Robert Whitfield MD is live!

Foreign. Everybody, we are going live here. We're going live from my new circle. So I'm Dr. Whitfield. We'll let everybody come into the rooms and then I'll explain how this is going to work. This evening we're doing this slightly different. We're live streaming from Drrobs circle.com which is my private community. And I'm going to give a 10 minute talk. And after that I'm going to have a Q A that's only going to be live inside the Dr. Rob's Circle community. So to actually get to Dr. Rob's Circle, you'll have to go into the bio. There's a bitly link that'll take you to it. Alternatively, you can just type in Dr.robscircle.com and get to it. So drrobscircle.com no apostrophes, no other quotes or anything in the URL. So I'll give the 10 minute talk in just a little bit and then we'll do a live Q A. Ask me anything afterwards. Oh, Lisa's already got her hand up. All right, how am I going to do this, Lisa? And. What is your question, Lisa? Type it in the chat, Lisa. All right. Or going to let everybody get on? Just give it a little bit. Sometimes it takes a little bit to get logged in. Remember this is going to be live in my circles community. Oh, leah, I'm sorry, not lisa. What's your question, leah? Well, answer Leah's question. If she puts it in the chat before we get started. If you guys knew how many phones I have going right now. It's a little crazy. Everything's tracking and so far it looks pretty good. Oh, I got you, Lisa. No worries. All right, so I'm gonna close out the chat and then we're gonna get ready to do the talk. That's why my camera was messed up, because of the chat. Okay, got it. All right, so those are. Okay. All right, so once again, it's just a brief 10 minute talk. We're going to focus on one topic and then I'll open to a live Q and A and you can ask me anything. I'm Dr. Whitfield, board certified plastic surgeon. Been operating in practice since 2005. Started circle training in 96, so almost 30 years of surgery, predominantly in cancer, but cancer, cosmetics, reconstructive surgery, all the things. We're gonna give to 705 for everybody to get on and then we're gonna give a 10 minute talk. I'll, I'll start the talk at 7:05. It'll run for about 10 minutes and then I'm going to turn off the lives on Instagram, Facebook, Tick tock. And we're just going to go from circle. And that is my commitment to the community in our Dr. Rob circle. We're going to make sure that it's a, a completely private community where you can ask what you want and I can answer. All right, a couple more minutes. How many people we got on? All right. Okay. So as I look at all of the different forms, remember you got to go to drrobcircle.com for the live Q A after the 10 minute talk because I'm going to shut the other cameras off. Okay, just so everybody's clear, give me a thumbs up if you understand. Yeah. Please share this live with friends who would benefit from understanding about whether it's natural augmentation, unaugmentation, implant removals, surgical prep and recovery. We can cover quite a bit. I see you, jennifer stroll. Yeah, we'll talk about how to do that with fat. I, I was doing that certainly before it was popularized with something called Brava. So we can talk about that. Jennifer Stroll Hudson, make sure you go to Dr.robcircle.com. it's free to join. You're going to be able to get that question answered live with me afterwards. Okay, anybody else? Is everybody populating here? All right, so everybody share if you want to share this stream with friends and family and then we'll get started here. Sometimes it's challenging. Can everybody hear me? Okay, give me a thumbs up wave. I still have people joining, so. Can you hear me? Okay, somebody say yes. Anybody type yes. Thank you, Kim. Thank you. Appreciate y'. All. So I'm doing this without my headphones and podcasting mic. I'm doing it with a remote mic that I used to do other recordings with. So just double checking foreign. So I want everybody to understand. We're going to give a 10 minute talk on a topic. Then I'm going to turn the lives off and just do the live from Dr.robcircle.com that's my commitment to the community. We want to have great conversations inside the community. You'll see all of my content. It's like a huge umbrella for all of my content, whether it's on YouTube or where I have 30 million views and I don't know, 3,000 videos. I have Apple and podcasts, I'm sorry, Apple and Spotify podcasts if you want to listen. I have a couple books. We have multiple courses for you and I don't know how many blogs we have now? I'm sure we have over 30 blogs. Probably it's all going to be in there all in one spot. Free to join, Totally not going to get censored. Just obviously be, be kind to each other. Jennifer stroll hudson. It is Dr. Robs circle dot. Oh, wow. Tried to type it. Hold on a second. Wow, it won't let me type it. All right, it's Dr. Robcircle.com everybody. Okay, we're going to start with the 10 minute talk as, as people filter in, we'll just keep rolling. Okay, so if you've heard me on YouTube, Instagram, Tik Tok, Facebook, if you heard my podcast on Apple or Spotify or, or however you listen, if you've listened to the books I've written about breast implants, explant surgery, breast implant illness, or the sharp method, I talk a lot about fat grafting. So fat grafting, fat transfers, lipo filling, whatever term you use for that. In Europe it's referred to as lipofilling. In the United States it's fat grafting. And recently it's been more widely, I guess termed or use fat transfer. So fat transfer is one of the most, I think, underutilized but powerful tools in plastic surgery. It relies on your own fat, not a device. It's not synthetic, it is not foreign. It's your own genetic material. So that being said, it's your own tissue. And anybody who's ever had trouble losing a area with stubborn fat, ideally we would use those instead of using devices for contouring or reconstruction purposes. And so my whole career I took care of cancer patients, especially breast cancer patients, because it's such a prevalent cancer. And whether it's a breast cancer patient or a cosmetic patient, one of the most elegant, biologically intelligent procedures is to perform fat transfer. You know, we're not adding something artificial to the body, we are just restoring it using your own biology, which is your fat. So fat transfer is a process where we remove fat. So today I did two fat transfers from different areas of the body. Common areas are the love handle area, the inner and outer thigh area, and abdomens. Of course, I get asked a lot to do arms. I'll explain why I don't do that later. We collect the fat with special instrumentation that's just focused on fat harvest for fat transfer. We then contain the fat in a canister so it's not out in the open. And we use a vibration plate to separate the fluid and everything from the fat. And then in that closed system after everything's been separated, we can put it back. So we like to do that because it's, it's transplanting your own tissue. Now that tissue contains a number of cells, right? There's fat cells, of course, there's also stem cells, growth factors, and other stromal vascular components. And those elements are super important and they contribute to regeneration, not just volume restoration. So fat itself is, to me, it's a dynamic substance. It's not metabolically inert, it's active. So it communicates with the surrounding tissues. And I feel like that is probably one of the, the most important things was done by an Italian plastic surgeon named Rigoti. And when I was finishing and coming up in my early years of practice, there was tons of work between, you know, the early 2000s to the like 2010 period, really just tons of work on fat. So much so that, like, it became a topic in almost every single meeting. People debating, it's used, people debating then how to acquire and process it and all these things. Fat became really highly studied during that time frame. And there's a lot of, I think, headway that's been made. You know, I would say, like the things that are coming out now about fat seem like they've been recycled for many, many years ago. Your acquisition of fat matter. So the technique, we take kind of a specific size of fat, around 4 millimeters all the time. And then I place it beneath the skin, but above the breast tissue. I don't place it anywhere else because I want it in the fatty space, because that's biologically where it should go. I've done this for cancer patients to improve contour irregularities, restore the upper pole fullness and soften it, especially if they had an implant based reconstruction. Dr. Rigodi was really famous for the work he did on wounds, especially radiation wounds and radiation, injured tissues, usually from obviously cancer treatments. And then the fat can also be used in asymmetry cases to provide better symmetry. And for many of my breast cancer patients, so I did probably 150 transfers a year just for breast cancer. It really helps with contour regularities. So think of somebody who's underwent a mastectomy and a reconstruction. Invariably the two sides are different. And it's not because the surgeon wasn't trying to make everything even. It's just invariably going to be different. And then those differences will be noticeable after reconstruction, reconstruction. Because typically when we reconstruct, we're always going to use symmetrical implants. Typically we don't use asymmetrical implants when we're doing a reconstruction because we know the volumes, because we know the volume of the typically the expander we use. And then we can exchange that or upsize it or downsize it based on what we want with the a permanent prosthesis and then let that heal and then smooth out contours, any irregularities, any rippling, things like that, especially helping with the upper pole. And so I think in reconstructive cases that's where I gather a ton of experience with that. And then doing them for cosmetic cases is relatively, I think, straightforward in my hands because I've done so many in general. And then when I do it for cosmetic, I'm trying to acquire fat usually for a lower body weight patient because they need the most help typically. But today I did one for an average sized patient who never had implants, had had an old tummy tuck and just wanted some volume added. So we did some acquisition of fat from those typical areas we discussed earlier. And then we placed it and used about 350cc's per side, which was a nice natural change. So I think using fat allows me to restore symmetry and provide balance. It doesn't give you an exaggerated or distorted appearance change. Where implants can be too typically, if you think of like the upper pole, fullness can be too much because that's not necessarily a natural appearance. So I get asked like, how often can I do these, who's the candidate and how do I establish candidacy? Now I'm pretty strict with candidacy because I've got a lot of factors that I didn't used to have to deal with. I have people taking GLP1 agonists which are things like Olympic Mangaro will get OV and the newest ones coming, they're very effective at diminishing, if you want to think of it, your desire to eat sometimes binge eating people, sometimes because of the delay in gastric emptying, don't they stay full, they feel full for a long time. And if I'm going to operate on somebody, my rule of thumb is I want them off for about six months because I want them to have normal cognitive ability to, you know, be hungry and eat. I typically use higher protein, higher healthy fat diets around the time of surgery. Protein is incredibly important for recovery and fat grafting is surgery and it does have its own risk benefit profile. And I think a lot has been made of or a lot of shade has been thrown just on fat transfers in general that they don't work. So we can address that a little bit in the live Q&A. Because it works, I think very well. I think technique and experience matter. I think selection of the patient's probably the thing that's not being discussed enough broadly. I have my patients get a DEXA scan, so I know their body composition. And then we have a discussion about any medications, like if they're taking a GLP one, and obviously if they can't discontinue that for medical reasons or they don't want to discontinue it, then that automatically makes them not a candidate for fat transfer with me. And then we discuss dietary, you know, what, what I expect from a diet standpoint and exercise standpoint. So things from an exercise standpoint, because I get asked all the time. I think if you're a cyclist, a marathon runner, a person who really does a lot of crossfit, hi rocks or high intensity high interval training, in general, fat transfers don't make a ton of sense. I think if you look at trying to prevent osteopenia, osteoporosis, maintain thigh strength, which is what we want to protect from ourselves from having, like, hip fractures. So good balance, thigh strength, walking is great exercise. Obviously doing things like yoga and Pilates are fine, but doing resistance training, lifting heavy things, as my, some of my mentors say, that will help you maintain strength and be more resilient. I like, you know, using the patient's own tissue because autologous reconstruction was always my passion when I was just focused on cancer reconstruction. Many people don't know my past. So I'll just, I'll just take a few minutes and explain it. So I became really interested in microsurgery. And that happened in my second, just between my second and third clinical years of surgery. I did a year in the lab and I operated using a microscope. I did a lot of vascular surgery under the microscope. And I really, that was my groove. I really enjoyed that. So that left me just a few pathways if I wanted to do microsurgery. And because I was so interested in doing what became to me more oncologic reconstructive surgery, it led me to plastic surgery because it had the most diversity. It wasn't confined to the head and neck. It wasn't confined to the arms or the legs or the trunk. It was all over the body. And you could take care of patients from each gender. You could take care of older and younger patients if you had to because of your skill set. And so skill sets travel. So I got, if you real, if you will, very well trained. I did six years of general surgery Two years of plastic surgery and a year of microsurgery. So nine years after I got out of medical school, so 13 after I got out of college, which always scares my children. So patient selection is important to me. Restoring volume with fat is important to me. I really like doing it in patients, especially if I'm augmenting someone, because I like the exchange of volume. I think restoring some volume helps with that change and, and then dealing with areas that have been difficult to either lose fat from or maybe just from a contour perspective they didn't like. That's great as a, a value add to our patients. The preparation to me is everything. So I used to, like I said, really be technically challenged by just the reconstructive problems with cancer cases. And I'll go off script for a minute. And one of my favorite things was to go to a particular cancer conference on Wednesdays was multidisciplinary sarcoma meeting. Sarcomas are rare cancers of bone, fat, cartilage, muscle. It's just a very small number of cases, but they were absolutely fascinating. And everybody in the room was literally just there to help sort out that problem for that, that patient and try to get them from point A to point B, whether it's with radiation therapy and a combination of surgery, surgery with a reconstructive allograft, maybe for a femur or something for their hip. I got involved with some of the most incredible cases during that time. I loved. Going to that conference on Wednesday is really challenging. And so now the challenge is. And the one I accept now, I. I feel like we've worked very hard in the explant space and really put a lot of effort into publishing the largest area series of explant specimens in the world that shows that 29 have bacterial contamination with biofilm. We'll also hopefully put out a genetics paper soon about the folks who suffer the most and their genetic mutations. And then I have another paper that I want to write about tox burden. And then I really, I feel strongly that we should move forward and help the community by providing real education around VAT transfer and not using any kind of frightening language or talking points about it, because I think it's a very good tool. I think it helps overcome some of the problems and challenges and, you know, preparation. My practice, like I said, I start with like getting a dexa. I want to have metrics I do in person. Physical examinations, of course, we look at toxicity, burden, gut health, food sensitivity, genetics, hormone balance. All those things are super, super important. We want to prepare the patients. And we have a very specific protocol. If we find something like a parasite or if we find somebody has a bad mold exposure or if they have some problem with heavy metals that we can help with up front, we certainly want to do that. We want to be very strategic and help patients get in their best possible shape before any of our treatments. So looking at all that holistically, using the sharp method is become my, you know, mantra. That's how I want to take care of a patient because I think that provides the best possible set of outcomes. The other issues that people are super, I think concerned about when you're taking fat. And everybody's got this concept that liposuction can be super painful. We do a lot of different treatment with local anesthesia, short and long acting. We do have a great relationship with our anesthesia folks who do regional nerve blocks for us. So we work really hard both pre op the night before surgery with a specialized protocol to decrease nerve pain, swelling, nausea and then all these other tools. Tools we use both prior to going to sleep with anesthesia, doing nerve blocks and then us doing more local anesthetic at short and long acting during the case to really get folks through the case and they wake up, they're really pretty comfortable. I like folks waking up at like a 2 or 3 on the, on the scale of 1 to 10 in terms of discomfort. I don't want to have any patient and shouldn't have any patient waking up more than that. They may need a little medicine but usually within 30 to 45 minutes they're ready to go. So with that, once again I'm going to tell everybody, I need you to switch from the platform you're on to drrobcircle.com because we're going to host a live Q A there. Okay, so I'll give you a few minutes to do that before I shut these off and then we'll switch over. But the live Q A is going to be hosted in our community and so I'm going to open the chat in the community and. All right, the chat is now open on Dr.robscircle.com so please everybody move over there. We're going to shut the lives off on the other platforms in just a moment. Now everybody go ahead and chime in on the chat and let me know you're here in the community. Let me know if anybody's having trouble. It's D R R O B S C I R C L E. If you're on Instagram, go to my bio, click the link there. Same with YouTube. Tik tok as well. If you get stuck, don't panic. It's all. It's all going to be okay. All right, I have 1, 2, 3, 4, 5, 6. Oh, my gosh. I have Holly on circle. Thank you, Holly. Oh, Kim's already got a question. All right, good, Denny. Yeah, we're gonna answer that question, Denny. We will. Awesome. You guys are great. I'm gonna give everybody time to hop over. All right. Do you want me to type in the comments on any of these lives? Where to go? Does everybody know where to go? Give me a thumbs up on the phones. Okay? Hi, Elizabeth. Elizabeth is one of our patients. Elizabeth, go to Dr.robcircle.com. okay, Y', all, I have the best patients, and we have such a good team at the office. If you get the chance to come to Austin and get taken care of by them, they are great. Elizabeth can tell you that. Hi, Elizabeth. Elizabeth, go to drrobcircle.com. danny, everything will go up in the community. Now that you're part of the community, all the lives will be reposted within the community. All right, I'm going to shut these others in off in just a moment. All right? Do we. How many people do we have inside? We only have 25. All right, to start, I want everybody on these other lives that go off. Okay? We're going to go to the other community now. All right, I'm. I'm going to shut them all off.