The Truth Behind Fillers & Botox: What You Need to Know About Safety, Longevity, and Results - Dr. Cameron Chesnut, MD

Summary

Podcast Summary: Pursuit of Wellness Episode: The Truth Behind Fillers & Botox: What You Need to Know About Safety, Longevity, and Results
Guest: Dr. Cameron Chesnut, MD
Release Date: November 4, 2024

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Introduction

In this enlightening episode of Pursuit of Wellness, host Mari Llewellyn welcomes Dr. Cameron Chesnut, a renowned facial plastic surgeon known for his innovative and minimally invasive approaches. Dr. Chesnut specializes in treating high-profile clients worldwide, focusing on procedures that yield natural and rejuvenated results.

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Dr. Cameron Chesnut’s Background

[02:26] Dr. Chesnut: "It's a long story of origin... I was a creative, athletic kid influenced by my mother's progressive thinking in nutrition."

Dr. Chesnut shares his journey from a nutritionist-influenced upbringing to medical school, where he initially lost touch with his creative and critical thinking skills. His return to these foundational aspects led him to specialize in plastic surgery, where he could blend creativity with medical expertise.

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Unique Approach to Plastic Surgery

[02:48] Mari Llewellyn: "He has a unique approach when it comes to surgery... focusing on everything from nutrition to peak performance."

Dr. Chesnut emphasizes a holistic approach, integrating functional medicine with surgical techniques. This includes optimizing patients' nutrition, utilizing regenerative medicine, and implementing advanced recovery techniques to ensure peak performance during and after procedures.

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Anesthesia and Pain Management

[16:20] Dr. Chesnut: "I push somebody just underwater so you're kind of like just barely asleep... I don't use any opioids or narcotics."

Dr. Chesnut discusses his innovative anesthesia methods, avoiding traditional opioids and benzodiazepines. Instead, he employs techniques like binaural beats with theta waves to induce a calm, trance-like state, minimizing post-operative fog and enhancing recovery.

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Regenerative Medicine and Stem Cells

[19:47] Dr. Chesnut: "Stem cells are the warriors of our cells... They release growth factors to help healing."

A significant portion of the conversation delves into the role of stem cells in regenerative medicine. Dr. Chesnut explains how he utilizes both autologous (from the patient) and allogenic (from donors) stem cells to promote healing, enhance collagen production, and rejuvenate skin and tissues.

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Red Light Therapy in Recovery and Skin Health

[25:00] Dr. Chesnut: "Red light is a baseline entry biohack... It helps via photobiomodulation."

Dr. Chesnut advocates for the use of red light therapy, highlighting its ability to penetrate deeply into the skin, activate mitochondria, and boost collagen and elastin production. This therapy is particularly effective when combined with procedures that create micro-injuries, such as lasers or microneedling.

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Fillers: Types, Misconceptions, Longevity, and Risks

[33:42] Dr. Chesnut: "Fillers are adding a gel that's intended to create volume... But is that what you want your lips to look like?"

The discussion shifts to fillers, where Dr. Chesnut distinguishes between different types, such as cross-linked hyaluronic acids and biostimulants like Sculptra. He addresses common misconceptions about their longevity, migration, and the phenomenon of perception drift, where continual treatments alter one's natural appearance over time.

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Perception Drift and Its Impact on Patients

[38:35] Dr. Chesnut: "Your perception of yourself is now off. This is called perception drift."

Dr. Chesnut introduces the concept of perception drift, explaining how repeated filler treatments can shift an individual’s self-image, making them perceive their altered appearance as their new norm. This often leads to overuse and dissatisfaction when results do not align with initial expectations.

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Sculptra vs. Fillers

[44:14] Dr. Chesnut: "Sculptra stimulates collagen by introducing a foreign body... It's creating a giant cell reaction."

Comparing Sculptra to traditional fillers, Dr. Chesnut highlights that while Sculptra stimulates collagen growth, it does so by introducing poly lactic acid, a foreign substance that elicits an inflammatory response. He cautions against overuse, noting that excessive Sculptra treatments can complicate future surgical procedures.

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Fat Transfers: Process and Benefits

[59:13] Dr. Chesnut: "Fat transfer is taking fat from another part of your body and moving it to a new location... and it cannot migrate like filler."

Dr. Chesnut elaborates on fat transfers, explaining the meticulous process of harvesting, processing, and reinjecting fat into targeted areas. Unlike fillers, transferred fat establishes its own blood supply, providing long-lasting volume and regenerative benefits without the risk of migration.

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Common Procedures and Focus Areas

[57:37] Dr. Chesnut: "When considering the eyes, anything we do around them is very important... it looks better and less like something has happened."

Eyelid procedures are among the most common in Dr. Chesnut’s practice. He emphasizes the significance of the eye area in conveying emotion and identity, aiming for subtle enhancements that improve appearance without overt surgical signs.

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Managing High-Profile Patients and Expectations

[65:14] Dr. Chesnut: "It's about setting realistic expectations and focusing on recovery... making that a great experience."

Working with high-performing and often busy individuals, Dr. Chesnut stresses the importance of setting realistic expectations and providing comprehensive recovery support. His approach ensures that patients can return to their demanding lives swiftly and seamlessly post-procedure.

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Defining Wellness

[68:49] Dr. Chesnut: "Wellness is an evolving journey... It's about climbing the right ladders in the right ways."

In a heartfelt conclusion, Dr. Chesnut shares his personal philosophy on wellness, viewing it as a dynamic and continuous journey. He underscores the importance of self-awareness, aligning one’s actions with personal values, and maintaining balance across emotional, relational, and physical aspects of health.

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Conclusion

This episode offers a deep dive into the intricacies of modern facial plastic surgery, underscored by Dr. Cameron Chesnut’s holistic and regenerative approach. From advanced anesthesia techniques to the nuanced use of fillers and fat transfers, listeners gain valuable insights into achieving natural and lasting results. Dr. Chesnut's emphasis on education, realistic expectations, and overall wellness provides a comprehensive perspective for anyone considering or interested in the field of aesthetic medicine.

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Notable Quotes:

• Dr. Chesnut [33:42]: "Fillers are adding a gel that's intended to create volume... But is that what you want your lips to look like?"

• Dr. Chesnut [38:35]: "Your perception of yourself is now off. This is called perception drift."

• Dr. Chesnut [59:13]: "Fat transfer is taking fat from another part of your body and moving it to a new location... and it cannot migrate like filler."

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Key Takeaways:

• Holistic Approach: Integrating nutrition, functional medicine, and advanced surgical techniques ensures comprehensive patient care.

• Innovative Techniques: Minimally invasive procedures and advanced anesthesia methods enhance patient experience and recovery.

• Regenerative Medicine: Utilizing stem cells and red light therapy promotes natural healing and sustained results.

• Educating Patients: Clear communication about procedures, expectations, and potential outcomes is crucial for patient satisfaction.

• Defining Wellness: Wellness is a personalized and evolving journey, requiring continuous self-assessment and alignment with personal values.

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For more insights and detailed visuals of the discussed procedures, visit Dr. Cameron Chesnut’s Instagram and TikTok profiles, linked in the podcast’s show notes.

Transcript

[A]

I see people, especially younger people, because now they're in trouble a little bit and they've realized somebody told them they saw an old picture or they just had that aha moment where, oh, shoot, I don't look like myself anymore. My lips aren't what they used to be. The filler has migrated, whatever it may be, and it's sort of like, well, now what we. Now what do we do?

[B]

This is the Pursuit of Wellness podcast and I'm your host, Mari Llewellyn. What is up, guys? Welcome back to the Pursuit of Wellness podcast. Today we are talking to Dr. Cameron Chestnut. This was such an incredible episode. I didn't quite know what to expect when bringing him on, but he was such a wealth of knowledge and he has such a unique approach when it comes to surgery. Dr. Cameron Chestner is a facial plastic surgeon for the world's highest performers. People from all corners of the globe seek his next level results. He has a minimally invasive procedure that leaves patients looking natural, rejuvenated and seemingly untouched. He is renowned for his progressive use of regenerative medicine and post operative recovery techniques. He has such a unique approach when it comes to surgery. I've never heard anything like it. He focuses on everything from nutrition to peak performance. And during medical school, he learned all about regenerative medicine, including stem cells and red light therapy. He uses hyperbaric chambers, IV drips, etc. It really is more of a functional medicine practice than anything else. But he's also doing amazing work on the face. He does treatments like CO2 lasers, fillers, lymphatic drainage, massages. He also emphasizes the importance of educating patients and turning down unnecessary surgeries. This was such an interesting episode, guys. And as someone who has acne scarring, I have so many questions about the right way to get a laser done. Do I need fat transfers in my face? Are fillers working? What's going on? So I asked all the questions also about sculpture, which is something I've been interested in. So we really got all the answers today and really heard the truth behind if these procedures are actually working and what are the ingredients in those procedures. We explore the balance between aesthetics, wellness, and what true health means in this evolving field. I know you guys are going to love this episode. Let's hop right into talking with Dr. Cameron Chestnut. Dr. Cameron Chestnut, welcome to the Pursuit of Wellness.

[A]

Thank you so much for having me. Very honored and grateful to be here.

[B]

So excited to have you. I know you're a facial plastic surgeon for the world's highest performers and you Have a pretty unique process and outlook on plastic surgery, which I find so fascinating. And we were already chatting earlier and I'm just so excited to dive into the functional medicine side of everything you do.

[A]

Right.

[B]

So I'd love to just start by hearing how you became interested in this industry. How did you get to where you are today?

[A]

Yeah, it's interesting going back into just life, you know, it's a long story of origin. Right. But I was just a creative kid. I was an athletic kid. My mom, I gotta give her a lot of credit here because whether she knows it or not, she was a very progressive thinker. She was a nutritionist. So I grew up with that mindset and thinking about that. And she was the one who, you know, didn't do margarine when that was in trend in her field. And she was mixing monounsaturated fats with our butter and things like this. And it seemed crazy. Or cooking with peanut butter or applesauce instead of oil, whatever it was. And I didn't at the time really understand what that meant, but that was always just part of my life. And so I get into medical school and I thought I was actually going to be a nutritionist too, but I went to medical school. And a lot of that, like creativity and curiosity, critical thinking that my mom had gets kind of beat out of you, to be honest, in a very. It's a sad truth, really. You have to be regimented. You have to get all the things down. You have to learn. And I. It's a very good system. I was very well educated in medicine when I was done. But I was not very creative critical thinking or curious really at that point. Then you get to this very kind of cool time in your life where you've invested eight years after high school and your education, and now you have to decide what you're going to be when you grow up a little bit like this path into how you're going to be a psychiatrist or an orthopedic surgeon or a family medicine doctor. And I really went back to those 3D spatial creative things that I liked when I was a kid and all the problem solving and curiosity and that really opened up a world like in the plastic surgery, 3D spatial type of realm. For me, even orthopedic surgery is that. But it's just not as creative, maybe. So that's sort of how I found myself where I was. I got to use all the things I liked as a kid. I kind of got back to my identity that I had lost through medicine. In a way. And got to go back to a lot of. For me, was back to my, like, athletic roots and my athletic background too.

[B]

I'm curious, in medal medical school, how often were they bringing up nutrition?

[A]

Barely any, actually.

[B]

Wow.

[A]

And it's. We took one class on nutrition, and I remember I was a nutritionist major as an undergrad, as an example. And I remember taking that nutrition class in college. And I had my academic side of me from majoring and I had my critical thinking curiosity side of me from my mom being a nutritionist and being an athlete and having applied all those things to myself over the years, I knew that when I did X, I performed well. When I did this, it didn't perform as well. So you kind of have some of that anecdotal part too. And I remember in that class thinking, this is absolute garbage, what we're learning. This is not right. This is not true. And it's really biochemistry. That's what nutrition is when we really get down to it. And so that part, it was real. But then the application, I'm like, this is not what we should be talking about, you know, which was kind of good. I think in some sense that it was only that because it didn't beat as much of that out of me, maybe. But for my classmates and the other, you know, 200 and some people I was in medical school with, it never came. You know, we didn't talk about that. We didn't talk about sleep. We didn't talk about super important things to our longevity in our health. And then even on a personal level for our performance as doctors. You know, then the next step, we go and we all get sleep deprived for five years.

[B]

I never understood that.

[A]

Yeah.

[B]

Like, how is that safe that people are sleep deprived? And then practicing on people, I would.

[A]

Say it's probably not that safe. The mindset, this is the paternalistic side of medicine that goes back. That is, you know, you, you know, if you're in medical school and you're getting through your hurdle, hurdle, hurdle, and you're jumping over them, how high? You know, how do I get through this? You're really good at achieving these metrics. Then you get into residency. That's what we call that period where you sub specialize. And you do get into this heavy, heavy type of training where you're paternalistically being sleep deprived. It's part of the hardcore initiation. Can you do hard things? Part of it. That realization actually happened when I was in training that we started to try to limit work hours so that we weren't working 110 or 130 hours a week. And when I say we, I'm talking like, the royal group of, you know, residents and all the different specialties. It's different and different things, but surgery tends to be one of those ones that is, you know, you work for two straight days, you don't sleep, then you go home and you have eight hours, and you come back and do it again wild. And that's not good. There's no way you're at your peak performance in that. There's no way you're even at a functional baseline of performance in that. And it. It's the opposite of what it should be. Not only is it, you know, should we be encouraging that for our patients, but we should be practicing that ourselves. And this is one of my big missions in my world of surgery. You know, I do. I'm. We were kind of talking about this. I'm very narrow and deep in my world of facial plastic surgery. But one of my missions is to. For all of my colleague, especially my surgical colleagues, is how can you be at peak performance? Because when you have a surgery someday, whatever, it's almost everybody's going to either have one or know somebody, a loved one who does, right? Could be a knee surgery, could be elective, could be orthopedic, could be taken out your gallbladder. Whatever it is, you want that surgeon to be at their best that day. That's the huge event for you. And for them, it's case number eight today. That's. Is that good, you know, or should that be their main focus? That's happening. And so I'm really about trying to make my colleagues at their peak performance in whatever specialty they're in as well.

[B]

So how do you take your values in health, nutrition, sleep, and apply it to your personal routine? Like, let's say you have a big surgery one day. What are you doing the night before the morning of.

[A]

Yeah, my whole. I don't want to say my whole life, but a lot of what I do from a very. This is a passion project for me. I love what I do. And so I'm thinking about my surgeries next week already, and I'm tailoring my workouts right now. My cognitive load, even something like this, you know, this is all built into my plan for next week. When I'm in the operating room. Those days that I operate next week, I will be at peak performance. I will break myself down to the right level. I will build my resilience, and then I will peak on Those certain days, that's kind of what an athlete does if you're pitching or you have a big game or something like that. So a lot of it revolves around that. So my workouts right now are tier geared towards being resilient, being strong, being hard to kill. Because something will, a hurdle will come up in that, like I'll have a kid who needs a little extra emotional support or I don't get the perfect night of sleep the night before. Whatever it is, I have to be able to bounce around that. But I have the luxury in my world because I can choose who I work with and I don't have to do a certain number of cases every day and bill insurance for what I'm doing. It's like it's me and you, and you're my only focus that day. You're the only thing I'm doing. So I can go into it like ready and I don't have to think about anything else. So because of that, I can really get to those levels. And I, I have a routine that I do the day of to get into like a flow state that day, which I'm very facile and good at now, but takes a long time to learn how to do that. And it's very energetically expensive and I have to learn how to recover afterwards to maybe do it again the next day. So there's a lot that goes into it. But I'm super fortunate and I'm very grateful that I can sort of have one kind of major thing to do a day. And it's my big event for the week or the year, whatever it is, and I get to kind of do that over and over and be on that cycle a little bit.

[B]

We talk a lot about toxins in everyday products on the show, makeup, skin care. But one thing we tend to skip over is toothpaste. Did you know we swallow 5 to 7% of our toothpaste every single time we brush? That is an entire blob of toothpaste every seven days. And most commercial toothpastes are filled with harsh chemicals, artificial flavors and preservatives, not things you want to be eating. And that's why Bite makes dry toothpaste tablets that are made with clean ingredients that are sulfate free, palm oil free and glycerin free. They are so convenient. You just pop a bit in your mouth, chew it up and start brushing. It turns into the paste you're used to, but without the plastic tube or messy paste. I find these so convenient to travel with. I'm always on the go. I'm going to Salt Lake City on Wednesday. I will be throwing one of these in my bag so I can stay fresh on the go and know I'm not consuming harsh chemicals. Bite is offering our listeners 20% off your first order go to try bite.com pow or use code Power Checkout to claim this deal. That's T R Y-B-I-T-E.com/POW. You guys know I've been through the wringer when it comes to skin. I had acne for about 10 years and it really, really had a huge impact on my life. I'm so grateful I have found skincare that I can trust and feel good about and know is non pore clogging. And that is Clear Stem. Clear Stem is the first skincare line that combines all three categories. Anti acne, anti aging, clean, meaning free of hormone disruptors and pore clogging fillers. The founders, Danielle and Kaylee, have had acne themselves and they know what ingredients to put in the products and what to leave out. These products are all super simple. I have my favorites. The Gentle cleanser. I love the sunscreen. I love the hair care, I love the body lotion. So many goodies. And I love the fact that they have an acne lab test on their website which is helping thousands of people get to the root cause of their acne through comprehensive lab testing and lifestyle based recommendations. I really think there's a root cause to all acne and doing lab testing is so important. Visit clear stemskincare.com and use code POW POW at checkout for 20% off your first purchase. Again, that's code POW for 20% off your first purchase at clear stem skincare.com so when it comes to your actual patients, what does that process look like? Because I think people listening, even myself, have a very different assumption about what plastic surgery might look like. But after researching you and your process, I was pretty like surprised by the way you do things. For example, the anesthesia, the pain medicine afterwards. How do you handle that approach that's different than maybe another plastic surgeon?

[A]

Yeah. So this is where my personal values and mission come into this a little bit too, in the application to my patients. So 100% of my patients travel to see me. So that's a little bit of unique aspect how we start virtually and meet and get to kind of have a relationship which is maybe kind of like virtually dating almost a bit before we get to meet. So there's a challenge to that. But then once we're Sort of together. That's when, you know, the time leading into it. I'm optimizing them from a nutritional standpoint, inflammatory standpoint. I want them ready for this event that's going to happen. In that athlete analogy, I'm treating them like an athlete, too. You're about to have a big event or in this case, kind of like a known injury. You know, it's a controlled injury, but we know that on this day this is going to happen. So let's have you ready for that. Right.

[B]

Out of curiosity, what is the dietary? I know it's probably individualized, but what is the dietary recommendation?

[A]

So that gets a little bit into. So for probably a lot of people who are listening with you, they're already familiar with a lot of these things to do. But that could be something as simple as eliminating processed foods, sugar, certain types of fatty acid profiles or oils. We're looking at all those. Sometimes we're even looking at what cleaning products people are using to sort of make that better going.

[B]

Do you have a recommendation of one?

[A]

Um, I. Let's just say I try to keep it clean. You know, we're going to go into like basic essential oil, types of cleaners and vinegars and things like that. And again, for a lot of people there, that's not an issue for them. But for some, very obviously, like you're cleaning your house with this product that we know is not great for you, or a lot of like, you know, artificial scents and things like that. So we'll get somebody. And this includes like a peptide protocol going into their procedure, stem cell mobilizing, all kinds of things like that. So they are ready when they come to see me. And then we get together and the day of the procedure is intimate. Like, again, you're the only thing I'm doing that day. So we have a lot of time together before that. And this is important to me because I want to be happy with what I'm doing and I want you to be happy with what we're doing. But it's a big relationship. We're forever enmeshed to some degree once we work together. And I work with a lot of younger people. And the reason for that is the procedure this gets into, like, I think the meatier question. The procedures that I do are very minimally invasive in comparison to what people think of. Okay, so let's say it's somebody who's having a facelift, right? And a facelift everybody thinks is, oh, incisions around your ears. And are you willing to trade this for that. And. Well, a lot of the lifts I do, I don't put incisions around the ears. I'm using these very remote, minimally invasive, we call them invisible access sites that may be hidden back in your hairline, little small spots. And I'm able to go into those fat pads and elevate them in a very minimally invasive yet robust way to do that. So it could be a little bit of an earlier stage where there's not such an initiation hurdle to get to have that type of a procedure done. And again, I'm not saying that younger people should be doing this has to match up with your value proposition and what you're after. But there's people who just have genetic predispositions to have some earlier aging changes, often in the lower eyelids or along the jawline and chin and things like that. And we can get into what to do about those. But so I'm working with a lot of younger patients in that. And then we get to the, like, time to go back to the operating room saying, this is where things get really, really different. And the point of anesthesia is to make you not feel anything, not remember anything, basically be unconscious, if you will. And so general anesthesia is the idea of just pushing somebody analogously to the bottom of the ocean. You just slam them down there, and then you breathe for them and take care of them, and they're just sort of like at the bottom. That's a huge physiologic load. And it's a big issue for your neurocognition. We are shutting your brain down, essentially.

[B]

Yeah.

[A]

So I like to do that a little bit different where I push somebody just underwater so you're kind of like just barely asleep. And before I even do that, I'm putting binaural beats in your ears that have, like, theta waves. And so you're getting to this very calm trance like state just with headphones before we even need any anesthesia. So you're already kind of partway there before any medications have been started. And when I do the medications, I don't use any opioids or narcotics. People talk about those. I don't use any of these things called benzodiazepines, which are sort of related to alcohol. And the reason I don't use those is because we know that opioids are hard on your brain and they make you not able to go to the bathroom. They make you. It's just a bad experience afterwards when you have them. And benzodiazepines are really hard on your brain. For young people, if we look at kids, we know that they lower kids IQs if they're constantly exposed to them. For older adults, we know that it can push older adults into earlier states of dementia. And that doesn't mean that if we take it, we're fine. It means we just don't notice those little changes that happen quite as much. So I'm not doing that for an elective procedure, especially on somebody who may be a little bit younger.

[B]

Is that something? So I've had a lot of friends that have had like boob jobs and things. And I know afterwards they're like recovering for weeks and weeks and weeks. They can't go to the bathroom. They feel foggy.

[A]

That's exactly what it is.

[B]

They're getting the benzo. What is it? Diazepines.

[A]

Diazepines, narcotics. And then they're getting the general anesthesia, which is these inhaled gases that are fat soluble. So they get into your body and you have to like clear them out after they've been in there. Everybody talks about these days of fog after their procedure. And that just doesn't exist with what I do.

[B]

Wow. Okay, so they're under. Now you're going in. How long is the procedure?

[A]

They vary in length. Sometimes they're an hour or two, sometimes they're eight or nine hours. Just depends on how much we're doing. I try to really get into comprehensively doing as many little small things together as we can. Kind of based off of your needs. Right. If you're in your late 30s, you're going to need a lot less than somebody who's in their 60s. And so that's just kind of how it all boils down during the procedure, you know, they have that type of anesthesia protocol that we talked about. They're just. It's just like this very perfect finite line. I use local anesthesia to help any discomfort during the procedure. So you don't basically feel anything. In full honesty, you could probably do these procedures fully awake because you don't feel anything. Now. There's a lot going on in the operating room and for most people it's nice to just kind of barely be asleep and. Great. That's a nice little happy medium. Basically we get done. And at the very end, I will also use these long acting nerve blocks at the very end of the procedure, which is great. I can do that on the face. I'm very. I've done tens of thousands of those now, in a sense where I don't want you to have to need pain pills after these little procedures. And so I do these nerve blocks, and they last about 72 hours. And for most people, the pain of a procedure is in the first 24 to 48 hours. So we nicely walk you through that window with this sort of blunted sensation, and then you come out the other end and you didn't need a pain pill. And for 95 plus percent of people, especially if you're motivated, that works great. You don't need them at all. So it's just a nicer experience, a nicer recovery during the procedure. I'm very aggressive with my regenerative medicine protocols that I'm doing. So I'm using your stem cells out of your fat, I'm using your growth factors out of your blood. All these things that are coming just from you and somebody like, you know, in their 30s, 40s, 50s, young, healthy, incredibly active stem cells. These are wonderful tools that we can use from you to help our results get better and help your recovery happen faster.

[B]

Okay, so stem cells I'm really curious about because I've heard a lot about them. I heard people are like flying to different countries to get them. Is that because it's not illegal in America to use them? Then why are people flying to other places?

[A]

It's interesting because that paradigm has been shifting a little bit. So I'm using them in a cosmetic, autologous, we call it, setting. They' coming from you. Right. And so that in the US that's totally allowed, totally legal, inbounds, no problems at all. Where the US limits it a little bit is in taking somebody's stem cells and then replicating them, proliferating them over and over, we call them these cell lines. And then using certain enzymes to process them and things like that, and then using those to inject into somebody. So if you go to, you know, Mexico or Central America, you can get this stem cell that has been replicated thousands or more times for 15 years, and then they just take some off of the pile and give them to you, and you can get these really, really high numbers. So that's kind of like outside of my particular specialty. But I do have that in my practice as an adjunct because I use those types of things to help my patients recover after their surgery. So during surgery, you get your own stem cells and your own growth factors. And then afterwards, in the recovery, we're often using these allogenic or allogeneic, which means they're coming from somebody else, like umbilical derived stem cells, which just come from normal births. Where they take the stem cells out of the, out of the umbilical cord. This cool stuff called Wharton's jelly. It's awesome. And we can take those stem cells and use them in a therapeutic setting after the, you know, the birth's done. So that's also legal in the US you just can't take those and proliferate them.

[B]

Got it.

[A]

The interesting thing is in these other countries where they've been proliferating these stem cells for years, this kind of makes common sense when we think about it, is every time they replicate, they lose a little quality. They're not absolutely perfect in this sort of like forever replication. And so the paradigm has shifted back towards, well, maybe it's better to use these brand new instead of replicating them over and over again. And then maybe the numbers that we were using in these incredibly high quantities, it wasn't that useful. There's some maximum dose. So the pendulum is really swung back to what we're doing in the US anyway, which is using fresh, non replicated stem cells, which the best kind, and then using numbers that are a little bit more reasonable and appropriate of them. So now, interestingly, all going overseas has really sung back to like, we can do a lot of that here. And I use them postoperatively. A lot of people are using them for orthopedic things. If you have arthritis or an injury or something like that, helping you recover after those.

[B]

So are stem cells injected in the area that needs healing? Okay, yeah. And how does it work?

[A]

So stem cells are, I call them like the warriors of our cells. They're the ones that when things get tough, they get activated and turned on.

[B]

Okay.

[A]

So inflammation, stress, injury, they get activated and they're magnetized to that area. And then once they get there, this is where the warrior thing maybe fails a little bit because they're not like fighting, but they're sort of more orchestrating the healing of this area. They're releasing growth factors, which we all hear about, but they're releasing growth factors through these little things called exosomes, which are these little pockets or these little envelopes of growth factors that they release to an area. And they basically just communicate with all the cells to help healing. They make new blood vessels, they help lay down collagen and elastin. They orchestrate all of the healing in that area. And then when their job's done, they aren't needed there anymore and they kind of move on or move away. In certain areas, we kind of have chronic inflammation going on. If you have osteoarthritis like joint pain. Great. Stem cells will do that really great there for a long, long time. If you have an injury from a surgery, great. They'll help that whole process of healing. Or if you have just sort of baseline aging changes going on, like, let's say you just have skin aging from a lot of sun damage over the years. If you put those stem cells in your skin, we know that they will change the way that your skin is healing and they'll upregulate the precursors for like, elastin tissue, which is the magic thing that we really, really want to have a lot more of in our skin because it goes away very quickly. Quickly.

[B]

I don't know if you know Chris Bumstead. He's Mr. Olympia bodybuilder.

[A]

I don't.

[B]

So he's won eight times in a row. Best physique in bodybuilding. My husband's into bodybuilding. That's why I know about this. And he was injecting stem cells into his kidneys.

[A]

Oh, yes.

[B]

During the process, I think, because obviously they take, you know, steroids and things like that to compete in bodybuilding.

[A]

Yeah.

[B]

I wonder if that was sort of his effort in offensive offsetting the negative side effects of steroids.

[A]

That's exactly what it would be. Steroids and probably a super high protein diet where you have to process all that nitrogen through your kidneys. And so, yeah, that would be a strategy to again, go to an area and put your warriors there, put those cells there that can help sort of orchestrate the healing.

[B]

Okay, that does sound pretty intense into the kidneys.

[A]

But you can put it. And, you know, I'm saying orthopedic things, but yes, you can put stem cells in a lot of different organs and spaces and help them happen. I think a lot of people think that stem cells means that you're like making little hearts in a, you know, dish and then implanting them. We're sort far away from that. Yeah. You know, we want the regenerative part of the stem cells to work, which is why you might put it in a damaged kidney or something like that.

[B]

Got it. And I've heard you mention that you're a big fan of red light therapy.

[A]

Yes.

[B]

For recovery. Can you tell us what you think of red light? Because I talk about it a lot. I love it.

[A]

Yeah.

[B]

I have a lot of, like, acne scarring and I use red light for that. But tell us how you use it.

[A]

Yeah, Red light is sort of the baseline entry biohack. And I don't love that word per se. But it's a way to sort of optimize our biology for healing.

[B]

Yeah.

[A]

And red light's great because it's simple. It has little to no side effects other than expense, really. That's the only thing I. When people are actually, I get a red light mask, I'm like, if you can afford it, absolutely get it. You know, it helps. And so if you just put it on normal skin, but is sort of unaffected, uninflamed, kind of like where you're at right now, you know, you have just normal life happening. Basically, it helps via a mechanism of. We call it photobiomodulation. It's kind of a fun word to say those photons activate because they're red light. So they're a long wavelength and they penetrate deeply into our skin. Where blue light, shorter wavelength, doesn't penetrate as deep. Right. But that red light goes deep and then it affects mitochondria. And the mechanism is still being really elucidated as to how that works. But it turns on the metabolism inside of our mitochondria and they do better. So those mitochondria in our skin fuel these cells called fibroblasts that make collagen and elastin. Again, I'm going to keep saying elastin every time I psychology, because that's the one we really want to focus on. And it's harder to make and it's a really delicate flower. It's more sensitive to oxidation and aging and photo damage. And so we really want to focus on elastin. And red light can help with that. So that would be why you'd see improvement with your acne scarring, especially if there's some activity happening in it where those fibroblasts us are active because you're making them work better. But where it really shines, this is my world more where it really shines is if you have now created a little micro injury on purpose. Microneedling, a laser, a surgery, something like that. Now things are really working to heal. And we can really fuel that process by putting red light on it. So it's even more efficacious in a setting like that.

[B]

Okay.

[A]

You know, which is what I'm doing all the time.

[B]

I just did microneedling a couple of days ago and I'm realizing I need to do more red light. So thank you for pointing.

[A]

Yeah, it's perfect. That's. I mean, that's kind of best bang for your buck when you're activated from that.

[B]

So when you have your patients Under. Are you ever doing any skin rejuvenation?

[A]

Yes. I am not an absolutist, but I must say, almost always I'm doing that. And the reason for that is, again, whatever sort of procedure we're doing from a surgical or minimally invasive standpoint, it's focused on anatomy and positioning and rearranging and kind of putting things back where they were. With those procedures, I'm usually moving fat pads back to the home that they were at before they moved away. Right. That doesn't do anything to the overlying envelope. And this is where I get into breaking down qualitative versus quantitative changes. The qualitative, the structure of our skin. Nothing surgically really touches that at all. This is where the regenerative medicine comes in. But the regenerative medicine, like the stem cells and the growth factors, just like the red light, work way better if there's a stimulus for that response to be happening. That's where the laser comes in. So I use lasers like a cocktail in my practice. I don't just do one. I don't just do the same thing for everybody. It's very much, who are you? What are your needs? What are the unique aspects of you we can address? So then I'm going to mix up the ingredients. I have lasers to kind of get the best and most efficacious cocktail for exactly where you're at. But that involves little micro injuries, again, on purpose. Very targeted, very controlled. And that's where we want to really help those heal. But that's the qualitative benefit of making new collagen again and new elastin tissue. The really, really hard one to make.

[B]

Have you heard of the CO2 laser?

[A]

I have heard of the CO2 laser.

[B]

Okay.

[A]

I use that one often.

[B]

You do?

[A]

Oh, very, very often.

[B]

Okay. Because I'm very curious about it. But it scares me that you kind of come out of it looking like a burn victim, almost like you have blisters on your face. It's a lot. And I'm nervous about that recovery.

[A]

Yeah.

[B]

And then don't they generally. I mean, other doctors would put you under anesthesia for that.

[A]

Right, right. Yeah. There's a few ways to do that. And defining what lasers are I think is important because there's lasers, there's other devices like radio frequency microneedling. I've heard you talk about Morpheus on here before. And it's really getting. Lasers are a specific wavelength of light. They are very targeted. So precise like that. Literally one wavelength of light has a specific target in the skin that it can hit. So with the CO2 laser, it's a very specific, it's the most specific laser that we have to hit water or collagen. And so, and it does so with such an affinity that it immediately heats it to, we call it vaporizing temperature. It's like greater than 100 degrees Celsius. It just kind of gets rid of that little area. So it provides a very precise amount of heat and definitely can control it so, so well. So when you think of a CO2 laser and you think of like a burn victim or that's not really what's happening because it's also not just taking the whole surface of your skin and getting rid of it, it's pixelating it. So it's like micro coring or people would say like aerating your lawn a little bit, but in a very sophisticated laser esque way. And so for something like acne scarring, that's going to be your gold standard to improve that and you have to do it in a way that is thoughtful and progressive and it shouldn't be a burn victim situation when you're done and you should be using these aggressive regenerative medicine, modal afterwards to help the healing happen. Not just faster, but better, better end results. I live in this like space of, you know, I'm taking a lot of people who had something done prior acne scarring surgery and they're like 7 or 8 out of 10, like it's pretty good but they know there's a little bit more on the top and that's the space that I live in to kind of help those last little bits happen. And that's where these little things help. Even if you're getting 5% better because of, well, let's do that. That's 5%, that's, that's real results, you know. And so, you know, for acne scarring, say, rarely am I ever just doing a CO2 laser by itself for something like that. I'm usually using fat based stem cells and often a little bit of fat underneath the scars to help support them. So there's just a lot more to it. You have to, and this gets into all the surgical aspects too. You have to think upstream, downstream, what are all the things that are contributing to this problem. And instead of just tractor beam focusing on one part of it, we want to be looking more holistically about how we can make all the other areas better.

[B]

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[A]

Oh, absolutely. I know most of what I do is surgically, again, minor things from an invasiveness standpoint. But if we want to go just down a non surgical route, we can absolutely do that as well. So for something like acne scarring, laser fat transfer, and I think that we'll get into this at some point, but when we start talking about fillers and filler alternatives, that's where something like fat transfer becomes a really beautiful option for that and can be something that's performed by itself or with a laser often.

[B]

Okay, let's talk about fillers. Do it. People my age are obsessed with fillers and I, I want to, I've talked about this before, but I've dabbled with it in the past. I've gotten lip filler a couple times. Not for a while because it hurts so bad. I was like, I can never do this again. And then one time, and this was my biggest mistake I've ever made. But I got it under my eyes.

[A]

Yeah.

[B]

And it looked crazy. Like when I smiled, my eyes just disappeared. So yeah, that was a very long time ago and I'll never do that again. But what are sort of the, what should people understand about filler before getting filler?

[A]

Yeah, well, I know you've talked about this on here before and I've had Celeste on and Dr. Yoon talk to some other people. They're really great and have, you know, lots of experience with them, getting them using Them. And I think that really understanding what they are, you know, the ones that most people are thinking of and the ones that you've had, I believe are these cross linked hyaluronic acids. And then I know you've talked about Sculptra on here, which is a biostimulant that you inject and it stimulates the growth of collagen. And so. Which sounds real sexy, right? Like, why wouldn't we want to do that? Let's do it.

[B]

Yeah, it sounds great.

[A]

And there's a bunch of other, these other biostimulants. And so it's really getting into. Okay, which one of these are we talking about? Because they're all under. Under fillers. And I also think a lot of people get fillers confused with Botox. Right. And you could see why that might be because you go to the injectable place and there's this magic array of all these little wands that they can do that help you. And so Botox is a whole nother category. Right. But when we talk about the fillers, these fillers are adding a gel that's intended to create volume. That's. That's where the baseline is. And so how old were you when you had your fillers?

[B]

Do you remember the under eye or the lips?

[A]

Either one.

[B]

Okay, so I'm 30 now. I probably got the under eye like five years ago, six years ago. And then the lip for the last time I got, it was probably two years ago.

[A]

Yeah. And so that you're. That's the younger end. And that's when people are often getting into this verse. And that makes perfect sense because they sort of have this idea about them that they're very low entry, they're not overly expensive. You can get them almost anywhere within here. There's probably five places within a mile that we could get it done. And so that seems so innocuous, but not like, no big deal. Let's just get it done. We have to understand at those ages especially, and even into our 30s is you probably didn't have a lot of volume loss happening at that point. Maybe the first steps of it. Right. And even in the long run, we have to understand how much volume loss plays into our facial aging. Because there's multiple parts of facial aging. There's volume loss, there's redistribution, there's change in positioning. And I always tell people to think about like breast tissue, because we can really put our mind around that as the breast ages, it doesn't just shrink, it changes shape, distribution, the direction. All the types of things. And so when we want to rejuvenate a fat pad in our face, it's very analogous to that. We have to think about, okay, well, if you have, let's just say an extreme age, a 70 year old breast, you're not going to add an implant to that breast to rejuvenate it. That's not going to look very good. Right. And that would be like adding filler to an aging face. Just doesn't look very good. So when we're getting it at younger ages, we really need to think of it more of a, instead of a rejuvenating type of treatment, trying to turn back the clock a little bit. Oftentimes it's transforming a little bit. Like making your lips a little bit bigger than they ever were prior. And that's totally fine. But we have to think of it that way instead of thinking, well, I've noticed some aging change in there. Probably very little of that aging change is volume. So when you're using volume to restore it, that paradigm gets off a little bit under your eyes. Again, an area you probably had very little actual volume loss. There's probably some genetic predisposition there for you to have a little bit of a tear trough or lower lid, eye bags we would call it. That's probably why when you got your filler, you're calling it the biggest mistake ever because you replaced what wasn't lost volume with adding volume to it. And it probably made your eyes smaller and kind of this like magic.

[B]

I didn't even dislike my under eyes. I don't know. She was just like, I would recommend doing it. I was like, okay, okay, yeah.

[A]

And you trust that person because you go to this person who's an expert, their mom wrote their bio, they're the best injector. They did all, you know, you know, it's all over.

[B]

Yeah.

[A]

Everybody on every corner is like the best ever. And so you trust them and that's. Why wouldn't you trust them? You know, you should do that. And that's where the paradigm gets off a little bit, because then you come out of that and you look different. This is my big question for everybody, especially after filler results is look at them and they look different. But do they look, look better? You know, because every filler result afterwards, it's different. But is that what you want your lips to look like? Is that how your lower lid should look? They were certainly different afterwards. But you went to somebody who you trusted and you paid them money and it looks different. So you Assume, well, this must be better. Right? This is. I. I trust that this is what it's supposed to look like. And this really interesting phenomenon happens especially when we're younger. Right. Where we're kind of setting our true north star every time we look in the mirror. That's your identity of who you are are. Right. And that changes over time. And if you all of a sudden look 65 today, that would you think what happened? But when you're 65 and you look in the mirror, you're gonna. That's you. Right. Because it's the slow evolution over time. So when we start adding filler into this mix and equation, things slowly morph and that becomes your new true north. What you see in the mirror slowly over time. And then the way that the paradigm works is, well, you need to get it done again in six months or a year. So you do it again, and you do it again and you do it again, and that slowly morphs, and all of a sudden you don't really look the same that you did before.

[B]

Yeah.

[A]

But that is what you are now perceiving as yourself. It's called perception drift.

[B]

Huh.

[A]

Your perception of yourself is now off. The same thing happens to your injector who is getting a double dose of that, because they're often injecting themselves too. So they're looking in the mirror and they're getting that change. But then they're also getting you coming in, or their patients coming in all day, every day, who've slightly morphed from the norm, but that's. They're getting that set is like, well, this is what it's supposed to look like down the line. So they're getting kind of a double dose. And you'll see that in injectors. Often if you walk into your injector and you look at them and they look a little bit off, you know that their true north has been reset. And it's true. And it happens all the time. And you're laughing, I'm assuming, because you know what I'm talking about. But you still have that person inject you, knowing that when you look at them, you're like, this is not what it's supposed to look like, but this is what they do, and they're the greatest. And it just, it's. It's very prevalent in this perception drift.

[B]

Totally.

[A]

And this is when I see people, especially younger people, because now they're in trouble a little bit, and they've realized somebody told them they saw an old picture or they just had that Aha. Moment where, oh, shoot, I don't look like myself anymore. My lips aren't what they used to be. The filler has migrated, whatever it may be, and it's sort of like, well, now what we. Now what do we do?

[B]

I saw on your TikTok account you had a younger woman in the office who kind of. It looked like it had migrated and was creating, like, imbalance, I think. Do you get a lot of those cases?

[A]

I do, yeah. So when. Once the filler is placed and present. And again, I am not anti filler. Right. I just think that our thought paradigm around it needs to shift to be what it is. And we can talk about, I think, what the big misperceptions and misunderstandings things are. And those are that it lasts a year or two. It does not. It lasts decades. And I see it in tissue all the time. That's a huge deal.

[B]

Okay.

[A]

The dissolution part of it, it doesn't work as well as we all like to think that it does. It's not a magic wand where if you just don't like it, you put the magic enzyme on and it all goes away. Some of it goes away, some of it breaks down, but a lot of it hangs around. I can't tell you. Every week I see somebody who had filler 12 years ago, and they've had it dissolved six times, and I still find it in the face all the time. And this is my lens, my world. And, you know, I have to acknowledge that that could be a sampling error, but I see it very, very regularly. Right. So it lasts longer than we think. It doesn't dissolve that easily. And it does move. We know that for sure. And we have evidence to back all those up through imaging studies and biopsies and what I see inside of tissue. And so if we understand those things, that it lasts a long time and it moves and it doesn't probably go away, it just shifts other places. Great. Then we can use it more appropriately. Right. And so I see folks who have been through the rounds of not liking it and having dissolution, and there's a whole conversation around pros and cons to dissolving. And oftentimes, when I'm getting to them, it's a point where, okay, now we are doing a few things. We are getting rid of the filler. That's problematic, some of which I'm doing manually. So through these invisible, scarless approaches, I'm trying to get the filler and manually remove it. Then we're also usually correcting the underlying thing that led them to get filler in the first place, that little genetic predisposition, whatever it was. And that's the, it's a really common scenario for me to be in where we're just like, okay, let's just keep this as stealth as we can, hit the reset button as best we can. But even in that, the sad truth is I can't get rid of it all. Even with dissolving, even with manually removing, it doesn't all go away. And especially in some very important areas like our lymphatic system, when we dissolve filler, filler is gel, that it like these polysaccharide sugar gels that get cross linked together. And this cross linker is not great either. But when the enzyme breaks it down, it breaks it from polysaccharides into disaccharides, like two groups. And they're still cross linked though. And our body has to clear those out, which it does through like normal metabolism in our kidneys and in our lymphatics. Well, those little guys get stuck in our lymphatics. And I see this in surgery all the time too. If you had, if you had filler 25 years ago and only had it one time, I know that when we do your surgery today, whenever we're doing it, that you're going to have more swelling afterwards because your lymphatics aren't going to work as well to drain that out. And that's a very acute amount of swelling. We're putting a bunch of load on those lymphatics from a surgery from little micro injury and they just can't drain as well. But a lot of people that have had fillers see this in these little microenvironments all the time. When you have a vaccine or a cold or get your teeth cleaned or have hay fever and you get this little systemic inflammatory reaction that your body's reacting to and your filler gets inflamed. Your filler gets inflamed because your immune system recognizes that it's still there. It is not inert completely. Our body knows it's not supposed to be there. And there's this little chronic inflammation that happens around it. And then that gets revved up by this systemic process that's happening. And this can be an aha moment for a lot of people too. They're like, oh yeah, my cheeks get sore when I get a cold. That's your filler lighting up. Or my lips get a little bit swollen when I get my teeth cleaned or when I have, you know, whatever it Is. But then that fluid doesn't drain out as well either. So you have this kind of prolonged swelling. So a lot of people. Again, that'll be an aha moment where they're like, oh, that does happen to me a little bit.

[B]

Yeah.

[A]

Yeah.

[B]

Are you a fan of lymphatic drainage massages? Oh, okay.

[A]

Yeah. I love them, and I use them postoperatively for my patients afterwards. Not only is it, like, a beautiful, wonderful experience to have it done, but it really does help, like, our. The way that our head and neck drains. It kind of goes to the back of our head and then down into our neck. And so most of the time, I'm focusing on the drainage through, like, your collarbone, clavicular area to help the lymphatic strain out.

[B]

And you mentioned sculptra. What is your opinion on sculpture?

[A]

Yeah, so sculpt. It falls in the same thing. Sculpture is an. The idea of injecting this stuff called poly lactic acid. It's a little acid that gets injected, and it is used in medicine in a lot of different ways. We use it in sutures, in orthopedics. They use it in these little bony screw anchors that they put into the bone, and then it goes in, and then it kind of dissolves over time. So our body breaks it down and gets rid of it because it's a little foreign body. So when you put little micro particles of this in your face, our body recognizes it as a foreign substance, and it lays down a little collagen border around it. So that's why I say, on one end, stimulating collagen sounds really sexy, and on the other one, you realize the reason we're stimulating collagen is because we're putting a foreign body in there, essentially, and we're creating this very specific type of inflammatory reaction called a giant cell reaction. Maybe it's not as sexy to do that. Right. And also understanding, well, what part of our facial aging. This gets back to, like, being curious and having common sense. What part of our facial aging is due to collagen loss? So if we just lay down a bunch of sculptra. A bunch of collagen, is that really the thing that we need to be replacing? Should we be replacing lost fat with fat? Should we be replacing lost fat with collagen? And I would say that in small quantities, it can do a really great job. It can be a good option. In larger quantities, I'll see people who've had three, six, ten sculptor treatments. It gets problematic when I do a surgery on that Person who's had all of those treatments, it's a whole different animal in there. Normally a surgery, when I take these tissue planes, like if I'm doing a little lifting procedure, they just separate beautifully apart. It's like opening the pages of a book. It's meant to open there. I'm going in areas that are very specific to be sort of separated out. When someone's had Sculptra, it's like you put a bunch of glue in that book, little dots of glue everywhere, and then I'm trying to open it without tearing the pages. It's a whole different animal. And I, on my Instagram, have some videos dedicated just to Sculptra. One of my highlights, I think, is for Sculptra, you can go look and see some of them are slightly graphic surgical videos. Not too bad. But you can go see what that actually looks like. These little weld points and these little white fibrotic areas of where the collagen is getting laid down. And I think it just puts a visual on, like, this is what's actually happening underneath our skin. So, again, not bad, not good. I just think it has to be understood for what it is, used appropriately. And this is my world and my opinion, fully my opinion. But I think there's better options to do what Sculptra is trying to do.

[B]

I think the way they sell it, which is interesting, is that it's stimulating something that already exists in the body. So I fully thought sculpture was like the bougie, correct version of filler.

[A]

Right.

[B]

So it's really interesting to hear this.

[A]

And that's not completely incorrect. Right. It's where the Sculptra is getting injected. Right. People put it inside of the subcutaneous fat of our skin, of our face, and that's the fatty layer that exists right below the skin. And our fat, fat pads in our face are actually in multiple layers. There's deep ones, there's superficial ones. They're meant to be the glide planes so that our muscles of facial expression that allow us to emote and animate and communicate can move very freely. So you could imagine that you don't want these little weld points in those areas of these fat pads that are supposed to be highly mobile and moving. That's where things can get. Collagen is essentially what scar tissue is made out of. Those little points don't move quite the same. And so there can be these subtle changes that happen that don't quite look right even from a normal animation standpoint.

[B]

I feel like Something I've noticed lately is this fascination with the upper bleph. Am I saying that right?

[A]

Yep.

[B]

So I've seen a lot of girls, even my age getting this done. Have you noticed that in your practice?

[A]

Yeah, this is one of those things where my job becomes to heavily educate.

[B]

Okay.

[A]

Upper bleph is short for a blepharoplasty, which is just means an eyelid surgery. Right. Changing the upper eyelid, eyelid. And it is trendy in a younger group right now in the, like, 20s, 30s. And this is where I have to get into sort of educating what's actually happening there. Right. Because when I really explore my job, my first thing that I do when we meet and we're like, having our first conversation is I want to seek to understand what you're after. It gets a little. And this happens all the time. It gets a little dangerous. If you tell me, like, I want an upper blepharoplasty, and I'm like, let's do it. Makes you happy. You know, get, for me is like, great, I get to do a surgery, but that's not what you need. Right. And this happens in all facets with. Sometimes a woman comes in and says, I need to want a lower face and neck lift. And the surgeon's like, great, let's do it. And that ends up being a really bad outcome for that person. In the end, she got what she wanted. The surgeon did the procedure, made her happy. But there was no second order thinking as to what did you actually need? What are the upstream and downstream effects of that? Because now you have this really tight fold lower face and neck, and everything else is sinking on top of it, and you look kind of ridiculous and unnatural. And that's what everybody thinks when they think of bad plastic surgery, is that first order thinking? Right. So the upper bl for young people is a first order thinking problem. Right. I. I have something in my upper lids that I don't like. Okay, well, let's explore what that is. Because in reality, no parts of our face age individually. They all age in unison. Right. Your forehead ages at the same rate that your cheeks and your jawline, while your genetic predisposition plays into what shows up first or what bothers you, maybe. But everything is aged in unison to some degree. So if your upper eyelids bother you, what's happening with your eyebrow up above? How's that playing into. Did you just get Botox? And now your forehead's heavy and you think you have extra upper eyelid skin? Super common. Do you actually have a Little bit of asymmetry to the space of your eyes. I call it the aperture of your eyes. Do you have this funny word that begins with a P where the P is silent, called ptosis? Do you have one eye that's a little smaller than the other that you notice when you take a picture or when you're sleepy first thing in the morning, late at night, or when you have a glass of wine? Well, that's not an upper eyelid surgery. That's not the same thing. So it's really delineating what's happening. And it's often, especially in a younger age group, one of those other things that is more responsible or partially responsible for what you're seeing. So your surgeon or whoever it is, really has to understand all of the factors that contribute to that one thing.

[B]

How often are you turning people down?

[A]

Very, very, very often. And it's not even that someone has an unreal expectation or doesn't understand. It is really. Again, for me, this is a huge relationship. I don't do four surgeries a day. And you're not. Case number three, the eyelids. It's like you're Mari and we're together forever, and I will always be there for you, and we will always talk, and I want to see you through this process forever as best I can. And so, from a capacity standpoint, you can only do that so much. Right. So I'm really choosy about who I work with for that, and because, you know, we both want that to be a happy relationship, and it's just a really personal thing for me that way. So I guess I have to give that caveat that it's not that I'm saying no to people sometimes because, you know, I think they're a bad candidate or they don't want something real. A lot of times, it's just I want to work with people who value what I have to give them. You know, like, if you appreciate all the things I can do for you, great. And if you don't, I'm kind of doing you a favor because you don't. You know, if you don't care about the recovery process and the hyperbaric chamber and all these wonderful things that we're going to do afterwards, I'm not a great value proposition for you.

[B]

Yeah, I think that's such an asset, though. Like, I really think. I hope people are becoming more educated about that side of things. And, you know, just by listening to podcasts or whatever it may be, I'm just. I'm thinking about the culture around plastic surgery and even the before and after photos on the Internet. I think that's a really. Like. I went through a little phase a couple years ago where I thought that I wanted a boob job. Like, I was certain I wanted a boob job. I even got the consultation and my whole for you page was these before and after photos. And I was just obsessed with looking at them. And even filler before and afters in la, they're really big. What is, what is the danger of the before and after photos?

[A]

Right. Well, there's a bunch to this and from a very. So there's two parts to this. There's the nuts and bolts logistics of the before and after dangers, which is. And I talk about this a lot. It's hard, especially as a consumer, to understand what a good before and after photo is from the level of like some. I could take two photos here right now that look incredibly different. Like the best results you've ever seen. And all I change is the lighting or the angle or the settings on the camera. Has nothing to do with the actual procedure that was done. And I see this done a lot. I like to think of this in Hanlon's razor, this thought paradigm, where most of the time I think it's because people just don't know. But oftentimes I see you. This person definitely knows what they're doing and they're altering their after photos. So that creates a dangerous expectation as to what's going to happen afterwards. You're now going in with. There's no way you could have realistic expectations because you see after photos that are totally different. So that's part one. And again, I like to think that that's mostly just like people not understanding, not doing it on purpose. But you thought as a consumer, you have to be careful. Does this person know how to take these before and after photos?

[B]

Yeah.

[A]

Part two, then is okay. It's different, but is it better? Right. And that's especially different for something like filler, which is more again, often transforming than it is rejuvenating or a rhinoplasty, a nose job or a breast augmentation. You're kind of by definition changing it into something that it never was before. So what the before and after photos you're looking at are not of somebody who's exactly you. Right. There is no. You can't show your doctor a photo of you five, 10 years ago and want to kind of go back to that. Like, that's a very realistic metric at that point. This is just something totally Novel and new. So you have to be careful with that too. And then it really gets into. Are the photos good? Are they better, not just different? Do you trust what this person can do? Are there lots of those consistent photos? It's not like I saw a couple that looked like what I'd want. And the other ones. Yeah, not so much. Well, that's. You're not. What are your odds of being the 2% of the good ones that you like? So there's that aspect of it and then there's just the creating cognitive dissonance by looking at these photos, which you probably experienced a little bit. It's hard to look at a lip before and after. You're like, well, my lips don't look like that. Is that. Should they look like that or should my breasts look like that? And that's where this transformative part is. It's not what I do. Basically, I do rejuvenative. I turn back the hands of time a little bit. I don't change you into something that you ever were. It makes me happier. It's just what I like to do. Not that that other part's wrong, but it's. They're harder targets to hit at that point because you don't. That. That lip that's different goes back to. Is that what your lips supposed to look like? Is that what your breast is supposed to look like? You just. It creates a lot of internal struggle as to. It's just like makes me sad a little bit inside in some way. Not sad, but just like it's. It's a struggle. It's a lot of work. It's a lot of emotional and cognitive to manage. Like, what are you supposed to do in that situation?

[B]

A little bit totally. I've even seen my personal weight loss before and after end up on plastic surgeons pages, which obviously I didn't do plastic surgery. So that's pretty wild to know that they're just stealing photos and posting whatever. So you actually don't even really know what you're looking at.

[A]

Right.

[B]

How often do people come into your practice showing you a photo?

[A]

Yeah, all the time. And I ask for this. It's funny with the stealing photos. Marby, who's sitting with me in the back, our social media coordinator. Photos get stolen all the time and in all kinds of settings. And it's blatant. Like we watermark them and then they get stolen for all kinds of purposes. Right. And that's just crazy. That's another. I guess I didn't even talk about that as A logistic is. Is this even this person's real before and after photo?

[B]

Yeah.

[A]

And so you'll see with my before and after photos, there's usually multiple sets of photos, multiple angles. There's usually a video. And oftentimes the way I like to do it from an educational standpoint is you can see that person's in entire journey from what we talked about before surgery the day of. Right. After a month, after three months, like, so there's a whole longitudinal gets kind of hard to steal that, you know, but that's kind of one of our struggles, right? Yeah. So I ask for photos. I generally like to see them of their goal. Well, and for me, in the rejuvenative standpoint, their goal is just, I want to see photos from the past every decade. So let's say you're 50 years old and. Or 30 years old, and you have, like, I have my first signs of lower eyelid bags. Say that's a really common 20s, 30s issue because it's strongly genetically predisposed. So you have your first 5 or 10% of aging that's happening on top of that genetic predisposition, and it turns into this conversation. Well, I kind of always had them a little bit, but now they're bothering me. And so let's see the photos from when you were 15, 20, 25 years old. And you can usually see that little evolution happening. So for me, that's great. Our goal is not 15 years old, but I can see exactly what the curve has looked like over time. So I know where my targets are. So I love seeing photos of the actual patient. Of the actual patient. It's a different story if they're. And I don't do this, to be honest, but if they bring in a picture of a celebrity that they want to look like, that's a whole different animal. Because now we're getting into that transformative side of thing that's not you, and that's not what we really. What, again, that's not what I find value in as much. So I don't want to do that. But I do love current photos, old photos. You can see the transition that's happening. It's. There's a lot of aha moments like, oh, you always had this little ptosis look when you were in your 20s, this incredibly beautiful picture of you. That little bit of Isla difference was even there then. And it's like, oh, my gosh, you're right. You know, so we have these little micro targets that we can go after.

[B]

What is the most Common procedure that you're doing?

[A]

Yeah, from. So the fat transfer and the laser that we've talked about a little bit. I think there's a lot more of the fat transfer to talk about, which is really cool. Those are kind of a staple of almost every procedure that I'm doing either by themselves or as part of the surgical procedures that I'm doing. When we get into the surgical procedures, the most common are definitely around the eyes. Because eyes are this very incredible part of our face that show all of our emotion, our nonverbal communication, how old we are, if we're attractive, all those things. Even like babies who have no sense of beauty recognize their moms by looking at the central portion of their face. We have these hardwired areas in our temporal lobe of our brain. Brain. This part called the fusiform gyrus, recognizes nonverbal communication. This part called the amygdala, recognizes emotional aspects. Like we can recognize more emotions than we can name in the face because of these cool parts of our brain. But it's all in the eyes. And so anything we do around the eyes is very important, very high impact, and we can do very little change there and have really nice results. And so when you look at my before and after results, which is what my practice is built on, basically, a lot of times you're looking at em, you're like, I can't even really tell what happened, or it looks like nothing happened, but it looks better. That's what that is. It's like triggering those little key areas of our brain that are highly in tune. And so I can take advantage of that in a way and be like, well, all we have to is these little changes to a little symmetry, a little this, a little that. And then all of a sudden it looks incredible. And. But you look like yourself and like nothing happened. So eyelids really, really play into that.

[B]

Fat transfers. I actually don't even really know what that means. Yeah, can you explain?

[A]

Yeah. So. So this gets into the idea of fillers a little bit. It's not the same. They're not this perfectly like, you know, if A, then B type of setup. But they're comparable in the sense that fat transfer is taking fat from another part of your body and moving it to a new location. We're going to talk about the face mostly because that's my world. But you can do it to breast tissue or buttocks tissue. That's like a Brazilian butt lift. I know you guys talked briefly about that on here in the past. Whole different animal than the Face, face, right?

[B]

Yeah.

[A]

Not even comparable conversations, actually. Different quantities, different way to do it. When I'm moving fat to the face, I'm doing so in very low quantity but in very high quality. So if I take a little bit of fat from you, which is this very minor process, we can do it when you're fully awake if we need to. Usually the person's like, you know, under that little bit of sleepiness for their procedure. But I use this little microcannula. It's like a teeny little thing like you would use to pump up a basketball, like, like a slightly larger version of that. And I use this little hand syringe and I put a little suction, I get some fat out, right? Minor deal, kind of like a little needle poke to get that done. But then I have your fat. And let's say I have your actual fat. Mari. It is going to be so stem cell dense and rich and perfect and wonderful because our fat is one of our most abundant sources of stem cells on our body. Our bone marrow and our fat are those best places to get them. So I can take your fat, I can take a little bit out, I can isolate this beautiful stem cell dense portion of it, and then I can use that, for lack of a better terms, as a filler to refill your fat pads. Because our fat pads lose a little bit of volume. That's not the only change that happens in them. They structurally change too. And I can refill a little bit of the volume that happens by putting fat directly back in the fat pad. Like, for, like kind of makes sense. And then the little regenerative aspect of those stem cells will also strengthen the structure of the fat pads. When you're in your 20s and 30s, our fat pads are like a honeycomb with fat in it. They're structural, they're strong, they stand up to force. If I take a 60 or 70 year old's fat pad, it's more gelatinous, it's not as strong anymore. And so we want to rejuvenate or regenerate back towards that strong structure in there. So the fat has this double benefit of being structural in its volumization and then recreating some of the actual bones, if you will, of those fat pads to make them better. So it's a little bit of a process and a procedure. I get very, I call myself like a fat connoisseur. I get very into this as far as, like taking fat and turning it into different sizes and different compositions and different stem cell densities. But Those stem cells help it take and, and they make it reliable. They give that regenerative benefit. And then because of the regenerative benefit, your skin also gets better because the fat cells are releasing those exosomes and those growth factors and it gets to your skin and you get more elastin tissue. So there's a lot of benefits to doing that, but it is a little procedure versus getting filler. And that puts a barrier for a lot of people because you have to be facile, you have to be able to do it. You have to have the setting to do it. And so there's just a little bit more to it, but it's much longer term.

[B]

Yeah.

[A]

Fat cannot migrate like filler can do. Once the fat is in the fat pad, it has to establish a blood supply, set up, and live there. So it cannot move. Once it's set up versus filler, that goes, sits and then starts to diffuse out from that area.

[B]

And when you put it in, it's.

[A]

Also with a needle, it's with a. Yeah, a little. It's kind of like filler where you'd use this little microcannula to put that in as well.

[B]

I feel like I imagined fat transfer as a full lifting of the skin thing.

[A]

It's a very non surgical way to do it. I'm accessing the fat pads and I quite literally go through your face one by one, each fat pad. And there's a superficial layer and there's a deep layer. And I just am visualizing again, back to that 3D spatial part.

[B]

Yeah.

[A]

Visualizing where these fat pads are. And this one just needs a little bit, like barely any. This one needs a little bit more. And then we kind of work through them because every fat pad is 8 age to some degree. And so I can just touch through. And in doing that, I can be really subtle with each area. But then when you step back and take the 30,000 foot view, it's like this whole area is rejuvenated and looks really nice.

[B]

Is that usually like cheeks?

[A]

Yeah, I'll go through forehead, temples, upper lids, lower lids, cheeks, jawline, around the mouth, sometimes hands, everywhere. Whoa. That can lose volume.

[B]

Okay. I had no idea.

[A]

Yeah.

[B]

So if I'm already under for my CO2, right. Might as well get a fat dragon transfer.

[A]

Right. Well, and again, it's. It's a value proposition. Right. Like if you have 5% volume loss, like is it worth, is that juice worth the squeeze to get, you know, 5% of your volume restored? But yeah, if there's a Little bit more. In some other areas or for managing acne scarring, the underlying fatty structure becomes really important because that scar is, you know, if we look at our normal skin structure, there's an area of it that is contracted with collagen. It's not as strong ever as your normal skin is. And, and then when we start losing the underlying fatty support when we're young, when we're in our teens and twenties, our fat is so robust and like literally keeps our skin tented up. And as we start getting early signs of fat loss and it starts to lose some of its sort of support of the overlying skin, that's when acne scars actually usually start to show up more. So patients that have acne scarring, we may not see them in their teens and 20s, but they may start coming in their 30s and 40s because they're losing a little bit of the underlying fatty support and it's no longer pushing that acne scar up and open. Well, now we can go to the scar directly with regenerative medicine and with laser to help restore some elastin. Some blood scars tend to tend to not have many blood vessels in them. So you can restore some blood vessels, some color, whatever it is in the scar itself and then we can volumize the scar and we can support it from underneath a little bit better. So that's be like a really winning combination for something like an acne scar.

[B]

So 30 isn't too young to get?

[A]

Absolutely not, no. And again, but you have to 30s not to end to get it done. If that meets your value proposition and it hits all the points that are important to you, we can keep it so minimally invasive from a standpoint that it's like you're not like doing a bunch to do that. You're keeping it very in bounds from a stealth standpoint and from a, you know, picking the low hanging fruit to a degree.

[B]

So I know you work on a lot of very high profile, high performing people. Is that a lot of pressure? Because I can imagine if it's like a performer or someone on stage, you're sort of responsible for their face.

[A]

It is, yeah. And this is where the relationship part of it comes in and this is where the seeking to understand comes in. And this is where the, on my end, the education part comes in. Most commonly when I see somebody for a fix or revision, which is a great proportion of my practice, 65% of people that I'm working with, I'm taking care of something that was done prior that wasn't not even. That was really bad. Sometimes they're in trouble. It was really bad. Sometimes it just wasn't great. They got their seven out of 10 and it's like, I know there's more okay, then there's 90% of people have done something prior and it's just, you know, neutral, no big deal. But with a lot of those folks I'm working with, sort of their past experiences, I'm not going to say traumas always, but there's a lot that goes into that. So part of my job becomes to educate them on what is realistic in their recovery. Because a lot of them were told, you're going to have this procedure done, two weeks later, you're fine and it's over with. There is not a procedure that you can do. Maybe microneedling is a little bit different because it's so minor, but there's not really a procedure you can do that's going to have a robust result where two weeks later you're fine like nothing ever happened. That's not how our body heals anything. Even you get a cut on your leg, it's not healed two weeks later. It takes a long time when that's on your face and you're healing from something. Even if it's non surgical, even if it's acne, scarring or fat and laser, we have to really discuss, okay, here's with our actual curve looks like to get through this. And so that's a big part of any high performing person where whether it's a someone who's in the spotlight or is just us and wants like, when can I work out again? You know, when can I get back to my life? And you have to like, really, that's where the relationship comes in, the education. Like, we really have to get to like, here's what this looks like for you, Mari. It's different than it's going to look like for the next person and the next person and setting those expectations, having the right relationship and then really focusing on our recovery again, you're an athlete who just got injured. Think of it that way. You're not returning to the game two weeks later. What does it look like for you to get back to your real life and how can we expedite that? How can we use hyperbaric oxygen? How can we use targeted IV nutrition, pemf mats, you know, light therapy? What can we do to like accelerate the process as much as we can also get you a little bit better results and then just make that a great experience. So when we're done. We're like hugging each other and like, that was so great. Thanks.

[B]

Yeah. And I guess with your procedures, you're not really creating a ton of scarring. So someone who maybe is in the spotlight could show back up to work a month later and not feel like it's obvious.

[A]

Exactly. And this is a very unique thing that I do that's like a little bit different in our field where I'm really focusing on those, like, stealth outcomes where, again, doing a lifting procedure of the face or jawline through a little spot in the temple is not normal. You're not going to find that very often. And especially in a way that kind of gives the results that I'm giving. And so that makes that really lines up for some people. And. But if you're 65 years old, that's probably not the right procedural choice for you because it maybe can't quite do what you need. And so I'm always just. Again, that's part of the seeking to understand going through the right options for you individually. These are not five minute conversations, which is the norm. That's what I hear all the time. I talked to somebody else. It was like five minutes. It's. I mean, we're in this hours at this point to get to the right spot for you. And yeah, it makes it. It makes it more accessible for somebody who is high performing in a busy life to get a lot of these things done.

[B]

Amazing. Well, I've learned a ton and I'm ready to schedule my appointment. I don't know how long your wait list is, but I'm gonna get on it. Thank you so much for coming in.

[A]

Thanks for having me.

[B]

I have to ask you the question I ask every single guest. The community loves this question. And whenever I skip it, they get very angry.

[A]

Okay. All right.

[B]

What does wellness mean to you?

[A]

Yes. So thinking about this question has been my favorite part of coming to visit you so far. Honestly, I love this. And it's. I've talked to friends about this. Marvi and I were talking about. I've talked to my wife about it. It is. I love thinking about this because there is no right answer to this. Right. And it's different for every person. And this is my opinion. This is a evolving journey throughout your whole life. Wellness is. And I think the first step of that is understanding your mission, your values, your purpose, which is hard to do. You have to be able to sit down with yourself quietly, and you have to go through what that is. That changes through your whole life changes when you're in your grinding phase and getting something, it changes when you become a parent. It changes as your business changes, as your workouts change, whatever. Like, what did God put you on this earth to do? Basically, understand that, right? Part one. Then once you understand that and you have to do it all the time, and you have to be able to sit with yourself uncomfortably do that, then you can get into the climbing the ladder, into the grind, into the what, what can I do to do this? And a lot of people are really good at that. They're good at the hustle, they're good at the grind, but they don't know what they're climbing for, what they're after. And they don't know when they got there because of that, or they get somewhere and they realize, I didn't want to be here. This isn't where I wanted to be. Right. So you have to be able to get to that. And then I think the third part, this is. I think what a lot of your audience is going to resonate with is you have to be able to do those things in a healthy way. Healthy for you from an emotional standpoint, from a relationship standpoint, and from a physical standpoint. Like, how are you doing that? Are you checking in? Are you burning out? Is the grind too much? Do you know? And so I think it's this constant. I do this quarterly, basically. I sit down and I look at my old ones, and I look at where I'm at now. Sometimes it minorly changes, sometimes it doesn't, but it gives me this, like, fresh, okay, here's what I'm working for. And I love that work. I love the grind. If you don't, you're maybe skimping on the wellness at the other end of your health and your emotional support. And so you just. I think you're constantly cycling through this, and that is wellness. Climbing the right ladders in the right.

[B]

Way, reevaluating at all times. I love that. That's great. And having flexibility, too, in the plan.

[A]

Right. And you have to have grace and compassion for yourself because, you know, nothing is perfect. Nothing ever. This is what I struggle with in my world. I am obsessed with my results.

[B]

Yeah.

[A]

That is, like, what it's all about for me. But I. That's unhealthy if I get too into it. Right. And maybe you don't want to hear your surgeon say that, but I. I'm obsessed with them. I. When we finish our procedure, I do my medical note, of course, like the documentation, but then I also go by myself and I sit in the sauna and I just journal, what did we do? What decisions did I make? What was unique? Because I want that to get better. And every time I do something, I change it a little bit. And what can I do to make this a little bit better this time? But I don't get feedback on that for months afterwards, right? Because I don't actually get to see the results. So then when I get your photos and your videos and Marvi gives them to me, finally someday I have this wonderful experience. Like, okay, I have the photos and the videos, I have my journal, and I just get to go digest that all out. But again, being too obsessed with that can be a little bit unhealthy. So when I look at the afters and I'm like, there's that one thing I wish was a little bit better. It's like, okay, 99% of it's great. There's that one thing. Like, let's just, you know, take the grateful attitude for what everything is.

[B]

I feel like you're in the right line of work. I think you're saying all the things everyone wants to do.

[A]

Right. And I love it. So it's good.

[B]

Where can everyone find you online?

[A]

Yeah, my most active on Instagram and we'll link to that in here. I have a TikTok as well that is very similar. And those are really focused on before and after photos and then on education about the procedures, about filler, about recovery, and then a little bit of just general like health and wellness. And that's actually really good towards my colleagues in this, like, peak performance. How do you get to peak performance for to show up every day, which is great for surgery but also great for everybody who's going through daily life.

[B]

Fantastic. It's great content, guys. Go check it out. And thank you so much for coming on the show.

[A]

Thank you for having me.

[B]

Thanks for joining us on the Pursuit of Wellness podcast to support this show. Please rate and review and share with your loved ones. If you want to be reminded of new episodes, click the subscribe button on your preferred podcast or video player. You can sign up for my newsletter to receive my [e-mail] it will be linked in the show Notes. This is a Wellness Loud production produced by Drake Peterson, Fiona Atex and Kelly Kyle. This show is edited by Mike Fry and our video is recorded by Lis Vargas. You can also watch the full video of each episode on our YouTube channel at Mari Fitness. Love you POW. Girls and power boys. See you next time. Time. The content of this show is for educational and informational purposes only. It is not a substitute for individual medical and mental health advice and does not constitute a provider patient relationship. As always, talk to your doctor or health team.