Simultaneous Fat Transfer at the Time of Explant Surgery

Simultaneous fat transfer with an explant. So let's get into it. I get asked this question routinely. Is it possible to do simultaneous fat transfer while you're doing an explant? And the short answer in my practice is yes. Now we have a much different practice than the majority of plastic surgeons around the United States, around the world for that matter. So everything in our practice is geared really strictly towards preparing patients, selecting patients that have been, you know, from a health standpoint, people use the words optimized. You know, I don't thoroughly evaluated using genetic testing, toxicity testing, gut health testing in the form of stool testing, looking at food sensitivities, hormonal balance, other indicators of inflammation, along with blood labs, which I mean have become normalized in terms of the standard labs in our patients typically don't show many disturbances. It's rare for that to happen. Actually. Many patients that come to me are already working extremely hard on their own health but are very concerned about the appearance change that will happen with a fat transfer. So for everybody, I'm doing an Instagram live live about this the 15th. So Thursday, 3pm Central, January 15th, I'm doing a whole Instagram live, Facebook live, TikTok live, YouTube live about this. And you can always get more information by going to our private Facebook group and joining that. It's for patients who want to be educated. Learn more. It's a great new asset that we decided to start in 2026. It houses all of free downloads, all of our mini courses for $10. Our books can be accessed there both the Sharp Method book, the breast implant illness book titled Breast Implants Explant Surgery and Breast Implant Illness. Access to our programming for Sharp. Many patients can't come to Austin and have surgery and spend the time here with us in Austin. So they will run our program, the Sharp Method remotely. That's ran by my two functional practitioners who have each had an explant with me also. I mean, obviously if I can take care of as many people as possible, that would be great. Love to have everybody come to Austin and have simultaneous fat transfer. It's top of mind because before the holiday break I did several fat transfers and so I do them both for cosmetic purposes. So strict augmentation, so removal of fat and placement of fat in another space in the body. This has been done for over a hundred years. I did a series of videos about this on my fat transfer channel on YouTube so that can be accessed by typing in fat transfer. And Dr. Robert Whitfield my, my videos will come up. I have a whole channel devoted to fat transfer. So the. I guess I'll make it simple. So if someone's getting a fat transfer and we'll say there's. The target tissues would be. Or the. The targets where we replace fat, we want volume, certainly in the time of the GLP GL1P agonist. And last night I was watching an advertisement for an oral one that happened to be during the Monday Night Football playoff game between the Pittsburgh Steelers and the Houston Texans. And it was NOOM advertising oral GLP1 microdosing. So I'll have to look at the latest literature about that. So the reason they're, you know, reducing dose, certainly patients. Patients want to control visceral fats. That helps with insulin resistance and all the things that lead to more and more metabolic disease. The problem I've ran into is people were injecting the drug. The drug may be compounded. The actual amount of the drug within the compounded formula they were given may have been too low. May have been. Absolutely. It was on the label on the bottle and may have been high. So the problem is, if it's high, of course, then you're burning more fat. So ozempic face or all that stuff, you know, has to be addressed through patient education. Patients should not, in my opinion, just be set free to inject themselves with peptides. People will do more than the labeled dose, which I find all the time. And then because they're so effective at making people feel satiated or not hungry anymore, and they lose weight relatively easily, they don't want to come off of them. Sometimes it lowers inflammation to the point where they feel a lot better and they don't want to come off of them. And people have been struggling with metabolic problems, especially my patients, who feel like no matter what they do, they remain inflamed. My. And this is kind of a. I'm going off script here. You want to get those patients so that you lower their intrinsic inflammatory burden. So we look at first someone's genetics to evaluate how they detoxify, and then two, we want to know their burden. So there's the burden of time, the burden of work, the burden of home, the burden of products, the burden of food, fluid, air, all those things get metabolized and they kick out toxins. Many toxins are stored. So we want to evaluate that up front. Going Back to the GLP1s, you get Ozempic phase. The number one way that that should be corrected is put fat back. But the best way is to avoid that happening by not Dosing somebody who doesn't necessarily be on that, need to be on that or controlling the dose that that doesn't happen. The target for facial fat grafting should be, you know, in my opinion, deeper. You don't want to be superfic because it'll be very obvious the fat that you transfer, the face is bigger. So think of a filler molecule like any of the hyaluronic acid fillers. That would be like stacking little skittles in a column. Whereas fat is more like the popcorn you get at the tin at Christmas. The bit of it, it's all uneven, it's all got different shape, etc. But it's much larger if that helps. So when you transfer to the fast, to the face, it's going to heal. So you're very conservative and you want to stay deeper. Commonly done with people getting facelifts, but certainly with Ozempic, Mugovi, Mounjaro, all of those drugs will contribute to facial fat loss if taken at high enough dose over a long enough period with enough weight loss. And some people will be more sensitive than others. So that's going to cause premature aging. Now the next target, the most common target for fat transfer is the buttock. And the buttock, it's more of a volume game and a placement issue. I wrote a safety paper about buttock augmentation using fat transfer several years back when there were deaths associated with buttock augmentation from actually injecting fat into the venous system and causing a sudden embolus in pat would arrest and die. So there's a technical issue that was resolved just with teaching. All that has improved. And that was just a technical point. The issue with placement of fats in that region was before that safety paper that I wrote, the question posed to me was, you know, can you write the paper? And let's be cognizant of how the fat is being placed. At that point, fat was being placed in the muscle, above the muscle, and then, you know, more superficial. So because the space of the buttock is such a large space that it can accommodate more volume. So there it's a volume game. If you did as little as 500cc per butt cheek in an advertised patient, it would be very hard to see the change. So you got to be plus 500, typically, in my experience, for yourself to see a nice visual change. And of course, you're doing that with reshaping the inner outer thighs and the waist area. So moving to the third, which is probably the least common place people do fat transfer for various reasons is the breast. So, you know, obviously one in eight women get breast cancer. We want to cognizant of screening. So when you're applying the principles of fat transfer to the breast, you want to stay beneath the skin, but above the breast tissue. I don't put it anywhere else but that plane. If you put it in the breast, you'll get cystic formation. More problems with cysts predominantly, you'll see them on mammogram. I've had patients referred to me, I've had patients referred to me that have had that done. And then you don't put it in the place where I take an implant out of. So that would be either behind the breast tissue or it would be in the retrofector position. So that's not where it belongs there. 29% of our patients on PCR testing that looks for DNA fragments show that they have bacterial contamination in that space which needs to be decontaminated or cleansed at the time of surgery. And that scar tissue is what contains that. So the things we think about in terms of fat transfer are obviously patient selection, timing, preparation, then proper placement. So we use the Wells Johnson fat transfer system have for many, many years. It's probably the most widely used for buttock augmentation and breast augmentation. It's not something you would use for the face ever. And it's very efficient. I was very efficient before I had it. It's made us more efficient now. So I don't feel like there should be any issues with fat transfers given proper patient selection, preparation, intraoperative assessment and treatment properly with volume placement, people ask, you know, how much can you transfer? And so just think of those places. Least amount you can transfer is to the face. Second least amount of space to transfer to is the breast. And then finally the buttock can accommodate the most volume, which makes sense if you just look at those areas from a volume standpoint. So I'm going to cut it off there and then we're going to see everybody on live on January 15th at 3pm Central. You can get it on my main YouTube channel, my Instagram Live, Facebook Live or Tick Tock Live.