Breast Implant Illness with Dabney Poorter and Dr. Brighton Miller

I have the pleasure to have Dabney, uh, Porter, and I have Dr. Brighton with us tonight, and we wanted to bring to their community and also to ours a full discussion about breast implant illness. So I gave them free rein to come up with as many questions to poke and prod me with as they wanted to, which is totally fine. I, I like it. They sent me a list of questions of which, um, I mean, everything was, you you know, as straightforward as could be. So I'm open to discuss anything y'all want to, and you know, you have the floor.

All right, very good. So exciting. Um, hey, well, I'm Dabney Porter. I'm a nurse practitioner here in Fort Worth, and I own Restore and Revive, which is a functional medicine practice and wellness center with different modalities. Our goals— a root cause approach to help with physical and emotional mental well-being. And I get the privilege of working with Dr. Miller, so I'll let her introduce herself.

Yeah, I'm Dr. Brighton Miller. I am a board-certified family medicine physician, but I found my wonderful future in functional medicine through my own journey with autoimmune disease and breast implant illness. So, um, I have quite a few questions for you and, and really want to dig into this, but currently focusing mostly on complex autoimmune diseases, including, you know, any kind of inflammatory process and integrative oncology as well in women who have breast cancer or potentially post reconstruction who may need some help. Yeah, yeah.

And that for every— for full disclosure, I have no conflicts. I did not operate on Dr. Miller.

No, no, no, I didn't tell you earlier.

She was not coerced to do this because she was not.

No, but we're super excited for this. I think this is important for our community to hear, and thank you for taking the time with us. Um, so to jump into questions, um, We do have people that are probably unfamiliar with you, and so we would love for you to share a little bit about your background and how you became a leading expert in breast explant surgery. If we can start there, that'd be great.

Sure. I'm a little biased. I'm old in terms of, you know, training now. I trained at a time before there was something called the 80-hour work week, so prior to 2002 Uh, I did 6 years of general surgery training with absolutely no work hours restrictions. So I got the pleasure to work many, many hours, and I was trained by excellent, uh, surgeons, and they wanted you to be a very, very good doctor prior to being a good surgeon. So that's how I was trained from '96 to '02 in general surgery, and then I trained in plastic surgery from '02 to '04, same institution, Indiana University Medical Center in Indianapolis. And then I did a 1-year microsurgery fellowship under the direction of Dr. William Zamboni, who's passed away from cancer. And, um, and then I really specialized in doing microvascular reconstruction for the first 15 years of my career. So I taught for 7 years at a medical school. I did group practice for another 5 years, and then I did a solo practice starting in 2017. My experience with, you know, implant-based problems predates any terminology of breast implant illness. So anybody who places implants for— Dr. Brighton mentioned cancer reconstruction, which of course I did, but I predominantly did an operation and really spent most of my career trying to do perforator flap surgery and specifically the DIP free flap reconstruction for breast cancer. And because breast cancer is the most common cancer that we would see, that's what we did the most of. I also did neck cancer reconstruction and sarcoma reconstruction. So when you look at publications, they'll be across all sorts of things, including, you know, vascular surgery and oncology and fat transfers, for that matter. So I got really adept at reconstructive surgery, both with implants and then with the DIEP flap. And then I gained a significant amount of experience doing fat transfers, which we can discuss at some point because I feel like Most people really don't understand fat transfers very much. And, um, very much— that's super elegant language. So I would say they don't understand them at all.

Yeah, we have many questions.

Yeah, so when you do breast cancer reconstruction, and so principally, say, you know, I did all that training and I had a couple options, right? I chose to go into academics and teach and do oncology reconstruction. And there's somebody who, say, predominantly majority of people go into private practice and they start doing general plastic surgery. They may or may not work in hospitals. They may or may not do ER call. They, they'll probably, uh, do their best, uh, to do what they can until they get a cosmetic practice that's strong enough to support themselves. So I say that because You know, like, there's, you know, these ladies are, you know, a few hundred miles away from me on I-35. Big highway, right? Two sides. So those two tracks are extremely different. And if you're a cosmetic surgeon, there's no way in hell you have as much experience doing fat transfers as I do, because every single breast cancer patient I operate on ultimately would have needed a fat transfer once or twice or sometimes 3 times. So when someone says they know how to do something, or when someone uses the term overgrafting, I get really sensitive and upset. My sister died from breast cancer. She had a breast cancer reconstruction with, um, implants, and had someone overgrafted her to give her a lump or fat necrosis or a cyst that she thought was cancer again, I would have been incredibly pissed off at them. I consider that to be unethical behavior.

Hmm.

So you really have a heart for this. Yeah.

Well, the people who talk about this, they should— every time I hear that come out of someone's mouth from my specialty, I get very bothered by it. That just tells me they did not train or ever take care of oncology patients because otherwise they would know, one, never to do that. And two, how stupid it sounds when it comes out of their mouth.

Right.

And there's people who honestly market to patients to over graft them, which is embarrassing to me and just unethical behavior.

Yeah.

So, you know, going back to how I got to where I am, anybody who puts in an implant, a knee implant, a hip implant, a jaw implant, a neurologic implant, a cardiac implant, all implants that are not your own tissue by definition implant. They can get infected, of course.

Yeah, yeah, right.

So the difference is always when I put in a tissue expander or an implant-based reconstruction for a cancer patient and I got a call— is always on Friday night or Saturday night— that that patient was in the ER with a red, you know, infected cellulitic breast. I had 24 hours to have the patient admitted, put on IV antibiotics, and if that didn't resolve, I had to operate on them. Because these people are on chemotherapy, they're all immunosuppressed, and you don't really have time to screw around, right, fiddle with it. So, you know, I had a very, very healthy respect for any device. I used to be the guy they called for sarcoma reconstruction. Most people don't even know what a sarcoma is. They're, they're tumors of bones, fat, muscle, tissue, tendon. Basically soft tissue tumors, but they are awful. I mean, they can take out large spaces. And I would get— I, I was called early in my career for these things, and I'd be like, oh my God, I've never even seen anything like this. And I'd have to call it.

My father passed away from an angiosarcoma of the vascular system. Yeah, it was rapid.

And yeah, and so most people don't really like it unless you worked around oncology reconstruction. It's a little bit different. You, you know how to speak to patients and what to say to patients and how to be careful about what you say. Everything's obviously got to be worthwhile. And when I took care of patients with implant-based reconstructions, or they were referred to me for problems with their implant-based reconstruction, I used to have this out And my out was I was a microsurgeon. So I could take your implant-based reconstruction always and remove it and then replace it with your own tissue.

Can you explain that a little bit more, the definition of what a microsurgeon is for our audience?

Oh yeah, sure. It's not what you read on Facebook. Let's start there, right? So a reconstructive microsurgery fellowship is done where Predominantly, are you taking care of patients who were, say, injured in accidents? So they may have lower leg injuries. And so they may have been in a, you know, on a motorcycle. And motorcycle accidents are bad because they're at the level where you get your leg hit by the bumper of the car. And they cause a lot of trauma. They break their tibia and fibula and expose the bones. And many times they lose a lot of tissue. So then they would call someone like us to do a soft tissue reconstruction over it. And using microsurgery, everybody remembers what a plastic coffee stirrer looks like. So just think of a piece of tissue on your body, whether it's skin and fat, which is what I did predominantly, or skin, fat, and muscle, which is a composite flap. You could transfer that anywhere on the body that you can find other blood vessels, an artery and a vein, and hook it up. So that's what I did.

Connecting to the microvascular. Yeah, you're— yeah, I understand. Okay, thank you so much.

So you're finding blood vessels somewhere in that area that aren't hurt, right, in the zone of injury, and then hook up to them. So when I did a breast reconstruction, we would take the tummy tissue discarded in a tummy tuck, leave it connected to the blood vessels. Then after we got enough length on the blood vessels, think of like a little extension cord, so to speak, artery and vein. You would transfer it up to the chest underneath the breastbone, take out a little piece of cartilage, see the internal mammary artery and vein, and sew those together.

So how much fat, how much fat is required for a fat transfer? Can you give us that kind of information, or is it— does it make a difference?

So this is different. I'm talking about a flap surgery.

Okay, I'm jumping back.

Yeah, you're jumping into the next question, next series of questions.

You go a little fast. So when I would take apart A— and the first time this happened to me was in 2006. Somebody was referred to me who kept getting red breast syndrome, is what they called it. So they had an implant-based reconstruction, and they would intermittently get admitted for red breast syndrome and put on vancomycin. And so, uh, everybody listening, red breast syndrome is not a thing. That's basically a histamine release caused by a device that's underneath the tissues that your body's reacting to. So I, I— all I knew at that point in my career was if I got rid of all that stuff and it was what was causing it, that would stop. So when I did that case on table that day, all the redness of the lady's chest went away because it was a reaction and not an infection. Yeah. So I did that case, the lady could breathe easier because I took all the scar tissue out, and then there was no redness anymore because the foreign body reaction or whatever histamine reaction she was having before, you know, mast cell activation became a thing. Like, oh my God, yeah, everybody's got mast cell activation syndrome now. I'd never heard of this stuff when I was training. So, right, that was our first, you know, quote-unquote, experience. Now, you know, I, I kind of define specific symptoms a certain way. So she had a lot of internal mechanical symptoms, which are from scarring. So scarring restricts your breathing capacity. So people feel like they can't take a deep breath. That makes people super anxious.

Yeah, yeah.

They also have a lot of, of tightness. And so you got tightness, shortness of breath, you got maybe pain from it. Like, it just is not comfortable.

Yeah.

And that's without any radiation or other weird treatment or other problems. So that can just be like baseline. Mm-hmm. So when you take all that out and do what's called an autologous reconstruction with their own tissue, then of course all that goes away. The first kidney transplant was done between genetically identical, or Siamese twins, basically in the '60s by Dr. Murray, who's a plastic surgeon. And what they did was they took the twins and they grafted skin from one twin to another to show that the graft wouldn't reject. And then as soon as the skin didn't reject after a week, they're like, oh, we can do this. No problem. Because you're genetically identical.

Right. Yeah.

So everything after that requires drugs.

Yeah.

Okay. So fast forward to what we see now. I see a lot of symptoms basically of chronic inflammation or a big paper was published last summer from Denmark that shows that many patients are experiencing what looks like an organ transplant rejection at the tissue level. So they have a ramped up, not just T-cell response— we can talk about T-cell response. T-cell lymphomas are caused, uh, in this group by textured implants, specifically the Allergan implant. But there's also a B-cell response. I took out a B-cell lymphoma early in my career doing this, one of 8 in the world. And then there is a large increase in plasma cell activity, so there's antibody production. For sure, that's not normal, right? Right. Normal would be a foreign body reaction that would lend itself to giant cells and histiocytes, signs of chronic inflammation from a foreign body. Yeah, but with molecular techniques, you can now see RNA and protein production. So now it's different. So we have the largest series in the world with PCR testing of scar tissue samples. 694 consecutive. I've done several thousand now, and it shows that 29% have biofilm. So all you do is take the biofilm and you have, quote unquote, somebody whose genetics really reject that device, and now you have the most symptomatic patient.

Yeah.

So those things—

can you kind of dive into a little bit more for our audience on kind of what the typical symptom, uh, presentation for breast implant illnesses?

Yeah, the top 5 things are always going to be relatively the same. They're going to be fatigue, and then somebody's going to complain either of, you know, joint pain, muscle pain, or shortness of breath, or chest pain, or they're going to have memory loss. There's going to be like those things, and then they're going to have a host of gut problems. Gut problems are just like, they're too long to talk about, to be frank. Um, then the rashes are more of the end game. So when you have someone come to you who has a rash that won't go away despite going to the derm and getting the 3 things derms get, which is antibiotics, steroids, and both. Yeah, the, the point of that is, and I have these talks all the time, I'm like, did anybody give you a MedDrol dose pack, or did anybody put you on a larger dose of steroid? And if they did, did all the symptoms go away? Right. Should always be like, if they did, then the short answer is yes, you have that problem.

Exactly.

Yeah.

Yeah. So those are all like the same. Yeah.

So it sounds like, you know, over similar to, I mean, Brighton, we both, we all have a story as to why we're doing what we're doing now. And so you saw early on you know, as an even young surgeon, you saw things that were— you were tying pieces together and you're saying, hey, these, this isn't normal, this is what's happening. And so that led you to this more holistic, root cause-focused approach as a plastic surgeon. And so can you speak a little bit to what that looks like now and how you're helping patients?

Yeah, there was a cancer patient in 2016 that really changed all this. So she's the one who showed up and said, hey, can you do an M-block cap selectin? And I was like, why? You know, I'm a— I know cancer, that's my whole career. And I'm like, why would a patient even use that term? Such a weird ask. And so obviously at that point, it's 2016, I'm not on like Facebook and all this weird stuff. I don't know anything about what's going on. So I'm like, yeah, I can do that, but that's really a cancer case for for somebody who has a cancer around the device and you've already had breast cancer, that doesn't make a lot of sense. And I was like, I do a— I always do these the same. I take everything out. I always did a complete capsulectomy. She was just asking to do an intact capsulectomy, which was, you know, we can talk about why that's feasible. Uh, and, and many times, uh, depending on the thickness, it's not as easy. Um, but so I sent off all her material. I always sent this— I was taught to do this same way every single time. Like, you send off all the capsule material after you swab it, make sure there's, you know, it's checked for bacteria, fungus, mycobacterium, and then you send everything off to make sure there's no recurrent cancer. That's just what I was trained to do, and that's what I do every single time. So her, uh, you know, it takes like a week to get everything back. Comes to the clinic and, um, her pathology is negative, which is great. She has no recurrence, the scar is negative, all the stuff's fine. And then it comes back, she has an occult E. coli infection, and not just a little bit, right? She has 10 to the 6 in a hospital, uh, setting, because I did her case at a hospital, uh, because she had a cardiac, uh, need to be monitored overnight. So I went back through all the notes and I was like, what? How did I miss this? And so the, the only thing she had, the only compelling thing she had historically was fatigue, which a lot of cancer patients who have, yeah, of course, chemotherapy have bone marrow suppression, have fatigue. So that's, you know, that's something that I, in retrospect, uh, that was my tell and I didn't really pick it up. She didn't have other things. She had no external signs or symptoms. So that led me to question over my, at that point, what was that? So that's a decade at that point of practice. I was like, at least over a decade. It's like, well, how many people have come to me with an occult implant infection who didn't feel well that we kind of said, ah, because you had this therapy, you, you're expected to be tired or whatever. So She put me on, I guess, a Facebook group, which I, I don't really like Facebook. And then I just had people start calling my office, and the staff were confused because the people were calling the office saying, hey, I want Dr. Whitfield to take my implants out. So, okay, yeah, that's basically set in motion everything. So then I got tabbed to be the guy to talk to the FDA because I was president-elect of of our research foundation. Now, there's something you need to know about me. If you don't want to know the answer to the questions or the problems, you should not ask me.

You will find them.

So I got curious and I remain curious about the problem. So the reason I got as far, you know, along as we did is I was made president of the research foundation. So some of the early publications we funded, et cetera. Which don't, that doesn't matter. The point was some more attention was paid to the problem. But I think technically the issues we had at that time were scientifically, we were, we were not able from a science standpoint to do the things that I just told you about happened in Denmark the year before, because if I'd known that was possible, I would've only looked for and found people who could do things at that level. Yeah. So I was the guy who signed off on funding all of that initially, cuz I testified in 2019 as the president-elect that I would fund research, you know, for that. But the, you know, it's like a timing thing, right? The Genome Project started, uh, af— uh, I guess, when was, was I in med school? It finished in '03. I don't remember when it started, but it took forever cuz computers were too slow. Yeah, that's why it took so long. Yeah. And then, you know, now we're just slowly creeping up on these answers to questions that we've had because the techniques are allowing us to look at the tissue levels and understand what's going on. And I don't envy any practitioner trying to figure this out. If you're a plastic surgeon trying to examine somebody and you're hearing this story but you don't see anything you don't feel on exam anything, and you know, you're, you're not curious about or able to listen to or understand the problems, then it's, it's a big, it's, it's a bridge too far, right? You just don't get it. And so I've always been very curious about genetics since university. Now, I, one of my earliest publications is on retroviruses having to do with HIV and AIDS. I've always been super curious about genetics. And I've done more genetic testing probably than you want to know. And we became, you know, very, um, focused on not just MTHFR but expanding that. And then when, when different commercial tests became available and were much easier to get access and then give to patients, we did that. So we have probably 500+ tests on patients, um, who show that there's about 83% of my patient population that have SNPs in antioxidant pathways. So they'll have problems with oxidative or cellular stress. They'll have problems with the glucuronidation pathway, which glutathione's master oxidant antioxidant that our body uses when it's exposed to all these different chemicals and things. Um, Everybody's heard about the MTHFR gene, like, I have it, you probably have it, whatever. 36% of the population has it, so that's nothing new. Um, and then vitamin D, I think, is the silent but naughty one in all this. So I'm a firm believer that women have osteoporosis not because they go just through menopause, but because they have huge problems with vitamin D. Exactly.

Yeah.

So like, I, I was interviewed by osteoporosis guy and he's like I was like, you should interview me on your show. And he's like, why? I said, I bet you your patients have osteopenia and osteoporosis, have vitamin D problems from genetics, and they have implant problems that is creating more inflammation for them. It's making it worse.

So speaking of genetics, my mother had breast implant illness and developed rheumatoid arthritis secondary to her implants back in the '80s. And, um, genetically, what have you found in association with like the HLA phenotypes or, you know, there's certainly a connection with autoimmune disease in general and its capacity to be passed down.

Yeah. So we didn't have HLA typing in that vendor. So we, I don't have that data.

Yeah.

But just like your, I mean, I don't wanna infer too much, but I don't think it's a big, inference to make. So some people— I always say the same things, like, you can't pick your parents and you can't outrun a bad diet, right? So I was on a phone call today. I, I am not lying to you. 4 girls, including the mom, from Guatemala, who, uh, the girls live in Houston, around Houston. The mom still goes back and forth between Guatemala And I have to tell them, like, I'm like, okay, they all have implants, right? Okay, not great. Now, in Guatemala, I guarantee you Monsanto sprays the shit out of them with glyphosate. All their food has glyphosate. Yeah, so I guarantee their glyphosate levels higher than it should be. Now, the others who live in Houston, very difficult place to live. Got the energy industry, you got hurricanes, floods, mold, all the things, right? And all you need to do now is live next to a golf course, and then I think you're going to have atrazine, organophosphates, you're going to have all these things. Not just— not to mention the fact these devices were placed in Central America. I don't know the vendors, so they're already experiencing shell degradation. Uh, the mom has 40-year-old implants that are ruptured. So when someone asks me, are they causing autoimmune system Symptoms, are they causing problems? I'm like, well, yes, obviously. And then they're like, well, we want you to say that so the insurance understands. I'm like, first of all, I stopped doing the insurance battle in 2019. I mean, I took care of cancer patients. I've spent more time with insurances and dealing with insurance than you would ever want to. I have a good, uh, what is that, 24 years of just that. Type of work. So no, I don't do that anymore. Um, they're not interested in the patients at all. So that problem is a real problem, but I don't have a real way to tell you the answer. So, uh, there's no specific biomarker. So the best studies right now are done, uh, one, uh, by Mathun Sina, which shows that oxylipin-10 home from a, a bacterial contamination standpoint is measurable in the research level in patients with breast implant illness. So that's the biomarker. Everybody wants, oh, what can you do, Dr. Whitfield MD? Like, well, in a research environment, this is what you test. So the bacterial biofilm, which is usually Staph epidermidis or Cutibacterium acnes, oxidizes the oleic acid in the breast. So everybody who's on, you know, video can see this. This is an implant. With a white towel wrapped around it, little paper towel. So that represents your collagen scar tissue bag that surrounds the implant. Now everybody thinks that this is impervious. It's not, right? It is a woven just piece of collagen your body lays down and it's not impervious. It allows cellular signaling across. So that in itself, when people say like, oh, it can't do this and can't do that, I'm just like, you just sound stupid. Stop talking. Like it's in Step Brothers. Just stop talking.

Understand physiology.

Yeah.

So the signaling happens and that oxidizes the oleic acid in the breast tissue. And that goes downstream, TBET, all these other reactions happening. And then there's finally at the end of it, macrophage polarization. It's responsible for a lot of the symptoms we see, whether it's, uh, headache or joint pain or whatever. And, you know, obviously you can have all the things with cortisol dysregulation, all the things with estrogen imbalance. I have a lot of people with estrogen problems, specifically too much estrogen and estrone. So like, none of this is rocket science. Anybody who does any of this for a living can understand this. Now, as a plastic surgeon, I probably know way too much about this problem at this point because I just keep getting, um, like further down the rabbit hole, right? So genetically, I understand what I'm seeing, but now I'm more focused on toxicity burden because I don't know where you grew up, I don't know where you, you know, moved to when you were in university or your first apartment. I don't know what kind of work you did. I don't know if you were a kid who grew up around ag and ran out in fields and got sprayed by crop dusters. I don't know all these weird things about people. So I ask a lot about travel history. I ask a lot about where you grew up and, uh, what kind of work you did. And did you live in a house that had mold or flooded? For reasons like, uh, not because I'm bored. I don't really listen to anybody anymore for like them to tell me symptoms to make a diagnosis. First of all, nobody comes here willingly, right? Everybody's like trying to find Dr. Brighton to help them, Dabney to help them, so they don't have to come see Rob, right? Nobody wants to come see Rob and be in Austin and have surgery because that's, that's not a thing that anybody really wants to do. Nobody really wants to come see me. It's usually like very reluctantly and they've tried all the other things. So we have to be very like focused on our program so that we make sure we're as comprehensive as possible because I can't have loose ends, you know, between the tox test and a gut test. And I have this love-hate thing with gut tests. I mean, they're just big Kodak moments of poop basically. They, um, the thing that I'm looking for, honestly, the, the the quiet, like, really frustrating assassin in all this are parasitic infections. And you can never really find— yeah, get a handle on them. You can by history when you talk to patients, but then if you don't show it, like, people don't believe you, right? They're like, oh, I don't have parasite, because the, you know, whatever test you're saying, the Gut Zoomer or the GI Map or the, uh, uh, Biome FX, what, whatever, it doesn't matter what it is. Oh, it's not on there, so I don't have it. Like, you have the history of going to Cabo and shitting your pants. You have the problem, right? So if you went off property and ate or drank, you have— yeah, you have a parasite. There's a reason when I go to Cabo, I don't go anywhere other than the property.

Yeah.

And I just go and I go out by the pool and I drink by the pool because They know the gringos need the filtered water so they don't get sick. Yeah, I mean, that's the way it is. So I'm in Austin, tons of people go to Cancún, Tulum, Costa Rica, all the places, and they come back and they're like, oh, my gut hurts, and I'm like, uh-huh, yeah, and it makes you crazy too. Yeah, yeah. Hormone problems.

Do you prefer for patients to have already gone through sort of all of that testing, like the gut testing and the total tox testing, and kind of doing the protocol that we do here at Restore and Revive ahead of time, or do you think that it's more beneficial post-explant?

I don't really want to operate on anybody or deal with anybody who's not prepared. So my program starts up front, just like you're trying to take care of people all at the same time. It does me no good to take somebody to the operating room who's got all those problems without any preparation. So most people don't know how important sleep hygiene is. So the most important thing is sleep. So if you can't sleep, which most of the patients you meet have dysregulated sleep hygiene, so you have to get them, you know, sleeping. And how many women do you all see who get up in the middle of the night to pee like an old man with a prostate problem? Right? That just makes no sense.

Yeah.

So you have to get them to really back off their fluid intake, even to 3 hours before they go to bed. So they'll just urinate and then try to get them through the night. And if they have a lot of dysregulated cortisol, they're still gonna have problems. And then, you know, get up in the morning and go look at the light, do something before you start drinking caffeine. And then try to get them on a higher protein diet, healthier fat diet. You know, I have a lot of people who have this mindset of overtraining, undereating, starving themselves, doing weird stuff. And it's hard for me to unravel because it's been going on for decades in their bodies and brains. And then they want me to do a surgery that's going to undo all this old surgery plus magically make everything look better, which is not terribly practical. So I, I just try to meet everybody where they are and try to get them sleeping better, eating better, taking really like looking critically everything they put in their body and on their body. And women have this— they get bombarded with weird stuff to put on themselves that has parabens and, yeah, and all these different things that affect and disrupt your, your hormone metabolism. So, you know, it's a long, ugly conversation a lot of times when people have not learned anything from somebody like y'all. Like, they know nothing. I'm just having your intake plus a surgery consultation all wrapped in one. Yeah, which is like drinking through a fire hose for them.

Yeah, right.

And I guess a big question for— I mean, I have so many questions. This is so fascinating. Thank you so much. I love it all. Um, so a couple things, like, I mean, we're really big, and I tell everyone, if when they come to us, my first goal is to build a strong foundation, right? I mean, there's things that are foundational and important. You mentioned sleep and using safe, clean products and eating healthy and clean things and exercise, but not over-exercising. Vitamin D, you know, there's just so many foundational things. But, you know, genetics obviously are a part of that, you know, supporting healthy, you know, supporting your genetics so you can be the best version of yourself, even in lieu of genetics that you may have that you can't help who your parents are. But so say someone is— has this really strong foundation and they are doing all the things right, they have breast implants, and they— I mean, are they still— they, they have no toxins, their environment's clean, no mold exposure, you know, none of that. I mean, is every single person with a breast implant at risk, uh, and, you know, of breast implant illness, you know. And that— because I think that's a question we get, you know. Um, what if I do all these other things? Is it one gonna get better, go away, or am I still at risk? I still decide to go do this, you know.

I mean, I do something else before surgery.

Yeah, I think you're asking— like, it's a fair question, right? So I, I get this— you're not doing this, but a lot of people don't want to have me on because they have implants. Right, right. So they don't want to have me on to have that conversation.

Yeah, well, that's—

I'm asking— I'm not asking for myself, I'm asking for friends though that would say, I don't want to have this conversation, I'm going to do all these other things, I still want to have my breast implants. And so, you know, what else can I do?

Yeah, can you coexist with them and they not bother you?

Right, right.

So you can do all the things that we just discussed. You, despite genetics, can support them. So all of my supplementation is based on genetic pathway support. None of it is proprietary blends of garbage. I don't support doing that at all. And I don't have any Dr. Whitfield MD special blend.

Yeah.

You know, everything is very basic to support genetic pathway function. And from a food standpoint, you can solve like so many problems with autoimmunity issues with just diet. So to me, the, the short answer is depending on the number of SNPs they have and then their exposures over time.

Yeah.

So when you exceed your capacity to handle those exposures, you will have problems.

Yeah, right.

So your friend's answer to their question is, you know, what else is there? For lack of a better term, you know, basic thing is like, don't go off property when you go to Mexico. Or, you know, make sure that the home you move into that's, you know, turn of the century has been mitigated properly.

Yeah.

Yeah. You know, if you're going to eat food, it better be of the absolute highest quality. And my poor folks who are vegetarian and vegan have the toughest time with good quality protein intake. It's just not, it's very hard for them. And I don't give a rat's ass what kind of diet you follow, but if you don't get enough protein in, you're going to struggle. So like, when you ask the question, the question is not, you know, if something can happen, you know, it's, it's a, if you're resilient enough, nothing's going to happen. But if you don't have enough reserve, if you're weak, if you don't eat right, sleep right, if you have genetic pathways that aren't supported properly because you just don't know or you're not, uh, able to keep up, whatever the reason is. But, you know, I'm very sensitive to mold. So, like, I can be, you know, I would be a setup for breast implant illness. My daughter is a setup because she has every genetic SNP I just mentioned.

Yeah.

So people always ask me, oh, would you let your daughter get implants? First of all, my daughter is a Leo like me, and you're not going to tell her anything. So Leos always do what they're going to do. And all I've ever tried to do, all Dr. Miller and, uh, Dabney should ever understand, for everybody listening, is I try to educate patients and practitioners so they can help their patients make the best informed decisions. That is it. Yeah, nothing else.

So can you kind of break down just quickly the, um, sort of what sets you apart with the Sharp Method?

Yeah, I, I, you know, I guess for me, like, in training, going back to training, like, I had to take care of patients just like everybody else did, and I was trained to make sure and pay attention to nutrition. Oh, it's really hard for me to understand why surgeons of, of any discipline don't understand that unique but most important element of taking care of patients, because they all learned it. Whether they choose or not to use it is another thing. They all learned it. So I don't really feel like that's a big stretch. I feel like that's just standard of care for us. Now, my curiosity about genetics and toxicity burden and gut health and all these other things led to writing the book, The Sharp Method, because I got very upset by not understanding why some patients got better quick, some patients took about 3 to 6 to 9 months, and then other patients just lingered for like a year. And they would come back all pissed at me saying that, hey, not better, why am I not better? I did this operation and I'm not better. And I was like, I never tell anybody they're going to get better. What I tell you is if this is driving a bunch of inflammation, this part's going to go away, right? So the other solve is the all the other things in the program. The Sharp Method is basically to fill in all those gaps.

Yeah, yeah.

And I hope to add like a, um, it would be so great someday to have a molecular test that would just at the end of the day tell you, oh, in addition to these, you know, bacteria you found, there's this antibody response happening at the tissue level. Now that indicates this because I'm not really interested in open loops. I like things to be closed and tidied up. So patients have a very, very firm understanding of what they did, why they did it, and it's closure for them. I try my best, but these newer studies that are coming out, I don't know how much time it'll take before something like an RNA test becomes commercially available for me to utilize. When it does, I'm sure it's going to cost a pretty penny, and I'm going to say we're going to do it because that's the best way to help the patients understand their problem. Now, you know, that's kind of to me, the, the future of all this stuff, because it's, it's a what's happening at the tissue level. The, maybe you know about the Baker grade of capsular contracture, which was made in 1975, just hilarious. Not because it was 1975, but because what it does, it assesses like how soft the breast is and do you have pain? Basically, it's very subjective, right? And I'm a firm believer that the capture contracture rate in this country didn't go down, um, because of a change in device or anything else. It went down because they stopped putting the implant behind the breast above the muscle and they put it behind the muscle. I just think they put the problem between more tissue, so it made it harder to feel. And made it harder for you to tell me about it. So I think that's ultimately— I've read all those papers and I did a 3-part capsulectomy series. I don't know if we ever— I don't know if we ever published it, but it doesn't really matter. It's just like, okay, we knew there was a problem back then and we didn't really understand the problem, so we, we figured out a way. In plastic surgery, you either hide the problem or you fix the problem. We didn't fix the problem, we just hid it. We just put it behind more tissue. So that's fine. Now, quote unquote, we're doing the opposite. We're going back in time and we're putting this implant— this is a Motiva implant. This is supposed to be the least stimulating implant. So now it's getting put back behind the breast tissue. What do you think's gonna happen?

It's gonna increase.

And so it's not supposed to cause a problem, but I've already taken out several of them. So nothing is without its problems, right? So that's just— I think that is a, like, a disingenuous position, right? Anytime you put in a device, the device can get infected and scar tissue can form around it, and it can be tight and firm and sore. And, you know, the breast itself is not some clean organ, for Christ's sake. It has ducts that connect to a nipple that goes to the outside world. Yeah, yeah. I'm a firm believer of the— do you know the number one problem after breast reduction, the infectious organism? It's Pseudomonas.

Pseudomonas. Yeah.

So my thought about this is, if I just sit back and think, how would a young girl get Pseudomonas and it colonize the breast over time? That's a pool when they were little and they hung out by the pool. Yeah, it doesn't take a rocket scientist to figure this out. Yeah, but it's never been written about because you can't prove it. And if we can't prove something in some double-blinded placebo whatever trial, like, it's not a thing. Like, I had a patient tell me that a certain person in this country who does fat transfers doesn't believe in hyperbaric oxygen. So for everybody listening, I have a hyperbaric chamber in my office. My boss was one of the leaders in hyperbaric medicine, trained me in it. And, uh, back then everything was a hard chamber, 2 atmospheres. So commercially available soft chambers came about in, we'll say, the last decade. And there are more and more available—OxyHealth, Summit by the Seas, blah, blah, blah. So we have a vertical chamber because I don't want my patients to press down to get up out of something, right? So is that the best situation for the patient? Well, the studies were done that were randomized on diabetic feet, and they showed that 2 atmospheres would definitely help them. Okay. Let's just think about this logically. What do wounds need to heal? They need nutrition. We talked about that. You have to have sleep because you only recover at night. And X, what is X? Like, you need more oxygen. Wounds heal if in fact there's proper blood flow, right? No infection, no foreign bodies, no radiation injury. Yeah. Now any of those things exist, you're gonna have a problem. The fifth thing is always I operate on people who've already been operated on. So I never operate on somebody for the first time. They always have a poor blood supply and I don't have a problem with healing. Why? Because we're super rigorous about all the things we just talked about. Yeah, you have to get enough sleep, 7 to 9 hours. If you say you sleep well, I'm going to say prove it.

Mm-hmm. Use an Oura ring.

And you guys should talk about obstructive sleep apnea more in your practice because women have it more frequently and they don't snore.

Yeah, we talk about it a lot.

Yeah. Yeah. I mean, fatigue is like the number one topic.

Yeah, it's huge.

One of the reasons fat transfers fail in women is that As you get hypoxic, when you get hypoxic at night, the whole goal of your whole body is to keep your brain from dying. So it diverts all oxygen up here to the brain, right? So when somebody comes in who's 34 who has a problem with their fat transfer, and I was like, this happened to me like 6 months ago, I was like, yeah, this is really abnormal. You're otherwise healthy, went through all the tox testing, all the stuff, and I'm like So this is an oxygen problem. Like, in my head I'm like, this is an oxygen problem. I'm like, do you snore at night, or do you wake up ever gasping? She's like, oh yeah. Like, you have sleep apnea. She's like, really? I'm like, yeah, it's not normal to wake up gasping unless someone's choking you. Yeah, unless your husband hates you. Like, you have sleep apnea, right? So those are things like And nobody wants— I, I have sleep apnea very badly because I have a congenitally narrow airway, and I, I operated for 15 years grinding my teeth, clenching, doing microsurgery, so I broke down most of my teeth. Yeah, yeah. So none of that's good. I had to get all my teeth redone, and I have CPAP every night. I look like a freak at night, but I don't care because I don't want to have Alzheimer's. Like, number one reason women get Alzheimer's, to me, is obstructive sleep apnea that's not been recognized, treated appropriately. And guys, they die in their sleep, they're overweight, they have hypertension, all these things, and, and they have sleep apnea. Yeah, it's not good.

What, what is your— I mean, when you test sleep apnea, what is your, what is your desired way to test and then treat?

Oh my gosh, well, I'm super lazy, so I just use this company ResMed that sends it to your house. Yeah, yeah, we just— I, I mean I ordered my own machine and they wouldn't send it to me. I was like sending them a message like, why won't you give me this machine? Like, you haven't done a sleep test. I'm like, oh, okay, send me a sleep test. And then I do the sleep test. And it's, you know, the— I do the telehealth appointment. And they're like, you have really moderate to severe sleep apnea. I'm like, I know that. Yeah, just want the machine. Give me the machine. Yeah. And so I wear it all the time. It's, it's, uh, It is what it is, man. It's just necessary. I have a 21-year-old son, a 17-year-old daughter. I'd like to be alive for my, uh, family. And I have, you know, a lot of interested parties in this office and around the country that I take care of. So we want to be non-brain dead for them.

Yeah, good job. Yeah, going back to the HBOT or hyperbaric, you— so you're saying that the soft-sided is going to be sufficient for these patients, correct?

I, I, you know, I consider it to be better than nothing. So if you're doing nothing after surgery— so everybody should understand what hyperbaric— the goals of hyperbaric to me are this: if you raise oxygen tension, you do a couple things, right? If your blood flow is poor, because every time you operate it is, it's not going to get better, right? I don't magically make blood flow unless I do a flap, which I I don't do any more for these surgeries. And I'm doing a lot of revision of skin lifts that have been messed up and redone and all this stuff. And I don't have wound healing complications. One, because we should knock on wood, I guess. One, because we take all these precautions and try to get people prepared up front. So we're trying to get you in the right mindset, right? You have to sleep right, you have to eat right, you have to exercise properly, like Walking's the exercise, resistance training's the exercise. Like, be thoughtful and intentional about what you do. The grams of protein, 100 to 150. If you're tired in the afternoon, that just means you need more, not less. So those are all the things. And then you have less problems with healing, but occasionally you'll have somebody who, um, has had so many surgeries, or they swell too much, or whatever. And it's nice that you're giving them more oxygen, right? And you're doing all these other things. We have lymphatic massage devices from New Zealand called Flowpresso, and that's really good to help people, you know, move fluid out more quickly because a lot of people don't— they've never had a lymphatic massage. They don't understand it really. It's a low-pressure system, and you can really help people move fluid out more. Quickly if you do that. And we combine it with NanoV therapy. I have a German device, uh, called the Human Regenerator, which gets everybody out of a sympathetic or high cortisol state down to a parasympathetic state more quickly. And that helps them too. And then I tell people, you got to get up, you got to go look at the sun. That'll help drop your cortisol fast. Like, there's, you know, I may sound like a weird mad scientist person, but there's always a reason why I'm trying to do something and trying to get people to do it a certain way, like tiny habits, right? You do all these little things, you'll have a bigger, better, easier recovery. It'll work, right? You just have to do all of them. Like, if you try to second-guess my 30 years of surgical experience and outwit me, you are going to not do a good job, right? I've got older people than me come in here all the time and I know they don't eat. They'll stay swollen longer. They'll come in and they'll be super fatigued in the afternoon, taking a nap like a baby. And I'm like, you're not a baby. You just didn't take in enough protein. They're like, what does that mean? I don't understand. Like, it's like the constant, uh, rehashing or retooling or re-explaining or reinforcing, like, this is how this works. Your body is in negative nitrogen balance after surgery, which means until you get enough amino acids, and/or proteins in the system to switch it into positive, you won't go into a healing mode. You'll just stay— we call it leaky. So people ask me why I don't do IV therapy. Because I'm operating on patients and I don't use drains, and they're leaky after surgery. They're not, um, pre-op. You could do that, and you can't do it post-op until they're in a positive nitrogen balance and they're not leaky. Because you'll make them swell more. So like, I get asked all the time, can I go get an IV drip? And I'm like, no, that just sounds stupid. Like, that's not going to help you. Yeah, I know the intent is to help you get a, um, delivery of what— whatever, you know, vitamin or whatever. But the reason we have the supplements, and all of mine are really— they're liposomal for a reason. My patients usually have really poor absorption, a lot of gut trouble. And it's hard enough to get them to eat enough protein, but if I had them take a bunch of supplement pills, I mean, that would just— my compliance would go to nothing. Yeah, yeah, for sure.

Um, so you've mentioned several things, like, so as far as therapies that you rely on specifically, um, I think obviously lymphatic is amazing, HBOT. I mean, you've named a lot. What about like red light therapy, peptides? Peptides, any other things that you guys are using that you would encourage people to look into? Or do you base it off of— I also want to— I do want to go back to one thing because I don't want to forget to ask this question because I think vitamin D is so extremely important. What genetics too should people be looking at from a vitamin D perspective? And how do you, how do you fix that? You know, what is your recommendation for helping people with that absorption of vitamin D? Because we see that a lot.

Yeah, the two SNPs we see are GPX and BDR typically, and we just use D3K2, the cytosomal, and I don't, I don't really overthink it beyond that. Yeah, okay, great. That's it for that. And in the room with the HBOT is a 6-foot-tall Juve red light, so everybody gets red light. Awesome. Um, what was the other question?

Oh, peptides, are you using any?

Oh, well, yeah, I mean, 3 years ago we First of all, like, if you go back in my email, I was using peptides like a decade ago. Didn't know what they were doing. It would make me poop my pants if I took too many. Like, so these were before it became like a thing, right? So now everything's like popular and all this stuff. And then 2 years ago we got— or whenever the letters came out from the FDA, our pharmacies stopped sending stuff to us. So I already get enough scrutiny about what I do. So for now we just hold off because I don't really trust the sourcing of peptides. So I don't feel good about, um, I know they were— BPC-157 is great, uh, GH-C copper. All— there's a lot of them that are great, but I don't really endorse or can't, um, vouch for somebody's, um, source. So I don't try.

Yeah, yeah, yeah. Okay. And I mean, I think you've answered so many of these questions, so I just want to make sure that we're summarizing in some ways. And so one of the questions—

can you wait for one second? Because we didn't talk about fat transfers. So one of the main reasons that people don't want to come see me, and Brighton probably didn't want to do this either, is what are you going to look like afterwards? Yes. So the reason I do simultaneous fat transfers is that specific reason. And even in low BMI patients, I can do fat transfers. And when somebody says they can't do a fat transfer on somebody who has a low BMI. You know what I would tell your patients, and for everybody listening, is you should get out of the door and just leave, right? Because you don't take a Ferrari to a Volkswagen mechanic. Yeah, if they don't know what they're doing, they don't know what they're doing, and they're telling you something that they don't understand or can't do. Yeah. So, and you can't make a surgeon comfortable. You should always understand this. Never try to make a surgeon comfortable with what you want. No, right, right, right. Surgery is a repetition sport. It is the only thing in medicine that over time, right after, year over year, you should get better and better. Yeah, right, until you get so good you're a master. Yeah, now I'm getting to the point where I'm too old, right? So I've, I've practiced long enough time that I, I only care about solving the problem for the patient who's been told there's no way to solve your problem.

So do you do like before and after kind of pictures to compare what it was like with the implant versus without after the fat transfer for the patient? Yeah, yeah. I mean, are you having good results? And I mean, I'm assuming, I'm assuming you have great results.

So the way to help a fat transfer patient of any variety, low BMI moderate BMI is to get a DEXA scan pre-op. Yeah, not an InBody, a DEXA scan, right? And have them get weighed at the facility with the DEXA, because if you just, you know, blow out some number, the machine's gonna calculate incorrectly. Yeah. Now those are a way for me to standardize everybody around this country because GE made most of the DEXA scans. Yeah, so, you know, people are going to say I have a lot of fat or I don't have a lot of fat or whatever. So the way I think about it is if you want to have a result, you have to have this mindset of, one, I'm going to listen to the recommendations. I'm not going to do what I want. I'm going to try to follow the recommendations that make the most sense. So the things that I would avoid are always GLP-1 agonists because they all work. And microdosing is stupid. So y'all may do it, it's fine. But for, you know, you know, no drug trial has ever been done microdosing anything, right? Right. So everybody listening to this call, this webinar should know that the FDA does not approve microdosing trials, right? There's a dose And that's what's approved. And so when I get patients who are trying to lower inflammation on microdosing a drug like tirzepatide, because that drug works, you can't have a fat transfer, right? That drug works to burn fat.

Yeah, get rid of it, right? Yeah. And so do you require certain— like, do you require certain—

it doesn't make you BMI. Did you hear what he said? Because that's important too. Because you need to eat too, right?

So it does everything that you were taught in school would never happen. Yes, it modifies behavior. Yeah. And so I never thought there'd be a drug created that modified behavior. And I'm a firm believer that if they knew it would do what it does, they would have not approved it, right? Because it's cost them a trillion dollars. Like all the money Starbucks lost, and Burger King, and McDonald's, and, you know, the Dorito company, whatever. Like all the junk food people, right? Right. You don't have a line at Starbucks anymore because nobody goes in there to get their shitty, you know, uh, Frappuccinos. So the thing is, you don't need to have a certain BMI. Yeah. So when everybody tries to pin me down, like, what's the cutoff? Like, there's not a cutoff. There's only what your DEXA scan shows, what your diet will allow. And then the main thing you have to do is not overtrain and create a calorie deficit. Yeah. If you maintain your BMI or elevate it, and elevating a BMI, I know right away people are like, oh, he wants me to get fat. No, I want you to be more resilient and strong. So thigh strength dictates resiliency to me more than anything. So everything should be focused on maintaining strength, building lean muscle mass, maintaining healthy fats in your diet, maintaining your BMI, and elevating it as you grow older. That doesn't mean you're getting fat and sloppy and all the things. It means you're being smart about training. You're not doing HIIT, you're not doing, uh, CrossFit, which has got to be the stupidest fucking thing ever. And the, um, cycling and the marathoning and the— my friends, my friends 50 doing ultra, ultra racing. I, I don't know what kind of cockamamie junk this is, but you know where that's going to land you? That's going to land you Yes, either dead. Yeah, dead, or a hip or a knee replacement, or ankle replace. I had somebody had to get their ankle replaced, which I thought was crazy. I was like, y'all are nuts. Like, I just want to lift weights, I want to go sit by the pool and enjoy my cocktail, see my kids grow up, and not need a cane. Yeah, yeah. So if you want to keep a fat transfer, just be smart. Like, okay, if you don't understand it, like, we have a whole series of videos about it, but like, okay, all those drugs work. GLP-1s all work, right? So just don't partake if you want to have a fat transfer. If you don't ever want to have a fat transfer by me, then take whatever you want. I don't care. Uh, you know, this is helpful information. I mean, we have to have the fat survive, which is everybody's question. Like, why does he say it can work and then everybody else says it's a crapshoot? Because I think if you're listening to me, I'm a little bit more methodical about what I want. Yeah, you don't come to my office and I squeeze your, you know, backside and go, oh yeah, you're fine, and put you on the schedule. But that's— a lot of people do that. I'm not joking. That's like, there's not a lot of thought put into a lot of this. Yeah, but I would like, before I check out here, get a dirt nap, uh, to have at least— I don't want to write another book, but about fat transfers, I think something needs to be written that's a bit more pragmatic, just like I laid out. I don't think anything I said was that out of bounds, right? Eat right, sleep right, maintain your BMI, don't overtrain, and don't take a drug that we know burns fat. I think that's all very—

we fall in line with the same philosophy.

Yeah, that's all pretty realistic, you know. So if you have people who have body dysmorphic disorder, or lean that way, they're not going to understand that. And they're going to try to manipulate the system. And there's a lot of that in my patient population. They like to get on their keyboard warriors, they write crazy things about me and say, I'm, you know, this, that, and the other, which is fine. But I'm always going to be brutally honest with everybody. And if you don't want honesty, you should not come see me.

So what if someone does want honesty, and they do want to come see you? What would that— what what— how would they find you? What would that look like? What is— what do you have, a big wait time? What's the best way to start and get to you?

Yeah, fortunately, uh, we don't have a wait time secondary to me being censored so much lately. So you can't really find me on YouTube anymore, even though I have a channel with like 30 million views. So if you go to my website, is drrobertwhitfield.com, and then we're live streaming in a private community we started to avoid censorship and just have honest, open discussions. And that's drrobcircle.com. The YouTube channel— I, I feel bad because I thought YouTube was the best educational platform, but they've censored us since July of 2025 about breast, breast implant illness, explant surgery. And I, I find that to be harmful to patients because I've only created content to help education— educate patients like we did tonight. I'm not saying anything different than I have in my other 4,000 videos. I don't like do anything sensational. I'm not trying to fearmonger patients. I'm trying to make sure you understand from somebody who's got almost over 30 years of operating experience what I see, you know, what's possible and what's safe and predictable to the best of our abilities. Like, I don't want any patient being told like it's a 50% chance your fat lives or dies. I don't want anybody being told, like, if you get an explant, you can get your lung punctured, which is just stupid. Like, it's just some of the stuff that's said is just dumb. You don't need a capsulectomy because that's not important. Like, okay, yeah, I had a patient come to me from Utah who won her implants on a radio ad, like, call-in, which one implant, got them done. Uh, it— one of them ruptured. The doctor took it out under local in the office. So just for everybody listening, a ruptured implant is like digging a whole thing of jelly out of somebody's chest. Now, when you do that, you're not taking any of the capsule out. So none of the patient's symptoms went away. Why? Because all the material is still stuck inside in the shell, or I'm sorry, the capsular material, right? Because the debris is embedded in the capsule, collagen scar, right? And so none of this is wasted surgery, you understand, right? But I get this patient coming and I'm like, they did what? Under local Why? And you know the answer, it's just money.

Price. Yeah, yeah, yeah, money.

And so some people don't want to do it because it's going to cost them money. Some people from patient side can't afford to spend the money. I get it. The thing that you should do and should always tell patients is a third of these, according to Dr. Whitfield MD MD, are basically infected. Hmm. And if you don't take this out, you can still have symptoms. Like, the whole reason we advocate for capsulectomy is if debris comes off of a shell of an implant, gets stuck in your tissue, and you leave it there, what do you think is going to happen? Your body's going to react to it. Yeah, yeah, exactly. The same thing happens in orthopedic implants. They call it poly wear. Yeah, I guess it's not new. We're not like breaking new ground here. So like, there's a reason to do a capsulectomy. It's not unethical, it's not unsafe, it's not you know, needed. Like, and you don't need to be scaring patients. Like, just say you can't do one, don't want to do one, don't care. Yeah, send them to somebody else, right? Don't, don't like scare the patient. Yeah, just say I, I don't have enough information. And then people say BII is not a thing, even though I'm the guy who testified at the FDA hearings about it, and everybody else did in 2019. Like, even the head of the FDA, Marty Makary, in his book Blind Spots said in 2006 when they re-released implants, silicone ones, they're all fine. That seems very, um, tough.

Well, it sounds like you're the guy to go to because you're very, very well-versed, and we're so grateful that we've had time to get to pick your brain with all of your experience. Um, anything?

Yeah, I mean, yeah, well, let's rapid-fire, a few little fun questions. I'm gonna do that. Okay. Yeah. So one toxic beauty trend you love— you'd love if it completely disappeared. Oh, a toxic beauty trend.

Oh my gosh. Um, wow. I don't even know what a toxic beauty trend is. What would they be? Give me an example. Well, any—

like, I mean, I— we were talking about this earlier, and I was saying my children and all of the really good, terribly smelling, um, perfume things that they love, you know, something like that, something that, you know, is like a trend right now that it's—

yes, I have heard of that. I, I think products in general, um, they scare me because I have a 17-year-old daughter and she's got sensitive skin, so anything like product-wise I, I think just is scary in general. Like, you really have to be careful with— and then I— the term organic's like probably overused, but it's just the quality of the ingredient.

Yeah, for sure. Yeah. What are your—

what's your opinion on sunscreen? Yeah, so it's kind of comical. Like, I tell people to not get sun exposure the first year for their scars because UV radiation really enhances, uh, the pigment in scars. So I've always been like just tone it down. If you're going to do stuff, be, you know, pragmatic. And you got to keep your scars protected because clothing does not protect you from UV radiation. So if you're going to go— you know, people ask me in the summer, like, when can I go back to the pool with the kids? And, you know, you got to wear a rash guard, you got to, like, block the sun. Yeah, mineral sunscreen is basically the answer to that. Yeah, right.

Okay, what about a I don't know this word, but biohacking or tool that you're loving right now? Something that you—

Oh gosh, you know, I've done all these things so much that it's hard to predict like what is the best thing right now? What is a good hack I like?

What have you seen success with? Yeah, yeah.

I mean, I used to have on my desk like 30 or 40 things I would try all the time. And the thing that I, you know, the biggest hack, the biggest hack, Okay. To me, the biggest hack has been since I got a Whoop strap in 2016, and I really work hard to have good sleep hygiene. I know that may sound like a boring answer. That's the right answer. Yeah. I look at my HRV and I don't get like wearable anxiety. That's not, you know, I'm trying to like, cause I have bad sleep apnea when I get up. You know, this morning I felt really good when I got up after sleeping, and that's not all the time. I was like, oh, what's my HRV? And I know it's going to be, you know, not over 30 because I don't really get over 30 anymore, but it's going to be like above 20. It's not going to be in the teens. You know, I have a son who's a professional athlete. His is in the hundreds, and I'm like, get out of here, you're a gross kid. So like, those are things that, you know, If you can sleep well, um, 7 to 9, then that puts you like in your best possible position for success.

Yeah, 100%. Agree. Agree. Yeah. Wonderful.

I think we could talk about sleep all night and sleep apnea because I think we see it so much and I think, you know, there's just so many things that could— solutions and things we could talk through. Um, so we usually do a whole nother webinar on that. Um, what's your go-to daily wellness ritual?

Oh God, I don't do this well at all.

Um, I mean, it could be anything like you drink enough water, you filter your water, you—

oh, if you guys outside, you know, when you come down to Austin, you'll come to my office. Like, we have an ecosystem, so it's all hydrogen water or filtered in the office. And you know, the, the big thing honestly for me is like taking 10 or 15 minutes and not doing something.

I love that. Yeah.

So I'll go into one of our rooms and just like in the middle of the day try to like check out for a little bit. And you know, otherwise I love all the stuff. I probably like doing a lymphatic massage the most. Yeah, definitely. Because when I stand and operate for long periods of time, the hydrostatic pressure builds up and then my legs, uh, it's harder after 30 years of doing that to recover.

Yeah, absolutely. Well, this is amazing. Um, like Brighton said, thank you so much for taking the time. Thank you for the education and what you did tonight, but more importantly, what you're doing on a regular basis with your patients. And, you know, digging deeper, root cause, individualizing care, and just helping people understand this really important foundational things to help them feel their best and optimized. So it's really cool.

I'm glad we got to go on. Now, everybody listening, they have a special link they'll send out with their cut-ups of this, and you'll be able to get a free discovery call with my team. If you need any help at all, we're happy to guide you. Um, once again, the thing for us is to help prepare patients for surgery, whether it's with, uh, Dabney and Dr. Miller You have to be prepared before surgery. Do not rush into surgery if in fact you become aware of the problem. Just tap the brakes a little bit, and you've had the problem more than a day, so just—

we can help you through that. Yeah, take it easy. Yeah, yeah, awesome.

Thank you so much. Yeah, thanks so much.

Yeah, all right, y'all have a good night.

I'm gonna end the stream. All right, bye.