https://www.listennotes.com/e/a33b9a7a57104c8fa8a37092af0ad1ca

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I did have 28 square inches of skin removed from my face. And I did that because of two things.

When you age, three things happen concomitantly. Your skin and your muscles and everything sags. Our facial framework is attached to the bone by little ligaments, and they stretch, so we start sagging. We also start losing volume as we age, and our skin quality deteriorates.

Stem cells, I think, are magic for skin.

Dr.

Victor Ozola is a renowned Costa Rican plastic surgeon known for combining advanced reconstructive techniques with regenerative medicine. He combines European surgical training with cutting-edge stem cell therapies to deliver both aesthetic and functional outcomes.

I think Botox is one of the things that CBD helps your skin because by blocking some muscles, you avoid your skin from breaking.

What advice would you have for young people who either don't want to have cosmetic surgery later in life or just want to remain looking really healthy? What should they do to their skin? You're listening to The Human Upgrade with Dave Asprey. I did have 28 square inches of skin removed from my face. And I did that because of two things. One, I used to be really fat. And in fact, you could grab a handful of skin on either side of my face. And on top of that, as you age, your skin, even if you are as healthy and you're following all the longevity programs like that, gravity still exists, sort of like how your fingernails grow and you cut them. Well, at a certain point, if we're going to live for a very long period of time, No procedure that I'm aware of stops skin from responding to gravity over time. So what do you do about it? I went through all the different tightening procedures, RF, lasers, and they help, but I lost my dimples because I'm at 5% body fat and that also will give you extra skin. So then people are saying, Dave, you're not at 5% body fat, dude. I don't care. 5.5%, whatever. Like, look at the COVID of Heavily Meditated if you think that I have large amounts of body fat. So whatever. But what's going on there is I said, all right, what am I going to do? I've looked at all these things for years, actually. I've tried all the different stuff, and I said, all right, I'm going to get this removed. So it's kind of like part facelift and part dealing with the side effects of obesity. And I would rather you not get obese in the first place because you will grow extra skin according to the equations. I've got about half of a large bath towel worth of extra skin distributed throughout my body because I was 300 pounds and I'm now about 195 pounds. So, yikes. That's not where you want to be. I don't want you to be there. And if you're there or you're just aging, we're going to talk about that. And we're also going to talk about boob jobs. I've been thinking about getting one for you. Okay, not really. We're going to talk about boob jobs or breast implants. Our guest today is Dr. Victor Urzola. And he performed the procedure on me. And he's also one of the top breast implant experts in the world, I would say, certainly in Costa Rica. And you fly around internationally and speak at conferences on this. And we're going to talk about breast implants so that you can understand if you have them or you're thinking about getting them. Is it always a bad thing? Who is susceptible? And I've covered this on other episodes as well. And you're going to find that Victor has a unique perspective on this. That is very personalized. So that's what we're going to talk about today. Victor, thanks for flying to Austin from Costa Rica in order to be on the show.

Thank you for the invitation, Dave. I'm very honored to be in this podcast and I'm very happy to share my experiences with you and your audience.

Let's start with the cool cutting-edge longevity stuff. So you work with RMI, which is the clinic where I've done the whole body regenerative therapies, where I've done the brain, incredibly powerful brain central aging clock reset using stem cells. And we work together on my recovery protocols with your work and with RMI in order to use stem cells to speed healing. And let's start with that. How have stem cells changed either breast implants or cosmetic work on the face?

Well, Dr. Giampapa and I co-founded RMI like around 12 years ago, and we opened to the public around 4 years ago. And basically we wanted to use the power of cells to improve, you know, humans and make them age better, treat conditions, you know. And as plastic surgeons, of course, one of the things that we started working with was skin enhancement, you know, and we developed a protocol that we called SKIN, you know. Basically we use needle radiofrequency to generate microtraumatism in the skin. And then we inject umbilical cord expanded MSCs in the skin, in the dermis, like, you know, you would to do with mesotherapy. And we started to notice that, you know, this skin was, you know, starting to improve a lot better than with the radiofrequency alone. And this is of course because of all the epigenetic, you know, modifications that the umbilical cord cells have on the resident cells, making them work better and work like younger cells, you know. So the skin quality started to improve a lot. Then we started to also combine plastic surgery with fat transfers using stem cells, you know, like when you do a lipofilling in your rather than using fillers, we started to combine this, you know, fat with expanded umbilical cord cells, MSCs, and also with some growth factors that were developed, you know, in a matrix of hyaluronic acid. And we started to see how the skin of these patients not only got better, but they also started to heal quicker. You know, the scars were better and the recuperation time was a lot faster.

Well, in my case, that's what we did. So you pulled some fat out of my butt. Could you find much fat there?

No, it was very hard to find fat.

Say that again louder. It was hard to find fat as a former obese guy.

You are probably at, you know, 5% body fat. You know, it was really the most difficult part of the surgery was getting your fat.

Was about 20 cc or 50 cc? How much did you get?

No, like I think maybe around 15 or 16, 17 cc.

So that was all you could find?

Yeah, it was really— yeah, it was really difficult to get it.

I did try to put on fat before. By eating even more carbs and it just doesn't work. So we took that fat and then you mixed it with the stem cells and the growth factors, and then you put that into my— into my face to help revolumize, which is good.

Yeah, exactly. When you age, 3 things happen concomitantly. Your skin and your muscles and everything sags, you know, due to gravity. Our facial framework is attached to the bone. By little ligaments called Fornix ligaments, and they stretch. So we start sagging. We also start losing volume as we age and our skin quality deteriorates. So when we're doing facial surgery, we need to try to address those problems. And this way we arrive to a much better result and a much natural looking result, which is what we're really striving to do with facial surgery nowadays.

I did ask for duck lips, but you wouldn't give them to me.

No, I—

we didn't do anything to my lips at all. Now, in terms of skin quality, what did you find in my skin?

No, your skin quality is pretty good. You know, when you take care of your skin, when you are very well with very good nutrition and you don't get as much sun exposure, you know, then skin quality tends to be better. This is also something very genetic. Some people tend to, to keep more hyaluronic acid and collagen in their skin. And this, of course, helps them have a better, quality of their skin. The less thickness your skin has, the worse quality it has and the more prone it is to getting wrinkled. And this is part of the things we try to do with radiofrequency and the stem cell combination. You know, this is something that helps the skin become thicker, tighter, you know, it generates collagen, new hyaluronic acid. And this, you know, of course helps skin quality and it looks a lot better. What we also do is we then follow up with a facial peel, you know, a soft peel. And this generates a little bit of trauma for the stem cells to start sending more information to the resident cells. And this improves further the quality of the skin.

I definitely remember the peel you did under my eyes. It was— it took about a week for it to fully peel, but the under-eye difference is really profound. I mean, it's completely smooth. And I you know, take good care of it. I don't avoid the sun entirely. Post-procedure, I avoided the sun for a while. I do put mineral-based sunscreen on, but I don't mind getting 5 or 10 minutes of UVA and UVB because it seems like it's a positive stimulus for collagen thickness in studies. But sitting out in the sun for an hour on my face isn't something that I want to do. So avoiding all sunlight seems a bit scary for skin, right?

No, no, no. You should never avoid completely sun. It's actually a very healthy thing to do.

There you go.

What you need to be very aware is Of course, after surgery, you have to avoid it.

Right.

And on your regular lifestyle, it's important to have sun, you know, but not in excess quantities because then you start to get more skin damage, you know, due to the UV radiation.

It also depends where you're from. So I'm primarily Northern European genetically with some other weird stuff mixed in there here and there. So I have easy to age skin. And fortunately, I think this, I, idea that I pioneered the collagen, collagen movement around eating collagen. There are studies that show that that helps with skin thickness. And I only recommend today 20 grams of collagen a day. There are people who go way above that, and there's reasons you wouldn't want to do it that have to do with oxalate formation from excessive collagen. But zero collagen doesn't seem to be a good idea either. So if you're listening to this and You know, you're familiar with my work back in Bulletproof. Number one, I have nothing to do with Bulletproof anymore. And there are tons of vendors of collagen right now. And 20 grams seems like the sweet spot. You don't need to go above that. And even 10 grams could be beneficial. And since I did that for many, many years, I like to think that that was one of the reasons my skin quality is where it was. So you could do a procedure that worked well. What advice would you have for young people who either don't want to have cosmetic surgery later in life or just want to remain looking really healthy, what should they do to their skin?

Well, you know, I think it's impossible to avoid aging, you know, and, and we've dedicated a long, a long time and a lot of thought and work to trying to make it slower. And I think with what we are doing in RMI and what we are developing for the future, we're going to get better at doing this, you know, for sure. I think there's a lot of things like stem cell reprogramming, viral vectors, and plasmids that we're going to incorporate in the future that are going to help, you know, humans slow much better. And not only that, but also live a lot better and healthier. The most important thing I think is to try to live a very healthy life. You know, nutrition is super important. Again, you know, sun exposure is good and healthy, but you need to have a controlled sun exposure.

Correct.

Using creams that can, you know, help your skin quality is very important. You know, skin is like a muscle. You need to work it out for it to grow and for it to be healthy. Right. And you work skin by inducing a little bit of trauma like you do when you work out, you know. So people that want to keep better quality skin as they age should do lasers, they should do microneedling with radiofrequency because this generates traumas that induces fibroblasts to produce new collagen. You know, also, if you are taking good quality collagen, this is also going to improve your skin quality. You need to start looking eventually into rehydrating with hyaluronic acid your skin. The use of soft peels, you know, once a week is very important. Think that, you know, fibroblasts have a 21-day cycle to produce collagen. So if you can do some sort of stimuli every 21 days to your skin, those fibroblasts are going to keep working and producing better quality collagen. And also, of course, very important, the use of Botox. You know, I think Botox is one of the things that really helps your skin because by blocking some muscles, you avoid your skin from breaking, having repetitive trauma in the places where your wrinkles are, you know, in correspondence with the muscle contraction. So these things do help a lot, you know, keep your skin in better quality and give it a little bit more like lifetime.

Got it. Soft peels. I don't actually do those very often, if ever at all. This is glycolic acid or what would you recommend?

Well, there's a bunch of soft peels in the market that you can use. Glycolic acid is one of them. The important thing, you know, is to, to be sure that the peel that you choose is a peel that really works for your skin. As you were saying, there's a big variety of skins. You know, there's a classification called Fitzpatrick, you know, classification. And it basically— very white people are type 1 and darker people are type 5, you know. And this, you know, range of variety requires different peels, you know.

So white people are basically fucked, is what you're saying?

No, but they tend to age a lot faster, you know, and they take sun damage worse.

Yeah, yeah, yeah.

So it's very important to have an assessment of your skin. We nowadays have machines with softwares that help us a lot, you know, see You know, what type of damage your skin has. And based on that, you know, we pick the better peel or the better skin protocol to help you. And definitely since we start using stem cells for this, the results are much, much better.

Stem cells, I think, are magic for skin. And guys, full info on this if you're interested. I just put all the links. It's DaveAsprey.com/RMI. That's got all the stuff I did to my face, all the stuff I did to my brain. Because I went down there and there's about 10 days of healing. So the first 5 days I had bandages on, and then the second 5 days as I'm healing, as I'm doing hyperbaric, I also did the central aging clock reset where we use focused ultrasound to open up my blood-brain barrier and put stem cells and exosomes into my hypothalamus and my hippocampus to improve memory and to improve the aging clock in the brain. So I'm like, if I'm going to be recovering, I might as well do all the upgrades I can while I'm there. So that was kind of a double thing. And just DaveAsprey.com/RMI has the info on the range of stuff that I did because I think you're interested in that. And if you're not interested, then don't go there, but there's still a lot to learn here.

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One of the things that makes me really happy is when supplements kick pharmaceuticals' ass, and I've got something for you. It's called C15 from a company called Fatty15, and it's more effective than metformin or rapamycin. In fact, scientists are calling this newly discovered essential fat the longevity nutrient, because it's the first essential fat to be discovered in the last 90 years. C15 is unlike anything else out there because it's a true geroprotector, meaning it actually slows biological aging in studies. How does that work? By strengthening your cell membranes by 80%, activating AMPK and mTOR, which you've read about in my books. That means less inflammation and a reduction of oxidative stress by 45%. Scientists have found over 36 clinically relevant health benefits from fatty 15. Public estimates are that 1 in 3 people have low C15 levels in their bodies. And if you don't have enough C15, you have fragile cells and you age more quickly. Fatty 15 supports your cells better than omega-3s or fish oil with 3 times more benefits for your cells. I use both. In clinical studies, 72% of Fatty 15 users reported deeper sleep, better mood, healthier joints, and better energy improvement in 16 weeks. It's a pretty incredible story and it's real. Better yet, they're giving you 15% off their 90-day subscription starter kit. Just go to fatty15.com/dave. Now, young people should be doing an occasional peel. They should be using some sort of skin cream. One of the things that I did to speed my healing is I brought one of the TrueLight devices down with me. And this is a light therapy device that did red two shades of red, infrared, and amber, which helps with small vessels. So every day I was doing probably 40 minutes of that. Is red light therapy important for people's collagen thickness and for their faces? Like, what's your take on it?

Yeah, I think, you know, again, you know, skin requires stimuli and there's many different types of stimuli and like muscles. And I always use this analogy because everyone goes to the gym and, you know, if you want to have a really good result, you need to work out. Regularly. You need to do intense, you know, lift so that your muscles become stronger. You need to have the right nutritional support, the right timing to do it. There's a lot of factors that help you build better muscle. Same thing happens with skin. And red light therapy is one of those things that can help, you know, improve the quality of your skin.

What about electrical stimulation of the face? I remember— geez, was it Suzanne Somers sent me this thing called like a FaceBlaster? And it ran little electrical currents through the face. Good or bad?

Well, the rationale behind this is trying to generate muscle contraction to increase the tone of your muscles. I don't really have a lot of experience with this. It does make sense that if you are able to accomplish better muscle tone, also like with facial yoga, this might, you know, improve the tone of your muscles and avoid laxity, which, you know, drives to falling down. Of course, you need to be very, very persistent. And, and do it very regularly to be able to accomplish a good result.

I've looked at facial yoga practices and they seem like a lot of work and I haven't really done them. I'm open to electrical stimulation on the face. I haven't done that much of it either, mostly because, well, I just have a lot of things to do and it just doesn't bubble to the top. But for people who are really interested, you probably can reduce the ligament lengthening if you're doing these yoga practices on your face. And that could be helpful, but there's something else that happens that I didn't know about that you taught me about. And it's that the muscles on your throat here, they actually start to split over time. And this is a normal aging thing. In fact, they'll also split on your abdominals as you age a little bit as well. What's going on with that? And what does that do with aging?

Well, there's a process that happens when we're in you know, embryologically, it's called gastrulation. And we go from being flat entities to circular entities. So basically gastrulation is a process where we start to go into a cylinder. One side arrives a little earlier than the other one to the midline. Then this is where we are not perfectly symmetrical. But like the platysma in this case is the muscle that goes from the anterior margin of your mandible to the clavicle and a little over the clavicle. And these muscles basically are united in the midline. As we age, they do stone and they start to become atrophied and they start to separate. So those bands that you see here, you know, are basically the platysma muscle that gave up and separated from its, you know, counterpart.

Can you exercise your platysma?

Yeah, of course. How? You can put your chin up and start doing like this.

It's like facial yoga moves.

Exactly. It requires a lot of time, you know, a lot of, you know, discipline. But of course, if you contract and contract the muscle, it's going to become stronger and have better tone. The problem is when it becomes lax, you know, and it's in a position that gravity really is not helping, everything that's attached to the platysma will fall down with the platysma. And of course, this is why the skin looks so tight when we do surgery. Basically fixing the platysma in the midline and pulling it upward makes the skin come tighter immediately. And that's basically what we do.

And in my case, I had a lot of extra skin. I think I've probably lost an inch and a half on my neck size from losing weight. So I had the extra skin there plus the platysma problem. So you actually sew the platysma back together?

Yeah.

In the middle. And then you change the attachment points on the edges.

Exactly. We basically— the platysma goes from the midline to around here. So we fix it in the midline and then we pick the platysma up and anchor it to the mastoid bone behind your ear.

Behind the ear. Okay.

And that basically gives, you know, a very, very good support to the platysma, which brings along the skin and gives support to the skin at the same time.

I have a little story about platysma that you may appreciate. When my kids were little, like 5, 6 years old, we would do this whole body awareness relaxation exercise where I started at their toes and say, you know, this is your toe and just do like a little massage. these are your big toes, your little toes— so that they could get better proprioception. And then I said, well, let's learn about the body. So this is the name of the bone. This is the tibia. This is the fibula. This is the femur. This is the quadricep. And we'd go up so that they just had the body awareness and the names where the organs are. And I was doing this with my son, and I got up to the platysma, and I couldn't remember the name of it, and neither could he, even though we'd done it before. So I said, this is your, uh, scrotum. And of course, being, you know, 5 or 6, whatever age was, he just starts laughing because he knows what a scrotum is. So then he runs out, goes, Mommy, Mommy, look, my scrotum! And he's pointing at his neck. So there you go, guys. That's my 7th grade sense of humor. Cordial longevity, but that's funny. So you're about to be, uh, a dad, right?

Yeah, I'm expecting a little girl.

Little girl.

And you have kids now?

No, first.

It's your first. Wow. It's going to be an adventure that leads us into a conversation around boobs. Now, you've done thousands of explants of people who have breast implants that are failing, and you've also placed a lot of breast implants. Can you tell me, how is it that you can take out failed breast implants and put new breast implants in people? I thought breast implants were supposed to be bad.

Well, around, I would say, 7 or 8 years ago, I had a lady who came into my office from South Carolina and she told me, Dr. Shilah, I saw you doing an unblocked resection on YouTube and I want you to do the same procedure for me and I want you to record that you did the full unblocked resection.

What's an unblocked resection?

Okay, so when you place a breast implant, into your body, we arise a type 4 hypersensitivity reaction. It's an immunological reaction to the implant which basically forms a shell, okay, a biological shell that covers the implant, okay. Your body cannot destroy it because it sees it as a foreign body. So basically it cocoons it with this biological capsule, okay. And an en bloc resection is removing that biological capsule completely without leaving any pieces of back behind and without breaking the biological capsule. Right. So you basically are taking it as a whole unit. And this is why we call it an en bloc resection.

Okay. And this is basically a balloon of scar tissue that's around the implant.

Yeah.

Because implants are not biocompatible. It's not that the body thinks it's part of the body. It recognizes it's a foreign body.

Right. Silicone is biotolerated, not biocompatible. That's a big difference. And that's a difference. Yeah. I always tell people you're biocompatible with your wife, you biotolerate her mom, you know? So, you know, that's, you know, a way of, you know, making it, you know, funny. But the body doesn't really recognize silicone as its own. So there's this reaction and it's called a biological capsule.

And some people get a much bigger reaction than others, right?

Yes. That's why we have capture contractures. For years, you know, we have tried to study why it happens. And the reality is that some people have different immunological reactions. Just like when you go on a field trip and you get stung by a bee, if you have 3 people, one of them can get a little, you know, lump in the skin that's itchy. Another one gets the lump and puffy eyes, you know, and another one gets an anaphylactic reaction. There's different immunological responses to every antigen. And in this case, the implant is an antigen recognized as foreign by the body.

So it's basically same implant, different responses based on biology and maybe some other stuff we don't even understand.

Exactly.

Okay. What is the best type of breast implant that's going to work for the most people?

Well, actually, you know, all breast implants are made out of polydimethylsiloxane. It's the name of a compound. And most breast implant companies, if not all, use the same manufacturer of silicone. As, you know, their raw material to fabricate the implants. And then they basically do a different manufacturing process to the shell, you know, to improve, you know, the biocompatibility of the implant.

So you're saying that there's no difference between any of the different types because they all have the same shell?

It's the same material that is used. The shell is different. Some companies make them with sugar or with salt, you know, and some other may make them with lasers. It's a big science behind it. The shell of the implant has a lot to do with how the body reacts to the implant.

Is there any kind of testing you could do to see which kind of shell material is going to be best for you?

Not really.

Okay. I would suggest that there's a company called Melisa Diagnostic or the Melisa test that would probably do that. And The reason I know this is I was a co-founder of that company in 2008 in the US. And I've, I know it's still available. I don't know who offers it now. This is where you can take various implant materials. When I was doing that, we focused on metal implants and we found that people would have a non-antibody mediated response to certain types of metal. Like we had a little boy who had that condition where your ribs grow inward and crush your lungs. And they have to put a brace in so you can survive. Well, they put a titanium brace in that contained nickel as well, even though it wasn't on the list. And he started dying. And we used the test to figure out which implant materials were compatible with him and got the FDA to give a compassionate exemption so he could get a zirconium implant, because zirconium doesn't cause any problems in humans, but most metals do. And number one, why do I need permission from the FDA to do whatever the hell I want? Guys, back off. And thank you, Bobby Kennedy, for becoming sane and relevant again. And secondly, the idea that maybe down the road we might be able to test breast implants to see, is this, is this working? So I don't know who runs Melissa these days, but I think there might be some cutting-edge ways to figure out what works. And I would encourage you and others in the field to say, well, maybe we can figure out what implant material will cause the least capsule formation so that you get more natural, soft results and you get less immune inflammation. Does that make sense?

Well, there's a lot of studies that have been done already to see which type of shell generates less capsule. And actually there is a company that has developed a capsule shell that generates very little response to the implant.

And is that what you use?

Sometimes I use this. I mean, it depends very much on the case. You know, surgery is not really like a recipe. Sometimes I use this, you know, type of implant, especially in women who have the history of capsular contractures. But, you know, these implants that generate less biological capsule also tend to open the pocket that is generated. So sometimes the implants can jiggle inside. So it depends very much on your skin quality, your history. You know, there's a lot to implant selection that requires a lot of, you know, medical expertise and also evaluating each individual separately.

And this is why you might want to work with someone who's done a huge amount of procedures because they develop that over time. And I just, I think there's wisdom to that. One of the reasons that I selected you and Dr. Vince Giampapa to do the work together on my face— Vince has been on the show a couple of times. He's a founder. There's this old group called A4M that was at a time, maybe like 25 years ago, sort of the leader in longevity education. And I think it's, it's gotten a little bit conservative and a little bit maybe almost stale at this point. But Vince was a driving force. I interviewed him last year at their event. And what's interesting with Vince is 34 years of, of experience doing this and a leader in longevity, advanced science. The fact that you and Vince partnered on this and that you're working on the longevity side of things which is larger than just the cosmetic side, but you're also both experts in that. I'm like, I want the longevity stuff first and foremost, and I want the world's best on the cosmetic side. So that was what drove me to come down and work with you because I'm like, wow, I'm getting someone who's done this procedure many, many times. So that's cool. That obviously, guys, I'm not talking about breast implants. I'm talking about the face stuff again. But when it comes to breast implants, you also want someone who really has just a huge amount of experience with it so they can select the right ones versus, you know, pharmaceutical rep came in, you should put this implant in and then just goes down the road.

Yeah, I think, you know, it's very important to let women know that there is a group of women that don't tolerate implants and there's a group of women who don't have any problems with implants. What I do recommend, at least in my experience, is that implants should be removed or replaced every 10 years. Because like the tires of your car, they start to wear off and they start to dissipate silicon molecules that can interfere with biological processes in your cells. They can chelate neurotransmitters, they can block receptors, they can interfere with your mitochondrion's function. They can generate upregulation epigenetically of some genes, MMP3 or TNNT3, and this increases upregulation of metalloproteinases, which can lead inflammation and the development of interleukins that have been isolated in women with breast implant illness symptoms and that are not isolated in women who don't express symptoms. So this is really important, you know, and we were speaking before about gluten, you know, 1% of the world's population is intolerant to gluten. We cannot forbid the rest of the world to eat pasta. But unfortunately, there is a group of women who you know, have a hard time with the silicone in their body and they do get sick and express a myriad of symptoms that, you know, makes them really sick. And by removing the implants, they really improve. I did a series of around 500 patients that I removed their implants and followed them up for around 1 year. And 87% of the women were rid of their symptoms after a year. And 92% reported important improvement, you know, in the way in which they felt. So there's a really, really big correlation with this. And I think people need to be aware, you know, and if you're a woman who has breast implants and you're experiencing massive hair loss, skin problems, polyarthritis, your knees and your joints hurt, you know, you have tinnitus, cognitive disorders, palpitations, you're probably suffering of this problem.

And low heart rate variability maybe would be a symptom.

Yeah.

Yeah.

And this is due to alterations in receptors and neurotransmitters that got chelated by the silicone molecules.

So there's a group of women who just don't tolerate them, and then there's a group of women who seem to have very few, if any, problems.

Yes.

Okay. For the women who don't have problems, you're still recommending every 10 years that you take out the implants and then replace them. Is that a big procedure?

No, it's actually a really quick procedure and it's very easy to do and with a very fast recovery. And the reasoning about it is very simple. When I remove implants that are around 10 years old and I basically touch them like that, I can see filaments of cohesive gel inside the implant starting to come out. And basically this is because the external shell of the implant starts to give up, you know, friction, changes in temperature, the hydrolysis of macrophages start to deteriorate the shell of the implant and it starts to give up, you know, like the tires of your car. So eventually it's better to change them. And then avoid all these silicone molecules to be leaving the implant and going into your body and generating problems.

It seems like sauna use would speed the breakdown of breast implants. True or false?

Yeah, there's a lot of people who say this happens. You know, I have not seen a study that will really certify this, but there's, you know, some people that say this major temperature changes, you know, this is a polymer. Can, you know, have an effect on it.

It makes a lot of sense. So I would say there's abundant evidence that using a sauna, infrared or not, has longevity effects that you want. But if you have breast implants and use the sauna, you might want to change them maybe every 7 years or something because the life cycle of them would go down.

Very likely.

Okay, got it. And it's so weird how things can be true and real reasonable even if there isn't a double-blind study. So I'm going to say that's what I would recommend just based on thinking. But like you said, I haven't seen a study. And isn't it weird that the breast implant manufacturers really wouldn't want to fund a study like that?

Well, actually, there is a study. It was done with 150 patients that was done. It used 3 groups, you know, 1 control group and 2 groups one with the 50 women who had implants and another group without symptoms and another group with implants and symptoms. And basically 3 interleukins were found to be upregulated in the group with implants and symptoms. And these are interleukin 17A, 13, and 22. And these are pro-inflammatory interleukins.

Got it.

So, you know, you can see it's a—

Those weren't from sauna though, just to be clear.

No, no, no. This is just, you know, but it's a very complex physiopathology. Okay. And basically I will divide it in the following way. There's an inflammatory component due to an upregulation, you know, of genes that produce inflammatory cytokines and also the immunological response that happens around the implant in the biological shell.

Okay.

The other one is biological. You know, there is basically a disturbance of the normal biology of your cell by, you know, blocking receptors or chelating neurotransmitters or affecting the phosphorylation process in mitochondrion, you know. And then another one, which is epigenetical, with the upregulation by the molecules of silicone of some genes that increase metalloproteinases, which, you know, turns over, you know, into pro-inflammatory cytokines in your connective tissue.

Let's talk about that for a minute, just in the context of overall aging. There's— I think I've identified 19 different unusual aging pathways that you can affect just by getting the right signal into cells. And something that you don't hear about except in longevity textbooks is MMP-9. And MMP-9 is a pro-aging molecule. And if anyone's ever eaten bad oysters. If you get the paralytic poisoning, you probably die. But the other kind is a bacteria that raises MMP-9 levels. And when MMP-9 goes up, this is what makes you feel like you got hit by a truck. And it can last for a couple, a couple weeks. And it's whole body aches, pain, swelling. It's miserable. So going back, oh, 6 months ago or something, I ate a bad oyster in Las Vegas. You know, note to self, eating oysters in the desert is probably not a good Idea. Anyway, I woke up just soaked in sweat the next day. It was like a truck hit me. Like, ugh. So I said, well, I know I've got the kind of bacteria that makes MMP-9, and this is a very strong pro-aging molecule, and you want to keep your levels down. So I did some research, and it turns out that there is a technology that lowers MMP-9, and it's what my company uses, called Wasabi Method, which is a shockwave type of therapy. So I got out my Wasabi device and I went over my pretty much entire body, but especially the sore points. And the symptoms went down dramatically because this physical mechanical shearing force vibration delivered in the right dose will affect that molecule. So people don't know MMP-9 is a core factor in aging. And if you get an advanced panel, you might have your levels monitored. And what you're saying is breast implants can increase levels of this, which cause that systemic pain and systemic inflammation, the things in the knees and all. So I would suggest you probably, if you're into longevity way above what's normal like I am, you might want to know your MMP-9 levels and you might want to manage them. You could do Wasabi Method, you could do any anti-inflammatory thing like that. But if you have breast implants and your MMP-9 is high or all these other inflammatory cytokines, maybe it's time to change them out. Or it's time to remove them.

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How would you know if a woman walked into your clinic tomorrow and said, I'm having some of these inflammatory symptoms, heart rate variability is low, if things aren't right, and I've had my breast implants for 10 years plus. How would you know if she's someone who needs to have her breast implants out or replaced?

Okay. This is a really tricky question to, to answer because there's really not a real rule about this. When I started doing this, like around 5 years ago, I got an email from a colleague from Monmouth Hospital in New Jersey. His name is Dr. Arthur Brower. He was the chief of the rheumatology department. Telling me, Dr. Ursoa, if you're planning to do research, take these papers that I wrote into account. And Dr. Brower is a very smart individual, very, very interesting papers, you know, and this of course opened my mind to a lot of things that most surgeons don't really take into consideration. We are not a lot into biology. Vince and I are maybe a little bit of an exception.

You guys are super nerds. I love that.

But this, you know, was very interesting to read. And of course, I'm always reading epigenetic journals and I start to find these things. And started putting this together. Women who have breast implant illness, as it's called, and I think it's more of a silicone toxicity syndrome because it follows a pharmacological pattern, you know, sorry, the most— the more exposure you have to silicone molecules, the more symptoms you have, the less. And then as you remove them, then the symptoms start to disappear over a period of time. Okay. And I think that It's very difficult to tell exactly who has, you know, this intolerance or not. In some women, some women come with a quantity of symptoms that is just, you know, they come and tell, take them out. You know, I know I'm sick. I am. I feel horrible. We take them out more or less a month later. They start to feel better and they start to feel better and better and better and better. And after more or less a year, they feel back to normal. And again, 87%. So it's a big correlation. Okay. But there is a group of women who are maybe expressing a couple symptoms at the 10-year mark. You know, it becomes their decision whether they want to replace them or remove them completely. And it depends very much on, you know, what the patients want, you know. But my recommendation is at least replace the implants every 10 years because you're going to be avoiding those silicone molecules from traveling all over your body generating these problems.

Danica Patrick came on the show and I thought she was really courageous for just talking about breast implant illness and what happened with her health when she had them taken out. So she would be an example of someone who, like, get them out and then her biology healed. And you're saying there's another group of people where they're saying, you know, I'm just going to change them out like I change the tires on my car because I like my breasts to look a certain way. And that you can do that and be healthy if you have the kind of immune system that doesn't respond. True.

Yes, I would say there's, you know, again, that immunological variability between people, you know, makes them more prone to developing the problem than other people.

One of the things that really changes breasts is breastfeeding. So a lot of women, they finish breastfeeding and they've told me this. You know, I'm a dad of two teenagers like, oh, my breasts don't look the same. They didn't bounce back. Dr. Zuckerman, if you have been breastfeeding and you want your breasts to bounce back, what should you do?

Well, that's very, very difficult for it to happen on its own. You see, there is some ligaments called suspensory ligaments which help, you know, have the breast in the right place. When you breastfeed, they stretch and they normally don't come back. Around 5% of women have this, you know, come back after breastfeeding, but it's, you know, mostly 5%. Yeah, most, most women would require a breast lift eventually.

Okay. What's the difference between a breast lift and a breast implant?

Well, a breast augmentation, or when you, or use an implant, is a procedure that you do through a very tiny incision, and you can place the implant under the gland or under the muscle or in dual plane. And basically it doesn't require major scars or the excision of skins.

Okay.

A breast lift requires the excision of skin because there's too much skin, the breasts are sagging. The repositioning of the gland in some cases and reshaping the breasts basically. And you can do this in 3 ways. You can do it without an implant in case you have enough volume and you don't desire bigger volume, with an implant if you desire bigger volume, and without an implant and a U-flap, which is this technique that I invented where you use a flap of the upper abdominal wall to basically fill the breast and use a biological breast augmentation.

So it's an interesting decision. You can have the implant, which is a relatively small procedure, but then it carries a risk of an inflammatory response to the implant. Or you could have a more invasive procedure that involves more trauma to the, to the skin and to the muscles. That doesn't have a risk of rejection. Is there a way to know which is the right way to go?

Well, again, not really. This depends very much on the age of the patient, the necessities of the patient. Some women didn't have breast— I mean, were not breastfeeding and they want bigger implants. And some women just, you know, want a lift without the implant. It depends very much on each individual.

But what you can do if you're doing a breast explant from someone who's getting sick from the breast implants, you could do your invented U-flap procedure. So then they still have breast volume, but they don't have implants.

Exactly.

That's groundbreaking and that's really important. And I know there's some people sitting here, you might be sort of judging, well, can't they just deal with it? Look, biohacking, you change the environment around you and inside you to have full control of your own biology. And if you want full breasts by any means necessary, it is your right to do that. And people want to judge you, well, they could probably go pound sand. Likewise, if you want a third eyeball in your forehead, I don't know how to do that, but that sounds kind of cool. So if we can do that with stem cells programmed to generate a new eyeball that can be integrated, maybe I would do that. So I would just say there's no good or bad. It's just, it's your body and you get to have it for as long as you have it and you can do whatever you want to it. And anytime people are super judgy about that, I'm like, you should go back and maybe do some trauma work on that, because anytime you're having these feelings of aversion, it's always a lack of forgiveness and trauma. If you read Heavily Meditated, I go through all the science, all the pathways, and what you can do about that. So bottom line is, if you look at someone and they've got a whole bunch of piercings, tattoos, fake boobs, butt implants, whatever, it's fine to say I wouldn't choose to do that to my body because of the risk or because it's just not what I want. But if you're sitting there feeling any emotion at all about someone else's choice, they could equally feel that emotion about you for not doing it. So if you just want to be peaceful about it, accept that people are going to do what they want. There are a lot of women who would like to recognize their breasts when they're 50 or 70. Like they did when they were 25. And there's nothing wrong with that. The difficulty is if you decide you want that and you're not informed of the potential risks and the potential opportunities for different ways to, to do this. And that's what I want to talk with you about. You could do a U-flap, more trauma, less rejection risk. You do an implant, higher rejection risk, less trauma, right? Or you could do a combination of the two. And if you have the bad response, which so many people I know have had, then you need to know that this is a likely cause and that you could remove them and still maintain the breast volume you want. And that's cool. That's useful. And I consider that biohacking. And look, if you want to lengthen your legs with some kind of technique, go for it. It's your body. And we're at the point in society where you can do almost anything you want. And it's not good or bad. It's just— it's your body, it's your future, it's how you feel, it's how you look. How much energy you have, you get to pick, just pick wisely. And that's what this whole thing's about.

You know, I became a doctor when I was 22 and I studied medicine in Costa Rica. Then I went to Italy to do my plastic surgery training, then to France to do my microsurgical training, and then to Hackensack Medical Center where I met Vince. And I have been in practice for 18 years. And if there's one thing that I have learned is to listen to patients. I think the patients are, you know, the people who really teach you how to do medicine better because everyone has a different necessity and that needs to be respected. I just told you a few minutes ago about that lady who came from South Carolina and she came to my practice in a moment in which I had no idea that this was a problem. And she was really prepared, a very smart woman, brought a lot of papers. And I had to tell her, look, you're speaking to me about something I just never read or heard about.

Wow.

So let me go study, come back in 2 days, and we'll have a more educated conversation on my side because she was really well educated already. I went and started looking at papers and researching, and I found a lot of information that I really didn't know being a doctor and a specialist in this field. And I spoke with several colleagues in different parts of the world and they had no idea about it also. So I think it's really, really important to be humble when you're a physician and to listen to patients. Everyone has different needs. Everyone has different issues or problems, psychological health problems, just needs, you know, And like you were saying, our job is, is not to judge them, but to listen to them and to help them in the best way that we can. And I think this is where, you know, science really has an important effect and positive effect in people.

That's fantastic. There are a whole bunch of functional medicine and longevity doctors who listen to the show, like a lot of them. And thanks guys for your time and attention, who I find are really good at listening. And if you go to, say, a family practitioner or someone who has 3 minutes per patient because of insurance company overregulation and things like that, they don't have time to listen, but they're also not trained to listen in medical school the way that you did. What made you the kind of doctor who listens?

This is how you're taught in Costa Rica.

It was the old school training. Got it. What are the differences between medicine in Central America and in, say, North America? What do you see as different?

Well, Central America is, you know, different because I was never a doctor in any other country of Central America but Costa Rica. Costa Ricans are nice people by, you know, by genes, I guess, you know, because, you know, Costa Ricans are very easygoing people and they are very friendly people. So they normally will sit down and talk to you and listen to you and share with you. And it's very, Cultural, I guess, you know, and this, I guess, is the way in which we're taught. You know, there's a lot of science in med school. We have a very solid health system, but I think there's a lot of humanity also in the way in which medicine is done in Costa Rica. And, and I think this, you know, helps a lot, you know, and I think that the system, I mean, I also studied in Europe for almost 7 years. I was in Italy, France, and Luxembourg. They're very good health systems with a lot of resources and a lot of possibilities. And then in the United States also when I did my fellowship in Hackensack with Dr. Capella and with Dr. Giampapa. And I think that probably what you were saying is very important. Time allocation is more difficult in the United States than in Costa Rica or also in So I think this has a lot to do, you know, because doctors are a little forced into taking decisions very quickly. And this sometimes has an impact in the quality of the, you know, service that the patients are getting.

Some women report huge increases in libido after having their breast implants removed. What's going on hormonally?

When you optimize your body systems, Everything works better. And I think that's the summary to your question. When you have a system that is loaded with molecules that are not supposed to be there, and I always use this analogy, if you have an engine that's perfectly running and you take a screw and you throw it inside, it's going to end up landing in a place where it wrecks the engine. And this is basically what happens when you have foreign molecules going around in your cells. They wreck hormones, they wreck the receptors where hormones have biological effects, you know, and the reproductive system is not, you know, an exception to these problems. So I would say this, you know, is very important. And also when you feel ill, you're inflamed, you can't sleep, you feel anxiety, you have palpitations, you have brain fog, you know, it's very hard to think about sex.

Sex. Yeah, there's also the HPA axis dysfunction. And if you're new to the show or just becoming a biohacker, it's hypothalamic-pituitary-adrenal axis. And when you have toxins and inflammation, something in that signaling gets messed up and then your adrenals start making too much adrenaline, or you can have too much cortisol. You can have them at the wrong time of day and that will kill your libido, whether you're a man or a woman. So So if they're causing problems, it could be, like you said, lack of sleep, which is tied to HPA. So I would just say if you've had implants for 10+ years, or you got them and things were never quite the same again, you probably should look at your inflammatory markers and see what's going on in there. And then you got— you can go to RMI and check it out. It's daveasprey.com/rmi. You can go to a local practitioner. How would someone go about if they just want to stay in their city, say I want to get my my breast implants removed, I know I have problems. How do you know if someone is good at explants versus someone who maybe doesn't understand the biology?

Well, I think nowadays it's very easy because you can just Google, you know, this information. There is many social groups in Facebook and Instagram where this information is available. I think if you're a patient who's considering having these services, it's very important that you look at the experience of the doctor, the techniques, before and after results, and also what patients are saying. There's a group called Breast Implant Illness by Nicole, and they have like a list of surgeons that, you know, are well recognized to do good, you know, jobs in this case. And the experience of many women there that, you know, have had services with these doctors. And then, you know, that would probably make it easier for you to have the right selection.

So testimonials is a good thing. I love that. My recommendation would be, well, if you can get stem cells to speed healing afterwards, there are things you can do with stem cells in Costa Rica that you cannot do in North America. In fact, I'm very skeptical of stem cells in North America because of the legal limitations we have. So I'll use exosomes in North America, but when I go to Costa Rica, I'm happy to get stem cells because I think it's much safer. So my recommendation would say it's a 3-hour flight. It's a similar cost, but you're getting advanced healing things that you wouldn't otherwise get in the US. So that's, well, that's why I went down and had my facial circumcision.

Well, you know, when I was a resident in Milano, I was in a hospital called Niguarda Hospital, and there was a doctor there who was treating people who had scars from burns with fat cells. Fat transfers. He would inject right under the scars fat that he collected through liposuction. And I asked him, why do you think these scars are improving? And he told me because there are mesenchymal stem cells in these fat cells, right, that help the skin. And that stuck to my brain. I wanted to learn surgery, not, you know, MSCs. Some years later, I met Vincent, and this triggered me starting an 8-year process to change the law in Costa Rica and have an executive decree to regulate stem cells in Costa Rica and make them legal. So it was not an easy task.

Wow. So you did that. I didn't realize that.

Yeah. It was an 8-year process. The regulations in Costa Rica are pretty strict.

Do you realize now Costa Rica and UAE are the two countries with the most acceptance of stem cells? In the world right now where there's medical freedom for people and physicians to do things. I didn't realize you played such a heavy role in that. Thank you.

Yeah, this was during the administration of former President Luis Guillermo Solís. Dr. Fernando Lorca was the health minister, and I basically started to present to the Ministry of Health, you know, all the information that Dr. Giampapa and I had put together from some studies that were done in Rutgers University a lot of information that we had developed in animal studies, et cetera, et cetera. And we were finally able to prove to the Ministry of Health that what we were doing was, you know, safe and that it has had efficacy. Nowadays, we have treated patients from all over the world and with very good results and also with impeccable safety margins. And this, you know, helped a lot. Of course, you know, going back to the breast implant illness problem, I was always very focused in trying to accomplish a good aesthetic outcome. This is not easy surgery to do. It requires a lot of expertise. I did my training in breast surgery in the European Institute of Oncology in Milano. Dr. Umberto Veronesi there was the guy who was the leader in reconstruction in one single time for women with breast cancer. So I started applying these concepts into reconstructing explantation patients. And, and yes, afterwards in the last few years when we were able to legally use stem cells, then we started to use stem cells during the surgery. And these, of course, like in your case, help them recuperate quicker, get less inflammation, and heal faster. Wow.

Well, Dr. Urzola, thank you for being on the show and for standing up for medical freedom in Costa Rica and for a real conversation for women about about the fact that you can in some cases safely have breast implants and what to do, and what to do if you want to have them removed, if you want to maintain breast volume, because I think this is something a lot of women care about. And thanks for the work you've done on my face and explaining what happens in the various parts of the face. And guys, if you're listening to the show, or ladies, DaveAsprey.com/RMI has all the info about the stuff that I did. My recommendation, if you're into longevity as a part of your biohacking practice is go down there and stack procedures the way I did. So I made my brain substantially younger while I did the work on removing all the extra skin from obesity and aging. So thanks again for your work.

My pleasure. Thank you for your invitation to come here. It was a pleasure. And anything that you need, I'm very happy to help.

See you next time on the Human Upgrade podcast.

The Human Upgrade, formerly Bulletproof Radio, was created and is hosted by Dave Asprey.

Dave Asprey.

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