Robert Whitfield MD is live!

All right, we are live now. I started a couple minutes early, but that's all right. We'll let everybody hop on A lot to get to tonight. Make sure everybody can hear. That was good. Getting the volume all the way up on the phones. All right, let's just make sure the volume's all the way up. Everybody chime in if you can't hear me. It's been a long day. Yeah, we've had a long day in the operating room. We had. We did three cases today. I got back, had a little admin to do, and we're gonna try to be very consistent and do a live hopefully once a week. It seems like Thursday is a good spot, but y' all will have to tell us what you think. Oh, I'm gonna wait to the top of the hour. Now, I went on today and I encouraged everybody to bring some questions, be interactive and look forward to sharing. We'll go through a bunch of things that we did today in the operating room. We'll give a shout out to the Olympics. And it's a good story from last night. If you're watching the Olympics, obviously there's a bunch of good stories. This one was just extra special for us. Almost to the top of the hour. It. Wait for everybody to hop in here. All right, I see Ms. Anya, nikki, Ms. Sarah, the energy center, dallas. All right, my manager is watching on facebook. Hi, jen. Jen's holding down Facebook for us. I don't know who's on YouTube. I need somebody get on YouTube. I have 2 million subscribers on YouTube and I have like nobody watching. That's hilarious. Tick tock. Who do we have? Caroline, Ariana. Hey, masanya. All right, it's 6:01. So in, in the spirit of the Olympics, I need everybody. If you didn't watch last night, you need to go and get the replay of Jordan Stoles setting the Olympic record in the men's 1000 meter speed skating. Now this is extra special to me personally because he grew up not far from where I used to work in Milwaukee, Wisconsin, when I was teaching at the Medical College of Wisconsin. And he's 21, which same age as my son. So I remember watching Apollo Ono and he, he talked about that in the 2010 Olympics. So if you didn't see his race last night, I suggest y' all go look. That, that, that was one of the more special things I've been able to see. See. So hold, hold up, everybody. Mrs. Anro One says I had an explantation six months ago and I feel Worse than before. I have Hashim Meadows and I believe it caused the inflammation to get worse. In our experience, explantation or removal of an implant is just one component of a much, much larger process. And I wrote a book about it called the Sharp Method. And the Sharp Method looks at a number of factors. And for everybody who doesn't know who I am, I'm Dr. Whitfield, I'm a board certified plastic surgeon. I'm in Austin, Texas. I focus on fat transfers, simultaneous fat transfers for explants, removals, lifts, reductions. I don't place implants anymore. And what Mrs. Ann Pro1 is describing is something I want every patient to avoid. And I think you can really by getting as much knowledge before you do something versus after you do something. So we look at genetics because about 83% of our patients have limited detox pathways when you look at their genetics, and I've talked about this on many, many shows, but vitamin D metabolism, the methylation pathways, glucuronidation and the antioxidant pathways are key pathways that are limited in my patients. Add in problems with estrogen metabolism and that's pretty much our avatar. Limited detox and poor estrogen metabolism. If you combine that with a lot of toxins that have built up over time, maybe they lived in mold 20 years ago, maybe they had a parasite exposure, maybe they had Lyme disease, maybe they had a long Covid or whatever it is, exposure to chemicals, heavy metals, all those things build up in your system. And if you don't have those detox pathways and, or you don't know about them, it's hard to get them out. So doing a implant removal doesn't resolve all those other things. Like if you had high heavy metals, high 10, cadmium, platinum, something like that, that would affect you. If you had a high mycotoxin level from a mold exposure, that would also affect you regardless of explantation. And of course if you had environmental toxins like say glyphosates are in the news because that's what's in Roundup, right? That that's been part of the problem for a long time with the food supply. There's also things like phthalates, the plastic, plasticizer that's used to make plastic water bottles firmer, that can leach out into the water and you can drink it, it can cause endocrine problems. And I wouldn't say it's the sole cause of somebody's Hashimoto's, but it certainly can contribute to it. Other things like atrazine very bad chemical that was used to treat golf courses for a long time. So there's all sorts of things that we look at in the pre op evaluation of a patient that I operate on not when I'm just doing the implant removal, but in all my patients I do fat transfers on because I I feel fat transfer should be done far more routinely with far more consistency for each patient if that's what they choose to have. If they want to have a holistic transformation with their own fat. Just like instead of a Brazilian butt lift. It's my one of my patient coordinators who recently left us called it the Brazilian lift. We'll give her credit to that. So I believe that's why Mrs. And Pro1 is having that situation. And the Sharp method can be run now remotely. So if you want to do that Mrs. Ann Pro Wine, go to DrRobsolution.com and set up a free discovery call or you can actually go to drrobertwitfield.com and do that as well because they'll talk to you about the Sharp method. And we do do run that for patients who are not operated on by me. So I was going to go down through the cases I did today and because they're very interesting and very diverse today. The first case I had was an explant. So I did implant removal of a textured device and I put fat back. So we prepared the patient a particular way. We look at DEXA scans pre op. So DEXA scans look at body fat, lean body mass, bone density. Gives me an idea of how much fat there is, where it is. I talk to the patients about where we can take it. I always let patients know that a fat transfer is something that's not going to give more than typically a cup size of transformation at one time. So there should be no confusion about that and it's a natural result. It should stay with the patient provided some very specific results criteria. I think somebody in my comments asked about GLP1s and fat transfers. You cannot be on a GLP1 and do a fat transfer with me. That's not compatible with my belief system about fat transfers because the GLP1 agonists all work extremely well and I would not risk a fat transfer with a patient on those or after I did a fat transfer having a patient on those. I would recommend a higher protein diet, healthier fats, keep the BMI at the pre op level or go up through strength training, resistance training if they like Pilates, yoga. But I would avoid hiit hyrox cycling, high intensity interval training, marathon running, things like that. So the first case I said was a texture device. Now, textured devices cause a lot of reactivity because they're rough and they're also the implants. Textured implants are most responsible for the breast implant associated anaplastic large cell lymphoma, which is a T cell lymphoma, presumably because of the irritation caused by the texturing. So I wanted to bring it up because the patient, to me, had bilateral capsular contractures that were much harder to appreciate on physical exam versus when I was operating on her. So what I mean by that is the capsules, the scar tissue around the implants was very tight. And when it's very tight and hard to move and it tears or shears or opens up, that's to me, more consistent with a capsular contracture. Because I'm moving it around, I can see and feel like the capsule and how tight it is on the device versus trying to examine somebody through layers of tissue or the muscle that's on top of the implants in the majority of the cases that I take care of. So that was a very interesting finding. The implants were intact, which is great for the patient. I did a muscle repair for the patient, and I put a little over 200 or approximately 200cc's of fat back for the patient, which I think to avoid really unwanted upper pole Halloween or just big volumetric changes, it's nice to do a simultaneous fat transfer. I feel like that is my. My preferred method. If I can get everybody prepared properly. If I can't, then we would do it in a delayed fashion. So that was case one. Let me see. I'm gonna take a question, see if there's any more questions here. Oh, thank you. Awesome. From Italy. It's a little late in Italy. It's got to be like one in the morning there. All right, who else do we have here? All right. Hi, Jackie. Do I have a comment or question? I'm checking real quick for a question, because I thought I saw one and. All right, I have a. Hold on. I have a question on tick tock here. Let me see, let me see, let me see. Let me see. I thought somebody asked me about a GLP1. I can't find it now. Sorry. Thought that was the glp one. Oh, my gosh. Carla. Giovanni. I saw that. That boy is going to two lane. Congratulations, Carla. Y' all can't see Carla on Facebook, but her and I and her husband go way back. Way back. We trained together. Jamie Lane asks, can you remove explant without lift and it be okay? Yeah, of course, yeah. It depends on how much tissue you have. First of all, I just gave you my preferences. No one has to do anything other than explant is purely up to them. But if somebody's asking me what I would prefer to do to help with the size and symmetry and volumetric changes, that's what I would try to do. And I combine it with a lift when needed. So second case of the day was a patient who came to us who had had multiple procedures and relatively speaking, a lot of scarring. So I, I did their case, revised everything on the left side, which is how I start. I always go left and then right, and on the right side there was a rupture. It was not contained. It was an older implant. And older implants, pre gummy bear, if you will have more liquid or syrupy type silica. And so it's important to get that material out. I think it's very obvious that it can cause a reaction. I don't, I don't think anybody should bendy should be misled in that it doesn't cause a reaction. We would not leave a broken and should not leave broken devices in people. So that was taken out. I'm hopeful that she makes a very, very speedy recovery, but hopefully it explains and helps with some of the symptoms she was dealing with. The third and final case I did today was a patient who had an asymmetry and they tried to correct an asymmetry with an augmentation. So for everybody listening who is entertaining an augmentation and maybe wants to understand better, like some of the pros and cons, I wrote a book about breast implants, explant surgery and breast implant illness. Not to, like, try to, like, cause fear or anything, but just explain situations that we've encountered in our practice through interviews with our patients, either on my podcast or through our interactions in the clinic to share their experiences of what they did and then after the fact, what they wish they would have done or had known. A lot of people complain about a lack of informed consent, and I always try to give the best information possible to help people make the best informed decisions. That's. That's basically it. So I always used to tell folks who were getting an augmentation that if you were asymmetric to begin with, you're going to look even more asymmetric with an augmentation because it's going to cause differences to be more noticeable. Now she had a big volumetric Difference. And the choice made by the provider at that time was asymmetric silicone, which you can do, but it didn't really give her a much better esthetic result. So I went ahead and did her removal today. I did a lift procedure and gave her better overall symmetry from, like, the skin perspective, but she still has a volume asymmetry. And we did not do a fat transfer today. She wanted to wait and do something like that later on down the road, either six months or a year. She just wanted to get feeling better. So that's kind of how a day will flow for us. And I typically do two to four cases. It just depends on the day. But on average, typically 3. We have longer days when we do bigger fat transfer cases. So we usually just do a couple of those. I was going to go into some of the main things we see in terms of reasoning behind removal surgery. And I think the first and most common one that I see is people just don't want to have implants anymore. Just doesn't align with them personally. People have changed philosophically how they're living, and they just want to have more of a cleaner, holistic lifestyle. So that's a very common one. And then number two is people felt that they became too large after placement, and they didn't want to be that large. And now they're kind of bothered by it and almost try to hide it. So it's not been something that I'm comfortable with. So this is the two most common, you know, reasons that we encounter folks, you know, for removal. And then now this is with and without symptoms. And then, you know, the third most common in my. My practice typically is going to be symptoms, like what's leading to symptoms. And so when we talk about, you know, the. The systemic symptoms or illness symptoms or chronic inflammatory symptoms, however each person characterizes that, you know, chronic inflammation happens, and how we deal with it is a function of our genetics, our diet, our environmental exposures, the air we breathe, the food we eat, the fluids we drink, the things we apply to our skin. So products are a big part of that. Clothing, you know, as well. So from a symptom standpoint, you know, when we go back to the book we wrote and try to, like, prioritize, like, how do we help people, like, right off the bat, get feeling better? It's trying to get them to focus on things they can change and try to improve right away so everybody can do a little bit better job about the choice of fluid. So, you know, try to drink filtered water, always believe and Drink filtered water. That's my gal, Courtney. Courtney got that cup for us then. Quality of air. Probably the most underappreciated thing, probably for me, was air quality. So I moved to Austin. Austin is a place where I have a lot more allergies because of the oak, cedar, and mold here. So I have an air filter in my office, multiple air filters at my home, multiple air through air filters throughout the clinic. I have an air filter in the operating room, wherever I operate. And that's just to constantly keep the. The count of the. The pollen or the spore count or whatever it is down. So it doesn't bother me. Food quality. I mean, my gosh, the food is really hard, so I know it's expensive. Don't want to make anybody go run out and try to buy anything that's, you know, gonna make it harder for them, you know, financially to survive. But there are, you know, I think when I work a lot on the weekends, I will go to the store and I'll get like a. A rotisserie chicken and a bag of apples. Jen will probably. My manager's on here. She'll start laughing at that. But then I just put them in the fridge and I. I eat them. So although that's not the most inexpensive way to eat, when you advertise it out over a week, probably is pretty inexpensive. I think that's about 25, 30 bucks. It probably lasts you, you know, several days. So you can consciously do better. Obviously, if you have multiple people in the family, kids and everything, it's much harder. So quality of fluid, air, food products. Don't put things on your skin that have parabens. Try to be super mindful of products, especially cosmetics. As a woman, and the thing that I'm going to say next that everybody can do better at is timing of when you eat last, when you drink last, and when you go to bed. So if you can. And a friend of ours, Reagan, Talked about the 3, 2, 1 rule and kind of beat it at me a little bit is stop eating three hours before bed, stop drinking flu fluids two hours before bed, and then get off screens and try to get in the right, you know, state of mind, I guess, to go to bed so that you're not, like, on a computer or on your phone or typing or working, and you're winding down. You only rest and recover when you sleep. So all of my patients know, and I talk about this to them before surgery. The morning of surgery, I talked to the family after surgery, like, make sure they get the rest. So Keep them up after surgery. So I operated today and I told every caregiver to keep their loved one awake and try to get them on a normal sleep wake cycle. So have them eat dinner, have them try to go to bed at a given time. That's pretty normal for them. And then have them get up in the morning because that's going to help their circadian rhythm. That's going to help with resetting their cortisol levels because I just caused a big cortisol surge by operating on them. And so when you come to my office the day after surgery, I have something called the human regenerator. It's this big device, it's from Germany and it helps lower sympathetic activation, increase parasympathetic activation, reset electron transportation forth. So the whole point is to calm everything down. Then we do lymphatic massage and nano V. So we have a flopresso with a nanov blow by. And that really helps get the fluids moving because we want to get the fluid out of the system from surgery. And then we have a hyperbaric chamber that's vertical so everybody can sit up like I am now. They can read a book or they can, they want to, you know, watch stuff on their phone is fine. And then we have a big 6 foot tall red light. We have some sound therapy coming very soon. So these are all things that we have in the office to really help stimulate people in terms of recovery. And then I, I really, really want everybody concentrate on their diets. Like you have to increase the amount of amino acids and or proteins overall on your diet. I try to get everybody above 100 grams because we got to get you into a positive nitrogen balance after surgery so that you can heal in recovery and recover. And it's, it's because we typically don't use drains. And like 95 to 98% of my cases, fluid buildup can be a problem if in fact we can't keep your protein content high because then your oncotic pressure within your vasculature or your, your blood vessels will not allow the fluid to come out of the tissues, back in the blood vessels and then be filtered out through the kidneys. So that's a very important step to us really keeping the diet on point. I got a dry mouth here. All right, I have another question. I will take this question from YouTube and it says Sherilyn Faith, I have old menstrual implants from the 90s, one ruptured in 2023. I am due to explant with you in April, but have had three unsuccessful blood draws. What can I do to prepare for surgery? Improve veins. Well, I think you better message us, you know, on Simplast. So I can understand the blood draw thing can be a hassle, but we can talk about that. Sometimes you need to be better hydrated and. But we'll help you with that. Okay. I'm sorry about that. We'll get that sorted out. Who else do I have? Let me go to Instagram here. Jackie's asking. Some people have the most unhealthy lifestyle and they are asymptomatic with breastplants. Do you feel that the most important underlying reason for BII is genetics? It plays a big role to me personally. Yeah. You know, everybody had talked about mthfr, and we knew that was a problem, but that's only about 36% of the population. The. The bigger thing to me is, like, it's additive. So if you have a very limited vitamin D metabolism, if you have a very limited methylation system, if you have a very limited glucuronidation system, you have a very limited antioxidant system, it's easy to get overwhelmed with inflammation. And then you throw in things like any kind of viral illness, any kind of significant life event or other stressor, plus a mold exposure or plus a parasitic infection or plus Lyme disease or whatever, and it's no wonder that people feel so poorly. So, yeah, I. I believe strongly in genetics being a component. We have an IRB that we put in, and we are looking at an audit of our audit of our results, and we want to compare it to Eric Topol's welderly population. We have gotten consent for that. We just have not. We need a data scientist to do that, so we don't have that evaluated. All right, do I have others here? Everybody on seemingly on Tik Tok wants to co host. Y' all can't co host with me. It's interesting, though. It's cute. Oh, my gosh. Sarah Highball McBride is watching. Hi, Sarah. I hope you're doing well. All right, I got a blast from the past tonight. Who else do I have here? Individual one. Hey, marcia, Other questions? Come on, you got to have another question. I've had some good ones here on YouTube. Any other ones? You're welcome. Shen, just message us. Okay. What else do I have? Oh, here it is. What are your thoughts on GLP1s? I did or I have done several episodes about GLP1s. I think I've been on several podcasts and talked about It. The thing with GLP1s, I mean, they're great and they work. I just don't want my fat transfer patients on them. And I, in general, when I'm trying to operate on somebody, they need to be able to eat. So those drugs are so effective. Hi, Ms. Vivienne. Those drugs are so effective that I really. I want the patients to be off of them several months. Otherwise, it's very difficult for them in terms of recovery. Jackie's asking, do you think saline implants would be safer than gummies? All implants have a silicone shell, so that's not really the issue. You would know about a rupture with a saline over a silicone implant because the saline would deflate. So that's, you know, basically that's how I think about it. All right, what else do we got here? Now, I'm going to say this name wrong, but it's Lim 70. I got my implants 18 years ago. I want to remove them, do fat transfer and lift. On last imaging results, there's a mass, very small, with benign characteristics. Is that a problem? So it should be characterized in a classification called birads. And if it's a birads, that's one or two. Then you just watch it. It shouldn't be an issue. All right, let me see what else we got here. Did I answer that? Yes. I'm board certified. That's yes. Should a person try to get to their ideal BMI before they come to you for an explant? Left a fat transfer, since you don't recommend high intensity exercise after explanting? Yeah. So, like, it's an interesting question. And this is a S H, J, O N E, S. Ash Jones Kurtz 76. There you go. So here's how I think about it. So you're asking a good question. The. The thing that, you know, for me, ideal bmi, like, I would get your DEXA scan and see what it is, but if someone has a lot of inflammation, it can be a little. I don't say inaccurate. Harder to appreciate what the BMI should be. What's the ideal? So what are you comfortable at? You know, what is your body composition? Like, that's more important to me than someone's weight, Whatever ideal BMI is. Like, what do they feel best at? And you should always, as you get older, you want to maintain strength, especially thigh strength to avoid falling. Resistance training, weight lifts. I'm sorry, lifting weights, doing something heavy. Perfect. One of my mentors, JJ Virgin, was like, you got to just lift Heavy, heavy stuff. You know, do some resistance training that will help you more avoid osteopenia and osteop. Osteoporosis. All right. Miss Anya has started to feel quite drained. Miss Anya, I. I bet money you don't get enough protein in your diet. So I would count. Protein grams count, you know, not calories, but, like, how much protein you're getting in, and that can help you. And then, you know, if you don't methylate. Well, methylated bees help. If you have a limited antioxidant pathway, then vitamin C helps, you know, make sure somebody's vitamin D level is appropriate. So we use D3K2. So all the things in the inflammation support bundle we have are meant just to support those genetic pathways that we talked about earlier. And if anybody's having trouble with understanding, like the testing, we have the ultimate wellness testing bundle. We have basic inflammation testing through our website and store. So all those things just help better characterize what's going on with you. And then you can learn more either, you know, through the one on ones that you can do through the. You can purchase them on the store or you can do the group program. If you're going to explant elsewhere. If you're going to explant with us, that's just part of the package. Hi, Caitlin. Oh, my gosh. I have Madison Miranda on here. Jackie, you're in Sydney, aren't you? I saw that. Why don't you message us? Because we work with vibrant wellness. I think most of that we can do. Yeah, I wish I had the. The time and bandwidth. I would just bring the test to you, Jackie, and drop them off, because I haven't. My wife wants me to take her to Sydney. I haven't taken her there. It's one of my many places I owe her a trip to. All right, did I get everything answered? Does anybody have any questions on Facebook, TikTok, Instagram? I could have had Ms. Miranda join me on here since she hopped. I saw her. Maybe we'll coerce Madison to hop on. We'll see. She might be busy. For everybody. If you look in the. The folks who joined Madison, Miranda's patient of ours, who's over two years out, she was on the podcast recently, and she had a simultaneous fat transfer. And I think it's a very good example of that. That procedure. She's done extremely well afterwards. And we're gonna. Actually, I'll bring this up now, so everybody probably should know that I've. I've faced a fair amount of censorship rate recently on both. Well, we won't say which platform, we'll just say I've, I've faced some, some censorship. So we're gonna have a, a new option to get our content and we'll be announcing that, that platform relatively soon. So always pay attention. Follow us on YouTube and Instagram and Tik Tok and Facebook, all the places and, and we'll announce it and we'll direct folks there. So then you can get all of the podcasts, either the links for Apple or Spotify, and then we'll have video links for all of my. I think I have over 3,000 videos now with over 30 million views, but we've been restricted a little bit, so. All right, what else do we got here. For all you Facebook folks? You, I don't know if you know this. I can bring them on video. That's hilarious. Hold on. I have seven messages on Tick tock. Hold on a second. I'm sorry about that, Sassy. That was my specialty. I did fat grafting 150 times a year for breast cancer patients, mostly for deep flap reconstruction, but I did it for patients with implant based reconstruction as well. That's why, like, a lot of people did reconstruction predominantly in their career. I'm very comfortable with fat transfers, so. All right, All right. Do I have another thing? No. Okay. All right, y', all, any other questions? Michelle May says, what percentage of people have staph and bacterial infections? So I published the largest, largest experience with that in the world in September of 24 with 694 consecutive test samples. And it's 29% have bacterial contamination on PCR testing. So if you want to keep it simple, say a third one out of three, Mostly staph and kidibacteria magnus, depending on whose study you look at. Mine was mostly ketobacterium acnes. Some of the others have been mostly staph. It's. I think it's just depends. It's not a big deal. Both of them rarely produce biofoam, so it's not surprising that that's the issue. Oh, oh, I see a Beth Dobbs. Hi, Beth. Good to see you. You d have worked hard all day today. I'm gonna miss her, which is great. All right, anything else? Let me see. Did I get all these answered? Y' all have had some really good questions. Let me see. Let me just make sure. Yeah, I don't see any other questions. Are there any questions on Instagram I can answer? Kim Banks. I'm a plastic surgeon. I do holistic transformations with fat and take care of a lot of folks with implant problems. Okay. All right. Oh, Tia, I've had my implants for 20 years. Should I replace them? They seem fine to me. Yeah, yeah. Like, that's a obviously very personal question. You got to decide if you want to keep implants. That's your prerogative. And then go see a provider and, you know, make sure that you get evaluated. If you want to you do something about another set, that's totally fine. That's totally up to you. But 20 years is long enough. Oh, Kim Banks. I hate that scar. I'm not the person to ask about tummy tucks or reverse tummy tucks because I don't like those scars. I came up with something called the smart tummy tuck and the holistic mommy makeover to get rid of that. Who is Moxie Girl? And everybody should know. I was born in Las Vegas, so they're saying, howdy from Las Vegas. Who is that? Who is Moxie Girl? Is that one of my friends from Las Vegas or somebody who knows me from Las Vegas? I know somebody who runs a company called Moxie. Okay, Michelle. Foreign. It's not really complicated. There are breast implant hearings held by the FDA in 2019 where everybody testified, including myself, about breast implant illness. So it's not a new thing. And I published a big paper in September of 24 that showed that explant specimens have in R series contamination from bacteria 29% of the time. So that's a real problem. There's also something called oxylipin tenhome produced, which is associated with folks who have increased symptoms, and that's from the contamination of the bacteria interacting with the fatty acids in the breast. That was published in 24, but I think it's earlier in the year by Dr. Muthoon Sina, who's been on my podcast. So go to my podcast. I don't know the episode number, but go to my YouTube channel and type in Mithune m I t h u n s I n h a and then you'll bring up the episode I did with him. If not, you just type it in. You know, however you listen to podcasts, type in my name and Mithun m I t h u n sina s I n h a and you'll pull up the show. What else do I got here? Jlo Mama. I don't want to get my knees replaced either. That's why I don't. I just try to keep my weight down and keep walking. I don't want my Knees replaced either. I'm with you, Caitlyn. I think last time I was on live I told you to start with like sharp or read like have a read of one of our books. Basically. I would definitely try to lower inflammation for you depending on your sensitivity to MCAS and the things like that. The kickstart or the information support bundle is a good way to start to be honest. Even with sensitive patients, they do well on that. Oh my gosh. Amy from Canada is on. We were just talking about. I have a bunch of Canadian clients and. They. You guys have a tough time in Canada. Kayla is asking. I have two 14 year old textured gummy bear implants I want to replace with fat. So remember, you're not going to replace the whole volume with fat and it does not go where the implant was. The fat goes beneath the skin above the breast. That's where the fat goes. But yes, I agree with you, Kayla. That's a. I, I do that case a lot. That's how I would prefer to do it if I can. Why does William want to join my live video? Yeah, William, I'm doing a discussion on plastic surgery here, so. All right, what else do we have here? Hey, Amber. Yes, Kayla? I did that in one surgery. So everybody, this morning I did a simultaneous explant fat transfer this morning. The second case was just a revision lift and explant. And the third case was just a expl with lift. Numbness and arms could be related to implants and fingers. Sometimes liquid around implants. Doctor said ultrasound is normal. So numbness in the arms, you always got to make sure the neck is okay first. And you definitely can have from weight and the bra straps, you can have more numbness in the arms. Definitely want to get that evaluated. So. Kayla, you know the thing with complications in surgery, so the things you want to avoid in surgery, number one is always bleeding. That's it. That stops everybody in their tracks. So that's the number one complication to avoid everything else with, you know, scarring and asymmetry or volume loss or skin redundancy or cosmetic, you know, problems with, you know, how the outcome was. Those are all secondary, especially when we're doing removals to like how much volume there's left and then what is the skin doing. So it's usually the problems have to do with that. Not so much technically what we did in the case. The explants are really straightforward. I've done several thousand of them. Limber, if you want to, you know, talk to us, that might be worthwhile. I would have to probably review some more information to see if there's anything else that could be going on with that. Quiet bud. What did you ask? Are implants much improved from early 2000s or basically the same now? Every generation they change. In the 2006 they changed quite a bit when they got reintroduced to the market. And then the cohesives. Thank you, Ms. Elizabeth. Now on Instagram, Elizabeth is a patient of mine who explained a couple days ago is already. She. She's doing wonderful, which is great. Thank you so much for coming on and saying that. And I'll see you in the office tomorrow, Elizabeth. I'll be here during the day. I have a podcast to do, but I'll be here. Kayla, I don't accept insurance. I haven't since 2019 when I stopped doing cancer reconstruction. Okay, well, we've gone just about an hour. Are there any last questions I can take before I mean test B dot one byBri. Oh, we have them on our store. Just go to drrobssolutions.com or go to my drroberwhitfield.com and shop. Now, there's a basic inflammation test on there you can take. It's very simple. It's a urine based test. There's also a total tox test that's urine based as well. But you need to do glutathione before that. All right, Pam, if you have enough breast tissue, yes, you can get a very nice cosmetic result with a lift, especially if you add fat. You're welcome, Bri. Oh, thank you, Michelle. May. I appreciate you. I need it. Like I said, I've been getting a little bit. We'll say censored. I won't say by whom and by what platform, but we'll just say it's not been good. So we appreciate you doing that. And certainly when I go live next Thursday, I will have some very specific directions for everyone. Sherlyn, Candida level levels. We don't look at specific candida levels usually. That's I guess more on a gut test. We look at mycotoxin levels and I have patients who have a lot of mycotoxins for sure. All right. Sarah High bar has not said a word to me. She's just been watching me all night. Oh, I'm glad. Amber, Thank you very much. I really appreciate that. Now Amber's commenting on this book. She read this book and it helped her with her explant. This is a really easy book to read. We like definitely made a point to keep it very, very straightforward. I Didn't want it to be confusing or really scientific, because it's not. That's not the point of it. It's meant to be very straightforward so you understand it. That's awesome. Thank you, Amber. When you're doing books, it's brutal. I've done two, and I think I'm. I'm done for a while. All right. Anything else? Y' all have done a really good job tonight. It's good. Yeah. Some. A med student just hopped off in here and said they delivered their first baby. Yes. I hate to tell you this for a med student, but most babies almost deliver themselves. You have to help a little bit, but. All right, y', all, I am tired and have a big day tomorrow. Gotta make a bunch of content in the morning, see a bunch of folks. Everybody operate on today. Everybody operate on from Tuesday and do a podcast, I think the biohacking Blondes. Tomorrow I'm doing a podcast with them. So any last questions I can get? Let me just double check. Let me double check. Oh, thank you for asking. Is it Cara? So you can get the book either on Audible, if you like to listen. So it's on all the audible platforms. And then if you want to purchase it, you can purchase it from our store, D R R o b s Sol ution s DrRobsolutions.com if you can't get to that domain, just go to my regular one, drrobertwoodfield.com and hit shop now and you'll get there. It's also on Amazon. Okay. Hey, thank you. Every. I want to thank you all for hopping on tonight. And next Thursday, we'll have a big announcement, hopefully with where to go to get completely uncensored all the information you want about all the things I normally talk about and don't get blocked for. Yes, Kara, you should read both of these. The first one is sharp, about how we prepare and recover patients. And this one is basically our experience with patients. All right, I am going to call it a night. Thank y'. All. Bye, Facebook. Bye, Sarah. Bye, Jen. Bye, Carla. All right, bye. Tick Tock. I don't know all the folks on Tick Tock. It's kind of hard for me to keep track of Tick Tock. I know how to shut Tick Tock off. Honestly, I might have showed. No. What did I do? Pause. I'll pause it. How about that? Okay. All right, Last. Last thing on Instagram. Anybody got anything? Mei, you just joined. I'm sorry, do you have a question before I hop off? Mei Kore 36. Just joined. She's late to the party, but we're going to make sure. Oh, your South Bay relator just joined, too. I'm sorry. And Kate, Katie, Daniel, 568, just joined. Did you all have questions? Before I hop off, you go ahead and ask anybody left on YouTube with a question. Sherlyn, we get everything answered for you. Danielle, did you have a question? Danielle, 21.