Fat Transfer

Just waiting for everybody to hop on. Everybody, everybody just hop on. Everybody just hop on, we'll get going in a minute. Gotta get a link up real quick and then we'll get going. Gotta invite a special guest on. Okay, we're gonna get started here in just a moment. All right, good evening everybody. Do a sound check. Does everybody, everybody hear me okay? A thumbs up in the chat, let me know. Nobody's going to join the, the presentation as a guest. I have a special guest, a patient of mine, uh, who's going to join later. Thank you, KJHS, for the sound check. Thumbs up, I appreciate you. Anybody else? Just gotta check nobody's in the circle. Is there anybody in the circle? Doing a special start time tonight. Oh, Danielle, thank you. Awesome, appreciate you. Okay, let's get rolling. Welcome everybody. So there's a question I get more than any other, and it's almost never the first thing that a woman says to me. It's usually at the end of a consult, um, kind of there's been time, um, it's quieter probably by that time. Um, she's listened to and trusts what we're saying. Um, typically she'll look down or look away and be very concerned and say, what am I actually going to look like? Not actually will I be healthy again, not will the fatigue go away, but what will I look like? It's a very fair question. I get asked a lot. People very concerned about it. And I want to speak to it directly tonight because that one question, the one most women are most embarrassed to ask out loud, is the single biggest reason women stay in this kind of chronic state of inflammation with their implants. They already know they're actually a source of chronic inflammation. So many of you hopefully have heard some of our videos or shows. I'm Dr. Robert Whitfield MD, I'm a board-certified plastic surgeon surgeon. I'm in Austin, Texas. I spent almost the last 10 years working on explant as a problem, testified at the FDA hearings in 2019, and devoted research dollars to BII as a past president of ACER. And so here is what I want to do for the next 30 minutes. I'm not going to, uh, be selling anything. We're just going to talk about what we found. We're going to include parts that, you know, other, other people probably won't discuss. And just, we want you to stay with us on this. And at the very end, we're going to tell you one thing that matters more than how much fat you have, more than your surgeon, more than the technique, more than any of those things. It's the one thing that actually determines whether you're going to be happy with your results, either 6 months later, a year later, or 5 years later. And most people never have heard of this, and we'll get there. So let's get started. Remember, we're gonna go live after I give this talk in my private community drrobcircle.com. It is free to sign up. Go to drrobcircle.com/signup. The first thing I want to say is, if you're afraid of what you'll look like, you are not vain, you are not shallow, and you're not alone. I've had women in my office who are genuinely sick— fatigue that doesn't lift, brain fog, joint pain, rashes, chronic problems with constipation, chronic UTIs, chronic bacterial vaginosis. Women who know that the implants are part of it, and they still wait another year, 2 years, getting sicker. And why do they do that? Because somewhere along the way, someone made them feel that wanting to look like themselves is a character flaw, that if you're really sick, you shouldn't care about your body. And that's complete nonsense. Your body is yours. You get to want your health and want to feel like yourself. In the mirror. Those two things were never in competition, and anyone who told you otherwise had done a disservice to you. So the fear is rational. It deserves a real answer, and we're going to get to that. Here's the crux of the problem. Most of the time, when a woman finally asks that question, the answer she gets is a scare or a shrug. You'll be flat, or we'll just put a smaller implant back in, or the worst one, silence. And a subject change. Or it's not a thing. It's in your head. Tonight you get the real answer. And it starts with dismantling one assumption that almost everyone in this position is carrying without realizing it. That assumption is the first loop I'm going to open. So hang on to it. Once again, afterwards, we're going to do a private Q&A. So Hang in there. The assumption is that an implant is the real result and anything else is what you settle for. Now think about that. No one starts out with implants. Think about how deep that runs. When a woman says, what will I look like, what she's really picturing is with the implant versus without it, as if the implant is the baseline, as if that's what's normal. And that's what normal looks like, and taking it out is subtracting from normal. So we want to change that around tonight carefully. An implant is a device, and I'm not here to demonize the device. I've placed them for cosmetic surgery, for cancer reconstruction. They have a role, and I'm not going to stand here and tell you that every implant is a problem. That's not honest either. But let's be clear about what a device is. It has a lifespan. Your body builds a capsule around it that walls it off because your body knows it's foreign. It doesn't belong there. It can rupture. Obviously, it needs to be monitored. And at some point, whether it's an 8 to 10, whatever window we're looking at, it's going to need to be exchanged or removed. And that's not a scare tactic. That is what comes along with having a device. Hip, knee, breast, dental implant. They're all similar in nature. So here's the reframe. An implant was never your baseline. Your baseline is you, your own tissue. And that changes the entire question. It's not, what will I lose when the implant comes out? It's, what can we restore using actually what your own tissue sources? That's not a consolation prize. That's actually a different starting point entirely. Now, I told you I'd tell you the truth, including the hard part. So let me open a second loop. And this one's going to sting A little for some of you. So if a surgeon has told you that a fat transfer won't work for you, that you're not a candidate, I want you to consider a couple possibilities because there are two and they're both very different. The possibility is first that that's actually the case, it's true. And I'm going to be honest with you, I do probably as many low BMI fat transfers, low body weight fat transfers, as anybody around the United States. States. And so there are people I just tell no to. Um, I go through a lot of studies and look at DEXA scans and physical examinations, um, and really try to be as data-driven as possible about it. Now, if there's not enough fat, then we can't transfer the fat. So, and that's reality. No source, can't have fat transfer. That's, that's just the, the nature of the body, and that's not an opinion. A good surgeon will tell you that plainly. And if someone told you that, they may have just been trying to do the right thing by you. But there's also a second possibility, and I hear this actually frequently, and it bothers me. That fat transfer is harder to do. It's a longer operation, requires harvesting the fat, processing the fat, and placing the fat with real technique. And the result depends heavily on how well each of those steps is done. Now, placing the implant is definitely faster and easier. It's more predictable to execute. So sometimes when someone tells you you're not a candidate, it means exactly what it is— like, you just don't have enough tissue to actually do the procedure. And sometimes it means This isn't an operation that the surgeon is experienced with, does, or feels is in their wheelhouse. And that's fair too. They just need to tell you that. Both are legitimate positions for a surgeon to hold. Nobody has to be, uh, the villain in either of those stories, but you deserve to know which answer you actually got because they lead to completely different outcomes. I can't resolve that, obviously, from the outside. But inside the Q&A tonight, if that's your situation, that's exactly the kind of thing I will help you go through. We can dig deeper in that if you want. Certain specifics, other things that we look at carefully. So, like, hold that thought. Let me show you what fat transfer actually is because I think most people picture it having probably the wrong types of frames. So I'll give you the version of this that most surgeons don't take the time to explain. So fat is a living tissue, right? Underneath your skin there's a fatty layer all over the body, and that's the whole key to everything I'm about to say. It's not a filler, it's not a product, it's living tissue. It has cells that need oxygen, it has a blood supply, and it needs to be placed in the appropriate area to survive. So when we do fat transfers, we're not injecting a substance into a space. Think of like you get a filler placed in your cheek to expand the cheek, and that's a hyaluronic acid filler, say. So that's very predictable. It's also something you can dissolve. When you place fat, it's a much larger molecule. It goes in the fatty space, and you can't put a lot of it, especially in the phase. So when we're removing fat from one area and relocating that tissue to another area to take and heal in that area, whether or not it takes depends almost entirely on the environment we place it into. And those are principles I build everything around. Fat belongs in the fatty compartment, like the call, with its fatty friends. And think about, once again, where fat naturally lives on your body. It's underneath the skin. It's in that layer. There's, there's a really nice blood supply there. And when we place transfer fat into that kind of environment, the right layer, the right plane, the right amount, the right time, it has its best opportunity to survive. It will revascularize. It'll grow blood vessels. It'll integrate and become part of that fatty layer that you already have. It'll augment that fatty layer. When the fat is placed in the wrong environment, so too much in one spot, in the wrong space, overgrafted, then the blood supply can be compromised. Its ability to heal can be compromised, and that's when you get problems. And there's all sorts of stories on online, obviously, about things like this, and those really aren't stories about fat transfer failing. They're stories about fat transfer done without the like right concepts, if you want to think of that. And essentially, this is why two patients, two women, can have the exact same amount of donor fat, the exact same procedure on paper, and get completely different results. The difference isn't the fat, it's the environment, the technique. And this is the part I'll get to— what happened in the woman's body before she ever got to the operating room. And that brings me back to what I spoke about at the very top of this. The one thing that matters more than any of this— I haven't forgotten, we're going to get there shortly. So once again, after the talk, we're going to drrobcircle.com/signup. You can sign up for free. drrobcircle.com. It's going to be a live Q&A after that. Yes, this is a discussion about subcutaneous fat, not visceral fat. Okay, let me deal with the fear head-on because I've been circling it and you deserve some more specifics about that. How much volume can you actually get back? Well, here's the honest answer. I actually have implant on my desk as usual. Um, you're never going to have an appearance like implants, so the volume issue is, is a little bit more complex because any surgeon who gives you a guaranteed number over livestream um, like we're doing now without examining you is not really informing you. What I can tell you is the, the shape that can be restored with fat is a natural appearing shape. It's not gonna be dramatic. It can't project, right? That's the issue that is really the, the crux of the problem with implants is the projection, whether it's for augmenting a deep flap breast reconstruction Or if it's a post-mastectomy breast reconstruction with an implant you're augmenting, or if you're doing a, what I call a holistic mommy makeover, where you take fat and redistribute the fat from the thighs, the abdomen, the love handles, the bra fat area, and augment the breast with that, with or without a lift. Or if you just do an augmentation. I saw a patient yesterday who just wants to be augmented with their own fat instead of an implant, which is absolutely fine. But it's hardest to do in the youngest patient because they haven't experienced weight loss or weight gain, breastfeeding, changes in the breast tissue, aging. So the skin is tighter, makes it harder to augment. So let's get back to the talk. For a lot of women coming out of explant, They really just wanted a fuller breast all along, not really the augmented look. They didn't want to be dramatically larger. I get all sorts of complaints all the time about people getting implants that they felt were too big or not what they asked for when they went in for consultation prior to surgery. Like, there's all these decisions that are made while patients are asleep that I find to be Very disconcerting. Like, everything should be agreed upon and not changed without a patient's permission after the fact. So basically, um, they just want to feel like themselves again. They, they wanted to— they want to fill up their bra and be comfortable both, uh, in clothing, um, in the mirror, and they just We wanna know that's achievable. And most of the time we can do that, not always. And here's the piece that gets missed. How much of that transfer fat survives? How much of it stays with you long-term? And obviously that's not a fixed amount 'cause you're gonna change over time. It's not a number you're born with. It's influenced by things you actually change. In this case, I'm gonna discuss how we change things before surgery. So that's the loop I opened at the very beginning. And let me close that now. At the top, I told you there's one thing that matters more than how much fat you have, more than your surgeon, more than the technique. And here it is. The single biggest variable in whether transferred fat survives and stays, in my opinion, the thing that almost nobody talks about, is the condition of your body when the fat is actually placed into it. So fat is a living tissue. It has to survive a move, and whether the living tissue survives a move depends on the environment it lands in. If your body is inflamed, if your circulation is compromised somehow, if your metabolic health is off, if you're nutritionally depleted, you're definitely asking the fat to take root in a more difficult or a more hostile environment. Now think of it kind of like gardening, right? You have the best seeds in the world and the most skilled gardener, but if the soil is depleted, the terrain is bad, if you will, nothing survives. It can't thrive. So if we took two identical seeds and put them in two different soils, two completely different outcomes could happen. And so we'll just think of like your body is the soil, it's the terrain, and we want to get that optimized. And here's what that means and why it should give you hope rather than anxiety. The soil, the terrain, is the part you can influence. You can change how skilled a random surgeon is. You can't change your bone structure, but your inflammatory state, your circulation, your nutritional status, your metabolic health, all can be changed going into surgery. They are not fixed. Those can be optimized deliberately in the weeks and months before you ever get to, in this case, Austin, Texas to visit me. This is the part that almost every recovery conversation skips entirely. Everyone obsesses over the operation itself, the 2 hours, 3 hours, 4 hours in the operating room, and ignores the months on either side of it that actually determine the results. In my opinion, I built an entire method around this, wrote a book about it. We're not going to go through the whole thing on the live stream. That's what the deeper conversation for is in Dr. Rob's Circle. So go to drrobscircle.com/signup. You can sign up for free. We'll go in there and we'll answer all the questions everybody has. Danielle is already in the circle, so she gets to go first. But what I want to leave you with tonight— oh, interesting, I just got restricted on TikTok. How funny. Operation is just a moment in time. There's always a process, and a huge piece of that process is in your hands. Before you ever come to the operating room. All right, so one more loop and then I'm going to bring it all together. So there's a timing question around explant fat transfer that most women never get told about, and getting it wrong costs people, um, quite a bit of, of obviously time and expense. So the question is, do you do the fat transfer at the same time as the explant, or do you wait and do it later? So we have a program to work people up and stratify them into candidacy. So that's how I accomplish that and vet people. And so it's hard to give a blanket answer. Each person is bio-individual. So we work each person up and then we decide in conjunction with them what we think their best options can be. And I will delay people if they're not in a good enough state of health, if I think the terrain is not good enough. So sometimes combining them is the right thing to do, and sometimes staging them is better for the patient. And the wrong move is just doing that and rushing into it without further analysis of the patient. So what I'll tell you is this: the women who, uh, I have who feel the best about their outcomes are most always the ones who understood all their options before they were ever on the schedule. Not the ones who found out their choices abruptly, made quick decisions, and did not have time to prepare. And that's the reason, you know, we've done these talks. I know many of you know since March I've done 3 a week, and we decided to do, uh, 1 a week moving forward at 6 PM, uh, Central is a good time slot for us, 7 PM Eastern. And we just want to share what we've learned to help patients make better informed decisions. We don't want you to rush. We want you to make a very informed decision. We want everybody to understand which path fits in their situation, and that's what tonight's conversation is about. So we're going to open up a live Q&A in drrobcircle.com/signup. You can go there, sign up for free, totally, uh, free to do. We'll answer all the questions I already have somebody in who's a 2-year expat, and they have some, some issues that we're going to help answer their questions. So, all right, I'm going to put in my URL. It's easy to sign up. You do not have to create a password. You can get a magic link by email. Super simple. Don't be a complainer. Just solve the problem. Yeah, because of legal constraints, we are not putting never-before-seen before and afters up. Our attorneys are like, nope, don't do that. So there you go. We're not going to do that on a livestream. That's what I was advised. So, all right, well, Cyber 5530, that's why we're doing the talk. I've done several thousand of them, and, uh, we're gonna go into the circle now. So if you want to go in there, it's free to join. I just put the URL up, drrobcircle.com. Yeah, you just get off of this live stream and you go into the circle. We'll be there. We're going to answer a bunch of questions, so you have plenty of time. Don't worry. Okay, I'll see you on drrobcircle.com. Go to my, uh, bio if you can't figure it out and hit the link. It'll help you get there as well. Okay, all right, everybody head over to the circle. Ouch. All right. I'm coming in there now. I just got to shut off some of the other things because we're live streaming all over the place, and I gotta— hey, Jess, where'd you go? Oh shit, huh. Trying to get our guest on. She was in my waiting area and then hopped off. So I'll get my guest back on, and she's great. So y'all are in for a treat.