Fat Transfer Part 2

Let's just make sure that— okay, got it. Okay, there we go. All right, perfect. Okay, so we're gonna do, um, 10 minutes live, and then, um, we will go ahead and switch over. I just have to Do one more thing. Is everybody having a good day? Chime in, make sure everybody is good. We're having one, uh, problem with the live stream. We got to correct real quick. Sometimes if your stream key fails, you have to replace I got to stop fiddling with this because everybody's going to get irritated at me. So sorry, we'll just get on with today. Um, excuse me. So today we're going to go through, um, part 2. Last night we covered um, part 1, and I think it was highlighted by, you know, I have a big preference for preparation. And we give a patient story about, um, a patient who had had a couple different fat transfer procedures that had not gone well for them. And then we utilized our program to improve both their preparation experience preoperatively. The, the most important things obviously are not whether or not we can technically do it. It's more about, you know, identifying opportunities for the patients to get in a better position you know, pre-op. So if you already, you know, were here last night, you know, it's not a webinar. This, uh, I'm not pitching on this. Um, we're trying to have a clinical conversation about, you know, success with fat transfer because I think, you know, that should be a much, um, more discussed alternative, uh, for enhancement. And if you're new, I'm Dr. Robert Whitfield MD, I'm a board-certified plastic surgeon in Austin, Texas. We've done a lot of work with breast cancer patients, with explant patients. We've published literature on safety of fat transfers, and we have the largest PCR-tested explant capsule study ever published. And what we've learned about inflammation and toxicity burden and gut health and just the patient's, you know, individual biology over time has really changed how we approach our procedures, including fat transfers. Last night was part 1, why most fat transfers fail before they ever get started. Part 2, um, is going to challenge, I think, a lot of things that we have as notions about fat transfer. So let me ask the question, and then y'all can chime in. Um, When fat's harvested, do you know exactly what's in the fat? All right, I'm waiting for something. Pop something in the chat. Let's see if anybody gets this. All right, somebody said it's just volume. Another person says just for filling. Um, so fat is a metabolically active tissue in your body. Um, it acts as an endocrine organ, it can produce hormones, stores energy, and it stores something else almost nobody talks about, and that's toxins and heavy metals, as well as endocrine disruptors, pesticides, microplastics. So your fat It's more of a biologic storage unit for everything in your body that sometimes we can't eliminate. And when a surgeon harvests that fat and reinjects it, there's a lot of things that can happen because of what's stored inside. So that's what we're covering today. By the end of this session, you'll have a better understanding about fat biology. Um, that will make you, you know, from an informed decision-making standpoint, better to decide and, and ascertain what you want to do in terms of fat transfer. And that's the gap between, you know, our teaching and what matters. Now, if you're watching this, I know you're not the average patient. Uh, you may have heard or, or followed me for several years now. Um, you know, I've written books and done, you know, almost 4,000 videos. So you're here because Maybe you were told something and it didn't seem right, and your instinct's probably correct. Fat transfer is not a simple procedure. It's more of a biological event. You're asking your body to accept transplanted tissue and keep it alive. So that requires specific environmental conditions. And if those are, you know, an environment where there's inflammation, toxicity burden, poor nutrient deposition, then it's harder for the fat to heal. That makes sense, right? It's harder for it to heal. Um, it'll be compromised, and that can happen to the majority of it. And that, if you think about that, that explains why there's a lot of variability in fat transfers. So the published literature shows fat graft survival rates between, you know, 30 to 70%. That's a big range, as high as 80% in some of the cases where certain criteria can be met. So, you know, the Sharp Method was engineered out of taking care of our patients suffering from chronic inflammation, and then we utilize that to lower inflammation pre-op to get the best possible situation for recovery. We don't want to just operate. Um, I want everybody to be prepared in a way that gives them the best possible outcomes. So what does this mean practically? First, wanting something— you want a fat transfer that actually lasts beyond the, you know, 6 to 12 months. We want it to be permanent, and we feel like that's achievable, but only if in fact we address a lot of the things that maybe under the surface but are poorly understood. Um, we don't want the fear of loss. If you already had a fat transfer that didn't, um, heal the way you anticipated, or you're still, um, struggling, you know, after the procedure, and maybe you're planning for another one without preparation, you're at risk for having a similar kind of outcome. And it's not to be fearful, that's just the physiology. Um, the people in this room, especially inside Dr. Rob's Circle, our private community, um, I feel like everybody wants to have the same, uh, type of answers and outcomes. They want the most information to help make them, uh, informed, and that gives them the most complete kind of medical picture. And it's not just for, for patients, you know, you, you want to always have the most information to be informed whether or not you're having that procedure or considering having that procedure. Um, you know, after our series, I hope that everybody is more informed and both at the patient and practitioner level, and they, they go through a consultative process and they feel like they understand it. And they feel comfortable with what's being explained from their level or the provider level. So let's go back to how we began, like what's inside the fat. So, you know, we know that if we look at preoperative testing, patients can be dealing with a lot of toxicity burden. We do this through a urine tox test. And we find heavy metals, we find organophosphates, we find phthalates, we find glyphosate, which is an organophosphate. We find all sorts of other things that can be stored in the fat. And I think I had Kyle Landry on my, my show and he talked about people having like hallucinations basically from, um, burning fat, if you want to think of it like that. Um, we've had a lot of, of interesting experiences in our practice, but I think the most important thing is you optimize outcomes by preparing the patient, understand their toxicity burden, gut health, food sensitivities, hormonal balance, all those things. And then as your body is beginning to heal and the blood supply where the fat transfer was placed is, is ready and accepts the fat, then you'll have a better outcome. You won't have this environment where there's compromised blood supply, there's potentially problems with the fat not healing. And we know that if we run the program We certainly get a decrease in inflammation, improvement in nutritional status. We can reduce inflammatory markers if those are elevated. We do this by supporting genetics, um, through detox pathways, and that helps the survival of the fat. We feel like that coupled with maintenance of, uh, BMI really explains the differentiator in retention rates. I don't think it's because we're doing anything different, you know, in terms of the surgical technique. It's about preparation. In recovery. That's the difference. That's basically why I wrote the book, The Sharp Method. So tomorrow night, 7 PM Central, is part 3. We're going to talk about that recovery process, how to engineer it, how to protect the results after surgery and make the fat transfer as, you know, able to be preserved and heal over time as possible. That's really the final piece. The broadcast is open. The Q&A is a real conversation. We do that in Dr. Rob's Circle. So go to drrobcircle.com. It's free to join. Um, we're not, you know, be upselling, uh, anything. We're just gonna give, you know, clear information. And if anybody's, uh, considering fat transfer now, or, you know, somebody who's considering it, please share it with them so they can come and learn more from us in drrobcircle.com, both before and after for the live Q&As. And we look forward to sharing that information. So I'll take a couple questions. Somebody had a really good one here and I saw it on Instagram. So I'm just going to scroll back and answer it here. I think they said they were 3 years. I had a fat transfer 3 years after explant and have pain and lumps. Is that normal? So Sarah, you can have cyst formation. Um, that can happen. Um, You can have areas of fat necrosis, but it goes to what we were talking about, how we look for everything we can preoperatively to help avoid that. And so those are all known risks and complications of fat transfer, but what we want to do is avoid that as much as possible by understanding preoperatively what you're dealing with individually. So that's why we run the Sharp Method. I wanted to come back to that question because I thought it was a great question. Yes, please do that. I'm glad you're going to do that. I appreciate that. Thank you, Sarah. Awesome. You can still come to us, Sarah. It's, it's not too late. Don't worry about that. We are happy to help you, and certainly we have answers for those questions. So I'm going to go live in the circle here in just a moment. I'm going to make sure I've answered everything I can. I want to make sure to answer Sarah's question because that was a really good one. My coordinator's in here, so if anybody wants to talk to her, she gave you a link. And, um, certainly pop over to DrRubbsCircle.com. And, uh, Dr. Micah Pittman's in the, in the crowd. Hey, Micah! Micah's awesome. He's a chiropractor here in the Austin area, and he takes great care of his patients. So if you need a chiropractor, please look up Dr. Micah Pittman. He's wonderful. I got the great pleasure to help take care of his wife. She's special to us, the practice. So, all right, please head over to the circle. And once you're in the circle, please hit us up in the chat so I know, and I will end up stopping the live stream other places once I know everybody's hopped over, especially Sarah. She had a really good question. I want to answer that in the circle as well. Thanks to everybody who joined this afternoon. I'm sorry I was late. I was taking care of a patient and that was the reason. Okay, and so we have Let's see, I want to make sure I see everybody in the chat. Is anybody having difficulty getting in? All right, let me see. Oh, there's a question here about how long should a person wait after chemo to do a fat transfer. So, uh, that's a great question. Um, it depends on the situation, Bless. Um, and are you on hormone blocking therapy as well? So that's more of a complicated, uh, question to answer. Uh, so Sensitive, yeah, we don't do a lot of serum testing, so I don't think I mentioned anything outside of hormones that were serum-related. Well, if it's true Keanu Reeves joined, uh, I don't know if that's the case, but, uh, certainly thank you. Gwyn, that really has to do with how much fat and breast tissue you have before you have implant placement. And certainly, you know, through examination consultation, you can get a better sense of that. Everybody's going to be different. Sure. All you got to do is go to drrobcircle.com and create a profile. It's free to join. Shouldn't be any issue. So on the landing page, you can just create a profile and join. Thanks, Nicola. Appreciate you following us and liking us. Appreciate it. Let us know if you have a question. Okay, we're just finishing up, um, this portion of the live, and then I answer, um, and do a live Q&A in drrobscircle.com. So that's D-R-R-O-B-S-C-I-R-C-L-E.com. Or if you just go to DrRobertWhitfieldMD.com, there'll be an opportunity to join the circle. And the reason we do that is basically to avoid any censorship on platform or getting your questions answered in the most clear way possible. I don't want anybody to feel like they can't ask me something. I think it's really unfortunate these days that that's become a problem. But that's definitely what we've been facing lately. So please hop into the circle. We're going to cut off the other feeds here shortly. Butera174, did you get in there? And then I don't see Sarah Scott or Sarah. Did you have trouble getting in or are you not going to be able to join this time? Okay. Oh, thank you so much, Nicola. Appreciate it. Any other questions in the Instagram or TikTok feeds before I switch over? Please go over to Dr. Rob Circle.com. We're going to continue the conversation there. Dr. Robert Whitfield MD.com. Hit join. Dr. Rob's Circle, or go to drrobscircle.com and join. Very simple. Okay, now when you come in, you have to unmute the stream to hear me, and you can go live in the chat as well. Okay. Mm, okay. That's a great question, Gwen. So most of the fat can really go between the nipple complex and the clavicle or the collarbone because that's the most real estate. Below the nipple onto the bottom of the breast, there's less area, so there's less fat that can be placed there. Excuse me. Okay, that's a good question though. Thank you, Gwen. Where are you located? All right, perfect. Is that Sarah, or who is that? When's in Florida? Awesome. I have a lot of clients in Florida. All right, I'm going to move this over here so I can see it easily and look at the chat at the same time. I have a lot of computer screens rolling right now, so I got to make sure I can see everything. Okay, yeah, you're in Arizona. Yeah, it's a quick trip from Sky Harbor. I have a lot of patients that come from Arizona, um, I've taken care of a bunch of good patients from Arizona. They're really receptive to the programming. And yeah, I'm very used to that environment. I've been in and around that area a lot of my life. So did you have a question? That way. Oh, hey, Cole. Yeah, so I think it's a great question, Cole. I think it all goes back to what I was saying about pre-op. I— there, there's not going to be some randomized controlled trial you can do about delayed versus simultaneous fat transfer, probably, unless I do it. And, um, you said answering that question would be great, but I don't, I don't see how you answer that. Uh, most of what you get, um, told is really subjective. It doesn't have any data to support it. So trying to lower inflammation always is important. To what level, to what degree, um, I think that's part of your, like, pre-op preoperative, you know, workup with us. And certainly when I have someone who's super symptomatic, I will tell them to delay. But that's based on my clinical experience with several thousand explant patients. Um, so that, you know, that's my own clinical judgment. I haven't published that. I don't, I don't think I'd be able to do enough cases to be able to show the you know, if you will, the correct way to do that. Good question, though. Cole brings the good questions. All right. What else do we got? We got to make this a little bit more interactive. I know it's during the day, But we're trying to do this one so that, so Gwen, if the fat heals, the fat should last. I mean, everybody has areas of fat they can't get rid of, and that's kind of how we want it to be when we place it. So the things that make it more susceptible to me personally are changes in BMI, alterations in hormonal balance that aren't addressed properly, increasing a calorie deficit by overtraining versus Intaking enough calories, things of that nature, changes in body composition, uh, those will affect it. That's why I'm so sticky about things. Yeah, I think that's, I mean, that's kind of how I think about it, to be honest. I would love to give, you know, more and more clarity about it. And as we learn more, you know, that's hopefully going to be the case. Just always want to make sure that we're improving the education around the fat transfer, the explant fat transfer, or whatever, you know, we're discussing as it relates to patient care. Had a great call earlier today. Somebody's going to run the SHARP program before their ACL surgery, which I thought, yeah, that is what it's meant to do. It's meant to help patients having any type of procedure or who want to lower their inflammation, improve that. So that was awesome for me to hear. Taking a lot of years to get that you know, message out, but that's okay. That is okay. Now, I don't know, but I can't see my person from Arizona. It just says member. So this is our member from Arizona. Do you want to chime in with a question? Did you have anything you liked during the last couple of days, if you were on yesterday or today, something that piqued your interest or you wanted to learn more about? Having a fast metabolism. Well, I mean, that's, uh, I mean, it's an interesting question. So metabolically, if someone can gain and lose weight or someone can put on muscle, um, in a healthy way, those are all like good signs of, you know, overall health in terms of metabolic activity. You know, I think of good hormonal balance, uh, good sleep hygiene, things of that nature. Proper dietary, uh, habits. So I think those are all fine, but, um, in terms of longevity, um, I don't have a, you know, specific like, oh, because you have a metabolism that is, you know, quote unquote appropriate, maybe, uh, is it a problem? I don't, I don't consider that to be the issue. That's why I look at body composition analysis through DEXA scanning. And obviously we back it up with in-person physical examination for anybody we're feeling like is going to be potentially an issue for them to have a fat transfer. I have a low BMI fat transfer that I saw preoperatively today. Uh, one of the reasons I was a little bit behind, but I feel I always feel good about resolving those, you know, conflicts or programming. So, all right, what else do we have? I love y'all sticking in the middle of the day. I did this so that we could get more of a, well, potentially people during the day who have a little bit of a gap, and then obviously those who are in other time zones, it may work out better for them to have this kind of timeframe, so. I've had all sorts of canceled appointments today. It's really kind of maddening. In any event, um, and then I have to do— oh, I guess I have a I have another pre-op to do and then we have a podcast. So still got a lot of work yet to do today. Any other questions for me? Please, like, if something's not clear, obviously ask. Feel free to share the link and we'll do part 3 tomorrow and go from there. Okay, thank y'all for hopping on.