Adam Rubinstein, MD - Plastic Surgeon in Miami, Florida

Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest here at the Aesthetic Meet live in Austin is Adam Rubinstein. He's plastic surgeon from Miami, Florida. Thank you for joining me.

Dr. Rubinstein (00:37):
It's my pleasure. Thanks for having me.

Eva Sheie (00:39):
What have you been up to today?

Dr. Rubinstein (00:41):
Oh, today, well, various things, committee meetings and running around seeing, one of the best things about coming to these meetings is seeing all my colleagues from around the country and even around the world that I don't get to see. In fact, there are some friends of mine that practice in Miami that I don't see until I come to a meeting and we might be down the street from each other, but you just don't see each other. So it's nice to have that collegial atmosphere while we're here.

Eva Sheie (01:05):
Miami is an interesting market to practice in. And how many years have you been there?

Dr. Rubinstein (01:09):
About 23 years. But who's counting

Eva Sheie (01:12):
Has it changed?

Dr. Rubinstein (01:13):
Well, there's ebb and flow in every market and everything always changes, everything evolves. But what I would say is when I started my practice, it was a bit more of the Wild West that there was a lot more of nefarious, questionable things going on. There were bad actors throughout the community that are getting bad outcomes and a lot of patients are getting hurt. And I think there's been a lot of work at the state level to try and begin regulating that. And I think there's also been an education that I like to think I've contributed to that helps the public understand what they should be looking for and how they can keep themselves safe. And still we see sad tragedies that happen on occasion, but I think that one thing that has changed in a very positive direction is that that number has declined.

Eva Sheie (02:04):
There was a lot of that work driven both by this particular society and then

Dr. Rubinstein (02:09):
That's right.

Eva Sheie (02:09):
From doctors that were from Miami. Were you part of that?

Dr. Rubinstein (02:12):
My part of this has been more on the educational front. My whole brand is about patient safety and education. I've got multiple Instagram accounts, one is plastic surgery truths. That entire account is just Q and A videos. People send a question, what's this? What's that? Tell me about this. And we'll create videos that are just answers to whatever questions come in. So we're trying to contribute to that. And I've also been a patient safety advocate and have personally taken on some of the bad actors in my community. And just generally in the community nationwide.

Eva Sheie (02:45):
What does it look like to take them on?

Dr. Rubinstein (02:47):
It's an interesting thing. You have to have the fortitude to stand up to it. I have been threatened with lawsuits. I mean, all I ever do, whenever I say take them on, is tell the truth. All I do is tell the truth and make it public and put it out there. And the truth is pretty damning sometimes. And the people that are fighting against me don't like the truth to be told. So when I call out a doctor or I call out a facility very publicly, I'm doing it with the backing of actual facts. I've written blog articles, I've done videos, I've done interviews, I've helped coordinate newspaper exposes. And all of that is because I care about the patients that live in my community and the greater community, the nationwide of patients that should not have to worry that their life might be threatened if they go and try and get a treatment to help themselves.

Eva Sheie (03:42):
Is there something in your past or your childhood or somewhere, I'm digging here, that made you brave enough to sort of take these people on and not just quietly go back to work and say, oh, that's too bad. I wish that wasn't happening. Someone needs to do something. Well, how come you're the guy that is doing something?

Dr. Rubinstein (04:01):
There's no one incident or some influence that led me to say, I'm going to be the cowboy of this industry. No, there's no one thing. But I just instilled in me, I guess in the way I was raised is there's a certain sense of right and wrong. And also instilled in me is a certain responsibility for your profession. If we are not the governors of our own profession, who will be, there has been too much of emperor's clothes in aesthetics, people that shouldn't be doing it, doing it, patients getting hurt because people are not qualified. Products being used that are being brought in from other countries that are not FDA approved back alley treatments that are being done that are really damaging people. All of that shouldn't happen. And for the longest time just about nobody was going to stand up and say, Hey, the emperor is not wearing clothes.

(04:56):
So I felt just personally, very strongly and passionately that we have to be the arbiters of right and wrong in our field. And I'm confident enough in my ability to communicate that I can try and tell the story in a fair and truthful way and not expose myself to litigation and to fall out. And I still get, lemme tell you, it's no fun being suit and some of the lawsuits that drag on, you have to get your own defense. It can be expensive too, and it can cost allegations that people will launch can cost a lot of money in your practice, not just in what you're paying but the business that you're losing because you're controversial. But I still think that it's something that is so important because if nobody stands up and does the right thing and says the right thing and sheds light on the underbelly of the business, then it goes on unabated and it just gets worse and worse. It festers when you have an infection, you've got to clean out the infection and wash it out. You don't just cover your eyes and make believe it's not there. And really the way I look at it, I was just treating some infections.

Eva Sheie (06:05):
Is there anything that you're known for in particular in Miami or do people come from all over to see you?

Dr. Rubinstein (06:11):
I've been very lucky and privileged to have patients from all over the world. We have patients that'll fly in from South America, from Europe. I have patients from Africa, some patients from Asia, though not that many, a lot from the Middle East, actually a number of patients from the Middle East, all over the world. And I think it's because of the way I treat people and the way I speak to them, the way we take care of them when they're in my practice, when they're my patient and there's a trust level. And I'm also someone that does surgery on the face, breast, body. And I've lectured around the world on techniques and products and technology that relates to all of those areas. So that's what I love about what I do. I don't walk into the OR and do the same thing every day. I'm going to walk into the OR and I might be doing a breast case and then we'll do a facelift.

(07:01):
I might have a massive weight loss patient, we're taking off a couple pounds of skin from around their body, and then maybe we're doing fat grafting on another patient. We might do a complicated breast revision for someone who got jacked up over the years or maybe from one operation done poorly someplace else. One of the things that I'm known for is corrective surgery because I was lucky to and privileged to be involved in a TV show called My Killer Body it's On Lifetime. You can still see it. It was hosted by a celebrity named K. Michelle. K. Michelle is a recording artist that is very famous for having had trouble with her butt, having had problems with implants that went awry. And

Eva Sheie (07:43):
Did she have one of those butt implants that flipped over?

Dr. Rubinstein (07:45):
She had one that became out of position live in a concert.

Eva Sheie (07:50):
What?

Dr. Rubinstein (07:51):
It was caught on video. She was very public about it. She was very out with it, and so you could see it moving around and that kind of stuff. It was been a really difficult time for her, and she's been an absolute ambassador for taking care of yourself and doing it the right way. And because of that, she hosted the show My Killer Body, and the show was about people that had bad outcomes from cosmetic surgery.

Eva Sheie (08:16):
I love the double meaning.

Dr. Rubinstein (08:19):
And so I was one of the main surgeons operating on people on the show and operated on a bunch of people to help them in that show.

Eva Sheie (08:29):
What was it like being on a TV show? Was it what you expected or?

Dr. Rubinstein (08:33):
Well, I do a lot of TV. I'd already been doing a decent amount of TV, so it's an intrusion into your practice, you've got lights, you've got sound, you've got cameras at two or three cameras at any one time filming simultaneously. Patients have to be cool with it. I mean, the people that are on the show, that's one thing. But then when it disrupts your normal day-to-day and you've got cameras, lights and all that stuff and your regular patient flow is coming through, they have to be understanding. And thankfully everyone was, we don't put anybody on camera that doesn't want to be on camera. All these patients were vetted and consented, but it's still a disruption to the normal flow and it's a little distracting. But patients were so sweet going through that process and it's a great experience. More so not so much being on the TV part, which is nice, it's fun, but the ability to turn around the lives of, I don't know, at least half a dozen people that just had a rough go.

Eva Sheie (09:25):
So the people who were on the show also became your patients?

Dr. Rubinstein (09:28):
Well, they become my patient the moment I say I'm going to operate on you. Yeah.

Eva Sheie (09:31):
They were on the show and became your patient. They weren't just,

Dr. Rubinstein (09:35):
Well, actually I had to help vet the patients too, cuz I wouldn't, they can't just give me a patient, say operate.

Eva Sheie (09:40):
No, here you go.

Dr. Rubinstein (09:40):
So they would have a list of people that could potentially be on the show and they would present me the cases. I'd look through the pictures, I'd talk to the patient, interview 'em, do a virtual consultation, make sure I understood their health issues, make sure I understood what their goals were, what did they have in mind. It is not a great idea to operate on someone that has unrealistic expectations. Understand the story of what happened to them. Was it something that was unavoidable or was it something that maybe they contributed to with a bad habit? And try and select patients that were someone that I really could help. Through that process, we got to choose the patients that I'd be operating on and then did the cases for TV and then followed them. And they're still my patients to this day.

Eva Sheie (10:23):
Were they from Miami or were they from all over?

Dr. Rubinstein (10:25):
All over. Yeah. I don't think any of them were from Miami. There's a couple from Florida, but I don't think anybody was from Miami, if I remember. Could have been.

Eva Sheie (10:35):
After you did the show, did more people with complications seek your help because of the show?

Dr. Rubinstein (10:40):
Sure. Yeah, that's you asked what am I known for? There are things I'm known for, facial rejuvenation, facelifts, minimally invasive techniques and making the neck look better without doing a facelift. Complicated breast revisions, partly because of my reputation for corrective surgery, because of the show and other things, body contouring after weight loss. But because of the show, my reputation for corrective surgery, aesthetic corrective surgery was spread even further.

Eva Sheie (11:08):
Yeah. Were there any huge challenges?

Dr. Rubinstein (11:11):
Yeah, I mean, some of these cases were tough, and sometimes you go in and say, I'm not sure what I can do for you. Everyone thankfully got better. Some of them just got, I have one patient that I'm thinking of that we made better, but I couldn't get where she really wanted to be, just the limitations of tissue. And then I have one patient that could barely raise her arm. She had done a brachioplasty arm lift. She had a horrible scarring on one side and she could raise her one arm up all the way and the other one would get up to about here. And she couldn't get it up any higher because she had some scar contracture. And that same surgeon tried to do a revision and just didn't do anything for her. And that was one of the ones where I said, listen, I have ideas of what I need to do and we're going to go in and we're going to do it. Pretty confident we'll make it better. I don't know if I'm going to give you a full range of motion in your arm. I know I'm going to make your arm look better. I'm going to remove the scars. Scars were also not great, they were in the wrong place. There was a lot of things wrong with it. And thankfully she worked out really well. And one of my favorite things from the show is seeing her afterwards, and we have a photo, I think we might even be on my Instagram, a photo of her with her arms up like this posing. And she had a sweet little girl daughter who was part of the whole process and was very supportive, interestingly, very supportive of her mom going through all this. One of the great things is not only that pose of her being able to put her arms over her head and cross 'em over, but she just made the comment that we kind of gave her her life back with her daughter. She was able to do things with her and really not be restricted. And those are the things that stick with you. Those are the real rewards for what I do.

Eva Sheie (12:48):
When you have cosmetic surgery and you, especially for people who do a lot of research and think they're making a great decision and then end up with a complication like that, the shame is so, so hard to live with that you did it to yourself.

Dr. Rubinstein (13:01):
Well, we had to deal with that on the show, and I try to address that not only on the show, but because I do see a lot of secondary and tertiary cases in these corrective operations. One of the first things I do when I see someone for consultation is kind of get their story, get their history. And most of the time it was no fault of their own that these things went sideways and sometimes not even the fault of the doctor. And so I always explain to them, listen, you a bad run here with these procedures, and I can't rewind the clock, but this is where we are now. And I'm not looking back, I'm looking forward. Let's not worry about why we're here. Let's get you to where you want to be and let's not worry about how we got here.

Eva Sheie (13:38):
I was reading data for fun. That's what I do.

Dr. Rubinstein (13:43):
Whatever floats your boat.

Eva Sheie (13:44):
I learned that 98% of arm lifts are done on women. And also that the growth of that procedure in particular has been about 20% year over year for the last three years.

Dr. Rubinstein (13:55):
It's been the more, it's interesting, one of the things that kicked off the interest in the arm was Michelle Obama. Michelle Obama had really lean athletic looking arms and she wore a lot of

Eva Sheie (14:04):
Oh she sure did.

Dr. Rubinstein (14:05):
Sleeveless things.

Eva Sheie (14:05):
Her arms looked like my arms in high school.

Dr. Rubinstein (14:07):
See, there you go. And then a lot of people say that, and she showed them off as she should. Beautiful woman. I mean, great physique, sleek arms. And she wore a lot of sleeveless things and people would talk about it. People would comment about her arms, and it became a thing in the press and it got some traction and people would talk about it. And so I started getting more people coming in and saying, oh, what can you do? I want to have arms like Michelle Obama. I would get those comments in those years when he was president, that I think brought it more to the forefront of people's thought and then the understanding that, hey, there are actually things you can do to make arms look better. That, and I'm not sure about the 98% you're talking about, but certainly the overwhelming majority in my practice,

Eva Sheie (14:48):
It was from the ASPS procedure statistics report.

Dr. Rubinstein (14:51):
Yeah, certainly.

Eva Sheie (14:52):
It stood out. I mean, I was just working on an arm lift episode for somebody and it jumped out and I wondered, why don't men get arm lifts? Because that's a really high percentage of women.

Dr. Rubinstein (15:03):
Yeah, I've done brachioplasties on some men, but it's probably an overwhelming majority of women.

Eva Sheie (15:10):
Yeah. Well, maybe in Miami they wear more sleeveless shirts than everywhere else.

Dr. Rubinstein (15:14):
Well, that could be, yeah. It may be more of a thing that's true.

Eva Sheie (15:19):
But they also can just work out five times and their biceps get bigger.

Dr. Rubinstein (15:24):
So here's the thing, right? We get this because especially in social media, there's a lot of people trolling. And when you're dealing with aesthetic surgery, cosmetic procedures get a lot of flack in the comment section. When you're talking about doing a procedure on someone, there's a lot of misunderstanding. There are certain things that you can correct in the gym. I love going to the gym. I'm in the gym five or six days a week, but I always tell patients, you cannot exercise skin. And when you have a significant amount of excess skin that hangs, there's no amount of weightlifting or cardio that you can do to make that go away. And still, people don't understand that. And for example, maybe a brachioplasty post.

Eva Sheie (16:04):
We can't just fill up the loose skin with bigger muscles?

Dr. Rubinstein (16:08):
You cannot, I mean, I don't care how much spinach you eat, you're not going to be Popeye, and you're never going to get that muscle growing big, big, big. If you have floppy skin under your arm.

Eva Sheie (16:16):
You're ruining my plans, Doctor.

Dr. Rubinstein (16:17):
I'm sorry I'm bursting in the bubble, but I'm hearing I'm a truth teller. I'm a truth teller.

Eva Sheie (16:22):
Yes, you are.

Dr. Rubinstein (16:23):
And there may be, depending upon the amount of redundancy and the laxity that you've got, there may be some minimally invasive things you can do. Renuvion is a great choice to firm up an arm without making an incision, and more and more people are using that technology to firm up an arm. It's never going to be the same as a brachioplasty, but it doesn't come with a long scar. Now, if you have the right amount of skin, that's just never going to go away. You need to get rid of that skin. And even the surgery can be done in a very artful way to keep the incision in a more discrete place. The patients that I operate on, the way we're talking, moving around, moving my hands sitting like this, you would never see their scar. It's not visible from normal conversational poses. From behind, especially when their hands are on their hips, you may see the scar, but very frequently it's a thin little line that's almost negligible, but certainly a good trade for the floppy skin that used to hang. So I mean, to me, it's one of my favorite procedures actually. To me, it's a no-brainer.

Eva Sheie (17:25):
I think to most people who do it, it's a no-brainer.

Dr. Rubinstein (17:28):
Yeah.

Eva Sheie (17:29):
Okay. You mentioned weight loss.

Dr. Rubinstein (17:32):
Yeah.

Eva Sheie (17:33):
I think part of that 20% increase year over year is certainly due to weight loss too.

Dr. Rubinstein (17:38):
Yeah. Well, I think not just recently. The GLP-1s are a big trend, but before that, bariatric surgery came on the scene and people were having gastric bypasses and then lap bands and then gastric sleeves, and that's still going on, and people are losing tons of weight, and that has an effect on the entire body faces, breasts, bodies, arms, legs, you name it. So yeah, I think weight loss, I'll tell you, probably about 80% of the brachioplasties that I perform are on people that lost weight. Surprisingly, 20% is just aging, just losing some volume, muscle atrophy, fat atrophy, as you get older, and I see 60 plus year old people that just have, they call 'em the bat wings. They've got the skin flopping in the behind their arm, and a lot of them just say, look, I don't want to deal with it. I don't want to mess around with some energy that's just not going to get me where I get rid of it. I don't care about the scar. I want to wear what I want to wear. I want to feel my arm tight and I'll take the scar. Just make it tight.

Eva Sheie (18:39):
When you are seeing people who've lost a lot of weight and haven't done anything aesthetic yet, what's the thing they ask for first or complain about first?

Dr. Rubinstein (18:48):
Well, that's a great question, and there is no answer to that. I'll tell you why. When I see someone, because we see a lot of weight loss patients. It's one of the things that I do the most of when I have a conversation. It's frequently kind of looking at a Chinese menu because weight loss affects, like I said, every part of you. You can have jowls that hang, neck skin that hangs. You can have the arms that hang, your tummy may have skin folding over, not just a tummy, it can go all the way around, the butt sags, the outer thighs sag, the inner thighs sag. I mean, the entire body gets smaller.

(19:22):
It all gets affected. Yeah. I mean, there's a lot. It's a to deal with when we have that conversation, everyone has their list, their Chinese menu choices in their mind. When I speak to them, I say, okay, let's lay out what you want to do. And then I always pose this question to my patients that have a lot of things they want to do. I say, okay, let's say I've got a magic wand and I'm going to wave the magic wand and poof, I'm going to be able to change one thing on your list. I may change one thing that you want to change without any surgery. Just magically, what's that one thing we're going to do? And that puts them into the perspective of what is the thing that's most important to me? What bothers me the most that if I could walk out of here with magic and be better, what am I going to use that on? And that guides us, that sets their priorities and for everyone, it's different. I'll tell you, for most people, the tummy is where they want to start because it's so bothersome. I've had people that say my arms. I've had people say my thighs. I've had people say, my face. I can wear everything in clothing. My face is on display. I don't like looking at the saggy skin. Everyone has their thing. There's no trend.

Eva Sheie (20:31):
It's interesting.

Dr. Rubinstein (20:32):
Well, there's a little trend. Tummies are probably the number one, but there's no one right answer.

Eva Sheie (20:36):
I thought the neck was going to be the thing that everybody said first.

Dr. Rubinstein (20:40):
No, no, no. But we do see a lot of people for necks and the thing about necks trending now, and it's not just necks with everything, trying to do more with less, right? Trying to do less operating and more smaller procedures. I lectured all over the world in Monaco, Paris, Vienna, I mean all over Europe, all over the United States on minimally invasive neck techniques. You can do a lot. There's techniques now that you can, in some patients, you can get a result that looks like a neck lift without doing a neck lift, and it takes about an hour, an hour and a half to do.

Eva Sheie (21:16):
I saw results of a peel the other day that looked like a facelift.

Dr. Rubinstein (21:20):
Yeah. Well, that skin quality and that can really look impressive. Peels, a deep peel can take a leathery wrinkled face and really refresh it. They're great, but they're not going to lift sagging skin, not to a real level.

Eva Sheie (21:34):
But amazing.

Dr. Rubinstein (21:35):
Yeah. Well, skin quality, when you talk about facial rejuvenation, skin quality is most frequently neglected as part of the plan, but you can do a great facelift, but if it's weather beaten skin, it's still going to be firmer weather, beaten skin. You've got to do something to improve skin quality along the way, and peels are excellent as an option for a lot of patients for that.

Eva Sheie (21:58):
You probably see a lot of sun damage in Miami.

Dr. Rubinstein (22:00):
Oh, yeah. I live in Miami, yeah, sure. South Florida.

Eva Sheie (22:03):
Probably full body sun damage.

Dr. Rubinstein (22:05):
Yeah. Well, we do. We'll see the beach bunnies that come in that have permanent tan lines and that. Well, it is a twofold problem, right? The skin on the body doesn't get affected the way skin on the face doesn't in the same way because it's not quite the same exposure. Skin on the face really can get a lot of sun damage, and it changes the way that it handles in surgery. It changes the options that we have for rejuvenation and refreshing the skin, but all over the body, including the face. It's a higher risk for skin cancer, and we do. I mean, that's a serious issue in South Florida.

Eva Sheie (22:37):
This is good stuff. I want to hear more about you, maybe a little bit of your history, your past.

Dr. Rubinstein (22:44):
Sure.

Eva Sheie (22:44):
We want to know, we know you've been in Miami for 22 years. Maybe go backwards and tell us how you landed there.

Dr. Rubinstein (22:50):
Okay. Well, I boarded a plane. Actually, no, I drove when I landed there. Well, I was born in New York. I grew up in New York. I went to college in New York. I went to medical school in St. Louis, and I did my training starting in Miami, and then went to California in San Francisco, and then I was in Houston to finish up. I've been in practice in Miami ever since.

Eva Sheie (23:14):
Tell me more about your time in Houston.

Dr. Rubinstein (23:16):
Houston was my plastic surgery training, general plastic surgery. I've done a craniofacial and pediatric plastic surgery fellowship. After doing general surgery in Miami, I did a hand and micro fellowship, that's what I did in San Francisco, and then in Houston was my plastic surgery residency. Here we are in Austin, so it's nice to come back to Texas. I had a great time. I had a great experience. I had fantastic teachers. I've been privileged in my career to work with some of the best and brightest innovators and contributors to our field. I did my craniofacial fellowship and pediatric plastic surgery fellowship with a guy named, well, Ralph Millard. Dr. Millard is an absolute god of plastic surgery. One of the grandfathers, the godfathers, if you will, of plastic surgery. I worked with Tony Wolfe, who is one of the most famous and talented craniofacial surgeons in the world. Unfortunately, they've both passed. I did my hand and micro fellowship at the Bunky Clinic and worked with Harry Bunky, who is one of the innovators, the guys that invented microsurgery and many of the techniques therein. I think he did the first toe to hand transplant. In Houston, I worked with a tremendous team. Ben Cohen was the chair of the division, just an absolute model of professionalism, gentlemanly behavior, and held us to a high standard. Ernie Cronin was from Cronin family that Tom Cronin was one of the guys that invented the breast implant.

Eva Sheie (24:35):
The breast implant, yeah.

Dr. Rubinstein (24:36):
Tom Biggs was on the team that invented the breast implant and in his own right was tremendously famous, was president of the International Society of Aesthetic Plastic Surgery, was editor of journals and still contributes, still continues to monitor what's going on. He is just a real pioneer, has always been in the field, and just so lucky to have had that lineage and had the influence of all these great people to help make me who I am today.

Eva Sheie (25:02):
You seem like you loved school.

Dr. Rubinstein (25:05):
I do, and I like what we do is we're forever learning, and I try, that's what I'm doing here. I'm go around. I'll look at all the new technology. I'm also, one of the things that I am known for is for emerging and upcoming technology, new technology, and this is where I learn about it.

Eva Sheie (25:23):
Give me one of those that you're excited about right now. There's probably a few.

Dr. Rubinstein (25:28):
I'd say one of the things that I'm really excited about, maybe most excited about is a new product that's just become available called AlloClae. AlloClae is a fat product. It's made from cadaveric fat that's processed and all genetic materials removed. It still retains a lot of the structure of the fat, and it's an off the shelf fatty grafting material. It's a filler. It's an injectable filler that is the structure of fat that you inject into areas that your body then grows into, takes it over. It becomes incorporated into your own living tissue. Much different from hyaluronic acid, from polylactic acid. It's a little similar to polylactic acid in the sense that it's more biologic. Polylactic acid, something like Sculptra stimulates your own tissue to grow, it makes your collagen grow. This stuff doesn't stimulate anything to grow.

(26:21):
It gives it a platform that it grows into and stays there. It's a really, really exciting thing. I've done a small handful of cases so far, and patients are just over the moon. One of the problems that we have in Miami is there's a bunch of really thin women that have no fat, but it's Miami, and they want a butt.Not just butts there's breasts that they just want to have a little bit more volume. When you were talking about before, maybe just fill out the upper pole, the breast a little bit. They don't really want to have an implant. You can use fat, but if you don't have fat, you don't have fat to use, so you can't use fat. AlloClae is a game changer, and I did a few cases with butts. I did one case of hands also. It's one of the latest things is hand rejuvenation.

(27:03):
I'm doing a lot of that now. The patients that we did are ecstatic. Two of them contacted me the day after. One of them was just raving. Everything's great. Nothing hurts. It looks, I'm so happy. Thank you. Thank you. Another one of 'em is my PA in my practice, who's super skinny. Ramsey is gorgeous woman, young, super thin, very, very fit, no fat. She's been lamenting not being able to have any kind of butt augmentation with natural tissue since I've known her, and when we heard about this stuff, she insisted on being one of the patients. She is really happy, very, very happy with our first experience with it. Another patient that I injected, this is the one I did, her butt and her hands. She sent me the most lovely, she messaged me on Instagram and basically said, everything is great. I'm so grateful. Thank you. You changed my life. It's life changing. I'm telling you, those are the moments that you're doing something that's really fun and really helping people.

Eva Sheie (28:05):
Have you been wanting to get away from, how would I refer to the fillers that are manufactured instead of from organic material? What would be the right way to ask that question?

Dr. Rubinstein (28:18):
Oh, I get what you're saying. Well, right now, there's a trend that's kind of pushing away from the typical fillers. The HA's, not just the HA's calcium hydroxyapatite and all the filling material that is perceived as artificial, but the truth is, hyaluronic acid is actually a natural material. It's a component of your skin, but still there's kind of a push against filler right now. It's sort of the trend. People say, oh, I don't want to use any filler anymore. What else can we do? And so I don't really prescribe to that point of view. I think there's a lot of good materials, HA is perfectly fine to use. I get why people want to use other things Now with a product like AlloClae, before AlloClae, one of the first to be introduced was Renova, which is a similar product. They're made differently. The structure of it's a little bit different. Same idea, but much smaller quantities. Renuva is meant for face. Do I think that there's merit to that? I think it's a role for everything that we do. I can't do things with AlloClae or with Renuva that I can do with HA and vice versa. So I don't think HA is the devil, but I think that that's the baggage it's carrying right now.

Eva Sheie (29:27):
Is there anything else you're looking forward to that, AlloClae sounds really interesting. We should talk about it again.

Dr. Rubinstein (29:33):
I think AlloClae is going to be a game changer. We just started my experience, I think what has to happen for this to really take hold is it has to do what it's projected to do, which is be a long lasting semi-natural filler. It's certainly natural, it's just, it's not your own tissue, but if it becomes your own tissue over time and you keep the majority of the volume that we inject, it is an absolute home run, and it is also the very first body filler ever introduced.

Eva Sheie (30:01):
Is it cost prohibitive or is it comparable?

Dr. Rubinstein (30:03):
It's expensive.

Eva Sheie (30:04):
It is.

Dr. Rubinstein (30:05):
It is expensive.

Eva Sheie (30:05):
But, if it lasts forever.

Dr. Rubinstein (30:05):
If you compare, well, that's the thing is we don't know right now what the duration's going to be, but if you compare it to what surgery would be, you might spend anywhere from 15 to $30,000 to get a BBL. This material is probably going to be about, in my practice, it's going to be 12 to $15,000 for the first level of buttock augmentation with it, kind of what I did for my three patients, that's going to cost around 12 to 15,000 bucks.

Eva Sheie (30:33):
And then a much smaller volume in the face would be, reasonable.

Dr. Rubinstein (30:35):
Oh, yeah, no, it's actually less expensive than Renuva. The market is moving in a positive direction for patient affordability.

Eva Sheie (30:44):
And are you one of the first to have this?

Dr. Rubinstein (30:46):
Yeah, there's only, I don't know the exact number, maybe a dozen doctors in the country that have had their hands on it so far.

Eva Sheie (30:52):
Oh, we'll have to come back and check on you.

Dr. Rubinstein (30:54):
Yeah, please.

Eva Sheie (30:54):
See how it's going.

Dr. Rubinstein (30:55):
I'd love to talk about it.

Eva Sheie (30:56):
If someone's listening today and they want to find out more about you, follow you on Instagram, where should they go look?

Dr. Rubinstein (31:03):
Well, I can give you a couple places. I do want to mention one thing, so I'm very excited about this. We were talking about GLP-1s earlier. I've been sitting on the sideline with GLP-1s, watching my colleagues expand, have booming practices related to weight loss. And I've watched a lot of people in my community in Miami, everyone's prescribing these GLP-1s, semaglutide, tirzepatide. Everyone's taking Ozempic, Mounjaro, everyone's on it. The problem that I saw with what's being done is that typically what that means is that they take some blood, they weigh you, and then they give you a prescription and say, Hey, good luck. See you in a month. Hopefully you lose some weight. And most people do, that's the thing. That's why it's so popular. They don't change their diet. They don't change anything. They go on and they can drop 10, 20, 30 pounds or more, but as soon as you stop using the medication, research shows you gain two thirds of the weight back in the first year.

(31:57):
That's not a sustainable way to make a life change. So I wanted to do this, but I wanted to do it in a way that would really help people. So I designed my program called LiveWell. The LiveWell program has a lot of technology included in it. It's got a very comprehensive plan. Now, we do offer the GLP-1s. You can get tirzepatide, you can get the semaglutide in my program, but you don't have to. You can choose to use the medications or not choose the medication because there's much more. Every patient comes in, yes, we're going to draw your blood, check a lot of things that might be contributing to your weight gain or failure to lose. We're going to do two dimensional photos, three dimensional photos. We'd make a three dimensional photographic model of your body as a baseline. I think we can also do some comparisons with. We're going to do a three dimensional scan of your body that I can do measurements across various parts of your body and track that as you go on your weight loss journey.

(32:50):
And we're also going to do a very comprehensive, I have the most advanced in-body machine available. So we do the highest level body composition analysis that you can do as the baseline and then track all of those things, water content, muscle content, and yes, fat content, both visceral and external, and track what those changes are going through the system. But what really differentiates is that every one of my patients gets a coach. The coach that they're getting is a professional nutritionist and trainer, and they're going to get on the phone for the first month. You have one-on-one coaching from, and there's a whole gallery of coaches. Everyone gets matched with someone that suits them, and that coach is going to talk to you one on one, and say, all right, tell me about your day. What is your day to day? When do you eat? How many times a day are you eating?

(33:34):
What are you eating? Do you ever get to the gym? What are the hours that you're awake and asleep? And get a sense of a snapshot of what your life is. And then they're going to design a diet plan. And probably you're going to be eating more than you were eating before, not less. And you are also going to be given recommendations for working out, a certain frequency, certain type of workout, depending upon the goals. And you're going to have to check in with that coach. When you're on the plan, you're going to talk to them a couple times a week, Hey, eating what you're supposed to eat. That comes with an app. On the app. You're going to log your weight every day. You're going to check off the meals that you're eating. There's a meal builder, so you're going to be assigned a certain diet and all the diets, all weight loss now, all the nutrition is by macros. How many carbs, how much protein, how much fat, and sometimes how much veg. Those macros will be, how you're going to build your meals. And so the app will help you build your meals and keep you on the plan and help you figure these things out.

Eva Sheie (34:26):
That sounds so useful.

Dr. Rubinstein (34:27):
Not only that, there's another piece of technology. They'll let you know what your metabolism is doing. Because the goal of eating right is not just to lower your calories, because if that were true, what I was doing before I started, I'm patient number one on LiveWell. I put myself on LiveWell, no meds. I didn't take any medications. No tirzepatide, no Ozempic. I used the coach and I used this device called Lumen. Lumen is a metabolic tracker.

Eva Sheie (34:53):
One of my podcasts they talk about it every episode. Because they're sponsored by Lumen. I know everything about it.

Dr. Rubinstein (35:00):
Well, there you go. Yeah, but it's fantastic. I have to tell you, I just as an unsolicited validation of what you're hearing.

Eva Sheie (35:07):
Yeah.

Dr. Rubinstein (35:07):
I personally use it, all of my patients get it. And we use it so that the patient knows at every moment, what is your metabolism doing? Because the truth is you're not losing weight when you're in the gym to any substantial degree. The weightlifting, the running, all the exercise you do accounts for a maximum of about 20% of weight loss. 80% of it is your habits and your diet, when you're eating, how much you're eating and what you're eating. But the lumen will let you know, will track what is your metabolism doing. And the majority of your weight loss is not when you're in the gym. It's in fact, shockingly when you're sleeping, because you send a huge amount of time in bed. If you're sleeping properly, you're getting six to eight hours of sleep, you're burning fat ideally in that time. When you wake up, you grab your lumen, first morning breath, not the first breath you take in the morning, but we call it checking a breath. And so you breathe into this thing, you breathe in and you breathe out, and it gives you a rating of what your metabolism is doing. So it'll tell you on a scale of one to five, one being mostly fat, five being mostly carbs, how it all shakes out and it gives you percentages. You want to be a one or a two, mostly fat in the morning because if you are, while you were sleeping, you burned fat. If you wake up and you're a four too many carbs. So I mean that alone.

Eva Sheie (36:23):
What have you learned from doing it yourself?

Dr. Rubinstein (36:25):
Well, let me tell you. I started at 203 pounds. I'm six feet, so I'm not obese, but I was bigger than I wanted to be, and I wanted to lose a little bit of weight, but I didn't want to use medications. So I went on my own program. Selfishly, I designed LiveWell for me and I wanted to make something that was sustainable. So I did it and I went on it and in two months I lost 20 pounds, no drugs. I went from eating one meal at the end of the day, cuz that was my lifestyle. I get up. I didn't stop for breakfast. I didn't stop for lunch. Work, work, work, work, work. Get home tired, eat a big meal, go to sleep. Terrible. Now that is intermittent fasting. You would think you're not having a lot of calories through the day. So how could it be bad?

(37:06):
Terrible, because your body adjusts to its norms. It knows that I'm going to be giving it a big bunch of food at night. So the entire day it dials down my metabolism to a crawl that I'm not actually burning much of anything through the day. And then it amps up my metabolism at the end of the day so that it's going to get this food and process it. And there you go. And it burns through that. But all it's doing is burning off carbs because your body burns carbs first. And all the fat that I was consuming is getting stored away because it's got to live on starvation through the day, but it's not burning enough fat. So I just kept slowly building, building, building with that terrible habit.

Eva Sheie (37:49):
So you had to start eating?

Dr. Rubinstein (37:51):
Yes. And that's what I mean. You eat more, you ramp up your metabolism. I eat four times a day now, which by the way, I'm about to do. I got to go have something to eat, but I eat four times a day. I eat more food than I did before, and I've lost 20 pounds in two months. I'm now about 25 pounds down.

Eva Sheie (38:06):
And how do you feel different?

Dr. Rubinstein (38:08):
Oh, my body moves differently. I feel differently in the gym. Interestingly, I'm still lifting weights. I'm still at the same weight level because I lost weight. I didn't lose strength. And now with my coach that I'm still working with, we're in a phase where we're building. We're going to start amping up muscle bulk and shaping the body, and I'm probably going to gain some weight back, but it's going to be lean mass and not fat.

Eva Sheie (38:34):
Which we need as we get older.

Dr. Rubinstein (38:36):
And that's a problem, that's a big problem, not only of getting older with the GLP-1s. The people that are using the tirzepatide and the semaglutide medications, muscle wasting is a huge problem. You're losing a little bit of muscle mass. It is sort of a side effect of those meds. By being in the gym, having your coaching going on, you're going to maintain that. And there's some interesting things we'll see. There's some technology that you can use to try and stimulate muscles to try and stimulate also collagen content in your body that's now being looked at to be sidecars to weight management programs. Soft wave is one of 'em to help stimulate keeping the skin firm not having the wrinkles start showing up. That seems to be working out well. There's others, there's a lot of technology, a lot of treatments, and even products that are I think are going to become part of this program, but LiveWell is very comprehensive. And by the way, very affordable. I did not make it cost prohibitive. It starts at 599 a month, including the meds.

Eva Sheie (39:37):
Oh.

Dr. Rubinstein (39:38):
Yeah.

Eva Sheie (39:38):
So you get all of that with meds.

Dr. Rubinstein (39:39):
All of that, with the meds, and you come back and we're going to do the scans. We'll do the body comp. It's all

Eva Sheie (39:46):
The data, I mean the data is so important. The other thing I hope you're doing is taking your patient's photos every time they come in.

Dr. Rubinstein (39:51):
Yes, of course.

Eva Sheie (39:52):
Because I would pay any amount of money to have the progression. Now, I've been at it for two years, and I seriously would pay any amount of money to see the progression.

Dr. Rubinstein (40:04):
A hundred percent. It's fascinating to see. We take pictures, not just 2D, we take the 3D photos and we take the body scans so we can give you measurements. We can see side by side. I can spin your whole body around and show you this is where you were. This is where you are. It's a big change. So yeah, it's all about that. And if you're not measuring, if you're not looking at that, how do you know what you're really accomplishing?

Eva Sheie (40:24):
Yeah, you don't. One of the best things about weight management is the relationships you build with the people who are helping you.

Dr. Rubinstein (40:30):
Yes, for sure.

Eva Sheie (40:31):
And have you seen that with your patients too?

Dr. Rubinstein (40:33):
Yeah.

Eva Sheie (40:33):
They're like friends. You've got hundreds of friends.

Dr. Rubinstein (40:35):
True. Well, because you're helping them. Losing weight is the biggest albatross that people carry around their shoulders for some people their entire life and people that go to battle with it by themselves, try these starvation diets, try intermittent fasting, try fad diets, and nothing really works well long term. You might drop, you're going to gain it back when you're not on, unless you make real changes to habits that are sustainable that you feel good about. You can eat things you want to, realistic gym goals, you can get there and do it. There's no way that you're going to keep that weight off. You have to live well. Everyone should live well.

Eva Sheie (41:12):
Well done. Well said. Thank you. If someone's listening,

Dr. Rubinstein (41:17):
Okay, there you go.

Eva Sheie (41:18):
And they want to reach out, find out more about you or schedule a consultation, where should they go?

Dr. Rubinstein (41:23):
Of course, you can go to my website and call the office office (305) 792-7575. If you want to go to the website, it's dr as in doctor -rubinstein.com. R-U-B-I-N-S-T-E-I N.com. And if you want to go to Instagram, TikTok snapchat, take your choice. It's at Dr. Rubinstein DR Rubinstein.

Eva Sheie (41:42):
Doesn't that dash drive you crazy when you bought that domain name? Why do I have to have the dash?

Dr. Rubinstein (41:46):
Yeah, I tried to.

Eva Sheie (41:48):
Who has it? Who has the real one?

Dr. Rubinstein (41:50):
Actually the real one wasn't even owned by a doctor. It was one of those we're going to buy. Yeah, it was one of the brokers. They wanted me to buy it from him and I refused.

Eva Sheie (42:01):
Good job. That was a good choice. Thank you so much. It was so nice to you.

Dr. Rubinstein (42:06):
My pleasure. It was great to chat. Happy to be here anytime you want me.

Eva Sheie (42:11):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at MeettheDoctorpodcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, theaxis.io.