BREAST IMPLANT ILLNESS & The Transformative Power of Plastic Surgery | Dr. Jonathan Kanevsky

I view surgery as a ceremony. Surgery is an opportunity to undergo a major transformation of the mind and body. And historically, I think that's really what the process of medicine and surgery was.

Today's guest is Dr. Jonathan Kanevsky, a highly trained plastic surgeon from New York. Dr. Jon completed his undergraduate degree and medical degree at McGill University, graduating at the top of his class. He was accepted into the competitive integrative plastic surgery residency at McGill University and became certified by the prestigious Royal College of Physicians and Surgeons of Canada. Dr. John is considered a leader in the field of artificial intelligence in medicine, and he is bringing the latest cutting-edge technology to plastic surgery. Dr. John puts the patient's needs first, and we'll get into this in our conversation today and how many lives, I guess, he's saved of women from breast implant illness. Outside the operating room, Dr. John has been active in humanitarian work, volunteering on medical missions in Guatemala, Kwala, raising awareness for animal and wildlife conservations, and fundraising for the Montreal Children's Hospital Division of Craniofacial Surgery. Welcome to the Longevity and Lifestyle Podcast, Dr. John. It's such a pleasure to have you on today.

Thank you so much for having me. It's a pleasure to be here.

So, Dr. John, I'd like to start with something that's very important, um, and it's breast implant illness. So for my audience listening, um, either perhaps they have breast implants or there might be some considering it, You know, what exactly is this breast implant illness? How many people does it affect each year and how can it be avoided, prevented and treated?

So breast implant illness has become a really pressing women's health topic in the past, I'd say 5 to 7 years. The issue with implants has actually been around for a long time. So maybe I could just start by telling you about my own sort of personal experience and history with implants as a, as a plastic surgeon. Then I'll tell you a little bit more about the details about breast implants. About 6, 7 years ago when I was nearing the end of my aesthetics fellowship training, I started to notice more and more discussion among patients. I'd have patients coming in and sharing this concern that, I think my implants are making me sick. At that time, the general consensus in the plastic surgery industry in the world was that this has been disproven in the past and there's not really a thing here. And very, very unfortunately, it seemed like the rhetoric was put more on the side of the patients rather than a real assessment and understanding of what's going on. Since then, there's been a complete reversal in terms of the depth and understanding with which I think the industry is starting to look at these issues. Unfortunately, not as much as I would hope. But at that point for me and my training and where I was at, I decided I'm not going to do any breast implant surgery until it's 100% clear. There's no 100% guarantees in medicine, but at that point I was like, there's, there's enough patients coming in complaining of this being a problem and I can't accurately predict who's going to develop breast implant illness or these symptoms. So I'd rather just not be involved with them. So what is breast implant illness? Breast implant illness is a constellation of symptoms that really fit in what most people in the medical profession would categorize as sort of the autoimmune category of symptoms. So it's a long list of symptoms. I may not get all of them, but in my practice, what I tend to see often is things like chronic fatigue, joint pain, hair loss, dry mouth, loss of hair. There's also disturbances in mood, sometimes gut issues. So it really is touching on a large number of organ systems. And part of the challenge is that because it's such a broad definition of symptoms, that it's not necessarily falling into the category of like an easily identifiable illness. There's no blood test at the moment that we know that you can take that will say, yes, you have breast implant illness. And who hasn't at some point in their life felt either a bit of fatigue or joint pain or hair loss, you know? And so it does make it challenging to consider this. But what we know so far about breast implant illness and what silicone does in the body— and this is not a new thing, by the way, it may have changed names and become more common— but if you look at the arc and the history of breast implants in throughout the plastic surgery industry, this was a big deal in the '90s. In fact, there was a moratorium, meaning a complete stop on breast implants in the '90s. So breast implants have this a bit of a controversial contentious history already in the past. At that time, breast implants were identified or thought to be associated with autoimmune illness. There was a syndrome called ASIA. So it's basically a constellation of symptoms associated to silicone toxicity, which in my mind, Asia and breast implant illness are actually in the same— they're kind of cousins. They're in the same category. So it's the body's reaction to silicone. So what silicone does in the body is that for some people, not everybody, silicone is technically inert. But for some people, when the immune system sees silicone, the white blood cells, they create a reaction around it. That forms a capsule. It's what the body does for any kind of foreign body. It'll create a capsule around it. But the silicone acts as something we call an adjuvant. An adjuvant is something that basically primes or accelerates the immune system's response. Now, many things in the body can act as an adjuvant. Some vaccines have adjuvants. But for a specific subset of people, we can't accurately predict who. We have some theories. I have some of my own personal theories, but for some people who have a predisposition to autoimmune illness, so that means if you have a lot of allergies, if you have known autoimmune conditions, hypersensitivities, it is more likely that having silicone implanted in your body is going to take your immune system from this baseline threshold of reactivity and put it into overdrive, which is then going to cause this flurry of autoimmune reactions, overproduction of antibodies, immune cells, and it's just going to put your body in a state of constant inflammation. Um, this, this topic was particularly interesting to me, um, from, from the medical standpoint because my background was immunology before I went into medicine. So I started looking at the literature and saying, this is— there is no way that this is just a random occurrence. There's that saying in medicine, like, one, one-time thing is maybe just a random, two is starting to be a pattern, three or more, there's definitely something to look at. And I was seeing patient after patient So it really, it really touched me. And I said, I'm just going to step away from this for now and focus on alternatives and, and helping patients through the process where clearly I think the industry has not done a good job of supporting women.

How soon are you seeing patients starting to notice symptoms? So maybe somebody who's listening is like, oh, like last year, 2 years, 5 years ago, 8 years ago, I've had breast implants and maybe it was, you know, at age 40, 45, 50. Sort of perimenopausal, menopausal, who doesn't have gut health issues? Like so many people do, right? So it's hard. Like the symptoms you're describing could tick the box. Lyme disease even sounds like tick a few of those boxes as well, right? So that's part of the tricky part about not having a proper, like, one diagnosis, right? If there's inflammation in the body, it could be from different sources. But I think if someone knows, okay, yes, they have silicone implanted in the body, right? So through the implants, how soon after do patients typically notice symptoms, I guess, is the first question that I just wanted to dig in there.

It's really been a range. And I think there is a really strong component to this that is not just the body and the physiology. And this is what I would consider maybe more of a psychospiritual aspect, which I think is very important, which is how people view their body and and the connection between the nervous system and the mind. But to give you the range, I've had patients come to me and say, immediately after the surgery, within the first week, I felt something was off. I started to feel itchiness in my eyes and my skin felt uncomfortable. I would say that's definitely the exception. More often after about a year or so, 6 months to a year, which makes sense physiologically because what's happening is over time the body's creating this capsule around the implant And some people believe, and you know, this has been, the literature's contentious, it's been proven and disproven. So basically I don't know where the truth lies, but the physiology says that it takes several months for this capsule to form around the implant and it's the body's reaction. The body's fighting at that capsule, that shell, which is what's creating some of the immunological response. On average, I would say it's somewhere within the 6 months to a year range. Now, many people, I'd say probably the majority of women with breast implants, don't— aren't thinking about symptoms or don't have them. On average, it's about 35 to 40% of patients. That's what's been reported in the literature, which is still very high, but it's still not a majority. That's a big number, especially if you think about up until last year, for the very first time— well, up until last year, breast implant surgery was the most common plastic surgery procedure, over 100,000 procedures done a year. I mean, that's insane. To think there's 30,000 patients a year otherwise avoidable. And there's, there's just so many little tabs I could open to talk about this in terms of like, how is the informed consent process done? Why, why aren't women being informed of these black box warnings on implants? You know, what are the alternatives that were discussed?

But, um, we're gonna dig into all of this. Yeah, yeah.

So I would say on average about a year, but I have had patients tell me, you know, within the first week they felt something was off. And it's possible. I mean, there's this foreign body that's inside your body interacting with it, especially if you're predisposed to have an autoimmune response.

Most people don't know if they have, right? Unless they've already been diagnosed, they don't necessarily know. Is that fair to say?

That's true. They wouldn't know. And, you know, unless you have a strong family history of it or for whatever reason, you know, the threshold to show up with autoimmune systems, you just wouldn't know. I would say in my experience, before I knew the stats and before this was more of a thing, I was like, maybe 10% to 15% of patients are likely to have predisposition to an autoimmune condition and should avoid this. And I would screen patients. This is back when I did implants. I no longer do them. I would ask patients, I would say, do you have any allergies or hypersensitivities, any family history of autoimmune conditions? And I would say, I think there's this link. I don't know for sure, but I found it a lot. Yeah. Yeah, and I found it a lot easier now just to, just to step away from it completely. And now I solely focus on explant surgery and then just doing the alternative, which is I think safer, which is fat grafting.

Yep. So we'll talk about that in a moment. And I have a question and a concern because I am wearing a silicone strap on my Apple Watch. So for those watching, you can see that I'm pointing to my Apple Watch. But is there studies or have you seen research around silicone against the skin externally versus implants internally?

I have not. So I don't want to speak with like 100% authority, but But what I know about the biology of the skin is that silicone is inert and your skin is a very, very effective protective barrier. Like our skin is essentially, it's like more or less waterproof if you think about it. So you have this really thick, durable layer of keratin on top of the skin, which is just dead skin cells and they have their oils that get secreted and then layers, layers deep. So it's the silicone that would be on something like a strap or a watch or something making contact with the skin is nowhere nearly as exposed to the immune system as something that's literally inside your body at body temperature, potentially shedding off little particles of silicone into the bloodstream. It's like two totally, two totally different things. So I personally wouldn't worry about it, but I have not personally looked at any literature that examines the difference. But I would say it's pretty low.

Okay, good. No, I mean, this is the great thing about having these fantastic conversations with experts. I learned so much myself. I had one week where I was learning about Hashimoto's and it's like 70% of women particularly who have hypothyroidism, which I do, have Hashimoto's antibodies. So I went and got myself tested and the antibodies are present. I was like, okay, talking to another biological dentist, he's like, any metal in the mouth? And I'm like, oh, I don't have any metal fillings. But lo and behold, I have a metal wire behind. So I'm like an antenna. I'm like, ah, another thing I need to do. One learns along the way.

And it might be the kind of, you know, there's a saying, there was a famous, I think it was a chemist or something, Paracelsus from the 1500s, and he said it's the dose that makes the poison. And it could be the case for a lot of the implantable foreign material in the body because, for example, there's many, many people walking around with orthopedic implants from bone for knee replacements, things like that. And those parts, some of them have silicone and other things in them. People who have pacemakers or wires, some of those leads are covered in silicone. So it could just be a question of, well, the amount of silicone or the amount of the product that could be stimulating that response. The problem is it's so variable it's actually hard to test and control for these things.

Yeah.

So, so we may never know for sure the answer, but it's just the signal is important and the signal's out there.

Yeah. So, so let's talk about what you were tapping on there before as well, that like, why is this not more publicly said? I mean, you were saying that reported cases, if I got the numbers right, 45— sorry, 35 to 40%. And those are reported cases. So the amount that are maybe unreported, so maybe we're looking at about 50% of cases. So you've got a 1 in 2 chance of developing breast implant illness, putting your health and your risk at life, because we all know that the heightened immune system just has a whole cascade of detrimental effects from it. So one is like, why is this not being communicated better? And two, you know, what are alternatives and what are also use case scenarios? Because some is more for aesthetics, but I'm sure there's other reasons why women decide to have these surgeries, right?

Absolutely. Absolutely. So to answer your first question, why isn't this more public? I would say now more than ever, there is a very large and vocal community of advocates. There is a Breast Implant Illness Foundation. There are surgeons that are starting to finally come around and speak more publicly about this, which I fully and strongly support my colleagues in doing that. I think it's important. And in addition to that, advocacy groups, the media has picked up on it, and there's books out there. I've been in contact with an amazing psychotherapist. Her name is Amanda Savage-Brown, published a book recently called Busting Free, which is all about the psychotherapy approach to getting ready to do explant surgery. So there's, there's definitely more information out there and more people that are picking up on this. So much so that the FDA had hearings about 4 or 5 years ago. To revisit the issue of breast implant illness. And it's not just breast implant illness that's the problem, it's also a rare type of cancer that's associated with implants. And that's a known number. There's no question that 1 in 3,000 women that get a certain type of implant are likely to have a very rare type of cancer associated with the implant. So I would say even if it's not as popular as it should be, I mean, my personal preference would be that this, that this be made a known women's public health issue because it's, it's shocking that it's still the number 2 most common plastic surgery procedure. Liposuction is overtaking as number 1. I hear what you're saying, like, why isn't this more common? But I would say at the same time, it's actually more discussed and popular than ever. In the— just to give you like the context of the history, in the '90s when the moratorium happened, basically all implants stopped. That's implants that are filled with saline and implants that are filled with silicone. Now it's a little bit of a misnomer because whether the implant is filled with saline or silicone, it still has a silicone shell. So the body's still reacting to it the same way. And there's a lot of questions about, well, the fluid that's in the saline implant, what happens to that over time? It's basically just sitting at body temperature over time. Is it growing things? What's, you know, what's happening? The moratorium was placed on the implants and all implant surgery stopped. And then a ton of research was done. You know, you could, you could ask questions about how was it funded and who and what, and what were the results. But basically to say that there is no association between breast implants and autoimmune illness, and it's back on. And so, so they put back on the market.

Um, who funded that?

Yeah, yeah. And it's, and you know, it's, it's critical thinking and asking more and following the money is always helpful.

I love the money.

Yeah, yeah. And, and the validity of the studies, you know, like there's, there's always people with good intentions doing that kind of research trying to show validity. But it is a problem to say that it wasn't unbiased. Now, fast forward to today, it's just not possible to quiet the storm of patients that are angry, that deserve representation, that deserve to be heard, and that deserve really an alternative. That's been a large part of my mission, which is to say, I mean, there's going to be surgeons putting them in, there's going to be surgeons taking them out. Just— it's just opposite sides of the same equation. The equation itself needs to change, which is what I've been trying to focus on. Say, let's come up with a better alternative and really focus on that, which is why I mentioned before I focus on fat grafting.

Can we dig into fat grafting? Um, like, fat— what, what are you doing with fat? And they're like, oh, is this an alternative to liposuction? Like, so can you share a bit about what is fat grafting and what, what's happening?

So fat as a regenerative medium, as a, as a tissue from the body, has, has been known for 50+ years. Fat is rich in stem cells, both from the fat but also from the blood. And it can be used as a filler material because fat, once grafted— so when you take tissue from one part of the body and put it somewhere else, the body is very intelligent. It surrounds it with all these growth factors and it starts to grow. Literally, it's like taking seeds and putting them somewhere else. And so that tissue is going to grow and it takes hold wherever you place it. So that makes it a very useful material for, for filling and creating shape. Since the research in fat grafting has evolved over the past 30 years, it's not just a useful filler, it can be used for its stem cell regenerative potential too, which is, which is really powerful. Interesting. And so, yeah, some of the early uses of fat grafting were actually in patients with burns and radiation therapy after breast cancer. What was noticed is when the fat was put under the skin, that the skin actually softened and regenerated. Because people who've had burns or radiation therapy for different parts of the body, their skin gets really damaged, it gets really hard and really stiff. And so the skin becomes more soft and supple with that kind of treatment. So fat grafting, what it is, is it involves removing fat from one part of the body, in some cases it's processed and purified, and then in a sterile container re-injecting it into a location. So you can either fill and create volume or for whatever regenerative purpose you want to use it for. The way that I use fat is I have a specific protocol and technique where I try and do everything as minimally invasively as possible. The majority of the surgery I do is on patients who are awake but comfortable. Oh, wow. And yeah, and it's part of keeping in mind that it's not just about the surgery itself, it's about the entire experience, trying to be as comfortable making a recovery as swift as possible because general anesthesia is really intense on the body. Going to sleep for a surgery is quite the thing to recover from. So patients are generally awake. I use a cocktail of medications to help them feel relaxed and comfortable. We then numb all the areas with medication that goes under the skin. So really all you really feel is like pressure and vibration. The fat then gets removed. I have a special way of processing it.

Where does the fat get removed from? Is it typically like the abdomen or the, the bum, like the buttocks, or where does it get removed?

It can be most just about anywhere in the body. Everywhere in the body there's a healthy layer of fat that's around, like right under the skin, on top of the muscle. The most common areas are around the abdomen, the arms, and like the inner thigh area.

Okay.

Yeah.

And so you just extract— like, how can you visualize it? Yeah, like it's a syringe extracting.

Sure. Yeah, it's, it's technically a type It's a type of liposuction. I use a variety of like sort of newer cutting-edge tools that allow— I do it all through basically like a millimeter-sized entry point, just a little dot. And so the tool goes inside and it's a combination of vibration and suction that will break up the fat. And it's like, it's like taking little tiny little bits of fat over large areas. Literally, it's sculpting. Picture like modern-day artists, you know. Yeah, there's a sculpture. So you're, you know, I'm just taking little bits of fat from certain areas. So I'm trying to leave to create an aesthetic salt from the area where I'm taking the fat. So it looks, looks great and toned. And with the fat that I'm removing, it's taking out little tiny microscopic bits of fat over a large area. And that fat then gets collected into a container. And I have a special way of processing the fat which enhances the stem cell. Historically, part of the issue with doing a fat graft is that not all the fat that gets transferred survives. So a lot of people traditionally maybe who have had fat transfer aren't— weren't as satisfied, or sort of a myth that got propagated was like, oh, it doesn't last, it doesn't work. Well, that's if it's not handled properly. And of course, not 100% of it will survive, but there's certain things you can do that can increase the survival rate to above 70%.

And so then you inject it then into the breasts and then it has the stem cell benefit because you've treated it basically. And yeah, yeah, yeah.

And to answer one of the, one of the questions or points you made earlier about is this only aesthetic or is it reconstructive? It's for both purposes. Originally, fat grafting to the breast was more so for patients who've had breast cancer as a means to reconstruct part of the breast. Anatomically, it makes a lot of sense because the breast tissue or the breast is comprised of glands, so the part that produces milk, as well as fat. It's a more, what I like to think is anatomically appropriate reconstruction. That can be done either as an aesthetic tool for what we call primary augmentation, so increasing the size of the breast without any history of cancer, just wanting a larger, fuller breast, or for the purposes of reconstructing the breast after cancer and restoring that femininity.

And you touched before that you have a spiritual practice, or you're quite spiritual as well. Could you share a bit more about that and how you bring that into your work?

Yeah, this has been, I would say, professionally a really rewarding aspect of my career in the past few years, which is finding a way to infuse all these different parts of my life into the work that I do every day. So I view surgery as a ceremony. Surgery is an opportunity to undergo a major transformation of the mind and body. And historically, I think that's really what the process of medicine and surgery was. And there's a lot of similarities between surgery and ceremony. The first is that there's an altered state of consciousness or elevated state of consciousness, whether it's through medication or other kind of ceremonial experiences. The second is that there's a strong desire to undergo transformation of the mind and body. In traditional ceremony work, it's more the mind, and traditional surgery is more the body, but it's both. It's a strong physical experience that people go through. And the last is that you have to undergo the journey. There's no question. If you want to have a transformation, you got to have the surgery. You got to go through it. So they're actually very similar in that way. And when I had that realization, I started to lean into it more to see that there's really an opportunity here to create this transformation for patients. And I think medicine and surgery has sort of drifted away from that over time. It's become less spiritual, less about that transformative process and more about, you know, we're in a hospital, you know, like this is a very sort of sterile, closed container. And it's interesting, I just got back from a trip from Egypt where I was just like, witnessing all these different medical hieroglyphs and hearing these stories and just seeing how much ceremony there was in the process of treating patients while respecting the actual biology and medicine. And I was like, wow, it's still the same thing. It's still the same thing. We still wash our hands a certain way. We still wear certain ceremonial clothing. The patient still undergoes a process. They fast before the procedure. So it's an interesting link that's there, but I don't think patients have been given the opportunity to use this very special, precious, maybe once-in-a-lifetime moment to have a transformational shift. So what I focus in on in my practice and trying to bring in that spiritual element is to create an opportunity for patients to undergo that process. So it's not just about the surgery, it's about the intention they set beforehand. In some settings, they could work with either a therapist or a guide beforehand to really hone in on what it is that they want to achieve. Afterwards to have this integration pathway. The surgery itself is very interesting to me because I, because I do the procedure awake. I use a special combination of medications that creates the opportunity for patients to undergo this change. And that medication is primarily ketamine. I'm not sure if you've heard of it before, but ketamine is a medical anesthetic that's been around for a long time.

Yes.

But only recently, I'd say in the past decade or so, it's become gaining popularity as more in the psychotherapy world as a treatment for depression, anxiety. The real interesting thing about ketamine is that it is a very useful anesthetic for patients who are undergoing procedures while awake. It creates a state of neuroplasticity where you can really be guided through an experience and have a realignment in terms of how you view yourself. And it's very gentle on the body. Meaning from the physiology, it doesn't really do— it's not dangerous for the heart rate or the breathing. So it creates a much lighter anesthetic and you need less medication. So I've had patients go through this experience where they have almost no— they don't really need pain medication afterwards. And their entire surgery process is just like— it really is like a ceremony. And I get to hold the space for them and guide them through that. And what I've noticed afterwards Yeah, it's, it's, it's been some of the most rewarding experiences I've ever had professionally.

That's really exciting. I've had several guests on in different relations with ketamine-assisted therapy. So Roots to Thrive, Dr. Pamela Crisco brings people— do you know her?

Yeah, I know. I just saw her recently at the MAPS conference in Denver.

You were there in Denver? I had a few friends there as well. Yes, a few of my podcast guests have been there as well.

She's amazing. She's a big inspiration. The way that she does her work.

It's phenomenal. Yeah. So I had her on and then recently Dr. Kat Meyer, who was also in Denver, she was on as well. And she does for sex therapy, ketamine-assisted therapy as well.

Yeah. She's also been really inspirational. I've talked to her about the way that she cares for her patients and given me some great ideas on how to integrate the best kind of psychotherapy before and after procedures.

So, which is so beautiful. Yeah.

Yeah. No, I just want to say a lot of really talented people working in this space and I'm grateful to all of them for the inspiration.

Yeah, and it's such— so beautiful to have that, that built network. And I really like your idea of it as a ceremonial procedure because it is transformational. And I think that it's probably just as important to do that mental work and peace around it as well. Because what would you say are the biggest drivers for people from a more aesthetic thing? Is it coming from a place of lack and lack of self-worth and unhappiness with self? And like, does it really— is it really solved then by having the procedure? Or like, how do you help patients decide is this the right choice for them? And what is that mental piece, if you will, the psychological piece that you recommend that they do before and then for the integration after?

I always come from a place of non-judgment. No matter why somebody is coming in for consultation, it doesn't— their desire to want to undergo transformation is where we start. And then I screen patients. I say no a lot. I probably say no I'd say maybe about 60 to 70% of the time for consultations, which I think is pretty high.

Yeah, sounds like.

But yeah, but it's not very typical. Yeah, but it's really important. I think it would be a disservice to my patients as well as to myself if I was just saying yes to every person that walked into my office. And so certain things that I screen for is trying to get an understanding of why somebody is wanting to make a change. And there are definitely certain things that I look out for. But most importantly, if I'm getting the impression that somebody is looking for an outcome that I can't, I don't think I can achieve either physically or a mental state I can help them get to through the procedure, it's just not the right fit. That being said, just about everybody, or I'd say the majority of patients that are under looking to undergo this physical change, there is the association of how they view their body. And we all have that. We all wake up in the morning and look in the mirror and try and figure out what's going to happen in the day and like, what do we need to do? How do we need to look? And that, and that does come from a place of, I think, scarcity in the way that we view ourselves and that place of lack. But holding that and an awareness of that and knowing that ultimately my goal is to help people feel in alignment with who they are as much as possible so they can thrive every day. I see it as sort of like an alignment of the spirit and the body. So if you look in the mirror and you feel more confident and you're happy, You feel more alive to sort of, sort of emboldened to see who you see in the mirror and you're like ready to go after the day. I think that's a success. But keeping in mind, I also say, you know, like aesthetic surgery is, is not something that anybody truly needs. It's more of a want. And so really reassess the risks and benefits of any procedure to understand that shift that you're going to go through. It's important to have just a very, very no-frills conversation during a consultation about what to expect.

Yeah, because I have a few friends who've had procedures done, different types of procedures as well, particularly after having kids, breastfeeding, et cetera. They're like, in the bikini, things don't look as good as they used to and I should do something. So I think that there are potentially that bucket of mothers that just don't feel like how they used to if they were breastfeeding, for example. Is it possible with the procedure, with the fat grafting that you do, to still breastfeed and everything after? So is it—

Yes. —particular ages? Absolutely. So all the tools I use are blunt, meaning there's no sharp instruments that affect or damage any of the breast glands. Not everybody— so an important thing to say there is not everybody has the ability breastfeed at baseline. So it doesn't impact the ability to breastfeed because there's no, there's no cutting of tissues. I'm not removing any glands. I'm just gently placing the fat around the breast gland with a blunt instrument. So there's no sharp cutting. Another tool that I use allows tightening of the skin to raise and sort of elevate the breast tissue. So it's like almost like a scarless way to do a breast lift. Yeah, both, both of those tools are not sharp. They don't damage the breast glands.

Yeah, because I mean, especially as you know, I have a goal. I'm biologically 26, I'm 15 years younger, working to reverse that even further and live to 100, 150, maybe even 200. Who knows? Like as things are progressing and obviously we want to represent how we feel inside, also outside. Right. And so I think support like that for those who choose to. Right. So again, no judgment. And I think it's always a question like, where is it coming from? Make sure it's coming from the right place. Um, but I think that it's beautiful to have different options as well.

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What are some of the biggest myths you hear about plastic surgery?

There's some industry-specific myths, meaning like specific to certain procedures about things you can and can't do. But as a whole, I would say one of the myths is just about the incidence of plastic surgery, meaning how often people are getting procedures and just some of the things we see. So something I see a lot is there's certainly a lot of thoughts about it in the media and judgment and how people think about it. But the truth is that a lot of people get procedures and you often wouldn't know or notice it just because if it's done well, it should just look like a natural Enhancement. Yeah, exactly. Like, my— the biggest compliment I can hear from my patients, like, oh, it looks like you've been working out, or something different about you, I can't quite tell. It's not like, did you get work done? I know. So yeah, so I think there's definitely a myth there. And I think in general, normalizing the conversation about our bodies and how we treat them and what we do to them, um, I think is— would be very helpful. And again, from a place of non- non-judgment. I joke with one of my friends saying, you know, like, we are just these avatars that we do things to, you know, whether it's like dyeing our hair or changing the way we look or putting on different clothing. Obviously, plastic surgery or undergoing a surgical procedure is way more intense than that, but it's still on that spectrum of things that we do to our body to help us feel more in alignment with who we are. So I think one of the, one of the messiest things I've seen is just like, I don't know if people necessarily realize that how much this industry impacts people and how much surgery people are actually having, whether it's a minor procedure or all the way to like a big procedure that involves general anesthesia. One of the more common myths that I hear specifically to the work that I do is that doing liposuction somewhere in the body causes fat to reappear elsewhere. And I hear that all the time, and it's not actually true. Fat, fat is not that intelligent at all. The body stores and puts that wherever it needs to, however it needs to. Yeah. And I always say that's not really a problem. It's just, you know, some people, if it's not where you want it to be, it's not— you can be less happy about it. So that's, that's one of the— one myth I see pretty commonly is like, oh, if you remove fat from somewhere, is it going to reappear somewhere else?

That sounds interesting. I want to ask a question around white fat versus brown fat. Right. So we all want more brown fat than white fat. Does that have any role with the fat grafting that you're doing?

So brown fat in adults is more of like a, what I'll call like a histological phenomenon, meaning it's like very, very small amounts. It's mostly small babies that have large stores of brown fat that you could probably isolate from somewhere. Adults still have it, but it's not necessarily like when I'm doing my procedure, I can differentiate between brown and between adipose fat, that of brown and white fat. But brown fat is fascinating and it's full of all this, all these other things that make it just that much more active. It helps keep you warm. It's just like metabolism of what's happening in brown fat is just very different. Yeah. Um, I have never looked specifically though at what the difference in fat retention would be if you're harvesting fat that has a higher incidence of brown fat. We do know that fat has a higher retention if it is mixed with stem cells and if you purify certain stem cells from fat. And it is possible that maybe some of those stem cells are more likely to come from brown fat areas.

But I don't know for sure because I think I know in the biohacking community it's like if doing the cold plunges, cold water therapy, even having like ice packs on the back of your shoulders. I did that for a while just walking before bed, things like that. It helps to promote brown fat, which the fat, by the way, if people like hear fat, they always think negative, but the brown fat is the one we want. So you're saying it has—

Yeah, we want it. I mean, it's full of mitochondria. It really helps stimulate the energy centers of the body. And exactly right. That's what I've heard and read as well, is that that kind of cold shock therapy trips, trips the biology of those fat cells to over— to increase production.

I want to touch on a few things. Stem cell research. What are some new evolutions in stem cell research that you find most exciting?

You know, stem cells have been around for a long time, but now we're finally, I think, starting to hit more and more mainstream use of stem cells.

By—

there's the ethical approach, the legal approach, and then there's like the actual what can stem cells do. So ethically, legally, the FDA, at least in the US, only allows stem cells to be used in the context of a clinical trial for very specific applications, which are usually having to do with blood-related illnesses, whether that's cancer or immune system dysfunction. But that's just the tip of the iceberg. And the reality is that in other countries and even around the US, stem cells are used very commonly for different types of procedures. Stem cells can be harvested just about anywhere in the body. And there's evidence that basically the earlier you're catching the stem cell in its origination, so if you catch either fetal stem cells, so from the placenta or from this umbilical cord, those are the richest, most valuable in terms of what they can do. And in the past decade or so, we've learned that it's not even just the stem cells so much. It's about what the stem cells produce. And I'm sure you live in this world, you know all about it, which is the exosomes.

Share with my audience.

Yeah. So exosomes are the little bits of genetic material and packets of information that stem cells secrete that are the effector, meaning like, like actually what the stem cells are doing. So stem cells are the puppet masters. The exosomes are the puppet strings that are moving the puppet. They're really having the effect on the body. And in the past 5, 10 years, there's just been an explosion in stem cell research and the production of these exosomes that can then be injected back into the body, which in some ways is safer than stem cells because stem cells are biologic material. Anytime you're injecting biologic material in the body, there's a whole bunch of things that could go wrong. So injecting exosomes is technically safer, and you're still getting the benefit. So, and then even a step further has been this concept of something called Yamanaka factors, which is a researcher who identifies like certain genetic codes that come from stem cells that can really rewire and reprogram the body to act and to turn on all these genetic programs that make the body younger. So exosomes specifically are— I'm very excited about, um, I guess I indirectly use it for my fat transfers. It's not technically like a stem cell product, but the way that I harvest and process the fat is that there's a special way to harvest the exosomes produced by the fat cells that I harvest, and it's all from the same patient and it can be re-injected back into the patient. So that's increasing the survival of the fat. Super exciting.

I want to touch on something you mentioned in passing. Your trip to Egypt sounds like it was amazing. Can you tell us a bit what you were doing there.

What was that? Egypt really is like a, you know, before going, I kept hearing from people like, oh, it's like a portal, it's like a corridor, it's just like a transformative place. I went with a group of friends on this incredible trip down the Nile where every day we would stop at different temples and have these experiences and just really learning not just about the culture and history of Egypt, but the sort of spiritual past of what would happen there. And one particular experience really stood out for me, which was And you'll find this really interesting, which is the Temple of Horus. So Horus was an Egyptian god who was associated with health and longevity and healing. And if you've ever looked at— there's an interesting sort of like medical trivia fact here, which is if you've ever looked at Rx, which is prescription, that comes from the symbol of the Eye of Horus. The R and the X is literally— you may have seen it in Egyptian hieroglyphs before— is just the eye with the R through it, which is known as a symbol of the Eye of Horus. And visiting that temple was just— I'm just kind of like a geek and a nerd for this kind of stuff. So seeing all these medical hieroglyphs that had to do with surgical procedures and doses of medications and things like that, I was like, it's like the equivalent of walking into an Egyptian hospital 3,000 years ago and sifting through some files, seeing these glyphs on the walls. Yeah. And it just kind of brought back that concept of surgery as ceremony even more, which is no matter how far far we've gone from the spiritual side of it, there's still the ceremonial aspect of what we do. And I heard that great quote from a friend the other day, which has been ingrained in me, which is, what is a protocol but a process? What is a process but a ritual? And what is a ritual but a ceremony? And that's a thought I had when I was standing there at the temple. I was like, I mean, whether it's hieroglyphs on a wall that are showing medications and surgical instruments, or me in the operating room holding it, there's a common thread that goes through all of that. You know, I wash my hands a certain way before procedure, I put my cap and gown on the same way, I prep the patient the same way. All of that is a protocol process, ritual and ceremony. And so, yeah, and so a lot of my experience in Egypt was, was just, um, just being witness to that, and it was incredible. It's amazing.

I've been hearing from different sources, um, I was listening also to Aubrey Marcus who had this incredible trip.

I don't know if you're familiar with We're on the same trip.

You were on the same trip? Yeah, yeah, I'm in the process of listening to his podcast interview.

I witnessed some of that stuff, man. It was a lot of people. Yeah.

And I'm— Matthias DeStefano is speaking in London in a few weeks' time. So I'm going to go to his workshop there as well.

Yeah. It was phenomenal. I witnessed him channeling and sharing his experience, and it was powerful. I mean, there's just so much we don't understand. If we just push the boundaries of what we're willing to accept as a real understanding, just a whole nother world of possibilities opens up where I think you can really just be in question and inquiry of like, what else is out there?

I can't believe that you were with them and I'm listening to the podcast.

Yeah, see, there you go. Cool synchronicity.

The universe just brings these things together. It's really incredible. So the perfect timing that we're speaking right now as well. So, um, when we're offline after, I have a few questions for you. Sure, sure. Dr. John, what is the future of plastic surgery, would you say?

This is my hope for the future of plastic surgery. I don't know if it's actually where the industry is headed, but I would hope that patients and surgeons come together to help everybody, whether it's through procedures, technology, every modality we have available to help people truly feel the source of their own creativity and divinity within. I think that's ultimately, ultimately the goal of any of these procedures. It's being able to wake up and feel as aligned, as empowered, in connection with what you see your body is. And a more, I think, industry kind of like standpoint would be something like everything is just heading towards being minimally invasive, so less and less invasive. Less and less general anesthesia. I don't think it's necessary or safe for patients to have to go to sleep for these big procedures anymore, or even small ones. I think that's more of a thing of the past and surgeon's preference. So doing procedures awake, less invasive, and more of a focus on what happens before and after surgery. So all these amazing longevity biohacking tools that we have available to us, as well as bringing on other allied health professionals whether it's therapists, to really create this arc of transformation. I think there's just gonna be more and more emphasis on that. It's no longer just about the knife in the operating room. Yeah.

And see you later. Good luck. Exactly. Yeah, exactly. Thankfully as well. Yeah. What are some of your favorite longevity and biohacking integration tools?

I've gone down this rabbit hole. I, I started a company called Regenerate Rx Generate with a, with a nurse colleague of mine. And we, we went down the deep end looking for all the different tools and hacks. I tried them all. I was wearing like 6 different gadgets at some point monitoring my sleep and like—

Got a few of those myself.

Yeah, I got my Oura ring, my watch. I was doing different infusions and IVs and things like that. And, you know, it's— I would say that keeping it simple and going back to the basics has been the best thing for me. And that has been 3 things or basically 2 ways of thinking about it. It's like, what am I putting in my body and what am I doing to my body? So really, and every one of those categories is optimizing for sleep. So it's the number one thing I do. It's the number one thing most people spend their time doing over a lifetime. So as far as best bang for your buck and time spent, you can improve your sleep quality. And it's so high on the chain of things that happen in the body, from restoration to mood and all the things.

And what are your hacks? Yeah, so we're going to dig into that. What are you doing? What are the biggest game changers for you?

What did you start doing? It's always the same thing. What am I doing to my body? What am I putting in my body? So before bed, I like to take magnesium, usually magnesium bisglycinate. I know there's a bunch of different kinds. There's also— I forget the brand, but it's got all 7 different forms of magnesium. Pure Encapsulations?

I think that might be it. With the blue?

Yeah. So I take that one before bed. So that's what I'm putting in my body. I have thoughts about what you're not putting in your body. I try to avoid eating about 3 hours before bed, try to go to bed on a relatively empty stomach, avoid any bright light, and I try and keep the light down low. Lately, I've been seeing some interesting research about how truly sensitive the eyes are to light even when your eyes are closed. So I'd like to watch— if on a day that I'm not working too late, I like to try and catch the sunset, and that just creates this interesting sort of— yeah. You increase melatonin production. I don't take melatonin before bed. There was a while I was taking valerian root and some other things. I like to be really comfortable when I sleep. I was using the Eight Sleep for a while to try and cool down my mattress, but I found ultimately just like setting the temperature properly in the room. I will always keep a hand or a foot outside of the covers, which is kind of a funny thing. Temperature measurement. Yeah, it's not just temperature measurement, but it's also your body's most efficient way of regulating your core body temperature is through your hands. Oh, interesting. Yeah, hands or feet and your face because the blood vessels are aligned in a certain way that allows them to cool off quickly. It's literally the same concept as an air conditioner. So I'll usually keep a few limbs out because that, I know when I'm sleeping, helps me regulate. I also try not to do any crazy exercise 3 hours before bed. Again, I don't always— if the decision is to exercise or not, I prefer to exercise. And then in the mornings, what I find is actually really helpful which sets the rhythm for how I get tired at night is just getting a lot of bright light during the day. And that's been really helpful. And I've heard a number of people speak on this, and I think Huberman popularized it a lot, but I've heard it from a lot of other places that I've noticed is a really thing. I literally wake up and I go outside to my balcony and just take in the nature and just get as much sunlight as I can in my eyes. Beautiful. Also, try to avoid coffee after 3 PM. Yeah.

So that's number one with sleep.

Yeah. So fasting has been incredibly helpful. I try not to go overboard with fasting. I've noticed, you know, like just, just being really concerned about eating all the time can create its own level of stress. But really simply, I try not to eat any major calories until about 11 or noon every day. So I guess you'd call it intermittent fasting. And every 2 weeks I do a 24-hour fast. Mine's actually about to start. Yeah, yeah. I just follow the calendar every, every 2 weeks. It's a really helpful way Psychologically, it helps me reprogram my relationship with food, reminds me that being hungry is not the end of the world. And it just feels good to kind of give my body, like, just to quiet the engine down a little bit. Because it's really that we know that the metabolic overfunction of the process of the body is what contributes to a lot of the factors that cause aging.

Yeah, I think that's really helpful too. Just to comment on that for people listening. So I've dug into intermittent fasting a lot, and especially for women, it's a lot. It can be detrimental. I think what I've found also with clients is that for men, it's a lot easier to not have food until, say, midday and then have that afternoon eating window. For women, it can really cause dysregulation of hormones and have a lot of knock-on effects as well. So Dr. Sachin Panda is actually going to be coming on. He's the sort of researcher around circadian rhythms. He even just says overnight, having that 12 to 14-hour 4 hours is enough to already see some of the benefits as well. And then doing the occasional 24-hour fast or 36-hour fast can be really beneficial. So just for women listening, take note. And then another thing I would just say to people listening, this is assuming you are coming from a healthy baseline. You don't have a depletion in minerals, vitamins, essential things as well. So some people who are like, their health or immune system is like shot and really bad when they start fasting and they're causing huge adrenal fatigue. And I've gone the wrong way myself, so I'm speaking from experience. So just if you're considering intermittent fasting, take note and also make sure that you have a really good baseline before you get into a regular practice. So sorry, I just wanted to caveat that point.

That's a great reminder. Thank you for saying that.

So the intermittent fasting, we've got sleep.

Oh, and cold plunge. Cold and hot. So I recently installed— it's my favorite part of my house. It's out in nature and there's an outdoor sauna that gets really hot. It gets up to about 180 degrees. And then the cold plunge. I love to do that as often as I can. Usually I'll do this. I think if you dig it far enough into this literature or what people are saying, everybody's got an opinion. I don't know if there's a hard set fact anywhere, but we do know that the alternation, the deltas, the difference between the hot and cold is what's important in allowing your body to just heat up on its own. But I found cold plunge to be really helpful. Just doing hard and comfortable stuff consciously, I think, is kind of the tagline. So whether it's strength training and lifting weights and building muscle mass, which we also know is very healthy and important for longevity and as we age. But also just that kind of cold exposure has been really helpful. Yeah.

And the combination of both as well. And funnily enough, my German grandmother used to go— in Germany you have these wellness, I guess you could call it a spa. It was seen more as like a medical thing. And literally the insurance companies used to pay for patients in Germany to go to this. And she used to go like 6 weeks a year paid by her insurance company. That's amazing.

Yeah.

And when we were little, we used to kind of go and you can visit these places and they would literally— they have these, if you imagine like almost like a snake, it was like super hot water you would stand in and then you'd walk into the really cold water and move it around. And they have all these different saunas with different temperatures and then the cold plunge as well. So this is all like this biohacking thing, but it actually has been around for like hundreds, if not thousands of years. Right.

So yeah, so totally. I just thought back on my— I'm Russian. My parents and grandparents had what was called the banya, just like a sauna that you go And like, they didn't call it biohacking.

It was just living. I'm actually going to the Russian banya in London tomorrow. Oh, awesome. Yeah, yeah, yeah. It's going to be fun. Yeah, exactly. What I'd love to finish up with is if you could live to 150 years old, Dr. John, with excellent health, how would you spend your time?

I plan on it, by the way. I'm going to make it a— Yeah, I'll see you there too.

See you in the banya.

I would say in the company of friends, family, loved ones, in celebration, in pursuit of joy and learning. Beautiful. Yeah, yeah. If I could live to— or when I lived to 150, I think it'd be the coolest, coolest thing to just keep learning and going deeper. I'd get maybe, I don't know, go get different degrees and try and find all the ways that they combine together to just create total alchemy of things we don't know yet. So exciting. But most important, yeah, most importantly, I think it's the relationship that I have in my life have created the most joy and meaning, and I would focus on those.

Yeah, I mean, Harvard's longest-running study, the world's longest-running study from 1938, right, that like shows for longevity and happiness and longevity is about human connection. And I think the world really needs to reshift post-COVID, right, to remembering what connection is. And I almost, you know, fear, and I try— my kids are a bit younger, 7 and 9, but like like letting them know that like these devices and just sending a WhatsApp to somebody is not really human connection. And when they hear the stories of like back in the old days, you would write somebody a letter like, I'm going to come visit, and then you'd visit for a few days and you sat around without devices and had conversations. It's like for them, they're like, what? Like, what did they do? Yeah, it's like they were speaking to each other, enjoying each other's company. So let's see where the world brings us. But I totally agree with connection and experiences, right? So like your Egyptian experience, right? Just these beautiful things the world has to offer that we just need to spend time uncovering. And to be able to do that with friends and family and loved ones is amazing. So what excites you most about the future of health longevity in the coming years and beyond?

It's two things: artificial intelligence as a tool to enhance health practitioners, and second thing is the proliferation of medicine as a, as a tool to help people who are already well rather than focused on just, just sick or unwell. And that's not to say that people who, who are sick and don't need help, or don't need help, absolutely not. It's not what I'm saying. But I think for the first time we're able to democratize information to make healthcare more accessible for everybody. And that's both for people who are unwell and well, just trying to optimize everybody's health. And on the artificial intelligence side, I'm really interested. I, I work advisor, a few companies in the healthcare artificial intelligence space. And I really think just how, you know, maybe a couple hundred years ago, before, before X-rays or medical imaging was used, like a doctor with an X-ray or a CAT scan was not nearly as good as one— or sorry, a doctor without that kind of technology is not as good as one with it. It'll be the same thing as artificial intelligence, you know, having that super superpowered approach to knowledge information will just, will just make healthcare more accessible and more efficient for everybody.

I'd love to ask a follow-on question on that. So in what ways or what applications of AI in medicine do you find it helpful? Because there is like IBM's Watson, which reads all the medical research because not like one human can read all research that comes out. So it's like up to date. So that's kind of one application versus I've had a recorded conversation, hasn't been published yet, about the MRI scanning, right? And like preempting, like early detection of potential cancer and things like that as well. So what area of AI application in medicine, um, do you think is most exciting?

Oh, that's a great— we could do a whole other podcast on that. So I started an AI company in Montreal called Imagia about 7 years ago that was focused on applications of AI medical imaging. I think every facet has, has some potential, but what, what I'm most excited about is the application of AI and surgical robotics. Yeah, I think there's a lot that happens in surgery and that could be improved. So I advise for a company called Neuralink, which is involved in putting, creating an implant for a brain-computer interface. And Musk, right? Yeah, yeah. And the amount of— the amount that we're learning and able to glean from being able to literally gather information from the brain, as well as the surgical robot that is mostly guided by AI, is just incredible. And so there's a number of companies that are working in that space that I think is fascinating. Apart from that, DeepMind, a company based out of London. Yeah. And they have a sister, like a related company with the same founder that is focused on protein folding, which I think is going to be incredibly fascinating for drug synthesis where you could have, you know, part of the problem with drugs and pharmaceuticals now today is that, you know, you're getting such a small amount of the bioavailable molecule, meaning you take like, what thing do you buy that you buy 100% of that maybe 10 to 15% is actually doing the thing it's supposed to do? Like not very often. And that's, that's the case with a lot of drugs, whether it's the body's breaking it down or it's not working the way it's supposed to. So with AI approaches in pharmaceuticals, there's the opportunity to develop extremely, extremely tailored molecules that can act specifically on certain parts of the body, designed just for you based on your genetics. And I think that's really powerful. So I would say, I've given you a big answer, but I'm excited for the really big robotic stuff. Up to the really tiny molecules. Um, it's like, it's, it's the extremes that I find pretty interesting.

Yeah, I know a lot of people always are fearful when they hear AI, but I do think there are a lot of positive benefits as well. So it's finding that balance. Yeah, that's another conversation.

Yeah, the fear is certainly warranted, and I'll be, um, um, definitely agree with you there, but there's also great benefit.

Yeah, as well. For my listeners interested in understanding more about about plastic surgery and the work that you do, and it's particularly around fat grafting as an alternative, and also around breast implant illness. What is an online resource, um, or you mentioned obviously the book— we'll link that as well— that you recommend they could start with?

I think, um, it could be just as simple as going on— on— so there's a few places, um, if you just go on Google and type in breast implant illness and fat grafting, there's a ton of information that you can find about problems with implants and, and the opportunities with fat grafting. I share regularly about these topics on my Instagram. So that's @drjon.k. So that's D-R-J-O-N dot K. Also on my website, auraaesthetica.com. That's A-U-R-A-A-E-S-T-H-I-C-A.com. Aura Aesthetica.

And we'll link everything in the show notes for people, so don't worry.

Yeah. Those are some of the best places. There's actually a few— there's going to be a few books and movies coming out on the topic of breast implant illness as well. So there's no shortage of information out there. I do think that the book that I mentioned, Busting Free by Amanda Savage-Brown, is also a great, great place to just get more context and information. Beautiful.

Do you have a final ask or recommendation or any parting thoughts or message for my audience today?

It's a message of gratitude and just, you know, every day I'm grateful for the work that I get to do and I hope that anybody listening, um, also can, can find something to be grateful for at some aspect of your day because that can be such a source of positive energy. Thank you for the work that you do and the guests that you bring on and this opportunity to speak.

I'm so grateful. Yeah, same here. Thank you so much for sharing your work, and I love the innovation that you're bringing across the field and the awareness, and also your decision not to do the, the typical breast implants when you were able to already foresee the risks and saving so many women's lives because of it. So thank you too. Thank you.

Thank you so much.