Pursuit of Wellness - The Truth Behind Fillers & Botox: What You Need to Know About Safety, Longevity, and Results - Dr. Cameron Chesnut, MD

Episode Date: November 4, 2024

Ep. 147 On today’s episode of Pursuit of Wellness, I sit down with Dr. Cameron Chesnut, a plastic surgeon with a passion for blending functional medicine and progressive thinking in his practice. We dive into his unique approach to patient care, focusing on everything from nutrition and peak performance during medical school to the latest in regenerative medicine, including stem cells and red light therapy. Dr. Chesnut shares insights into popular procedures like CO2 laser treatments, fillers, and lymphatic drainage massages, while also emphasizing the importance of educating patients and turning down unnecessary surgeries. We explore the balance between aesthetics and wellness, and what true health means in this evolving field. Leave Me a Message - click here! For Mari’s Instagram click here! For Pursuit of Wellness Podcast’s Instagram click here! For Mari’s Newsletter click here! For Dr. Cameron Chesnut’s Instagram click here! For Dr. Cameron Chesnut’s Tik Tok click here! Sponsors: Bite is offering our listeners 20% off your first order. Go to trybite.com/POW or use code POW at checkout to claim this deal. That’s trybite.com/POW. Sleep is the foundation of health, and there is nothing better than waking up feeling refreshed and ready to attack the day. Use code POW for 20% off your order at dreamrecovery.io Visit clearstemskincare.com and use code POW at checkout for 20% off your first purchase. Again, that’s code POW for 20% off your first purchase on clearstemskincare.com. Jaspr is offering an exclusive deal – get $400 OFF with code POW at checkout on jaspr.co. Again, that’s code POW at jaspr.co for $400 OFF your Jaspr air purifier! Topics Discussed 00:00:00 - Introduction  00:02:48 - Growing up as a creative and athletic kid 00:04:43 - Nutrition in medical school 00:05:59 - Sleep deprivation 00:08:00 - Remaining at peak performance 00:12:17 - Dr. Cameron’s process with his patients 00:16:01 - Protocol before operating and anesthesia 00:17:53 - Procedure length 00:19:48 - Understanding the use and legality of stem cells 00:22:22 - How stem cells actually work 00:24:57 - Red Light Therapy 00:27:07- Skin Rejuvenation 00:28:29 - CO2 Laser 00:33:04 - Nonsurgical options and fillers 00:39:43 - Migrating filler and filler misconceptions  00:43:45 - Lymphatic drainage massages and Sculptra 00:47:40 - Upper “bleph” 00:50:16 - Turning down patients 00:51:42 - Dangers of before and after pics  00:57:33 - Most common procedure 00:59:09 - Fat transfers 01:05:02 - Working with celebrities and the importance of educating patients 01:08:44 - What wellness means to Dr. Cameron Chesnut

I see people, especially younger people, because now they're in trouble a little bit. And they've realized somebody told them, they saw an old picture, or they just had that aha moment where, oh shoot, I don't look like myself anymore. My lips aren't what they used to be. The filler has migrated, whatever it may be. And it's sort of like, well, now what do we do? This is the Pursuit of Wellness podcast, and I'm your host, Mari Llewellyn. What is up guys?

Welcome back to the Pursuit of Wellness podcast. Today we are talking to Dr. Cameron Chestnut. This was such an incredible episode. I didn't quite know what to expect when bringing him on, but he was such a wealth of knowledge and he has such a unique approach when it comes to surgery. Dr. Cameron Chastner is a facial plastic surgeon for the world's highest performers. People from all corners of the globe seek his next level results. He has a minimally invasive procedure that leaves patients looking natural, rejuvenated

and seemingly untouched. He is renowned for his progressive use of regenerative medicine and post-operative recovery techniques. He has such a unique approach when it comes to surgery, I've never heard anything like it. He focuses on everything from nutrition to peak performance, and during medical school he learned all about regenerative medicine including stem cells and red light therapy, he uses hyperbaric chambers, IV drips, et cetera. It really is more of a functional medicine practice than anything else, but he's also doing amazing work on the face.

He does treatments like CO2 lasers, fillers, lymphatic drainage massages. He also emphasizes the importance of educating patients and turning down unnecessary surgeries. This was such an interesting episode guys. As someone who has acne scarring, I have so many questions about the right way to get a laser done. Do I need fat transfers in my face? Are fillers working?

What's going on? So I asked all the questions also about sculpture, which is something I've been interested in. So we really got all the answers today and really heard the truth behind if these procedures are actually working and what are the ingredients in those procedures. We explore the balance between aesthetics, wellness, and what true health means in this evolving field. I know you guys are going to love this episode. Let's hop right into talking with Dr. Cameron Chestnut. Dr. Cameron Chestnut, welcome to the Pursuit of Wellness.

Thank you so much for having me. Very honored and grateful to be here. So excited to have you. I know you're a facial plastic surgeon for the world's highest performers and you have a pretty unique process and outlook on plastic surgery, which I find so fascinating. We were already chatting earlier and I'm just so excited to dive into the functional medicine side of everything you do. So I'd love to just start by hearing how you became

interested in this industry. How did you get to where you are today? Yeah, it's interesting. Going back into just life, it's a long story of origin, but I was just a creative kid. I was an athletic kid. My mom, I got to give her a lot of credit here because whether she knows it or not, she was a very progressive thinker. She was a nutritionist. So I grew up with that mindset and thinking

about that. And she was the one who, you know, didn't do margarine when that was in trend in her field. And she was mixing monounsaturated fats with our butter and things like this. And it seemed crazy or cooking with peanut butter or applesauce instead of oil, whatever it was. And I didn't at the time really understand what that meant, but that was always just part of my life. And so I get into medical school, and I thought I was actually going to be a nutritionist too, but I went to medical school, and a lot of that creativity and curiosity, critical thinking that my mom had gets kind of beat out of you, to be honest, in a very, it's

a sad truth, really. You have to be regimented, you have to get all the things down, you have to learn, and it's a very good system. I was very well educated in medicine when I was done, but I was not very creative, critical thinking, or curious, really, at that point. Then you get to this very kind of cool time in your life where you've invested eight years after high school and your education, and now you have to like decide what you're going to be when you grow up a little bit like this path into are you going to be a psychiatrist or an orthopedic surgeon or a family medicine doctor and I really went back to those like 3D spatial creative things that I liked when I was a kid and all the problem solving and curiosity and that really

opened up a world like in the plastic surgery 3D spatial type type of realm for me. Even orthopedic surgery is that, but it's just not as creative maybe. So that's how I found myself where I was. I got to use all the things I liked as a kid. I kind of got back to my identity that I had lost through medicine in a way and got to go back to a lot of, for me, was back to my athletic roots

and my athletic background too. I'm curious in medical school, how often were they bringing up nutrition? Barely any, actually. Wow. We took one class on nutrition, and I remember I was a nutrition major as an undergrad, as an example.

And I remember taking that nutrition class in college, and I had my academic side of me from majoring, and I had my critical thinking curiosity side of me from my mom being a nutritionist and being an athlete and having applied all those things to myself over the years. I knew that when I did X, I performed well. When I did this, it didn't perform as well. So you kind of have some of that anecdotal part too.

And I remember in that class thinking, this is absolute garbage, what we're learning. This is not right, this is not true. And it's really biochemistry, that's what nutrition is when we really get down to it. And so that part was real but then the application I'm like, this is not what we should be talking about, you know Which was kind of good I think in some sense that it was only that because it didn't beat as much of that out of me maybe but For my classmates and the other, you know 200 and some people I was in in medical school with

It never came. You know, we didn't talk about that. We didn't talk about sleep. We didn't talk about super important things to our longevity and our health. And then even on a personal level for our performance as doctors, you know, and the next step we go and we all get sleep deprived for five years. I never understood that. Yeah. Like how is that safe that people are sleep deprived and then

practicing on people? I would say it's probably is that safe? That people are sleep deprived and then practicing on people? I would say it's probably not that safe. The mindset, this is the paternalistic side of medicine that goes back that is, you know, if you're in medical school and you're getting through, you're a hurdle, hurdle, hurdle, and you're jumping over them, how high? You know, how do I get through this? You're really good at achieving these metrics. Then you get into residency.

That's what we call that period where you sub-specialize. And you do get into this heavy, heavy type of training where you're paternalistically being sleep deprived. It's part of the hardcore initiation, can you do hard things, part of it. That realization actually happened when I was in training that we started to try to limit work hours so that we weren't working 110 or 130 hours a week and

When I say we I'm talking like the royal group of you know residents and all the different specialties It's different and different things but surgery tends to be one of those ones that is you know You work for two straight days You don't sleep and you go home and you have eight hours and you come back and do it again And that's not good. There's no way you're at your peak performance in that there's no way you're even at a functional baseline of performance in that and it It's the opposite of what it should be not only is it you know Well, should we be encouraging that for our patients? But we should be practicing that ourselves and this is one of my big missions in my world of surgery

You know, I do I'm we were kind of talking about this I'm very narrow and deep in my world of facial plastic surgery but one of my missions is, for all of my colleagues, especially my surgical colleagues, is, how can you be at peak performance? Because when you have a surgery someday, whatever it's, almost everybody's gonna either

have one or know somebody, a loved one, who does, right? Could be a knee surgery, could be elective, could be orthopedic, could be taking out your gallbladder, whatever it is, you want that surgeon to be at their best that day. That's the huge event for you. And for them. It's case number eight today That's is that good, you know, or should that be their main focus that's happening And so I'm really about trying to make my colleagues at their peak performance in whatever specialty they're in as well

So how do you take your values in health, nutrition, sleep, and apply it to your personal routine? Like, let's say you have a big surgery one day, what are you doing the night before, the morning of? Yeah, my whole, I don't want to say my whole life, but a lot of what I do from a very, this is a passion project for me. I love what I do. And so I'm thinking about my surgeries next week already.

And I'm tailoring my workouts right now, my cognitive load, even something like this. This is all built into my plan for next week when I'm in the operating room. Those days that I operate next week, I will be at peak performance. I will break myself down to the right level. I will build my resilience, and then I will peak on those certain days. That's kind of what an athlete does if you're pitching or you have a big game or something like that. So a lot of it revolves around that. So my workouts right now are geared towards being resilient, being strong,

being hard to kill because something will, a hurdle will come up in that. Like I'll have a kid who needs a little extra emotional support or I don't get the perfect night of sleep the night before, whatever it is, I have to be able to bounce around that. But I have the luxury in my world because I can choose who I work with and I don't have to do a certain number of cases every day and bill insurance for what I'm doing. It's like it's me and you and you're my only focus that day. You're the only thing I'm doing. So I can go into it like ready and I don't have to think about anything else. So because of that I can really get

to those levels and I have a routine that I do the day of to get into like a flow state that day, which I'm very facile and good at now, but it takes a long time to learn how to do that. And it's very energetically expensive and I have to learn how to recover afterwards to maybe do it again the next day. So there's a lot that goes into it, but I'm super fortunate and very grateful that I can sort of have one kind of major thing to do a day and it's my big event for the week or the year, whatever it is. And I get to kind of do that over and over and beyond that cycle a little bit.

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Because I think people listening, even myself, have a very different assumption about what plastic surgery might look like. But after researching you and your process, I was pretty surprised by the way you do things. For example, the anesthesia, the pain medicine afterwards, how do you handle that approach that's different than maybe another plastic surgeon? Yeah. So this is where my personal values and mission come into this a little bit too in the application

to my patients. So 100% of my patients travel to see me. So that's a little bit of a unique aspect, how we start virtually and meet and get to kind of, you know, kind of have a relationship, which is maybe kind of like virtually dating almost a bit before we get to meet. So there's a challenge to that. But then once we're sort of together, that's when the time leading into it,

I'm optimizing them from a nutritional standpoint, inflammatory standpoint. I want them ready for this event that's going to happen in that athlete analogy. I'm treating them like an athlete too. You're about to have a big event, or in this case, kind of like a known injury. You know, it's a controlled injury.

But we know that on this day day this is going to happen. So let's have you ready for that, right? Out of curiosity, what is the dietary? I know it's probably individualized, but what is the dietary recommendation? So that gets a little bit into so for probably a lot of people who are listening with you, they're already familiar with a lot of these things to do. But that could be something as simple as eliminating processed foods, sugar, certain types of fatty acid profiles or oils. We're looking at all those. Sometimes we're even looking at what cleaning products people are using to sort of make that better. Do you have a recommendation of one? Let's just say I try to keep it clean. We're going

to go into like basic essential oil types of cleaners and vinegars and things like that. And then again, for a lot of people, that's not an issue for them. But for some very obviously, like you're cleaning your house with this product that we know is not great for you or a lot of like, you know, artificial scents and things like that. So I'll get somebody and this includes like a peptide protocol going into their procedure, stem cell mobilizing, all kinds of things like that. So they're ready when they come to see me. And then we get together and the day of the procedure is very intimate.

Like, again, you're the only thing I'm doing that day. So we have a lot of time together before that. And this is important to me because I want to be happy with what I'm doing. And I want you to be happy with what we're doing. But it's a big relationship. We're forever enmeshed to some degree once we work together. And I work with a lot of younger people.

And the reason for that is the procedure, this gets into like, I think, the meatier question. The procedures that I do are very minimally invasive in comparison to what people think of. So let's say it's somebody who's having a facelift, right? And a facelift, everybody thinks, is, oh, incisions around your ears, and are you willing to trade this for that? And well, a lot of the lifts I do, I don oh, incisions around your ears, and are you willing to trade this for that?

And well, a lot of the lifts I do, I don't put incisions around the ears. I'm using these very remote, minimally invasive, we call them invisible access sites that may be hidden back in your hairline, little small spots. And I'm able to go into those fat pads and elevate them in a very minimally invasive yet robust way to do that.

So it could be a little bit of an earlier stage where there's not such an initiation hurdle to get to have that type of a procedure done. And again, I'm not saying that younger people should be doing this. This has to match up with your value proposition and what you're after. But there's people who just have genetic predispositions

to have some earlier aging changes, often in the lower eyelids or along the jawline and chin and things like that. And we can get into what to do about those. But so I'm working with a lot of younger patients in that. And then we get to the time to go back to the operating room, saying this is where things get really, really different. And the point of anesthesia is to make you not feel anything,

not remember anything, basically be unconscious, if you will. And so general anesthesia is the idea of just pushing somebody analogously to the bottom of the ocean. You just slam them down there and then you breathe for them and take care of them and they're just sort of like at the bottom. That's a huge physiologic load and it's a big issue for your neural cognition. We are shutting your brain down essentially. So I like to do that a little bit different where I push somebody just underwater. So you're kind of like just barely asleep. And before I even do that, I'm putting, where I push somebody just underwater. So you're kind of just barely asleep.

And before I even do that, I'm putting binaural beats in your ears that have like theta waves. And so you're getting to this very calm, trance-like state just with headphones before we even need any anesthesia. So you're already kind of part way there before any medications have been started. And when I do the medications, I don't use any opioids or narcotics. People talk about those. I don't use any of these things called benzodiazepines, which are sort of related to alcohol. And the reason I don't use those is because we know that opioids are hard on your brain and they make you not able to go to the bathroom. It's just a bad

experience afterwards when you have them. And benzodiazepines are really hard on your brain for young people. if we look at kids, we know that they lower kids' IQs if they're constantly exposed to them. For older adults, we know that it can push older adults into earlier states of dementia. And that doesn't mean that if we take it, we're fine. It means we just don't notice those little changes

that happen quite as much. So I'm not doing that for an elective procedure, especially on somebody who may be a little bit younger. Is that something, so I've had a lot of friends that have had like boop jobs and things, and I know afterwards they're like recovering for weeks and weeks and weeks. They can't go to the bathroom. They feel foggy.

That's exactly what it is. They're getting the benzo, what is it? Diasepine? Benzodiazepines, narcotics, and then they're getting the general anesthesia, which is these inhaled gases that are fat soluble. So they get into your body and you have to like clear them out after they've been in there. Scary.

Everybody talks about these days of fog after their procedure and that just doesn't exist with what I do. Wow. Okay. So they're under now, you're going in, how long is the procedure? They vary in length. Sometimes they're an hour or two,

sometimes they're eight or nine hours, just depends on how much we're doing. I try to really get into comprehensively doing as many little small things together as we can kind of based off of your needs, right? If you're in your late 30s you're gonna need a lot less than somebody who's in their 60s and that's so that's just kind of how it all boils down. During the procedure, you know, they have that type of anesthesia protocol that we talked about. They're just it's just like this very perfect finite line. I use local anesthesia protocol that we talked about. It's just like this very perfect finite line.

I use local anesthesia to help any discomfort during the procedure so you don't basically feel anything. In full honesty, you could probably do these procedures fully awake because you don't feel anything. Now, there's a lot going on in the operating room and for most people, it's nice to just kind of barely be asleep and great. That's a nice little happy medium basically. We get done and at the very end,

I will also use these long acting nerve blocks at the very end of the procedure, which is great. I can do that on the face. I've done tens of thousands of those now in a sense where I don't want you to have to need pain pills after these little procedures. And so I do these nerve blocks and they last about 72 hours. And for most people, the pain of a procedure

is in the first 24 to 48 hours. So we nicely walk you through that window with this sort of blunted sensation, and then you come out the other end and you didn't need a pain pill. And for 95-plus percent of people, especially if you're motivated, that works great. You don't need them at all. So it's just a nicer experience, a nicer recovery.

During the procedure, I'm very aggressive with my regenerative medicine protocols that I'm doing. So I'm using your stem cells out of your fat, I'm using your growth factors out of your blood, all these things that are coming just from you, and somebody like in their 30s, 40s, 50s, young, healthy, incredibly active stem cells. These are wonderful tools that we can use from you

to help our results get better and help your recovery happen faster. Okay, so stem cells I'm really curious about because I've heard a lot about them. I heard people are like flying to different countries to get them. Is that because it's not illegal in America to use them? Then why are people flying to other places? It's interesting because that paradigm has been shifting a little bit. So I'm using them in a cosmetic autologous, we call it setting. They're coming from you, right? And so in the US that's totally allowed, totally legal, inbounds, no problems at all.

Where the US limits it a little bit is in taking somebody's stem cells, and then replicating them, proliferating them over and over. We call them these cell lines, and then using certain enzymes to process them and things like that, and then using those to inject into somebody. So if you go to Mexico or Central America, you can get this stem cell that has been replicated thousands or more times for 15 years, and then they just take some off of the pile and give them to you, and you can get these really, really high numbers.

So that's kind of like outside of my particular specialty, but I do have that in my practice as an adjunct, because I use those types of things to help my patients recover after their surgery. So during surgery, you get your own stem cells and your own growth factors, and then afterwards in the recovery, we're often using these allogenic or allogeneic, which means they're coming from somebody else, like umbilical derived stem cells, which just come from normal births

where they take the stem cells out of the umbilical cord, this cool stuff called Wharton's jelly, it's awesome. And we can take the stem cells and use them in a therapeutic setting after the birth's done. So that's also legal in the US. You just can't take those and proliferate them. Got it. The interesting thing is in these other countries

where they've been proliferating these stem cells for years, this kind of makes common sense when we think about it, is every time they replicate, they lose a little quality. They're not absolutely perfect in this sort of like forever replication. And so the paradigm has shifted back towards, well, maybe it's better to use these brand new instead of replicating them over and over again. And then maybe the numbers

that we were using in these incredibly high quantities, it wasn't that useful. There's some maximum dose. So the pendulum has really swung back to what we're doing in the US anyway, which is using fresh non-replicated stem cells, which is the best kind, and then using numbers that are a little bit more reasonable and appropriate of them. So now, interestingly, all going overseas has really slung back to like, we can do a lot of that here. And I use them post-operatively. A lot of people are using them for orthopedic things.

If you have arthritis or an injury or something like that helping you recover after those. So are stem cells injected in the area that needs healing? Mm-hmm. Okay. Yeah. And how does it work? So stem cells are, I call them like the warriors of our cells. They're the ones that when things get tough, they get activated and turned on.

So inflammation, stress, injury, they get activated and they're magnetized to that area. Then once they get there, this is where the warrior thing maybe fails a bit because they're not like fighting, but they're sort of more orchestrating the healing of this area. They're releasing growth factors, which we all hear about, but they're releasing growth factors through these little things called exosomes, which are these little pockets or these little envelopes of growth factors that they release to an area. They basically just communicate with all the cells to help healing. They make new blood vessels, they help lay down collagen,

and then elastin. They orchestrate all of the healing in that area, and then when their job's done, they aren't needed there anymore, and they kind of move on or move away. In certain areas, we kind of have chronic inflammation going on. If you have osteoarthritis, like joint pain, great.

Stem cells will do that, really great there for a long a long long time if you have an injury from a surgery great They'll help that whole process of healing or if you have just kind of sort of baseline aging changes going on Like let's say you just have skin aging from a lot of sun damage over the years If you put those stem cells in your skin We know that they will change the way that your skin is healing and they'll upregulate the precursors for like elastin tissue, which is the magic thing that we really, really want to have a lot more of in our skin because it goes away very quickly. I don't know if you know Chris Bumstead, he's Mr. Olympia bodybuilder. I don't.

So he's won eight times in a row, best physique in bodybuilding. My husband's into bodybuilding. That's why I know about this. And he was injecting stem cells into his kidneys during the process. I think because obviously they take steroids and things like that to compete in bodybuilding. I wonder if that was sort of his effort in offsetting the negative side effects of steroids. That's exactly what it'd be, steroids and probably a super high protein diet where you have to process all that nitrogen through your kidneys. And so yeah, that would be a strategy toids and probably a super high protein diet where you have to process all that nitrogen through your kidneys. And so yeah, that would be a strategy to, again, go to an area and put your warriors

there, put those cells there that can help sort of orchestrate the healing. Interesting. Okay. That does sound pretty intense into the kidneys. Yes, it does. And you can put in, you know, I'm saying orthopedic things, but yes, you can put stem cells in a lot of different organs and spaces and help them happen. I think a lot of people think that stem cells means that you're like making little hearts in a you know dish or then implanting them. We're

so far away from that. Yeah. You know we want the regenerative part of the stem cells to work which is why you might put it in a damaged kidney or something like that. Got it. And I've heard you mention that you're a big fan of red light therapy. Yes. For recovery. Can you tell us what you think of red light? Because I talk about it a lot. I love it. I have a lot of like acne scarring and I use red light for that. But tell us how you use it. Yeah, red light is sort of the baseline entry biohack. And I don't love that word per se, but it's a way to sort of optimize our biology for healing. And red light's great because it's simple. It has little to no side effects other than expense, really.

That's the only thing. When people actually, I get a red light mask, I'm like, if you can afford it, absolutely get it. It helps. And so if you just put it on normal skin that is sort of unaffected, uninflamed, kind of like where you're at right now, you have just normal life happening, basically.

It helps via a mechanism that we call photo biomodulation, it's kind of a fun word to say. Those photons activate because they're red light, so they're a long wavelength it helps via a mechanism that we call photo biomodulation, it's kind of a fun word to say. Those photons activate because they're red light, so they're a long wavelength and they penetrate deeply into our skin, which blue light, shorter wavelength, doesn't penetrate as deep, right?

But that red light goes deep and then it affects mitochondria. And the mechanism is still being really elucidated as to how that works, but it turns on the metabolism inside of our mitochondria and they do better. So those mitochondria in our skin fuel these cells called fibroblasts that make collagen and elastin. Again, I'm going to keep saying elastin every time I say collagen because that's the one we really want to focus on. And it's harder to make and it's a really delicate flower. It's more sensitive to oxidation and aging and photo damage. And so we really want to focus on elastin

and red light can help with that. So that would be why you'd see improvement with your acne scarring, especially if there's some activity happening in it where those fibroblasts are active because you're making them work better. But where it really shines, this is my world more, where it really shines is if you have now created

a little micro injury on purpose, micro needling, a laser, a surgery, something like that. Now things are really working to heal and we can really fuel that process by putting red light on it. So it's even more efficacious in a setting like that, which is what I'm doing all the time. I just did microneedling a couple of days ago and I'm realizing I need to do more red light.

So thank you for pointing that out. Yeah, it's perfect. I mean, that's kind of best bang for your buck when you're activated from that. So when you have your patients under, are you ever doing any skin rejuvenation? Yes, I am not an absolutist, but I'm gonna say almost always I'm doing that.

And the reason for that is, again, whatever sort of procedure we're doing from a surgical or minimally invasive standpoint, it's focused on anatomy and positioning and rearranging and kind of putting things back where they were. With those procedures, I'm usually moving fat pads back to the home that they were at before they moved away, right?

That doesn't do anything to the overlying envelope. And this is where I get into breaking down qualitative versus quantitative changes. The qualitative, the structure of our skin, nothing surgically really touches that at all. This is where the regenerative medicine comes in, but the regenerative medicine, like the stem cells and the growth factors, just like the red light,

work way better if there's a stimulus for that response to be happening. That's where the laser comes in. So I use lasers like a cocktail in my practice. I don't just do one, I don't just do the same thing for everybody. It's very much who are you, what are your needs, what are the unique aspects of you we can address, so then I'm going to mix up the ingredients I have, lasers, to kind of get the best and

most efficacious cocktail for exactly where you're at. But that involves little micro injuries. Again, on purpose, very targeted, very controlled, and that's where we want to really help those heal. But that's the qualitative benefit of making new collagen, again, and new elastin tissue, the really, really hard one to make. Have you heard of the CO2 laser? I have heard of the CO2 laser. I use that one often. You do?

Oh, very, very often. Okay, because I'm very curious about it, but it scares me that you kind of come out of it looking like a burn victim almost. Like you have blisters on your face, it's a lot. And I'm nervous about that recovery. And then don't they generally, I mean, other doctors would put you under anesthesia for that, right? Right. Yeah, there's a few ways to do that. And defining what lasers are, I think, is important because there's lasers,

there's other devices like radiofrequency of micro-neuron. I've heard you talk about Morpheus on here before and It's really getting to lasers are a specific wavelength of light They are very targeted so precise like that literally one wavelength of light has a specific target in the skin that it can hit So with the co2 laser, it's a very specific It's the most specific laser that we have to hit water or collagen. And it does so with such an affinity that it immediately heats it to, we call it vaporizing temperature. It's like greater than 100 degrees Celsius.

It just kind of gets rid of that little area. So it provides a very precise amount of heat and definitely can control it so, so well. So when you think of a CO2 laser and you think of like a burn victim or that's not really what's happening because it's also not just taking the whole surface of your skin and you think of like a burn victim or that's not really what's happening because it's also not just taking the whole surface of your skin and getting rid of it, it's pixelating it. So it's like micro-coring or people would say like aerating your lawn a little bit, but in a very sophisticated, you know, laser-esque way.

And so for something like acne scarring, that's going to be your gold standard to improve that. And you have to do it in a way that is thoughtful and progressive and it shouldn't be a burn victim situation when you're done. And you should be using these aggressive, regenerative medicine modalities afterwards to help the healing happen, not just faster, but better, better end results.

I live in this like space of, you know, I'm taking a lot of people who had something done prior, acne sc surgery and they're like seven or eight out of ten like it's pretty good but they know there's a little bit more on the top and that's the space that I live in to kind of help those last little bits happen and that's where these little things help even if you're getting five percent better because of well let's do that that's five's 5%. That's real results. And so for acne scarring, say, rarely am I ever just doing a CO2 laser by itself or something like that. I'm usually using fat-based stem cells and often a little bit of fat underneath the scars to help support them.

So there's just a lot more to it. And this gets into all the surgical aspects, too. You have to think upstream, downstream. What are all the things that are contributing to this problem? And instead of just tractor beam focusing on one part of it, we want to be looking more holistically about how we can make all the other areas better. Are you ready for the best sleep of your life? Dream Recovery has science-backed solutions to help you feel your best each morning. You guys may remember Todd Anderson.

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Yeah, no. Most of what I do is surgically, again, minor things from an invasiveness standpoint. But if we want to go just down a non-surgical route, we can absolutely do that as well. So for something like acne scarring, laser, fat transfer, and I think that we'll get into this at some point, but when we start talking about fillers and filler alternatives,

that's where something like fat transfer becomes a really beautiful option for that. And it can be something that's performed by itself or with a laser often. Okay, let's talk about fillers. Let's do it. People my let's talk about fillers. Let's do it. People my age are obsessed with fillers. And I've talked about this before,

but I've dabbled with it in the past. I've gotten lip filler a couple times, not for a while, because it hurts so bad. I was like, I can never do this again. And then one time, and this was my biggest mistake I've ever made, but I got it under my eyes and it looked crazy. Like when I smiled, my eyes just disappeared. So yeah, that was a very long time ago and I'll never do that again.

But what are sort of the, what should people understand about filler before getting filler? Yeah. Well, I know you've talked about this on here before, and I've had Celesta on and Dr. Yun talk to some other people that are really great and have lots of experience with them, getting them, using them. And I think that really understanding what they are, the ones that most people are thinking of

and the ones that you've had, I believe, are these cross-linked hyaluronic acids. And then I know you've talked about Sculptra on here, which is a bio-stimulant that you inject, and it stimulates the growth of collagen, which sounds real sexy. Like, why wouldn't we want to do that? Let's do it.

Yeah, it sounds great. And there's a bunch of these other bio-stimulants. And so it's really getting to, OK, which one of these are we talking about? Because they're all under fillers. And I also think a lot of people get fillers confused with Botox, right? And you can see why that might be, because you go to the injectable place and there's this

magic array of all these little wands that they can do that help you. And so Botox is a whole other category, right? But when we talk about the fillers, these fillers are adding a gel that's intended to create volume. That's where the baseline is. And so how old were you when you had your fillers? Do you remember the under eye or the lip either one? Okay, so I'm 30 now I probably got the under eye like five years ago six years ago And then the lip for the last time I got it was probably two years ago Yeah and so that you're that's the younger end and that's when people are often getting into this verse and that makes perfect sense because

They sort of have this idea about them that they're very low entry they're not overly expensive you can get them almost anywhere within here there's probably five places within a mile that we could get it done and so that seems so innocuous but not like no big deal let's just get it done. We have to understand at those ages especially, and even into our 30s, is you probably didn't have a lot of volume loss happening at that point. Maybe the first steps of it, right? And even in the long run,

we have to understand how much volume loss plays into our facial aging, because there's multiple parts of facial aging. There's volume loss, there's redistribution, there's change in positioning. And I always tell people to think about like breast tissue, because we can really put our mind around that. As the breast ages, it doesn't just shrink, it changes shape, distribution, the direction, all the types of things.

And so when we want to rejuvenate a fat pet in our face, it's very analogous to that. We have to think about, okay, well, if you have, let's just say, an extreme age, a 70-year-old breast, you're not going to add an implant to that breast to rejuvenate it. That's not going to look very good, right? And that would be like adding filler to an aging face. It just doesn't look very good.

So when we're getting at it younger ages, we really need to think of it more of a, instead of a rejuvenating type of treatment, trying to turn back the clock a little bit, oftentimes it's transforming a little bit, like making your lips a little bit bigger than they ever were prior, you know? And that's totally fine. But we have to think of it that way. Instead of thinking, well, I've noticed some aging change in there. Probably very little of that aging changes volume, so when you're using volume to restore it, that paradigm gets off a little bit.

Under your eyes, again, an area you probably had very little actual volume loss, there's probably some genetic predisposition there for you to have a little bit of like a tear trough or lower lid eye bags who would call it That's probably why when you got your filler you're calling it the biggest mistake ever because you replaced What wasn't lost volume with adding volume to it and probably made your eyes smaller Yeah, I didn't even dislike my under eyes. I don't know. She was just like I would recommend doing it. I was like, okay Okay. Yeah, and you trust that person because you person because you go to this person who's an expert, their mom wrote their bio, they're the best injector,

they did all, it's all over. Everybody on every corner is like the best ever. And so you trust them, and that's, why wouldn't you trust them? You should do that. And that's where the paradigm gets off a little bit because then you come out of that and you look different. This is my big question for everybody,

especially after filler results is look at them and they look different, but do they look better? Because every filler result afterwards it's different, but is that what you want your lips to look like? Is that how your lower lid should look? They were certainly different afterwards, but you went to somebody who you trusted and you paid them money and it looks different, so you assume, well, this must be better, right? This is, I trust that this is what it's supposed to look like.

And this really interesting phenomenon happens, especially when we're younger, right? Where we're kind of setting our true North Star. Every time we look in the mirror, that's your identity of who you are, right? And that changes over time. And if you all of a sudden look 65 today, that would, you'd think, what happened?

But when you're 65 and you look in the mirror, that's you, right? Because it's the slow evolution over time. So when we start adding filler into this mix and equation, things slowly morph and that becomes your new true north, what you see in the mirror slowly over time. And then the way that the paradigm works is, well, you need to get it done again in six months or a year.

So you do it again and you do it again and you do it again and that slowly morphs and all of a sudden you don't Really look the same that you did before. Yeah, but that is what you are now Perceiving as yourself. It's called perception drift Your perception of yourself is now off The same thing happens to your injector who is getting a double dose of that because they're often injecting themselves, too So they're looking in the that because they're often injecting themselves too. So they're looking in the mirror and they're getting that change.

But then they're also getting you coming in or their patients coming in all day every day who've slightly morphed from the norm, but they're getting that set as like, well, this is what it's supposed to look like down the line. So they're getting kind of a double dose. And you'll see that in injectors often. If you walk into your injector and you look at them

and they look a little bit off, you know that their true north has been reset. And it's true and it happens all the time and you're laughing, I'm assuming, because you know what I'm talking about. But you still have that person inject you, knowing that when you look at them, you're like, this is not what it's supposed to look like. But this is what they do and they're the greatest and it's very prevalent in this perception drift.

And this is when I see people, especially younger people, because now they're in trouble a little bit. And they've realized somebody told them, they saw an old picture, or they just had that aha moment where, oh shoot, I don't look like myself anymore. My lips aren't what they used to be. The filler has migrated, whatever it may be. And it's sort of like, well, now what do we do? I saw on your TikTok account, you had a younger woman

in the office who kind of, it looked like it had migrated and was creating like imbalance, I think. Do you get a lot of those cases? I do, yeah. So once the filler is placed in present, and again, I am not anti-filler, right? I just think that our thought paradigm around it needs to shift to be what it is. And we can talk about, anti filler, right? I just think that our thought paradigm around it needs to shift to be what it

is. And we can talk about I think what the big misperceptions and misunderstandings are. And those are that it lasts a year or two, it does not last decades. And I see it in tissue all the time. That's a huge deal. The dissolution part of it, it doesn't work as well as we all like to think that it does. It's not a magic wand where if you just don't like it, you put the magic enzyme on and it all goes away. Some of it goes away, some of it breaks down, but a lot of it hangs around.

I can't tell you, every week I see somebody who had filler 12 years ago and they've had it dissolve six times and I still find it in the face all the time. And this is my lens, my world, and I have to acknowledge that that could be a sampling error, but I see to acknowledge that that could be a sampling error, but I see it very, very regularly. So it lasts longer than we think, it doesn't dissolve that easily, and it does move. We know that for sure. And we have evidence to back all those up through imaging studies and biopsies and what I see inside of tissue.

And so if we understand those things, that it lasts a long time and it moves and it doesn't probably go away, it just shifts to other places, great, then we can use it more appropriately, right? And so I see folks who have been through the rounds of not liking it and having dissolution and there's a whole conversation around pros and cons to dissolving. And oftentimes when I'm getting to them, it's a point where, okay, now we are doing a few things. We are getting rid of the filler that's problematic, some of which I'm doing manually. So through these invisible scarless approaches, I'm trying to get the filler and manually remove it. Then we're also usually correcting the

underlying thing that led them to get filler in the first place, that little genetic presupposition, whatever it was. And that's the, it's a really common scenario for me to be in where we're just like, okay, let's just keep this as stealth as we can, hit the reset button as best we can. But even in that, the sad truth is I can't get rid of it all. Even with dissolving, even with manually removing, it doesn't all go away. And especially in some very important areas like our lymphatic system. When we dissolve filler, filler is gel that like these polysaccharide sugar gels that get cross-linked together. And this cross-linker is not great either, but when the enzyme breaks it down,

it breaks it from polysaccharides into disaccharides, like two groups. And they're still cross-linked though. And our body has to clear those out, which it does through like normal metabolism in our kidneys and in our lymphatics. Well, those little guys get stuck in our lymphatics. And I see this in surgery all the time too. If you had filler 25 years ago and only had it one time, I know that when we do your surgery today, whenever we're doing it, that you're going to have more swelling afterwards because your lymphatics aren't going to work as well to drain that out.

And that's a very acute amount of swelling. We're putting a bunch of load on those lymphatics aren't going to work as well to drain that out. And that's a very acute amount of swelling. We're putting a bunch of load on those lymphatics from a surgery, from little micro injury, and they just can't drain as well. But a lot of people that have had fillers see this in these little micro environments all the time when you have a vaccine or a cold or get your teeth cleaned or have hay fever and you get this little systemic inflammatory reaction that your body's reacting to and your filler gets inflamed. Your filler gets inflamed because your immune system recognizes that it's still there. It is not inert completely. Our body

knows it's not supposed to be there and there's this little chronic inflammation that happens around it and then that gets revved up by this systemic process that's happening and this can be an aha moment for a lot of people too. They're like, oh yeah, my cheeks get sore when I get a cold. That's your filler lighting up or my lips get a little bit swollen when I get my teeth cleaned or when I have you know whatever it is but then that fluid doesn't drain out as well either so you have this kind of prolonged swelling. So a lot of people, again, that'll be an aha moment where they're like, oh that does happen to me a little bit. Yeah.

Yeah. Are you a fan of lymphatic drainage massages? Oh, OK. Yeah, I love them. And I use them post-operatively for my patients afterwards. Not only is it a beautiful, wonderful experience to have it done, but it really does help. The way that our head and neck drains,

it kind of goes to the back of our head and then down into our neck. And so most of the time, I focusing on the drainage through like your collarbone collicular area to help the lymphatics drain out. And you mentioned Sculptra. What is your opinion on Sculptra? Yeah, so Sculptra, it falls in the same thing. Sculptra is an idea of injecting this stuff called polylactic acid. It's a little acid that gets injected. And it is used in medicine in a lot of different ways.

We use it in sutures and orthopedics, they use it in these little bony screw anchors that they put into the bone and then it goes in and then it kind of dissolves over time. So our body breaks it down and gets rid of it because it's a little foreign body. So when you put little micro particles of this in your face, our body recognizes it as a foreign substance and it lays down a little collagen border around it. So that's why I say on one end, stimulating collagen sounds really sexy. And on the other one, you realize the reason we're stimulating collagen is because we're putting a foreign body in there essentially

and we're creating this very specific type of inflammatory reaction called a giant cell reaction. Maybe it's not as sexy to do that, right? And also understanding what part of our facial aging, this gets back to being curious and having common sense, what part of our facial aging is due to collagen loss? So if we just lay down a bunch of Sculptra, a bunch of collagen, is that really the thing that we need to be replacing?

Should we be replacing lost fat with fat? Should we be replacing lost fat with collagen? And I would say that in small quantities, it can do a really great job. It can be a good option. In larger quantities, I'll see people who've had three, six, 10 sculptor treatments. It gets problematic. When I do a surgery on that person

who's had all of those treatments, it's a whole different animal in there. Normally a surgery, when I take these tissue planes, like if I'm doing a little lifting procedure, they just separate beautifully parts like opening the pages of a book, it's meant to open there. I'm going in areas that are very specific to be sort of separated out. When someone's had Sculptra, it's like you put a bunch of glue in that book, little dots of glue everywhere, and then I'm trying to open it without tearing the pages. It's a whole different animal. And I, on my Instagram, have some videos

dedicated just to Sculptra. One of my highlights, I think, is for Sculptra. And you can go look and see, some of them are slightly graphic surgical videos, not too bad. But you can go see what that actually looks like, these little weld points in these little white fibrotic areas of where the collagen is getting laid down.

And I think it just puts a visual on like, this is what's actually happening underneath our skin. So again, not bad, not good. I just think it has to be understood for what it is, used appropriately. And this is my world and my opinion, fully my opinion, but I think there's better options to do what Sculptra is trying to do.

I think the way they sell it, which is interesting, is that it's stimulating something that already exists in the body. So I fully thought Sculpt sculpture was like the bougie, correct version of filler. So it's really interesting to hear this. And that's not completely incorrect, right? It's where the sculpture is getting injected, right?

People put it inside of the subcutaneous fat of our skin, of our face, and that's the fatty layer that exists right below the skin. And our fat pads in our face are actually in multiple layers. There's deep ones, there's superficial ones, they're meant to be the glide planes so that our muscles of facial expression that allow us to emote and animate and communicate can move very freely. So you could imagine that you don't want these little weld points

in those areas of these fat pads that are supposed to be highly mobile and moving, that's where things can get, you know, collagen is essentially what scar tissue is made out of. Those little points don't move quite the same. And so there can be these subtle changes that happen that don't quite look right even from a normal animation standpoint. I feel like something I've noticed lately is this fascination with the upper bleph. Am I saying that right? Yep. So I've seen a lot of girls even my age getting this done.

Have you noticed that in your practice? Yeah, this is one of those things where my job becomes to heavily educate. Upper bleph is short for a blepharoplasty, which just means an eyelid surgery, right? Changing the upper eyelid. And it is trendy in a younger group right now in the like 20s, 30s. And this is where I have to get into sort of educating what's actually happening there, right?

Because when I really explore my job, my first thing that I do when we meet and we're like having our first conversation is I wanna seek to understand what you're after. It gets a little, and this happens all the time, it gets a little dangerous if you tell me like, I want an upper blepharoplasty. and I'm like, let's do it. Makes you happy. You know, get for me is like, great, I get to do a

surgery. But that's not what you need. Right. And this happens in all facets with sometimes a woman comes in and says, I need to want a lower face and neck lift. And the surgeon's like, great, let's do it. And that ends up being a really bad outcome for that person. In the end, she got what she wanted, the surgeon did the procedure made, let's do it. And that ends up being a really bad outcome for that person in the end. She got what she wanted, the surgeon did the procedure, made her happy, but there was no second order thinking

as to what did you actually need? What are the upstream and downstream effects of that? Because now you have this really tight, full, lower face and neck, and everything else is sinking on top of it, and you look kind of ridiculous and unnatural. And that's what everybody thinks when they think of bad plastic surgery,

is that first order thinking, right? So the upper bleph for young people is a first order thinking problem, right? I have something in my upper lids that I don't like. Okay, well, let's explore what that is. Because in reality, no parts of our face age individually. They all age in unison, right? Your forehead ages at the same rate that your cheeks and your jawline, while your genetic predisposition plays into what shows up first or what?

Bothers you maybe but everything is aged in unison to some degree So if your upper eyelids bother you what's happening with your eyebrow up above? How is that playing into it? Did you just get Botox and now your foreheads heavy and you think you have a extra upper eyelid skin? Super common. Do you actually have a little bit of asymmetry to the space of your eyes? I call it the aperture of your eyes. Do you have this funny word that begins with a P, where the P is silent, called ptosis? Do you have one eye that's a little smaller than the other that you notice when you take a picture or when you're sleepy, first thing in the morning, late at night, or when you

have a glass of wine? Well, that's not an upper eyelid surgery. That's not the same thing. So it's really delineating what's happening. And it's often, especially in a younger age group, one of those other things that is more responsible or partially responsible for what you're seeing. So your surgeon or whoever it is really has to understand all of the factors that contribute to that one thing. How often are you turning people down? Very, very, very often. And it's not even that someone has an unrealistic expectation

or doesn't understand. It is really, again, for me, this is a huge relationship. I don't do four surgeries a day, and you're not case number three, the eyelids. It's like you're Mari, and we're together forever, and I will always be there for you, and we will always talk. And I want to see you through this process forever, best I can and so from a capacity standpoint you can only do that so much right so I'm really choosy about who I work with for that

and because you know we both want that to be a happy relationship and it's just a really personal thing for me that way so I guess I have to give that caveat that it's not that I'm saying no to people sometimes because you know, I think they're a bad candidate or they don't want something real a lot of times it's just I want to work with people who Value what I have to give them, you know like if you appreciate all the things I can do for you great and if you don't I'm kind of doing you a favor because You don't you know if you don't care about the recovery process and the hyperbaric chamber and all these wonderful things that we're going to do afterwards, I'm not a great value proposition for you.

Yeah, I think that's such an asset though. Like I really think, I hope people are becoming more educated about that side of things. And you know, just by listening to podcasts or whatever it may be, I'm just, I'm thinking about the culture around plastic surgery and even the before and after photos on the internet. just by listening to podcasts or whatever it may be. before and after photos and I was just obsessed with looking at them and even filler before and afters in LA they're really big. What is the danger of the before and after photos? Right. Well, there's a bunch to this and from a very, so there's two parts to this. There's the nuts and bolts logistics of the before and after dangers, which is, and I talk about this a lot, it's hard, especially as a consumer,

to understand what a good before and after photo is from the level of like, I could take two photos here right now that look incredibly different, like the best results you've ever seen and all I change is the lighting or the angle or the settings on the camera. Has nothing to do with the actual procedure that was done.

And I see this done a lot. I like to think of this in Hamlin's razor, this like thought paradigm where most of the time I think it's because people just don't know. But oftentimes I see this person definitely knows what they're doing and they're altering their after photos. So that creates a dangerous, dangerous expectation as to what's going to happen afterwards. You're now going in with, there's no way you could have realistic expectations because you see after photos that are totally different, right? So that's part one.

And again, I like to think that's mostly just like people not understanding, not doing it on purpose. But you saw as a consumer, you have to be careful. Does this person know how to take these before and after photos? Part two then is, okay, it's different, but is it better? And that's especially different for something like filler, which is more, again, often transforming than it is rejuvenating or a rhinoplasty a nose job or a breast augmentation you're kind of by definition

changing it into something that it never was before so what the before and after photos you're looking at are not of somebody who's exactly you right there is no you can't show your doctor a photo of you five ten years ago and want to kind of go back to that like that's a very realistic metric at that point. This is just something totally novel and new. So you have to be careful with that too. And then it really gets into, are the photos good? Are they better, not just different?

Do you trust what this person can do? Are there lots of those consistent photos? It's not like, I saw a couple that looked like what I'd want and the other ones, you know, not so much. Well, that's, you're not, what are your odds of being the 2% of the good ones that you like? Yeah. So there's that aspect of it.

And then there's just the creating cognitive dissonance by looking at these photos, which you probably experienced a little bit. It's hard to look at a lip before and after, you're like, well, my lips don't look like that. Is that, should they look like that? Or should my breasts look like that? Or, and that's where this transformative part is,

it's not what I do basically, I do rejuvenative. I turn back the hands of time a little bit, I don't change you into something that you ever were, it makes me happier, it's just what I like to do. Not that that other part's wrong, but they're harder targets to hit at that point because you don't, that lip that's different goes back to, is that what your lip's supposed to look like?

Is that what your breast's supposed to look like? Is that what your breast is supposed to look like? It creates a lot of internal struggle as to, it's just like makes me sad a little bit inside in some way, not sad, but just like it's a struggle. It's a lot of work, it's a lot of emotional and cognitive load to manage like, what are you supposed to do in that situation a little bit? Totally, I've even seen my personal weight loss before and after

end up on plastic surgeons' pages, which obviously I didn't do plastic surgery. So that's pretty wild to know that they're just stealing photos and posting whatever. So you actually don't even really know what you're looking at. How often do people come into your practice showing you a photo?

Yeah, all the time. And I ask for this. It's funny that the stealing photos, Marby who's sitting with me in the back, our social media coordinator, photos get stolen all the time. And in all kinds of settings, and it's blatant, like we watermark them, and then they get stolen for all kinds of purposes, right? And that's just crazy. That's another I guess, I didn't even

talk about that as a logistic is, is this even this person's real before and after photo? Yeah. And so you'll see with my before and after photos, there's usually multiple sets of photos, multiple angles. There's usually a video. And oftentimes the way I like to do it from an educational standpoint is you can see that person's entire journey from what we talked about before surgery, the day of, right after, a month after, three months. So there's a whole longitudinal, it gets kind of hard to steal that. But that's

kind of one of our struggles, right? Yeah. So I asked for photos. I generally like to see them. Of their goal. Well, and for me, in the rejuvenative standpoint, their goal is just, I want to see photos from the past every decade. So let's say you're 50 years old or 30 years old and you have like, I have my first signs of lower eyelid bags say that's a really common 20s 30s issue because it's strongly genetically predisposed. So you have your first five or 10% of aging that's happening on top of that

genetic disposition and it turns into this conversation well I kind of always had him a little bit but now they're bothering me and so let's see the photos from when you were 15 20 25 years, and you can usually see that little evolution happening. So for me, that's great. Our goal is not 15 years old, but I can see exactly what the curve has looked like over time so I know where my targets are. So I love seeing photos.

Of the actual patient. Of the actual patient. It's a different story. I don't do this to be honest, but if they bring in a picture of a celebrity that they want to look like, that's a whole different animal. Cause now we're getting into that transformative side of thing. That's not you. And that's not what we really, what again, that's not what I find value in as much. So I don't want to do that,

but I do love current photos, old photos. You can see the transition that's happening. It's, there's a lot of aha moments. Like, Oh, you always had this little ptosis. Look, when you were in your twenties, this incredibly beautiful picture of you, that little bit of Isla difference was even there then. of aha moments like, oh, you always had this little ptosis. Look, when you were in your 20s, this incredibly beautiful picture of you, that little bit of islet difference was even there then. And it's like, oh my gosh, you're right. So we have these little micro targets that we can go after. What is the most common procedure that you're doing?

Yeah, so the fat transfer and the laser that we've talked about a little bit, I think there's a lot more of the fat transfer to talk about, which is really cool. Those are kind of a staple of almost every procedure that I'm doing, either by themselves or as part of the surgical procedures that I'm doing. When we get into the surgical procedures, the most common are definitely around the eyes because eyes are this very incredible part of our face that show all of our emotion, our nonverbal communication, how old we are, if we're attractive, all those things. Even like babies who have no sense of

beauty recognize their moms by looking at the central portion of their face. We have these hardwired areas in our temporal lobe of our brain. This part called the fusiform gyrus recognizes nonverbal communication. This part called the amygdala recognizes emotional aspects, like we can recognize more emotions than we can name in the face because of these cool parts of our brain. But it's all in the eyes. And so anything we do around the eyes is very important, very high impact, and we can do very little change there

and have really nice results. And so when you look at my before and after results, which is what my practice is built on basically, a lot of times you're looking at me like, I can't even really tell what happened or it looks like nothing happened, but it looks better. That's what that is. It's like triggering those little key areas of our brain that are highly in tune. And so I can take advantage of that in a way and be like, well, all we have to is these little changes to a little symmetry, a little this, little that, then all of a sudden it looks incredible and but you look like yourself and like nothing happened.

So eyelids really, really play into that. Fat transfers, I actually don't even really know what that means. Can you explain? Yeah. So this gets into the idea of fillers a little bit. It's not the same, they're not this perfectly like, you know, if A then B type of setup, but they're comparable in the sense that fat transfer is taking fat from another part of your body and moving it to a new location.

We're going to talk about the face mostly because that's my world, but you can do it to breast tissue or buttock tissue, that's like a Brazilian butt lift. I know you guys talked briefly about that on here in the past. Whole different animal than the face, right? Yeah. Not even comparable conversations actually. Different quantities, different way to do it.

When I'm moving fat to the face, I'm doing so in very low quantity, but in very high quality. So if I take a little bit of fat from you, which is this very minor process, we can do it when you're fully awake if we need to. Usually the person's like, you know, under that little bit of sleepiness for their procedure, but I use this little micro cannula. It's like a teeny little thing like you would use to pump up a basketball, like a slightly larger version of that. And I use this little hand syringe and I put a little suction, I get some fat out, right? Minor deal, kind of like a little needle poke

to get that done. But then I have your fat. And let's say I have your actual fat, Mari. It is gonna be so stem cell dense and rich and perfect and wonderful, because our fat is one of our most Abundant sources of stem cells on our body our bone marrow and our fat are those best places to get them So I can take your fat. I can take a little bit out

I can isolate this beautiful stem cell dense portion of it and then I can use that at for lack of a better terms as A filler to refill your fat pads because our fat pads lose a little bit of volume That's not the only change that happens in them. They structurally change too. And I can refill a little bit of the volume that happens by putting fat directly back in the fat pad like for like kind of makes sense. And then the little regenerative aspect of the stem cells will also strengthen the structure of the fat pads.

When you're in your 20s and 30s, our fat pads are like a honeycomb with fat in it. They're structural, they're strong, they stand up to force. If I take a 60 or 70 year old's fat pad, it's more gelatinous, it's not as strong anymore. And so we want to rejuvenate or regenerate back towards that strong structure in there. So the fat has this double benefit of being structural in its volumization and then recreating some of the actual, you know, bones, if you will, of those fat pads to make them better. So it's a little bit of a process and a procedure. I get very, I call myself like a fat connoisseur, I get

very into this as far as like taking fat and turning it into different sizes and different compositions and different stem cell densities, but the stem cells help it take and they make it reliable. They give that regenerative benefit. And then because of the regenerative benefit, your skin also gets better because the fat cells are releasing those exosomes and those growth factors and it gets to your skin and you get more elastin tissue. So there's a lot of benefits to doing that,

but it is a little procedure versus getting filler. And that puts a barrier for a lot of people because you have to be facile. You have to be able to do it. You have to have the setting to do it. And so there's just a little bit more to it, but it's much longer term. Fat cannot migrate like filler can do. Once the fat is in the fat pad, it has to establish a blood supply, set up and live

there. So it cannot move once it's set up versus filler that goes, sits, and then starts to diffuse out from that area. And when you put it in, it's also with a needle. It's with that, yeah, a little, it's kind of like filler where you'd use this little micro cannula to put that in as well. I feel like I imagined fat transfer as a full lifting of the skin thing. It's a very non-surgical way to do it.

I'm accessing the fat pads and I quite literally go through your face one by one, each fat pad and there's a superficial layer and there's a deep layer and And I just am visualizing, again, back to that 3D spatial part, visualizing where these fat pads are. And this one just needs a little bit, like barely any. This one needs a little bit more. And then we kind of work through them because every fat pad is aged to some degree. And so I can just touch through.

And in doing that, I can be really subtle with each area. But then when you step back and take the 30,000th of view, it's like this whole area is rejuvenated and looks really nice. Is that usually like cheeks? Yeah, I'll go through forehead, temples, upper lids, lower lids, cheeks, jawline, around the mouth, sometimes hands, everywhere that can lose volume. Okay, I had no idea. Yeah.

So if I'm already under for my CO2, might as well get a fat transfer. Right, well, and again, it's a value proposition, right? Like if you have 5% volume Right, well, and again, it's a value proposition, right? If you have 5% volume loss, is that juice worth the squeeze to get 5% of your volume restored? But if there's a little bit more in some other areas, or if we're managing acne scarring, the underlying fatty structure becomes really important because that scar is, if we look at our normal skin structure, there's an area of it that is contracted with collagen.

It's not as strong ever as your normal skin is. And then when we start losing the underlying fatty support, when we're young, when we're in our teens and 20s, our fat is so robust and literally keeps our skin tented up. And as we start getting early signs of fat loss and it starts to lose some of its support of the overlying skin, that's when acne scars actually usually start to show up more. So patients that have

acne scarring, we may not see them in their teens and 20s, but they may start coming in their 30s and 40s because they're losing a little bit of the underlying fatty support and it's no longer pushing that acne scar up and open. Well now we can go to the scar directly with regenerative medicine and with laser to help restore some elastin, some blood, scars tend to not have many blood vessels in them. So you can restore some blood vessels, some color, whatever it is in the scar itself, and then we can volumize the scar and we can support it from underneath a little bit better. So that's be like a really winning combination

for something like an acne scar. So 30 isn't too young to get this done. No, absolutely not. No. And again, but you have to, 30 is not too young to get it done if that meets your value proposition and it hits all the points that are important to you. We can keep it so minimally invasive from a standpoint that it's like, you're not like doing a bunch to do that. You're keeping it very in bounds from a stealth standpoint and from a, you know, picking the low hanging fruit

to a degree. So I know you work on a lot of very high profile, high performing people. Is on a lot of very high profile, high performing people. Is that a lot of pressure? Because I can imagine if it's like a performer or someone on stage, you're sort of responsible for their face. It is. Yeah.

And this is where the relationship part of it comes in. And this is where the seeking to understand comes in. And this is where the, on my end, the education part comes in and this is where the on my end the education part comes in. Most commonly when I see somebody for a fix or a revision, which is a great proportion of my practice, 65% of people that I'm working with, I'm taking care of something that was done prior that wasn't, not even that was really bad. Sometimes they're in trouble, it was really bad.

Sometimes it just wasn't great. They got their seven out of 10 and it's like, I know there's more. Okay. Then there's 90% of people have done something prior and it's just, you know, neutral, no big deal. But with a lot of those folks I'm working with sort of their past experiences. So I'm not going to say trauma as always, but there's a lot that goes into that. So part of my job becomes to educate them on what is realistic in their recovery,

because a lot of them were told, you're going to have this procedure done, two weeks later, you're fine, and it's over with, there is not a procedure that you can do. Maybe micro needling is a little bit different, because it's so minor, but there's not really a procedure you can do that's going to have a robust result, or two weeks later, you're fine, like nothing ever happened. That's not how our body heals anything, even if you get a cut on your leg,

it's not healed two weeks later, it takes a long time. When that's on your face and you're healing from something, even if it's non-surgical, even if it's acne scarring or fat and laser, we have to really discuss, okay, here's what our actual curve looks like to get through this. And so that's a big part of any high-performing person,

whether it's someone who's in the spotlight or it's just us and wants like, when can I work out again? When can I get back to my life? And you have to really, that's where the relationship comes in the education. We really have to get to like, here's what this looks like for you, Mari. It's different than it's going to look like for the next person and the next person. And setting those expectations, having the right relationship, and then really focusing on our recovery. Again, you're an athlete who just got injured. Think of it that way

You're not returning to the game two weeks later What does it look like for you to get back to your real life? And how can we expedite that? How can we use hyperbaric oxygen? How can we use targeted IV nutrition? PEMF mats, you know light therapy What can we do to like accelerate the process as much as we can also get you a little bit better results? And then just make that a great experience. So when we're done, we're hugging each other and like, that was so great. Thanks.

Yeah. And I guess with your procedures, you're not really creating a ton of scarring. So someone who maybe is in the spotlight could show back up to work a month later and not feel like it's obvious. Exactly. And this is a very unique thing that I do. That's like a little bit different in our field where I'm really focusing on those like stealth outcomes where again, doing a lifting procedure of the face or draw line through

a little spot in the temple is not normal. You're not going to find that very often and especially in a way that kind of gives the results that I'm giving. And so that makes that really lines up for some people. But if you're 65 years old, that's probably not the right procedural choice for you because it maybe can't quite do what you need. And so I'm always just, again, that's part of the seeking to understand,

going through the right options for you individually. These are not five minute conversations, which is the norm. That's what I hear all the time. I talk to somebody else, it's like five minutes. I mean, we're in this hours at this point to get to the right spot for you. And yeah, it makes it more accessible

for somebody who is high performing in a busy life to get a lot of these things done. Amazing, well, I've learned a ton and I'm ready to schedule my appointment. I don't know how long your wait list is, but I'm gonna get on it. Thank you so much for coming in. Thanks for having me.

I have to ask you the question I ask every single guest. The community loves this question and whenever I skip it, they get very angry. Okay, all right. What does wellness mean to you? Yeah, so thinking about this question has been my favorite part of coming to visit you so far. Honestly, I love this and it's,

I've talked to friends about this, Marvie and I were talking about it, I've talked to my wife about it. It is, I to friends about this, Marvie and I were talking about it, I've talked to my wife about it. It is, I love thinking about this because there is no right answer to this, right? And it's different for every person and this is my opinion, this is a evolving journey

throughout your whole life, wellness is. And I think the first step of that is understanding your mission, your values, your purpose, which is hard to do. You have to be able to sit down with yourself quietly and you have to go through what that is. That changes through your whole life. Changes when you're in your grinding phase

and getting something. It changes when you become a parent. It changes as your business changes, as your workouts change, whatever. Like what did God put you on this earth to do, basically? Understand that, right? Part one. Then, once you understand that,

and you have to do it all the time, and you have to be able to sit with yourself uncomfortably, do that, then you can get into the climbing the ladder, into the grind, into the what can I do to do this? And a lot of people are really good at that. They're good at the hustle, they're good at the grind, but they don't know what they're climbing for, what they're after, and they don't know

when they got there because of that. Or they get somewhere and they realize, I didn't want to be here, This isn't where I wanted to be right So you have to be able to get to that then I think the third part This is I think what a lot of your audience is going to resonate with is you have to be able to do those things In a healthy way healthy for you from an emotional standpoint from a relationship standpoint and from a physical standpoint Like how are you doing that? Are you checking in? Are you burning out is the grind too much? Do you know and and so I think it's this constant, I do this quarterly, basically.

I sit down and I look at my old ones and I look at where I'm at now. Sometimes it minorly changes, sometimes it doesn't, but it gives me this like fresh, okay, here's what I'm working for. And I love that work. I love the grind. If you don't, you're maybe skimping on the wellness of the other end of your health and your emotional support. And so I think you're constantly cycling through this and that is wellness. Climb up the right ladders in the right way. Re-evaluating at all times. I love that.

That's great. And having flexibility too in the plan. Right. And you have to have grace and compassion for yourself because nothing is perfect, nothing ever. This is what I struggle with in my world. I am obsessed with my results. That is like what it's all about for me. But I, that's unhealthy if I get too into it,

right? And maybe you don't want to hear your surgeon say that, but I'm obsessed with them. When we finish our procedure, I do my medical note, of course, like the documentation, but then I also go by myself and I sit in the sauna and I just journal. What did we do? What decisions did I make? What was unique? Because I want that to get better. And every time I do something, I change it a little bit. What can I do to make this a little bit better this time?

But I don't get feedback on that for months afterwards, right? Because I don't actually get to see the results. So then when I get your photos and your videos and Marvie gives them to me finally someday, I have this wonderful experience like, okay, I have the photos and the videos. I have my journal and I just get to go digest that all out. But again, being too obsessed with that can be a little bit unhealthy. So when I look at the afters and I'm like, there's that one thing I wish was a little bit better. It's like, okay, 99% of it's great. There's that one thing like, let's just, you know, take the grateful attitude for what

everything is. I feel like you're in the right line of work. I think you're saying all the things everyone wants to do. And I love it. So it's good. Where can everyone find you online? Yeah, my most active on Instagram, and we'll link to that in here. I have a TikTok as well that is very similar. And those are really focused on before and after photos, then on education, about the procedures, about filler, about recovery, then a little bit of just general like health and wellness. And that's actually really geared towards my colleagues and this like peak performance.

How do you get to peak performance for to show up every day, which is great for surgery, but also great for everybody who's going through daily life. Fantastic. It's great content guys. Go check it out. And thank you so much for coming on the show. Thank you for having me. Thanks for joining us on the Pursuit of Wellness podcast.

To support this show, please rate and review and share with your loved ones. If you want to be reminded of new episodes, click the subscribe button on your preferred podcast or video player. You can sign up for my newsletter to receive my favorites at marieloellen.com. It will be linked in the show notes. This is a Wellness Loud production produced by Drake Peterson, Fiona Attucks and Kelly Kyle. This show is edited by Mike Fry and our video is recorded by Louise Vargas. You can also watch the full video of each episode on our YouTube channel at Mari Fitness.

Love you, Power Girls and Power Boys. See you next time. The content of this show is for educational and informational purposes only. It is not a substitute for individual medical and mental health advice and does not constitute a provider-patient relationship. As always talk to your doctor or health team.