Keeping you safe during BBL surgery [Maria LoTempio, MD, New York City]

Dr. LoTempio (00:00):
Hi, I am Dr. Maria LoTempio. I'm a board certified plastic surgeon living in New York City.

Eva Sheie (00:06):
What's been happening in terms of plastic surgeons working together to make the BBL more safe for patients? And what kinds of things do you do personally in your office to keep them safe?

Dr. LoTempio (00:22):
So in the state of Florida, they advocated ultrasound guidance fat injections, which Florida has the highest supported reported death or fat embolus. And that's really what we're all scared of is the embolus. The literature is very clear on this, if it's injected in the muscle or below, the chances of a fat embolus is exponentially increased and what we call mortality or death rate is high. So with me, I don't necessarily use ultrasound. I'm not opposed to using ultrasound, but I just haven't, with my last 2000 patients. It's really feeling and really taking my time doing the injection part. I like to do the patients awake. I'd like them talking to me a hundred percent. I don't want them under any anesthesia when I'm actually injecting. They can be under anesthesia a little bit when I'm doing the procedure to remove fat, but when I actually inject, they are a hundred percent awake, they're moving and they're talking to me throughout the whole time.

Eva Sheie (01:25):
They can't feel it though, they're not in pain, they're awake.

Dr. LoTempio (01:29):
Right. So this is a thing. Yes, and that's kind of what you want, but if you go deep enough, you're going to feel pain. So by them telling you something, it's alerting you, Hey, maybe something's going on. So that's why I want them awake, because if I'm putting in the fat and they're fine, I'm in the right space. I'm in the right place.

Eva Sheie (01:51):
Weirdly, this is why my laser aesthetician doesn't use a lot of numbing because she actually wants the feedback because that's how she knows. Yeah.

Dr. LoTempio (02:00):
Yeah. And it's interesting, I mean, I think we all do different things. I mean, I started off training where everyone was under general anesthesia. I mean, first, how many years of my practice and training, I mean, they were all zonked and talking to anesthesia and the nurses. And then I started doing everything awake, and I forgot the patient's awake and engaging in conversations with me. And I was like, okay, now I have to learn how to operate and talk and make sure the patient's okay. So I had to quickly learn how to multitask, which was very easy to do. And now that's how I do it, and that's how I've been doing it. So I think it's safer to do it that way. I always am really pretty much in tune with my patients and what they say and how they say things. And I think they feel pretty comfortable with me so that they're actually pretty honest when they don't think something's going quite right, which a lot of the times it's nothing, which is what you want, but on that off chance, it's something then you know what they feel comfortable enough to like, Hey, just checking in.

Eva Sheie (03:05):
Yeah. That was my next question. Did they ever ask you weird questions? Do they try to have conversations with you? What are you watching on TV right now, Dr. L?

Dr. LoTempio (03:14):
Oh my God. So yeah, so come to conversations that we have during the surgery are wild. I mean, oh my God. I mean, I've had every conversation under the sun. I mean, who they're cheating with or, because don't forget, they are under medication. They do have medication that's somewhat uninhibited, and they'll say, oh, yeah, I just went on this huge shopping spree and my husband's going to kill me, cuz we're already doing the surgery. And I'm like, okay. Or they'll say certain things. It's like, oh, my one child, I love him, but he's a pip.

Eva Sheie (03:52):
This gives whole new meeting to the doctor, patient privilege. I think it's important that we all remember, you can't say anything.

Dr. LoTempio (03:59):
Oh, not a single thing to anybody or my nurses can't. And my nurses, I could see them peripherally because they're circulating in the room and certain things that my patients say and their eyes are bugging out. Certain patients want to talk about politics, and that's a no. We squash that, and sometimes my nurses will kind of edge the conversation, egg it on, and I'm like, Nope, nope, nope, nope, nope. We're not going to talk about that. Nope, nope, nope. Not talking about world events. Nope. Nope, nope, nope. I dig into an issue with one of my nurses, God, this must've been like eight years ago, and we were operating on an individual in a very high position of power in politics, not from this country, and the individual started talking about certain things, and my nurse just went off. I mean, she just lost it. And I'm thinking, at this moment, is secret service going to come in?

(05:05):
I don't want to know anything. And so I'm like, we need to not, kind of calm her down and be like, you know what? Let's talk about the weather. I'm like, you know that New York winter, we haven't had that much snow. Do you like snow? You like snow? I love snow. I'm from Buffalo. And tried to kind of take that conversation. Yeah, so I'm watching Netflix, what's the movie of the week? I'm like, I'm in it's Christmas time. I watch all those Christmas Hallmark movies, and to try to get the conversation and come back. But yeah, so it's very interesting. At the same time, I'm actually doing the surgery, and the only time that I'm really not gregarious is actually when I'm injecting the fat. That I'm quiet, because that really requires just a different level of thought. And being a conservative surgeon, which I am, I pretty much shut the music off. It's a quiet room, and I will engage in certain questions at certain times of the injection just so I could hear the patient's voice and understand where they're at. And it doesn't take that long. The injection parts only can anywhere be from 20, 25 minutes, so it's pretty quick.

Eva Sheie (06:20):
Now, there's no such thing as a BBL without liposuction, because you got to get that fat from somewhere in order to put it there.

Dr. LoTempio (06:26):
But you would be surprised how many calls we get, just want the BBL

Eva Sheie (06:33):
Without lipo?

Dr. LoTempio (06:34):
Right. They're like, we don't want the lipo.

Eva Sheie (06:36):
Where do they think you're going to get the fat, at the fat store?

Dr. LoTempio (06:38):
I dunno. Yes.

Eva Sheie (06:40):
Oh, okay. Fascinating.

Dr. LoTempio (06:42):
I'll be a donor. Yeah, no, I mean, it's incredible. My staff's like, we all want to be professional and we all are, but when we get some questions, my staff has to actually tell me some of these questions, and they're like, we're kind of at a loss sometimes. Like we can't explain to them, we got to get something to put something in.

Eva Sheie (07:06):
Where can we see these results of yours,

Dr. LoTempio (07:10):
RealSelf, online, more importantly, come to my office, fifth Avenue, next to Sephora.

Eva Sheie (07:16):
Is there anything we can see on Instagram?

Dr. LoTempio (07:19):
Some of them are, except Instagram has an issue now that they constantly take.

Eva Sheie (07:25):
Butt policy?

Dr. LoTempio (07:25):
Yeah, they're constantly taking it down. Now I tell people like, go meet your surgeon, go talk to them, go see their before and afters. I have 200, 300 slides of BBLs.

Eva Sheie (07:37):
So, if there are some photos online, there are many more to see when we come to the office.

Dr. LoTempio (07:42):
Yeah. And those we just can't put online. A lot of them, those are just, we can't, for various privacy reasons, confidentiality.

Eva Sheie (07:50):
Too beautiful to see. You just got to come in.

Dr. LoTempio (07:53):
It's all about the beauty of the booty.

Eva Sheie (07:57):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.