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's 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. Thanks for listening to Meet the Doctor. My guest today is plastic surgeon in Miami. His name is Dr. Alex Zuriarrain, and he goes by Dr. Zuri sometimes and also has the distinction of operating on several of my friends this year, last year. Welcome to the podcast Dr. Z. I'll continue after you say hi.

Dr. Zuriarrain (00:51):
Okay. Thank you so much for having me on it. It's been a long time, but I'm happy to be back.

Eva Sheie (00:57):
Yeah, I've been working in plastic surgery marketing for a very long time, and I learned very, very early in my life not to recommend doctors for various reasons. I think people should make their own decisions, and I never want to be the person on the other side of a recommendation that goes wrong, so I just stopped doing it. But I mentioned you to one friend earlier in 2023, and she ended up becoming a patient, and then it opened up a pipeline of people flying from Houston to Miami to see you, which I find really fascinating.

Dr. Zuriarrain (01:31):
It is very fascinating. So many amazing surgeons in Texas, Texas,

Eva Sheie (01:36):
In Houston. I know.

Dr. Zuriarrain (01:37):
Yeah. I know.

Eva Sheie (01:39):
Not knocking the Houston doctors, but I guess the thing that made you really interesting to them was your experience with the backside. So let's start there.

Dr. Zuriarrain (01:53):
Yeah. I could say at this point I'm pretty much an expert on the backside having done so many cases related to the enhancement of the backside. So yeah, the backside comes in a lot of shapes, a lot of sizes, a lot of varieties and aesthetic appeals to different types of people around the world. But here in Miami, we're really good at making, at least I feel like I'm good at making some very well-rounded, nice volume enhanced backsides that are attractive, that are not overly done, that are not disproportionate, that it's not as we like to say, an ant booty, what people like to say.

Eva Sheie (02:33):
I was exporting a list for somebody this morning and it was a list of BBL leads, and one of the comments from one of the leads said, do you do a black juicy booty?

Dr. Zuriarrain (02:48):
Yeah, we actually get that quite a bit. That is one of the looks that's very popular nowadays.

Eva Sheie (02:52):
I had no idea that was a subcategory, but I learned something new every day, and that's why I love my work so much.

Dr. Zuriarrain (02:59):
Well actually operated this morning on a doctor. She came all the way from Mississippi and she was looking for an enhancement of her buttock, and she a Caucasian young, 30 some year old gynecologist. So yeah, I mean, great person, but yeah, everybody's looking sometimes to get a little reinforcement back there.

Eva Sheie (03:21):
Well, how would you describe that sort of over the last 10 years, how the trend and the shape has changed? If you could sum that up.

Dr. Zuriarrain (03:31):
Yeah. I think that it really started off with the J Lo movement. She really took it international, and so everybody was really chasing that J-Lo buttock for quite some time, which at the beginning, I'll be quite honest with you, is not a disproportionate buttock necessarily. It's just a very Hispanic, Latin, Puerto Rican type buttock, and there's nothing wrong with that. But it started to grow and grow and grow into a Kim Kardashian buttock, which became, in my opinion, way too disproportionate, way too out of control. And so it was basically culminating in the extreme of the big juicy, huge buttock look. And so now it's kind of turned itself way around. Now, my patients coming in, the vast majority of them, the first thing that comes out of their mouth is Dr. Z do not make me a Kim K booty. I do not want that. I have to constantly, not convince, but just remind people that I'm not in the business of trying to create huge disproportionate looking rear ends.

Eva Sheie (04:38):
So they tell you what they don't want. Do they give you the name of someone they do want now, has Kim been replaced?

Dr. Zuriarrain (04:45):
No, no. Kim is just like, definitely don't want that, but they don't have an aesthetic standard in a celebrity that they're like, okay, I want to have her buttock. That's the buttock that I want. They don't show me a ton of Instagram pictures from a lot of these 20-year-old Instagram models that are working out two times a day every day and have 0% body fat. I never had a single pregnancy, and it's just like, no, this is not real. I cannot create this kind of buttock for you.

Eva Sheie (05:13):
Man. I would love to have my 20-year-old butt when I was a cross country skier.

Dr. Zuriarrain (05:16):
Yeah.

Eva Sheie (05:16):
But no, not anymore. It's interesting. I had a bad attitude about this particular surgery for a long time who could possibly care about what their butt looks like this much, that they would put themselves through this, and then when one of your very best friends does it, you have to really think about things differently. And that's true for any surgery. She looks amazing, and you would never have said in a million years that she didn't look amazing before. But then when you look at the pictures side by side, it is so incredible what a difference it made.

Dr. Zuriarrain (05:58):
Yeah, yeah, it's huge. It's huge. It's just a lot about proportions and symmetry and lines, and when you do certain procedures, it's almost like if you don't finish that part of the anatomy, you just didn't really get a full result. You kind of got a half result sometimes, which is okay. There's a lot of fear in this procedure, and it's very understandable, and it should be very highly respected as an operation. It is the most dangerous surgery that we do. Statistically, it is the one that has the most risk. So in Florida, the legislature has been very strong in passing law that basically you have to use wireless ultrasound when doing the fag grafting. We're the early adopters of that technology, and it should spread to the rest of the country, I would expect.

Eva Sheie (06:48):
I think that it is and that it has. Okay, so you're well known for this procedure, but are you known for other things too? Do people come find you?

Dr. Zuriarrain (06:59):
The interesting part about my practice is it hasn't been on purpose, but I feel as if I do almost everything, and it's not by, not so much by design, it's just by how my practice has evolved over time. I'll give you an example. Last year there was a two week span where I did probably about 12 facelifts.

(07:24):
And it was so odd because I'm not ever promoting myself as being great at one particular surgery, but I was doing a lot of facelifts and then it sort of morphed into a lot of mommy makeovers. So right now I'm in kind of this phase of mommy makeovers, and then now it's turning into massive weight loss patient situation, makeovers, and then it's back lifts and thigh lifts and arm lifts that a lot of surgeons don't even want to get into that world. But I've always felt that because I was a general surgeon before I ever started in plastic surgery, I feel very comfortable taking on a lot of tough cases that I think a lot of people would probably shy away from for reputation's sake and all that. But people ask me this all the time, are you known for a particular operation? Is this something? Is this your thing? And I'm like, no, not really. For example, today I did an upper and lower blepharoplasty on a young woman, and at the same day today I had a mommy makeover. So I'm not the kind of guy that is just a one surgery type guy.

Eva Sheie (08:39):
What kinds of surgeries do you learn when you're doing general surgery and then what are you doing all the time?

Dr. Zuriarrain (08:45):
I mean, general surgery is, it's kind of like a shotgun experience of every single surgical subspecialty from vascular surgery to thoracic to trauma, to pediatrics, to endocrine surgery, to being in the ICU, not sleeping for two, three days in a row. I think that that really prepares you to pretty much take on any surgical procedure. And then you get into plastic surgery and it's so refined and it's so elegant and it's so artistic and it's so different from the general surgery experience that I just gravitated towards that type of procedures.

Eva Sheie (09:26):
So general surgeons tend to work in hospitals I would think most of the time, and that's their life, their environment, their universe is entirely within the hospital, so they get everything that comes through the hospital until they need a specialist.

Dr. Zuriarrain (09:44):
Yeah, they're kind of like your ER doctor that tries to take care of as much as they can in that sense. And then they have to triage very, very difficult cases. They'll triage. But interestingly enough, in this country, number one, there's a shortage of general surgeons, and number two, it depends on what part of the country you're at, where you're living, because you can be in the middle of New Mexico where I happen to have trained in general surgery.

Eva Sheie (10:07):
Oh, you're one of those guys. Because I've interviewed so many doctors this year on this podcast, I noticed that this thing about New Mexico, because there really is, tell me if I have this wrong. There's one place in New Mexico where you can see a surgeon, and so all the patients in the whole state go to that one hospital, and it's crazy, right?

Dr. Zuriarrain (10:34):
It's crazy. Yeah. Oh, it's nuts.

Eva Sheie (10:36):
And so you came from that.

Dr. Zuriarrain (10:38):
Yeah, so I came from that. That was my upbringing in surgery. So we saw it all. I mean, we took care of everything, and then you compound the fact that you're surrounded by a lot of Native American reservations and a lot of immigrants from Latin America and Mexico. And so the access to care, that was the only big hospital where they could access care, and it was intense, very intense place.

Eva Sheie (11:03):
So how did you get from New Mexico to Miami?

Dr. Zuriarrain (11:06):
So then I went to Cleveland Clinic and I did my plastic surgery residency right out of general surgery, and I ended up going there to do three years of plastic and reconstructive surgery. And then when I graduated from that, I started in private practice, but I actually, interestingly enough, I had a mentor of mine who was a cosmetic surgeon, and I wanted to learn what I could from him because he had a background in ENT and I didn't have an ENT background. I had a general surgery background, so he was really good at facial procedures, rhinoplasties, facelifts, neck lifts, eyelids. So when I was in the first year of my practice, I spent a lot of time with him, and because of that, I was able to basically complete a fellowship. He was a fellowship director for cosmetic surgery, and I was able to take the board for cosmetic surgery. And now after all these years, I'm basically four board certified. I have the American Board of Surgery, the American Board of Plastic Surgery, the American Board of Cosmetic Surgery, and the American Board of Facial Cosmetic Surgery.

Eva Sheie (12:16):
You're like a unicorn. So what do you say to people who say that American Board of Cosmetic Surgery is not a real board?

Dr. Zuriarrain (12:25):
I tell 'em that. It's unfortunate to think like that because they are required to take a board exam. It is an oral exam as well as a written exam. I happen to have scored, I'm not going to brag, but I'm going to throw it out there. I happen to have scored the highest exam in the United States for the oral cosmetic surgery exam when I took it. Here's what I have to say about it. I would not have scored the highest score in this country on the cosmetic oral exam if I was not a board certified plastic surgeon. There is no way. There is no way. So do I think that the cosmetic surgery board certification should replace the American Board of Plastic Surgery somehow? No, I don't think so. I think that would be a huge mistake and a huge disservice. I think they have very different, in some occasions, they have a little bit of a different focus when it comes to cosmetic surgery versus plastic surgery, but I would recommend that that fellowship be much longer and be much more possibly university based like the Plastic Surgery Residency Program.

Eva Sheie (13:33):
Yes. Two things that I know about that fellowship are that there aren't that many of them. So there's only, I think less than five, right? Maybe six.

Dr. Zuriarrain (13:43):
They're growing. They're growing faster and faster and faster.

Eva Sheie (13:46):
But for a while there was only a handful every year. And then the other weird thing that people might not expect is there's maybe 200 or 250 board certified cosmetic surgeons in the United States. There aren't that many of them. They're treated unfairly and they're lumped in with other people who are just calling themselves cosmetic surgeons instead of the people who were actually went through this particular training. So it's a rabbit hole. Patients at the end of the day, they don't really care or understand the difference. And so when we're trying to make decisions about what doctor to see or choose, it's really more about experience and results and seeing those results with your own eyes. You would never go to a hairdresser and ask for blonde hair if they'd never done blonde hair before?

Dr. Zuriarrain (14:35):
Yeah. No, that happens to me quite often. We get a lot of virtual consultations. People send us photos and I evaluate them. And there cases that there are certain types of rhinoplasty that I will not do certain types of, for example, Asian eyelid surgery that I will not do. So there are things that I stay away from because it's not in my wheelhouse. If I had been maybe trained in San Francisco where they have a really high volume of Asian eyelid surgery or maybe if I was in Chicago and maybe there was a lot more ethnic rhinoplasty surgery that I would offer it, I was very well versed in it. But no, there's a lot of cases in plastic surgery that you have to be careful if you're not doing them often.

Eva Sheie (15:19):
That's true. Well, I was going to say, what kinds of things do you turn away? But you already answered that. You said it.

Dr. Zuriarrain (15:26):
What I'm turning away now more than ever, more than are the repeat Brazilian butt lift or the what I call the Brazilian butt lift train wrecks where they got infected or they got fat necrosis or they have a huge dimple or divot in their buttock, and they're expecting that to kind of just somehow be corrected by pumping more fat in there or bad asymmetries, like one buttock is way bigger than the other buttock and they're trying to fix that, but then they have no body fat to give you. So there's a lot of unfortunate cases out there that come through my desk and a lot also from Latin America, I will tell you from Columbia, some crazy, crazy cases.

Eva Sheie (16:06):
That is really unfortunate. How often is that coming your way?

Dr. Zuriarrain (16:12):
I'd say at least I have a couple a month, two or three a month that come through the clinic that are kind of desperate situations that I can't fix.

Eva Sheie (16:20):
Is there anybody who's taking those in Miami?

Dr. Zuriarrain (16:23):
Just depends the case. There was a big issue here with what we call biopolymer injections. So it's not even hyaluronic acid like what we use today. It's like silicone beads that they would pump into women's rear ends buttock to try to give them better shape and all that. And so there was a lot of patients that were getting this done maybe about 10 years ago, and they were coming through in Miami trying to get it removed. I do know of one surgeon that was removing it with liposuction and then sometimes having to cut it out, but I was seeing the work that was done and I was seeing the results and I just thought it was so morbid. It was just the scars were so bad and the infection rates were so high and the hospitalization rates, I just felt like it's not a great thing to be offering.

Eva Sheie (17:12):
One of the best things plastic surgeons have done and in recent memory is that the effort to band together and really fix what was going on with these negative trends that were happening in Miami I think is one of the coolest things I've ever seen was all that work between the two plastic surgery societies and the doctors that were leading that. And all of you in Miami were such a big part of that. Do you feel like we've turned the corner and it's getting better?

Dr. Zuriarrain (17:38):
Oh, I think it's gotten way better way, way, way better. I mean as of about two or three years ago, every few months somebody would tell me about a death that was happening in Miami in some sort of clinic and some sort of, we call 'em chop chops, we call 'em high volume chop chops, low price, high volume. But yeah, I haven't heard of any of those cases in over a year. I would say that anybody has had a patient death in a clinic due to a BBL or anything like that. So I think the wireless fat grafting mandate definitely helped. Now there's a scarier mandate trying to get pushed through regarding the actual BBL procedure that it would have to be done in a hospital setting, which I think is unnecessary and I don't think that's going to change at all.

Eva Sheie (18:35):
It's not even necessarily safer, is it?

Dr. Zuriarrain (18:39):
No, not necessarily safer. And I don't know what data they're going to try to use to push that. It's somehow safer. But there was a study a long time ago that compared having plastic surgery in the hospital setting versus office-based or ambulatory facility, and the hospital was not found to be superior at all. So after that study, it pretty much proves to everybody that having surgery in an office-based setting, it's very safe. But this is the legislature, these are the lawyers that push these agendas and then the doctors just sometimes we can fight it, sometimes we can't. And it really impacts us negatively many times.

Eva Sheie (19:18):
Well, there's always going to be a battle to fight on every front, and I think what's important about what the societies are doing and that's made up of surgeons like you is advocating for patients really well. So hopefully you guys win and the lawyers and it's a tale as old as time. Well, we should talk about something more fun. Last time we talked, I asked you what podcasts you listened to, and I remember being surprised by your answers. And I'm curious if you want to, can I ask you the question again? What are you listening to? What's in your headphones?

Dr. Zuriarrain (19:56):
Oh. It's crazy. Things have changed a lot, I think since Covid and so I'm actually in the process of opening a wellness facility. Actually we're about to finish the wrap up construction in the next couple of weeks. And so I've been heavy into these wellness podcasts. I've been listening to a lot of getting a lot of information on all of these modalities that are being used, like hyperbaric oxygen and infrared sauna. And so I'm really diving into those more than anything. There is a neuropsych, I think he's a neuropsychologist or neurobiologist that I really like to listen to out of Stanford, and I got to remember his name because he's just an amazing guy. Joe Rogan always makes me laugh.

Eva Sheie (20:47):
He's got to have the right guest on and then you got to have the time to listen to it to enjoy it. Yes, which is kind of a rare combo these days, I feel like.

Dr. Zuriarrain (20:56):
It is. It's a rare combo and it's really hard to carve out the time. It's just so much an overwhelming amount of information that I think it's just getting more intense every day. But the guy that I love to listen to is Andrew Huberman.

Eva Sheie (21:10):
Oh yeah. I saw him speak live last year because YouTube expanded into podcasting and they did a huge splashy kickoff with him on stage at a podcast conference. And so they were trying to convince everybody to put their podcasts on YouTube, which we obviously do because that's where everybody is. That's a great show. And there's so many good ones. So wellness, it seems like is also a topic that keeps coming up, and the boundary lines between wellness and aesthetics are almost gone. And so this stuff that maybe 10 or 15 or 20 years ago, we would've said that's for the quacky people. A lot of it is just fully integrated into what we're doing because it's so, so important and I think such a positive change that plastic surgeons are looking at people beyond what surgery they need and taking care of way more of the whole person. So that's exciting news. What else are you going to offer in this?

Dr. Zuriarrain (22:14):
Oh, we're going to have cold plunge and we're going to have cryotherapy and we're going to have massage, and then we're going to do all the basic med spa HydraFacials and skin peels and lasers and hair removal. And I'm more on the end now being in cosmetic and aesthetics and cosmetics for so long that I'm really diving deeper into the cold plunge and the infrared sauna. And I'm really now, and I just acquired this device. I'm super excited for it. It's the Balancer Pro. It's a compression therapy system, so we'll be offering compression therapy as well, of course, IV fluids and micronutrients. I'm even going to have a provider in there that's going to offer concierge healthcare. So it would be very nice to be able to have somebody in there that can see patients and can help me with that. So yeah, I mean this is something I've been on for about a year and a half in development, and so it's coming up fast.

Eva Sheie (23:15):
That is really exciting to hear. And you mentioned earlier that you're seeing a lot of weight loss patients, and so we can't ignore that Semaglutide Terzepatide and their respective brand names, which I won't say right here, because if you know are having such a huge impact on aesthetics as people lose weight. And I feel very strongly that when you get a prescription and you realize very quickly that the prescription is cost prohibitive for most people or that the shortages are making it impossible to get, even if you have a prescription, then it's important that we don't just go online and find some sketchy source when we want to get that medication for ourselves. So plastic surgeons and reputable people in aesthetics have a great opportunity to meet those people in the middle. And I think you told me that you're offering medical weight loss too.

Dr. Zuriarrain (24:14):
Yes, yes, we are offering it. We've been offering it for about a year and it's gone well. It's gone well. We've had some pretty, very good success stories. Issues with Miami are always in any major city, New York, LA, Miami, it's always the corner facility that wants to sell it for half of what it's really worth and God knows where it came from. So we only network with real pharmacies.

Eva Sheie (24:42):
What kind of results have you been seeing from your patients?

Dr. Zuriarrain (24:46):
Oh, it's been fantastic. I mean, the weight loss is just awesome. I mean, the way that we do it is that we start 'em off with a lab workup, so we make sure that they get a full panel of labs and we have to check that first. I mean, just that's the right thing to do. I think a lot of people are just jumping on this medication thinking that it's not going to have any side effects or it couldn't have any untoward issues associated with it. So we test that and then we start with low dose and we slowly increment as we go. And I haven't had any issues with nausea or vomiting or any upset stomach thing, but I do think it's because we're so careful in the way that we progress with the patient and I tell them, this is going to be month to month to month to month. This isn't going to be, try to lose as much weight as you can in two weeks. And in my experience with the patients that we've been working with, it is a slow process, but it is powerful and it is very predictable and it works.

Eva Sheie (25:45):
It does. Glad to hear it. And then what kinds of aesthetic things are they asking for along the way? Do you see the sort of light switch go off somewhere along the way? Like, uh-oh .

Dr. Zuriarrain (25:56):
Yeah. Yeah. It starts to go off probably a couple months after they started treatment because the skin laxity starts to creep up relatively quickly, some more than others, depending on their genetics and their skin quality. But others are just like a weight loss patient. Just like any massive bariatric weight loss patient, they start to want to do facelifts and neck lifts and breast lifts and domino plasty, and then the extremities are always on their list. They always want to get better arm contouring or thigh contouring. So kind of just like a snowball of surgeries.

Eva Sheie (26:31):
Yes, indeed. And they're in the right place for that. So when you're not working, obviously you've been working very hard on getting your wellness space launched, so maybe that's what you're doing with your free time, but is there anything else you're into right now?

Dr. Zuriarrain (26:46):
Heavily into my kids. I have a six and a 5-year-old, so they have kept me very busy just going into sports with them. I was doing jui jitsu for quite a long time with my son, so that's been awesome. He's really enjoyed that. He is been growing in that as well. And then boating. I mean, boating is my real passion, but the ocean out here in Miami is just amazing and it's always warm enough that you can get in and not get hypothermia. So I get in December, I'm in the water now in February, January. So yeah, that's my go-to escape when I can because as you know with kids, it's really hard to get away.

Eva Sheie (27:27):
They go on the boat with you though, right?

Dr. Zuriarrain (27:28):
Oh yeah. Yeah. They love it. They love it. And my wife enjoys it too, but it's really my passion.

Eva Sheie (27:34):
That's so fun. Okay, well, I've taken enough of your time for today. I really appreciate it. It's really good to see you again, and I am going to keep sending people from Texas to Miami, I guess.

Dr. Zuriarrain (27:48):
Awesome, thank you.

Eva Sheie (27:50):
If someone's listening and they need to find out more about you or want to follow you on Instagram, where should they look?

Dr. Zuriarrain (27:57):
Yeah, so our Instagram is Dr. Z, D-R-Z, plastic sur,gery and the website's just the easiest way to get all the information that you need. It's going to be Zuri, which is Z as in zebra, U-R-I plastic surgery.com.

Eva Sheie (28:12):
Thank you so much.

Dr. Zuriarrain (28:14):
Thanks Eva.

Eva Sheie (28:15):
See you soon.

Dr. Zuriarrain (28:16):
Alright, thank you.

Eva Sheie (28:20):
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 Meet the doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, T-H-E-A-X-I-S.io.