Wednesday Live!

Remember, afterwards we're going to go live into the circle. We're going to have a private Q&A for everybody who wants to join. So just hop on, getting it started in a few minutes. We are good across all platforms. Just going to do sound check. All right, swig of coffee here. All right, Grant, awesome. Mr. Grant Stevens in the house. Dr. Grant Stevens, not Mr., sorry. It's been a minute since Grant was in town for the F1 race and gave a talk, but one of the better moments in, uh, Austin for us. So welcome to have you on. Everybody hear me okay? People still hopping on, so give it a minute. We should be good across Facebook, LinkedIn, YouTube, X, Rumble, Substack, and live in my private community. If anybody on Facebook could just chime in so I can make sure that the audio is great, that'd be wonderful. Thank you. Feel free to share it with your friends. Hi Nedra, hi Dolly, hi Mandy, hi Jen, hi Nancy, Elizabeth. All right. Hi, Caitlyn, good to see you. Just let everybody hop on here, give it a moment. So we'll be going over, you know, prep for fat transfer, whether it's, um, cosmetic for augmentation or cosmetic for explant or cosmetic for reconstruction. I have actually an example of all those cases, um, in the past, uh, week or so. Several people in my clinic today following up and getting ready to head back out of town. So for all of you who don't know, I'm Dr. Whitfield MD. I'm a plastic surgeon in Austin, Texas. I wrote the book about the Sharp Method, which we'll discuss about preparation for not just surgery, but in this case we're talking about fat transfer. So fat transfers to me honestly should be very straightforward all the time. And we'll take a departure here and open a loop in that a fat transfer is a genetically identical transfer, much like the first transfer that was done of an organ. From one person to another in 1952 by Dr. Joseph Murray, a plastic surgeon. So we showed that you could actually switch out the kidney between genetically identical patients. So that's an autologous, if you want to think of it that way, transfer, because it's the same genetic identity in terms of the code. So if we're doing a transfer of genetically identical material, then it's basically autologous. So when you take fat from one place and move it to another, it's autologous, it's your own genetic material. If you put it with its fatty friends, I like to, to say it will heal. So what are the differences that determine or differentiate the amount of fat that heals in one person versus another, in one compartment versus another? And so we can approach that. So each of us inherits a set of genes from our biological parents, which makes us obviously genetically diverse. Allows us to detoxify what we come into contact with. So the air we breathe, the food we eat, the fluids we drink, the products we apply to our skin. So all those things create a series of exposures over time. And if you look at my last 500 patients, the number one toxin they are exposed to is BPA from plastics. Number two is glyphosate, which is Roundup, that comes from the food they eat. And number three is aflatoxin, which can be from contaminated food, if you want to think of it that way, grains, nuts, or it can be exposure in a home or workplace that has mold. So those are the top 3. Then gut health is an entirely separate issue, which is very difficult to completely break down. It's the most complex, probably, you know, problem we still face then, and the least understood. We don't have parasitology that's, um, I think easily accessible to figure this out. So we do a lot of next-gen sequencing, which is PCR analysis of stool samples, to look at the, the organisms there, whether they're bacteria, fungus, parasitic, right? So if we have, say, a parasitic infection, we want to know that, identify that, and treat that. Obviously, the number one reason around the world to have liver disease still, or liver abscess if you want to think of it that way, is an infection that's parasitic from Entamoeba histolytica. Many of you equate this to traveler's diarrhea or Montezuma's Revenge if you go to Mexico frequently. So that's one problem that we're always trying to look at because it's a big driver of disease. Toxoplasmosis is also a parasite that comes from potentially animals, cats in particular. And then malaria is also a parasitic disease as well. So lots of reasons that we have to evaluate that for our patients. And in addition, we look at other sensitivities, particularly in our population. I look for food sensitivities. So we look for things so that we can guide our patients to decrease inflammation by whatever it is they're putting in and on their body. So obviously going back to the same things I said, whatever you put in and on your body, super important. And then the final test we look at is hormone balance because we don't want to have somebody with completely dysregulated hormones. Now that's upfront in terms of testing. Supplementation's very basic based on genetic results from our patients and over probably at this point, uh, over 500, uh, different genetic testing vendors we've used. We have problems with vitamin D metabolism, glucuronidation, antioxidant pathways, methylation pathways, pathways, estrogen metabolism. Say we look at and support the main detox pathways with liposomal products to make them easy to absorb. I do that on purpose because if you remember when you're little and you try to get your son or daughter to take a, um, a medicine, it was easier in a liquid formulation. We've equally tried to embrace that concept to make it simple for absorption as well. So we have a testing, a supplement, nutrition, and sleep. We're going to put them all together. Nutrition patterns. I follow a very, very pragmatic approach with higher protein. I'm not going to get into the source of the protein. I want the highest quality protein source in the amount that gives you between 100 and 150 grams a day. That's post-op, pre-op, not as much. And then healthy fats, of course. The other thing that is the underappreciated largest driver in recovery personally for our practice, we prioritize the most is your sleep. So we follow a 3-2-1 rule as regards to sleep. So stop eating 3 hours before bed, stop drinking 2 hours before bed. At that last drink, if you want to post-op, No, my hack for getting more protein in your system is mix that with filtered water and your protein powder, not aminos, because aminos can make people a little bit more lucid at night. Take that, go to sleep. 7 to 9 hours is your sleep, right? So you can track it, you can see what your HRV is, you can see and know your quality and depth of sleep. When you wake up, you should feel refreshed. That's when your glymphatic drainage, your lymphatic drainage actually happens. Then in the morning, get up, drink another round of filtered water, use electrolytes. At that point, you can use more aminos or protein at that point at your discretion. That gives you a jumpstart to your day, but also gives you what your body needs in terms of nutrients. We haven't mentioned trace minerals, but those are important as well. Then, you know, throughout a given day, pre-op and post-op, you have activities. I'm going to give you an exercise approach. Walking is great. Resistance training is great. I don't believe in, don't support HIIT, CrossFit, HIIT, circuit training, or high-intensity interval training, or running, or cycling. I, I need to maintain results. As it pertains to fat transfer, we want patients' BMI pre-op according to DEXA scan to be maintained post-op. So DEXA scan pre-op, not in-body, that establishes a pretty easy thing for us to follow post-op. Now the transfer, everybody asked me how low is too low of a BMI, how, um, how do I, you know, come up with an approach that depends on the patient, where they genetically accumulate fat, and then are they on medicines like GLP-1s, are they maintaining a diet exercise pattern that's consistent with the result. So we want to help everybody and meet them where they are. Acquisition of fat can be done with instrumentation that is available. We use all single-sided instruments. We can do low BMI fat transfers. And then the goal will depend on the patient and their body habitus. If we're doing a straight aesthetic, we want to change a cup size, of course. If we're doing an explant, Then it depends on the patient's tissue volume, the implant volume. Remember, fat does not go where the implant was and it does not go in the breast. As it pertains to breast, we don't have as much space as a buttock. So that's the big differentiator. They both have muscle. Obviously they both have a skin envelope. There's much more real estate for a buttock transfer versus a breast transfer. And of course we don't want to stick fat in the breast. Males and females both have breast tissue between the fatty layer and the muscular layer. Layer, but we don't want fat stuck in the breast tissue. That creates cyst formation, can be problematic. So in terms of how do we maintain a result, we maintain our BMI. We don't overtrain, we don't under-eat, we don't create imbalance. You can actually improve your BMI in a healthy way by increasing your resistance training to increase your bone density and lean muscle mass, mass, and maintain your healthy fats in your diet to improve and maintain your BMI as well. And then, so that's basically fat as it pertains to the breast. The buttock, you need a higher volume to get a visible change. In the face, you need tiny amounts strategically placed deeper rather than superficial to get the appearance change we want, the volume change we want. We've discussed a lot of, uh, in the past about Ozempic face. I have a whole separate series about that. We have resources on my website. Go to drrobertwhitfieldmd.com to learn more about Ozempic face fat transfer. The no-cut facelift for it, with or without fat transfer, of course. So fat to the face, very little deep. Breast, you got to be beneath the skin, above the breast tissue, in the fatty layer, and you're limited on how much volume you transfer at one point. I do that, uh, because obviously in my past I took care of cancer patients. That's where I got the majority of our experience early on with fat transfers. I did 150 per year annually from 2000 2004 to 2019. So that's quite a bit of experience just with fat transfer in mastectomy and post-mastectomy contouring. And then of course in natural augmentation, in explants. Of course, all of those things, uh, create this wider experience that our clinic and I have. So in terms of recovery, you know, post-op for fat transfers, I favor hyperbaric oxygen, I favor lymphatic massage, I favor high protein diet, proper amounts of sleep, proper amounts of exercise, maintaining nutritional balance, not creating a calorie deficit. That's the best way to have a result that is long-lasting. I guess parting thoughts that I would, I would do, I don't wanna write another book, but if I had to, I'd write it about fat transfer, making it more of a, a understood process with predictable results in certain, um, with certain parameters being met in terms of genetics, toxicity burden, gut health, food sensitivities, hormonal balance. Um, I try not to throw age in there because age simply is a number. I think it's about your overall health and wellness. So that being said, I'll take a question off of Instagram, TikTok, and whatever I have online. Before going into the circle. I have a limited amount of time before I have to hop off and get on with my day. So we'll see what we have on Instagram. Do I have a question? No. And do I have one on TikTok? No, I do not have a question on TikTok. All right, we're gonna go into Dr. Rob's Circle. It's free to join, drrobscircle.com, or you can access from my website, drrobertwhitfield.com, sign up for free. Do a live Q&A in there for the next 10 minutes. All right, we're going to shut down the live stream now.