Well with Arielle Lorre - 259: Breast Implant Controversy, Augmentation Options & the Latest Science with Dr. Robert Cohen MD, FACS

Episode Date: July 19, 2023

Dr. Robert Cohen is a world-renowned, board-certified plastic surgeon who has distinguished himself as one of the top leaders in aesthetic breast and body surgery. With extensive training and an impressive history of awards, medical journal publications, book chapters, and worldwide lectures, Dr. Cohen provides the absolute highest-quality results possible for his patients (including me!). He joins the show to discuss the current controversy around breast implants, the science behind breast implant illness, explanting, different types of breast augmentations including lifts, implants and fat transfers, possible implant complications, body work trends and more. This episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct, or indirect financial interest in products, or services referred to in this episode.Start exploring FARFETCH now and choose your new forever piece from the new season or pre-loved collections. Your choice, your FARFETCH.AG1 is giving you a FREE 1 year supply of Vitamin D and 5 FREE travel packs with your purchase. Head to drinkAG1.com/blondefiles to redeem. For 15% off Ned products, head to helloned.com/blonde or enter the code BLONDE at checkout.LMNT is offering my listeners a free sample pack with any order, That’s 8 single serving packets FREE with any LMNT order. Get yours at DrinkLMNT.com/BLONDEFILES. Go to BeisTravel.com/blonde for 15% off your first purchase. Visit CleanSimpleEats.com and use code BLONDE at checkout for 20% off your first order.Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The following podcast is a Dear Media production. I am on a trip right now. It's kind of a work slash relaxation vacation type of trip. And when I was shopping, the first place that I went was, of course, Farfetch. Farfetch has been my number one destination for all of my shopping needs, whether it's for a trip or just for regular life or for an event or anything. They really have everything that you could possibly need. So Farfetch connects customers across the globe with items from over 3,000 of the world's best brands, boutiques, and department stores ranging from heritage labels to emerging designers. It is the global platform for modern luxury, which is powered by an international network of over 800 boutiques and more than 500 designers.

You can find emerging labels, iconic super brands, and rare vintage vines all in one place. you will definitely find a lot of things that you want on Farfetch. They really have the most extensive selection of luxury on a single platform. I get everything there and they have the best selection, whether it's casual daytime clothes, things for work, like I said, things for events, vacations. They have incredible accessories. So definitely take advantage of this deal. Start exploring Farfetch now and choose your new Forever Peace from the new season. or pre-loved collections, your choice, your far-fetch. Welcome to the Blonde Files podcast.

I'm your host, Ariel Lurie, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits. I know there's so much information out there, so I'm bringing on expert guests and sharing my own experiences to help you sift through all the wellness stuff without the BS. Enjoy the show. Hi everybody. Welcome to the show. I have return guest today, Dr. Robert Cohen. Dr. Cohen is the surgeon who did my breast augmentation almost exactly a year ago. July 27th, I believe, is my boobversary. And if you are listening to this or you clicked on this and you are thinking, well, I don't really care about boobs. This episode is fascinating regardless. of whether you care about breasts or breast augmentation or not.

Robert is such an amazing educator and person and he's so dedicated to what he does. And it's just really interesting to learn from him. So a little background on Dr. Cohen. He has an interesting trajectory because while many plastic surgeries opt to start their careers after residency, Dr. Cohen chose to pursue additional advanced training in aesthetic surgery. He was selected over some of the world's most promising young plastic surgeons for a highly coveted aesthetic surgery and laser surgery fellowship with world-renowned L.A. plastic surgeon, Dr. W. Grant Stevens. Additionally, he was the first ever to be offered this fellowship for a full year. And then in 2005,

he returned home to Scottsdale, Arizona to establish what is now a thriving private practice. He earned board certification from the American Board of Plastic Surgery in 2006, and he continues to be an active member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. Through his continuous research, publishing, and presenting, Dr. Cohen has pushed the frontiers of his specialty and emerged as a thought leader in aesthetic surgery. He is regularly invited to present and teach courses to his fellow plastic surgeons on topics such as optimal techniques and breast augmentation and complex breast revision surgery. Dr. Cohen has been a leading figure in Scottsdale's Plastic Surgery Circle and has won numerous top doc awards from Phoenix Magazine, Castle Connolly, as well as

other peer-voted lists of the best plastic surgeons. And he also practices here in Beverly Hills with Dr. Ben Talley at the Beverly Hills Center. That's where I saw him. And I just think he's amazing. Like I said, this is such a fascinating conversation, whether this is a topic of interest to you or not. So in the episode, we discussed the controversy around implants, and we talk about what is breast implant illness and how to approach it in a really scientific way. And we do talk about ex-planting and different experiences that he's had with patients when it comes to breast implant illness. We talk about legitimate possible complications of implants. We talk about capsule or contracture. We talk about breast cancer imaging with breast augmentation.

And then we also talk, of course, about different types of augmentations like lifts, fat grafting, which a lot of people are interested in now because of the noise around breast implant illness. And fat grafting obviously is a more natural modality when it comes to breast augmentation. We talk different types of implants. We talk about bodywork trends that he likes and that he doesn't like and so much more. So please enjoy Dr. Robert Cohen. Welcome, Dr. Cohen. Hi. Thanks for having me. I appreciate her. Having me back, I should say. So excited to have you back. I always feel like it's different doing it in

studio. So I was saying before, like we might cover some of the same topics, but they're still very relevant. Absolutely. So we have been talking before we started recording just about the controversy around breast implants. Seems to be at an all-time high right now, or at least it's gotten very loud in the implant space. So let's just start out with that and talk about like a little bit of the background of, you know, breast implant illness, what it really is, how prevalent it really is and all of that. So, you know, obviously implants have been around for decades. I mean, they came out in the 60s and they've been continuously improved in terms of the quality of the implants themselves. And then what's really taken a big improvement, I would say beyond that, is the technique of placing

implants and our understanding of how important it is for close to near sterility as possible. And when you're putting a, you know, a foreign body in a person, obviously the key is to make sure there's minimal bacterial contamination, so it's as clean as possible. And then what happens is the body will just wall off that foreign body, whether it's a pacemaker, an implant, a joint, or whatever, it walls it off a scar tissue and that just becomes part of your body. And so with implants, you know, obviously we have millions and millions of people out there with breast implants. the vast majority of them have done great. And there is like a smaller subset of patients now

who are developing various things associated with their implants, whether it's fatigue or, you know, just brain fog or whatever, that sometimes can be related to breast implant illness. And right now there's a ton of research being done on this topic amongst various plastic surgery societies. And all the paths are kind of pointing towards bacterial biofilm is the most likely culprit, meaning you get some bacterial contamination at some point

that can sort of form a biofarm. film that lines the implant, the body's unable to clear that. And in sensitive patients, that can be enough to maybe make them feel unwell or give them some of those symptoms. Whereas maybe in other patients are not as sensitive, it might result in scar-hardening, which is called caps or contracture, other patients that may result in nothing. So that's kind of the basic theory as far as what's causing this issue. And so, you know, when people are talking about like implants being like a toxic bag or this or that, it's really an inert product. It's just silicone gel wrapped in a silicone polymer shell, there's nothing inherently bad about that itself.

They've done studies to check on heavy metals and this and that. There's no difference in patients of implants or patients who have and don't have implants. So the real factor, I think, is the biofilm because of a foreign body. Yeah, so that's kind of where a lot of these issues happen. And I see a lot of patients for breast implant illness, quote unquote breast implant illness, and a lot of them don't know if it's their implants making them sick or something else. So I always tell them, you know, we can take the implants out, get everything cleaned out in the pocket. and sort of see how you do. And if you do better, which is amazing when it happens,

then we know that was the implant causing the issue. And in a lot of those patients, they don't feel any different. Then we know it wasn't the implant, but at least we've ruled that out for them. They can focus on other areas of their health to see how they can make themselves feel better. Yeah, I was talking about a post that I did that went viral, and I got a lot of comments, almost all the comments on the post were people who said, oh, I got mine taken out and I've never felt better. Thank God, the toxic bags are out of my body.

I kind of said like, how do they think this is being helpful? I mean, I'm also a person on the other end of this who's talking about how much I love them. I got them six months ago. Like, what am I supposed to do with that information? And those were kind of the arguments. They're toxic bags. Your body is going to reject anything foreign that you put into it, to which I said to one person, well, then wouldn't there be like hip replacement illness, chin implant illness?

And I'm not saying BII isn't real, of course. But by that logic, anything paste. makers, like you said, your body would reject. And then they said, well, no, it's the placement of the implant that makes you sick. And so there's kind of an argument for everything. But for as many of those comments as I got, I did get a lot of private messages from people saying, I've had implants for five years, 10 years, 20 years. I've never had any issues. I had mysterious symptoms and was convinced I had BII and got my implants taken out. And then I found out I had mold toxicity. You So there are a lot of people who said that they were kind of influenced by this community to believe because it's very fear mongering.

I mean, I saw some of the comments and was like, oh, my God, you know. It can get a little out of control. And it's just like with everything else, there's a balance. So I think that there's the surgeons who are saying, oh, BII doesn't exist as BS. I don't think that's true. And I think those people are discounting symptoms of patients who are really having issues. But then on the other end of the spectrum, if you have somebody who says, well, implants are bad for everybody, nobody should be able to have them. That's not really reasonable either because the vast majority of people

who get implants do just fine and don't develop breast implant illness. And there's plenty of patients who, for various reasons, whether it's, let's say, the most extreme would be like breast cancer reconstruction, who need an implant to create a normal look for themselves where they can feel comfortable, or just patients, let's say, who just have no breast tissue and don't have fat for fat grafting as an option, and they just feel unbalanced or just not feminine enough and they want more volume. There's a lot of people who really get a lot of satisfaction. You're a great example.

Somebody who you were obviously beautiful before. You didn't need the implants, but you had them, and it made you feel even better about yourself and give you more confidence. And you can see that it's like, you know, your post things for the best decision I made. You know, it's giving you a lot of joy in your life. And whether that's a good or bad thing

that we find happiness in our appearance sometimes. I mean, we can argue that's a whole different philosophical topic. You can talk about that too. But we're human beings and our appearance does matter for better or worse. That's just the nature of what we are. So if it makes somebody happy and it's not doing harm to them, I don't think it's great for somebody to say, well, you shouldn't be able to do this.

I don't think it's for everybody. I think some people, especially if maybe you already have some preexisting health issues or you have more of a delicate immune system or whatever, yeah, maybe putting a foreign body in isn't the best idea. But for the vast majority of people who get implants, they do well. You know, I think it's just sort of sometimes you get these extreme voices on either side of the spectrum, or you have the patients who are like, you know, like I was just telling you earlier, I was kind of cracking me out, but I did a post on my Instagram a couple weeks ago

talking about how it's important to try to stay within a natural range, don't oversize the implants because it's going to, can cause physical damage, like stretching out tissues and this and that, and I had somebody, you know, comment like, well, you shouldn't be able to tell people, like, what size you use. I'm like, I'm not really trying to tell you what size you use, but obviously there's factors you have to decide when you're putting implants in to make sure that they fit your body and they're not going to damage the tissue. So it's like, no matter what you say or do, there's going to be somebody who maybe disagrees with it, and that's okay. But sometimes it gets a little bit,

a little bit extreme in terms of the degree of forcefulness of some of these arguments. And they're not always based on the real science. Sometimes they're based on what you've heard from other people or just stuff online, which, as we know, is not always the most accurate information. So to that point, you mentioned that most often it's caused by bacterial biofilm. What are some of the symptoms that you have seen in patients who have had BII or you said you have patients who do have it, are there people who have it and they opt to keep the implant in and see if they can get better or what does that look like? Yeah, I mean, there's, so there's no right or wrong with this. There's like basically a huge gray area that people can decide what they want to do. And I just

try to advise people based on what I think is going to work best for them. If somebody thinks they have breast implant illness, the most common issues I think would tend to be sort of just a general fatigue, maybe like the brain fogginess, just feeling just unwell, just not feeling like they're best, like something is holding them back a little bit. And the problem with that is that those symptoms go along with a bunch of other things, various autoimmune diseases and other stuff, and it's sometimes very hard to parse things out. So a lot of my patients who come to see me who are interested in possibly explantation, which I do a lot of explants too. So I'm not just all about putting implants in. I just try to do whatever I think is going to be best for a given patient.

For the patients who want implants out, we always talk about it and I'll say, okay, we don't know these symptoms or breast implant illness related, but if we take your implants out and, you know, wash the pockets out, well, we've removed the foreign body, we've removed any bacterial biofilm, now you can see how you feel. And those patients usually take that as a gamble that they take the implants out and they may not feel better, but they want to eliminate that as a possibility. And that's fine. Other patients who really like the way they look and they're very reluctant to remove their implants,

they may try to work, work up things without taking the implants out first and see if they can find any issues that autoimmune disease or other stuff that's not related directly to the implants, and then maybe treat that and see if they feel better. And that's a reasonable approach as well. Just, you know, for people, it just depends on, have you eliminated every other possibility? Are the implant still a potential issue? Are you feeling bad enough where you want to take the implants out and see how you feel? And I'm always supportive of whatever the patient decides to do, you know, if they want to take

their implants out, I think it's very reasonable to do. And I've definitely had some patients who thought they had breast implant illness, took the implants out, didn't feel any different, figured out it was something else, and then decided to have implants put back in later because they miss the visual aspect. And I have some people who take their implants out and they're like, you know, I'm just feel better physically not having them in. I'm just going to, you know, lift what I have or, you know, fat graft or do whatever I need to do and skip the implants. Both options are totally fine depending on the situation. You guys have probably seen some of my viral yogurt recipes recently on Instagram. I did the viral yogurt shell cup. And I also did these amazing yogurt protein bars. They're so good. I freeze them. They're really refreshing for summer. And the main question on these recipes was

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and the code is blonde for 20% off your first order. I don't know how it is where you are, but it seems like across the country, it is hot A.F. Everywhere. I don't know about you, but I am definitely sweating more. And when it gets hot like this, I can get headaches. I can feel lightheaded. And one of my little hacks to avoid all of this is to replenish my electrolytes. It's so important, whether it's after you have a few glasses of wine, if you're working out, keeping an active lifestyle, sitting on the beach, or even if you are just very health conscious, you cook a lot of your own food, whole food, sourced ingredients, and you're not eating a lot of salt, you may not be getting your electrolyte needs. So I like to replenish with Element. They are my favorite. Element is a tasty

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and they will give you your money back, no questions asked, so you have nothing to lose. Media Original podcast. Her name is Coco. For a while, it seemed like Cocoa Berthman was everywhere. There was this girl from Germany who had been trafficked in a most horrible way. But in early 2022, it all fell apart, and people started questioning everything Coco had ever said. Is her name even fucking Coco?

We don't even know that. I'm Sarah Gannam, host of Believable, the Cocoa Berthman story, a new investigative series from Dear Media. Find it wherever you get your podcasts. if you have it in your head that your implants are making you sick, you're not going to feel better no matter what until they're out. Like that's what I would suspect. And I think to that point,

if you think that implants cause BII, like you're going to maybe have symptoms and attribute those to BII, if that makes sense. I don't know if I'm articulating it well. Like I remember I did a solo episode where somebody asked me about it. And I kind of said, like, I think if you're really concerned about it and you're considering implants, maybe don't do implants.

I agree. Look at other options because if you have that in your head and then you get a rash two months later, you're going to think that's BII. And you've got a headache in three months. You're going to think that's BIA and everything that you experience that could be hormonal related. It could be autoimmune. It could just be allergies. Who knows?

Like you're going to think that those are making you sick and that's going to manifest in physical symptoms, I think. I would agree in the sense that I think if a patient is already kind of anxious about those kind of issues to begin with, probably putting implants in is not the best idea for you. Implants are not for everybody. I mean, there are certainly patients who do amazing with them and really are super happy, and they have them for decades and no issues. But if you're sort of an anxious person and you're going to worry about those kind of things, then maybe not the best idea for you.

And that's the kind of stuff when I see patients in consultation. We have this long conversation about all these things. And if that's an issue, I might say, well, maybe consider fat grafting or consider a lift if they have drooping, but they don't necessarily need the volume, those kind of things. I mean, to your point, you know, I had a patient a number of years ago scheduled for breast augmentation, and I think it was like two months after the scheduled surgery. She developed psoriotic arthritis, which is a type of autoimmune disease. But the thing in that situation was that we'd actually, for, I don't remember if it was like some other health reason or whatever, we'd have canceled the surgery. So she developed the issue two months after when she would have had the surgery, but she didn't actually have their surgery. And she saw me like later to get implants and later. And she's like, you know, I 100% would have blamed the implants because of the time. Yeah. And you have coincidences like that too. And people are very kind of linear. Okay, if A happens and B happens, A cause B, it's not always the reason. So that's why, you know, when our societies are doing a lot of research on this stuff, we're doing like, you know, trying to do double blind, randomized perspective studies, trying to really be very scientific about what is the cause and effect of these things. What's the relationship? You know, like certain things they found, like the capsule, for example, which is the scar tissue that people form on the inside around the implant. There's been a lot of people who are very adamant about, unblock removal where you're removing the implant and the scar tissue as one unit, which requires a much more significant scar.

And it's not always physically possible if you're under the muscle in a very thin capsule. It's not always physically possible. So people who promote that, I always feel there's a little bit of a dishonesty there. If you're not saying, well, it's not always physically possible to do this surgery. You know, people who are having that kind of surgery done, we've done studies to show that it doesn't make a difference for BII symptoms, whether you leave the capsule in, take part of the capsule out or take all the capsule out. So there's a lot of extra work being done because people think that's what they should have done based on what they're reading online when the data shows that doesn't help.

And in fact, if you do a capsuleectomy and somebody who has a thin capsule, you're just creating extra tissue trauma that would create other issues like seromas, which are fluid collections or bleeding or other stuff. And sometimes the capsule can be very helpful if you're doing fat grafting to keep the fat from leaking through the tissues in the space where the implant used to be. So again, when you're a surgeon, you know, you're also basically a scientist as well. well, you have to do things data-driven, you know, database, not just based on anecdotal stories. So we're always trying to look for like, what's the truth of the situation and how can we make things better, try to keep an open mind as well. That's not to say that if a patient comes to me and says, I want my capsules out and I tell them, well, you know, we've done studies to show the capsule removal doesn't make a difference

with BIA and they say, you know, I don't, that's fine, but I still want my capsules out. I'll take their capsules out. I mean, that's their right and their choice if they want to. But I always want patients to make decisions based on data and science, you know, and the latest information, not just about internet hearsay and stuff. So, you know, I try to keep a very open mind myself. I try to really, you know, I see a wide range of patients. I really try to respect everybody's viewpoint and be understanding of where people are coming from.

And you have people are like hardcore. They love implants. You have people who would never touch an implant. And you have everybody in between. And I deal with all those kind of patients. So you just have to kind of adjust what surgery you're doing based on what the patient's goals are. But I always want to do it based on data. and, you know, the latest science, not just, you know, what I think is right.

What are some of the legitimate complications, even if they're very rare associated with implants? I mean, I saw something that there's a certain type of cancer or lymphoma with some textured implants. I saw that there's a new FDA warning or something on certain implants. Maybe it's related to that. I'm not sure. You know, the ALCL, which is anoplastic large cell lymphoma that you're referring to is a type of cancer or lymphoma that you have seen. We've seen associated with implants, but just textured implants. As far as I know, there's no smooth implant cases. So a lot of us have just stopped using textured implants.

It was a very, very rare problem. So it's like one in 30,000 or 300,000 or something? Very dramatically. So certain textures like Allergan Biocell had maybe 1 in 3,000-something odds, but even that's super low. And keep in mind, the cure rate if you got it, was close to 99% just by taking the implant in the capsule out. That's one situation where you did have to take the capsule completely out.

And then with certain other brands like Sientra, for example, I think it was closer to like one in 100,000 odds or whatever. So it's going to vary. But either way, for me, I just found like the textured implants were they had a lot of benefits in Europe. That's pretty much the majority of what they used in the U.S. was more of a smooth market because they switched from saline to silicone versus in Europe. They'd been using silicone the whole time. Texuring created stability of the implant and reduced the risk of capsule contraction and had some other benefits. But I found that just, again, like you're sort of talking about people worrying about stuff. It just wasn't worth having patients even worrying for a second about it.

So I just got to the point where when I need the stability instead of using a textured implant, I'd use smooth implants with reinforcement mesh or reabsorbable mesh instead. So, but yeah, that exists and it's legitimate, but super, super rare. Any kind of surgery, you're going to have complications. Most of the complications with implants tend to be sort of fixable, easy complications. You know, get bleeding. You go back to surgery, stop whatever's bleeding, and it's fixed. a little bit trickier complications would be where you get pocket stretch where the implant shifts

somewhere it's not supposed to go. Then you have to do some kind of revision work to fix that. Most of the things that you'd see is complications or technically more, you know, aesthetic or mechanical issues. And then you'd have like the rare kind of infections. That'd be a more severe complication where you might have to take an implant out. Thankfully, it's very, very unusual to get implant infection. I think I've had maybe one or two in my career out of God knows how many thousands of implants I've put in. You know, how the scars are and whether the skin stretches, ripple. I mean, there's, there's a a bunch of things that can happen. That's why it's super important to go to an experienced surgeon. And if you're not a great candidate for the surgery, they should tell you don't do implants.

If somebody has very weak skin, very, very, very thin tissues, I usually would try to advise away from implants and towards fat grafting if it's an option. We talked a fair amount about fat grafting on the last episode, but maybe we can just kind of briefly explain who's a good candidate for fat grafting versus an implant. Obviously, if somebody's concerned about their health, it's definitely a more natural option. but aesthetically, who's the right candidate? Yeah, so fat grafting, like I wouldn't want people to think of fat grafting as like an equivalent alternative to implants. It's just not.

Implants have structure and they have predictability. So, you know, if somebody wants to be 300 cc's bigger, which, you know, we do sizing and measurements and all that stuff to figure out approximately what size they want, I can guarantee that volume because you open up a box, implants in the box, and you put that in the patient. When you're doing with fat grafting, it's a lot less predictable because you don't know how much fat you can harvest of the size. the fat that's harvested, not all of it's going to be good enough to put back in after processing. And then once you inject that fat into the tissues, not all of it will stay permanently. Usually, it's hard to say. It varies patient to patient.

Maybe 60% take is probably about average. From that standpoint, if you need predictable volume, then you're not going to get as much with fat grafting as you are with implants. The other thing is that an implant has like mechanical structure to it. So when you put an implant in it, it applies pressure to the tissues and it can create roundness or it can create shape. Fat grafting will fill volume in, but it's, if you're, if you're not, if you're If you have tight skin, you're not going to see that volume projection as much as you will with an implant.

So, like, for somebody who has very tight skin, very flat chested, they're not generally going to get a great result with fat grafting. Usually you won't see much of a change and you won't get the roundness or the shape that you can get with an implant. So I would say the patients, I think, are the best candidates for fat grafting are the ones who have a little bit looser skin, who maybe need a lift, and they just have some volume loss in the upper breast, where I'll put fat grafting into fluff out the upper pole without creating heaviness or drag on the body. breast. Patients were getting, let's say, a breast reduction where they already have too much tissue, but also maybe not enough at the top. So you take off tissue in the bottom and add a little bit of fat grafting up top. That works really well. Patients who maybe have already had implants, but have some rippling or regularities where you need to thicken the tissues up a little bit, and you harvest fat and add some fat in. That works very nicely. So that can be fat grafting

in conjunction with implants. The patients I'm least likely to put it in fat grafting in would be like, again, the tight skin, flat-chested patients who technically are the most ideal for implant placement because they're the ones where the implants don't go anywhere. You put those implants in, they just stay put. Patients who already have like drooping because of pregnancies or other things, those are the ones that are a little bit riskier for implants because the skin's already a little bit more stretched or damaged. So it's a, you know, every case is going to be just a specific, you know, you're assessing this patient, their tissues, their goals, their, you know, pros and cons and you lay it all out and then you decide what to do. The other thing also is a lot of patients who would be good candidates for implants or not, don't always have a lot of fat to heart. harvest. So a lot of those patients can be very slim and they may have virtually no fat for harvest.

And then it's like, it's kind of a running joke. Like literally every time I see one of these patients, whoever's come in with them, they're always like, hey, I'll donate fat. You know, it's like, even if they're skinny. It's like everybody always wants to be the fat donor. But you can't use somebody else's fat. It has to be your own. So maybe someday we'll be able to grow out a big vat of somebody's own fat cells. That'd be awesome. But right now we don't have that technology yet. And does it work for somebody to gain weight for the surgery and then have you harvest that fat? Or then like If they go back, if they lose weight, are they going to lose the breast? Yeah. So that's for me. It's like it never made sense to make somebody gain weight

naturally and then you harvest it and then you stick it in and they lose the weight again. I feel like people do that for BBLs all the time. You hear about them eating a lot to gain beforehand. I had never really understood that strategy personally. I like to do surgery on patients when they're at their long term stable weight. That's the most accurate. So it has to be something that can sustain over time, something where they're eating like a healthy, you know, healthy food and kind of dieting and exercise.

like, not dieting, but like healthy diet, regular exercise. That's kind of how I want my patients because that's ideal health. And then we're going to just adjust their physique based on where they are at that point. So I tell people, you know, they don't want you to lose weight in a natural or unhealthy way. I don't want you to gain weight. I just want to be where you are. And if you feel like you're not at your best in terms of diet and exercise, just optimize that. And then we'll do the surgery when you're at that point.

But it has to be sustainable, you know. So don't get fat grafting and then go on a Zembek. Yeah. You'd probably lose a lot of that volume. So, yeah, that's going to make things a little bit weird too because people really shrink you down their natural fat volume. The thing, though, that people sometimes don't understand is that fat, there was a thing, does fat move around, or does it do this or do that?

You know, you have a certain number of fat cells in your body, and those fat cells will shrink or grow depending on your weight, but they don't really change in number. The only way you really adjust that is if you're doing liposuction, you're removing fat cells from a given area. You'll have less fat cells to shrink and grow in that area. And then if you reposition them with fat grapacting, now you have whatever those fat cells acted like in the one area.

Usually we're trying to target diet resistant areas like love handles or thighs or somewhere where it's the last area to go when you lose weight. You take those cells and you stick them in an area where you want them like the breasts or the hips or whatever. Face. I did my face. Face smaller volume. Yep.

And then you retain that same diet resistant fat cell but now in a new area. So it's kind of a nice concept. When I did my face a couple years ago, I think he may have taken some from my inner thigh and then some from my stomach. But I definitely notice it fluctuate, like when my body fluctuates because it does throughout the month, whether it's like water retention or I just gain and lose, you know, a few pounds here and there. But it drives me crazy. I mean, not so much anymore. But that was one reason, too, why I was like, oh, I could just not handle like doing fat transfer to my breasts.

Like, first of all, I don't think that I had enough fat to begin with. That's probably true. But also, like, I just know how my body fluctuates and I know how, even with that small amount in my face, I can just tell. Like I had a stomach bug a few weeks ago and I lost a bunch of weight and my face got flatter. And I just knew that like, you know, back to what you were saying, I would want a consistent result. Sure. And that's something, you know, again, one of the things that, you know, I talked to patients about because it's really a pros and cons list. And, you know, I do a lot of talks around the world on various things.

And one of them I just spoke at a Canadian society meeting was explantation and that sort of like how to how to go down that algorithm. of like, you know, you have a patient show up and they're saying, I don't know if I want my implants anymore. How do you manage that situation? And you have to talk about implant options, fat grafting options, lift options. There's a whole bunch of things. And a lot of times you have to take out the volume before you even get started with that process to allow the tissue they have to shrink. And every choice that they make has its own sets of pros and cons. There's not like one right option or one wrong option. Sometimes there's like a kind of a clear cut option, like let's a flat chested patient who doesn't have any fat, okay, that's an implant patient if they want

more volume, or if you have somebody that's really, you know, way oversized breasts that have much too much tissue, you're not going to be putting implants in that patient. You're going to do a reduction and a lift on somebody like that. But then there's everybody in between that can be tricky. And it's really a matter of laying out the, you know, what are the pros, what are the cons, and discussing it as a team, teaming me and the patient, and deciding what sounds best to them and what makes most sense. And I'll give them my opinions. You know, usually and a lot of times, I mean, honestly, a lot of times I'm leaning away from implants in patients where I think I can get a really nice result without implants. But for patients who need

implants, then they either accept, you know, potential risks with implants or they have to just deal without them. And some people don't have great options without implants. Again, somebody like yourself or somebody like to say breast reconstruction patient where they've lost all of their breast tissue and maybe they don't have tissue to do a flap, your only option if you want a breast back is maybe an implant. And so those patients, it's a really important device for them to feel feminine and feel whole again, you know. And so that's where I kind of like, where people get too hard line on this stuff, you know, you're not thinking about everybody's not the same as you. And so it may not be right for you, but there might be somebody else who really

would not even be able to feel comfortable, you know, walking around in the nude in front of their spouse or whatever without reconstruction. Some people don't care. So it's really, you know, it's so, everybody's so different. And so you have to be able to customize things and you have to be open-minded and you have to have options for everybody. Well, yeah, and that's where the people come in and say, you shouldn't have to do anything to feel confident and you shouldn't, like I got a lot of comments about something about, you know, not having to conform to a male's ideal of beauty. And I was like, I didn't do this for a guy. It was not you at all. I was going to say. In fact, I did that's when I was, like, divorcing my husband. We since got back together. But I was like, I was doing it fully for me.

Absolutely. Just, you know, and I joke, like, I never even cared about my breasts ever. Yeah. Until, like, maybe a year before I did them when I started noticing that I needed more of a lift. I didn't really care about the volume aspect. And then when I met with you and I saw friends who went to you, I was like, okay, yeah. And I think I actually initially wanted to go smaller than we actually went. And you were like, well, no, because, like, too small is also not going to look natural.

Right. It's all the balance, you know. Yeah. And it's just, I mean, obviously, I'm so happy with what I. And I don't, and, you know, I don't try to talk people into big implants at all. No. I think that's probably, like I do a ton of revision work. That's been one of my specialties over the last, you know, a couple decades of practicing and fixing problems.

I would say one of the number one causes of problems with implants is implants are too big for what the patient's tissues can handle. So that's like, it's one of the most common reasons I see revision work. So for me, I've always been somebody who advises for more modest-sized implants or smaller implants when you can get away with it. because they hold up better. There's just less strain on the tissues. But if you go too small, then it can have an unnatural look because the width of the implant may not fit the width of the patient's chest. The base width is what we call it. And if the base width of the implant and the base with the chest don't match up well, then you can get like a weird gap in the cleavage area.

Or you can get, you sort of see the edge of the implant. And so the true key, in my opinion, with implants, is to make them look like they're part of that patient's body, have them blend. And so that people don't necessarily know, do you have implants or not, they just look like you have a nice breast. And there's a range of what looks good, you know, from anywhere from like the full A small B range, maybe to the full D, double D range, depending on the person's body, I tend to, you know, I'd say most of my patients are coming in for more like B, C range for the most part. You know, and if somebody aesthetically likes a fuller look, that's fine, but you sometimes have to take extra precautions, like putting a reinforcement mesh in or, you know,

a resorvable mesh to help stabilize the pocket. You know, there's some surgeons who are like known for, I like to put in big implants. Like, for me, that doesn't make sense. So you should, the implants should kind of match the person and also be a judge. based on that person's goals with limitations based on what's safe for the patient. So, you know, like I think there is, you could talk about slippery slope maybe, but there's a point where it gets extreme. Like I've seen patients who have had, you know, thousands of CCs per breast and that, in my opinion, should not be done physically. And it's not illegal, but I think

it's highly unethical. But then again, you know, you have some surgeons who say, I never put in an implant bigger than X number of CCs, but what if you have somebody who's like six foot two? I mean, I've had, I've had some really big patients who come in and you can put a 500-c implant in, you barely see a difference on the table. And you have to put in maybe 7,800 C Cs because that person is just very large. So everything has to be, again, customized to that specific patient. I have some patients are really small. You put in a, you know, 180 C-M implant or whatever, and that looks good size. So it's like all over the place.

So you just have to be prepared for each patient's exact needs. Yeah, and I think that's so important because a lot of people ask me what amount of Cs. Cs I got and what bra size I am and everything. And I'm like, well, it's so different because, you know, one of my best friends, I won't name her, but she got around the same amount of Cs with you. And they look different on her than they do on me because of the amount of breast tissue that she had to begin with and what I had. And then she's like a C, I'm a D, but I don't look like a D. I mean, you think D and you think huge, but like it's just. just it's not a good indicator of really what it actually looks like. I am traveling this week,

so you know what that means. I am starting my day as usual with my AG1 so I can go out and live my best life and eat tacos and fries and all the things and still know that I am getting all my essential vitamins, micronutrients, pre and pro biotics in. And AG1 is amazing for exactly that. So every scoop of AG1 is packed with 75 vitamins, minerals, probiotics, and whole food sourced ingredients of high quality that give me major benefits like gut and mood support, boosted energy, and even healthier-looking skin, hair, and nails. I started taking AG1 years ago for gut health, and I loved it so much. It's just been a foundational thing in my life. And it's so convenient because it can be so hard to keep up with a supplement

routine that comes with a bunch of different products and you don't know where to start and you don't know who to trust and AG1 has everything that you need in it. And it's so convenient, especially like I said, when traveling those travel packs are one of my ultimate wellness hacks. So if you want to take ownership of your help, try AG1 and get a free one year supply of vitamin D and five free AG1 travel packs with your first purchase. So you can get in on this when you are traveling. So go to drinkag1.com slash blondefiles. Again, that's drinkag1.com slash blonde files. Check it out. You guys probably know that one of the things in my routine that I look forward to the most is my shudai-chai magnesium latte from Ned at night. It has become like this bookend to my day where I start

my day with my macha and I end with that. And it's just so nourishing. It helps me relax and it helps me to have the best sleep. So Shudai Chai is this amazing latte for sleep that combines magnesium, adaptogens, aminos, functional mushrooms. Seriously, the best ingredients out there are all wrapped in this heavenly masala chai inspired spiced body. So think cinnamon, clove, ginger, all that good stuff. And it doesn't just set you up for amazing sleep. The functional mushrooms and adaptogens are deeply nourishing to your body, so you're getting a ton of additional benefits. It's crafted from the highest grade single origin ingredients. It's ethically sourced from some of the world's best small scale farms. And it will calm your nervous system, nourish your senses, and send you peacefully off

to Dreamland. And as I've mentioned in this episode multiple times, I am traveling. So I bring the individual mellow magnesium packs with me. So it makes it super easy to get the same benefits of magnesium in a really convenient way, especially when I'm on the go. I just mix a little with water before bed and it's helped so much. Like when I'm consistent, it helps me with my sleep, my anxiety. It really helps with jet lag and all of that. So discover how should I try can revolutionize your sleep and get 15% off with the code blonde. Go to hello ned.com slash blonde or enter the code blonde at checkout. That's h-e-l-l-n-ed.com slash. blonde to get 15% off. As I've mentioned numerous times in this episode already, I am traveling and you

guys are like, okay, Ariel, we get it. But I am traveling for a couple weeks and I'm going to a lot of different places. And one of my struggles is packing light. I am not able to pack for anything less than about six months abroad, even if I'm going away for a week. And this is kind of a problem if I'm going to pop over somewhere for a weekend, which is what I'm doing on this trip. So I had been seeing BASE everywhere. I'm sure you guys are familiar with Bace. It was created by Shea Mitchell. So they make really sleek and affordable bags, luggage and accessories that really help you travel effortlessly while still looking fashionable. So I got the Weekender bag from them and I have to tell you, I am absolutely obsessed. It makes getting everything in and out so easy. They have a

bottom compartment designed to keep shoes, toiletries, and travel essentials separate. You can add a hairdryer in there. There's so much room, but it doesn't feel cumbersome. It's very chic and I'm absolutely obsessed with it. Base has everything you could ever want in luggage. So they have 360-degree gliding wheels, a cushioned handle, built-in weight indicator. I mean, hello, that's amazing. Washable bags for your dirty clothes and all the interior pockets you need to keep organized and also their luggage comes in so many sizes and colors. The colors are incredible. I love the beige. That's what I got my weekend or bag in. And everything is really functional and really versatile for whatever your trip includes. So whether you're packing for a quick trip or

looking to breeze through the security line, which we are all looking to do, BASE has your personal items covered. And right now, BASE is offering my listeners 15% off your first purchase by visiting base travel.com slash blonde. So go to basestravel.com slash blonde for 15% off your first purchase. That's B-E-I-S travel.com slash blonde. One question I get a lot is like, well, what cup size is 300 cc's? And I'll say, like, I'll kind of answer with a question. I'll say, how far can you drive on a gallon of gas? It completely depends on what car you put that gas in. So it's the exact same thing with implants. You know, you take a given size, put it in two different people, can look totally different. So I always tell patients, don't really worry about, like, how many CCs somebody else has.

Just I want to see the look that you like. And if I know what the look is, then I can kind of match up to that pretty well. And then the other thing is bra size, there's no rhyme or reason to it. You know, I had a patient years ago who came in super happy with the result. And then like an hour later, she called in crying on the phone because I was like, you're just happy. Like, you know, an hour ago, what happened? And she's like, I went to the store and they said I'm a C cup and I wanted to be a decup. And I was like, all right, well, go to Victoria's Secret. give us a call back and she went to Victoria's Secret and she's like, oh, I'm so happy, I'm a double D or whatever.

I was like, your breast did not change size, but okay. So there's a lot of variability across manufacturer. So I never go by cup size as anything but maybe a basic starting point to get a sense of where a patient wants to be. But yeah, nobody in their right mind would say you look like a D cup. You look like maybe a Cish, you know, if that. But it's, again, it's just based on where you buy the bra. So I don't really worry about the letters.

I don't really worry about the numbers. I just worry about what is a patient. look like, are they proportionate, and am I close to the sort of their goal look? And that's, that's kind of the key. Yeah, and we talked about this on the last episode, but we were very aligned. I think you pulled up the same picture prior to our consult that I pulled up going into it, which just tells me that, like, you are committed to that natural aesthetic and what fits the person best. Yeah. Because that's what I was really going for, too, was like the did she or didn't she? Exactly. And that's the kind of, in general, that's kind of the patient that I tend

to attract or people who want a natural look. There's obviously, you know, you're going to find whatever kind of surgeon you're looking for, you're going to find them out there. Somebody wants, like, big, huge, fake, round breasts. They're surgeons that's their kind of thing that they're doing all the time. And that's fine, I guess, for if that's what you're shooting for. Personally, I don't think that holds up as well over time. I think there's sort of a beauty to, like, a natural appearance that you don't get

with, like, a fake look. So I try as much as possible to stay within that natural range. and I will kind of veer towards the edge of what I'm comfortable with if a patient really wants that look. If I've talked to them about what the pros and cons are and they still want it, as long as it's within what I feel comfortable with. If it's out of my range of what I feel comfortable with, I just tell them, you know, you're just asking for something that I don't think is a good idea for you. Obviously, you'll be able to find somebody to do it, but I advise against it,

and then they can choose to do what they want to do. But I don't want to be responsible for putting a big oversized implant in somebody that their tissue can't handle, and then they develop problems as a result of that. With capsular contracture, does that happen soon after surgery or is it something that happens like years down the road? And is it more common in somebody who's putting in like something that's too big for their body, essentially? I don't think capsular contracture is very related to implant size. I think it's more related to implant sterility during placement. So if you're not doing super precise surgery where you're using extremely clean technique, washing out the pocket with antibiotics, minimal handling of the implant,

funnel device, put the implant in, changing gloves. I mean, there's literally about 14 points that you can talk about that you do. I never knew the funnel device until my friend sent it to me. And I was like, oh, it's like a pastry thing. It is exactly. That's exactly what it was designed after from William Sonoma, I think. Yeah, who knew. The surgeon who invented it saw those pastry dispensers.

And he's like, oh, yeah, you know, that'd be easy to put an implant in that way. And that's how it came about. And it's become kind of, I'd say, relatively gold standard as far as implant placement. So it's another way to keep a really clean approach where the implant doesn't get contaminated by bacteria that are naturally on the skin. So, yeah, if you do all those different things to minimize and then minimal bleeding, all that kind of stuff, you know, my capser contracture rates are under 1%. Also, under the breast crease incision is another key to minimize contamination,

putting the implants in. So you can keep those rates super low. Can they still happen? Yeah, you can do everything right and you can still get a capser contracture. That's one of the risks of surgery, but it should be a very controlled risk. Capsar contracture does not tend to happen immediately after surgery. It's usually, I'd say on average, it seems like a year to two years out is probably when we see them the most, but you can sometimes see them many years afterwards. It's not only biofilm related. That's the main reason we think it happens, but it can also be trauma related, like somebody gets in an accident and traumatizes their breasts and tears the capsule or has some bleeding that can trigger scar tissue formation.

So there's various reasons that can cause it. But thankfully, it's pretty uncommon these days with modern techniques if somebody knows what they're doing. It reminds me a little bit of complications with filler. You know, I mean, like vascular occlusion that can happen to anybody. It can happen to the best injectors. And it sounds like that's kind of the same case with this. You can be super careful and diligent and everything, but it might happen once in a while. That's true.

So with surgery, you know, again, you're dealing with human beings, biological creatures. It's not predictable in the same way as like working with like metal or wood is, you know, because you have the mechanics and then you also have the biology. that are both combined together. So you can reduce risks. That's certainly part of being knowledgeable and skillful is trying to minimize risks by predicting ahead of time

what is going to cause the problems and avoiding those as best as possible. And the other really important thing is knowing how to handle those problems. So like you're talking about vascular occlusion, so yeah, that can happen to the best injector in the world. But the best injector in the world, if they get an occlusion, they're going to recognize it quickly

and put in hyal uranidase and fix the problem versus somebody else who's not his experience might sit back and say, well, I'm not really sure what's going on, and by that time you lose the tissue. So it's the same thing with implants. You need to not only need to know how to put them in, but you need to know how to deal with problems or complications and fix those problems, or else you're not really experiencing the full spectrum of what you need to be able to do with implants or with breast surgery in general. I can't remember if we talked about this last time, but does fat transfer make it more difficult when somebody is getting imaging of their breasts to detect cancer?

Yeah, no, technically it should not. You know, if you do the fat grafting, properly trained mammographer should be able to tell the difference between the fat graft and microcalcifications and other things. So they've done studies that show that, you know, fat grafting is no more difficult for mammographers than breast reduction, for example, when you're readjusting the tissues and stuff in terms of seeing breast cancer. So all these things, you know, if you're going to somebody who's properly trained, they should be able to tell the difference. Are there any other trends that you have seen lately that you're not a fan of and any trends, conversely, that you do like? I mean, it seems like you like that there's a trend more towards natural, which I think we're seeing a lot more of. I mean, that's been my biggest thing that I've been happy about. And like we sort of started at the beginning of this podcast, it can get a little extreme sometimes if somebody is like really just like sort of black and white about it, nobody should get implants, you know.

And that's, I don't think it's a fair statement to make. for people who really need them or really benefit from them. But I do like the fact that things are going towards a more natural look and that people are being open-minded to maybe not using implants when they don't need them, which I think is great. When they need them, maybe going with a more fitted implant for them rather than something that's oversized or very unnatural. So that trend, I think, has been great.

The trend, I think, in general, that's not specific to breast surgery. Obviously, I do, I don't just do breast surgery. I do a bunch of other stuff, too. But the trend that's been most concerning for me is the use of, like, these AI, image generators that people are seeing these like kind of idealized versions of themselves produced on the computer or on their iPad or whatever and they literally you know I've been hearing from like you know I think you'd maybe done a thing with Jen Hollander or a nurse nurse injector where people are coming in and showing her pictures of themselves as a like a digitally

altered image and saying I want to look like this and it's kind of a little horrifying that now people are getting these ideas in their head like I want to look like this image that's sort of perfected and not realistic, and that's not what a human being looks like, it's kind of a bad trend, because I think it's only going to lead towards disappointment and dissatisfaction. I mean, that's the tough balance of plastic surgery, and I know it's, you know, I try not to be a hypocrite at all. There's sort of like this idea that you're trying to make people look like better versions themselves, but there's also a limit to, you know, and that's part of being a good surgeon

is telling a patient, okay, this is what you can realistically expect. And if you keep pushing, excuse me, beyond that, you're going to, it's going to backfire on you. You're going to look worse or something's going to look unnatural or, you know, the expression that's used a lot in surgeries, the enemy of good is better. And you kind of, if, you know, at a certain point, you have to know when to say enough is enough. And if you keep pushing that, that's where you get into trouble. And so I think that's the role of leaders in plastic surgeries to sort of help patients guide them to feeling better about themselves, improvements, things that are maybe changed that look worse from, let's say, pregnancy, trying to take them back to where they're, started from, or maybe people who are not happy with something in the first place, like I'd say, they have a big hump on their nose and it bothers them. You can straighten that for them.

Those are all reasonable things to do, and not everybody needs to do them or should do them. But for people that really bothers them, it's an option for them, right? The plastics are an option. But you also have to know where to draw the line and say, okay, that's it. And if you keep pushing it, you're going to start damaging yourself or you're going to start creating something that doesn't look human anymore. And that's where we sometimes get in trouble is there's always going to be the outliers, patients and surgeons who are willing to keep pushing the limit. it's whereas I think we should be going back towards more of the back towards the center, I guess.

I kind of feel like that in all aspects of life right now. Everything's getting too extreme. I wish it would just come back more towards the moderate, you know, politically, medically, whatever. But I think that's where you find people tend to do the best. I feel like I know that there is a trend towards more natural when it comes to like noses. And I think we're seeing it with breasts as well. I think the younger generation, as insidious as the social.

media and the filters and all that can be. I think that to your point, I think the pendulum swung one way where it was like this very AI kind of fake, everything filtered look, and then it kind of swung back the other way. Now it's maybe settling somewhere in the middle, at least with the younger people. I hope so too. I mean, I hear from other friends in the medical profession who, you know, are saying that a lot of people are coming in to get filler in their noses because they want to go back to their more natural nose and people, you know, are just opting for a more natural aesthetic when it comes to that. But I think also people fixate on different areas like too. I know that now, like the eyes are a big thing. Everyone's doing the brow lifts and the bluff and everything like that.

So it's like fixing on, fixating on something different. Well, you get like the trendy, like the fox eye or the this eye or that. It's like you get these like things that become like a trend and then people start following a trend and then the trend's over and all of a sudden they're like, okay, I don't want to look like this anymore. BBLs, huge asses. Exactly. Exactly. And it's not always easy. Like some of these things are not fully reversible. Yeah. So that's what, like when I was telling you about that, you know, I was talking about natural breasts and the patient was getting upset.

But like if you put in like a thousand C. C implant on a small person, you are permanently changing that breast. You take that implant out. That tissue is completely stretched out. At the very best you can, you know, lift and tighten it. And, you know, you obviously have to add scars to do that. But and faces can be even more challenging. If you're adding in a ton of fat somewhere and you want that fat out, how do you remove

that fat without creating irregularities or loosening the skin, not always possible. So the best way to avoid those problems is not to get in that situation in the first place and do more moderate changes. And then it's not really trend-driven. It's certainly not like you were saying. I mean, it's not spouse or other person driven. If you're having plastic surgery and you're doing it for somebody else, you're doing it for the wrong reason. If you're not there for yourself, then don't do the surgery. A hundred percent. And most good surgeons, we can spot that in like two seconds. You know, if somebody's coming in and you think it's the spouse driving the surgery, that is immediately something I'm going to put the brakes on, you know, just because that's the,

you know, just nothing good comes to that situation. To be perfectly honest, 99% plus of the patients I see, it's very obvious. They come in. They're doing it for their own reason. Usually a lot of times, like if they're trying on sizes, they'll look over their spouse and what do you think? And then I'd say the vast majority of time, the answer is whatever you think. You know, they don't even want to say because it's, because it's not for them. And that's, That's how it should be. It's for the person having the surgery. I'm laughing. I'm smiling because I'm like, if my spouse told me to get surgery, I would be like, get the fuck out of here. It would not be, it just should not work that way.

So thankfully, that's kind of like a thing of the past where like, oh, I'm buying the implant so I get to choose what size. I mean, that's just, it's just repulsive. And again, I think it's much less common, at least in my practice. I almost never see anything like that. Yeah. Yeah. Well, thank you so much for coming back on. It was so good talking to you. Tell everybody where they can find you.

Thanks. And I really appreciate you having me on again. So my website is Dr. Robert Cohen.com. So just D-R-R-R-B-E-R-T-C-O-H-E-N.com. And then my Instagram is at Robert Cohen, M-D. And, you know, between those two things, there's a lot of information and stuff. And I try to do, you know, I try not do too many, like, silly dances and stuff like that. I'm mostly trying to just show what's capable of plastic surgery and give people some idea of what the latest information is out there. Amazing. Thank you so much.

I appreciate so much having me. I hope you enjoyed that episode. And if you liked it, and if you liked the show in general, please take a second to rate, review, and subscribe. It goes a long way, and it's actually the best way to support the show. Also, if you want to see more about each episode, you can head over to The Blonde Files podcast on Instagram. You can go to areallori.com. and I'm always posting about each episode over on my personal page at Ariel Laurie. Please note that this episode may contain paid endorsements and advertisements for products and services.

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