Matthew Nykiel, MD - Plastic Surgeon in Newport Beach & Upland, California

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. Well, today on Meet the Doctor, my guest is Matt Nykiel, not Nykiel.

Dr. Nykiel (00:36):
That's right.

Eva Sheie (00:37):
Who is a plastic surgeon in Newport Beach, formerly the Inland Empire.

Dr. Nykiel (00:43):
We still, we still have an office in the Inland Empire.

Eva Sheie (00:44):
Oh, good.

Dr. Nykiel (00:45):
Yeah, so we have two, two offices. So,

Eva Sheie (00:47):
Yeah. That's great. How often do you go back and forth?

Dr. Nykiel (00:49):
Uh, usually we split the week, so I'll spend about two, two or three days in one location one week, and then two to three days at the, at the other week. So, um, so usually even split.

Eva Sheie (00:57):
What do you do while you're driving?

Dr. Nykiel (00:59):
I listen to podcasts, <laugh>.

Eva Sheie (01:01):
Oh yeah. What do you like?

Dr. Nykiel (01:01):
So, I love doing the informational podcast. I don't know, kind of what, what everybody else is into, but more so in the mornings, I find in the afternoons, I, I don't have, like, I, in the afternoons I want to, on the drive home I just want to listen to some music.

Eva Sheie (01:12):
Right.

Dr. Nykiel (01:12):
But in the morning, I just feel like you're, you're geared up.

Eva Sheie (01:13):
Learning time.

Dr. Nykiel (01:14):
Yeah, you're right. And you want, so, um, it kind of just depends on what the topic is. Right. So any type of learning, I mean, sometimes it's topics as far as, uh, house repair, <laugh>, sometimes it's, uh, I have, like we were talking about, I have two kids, so sometimes it's, uh, it's parenting.

Eva Sheie (01:28):
Parenting.

Dr. Nykiel (01:28):
Yeah. You know, um, it just, it depends on what sort of what's going on in your life. But, but honestly, podcast to me in the morning. Great.

Eva Sheie (01:36):
Yeah.

Dr. Nykiel (01:36):
Sometimes the Real Self podcast obviously.

Eva Sheie (01:39):
Oh yeah. That old thing.

Dr. Nykiel (01:40):
Yeah. Yeah.

Eva Sheie (01:41):
Right. Amazing how many people still listen to that and they haven't put an episode out in a since I left.

Dr. Nykiel (01:47):
That's right.

Eva Sheie (01:47):
Years.

Dr. Nykiel (01:48):
That's right. That's right.

Eva Sheie (01:49):
So tell us a little bit about yourself as if patients are listening to this, because that's really the purpose.

Dr. Nykiel (01:55):
So, my name's Dr. Matthew Nykiel. I'm a board certified plastic surgeon. I'm located in, uh, Southern California. We have two offices, uh, Newport Beach and, in Upland, California. Our specializations are in body contouring. So I, I would say the majority of my practice is liposuction, contouring, whether that be high definition or soft definition or lipo sculpting fat transfers typically to the buttocks. And then tummy tucks and, and breast augmentations. I really, I think make up, uh, the, the bulk of my practice

Eva Sheie (02:23):
Since fat seems to be the, the sort of hot topic of the, of the day.

Dr. Nykiel (02:28):
Yes.

Eva Sheie (02:29):
Are you using fat for all of these things, including breast augmentation?

Dr. Nykiel (02:34):
So, I don't really like fat transfers for breast augmentation themselves. I think, I think we do it in the reconstructive side. I think it's a, an option on the reconstructive side, but I think there's some, some just some limitations to fat transfers to the breasts that aren't as big of a deal on the reconstructive side as they are on a completely elective cosmetic side. And I think the first and foremost is typically when we're doing reconstruction is because someone either a portion of their breast or their entire breast removed. And so I think the, while we're always striving to get the best result possible, I think that when you're comparing a breast that had either a portion or the entire breast removed, I think a fat transferred breast looks better than having no breast. But I think from an elective sort of cosmetic standpoint, I just think implants give typically a better look.

(03:25):
I think that for most people, what they are thinking of when they want a augmented breast, they have the idea of what an implant does and that, and that's not typically what a fat transfer of the breast does. I think if you're a young individual, 20, 21, 22, I think you have to think about breast cancer screening when you get older. And they've done studies and I know, and the studies are out there and the studies basically say that digital MRI mammograms combined with biopsies do an effective job at sort of screening the breast for breast cancers. But I think that if you're 20, that's a long way to pigeon and hold yourself. And you don't know what's coming down your life in, you know, 10, 20, 30 years. I don't, I don't know. And so my sort of feelings have shifted on that. I get 20, 21, 22 year olds that come in and say, oh, I'd like fat transfer the breast. I say, you know, I really would encourage you to research this more. I think you've gotta take a step back. You've gotta think about what's gonna happen 20, 30 years down the road. And I, I don't like it for primary augmentations.

Eva Sheie (04:21):
Tell me more about this, because a 20 year old who just wants bigger breasts, you don't think they should have fat in there at that age?

Dr. Nykiel (04:32):
I think this, I think that, so if, if we think about this on a high level sort of topic in my opinions about this have changed over time. And I think, you know, that's sort of the part of medicine and, and there'll be studies and data and things that'll come out. So when we fat transfer the breast, we're essentially creating scars and we're placing little pockets of fat. And sometimes those fat can get hard, sometimes they can calcify, sometimes they can can look kind of scar tissue on a standard mammogram.

Eva Sheie (04:57):
Oh, I see what you're saying.

Dr. Nykiel (04:58):
On a standard mammogram, they cannot tell the difference between is that a cancerous lump? Is that fat transfer? Now there's other types of mammograms, MRI mammograms, and they've shown in some studies that the, that the MRI mammograms can.

Eva Sheie (05:11):
Can tell the difference.

Dr. Nykiel (05:12):
So that means that for the rest of your life, you're gonna have to find an MRI mammogram. Now that may not be a big deal if you live in a very populated urban area, but if you're living in a rural area, that may be a huge deal. And you may be, even with that digital MRI mammogram, they may say, yeah, we're not totally sure we need to biopsy these spots and that may be your life. Again, is that the end of the world? No, it isn't. But is it something that I think you should think about? Yeah, it is. And to me, I think when you compare that, at least with all current breast implant literature, put an implant in, let's say you don't like it, you take the implant out.

Eva Sheie (05:47):
Right.

Dr. Nykiel (05:47):
We can't do that with, you know, with and once the fat transfer has been done once we've made the, that's it. Yeah. I, I just don't think that that's a, a great option for a healthy 20 year old. That now again, studies may come out, my opinions may change. I, that's just sort of where I sit right now on, on the thoughts of it.

Eva Sheie (06:02):
Oh, I wanna throw an analogy at you.

Dr. Nykiel (06:04):
Yeah.

Eva Sheie (06:04):
When I was 20, I was in, I mean, roughly I was in grad school. And the people I was around in grad school who were in their fifties because they were all musicians, did not take care of their teeth when they were 20.

Dr. Nykiel (06:17):
Yeah.

Eva Sheie (06:18):
And so I could see what was happening to them in their fifties, that they were needing 20, 30, 40, $50,000 in dental work because of things they had done when they were much younger.

Dr. Nykiel (06:28):
Yeah, yeah. Yeah.

Eva Sheie (06:29):
That stuck with me for so long about healthcare decision making.

Dr. Nykiel (06:34):
Yeah. Yeah.

Eva Sheie (06:35):
Am I doing something stupid right now that's gonna cost me a lot of money? Usually when you attach a price tag to something people think.

Dr. Nykiel (06:40):
Yeah. That you're right. And and that's usually the discussion I have. Like, listen, in the short term, I want you to think about this cuz of the long term issues. And it's interesting cuz I think that the fat transfer to the breast has picked up a little bit, right? Because of some concerns of implants, uh, whether that be the extremely rare concern with textured implants about A L C L. Um, they've also identified about 14 or 16 people in the world that have they found the skin cancer on the inside of their breast implant pocket in the world, about a million augmentations are done. So I, that's a very small number comparatively. And then there's this whole nebulous of, of breast implant illness, which scientifically we just has never been shown to have any definition. But, and so people look at it and they say, well I'm, I'm worried about that.

(07:24):
I don't wanna necessarily get these symptoms of, you know, sort of feeling weak and fatigue or, or these sort of generic symptoms that get thrown on breast implant illness. And okay, I get that. And then they think, well, so I'm just gonna do fat transfer to the breast instead. And my conversation there is, hold on, stop. Think about what you're saying. You're saying that something, a very high concern, which is breast cancer in women, one out of eight. So it's it's a very, very high, we're going to do something today that is going to force you to have certain types of screening in the future on it. Something that we know is very high. Or we can do an implant augmentation if you get these feelings of fatigue or, or tiredness or sort of these generic terms. The answer is you take out the implant and then yeah, that's it. I mean, to me, I just think when you frame that discussion a little differently, I think, yeah, I don't know that that's, that's your best, I mean that's your best option. No cancer, cancer reconstructions, they're, they're little touch up areas, et cetera. I, I just, that's a different story, but I think the primary complete breast augmentation with fat transfer, that's something that you need to do your homework on.

Eva Sheie (08:29):
Mm-hmm <affirmative>, You moved fat to many other parts of your body.

Dr. Nykiel (08:33):
I do, I do.

Eva Sheie (08:34):
In fact, you're well known for moving fat to the rear. Yes. And that was kind of how you got started, wasn't it?

Dr. Nykiel (08:39):
It it is actually, yeah. We, you know, we're here in, in a real self booth. So actually it was real self that actually really helped us get started. And it was because I had interest in liposuction fat transfer. I had previously done some fellowships with fat transfer to the breast for reconstructive purposes. And we realized that there was just a need in our area that was not being met. And that's really how I think that it, it helped us to get started. I think that there's a, a wonderful topic about lipo fat transfers to the buttocks or, or BBLs Brazilian butt lifts. And there's been such a tremendous evolution in it. I think they, they, you know, fat transfers to the buttocks really took off. Uh, cuz in the beginning, fat was being placed intramuscularly. Right? And that's obviously unsafe. It's not being done.

(09:24):
Um, the risk of fat embolisms is there, but what that allowed was it allowed your butt muscle to get bigger, which negated the need for implants. And so I think a lot of people in our community really latched on to that. They're like, well we, we, we don't need to do but implants, it's just, but implants have a much longer recovery, healing process cuz it's very easy to stay off your breast when you get breast implants. It's not as easy to stay off your butt when you butt implants in the beginning. And so I think that the community really loved that and identified with that. And then that moved on to the patient community because the recovery was easier and the experience was easier. And also the results were as good. To fast forward years later, people recognize that injecting fat into the buttocks muscle is not safe cuz cuz the risks of fat embolism.

(10:03):
So the struggle has been, well how can you create this sort of muscularly athletic shape when we're injecting above the muscle? And so I think that we're seeing a little bit of a evolution where butt implants are starting to get reintroduced back in. I think you're seeing more and more people doing it. I think that's a direct result of that. I think there's been an overall change of what people like too, right? I mean previously conversations were not focused so much on, Hey, what's the sculpting? How does the body look? What's the shape here? The conversation's focused on how big could you get my butt now that honestly that was never really our practice. So, um, I think we, we kind of always focus more on the sculpting or the contouring aspect of it. But in general now when you have people come in the conversation, the questions go directly towards, Hey I want to get sculpted.

(10:45):
I want to have just a little bit more fit, a little bit more athletic. I just, or a little bit more youthful. Cause I want you lose volume to that buttocks. It just makes it look older. And then you collect fat in different locations that just kind of make it look square and just not as youthful. And, and that's I think what the, what people want now in general, I think that the size of people's butts was getting extreme right? And it's always good to see things kind of come back into the midline. And I think that's where we are. So I think that's a great time. I think a lot of people are sort of focused on hourglass curvature, which has been around <laugh> I think, as long as time has. So I think, I think that's great when you have a, when society deems something as attractive and it coincides with something that's been consistent throughout time, I think that's usually a good thing.

Eva Sheie (11:33):
Are you seeing more people near you who are losing a lot of weight from the ozempic or the semaglutide shot?

Dr. Nykiel (11:39):
Yes. So the secretagogues or the secretatites are starting to revolutionize things that people can do. Right. And of course they would, if you're saying, Hey, we can see significant weight loss from this and you were maybe a person who was looking at things like physically undergoing surgery, you absolutely would try that, right? It's got, it's slated to be the number one prescribed drug ever in history. That's wild. Right. So from our plastic surgeon standpoint and the, the number of people that we're seeing on it, it's huge. Right? I think it, it's been interesting for all of us as a community cuz this, this basically, this happened since November, since like last year. All of a sudden it got traction and it has taken off. So as a community, as physicians too, we're all sort of like, uh, really on the front end trying to say, okay, how do we integrate this?

(12:28):
How do we do things? And, and it brings up some good important points. You know, the, the drug itself stops you making you hungry. Like, like it's just, you're not hungry, you don't eat. So that has real world implications because from a surgical standpoint, I need you to get a certain number of proteins and nutrients and things because we need you to heal. And we, we've logged on that if we don't get the right nutrients, you won't heal. I mean obviously the pirates knew it, hence scurvy. But I mean, cuz literally their gums would start bleeding if they didn't get the right nutrients. And for us from surgeons, if we do surgery on you and you don't have the proper nutrition, you won't heal.

Eva Sheie (13:03):
So don't be a pirate.

Dr. Nykiel (13:05):
That's right. So it's, it's made an interesting thing as far as, well when can we safely start doing surgery after you have been off this medication or, or if you're on this medication we need to make sure that we're, we're checking things.

(13:18):
I think the other portion of it too is, you know, people don't always think of that as a medication. When you ask them, Hey are you on any medications or for any medical problems? It's weird, but a lot of patients sort of think, well I I just take this as a cosmetic,

Eva Sheie (13:31):
I'm not sick. Right?

Dr. Nykiel (13:32):
Yeah. Right. And so you would not even think then to need to do cuz you would be like, oh this is just a normal, like that we need to run a bunch of nutrition lab panels on you. So it's even, right. It's even become interesting in that standpoint that we have now started and, and we're gonna go back, you know, and really start like making sure that we actually outline these questions. Hey are you taking these weight loss medications? And then the other thing is the medication works by basically keeping you full.

(13:56):
Right? So that's called delayed gastric emptying. And so when you undergo surgery, you're told don't eat or drink anything after midnight. And the reason for that is because we don't want your stomach to be full when you come in cuz it could risk a aspiration event when you're in surgery. Right. And does that now change some of when we need to tell you not to eat or drink?

Eva Sheie (14:18):
It could be 24 hours or longer.

Dr. Nykiel (14:20):
That's right. Yeah. But we wouldn't know to tell you that if we weren't told about the medication. So it's, I think it's a really exciting time that, that you have a now a non-surgical option for people to help with weight loss. I think it's from our, from a plastic surgeon standpoint, I think it's in, in actually any surgeon standpoint. It's an interesting time trying to figure out, okay, how, how do we integrate this in the practice when we start offering people the surgery we need to make sure that we're adequately screening for it, et cetera.

Eva Sheie (14:47):
Yeah.

Dr. Nykiel (14:48):
Yeah.

Eva Sheie (14:48):
But I mean I haven't thought of that. That's very useful.

Dr. Nykiel (14:51):
Right, right. I think it's a neat time from the standpoint of we also have options now that we can discuss. Cuz sometimes, you know, patients find you in different ways and sometimes patients are uh, struggling with weight and so they come to you cuz they wanna get like liposuction and, and we see 'em and we just say, listen, you're not a candidate for liposuction. We need to address some lifestyle issues first before we're a candidate for liposuction. Cuz it's certain BMIs we just see increased risk of complication and you see things that just aren't safe. Right. And it's nice now to say, Hey listen, we actually have some options. We're happy to discuss these things with you that this may be something that you want to do. I think that that's great. Right. I mean I think that that's great that you can get somebody in, you can provide 'em with some other options and then, and then once they lose weight and they may or may not, then they may or may not need to go get ps. Right. They may not want to, but if they do then we can move forward and discuss Okay. Surgical options that you have.

Eva Sheie (15:41):
I think there's another angle too here, which is when you're someone who needs to lose weight, you sort of make that your only thing and you and everything else is number 2, 3, 4, 5, 6. So you might say to yourself, I would love to get my chin lipoed, but I really need to lose weight first so I'm gonna wait. And so you end up waiting your whole life and really what what happens is you're not happy or you're not as happy as you could be. Yeah. Because you keep delaying things that, that would make you happier or feel better about yourself. Cuz you're always trying to lose weight first. <laugh>.

Dr. Nykiel (16:18):
Yeah. I never thought about that. That's a really interesting take and top of it. Yeah.

Eva Sheie (16:22):
Yeah. It's life changing.

Dr. Nykiel (16:24):
Yes. And I, and I think even from the standpoint of if I was slated to undergo bariatric surgery or, or or the weight loss surgery, right. Like and I'm in today. I'm here today.

Eva Sheie (16:35):
Yeah.

Dr. Nykiel (16:35):
And I hear that there's a medication that may improve my, my weight loss and you're telling me I don't need to undergo a, all surgeries have risks and complications. I can decrease some of these risks and complications. The medications have risks and complications too. But, but just, I mean this is a surgeon I went towards the the medical rather thing.

Eva Sheie (16:54):
Totally. No. Have we ruined bariatric surgery?

Dr. Nykiel (16:56):
Oh, you know, I, you know, this is sort of, I don't think so. I think, I think what you're gonna find is that's gonna be the trial of the medication gets you down a certain weight. I imagine then they're gonna taper people off and they're gonna see if people can maintain that. And I think you'll basically have some people that that don't. And I think those people are gonna move forward with surgery. I think on the flip side you'll have people say like, you know, I'm just not really interested in having to take a a, a shot per week. Or now they actually have a pill that, that that's a daily pill. I think you have those people say, I don't wanna do that. So I don't know.

Eva Sheie (17:26):
It's gonna be interesting.

Dr. Nykiel (17:28):
You know, it's, it's one of these sort of strange things where when you saw up and think about that first statistic we talked about, which is gonna be the most prescribed drug ever in the history of medications. That is crazy.

Eva Sheie (17:41):
So we were really here talking about you.

Dr. Nykiel (17:44):
Yes.

Eva Sheie (17:45):
But these are really interesting and important topics for people who are kind of, are you offering the skinny shot at your office?

Dr. Nykiel (17:52):
We are. We're gonna start, we're giving medication. We, we, we've released a couple videos on Instagram and TikTok and actually the, the response, hundreds of thousands of people, you know, music, et cetera, and, and people are calling our office significantly said Okay. We did a actually I think a really interesting video, which is, um, where we talked about, cause I think there's so much confusion cuz there's, there's like four different names of these medications, right? And it, I think it gets really confusing. So we sort of, we sort of basically treat it out so people can sort of understand that there's really only two medications, <laugh> and they've just started branding these the same medication in different ways and it gets confusing. But yeah, once we did that, we realized that there was a huge sort of need and, and we wanted to spend some time sort of really working on how are we gonna integrate this in? How are we gonna do it in a way that's both a positive experience and safe. Obviously safety's number one.

Eva Sheie (18:39):
Always. And then, uh, you're gonna find people who are coming back, um, every month to see you and they're gonna be asking for other things like, what do you have for skincare? What do you have for, can I get my Botox here?

Dr. Nykiel (18:54):
So that that's right. And, and, and I think from a standpoint too, there's gonna be a lot of just discussions of what are you gonna do with this? You know, depending on that weight loss, even if you lose, uh, may, it may not be a hundred pounds, but let's say if you lose 30, 40 pounds, there's gonna be some, I think some skin lax the issues where you say, Hey, hey, what can we do to tighten this up? What, what are my options from non-invasive at the med spa all the way to surgical. So it's really cool.

Eva Sheie (19:15):
What I love about it the most is it's gonna let you build relationships with people

Dr. Nykiel (19:19):
Yes.

Eva Sheie (19:20):
In a different way that you didn't have available to you before.

Dr. Nykiel (19:22):
That's right. None of us did. Right. The the answer was just, which we try to do. We just say, Hey listen, we need to work on some diet and exercise. I'm happy to recommend some, some fitness. Yeah. You know, people that, that we know <laugh>,

Eva Sheie (19:33):
And then you never see 'em again. Yeah.

Dr. Nykiel (19:34):
Come back. Right. Come back to us when when you're ready. But it's neat that we can, for those people that want that we can actually then start to build a program within our office that starts to go, because prior to this, the other sort of weight, no not, not a knock against the other weight loss programs, but essentially the other weight loss programs where they are giving you some versions of, of basically like an amphetamine, uh, a legal amphetamine, which basically just kind of makes you like you're on an amphetamine and burning your <laugh> the energy. And that didn't really ever appeal to me. I didn't wanna, it just wasn't, that wasn't for me. But this option seems a little bit better, you know, it's just, it's such a, it is what a neat, simplistic way of just, it keeps the food in your stomach longer so you just feel full, you're not actually hungry and, wow.

Eva Sheie (20:16):
Beautiful. What do you want patients to know about you before they come to see you?

Dr. Nykiel (20:21):
Our main focus, or our focus always has been, I think, or has really been since about 2016, which is just, we say a couple things. We empower expression, we help achieve your goals. Our focus is ultimately trying to, you know, just improve, get you to the point where you're happier and also trying to educate you along the way. And I think we do a good job at, at all those things. So, and that's sort of the discussion too, I think what we had with the fat transfer. Right. Just that, that's what we wanna do. We want, whatever your goals are, tell us, let's discuss your options, what you want done, and let's do it. So the way that we typically do it the most is liposuction, fat transfer. We do a lot of sort of higher definitions all the way this to what I call lower definition, softer sculpting and body contouring, tummy tucks, breast augs. I think that whole package, we focus a lot on balancing the body, which I think is really the take home. You want a balanced body.

Eva Sheie (21:12):
Where can people find you online if they're interested in seeing you in person? That's

Dr. Nykiel (21:16):
Right. So on Instagram and TikTok, we are at SoCal Plastic Surgeon. We do some Snapchats, uh, where we're just sort of putting things before and afters. Things that, that I think are a little bit, that are not allowed as much on, on Instagram and TikTok. And that's at Butts by Design. Our website is Butts by Design. Um, our office is located in Newport Beach and Upland, California.

Eva Sheie (21:35):
Thank you Dr. Nykiel.

Dr. Nykiel (21:36):
Hey, it's always great to see you and I can't believe it's been three years.

Eva Sheie (21:40):
I know.

(21:43):
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