Cameron Chesnut, MD: Hair Restoration, Skin Treatments, and Filler Use | TUH #049

It seemed like for the last 10 years I saw this dramatically progressive of women with normally large lip. It seems like there's a filler revolution, this perception drift. By the time she's in her 30s or 40s, their face looks noticeably distorted through everyone but them.

The FDA trials, they looked at a certain time frame until it quit correcting, and then they said, oh, well, it's not correcting anymore. That doesn't mean the filler is gone. This is a permanent to semi permanent implant, but it's viewed as lasting six to 12 months, which is really problematic over time. Rare that I do it surgery now where I'm not managing film. Every single time I'm manually removing it, I'm trying to dissolve it. The literature says that there's no issues to our native tissue. I don't fully believe that.

Ultimate human. Hey, guys, welcome back to the Ultimate Human podcast. I'm your host, human biologist Gary Brea. Where we go down the road, everything anti aging, biohacking, longevity, and everything in between. I am really excited about this podcast. I think I'm going to have a hard time containing myself going down so many different avenues because this has had such an extremely high response from the audience about facial and cosmetic surgeries, basic cosmetic surgeries, the intersection between, you know, cosmetic surgery and biohacking and healthy living and anti aging. And we're going to go down all of those roads today, including. Stay tuned. Male and female pattern baldness. So welcome to the podcast, Dr. Chestnut. It's a pleasure to have you on. I've, I've listened to some of your other podcasts with Ben Greenfield, who's a great friend of mine. You guys have known each other for 25 years.

Absolutely.

I love that you're, you know, you're, you have had this journey as, know, an athlete and sports medicine and, and now you're, you're board certified. You actually have two board certifications. If I'm.

Yeah, absolutely. Yeah. Yeah. So, well, I want to say first, thanks for having me.

Of course.

Super honored to be here. Your guest list is incredible and I'm just really honored to be part of it. I'm grateful you have a. You're awesome. Your team's great. Your facility is awesome. This, you know, new studio, I love it. No, and, but then I think I'm also like, super grateful to your audience. Like, that's just a subtle side note of like, people who are interested in optimizing themselves and, you know, being the best. The ultimate human, the best they can be. That's rare, right? It gets lost on us a little bit how rare that is. But that's incredible that there's people who want this knowledge and you know, allow us to do what we love.

And you know, what I'm excited about today is that you wouldn't think, you know, knowing about most of my podcast guests and most of what I preach out there, which is essentially getting back to the basics, healthy lifestyle supplementation for deficiency. I do use a lot of biohacking modalities. Huge believer in red light therapy, pmf, oxygen. But I'm also a big believer in, in the basics, you know, grounding, sunlight breath work, cold showers. But I do think that, you know, I think people may be reading the headline and go, why has he got a facial cosmetic surgeon on there? And we're going to, are we going to talk about tummy tucks and boob jobs and, and butt lifts when he's kind of the antithesis of that. And I, and I generally am, but I also, you know, the reality is that people do have scars, people do have stretch marks, people do have droopy eyelids, people do have other age related or trauma related conditions that, you know, I'm a big fan of fixing those because your self esteem and your self image, you know, especially on your face.

Right.

When you have some kind of condition going on your face. I don't care about how much biohacking you do, it's going to be front of mind for you all the time.

Yeah.

And I think there's a difference between being extremely vain and going down that, that, that long term road of just vanity and wanting to look and feel your best and maybe using the best of what modern medicine has to offer.

Absolutely. And, and that's what most of my patients come to me saying is I want to look how I feel. That's the most common, that's sort of like my magic words. I know that we're probably going to be a good fit to work together when I hear that because we're so focused on reducing our biologic age and longevity and all these wonderful things. But you know, that has some benefit to our cosmetic aging. But what good is it to be older or aging, you know, non biologically if you're just looking older.

Right.

So you and I were talking offline a second ago about this connection of, you know, your patients come to you and they see you and they feel so good afterwards, they can't even explain it. It's hard for them to like put it into words. Right. It's so core and primal for Them how good they feel. And they look better too. Like the side benefit to it. And my world is very much the flip of that, the yin and yang, the, you know, this wonderful juxtaposition where they look incredible rejuvenated. That's the real thing here. It's not transformative. They're not looking different than they ever did. They just look a little rejuvenated. They, and you know, it's. The proof is in the pudding a little bit. I'm, you know, blessed that what I do, you can see. Really?

Yeah.

But then they do feel better afterwards too. And it's this sort of like chicken or the egg question which happened. But you know, they work really, really well together when you are optimizing yourself and your health and attention to these things and looking better at the same time, they really fit together quite well.

You know, in preparing for this, I, I went, I went out to my community and the ultimate human community and I, I sort of asked for like, you know, what topics would you like to see covered? You know, there were a lot of questions about eye lifts. There were a lot of questions about minimal, they call them minimal facelifts. If I was to just put it all into it into a category, lots of questions about male and female pattern baldness. I happen to. Where's the camera?

Right there.

Be dealing with a little bit of this myself. And I've tried to biohack it. So, you know, I want to open the discussion with, I would say of all of the topics that seem to be the one where my audience was like, you know, we'd love to have any kind of guidance on whether or not should we be using finasteride or propecia or should we be using, you know, some of these other orals which I'm personally not a big fan of, I think, you know, sort of destroying your hormones in order to save your hair.

Exactly.

Kind of a, kind of a trade off that I'm not, not enormous fan of. But so let's start there. Let's start with male and female alopecia.

Yeah.

What's so, you know, diffuse hair loss. I mean, especially in women. This is a, this is a serious issue with your, you know, your self esteem and not having a thick head of hair. I mean it's easier for guys. We just start shaving it closer and closer and to shave it off. But you know, what are some of the root causes? What are some of the treatments that you're doing? Tell me a little bit about the platelet rich plasma treatments and Some of your theories on gravity and fat deposition into the scalp as maybe being some of the root causes of this?

Yeah, I mean, when we really, we want to define what that is, the sort of, you know, male and female patterned hair loss, because it's different in a man than it is in a woman often. And there are. It's a challenge because it's multifactorial. There's so many things that go into it. There's genes, there's environment, there's exposures, there's all kinds of things. Right, exactly. There's a lot of, you know, endocrine issues that can relate to it. There's nutritional things that can cause it. And so it's really. Well, what is it first? Well, it's just thinning generally of our hair follicles. Our hair follicles are, for lack of a better term, a collection of stem cells.

Right.

That's what it is. These stem cells have all the normal paracrine signaling, the stem cells that make keratin and grow the hair. Keratin is the protein that our hair is made out of. There are stem cells that put pigment in the hair that make it colored.

Right.

So these are all existing together and they're signaled to grow and not grow.

Right.

But then they have to have the substrates, they have to have the things they need to make the hair as well. And so when there's changes in that, whether it's just normal cellular senescence and aging, they don't do that as well. And so when we look at the density of hair on a given area, we're looking at, it's really a function of how many hairs are there and how thick are those hairs. If you had one hair that was this thick, you would technically have really great hair density.

Yeah, yeah. Right, right.

And so as the hairs thin out, which is usually the first thing that happens, it's actually less loss and more thinning that happens first. And we have this sort of arbitrary threshold that we cross over where we notice like, oh, my hair is thinning. And we're all approaching it as we age. And then we start to get to it a little bit and it's like, okay, well, what's happening now? So that is where things like growth factors can come in. Prp, prf. I like to use fat based stem cells, which we'll talk about a second benefit of that, because then you have like release of exosomes and growth factors from the source. When we do that, that can just kind of like amp up the collection of stem cells.

And when you say fat based stem cells, you're talking about adipose derived from the patient, right? Correct. So you're going to take my own stem cells from, I assume, my abdominal fat, and then you're going to inject those subcutaneously into the.

Correct. Yep.

Into the scalp.

Yeah. When we use stem cells, we'll talk about this a lot today because I use this with all of my cosmetic procedures as well. They are the ultimate mediators and orchestrators of positive types of healing and it's inflammation.

Right.

But positive types of that.

Right.

And we do get it from your own fat. There's certain areas that I like to take it from that have a little bit higher stem cell density and then I minimally manipulate it, which is, you know, what's okay with the fda, Right. I'm using it for homologous use. So it's being used for what it's meant for and it's from you.

So.

So all of these beautiful things, fat's really accessible. So you have the stem cell portion, plus you have the mechanical portion of the fat.

Right.

So in our scalp, men, especially on the top of our scalp, we lose a lot of that fatty support there, which causes issues with the microvascular circulation and we get hair loss. So now by using your own fat based stem cells in that same subcutaneous adipose or fat plane, we lift it and cushion it and we add growth factors and new angiogenic creation of blood cells back to that area. Very akin to facial aging, where we're losing fat in our facial fat pads. I can use the same fat, restore the structure of the facial fat pads, regenerate the amount of adipose tissue that's there, change the contours of the face, all these wonderful beautiful long term things that come with your own fat being used there. But that's applicable in all kinds of facial aging.

Now these are, these, these are outpatient procedures. Right? I mean, minimal, if any, anesthesia. I'm sure you have anesthesia for the, for, for the.

Yeah, that can be done with just local anesthesia.

So local anesthesia. And where you, where are you, where are some of your favorite places to bowl stem cells from?

Yeah, and this is just evidence based as far as like where our stem cell density is the highest. But it tends to be like perium bilical around our belly button and in the flanks and then medial and sometimes lateral but generally more medial thighs that'd be more common in a female patient to be taking it from those areas.

And then how much fat Are you pulling out for, let's say, a scalp procedure?

This is such a good question. And I get this all the time. I ask great questions. Get used to it. People think of this as like liposuct liposuction procedure. When you're doing liposuction on a body, you're taking thousands of cc's of fat out for contouring purposes.

That's because I don't. I. I don't want to send the wrong mess because everybody's seen the canulus with the Dyson hooked up to it.

Exactly. That's like attached. We call it wall suction with this big cannula. Well, I'm using a micro canula. I'm doing the suction by hand. So very small. And instead of taking like thousands of CC's, I'm taking tens of CCs. Right. So this is very much not a body contouring procedure. I don't do body contouring things. But I also want to leave. Most of my patients are relatively fit. I want to leave no sign that I was there. They don't need liposuction.

Right, right.

And that's great because patients who have generally lower body fat percentages, I get better fat from them. Higher quality, more stem cells. Specifically, the stem cells I'm taking, we call the stromal vascular fraction. There's young, healthy adipocyte stem cells, like bat stem cells. There's also all the things that go into the vasculature, like these things called pericytes that help create new blood vessels, which is really important in the scalp or when you're doing a fat grafting procedure that now has to establish a new blood supply. So you have all the orchestrators of that kind of put together. So I'm doing tens of CCs of harvest, and of that, those tens of ccs, maybe I take 60 or 80 cc's. That'd be, you know, or 100. That's a big harvest. I'm really using a very small portion of that.

Very small. And it's. And it's going through a centrifug process. It's actually going through a separation process. So talk a little bit about taking the fat out and then preparing it to go into somebody's scalp.

Yeah. So I'm like a fat connoisseur in this way. My whole team is like, when we take it out, I have a very sort of like, dialed them and proprietary process that I utilize with centrifugation, but it's also very customized. Like, I'm Basing it off of what I'm seeing, I'm problem solving the whole time. Like what RPMs do I want? How many spins, how many times are we doing this? What size are we making the fat? Because different fat we want, or different fat purposes, at least we want different sizes of this fat. If I'm putting it around the eyes to revolumize around the, the orbit or the eye socket or where there's volume loss, it's very different than if I'm putting it deep in the structural portions of the cheek or something like that.

Right.

So that process, you know, from harvesting to yield from what we're actually going to use, when I get that back, let's say I harvested 100 just for an easy number, I may have 15 or 20 cc's of fat that I'm going to use, depending on how quality it is. And there's multiple sizes and multiple. Like, we have all these fun names that we call like micro fat millifat, super millifat, like all these things that we're putting together and nanofat and all these different things. Nanofat becomes almost purely regenerative, no longer volumizing, because it's the smallest portion of it. And so we may use that in just the skin or something like that. But the overall message is the yield is very low. So this is a little bit of structural regeneration, and that's a lot of actual regenerative medicine put together.

Wow. So you're actually creating, you're putting back the fat that's lost. And I, I. And I was actually listening to a previous podcast that you were on, and there was a really interesting theory, but made a lot of sense to me that you called the gravity theory. It wasn't your theory. It was another colleague of yours, essentially. You know that during the, at the apex in the crown, where where most of the gravitational weight is, it's constantly pulling down on that area that you, you do have density loss in that tissue and maybe restoring that density to its natural state. You know, I guess the question is, you know, once we, once our hair has really thinned or we've lost the hair. Right. So now it's down to skin. What are the chances of reviving that hair follicle? There's a, I know that there's a dormancy phase before it actually dies and becomes necrotic.

Exactly.

You can't wake up dead tissue or there would be Jurassic Park. We have dinosaurs running around. So we know we, we can't wake up dead tissue. But I imagine that we can recreate dormant tissue and dormant follicles. So talk a little bit about that. We take this fat. Now you divided into different categories and now are you just hand injecting it above the periosteum beneath the deepest layer of the.

Yeah, this is a really great point. Yeah. The layer that you're putting in it is very, very important. The hair follicles live in the subcutaneous tissue. I actually see a lot of people put their growth factors, including prp, they go down to. Go down to bone and put it in there. And I always question them, like, are we thinking. This is what I'm teaching my fellows, my surgical learners who spend a year with me. Like, are we thinking three dimensionally? We're not. This isn't a two dimensional plane. We have to think of what our target tissue is, where it's living in the tissue, and that's where we need to be working for it, whether we're talking about surgery or injections or anything like that. So I'm actually putting this in the subcutaneous space, which makes sense when we're using fat because we're putting fat in a fatty plane. But that can restore some of that cushioning and restore some of the microvascular circulation mechanically and physiologically with the growth factor release. Because like you said, the hair follicles miniaturize, they get smaller. And their product, the hair shaft gets smaller too, to a point. And then they go dormant. And they are, the stem cells are alive and they're sitting there, they're just kind of like chilling. They're not being told to turn on. They're not being stimulated to grow anything. So that's like the ultimate dependency. If we could get all of those dormant ones to turn on, which is way more challenging than it sounds, then we'd be able to actually regrow some lost hair. It's much more efficacious to think about stopping or arresting hair loss and maybe getting some girth or some, you know, some width back to our hair follicle shaft.

Right.

That is a much easier task than taking us, you know, sleeping senescent follicle and turning it back on.

That's right.

That's a challenge for sure. And that's when most people seek care. And this is, this is where we get all the way down the road. Most people are coming in when they're at that point. They're not coming in when they're on the progression of thinning.

They're.

It's gone.

Right.

And they're coming in and so we do have options there as well for actually restoring lost hair, but those are mechanical procedures.

Transplant.

Yeah, yeah.

And then what about when you do these transplants? And, I mean, you still need to transplant it into. You got to put a plant into fertile soil.

Right, Right.

Or else the plant's eventually going to die again. And if it dies, you can replant it. But. But so when they. When they do these hair transplant procedures, and I. And I know several physicians that do them, and I've had several of my very close friends have phenomenal results. But my. I'm always wondering, what's going to happen to this five years, 10 years, 15 years down the road. So in addition to just doing the hair transplant, if you're at that phase, what are some ways that men and women that have either had a hair transplant or they're considering one can extend the lifespan of that hair?

This question is so deep and so great, and it's analogous to a lot of things we'll talk about with cosmetic surgery, too. You want the substrate that you're working on or that you're correcting or rejuvenating to be optimized before you do the rejuvenation.

Right.

Because you said, you know, if you put it in there, you plant it and it dies, you can put another one. Well, we have a fixed number of these that we're. That we're able to utilize in the lifespan of. Of, you know, whatever hair restoration we're doing, meaning our donor area where we're taking back on the back of the scalp is fixed. There's only so many you can use. We never use them all at once, actually. We kind of leave it to be the stepwise fashion time. Sometimes people come in their 20s, sometimes they're in their 40s or 60s when they come in for this the very first time. And this field has progressed a long ways from taking a strip of hair that you didn't sew together and leave a scar on the back of the scalp, to now literally going hair by hair and individually harvesting them. Like, basically no trace that we're there, because the density in that area is so high that we can kind of borrow without throwing over that arbitrary threshold we talked about earlier.

Right.

And so we're just rearranging the density we have. We're not making magical new hairs. So when we put them in there, we want them stay forever.

Right.

We can't afford to lose this.

Right.

And so there are things that we can do to optimize the recipient area before we do it that's growth factors. That can be fat, that can be a lot of things. If somebody has like a scar, let's say they have a trauma and have a bald spot from a scar, before I can put grafts in that scar, I have to, have to, have to optimize it. I have to go do these fat based stem cells to make new blood vessels in there so that they can actually receive a hair graft. If I just put it in the relatively avascular, non vascular scar, it's just going to die.

Right, right.

So we can apply those aspects of reconstruction in that case to all of these cosmetic things too. And so there's questions about all the topical things you can use. Minoxidil, finasteride.

Yeah, I want to go down that road too. I want to go through the, you know, the, the chemical synthetics, pharmaceuticals. But then I also want to go down the, the peptide route that TB500, maybe BPC157, GHKC copper peptides or even, you know, some of the topical finasteride, ketoconazole, minoxidils, you know, which would be my preference in somebody that is taking an oral finasteride or propecia for hair loss instead of again killing the hormones to save the hair, maybe even applying those kinds of things topically so that less of it's in serum concentration and maybe not lowering your hormone levels, but it's going into the area where it can do its job.

Exactly. And all the topicals carry these relatively low but real efficacy numbers. Single digit percentage points. I always tell people, like, you can get single digit percentage points with topical minoxidil.

Right.

Great, that's easy. Do it. Same thing with topical finasteride. That's emerging more as an option as people have become more aware of the issues with oral finasteride, which is a central testosterone blocker, let's just call it that.

Right.

Including in our central nervous system, which is what you're talking about, what I'm concerned about. I would, would personally never want to take something that's blocking what makes me partially who I am.

Right.

In my central nervous system. Right. So it can have issues with all of the volition and libido and all these things. So. Okay. Right, yeah.

Mood.

You know, there's a, there are a lot of, you know, we have such a volume of, of patients coming through our clinics that, you know, our clinical teams a good job of, of tracking the anecdotal things or the, the subjective findings. When somebody takes a oral finasteride or propecia or they come to see us with that. You know, they, they, they note that they're almost always experiencing some kind of not mood disorder, but they're just, they don't feel themselves.

Right.

They sometimes they have that, that mood numbness kind of feeling, a lot of erectile dysfunction and, and lack of sexual arousal in women, but, but significant erectile dysfunction complaints in, in, in men. And even just the, you know, there's the, there's the arousal and libido factor and then there's a performance factor. And it seems to be on both sides of the equation. I'm just like not that interested and I don't perform that way.

Right.

Kind of, kind of both. So it seems like defeating the purpose, right? Yeah. Get a great head of hair and then go out and do nothing, right?

Exactly. And that's, I mean that's always the question. And so that's not something that I utilize. If that's, if somebody's does have efficacy for hair retention. Right. That's the issue. So I'll see people who are on it sometimes. And I'm kind of, I'm a surgeon, right. So I'm not necessarily managing as hardcore the medical aspects. I'm generally seeing people who have been doing that. Generally it is finasteride and these other things. And then I'm adding all these regenerative modalities plus surgery. That tends to be my role more. So I don't necessarily stop somebody who's on it and having efficacy, but I don't start people on it. That's just not my personal philosophy and value and what I want to do.

So what are some of your go to topicals or go to peptides that you think for, you know, for the folks that are listening in there and they're having some thinning, some alopecia. Men and women, what are some of your go to's?

Yeah, so the first thing, and this gets very into your world of like, well, are, do we have the proper substrates in the first place? So that's always like starting point number one. The answer is usually yes, which is good. But it's a simple thing to look for, right? Are you getting the proper substrates? Usually when I'm seeing people, they've been down this road, they've had that, right. So that's vitamins and you know, making sure they're getting enough proteins and amino acids and all the things that they need to build it. So then we're going down the regenerative capacity. Okay. You've got the substrates let's stimulate these follicles to grow. Let's use regenerative things. Let's use growth factors. But then also from more of a pharmacologic mechanism. What can we do? Minoxidil is a vasodilator. Increases blood flow to the area. That's all it's doing.

Right.

So we talk about microvascular circulation, mechanically, physiologically, that's. That's what it's doing. From a peptide standpoint, you mentioned GHK copper, which is a really small kilodalton peptide that has some topical efficacy because of that. But then a lot of the other options we can do orally or injections or sublingual. And oftentimes those are being paired with a stimulus.

Right.

If that stimulus is regenerative or if that stimulus is surgery.

So by stimulus you mean red light therapy or.

Oh, well, it can be red light.

Red light therapy is, you know, massage.

I'm talking, like, physiologically stimulating with the growth factors injecting and. Or surgery.

Right.

The ultimate stimulation in that sense.

Right.

And so those. When we're doing those, then we want to focus on what's happening at the cellular regenerative level, which is where the peptides are working.

Right.

VPC157, thymosin beta 4. All those GHK. Copper also has copper in it. Right. Which is a substrate needed for, like, collagen production. So helpful when we're regenerating a hair follicle or when we're doing elastin and collagen creation in the skin with, like, a laser or something like that, or healing a surgery from a facelift or whatever it may be. So peptides play a big role in that as well. And that's a, you know, wonderful, deep, dark hole you can go far, far into.

Yeah, you really can.

Good way. But there's some very simple ones that people often are totally naive to when I see them, and we can help sort of optimize.

Like your copper peptides, your BPC157, thymus and metaphor.

Yeah, those are my favorites.

Yeah. You know, you mentioned collagen, and I wanted to just touch on that for a second because I think there's this mystique. I'll tell you my position on collagen. Tell me if you agree with this or not, because I get clients that ask me about it all the time. And I said, well, you know, collagen's a protein. And like any other protein, whey protein, steak protein, egg protein, if you ingest it, it's not Going to stay in the form that you ingested. It's going to turn into amino acids, and then those amino acids are going to be shipped off to tissues, muscle being one of them, but also blood, lymph system, our natural killer cells. You know, our. Our skin. I mean, the amino acids are in every cell in the body. And so when you take a collagen or collagen peptides and you put a scoop of it in your coffee, which is great because you're getting the protein, but that collagen doesn't somehow magically migrate into the body and deposit collagen. Right. It'd be sort of like the thought of, like, if. If I eat hair, I'll. It'll show up as hair.

That's exactly right.

If I. My nails, I'll grow nails. If you eat collagen, it doesn't show up as collagen, first of all. Do you agree with that?

Absolutely. Yeah. Yeah. And. And I kind of tell my patients this, this way is that, you know, proteins are amino acids linked in a certain way, different shapes. So it's kind of like a novel of a book. A novel. And the amino acids are the individual letters. So not only you have the novel, you got the chapters, you got the paragraphs, you got the sentences. You're breaking that all down into letters, and you're getting all the letters that you need across. But it's a very sophisticated, you know, way to reassemble that back into the protein. It is not. Again, people think you eat collagen and it goes right to your skin.

Right, right, exactly. That's the myth that I wanted to dispel. If I eat collagen, then I'll have more collagen in my skin.

Right.

And collagen, it's like eating keratin and have more hair.

Yeah. And collagen's not. Doesn't even have all of our essential amino acids. It's missing some of them, which is fine when you're trying to recreate collagen, but as a whole protein, it's missing tryptophan. And then on. As a total side note, that it goes along with this, because collagen is like the. Well, skin aging collagen. You know, I kind of always tease my patients that it's not collagen that we're worried about as much. It is. That's. It's an important aspect of what we're doing. But it's really elastin, which is the other little substrate of our skin. Collagen gives it strength. Elastin gives it elasticity.

Right.

When we really think about it, our skin's not tearing apart as we age, not getting that weak. It's getting. It's losing its elasticity. We want it to recoil and rebound and lift, and it's not. There's a bunch of different types of collagen in our body. Type 1 is the one we're thinking about mostly when we're talking about our skin. But elastin is a very delicate flower in comparison to collagen. It's very delicate from an aging standpoint, from an oxidation standpoint, from a UV damage standpoint, it's the one that goes away first.

Right.

And so when we're talking about regenerative medicine, we're talking about lasers, and we're talking about stem cells in our skin and our fat pads, we're really focused on restoring our elastin tissue, our elasticity. That is where the magical anti aging happens. And so we have to. If you just injure the skin, you get a scar. We call it fibrosis, but it's a scar that's like the layman's term for it. And that scar is a very organized band of collagen. Normally, collagen lays in our skin very haphazardly arranged, which makes it really strong. It's like rebar.

Right.

Okay.

But now it all runs in the same way in a scar. So scars are never as strong as regular skin. And it's just pure collagen. There's not a lot of blood vessels. There's no elastin tissue in it. So we want to create a micro injury, whether it's with a laser, with our surgery, whatever we're doing. And then we want to purposefully change the growth factor milieu to make more elastin tissue.

Wow.

And that's where these, like, beautiful, wonderful, autologous, our own fat based stem cells can help do that really well even without an injury. If you just take your stem cells and inject them in your skin and we biopsy it down the road, we'll see upregulators of color of elastin precursors in those areas.

Wow.

Which. So apply that to when there's a stimulus like a surgery or a laser or something, and boom, we got a lot more el being created.

So you're. Would it be fair to say you're not a fan of derma rolling, but you are a fan of micro needling?

Yeah. Similar veins. Right. You know, we were talking about offline, like the idea of a derma roller kind of Coming in at a non perpendicular angle and creating some shearing or tearing forces. Yeah.

Because it kind of punctures and then like a wheel, it, it's under the skin. It sort of lifts the skin and tears it on the way out.

Right.

And then you have microneedling, which tends to be more of like a 90 degree penetration and out. And I mean, we could get really nitpicky on that and say, yeah, that's maybe suboptimal, but an injury is an injury.

Right.

And I guess, you know, I'm much more focused on, okay, we've created an injury. What kind of. We, we don't want to create a bad injury. Right, Right. And that's where the tearing can become controlled, controlled trauma. But then we want to focus on, okay, this is just like all of our things, it's a hormetic dose of an injury.

Right, Right.

But then we have to recover from it. So what are we doing? How are we recovering from that injury? I'm not as concerned with what the injury is. I don't care if you did hack squats or back squats or whatever. How are you recovering from that trauma that we created?

Right.

And we can make the injuries much more sophisticated than microneedling can when we're using lasers as an example.

Right.

Because you have some of the physical mechanisms, you can get the ablation that, you know, that a micro needle might do, but then you have heating that happens in the surrounding area. You can target very specific parts. You can target pigment or blood vessels or water or collagen, whatever you need to do. So we can be a little bit more specific, specific with our injury in that sense, with what we're trying to recreate. But in general, whatever the injury is, we want to really focus on the recovery. And this is applicable to our lives as humans.

Right.

What's your recovery look like after that? That's what we want to optimize. That's what, that's what makes the difference. That's what creates things at the next level, really.

So, so what are some of the, let's call them, biohacks that you use? You know, when I was looking at your, your, your practice, I was like, wow, he's got red light therapy, he's got cryotherapy, he's got hyperbarics. You got pulse electromagnetic field. I mean, these are right in my wheelhouse. And those are not the typical norm that I would think you'd see in any surgical clinic or even in any cosmetic surgery. So talk a little bit about this intersection between biohacking and the best that modern medicine has to offer, Are you able to bring the threshold for what you have to do to a patient in terms of the amount of invasiveness you make with the scalpel? Are you able to bring that down because you're using some of these modalities to enhance those outcomes?

Yeah. This is such a great point in question, and this sort of, you know, question I asked a lot. I'm giving you that. You're asking a lot of good questions one after another.

If there's too many, let me know and I'll ask a really stupid question like where you get your shoes.

This is a. Yeah, this is a good shoes. Thank you. I appreciate.

Nobody cares.

This is a good one in the sense of, like, this embodies a lot of who I am as a surgeon. Basically, you know, very intellectually curious at baseline, but also skeptic mixed together. I think that's a healthy balance of things. And paired with my athletic background.

Right.

So you and I were talking offline before. I'm really focused on pre, during, and post, just like an athlete would be. That's for me, how I prepare, what I'm doing during surgery, how I do it afterwards. Same with my patients, what they're doing before they get to me. What happens during surgery. We could talk about that forever. What the after is, which is what you just hit a little bit. And I want to optimize that. I mean, my patients are coming to me from all over the world, all over the United States. Everybody's traveling to see me. And when they're there, I have them for a week in a very positive way, like, we're going to do your procedure, and then for. We have a whole week to just optimize your recovery. Nowhere to be, but right here.

I love that. And, you know, I. I want to continue on this vein, but I. I don't want to forget the thought that just popped into my mind because we were talking before the podcast, and one of the things that really struck me, and I want to highlight it, is how you manage your own mental state for surgeries. And I. I love that you refuse to pack your schedule with just surgical procedure after surgical procedure. You say that the state that you're in has a lot to do with the outcome for the patient. You say no a lot. You're very mindful and intentional. A lot of your surgeries are six or eight hours, which is a pretty intense timeframe to be focused. So I don't want to lose that subject. I want to Talk a little bit about how you prepare for your surgeries and how you keep yourself in a condition to be the best for your patients, because I think a lot of doctors could learn a lot from what.

You'Re about to see. And this is one of my missions, honestly, as a surgeon. So, you know, my messaging on my social media that I'm putting out is, you know, it's kind of this. It's very educational to my patients. It's a lot of before and after photos, because that's what I'm built on.

Right, Right.

And then I have this big following of surgeons, not just in my specialty, but in a lot of other ones, about optimizing your surgical protocol or who you are when you step in the operating room. Surgeons are incredibly high performers at baseline.

Right.

And we go through this medical training system that kind of beats us down a little bit, and it takes away some of that, like, super, you know, bad, you know, badass person that you were going into.

And I want my surgeons like my pilots. I want you guys at a 10.

Right.

Exactly. 100% going in.

Right.

And so my personal philosophy towards this is, like, I want to be at 100% when I go in. If I'm not. I'm not happy either. And I want to be happy when I'm working. And if I know I'm at 95%, like, that sounds silly, but I don't want to be at 95%. I want to be at 100. Like, this is my masterpiece I'm about to go do every single time.

Yeah.

And I can't. And any athlete will tell you, you can't do that five or six days a week. It's just. You just can't get up that many times. Right. And so I really. I do say no a lot. You know, you get in high demand, and it's. That's a whole nother topic of, like, learning how to say no is a thing in and of itself.

Right.

But once you learn to do that, you create a new freedom around yourself. To where I can be like, okay, every time I go in, this is, like, the person. I'm in a tight relationship with them at this point. I know them very. This is not, you know, we are. We know each other. We chose each other, if you will.

Right.

Yeah.

And, you know, I've been preparing for this for months or weeks, visualizing different types of visualization process, visualization, outcome visualization. I am a surgeon. I don't get. As a professional athlete, if you're shooting, you get hundreds of reps a day, you know, tens of thousands a week. Millions over your career? I'm a surgeon. I don't get to do millions of these over my career. So my way to get reps is to be an intrinsic learner and go through it over and over and over. And as you get better at that, it's a skill. These are my reps. This is my practice. Right. So by the time I've done your surgery, I've literally probably done it hundreds of times at least all the key aspects. But then there's new things that pop up, right? There's this uncertainty, there's this novelty. That's. That's the dopamine response that we get as a surgeon. Right. That's what fuels us. Like, that's the addictive portion of it, you know, Cold, plunging drug of choice. Mine, yeah, that's my drug of choice too. Yeah. Mine might be in the operating room. This is my drug. This is what I'm addicted to. I'm obsessed with these outcomes, and I get all these things pop up that make you very much have to solve problems, take things as they come. But you've already been through it a bunch of times before.

Right?

And, you know, every day, if I'm not doing surgery, I'm waking up and I have, you know, the beginning of my day is a very relatively simple set protocol that I'll go through. I'm just kind of getting ready. But then if I'm not operating, I'm going to jujitsu or something. The hardest thing I'll do all day, I go choose to put myself in an extremely pressure filled, uncomfortably primal situation where I have to learn how to make important decisions in duress, right.

To avoid pain.

Right.

That makes me better at surgery, and it gives me more capacity. Because when you're at a really high level, it's hard to find things that challenge you in that way. Right? So this total side note of jiu jitsu, giving me that sort of realm for it and being a nice competitive outlet and things like that, or the type of training I'm doing, I'm thinking about that day. But on a surgery day, it's a different animal. I'm like, I'm seeking my flow state, and I have a very set routine that I've developed over the last decade of how to get there. And it involves hyperbaric oxygen flow state. Oh, my gosh. And I want to gloss over that once you get there. We've all been there. And if you really start to define what it is like, you want to be there all the time.

Right.

Like, why would you not want to be in your flow state? But it takes effort to get into it. You can't just click into it.

Right?

Right.

You have to be intensely focused. And so I'm getting in the hyperbaric chamber in the morning, and I'm doing some consuming of academic things usually. And then I get in a sauna and do a little workout, and I produce some things. And that workout is very specific to, like, activate my corpus callosum. So I'm doing like asymmetric bilateral things to get my brain ready for, like, what I'm about to go do in the operating room, which is 3D spatial plus technical at the same time.

Right.

And then I'm getting cold afterwards. And then I'm going through my last visualization and I'm visualizing the outcome. Not even just the process, but what.

The outcome I talk about all the time. So you actually visualize the outcome for your patient?

Yeah, yeah, yeah.

And I think, man, for a surgeon to be able to do that is. That is in incredible. I mean, I. I work with a lot of professional athletes. One of the things that I teach them to do is to visualize the outcome, never the journey. Because if you visualize the journey and then the journey doesn't go as you visualize it, you'll recognize it during that event.

It's a good point.

And it can be very dangerous, especially in the fight game. But when you visualize outcomes, I think it puts your brain. Well, we know that it puts your brain in a different state because it feels as though it's already been there. It's like the more times you take the stage, the easier public speaking becomes. But if you're not at least trying to have your. Your. Your brain and your nervous system think that it has already had this experience, then the experience is brand new when it's happening. And that's where the nerves and all of these other things kind of. Kind of kick in. So. So we took a little diversion there. I want to go back to how you're incorporating the biohacking techniques in with your surgical procedures. First of all, I love the peptides. Huge fan of peptides. And, you know, I've. I've seen those on their own have significant improvements, not just for, like, my skin and, and the little success I've had in my hair, and I emphasize little success. But. But I've seen it for. For thousands of clients.

So.

So talk about a little bit about the intersection between these different modalities like hyperbaric chamber, red light therapy, pulse electromagnetic field, maybe even your preparation protocols with peptides and how it's enhancing these surgical outcomes.

Yeah, it really kind of starts again that preoperative we talked about a bit, but some of it starts in the operating room too, right. That when we step in there again, I'm in my flow, I'm in my happy place there. That's like vibe is right. We're going to. And I apply a lot of those things. We talked about the fat based stem cells pretty extensively to this point, but that's a big part of what I'm doing interoperatively. I'm putting them very specific places. And then even after we're all done, last thing, case is over, we've done our laser at the end, I'm using topical stem cells afterwards that I've kind of saved from the, you know, so there's all kinds of places for that. But I know you've talked about this on your podcast before, but like even in spaces where I'm working and I get these little micro things done and I've targeted everything, exactly what I'm after, you know, last thing I'll do is stuff a little platelet rich fibrin membrane in there.

Right.

And that is super under or non utilized in my specialty. But I'm starting the healing cascade I'm getting. We call it hemostasis, like stopping any little micro bleeding that might be there. I'm giving a growth factor balm basically to that area, so they're healing faster. And so a lot of this is starting intraoperatively with the or non utilized in my specialty. But I'm starting the healing cascade I'm getting. We call it hemostasis, like stopping any little micro bleeding that might be there. I'm giving a growth factor balm basically to that area, so they're healing faster. And so a lot of this is starting intraoperatively with these little sort of biohacks mixed in. Not to mention just the planning and the procedure that we're doing that's already at a next level by itself. And then we get to the end and we talked a little bit offline. Like I do not use any opioids during my procedures at all. Not during their answer.

Hold on, you don't use any opioids?

None at all.

So no narcotic painkillers, Nothing.

Right.

Wow.

And so the ways to achieve this. We talked about this before when we were kind of walking through, you know, you have a sound bed, right? That Kind of plays these delta theta waves. I utilize that, which helps kind of get our brain to a very specific sort of state that we want it to be in. The type of anesthesia that I'm using does not have any opioids in it. I use local anesthesia to help with the pain. So we're kind of controlling consciousness, we're controlling pain. It's a very simple, straightforward procedure for the patient that's incredibly safe. Incredibly safe.

Right.

I'm not gonna. We know that repeated bouts of general anesthesia for people, when you get, if you get it a bunch when you're a kid or you get a bunch when you're elderly, you're have a lower IQ or you're going to have an earlier onset of cognitive decline dementia. I am not going to blunt my patient's neurocognitive function for a cosmetic procedure. I would not do that to myself. I'm not going to do it to my patients. And this is not the norm.

Right.

So I'm really focused on opioid free anesthesia. I want this to be. I'm rejuvenating you. I don't want to, you know, you're. You're reducing your biologic age and I'm rejuvenating. I'm not going to knock your neurocognitive function down.

Right.

They need to come see me first.

Right, exactly. And so, you know, we have that all very dialed in at the very end of the procedure. I use long acting nerve blocks. So very strategic. And I'm very skilled at these at this point. I've done it hundreds of thousands of times to get pain relief with a local anesthetic that lasts about 72 hours. Most postoperative surgical pain happens in the first 24, maybe 48 hours. So I'm through that. Like any actual discomfort you'd have, we block and we're through.

Right.

So I'm not saying it's rainbows and puppy dogs and we're singing Kumbaya, but for the most part, we've taken the edge off to the point where you don't need any narcotic or opioid pain pills afterwards. And that's like, boom, great. And that makes your recovery a better experience. It makes your brain work better, it makes your bowels work better. It's just overall what we're seeking at this sort of next level that we're doing. So, you know, it's incorporated into the procedure itself.

Right.

And then we get them to the kind of next day, let's call it the day after surgery, post operative, postoperative at the end of the case, sometimes I'll do some targeted IV nutrition the same day.

Right, right.

And generally we'll have laboratory work and if we're really lucky, we'll also have genetic testing on our patients. We'll have their genetic profile.

Singing my tune.

Right?

Yeah.

Right.

Because I mean, reducing inflammation and improving the detoxification pathways, glutathione synthesis, all of that.

Right.

And, and in your IVs, because I don't want to just jump over that. In your IVs that you're using targeted IVs, are you doing high dose vitamin C, you're using glutathione, what kind of things are going.

Yep. So vitamin C, glutathione, B, methylated B vitamins generally, depending again, on what they need, amino acids, sometimes we'll do some NAD in there as well.

Okay.

Again, we're very, we're trying to customize and tailor this to the information that we have. And even the procedure that, that I did and you know, if there would, if there were stem cells or fat grafting, how far post operative they are, because we do this more than just this one time. But that's very, very customized for them. You know, it's not just a thoughtless, like we're hanging a Myers bag or something like that, you know, balance.

So that, so that's so awesome. And, and, and then, so now post op, are they still coming to your office for any of these biohacks or what are some of the things that you recommend that they do post operatively? Are there ever peptide recommendations? Do you do things like hormone balance, look at nutrient deficiencies, any of those things to kind of set them off on that path to be optimal inside and out.

Right.

You've.

Yeah. This goes back a little bit to that chicken or the egg question. We talked about the very beginning where, you know, they're going to look really great after we're done and then all they, they feel better too. And this is where all these things really start to come together. Right.

Is.

Yes. You know, I have a very, I'm patenting my protocol for recovery that involves hyperbaric oxygen at very specific depths and times and time frames. We even like to do that preoperatively if we can, to mobilize some stem cells before their surgery. We talked about the IV nutrition, pulsed electromagnetic fields, which we were kind of talking offline. I'm a big fan too. There's one paper, one white paper in the plastic surgery literature on healing with pemf. And I'm like, how did this get buried in the literature? This needs to be out there. And so, you know, in addition to the actual healing of the at the cellular level, there's creation of extracellular matrix and reduction of edema. Like most of my recovery, super secret, most of my recovery that I'm really getting through in the first week that seems so miraculous. I'm just getting rid of swelling. You know, we injure something that swells, it's supposed to do that.

Right.

So the better we can make people in that first week. It's this miracle. But we're really just helping them with swelling a lot of times.

Right.

And you find the PMF does a lot with swelling. I mean, I know that it improves microvascular circulation. It can even repolarize the surface of our, our cells, depending on whether you're using low gas current or other currents. I, I sleep on one every night. So I'm a huge fan of pmf. I also encourage people that don't want to spring for a PMF mat to be touching the surface of the earth, grounding sunlight.

Free.

Free, Right. The free, the free options. But can you talk a little bit about the science behind the impact of what is pulse electromagnetic field or logos current doing in the body at a cellular level that's having the kind of efficacious outcomes that you're having?

Well, and you kind of just touched on a little bit when we're talking the membrane of the cell is our key for that. Right. So we have the extracellular processes that are happening where we're creating extracellular matrix. And the paper that I'm referencing in the plastic surgery literature actually kind of talked about that mostly like this is what we really noticed is there was an increase in extracellular matrix matrix, which is sort of the scaffolding with which things healed across. And these non healing abdominal wounds is what it was looking at. And so. And PEMF is approved by the FDA for non and malunion of bones. Right. You break your bone, it doesn't heal. PEMF helps it heal. Right, right. And that's collagen as well. You know, so that does have medical indications, but applying it to this is very different.

Right.

And there's a lot more things that are happening than just the creation of the extracellular matrix. The mechanical portion of it also helps with some of the edema.

Right, right.

The polarization helps with the edema. But then at the cellular level, these cells are inflamed, they're shocked They've been through a lot. You know, they're like, and this is stem cells and that their stem cells are our warriors. They're turned on, they're activated by that stress.

Right.

Not every cell gets so turned on by it. Some of them just kind of shut down. And no matter how many great substrates you have flowing around, they're not, they're not functioning properly to regenerate. And that's what the PMF's doing. It's getting the cellular membrane kind of back into a state where, okay, this thing's like, okay, let's get to business. Now we've got kind of what we need around us because we're doing all these other things. Like there's oxygen available, there's nutrients available, like, great. But the cell needs to be able to use them, right?

Yeah.

And that's what the PMF's optimizing.

Okay, great, man. I'm a huge fan. You know, we had a really interesting conversation off camera before we, before we got onto the podcast. And you know, I live in Miami and I spend usually four to six days a month in, in la, probably the, probably the two vein capitals of America, if I was to guess. And I, I'm seeing less and less of it now, but it seemed like for the last 10 years, I saw this dramatically progressive. No amount of, of women with what I perceive to be abnormally large lips, abnormally large rear ends. And it seems like there's a filler revolution going on right now. So I want to talk about your, your opinion on, on fillers. But you said something really interesting. You talked about something you called perception drift, right? And how, you know, young woman starts with just like a minor lip injection or maybe a little bit of cheek filler. And this, the, the, this perception drift by the time she's in her 30s or 40s. Men, same thing. By the way, it's not just germane to the women. Their, their face looks noticeably distorted to everyone but them.

Right.

So talk a little bit about the perception drift and then I want to get into your, your, your feelings on fillers and some of these other cosmetic procedures that, you know, Botox, cmn, those sorts of things.

Yeah, yeah. Well, when we think about filler in general, right. We have to look at our, how our face ages as a whole. We have to have a deep understanding of this. And we all do on some level actually. Like facial recognition is built into us as human beings deep in our brain, like our amygdala, like part of our core core, like our brain's like a, an onion.

Right.

The middle is the most primitive and then it just gets slightly more sophisticated. And what makes us higher thinking as we go exterior from that. And at that very core, the amygdala, like part of our emotional regulation, recognizes faces really well. In our temporal lobe there's also this fusiform gyrus in there that recognizes more of like a communicative part of how our face works. Right. So we're just really in tune with what happens in the face, especially around the eyes and the mouth.

Right.

This is really important. This gets into like how I'm able to achieve these incredible results without you even noticing what was done. Like this just looks better. But I can't tell you a great.

Night'S sleep or something.

Right. It's just understanding these little facets of where the low hanging fruit, the high impact things are that you don't need much input to get. But this goes back to where filler comes in now a little bit. Because when there's little derangements in those areas, we pick them up pretty quickly. Like I could cover up my ears and nobody could ever draw an ear very well.

Right.

It's too complex. We don't pay that much attention to them. Even though you see a ton of ears.

Right, right.

But we go to your eyes and your lips and there's tons of important contours, convexities, concavities on all of these angles. People can draw those pretty well. Like we know what they look like because we just pay more attention to them.

Right.

This is also where most fillers getting injected around our eyes and our lips, really. And so when there's little derangements of the norm there, we pick those up more astutely than we might some other place. Even like jawline filler, even a face or neck lift like the filler, because it's in those key, key areas is going to be really, really high impact. It's how we recognize who somebody is. Even when we're babies, we really focus on the face. Is this my mom? Is this person nice? Are they going to hurt me? What's their current emotional status? We can recognize more emotions with facial expressions than we can name.

Right.

Because of those really, really core parts. So digressing a little bit, but that is the key to what's happening. So you go get a little filler injection and let's call volume loss arbitrarily. 15% of our aging process is from actual volume loss. Then there's gravitational descent and changes and there's qualitative changes to the surface of our skin. There's just certain parts of beauty that we really recognize as humans too into that thing is like, like, you know, we want mates that are fertile, we want mates that are fit. And we recognize those with like symmetry skin. Those are the things that universally everybody appreciates as beautiful.

Primal, right?

On a very primal level. State of attraction, part of our selection.

Right.

And so some of those things we just pay a little bit more attention to and, and volume is generally not one of those. Actually. We're not really like, oh, super volumous face. There's some of that in fertility. Actually in the lips of women. We can get cues as to fertility, which is a whole interesting side note topic. But so that's a really common area to put filler right around the eyes because we get volume loss and we really pay attention to it around the lips because women want their lips to be bigger, men want their lips to be bigger, whatever it may be.

Right.

We were just hyper focused on those areas. And to a small degree it can be really corrective. It can help with that when we correct the volume change that's happened. But the revolution that's happened in America, in the world really, but especially, let's call it over the last decade is that now that's becomes a lot of people's only tool to correct aging, or at least their main tool to correct aging. And so instead of addressing the 15% that it really is, it's turned into 100% of the. The problem is 15%. The solutions to, well, let's blitz it 100%.

Right.

And it happens so slowly and so frequently that you get this little change. You go look in the mirror and you're like, oh, it's different. And so we assume, we paid money for it. We went to somebody who is the world's expert in it or whatever and it's different. So it must be better. Even though we don't really have a critical eye. Like, is this actually better? It's just like, it's different. It looks different.

Great.

And then it drifts and that becomes your new norm. And then you're told six months later you got to go get it again. And so you go back in six months because the FDA trials, they looked at a certain time frame until it quit correcting. And then they said, oh, well, it's not correcting anymore. That doesn't mean the filler is gone. This is a permanent to semi permanent implant. But it's viewed as lasting six to 12 months, which is really problematic. Over time. And so they get.

Get it.

They get it once, they get it again, they get again. They get the slow drift over time that starts happening where their norm of what they've seen the mirror for six months or a year has changed a little bit. The injectors themselves have the same thing happening to them often, usually to them. And they have way more access to filler, so they're probably getting it slightly more frequently, but they're getting the. The feedback from their patient walking in the door. They're getting the feedback from the mirror. So they kind of have this double input to get this perception drift.

Right.

So if you go into an injector and they look off to you, you know, that's. That is their definition of normal at this point.

Right, right.

They don't want to walk around looking funny, but that's what they think it looks like. So should be red flag number one.

Right?

Like, oh, this is. There's been some drift here. So then we get this filler and, and we get into like, you know, what it does over time. And understanding this is, this is like one of my missions in life is just educating. Like, you know, I do surgery, I. I find filler. I. It's rare that I do a surgery now where I'm not managing fillers. It's not all bad. Every single time I'm manually removing it, I'm trying to dissolve it, which is a whole topic. Dissolving is not some magic wand that makes it go away. It just can kind of help debulk it a little bit. But the dissolver dissolves hyaluronic acid, including our own hyaluronic acid.

Right.

So in my world, when I'm lecturing, like, I'll be giving a lecture soon back here in Florida, actually in a few weeks about managing filler around surgery, especially around the eyes. This is like one of my areas that I work on a lot because. Because it's prevalent.

Right, right.

And you know, it's just turned into this sort of like filler fiasco or filler issue of just like over treating, not understanding what it's doing, not understanding how long it's lasting, and using that as our only, only option to get it done and treating it like a semi permanent or a temporary implant when it's a permanent implant.

And when. And these fillers are, are, are the. When you dissolve them or. First of all, I didn't know that they were cumulative. So they stay in the face or in the lips.

Lips.

So they never really dissolve. Right. They're Just staying there. And you're continuing to add volume because you're like you say, your perception drifts so that your, your new volume becomes your new baseline. And now you want the next like, improvement. So these fillers, I'm, I can't get my arms around, but I also don't have any evidence to back this statement up. I can't get my arms around something that is, is synthetic enough to not be dissolved by the body's own natural enzymatic process. And something that has got to have some kind of long term detrimental side effect.

Yeah.

You know, I have a very close friend of mine, she's very, very influential in the network marketing world. Beautiful young black woman. And she had one of these Brazilian butt lifts done. I think she actually had several of them done. And, and then as it turns out, the, the silicone that they used began to actually leach into her body. She went out and did one of these, you know, procedures outside the United States to save a few dollars. I know a lot of women are doing this and, and she almost died from it. And, and to her credit, what she did was she documented the entire process. The pain and the agony, the mental anguish, not the, not to mention the physical pain and the repeated surgery. She had to have, to have these things removed and showed the gnarly aftermath inside her body that had gone on from the, from this silicone being, being dissolved. And, and her mission now is like, hey, don't do it right. Perfect the way, the way that you are. Those are extreme changes. And you could definitely tell it was pretty extreme change. So what is your feeling, what is your position on the long term risks or lack thereof of some of these fillers?

Can I tell you, that's a great question, but I kind of played that one out.

Another great question. Just.

Well, it's just so insightful to get to that point.

Right.

That level of understanding so quickly, honestly. Because silicone is a true foreign body.

Right.

Not completely non related to our structure.

Yeah. You don't find silicone anywhere in the human body.

Hyaluronic acid we find in the human body.

Right.

It's actually the structure of hyaluronic acid is preserved through all species. It's the same.

Right.

What happens though? And there's low and high molecular weight.

Yes. That's why I love exosomes. We can get into that too.

Yep.

Remember, hypogenally, it's this cross linked mix that makes it this proprietary filler gel that goes in and these cross links are what make it. Because if you Just put a little strand of hyaluronic acid in. Yeah. It would probably degrade pretty quickly like our normal hyaluronic acid does.

Right.

Once you've made it resistant to degradation on purpose so that it lasts. There you go. It's linked. And some of it breaks down, some of it doesn't and loses its efficacy in the volumetric part of what it was trying to do. But then still remains there as a physiologically active. Like it attracts water. Right. And then it. We get immune reactions to it too. And this was really common with. When someone gets just like a cold, has a teeth cleaning. Anything that act or anything where their immune systems act. Yes.

That's why I love exosomes. We get into that too.

Yep.

What happens in a filler gel is they're cross linked. They cross link. They cross linked. These usually a mix of high and low. Some are just low, some are high. But generally it's this cross linked mix that makes it this proprietary filler gel that goes in and these cross links are what make it. Because if you just put a little strand of hyaluronic acid in. Yeah. It would probably degrade pretty quickly like our normal hyaluronic acid does.

Right.

Once you've made it resistant to degradation on purpose so that it lasts. There you go, it's linked. Systemic immune system is active. A vaccine even.

Right.

Can cause your body to recognize. Oh shoot, this is a semi foreign body sitting in my face.

Face.

And people will very commonly get tenderness and swelling around their old filler injections from eight years ago. No issues with it. They get a cold and their filler gets inflamed. It's still there, it's still present and it's still immune active.

Right.

So versus silicone, which is just foreign body straight up. The hyaluronic acid serves this sort of like intermediary. It's kind of part of us, but it also has these non natural features. It breaks down, it attracts water, it looks funny. It's immune active. And it's really challenging to get rid of in the long term.

Right.

Plus it's free floating so it migrates. That's a whole nother topic. You put it in a muscle around the lip around the eye which is basically just free floating muscle. And it moves through the muscle. It doesn't stay in one place. There's nothing keeping it there.

Right.

It's not an encapsulated breast implant. It's this free floating implant. And we know that as our soft tissue gets volume in it, we call it Tissue expansion, it stretches out and it changes the vasculature changes, the collagen and the elastin change. Sometimes reconstructive surgeons will use that therapeutically. Someone has a mastectomy, they don't have enough tissue to recreate the breast. They'll put a tissue expander in, they'll make more tissue, and then they'll reconstruct the breast. Well, if you do that in the face with filler, we don't want there to be tissue expansion. That's a bad thing.

Right, right.

And so when it gets overdone, all of these little, like, even if it's just the microvascular changes that happen or the soft tissue qualitative changes that it can become issues in the long run.

Are there anything that they can do to have it removed? Like you talked about dissolving it? I mean that's, that's just my biohacker Bell goes off and says, wow, dissolving it back into the bloodstream might not be the best choice of all. Unless it's maybe this hyaluronic acid matrix. Certainly not if it's full silicone.

Right.

But I do know women that have had to go in and have their lips injected to have it removed or to stop the reaction. So.

Yeah, and injecting with an enzyme. The enzyme is called hyaluronidation. It's a normal occurring enzyme in our body. It's been used in surgery for years. It's used in surgery with local anesthesia, often to help the local anesthesia spread because it breaks down the glycosaminoglycans, which hyaluronic acid is a water attractor in our skin, helps break that down so the anesthesia can spread more. So it's been used for years and years and years. But now we're using it for this like off label purpose and the FDA off label to treat filler that's there. So it helps break down some of it and de bulk it a little bit, but it doesn't get rid of all of it. And then there's questions. Yeah, what happens to those little micro particles? Are they going to our lymphatics? Lots of people note lymphatic issues with filler afterwards because it's a molecule that's migrating around. It's going to end up in our lymphatics. I see when I have a post operative patient, I talk about like three things that makes their downtime longer if they had prior surgery. So many of my patients that I see, I just do a lot of revision work. They're in a challenging spot from a prior surgery. And so they come to me and I fix it basically makes their recovery longer. They have more swelling because you're working through scar tissue. Makes sense. They're at one of the extremes of age. They tend to swell a little bit more. But the other one is filler. If you've had prior filler anywhere, anytime, I don't care if it's 25 years ago, you're going to swell more after your surgery, really, because you're going to attract water and you're going to have your lymphatics not working as well afterwards. And so the dissolver can maybe help with some of those things. But it's also, I believe, and this is a little bit counterculture in my world, I believe that I don't want to be flooding people with dissolver. And the literature says that there's no issues to our native tissue. I don't fully believe that, to be honest. Part of that's anecdotal. I've seen people who've had it on one side of their face and not the other, and the qualitative changes on the treated side are certainly different. I can't argue with that. There's no other explanation for that.

Right.

So I like to be really diligent with it. If I'm. If I'm injecting it, I'm using ultrasound guidance, or I'm physically looking at the filler in tissue during surgery, and then I'm mostly manually removing it. Right. So this is a big. Another part of my practice. Someone comes to me for surgery. We're choosing these little minimally invasive, smallest things that we can do. But then we're also saying, okay, here's where the filler is problematic. We're going to target that. I'm going to manually remove it. Any part that I can't get manually will dissolve. But then we need as little dissolver as possible.

Right. So that's sort of how it works. And. And in your practice, what would you say is the most common facial procedure that you're doing for. For men and women? What's your. What's your patient split? I mean, what percentage. And what percentage of women? Because I think it's becoming less taboo for men to get a little of these procedures done. And I've got several patients in their 50s, 60s, even early 70s that have had minimal facial procedures done. So what is the most common reason why somebody is coming to you and for what procedure?

So I generally want to see people as early on in the process as I can, which is a little bit counterintuitive. A lot of people think they're going to wait till they get worse to get their procedure done. I'm going to get the most bang for my buck. That's actually quite flawed logic because the longer we wait, the more surgery we need to get to an endpoint. The endpoint's never quite as good. I can always get a 45 year old to a better place than I can get that same 65 year old.

Right.

And then the longevity is different.

Right.

Our qualitative portions of our tissue, how long it lasts once we get to that magical spot, it lasts longer the earlier you do it. So it's actually a better bang for your buck.

Right.

So I'm seeing a lot of people who are in that world of like first signs of aging and things like that. And so, so a lot of eyes.

Right.

Because when we really get into like those intricacies that I talked about earlier, things on the eyes can be really small, really minimally invasive, but really high yield at the same time. Like incredible results where you just look my goals, my, my calling card, if you will, is like so much better. So natural and unoperated looking. I don't even know what you did.

Right, Right.

Like that's the, the jam. And it's, it's really understanding all these like, nuances that happen to make asymmetries and how one eye is bigger than the other or all those little things go in. And this is where, you know, most people think an eye lift. They do an eye lift and that's it. And they're like, well, you ignored everything upstream and downstream. That was actually really important to that, you know.

Right.

So that's what makes these little.

So like brow and lid lifts.

Yes, brow lid. So that's a really important one. Lower lid bags and things like that. Early changes along the jawline and into the neck, like laxity in the neck. These are the types of procedures that I'm doing most commonly my split of men and women. This is another, you know, really insightful question. Generally in plastic, plastics, facial plastics is you're going to look at like 90, 10. That's just like a very, you know, cut number. Like I tend to have a few more men or just a higher proportion of men. I think a little bit of his like attracts like, you know, I'm working with a lot of people in our space like this and there just tend to be a few more men in there.

Right.

But I love it when I Get somebody who's into these things that we are, because I know I can make them better. I know that they just generally have a little bit of a higher capacity for dealing and healing and things like that. And so I get a few more men in that. And men tend to be more procedures around the eyes.

Right.

Because men I generally kind of tease. I'm gonna get one shot with a guy like, I'm gonna see you, we're gonna do this procedure, we're gonna high five and I'm never gonna see you again. It's over. You're gonna go about your life. And so we're looking for those high yield, those like low hanging fruit, high impact, minimal input things. And that really, really, really tends to be around the eyes. Male and female facial plastic surgery are almost two completely different specialties. In a way, it's not the same procedures and it shouldn't be. This is when you see men, especially around the eyes, who get feminized looking. They look, look like a woman after they're done with their procedure. It is not, not, not the same procedure needs to be approached differently. It needs to be planned differently, executed differently. And so, you know, my mix tends to be a little bit more split because of that.

Wow. And, and as far as the, so you do a procedure on let's say the eyes or, or to lift the neck. And are you at the same time also trying to rejuvenate the skin? Because I know that you're very big on, on, on lasers and lasers is another one of those fields. I feel like you could just get a PhD and just right for your laser to use. I've done them. I have something called poikilodermal savant. The reds from sun damage, you know, when I was, when I was younger, in high school, in the first three years of college, you know, like an idiot. And I'm, I'm very light skinned. I sat out in the sun. I was a lifeguard in ocean City Beach, Maryland. And we were out there 9:30 in the morning until 4:35 o' clock in the afternoon and not wearing sunscreen.

Right, right.

And just getting repeatedly fried. And now I'm paying the price for it. But they use, you probably know better than I do, you know, a laser that targets the reds. And it's been a long process, it's been a really difficult process because I probably had it done four or five times. Used to have these big white lines where the creases of my neck were. But you could just see the sun damage. I wanted to get rid of the sun damage. But for those people that are, you know, in their entry phase of, you know, looking at doing some enhancement to their skin, maybe not a surgical procedure so far, what are the kind of different benefits of lasers and, like, how do they navigate this maze of lasers? Because some of them have no downtime.

Right.

And then some of them look like, you know, snake bit you over and over again.

Absolutely. Yeah. And so with any. If we're talking surgical or non surgical, it doesn't matter. I'm always focused on the qualitative parts of what's happening.

Right.

This is what the fat transfer that we talked about is qualitative in the sense of all the regenerative and then some quantitative and correcting volume. Like devolumized fat pads. I can refill them with fat. Beautiful. Wonderful option. No, no surgery for that. You know, it's a procedure, but it's not a surgery laser. Same thing. It's. It's almost unheard of that I do a surgery without a laser. It's not really. Not an absolute, but almost always with it, the patient's already under anesthesia. They've already dedicated time to recovering. And no surgery that I'm doing, no matter what, is changing the quality of the substrate that's left behind.

Right.

You know, you asked about, like, these entry phases. Like, one of the procedures that I'll do really commonly is a super minimally invasive facelift with an incision like this big hidden back in the hairline, versus a traditional incision facelift, where they're getting this big, you know, massive procedure. Like when you're in your 40s, early 50s, maybe even late 50s. I can do that through nothing. And this is what people are seeking me for.

Right.

But in that cool, like, incredibly wonderful lifting procedure, the skin surface is still untouched with that.

Right, Right.

So you have no visible incisions. You look so much better. But like I was talking about earlier, like, the quality of our skin is one of those, you know, measures of fitness and fertility that everybody. Nobody with clear skin doesn't look at it. Like, that's incredible.

Right.

So when I do lasers, I kind of have this freedom to me in that my patient's generally already sedated and numb.

Right.

So I can kind of do whatever I want. I have no limitations. And so I'm putting together what I call a cocktail usually. So when I look at you, I'm saying, okay, you got some pigment, you got some red tones, you've got some laxity, you got some fine wrinkles. And I'm going to make literally a cocktail of different lasers that I'm using, stacking on top of each other to get it done. Everybody's a little bit different from the energy and the like, kind of how I'm crafting them together. But just like the bar behind you, you have like a set of ingredients. Here's what I have to work with. And I'm going to like make the best cocktail that I can. And so arguably one of the most regenerative parts of these procedures, because you're again in this low hanging fruit. These are really low hanging fruit. We can make this look a lot better. So it's kind of, you know, ironic in these beautiful surgeries that sometimes the skin is maybe one of the most impressive parts, you know.

Yeah.

And with no extra intervention, essentially, in that sense.

And, and so there's. What is the, the big sort of categorical difference between the lasers? Are some just working at different superficial layers or are they actually looking. Working on different physiologic. Physiologic structures in the body? I mean, are they? Yeah, because I know that some really make you look like you've been badly burned and some you can leave the office that day and you're just back to work.

Yeah. At a very sort of like nerdy nuts and bolts level. Lasers are by definition one wavelength of light. So it's. Laser is an acronym, actually. Light amplification by stimulated emission of radiation. So you stimulate this light or this medium to release energy from electrons that get activated and drop and you get one wavelength of light. So, so it's by definition that way. And so we can take that wavelength and then we can look at what part of the skin is. We call them chromophores, the targets in the skin.

Right.

And so I sort of mentioned some of them. There's brown, like pigment, like melanin or melanosomes. There's red blood cells, whether they're oxidized or not. Oxy or deoxyhemoglobin, specifically in the red blood cells, which is what you had with your redness. One, we can target collagen, which is like water. And with that different absorption spectrums come in. So like some things really love water. And they'll just hit it and heat it up and it ablates it right away. We call those ablative lasers. And you can get ones that are where the wavelength slightly less has less affinity.

Why is that good? Why is just. Why is just heat deep in the skin good?

Right?

Yeah. So heat causes there when we have an ablative injury, it vaporizes it. It's gone that physically. That's like the equivalent of microneedling.

Right.

Boom. An injury in that sense. But the surrounding heat causes the collagen and elastin and vascular structures to have a, you know, a subtle injury, just like all these other hormetic doses we've talked about, whether it's cold or hot or exercise or whatever, that it causes this little micro injury that then caught, you know, it recovers from that.

Right.

It creates more elastin. That's the one we talked about earlier. I really wanted to create more elastin in that process. And we can manipulate that a little bit with our growth factors. But that's a micro injury to those areas just from this peripheral heat spread that happens in there. And so the more you can target your chromophore, you can get heating just inside of your blood vessel and nowhere else.

Great.

Wow.

You know, like everything else is essentially left alone, which then relates to some of the downtime things that you're talking about. Generally, the downtime is going to be relatively proportional to the result that you get. Like no downtime, probably minimal results.

Results.

But some things you can decouple or hack that a little bit by being really specific with what you're targeting. You can get incredible results to shut down your blood vessels with minimal downtime because the injury was only on the inside of the blood vessel.

How do you make a discern a distinction then, between when a patient comes to you to have some skin rejuvenation done, between whether or not you're going to do a microneedling procedure with their own prp, whether you're going to do some kind of stem cell injection or you're going to use a laser. What's that Kaisen decision matrix like? Is it about downtime? Is it about targeted outcome?

The point that I'm at in my career, it's results driven usually. So not that I'm not concerned about downtime, because I'm certainly am. We just talked about all the things I do to try to hack away downtime, but in general, I'm after the results. That's why I am where I am, because of the results that I can deliver. So I'm really going to give you usually what's the best for you to get the best optimal outcome we have. Now, of course, there's a discussion around that as to. Okay, well, here's what that involves. Here's the, you know, downtime needed. Here's the lasers. We'll need. And so then it gets customized in that sense. But generally we're kind of going for the most that we can because with that one treatment I'm able to get somebody to a place that they could have. You'll see this common thought paradigm. Well, I'm going to have these three small lasers that only have two or three days of downtime each. I can kind of do it in a weekend and then I don't have to ever have this big period of downtime. Well, those three lasers that total up to nine days of downtime never get you to the same place than had you just done the six day downtime that one time.

Right, right.

So I'm going to go for the results and then I'm going to do everything I can to optimize the results and optimize the recovery and things like that at the same time. And you know, this goes back to the initial pre consultation like we talked about things I do before surgery. I am very, and this is all over my social media. I'm very big on proper expectations going into the procedures.

Yeah, I did see that.

I too commonly see somebody who comes to me and they're six months after a procedure and they're unhappy with the procedure they had because they didn't even really talk about it much with the doctor. They thought that they were told it was going to be two weeks of recovery and that they just said they wanted a facelift. And the doctor, great, let's do a facelift. No discussion of, well, you also probably need to be doing these things with it. No, like second order thinking that goes with it. No planning, just like I'm just executing.

Yeah, come in Tuesday and we'll do a facelift.

Right. And then you'll be back in two weeks. Well, you're kind of back in two weeks, but you are by no means done healing. This is a multi step process that's very complex and, and it's months before you're really healed. And that sounds daunting, but when we really get into what those months look like, it just setting proper expectations is like a huge part of having a successful procedure. To know what can I expect to happen, how long is it going to take, what does that time look like, when can I exercise? And you know, all the things that go into it, those are really, really, really, I'm not shy, I'm not hiding those, I'm not underselling them. I want you to be so dang educated.

Right.

Coming into it that you're like, this is exactly what I expected it to be.

So if you were to say, if I was to ask you what is the one best thing that you're the best at, would you consider to say I am known for X or I feel like I am the best at Y. What would that.

Oh, this is a little bit of an identity question too. Right.

Somebody that had nose jobs gonna be like, you didn't say the nose shot.

Yeah, right, right, right. Which I actually don't do. I don't do.

No, I just say whatever.

I mean I would say I'm certainly, I'm most known for what happens around the eyes. Like my eye procedures, upper and lower and brow because of the complexity there and the attention that I pay and the results that I get. And that's usually the first place I'm starting. So definitely that I think next would probably be the sort of minimally invasive facial rejuvenation, the lifting procedures. It's pretty unique that I do that.

That.

And then to my colleagues it's certainly just the like performance readiness. That's like what I.

No, that is, I'm, I'm fascinated by that. And one of the reasons why I invited you on the show because I, it wouldn't be the norm for me to put a plastic surgeon on here. Not that I have anything against plastic surgery at all. I, I just feel like a lot of people are not doing the basics to get their bodies contoured to, into the condition that they, they need it to be. And they're going to have surgery, but they're still not working from the inside out. And, and I love that you are big on the inside out. You're big on the other biohacking modalities. The fact that you even know what a peptide is in that surgical world to me is really just, you know, exciting and fascinating. But by the same token, I also realized, I mean we have a patient that just lost 2, 284 pounds.

Wow.

And he is go and, and God bless. We have lots of patients that have. Yeah, yeah. Lost you know, 100 plus pounds. We're working with a very, very famous one now that's I think going to rattle the world when we show the transformation. And I realize that, I mean these people are going to have to have some body contouring done because there is just no other way to, to bring them back. And they've put the work in and they got to have the body contouring done. And I also see the implications of, you know, men and women, this, this whole anti aging longevity biohacking you know, bio optimization, whatever you want to call it field right now that's getting so much attention, wellness functional medicine, you know, it doesn't have just one solution.

Right.

And I think that getting a minimally invasive procedure, getting some resurfacing done, rejuvenation done, can not only be good for the, you know, the appearance wise, but I think it has a lot to do with people's mental well being and I think it actually has some positive physiologic outcomes because, you know, you were a dermatologist, your dermatology trained before your cosmetic surgery trained. And you know, maybe there are potential risks going on on their face, you know, scars and other things that you can get rid of those, you know, precancerous lesions and things like that. And you get rid of those, they can have real implications.

Absolutely.

You know, on, on, on your outcome. So yeah. What's. Do you feel like there's anything that we haven't covered today that my audience should know about minimally invasive procedures? I feel like there's so many rabbit holes that we could go down. We covered a lot of the big ones that my audience asked about. They, you know, the, the hair loss and, and some of the, your, your thoughts on, on biohacking. But what if any topics do you think that the person that's interested in this longevity anti aging trajectory that they're on, majority of my audience is middle age. What would you like to tell them about that journey? Where do they look? What should they be thinking about?

Yeah, that's a great, great question again. And I think you just really, you know, you want to really just turn your brain on when you're doing this.

Right?

Like that sounds simple, but it sounds so simple to say, but this is, and I tell everybody this with, in a world driven by before and after photos for me is like, go look at before and after photos and be critical. Don't look at it and say that's different. Great, it's different. But is it better? Like look at it and try to figure out and get into it and know. And not that you should know everything off the get go, but, but get a real visceral feel as to. And when I say visceral, I'm saying like, that's part of how our brain's programmed to recognize it. Like pay attention to those things.

Right?

And understand like, okay, here's what, here's what I resonate with. And then when you go into it, go into it with the open mind of like, okay, well there's Gonna be qualitative. There's gonna be like physical and anatomical aspects of what can be done and sort of hear, hear it out, you know, don't go, I don't wanna like direct to this degree, like go in knowing what your concerns are, having that self check, here's the things that are most important to me and be able to articulate those. But also don't tell the person what you want because it could be really dangerous, you know, because I was like, yeah, great, let's do it. Because that's what's going to make them happy. And that's a very sort of like bush league, first grade level of thinking. Like the person asked me for a facelift. That's what it's going to take to make them happy. But then they walk around looking abnormal afterwards.

Right.

And this is what I fix. This is 80% of my practice is fixing these things. I love it when I get somebody who's never done anything. It's just pretty rare at this point. And so, so go into it with that. And that's like a PSA public service, a little bit of like, you know, understand it. Be careful with filler. If it seems too good to be true, it probably is. If your injector looks off, they're probably going to try to create that in you. And then I think also I mentioned a little bit of like not waiting until you're desperate or it's too late. Like don't, just don't think, well, I'm just going to wait till it's as bad as it can get because there's issues. We didn't really get into this too much, but as we get, you know, with women perimenopausal, that changes a lot of things, right. And so I tend to kind of like, like step back and help them manage that via, you know, I have a functional medicine part of my practice that evolved solely out of my surgical recovery. I already had it there and I had the mindset and all the things. And so I bring in people who know more about it than I do, right. And say, let's have this functional medicine practice. But now it's this beautiful adjunct for my patients who are going through this whole journey of rejuvenation.

So postmenopausal is going to, is going to determine some of their post surgical recovery.

Our soft tissues are, are so responsive to sex hormones, particularly estrogen. We're talking about fat, even vessels and things like that, right. So I want those to be optimized as much as they can. For some people, it may be the right call. For others, it might not. I'm sort of like, you know, stepping back and doing my job and sort of, you know, you know, managing everything from afar, but letting those things get, like, worked into what is best for you as a human. And then with that, I'll work and, you know, we'll make the. We'll make magic happen other ways.

That's. That's amazing. I. I wind down every podcast by asking every guest the same question. There's no right or wrong answer to this question, but I ask everyone this questions. I've had some really interesting answers. But what. What does it mean to you to be an ultimate human?

Thinking about this question has been my favorite part of this.

You watch my podcast answer?

Of course. No, not even that. But I. This, this, just thinking about this question has literally been the most fun of this for me, I think. Really? And I've talked to my loved ones and my friends about this a little bit. So, yeah, I mean, I have thought about this and not. This isn't some canned answer. It's actually probably still in the works because it will be for the next years for me, because I love it. But I think that being the ultimate human involves a few facets. Right? You have to know what your goals, missions, values, what did God put you on this earth to do? You have to understand that first and foremost.

Yeah.

Amen.

And I think that a lot of people could do better with that, myself included.

Right.

I revisit this quarterly almost weekly. I do year end reviews. I'm like, what am I climbing up? What am I shooting for? What are my goals?

Right?

But you have to understand that first. And sometimes it's hard for people to sit with themselves quietly enough to do that. I think they don't really want to get into who they are and what their values are, because it's hard to define. But once you know that, then you can start working, grinding, climbing the ladder, whatever you want to call it. And a lot of people are really good at that, right? They're climbing and grinding and they're like, busy, and they don't know what they're. Where they're going even. Like, there's no end in sight. They're just going, going, going. They don't know when they got there and they might get to a location. They're like, this isn't where I wanted to be, right? So. But we have to be able to do that, the grind, right? I think, you know, that's an important part. Some people Never get to that. They're really good at knowing what they want, but they'll never go do it.

Right.

So then you gotta go do it. But then along there is. This is where. This is why people are listening to this. This is what we're so into is like, great. Now this person who has a mission, who's going along. What. Where are they at? Like, are they at 100%, you know. Right. Which probably will never be a truly 100. But we're shooting for it.

Right.

And when we're doing that, you know, we can climb faster, we can get to that location better, and we can serve those facets that we're after. You have. That's dynamic. Like, when you become a parent, that certainly changes.

Right.

What's happening with your career, with your marriage. Like, those. Those are dynamic. You got to be kind of keeping a tab on those all the time. So you know what you're working for and that you're not going to burn out. You're going to be healthy, you're going to be happy. And when you do get there, you're the. You can do it the best that you can. Whatever your mission and values are. That is, to me, like, all of those things together. That's the being the ultimate human.

That's being the ultimate human. Wow. Dr. Chestnut has been amazing. Cameron. Dr. Chestnut. You know, I feel like my audience is really going to resonate with this, with this podcast. I'd love to have you back again and I'd love to continue to, you know, follow your work. And we're going to do some biohacks.

Yeah.

We didn't even chat.

Cold plunging. That's another. There's. I love cold plunging because we have some definite differences there that are kind of fun and really. Yeah. I mean, lay it out well right.

Here before we wind up.

Okay, let's. Well, before we wind up. So, I mean, I've been cold plunging for 25ish, 26 years.

Really?

Well be. I was a collegiate athlete.

Right.

Okay.

And so for us, cold plunging was getting in the therapy pool. Like, it wasn't cold plunging. It wasn't cool. You were semi injured all the time.

Right.

And so you're like, getting in this therapy pool and it was. The whirlpool is metal. It wasn't cool. It wasn't you in it because it. It made you feel better after your injuries.

Yeah.

And it made you able to train more.

Right.

And so I took that. And then as I got into my life as a triathlete and these other Things I just kind of took it with me. And I literally did it only for the only reason of increasing my training capacity and which, in hindsight, was recovering after workouts. And so I just love this, you know, like, thinking back about it, it's like, it wasn't cool. I didn't talk about it. Like, you know, you love the jokes now of. Show me somebody who cold plunges without talking about it. That person's rare.

Right.

That's rare. But back then, it was just. You just did it right. For the function of then. Then, you know, as we. I love that you're woke to wellness. As we became more understanding of what it was doing, it came very in trend. I don't know how many years ago it's been now, but yeah. And when I just think back, like, you know, all the things that I've cold. I plunged in my hotel bathtub today with a garbage can full of ice.

Right.

Like, and so it's like, all the things I've been through horse troughs and, like, rivers and lakes and snow and everything.

Cattle drops when I'm in Colorado.

Right.

Yeah.

And I still have my. My converted chest freezer that I would cold plunge in. That might be my favorite one ever.

Right.

Because when you're hopping in a meat locker to get cold, you're like, it's.

All those people that buy those ones from Costco.

Right.

And seal it up and hop in. It's a great, you know, financial option and easy way to do it. But then you have all the wonderful, beautiful ones. Now, that can make you so cold. I tend to plunge a little bit colder than you do.

Okay.

I think partially because I'm seeking that recovery and that, like, little. I want to build the, like, willpower part of my brain. The, like, mid cingulate cortex, it's called this, like, anterior portion of it. Like, like. And if I get in. Yeah.

Huberman talks about that. Doing things you don't want to do.

Exactly.

And strengthening that part.

And this is one of the things, the message to anybody starting, like, it gets easier, but it's never fun, even if it's your drug of choice. Like, that initial plunge went, oh, you can make it as miserable as you want no matter what. So I like a little bit colder. I'm pretty skinny, so I'd like. I get my core temp down pretty quick, and then I kind of stay there. And I know, you know, you say there's no evidence to, like, colder is better. To me, it really boils down to, like, what's Happening in my core, right. Like, and if I can get there faster, like it'll be midday, I'll be mid surgery some days and I still feel like contracted and constricted.

Yeah, no, I love that feeling too. I, I've actually. So, you know, my thing is as a general guide because there's a very small sliver of the population that has, you know, risks of getting into a cold plunge and, and obviously colder for them would increase that risk. But So I say 48 degrees, three minutes minimum, six minutes maximum. Great sweet spot. Cold shock the body, not cold adapt the body. But I, I really, I want people to get the benefits of the peripheral vasoconstriction, the brown fat activation, the, the cold shock proteins. I've actually started doing some research on individual cold shock proteins because there's a, I think therein lies, you know, where the evidence is really going to emerge about, about you know, the benefits of cold plunging. I mean there's this LIN28A and LIN28B that, that, that appear to have very positive effects on upregulating glucose metabolism by improving insulin sensitivity. And there's, there, there seems to be a direct link there. I wouldn't say that there's a clinical study that proves that yet. And I say things like, you know, cold plunging is a great way to, to do a great add on to your fat loss routine because. Not, because there is a peer reviewed randomized controlled clinical trial proving that it reduces, you know, causes fat loss. But there's enough, there's enough evidence in the periphery to say that that's happening. I mean if you have to, if you have to exchange calories for heat, like brown fat activation, if you're raising your metabolic rate, if you're releasing endorphins, if you're upregulating glucose dose metabolism or upbreaking insulin sensitivity, all of these things have an indirect relationship to fat loss.

Right?

So it's, it's a very linear projection to say that, you know, it could help improve fat loss.

You got my brain going crazy with that because I wonder like, are these activated different temperatures? And you know, I wear a CGM during surgery times because is, this is, you know, your, your audience is high performers, right? These are my patients and me too. Like, and then we talked about flow state extensively. But getting into a flow state not is very energy demanding. It's hard.

It really is a big recovery.

And so these things help. And so I wear the cgm, right? To just to kind of know it's actually pretty boring to Be honest, for me, which is good. But the most changes I get in my CGM when I have it on are when I'm alternating therapy between hot and cold.

Right.

When I'm doing contrast therapy, I see this like, pattern of this slow rise when I'm in the sauna, and then a sawtooth straight down when I get in the cold plunge. Immediate drop in that insulin sensitivity.

Right.

Then back in the sauna. And I just, I can get this sawtooth to repeat with that.

Yeah.

And, you know, it definitely is changing your insulin sensitivity and all. That's a huge metabolic thing. And to see it, you know, you don't really see it. And that's where I see it the most. So with your high performing audience who, you know is trying to recover from their big days at work where they're doing all these things like, like, you know, I like cold plunging, honestly, probably more for the mental toughness part of it. Like, I do love all the physiologic benefits and they're there, but I probably really do it more for myself.

I'm just gonna deal with it.

One of the hardest things I'm gonna do today.

Yeah.

And, and that's, that's why I do it for my kids. Yeah.

And that, maintaining that, that state of calm, you know, I do it now where I wake up. We walked around my house. So you see, I've got my master bedroom, then my bathroom room, and then to get to my gym or to get down the hallway, you got to go through the room with the cold blunt. And I did that on purpose because I'll, I'll walk in there and I don't think that I've walked in there one morning. God, man, I'm so psyched to get in here.

I know.

Every morning I pause and then I, I, I don't know why, but I hear David Goggins voice in my ear, like calling me a. And, and because I saw him on a podcast and he was like, you could solve anything with massive action. Quit negotiating with yourself. Yeah, I've never, I've never, I've actually met him a few times, but he's in my ear every day going, get in there, you. And, and then. So I, I've got my underwear on. I just get in the cold plunge. And I've never regretted that. I get out, dry off, put dry shorts on, and get on the hypermax. But by the time I make it down the hallway and reward myself with a coffee, I've got 70 of my routines. I've done red Light. I've done hypermax. I've done cold plunging. Brush my teeth, put. Put water on my face, and I feel amazing.

Yeah.

So. But meeting me at that end of the hallway versus this end of the hallway, 20 minutes apart is night. Night and day.

This is atomic habits. This is setting up your habits in front of you so that there's literally hurdles to not do them.

Yeah, right.

They're like.

And I have this, like, mental game with myself. It's funny because if I go out the other door of my bedroom and I go down to get coffee, I feel like such a loser. Nobody's watching. I'm all by myself. I'm like, you are a loser.

I spent last week. Week, like, I did a three day in the life of a professional UFC fighter.

Yeah.

With Juliana Pena, who is the former bantamweight champion, maybe soon to be, you know, getting that title back. And it was just fascinating to be in her life and see three workouts a day and all that so that we can get into all the recovery things. But one, I think the biggest changes I, you know, impressed on her was cold plunging, right?

Yeah.

Well, she had it, but she just wasn't using it regularly. And, you know, you have all those physiologic benefits for her. Three workouts a day. I work, was smoked after three days of that. Like, it's hard.

You did three days with her?

Yeah, three days, three work, three workouts a day. You know, it's like strength training in the morning, grappling, you know, jiu jitsu in the afternoon, MMA or striking at night, like, and just rep on repeat.

Right.

And it's a whole another level. I know, you know, way more about that than I do, but, you know, I've had the privilege of getting to work with some of the UFC fighters for, you know, fixing things after.

Yeah. Yes.

But, you know, in that world, like, that's the one that I'm still getting messages from her about, like, she's got a daughter who's 6 years old, who's the one encouraging her in there now, like, getting her to go in and, like, filming it, keeping her accountable. And when you think about, you said keeping calm.

Right.

We have that panic response. This is what I get. I get. I live on a body of water, and I get in it every single month. Just kind of like, for myself, sometimes I'm walking out on the dock and I'm doing kettlebells on the dock and then hopping in the water and getting out. Just like, it's a mental toughness that's all it is.

Right, Right.

But that panic response, especially when the water's moving.

Right.

Yeah.

And this is what I saw with her. She was phenomenal at overcoming that panic response better than anybody I've seen. She's used to, like, trying to survive, you know, getting choked and all these things. So anyway, I just thought that was really fascinating that I saw. It was really hard for her to get in. But when she did get in, she overcame the, like, panic that getting from parasympathetic to sympathetic or sympathetic to parasympathetic really quick. I love of submerging my face first.

Yeah.

Taking advantage of that mammalian diving reflex.

Right.

Which is in my world.

You mean before you actually get in?

Well, the first thing when I'm in. Cold in your nostrils triggers a physiology that slows us down.

Right.

Our cranial nerve number five is our facial or is our trigeminal nerve. It's the sensory nerve to our face. And when it gets cold and shocked, it sends a signal through our vagus nerve to slow down our physiology, slow down our heart rate, slow down our breathing. That's how mammals, animals, you know, otters and whales and things can die for so long. It slows them down. And we have the same response all over. Like, if I push on somebody's eyeball hard enough, I'll slow down their heart rate. It's all this, like, cranial nerve 5 to cranial nerve 10 connection.

Really?

Which we call the oculocardiac or trigeminal cardiac reflex.

Well, did you actually have them close their eye and.

Well, I'm saying, like, in surgery, if we're working on the eye, sometimes we'll see them get. We call it bradycardic slow heart rate. And I'm communicating with my, it happens more in younger people, but I'm communicating with my anesthesiologist on that and things. Things. But I just love that, that and most surgeons don't even know that exists. So I teach about this. I just wrote a paper on it, published it, you know, a couple years ago now, maybe. But like this trigeminal cardiac or ocular cardiac reflex, how it relates to facial cosmetic surgery. But I love on the flip side of that, that this thing that I do, cold, plunging every day, get my face wet, you know, overcome the shock, get your heart rate down. That's the best part. Like, there's a physiologic response in all.

Mammals to that and overcoming that panic, you know, I, I, I saw an interview, it was an older interview with Dana White. It was because. Become a very good friend of mine now. And he was asked, I think the question was, what makes the difference between a good fighter and a great fighter? What? And.

And.

And if you were to pick one word, that would be the difference between a good fighter and a great fighter. And he said, composure.

Really?

And, you know, if you think about it, the. The situation they're in, I mean, usually the one that loses their temper loses the fight.

Right.

The least composed loses the fight. I mean, at that level, it's like jiu jitsu, you know, it's. It's a. It's a thinking man sport, and it's like the ultimate gentleman's game of chess. Just has a possibly very negative outcome. Right.

For the loser.

But. So, you know, just getting to your point about, you know, how this athlete was able to overcome that panic response. Probably just used to being very composed, right?

Yeah.

If you can be composed in. In cold water.

Water.

And for me, there's. There's nobody in there. I got nobody to impress. So I. I do freak out a little bit. The people are in the room. I'm very composed.

Yeah.

So I pretend like the cold water doesn't bother me.

It resonates most of me.

I got in there, my wife's like, are you cold? I'm like, not at all. Like, she goes, can I talk to you, or do you want me to wait till you get out? And I'm like, you can talk to me, you know?

Yeah.

Why can't we talk? It was just because my voice sounds like it takes a sec. Yeah. Yeah.

It resonates most with me as a dad, actually. Like, that keeping composure as, like, your superpower as a dad. I mean, my kids are younger than yours. I have, like, 10, eight, six.

Yeah.

So you're constantly trying to, like, keep your composure and demonstrate emotional.

Such a metaphor for life, man.

Right.

Great way to start the day. Well, again, Dr. Chestnut has been amazing, brother. Thank you for coming on and making the trip here.

So grateful. Thank you for having me.

And as always, that's just science.