Look Good, Feel Better: When Plastic Surgery Meets Longevity

Podcast Introduction and Guest Welcome 0:00

Medicine will always be there to fix problems, you know, disease, cancer, traumas. But the shift is here, where people are like, we can actually use medicine to either prevent disease or actually live life healthier and better, you know. Diet and exercise are only taking so far, your genetics are what they are, your environment, you know, the toxins you're exposed to in your environment are what they are. And people I think, like, I noticed it post-COVID when people, you know, there's a real paradigm shift where they're like, how do I take, invest in living life better, potentially living life longer, but really living life better.

You're listening to the Lifestyle Medicine podcast with Dr. Ivan Rusilko, brought to you by Access Lab, where we explore new perspectives at the forefront of personalized healthcare. Welcome back to Lifestyle Medicine Podcast. My name is Dr. Ivan Rosilko, your host, and this is powered by Access Medical Labs. If your doctor's not checking labs, they're not a doctor. And I have got a celebrity on today, my God. Picasso had the canvas, you know, Beethoven had the piano. And Dr. Neinstein here, he owns the Mommy Makeover.

So I couldn't be more honored. He's a plastic surgeon out of New York City. He is the only physician I send any of my patients to. And he has done nothing but hit home runs on absolutely all of them. So Dr. Neinstein, thank you so much for taking time to be here with me. It's an absolute honor to have you. Ivan, thank you so much for having me. I've been looking forward to this for a long time. And, you know, similar, you know, all of our South Florida patients, which is like a third of my practice, we send them all to you because we can make them, you know, look good in the OR, but you make them feel good and optimize their health long term.

And like the patients are just so happy with that one-two punch. And it's been a great, you know, tandem. And I'm looking forward to getting into this podcast. No, heck yeah, man. I got to say it's always unique because there's always like that friction between surgeons and like anything that's not surgery. You know, I mean, my brother's a urologic reconstructor surgeon. And the arguments we've had going back and forth, you know, ever since I started this kind of stuff, he was just like, nah. So it's so good to see like people such as yourself, who is not only a trailblazer in plastic surgery, kind of seeing the value in the wellness industry and then kind of incorporated for your patients.

And again, like I said, you know, we share several, several really unique patients and you've done nothing but just miracle work with them. So again, kudos to you on that one. I mean, we are like responding, you know, everything I've focused 100% on doing my mommy makeovers because that's, you know, the type of people I like to treat and we solve the problems I like to solve, we get the results we want to get. And when I listen, you know, I truly listen to the patients and I evolve the operations to what they truly want.

And when I'm hearing now, it's not noise from the patients about peptides and hyperbaric and longevity. It's not noise. It's a signal. We all hear sounds and a lot of people think it's just noise, but it's not. It's a true signal. The patients, when they're telling me what they want their body to look like, they're all telling me how they want to live their life. It's just absolutely imperative that you are on board, you know, and I'm smart enough or, you know, I'm smart enough to know like what I don't even know.

So it's like, I'm not in my mind thinking like, hey, let's add longevity onto our practice because there's like, you know, are we leaving dollars off the table? It's like, no, same thing with everything else. You know, my social equity with the patients is in the referrals and they appreciate when they like, when I say, I'm going to refer you to like Dr. Ivan, who cares as much about that as I do about this.

Medicine, Wellness, and the Post-COVID Shift 3:34

They don't want the one-stop shop. They want the people who truly care. And there's so many docs in my space that are not accepting it, but like, you know, Like Socrates said, like the moment you know, you think you know everything is the moment you stop growing. And I think a lot of people, I'm interested in what you think, like a lot of people in medicine, I think they're straight up scared because it wasn't in the textbook when we went to medical school. If you wrote a new chapter on endocrinology, everyone would read it, but it's not in the syllabus from medical school, so they're scared and they're not really exploring.

a lot of physicians are practicing scared like you said and the problem with that is you know whole thing is do no harm to your patient i think complacency and not at least dipping your toes or understanding what wellness actually is is kind of just just as bad as doing harm i mean like so it's a situation where we all know what healing is we all know regeneration neurodegeneration whatever you want to call it There's so many different levels of what health actually is, mental, physical, emotional.

And I'm curious to sit there and see when it comes to you, because you treat the crème de la crème, you treat the women who are coming in. And again, I hope if you have a chance, go check his Instagram out. I just got done going through it. There's so many cool transformations. It almost looks fake. It's so awesome. But it's cool to sit there and see you aren't only changing how a person looks. You're changing how they perceive life, how they perceive themselves, and hopefully, in the long run, perceive their actual health.

People like we all get medicine is like, you know, building block of society and medicine will always be there to fix problems, you know, disease, cancer, traumas. But the shift is here where people are like, we can actually use medicine to either prevent disease or actually live life healthier and better. Because diet and exercise will only take you so far, your genetics are what they are, your environment, the toxins you're exposed to in your environment are what they are. And people, I think like I noticed it post-COVID when people, there's a real paradigm shift where they're like, how do I take, invest in living life better, potentially living life longer, but really living life better.

If they have an existential understanding, like we all have a finite time, how do I use my resources to live life better? And that's an absolutely new way to look at medicine when we're not just the people to fix stuff and maybe get you back to normal. And I always used to compare like the traditional forms of it. You know, both of us has gone through the, obviously the whole traditional route to actually get our degrees. But it's unique to sit there and see how I personally believe, I'd love to see your thoughts on this.

Traditional medicine is more about the prolongation of death. Don't let my patient die. Don't let me get sued. Whereas the wellness industry and kind of everything that the aesthetic industry is about, let's live a higher quality. Let's augment our life and then also prolong at the same time. It's kind of you can see that that paradigm shift is taking place. I think we're at a very, very unique reflection point that I think the next three years is going to really define where medicine goes with what's going on in the White House, with what's going on on influencers and Instagram.

It's almost one of those, you know, too big to fail type machines. And I'm curious to see when it comes to the actual plastic surgery market, since you're you're basically at the top of the food chain with that. Do you see a lot of physicians who are in your position kind of gravitating towards that way? Is it more just cut, cut, cut, and that's it? There's a lot who are cut, cut, cut, and that's it. Stay in our lane. If someone asks them, hey, should I do whatever, peptides, hyperbaric, before surgery, they say, I don't know.

But if you have, if eight out of your 10 patients are asking you something like, time to start figuring out what they're talking about. And it's important to build these alliances with doctors that, you can ignore it all you want, but your patients are gonna go find it. So you wanna make sure you have alliances with doctors that you trust that there's a free flowing communication. Plastic surgery has evolved to the point now where people are really trusting surgery as the solution to frustrations.

The things that will never go away, Facial aging and body changes from pregnancy, weight loss, and menopause. What I do now and the face of guys do now, we do classic operations. We just do the better because we hyper-focus and we do more surgery to make it look like people had... All the days of the mini this, the mini that, the modified this, the non-surgery are all over. We do big surgery now, so it looks like people never had surgery. We take everything apart and put it back together so it looks more natural, more harmonious.

Because on the East Coast, especially in New York, and why we get so many patients from South Florida, they don't want to look done. They understand that they're willing to have a bigger operation. because they wanna do one operation, do it right, and look great for the rest of their life. And as soon as they look great, they're like, okay, now I wanna feel great. They'll look good, feel good. Looking good and looking in the mirror and not seeing loose skin, stretched muscles, that's only part of it.

And I get so much feedback from my patients. I'm always learning about the different longevity clinics, because my patients are, Globally so I get you know reports from longevity clinics all over the world Highlight everywhere. Yeah, they're everywhere from top to bottom left to right and it's like that's why I tell don't like my patient in London Paris, Dubai Tennessee Oklahoma, they all say the same thing like it doesn't matter where they live or what language they speak if they're a 52 year old like I know they're all saying the same thing and they're all going for it and The longevity is here to stay.

I think for a lot of surgeons who, they always ask me like, where do you even start in this? You know, how do we? Well, they're scared, you know, and I understand, and rightfully so. Like I'm not cavalier in the sense that like, I'm like, hey, let's just like have someone inject whatever. They're scared of like, you know, They wanted, obviously a surgeon want to optimize their surgery. So like I say, like, think about it. Don't worry about what the patient does like six months down the road, but like you can use your local, you know, respected longevity physician to improve your outcomes.

Like that's how you can help people prepare for surgery and heal better. And I think a lot of surgeons, if they listen to this, they're going to want to know, Hey, I have a patient who's having a facelift in a month or a tummy tuck in a month. What would you guys do for them? No, it's unique. And again, when you take a look at it, we do a lot of the pre and the post have, or I'm sorry, yeah, the pre and the post surgical care. And it's always about the optimization before and after. And I think a lot of people don't understand that because how you walk into a surgery is almost how you walk out of a surgery, you know?

So if you walk in healthy, nutritionally balanced, you have your toxic heavy metals cleared, where your hormones are right, which are probably the most important thing because, you know, hormones are how we heal. I mean, if you have those optimized as you go into it, healing time goes down. I mean, the scar reduction, all that kind of stuff is pretty, pretty unique.

Plastic Surgery Meets Longevity Care 10:51

But even if it comes to the basic stuff like lifestyle medicine, when it comes to what you're eating before, the exercises you're doing, how you're sleeping. And again, probably the most important, which I think you agree with me, is hydration status. You know, I mean, just basic, basic things when you walk into surgery dictates how you walk out of it. And then when it comes to the longevity clinic, or the aspect of what longevity, wellness, regenerative, whatever you want to call it, comes into the actual healing of it, you will sit there and see like peptides.

Peptides are fantastic, but peptides are only as good as the system you put them in. So if you want to use things like BPC and thymus and beta and IGF, all these things that are phenomenal at healing, this is how we heal naturally. So imagine augmenting that after surgery to sit there and see if you do that properly in a patient who's ready for them. I mean, like, you know, again, I'm sure she'd love that we're talking about her Sharon, who's a patient that we share. I mean, she came in and like this woman went from, I mean, a beautiful woman to begin with.

no matter what. And like now she's walking around like the bees knees. And again, it's because she was optimized going in, went to the best doctor on earth for this procedure. And then she came right back in jumped into it. And I mean, like, I mean, we're gonna try to put some pictures of her on the screen here. Just absolutely spectacular with what you did with what I did. And the most important thing is she wanted to actually get better through her surgery. not just going there and playing that pick and like, Oh, I'm hurt.

I'm not doing it. She was doing everything that you told her to times 10 plus she was like, Okay, what else can I do hyperbaric? So it is that the other thing and like the proof is in the pudding. So it's really, really unique that as a surgeon, you have the opportunity to sit there and say, if I want to, you know, have better outcomes for my patient, which makes you look better, more better word of mouth, whatever it could be, or just try to optimize it, whether you do it yourself or rather you actually kind of refer it out.

And the question I have for you now, which I'm sure everybody on this podcast is gonna win, walk me through that mentality when it comes to a mommy makeover. What is a mommy makeover? Who qualifies? And how does this procedure work? So, you know, I stick to one thing because it works every time. It solves a real problem. And, you know, neck up was not for me because you can do a perfect face lift. Someone may not like the way they look, Body is bubblegum. It's ice cream. You know, perky boobs. Put that on a t-shirt.

Body is bubblegum. I like that. Flat tummy, narrow waist, perky boobs, perky bum. Everyone's happy. It's like period, full stop. We don't even have to discuss what the outcome is. Like, I get it. You want to be hot, right? Exactly. And what's great about the Mommy Makeover is, you know, since the GLP-1 revolution or renaissance, you know, even if you don't have kids, it's the same operation, right? Because the diagnosis is the same. Stretched skin, stretched muscle. So, you know, pre-COVID, I never did these operations or rarely did it on someone who Didn't have kids.

Now I do one or two a week because you're a 45 year old lawyer in midtown and you just lost 85 pounds and you're building muscle mass and you can't get your body where you want. So guess what? You're having the makeover, just drop the mommy. It's the same operation. But the traditional operation, which was great in the early 90s and late 80s when I was invented, was just try to get the flat tummy. But patients over the last decade have really evolved these procedures. Patients were like, hey, the front of the box is great, but the right side, the left side, and the back, the other three sides of the box.

that there's something wrong, it doesn't look right, still loosey-goosey, things are deflated and droopy. And it was a giant leap, just like longevity for surgery is a leap. It was a leap for me to say to people like, hey, let's do the operation all the way around. And once I got that critical mass, people were like, I don't know if I want to get cut all the way around, this and that. And once you hit a critical mass, 1,000 patients, and I'm up over 8,000, where the before and after pictures were just undeniable, where people were like, I get it, she looks great on the front, she looks great on the side, she looks great on the back, her butt looks good, her stomach looks good, all elegant, natural, and age appropriate.

That was the shift. It's so rare now, we just treat one side of the box. And once we get the body, we've unwound the changes from baby's menopausal weight loss, They're always like, what's next? And they're not talking about Botox and filler. Like, they're past that. They want cellular regeneration. They want to feel better. You know, if you look good, but you never want to go out because you're always exhausted and this, and just like, you don't sleep well, you have no energy, you don't feel good in the gym, your libido's down, you know, look good's only part of it.

So that's why, the other thing I tell the other surgeons, who I speak to all the time on this, I'm like, go do it yourself. Trust me. I know what you're doing. You're getting up early, you're staying up late, you're not eating well, you're drinking coffee all day, no water. I know how you're feeling. You're feeling sluggish, you're skipping the gym, you're getting bad sleep. Like why don't you go see who your patient's seeing and like call me in six months and I guarantee you, you know, I know you're going to, you have adrenal fatigue.

Like I know your hormones are probably off and you could probably, you know, use a little optimization of yourself. And as soon as they, once they go, it's like, that's it. Like then they tell us, I mean, they're wearing whatever, they're wearing a peptide hat. You know, they got a PPC 157 jersey on going into the OR. That's hilarious. Because listen, there's a lot of surgeons, male or female or whatever, they're exhausted. They're like, you get it, your brother's a surgeon. You know what it's like.

If you're working 14, 16 hour days and you have the pressures of running a business and you have your family, these people are worn out. big time. And it's funny, the only reason I finally got my brother on a program is because his wife went on it and did so well. So you know, it's just like, I always say, especially in my in my practice, if you know, if a woman comes in, two weeks later, her husband's coming in, that comes in second, because once you get that that that feeling of 25, again, you want to experience it with somebody, you know, I mean, like, it's not fun being healthy and vibrant and being next to somebody who's just worn down and just done with life.

So it's actually funny. If you ask me about my average patients, they're either in their mid-30s or mid-50s, almost like 90%. It's like they just finished having their kids and they don't want to wait. They want to fix their body or they just did their weight loss. Or the mid-50s is like, hey, they felt pretty good up until menopause. Menopause stretched them out. So like the 35-ish moms, the 55-ish moms, those are my people. And who's like the bulk of your patients? That's a good question. It used to be that exact bulk.

And ever since we got into like the weird chronic issues, because now like everybody comes to me for cancer and MSA and all these things that are kind of outside of the purview of wellness, that demographic went from that to like 12 to 95 and everything in between. But if I had to sit there and say what the bulk of what I see right now is, I'd say probably 40 to 55, 60. Women obviously- Everyone I know is like in my cohort of life, are like in their mid forties and it's like apex workload, apex family stress.

I've never seen people more productive. And more exhausted like in my life, you know, because you're kind of at the mid forties is gotta be the time where, you know, you don't have that youthful, just like never ending Energizer Bunny energy, but you still have this huge intellectual capacity and you're still pretty good physically, but like that's gotta be everyone I know in their mid forties is working hard. I'm curious with you this one too, because obviously now I think it's three out of every four marriages end in divorce.

So you're seeing a lot more women and men coming in in their mid 40s and 50s. We're looking for that divorce pod. You know what I mean? And it's a situation where as I'm seeing a lot of that now and it's a very unique thing to see because you see people come in who have this new renewed zest of being like, well, I'm not stuck with the same person over there. I got to look good in the bikini. I go out and find it. And I think that's what's driving a lot of this actual wellness industry because people aren't just comfortable with settling anymore.

You know, we are not a society of settling. I think I might say, I actually see a lot of very happily or they appear very happily married people. I don't see as many divorced, but what it's interesting I do notice is the wife comes in for surgery with me. And when the guy, you know, a lot of times I'll meet the husband and he's doing longevity. He's like, I got a trainer. I'm on peptides. I'm on hormones. Like that's his plastic surgery because yeah, that's like the majority, you know, men just, just the is they don't have as much plastic surgery, but they're.

new Botox and filler. Like, I don't think I know a guy who's not on a peptide, like, you know, like, literally, because it is, it is the social, and it's crossed that social, you know, there's a lot of things that are good for you, but like, socially acceptable social equity. It went from like, oh, you're taking this weird stuff to now, it's like, it's, if you're not doing something, like people almost look down at you, like, what do you mean, you're not doing something to make your life better, to make your body better?

It's like, almost like, You know, like you don't shower, you know, like it's become, especially in the male world, I could tell you,

Mommy Makeover Philosophy and Patient Outcomes 19:48

like, you know, they won't, you know, we still do surgery on men, but they never talk about it. But like, I don't have to tell you, like mentioned peptides, no one will shut up. You know, it's like CrossFit now, you know, like everyone wants to show you their stack, you know, it's like, it's the new CrossFit. So it's definitely pushed into like society on that side. You know, I found it, like, interesting. I was reading, like, there were more epigenetic tests in 2025 than there were annual physical exams.

What? Yeah. I didn't know that. Okay, that's a pretty cool stat. That's insane. I mean, think about it. There's a lot of people who aren't sick, like, who don't have a disease. Like, I don't know many people who go for, like, a true annual physical, but they will go to you and do their blood tests. I guess you pull the next like 30 people ask how many of you went to your primary this year for a real annual physical? It's gonna be it's not that lot a lot, but they're coming to you and getting you know, it's all This is where primary care if they're not careful, they're gonna lose their primary care because the doctor their Patients are spending more time with doing more blood tests with and have more trust with are gonna be the longevity, the wellness side.

Because- Yeah, there's some things that might get pushed out. I mean, not to mention AI is gonna start monkeying with that as well. Well, I think primary is almost moving to urgent care, like call them when there's a problem. Yep. But I don't know, like people are not like, the rate of physical exams in the United States, like just annual physicals, people don't wanna do it. Unless they have an active problem, like they're not going to see their doctors because You know, I think they probably don't want to find out that they have a problem or like nothing.

They're not excited. You know, it's one of those things. Like it's not exciting. Like you don't want to get your teeth cleaned. At least they feel better after. When you go to your physical, what's the best case scenario? Nothing changed. Like, you know. Oh, very, very true. That's why it's amazing that there's more epigenetic testing than annual physical exams. Like, and you know, obviously the insurance probably makes it more difficult. Listen, if you have X amount of money to spend on your health, I guarantee you a lot of people would be like, well, why don't I spend on something that might make me be healthier than just telling me I'm not unhealthy.

Health is a new currency, it seems, especially in Miami. So Miami and New York are two different animals, you know what I mean? And it's as funny as... I get to see, and you probably do too, I see patients from everywhere, all across the country every day. It's the same. It's the same. I don't care if you're in Tuscaloosa, you know, or, you know, it doesn't matter. Like in Illinois or Alabama, like- Same, same ideology. Because the world is so small. You know, everyone's, it doesn't matter where you are.

With your phone, everyone is fully immersing in the exact same world. Yep, you're right. Fully connected. They're fully connected. They're not missing out on anything wherever they are. And if they have means, they're not geographically limited for treatment. Now, you know, with all these access medical labs, I'm sure you can get blood work drawn anywhere and medication sent anywhere. Exactly. No, it's very, very true. And so I'm curious, you just got back from the Middle East to Dubai, went to your first longevity clinic, which you're the only surgeon to speak at.

So that's a hell of a thumbs up there. Where did you see that differs from when you go to aesthetic conference or surgery conferences, when you compare the longevity, what you just saw for the first time versus what you've been doing your entire life? I really enjoyed going to this conference. It had more breadth and more depth. A lot of surgical conferences have just not involved a lot. At a surgery conference, they never really have a lot of people who are in the sphere of treatment, but outside of just the doc speaking.

So it's very limited. Whereas when I went to the longevity, they have people from all different backgrounds, not just doctors, from physical fitness to physiotherapy. All scientists, there's more breath, and within that there was more depth, and you're getting a bigger and better understanding of the sphere. The conference, listen, you have to take everything with a grain. People are like, well, they don't publish all, everything's not evidence-based, this, that, and the other. I'm like, have you ever been to a medical conference?

Very few people are, you know, in surgery or anything are really presenting like, you know, game changing level, you know, level four evidence-based. Like most of it in reality is anecdotal. Okay. So like, you know, there's no reason, most of the stuff in surgery is just someone, some guy just showing you how he does it. And that's like, and claim it research-based. When you take a look at the third leading cause of death in the United States, it's what? Medical error, which is based off of research that everybody wants to sit there and say they're basing it off of.

So I'd almost rather see not research-based information anymore with how that kind of stacks up. There's actually a study and it came out yesterday, I can't remember which journal. People who don't go to medical conferences have lower rates of medical error. No. Because they think it's twofold. Number one, they're just working, you know, the idea is they're probably just working more. So they have more hands-on experience. And then a lot of people go to conferences and then like come back and try new stuff that they think is like evidence-based because someone gave a fancy presentation.

Exactly. And then they hurt people, but it's like, the data is like absolutely clear. Like the less conferences you go to and the more like fundamentals you work on, like the less errors you cause. Oh my God. And that's why you see specialty surgeons hyper hyper-specializing now. Why? Safety and predictability. Like if you just, you know, the muscle memory and all of the things you learned, like you just have, you're just going to stay out of trouble by doing the same operations every day. And people don't get bored.

Like people are like, Oh, you get bored? Like, no, no. How do you get bored of being awesome at something? Dude, what we're doing is amazing too, man. I would like to check his Instagram out. It is the coolest thing in the world. The thick glasses are amazing, you know what I mean? When you hyper specialize, you never stop getting better and it's fun to go in the operating room being like, not only am I gonna rock this, that comfort and confidence knowing I got this surgery, I got it probably better than anyone else and I know I'm gonna be able to help my patient.

I just know I'm gonna deliver what this patient wants. But I think, I know in New York, there's not a lot of real longevity wellness docs. Is the biggest constraint, is the biggest doctors like the actual physicians? Well, I think right now everybody is a peptide specialist online. If you have a million followers and you have a good following, there are people who come. I got people come and talk to me like, have you heard of this peptide? I was like, we've been doing peptides for 15 years. I know every one to the T.

And I think a lot of physicians are trying to get into it. They just don't know how to. Kind of like you were saying, they might be scared because it is a completely new market. But I don't think a lot of physicians are students of life. I think me and you are students of life. We're always learning. We're always going to find what's next and what's better. And I think a lot of people get stuck in their old ways. They think it'll be like this for the rest of their life, and they're not going to worry about it.

But they're like, like we talked about earlier, I think they're going to get swallowed up. And then another big aspect of what I think is going on, especially like, you know, in the in the bigger metropolis cities, are I think there's like one or two specialists and they get such a name that it's hard to break into that industry. The actual longevity industry is probably one of the hardest, I guess, categories in medicine to get into now because everybody sees no call, cash-based, very easy, and patients like to see you, kind of like with what you do.

Your patients love you, you know what I mean? Whereas traditional doctors are like, I don't want to go there and get a thumb stuck up my ass for prostate where it could be. It's not very fun to be a doctor anymore. So I think to answer your question, a lot of physicians are kind of, I think, scared to get into it, don't know how to get into it, and the amount of dis and misinformation out there about what this industry is and can be, I think it's just too popularized right now. What are the most common pathways people go in to get into it?

So basically conferences, that's how I did it. There's a couple credentialing bodies that you can kind of go through. There's no real thing. I mean, any physician can actually- There's no like residency program yet. No, not yet. And it's funny, I've actually speak in my medical school, I'm doing a functional medicine type residency. I think they're actually trying, I just saw Harvard was trying to start something up when it came to this.

GLP-1 Weight Loss and Surgical Recovery 28:38

But I do foresee that- Major institutions are starting wellness, longevity, you know, research and programs. And like that, when that hits, I mean, it'll just become a specialty. No, no, it's what it is. And it's funny. So I have internal or whatever. Yeah, you know, expand into it. We're actually open. I have something called the solar Institute. We just we have this really unique AI that we're doing in two days in Vegas at the A4M and attached to that's actually we call it the solar Institute, which is all basically every protocol you could possibly think to get his industry took me 15 years and like 150 grand, you'll cure all this knowledge and information.

And the whole thing is we're trying to give it away. You know what I mean? Like, because if you understand this medicine, not only efficacy for your patients goes up, but also does, you know, so does your profitability. You enjoy going to work, which I think, you know, a lot of physicians need a singular source for actual real traditional protocols, which is kind of scattered right now. You know, you'll sit there and look up and this person said this and this person just became a peptide specialist because they stayed at a Holiday Inn last night.

It's nonsensical. I mean if I was getting into it and just like I would tell anyone else I'd be like focus on the details and like at the beginning just pick a few details like like just keep it like you slowly build like don't think you know I don't think someone should open day one with every offering every peptide every hormone every plasma exchange hyperbaric everything under the sun like literally start with like Start small and work baby steps. Start small, baby steps and like work your way up.

And like, you got to build a practice based on trust. What do you think the biggest, so when docs, say you're like a pediatrician or an ER doc and you're like, you know, I think there's an easier path. Whenever people say there's an easier path, they thought cosmetics was an easier path. I'm like, I work 100 hours a week. I'm up at 3.45 in the morning. I promise you, it is not easy. It is not the easy path. The longevity, wellness, you're starting a business, customer service business, that's high risk.

If you think that's an easy path, you are nuts. What do you think that people go into it? What do they get? What do they not know and what are they getting wrong? I think the biggest thing is they don't know is that there isn't, like you said, there's not a standard protocol for any of this stuff right now. It's based off of various types of research. What they're missing is the common sense aspect of what this is. I think the most important thing is learn the basics. How does a mitochondrial work?

If you understand how a mitochondrial works, you understand NAD, humanin, MOTC, everything under the sun. If you understand how hemoglobin attaches iron, now you know methylene blue, you know IRA. There's all kinds of different things to understand once you know the basics. So if you want to come and say BPC heals, How does it heal? I don't know. It's just, you know, this is, this is what I read online. It's just like guys and how these things work. And I think that's the biggest problem right now.

Every physician sees a gold rush and they're just like, we get in and time to see beta BPC, GHK and this, that and the others. It's like, do you guys know how it works? Well, no, not really. Listen, when there's not knowledge and there's no way they're going to have stickiness, meaning they're going to have big churn. They're going to be like the person who opens a Botox clinic who doesn't really get it. People may come once, but they're just going to leave and they're going to go find someone else.

The stickiness is trust, and trust means it's got to work. Yeah, and again, like I said, I've been doing this since 2010. The amount of articles I have on me, and even front page covers being like, is this guy a snake oil salesman? Peptides, is he hurting people? It's just like, you know, IVs, like what is an IV, you know? And now you can't walk down Miami Beach without hitting three IV clinics, you know? Peptides is like the number one word on Instagram in the last three months, you know? There's more med spas in America than there are McDonald's and, yeah, in 2025. And if you don't think, Every one of those spas are going to be adding compounded GLPs and peptides and giving it out like candy and causing real, they may not cause harm, but they're probably not going to help anyone.

Like they think that's the next task. You know, people look at it the wrong way. They're thinking, you know, what's going to make money? Let's do that versus like, how do we help people like and be good doctors? And then the money will come if you're a good doctor. You're going to be more right. GLP ones are great when you do them right. When you do them wrong, they're horrendous. You know, I mean, you're literally manipulating how your body handles sugar, the most important thing in our system.

So now they're like, actually, so I'm curious, actually, that's a good question. Ever since the whole ozempic Crazy hit. Has your business gone up because people have lost so much weight, there's so much sagging skin, and that's what kind of spurs? I'd say 80% of my patients are on a GLP-1. In New York, it is just a vitamin, okay? It's no longer like, okay? And it used to be something again, similar to like the guys talking about peptides. It used to be something that like was hush-hush and now everyone's on, you know, maintenance or a micro dose or a longevity dose.

Like they just are, you know, and that's why all the New York restaurants are turning to membership models because, you know, nobody's going in and having an appetizer, a main and a dessert anymore. So they got to charge a membership model. I'll put some lettuce in the water, you know what I mean? But my journey like weight loss fads have been around probably since like they discovered fire, okay? And You know everyone knows about fen-fen I think it was in the 90s and that was a miracle drug and then the class-action lawsuits because it hurt a lot of people so I think people have always been there's always a new craze in weight loss and I thought after the pandemic, I was going to come out and everyone's going to be fat.

And then I walked out and I was like, something's different because nobody's fat and they're all thin. And that's when I started to really pay attention to GLP ones. And yeah, our businesses shot up because The old model for weight, when someone needs to lose weight, they go to their doctor. Oh, you need to eat less and exercise more. Well, that is not really for everyone. There's a lot more. And the answer is also not just prescribe a GLP-1. Let's figure out, a lot of these people have thyroid issues, other issues that can be optimized medically.

There's a lot more to it. But we just see people who've lost the weight, they've struggled with their whole life and not through lack of effort. It's not like they're like, you know these people are those people who carry those extra 30 40 pounds it wasn't like they were like you know these overeating like their dna programmed them to have that fat and like these medications take it off and they don't feel like they get the win until the skin's removed so yeah we're busier god bless but like You know, we see issues too.

You know, we see wound healing problems when people go on their GLPs. That was my next question. That was my next question. Wound healing. We like to stop it, you know, three weeks before, three weeks after, but like some people, you know, unfortunately some people do get. you know, almost an aversion to food, especially if you've lost a lot of weight, like they're scared of food. Cause they like food is, you know, that hunger is associated with the feeling of a different life that they don't want to live anymore.

So there's some, you know, there's some wounding, some emotional and the psychological issues of that. But at the same time, you know, I have met over the last four or five years, you know, thousands of people whose life Quality of life is like so much higher when they've lost the weight and we did our thing. They live a life they could never have imagined. Like someone who was like... It's like someone who never really wanted to leave their house without baggy clothing on, and now they never think about their body.

There's no noise in their head about their body. They really just are comfortable and confident, and they can walk through life forever being confident in their body. That's meaningful medicine to me. What a cool gift to give people. It is not like gimmick or trending plastic surgery. We see our follow-ups, they're crying. It's like, hey, I can wear clothes normally now. I speak to a bunch of them in my clinic. They come in. Listen, obviously in New York, we see a lot of like moms who are 118 pounds that are now 102 pounds, but like, Hey, that's their world.

That's their life. That's their narrative. Like that's their, that's their thing. That's their story.

Entering Longevity Medicine and Building Trust 37:18

But, and those medications go so seamlessly into the world. Like it's the gate, you know, that's the gateway drug. Drew. No, very true. You get that, like, okay, now I'm gonna work on my mentality, my sexuality, my sleep. I think the two biggest things, because everything's trending now, I think the two biggest things in the wellness industry for the next two years are gonna be sleep medicine and synthetic therapy. Just mark my words on that one. You're gonna see both of those pop up at all the conferences you're gonna start going to.

I mean, who doesn't want, like, you know, a better, stronger libido and to sleep better? Like, those are, like, fundamental. Take my money. Those are, yeah, exactly. Like, people, you know, it's fundamental. If someone told me they don't care about sleeping better or their libido or their partner's libido, I'd be like, nope, you're lying. Like you're a liar. Those are wired into making life worth living. That's how you make life worth living. Yeah, exactly. What's the point of living 120 if it's about bad sex and bad sleep?

Yeah, I mean, that's what they do in prison. That's how they punish people. That's a good one. You got me on that one. That's how they punish you. They make you alone. You can't have sex. And they give you an awful sleep. That's how they punish the worst criminals. Trust me. That's coming. Now we have the ability to meet people, which is awesome. Well, Dr. Nice, I gotta say one thing, man. This has been an honor. It really, really has. You know what I mean? Like, and again, like we've actually gone long here, so I'm very happy.

It's been a time for me, man. I know you're busy changing all the moms and all the women up there, but I always ask every guest two questions. So I'm going to shoot from the hip. Sure. Bert, if you're a physician who's not in this, so imagine either a surgeon or a regular physician. who's looking to get into this wellness aesthetic industry like you are right now. What's the best advice you could give them? An aspiring surgeon who wants to take it to the next level, I guess you could say. So you got to have some hotspot in life.

And what I do is if I want to learn something, I truly believe medicine is a field that we share. Like I will like call someone and go visit them. Like I've done that in New York. I visited you in Miami. Like if I wanted to get into longevity wherever I was, I would find whoever the physician closest is that I could, you know, was referred with the most respect. I would call that person and say, Hey, I'm really interested in this. Can I come visit? And like, listen, you get business by giving business.

So like when you tell the person, you know, I'm a surgeon or whatever, and I'm interested in referring my patients, can I come learn about it? There's no chance they're not going to say, and you're going to go and, you know, spend a half a day with them. And most physicians love the opportunity to share what they're doing, share knowledge, also build networks. Old school, knock on doors. Okay. Feet to pavement, you know what I mean? I still, still, you know, people are like, you know, every doctor in New York.

I'm like, yeah, cause when I'm walking down park on my way home, if I see a doctor's office, I don't know, I knock on the door. I love that about you, man. That's awesome. I go in and I introduce myself and no one is ever like, people are like, great, meet another doctor. You never know. By the way, you never know where that goes. They may be someone who like, by the way, they may know like a good chest instructor for your kit. Like you don't know. Just like, I just think like literally people like, you know, the phone and the internet is really important.

But like I have built my career and my life through human to human interaction. Exactly. Old school these days. Honestly. And when you do it now, there's like so much more power to it. Like when you go, just go visit another, like call them up. Hey. You're doing amazing things. I'd love to come visit you, spend a half a day, learn about you, and send you some patients. That's the number one thing. By the way, it's that simple, but you got to actually do it. Yeah, no, again, that's probably one of the best answers we got to that question too, by the way.

I mean, I have it in my calendar to try to meet a new doctor in New York every week. I don't even care what their specialty is. Dude, you're inspiring me, man. I hardly ever get inspired these days. By the way, you don't have to meet... I'm friends with obviously all the facelift guys, but I have allergists and pediatricians who refer me a ton of patients. Not all their patients, maybe just their network of who they hang out with socially. Just go meet people. You'll be fine. Go meet people. Go for a butterfly.

I love that. All right, question number two. If you're a patient, so say you're a person looking to who has loose skin or if you're looking to get into the longevity market or do something such as the mommy makeover, what is the best approach at finding the correct person to actually go to? So I put a lot of social equity into referrals. And I know, and you do the same thing, like every night I probably get six texts from patients. When they trust, like go to a doctor you trust. Everyone knows a doctor you trust, whether it's your doctor or a family member or a friend, and ask them.

Because I think doctors, like when I refer someone to you, like that's on me. Like, you know, like I think- It's as if I'm the treating physician. You know, when I refer someone, it's a hundred percent on me. Cause guess what? If someone has, if I refer to whoever and they have a bad experience, they're calling me. Why'd you refer me to that? And doctors, I believe, and I know you feel the same way. Like when we refer it, we put our whole reputation behind it. So. You know, don't start on the internet, finish on the internet.

Start with a referral and then go look at, you know, what they're doing so you can see their before and after, see their vibe, see their attitude. You know, you want to go to someone you like because you, you know, and that's why a lot of the times we'll refer like two or three people and I'll say, Hey, here's three docs that are really good. Go check out their Instagram because you'll probably like one of them and not like two of them. And that's fine. Like there's a different lane for different people.

But find a doctor you like and trust and ask them for a referral. I promise you that doctor cares about their own reputation. Oh, I dig that, man. Honestly, this has been one of my favorites. Kind of old school, but like... No, but hey, man, old school is a real school these days. You know, everything, all this new stuff is scary some of the time. This is the old school literature here. I love that. Yeah. Dr. Neinstein, thank you so much for taking the time. This has been spirited. I'm sure there are going to be all kinds of questions at the end of this.

Yeah, I love it. So we'll make sure to get everything going. But again, check him out. Dr. Neinstein, The Mommy Makeover. If you're in New York City, Japan, Tokyo, wherever you are, get ahold of this guy. He's the best in the business. He's the only plastic surgeon I refer to. Dr. Robert Soko, Lifestyle Medicine, sponsored and brought to you by Access Medical Labs. Dr. Neisting, thank you so much, man. This has been legendary. Thank you. Thanks for joining us today on the Lifestyle Medicine Podcast.

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