Fat Transfer Part 2

Um, had some technical difficulties with the stream, so sorry about that. So we're going to get rolling just a second. I want to make sure the audio is okay since I had technical problems with the stream. And so just give me a hand wave if you think my audio is okay. If you're on in the circle, please hit the chat. I'll make sure that's open. And so I had a camera problem, so I've had a couple different issues already with the stream. Oh, that's a problem too. All right, fine. Um, that's okay, just give me a moment. I'm going to double-check a couple things. And then we'll get started. Got to turn everything on. So this is what happens when you have too many platforms to get onto. So I just got to double-check and make sure everything's on and functioning. Sorry about the delay once again. Everybody hop on. Okay, so I've got my live chat up. We're going to clear the chat. In Dr. Rob's circle. We had a big talk last night, part 1 of fat transfer, so we're going to do part 2 today. Once again, everybody chime in, let me know you can hear me okay. All right, all right. Once again, I had a camera problem, a bunch of tech issues already, so I apologize for the delay. But hop on, share the stream. We're going to do fat transfer part 2. If you want to, um, get fat transfer part 1 that I did yesterday as a live stream in my private community, drrobcircle.com, you have to go join that. It's free to join. All the replays are posted in Dr. Rob's circle. All right, let's do part 2 today now that I've actually got the stream up and running. So, all right, last night I said, you know, we did part 1. So part 2, we're going to talk about what you actually need to do for fat transfer. So I like fat transfers, um, As I mentioned, it's autologous, your own tissue, genetically identical to you, can't be rejected. All we have to do is, if, is think fundamentally to summarize and recap what I did last night, you know, right timing, right space, right amounts. So last night inside the circle, we went into, um, you know, and I covered things like foundational science of fat transfer, um, the process of revascularization. Uh, inhibition, angiogenesis, vascular biology, um, some of the metabolic candidacy issues versus, uh, volume. We talked about why some fat survives and why some fat dies. The session was for my members, and if you were in there, great. I had a ton of folks in there. But if not, then you just really need to go back and join. It's free. Go to Dr. Rob's Circle com. So, uh, many of you don't know that I've spent, um, since 2016 roughly working on the problem of explants with, without fat transfers, without lifts, doing PCR testing since 2019. I've published a couple books, uh, one about breast implants, explant surgery, and breast implant illness. Done 160 podcasts, appeared on another 60. And have over 4,000 videos with over 30 million views on YouTube, but you may not know that because they get censored on those platforms right now. Just fine. Um, they don't call it censorship, they call it, uh, being out of alignment with their health and advertising policy. That's fine too. So today we're going to talk about this publicly, and then we'll go into the Circle 4 live private Q&A. So for everyone researching fat transfer, let's go into the details. Um, if you're researching and finding difficult to think about fat transfer, or if you've already been told you may or may not be a candidate and wondering what the next steps are, this is definitely a session for you. I want you to understand before we go any further, the outcome of your fat transfer is not primarily determined in the operating room. My thought process, and I explained it in part 1, it is determined by your preparation and run-up to the operating room and then the time spent after the operating room. Technically, there are gonna be some variations in the techniques used to acquire fat, process fat, and transfer fat. But ultimately, that's a small window of time. And instead of underemphasizing, we're gonna overemphasize the preparation. The recovery phase, and then obviously give the attention it's due in the operating room. So that's the framework I want to use for the next bit for this talk. So once again, let's focus on those three phases: prep, operation, and the recovery phase. So surgery is already a stress test. It's not some mechanical event. Most patients think of surgery as this kind of transaction. You show up, the surgeon performs the technical work, and you go home and you heal, and that's it. It's, it's done and dusted. So that is not what surgery is and how it actually works. And the best way to control or improve your outcome surgery is a controlled event, a traumatic event. It's a large acute physiologic stress event, and your body's ability to respond to that stress at all levels— cellular level, vascular level, immune level— determines whether or not that surgery or any surgery, fat transfer or whatever, is going to work. In this case, we want the fat to live, not resolve. So the specific problem with fat transfers that I find are— or that I found is preparation, just like all of our surgical patients. I try very hard and have worked very hard to create a methodology to follow to prepare surgeons better for— or prepare surgical patients better for those procedures. And when we move fat from your abdomen or your, um, your thighs or wherever the donor site is to the breast, we are transplanting that tissue, that those fat cells have been taken from one blood supply and moved to another space where they have to heal and thrive through a process of initially inhibition, then ultimately angiogenesis as the blood flow or, uh, new blood flow is established in that area. And we have a, a period of time where all those things, and this has been studied extensively in the literature where that graft needs to heal before that new vascular network is develop and the fat completely heals. The process is called angiogenesis. It's not new. It's been talked about for many, many decades. Angiogenesis requires resources. So these are things like— I always talk fundamentally about sleep hygiene, nutrition, proper supplementation, the preparation, lowering toxicity burden. Those are the things that the Sharp Method is founded upon. It requires that so that your body can fight and recover as quickly as possible. If your body's carrying a really high inflammatory burden, um, gut dysbiosis, from a toxic burden, whether it's mold, heavy metal, environmental toxins, from chronic inflammation, chronic immune system activation, uh, for whatever reason— in, in my, you know, practice, I deal a lot with patients with chronic inflammation, breast implants. So if your body doesn't have the bandwidth to heal and build all these new blood vessels for the transferred fat. Um, it's already— because it's already occupied doing all these other things, it's going to be harder for your fat to heal. So this is the most important thing that I try to encourage patients to understand. An inflamed body is one that makes it more difficult for the blood supply of the transferred fat to develop and heal. So the fat won't, in terms of take have as good an opportunity. All things being equal, wherever you transfer fat, it should heal, um, whether it's face, breast, buttock, it doesn't really matter. And here is what the usual standard prep looks like. Like, stop things that will thin your blood a couple weeks before surgery so your platelet function is allowed to recover. And then obviously don't eat or drink in the run-up before the procedure. That may be, you know, 8 to 10 hours. Obviously, um, everybody, um, should follow that. That protects the patient from having a problem with their airway prior to surgery, especially in the advent of GLP-1s where delayed gastric emptying can happen routinely. Um, you have to stop that medication, uh, a minimum of 2 weeks, uh, before surgery now. And that's kind of the basic thing. You may have a blood work panel as part of the pre-op. You may have, depending on your age, other studies. But that's the basic thing outside of physical exam, which is very different from how I feel patients in 2026 should be prepared for any operation I do, but just in general. And I think we want to move beyond that standard model. We want to do whatever operation— in this case, we're going to move fat, we're going to close incisions. And, you know, in a subset of patients who are already metabolically healthy with low inflammation and well-nourished, that's going to work extremely well. And that predicates why things are so variable in terms of results. But most of the patients that come to me are not in a great metabolic state, and they may have a higher toxic burden. Um, most of the patients I see have been living with implants, as we discussed before. Um, this is separate from a discussion where somebody's just coming for a cosmetic breast augmentation. I would work them up the same way. So my patients have been dealing with systemic effects of, uh, inflammation. They may have capture contracture, they may have a biofilm contamination. We've shown that 29% of the patients on PCR analysis have bacterial contamination. And in some studies, it was as high as 48% that were published previously. I felt that was far too high, so we looked at 694 consecutive, uh, samples in my personal series, and that was published in September of 2024 in Microorganisms. And the standard, uh, two things that we saw, uh, were Staph epidermidis and Cutibacterium actans. So, and we found those on PCR testing, not standard cultures, because PCR is more sensitive and specific to detect bacterial contamination that cultures may miss. And as I alluded to, it's 29%, so that's nearly 1 in 3 patients have a bacterial contaminant driving as part of their systemic inflammation. And you cannot take a body that is already, you know, fighting that level of chronic inflammation without preparation and expect to get successful integration of the fat graft. So that environment's already difficult. So I routinely will tell patients that until we get their toxic burden down, we can't really do their fat transfer. And I've denied some patients, um, because of that, and then patients get frustrated, but I hope it makes logical sense why we're doing that. What happens is, um, you know, if we haven't prepared the patient, if they don't maintain their BMI, if they overtrain and under-eat, then we're going to see all that volume potentially disappear that we transferred, and it may become hard, it may become painful, there may be cysts or whatever. And I've done several thousand explant procedures. You know, we've done several thousand fat transfers and I've seen this pattern. And I built the Sharpe Method specifically because the standard model I felt was not adequate to address what we were seeing in terms of patients. And we wanted to always improve their outcomes. So we always want to make it about patient safety and patient education so they can make really good decisions. And nothing is, is more important than the patient understanding everything so they make a really good decision. So our SHARP program is, you know, it is a system. It's not a checklist. It's not really a dust stack. It's not like all the fancy things that might have in my office, like the Human Regenerator and the hyperbaric chamber, uh, Juve red light, and the Lopresso and the Nano V and all the things. It's not about all that. I mean, pre-op, we just really want everybody to go through all the phases where we can get you prepared. And, you know, that is what's going to separate people and really allow them to allow their body to heal, right? If you give your body all the tools, it will heal. You cannot optimize what you haven't really looked at. So we always, before surgery, We're looking critically at your genetics so we understand basically how you detox. And then we want to look at your toxin burden. We do a, uh, total toxicity burden test. We do a gut health test. We do food sensitivities. We look at hormonal balance and of course blood labs. Um, but those are typically normal in my patients. So we look at all these things and the goal is not to, um, I, I try to— I can't risk stratify it rather than I can say, wow, you know, we have this genetic ability and this toxicity burden and this gut health and this, uh, hormone balance and these sensitivities. So what can we do to help the patient navigate their specific biologic environment, right? So everybody's got their own set of genes. They get them their parents. Everybody's got their own set of exposures. And we look at the tox test, you know, maybe you grew up in an area with a lot of agriculture, so you may have gotten exposed to more glyphosate. That's pretty normal. Um, everybody's heard of Roundup. Glyphosate is in Roundup. If you grew up near or around a golf course like my patient Ashley Hurts— we did a big show with her because she had the most, um, like herbicides that I'd ever had in a patient. And that's because she played junior golf, she played high school golf, she played golf in college, and she worked at a golf course after college. So that is an extended amount of exposure. And things like chlorpyrifenos or thalanyl, all of those things were broken down and showed up in her toxicity burden test as well as mold. So mycotoxins, just think of a golf course. Golf courses are constantly being watered, and they're, uh, if you're in a hot environment, you know, hot, humid, and, um, you know, damp makes it easy for mold to grow. And many, many golf courses have had to have their entire surfaces torn up and changed because of mold. Um, so why does all this metal matter? You know, basically for fat transfer. So we'll just take Ashley Kurtz, for example, and you can go listen to her show that I did. It's on my podcast channel, the Dr. Robert Whitfield Show, and it's on YouTube, Dr. Robert Whitfield MD. It's in the circle as a replay. And so when your, your body's in that state of chronic hyperactivation, if your gut has dysbiosis, if you have chronic systemic inflammation, You know, these variables are going to directly affect how you heal and whether a fat graft will heal. So for Ashley, who wanted a fat transfer, I told her it would not be a good idea to do it right now. One, she had the most organophosphates, those environmental toxins, that I'd ever seen before. She has a whole page of them. And so we went over that on the live stream we did recently when we we had her on. And I don't know how she felt as good as she felt with that. So we took her implants out and, um, you know, we're going to work with her and then later on she'll have a fat transfer. But we want to get her metabolically doing better. We want to lower her toxicity burden. Um, and once we have all this data like I'm describing, we build essentially a detox protocol for, you know, each different person. And it's not, uh, you know, based on like a juice cleanse or a specific thing like that. We have targeted detoxification that uses medical-grade and homeopathic binders. We do different things to support the kidneys and liver. We want everybody to have the best possible experience. I have lots of patients with cystic activities of lots of patients with things like mast cell activation, POTS, Lyme, Epstein-Barr virus, sure, parasitic problems. And so the logic here is to be straightforward. Everybody has toxins that drive inflammation. Inflammation then consumes our body's resources, and those resources are needed to help support us in terms of healing. And so we want to give the body everything it needs to heal— proper sleep, proper hydration, proper nutrition, proper supplementation. Those are the key elements. Then with that, we'll have the best outcomes. Now, if we add on, you know, a fat transfer in the case where somebody's really already not in a good physiologic state, that's not going to help them. Now, this is where once again we go back to nutrition and supplementation. Um, I operate on supplementation. I don't stop it, but that's my personal view. I have it organized in my stack to do that, and I feel very comfortable on that. And you should, um, respect whoever's operating on you and their experience. But I operate on supplements. I have for several years. But it's my supplement stack. It's no others. And you got to avoid combining things, especially specific proprietary blends. Now I do always eliminate primary drivers of inflammation. I have people on gluten-free, dairy-free diets, get rid of refined sugars or processed or ultra-processed foods, seed oils. We're trying to reduce all these things. Now we want to really do that to, you know, decrease inflammation or inflammatory cytokine production. And I do that by concentrating on sleep, building a proper diet with high-quality protein, because protein is what our body needs to actually repair and recover so that that angiogenesis will happen. We optimize all the different levels of the nutrients that we can. We improve as much as we can, um, through nutritional support and sleep hygiene and supplementation, everything that's needed by the body to heal. So, you know, vitamin C is important antioxidant for the body and for collagen production. Uh, proper, uh, proper, um, fatty acids in the diet are, are going to help with your what's called the phospholipid bilayer, all the things that are needed for recovery and for proper function. And at the— think about the cellular level as well as, um, you know, just Oxygen carrying capacity. I like to use hyperbaric to improve the oxygen in the tissue levels because think every time I operate, we're not improving the blood flow. The only operation that improves blood flow is when someone gets heart surgery. It helps their overall blood flow improve because the heart can be more effective in terms of production of blood flow. That's really the number one, you physiologic operation. Now most of that was taken over with stenting, removing the obstruction or the blockages in the left anterior descending and things like that. That happened when I was in training. So it's critical, right, that we have enough oxygen, nutrition. That's how we heal. And so the last points I'll make are critical ones. The endothelium, the lining of our blood vessels, You know, the tissue that has to develop in this, um, area will replace the new fat, right? So if everything is healthier and more responsive to development of those new blood vessels, the angiogenesis process that we've been speaking about both last night and today, that will be more efficient. If it's damaged by oxidative stress or chronic inflammation, it will be harder for the fat to heal. So once again, we address the sleep. We want you to be in a, um, you know, more parasympathetic state. So it's okay to be anxious to have surgery, but we don't want supraelevated levels of stress because that just creates more cortisol. And both cortisol and estrogen are stress hormones. You know, those make it worse. We want to lower that. We want to have a good circadian rhythm because cortisol dysregulation directly will suppress the ability of those fat transfers to heal better by limiting angiogenesis. And this is nothing new. This is just standard basic science, and we've known this for a long period of time. Um, Now, I would like to, to be, you know, pretty direct about this, um, in terms of fat transfers. I think these are, are my basic non-negotiables, including things like a DEXA scan. So it's not enough to just see somebody, examine them, pinch their fat, and say, okay, you can have this procedure. It's not enough to do standard labs. All of the patients would be served better by doing a more thorough workup of understanding their genetics. So that explains how they detoxify in conjunction with their toxicity burden. And then we do, do gut health or gut testing because it is very important, but it's one of the harder tests sometimes to interpret. We look at food sensitivities because triggers in diet cause a lot of inflammation. And we want to know about hormonal balance. We feel like that's sometimes really underappreciated. Now, the cost of, you know, a procedure failing at any level is more than financial. It may lead to another surgery, prolonged recovery, all the psychological issues that go along with it. And if it's a fat transfer, in cases where the fat doesn't heal properly, you can have fat necrosis. And this can happen um, even when all the things are aligned. Um, but you're trying to really reduce the problems with cyst formation, fat necrosis, any kind of problems with calcification or firmness, and that's what's most important. So trying to do these in a more logical, well-thought-out, um, way makes the most sense to me. I feel that's why Many of the results I hear about, uh, weren't optimized. I also don't, uh, align with overgrafting patients. I think that's a very poor idea, especially in the cancer population. Um, I believe that patients go through SHARP, uh, our methodology can recover faster. I feel like they'll retain more volume along with maintaining their BMI or elevating it in a healthy manner. And not using medications that burn fat, not participating in working out or training in a way that's gonna create a calorie deficit. So I would prefer that patients concentrate on resistance training when released to do that. And in the interim after surgery, it's always walking is a perfect exercise. It doesn't elevate the heart rate or the blood pressure too much, so it doesn't increase chances for bleeding. And then we have a very specific set of protocols for recovery. One of our patients, Courtney, created a whole program for chest wall, uh, rehab. So if we're doing that, there's a program for it. And preparation is not really an option to me. I think that should be the standard of care moving forward. And that's what I'm here for. I think it's practical to start that way. And if you're interested in that, um, I think you're then thinking more logically about it. So I think proper preparation can take several weeks to months depending on how you want to move forward with what you're doing. And that's not to rush you after you've made a decision. It's just to help your biology so that you don't put too much pressure on it, too much demand on it. You want to get your data, you want to understand your genetic markers, your toxicity burden, your inflammatory situation, and so that a protocol is really built more tailored to you. And you need a system, not like a random set of things you get from influencers online. You want a very, you know, structured sequence protocol that addresses your, like I said, genetics, toxicity burden, gut health, food sensitivities, your hormonal balance. Looks at your, your blood labs, even though those better be normal, and really just help optimize you. And that's what we do and we've been doing for years with the Short Method. That's why we wrote the book about the methodology. I feel like that's the way to move forward and bridge the, you know, medicine I was taught with what we're learning about and have learned about integrative techniques, uh, more genetic, uh, more you wanna think of like biohacking. Most of those things to me are not new. Peptides to me are really old now. We've been working with them for 10 years. Our concern with peptides is just sourcing them. So peptides are great, including BPC-157, but we don't source those. So I don't have additional guidance on. We try to give you the roadmap. We try to track your progress always. We want you to learn and take care of yourself the best possible ways. If you're interested in this or other things we've talked about today, go to my website, drrobertwhitfield.com. If you are inclined to have a more private discussion with me, you have to join drrobcircle.com. I'll stay on and answer a few questions here live, and then we'll go into the circle for a live Q&A. Thanks again for your time. My chat is now open in the circle. I'll take a couple questions online. All right. I'm going to go over to Instagram, see if there's a question. I am having a great day. Thank you for asking. Fat transplants— or sorry, fat transfers I've done on type 1 diabetics. Um, type 2, I would look at more body composition, why they have insulin resistance, and how is that being addressed. So that would be case by case. Yes, a mastectomy patient can do a fat transfer. I've done several thousand fat transfers for mastectomy patients. That was principally where I got my experience, was with patients with post-mastectomy breast reconstruction, both the deep flap and implant-based reconstruction. All right, let's take something from— I have so many things on TikTok here, it's hard to keep up with. Trying to see if I got a question question. I find my trying to answer questions on TikTok is a little bit more challenging. So TikTok says it filtered comments. That's interesting. So interesting how like, uh, everything is being controlled. Thank you. One of my cancer patients, uh, is on TikTok saying that I did a great job on our fat transfer. Thank you so much. So we don't work at hospitals anymore, or IRI 1940. We do outpatient surgery. Trying to see if we got any of this. All right, so that's all I have on Instagram. So I'm going to shut down the feeds, and, uh, if you would like to go to Dr. Rob's Circle and join us, that'd be great. I can carry on the discussion there. Any questions? All right, I'm in the circle now. So what I'm going to do is turn off the other feeds, and I will let everybody hop in from TikTok, Instagram, Facebook, YouTube into the circle. I just have to address, um, the differences in the streams. Right. We're going to go off of X and we're going to go off of LinkedIn now. Make sure and go over to DrRobCircle.com. Going on Facebook now. Make sure to go over to DrRobCircle.com.