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Botox, Fat Transfers & Microplastics: The Future of Clean Plastic Surgery | Dr. Cameron Chesnut
01:30:40
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- [00:00]
A
On today's episode of the Real Foodology.
- [00:02]
B
Podcast, most commonly now when I hear somebody say, or you know, even just like kind of off the cuff, like, oh, I don't want to look like so and so. Now most of the time when people say that, interestingly, they're talking about somebody who had filler, not somebody who had surgery. And people don't know the difference, they just know that somebody looks funny. The immediate attribution is plastic surgery, but it's actually filler that's causing that now.
- [00:24]
A
Hi friends. Welcome back to another episode of the Real Foodology Podcast. What happens when a world class facial plastic surgeon applies the principles of functional medicine and metabolic health to the operating room? In this episode of the real foodology podcast, Dr. Cameron Chestnut joins me to expose the hidden toxins of the cosmetic industry. From fillers he calls the seed oils of beauty to plastics and phthalates still used in most surgeries, and to share how healing and recovery starts with the body's unique biology, he's redefining beauty through regeneration and proving that peak health and peak performance are the real anti aging tools. If you're loving this episode and loving the podcast, if you could take a moment to rate and review, leave. A five star review means so much to me and it also really helps the show. Thank you so much and I hope that you enjoy the episode. Cold and flu season is upon us and I have something in my back pocket that I always bring out during the winter just to make sure that my immune system is really bolstered. I love Colostrum. In fact, my mom got me on colostrum about 10 years ago. Colostrum is the very first milk, known as liquid gold that babies receive from their mothers after birth. It's packed with proteins, natural growth factors and antimicrobial peptides that work in harmony to enhance your immune response and reduce inflammation while also repairing and balancing your gut lining. And it also helps with reducing bloating. Today's sponsor is Cowboy Colostrum. They offer the highest quality bovine Colostrum available in the US it's 100% made in America from 100% American grass fed cows, which we love. It's sourced from the first milking of US grass fed cows, but they only collect the surplus Colostrum after baby calves have had their fill and they don't over process or strip their colostrum like other brands do, leaving it whole, full fat and high protein for ultimate nutrient density, making it the highest quality bovine colostrum that you can buy. It's easy to drink, made with delicious natural ingredients, no artificial flavors. You simply add a scoop of the chocolate, the Madagascar vanilla or the strawberry into your coffee or smoothie. And as an added bonus, the natural growth factors and peptides will make your hair and skin look amazing. For a limited time, our listeners get up to 25% off their entire order. Just head to cowboy colostrum.com realfoodology and use code realfoodology did you know that all chips and fries used to be cooked in tallow up until the 1990s when big corporations switched to cheap processed seed oils? Today, seed oils make up 20% of the average American's daily calories and recent studies have linked seed oils to metabolic health issues and inflammation in the body. Vanicrisps decided to do something different about it. They created a tasty and delicious potato chip with just three ingredients and no seed oils, heirloom potatoes, sea salt, and 100% grass fed beef tallow. That grass fed beef tallow is not just for flavor. It's packed with nutrients which are great for your skin, brain and hormones. Snacking on Vandy is nothing like eating regular chips with vanity. You feel satisfied, light, energetic. You have no crash bloat or gross sluggish feeling afterwards. It's 100% American made with zero compromises. It's the best chip that I've ever had. Plus the added bonus is that the beef tallow makes the chips so much more satiating, so you won't find yourself uncontrolled, binging and still feeling hungry afterwards. Personally, my favorite flavor of Vandy is the herbs de Provence or the French onion. The French onion is unreal. If you're ready to give Vandy a try, go to vandycrisps.com Real Foodology and use code Real Foodology for 25 off your first order. That's vannycrisps.com Real Foodogy and code Real Foodology for 25 off YOUR first order. And if you don't feel like ordering online, you can find them at Sprouts and stop by and pick up a bag before they're gone. Dr. Chestnut, thank you so much for coming on today. I have really been looking forward to this episode.
- [04:15]
B
Thank you for having me. I'm super honored to be here. Excited?
- [04:17]
A
Yeah. So we were actually talking before the show that you grew up very similar to me, which I was really shocked to hear because I generally think and sorry to stereotype you, but someone who's in your field I wouldn't necessarily consider to be Someone that would be super on nutrition. And you, what you have done in your office is remarkable. And I'm so excited to talk about all this today. Can you talk a little bit about how you grew up and how you got to this point?
- [04:40]
B
Yeah, yeah. I think the commonality there. My mom was a nutritionist, a registered dietitian, and that I took a lot away from that just with learning from her and how we did things. And as I grew up, I realized that she was a bit counterculture in her world, which I was too young to I think realize at the time. But even with the ada, the American Dietetics association, how she talked about their interaction with the food industry. And I just happened to be this memory of mine of growing up at a time when margarine became like the suggested fat to have. And I remember my mom thinking that that was crazy. Asinine were her exact words. I remember learning that word around margarine, basically. And this had to do with a lot of different oils that, you know, she's. These were industrial oils and she said this when I was a kid. And they will not be in our household and margarine is not a great option. And so we were taking like local grass fed butter and she was adding olive oil to it, which I think is a commercially available product everywhere now. But at the time she was making it herself. And so there's, there's even around her time restriction of her eating and things like that. And I paints my mom as this like really cool countercultural person, which she probably wasn't actually. She was just a little bit more rational and that really shaped how I viewed nutrition and food. And she taught me a lot. And as I got more into sports, honestly is when those things really started clicking for me, I was like, these are enhancing my performance. They're making me better at this goal that I have. And I think if we were to just like timeframe shift to where I'm at now, it's kind of the same thing. I like to leverage those types of things metabolically, nutritionally, recovery wise, because it makes my current goals better, which is better procedures for me, better outcomes for my patients. And I think that's like a lot of the common connection between those right there.
- [06:16]
A
Yeah, it's so cool. I was so. I loved hearing that part of your story because I was curious where you kind of got into all of this, because if people follow you on Instagram, they know that you're very about environmental toxins, you're very about the outcomes of your patients. And I'm not saying other plastic surgeons aren't, but you're on it on a different level than I haven't ever seen in your world, which is really cool.
- [06:38]
B
Yeah, the more, the more you look, you know, the more there is to improve results for me because, you know, if I were to theme a lot of this, I want the best outcomes for my patients, but that comes for me with a bit of a selfish motivation, is that I have a carry, I'd say healthy obsession with the results that I produce. That's my, my passion. And so it's a win win for both of us. But I'm looking for single digit percentage points of improvements in these things at the level that I'm at now. And there's a lot of levers to pull to do that that are just sort of unexplored, which is a lot of things that you talk about regularly though, you're right. Are just completely ignored. In my field. We could go into even just the personal performance side of it, which are largely ignored in all surgical fields in my opinion as well. Which is terrifying or unfortunate or, you know, however you want to label that.
- [07:25]
A
Yeah, I think it's a little terrifying. And the fact surgeons like, for example, when you get surgery, most surgeons are not telling you before and after. Let's be mindful of your diet, let's you know, eat anti inflammatory foods. Here's an anti inflammatory protocol, which I know you do, which I'm going to get into things like that that can really change the outcome for people's overall outcome for their surgery.
- [07:45]
B
Yeah, absolutely. And I have a luxury and I will. This is an openly admitting this. I have a luxury that I have a really tight relationship with my patients, which is one of my core values as a surgeon. I have low number, I would say like low quantity, high quality interactions with my patients. All elective people are coming to me from all over the world at this point. I have a lot of interaction with them before they come, a lot of prep time, which is unique. I'm not meeting somebody and then we're operating the next week and they're from my hometown. It's somebody coming from far away. So we have a lot of. I have a lot of ability to do these things beforehand, which is uncommon. And so I like that though, because it helps me even for my colleagues that maybe don't have that same luxury. Maybe they're in a different specialty, maybe they're an orthopedic surgeon and somebody comes in with more of an acute thing. There's still things that can be pulled out of this. I think from my colleague's perspective, then for every patient, everybody who's going to have a procedure, not even just a surgery, there's something to pull out of all this, which is what I hope kind of some of the takeaways are.
- [08:38]
A
Yeah, for sure. Well, let's get into it because I. So I just hit my 40s last year and I'm starting to see things drop a little bit. And in my world, where I come from, Botox is a huge. No, no. Especially there was like some studies that came out recently showing that it crosses the blood brain barrier. And it's a big concern of mine. But also my whole job requires me to be on camera. You know, my job is contingent on how I look to a certain degree. And I want to know your thoughts on Botox. And is Botox the seed oil of the beauty industry?
- [09:09]
B
Ooh. Well, I think I'm going to shift the paradigm a little bit here for you and say I'm a little bit more neutral about Botox as opposed to something like fillers that we'll talk about. I think fillers are the seed oil of the beauty industry. Just to like blow that off right there so you can get into that.
- [09:24]
A
Filler was better than Botox.
- [09:26]
B
And this is. This is where the discussion comes in, I think, a little bit into this. Botox is a toxin by nature, right? Yeah, it's botulinum toxin. A and Botox carries a bunch of different brand names in the US and different in Europe. So we can talk about Botox, but there's different brands that are important to know. And it is a biologic toxin. It's broken down so it doesn't accumulate. Like, we'll probably talk about some other toxins later that have accumulation. This does not. But when we get into what its mechanism of action, what it's doing and how it affects the muscles in the face and facial aging and things like that, that's where I think we can say, okay, because there is this evidence of it crossing the blood brain barrier having central effects proven by EEG by functional mri. When you really look at those studies really close, there could be just some effects from the peripheral part of it that we know is happening and how that has some remodeling centrally. So it may not be that this is like retrograde axonal movement of the Botox across the blood brain barrier. It could just be that the peripheral effects are affecting how the central nervous system responds to that. So there is that asterisk or caveat, like maybe that could be what's happening. But nonetheless, there's a central effect when you get it. No question getting it in cosmetic doses is different than getting it at other medical doses. It, it carries a black box warning on it that there's distance spread. Right. That is more common when it's used for spasticity, like higher dose medical indications in pediatric populations, people with neuromuscular disorders, it's different. But I would, this is where it gets really messy, is that I would guess that most injectors injecting Botox, wherever we could go, right on the corner around here, could not tell you the black box warning off the top of their head. They just don't know it. Right. Which is what carries into fillers as well. Botox goes in, it gets broken down and it does its job, but its job is to make muscles not contract. So I think shifting gears a little bit, how does that affect our face? Right. Well, Botox is preventative and that's why you're saying like early 40s, first signs of aging. What can you do to make them not happen? And I like to tell my patients that there's this tug of war happening between our soft tissue, let's just call it our skin to be simple, but it's also fat pads and the muscles of the face and how they're pulling against each other. And the constant pull is how we animate. That's how we non verbally communicate. It's one of the core things that makes us very, very human. Right. And we have whole areas of our brain that are dedicated to recognizing that that goes. It's not part of our frontal cortex where we're analyzing. It just happens. Right. So we have to respect those areas and know that if we're taking that away, something looks off just by definition because we're taking away one of our main ways to communicate. And I've caught a lot of heat for saying these types of things in the past. But you know, when we're maybe communicating with somebody who doesn't have as much verbal communication and it's mostly non verbal, say like a mother baby interaction, I would just say, ok, maybe that's the time to think about having your full ability to non verbally communicate. That's there's no shaming there, there's no issues with like if you've had it when you had baby, like that's not it at all, but it's just like something to think about, right?
- [12:21]
A
Yeah.
- [12:22]
B
So how do we shift, how do we think about that. We have this tug of war happening. We don't want the muscle to break down the skin. That's really what the ultimate end goal is. And so you weaken the muscle, and so it can't pull on the skin as hard, and we don't get wrinkles because there's not the muscular force being placed on it. So I say, okay, let's go to, like, root cause and think about this again. Let's, like, just flip and look at the whole picture instead of just looking at the toxin part of it and say, well, what if we let the muscles do their thing normally, not use Botox, and then shift over and look at what's happening with the skin? Well, part of the reason in your 40s that we start to notice this more, it's not that the muscles get crazy stronger. It's that the skin's getting weaker. Right. Like, somebody who's in their 20s has just as much muscular force being placed on their skin, but it doesn't break down in the same way. Okay, well, how do we then make the skin stronger so that we can still have the muscular force and not get the aging changes that accumulate over time? And so that's where I really go, okay, well, let's focus on the regeneration of the skin, which is. We all talk about collagen. Collagen is so hot. You, you know, eat collagen, build collagen. And there's truth to all those things, because collagen is the structural strength of our skin. Like, what? Whether it breaks or not. But there's also a really important little molecule called elastin. And elastin, as I would suggest, is the elasticity, the recoil of the skin. The skin moves, and then it goes back to its normal shape. That's what we really want to. Because that's what's fighting a lot of changes that come with movement, with gravity. We want elastin to be high, but elastin is very delicate. It's much more subject to oxidative and environmental stresses and breakdown than collagen is. Collagen's stronger, quite literally. So we want to focus on things that rebuild elastin, and then we can take that paradigm of pulling, you know, muscles on soft tissue, and we can make the soft tissue stronger, more resilient, more elastic, and voila, we have sort of eliminated. Not eliminated, it's not the right word, but we have reduced the need for Botox or something along those lines.
- [14:10]
A
Something I'm super passionate about. And I think a lot of people forget about this is what you're using to cook your food on. I think we're so focused on ingredients that people forget that what you're cooking your food in can also have an impact on your health. If you're not paying attention to the chemicals that are being used in your cookware, it can very easily end up in your lungs because as you're cooking, it ends up in the air. Also, anything that's in your cookware will end up in your food. So this is why I'm so passionate about getting non toxic cookware and I love of Our place. You can actually save up to $150 when you buy a set versus buying individual pieces. They have a four piece cookware set that saves you 150 bucks. And their cookware is amazing. It doesn't sacrifice performance or safety and it's still nonstick. But they don't use PFAS and they don't use so many other chemicals. And you go look on their website to see everything that they don't use. Their cookware is so sexy. And it doesn't have Teflon, it doesn't have PFAS in it. It's just, it's my favorite. I love it so much. I love the colors that they offer. And if you go to their website you can check out they have pots and pans and then they also have a wonder oven which I love. And then they also have the dream cooker which is their version of the instapot. And they have so many amazing options and in fact they are having their biggest sale of the year right now. Save up to 35% sitewide now through December 2nd. Head to fromourplace.com to see why more than a million people have made the switch to Our place cookware. And with their 100 day risk free trial, free shipping and free returns, you can shop with total confidence. Shop the Our Place Black Friday sale right now. No code needed. Do you ever just feel bloated, sluggish or just off? Even when you eat healthy, your body might not break down food properly. You eat the nutrients, but sometimes you may not be absorbing them. This is where mass zymes comes in. It's packed with 18 powerful enzymes in one science backed formula. It really helps to unlock protein to release vital amino acids which are the building blocks your body needs to recover, repair and also create energy. It breaks down carbs, fat and fiber so you feel light and energized instead of weighed down. You can trust Bioptimizer's science backed formulas because They've conducted over 4,000 lab tests for quality and potency, all backed by a 365 day guarantee. And you know, you can always get 15% off with my promo code, Real Foodology. But if you were listening to this on the weekend week between November 23rd and December 3rd, you can get 25% off plus gifts with purchase on orders above 250. It's the biggest offer of the year. Don't wait, just go to bioptimizers.com real foodology. Your digestion and your energy will thank you. So how would somebody support or also add more elastane? Is this something you can consume? Because with collagen I would assume you think you can consume it and it really does help your skin.
- [17:08]
B
Yep. So I, you know, you can think of the skin a little bit get like a muscular tissue. This is not a perfect analogy, but that you have to have building blocks, then you have to have a stimulus. Like, just like when we want to build muscle, we have to have a stimulus. We have to sort of work it out and then you have to have the building blocks to do it. So there are precursors for elastin that we can have in a normal diet, we're getting those and I'm normal. So what does that mean? Right. But in a diet that's, you know, has the right micronutrients, protein macro ratios, you have what you need to build elastin, you need the stimulus to do it and you're fighting the environmental part of it. So if you have a lot of UV exposure, I am by no means against getting sun exposure, but that has to be thoughtful and respectful. Your skin type versus somebody else's skin type is going to have different abilities to tolerate UV damage. And one of the first things that fails with a lot of UV UV damage is elastin. And when you look at the skin under a microscope, you can quite literally see these gray balls of elastin that have broken down from UV exposure. And they're at the right distance into the skin from how deep the UV can penetrate. Different types of uv, uva versus UVB damage, elastin more, they penetrate deeper. So it's really, really interesting. There's no question when you see it under a microscope, like, oh wow, you can recognize sun damaged skin and it's elastin. So we have that part that's one huge lever we can pull, right, to make sure it doesn't break down in the first place. But then we're going into stimulating it and most of the things just to get into like devices. When you think about stimulating elastin, you have everything from at home, micro needling devices. Right. You have in office microneedling, laser types of things. So these are these like stimuli to make the skin go into a regenerative mode. The interesting paradigm here is that when you injure the skin alone, it heals, but it tends to overproduce collagen in comparison to elastin, which when we think about it, is what a scar is. A scar is very dense, pure collagen that is arranged in one direction versus it. Normally it's kind of more haphazardly arranged in our skin. And so it's a little bit of an aberrancy, but it's, it's functional, it's healing a wound. Right. So we can also take that process and we can, I'm going to say, optimize it. Use growth factors to influence how this inflammation happens. Growth factors can come in the form of prp, platelet rich, plasma, platelet rich fibrin exosomes, stem cells. So these things can take the normal injury that we're causing on purpose with a laser or micro needling device and they can manipulate in a positive way, in this case, manipulate the way that it's healing to create more elastin than collagen, comparatively from what a normal healing process would do. And then all of a sudden we have rejuvenated skin.
- [19:43]
A
That's so cool. So there's a treatment that I get every time I go to la, because there's a woman that I really trust in LA that does this and she does. It's not exactly microneedling. I forgot what she calls it. But I guess apparently it doesn't penetrate as deep as microneedling. But she said it does the same effect because she actually thinks that microneedling can be a little bit too harsh. But essentially it's like little kind of needles that she kind of like buffs your skin out with and then she puts exosomes on top of it.
- [20:08]
B
Yep, great option.
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A
Okay, awesome. I do that a lot. Like every time I go to la, I get that Done. Done.
- [20:12]
B
And at your age, that would be a very age appropriate type of thing to do. Right? That's your little workout for your skin, if you will, going back to that semi. Okay. Analogy. And there's different ways to do that. You're like, she's talking about microneedling being too aggressive. Well, that, you know, it's a bit of a broad statement because you can do lots of different things with different micro needles, how deep, how what the density of those penetrations are. You can even do like radio frequency with the micro needling. These are, these are not my favorite things. I'm just listing them off as sort of options. I tend to like more laser or light based energy devices to do those things. They're a little bit more, let's call it precise. And then I think one of the big take home messages here for anybody who's in this like early stages of aging, just kind of, let's use you as an example is if you're using a device or a treatment like that with the expectation that it is going to tighten and lift your face, you are going to get in trouble. Doing it for skin health like we just talked about extensively. Great. Like if that's the intent of it, that is fine. But if you're putting micro needles deep into your soft tissue and creating damage, heat energy with the intent of lifting and tightening, number one, it's not going to happen. So at best case, you just kind of waste your money or waste the risk or whatever, however you want to look at that. And at the very worst, this is where I see is people that get damaged from that over time because it unquestionably damages our soft tissue, the microvasculature that goes to those soft tissues, which then makes the subsequent procedure that you might want to have down the road more difficult. So I'm not saying they're all bad. If you've had that, oh no, you're in trouble. That's not what I'm saying. But saying at a worst case scenario, that's it. At a best case scenario, it's going to make your skin better. But most people are kind of shooting for this thing. That's not going to happen.
- [21:45]
A
Yeah, that happened to me. I got sold Morpheus. I did it a couple times actually. You know what, it wasn't Morpheus, it was the other one, rf. Is that what.
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B
There's so many names for the same things, which is radio frequency microneedling.
- [21:56]
A
Exactly. I was told it was basically the same thing. It was like the competitor Morpheus or whatever. And I was promised that, oh, it would lift your jowls and do all this stuff. And I didn't have a negative effect to it. It just kind of felt like it didn't really do much.
- [22:07]
B
So you're in that biggest cohort, the group that like had it kind of nothing happened. It was a waste with risk, basically.
- [22:13]
A
Exactly.
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B
So the, the risk to benefit this doesn't weigh out in that. In My opinion?
- [22:17]
A
Yeah. Oh, that's so fascinating. So what do you like? And I'm also curious. I have a girlfriend that just created her own derma roller. Do you know who Jamie Ann Esthetics is?
- [22:26]
B
I don't.
- [22:27]
A
You should follow her. She's really great. Her whole thing is skin care.
- [22:29]
B
Okay.
- [22:30]
A
And she just came out with her own little personal derma roller that you can buy. And she said that a lot of the derma rollers that you can buy on like, Amazon or whatever, they. I'll probably mess this up. But it's like a little spin wheel. And she said that the needles are.
- [22:42]
B
Kind of messed up, kind of enter and tear. Y.
- [22:44]
A
And they can. Exactly. They can injure and tear. And so what she did is they're individually placed needles, and it's a little derma roller thing that you use like 10 times or something, and you replace it. It's surgical steel. Her skin is. I've never seen skin like hers before. And she had a botox injury a couple years ago, so she's just face taping derma rolling. Her skin looks insane.
- [23:02]
B
Incredible.
- [23:03]
A
What do you think about derma rolling?
- [23:05]
B
Yeah. So that would be like one of those little micro workouts right there to do it all the time. And there's, you know, pros and cons to the different devices out there. And so, yeah, if you find one that you like and you're using regularly and you're seeing good results with it, that's awesome. The next level is to then add something more regenerative to it. The one that you're describing with her usually are very superficial needles, in a good way. This is very superficial in a good way. So you can do them more frequently. They're disrupting the skin barrier. They're a little stimulus to change. And, you know, this would be akin to your workout. Every workout you do shouldn't be your 100% on the day.
- [23:32]
A
Yeah.
- [23:32]
B
You know, most of them should probably be like 80% of what you're capable of that day type of a workout. And that would fall into the same type of a skin treatment where you're causing a little stimulus. They're hormetic stresses on our skin. Just like fasting sauna. It's like applying that to that same thought paradigm to our skin.
- [23:47]
A
Yeah, exactly. Like creating a little injury or inflammation to then get your cells to go in and repair.
- [23:52]
B
Yep. Cool.
- [23:53]
A
What do you think about red light? Do you think it works?
- [23:54]
B
Oh, yeah. So red light's a huge part of my post operative recovery protocol, which Is definitely something that I'm known for. Like when my patients come in, they stay with us. We have a home for them to stay in. It's beautiful. It's on the water, it's got fractal patterns of plants and mountains and everywhere. It's like so healing. Right. And that would be like the very sort of like I would say organic part of the experience. But then every day that they're with me, they're also in a pretty extensive recovery protocol that is based around hyperbaric oxygen, red light, pulsed electromagnetic frequencies, all kinds of fun little things in there. Nanov and biochargers and a lot of things to sort of get them healed faster. Red light being a very, very, very, very key part of that in multiple ways. There's just the systemic effect of the red light on mitochondrial health and function. We know how that works. Krebs cycle via cytochromes and incredible. Probably most importantly with my patients is most of them are having a skin based treatment at the time of even if they're having a surgery. I'm often treating the skin simultaneously. And now you have a direct injury to the most exposed part that we can get red light to. And we can really optimize that healing with red light. And if we can, I could super nerd out on this and get into the varying wavelengths of different types of tissue injuries. I even use red light on my stem cell rich face fat in the operating room before I transfer it and which is a different red light than I'm using post operatively different purposes. But I'm activating stem cells with red light. We know that they're, you know, they have photobiomodulation to them from the red light. And so if I take your fat like this would be like a, what's an alternative to filler? As we get to that, I'm going to talk about fat transfer because it's more than just adding volume. It's also regenerative to our fat pads, the structure of our fat pads and to our skin. And so I can increase the regenerative potential of something I'm already doing with red light in the operating room room. That's going to fall on that 1% for me. No question.
- [25:39]
A
That is so cool. Oh, it's so cool. I love what you're doing in the operating room. It's so cool. Well then let's talk about that because that was going to be my next question is what would be the alternative to filler? And I want to know your thoughts on prp. I actually got PRP done. I had pretty deep under eyes a couple years ago and I got PRP done a couple times and it actually worked and it stuck.
- [26:01]
B
Yeah. So I think there's three things to unpack here with that that are really all important points. There's just filler in general, I think, which is a big topic. And we could go superficial or deep into that. I think there's what the alternatives are. And then under that falls a little bit of the prp. There's something called pdgf, platelet derived growth factor that's out now as well. It's another sort of regenerative protein. And so filler is. I'm going to just define there's different types of filler. If we were to split it into two categories, you're going to have your bio stimulatory fillers. And since this is an academic talk, I can talk about like things like Radiesse and Sculptra. Those are going to fall in these. Like you inject them. Their intent is to cause an inflammatory reaction that builds collagen, which is like the wrong way to think about it, but that's how they're marketed to do. Right. They create a foreign body response and your body tries to heal from that. Those are one thing. Causing an inflammatory reaction in collagen building. Not great, honestly. In the end then we have the much more common hyaluronic acid fillers. This is what has been around for decades in the United states now, since 2003, they've been really, really heavily used. Over the last 10 to 15 years, their use has just like exponentially increased. And these are Restylanes and Juvederms and RHA and all brands like that that anybody who's in the industry has heard about. They're. And the whole thing around them is that the fillers are not bad. Like, I just, I will say they are not bad. The understanding around them is troublesome. And going back to that injector, who doesn't know the black box running on their Botox? If we were to get into the same questions with them about do you know what you're injecting and what it does, there's just so much misinformation. They, they have no idea. Uh, they're poorly trained, they're trained by the industry, however you want to say it. They just don't know what they're doing. So when you get filler, they're telling you, well, this is, this gel. It's part of our normal human anatomy. It exists in Our skin, we put it in. It adds volume in areas that you've lost volume. If you don't like it, we can just get rid of it. We can use a eraser on it. It goes away. There's an enzyme that's really simple to get rid of. It only lasts like 6 to 12 months. Well, some of them. Oh, this one lasts actually 18 months. It's longer duration. And when we put it in, it goes there. And that's. That's where it is. It doesn't move or anything like that. And we could literally break down every one of those things as untrue. And that is 99.9% of the time what is being told to the patient that is getting it right. So I get this. In my world, I'm definitely swimming upstream in this area a little bit. And it's not because I want people to do surgery. It's because I want them to understand what they're getting when they get these products or procedures done. And when you get into the duration of it, they do not last last 12, 6, 18 months. They last decades. And there's variability to that. But I regularly, every week I see filler that's been present for sometimes it's one, three or five years, sometimes it's 13 or 20 years. Sometimes I have patients from Europe who had it more than 20 years ago because it was available over there first. And they still have filler from this one injection. So it lasts a long time. And when I see it still present, I'm looking at it. I see it in different forms. I see it encapsulated like a breast implant would be sometimes, where we've created an inflammatory reaction around it and we've walled it off. I see it floating around free like sugar. I see it in the musculature, which is problematic because it attracts water and looks funny. This is ultimately what everything boils down to is it starts to look really funny. If you buy into that, you know, get it frequently, it doesn't last that long. You can just get rid of it. It does not break down easily with the enzyme. It does work, but it's not as though you magic wand, put one application and all your filler's gone. It's. It becomes a pretty onerous process to truly get rid of it all. And oftentimes we don't ever get rid of it all. Same thing. I see people who have had multiple dissolutions, 5, 10 rounds of dissolution, and it's. There's still filler present, most certainly this.
- [29:45]
A
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- [33:11]
B
Yeah, the pendulum is swinging a little bit and there's this, like, filler fear that's happening.
- [33:15]
A
Yeah.
- [33:15]
B
There's more awareness around it. A lot of the situations that you're talking about where we would see. See this, you know, drastic change if you really break it down. And look, it happens slowly over time because people are subscribing to the last six to 12 months. So I got to get it.
- [33:27]
A
I got it on more.
- [33:29]
B
And. And the one thing we didn't talk about is that the filler moves when it goes in a tissue plane. There's nothing to keep it in place, so it moves. And so a lot of people would, like, get it in their lips and they'd get too much. Our lips can only tolerate a very small amount of volume. They're. That's not really what lip aging is. If we get into it. Yeah, there's a small amount of volume it can tolerate. It's getting three to five times that volume. And guess what? The pressure and muscular movement causes the filler to. And then you think, oh, it only lasted three months in my lips. Well, the filler's not gone. It just went somewhere else. So then you add behind it and guess it backfills and keeps moving. Right. And so this process happens, and there's been this name attached to it that is really good. And it's a psychological phenomenon called perception drift. And if we get into how, you know, psychologically it works, it. It makes sense, and that you have these small micro changes. Your. Your norm adjusts to your new true north, basically. So it's not just your norm that's adjusting. It's also your injector's norm.
- [34:20]
A
Yeah.
- [34:21]
B
And in my opinion, nobody really talks about this, but the injector, a double dose of that, because they're getting what they see in the mirror for themselves, plus the tens of patients that they're seeing every day coming through. So they get these, like, micro adjustments, and this is what normal looks like. And we all know when we get the snapshot, like, you know, a celebrity, like, this is not normal anymore. And so it happens slowly, but then we get these, like, snapshots that. That looks funny. That's off. You know, and then the funny part in my office is that most commonly now when I hear somebody say, or, you know, even just like, kind of off the cuff, like, oh, I don't want to look like so and so thinking, talking about plastic surgery, it used to be like, you know, this guy whose eyes got feminized from an eyelid surgery or something, like, I don't want to look like that guy.
- [35:00]
A
Yeah.
- [35:01]
B
Now most of the time when people say that, interestingly, they're talking about somebody who had filler, not somebody who had surgery. And people don't know the difference. They just know that somebody looks funny. The immediate attribution is plastic surgery, but it's actually filler that's causing that. Now.
- [35:14]
A
That's so interesting. And I also, I read somewhere, maybe I saw like a social media post where surgeons, when they go and do facelifts, they're just seeing all these, like, pockets of filler everywhere. And that really freaked me out.
- [35:26]
B
Exactly.
- [35:27]
A
That is. I don't. I don't want to know what that's doing long term.
- [35:30]
B
Right.
- [35:31]
A
What is the alternative? Like, is there something that somebody could do? For example, if they want to do their lips and they don't want to do filler or what would you do in the under eye?
- [35:37]
B
Yeah. So this is where I really get into like thinking root cause. What's happening. Some of our facial aging is truly volumetric, right. We have fat pads all over our body, not just in our face, but we can think of all the fat pads, pads that we can think of. And they start at a certain structure and over time they don't just lose volume, but they also usually sink down with, with gravity and they redistribute. Think of a breast tissue. Not a perfect analogy, but another good one. It's not just losing volume, it's not just sinking, but it's sinking, shrinking, redistributing, right? So if we just apply that to our facial fat pads, that's how they're aging as well. Our facial fat pads are different in their function. They're very important in how our muscles function in our face. That's kind of their main purpose is to be a glide plane and vectors for how musc, which we talked about earlier, how important those muscular contractions are. So the facial fat pads functionally are linked to that muscular movement, to non verbal communication, which is why they give signs of youth and vitality and things like that. And as they change, we pick up those changes, right? And most people, it's like hard to explain, but you know it when you see it. Unless you get into like my level, then I can explain everything, right?
- [36:40]
A
Yeah.
- [36:40]
B
So when we think about how those fat pads change, it's not just about adding volume, which is what filler is doing. So if we think about that breast tissue, tissue that's aged and you add an implant to it, it changes the volume, but it doesn't change the position or projection of it, right? So now we switch to, okay, we want to add volume, but we also want to change the structure so that it's stronger. Our facial fat pads are very unique compared to other fat pads. Even when we talk about thighs, body, whatever that they. Some the best way to think about them is almost like a piece of honeycomb. So there's these collagen septae inside of them, a lot of them actually in our facial fat pads. And then the fat kind of fills the middle where the honey would go. And we're lose volume or we lose the honey out of it. But we also want to make that structural part of it, the honeycomb, stronger as well. This is why something like fat transfer is such a beautiful option for this. Fat transfer comes in lots of different shapes, lots of different ways to do it. But when you really focus on fat as not just volumetric but also as regenerative, now you're Addressing the. The honeycomb structure and the volume of that fat pad altogether.
- [37:38]
A
And it's not a foreign object. Your body already recognizes it like for like.
- [37:41]
B
And in the United States it's approved for that because although it is a regenerative proced in a sense we're doing it at the same. We're harvesting, you know, processing and using it at the same time. And it's quite literally like for like. So it's totally okay to do as replacing lost fat with new fat. All great. The element that that's missing if we really get into it, as we talked about like volume, shape, projection, things like that is. So now we've talked about restructuring and revolumizing. But then it's the positional part. That's where things like surgery come in. But they're. That maybe not absolutely essential because you've addressed two out of the three things very robustly, very respectfully. I would say not overdoing any of you've done it in a way that's durable. I think when you get in trouble is when you try to overcompensate for something you're not doing by overdoing some other aspect, which is what we see with volume in the face. People think they're getting a facelift with filler, but they're just over puffing over volumizing and it looks crazy, but they're like, oh look, my jowl's better. I'm like, your cheeks also up here. Right. So it doesn't. That's not how we're built to go. It gets all into the root cause part of things.
- [38:40]
A
Yeah. And I'm curious, where do you get the fat from like physically? Like, is it from like someone's stomach? And what do you do if someone's like really thin and they don't have a lot of fat to give?
- [38:49]
B
Right. So. Oh man. So there's a bunch in here. I can always find the fat that I need. You could give me a low single digit body fat percentage guy, which is a large part of my practice or, or woman. And I'll find the fat that I need because I don't need that much. And I'd be like, go for mine. Well, so this gets into the location part of it too. Right. So when I think of harvesting fat, I think about it different. The traditional way to do fat, like let's say you're doing a breast augmentation with fat. Not something I do at all, but just as a comparison person or a butt lift with fat, you take fat out Put it back in immediately, just kind of in out one in the other type of thing. And that's a very sort of crude way to do it in my opinion. That's sort of like the volume you harvest is the same volume you transfer. When I do it, I harvest and then I process the fat into the types of fat that I want. So I'm taking the regenerative capacity of it and I might take only 10% of what I harvested because I'm looking for quality of that fat. And our face, thankfully we don't need a ton of volume. So I can do that much more easily than you could in the body. But that very like stem cell dense fat I call it and just we can like measure the stem cell density of it is the key to having very predictable amounts of fat take. It's the key to the regenerative part of it. And you know, even doing things like I was talking about the red light are really important to make that work. But then when I go to put that fat in, I'm aiming for these fat pads very specifically. I'm thinking about how that goes. And you know, that whole process is very different from a regenerative capacity than just kind of, kind of like taking it out, putting it in, thinking about it. So I can get the fat that I need. I don't need that much to do it. When I'm taking it or where I'm taking it from is dependent on the number of stem cell density that I want. Right. So I'm definitely asking you like, where do you hang on to fat? What are the, your problem areas? But I'm also thinking that, I'm thinking of the quantity and the quality of the stem cells. That single digit body fat percentage person metabolically is going to have really, really healthy stem cells in their fat. They're like survivors if they're living in that single digit body fat percentage. These are the ones that are. They're not going anywhere. Right. So that's good. So it'll be really, really high quality. And then from a quantity standpoint, it's very dependent on where I take it from. So to simply answer the question, I'm usually looking at abdomen, flanks, thighs and buttocks.
- [40:57]
A
Yeah.
- [40:57]
B
More centrally. Like the closer, a crude way I think of it is the closer to your belly button we can get, the more stem cell density we're going to get.
- [41:04]
A
Makes sense. It's usually where most people hold fat anyway, so. Wow. The quality thing, that's so interest. Thought about that before. That's really cool.
- [41:11]
B
Huge. And I, we, if I have somebody who's like a higher bmi, more metabolically unhealthy, it's a whole different. We know from the get go that we're going to probably need a larger harvest to get the quality of the fat that we want. So it's just a whole different sort of process for them to get what we want.
- [41:28]
A
Yeah, that's so interesting.
- [41:29]
B
And those stem cells perform differently.
- [41:31]
A
I'm curious, do you think that it's better to just get a few surgeries along your lifetime versus chasing filler and Botox?
- [41:40]
B
Well, I mean this gets into goals a little bit and where you're at in the process. And I can probably use that to answer a little bit of the last question that we didn't about like prp. Oh yeah, right. PRP under your eyes. And because it really boils down to the same question you asked is what are your needs? Where are you at in the process? You getting PRP under your eyes and having a good outcome does not predict that somebody else who has lower eyelid issues is going to get PRP and have the same thing. What's happening in your lower eyelids? What's going on there? Do you have a genetic predisposition exposition to eye bags because of your, the, your bony structure or what happened with your palate? And all kinds of things we can really get into there. But in that situation, that's an anatomic change. And the prp, something like PRP is not going to have an effect on that. You know, in your 40s. Things that, you know, maybe could have been addressed when you were 6 or 8 years old are not. It's not going to change that. Right. So your PRP under eyes would be different for somebody else. If the, if you're just lacking volume in that area and you put in something like prp, we have to think, okay, now we're talking about putting a regenerative product in a fat pad with no volum volumetric benefit directly. But we can restructure the fat pad a little bit. Kind of like the honeycomb part of it. Again, you could have a benefit from that that's durable and real. So that would be like a. Oh yeah, that might have a benefit, but it's probably not the perfect solution for it.
- [42:55]
A
Yeah.
- [42:56]
B
Then you have a situation where you have aging related changes in your lower lid from sun exposure, inflammation, whatever it may be, that have changed the structure of the soft tissues in your lower lid. Now putting something regenerative into that can have a huge benefit because that's the main thing that's moved and changed which, which may have been your situation or who knows, you're probably in one of those latter two categories. And so you get something like PRP that's regenerative in nature and you have a durable long term result out of it. That's the ideal.
- [43:22]
A
Yeah.
- [43:23]
B
So it's just not this one size fits all approach. So jumping into your question about should we be chasing Botox fillers versus having procedures, it's like, well, what are we after? What are our goals? What's our, you know, tolerance for invasiveness. Part of my practice is really focused around getting around that last hurdle of doing things. Like if we go to the lower eyelid example for that first person who has genetic anatomy changes, I can fix that. And I say fix, you know, respectfully or fix it without putting a scar anywhere, like completely invisible to do that. So now we've gotten around a lot of that invasiveness part of things. And this person is now restructured for the rest of their lives. That doesn't mean there's no maintenance involved with the other aging changes, but we've sort of fixed the anatomy part of things with it a little bit. So, so cool. It's just so variable to do. And again it just gets into like, what are we after? What are realistic expectations? What's long term? I really like to think long term with things. And you know, if, if you're, let's say mid-40s now somebody and they are notice noticing gravitational changes. That's a hard one because they're. The traditional thing is do nothing or do these devices that aren't going to work or go to a facelift. Right.
- [44:32]
A
Yeah.
- [44:32]
B
Which is super invasive on the other and probably in my opinion overkill for what most people in that category need. But I'll see people in their 30s who are getting a very traditional deep plane facelifting procedure because the surgeon that they to want went to. That's what they offered. Right. And then. But there's a middle ground to that and this is the space I live in that's like a little bit less invasive. We can still get some surgical results long term durations, but you don't have incisions around your ears and things like that in that particular type of a group.
- [44:56]
A
Fascinating. Well, I was going to ask you because everyone's talking about Kim K. And Lindsay Lohan's transformations, which are unreal. I think I DM'd you about this because I was like, what is happening here? I need to know Right. I mean, Lindsay Lohan looks insane. Do you feel like they got DM plane. What do you call this? Deep plane surgery?
- [45:13]
B
Plane lift. Yeah. And so, yes, getting into that, the different types of deep planes, they had some version of that. And whether that's the right treatment for somebody in their early 40s, it's debatable. Right? It's. It's interesting because when you look at what, like what you were sending me, when we get into all of those celebrities who've had it recently, when you see those images versus, like, sort of images in real life that are not brushed, not touched, you can really actually kind of see better what they had done. And. And it's, you know, less flattering, I would say. But I'm not saying they don't look great, but you can kind of start to get a little bit more hint of the. What happened with them a little bit. So in that younger age group, having these procedures done gets divided into not doing it, doing something extreme, doing something in the middle, which is the space I like to explore and live in the most, like, kind of what's right for you. Because doing procedures earlier, let's say Lindsay Lohan or something like that, doing a procedure earlier has benefits in that you're achieving the thing that you want to achieve. And presumably, presumably the most minimally invasive way possible. This is what I'm shooting for. Like, how can we get what you're after with as little input as possible? The 80:20 rule applied to your face, basically, how do we get 80% of those results with 20% of the input? That's a. That's a good outcome for somebody who's young. When you do them younger, it's more durable too, because your soft tissue quality is better and you can get to a better point. Like Lindsay Lohan or whoever, getting a procedure now, she'll always look better than if she would have waited 10 years. She'll never be able to get to the same point. So less surgery, longer duration, better results. Those things add up to be. When it's right. Right for you. It's. You can explore doing that. So there is no age to do it. The right age, the wrong age. It's really, I would say, an introspective. I always encourage my patients, like, be introspective here. Like, is this the right thing for where you're at right now? Do you want this in this way? Does it line up from a value proposition? Not even financially as much as just like, for what you're after and what you need to Achieve these goals that you're after. Because it's mostly, let's say somebody's like, really following something. They're very, very healthy person. You can change your aging curve for sure, but there starts to be this decoupling that happens, no question about it, with your appearance versus how you feel. And I kind of always say my job is to live in that space and make those match up better. That's what I want to be doing.
- [47:24]
A
Yeah, yeah, yeah. That's amazing. I want to know what surgeries do you think make the biggest difference in people that are looking for? Maybe just like a rejuvenation or. What I always like to say is I always want to look like me. I just want to look a little refreshed.
- [47:37]
B
Right. Yeah.
- [47:38]
A
What do you think works the best?
- [47:40]
B
So I like to think about this, again, getting very nerdy on a neuroanatomic level, like how we interpret faces, beauty, communication, things like that. That going to that level really helps me understand this question on a different level. Because most people come to me at 40 and they're like, I'm noticing these changes down along my. I have a little bit of laxity here. And the real truth about that is nobody else walking around is noticing those changes. You're noticing them because when you look in the mirror, you're in your frontal cortex, your analytical part of your brain, and you're, like, assessing everything.
- [48:09]
A
Yeah.
- [48:09]
B
When you and I meet for the first time, we are in our temporal lobe or these other parts of our brain that are interacting, interpreting, like, what's your emotion right now? What are you thinking? What's coming next? Are you engaged in this conversation? What do you, you know, what are the nuances of our conversation? But in that is really highly leveraged around eyes and mouths, which makes sense. Right. That's even where most of our muscles of facial expression are located, around our eyes and our mouth.
- [48:30]
A
Yeah.
- [48:31]
B
So there's a very simple way to answer that question. That is anything you do around your eyes predominantly or your mouth is going to have a much greater impact on your overall perception to the world. Like, what the. How the world is interpreting you, what you're putting out from an age vitality. You know, people say, like, how awake they are, but I would just say that's sort of their overall vitality and symmetry. Right. Eyes are where it's at. And so the beautiful part of that is that those procedures with me are the least invasive, so the most likely to maintain your character, who you are, but look like you had a great night's. Sleep, or you're slightly more refreshed, or we've restored symmetry a little bit. I do that. I approach that very differently than most people would approach it. You know, most people would say, oh, I have an older eyelid. My eyelids are droopy or hanging. I need to have an eyelid surgery. And I'd say, step back. What's happening with your forehead? What's happening with your. The aperture of your eyes, like how physically large your eye space is. There's asymmetry. It changes throughout the day. Thinking a little bit more that way because then we can achieve. If you've. I mean, I know you've seen some of my before and after results. The idea is that you look at them and you're like, I don't even know what happened right there, but I know something happened. But that person looks better.
- [49:36]
A
Yeah.
- [49:37]
B
And I. I can't even put my finger on it exactly. But this is brighter, lighter, better. You know, more vibrant. That becomes especially true when you take away the before and after, because right then we have analytical comparison. But if you just take away the after and you just see. Or the before, you see the person walking around in the real world and they just look great, and you have no idea kind of what they look like before, but, oh, this is just bright. You got better night's sleep. That's what most people are kind of saying.
- [49:58]
A
Yeah.
- [49:59]
B
Yeah. So that's. That's a long answer of saying, generally things around the eyes carry the most impact. But that's a flipped paradigm from what I hear from most people. So I'm always sort of walking this line of what can we do to have the greatest impact versus what are you holding the most value in? And trying to line those things up. And sometimes they do, and sometimes they don't. And sometimes we do both, or, you know, we. I ultimately want you to be happy.
- [50:19]
A
Yeah.
- [50:19]
B
When all things are said and done. But it's. My job is to help you navigate sort of what you're seeing and feeling with sort of how your interaction with the world is too.
- [50:27]
A
Yeah. Have you ever turned away a patient or. Or at least been like, I'm not doing that to you because you don't.
- [50:33]
B
Need that all the time. Yeah. Yeah. And so I. The way that I. Because everybody's traveling. To me, my initial. Sort of. My initial impression of people, sort of the initial contact we have is a mechanism by. Where people send me photos and information, and there's no cost to this at all. It's like a photo screening I do them myself. I look at every single one of them and the more information I get, the more in depth I go, like, kind of like quality in, quality out, basically. And I look and I try to be really honest, like, is this person a good candidate for what they're interested in? Can I help guide them towards something they'd be really good at? Do I want to work with them forever? Like, is this seem reasonable? And so, honestly, about 20% of those I say yes to, like, things line up, this is a good thing. A lot of them not a good candidate. Maybe not the right fit for what they're after. Like, things aren't lining up perfectly. And so that's sort of how I'd get to that initially. And like I said, I, I value these relationships. I learned that over time, honestly, that, that how when I looked back at my year reflections every year of like the best parts and the most negative parts of my life, whatever, I really realized, like these in depth patient interactions, friends at that point really became like, I love those things. So I want more of that. And that changed my practice a little bit in that sense too. And anyway, so I'm, I'm screening for those things right from the get go. Like, would I want to be enmeshed with this person forever?
- [51:57]
A
Oh, yeah, yeah.
- [51:58]
B
Because in my view we are in a very positive way, enmeshed forever.
- [52:01]
A
Yeah, well. And I can imagine sometimes people, people, some, like someone will come in and say, oh, I want to do X, Y and Z. And you're looking at their face, knowing symmetry and going, I'm not going to do that because it's going to look bad. Or, you know.
- [52:12]
B
And so hopefully I definitely get fewer people who are like, truly dysmorphic is the word we use. But in a bad way where they're just like not seeing something that's real. I don't get as much of that because my practice is very rejuvenative versus transformational. So that helps that just not be part of. It's like I'm never turning some. Somebody into something that they weren't before. I'm just rejuvenating. Or restoring would be another way to say it. At no point am I changing something. Like even a rhinoplasty, a nose job, something I don't do is generally transformative. Like you're changing it to something that never existed before, changing the shape of it. A breast augmentation. Another thing I don't do, generally you're just making them different than they were before from a breast standpoint. So those are transformative. I don't do that. So that helps, sort of. I just don't have as many people seeking to change, people seeking to reject, rejuvenate more.
- [53:02]
A
Speaking of breast rejuvenation, I think you said you don't use implants, correct?
- [53:06]
B
Yeah. So what do you do instead? Well, so I don't do any breastwork. I'm only face.
- [53:10]
A
Right.
- [53:10]
B
I only do facial things. But in the face, where implants are very commonly used, I don't use implants there either. And in full transparency, that's me projecting a little bit of my values into not wanting to put something foreign in the human body. From a loads, we could get way into that. Putting silicone in is, you know, tolerated, but suboptimal even. I don't even use permanent sutures in the face, which is very atypical.
- [53:33]
A
Can we talk about that?
- [53:34]
B
Yeah, yeah. And so, you know, I look at all this from putting a foreign body in, having inflammatory responses, having, you know, there's chemical load issues, there's all kinds of things that could come with that, and I don't want to be contributing to it. And I have other ways to get around them. When we're talking about where a facial implant would go, that's where I'll use like very structural fat from you, which is probably not as fully predictable as putting something silicone in there. When I put a 10cc silicone piece, I know exactly how much volume I'm getting.
- [54:02]
A
If I.
- [54:03]
B
If I put 10cc's of fat, I might only get 9.2. Well, okay, I will tolerate that small change for not having silicone in forever.
- [54:10]
A
You know, I didn't know people put silicone implants in their face.
- [54:12]
B
Oh, yeah, yeah, very commonly.
- [54:14]
A
Where is it like cheeks or where.
- [54:15]
B
Chin. Cheeks. Jawline all over. Yeah. Chin implants would probably be the most common area to get them.
- [54:21]
A
I've never heard this before.
- [54:22]
B
Very, very common.
- [54:23]
A
Oh, that freaks me out. Just everything I know about breast implant illness, I would assume it would be a similar.
- [54:28]
B
Yep. Smaller surface area, but same types of ideas, right?
- [54:31]
A
Yeah. Where the body's essentially attacking it, Right, Exactly.
- [54:33]
B
Yeah. It creates a capsule around certain type of hyp. Hypersensitivity reaction that our body has to them. And it creates a, you know, a capsule around it. And you know, with breast explant surgery, again, this is not something that I do. But oftentimes when they take a breast, when they do an explant, they're trying to take out and block like the whole capsule around the implant. As well. And the same thing happens in our face. So even on a microscopic level, when we're talking about permanent sutures, that same things happen. When I do revision surgeries, which is a big part of my practice, very commonly I'm coming across old sutures and. And I'm like, okay, I had this assessment very early on in my practice. What's happening with the suture? Why is it here? What's it doing? What am I seeing around it from a tissue change? And I very quickly realized it doesn't need to be here. It's not doing anything, and it's causing tissue change around it. So it was a fear that the procedure that the surgeon was doing wasn't gonna last. So they needed this extra help from this permanent implant. But that's not how it interacts with our tissue. A better way is to do a really good surgery, like be in the right tissue planes, move things appropriately, let our body heal that tissue back into place, which it does very, very efficiently. And if it's in the right place, in the right plane, it's going to do that in a way that is, you know, non disruptive. Then let the suture or whatever that's there go away. Like, and there's different ways that dissolving sutures get sort of resorbed by our body or natural fiber. Some of them are, you know, just collagen, basically. And that, you know, that for me, has worked out really, really well. And then I don't have this internal cognitive dissonance of like implanting something foreign. Wow.
- [56:02]
A
Okay. So you just. Only you solely use the dissolving sutures.
- [56:06]
B
Yes, exactly.
- [56:07]
A
Wow.
- [56:07]
B
Yeah. So I'll use permanent sutures, or we'd call permanent sutures temporarily on the surface that come out five days later or something like that, but those are removed quickly versus something that, like, remains in the face forever. Everything that is. That stays there is dissolving and goes away.
- [56:22]
A
Wow, this reminds me of threads. What do you think about facial threads?
- [56:25]
B
Oh, yeah, those also, really a gigantic thumbs down, basically, they're doing. So threads exist for the purpose of kind of what I was talking about in that middle ground between doing nothing and having a big facelifting procedure. This is the space that threads is trying to fill. So you can't blame it. It's like, well, I'm going to put this thread in that's going to lift and tighten, or lift and not tighten, but just lift and elevate. Then they say as they dissolve, collagen gets created. That's the scar tissue Part of it going back to that initial conversation that we have. So it fills a space that is understandably, there's a solution there. It's just not a good solution because it does. Doesn't do much because nothing's actually moved. Right. You haven't taken the fat pad that sunk and actually moved it back to its new location. It's like taking the breast and trying to just like pull it up with your skin. Like, it doesn't look that great. It's not really doing anything. You gotta like, put it back. Put the fat pad back in place. Right?
- [57:16]
A
Yeah.
- [57:17]
B
So there's risk to them too being too superficial, causing nerve damage, causing all the inflammation, the. The changes that happen with them underneath. So it's another one of these like, risk reward profiles. Like, it doesn't line up very well because. Cause they just don't do much. You're not gonna show me a thread lifting result beyond a couple of weeks, which is when. How long the swelling lasts. That's going to be durable. Right. And that's. That's pretty well adopted. You know, you definitely have like threading experts out there who will vehemently argue with this to the grave. And I understand that. But when you get to people who are doing like, have really good outcomes, procedurally, they're not using threads.
- [57:52]
A
Yeah. Just the whole concept freaks me out because you're essentially putting like a metal rod that supposedly dissolves over time in your cheek.
- [57:59]
B
Yeah. And they're made of different things. They're of dissolving sutures. There used to be permanent ones. Those were really problematic.
- [58:05]
A
Yeah, I can only imagine.
- [58:06]
B
But the dissolving ones are sort of more in fad now and. But it's the same story. Even if it did work now. And this is the argument that will come is like, well, they work for a period of time and then they go away like a Botox or a filler. Okay. But they don't really. Expectations are too high for what they're doing. And so you're just setting yourself up at best back to this. At best case, you're just wasting your money. It's not doing much. And at worst case, you're causing damage or creating difficulty with future procedures or something like that.
- [58:32]
A
It sounds like there's so many better options.
- [58:34]
B
Well, there are better options, but it's not. The issue is there's not so many.
- [58:38]
A
Okay.
- [58:39]
B
And this is a space that like, this is why it exists. There's this like, very important space that's just not filled. Not. Not many people do these Very minimally invasive lifts that I do.
- [58:47]
A
Yeah.
- [58:47]
B
And it's usually sort of an all or none. And I'll have. And I'll have great colleagues who do really beautiful work, and somebody in the middle comes to them and they very wisely and respectfully turn them away.
- [58:58]
A
Yeah.
- [58:59]
B
And so. So which is better than doing something that's overkill or unnecessary? In my opinion, like, that's a noble thing that, like, this is what I do. I do this one thing well, I'm going to do it. You're not a good candidate for it. Yeah, I respect that. Versus I want to do as many cases I can. You're willing to do this, I'm going to do it. Even though it's not the ideal thing for you. Right. That happens too frequently. And so I respect that. But in the middle ground is then like, that's again, a space that I live in because I really love this minimalist, invasive type of approach to things is, okay, what can we do? Not. I don't do one thing I try to take. It's just not how I've ever worked. You know, that's not how my brain goes. I like to, like, look at what's in front of me and find the best way to do it with the tools that I have available, including all these little micro tools that we talked about with preparation and recovery.
- [59:45]
A
Yeah. And what I love so much about your approach is that you're. You're cognizant of what work, of what the body already knows how to do, and you're working with the body instead of where. I feel like a lot of times surgery works very much against it.
- [59:56]
B
Right, exactly. And you. I mean, yes, so much. You can. And you can get that going before we ever see each other. You know, you can be ready for these things nutritionally inflammatory wise. Like, you can just be in a great metabolic place to heal. I think of all of my patients like an athlete, and I think of myself like an athlete, too. That's, again, going back to our beginning of our conversation. That is a lot of my framework of performance is based around athletics. Preparation, execution, recovery. There's so much in there with how I prepare myself, but I think of my patients the same way. And if I don't know, let's think of LeBron James, a famous athlete. If we know that he's gonna have an injury on a certain date leading into that, we know we're gonna have him so optimized to be recovering from that injury before it happens, that then when we actually get to the phase that we have to go through healing from that injury. He's got a big head start on it. That exists for every surgery that we do, especially elective ones. And nobody's taking advantage of it.
- [60:53]
A
Yeah, that's just so wild. And this is what I love so much about what you do. So I know you give your patients a whole pre and post protocol and includes nutrition detox advice before and after surgeries. What do you even, what, what do you do for them? What do you suggest? What are the supplements? What's the whole protocol?
- [61:10]
B
There's a lot to this. So there's a bunch of individual basis in this too. Depending on how much information I have from you before you're coming in. Let's say, let's just pretend I have a really thorough functional medicine type of blood panel on you, like a whole metabolic picture of you. And let's say I have your genetic information. I know to how you methylate, you know, vitamins and things like that. Great, okay, so I have this whole picture. So coming in I'll usually. And I find that a lot of my patients are doing some of these things already. But even from like the types of cleaners that you're using in your house, you know, I'll be encouraging. Like let's switch over. Let's look at this cleaner. Like there's this one particular bottle that I love from this company called Echo and they have this thing called an Echo clean. You put water in it and via electrolysis you make hypochlorous acid or sodium hypochlorite.
- [61:53]
A
Is this the one where it comes with a little machine that you like put it in there and it does it.
- [61:57]
B
You could. There's any types of versions of this, but this one in particular is like a bottle that you just put water in and if you add salt to it, depending on how you mix it in, you're getting sodium hypochlorite. If you add salt or hypochlorous acid. These are things that I use in the operating room. Now granted we're talking about different parts per million. So this is like a light super diluted bleach basically. But you're making it in your home out of your own water, like okay, great. The most sort of anti inflammatory type of cleaner also with high efficacy that you can get. So you know, just encouraging people like, like let's look at the cleaners that you're using. Let's look at what your diet looks like coming in. Even just things like refrigerated fermented types of foods leading in like that's going to get them more metabolically and nutritionally ready for a procedure with me. So I'm like encourage like for a lot of even people who are very into it, that's relatively new to be thinking about having servings of that coming in. Of course, like going through types of like the types of oils that they're eating, what their macronutrient ratios are. And a really interesting one is, is fasting and ketosis or ketones. Right. And a lot of people that I again probably a sampling error but a lot of people that are watching this or that they're familiar with fasting already. So I get the question a lot like what can I do? Fasting leading into surgery, which is really great because leading into surgery with a fast and then refeeding before the procedure starts kind of creates metabolic flexibility and gets us in a really great spot to heal afterwards. Not fasting all the way through surgery, that's too much stress basically. But having a strategic plan leading into it and then refeeding afterwards and then simple things that like let's avoid these very basic, let's like not drink alcohol leading into the procedure. Like I'm not drinking leading into your procedure. You don't, let's have you not drink too, you know. And so which for some people they don't do and some they do. But these are the types of things I'm doing before from a supplement standpoint. I'm starting them on a peptide regimen before they come things like creatine, which I would say even over the past two years that used to be kind of a more novel thing. And now most people I would say are actually on it already which has been a very interesting change. And then you know, I think, think the simplest thing that I, if I could give one piece of advice to everybody to heal better from a procedure is like sleep which is so simple, free, you know. So I'm getting people sort of like sleep acclimated and this is a challenge when I have somebody coming From Europe, say 9 hour time difference or something. So I'm trying to get people sleep acclimated and ready. So I might give that patient melatonin, which has an anti inflammatory benefit but also a sleep benefit as well. Yeah, even the anesthesia that I'm using during the procedure is not general anesthesia. It's very, very different. Which has a whole bunch of, a bunch of things with our, how our neurocognition is after surgery. But one of the big parts of that too, is thinking about sleep after the procedure. Because now we've kicked off your recovery intraoperatively in a big way, by optimizing your sort of sleep architecture immediately after the procedure, which is generally wildly disturbed for days after a surgery.
- [64:42]
A
Interesting. I wanted to ask you about the anesthesia, actually. So this is. This blew my mind. You don't use general anesthesia in your surgeries. What do you use instead?
- [64:51]
B
I do not. So just to define a general anesthetic is something that comes completely, let's just say, paralyzes you and puts you unconscious all the way. Then you need a intubated breathing tube. I think that's what people would call it, to breathe for you. Right. So it's sort of like pushing you to the bottom of the ocean and then keeping you alive while you're there shutting your brain down. Right. And then you can't, like, register any feelings. I'm not even going to say you can't feel anything, because when you're under general anesthetic, if you have a pain stimulus that the signal is still going from your periphery to your central nervous system, it's just not sort of like, registered in your central nervous system. But the signal's still traveling through the pathway, which is important. But, you know, when you wake up after that, let's say you have general anesthesia, you have an incision somewhere. Now that pathway is wide open, and so you tend to have more pain after something like that. So what I'm doing instead is I'm focusing on the peripheral stimulus, which is very easy for me to do because I'm working on the face. I'm not working in the organs or something like that. So that's an important distinction here. Like, sometimes you need general anesthesia. Okay, great. That's a whole other conversation about how do we optimize that experience if you have to have it. For what I'm doing, I don't need general anesthesia. People in my world that use general anesthesia, it's, you know, people will argue with this, but it's less about patient safety and more about ease for the surgeon.
- [66:05]
A
Right, Makes sense.
- [66:06]
B
So I'm focusing on really great peripheral, like, local anesthesia for what I'm doing, which is super doable with blocks and local and things like that. And that goes into the after part as well.
- [66:17]
A
Does that look like just doing, like, shots in the area that you're going to do?
- [66:19]
B
Yeah, kind of like that. Exactly.
- [66:20]
A
Like when you go to the dentist.
- [66:21]
B
Yeah, something like that. But before we do that, you are put to sleep. And that's the best way to think about it. I think a lot of people hear this and they think that they're going to be awake. You are not awake through this. But instead of pushing you to the bottom of the ocean, I've put you just underwater so you're like unconscious, but just to a very light degree. And I'm doing it with very specific agents. A traditional way to do something like this, like let's say somebody's having a quick procedure like a colonoscopy, they get this twilight IV sedation, like a lot of people have heard of that, but they're using benzodiazepine and an opioid, which are both very aggressive and hard on your brain. Let's just like use that hard on your brain, hard on your bowels, hard on everything. Like we want our bowels to work after surgery. That's one of our detoxification pathways. Right. And it's a better experience. So I do not use any benzodiazepines or opioids at any point in the procedure, before, during or after, hopefully as well. Instead I'm using agents that are pushing you just under, but in a way that is again maintaining your sleep architecture and not over overly aggressive on your brain. So when we get into this post operative cognitive issues which usually happen from inflammation and microemboli, we have not caused those things to happen. So you wake up clear, you think better. I mean I, I can't tell you how often I hear this. Like that was incredible. Like that was a whole different experience than what I've had in the past. But that can't be done without really great local anesthesia because you know, my patients are asleep and don't move and they, it's. Nothing ever gets registered because no signal's ever being sent from the periphery to the central part anyway. That's really, really important. That's a really important element in it. And so my patients are breathing on their own. There's no respiratory depression that comes with benzodiazepines and opioids. Their brain is more protected. It's a very wonderful sort of experience, all things relative, a very wonderful experience for afterwards. And then they can sleep afterwards too. One of the main agents that I use is very focused on sleep architecture. Some of them are kind of neuroregenerative in a way. Like there's ketamine, A lot of people have heard of. Ketamine is a minor part of my regimen. And the reason it's minor is because it has this bimodal dosage. In high doses it's not great for your brain, but in these low doses it's great. It's like a neuro anti inflammatory. So I can get some anesthetic out of it and help the recovery afterwards. So that's sort of how I work through this sort of local anesthesia with the IV sedation. People are asleep, comfortable, wake up quickly or clear. And then the pain afterwards is reduced because this is another big one. Okay, so now the surgery is over. What's the recovery like? Is it hurt? And in general people get opioids for that and they'll here's your pain pill pills. So I don't want that to happen because they're addictive, they make you foggy, they're central nervous system depressants, they cause constipation or bladder issues, all the things. Right. And we have to think about that's a central acting. So the pain signal's still coming and then it's just blunting your brain's sort of like reception of that peripheral signal. Well, what if we go back to the source there? So the last thing I do in a procedure is a very long acting local anesthetic. And for a nerve block in the areas that I worked lasts about 48 to 72 hours. Hours. And so that really stops a lot of the peripheral signals that are coming to the brain in the first place. So there's no registration of those at all. So it's like that the dental block happens while you're asleep, but it's like the dental block and it lasts a few days. Well that's great. And there's a new agent on the market like this year in the United States, brand new, first in class, that would be an alternative to like an opioid pain medicine. And it works peripherally by blocking the pain signal at the periphery. Interestingly, if we get nerdy on it, it's in the same mechanism by which the local anesthetics work. They stop the sodium channel from sending a signal. Well, these block a very specific sodium channels, same story. So it's like taking an oral local anesthetic in a way it's not perfect, but we could think of it that way. So the signal never gets sent in the first place. So this makes my world one that with 95 plus percent of my patients, nobody has to take an opioid afterwards as well. The ones that do is usually out of like anxiety, I would say for pain that they haven't had yet. Yeah, but that just Makes the whole recover so much better. You know, again, they're able to detox through their bowels, they can think clearly, they can communicate with their loved ones. It's just a much better experience that way. And the pain is well managed. Oh, my God.
- [70:23]
A
This is. I just love that.
- [70:24]
B
Very different, very different way to think about it.
- [70:26]
A
I know, it's so cool. You thought, you thought of every step along the way. One of the things that concerns me about these elective surgeries is the anesthesia. Because, you know, obviously if you have to have, you know, a brain surgery or knee surgery or whatever, like you, you need to use the anesthesia. But my parents, you know, they're getting older and they've had to do like, my dad had a major knee surgery and he's had to do it twice because he messed it up the first time and he's fine. But you hear about this, like, especially as you get older, this, you know, this cognitive decline that starts happening. And every time my parents have to go for a surgery, I just think about that. I get nervous. And so I feel like anytime you're getting some sort of elective surgery and if you can avoid that concern for the cognitive decline, I feel like it's.
- [71:07]
B
And I just, you know, with a lot of these, I just try to do what I would want, you know, again, very personally projecting that. But, you know, I, I get the question a lot. Like I'm, you know, fill in the blank. Someone's 52 years old, they have kids, they like, I want this elective thing done, but I also don't want to take a risk for my family.
- [71:22]
A
Exactly.
- [71:23]
B
That resonates very much with me. And so this is what I would do because of that. And you know, like you're describing with your parents or it. We definitely see it more in older patients. And that's why this postoperative pocd, postoperative cognitive dysfunction is well described in older populations. But if you or I have surgery, it doesn't mean that we don't take a hit. Right. We just have the cognitive reserve to get around it. But is that eating into our long term cognitive reserve, is it worth it for an elective procedure to do that? That's exactly what I think my answer is. No. So here's a way that we can do this in a way that, you know, kind of lines up with your value system maybe a little bit better.
- [71:56]
A
Yeah. That's so cool. Something else that blew my mind. You just blew my mind. With so many things that you're doing, you Got plastics out of your operating room? Oh, yeah, phthalates. One that I want to hear about specifically, that Europe has banned called dhep. I actually never heard about that. Can you talk about what you're doing instead?
- [72:14]
B
Yeah. So DP is a phthalate. The P in the. Is a diethyl hydroxy phthalate, I believe is what it stands for. And it's a plasticizer used in, like, PVC types of plastics. So we have polyvinyl chlorides and polycarbonate different. We can get nerdy on plastics, too. But it is a very, very specific softener that's used and in medical applications. We want a lot of our plastics soft. An IV bag has to be, like, squishable. The IV tubing has to be flexible. And so in the United States, that is near ubiquitous, nearly universally used in these, you know, sort of products. And in Europe, it's can't use it. Right. The US does acknowledge that there can be endocrine issues with it, but they've kind of hidden it. I'm not trying to say that this is all malicious, so I'm not saying hidden it on purpose, but it's sort of under this, like, invulnerable populations, pediatric populations, older populations, people who have a lot of IV tubing for a long time think of like a pediatric cancer patient or something like that. Right. But that doesn't mean, just because in high doses it registers to be really bad, that in low doses it's okay either. Right?
- [73:23]
A
Yeah.
- [73:24]
B
And so I can remember these moments in my career where again, I. This is. I. What I'm wearing, like, organic cotton. Right. Like, I'm not trying to monitor these things in myself. And I was like, do what? I want plastic tubing with these, you know, particular phthalates in it that I know are not good for me and that are accumulating. Like, I'm not getting rid of these or not quickly at least. And especially again, then this gets into, like. The other part is like, especially in a healing situation, because I am by definition causing a significant metabolic, immune demand healing stress that is going to be disrupted by these things if they're present. Right. So not only is it just like my overall value system, but then back to my, like, obsession with my results. I don't want to compromise those either. So it lines up fairly well here. And so I went on this deep dive into what I could do to get these out of my operating room. And then I of course, discover, as I'm diving in deeper, that it's not just that it's like the types of gloves we're using, the drapes, we're using, the instruments we're using disposal versus non disposable. What, you know, like coatings they have on them. And so just like a very. I love my staff because I before I kind of like laid this out, I went in deep in this rabbit hole and did all my own research on all these things that we could do. And then I kind of like vomited out there to everybody. Like, here's the changes we're going to make. And normally that makes people's life a lot more difficult. Like if you're a nurse and all of a sudden your whole life changes around what we can't and can't use, you're like, ah, do I want to. Like, I'm out of here. You know. But my staff is very different because we all share this value system. And they're like, this is incredible. You know, and so they nerd out with me on it a little bit. But we went very into getting rid of these types of phthalates and you know, the forever PFAS is the, you know, different type of chemical there. But to get them out because they're everywhere in surgery and with via different routes. Some of the key elements in IV tubing too were anything that's heated. And we're often using heated fluids because, you know, we want to regulate body temperature very narrowly when we're in the operating room. Like a warm patient's going to heal better. So we start that with even the types of fluids we're putting in. But that changes the way that these leach into the fluid or something that's very lipid soluble. So some of our anesthetic agents are li. Are carried in a lipid carrier. And so now that's sitting in this tubing as well. So again, as I went into this, I'm like, this is not what I would want and how can we make it better? And there's some alternatives that do exist. They're more. Way more expensive to get and they're more onerous and it's a pain for my staff and it's more expensive for us and things like that. But like, okay, this is what I would want and this is what I'm going to do for my patients.
- [76:01]
A
Yeah, well, I just saw that a study came out. I just saw it last week. I don't know exactly when it came out, but that they just found that IV bags and the tubing are putting thousands of microplastics in your body.
- [76:13]
B
Body Totally.
- [76:14]
A
I don't know why I didn't think about that before. That was one of those moments where I was like, duh, of course it does. Why didn't I think about this sooner? Is there an alternative? Are they going to be able to fix that with IV bags?
- [76:25]
B
Yeah. So in, in the IV bag specifically and the tubing, there are some very specific compounds that don't have that. Like polyn I believe is one of them. Just to throw it out to my colleagues who are looking at this or any IV clinics, because my patients aren't just getting, getting IVs during surgery. I'm using them in their post operative period as well to help them recover. And that's a very customized thing with amino acids and glutathione and nad and all kinds of, you know, whatever they need. Kind of again, if we have micronutrient deficiencies, we're restoring them then yeah, gets very into our world of nutrition with that. But so they're getting it, they're getting multiple exposures to this. So there are ways around it. And you know, the microplastics part, you know, mixed evidence. And we know that they're present in organs, we see that, but we don't actually know exactly what they're doing, doing. But this is where I have to take like my very evidence based scientific physician self and say we know that they're present, we know that they're causing some physiologic change or metabolic change that's present. What organs are they in? All these things. And then I have to go like sort of common sense me on what I would want and go like these are going to interrupt our healing. You know, you're finding these in a atherosclerotic plaque that's they're having a vascular effect. And vascular healing is wildly important. Like we call it angio neogenesis or making new blood vessels after surgery. One of the most important things we can do. So we know that if there's microplastics around that could theoretically, no, no proof, no evidence to show that, but that could disrupt that. Or we're finding them in our liver. Well, I need our liver at tip top shape in the recovery period. Not just from the anesthetics and things like that, but to help, you know, like basically detox everything that's in, you know, rapid healing. And so many of the things I do to make recovery faster, which would be like hyperbaric oxygen. We talked about red light and peace emf. That's important to you. A patient who's gonna have it done because you wanna get better faster. Yeah. So that lines up really well. But the other side of it for me is it's also helping you recover from your anesthesia. So any, like, little neuroinflammation we do have, we're wiping out. Great. And again, back to. For me, it also makes the results better in the long term. So yeah, win, win, win across the board. Although the focuses might be different on how that goes. And getting back to like microplastics fall into that for me. Like, even if it's a small degree of change, it's component completely worth, you know, making those changes to have those small degrees of improvement.
- [78:40]
A
100. I think this is one of those areas where even these small little changes will add up over time. And I really believe. I think there's a couple things and I think microplastics is going to be one of the biggest things that we have to deal with in the next 10 years or so regarding our health. I think this is going to be a big deal.
- [78:55]
B
Yeah. I mean, again, getting into even like the clothes that I'm choosing to try to wear in the operating room and, you know, it was such a new thing to us as humans to be exposed to and the world really.
- [79:07]
A
Oh, yeah.
- [79:07]
B
So it's very interesting.
- [79:09]
A
And it's in every area. Like I said with the IV bags. I mean, I think about, you know, when I buy, like I bought. I brought you a glass water bottle because I refused to drink it.
- [79:17]
B
Yeah, yeah.
- [79:18]
A
Out of plastic. And I know you're the same way, but there's those other things that I don't even think about, like the IV bags and so many things that are necessary. You know, if you have a surgery, you have to have an IV back bag. So there's like.
- [79:28]
B
Yeah. And if we want to go, like when this goes back to when I was in medical school, I'll never forget, like my first trip to the operating room as a medical student. You're so nervous. Like, am I doing things right? Am I scrubbing right? Am I don't. What can I touch? What can I not touch? You know, but then. And so it's an incredibly novel environment full of epinephrine and norepinephrine. Like, you're. You're creating core memories, quite literally. If we get into how that works, like, yeah, you're. You're peaked. And so you remember everything from those first experiences. Right. And in the operating room, it's especially heightened because somebody's life is presumably on the line or whatever. But I remember at the end of that day, you know, you're like, okay, how do I take my gown off the right way? And you take it off and throw it away. And I remember looking at like three giant full garbage cans from this really minor procedure. The procedure probably took 35 minutes and at the end it was just like plastic garbage everywhere. And I'm not even talking environmentally, but when I think back to that, it piqued me as like, this is really odd and wasteful and there's a lot of plastic involved with this. That was like my thought, you know, going back however many years that was. And it's funny to think about that now with when I had this big change in my operating room. This is one of the benefits for me of like I own and control my operating rooms fully. From an infectious standpoint, there's wild benefits to that. But even something like this at a hospital, they would there no way you're going to do this. Zero percent chance, you know. But with me, I can do whatever I want. So we're, we're getting all these out of our operating room starting tomorrow, like throw away what we have. We're not using it. We're not going to like burn through it to save money. Money. It's gone. The new ones are in play. And so this was a funny moment because honestly, we threw away a bunch of these plastic IV bags and things that I no longer wanted. But I'm thinking like, well, here's that waste that I was focused on as a medical student.
- [81:06]
A
Yeah, that's so interesting. So as a surgeon, I can imagine that there's a lot that goes into your own protocol. I know you care a lot about nutrition and a lot of the stuff that we've been talking about, this whole podcast. What's your regimen that you do do before to get yourself really ready for surgery?
- [81:22]
B
Yeah, so this goes to that athletic part of things. So nutritionally I try to stay really metabolically flexible when I can. I go into ketosis before surgeries. Depends on the week I'm having, how many days I have. Honestly, I have kids and a life and wife and what our life is looking like. And I'm like, I have a surgery tomorrow, you know, so I will not be in ketosis for that surgery, but I'm will be super ready nonetheless. Right. But I'll fast leading in and then I'll refeed before and that's, you know, very regimented. I'll use ketones and things like that. But I start preparing for surgeries like my surgery tomorrow, I've been getting ready for. For weeks, you know, and I kind of have a lot of that evolving. And that gets into the visualization part of things like process and outcome visualization, and goes back to things I learned as an athlete. Right. So I get very, very ready cognitively and then physically leading in nutritionally. If anybody has ever experienced ketosis in a really demanding cognitive setting, it really makes me think, like, this is how we're meant to be a little bit. So it's kind of fun. Yeah. And I'm. I go in and out depending on what I'm doing for surgery, but so I'm very optimized in that way. Then the morning of the surgery, I have a very intense routine that's like a flow state entry that has taken me a good 10 years to perfect. I'm still doing it, but it involves me getting in the hyperbaric oxygen chamber with some sensory deprivation and some visualization. And then I get in a sauna with some red light, and I do a very specific type of workout that's very balance focused. A lot of. Interestingly, yesterday we're here in Austin, yesterday, I got to meet somebody who I've kind of followed for a long time and used some of their things. This guy named Jay Rose, who's really interesting. But anyway, so I'll do a very specific workout in the sauna that's bihemispheric, like stimulating your corpus callosum. So there's this idea that you're kind of getting your left and your right hemispheres connected, maybe. But in general, it's definitely getting me coordinated, if you will.
- [83:06]
A
Yeah.
- [83:06]
B
And then I'm going to the operating room, like in a true flow state, which is a wonderful, beautiful place to be. Loss of time, everything's flowing. It's wonderful. It's. I make better decisions. And then afterwards, that's really, I would say, energetically expanded. Expensive to get in it and stay in it. And then so the second I finish, I'm going into recovery for the next case. That could be the next day or the next week, who knows? But I'm really focused on, okay, now how much can I break down? Like, should I be working out? Sometimes I work out right after surgery, like to get ready for the next one. And then I have a very thoughtful journaling process afterwards. When we do a surgery, we write a medical note. Here's what I did, here's the procedures, here's the sutures, the details. Right. But then I kind of take it to another level that night where I get reflective and introspective. Like, what decisions that I make that were unique and interesting. How did I get 1% better on this? What are the little micro changes I made? What were the branch points in my decision making that I thought were key, that I had to like make a decision and what did I choose and why and what was the alternative? And it sounds kind of crazy. It's really therapeutic for me in a way. And it helps me get nerdy and deep dive. And then usually after that I'll kind of do some research too. But the most fun part of that is three, six, nine months down the road when I get to see that person's results again. I can now take. Take these beautiful photos and videos that I have and look at them and then deep dive into what I was thinking and go like, oh, here's the little micro changes. So in sports we watch film afterwards, right? You have a game and usually the next day you watch film and you're like, oh, that was a mistake, I shouldn't have done that. Or that was really good. I didn't even realize I did that, whatever it is. But you get to kind of take this like objective look at it from like a, you know, 30,000 foot view. And I get to do that, you know, in the future with this journaling process, which is really fun.
- [84:46]
A
That is so very unique.
- [84:47]
B
I try to like tell all my colleagues, like, you should do this. This is really, really, really enhancing to your practice. And honestly, just your. How much you love what you're doing.
- [84:54]
A
Yeah, it's really cool.
- [84:55]
B
Wow.
- [84:56]
A
I've never heard a surgeon talk about it like that. That's really cool. I love how thoughtful that is. It really. I'm sure it really helps you with your craft too because you learn from your mistakes and.
- [85:04]
B
Right. And it just adds value to me just in like you. It's almost like a gratuity practice. Like when you. I just, it makes me feel grateful for what I got to do that day as well.
- [85:11]
A
Oh, that's so cool.
- [85:12]
B
Yeah.
- [85:13]
A
Well, I got through all of my questions. I want to know if there's anything else that you feel like the listeners really need to hear here before we go.
- [85:20]
B
I mean, I think we really got into. I think those key takeaways are just understanding what your non surgical options are. Being ready for surgery, like what that means to you, being introspective about that, knowing that there's some middle grounds. And then I think the other one, like apart from all those cosmetic things Are just like being metabolically and nutritionally optimized leading into surgery. There's ways to do it. You know, we didn't talk about peptides and you know, those types of regimens afterwards as well. But it's worth chatting with your surgeon if that's something you're interested into. I about talked talk about this on my channels a lot. And then, you know, I don't think it matters what the procedure is, but there's, you know, benefits to it afterwards. I think the one, you know, I said get good sleep then if I were to add the one modality which we didn't talk much about, but I'd say the best bang for your buck is hyperbaric oxygen. After your surgeries. I use it pre surgery to get oxygenation going and then immediately post surgery as well, quite a bit because again my patients are with me for a week. And so we have a very active type of thing that we're doing together. But hyperbarics is certainly the anchor of that.
- [86:21]
A
Can you explain why really quickly for people why that's so good?
- [86:24]
B
So hyperbaric oxygen chamber is a pressurized tank that you get in. They come in different sizes, shapes, flavors. There's you can find these zip up soft sided chambers that can't put as much pressure on. So they're okay, but suboptimal versus like a hard sided medical chamber that can go to higher pressures. You go to higher pressures and you breathe in 100% oxygen. And so what that does is you and I, I right now are saturating our red blood cells at probably 99%. We're carrying all the oxygen we can carry. And so we can only deliver so much oxygen to our healing tissues if we are post operative. Sometimes the amount we can carry actually goes down a little bit because of these things called like acidosis and things that happen postoperatively. So if we get in a hyperbaric oxygen chamber and we breathe in 100% oxygen under pressure, much like, like putting carbon dioxide in a can of soda, we can carry more oxygen instead of carbon dioxide in our blood, so it's in our plasma. And then it gets to the site of injury, which in my case is your face, and it releases more oxygen. So this stressed area that's trying to heal, that's lacking oxygen, that's trying to make new blood vessels. Let's say it's a stem cell that we put in, in the fat transfer that's kind of like being activated, but trying to get oxygen. It gets this like little bath of oxygen in this period of time that you're in the hyperbaric. Hyperbaric chamber. And it accelerates the healing, reduces the inflammation. Because when cells lack oxygen, they release all these stress signals called cytokines and that can cause local damage. So we reduce all these things, we help make new blood vessels, we reduce infection risk. All kinds of great things go in. Plus just the mechanical benefit. Like if you were to take a plastic bottle in the hyperbaric chamber, it would crush. So you get the mechanical effect of squeezing out some of your fluid, swelling, inflammation into your lymphatics. And it's just a wild benefit to your, like making you feel better faster. But then it's the perfect analogy. Makes you feel better faster, you recover faster, less bruising, less whatever. But you also get better results after your procedure because of it.
- [88:22]
A
That's so cool. I feel like everybody should get in a hyperbaric chamber when they do surgery after.
- [88:26]
B
Yeah. Oh, I mean, that. That again, that'd be the one thing.
- [88:28]
A
Yes. Okay. Well, yeah, I mean this. I. Wow. This was such an amazing episode. I've been looking forward to this for months. And I just want to say I'm so grateful for the work that you're doing. Truly, I want to honor you for that because there's not a lot of surgeons and that are doing what you're doing and going to the lengths that you're going. It's very apparent that you care very much about your patients outcomes. Again, I'm not saying that other surgeons don't, but just the lengths that you go to really ensure that they're, you know, their health is really taken care of afterwards, their inflammation is down, their healing process is like at optimal that it can be. It's really cool what you're doing.
- [89:02]
B
Thank you. Very good. Thanks.
- [89:04]
A
Appreciate that. Thank you so much for coming on. Please let everybody know where they can find you, you. And also maybe if they want to get a consult with you where they can do that.
- [89:10]
B
Yeah, absolutely. I'm most active on Instagram. That's probably the best place to go. Look, my hand will be tagged somewhere, I'm sure. And then like I said, I start everything virtually. So it's actually pretty low friction to start a process with me. And like I said, I. It's. It's me looking at it, which I think a lot. It blows a lot of people's minds in a free sort of setting. And then if we just, if, you know, for a yes and a yes on both ends, then we can move forward with like talking to each other and then we kind of really get the ball rolling. Rolling. But it's pretty, pretty easy to start the process.
- [89:39]
A
Cool. You might be seeing my photo be submitted in there soon.
- [89:41]
B
I love it. I love it.
- [89:43]
A
Cool. Thank you so much for coming on.
- [89:45]
B
Thanks for having me.
- [89:46]
A
Thank you so much for listening to the Real Foodology podcast. This is a Wellness Loud production produced by Drake Peterson. Theme song is by Georgie. You can watch the full video version of his podcast inside the Spotify app or on YouTube. As always, you can leave us a voicemail by clicking the link in our bio. And if you like this episode, please rate and review on your podcast app. For more shows by my team, go to wellnessloud.com see you next 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 doesn't constitute a provider patient relationship. I am a nutritionist, but I am not your nutritionist. As always, talk to your doctor or your health team first. If you struggle with bloating, gas constipation, digestive issues, yeast overgrowth, well, you you may already know about Digest this. It's the podcast hosted by me, Bethany Cameron, also known as Little Sipper on Instagram. I dive into gut health, nutrition, the food industry, and drawing from my own experience, I break down what's good, what's bad, and what's the best for your gut, your skin, and so much more. I even offer gut friendly recipes. New episodes every Monday and Wednesday. Produced by Wellness Loud.