blood clots, all those things are very important.

So I guess. It's very, um, it, it, [00:14:00] it's, it is very, very important that you be truthful with your surgeon because, uh, it's only gonna help you in the long run.

Sam Rhee: It can be embarrassing to disclose everything to somebody, but in these cases, uh, I think people have to take their cur, you know, be courageous, tell everything, and sometimes people forget. I cannot, like last week I had someone who came in for tummy tuck, forgot that she had liposuction. We screened her twice.

We, we talked to her on the phone. Uh. Then my medical assistant talked to her before I saw her, and it was only after about 15 minutes of talking, she was like, oh yeah, by the way, I also had liposuction, uh, in addition to, you know, whatever hysterectomy or gallbladder surgery or whatever else she told us about.

So, um. Yeah, like take, take a second and sort of think about your medical history. Um, I know you feel like, you know, all this stuff [00:15:00] is not something that is that important, but it is very, very, very, very important for you to get the best results, uh, for your outcome,

Lawrence Tong: Yeah, I think. You tell us what you've had or what your history is and we'll decide if it's important or not.

Sam Rhee: right? So what else do you want to talk about with Rii right now?

Lawrence Tong: Alright, so, um, I want to talk about people who go to other countries, uh, to have surgery, uh, often known as, you know, medical tourism. Um, so in general there, there are issues, uh, related to that. Um, and that's not to say that. Um, you know, every, uh, foreign country is bad compared to North America, and you shouldn't, uh, go to, uh, international surgeons because there are many, many excellent, uh, well-trained, world renowned, um, [00:16:00] you know, uh, respected, uh, surgeons.

But, um, patients have to do their due diligence because, uh. It's not the same as in North America. I think that in my opinion, north America has the highest standards for physician training and for regulation and licensing of, uh, facilities. And so it, you know, if a patient, um, is thinking about medical tourism, they have to, uh, be extra careful in choosing.

Who they're going to and, and what country they're going to. And, uh, you just have to look at all of those things. Um, in, you know, from a training standpoint in the United States and Canada, plastic surgeon trains from anywhere from five to seven years and then goes, uh, goes to have board certification, uh, which is, um, a rigorous, uh, type of, [00:17:00] um, examination to make sure that.

The surgeon is sort of up the snuff to, to do the surgery. Um, surgeons in the United States and Canada have to operate in an accredited facility. That means a, uh, place where they do the surgery, which has standards that is, um, you know, recognized by certain, um, regulatory, uh, groups. Um, and in North America, you know, each jurisdiction has a strong medical board, um, which means that.

Uh, they conduct surgeon licensing and patient complaints and investigations so patients have, you know, strong, uh, legal system and, and, uh, protections with, uh, surgery. And so in other countries, not all of these, uh, safeguards, um, are in place.

Sam Rhee: I think, um, there are two things I think about when I think about these types of issues associated with medical tourism. The first is, is you're absolutely right. There [00:18:00] are great surgeons everywhere, but the biggest thing that I have seen for patients who go somewhere outside of their own country for surgery is cost.

It is generally expensive in North America to have aesthetic surgery procedures, and so they're looking for a cheaper way of doing it. And, um, that is very like, popular for a lot of types of procedures, especially hair transplantation in Turkey. Um, what Ms. Baldini went through, like there was like something like.

2 million visitors that went to Turkey last year, um, in 2024, that's like $12 billion. Um, and the reason is, is that

Lawrence Tong: 2 million people who went for surgery, you mean?

Sam Rhee: Yes, 2 million people went for surgery and it was like a $12 billion industry, uh, uh, in Turkey right now for medical tourism. And so the cost is such a powerful draw factor [00:19:00] for so many people.

Um, but that doesn't mean that you are absolved of your responsibility of finding the right person. In fact, it's probably even more so. And the issue is, is that a lot of it is based on. social media or other issues, like, I understand that people don't want to delve into the regulatory or certification sort of aspects of stuff.

Very boring, not exciting. Doesn't make any diff like, and, and I agree. It doesn't necessarily, if people will argue. That doesn't mean that that person is a great surgeon. That is true. Just because you have your driver's license does not mean you are a great driver. However, you probably are going to be a safer driver than someone who does not have their driver's license in general.

So there are some minimum standards there. That's what you can think of it as. And then, and then you have to find someone that you think is going to do a great job, but social media from someone. 5,000 miles away is probably not going to give you [00:20:00] necessarily an accurate picture. I don't know how Ms.

Baldini picked this particular surgeon. I mean, it looked like a negotiated transaction where. This hospital who, which had had some regulatory issues or, or some uh, negative publicity or incidents, was literally trading, uh, procedures for social media exposure. And how do you feel about that as a plastic surgeon?

Lawrence Tong: Well, it's a, it's sort of a slippery slope because, um, once you have that aspect involved, it's not the norm. And, um, sometimes you don't treat the patient. As your typical patient, which is, uh, something you should absolutely not do, you should be treating, uh, patients all you know, equally with the same degree of, uh, safety, with the same, uh, protocols.

Um, because if you, if you [00:21:00] deviate from that, that's when you run the risk of, um, you know, complications happening such as, um, you know. Mm. Having, you know, drinks or partying with the, with the patient prior, uh, the surgeon might have felt that, you know, this is something to gain favor or, um, you know, something that, that surgeon probably would not have done if it was just a sort of a regular patient that he was gonna do on a Tuesday.

And so, um, it's an issue because. Uh, the incentive is very strong when you have, um, somebody who is an influencer and, and, uh, this patient had I think 800,000, uh, subscribers then that, that draw can be, um, something that clouds your, your judgment.

Sam Rhee: Absolutely. Um, I always. Uh, it makes me [00:22:00] wonder, like you said, they're providing their services for free. Did that alter how they managed this particular patient, why they pushed this patient two days sooner? Why they, uh, you know, didn't, weren't allegedly concerned about the NPO status of this patient? Like all of those things are.

Are brought into question. When you look at the transactional nature of this surgeon in patient relationship, which, uh, as you said is that's, that's very concerning. I don't, I've never, ever done something like that and I, I don't think I would ever want to do something like that. But even if you did, let's suppose.

We're a surgeon who did something like this. Like you said, that patient has to be treated just like every other patient, whether they're paying zero or a million dollars, whatever it is like that, that treatment has to be top notch regardless.

Lawrence Tong: Yes. And um, [00:23:00] a another issue with, uh, medical tourism. Is from a logistic point of view, what if you have a complication after you've flown back to the United States? What if you're not happy with how uh, the procedure has turned out? Those things, um, are difficult to treat even in my patients who maybe come from cities further away or even from different provinces.

It is, uh, exponentially more difficult when it's in a different continent and, um. You know, unless you're, you're Turkish, you're, you don't even understand the language. So there's a big language barrier, uh, as well with that. So if a patient is going to consider having surgery, as you said, price is a big driver, but you have to think about the whole picture.

Uh, because if you end up having a complication and it needs surgery, um, then you're either [00:24:00] stuck. With accepting the appearance that you don't like, or you have to take a plane back to Turkey if they're even willing to do more surgery on you, or you have to find a surgeon where you live, and then at that point, your savings from the original surgery are probably erased, and you're probably paying more than you would've if you just had the surgery done in North America.

Sam Rhee: You're, you're a hundred percent right. I, uh, have seen multiple versions of, um, medical tourism patients, either to Florida or to the Dominican Republic, uh, Latin America, um, and. It's funny, most of them won't go back again. So they've done it once, and then after that, they will find someone in who is closer to them.

So there are very few patients I've seen who go multiple, multiple times back. Uh, most of the experiences are adverse to some degree, either results, uh, the way they were treated, the [00:25:00] difficulty with it. Um. You know, all of those, you know, the logistics, like all of those things are, it, it sounds great on paper.

And then when they actually go through it, most patients have related, uh, yeah. You know, and they, and they will, it's so funny 'cause I'll say, oh, how was the experience? And they'll say, oh, it was great. And I'll said, okay, well, so then why don't you go back? For your next procedure with them and they're like, oh.

And then like some variation of some excuse comes up and I can tell it's hard for them to own that maybe that wasn't the best idea for them to have done that. Uh, and I'm not pressing them on it, but it is interesting to hear or see so many patients who've tried it once but then won't try it again. So there, there's something to that for sure.

Lawrence Tong: Now I'll also take the flip side of that. We are seeing the patients who have problems. There may be many, many, many. Patients who've gone through the experience and [00:26:00] haven't had any issues. So we never see them.

Sam Rhee: very true. I, I'm biased for sure in terms of my, my what I see.

Lawrence Tong: Um, one, one thing that I want to touch on is, um, having multiple procedures in, in one, uh, setting. Uh, so this patient had rhinoplasty, breast augmentation, and liposuction. Um, I think. One of the things that's important to find out and learn about this is how much liposuction did this patient have? Because out of those procedures, I think, uh, liposuction is actually the one that has the most potential to cause physiologic, uh, problems, uh, in the perioperative, uh, period.

How do you, how do you feel about that?

Sam Rhee: Uh, I agree. I think, uh, there can be a lot of, of fluid shifts, volume changes with large volume liposuction that, that might potentially need to be managed. I think [00:27:00] if you're doing position changes in the operating room with liposuction and the patient is under general, uh, general anesthesia, that's always a challenge.

Um, I, I. Don't think people necessarily think of liposuction as an arduous or complicated procedure, but like you said, it, it really depends on the situation.

Lawrence Tong: That's right. Uh, because what patients see is this little, couple tiny incisions. It's not like some long scar, like a, a tummy tuck. So they will equate that to a, a sort of, uh, easier or smaller procedure. Um, but there are a lot of fluid shifts and, um, for the viewers who don't know, there's actually. A guideline or a limit that the American Society of Plastic Surgeon puts out as to how much liposuction you can do in one setting.

And that number is five liters. So, you know, five liters is a pretty large amount, and once [00:28:00] you hit five liters, uh, the recommendation is that you have to hospitalize the patient. And that's because it's been, um, shown that, uh, the complication rate goes, um, significantly higher. Beyond five liters. So in my practice, I never go beyond five liters.

I try to stay away from that number as much as possible. And if a patient comes in and they want to do multiple, uh, areas of liposuction, and I think it's gonna hit more than five liters, then I will have a discussion with them beforehand. They can either choose to break it up into two procedures or we'll get as far as we can.

And then before we, you know, well, before we get to, or once we're getting close to that five liter mark, we, we will stop and, and then. You know, do the rest of it at a later date.

Sam Rhee: Um, in Florida, I think it's even more restrictive. They, in terms of doing an ADOMINOPLASTY plus liposuction, I think they restrict the liposuction lipo aspirate to like one liter with a tummy tuck or something like that, just because [00:29:00] they've had so many complications in Florida with large volume liposuction.

Um, and then probably other procedures. So you're right in this case, what they called a bob lift, breast augmentation, liposuction, rhinoplasty. None of those procedures themselves are particularly, um, of issuing in them of themselves. And I have, I mean, I will say I, I've never done a bob lift. I've done breast augmentation, liposuction simultaneous in one sitting.

Um. What, what are your criteria in terms of combo, uh, procedures and, and when patients want multiple things done at one time, like how, how do you, what are your guidelines or how do you advise patients on that?

Lawrence Tong: So I would say there, there's no one specific way you evaluate it. Um, but in general, uh, one of the more important things is, uh, how long the surgery is gonna take. So. If a person wants, [00:30:00] you know, five procedures done, and you sort of look at it and it's gonna be like 10 hours, then I'm not going to do all those things in, in one sitting.

Um, and that's because the longer the surgery is, the more physiologic changes start to occur. The patient starts to get, um, the body temperature starts, uh, to drop. Uh, there's more blood loss associated with it. There's more fluid shifts associated with that. So. Um, timing is one thing. Also, you don't want your surgeon to be like, exhausted when they're starting your, you know, fourth procedure.

You want your surgeon, uh, to be fresh and, you know, I, I don't want to operate when I'm exhausted either. So time is one of them. Also, um, combination surgeries where you're gonna be really impeding on their ability to, to heal postoperatively, I think is, is an issue for example. If you're doing [00:31:00] brachioplasty, which is arm lift, and then bilateral vertical thigh lift, which is basically long incisions on the legs and long incisions on the arms, that can maybe really impede on them being able to move around or do self care and hygiene after surgery.

So sometimes I will have a discussion with them. Um, sometimes there are practical reasons, like if I'm doing a tummy tuck, um, which involves an incision. Uh, big incision on the front. And they also want a, um, Brazilian butt lift, which is fat injection, um, in the, in the butt. That's not a, a practical combination because after the surgery, the patient has to basically lie on their back and be sort of a, the fee position so they don't put too much stress on the abdominal plasty incision, but then you don't want them to be sitting on the fat 'cause that's gonna impede on how much of the, the fat will survive.

Um. With, with the, with the bbl l uh, but I think the, the main thing is, you know, timing. I also look at blood [00:32:00] loss, although traditionally, uh, cosmetic surgery does not have a lot of blood loss unless you're dealing with somebody who's like, really, really large in, in some of these body conting procedures.

So blood loss is, is another factor to look into. And then, of course, overall health status. I'm, I'm discussing this assuming a healthy patient, but if a, if a patient is older or frail or has, uh. You know, me, systemic medical issues such as, you know, diabetes and, and things like that, um, it's probably not the best idea to do big long procedures on them.

Sam Rhee: Um, I have done just full disclaimer, uh, tummy tuck plus BL and it is a challenge in terms of recovery, in terms of positioning. They end up getting like body pillows and sort of like on their side, like kind of curled up and it's not optimal. Uh, you really have to work with a patient to try to get that to, to work and, uh, but it is always a challenge.

But I agree with you. For me it's operative time. I mean, I was just thinking about it when you mentioned it. In this case, [00:33:00] I can't remember the last time I was operating at 11:00 PM like maybe like, I mean that wasn't in the er, like, or some kind of like trauma case, like when was the last time you did an elective case at 11:00 PM Honestly, I.

Lawrence Tong: Never.

Sam Rhee: Right, like there's a reason, like we should not be operating on elective people at 11:00 PM Uh, and if you are, either you are the busiest plastic surgeon out there and you have inexhaustible energy or,

Lawrence Tong: Or maybe you start your day, like at, you know, four o'clock in the afternoon or something like that.

Sam Rhee: Yeah. Maybe you're Dracula and you're, and you're keeping odd hours. But on the other, I mean, listen, every hospital I've been to surgical start time's, usually seven 30, like we're early morning type people. Uh, the other thing is, is have you ever partied with a patient ever prior to any procedure?

Maybe not even the day before, but like ever.

Lawrence Tong: I have [00:34:00] not, I have not partied prior to any procedure with anybody, not even

Sam Rhee: I'm not even a, I'm not really a party guy and I don't, even, if I have a case the next day, I don't like going out in general, like, um, I mean, listen, when I was a resident and all that, like that's a totally different situation. I was 20 in my twenties. Um, I had limited, more limited responsibilities, but as, but as an attending, like, it's not awesome, especially.

Uh, for these types of procedures to be out late at night. Um, it's, so, it's always funny 'cause I always have a patient or two who will like, look at me very carefully before a surgery and be like, how you doing? Are you good? Do you have a good night's sleep? Do you feel, do you feel good? And I'm always like. Dude, it's

Lawrence Tong: like I'm a little bit hung over.

Sam Rhee: and I know, right? Like that's what I should say, right? As a joke. But no, I mean, I'm always like, dude, it's more important for me to feel good about this, uh, than [00:35:00] you even know. Like, I, I, I, I can't stand not being optimized for my procedures. And, and so that just makes no sense to me really.

Lawrence Tong: Alright. So, um, in closing, you know, some patients might wonder, okay, well if I am gonna, if I'm dead set, ongoing. Outta the country because I can't afford it any other way. Uh, what are some of the criteria we should try to look at if we're, if we're choosing a surgeon outside? So I, I have, uh, I have a few that, uh, I have listed here and, uh, you know, maybe you can give some comments on that.

So, number one, find a reputable plastic surgeon.

Sam Rhee: Reputable meaning what? That they have a million followers on Instagram.

Lawrence Tong: No, I would say, you know, ideally American Board, American Board of Plastic Surgery certified, but it started that something equivalent to that in their, in their home country, maybe internationally known, uh, well [00:36:00] published, uh, with multiple years, uh, of experience. You know, the pitfalls is that there may, might be difficult to actually know what these.

Credentials are because of, uh, language barriers and, you know, lack of some degree of, uh, transparencies. Um, number two, uh, facility standards. Any comments on that?

Sam Rhee: Uh, yes. So. I don't know how much due diligence you can do for a facility thousands of miles away. But um, yeah, there, I would assume that Turkey does have some sort of regulatory body that does certification and, uh, probably need to find out if they are, I mean, people in Florida who get surgery done down there, it wouldn't be hard for them to find out that a center down there is not.

Quad a certified or has whatever appropriate certification, um, [00:37:00] probably you could do something similar for the country that you're in, uh,

Lawrence Tong: like a, a larger center, like a, a well-known hospital that they're at.

Sam Rhee: that's right.

Lawrence Tong: so something like that. Just make, do some di diligence on, on the facility and then, you know, who's doing your anesthesia. Um, ideally an anesthesiologists. And then, you know, if not an anesthesiologist, some sort of equivalent to a nurse anesthetist.

Um, barring that, if it's, if it's maybe a small, small procedure, like at least a nurse administering some sedation, you don't want to, you don't want to be in a situation where the surgeon is also the person giving your anesthesia. You want your surgeon to be focused and concentrating on the surgery and the surgery alone, not also, uh.

You know, giving something to knock you out while they're doing it at the same

Sam Rhee: if, if you're doing something big, for sure, if you're doing IV [00:38:00] sedation or general anesthesia, you know something more than say light sedation. Yeah. You need, it's very important to have someone who's, um, I. Trained appropriately. And that's really hard to find out. I'm sure that if you ask these people, um, who does your anesthesia for you, uh, they may give you any kind of answer.

And so, you know that that's a tough one.

Lawrence Tong: Yep. Hopefully they'll say an anesthesiologist and then

Sam Rhee: 1, 1 would hope. But you're right. Um, the way that the. The surgeon helps to, uh, make sure your anesthesia is safe, is is critical.

Lawrence Tong: Uh, make sure that you know, when, when they go through your consultation that they ask you about your full medical history, want some blood work, maybe EKG, and as necessary, get clearance from your other doctors. Like if you have some sort of, [00:39:00] you know, heart condition arrhythmia, or you're on some blood thinners, you know, all those types of things, um, are important.

Um, you know, they should be setting realistic. Expectations and really not trying to sell you the surgery. They should be telling you how it is, what the complications are, what the expected outcomes are based on, uh, your particular anatomy and, and, and, you know, and your health status. And, uh, you know, you should be maybe a little bit concerned if they think, oh, everything's gonna be great.

It's gonna be fine. And they don't talk about any of the potential downsides to surgery. I.

Sam Rhee: Yeah. I think the biggest thing is, and I've heard this time and time again with, with patients who've had not awesome experiences, is that they felt like there was no due diligence on the surgeon's part. They blew through the prior medical history, they blew [00:40:00] through any health issues or you know, medications, and they had some other person pressuring them to put a deposit down right away for their procedure.

Like if. If that person isn't actually taking any time to, to know you as a potential patient, that's a red flag. Like you better not just walk, but you better run away from that place because every surgeon out there, uh, that is worth their weight. And, um, uh, as a surgeon is going to try to avoid complications, make sure it goes smoothly.

And the number one way that we can do that as surgeons is to know our patients. Make sure we know. All of their medical history know everything that they've ta, uh, talked about. We just talked about that, like being truthful, like that's critical and, and if a surgeon doesn't even bother to take the time to do that before taking your money, that's, that's a huge problem.

Lawrence Tong: All right. And then the, the last thing is make sure you, you, um, portion enough [00:41:00] time to recover before you leave. Make sure you at least see the patient and have your stitches removed, uh, before you leave. I mean, we see patients. We get called all the time, oh, I had surgery here. Can you take my stitches out?

And I said, you know, I was wondering why they didn't just stay a few extra days and, and get their stitches out. I, I, you know, that's not just to get the stitches out. You want the surgeon to see, to make sure you're, you're not having an infection, your wounds are healing properly, you're not having some sort of complication that you might not be aware of.

Sam Rhee: That is universal. I can't, my office staff have a standing policy now if someone wants some sort of follow up after a procedure that they've had somewhere like. In Florida or another country like that's a hard no. Like that's a hard pass. And the funny thing is, is a lot of these surgeons that are um, from a distance will instruct their patients, get on the [00:42:00] plane, fly back.

You can find someone to do this. It's very simple. They just have to like, take out some sutures or do something like that's part of their standing post-op instructions. And I'm like. Wow. Like who has the balls to do something like that? Like, that's crazy. Um, to not actually know or care, uh, about the outcome of your patient in any way.

Lawrence Tong: Yeah, and, and I just thought of something, you know, getting on a plane after you've had a major surgery that increases your risk of having DVT, especially if you're doing some sort of transcontinental flight.

Sam Rhee: Dude.

Lawrence Tong: So, you know, um, if you're gonna do it, at least stay there to recover to a pretty good extent before you decide to come back home.

Sam Rhee: A a agreed a hundred percent.

Lawrence Tong: All right. So in summary, red flags, if you're going, um, outta the country to do surgery, uh, as red flags are, you know, inadequate board certification or trainings or equivalent to something like American Board of Plastic Surgery, [00:43:00] uh, if the procedure is done in an unlicensed facility or maybe sometimes in a hotel.

Uh, having multiple procedures done in one setting. For example, getting a BBL LA tummy tuck, lipo 360, and breast augmentation lift in one setting, that is probably not a smart, uh, strategy to go with, uh, very short post-op stays. So make, you know, make sure that your surgeon is gonna see you afterwards to make sure you're okay before you leave.

Um, no anesthesiologist, especially in any of these standard procedures that require, um. You, you, you'd go into general anesthesia or even deep sedation, smaller procedures. Maybe it's acceptable. Um, if the clinic refuses to answer detailed questions beforehand or maybe, um, you know, you want to know more about it, and they sort of gloss over all the, all the potential risks and complications.

And then lastly, if the price is too cheap, if the price seems too good to be true, [00:44:00] um, you know, they, they have to be. Cutting corners in some aspect.

Sam Rhee: Larry, that's such a great summary. Um. Agree with a thousand, a thousand percent with everything you just said. I think everyone who's considering something that, uh, similar to what Ms. Uh, Bini did, um, should, should take that to heart. Uh, certainly. Um, it's really tragic what her outcome was. Uh, and I hope that anyone who was a Bini fan who followed her, who, uh, admired her work, uh.

Will take her passing to heart and, and if they're ever considering something like this, um, do it safely. Uh, do it with the guidelines you mentioned, and, uh, make sure that, uh, they avoid such a tragic, uh, potential risk.

Lawrence Tong: A hundred percent agree.

Sam Rhee: Yeah. Thank you so much, Larry. Uh, until next time, [00:45:00] man.