Transcript for:
Ultimate Human Podcast - Featuring Dr. Cameron Chestnut

seemed like for the last 10 years I saw this dramatically Progressive of women with normally large lips it seems like there's a filler Revolution this perception drift by the time she's in her 30s or 40s their face looks noticeably distorted to everyone but them did the FDA trials they looked at a certain time frame until it quit correcting and then they said oh well it's not correcting anymore that doesn't mean the filler is gone this is a permanent to semi-permanent implant but it's viewed as lasting 6 to 12 months which is really problematic over time rare that I do a surgery now where I'm not managing fil every single time I'm manually removing it I'm trying to dissolve it the literature says that there's no issues to our native tissue I don't fully believe [Music] that ultimate human hey guys welcome back to the ultimate human podcast I'm your host human biologist Gary Brea where we go down the road everything anti-aging biohacking longev and everything in between I am really excited about this podcast I think I'm going have a hard time containing myself going down so many different Avenues because this has had such an extremely high response from the audience about facial and cosmetic surgeries basic cosmetic surgeries the intersection between um you know cosmetic surgery and biohacking and healthy living and anti-aging and we're going to go down all of those roads today including stay tuned male and female pattern baldness so welcome to the podcast Dr Chestnut it's a pleasure to have you on um i' I've listened to some of your other podcasts of Ben Greenfield who's a great friend of mine you guys have known each other for 25 years abely um I love that you're you know you you have had this journey as a you know an athlete and sports medicine and and now you're you're board certified you actually have two board certif ifications if I'm yeah absolutely yeah yeah so um well I want to say first thanks for having me I'm like super honored to be here your guest list is incredible and I'm just really honored to be part of it I'm grateful you have you're awesome your team's great your facil is awesome this you know new studio I love it I know and uh but then I think I'm also like super grateful to your audience like that's just a total side note of like people who are interested in optimizing themselves and you know being the best the ultimate human the best they can be that's rare right it gets lost on us a little bit how rare that is but that's incredible that there's people who want this knowledge and you know allow us to do we and you know what I'm excited about today is that you you wouldn't think you know knowing about most of my podcast guests and and and most of what I preach out there which is essentially getting back to the basics healthy lifestyle supplementation for deficiency I you I do use a lot of biohacking modalities huge believer in red light therapy pmf oxygen but I'm also a big believer in in the basics you know ground sunlight breath work cold showers but I do think that you know I think people may be reading the headline and go what why is it got a facial cosmetic surgeon on there and we're going to are we going to talk about tummy tucks and boob jobs and and buttlifts um when he's kind of the antithesis of that and I and I generally am but I also you know the reality is that people do have scars people do have stretch marks um people do have droia eyelids um people do have other age related or trauma related or um conditions that you know I'm a big fan of fixing those because your self-esteem and your self-image you know especially on your face right when you have some kind of condition going on your face I don't care about how much biohacking you do it's going to be front of mind for you all the time yeah and I think there's an a difference between being extremely Vain and going down that that that longterm Road of just vanity and wanting to look and feel your best and maybe using the best of what modern medicine has to offer absolutely and and that's what most of my patients come to me saying is I want to look how I feel that's the most common that's sort of like my magic words I know that we're probably going to be a good fit to work together when I hear that because we're so focused on reducing our biologic age and Longevity and all these wonderful things but you know that has some benefit to our cosmetic aging but what good is it to be older or aging you know non-biologically if you're just looking older right so you and I were talking offline a second ago about this connection of you know your patients come to you and they see you and they feel so good afterward they can't even explain it it's hard for them to like put it into words right it's so core and Primal for them how good they feel and they look better too it's like a side benefit to it and my world is very much uh the flip of that the ying and yang the you know this wonderful ju to position where they look incredible rejuvenated that's the real thing here it's not transformative they're not looking different than they ever did they just look a little rejuvenated they and you know it's the proof is in the pudding a little bit I'm you know blessed that what I do you can see really but then they do feel better afterwards too and it's this sort of like chicken or the egg question what which happened but you know they work really really well together when you are optimizing yourself and your health and paying attention to these things and looking better at the same time they really fit together quite well you know in preparing for this I I went I went out to my community and the ultimate human community and I I sort of asked for like you know what topics would you like to see covered um you know there were a lot of uh questions about ey lifts there were a lot of questions about um um minimal they called them minimal facelifts if I was to just put it all into into a category lots of questions about male and female pattern baldness um I happen to where's the camera I dare be dealing with a little bit of this myself um and I've tried to biohack it so you know I want to open the discussion with I would say of all of the topics that seemed to be the one where my audience was like um you know we'd love to have any kind of guidance on whether or not should we be using feride or propa or should we be using you know some of these other orals which I'm personally not a big fan of um I think you know sort of destroying your hormones in order to save your hair exactly kind of a kind of a trade-off that I'm not not an enormous fan of but um so let's start there let's start with male and female alopecia yeah um what's so do you know diffuse hair loss um I mean especially in women this is a this is a serious issue with your you know your self-esteem and um not having a thick head of hair I mean it's easier for guys we just start shaving it closer and closer and closer than to shave it off but but um you know what are some of the root causes what are some of the treatments that you're doing tell me a little bit about the platelet rich plasma treatments and some of your theories on um gravity and and and fat deposition into the scalp as maybe be being some of the root causes of this yeah I mean when we really we want to Define what that is this sort of you know um male and female patterned hair loss because it's different in a man than it is in a woman often and there are it's a challenge because it's multifactorial there's so many things to go into it there's genes there's environment there's exposures there's all kinds of things right exactly um there's a lot of you know endocrine issues that can relate to it there's nutritional things that can cause it and so it's it's really well what is it first well it's just thinning generally of our hair follicles our hair follicles are for lack of a better term a collection of stem cells right that's what it is these stem cells have all the normal paracrine signaling the stem cells that make keratin and grow the hair keratin is the protein that our hair is made out of there are stem cells that put pigment in the hair that make it colored right um so these are all existing together and they're signaled to grow and not grow right but then they have to have the substrates they have to have the things they need to make the hair as well and so when there's changes in that whether it's just normal cellular Essence and aging they don't do that as well and so when we look at the density of hair on a given area we're looking at it's really a function of how many hairs are there and how thick are those hairs if you had one hair that was this thick you would technically have really great hair density right um and so as the hair is thin out which is usually the first thing that happens it's actually less loss and more thinning that happens first and we have the sort of arbitrary threshold that we cross over where we notice like oh my hair is thinning and we're all approaching it as we age and then we start to get to it a little bit and it's like okay well what's happening now so that is where things like growth factors can come in PRP prf I like to use um fat-based stem cells which we'll talk about a second benefit of that because then you have like release of exosomes and growth factors from The Source when we do that that can just kind of like amp up the collection of stem cells and when you say fat-based stem cells you're talking about adapost derived from the patient right so so you're going to take my own stem cells from from I assume my abdominal fat yeah um and then you're going to inject those subcutaneously into the correct into the scalp yeah when we use stem cells we'll talk about this a lot today because I use this with all of my cosmetic procedures as well they are the ultimate um mediators and orchestrators of positive types of healing and it's inflammation right but positive types of that right and we do get it from your own fat there's certain areas that I like to take it from that have a little bit higher stem cell density um and then I minimally manipulate it which is you know what's okay with the FDA I'm using it for homologous use so it's being used for what it's meant for and it's from you so all of these beautiful things that's really accessible so you have the stem cell portion plus you have the mechanical portion of the fat right so in our scalp men especially on the top of our scalp we lose a lot of that fatty support there which causes issues with the microvascular circulation and we get hair loss so now by using your own fat-based stem cells in that same subcutaneous atap POS or fat plane we lift it and cushion it and we add growth factors and and new angiogenic like creation of blood cells back to that area very akin to facial aging where we're losing fat in our facial fat pads I can use the same fat restore the structure of the facial fat pads regenerate the amount of adapost tissue that's there change the Contours of the face all these wonderful beautiful long-term things that come with your own fat being used there but that's applicable in all kinds of facial aging including now are these um these are outpatient procedures right I mean minimal if any anesthesia I'm sure you have anesthesia for the for the that can be done with just local anesthesia so local anesthesia and where you where you U where are some of your favorite places to pull stem cells from yeah and this is just evidence based as far as like where our stem cell density is the highest but it tends to be like per umbilical around our belly button and in the flanks um and then medial and sometimes lateral but generally more medial thighs that'd be more uh common in a female patient to be taking it from those areas and then how much fat are you pulling out for let's say a scal procedure this is such a good question and I get this all the time I ask great question yeah um people think of this as like liposuction like a liposuction procedure when you're doing liposuction on a body um you're taking thousands of cc's of fat out for contouring purposes that's because I don't I want I don't want to send the wrong mess cuz everybody seen the canula with the Dyson hooked up to it exactly that's like attached to we call it wall suction with this big canula well I'm using a micro canula I'm doing the suction by hand so very small and instead of taking like thousands of cc's I'm taking tens of CC's right so this is very much not a body contouring procedure I don't do body contouring things but I also want to leave most of my patients are relatively fit I want to leave no sign that I was there they don't need liposuction right right and that's great because patients who have generally lower body fat percentages I get better fat from them higher quality more stem cells specifically the stem cells I'm taking we call the strumal vascular fraction there's young healthy ocy stem cells like fat stem cells there's also all the things that go into the vascular like these things called parasites that help create new blood vessels which is really important in the scalp or when you're doing a fat grafting procedure that now has to establish a new blood supply so you have all the orchestrators of that kind of put together so I'm doing tens of cc's of harvest and of that those tens of CC's maybe I take 60 or 80 CC's that' be you know or 100 that's a big Harvest um I'm really using a very small portion of that very and it's it's going through a centrific process it's actually going through a separation process so talk a little bit about I'm taking the fat out and then preparing it to go into somebody's scalp yeah so I'm like a fat connoisseur in this way my whole team is like when we take it out um I have a very sort of like dialed and and proprietary process that I utilize with centrifugation but it's also very customized like I'm basing it off of what I'm seeing I'm problem solving the whole time like what RPMs do I want how many spins how many times are we doing this what size are we making the fat because different fat we want or different fat purposes at least we want different sizes of this fat if I'm putting it around the eyes to revolumize around the the orbit or the eye socket or where there's volume loss it's very different than if I'm putting it deep in the structural portions of the cheek or something like that right so um that process you know from harvesting to yield from what we're actually going to use when I get that back let's say I harvested 100 just for an easy number I may have 15 or 20 cc's of fat that I'm going to use depending on how quality it is and there's multiple sizes and multiple like we we have all these fun names that we call like microfat milliat super like all these you know things that we're putting together um and nanofat and all these different things nanofat becomes almost purely regenerative no longer volumizing because it's the smallest wow portion of it and so we may use that inest the skin or something like that but the the overall message is the yield is very low so this is this is a little bit of structural regeneration and that's a lot of actual regenerative medicine put together to do this W so you're actually you um creating you're putting back the fat that's lost and I I and I was actually listening to a previous that you were on and there was really interesting Theory but made a lot of sense to me you called the gravity Theory it wasn't your theory it was another colleague of yours um essentially you know during the at the Apex in the crown where where most of the gravitational weight is it's constantly pulling down on that area that you you do have density loss in that TI tissue and maybe restoring that density um to its natural state you know I guess the the question is um you know once we once our hair has really thinned or we've lost the hair right so now it's down to skin what are the chances of Reviving that hair follicle there's a I know that there's a dorcy phase before it actually dies and becomes necrotic exactly you can't wake up dead tissue or there would be Jurassic Park right we have dinosaurs running around so we know we can't we can't wake up dead tissue but I I I imagine that we can recreate dormant tissue correct and dormant follicles so so talk a little bit about that we take this fat now you you divided to different categories um and and now are you just hand injecting it correct above the periost beneath the deepest layer of the yeah this is a really great Point yeah the layer that you're putting in it is very very important the hair follicles live in the subcutaneous tissue I actually see a lot of people put their growth factors including PRP they go down to go down to Bone and put it in there and I always question them like are we thinking this is what I'm teaching my fellows my surgical Learners who spend a year with me like are we thinking three-dimensionally we're not this isn't a two-dimensional plane we have to think of what our Target tissue is where it's living in the tissue and that's where we need to be working for whether we're talking about surgery or injections or anything like that so I'm actually putting this in the subcutaneous space which makes sense when we're using fat because we're putting fat in a fatty plane um but that can restore some of that cushioning and restore some of the microvascular circulation mechanically and physiologically with the growth factor release because like you said the hair follicles miniaturize they get smaller and their product the hair shaft gets smaller too to a point and then they go dormant and they the stem cells are alive and they're sitting there they're just kind of like chilling they're not being told to turn on they're not being stimulated to grow anything so that's like the ultimate the panty if we could get all of those dormant ones to turn on which is way more challenging than a sounds um then we'd be able to actually regrow some Lost Hair it's much more efficacious to think about stopping or arresting hair loss and maybe getting some girth or some you know some width back to our hair follicle Sha that is a much easier TK than taking you know sleeping ccent follicle and turning it back on that's that's a challenge for sure uh and that's when most people seek care and this is this is what we get all the way down the road most people are coming in when they're at that point they're not coming in when they're on the progression of thinning they're it's gone right and they're coming in and so we do have options there as well for actually restoring Lost Hair uh but those are mechanical procedures transplant yeah and then what about when you do these transplants um and I mean you still need to transplant it into you got to put a plant into fertile soil right right or else the plant's eventually going to die again and if it dies you can replant it but um but so when they when they do these hair transplant procedures and I and I know several Physicians that do them and i' I've had several of my very close Hands that have phenomenal results but my I'm always wondering what's going to happen to this 5 years 10 years 15 years down the road so in addition to just doing the hair trans if you're at that phase um what are some ways that uh men and women that have either had a hair transplant or they're considering one can extend the lifespan of that hair yeah this question is so deep and so great and it's analogous to a lot of the things we'll talk about with cosmetic surgery too you want the substrate that you're working on or that you're correcting rejuvenating to be optimized before you do the Rejuvenation right because you said you know if you put it in there you plant it and it dies you can put another one well we have a fixed number of these that we're that we're able to utilize in the lifespan of of you know whatever hair restoration we're doing meaning our donor area where we're taking back on the back of the scalp is fixed there's only so many you can use and we never use them all at once actually we kind of leave it to be the stepwise fashion over time sometimes people come in in their 20s sometimes they're in their 40s or 60s when they come in for this the very first time and this field has progressed a long ways from taking a strip of hair that you then sew together and leave a scar on the back of the scalp to now literally going Hair by hair and individually harvesting them like basically no Trace that we're there because the density in that area is so high that we can kind of borrow without throwing over that arbitrary threshold we talked about earlier right and so we're just rearranging the density we have we're not making magical new hairs so when we put them in there we want them to stay forever right this we can't afford to lose this right and so there are things that we can do to optimize the recipient area before we do it that's growth factors that can be fat that can be a lot of things if somebody has like a scar let's say they have a trauma have a bald spot from a scar before I can put graphs in that scar I have to have to have to optimize it I have to go do these fat-based stem cells to make new blood vessels in there so that they can actually receive a hair graft if I just put it in the relatively avascular nonvascular scar it's just going to die right right so we can apply those aspects of reconstruction in that case to all of these cosmetic things too and so there's questions about all the topical things you can use Minoxidil finasteride like yeah I want to go down that road too I want to go through the you know the the the chemical synthetics Pharmaceuticals but then I also want to go down the the peptide route the tb500 maybe bpc157 um GH KCU copper peptides um or even uh you know some of the topical um feride ketoconazol minoxidil um you know which would be my preference in somebody that um is taking an oral feride or propa for hair loss instead of again killing hormones to save the hair maybe even applying those kinds of things topically um so that less of it's in serum concentration and maybe not lowering your hormone levels but it's going into the area where it can do its job exactly yeah and all all the topicals carry these relatively low but real efficacy numbers singled digigit percentage points I always tell people like you can get single digit percentage points with topical minoxidil right great that's easy Do It um same thing with topical finasteride that's emerging more as an option as people have become more aware of the issues with oral finasteride which is a central testosterone blocker let's just call it that right including in our central nervous system which is what you're talking about what I'm concerned about I would personally never want to take something that's blocking what makes me partially who I am in my central nervous system right so it can have issues with all of the volition and libido and all these things so okay function mood um you know there's a there a lot of you know we have such a volume of of of patients coming through our clinics that you know our clinical team is a good job of of of tracking the anecdotal things or the the subjective findings when somebody takes a oral fineser ride or propa or they come to see us with that you know they they they note that they're almost always experiencing some kind of not mood disorder but they're just they don't feel themselves right um they sometimes they have that that mood numbness kind of feeling a lot of uh erectile dysfunction and and lack of sexual arousal in women but but significant erectile dysfunction complaints in in in men and even just the you know there's the there's the arousal and libido factor and then there's a performance factor and it's seems to be on both sides of the equation I'm just like not that interested and I don't perform that well um kind of kind of both so it seems like defeating the purpose to yeah get a great head of hair and then go out and do nothing right exactly and that I mean that's always the question and so it's not something that I utilize if uh somebody's it does have efficacy for hair retention right that's the issue so I'll see people who are on it sometimes and I'm kind I'm a surgeon right so I'm not necessarily managing as hardcore the medical aspects I'm generally seeing people who have been doing that generally it is finasteride and these other things and then I'm adding all these regenerative modalities Plus plus surgery that tends to be my role more so I don't necessarily stop somebody who's on it and having efficacy but I don't start people on it that's just not my personal philosophy and value and what I want to do so what what are some of your go-to topicals um or go-to um peptides um that you think for you know for the folks that are listening and they're and they're having some thinning some alopecia men and women what what are some of your go-tos yeah so the first thing this gets very into your world of like are do we have the proper substrates in the first place so that's always like starting point number one the answer is usually yes which is good but it's a simple thing to look for right are you getting the proper substrates usually when I'm seeing people they've been down this road they've had that right um so that's vitamins and you know making sure they're getting enough proteins and amino acids and all the things that they need to build it so then we're going down the regenerative capacity okay you've got the substrates let's stimulate these follicles to grow let's use regenerative things let's use growth factors but then also from more of a pharmacologic mechanism what can we do minoxidil is a vasodilator increases blood flow to the area that's all it's doing right um so we talk about microvascular circulation mechanically uh physiologically that's that's what it's doing um from a peptide standpoint uh you mentioned ghk copper which is a really small kilodalton peptide that has some topical EP efficacy because of that um but then a lot of the other options we can do orally or injections or sublingual um and oftentimes those are being paired with a stimulus right what if that stimulus is regenerative or if that stimulus is surgery um so by stimulus you mean mean red light therapy or oh well could be red red light therapy is massage I'm talking like um uh physiologically stimulating with the growth factors injecting okay um and or surgery right the ultimate stimulation in that sense right um and so those when we're doing those then we want to focus on what happening at the cellular regenerative level which is where the peptides are working right um bpc157 thymus and beta 4 all those um ghk copper also has copper in it right which is a substrate needed for like collagen production so helpful when we're regenerating a hair follicle or when we're doing elastin and collagen Creation in the skin with like a laser or something like that or healing a surgery from a facelift or whatever it may be um so peptides play a big role in that as well um and that's a you know Wonderful deep dark hole you can go far far into in a good way um but there are some very simple ones that people often are totally naive to uh when I see them and we can help sort of optimize be like your copper peptides your bpc157 thymus and bet 4 those are my favorites for you know you mentioned collagen and I wanted to just touch on that for a second because I think there's this um um Mystique I I'll tell you my position on collagen tell me if you agree with this or not because I get uh clients that ask me about it all the time and I say well you know collagen's a protein and like any other protein wheight protein steak protein egg protein if you ingest it um it's not going to stay in the form that you ingest it it's going to turn into amino acids and then those amino acids are going to be shipped off to tissues muscle being one of them but also blood lymph system um our natural killer cells um you know our our skin I mean the amino acids are in every cell in the body and so when you take a collagen or collagen peptides and you put a scoop of it in your coffee which is great because you're getting the protein but that collagen doesn't somehow magically migrate into the body and deposit collagen right it' be sort of like the thought of like if if I eat hair I'll it'll show up as hair if I eat my nails I'll grow nails if you eat collagen it doesn't show up as collagen um first of all do you agree with that abely and and I kind of tell my patients this this way is that you know proteins are amino acids linked in a certain way different shapes so it's kind of like a novel a book a novel and the amino acids are the individual letters so not only you have the novel you got the chapters you got the paragraphs you got the sentences you're breaking that all down to the letters and you're getting all the letters that you need across but it's a very sophisticated you know way to reassemble that back into the protein it is not again people think you eat collagen and it goes right to your skin and all SK strong that's the myth that I wanted to dispel if I eat collagen then I'll have more collagen in my skin right like eating keratin and have more hair yeah and collagen's not doesn't even have all of our essential amino acids it's missing some of them which is fine when you're trying to recreate collagen but as a whole protein it's missing tryptophan um and then on as a total side note that it goes along with this because collagen's like the well skin aging collagen you know I kind of always tease my patients that um it's not collagen that we're worried about as much it is that's it's an important aspect of what we're doing but it's really elastin which is the other little substrate of our skin collagen gives it strength elastin gives it elasticity right when we really think about it our Skin's not tearing apart as we age not getting that weak it's getting it's losing its elasticity we want it to recoil and rebound and lift and it's not there's a bunch of different types of collagen in our body type one is the one we're thinking about mostly when we're talking about our skin um but elastin is a a very delicate flower in comparison to collagen it's very delicate from an aging standpoint from an oxidation standpoint from a UV damage standpoint it's the one that goes away first right and so when we're talking about regenerative medicine we're talking about lasers and we're talking about stem cells in our skin and our fat pads we're really focused on restoring our elastin tissue our elasticity that is where the magical anti-aging happens and so we have to if you just injure the skin you get a scar we call it fibrosis but it's a scar that's like the layman's term for it and that scar is a very organized band of collagen normally collagen lays in our skin very haphazardly arranged which makes it really strong it's like rebar right okay but now it all runs in the same way in a scar so scars are never as strong as regular skin and it's just pure collagen there's not a lot of blood vessels there's no elastin tissue in it so we want to create a micro injury whether it's with a laser with our surgery whatever we're doing and then we want to purposefully change the growth factor milu to make more elastin tissue wow and that's where these like beautiful wonderful olus our own fat-based stem cells can help do that really well even without an injury if you just take your stem cells and inject them in your skin and we biopsy it down the road we'll see upregulators of coll or of um elastin precursors in those areas wow which so apply that to when there's a stimulus like a surgery or a laser or something and boom we got a lot more elastin being created so you're um would it be fair to say you're not a fan of dermar rolling but you are a fan of micro needling yeah similar veins right you know we were talking about offline like the idea of a dermar roller kind of coming in at a non-perpendicular angle and creating some shearing or tearing forces yeah because it kind of punctures and then like a wheel it it it's under the skin it sort of lifts the skin and tears it on the way out right and then you have Micro needling that tends to be more of like a 90 degree penetration and out and I mean we could get really nitpicky on that and say yeah that's maybe suboptimal but an injury is an injury right and um I guess you know I'm much more focused on okay we've created an injury what kind of we we don't want to create a bad injury right that's where the tearing can contr contr trauma but then we want to focus on okay this is just like all of our things it's a hormetic dose of an injury right and then we have to recover from it so what are we doing how are we recovering from that injury I'm not as concerned with what the injury is I don't care if you did hack squats or back squats or whatever how are you recovering from that trauma that we created right and we can make the injuries much more sophisticated than Micron needling can when we're using lasers as an example right because you have some of the physical mechanisms you can get the oblation that you know that a micron needle might do but then you have heating that happens in the surrounding area um you can Target very specific Parts you can Target pigment or blood vessels or water or collagen whatever you need to do so we can we can be a little bit more specific with our injury in that sense with what we're trying to recreate um but in general whatever the injury is we want to really focus on the recovery and this is applicable to our lives as humans right what's your recovery look like after that that's what we want to optimize that's what that's what makes the difference that's what creates things at the next level really so so what are some of the um let's call them bioh hacks that um you use you know when I was looking up your your your practice I was like wow he's got red light therapy he's got uh cryotherapy he got um hyperbarics you got pulse electromagnetic field I mean these are right in my wheelhouse and those are not the typical Norm that I would think you'd see in any Surgical Clinic or even in any cosmetic Surgical Clinic um so talk a little bit about this intersection between biohacking and the best that modern medicine has to offer is is are are you able to bring the threshold for what you have to do to a patient in terms of the amount of invasiveness you make with the scalpel um are you able to bring that down because you're you're you're using some of these modalities to enhance those those outcomes yeah this is such a great point in question and this sort of you know Compass lot great question I ask a lot I'm giving you that you're asking a lot of good questions just one after another if there's too many let me know and I'll ask a really stupid question like where'd you get your shoes this is a yeah this I like your shoes appreciate nobody cares um this is a good one in the sense of like this embodies a lot of who I am as a surgeon basically you know very intellectually curious at Baseline but also skeptic mixed together I think that's a healthy balance of things and you paired with my athletic background right so you and I were talking offline before I'm really focused on pre during and post just like an athlete would be that's for me and how I prepare what I'm doing during surgery how I do it afterwards same with my patients what they're doing before they get to me what happens during surgery we could talk about that forever what the after is which is what you just hit a little bit and I want to optimize that I mean my patients are coming to me from all over the world all over the United States everybody's traveling to see me and when they're there I have them for a week in a very positive way like we're going to do your procedure and then for we have a whole week to just optimize your recovery love nowhere to be but right here I love that and and you know I I want to continue on this vein but I I don't want to forget the thought that just popped into my mind because we were talking before the podcast and one of the things that really struck me um and I want to highlight it is how you manage your own mental state for surgeries and I I love that you refuse to pack your schedule with just surgical procedure after surgical procedure you say that the state that you're in has a lot to do with the outcome for the patient you you say no a lot um you you you're very Mindful and intentional um you said a lot of your surgeries are six or eight hours which is a pretty intense time frame to be focused um so I don't want to lose that subject I want I want to talk a little bit about how you prepare for your surgeries and how you keep yourself in a condition to be the best for your patients because I think a lot of doctors could learn a lot from what you're about to say yeah and this is one of my missions honestly as a surgeon so you know my messaging on my social media that I'm putting out is you know it's kind of this it's very educational to my patients it's a lot of before and after photos because that's what I'm built on right um and then I have this big falling of Surgeons not just in my specialty but in a lot of other ones about optimizing your surgical protocol or who you are when you step in the operating room surgeons are incredibly High performers at Baseline right and we go through this medical training system that kind of Beats us down a little bit and it takes away some of that like super you know bad you know badass person that you were going into I want my surgeons like my Pilots I want you guys at a 10 right exactly 100% going in right and so my personal philosophy towards this is like I want to be at 100% when I go in if I'm not I'm not happy either and I I want to be happy when I'm working and if I know I'm at 95% like that sounds silly but I don't want to be at 95% I want to be at 100 like this is my masterpiece I'm about to go do every single time yeah and I can't and any athlete will tell you you can't do that five or six days a week it's just you just can't get up that many times right and so I really I do say no a lot you know you get in high demand and you it's that's a whole another topic of like learning how to say no is a thing all in in and of itself right once you learn to do that you create a new Freedom around yourself to where I can be like okay every time I go in this is like the person I'm in a tight relationship with them at this point I know them very this is not you know we are we know each other we're we chose each other if you will right um and you know I've been preparing for this for months or weeks visualizing different types of visualization process visualization outcome visualization I am a surgeon I don't get as a professional athlete if you're shooting you get hundreds of reps a day you know tens of thousands a week Millions over your career I'm a surgeon I don't get to do millions of these over my career so my way to get reps is to be an intrinsic learner and go through it over and over and over and as you get better at that it's a skill these are my reps this is my practice right so by the time I've done your surgery I've literally probably done hundreds of times at least all the key aspects but then there's new things that pop up right there's this uncertainty there's this novelty that's that's the dopamine response that we get as a surgon right that's what fuels us like that's the addictive portion of it you know cold plunging drug of choice mine might be my drug of choice too mine might be in the operating room this is my this is what I'm addicted to I'm obsessed with these outcomes and I get all these things pop up that make you um very much have to solve problems take things as they come but you've already been through it a bunch of times before right and um you know every day if I'm not doing surgery I'm waking up and I have you know the beginning of my day is a very relatively simple set protocol that I'll go through I'm just kind of getting ready but then if I'm not operating I'm going to Jiu-Jitsu or something the hardest thing I'll do all day you know go CH choose to put myself in an extremely pressure filled uncomfortably Primal situation where I have to learn how to make important decisions in duress right like to avoid pain right that makes me better at surgery and it gives me more capacity because when you're at a really high level it's hard to find things that challenge you in that way right so this total side note of jiujitsu giving me that sort of Realm for it and being a nice competitive outlet and things like that or the type of training I'm doing I'm thinking about that day but on a surgery day it's different animal I'm like I'm seeking my flow State and I have a very set routine that I've developed over the last decade of how to get there and it involves Hyperbaric my flow State oh my gosh and I want to gloss over that and once you get there we've all been there and if you really start to Define what it is like you want to be there all the time right like why would you not want to be in your Flow State but it takes effort to get into it it's it's a you can't just click into it right right you have to be intensely focused and so I'm getting in the hyperbaric chamber in the morning and I'm doing some consuming of academic things usually and then I get in a sauna and do a little workout and I produce some things and that workout is very specific to like activate my Corpus colossum so I'm doing like asymmetric bilateral things to get my brain ready for like what I'm about to go do in the operating room which is 3D spatial plus technical at the same right um and then I'm getting C afterwards and then I'm going through my last visualization and I'm visualizing the outcome not even just the process but the out about this all the time so you actually visualize the outcome for your patient yeah yeah yeah and I think man for a surgeon to be able to do that is that is in incredible I mean I I work with a lot of professional athletes one of the things that I I teach them to do is to visualize the outcome never the journey right um because if you visualize the journey and then the journey doesn't go as you visualize it you'll recognize it during that event a good point and it can be very dangerous um you know especially in the fight game but when you when you visualize outcomes um you know I think it puts your brain well we know that it puts your brain in a different state because it feels as though it's already been there it's like the more times you take the stage the easier public speaking becomes right but if you're not um at least trying to have your your your brain and your nervous system think that they it has already had this experience um then the experience is brand new when it's happening and that's where the nerves and all of these other things kind of kind of kick in so um we took a little diversion there I want to go back to how you're incorporating the biohacking techniques in with your surgical procedures um first of all I love the peptides huge fan of peptides um and you know I've I've seen those on their own have significant improvements not just for like my skin and and the little success I've had in my here and I emphasize little success but um uh but I've seen it for for thousands of clients so so talk about a little bit about the intersection between these different modalities like hyperbaric chamber red light therapy pulse electromagnetic field maybe even your your preparation protocols with peptides right and and how it's enhancing these surgical outcomes yeah it really kind of starts again that pre-operative we talked about a bit but starts some of it starts in the operating room too right um that when we step in there you know again I'm in my Flo I'm in my happy place there that's like Vibe is right we're going you know yeah and I apply a lot of those things we talked about the fat-based stem cells you know pretty extensively to this point but that's a big part of what I'm doing interoperative I'm putting them in very specific places and then even after we're all done last thing case is over we've done our laser at the end I'm using topical stem cells afterwards that I've kind of saved from the you know there so there's all kinds of places for that but I know you've talked about this on your podcast before but like even in spaces where I'm working and I get these little micro things done and I've targeted everything exactly what I'm after you know last thing I'll do is stuff a little platelet rich fibrin membrane in there right and that is super under or non-utilized in my specialty but I'm starting the healing Cascade I'm getting we call it hemostasis like stopping any little micro bleeding that might be there I'm giving a growth factor bomb basically to that area so they're healing faster and so a lot of this is starting intraoperatively with these little sort of bioh hacks mixed in um not to mention just the planning and the procedure that we're doing that's already at a Next Level by itself um and then we get to the end and we talked a little bit offline like I do not use any opioids during my procedures at all not during their Ania you don't use any opioids none at all like I so no narcotic painkillers nothing rightow and so the ways to achieve this we talked about this before when we were kind of walking through you know you have a sound bed right that kind of plays these Delta theta waves I utilize that which helps kind of get our brain to a very specific sort of state that we want it to be in um the type of anesthesia that I'm using does not have any opioids in it I use local anesthesia to help with the pain so kind of controlling Consciousness we're controlling pain it's a very simple straightforward procedure for the patient that's incredibly safe incredibly safe right I'm not going to we know that repeated bouts of general anesthesia for people when you get if you get it a bunch when you're a kid or you get a bunch when you're elderly you're going to have a lower IQ or you're going to have an earlier onset of cognitive decline dementia I am not going to blunt my patient neurocognitive function for a cosmetic procedure I would not do that to myself I'm not going to do it to my patients and this is not the norm right so I'm really focused on opioid free anesthesia want this to be I'm rejuvenating you I don't want to you know you're you're reducing your biologic age and I'm rejuvenating you I'm not going to knock your neurocognitive function down right they need to come see me first right exactly and so you know we have that all very dialed in um at the very end of the procedure I use long acting nerve blocks so very strategic and I'm very skilled at these at this point I've done it hundreds of thousands of times to um get pain relief with a you know local anesthetic that lasts about 72 hours most postoperative surgical pain happens in the first 24 maybe 48 hours so I'm through that like any actual discomfort you'd have we block and we're through right so I'm not saying it's rainbows and puppy dogs and we're singing Kumbaya but for the most part we've taken the edge off to the point where you don't need any narcotic or opioid pain pills afterwards and that's like boom great and that makes your recovery a better experience it makes your brain work better it makes your bowels work better it's just overall kind of what we're seeking at the sort of Next Level that we're doing so you know it's incorporated into the procedure itself right and then we get them to um the kind of next day let's call it the day after surgery postoperative postoperative at the end of the case sometimes I'll do some targeted IV nutrition the same day right and uh generally we'll have laboratory work and if we're really lucky we'll also have genetic testing on our patients we'll have their genetic profile you're singing my tune now T yeah I mean reducing inflammation improving the detoxification Pathways glutathione synthesis all all of that right and and and in your IVs because I don't want to just jump over that your IVs that you're using targeted IVs you doing highd do vitamin C you're using glutathion kind of things are going so vitamin C glutathione um B methylated B vitamins generally depending again on what they need amino acids sometimes we'll do some NAD in there as well um again we're very we're trying to customize and tailor this to the information that we have and even the procedure that that I did and uh you know if there if there were stem cells or fat crafting how far postoperative they are because we do this more than just this one time but that's very very customized for them you know it's not just a thought lless like we're hanging a Myer's bag or something like that you know yeah that's so so that's so awesome and and and then um so now posttop are they still coming to your office for any of these biohacks or what are some of the things that you recommend that they do postoperatively are there ever peptide recommendations um do you do things like uh hormone balance and look at nutrient deficiencies um any of those things kind of set them off on that path um to be optimal inside and out right you've yeah this goes back a little bit to that chicken or the egg question we talked about the very beginning where you know they're going to look really great after we're done and then all they they feel better too and this is where all these things really start to come together right is yes you know I have a very I'm patenting my protocol for Recovery that involves hyperbaric oxygen at very specific depths and times and time frames we even like to do that pre-operatively if we can to mobilize some stem cells before their surgery um we talked about the IV nutrition PST electon magnetic fields which we were kind of talking offline I'm a big fan too there is one paper one white in the plastic series literature on healing with pmf and I'm like how did this get buried in the literature this needs to be out there and so you know in addition to the actual healing of the at the cellular level there's creation of extracellular Matrix and R reduction of of Edema like most of my recovery super secret most of my recovery that I'm really getting through in the first week that seems so miraculous I'm just getting rid of swelling you know we injure something that swells it's supposed to do that right so the better we can make people in that first week it's this miracle but we're really just helping them with swelling a lot of times you know and find the pmf does a lot with swelling I mean I know that it improves microvascular circulation it can even repolarize the surface of our our cells depending on whether you're using low gal current or or other currents um I I sleep on one every night so I'm I'm a huge fan of pmf um I also encourage people that don't want to spring for a pmf that to be touching the surface of the Earth grounding sunlight free um free right the free the free options but um can you talk a little bit about the the the science behind the impact of you know what is pulse electromagnetic field or low gous current doing in the body to Cellular level that's having the kind of eous outcomes that you're having well you kind of just touch on a little bit when we're talking the membrane of the cell is our key for that right so you know we have the extracellular processes that are happening where this we're creating extracellular Matrix and the paper that I'm referencing in the plastic culure actually kind of talked about that mostly like this is what we really notied is there is an increase in extracellular Matrix which is sort of the scaffolding with which things healed across and these non-healing abdominal wounds is what it was looking at um and so and P MF is approved um by the FDA for non and Mal Union of Bones right you break your bone it doesn't heal pmf helps to heal right right and and that's collagen as well you know so that does have medical indications but applying it to this is very different right and there's a lot more things that are happening than just the creation of the extracellular Matrix the mechanical portion of it also helps with some of the edema right the polarization helps with the edema but then at the cellular level these cells are inflamed they're shocked um they've been through a lot you know they're like and this is stem cells and that they're stem cells are our Warriors they're turned on they're activated by that stress right not every cell gets so turned on by it some of them just kind of shut down and no matter how many great substrates you have flowing around they're not they're not functioning properly to to regenerate and that's what the pmf is doing it's getting the cellular membrane kind of back into a state where okay this thing's like okay let's get to business now we've got kind of what we need around us because we're doing all these other things like there's 's oxygen available there's nutrients available like great but it the cell needs to be able to use them right and that's what the pmf's optimizing okay great man I'm huge fan you know we had a really interesting conversation off camera before we before we got onto the podcast and you know I live in Miami and I spend usually four to six days a month in in La probably the probably the two vain capitals of of America if I was to guess and I I'm seeing less and less of it now but it seemed like for the last 10 years I saw this dramatically Progressive um know amount of of women with what I perceive to be abnormally large lips abnormally large rear ends um and it seems like there's a filler Revolution going on right now so I want to talk about your your opinion on on on fillers but you said something really interesting you talked about something you called perception drift right um and how you know young woman starts with just like a minor lip injection or maybe a little bit of cheek filler and this the the this perception drift by the time she's in her 30s her 40s um men same thing by the way it's not just gerain to the women um their their face looks noticeably distorted to everyone but them right um so talk a little bit about the perception drift and then I want to get into your your your feelings on fillers and um some of these other cosmetic procedures that uh you know Botox Zam in those those sorts of things yeah well um when we think about filler in general right we have to look at our how our face ages as a whole we have to have a deep understanding of this and we all do on some level actually like facial recognition is built into us as human beings deep in our brain like our amydala like part of our core core like our brain's like a uh an onion right the middle is the most primitive and then it just gets slightly more sophisticated and What Makes Us higher thinking as we go exterior from that and at that very core the amydala like part of our emotional regulation recognizes faces really well in our temporal lobe um there's also this fusiform gyrus in there that recognizes uh more of like a communicative part of how our face works right so we're just really in tune with what happens in the face especially around the eyes and the mouth right this is really important this gets into like how I'm able to achieve these incredible results with without you even noticing what was done like this just looks better but I can't tell you had a great night's sleep or something right it's just understanding these little facets of where the low hanging fruit the high impact things are that you don't need much input to get but this goes back to where filler comes in now a little bit because when there's little derangements in those areas we pick them up pretty quickly like I could cover up my ears and nobody could ever draw an ear very well right it's too complex we don't pay that much attention to them even though you see a ton of ears right U but we go to your eyes and your lips and there's tons of important Contours convexities concavities on all of these angles people can draw those pretty well like we know what they look like cuz we just pay more attention to them right right this is also where most fillers is getting injected around our eyes and our lips really and so when there's little derangements of the norm there we pick those up more astutely than we might um some other place even like jawline filler even a face or necklift like the filler because it's in those Kik key areas is going to be really really high impact it's how we recognize who somebody is even when we're babies we really focus is this my mom is this are they going to hurt me what's their current emotional status we can recognize more emotions with facial expressions than we can name right because of those really really core parts so digressing a little bit but that is the key to what's happening so you go get a little filler injection and let's call volume loss arbitrarily 15% of our aging process is from actual volume loss then there's gravitational descent and changes and there's qualitative changes to the surface of our skin um there's just certain parts of beauty that we really recognize as human too into that thing is like you know we want mates that are fertile we want mates that are fit and we recognize those with like symmetry skin those are the things that universally everybody appreciates as beautiful right on a very Primal level part of our selection right and so some of those things we just pay a little bit more attention to and and volume is generally not one of those actually we're not really like oh super volumous face there's some of that in fertility actually in the lips of women we can get cues as to fertility which is a whole interesting side note topic IC but so that's a really common area to put filler right around the eyes because we get volume losted and we really pay attention to it around the lips cuz we women want their lifts to be bigger men want their lifts to be bigger whatever it may be right we just hyper focus on those areas and to a small degree it can be really corrective it can help with that when we correct the volume change that's happened but the revolution that's happened in America in the world really but especially that's call it over the last decade is that now that's becomes a lot of people's only tool to correct aging or at least their main tool to correct aging and so instead of addressing the 15% that it really is it's turned into 100% of the the problem is 15% the solutions to well let's Blitz it 100% right and it happens so slowly and so frequently that you get this little change you go look in the mirror and you're like oh it's different and so we assume we paid money for it we went to somebody who's the world's expert in it or whatever and it's different so it must be better even though we don't really have a critical eye like is this actually better it's just like it's different it looks different great and then it drifts and that becomes your new norm and then you're told 6 months later you got to go get it again and so you go back in 6 months because the FDA trials they looked at a certain time frame until it quit correcting and then they said oh well it's not correcting anymore that doesn't mean the filler is gone this is a permanent to semi-permanent implant but it's viewed as lasting 6 to 12 months which is really problematic over time right W and so they get it they get it once they get it again they get it again they get this slow drift over time that starts happening where their Norm of what they've seen in the mirror for six months or year has changed a little bit the injectors themselves have the same thing happening to them often usually to them and they have way more access to filler so they're probably getting it slightly more frequently but they're getting the the feedback from their patient walking in the door they're getting the feedback from the mirror so they kind of have this double input to get this perception drift right so if you go into an injector and they look off to you you know that's that is their definition of normal at this point right they don't want to walk around looking funny but that's what they think it looks like so should be red flag number one right oh this is there's been some drift here so then we get this filler and and we get into like you know what it does over time and understanding this is this is like one of my missions in life is just educating like you know I do surgery I I find filler I it's rare that I do a surgery now where I'm not managing filler it's not all bad every single time I'm manually removing it I'm trying to dissolve it which is the whole topic dissolving is not some magic wand that makes it go away it just kind kind of help debulk it a little bit but the dissolver dissolves hyaluronic acid including our own hyaluronic acid right so in my world when I'm lecturing like I'll be giving a lecture soon back here in Florida actually in a few weeks about managing filler around surgery especially around the eyes this is like one of my areas that I I work on a lot because it's prevalent right right um and you know it's just turned into this sort of like filler Fiasco or filler issue of just like overtreating not understanding what it's doing not understanding how long it's lasting and using that as our only only option to get it done and treating it like a a semi-permanent or a temporary implant when it's a permanent implant and and these fillers are are are the um when you dissolve them or first of all I didn't know that they were cumulative so they stay in the face or in the lips um so they never really dis dissolve right they they're just staying there and you're continuing to add volume because your like you say your perception drifts so that your your new volume becomes your new Baseline and now you want the next like Improvement so these fillers I'm I'm can't get my arms around but I also don't have um any evidence to back this statement up I can't get my arms around something that is synthetic enough to not be dissolved by the body's own natural enzymatic process and something that has got to have some kind of long-term detrimental side effect yeah um you know I have a very close friend of mine she's very very influential in the um network marketing World um beautiful uh young black woman and she had had one of these Brazilian butt lifts done I think she had actually had several of them done and um uh and then as it turns out the the silicone that they used began to actually leech into her body um she went out and did one of these uh you know procedures outside the United States to save a few dollars I know a lot of women are doing this and um and she almost died from it and and to her credit what she did was she documented the entire process um the pain and the agony the mental anguish not to not to mention the physical pain and the repeated surgery she had to have to have these things removed um and showed the gnarly aftermath inside her body that that had gone on from the from this silicone being being dissolved and and her Mission now is like hey don't do it right perfect the way the way that you are sort those are extreme changes and you could definitely tell it was pretty extreme change so what is your feeling what is your position on the long term yeah um risks or lack thereof of of some of these FS going tell you that's a great question but kind of play that another great question just well it's just so so it's so insightful to get to that point right that level of understanding so quickly honestly um because silicone is a true foreign body right not completely non-related to our structure you don't find silicone anywhere in the human body hyaluronic acid we find in the human body right it's actually the structure of hyaluronic acid is preserved through all species it's the same right what happens though and there's low and High molecular weight that's why I love exosomes we get into that too yep what happens in a filler gel is they cross- link they cross- link they cross- link these usually a mix of high and low some are is low somewh is high but generally it's this cross-link mix that makes it this proprietary filler gel that goes in and these cross links are what make it because if you just put a little strand of hyaluronic acid in yeah it would probably degrade pretty quickly like our normal hyaluronic acid does once you've made it resistant to degradation on purpose so that it lasts there you go it's linked and some of it breaks down and some of it doesn't and so it changes structure and form and sadly kind of loses its efficacy in the volumetric part of what it was trying to do but then Still Remains there as a physiologically active like it attracts water um right and then it we get immune reactions to it too and this was really common with um when someone gets just like a cold has a teeth cleaning anything that act or anything where they're um let's IM system active systemic immune system is active a vaccine even right can cause your body to recognize oh shoot this is a semi forign body sitting in my face and people will very commonly get tenderness and swelling around their old filler injections from eight years ago um no issues with it they get a cold and their filler gets inflamed it's still there it's still present and it's still immune active right so versus silicone which is just foreign body straight up um the hyaluronic acid serves this sort of like intermediary it's kind of part of us but it also has these non-natural features it breaks down it attracts water it looks funny it's immune active um and it's really challenging to get rid of in the long term right plus it's free floating so it migrates that's a whole another topic you put it in a muscle around the lip around the eye which is basically just free floating muscle and it moves through the muscle it doesn't stay in one place there's nothing keeping it there right it's not an encapsulated breast implant it's this free floating implant and we know that as our soft tissue gets volume in it we call it tissue expansion it stretches out and it changes the vasculature changes the collagen and the elastin change sometimes reconstructive surgeons will use that therapeutically someone has a myectomy they don't have enough tissue to recreate the breast they'll put a tissue expander in they'll make more tissue and then they'll reconstruct the breast well if you do that in the face with filler we don't want there to be tissue expansion that's a bad thing right and so when it gets overdone all of these little like even if it's just the microvascular changes that happen or the soft tissue qualitative changes that it can become issues in the long run are there anything that they can do to to have it removed um like you talked about dissolving it I mean that's just my my biohacker Bell goes off and says wow well dissolving it back into the bloodstream might not be the best choice of all unless it's maybe this honic acid Matrix um certainly not if it's full silicone right um but I do know um women that have had to go in and have their lips injected to have it removed or to to stop the reaction so yeah and and injecting with an enzyme the enzyme is called Huron AAS it's a normal occurring enzyme in our body it's been used in surgery for years um it's used in surgery with local anesthesia often to help the local anesthesia spread because it breaks down the glycosaminoglycans which hyaluronic acid is a water retractor in our skin helps break that down so the anesthesia can spread more so it's been used for years and years and years but now we're using it for this like off label purpose and the FDA off Lael to treat filler that's there so it helps break down some of it and debulk it a little bit but it doesn't get rid of all of it and then there's questions yeah what happens to those little microparticles are they going to our lymphatics lots of people know lymphatic issues with filler afterwards because it's a molecule that's migrating around it's going to end up in our lymphatics I see when I have a post-operative patient I talk about like three things that makes their downtime longer their if theyve had prior surgery so many of my patients that I see I just do a lot of revision work they're in a challenging spot from a prior surgery and so they come to me and I fix it basically okay makes their recovery longer they have more swelling because you're working through scar tissue makes sense they're at one of the extremes of age they tend to swell a little bit more but the other one is filler if you've had prior filler anywhere anytime I don't care if it was 25 years ago you're going to swell more after your surgery because you're going to attract water and you're going to have your lymphatics not working as well afterwards and so the dissolver can maybe help with some of those things but it's ALS I I believe and this is a little bit counterculture in my world I believe that I don't want to be flooding people with dissolver and the literature says that there's no issues to our native tissue I don't fully believe that to be honest part of that's anecdotal I've seen people who have had it on one side of their face and not the other and the quality changes on the treated side are certainly different I can't argue with that there's no other explanation for that right so I like to be really diligent with it if I'm if I'm injecting it I'm using ultrasound guidance or I'm physically looking at the filler in tissue during surgery um and then I'm mostly manually removing it right so this is a big another part of my practice someone comes to me for surgery um we're choosing these little minimally invasive smallest things that we can do but then we're also saying okay here's where the filler is problematic we're going to Target that I'm going to manually remove it any part that I can't get manually will dissolve but then we need as little little dissolver as possible right so that's sort how it works and and and in your um practice what would you say is the most common facial procedure that you're doing for for men and women what's what's your patient split I mean what percentage of men what percentage of women because I think it's becoming less taboo for men to get a little these procedures done um I've got several patients in their 50s 60s even early 70s that have had minimal facial procedures done um so what what is the most common reason why somebody is is coming to you and for what yeah procedure so I generally want to see people as early on in the process as I can which is a little bit counterintuitive a lot of people think they're going to wait till they get worse to get their procedure done I'm going to get the most bang for my buck that's actually quite flawed logic because the longer we wait the more surgery we need to get to an endpoint the endpoint's never quite as good I can always get a 45y old to a better place than I can get that same 65-year-old right um and then the longevity is different right our qualitative portions of our tissue how long it lasts once we get to that magical spot it lasts longer the earlier you do it so it's actually a better bang for your buck right so I'm seeing a lot of people who are in that world of like first signs of aging and things like that and so a lot of eyes right because when we really get into like those intricacies that I talked about earlier things on the eyes can be really small really minimally invasive but really high yield at the same time like incredible results where you just look my goals my my calling card if you will is like so much better so natural and unoperated looking I don't even know what you did right like that's the the jam and it's it's really understanding all these like nuances that happen to make asymmetries and how one eye is bigger than the other all those little things go in and this is where you know most people think an ey lift they do an eye lift and that's it and they're like well you ignored everything upstream and downstream that was actually really important in that you know right so that's what makes these little so like brow and lid lifts yes brow and lid so that's a really important one lower lid bags and things like that um early changes along the jawline and into the neck like laxity in the neck these are the types of procedures that I'm doing most commonly my split of men and women this is another you know really insightful question generally in Plastics facial Plastics is you're going to look at like 90 10 that's just like a very you know cut number like I tend to have a few more men or just a higher proportion of men I think a little bit of his like attracts like you know I'm working with a lot of people in our space like this and there just tend to be a few more men in there right but I love it when I get somebody who's into these things that we are because I know I can make them better I know that they just generally have a little bit of a higher capacity for for heing and healing and things like that um and so I get a few more men in that and men tend to be more procedures around the eyes right because men I I generally kind of teas I'm going to get one shot with a guy like I'm going to see you we're going to do this procedure we're going to high five and I'm never going to see you again like you're going to go about your life and so we're looking for those high yield those like low hanging fruit high impact minimal input things and that really really really tends to be around the eyes male and female faci facial plastic surgery are almost two completely different Specialties in a way it's not the same procedures and it shouldn't be this is when you see especially around the eyes who get feminized looking they look like a woman after they're done with their procedure it is not not not the same procedure needs to be approached differently it needs to be planned differently executed differently and so you know that my mix tends to be a little bit more split because of that well um and and as far as the so you do a procedure on let's say the eyes or or um to lift the neck and are you at the same time also trying to rejuvenate the skin because I know that you're very big on on on lasers and lasers is another one of those fields I feel like you could just get a PhD and just laser to use I've done them I have uh something called poos saat the Reds um from sun damage you know when I was when I was younger in high school in the first few years of college um you know like an idiot and I'm I'm very light-skinned I sat out in the sun I was a lifeguard and Ocean City Beach Maryland and we were out there at 9:30 in the morning until 4:30 5:00 in the afternoon and not wearing sunscreen and uh just getting repeatedly fried and now I'm paying the price for it but they use you probably know better than I do um you know a laser that targets the the Reds and it's been a long process it's been a really difficult process because I probably had it done four or five times used to have these big white lines where the creases of my neck were but you could just see the sun damage I wanted to get rid of the sun damage um but for those people that are you know in their entry phase of um you know looking at doing some enhancement to their skin maybe not a surgical procedure so far what are the kind of different benefits of lasers and like how do they navigate this Maze of lasers because some of them have no downtime right and then some of them look like uh you know snake pit you over and over again absolutely yeah and so with any if we're talking surgical or non-surgical it doesn't matter I'm always focused on the qualitative parts of what's Happening right this is what the fat transfer that we talked about is qualitative in the sense of all the regenerative and then some quantitative in correcting volum like Dev volumized fat pads I can refill them with fat beautiful wonderful option no no surgery for that you know it's a procedure but it's not a surgery laser same thing it's it's almost unheard of that I do a surgery without a laser it's not not an absolute but almost always with it the patient's already under anesthesia they've already dedicated time to recovering and no surgery that I'm doing no matter what is changing the quality of the substrate that's left behind right um you know you asked about like these entry phases like it one of the procedures that I'll do really commonly is a super minimally invasive facelift with an incision like this big hidden back in the hairline versus a traditional incision facelift where they're getting this big you know massive procedure like when you're in your 40s early 50s maybe even late 50s I can do that through nothing and this is what people are seeking me for right but in that cool like incredibly um wonderful lifting procedure the skin surface is still untouched with that right right so you have no visible incisions you look so much better but like I was talking about earlier like the quality of our skin is one of those you know measures of fitness and fertility that everybody nobody with clear skin doesn't look at it like that's incredible right so when I do lasers I kind of have this freedom to me and that my patients generally already sedated and numb right so I can kind of do whatever I want I have no limitations and so I'm putting together what I call a cocktail usually so when I look at you I'm saying okay you got some pigment you got some red tones you've got some laxity you got some fine wrinkles and I'm going to make literally a cocktail of different lasers that I'm using stacking on top of each other to get it done everybody's a little bit different from the energy and the like kind of how I'm crafting them together um but just like the bar behind you you have like a set of ingredients here's what I have to work with and I'm going to like make the best cocktail that I can and so arguably one of the most regenerative parts of these procedures because you're again in this low hanging fruit these are really low hanging fruit we can make this look a lot better so it's kind of you know ironic in these beautiful surgeries that sometimes the skin is maybe one of the most impressive Parts you know yeah um and with no extra intervention essentially in that sense and and so there's what is the big sort of categorical difference between the lasers are some just working at different superficial layers or are they actually looking working on different physiolog physiologic structures in the body I mean are they yeah um because I know that some really make you look like you've been badly burned and some you can leave the office that day and you're right just back to work yeah at a very sort of like nerdy nuts and bolts level lasers are by definition one wavelength of light okay so it's uh laser is an acronym actually light amplification by stimulated emission of radiation so you stimulate this light or this um uh this medium to release energy from electrons that get activated and drop and you get one wavelength of light so it's this by definition that way and so we can take that wavelength and then we can look at what part of the skin is we call them chromophores The Targets in the skin and so I sort of mentioned some of them there's Brown like pigment like melanin or melanosomes there's red blood cells whether they're oxidized or not oxy or deoxyhemoglobin specifically in the red blood cells which is what you had with your redness one um we can Target collagen and wa which is like water and with that different um absorption spectrums come in so like some things really love water and they'll just hit it and heat it up and it ablates it right away those a blade of lasers and you can get ones that where the wavelength slightly less has less Affinity why is that good why is just why is just heat deep in the skin good right yeah so um heat causes there when we have an ablative injury it vaporizes it it's gone that physically that's like the equivalent of micro needling right boom an injury in that sense but the surrounding heat causes uh the collagen and elastin and vascular structures to have a you know a subtle injury just like all these other hormetic doses we've talked about um whether it's cold or hot or exercise or whatever that it causes this little micro injury that then C you know it recovers from that right it creates more elastin that's the one we talked about earlier I really want it to create more elastin in that process and we can manipulate that a little bit with our growth factors but that's a micro injury to those areas just from this peripheral heat spread that happens in there and so the more you can Target your chromophor you can get heating just inside of your blood vessel and nowhere else great w you know like everything else is essentially left alone which then relates to some of the downtime things that you're talking about generally the downtime is going to be relatively proportional to the result that you get like no downtime probably minimal results um but some things you can decouple or hack that a little bit by being really specific with what you're targeting you can get incredible results to shut down your blood vessels with minimal downtime because the injury was only on the inside of the blood vessel how do you make a discern a distinction then between when a patient comes to you to have some skin Rejuvenation done between whether or not you're going to do a micro needling procedure with their own PRP whether you're going to do some kind of stem cell injection or you're going to use a laser what's that kaisen decision Matrix like is it about downtime is it about targeted outcome the the point that I'm at in my career it's results driven usually so not that I'm not concerned about downtime because I'm certainly am we just talked about all the things I do to try to hack away downtime but in general I'm after the results that's that's why I am where I am because of the results that I can deliver so I'm really going to give you usually what's the best for you to get the best optimal outcome we have now of course there's a discussion around that as to okay well here's what that involves here's the you know downtime needed here's the lasers we'll need and and so then it gets customized in that sense but generally we're kind of going for the most that we can because with that one treatment I'm able to get somebody to a place that they could have you'll see this common thought Paradigm well I'm going to have these three small lasers that only have two or three days of downtime each I can kind of do it in a weekend and then I don't have to ever have this big period of downtime well those three lasers that total up to nine days of downtime never get you to the same place than had you just done the six day downtime that one time right right so I'm going to go for the results and then I'm going to do everything I can to optimize the results and optimize the recovery and things like that at the same time and you know this goes back to the initial pre-consultation like we talked about things I do before surgery I am very and this is all over my social media I'm very big on proper expectations going into the procedures yeah I did see that I too commonly see somebody who comes to me and they're six months after a procedure and they're unhappy with the procedure they had because they didn't even really talk about it much with the doctor they thought that they were told it was going to be two weeks of recovery and that they just said I wanted a facelift and the doctor great let's do a facelift no discussion of well you also probably need to be doing these things with it no like second order thinking that goes with it no planning just like I'm I'm just executing come in Tuesday and we'll face right and then and you'll be back in two weeks well you're kind of back in two weeks but you are by no means done healing this is a multi-step process it's very complex and it's months before you're really healed and that sounds daunting but when we really get into what those months look like it's just setting proper expect expect like a huge part of having a successful procedure to know what can I expect to happen how long is it going to take what is that time look like when can I exercise and you know all all the things that go into it those are really really really I I'm not shy I'm not hiding those I'm not underselling them I want you to be so dang educated right coming into it that you're like this is exactly what I expected it to be um so if you were to say if I was to ask you what is the one best thing that you're the best at would you consider to say I am known for x or I feel like I am the best at why oh man what what would that oh this is a little bit of an identity question too right like oh man deep um somebody that had nose job is going to be like he didn't say the nose job yeah right right right which I actually don't do I don't do no so I whatever um I mean I would say I'm certainly I'm most known for what happens around the eyes like procedures upper and lower brow because of the complexity and the atten that I P and the results that I get and that's usually the first place I'm starting so definitely that um I think next would probably be the sort of minimally invasive facial Rejuvenation the lifting procedures it's pretty unique that I do that and then to my colleagues it's certainly just the like performance Readiness that's like what I'm no that is I'm I'm fascinated by that and one of the reasons why I invited you on the show because I it wouldn't be the norm for me to put a plastic surgeon on here not that I have anything against plastic surgery at all um I I just feel like a lot of people are not doing the basics to get their bodies contoured to into the condition that they they need it to be and they're going to have um surgery but they're still not working from the inside out and and I love that you are big on the inside out you're big on the other biohacking modalities the fact that you even know what a peptide is and that in that surgical world to me is really just um you know exciting and fascinating but by the same token I also realized I mean we have a patient that just lost two 284 lbs wow and he is and and God bless him we have lots of patients that have yeah um lost you know 100 plus pounds um we're working with a very very famous one now that's I think going to Rattle the world when we show the transformation and I realize that I mean these people are going to have to have some body contouring done because there is just no other way to to bring them back and they put the work in and they got to have the body Contour done and I also see the implications of um you know men and women this this whole anti-aging longevity biohacking you know bio optimization whatever you want to call it field right now that's getting so much attention Wellness functional medicine you know it doesn't have just one solution right um and I think that getting a minimally invasive procedure getting some resurfacing done Rejuvenation done can not only be good for the you know the appearance wise but I think it has a lot to do with people's mental well-being and I think it actually has some positive physiologic outcomes because um you know you were dermatologist you're Dermatology trained before you were cosmetic surgery trained and you know maybe there are potential risks going on in their face you know scars and other things that you can get rid of those um you know pre precancerous lesions and things like that you get rid of those um they have real implications abut you know on on on your outcome so yeah um what's do you feel like there's anything that we haven't covered today that my audience should know about minimally invasive um procedures I feel like there's so many rabbit holes that we could go down we covered a lot of the big ones that my audience asked about the you know the the hair loss um and and some of the your your thoughts on on biohacking but what if any topics do you think that the person that's interested in this longevity anti-aging trajectory that they're on um majority of my audience is middle-age um what would you like to tell them about that Journey where do they look what should they be thinking about yeah that's a great question again and I think you just really you know you want to really just turn your brain on when you're doing this right like it sounds simple it sounds so simple to say but this is and I tell everybody this with and the world driven by before and after photos for me is like go look at before and after photos and be critical don't look at it and say that's different great it's different but is it better like look at it and try to figure out and get into it and know and not that you should know everything off the get-go but get a real visceral feel as to and when I say visceral I'm saying like that's part of how our brains programm to recognize it like pay attention to those things right and understand like okay here's what here's what I resonate with and then when you go into it go into it with the Open Mind of like okay well there's going to be qualitative there's going to be like physical and anatomical aspects of what can be done and sort of hear hear it out you know don't go I don't want to like direct to this degree like go on knowing what your concerns are having that self check here's the things that are most important to me and be able to articulate those but also don't tell the person what you want because could be really dangerous you know because like yeah great let's do it because that's what's going to make them happy and that's a very sort of like Bush league first grade level of thinking like the person asked me for a facelift that's what it's going to take to make them happy but then they walk around looking abnormal afterwards right and this is what I fix this is 80% of my practice is fixing these things I love it when I get somebody who's never done anything um it's just pretty rare at this point and so you know go into it with that and that's like a PSA Public Service a little bit of like you know understand it be careful with filler if it seems too good to be true it probably is if your injector looks off they're probably going to try to create that in you and then I think also I mentioned a little bit of like not waiting until you're desperate or it's too late like don't just don't think well I'm just going to wait till it's as bad as it can get because there's issues we we didn't really get into this too much but as we get you know with women per menopausal that changes a lot of things right and so I tend to kind of like step back and um help them manage that via you know I have a functional medicine part of my practice that evolved solely out of my surgical recovery I already had it there and I had the mindset and all the things and so I bring in people who know more about it than I do and say let's have this functional medicine practice but now it's this beautiful adjunct for my patients who are going through this whole journey of Rejuvenation so postmenopausal is is going to is going to determine some of their surgical recovery our soft tissues are so responsive to sex hormones particularly estrogen we're talking about fat even vessels and things like that right so um I I want those to be optimized as much as they can for some people it may be the right call for others it might not I'm sort of like you know stepping back and doing my job and sort of you know you know managing everything from afar but letting those things get like worked into what is best for you as a human and then with that I'll work and you know we'll make the we'll make magic happen other ways that's that's amazing um I I I wind down every podcast by asking every guest the same question there's no right or wrong answer to this question um but I ask everyone this questions I've had some really interesting answers but what what does it mean to you to be an ultimate human thinking about this question has been my favorite part of this podcast podcast you prepared going to have the best answer of course I no not even that but I this just thinking about this question has literally been the most fun of this for me I think really and I've talked to my loved ones and my friends about this a little bit so yeah I mean I have thought about this and not this isn't some canned answer it's actually probably still in the works because it will be for the next years for me because I love it um but I think that being the ultimate human involves a few facets right you have to know what your goals missions Valu what did God put you on this Earth to do you have to understand that first and foremost amen and I think that a lot of people could do better with that myself included right I revisit this quarterly almost weekly I do year interviews I'm like what am what what am I climbing up what am I shooting for what are my goals right but you have to understand that first and sometimes it's hard for people to sit with themselves quietly enough to do that I think they don't really want to get into who they are and what their values are because it's harder to Define but once you know that then you can start working grinding climbing the ladder whatever you want to call it and a lot of people are really good at that right they're climbing and grinding and they're like busy and they don't know what they're where they're going even like there's no end in sight they're just going going going they don't know when they got there and they might get to a location they're like this isn't where I want to be right so but we have to be able to do that the grind right I think you know that's an important part some people never get to that they're really good at knowing what they want but they'll never go do it right so then you got to go do it but then along there is this is where this is why people are listening to this this is what we're so into is like great now this person who has a mission who's going along what where are they at like are they at 100% you know which probably never will never be at truly 100% but we're shooting for it right and when we're doing that you know we we can climb faster we can get to that location better and we can serve those facets that we're after you have that's Dynamic like when you become a parent that certainly changes right what's happening with your career with your marriage like those those are Dynamic you got to be kind of keeping a tab on those all the time so you know what you're working for and that you're not going to burn out you're going to be healthy you're going to be happy and when you do get there you're the you can do it the best that you can whatever your mission and values are that is to me like all of those things together that's the being the ultimate human that's being the ultimate human wow um Dr Chestnut has been amazing Cameron Dr Chestnut um you know I feel like my audience is really going to resonate with this W with this podcast I'd love to have you back again um and I'd love to continue to you know follow your work and we're going to do some biohacking in my we didn't even chat cold plunging that's another there I love cold plunging because we have some definite differences there that are kind of fun and our yeah I mean lay it out well right here before we wind okay let's we before we wind up so I mean I've been cold plunging for 25ish 26 years really well be I was a Collegiate athlete right okay and so for us it cold plunging was getting in the therapy pool like it wasn't cold plunging it wasn't cool you were semi- injured all the time right and so you're like getting in this therapy pool and it was the whirl pool was metal it wasn't cool it wasn't you just got in it because it it made you feel better after your injuries and it made you able to train more and so I took that and then as I got into my life as a triathlete and these other things I just kind of took it with me and I literally did it only for the only reason of increasing my training capacity and which in hindsight was recovering after workouts and so I just love this you know like thinking back about it it's like it wasn't cool I didn't talk about it like you know you love the jokes now of show me somebody who Co punches without talking about it that person's rare right it's rare so true um but back then it was just you just did it right the function and then you know as we I love that you're a woke to Wellness as we became more understanding of what it was doing it came very in Trend I don't know how many years ago it's been now but and when I just think back like you know all the things that I've cold PL I plunged in my hotel bathtub today with a garbage can full of ice right like and so it it's like all the things I've been through horse troughs and like rivers and lakes and snow and uh everything cattle drops when I'm in Colorado right yeah and and I still have my converted chest freezer that I would call lung and that's might be my favorite one ever cuz when you're hopping in a meat locker to get cold you're like all those people that buy those ones from Costco right and seal it up and hop in it it's a great you know Financial option and easy way to do it but then you have all the wonderful beautiful ones now that can make you so cold I tend to plunge a little bit colder than you do I think partially because I'm seeking that recovery and that like little I want to build the like willpower part of my brain the like mid singulate cortex it's called this like anterior portion of it like and if I get in yeah humman talks about that doing things you don't want to do exactly um and strengthening that part of and this is one of the things the message anybody starting like it gets easier but it's never fun like even if it's your drug of choice like that initial plunge when oh you can you can make it as miserable as you want no matter what so I like a little bit colder I'm pretty skinny so i' like I get my core temp down pretty quick and then I kind of stay there and I know you know you say there's no evidence to like colder is better to me it really boils down to like what's happening in my core right like and if I can get there faster like it'll be midday I'll be mids surgery some days and I still feel like contracted and constricted no I love that feeling too I I've actually so you know my thing is as a general guide um because there's a very small sver of the population that has you know risks of getting into a cold plch and and obviously colder for them would increase that risk but um so I say 48 degrees 3 minutes minimum 6 minutes maximum so great Sweet Spot cold shock um um the body not cold adapt the body but I I really I want people to get the benefits of the peripheral vaser constriction the brown fat activation the the cold shock proteins I've actually started doing um some research on individual cold shock proteins because there's a I think therein lies you know where the evidence is really going to emerge about you know the benefits of Cal plunging I mean there's this Lin 28a and Lin 28b that that that appear to have very positive effects on um upregulating glucose metabolism by improving insulin sensitivity and there's there there seems to be a direct link there I wouldn't say that there's a clinical study that proves that yet and I say things like you know cold plunging is a great way to to a great add-on to your fat loss routine because not because there is a peer-reviewed randomized controlled clinical trial proving that it reduces you know causes fat loss but there's enough there's enough evidence in the periphery to say that that's happening I if you have if you have to exchange calories for heat like brown fat activation um if you're raising your metabolic rate if you're releasing endorphins if you're upregulating glucose um metabolism or or upregulating insulin sensitivity um all of these things have an indirect relationship to Fat Loss right um so it's it it it's a very linear projection to say that you know it could help impr improve fat loss you got my brain going crazy with that because I wonder like are these activated at different temperatures and you know I wear a CGM during surgery times because this is you you know your your audience is high performers right these are my patients and you too like and then we talked about Flow State extensively but getting into a flow State out is very energy demanding it's hard it really a big recovery and so these things help and so I wear the CGM right to just to kind of know it's actually pretty boring to be honest for me which is good but the most changes I get in my CGM when I have it on are when I'm alternating um therapy between hot and cold right when I'm doing contrast therapy I see this like um pattern of this slow rise when I'm in the sauna and then a saw tooth straight down when I get in the cold plunge immediate drop in that insulin sensitivity right and then back in the sauna and I just I can get this Sawtooth to repeat with that yeah um and you know it it definitely is changing your insulin sensitivity and all all a huge metabolic thing and to see it you know you don't really see it and that's where I see it the most so with your high performing audience who you know it's trying to recover from their big days at work where they're doing all these things like you know I like cold plunging honestly probably more for the mental toughness part of it like um I do love all the physiological benefits and they're there but I probably really do it more for myself deal it one of the hardest things I'm going to do today right and and that's that's why I do it for my kids you know and that and that maintaining that that state of calm um you know I do it now where I I wake up um we walked around my house so you see I've got my master bedroom then my bathroom and then to get to my gym or to get down the hallway you got to go through the room with a cold lunch and I did that on purpose cuz I'll I'll walk in there and I don't think that I've walked in there one morning go man I'm so psyched to get in here I know every morning I pause and then I I I don't know why but I hear David goggin's voice in my here like calling me a and um and because I saw him on a podcast and he was like you could solve anything with Massive Action quit negotiating with yourself like I never I've actually met him a few times but he's in my ear every day going get in there you and um and then so I I got my underwear on I just get in the cold plunge and I've never regretted then I get out dry off put dry shorts on and get on the hypermax but by the time I make it down the hallway and reward myself with a coffee um I've got 70% of my routines already done I've done red light I've done hypermax I've done cold plunging brushed my teeth put water on my face and I feel awes amazing yeah so but meeting me at that end of the hallway where there this end the hallway 20 minutes apart is night night and day this is atomic habit this is setting up your habits in front of you so that there's literally hurdles to not do them right they're like crazy and I have this like mental game with myself it's funny CU if I go out the other door of my bedroom and I go down to get coffee I feel like such a loser nobody's watching I'm all by myself I'm like you are a loser I I spent uh last week like I did a three-day in the life of a professional UFC fighter yeah with uh Juliana Peña who is the former bantamweight champion maybe soon to be you know getting that title back and it was just fascinating to be in her life and see three workouts a day and all the so we can get into all the recovery things but one I think the biggest changes I you know impressed on her was cold punching right well she had it but she just wasn't using it regularly and you know you have all those physiologic benefits for her three workouts a day I was smoked after three days of that like it's hard you did three days with her yeah three days three work three workouts a day you know it's like strength training in the morning grappling you know Jiu-Jitsu in the afternoon MMA striking at night like and just rep on repeat right that's unre and it's a whole another level I know you know way more about that than I do but um you know I've had the privilege of getting to work with some of the UFC fighters for you know fixing things afterwards um but you know in that world like that's the one that I'm still getting messages from her about like she's got a daughter who's six years old who's the one encouraging her in there now like getting her to go in and like filming it keeping her accountable and but when you think about you said keeping calm right we have that Panic response this is what I get I get I live on a a body water and I get in it every single month just kind of like for myself sometimes I'm walking out on the dock and I'm doing kettle bells on the dock and then hopping in the water and getting out just like it's a mental toughness that's all it is right but that Panic response especially when the water's moving right yeah and this is what I saw with her she was phenomenal at overcoming that Panic response better than anybody I've seen she's used to like trying to survive you know getting choked and all these things anyway I just thought that was really fascinating that I saw it was really hard for her to get in but when she did get in she over came the like Panic the getting from parasympathetic to sympathetic or sympathetic to parasympathetic really quick I love submerging my face first taking advantage of that mamillion diving reflex right which is in my world you mean before you actually get in well the first thing when I'm in I get my face that cold um in your nostrils triggers a physiology that slows us down right our cranial nerve number five is our facial or is our trigeminal nerve it's the sensory nerve to our face and when it gets cold and shocked it sends a signal through our Vegas nerve to slow down our physiology slow down our heart rate slow down our breathing that's how mammals you know otter and whales and things can dive for so long it slows them down and we have the same response all over like if I push on somebody's eyeball hard enough I'll slow down their heart rate it's all this like cranial nerve 5 to cranial nerve 10 connection really which we call the oculo cardiac or trigemino cardiac reflex well did you actually have close your eye and well I'm saying like in surgery if we're working around the eye sometimes we'll see them get we call it Brady cardic slow heart rate and I'm communicating with my um it happens more in younger people but I'm communicating with my anesthesiologist on that and things but I just love that that and most surgeons don't even know that exists so I teach about this I just wrote a paper on it published it at you know a couple years ago now maybe but like this trigemino cardiac or ocular cardiac reflex how it relates to facial cosmetic surgery but I love on the flip side of that that this thing that I do cold plunging every day get my face wet you know overcome the shock get your heart rate down that's the best part like there's a physiologic response in all mammals to that it's really cool and overcoming that Panic you know I I I saw an interview it was an older interview with Dana White who's become a very good friend of mine now um and he was asked uh I think the question was what makes the difference between a good fighter and a great fighter what and and and and if you were to pick one word that would be the difference between a good fighter and a great fighter and he said composure really and um you know if you think about it the the situation they're in I mean usually the one that loses their temper loses the fight right um the least composed loses the fight I mean at that level it's like jiu-jitsu you know it's it's a it's a thinking man sport um and it's like the ultimate gentleman's game of chess just has a possibly very negative outcome right for the loser but um um so you know just getting to your point about you know how this athlete was able to overcome that Panic re response which probably just used to being very composed right yeah champ you can be composed in in cold water and for me there's there there's nobody in there I got nobody to impress um so I I do freak out a little bit um the people are in the room I'm very composed yeah so I pretend like the cold water doesn't bother me it resonates most with me as I got in there my wife's like are are you cold I'm like not at all like she goes can I talk to you or do you want me to wait till you get out and I'm like you can talk to me right now of course you can talk to me you know why can't we talk was just because my voice sounds like it takes a sec yeah it resonates most with me as a dad actually like that keeping composure as like your superpower as a dad I mean my kids are younger than yours I have like 1086 so you're constantly trying to like keep your composure and demonstrate such a metaphor for Life man great way to start the day well again Dr chest has been amazing brother thank you for coming on and making the trip here so grateful thank you for having me and as always that's just science