Butts Aren’t the Only Place Fat Belongs! The Full Fat Transfer Guide

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. Okay. When people hear fat transfer, most people think of one area

Bri (00:15):
Booty.

Dr. G (00:15):
Yes. Thanks for elaborating. But as we know in plastic surgery, fat can be used in a lot of different places. And today we're going to explore all those different places. We're going to walk through fat transfer to face to breasts to body and different types of fat. Right? You don't have to use your own. Now you can rent it.

Bri (00:39):
Well you should buy it. You don't want to give it back.

Dr. G (00:40):
Maybe purchase it. But we still haven't cracked the, every time we talk about fat, I feel like somebody is like, oh yeah, my friend said they wanted to donate. Or somebody in the room is like, if they want some fat, they can have mine. We haven't made that happen yet.

Bri (00:55):
No, and that's super funny because actually somebody asked me that over the weekend is she had a girlfriend that wanted a skinny BBL, but she didn't have enough fat. She's like, can I donate my fat? I was like, no. No, you cannot. I mean

Dr. G (01:08):
You can donate your kidney but not your fat. It just seems criminal. Yeah. Think of all the good in the world we could accomplish.

Bri (01:16):
Can you imagine? We don't want organs anymore. We just want our friends fat.

Dr. G (01:23):
True friends donate fat.

Bri (01:24):
Amen. Amen.

Dr. G (01:26):
You can donate breast milk.

Bri (01:28):
Yeah, you can pretty much donate everything. You can donate blood. You can donate plasma organs. You can donate.

Dr. G (01:34):
Yeah. So why not fat?

Bri (01:36):
Yeah. Somebody needs to work on that.

Dr. G (01:38):
Someone make it work. Make this make sense.

(01:42):
Okay. Alright. But you know, first we have celebrity news. Did you watch the Grammys?

Bri (01:47):
I watched all the after on Instagram.

Dr. G (01:49):
Oh yeah. It's probably a better pace. There is literally a commercial every two seconds. But It was good. There were some looks.

Bri (01:57):
I saw Bad Bunny won, which was very fitting leading up to a Super Bowl performance on Sunday.

Dr. G (02:01):
I know you couldn't ask for a better promo for your Super Bowl half party than to win.

Bri (02:08):
Let we just win a Grammy.

Dr. G (02:09):
I was going to say, I can't think of her name. Tessa the girl from, I'll think of her name. Anyway, she had a little bit of, I thought she looked stunning. She presented at the Grammys and she's in that really popular movie and she just won a Golden Globes and she was wearing this insane dress and my friends were all like, did anybody clock the cap con on the right side? Does that not bother anybody? And I was like, damn,

Bri (02:33):
Is this giving, what was it? Doja cat all over again.

Dr. G (02:36):
They're like, what Stylist is responsible for that? And I'm like, oh, all I saw were abs. I was like, wow, she just looks so good. Okay. All right. Well let's go to Carrie Underwood who was branded unrecognizable by fans

Bri (02:51):
At the Grammys?

Dr. G (02:52):
No, we're off the Grammys already by her American Idol audition from 20 years ago. Resurfaces. I mean, first of all, it's 20 years ago, so

Bri (03:03):
I feel like she looks the same. Just heavily botoxed.

Dr. G (03:05):
And older and filled. People get crazy

Bri (03:11):
And

Dr. G (03:12):
Sometimes the makeup's a little more, she's like 20 years younger and has very little makeup on and is cute.

Bri (03:18):
I feel like she looks more the same than most people

Dr. G (03:20):
I know,

Bri (03:21):
But I think she looks great. Yeah,

Dr. G (03:24):
She's taking care of herself.

Bri (03:26):
Yeah,

Dr. G (03:26):
Moving on. Oh, you know who looked cryo-preserved at the Grammys? And I always call this I love her because people will be like, you know, look just like Cher. I'm do I, oh yeah. But she is like 80 or something and she walked out there and looked perfect. Yeah, she the blonde kind of fucked, fucked it up

Bri (03:51):
Cooking.

Dr. G (03:52):
She did cook, but then she missed, so first of all, she won a lifetime achievement award. I watched this in real time and then she walked off like, okay, I guess I'm done. And then as she walked, she just took it and went, no. Well she got her award and then she gave a little speech and then she sort of kind of forgot what was supposed to happen next and started walking off stage. But there was no music playing or anything. So then the host Teva Noah is like, share, share, come back. Literally that's what was happening. So she turns around and he's like, you're supposed to present the award. Yeah, that was her next job. I love that. And then she opens it up and the song that won was Luther by Kendrick Lamar and csa and she goes, the Grammy goes to Luther Vandross. Wow. Who be dead and who this song was tribute for. But everyone's like, oh, little Boomer.

Bri (04:56):
I know I can't talk about politics, but she's giving me the, if you guys all know who I'm talking about, losing it a little bit. Oh yeah, lost president. Yeah. I mean she is, you just don't know where you're going. You're like, what do I do now? Am I going left off stage? Right off stage. I present who's alive, who's not alive.

Dr. G (05:16):
Yes, Iceland, Greenland. But they were very gracious and then she stood on stage the rest of the time as they won the reward because I think she was afraid to walk off, know what to do off. Yeah. She didn't have a handler. And I think at that age, I think I've seen Jane Fonda present and sometimes I think if you're over 80, 85, they probably just need to have a handler with you.

Bri (05:38):
She needs to be on the Martha Stewart Green Juice diet and then maybe she,

Dr. G (05:42):
Oh my god, she looks so good. But it was got to be overwhelming.

Bri (05:46):
That's hilarious.

Dr. G (05:47):
It was a good little speech.

Bri (05:48):
I think you should try a blonde wig.

Dr. G (05:51):
Oh my God, that'd be great. It would look insane. Next little bit of celebrity news, botch plastic surgeon. It makes it sound like he's botched. So I just love a complete a daily mail and their mastery of the English language is just nuts.

Bri (06:11):
Sounds like me when I try and talk,

Dr. G (06:13):
Where's the

Bri (06:14):
Sometimes just words don't come out together,

Dr. G (06:16):
Quotation marks or something like the show botched. So it makes it sound like Terry Dubrow is botched the botched plastic surgeon. Terry Dubrow sued by former patient for negligence over complications from boob job.

Bri (06:28):
But isn't it, his whole thing is he's trying to fix botched work and then

Dr. G (06:33):
So he's already doing essentially high complication rate, high revision rate surgery.

Bri (06:41):
I'm surprised he doesn't have a NDA where you can't sue. So the plastic surgeon I went to that I didn't know wasn't a plastic surgeon at the time. I found my old paperwork a year ago when I was going through some files, which I thought was really interesting and all the things I never read in my consents, there's a whole thing. It's essentially an NDA. You cannot sue him, you can't do anything. Everything has to be settled in office. And I read it through and I was like, oh my God,

Dr. G (07:14):
You were like, why aren't we using this?

Bri (07:15):
Yeah, exactly. But the fact that I just signed this, that should have been a huge red flag right there. But I am saying I am very surprised he does not have that sort of NDA with how big he is and he can get sued. Right.

Dr. G (07:29):
So yeah, so two reasons. Probably just one reason. First of all, he's a board certified plastic surgeon and he is highly qualified. So the people who make you sign an NDA before you've even had surgery are generally not board certified plastic surgeon. I feel like it makes sense. They tell you to do that at the weekend course you take so that you can do surgery. It's the cosmetic, it's like the non-core cosmetic surgeons. I unaware of any board certified plastic surgeons that do this. I don't think ethically it's you can do it. I don't know. First of all, I don't think it would stand up in court.

Bri (08:09):
It feels like it's almost giving them the right to make mistakes or do something wrong.

Dr. G (08:12):
It just seems like a bad idea. We know complications happen and if you've effectively counseled the patient, then nobody ever thinks a complication's going to happen to them. But when it does happen, at least you've had that conversation in advance. And the NDA is probably, I don't know, it's interesting. I don't think it's enforceable and it's not common practice for legitimate surgeons, which is probably why he doesn't have one. He might have one for the patients that go on the show. That's probably reasonable, but no, and so in essence, you just end up a wide open target. Right?

Bri (08:49):
Yeah.

Dr. G (08:50):
It's kind of annoying that they're like, oh, he got sued. Well, as you know, you can sue anybody for anything and then make them go through the rigmarole of having to prove that you didn't do anything wrong. So I guess I would just say, but this

Bri (09:08):
One here, let

Dr. G (09:08):
Me know when it settles or if he gets found of something wrong.

Bri (09:12):
It's just a hematoma that could have been caused by mesh, which is just a complication of having surgery, period. It happens.

Dr. G (09:20):
Bleeding is a complication.

Bri (09:21):
That's not his fault. There's nothing honestly, I mean you can do your most to minimize bleeding during surgery, but how is he supposed to know?

Dr. G (09:32):
Yeah, I know. So it just seems they're like, I got, he's this famous guy. I know I've got this famous guy, he must be very wealthy. I had a minor complication after surgery. I think the ones that are concerning is when somebody gets sued and it's just a tip of the iceberg and you realize, oh my gosh, they're not good at what they do. That's really what malpractice and lawsuits are for to some degree when you've been wronged or there's some egregious wrong doing, but a complication does not translate into malpractice if everything he did up to that point met the standard of care.

Bri (10:10):
Right.

Dr. G (10:10):
Patients just either don't understand that or they don't want to accept it. I think it's hard. It's very hard to be, then you start practicing defensive medicine. Yeah. I feel for him, this is brutal. I'm sure he'll be fine because he's a good surgeon and he's perfectly capable of managing it. But

Bri (10:29):
Yeah, and I'm sure it's not like he was like, oh, there's nothing I'm going to do about it. Maybe if he was like, sure, he offered to help. I'm not going to help your hematoma. I got a hematoma at the last surgeon I went to after my second breast surgery. Right.

Dr. G (10:42):
It's not uncommon.

Bri (10:43):
It's not uncommon. Got it drained and that was it.

Dr. G (10:47):
I always say surgery would be easy if there wasn't hemostasis, which is the part where you have to make sure there's nothing still bleeding and it freaking happens. It's a three percent-ish risk to all surgery and can come in varying levels of bleeding and it is a bummer when it happens, but you have to take care of it and you don't want to ignore it and then usually people end up fine.

Bri (11:18):
No, I'm sure if he was like, fuck off, that'd be another thing. But I have a feeling he did it.

Dr. G (11:23):
No, I don't think so. Alright, so we're rooting for him also just because I mean again, call me when this turns into he loses a lawsuit. I know he won't. So why even give that negative press room to grow and also just don't call him a botched plastic surgeon.

Bri (11:41):
Yeah, bad choice. Choice of words there, but more of the story. If you have somebody that wants you to sign an NDA prior to surgery, don't do it.

Dr. G (11:48):
Yeah, that's a bad idea. That is a PSA.

Bri (11:51):
Yeah.

Dr. G (11:52):
Maybe then go back and check their credentials.

Bri (11:54):
Yeah.

Dr. G (11:55):
Okay. Alright. Martha Stewart, who we just mentioned, 84 reveals why she showers and puts on makeup before hitting the gym at 6:30 AM

Bri (12:05):
Amen. Martha. I would too. There is that thing. It's like you look good, you feel good, you have a better workout. When I go to the gym and I look homeless, it's really not that I don't feel great about working out.

Dr. G (12:19):
I know six 30 is early though. I mean I usually roll in and work out at 6:00 AM and have that I just woke up like this look, that's my look. I threw on my yoga clothes and I'm going to work out and the room, the yoga room,

Bri (12:35):
Hot yoga, I do not wear makeup to.

Dr. G (12:37):
Yeah, that's crazy.

Bri (12:38):
You just sweat it off your body.

Dr. G (12:40):
And even when I do the HIIT workouts and all that stuff, the room isn't so bright either, so you don't have to worry about the fact that you don't have makeup on. I think that's nuts. I just took my youngest daughter to a volleyball tournament last weekend, so a bunch of 14 year olds playing volleyball and I was looking across the way watching the other, you're watching back and forth and this one girl had a full face of makeup on and lashes and everything and I was like, what is happening? It was just wild.

Bri (13:13):
I just want to comment. So on Christmas, my girls' Christmas party, we had our work Christmas party the next morning or the next day, but that morning we were all doing a Santa run with some of the girls in the office and I don't want to say I drank too much wine, but I drank way too much wine. I'm pretty sure I was probably still intoxicated when I woke up. Don't worry, I didn't drive. I still got at 4:00 AM My eyelashes on a full face of makeup. Pretty sure I was throwing up still, but I got it together. I did my hair, I got there, I still ran. Got to look good. Got to look good.

Dr. G (13:49):
You guys are crazy.

Bri (13:51):
Yeah.

Dr. G (13:52):
Yikes. I know. I was waiting for you guys to run by

Bri (13:55):
And you should have texted me.

Dr. G (13:56):
There was so many people in that Santa run. It was wild.

Bri (13:59):
Everyone looks like Santa. It was, they were all dressed Santa. But yeah, go Martha, I am a fan of getting your six 30 on full beat.

Dr. G (14:09):
That's a thumbs up from Bri. I'm going to take a hard pass. I'll love it on the weekends if I have nothing to do and so I don't have to put makeup on all weekend. I'm like, yes.

Bri (14:17):
Yeah,

Dr. G (14:19):
Alright. God bless Martha Stewart. But now we're going to talk about fat transfers. So did Brad Pitt have a facelift or did he have fat transfer instead?

Bri (14:29):
So he looks to me like he had a fat transfer. I think that if he had a deep plain facelift, I feel like his cheeks would be pulled up more, but he does look very filled, so that's why I'm going to go with fat transfer over facelift. I'm going to say both. I need to see his ears.

Dr. G (14:48):
I know. Let's just see the So also though, Dr. Bob Basu, who's the current ASPS president was at my symposium. He was the sole man representing at the Women's Plastic Surgery Symposium this weekend.

Bri (15:02):
Smart man.

Dr. G (15:03):
So shout out to Bob. He did well. So he was visiting as our A SPS president and in support of women and our field and also gave a talk on deep plane facelifts and I believe it was him who showed a photo of a scar and you couldn't see it. So one of the pros of a deep plane facelift is if you take all, it's a composite flap and if you're taking all the tension off the skin because original the OG facelift, which was skin only, all the tensions on the skin, if you're offloading this by putting the tension on the SMAS which you're lifting, then the scar should be minimal.

(15:43):
Oh no. You know who it was was Gabby Mioto also a great plastic surgeon. She's in Atlanta, but they both gave talks on deep plane facelifts. It was kind of cool to see how excited they are about what they do.

Bri (15:56):
Love that.

Dr. G (15:56):
I know. I love that for them anyway. So I think if he had it done right, it would be hard to see the scar in front of his ear. But it's pretty hard to hide the scar behind your ear in a man especially. But I think it's reasonable and I think the one thing they did for him was not mess with his eyes because usually that's where you get away. Get in trouble with men. Yeah. Ala Kenny Rogers or Donnie Osmond or Jim Carrey, anybody where you start doing too much to the eyes. He always had that kind of hooding of his upper eyes and to change that would've changed how he looked. Now did they add fat? Probably. It looks like it but it won't last. It'll dissipate with time. But he looks good.

Bri (16:43):
He does. He looks great. How old is he again?

Dr. G (16:45):
60 or a little over.

Bri (16:47):
Yeah, he looks great. Props maybe he has. This is very nice and smooth.

Dr. G (16:52):
I know his jawline looks good.

Bri (16:54):
We definitely need a side profile.

Dr. G (16:55):
But I have seen Instagram photos or reels of Demi Moore. That's another person who had a couple facelifts and you can see the scars if you look closely.

Bri (17:05):
She looks phenomenal in Landman so, so good. And then I see some pictures.

Dr. G (17:10):
Demi Moore, is she in Landman?

Bri (17:12):
Yeah.

Dr. G (17:12):
Oh, I haven't gotten that far.

Bri (17:13):
She looks so great. Great. No, yeah, she's the wife. She turns into the main character on

Dr. G (17:19):
Shut up. Yeah. Okay.

Bri (17:20):
She looks phenomenal. But then you see obviously of course other pictures and you're like, oh yeah.

Dr. G (17:27):
I mean a filter goes a long way. Right. And good lighting. But yeah, so I think most people benefit from a fat transfer conservative at the time of a facelift and it's a good adjunct because it adds volume, restores volume. It also has this kind of beneficial glowy, You're not allowed to say stem cell, but stem cell effect, rejuvenating effect that lasts longer than the fat does Love that. And so for that reason, I think it's beneficial. I have a picture in my office of where I'm at a graduation ceremony for residents and interns in the Navy and I'm like 10 days out from a fat transfer to my face.

Bri (18:09):
Is that the one you did awake?

Dr. G (18:11):
Yeah,

Bri (18:12):
On a bet. Okay.

Dr. G (18:16):
Yeah. My friend convinced me we could do a fat transfer

Bri (18:18):
Awake. Oh, we found an ear picture. Can we zoom in? I don't have

Dr. G (18:21):
To zoom in on that. I don't know. I'm going to say but see how he is. Got the hair covering it. I'm going to go. Yeah,

Bri (18:30):
I'm going to say yeah too

Dr. G (18:32):
A hundred percent

Bri (18:33):
Because the ear,

Dr. G (18:34):
He looks good though.

Bri (18:35):
I feel like they always say the tragus gives it away and it really does.

Dr. G (18:39):
Yeah, a little blunting there.

Bri (18:40):
Yeah. All right. So just our opinion,

Dr. G (18:43):
But probably had fat, and I'm telling you, the fat transfer did justice to my face for a long, long time.

Bri (18:49):
He looked snatched little. He's got nothing there. Alright, so we say yes.

Dr. G (18:56):
Nothing wrong with it.

Bri (18:57):
Looks great, but very natural. Like a man.

Dr. G (19:00):
Who's looking lovingly at someone who's 30 years younger, but that's another problem.

Bri (19:06):
Love that. Okay,

Dr. G (19:08):
Let's talk more fat transfer to the face. I think Jesse from Secret Lives and Mormon wives had some radical transfer. I've actually been scrolling past this so I hadn't looked. I mean she's had a lot done period, but I guess it's even her most recent.

Bri (19:28):
She's been going under the knife a lot. She's done back-to-back surgeries. This last one, she came off online and said that she ended up having a ruptured implant or something. So she had surgery a week after her previous surgery. But I do have to say when you're in the spotlight like that and then all of a sudden, I know she had money before from her hair stuff, but now she's really in the spotlight. Went through a cheating scandal. I don't know if it's actually a cheating. No one knows that.

Dr. G (19:55):
You can use quotes.

Bri (19:56):
Yeah, I do think she obviously looks like she's had work done, but I really love it. You're here for it. I'm here for it. Is she the one who had the labiaplasty in the first? Yeah, the labiaplasty. If I could get my skin to look like that, I would too. I just need a week off.

Dr. G (20:15):
You want a fat transfer?

Bri (20:17):
She also had a lower skin pinch so they excised the skin. I think she had an upper bleph as well. She just went under for something else for her skin. She did CO2 and then she did something, but I don't think she's talked about it yet. She wanted to be more healed before she talked about it because she was getting a lot of hate on it, but she's gotten not a wrinkle in sight.

Dr. G (20:42):
Yeah, she looks good there. I don't know what people are freaking out about.

Bri (20:46):
Yeah, I think

Dr. G (20:48):
There she just looks overfilled, but if she did have a fat transfer with everything else and a bunch of laser, you're going to be a little swollen for a while and it takes some time. Again, at my conference I learned, I don't do rhinoplasties for the record, but a couple people presented on it and one person was talking about how after the splint comes off for the first week, she has them put a pea size dab of preparation H on their nose.

Bri (21:14):
Oh really?

Dr. G (21:14):
For the next month. Every day because the medication and prep H helps constrict the skin. So it helps take down the swelling.

Bri (21:26):
I love that.

Dr. G (21:26):
I was like, that's brilliant. Where else can we use that? Yeah, I mean to be honest, that's why I like going to these things. Even if it's a topic for something I don't do rhinoplasty or pediatric microsurgery. There's usually some surgical pearl in there where I'm like, huh, how can I apply that to what we do?

Bri (21:44):
Like the TXA?

Dr. G (21:46):
Yeah. TXA

Bri (21:47):
Oral TX, A

Dr. G (21:48):
Oral T for

Bri (21:48):
Fillers. Bruising.

Dr. G (21:50):
Yeah, there's always something Anyway, prep H. Okay. You can put it under your eyes for eye bags. It's just temporary. It's an old,

Bri (22:01):
I'll be ordering that off Amazon.

Dr. G (22:03):
It's an old beauty pageant trick.

Bri (22:05):
Oh, okay. Absolutely. I'm going to try it.

Dr. G (22:10):
So anyway, so yeah, I mean I think she looks a little puffy there, but her hair looks weird and I think.

Bri (22:15):
She's got an abnormal part. She looks very glammed. That's not how she normally looks.

Dr. G (22:21):
It's kind of maga,

Bri (22:22):
It's almost giving a wig.

Dr. G (22:25):
But if she's in a recovery process from something, then I think it's probably okay and it's going to settle down. I do say a judicious use of fat transfer to the face has that kind of rejuvenating benefit. But you are going to be puffy for a minute. We don't have it on the list, but when Jennifer Aniston went through what happened to her face situation, I know fifth hand that she had fat transfer that went wrong. So you don't want to overdo it and there are some potential complications, but pretty minimal can Occasionally more is not always better. Not always better Bri. Alright, Kylie Jenner sparks rumors. She's had a Brazilian butt lift after Timothee Chalamet grabs her behind.

Bri (23:10):
I feel like I could have told anybody that. I mean her butt gets bigger and bigger, but you just don't know these days because everything is so edited and filtered. You really do got to see the videos.

Dr. G (23:21):
Yeah, I a,

Bri (23:23):
She's obviously had a lot of work done. Her boobs keep getting bigger every other photo.

Dr. G (23:30):
I mean yeah, I think she just tweaks the edit

Bri (23:36):
And I'm sure she's wearing some stuff under there that makes it

Dr. G (23:39):
Right. Why wouldn't you just put little pads in your dress? That's the easiest thing to do.

Bri (23:43):
They have little butt underwear.

Dr. G (23:45):
Right.

Bri (23:46):
So I don't know. I feel like that whole family kind of went to the I'm going to be skinny ozempic look. So I feel like it would be very odd if she somehow got fat somewhere and put it back in her butt

Dr. G (23:57):
Unless she purchased.

Bri (24:00):
Alloclae.

Dr. G (24:00):
Yeah. I mean it wouldn't be beyond to do Alloclae, but you just need to, it takes time for it to kick in. It's not an, I mean it is an immediate boost, but you can't put tons of it in at one time. You have to do it over time.

Bri (24:15):
So yeah, I mean that track, she's got the throw money away for it kind of vibe. So I would do it if I had it.

Dr. G (24:27):
Oh my Lord. Okay. What do we think the most popular area is to get a fat transfer at this point?

Bri (24:35):
Absolutely your butt.

Dr. G (24:37):
I think it's still,

Bri (24:38):
I think it will, yeah, it will always be your butt and I feel like that's the most talked about thing. However, I would say within the last year or so we also do a ton of fat transfers to the breast because everybody is getting their implants out or a lot of people are choosing to and they just want to put fat back in there.

Dr. G (24:58):
I think people get excited when they hear that's an option. Like oh, I can get liposuction and add some volume to my breasts all at the same time. Yeah. So

Bri (25:12):
We definitely do I feel like a lot more of that now than anything else.

Dr. G (25:16):
Yeah, my patient population isn't really the BBL crowd for whatever reason, but I can do it and we do do it and I like doing it safely with ultrasound.That's helpful. Although it's not a requirement in the state of California, if you are getting your BBL in Florida, make sure they're somebody who you've met more than five minutes before the procedure and they're going to use an ultrasound. So that's kind of where it's still like the BBL capital is Miami but there's a lot of shadiness happening so you really have to do your research there and then overseas is also problematic. Going to the Dominican Republic or other places to get that fat transfer is probably not worth it in the long run if you have a complication.

Bri (26:04):
Mexico especially, I'm not hating on Mexico at all, but we've seen some complications come up from Mexico and it's also, you don't think you have to report it if you have a fatality or something do you? Or people that aren't licensed?

Dr. G (26:22):
Yeah, they did do, so I've spent some time with the plastic surgeons in Mexico at meetings and stuff and they did create a law where it's a felony to perform plastic surgery if you're not a plastic surgeon, which is kind of wild, but there is that rampant when you have tourism happening, not only are the plastic surgeons doing surgery, it just opens. Scamming is always there. So people are like, oh, these people don't even speak English. I can pretend to be

Bri (26:54):
Take an organ.

Dr. G (26:55):
Yeah, I can pretend to be a plastic surgeon and do whatever I want and then they go back to their home country and nobody's worse for the wear. So I think it's an interesting approach because it does give Mexico a bad rap for medical tourism. I just think you need to go to somebody who's qualified. If we spend so much time educating our patients, why would you go somewhere and make all these decisions and you don't even understand what the language is. It's just silly

Bri (27:23):
And then

Dr. G (27:24):
Leave after a week.

Bri (27:26):
I think also the aftercare thing to me, I feel like we've harped so much on aftercare and how that's so important to people and you don't really get a lot of aftercare. Especially imagine you're going down and you stay in Mexico for a couple days and then you're coming back up. It's not like you're traveling back and forth. Most people aren't going back for aftercare. And then we have some of these patients, I mean over the years I've seen quite a few patients that come in with the craziest scars just like they're all from Mexico and I'm not, like I said, not hating on Mexico, but do your research.

Dr. G (27:59):
Do your research. I know and people will complain on the forums, social media forums and whatnot. Well, it's just too expensive here yet you're paying, don't do it paying for safety, so maybe then you can't afford it. You're paying for a credentialing, you're paying for safety. What happens if there's a problem on the OR table in Mexico? Where are you going? Do they have a transfer agreement with the local hospital? Do they have credentials? You are always hoping none of this actually happens, but

Bri (28:33):
It happens. I'm sure a lot.

Dr. G (28:35):
You're paying for us to have all of that at the ready for you here and we're going to pray it doesn't happen. But we have all of that. We have crash cart, we have a board certified anesthesiologist, we have a transfer, I have a certified or all of that costs money and that's part of what you're paying for. You're also paying for a credentialed plastic surgeon.

Bri (28:58):
Yeah, I mean I'm just envisioning when I went down there, there was people poking me with needles that had no business poking me with needles that honestly had no idea. They just jam it in all over. But just imagine somebody like that mixing together your tumescent or putting lidocaine in you or doing things and then you say maybe you don't have a crash cart or intra lipids or anything that you actually need to reverse lidocaine toxicity. That's what I envision is just somebody not qualified doing all of that and that has no idea what they're doing. That was the experience that I got when I went down there. But I learned my lesson the hard way. Fat transfers

Dr. G (29:37):
Back to fat transfer in the United States preferably.

Bri (29:41):
I feel like you can put fat anywhere. Is there anywhere you can't put fat you can put in your knees?

Dr. G (29:48):
Yeah, that's true. Fat does best in an area that has some fat. So if you're super, super skinny and you try to put fat somewhere, I don't know the under eyes or your hands, you have two potential downsides. One it doesn't take which sucks or it just gets lumpy and looks like it doesn't belong there.

Bri (30:13):
Which is also, isn't that a way you process the fat whether you're doing nano fat or fat?

Dr. G (30:20):
Yeah, I think that has something to do with it. So we like to think of fat like the straight fat that comes out and is rinsed and then minimally processed. That's the kind of fat we put in the breast or in the butt. But for the face, because you're on the back table doing it, you're passing it through these little filters that are kind of breaking up the fat into smaller particles. And so you think of macro fat, Millie fat and then nano fatt, which is essentially a slurry of fat. That's something you want to layer in those delicate areas in the face and you get the benefit, but not a bunch of volume or chunks and lumps.

Bri (31:02):
I mean we process it all different ways through the centrifuge, through the little tulip machine, through our fat transfer system. So I think it's just knowing, I know I had one girl call not too long ago and ask for nano fatt in her breasts and I'm like, somebody told me I had to have nano fat and I'm like, huh? I thought you'd only really put that in your face.

Dr. G (31:24):
I dn't know that you could put nano fat in your breast.

Bri (31:26):
It would take a lot of filtering

Dr. G (31:28):
If you wanted. Yeah, it's a lot of filtering. If you wanted, maybe you had some crepey skin or you wanted to do your chest area where people get those little wrinkles in center, then I would put nano fat there because really the goal of nano fatt is to kind of rejuvenate the skin and minimal volume. But yeah, it's not going to add, it really isn't going to help your breast volume if that's what you concern or fat transfer, but it's a very buzzy word so people are like, oh, I want nano fatt. Yeah, I think fat for the face is a good option. It doesn't last forever. I guess the question is do you do fat or do you do filler fat's a little bit more long lasting, but it's not like I can just inject it. So I have to harvest it from somewhere so it's a little more invasive and takes a little more time. So therefore it's more expensive. And usually if you're going to do that, we're not going to just do lips. Right? Yeah. So then now you're down the whole I'm in the whole facial fat transfer and it becomes a big thing. Yeah, there are some great areas to layer it in. Cheeks, nasal labial, folds, temples, lips. I do like to make nano fat and you can microneedle it in. If you already are there and you've got the fat, then you might as well go for it. But it's not like I'm going to schedule a 1230 appointment on a Friday and get a little fat in my cheeks. No, if you want that, the alternative is to use the fat off the shelf.

(33:06):
So there's two major kinds available now, renova, which is more of a scaffolding. There's no actual fat in it, but it's a scaffolding that you can inject and it's on label for face. You can also use it in really small areas, maybe a little dimple in the breast, in the hands. Again, my success with it in the hands was a little bit limited because the people who want it the most in the hands have no fat in the hands, myself included. So then it just sort of disappears when you transfer it. It's reliant on the surrounding tissue to have it live. And so if you put it where there's no fat, it just starves and dissolves. But in the cheeks and temples, it's a good solution. If you have a little medial like divot or some rippling or something, it's a good choice there because it comes in like three CC syringes. So not a lot of volume. It's also a little bit expensive because all of this stuff is human derived, so it's been processed to the nines to make it safe. And then lip derma is another fat product which is actually fat human derived and it's been processed and is almost like a slurry. We did put some in my hands, we were playing around with it. It's also indicated for the under eye area, kind of like a nano fat injection, but you don't have to harvest anything.

Bri (34:28):
I love that.

Dr. G (34:31):
So that's more recently available, but also FDA approved. And then our fan favorite, we do a lot of body work is Alloclae, which is human derived fat that comes in a much larger volume. It's fat cells and the extracellular matrix, so that's scaffolding and wherever you inject it, it adds volume and then structurally sticks around as your body replaces it with your own fat. And so it gives a lot more boost in the area you put it than using your own fat wood because when we put fat, let's say in the breast or the butt, we over graft because we know some of it's the fluid and this other stuff and you are going to lose some of it. But Alloclae, it's kind of chunky.

Bri (35:18):
Yeah, it's very chunky.

Dr. G (35:20):
So what you get is what you get and you can put 25 ccs in the breast and get a lot of volume for that. We would almost never put 25 Cs of someone's own fat in their breast. We're usually minimum 200.

Bri (35:34):
So what's the retention rate of Alloclae versus if somebody did lipo when we harvested fat?

Dr. G (35:39):
So the retention rate is supposed to be around 90%. I don't think it's been out long enough for us to say that conclusively, but that's what we're seeing and I can put a little bit and see a lot of progress in my patients. So I think areas that are great for it are areas where maybe you have a dent from prior liposuction. We put it in someone's medial thigh who had that hip dips are a great one. You don't have to do the fat transfer like harvest and then put it in where you can do maybe 25 ccs or 50 ccs total and the hip dips. And then if you have disposable income and you want to spend money on a hundred ccs, you can start doing more. But 25 ccs in the upper breast really is making an impact.

Bri (36:27):
Very pure fat. It's beautiful fat.

Dr. G (36:30):
Yes, and it's an office procedure, so it's the lunchtime essentially. You're going to come in, we are going to make you comfortable. I'm going to put a tiny little numbing injection so that I can make a hole for the cannula. I'm going to put a little bit of numbing fluid in the area that I'm going to inject because the product does sting a little bit when it gets in there and then inject and then

Bri (36:54):
That's it.

Dr. G (36:54):
Bandaid, and you're done.

Bri (36:55):
Yeah, love that. Versus fat transfer where you're probably what, retaining maybe 60% Sometimes

Dr. G (37:04):
And you're going to be swollen and sore wherever the lipo sites were and wear a compression garment, you're going to wait three to six. There is a waiting period for Alloclae. Right. It's a little lumpy at the beginning and it softens up over time and it takes three to six months to settle down, but you're not sore and lumpy or swollen where we took fat from. So you don't have a donor site issue.

Bri (37:30):
Is there anyone that wouldn't be a good candidate for say fat transfer or alloclae or how do you,

Dr. G (37:37):
Yeah, so speaking of that, if you were actively losing weight on a GLP one, probably not a good idea. You got to feed the fat. That's what you always say.

Bri (37:47):
I do feed the fat with protein.

Dr. G (37:50):
Yeah. And chicken nuggets according to Bri.

Bri (37:53):
No. Oh yeah. I do love me some chicken nuggets.

Dr. G (37:59):
So if you are losing weight, especially on a GLP one, because we know you have to make an effort on those to maintain muscle mass, so you're rapidly losing muscle and fat and everything. You can't expect the body to also then swoop in and take care of the fat that you injected, whether it's your own or someone else's. Right. You need the body to be healing and restoring and providing nutrients for that. And it's just in direct conflict with rapidly losing weight. So it's not a great idea if you're planning to lose weight immediately after or you're currently losing weight, you want to be at a stable weight for sure. Then whatever takes takes. I always say once those fat cells are grafted and six months later you have what you have, if you gain weight, those fat cells will get bigger. If you lose weight, those fat cells are going to get smaller. So let's say we put it in your breast, if you lose 20 pounds, your breasts are going to get smaller, but those fat cells haven't disappeared. So if you gain five more pounds, they'll plump up a little.

Bri (39:03):
They do actually, because I've got my butt done twice and I've also lost a bunch of weight and my butt did get very small, but when I start to eat a little bit more, it actually plumps back up and I'm like, oh, slay.

Dr. G (39:17):
It's like watering it.

Bri (39:18):
Yeah, feeding the fat. Got to water my garden back here.

Dr. G (39:24):
It's true though. That's what it is. And then so we have been doing fat transfer for a long time. It's safe, but maybe 30 years ago when fat transfer was kind of early in our field, there were people who were actively against it in plastic surgery. Some leaders who thought it was risky that it was going to cause cancer, that it was problematic. Oh, interesting. There was one guy who used to show photos of people who maybe had a fat transfer to their face and then lost weight and then 20 years later show up, gained weight and that fat hasn't gone anywhere. So it's weirdly on their face dispersed like these horror stories and you're like, but I think that was 30 or 40 years ago and now we are a little bit more careful about how you lay it in because it is going to change over time with you.

(40:16):
It doesn't just magically disappear. So whatever you hold onto, just remember you're going to hold onto it. Which always makes me crazy when I see the high definition lipo people because when you're etching out abs talking to you, Drake, and that's one thing, fine, that's okay. You're going to really take all the little fat in that one spot. But sometimes they'll take the fat that they've harvested, inject it over the areas of muscle so that it makes the muscle look bigger. So for example, a man's bicep, you might really get all the fat and make it lean and define and then just put a little fat here to make the deltoid pop. And in the abs that you make that six pack with a little bit of fat, I'm like, well, that's great. If they maintain that weight right, you gain 30 pounds, you're going to have these little blobs of fat over where your six pack should be. I think it's going to look crazy. So just got to be in it for the long haul and think of the long-term effect of doing what you're doing. And then I would also say that more is not better. I know you don't always agree that

Bri (41:30):
Unless it's in your butt. Just kidding.

Dr. G (41:32):
People who put mean, if you get on TikTok and these ladies who are putting three or four liters of fat in their booty,

Bri (41:41):
That is not good.

Dr. G (41:42):
And it's causing, it's just like a giant implant. The weight of that is going to stretch your skin out and then God forbid you ever want to try and reverse, you can liposuction it out, but that skin's not going to retract and so you're going to have new problems.

Bri (41:57):
Yeah, don't do that. Start slow.

Dr. G (41:59):
Distort things.

Bri (42:01):
Do it naturally.

Dr. G (42:02):
Yeah. And then my patients always ask, where are you going to get the fat from? And I think oftentimes it's the abdomen, the lower back and flanks is usually another good target site. Inner thighs are good. Those are all reasonable areas. They've done studies. There's no one area that they're like, oh, it has to come from the inner thighs. That's going to be the magical fat. It hasn't been proven one way or the other, so we take it from where we can take it.

Bri (42:31):
Yeah. Sometimes you're scrounging.

Dr. G (42:33):
Yeah, sometimes we're scrounging. Sometimes it's taco bell fat.

Bri (42:36):
Yeah. You can see there's a huge difference in people's fat. Some is just oily and we call it taco bell fat. Some is great, beautiful, this golden fat and some is just like damn.

Dr. G (42:50):
Yellow. Yeah, nice yellow, golden fat is the best.

Bri (42:53):
Very small. We put it through a strainer and everything within our system and when you have good fat, it looks good, stays and it looks good, and the other fat just,

Dr. G (43:06):
And then so you can have, I think it's all on a bell curve. You can have white fibrous fat. It's generally not amazing. The yellow golden fat that we love and then the orange taco bell, oily fat. Oily fat is also not awesome and it's hard to know sometimes. It's surprising who has good fat and who doesn't. You can't always just eyeball somebody. It's not always age related.

Bri (43:33):
I also think I just have always assumed if you have more fat on you, I'm like, oh, that looks like great fat. You know what I mean?

Dr. G (43:40):
Yeah,

Bri (43:41):
The fluffiness. Yeah, the fluffiness. That is not the case.

Dr. G (43:44):
No, Sometimes I was very disappointing.

Bri (43:46):
Yeah. I'm like, damn. Right.

Dr. G (43:49):
Yeah. I've been surprised sometimes. I've scrounged for fat on very, very lean men and gotten what I needed and then a little fluffier female and I'm like, Oh, What I'm, lipoing nothing's coming. What's happening?

Bri (44:04):
Which I assume is just your diet and nutrition, Right?

Dr. G (44:08):
Yeah, I guess so. And some genetics. It does matter. If you've had prior liposuction, makes it a little bit harder to do. There's more scarring or prior surgery. Those things can impact it. But yeah, take a little fat biopsy before your surgery. I know that's what we should be able to do and then see what it looks like.

Bri (44:26):
That'd be awesome.

Dr. G (44:28):
They have looked at trying to enhance the fat before they transfer. There's a lot of research in that area. Nothing is to market yet or conclusively. Good things to mix it with. Yeah, a little boost if you will. So that's coming. I feel like when I was at our national meeting, there was tons of research being presented on fat transfer. It's not going to go away. It really is. It's going to be around here. We're always looking for new ways to make it more effective and better. Yeah.

Bri (45:03):
I feel like it's giving me PTSD to that one time. We use that one thing that I won't name names and we use something to clean the fat and we were like, yeah, no.

Dr. G (45:12):
Yeah, more complicated is not always better.

Bri (45:14):
Yeah.

Dr. G (45:15):
Yes, there are little, but I'm thinking, I read a research paper, I had to give a talk and so where they were taking PRP and PRF and spinning that down at the same time and then adding it to the fat, but then clinically looking at whether the fat stays or doesn't stay more, are you enhancing it by doing that? And it didn't, at least the way they did it, it didn't make a clinically significant difference. And then they're adding hydrogels and some other things to the fat to kind of have it hold structure a little bit more and then it might help it hold in place until it does reabsorb. I don't know. People are thinking about it though actively, and so we're here for it when they sort it out. Yeah.

Bri (46:02):
I'm just bummed because I've already lipoed everything I can possibly lipo.

Dr. G (46:05):
I know you're left with the alloclae option, which is unfortunately a little expensive out the door, but that's why it's safe, so don't get that. I read an article I think yesterday about the peptide revolution and that people are buying their peptides from China and TikTok, and I was like, oh no. Yeah, so don't buy your fat off Amazon.

Bri (46:27):
I've seen a lot of people actually posting lately on just like, oh, everyone's like, if you ordered this peptides here, this is here. I'm like, where are you guys even getting these from?

Dr. G (46:37):
Yeah. A big warehouse is in China apparently.

Bri (46:40):
Yeah. Posting, everyone is getting peptides from places and I'm like, is anybody prescribing these or are you seeing a doctor to see if you need these peptides? What is the,

Dr. G (46:51):
It's like the wild west right now. Yeah. We'll just wait until that doesn't work out.

Bri (46:58):
We'll see.

Dr. G (46:58):
Again, cheaper's not always better.

Bri (47:00):
It was like when they had that fake Botox that was going around for a hot second.

Dr. G (47:04):
Yeah, that was here in San Diego.

Bri (47:06):
Yeah.

Dr. G (47:06):
Just don't get it from a warehouse in China. I mean, you can, you just might not actually get what you're paying for.

Bri (47:13):
Yeah. Who's to know?

Dr. G (47:16):
Anyway, any other lasting questions?

Bri (47:20):
Is there anyone that's not a candidate for a fat transfer besides GLP one people? No. Or needing to lose weight and then

Dr. G (47:27):
No. I mean as long as your weight's stable, usually a candidate, you can do it and it's usually one and done. You can redo it. So there are some limitations when you do fat transfer. I have to be able to transfer it, like I said, into an area that maybe has some fat and can sustain the fat that I transfer. So if you have really small breasts, I can't put 400 ccs of fat in there because if you have a 100 cc breast, that's never going to work.

Bri (47:53):
Which I think a lot of people misconstrue like, I have all this fat, and then we go in there and we get out all this fat and they're like, well, why couldn't you put more in? And I was like, if I could just show you what we're seeing when we're putting in the fat, it just comes back out.

Dr. G (48:07):
Yeah. It's pushing back at us. So you can't overdo it or you end up with fat necrosis or it all dies or it just disappears. So if you have a hundred cc breasts, you're not getting more than a hundred ish ccs of fat in there. So you could do that. You could do a hundred ccs, wait three to six months. Now you have a slightly bigger breast, the half a cup size bigger and then do it again. It's just rarely people want to do it again. It's expensive. You got the downtime. So now, I mean maybe you can do that and then if you need a little bit more, maybe turn to alloc Clay. It would be nice if I could go from a cup to a DUP breast just with fat, but you can go from a C cup to a dup, but an A cup to a B cup, but you can't make that leap just with fat. If you really want a huge increase in volume, you're back to implants or

Bri (49:03):
Implants and fat.

Dr. G (49:04):
Yep. The composite augmentation, it's an option. We just did one.

Bri (49:08):
Two birds, one stone.

Dr. G (49:10):
Right.

Bri (49:11):
Do you recommend that being an option though, or do you recommend doing one or the other?

Dr. G (49:17):
I think that's a good option if you're, you have a purpose for doing that fat. So if you're adding the fat to the augmentation because you want a little bit more medial cleavage or you want less implant visibility or you're trying to even outside, I think that's a great option. It doesn't make sense. If you're putting 300 ccs of fat in the breast and an implant, then you should probably pick one. But I think if you want some volume and you don't want to put a large implant in, I think it helps in certain situations. It's a really nice, nice look. And it tends to be the thinner patients where you just don't want to look like you have an implant stuck on there, but you don't have enough fat to do a total transfer. So that's your middle man.

Bri (50:05):
There you have it.

Dr. G (50:07):
All right. If you're listening today and you have questions, reach out, DM us, call the office, let us know.

Bri (50:14):
Let's chit chat.

Dr. G (50:15):
Yeah, let's chat. Alright everybody. Thanks. We're going to scrub in.

Bri (50:20):
And scrubbing out.

Dr. G (50:23):
If you're listening today and have questions, need info about financing, reviews or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, apple Podcasts, Spotify, or wherever you like to listen to podcasts.