WEBVTT - Dr Naveen Somia, Plastic and Reconstructive Surgeon QandA 0:00:05.921 --> 0:00:07.281 Apolgie production. 0:00:11.121 --> 0:00:14.481 Hi, my name's Beck Woodbine and welcome to Tenderness for Nurses. 0:00:15.081 --> 0:00:18.921 I'm grateful for the person that I have the opportunity 0:00:18.961 --> 0:00:19.321 to be. 0:00:20.041 --> 0:00:23.761 So I hit it and parked it for nearly four years. 0:00:24.201 --> 0:00:26.441 We always have free will, We always get to choose. 0:00:26.521 --> 0:00:27.641 We are autonomous. 0:00:27.721 --> 0:00:30.521 Welcome back to Tenderness for Nurses and part two of 0:00:30.641 --> 0:00:34.041 Beck's chat with Doctor Levine. In this episode, Beck goes 0:00:34.081 --> 0:00:37.960 through your questions submitted to doctor Devine about lipidemia. So 0:00:38.120 --> 0:00:40.641 I'm just going to start asking some of the questions 0:00:40.641 --> 0:00:42.361 that have been sent in to me. 0:00:42.521 --> 0:00:43.281 Happy to answer that. 0:00:43.321 --> 0:00:50.040 Okay, So, will lipidema ever be covered by Medicare? And 0:00:50.120 --> 0:00:52.681 who should the lipidema community talk to to get the 0:00:52.721 --> 0:00:53.281 word out. 0:00:53.801 --> 0:00:57.321 So it's a very difficult question to answer because coverage 0:00:57.321 --> 0:01:00.601 of Medicare is basically acknowledgement of lepidema as a disease, 0:01:00.641 --> 0:01:03.761 as in a medical condition. And this is where there 0:01:03.801 --> 0:01:07.161 is no acknowledgment of lipedemas a disease condition. It's as 0:01:07.200 --> 0:01:11.801 a multiple mentions of lipedema as a rare quote unquote 0:01:11.961 --> 0:01:14.681 fat disease. And usually when people talk about rare, it's 0:01:14.761 --> 0:01:16.881 usually talk about point one percent point two percent. This 0:01:16.961 --> 0:01:19.560 is like one in ten, and average medical students do 0:01:19.601 --> 0:01:21.881 not go through medical school learning about it. And my 0:01:21.961 --> 0:01:25.280 personal experience of lipedemas I went through specialist training and 0:01:25.321 --> 0:01:28.080 I didn't know about lapidema. We knew about lymphedema, but 0:01:28.121 --> 0:01:31.081 not lipidema. It's only when I started practicing as a specialist, 0:01:31.081 --> 0:01:33.000 when I'm kind of my first lip and patient, That's 0:01:33.000 --> 0:01:35.241 when I got to know about lipodma. And when you 0:01:35.280 --> 0:01:39.041 start to read the literature, there's plenty of papers around lipedema, 0:01:39.081 --> 0:01:41.961 but you have no ideas to how come this was hidden. 0:01:42.200 --> 0:01:44.521 What was interesting was most of the papers when I 0:01:44.560 --> 0:01:47.000 first read. In fact, most of the papers still are 0:01:47.041 --> 0:01:51.041 based out of Germany, and doctors in Germany have a 0:01:51.081 --> 0:01:55.081 better understanding, or probably an early understanding of lipedema, and 0:01:55.161 --> 0:01:59.281 they have kind of been pioneers in treating lipedema. It 0:01:59.521 --> 0:02:03.321 is coming to the English speaking world gradually, little by little. 0:02:03.561 --> 0:02:08.601 This is probably a question out of curiosity. Say you, 0:02:09.401 --> 0:02:12.841 as a parent have like p edema and you have 0:02:13.121 --> 0:02:23.521 a daughter, if you could control, you know, educate on diet, exercise, hormone, 0:02:23.881 --> 0:02:29.280 managing all of that side of things, can you control it? 0:02:29.721 --> 0:02:33.041 Can you manage it better, or at some stage will 0:02:33.041 --> 0:02:35.401 it just start to exploit explode. 0:02:35.441 --> 0:02:38.121 Look, it's a it's a common question to get asked because, 0:02:38.240 --> 0:02:41.841 as you imagine, if you treat somebody who's got lepidema, 0:02:42.041 --> 0:02:45.240 there's a good chance that their daughter may have the tendency. 0:02:45.680 --> 0:02:49.561 So it's a very very delicate question to delicate subject 0:02:49.561 --> 0:02:52.561 to broach with a teenager because if you know, the 0:02:52.881 --> 0:02:54.921 typical age of flare up of lipideemer its when you 0:02:54.921 --> 0:02:57.001 go through puberty. It also coincides with a lot of 0:02:57.001 --> 0:03:00.161 other changes in the teenager during the time, starting from 0:03:00.201 --> 0:03:06.081 being socially different, lack of exercise, so on and so forth. 0:03:06.121 --> 0:03:08.321 But at no point I tell my patients that you 0:03:08.401 --> 0:03:11.800 need to be focusing on the word diet, because that 0:03:11.881 --> 0:03:16.601 will make things very hard for the teenager, because we 0:03:16.680 --> 0:03:18.960 know that even if your diet, you will not see 0:03:18.960 --> 0:03:22.561 a reduction in your leg fat deposits of light padema. 0:03:23.001 --> 0:03:25.761 And if you tell someone you're not seeing any deposits 0:03:25.761 --> 0:03:28.281 of fat disappear because you're dieting, you need to diet more, 0:03:28.401 --> 0:03:30.881 you can tip them over into a condition that is 0:03:30.960 --> 0:03:34.881 actually quite awkward. Right with the disorted eating habit, and 0:03:35.121 --> 0:03:38.321 we see this very commonly. So it's a very difficult 0:03:38.401 --> 0:03:40.321 and a very delicate one, and I don't have an 0:03:40.321 --> 0:03:42.361 answer for that. So what I tell patients is, if 0:03:42.401 --> 0:03:44.561 you want to ever broach the topic with your young 0:03:44.601 --> 0:03:48.681 teenage daughter, will recommend that you somehow introduce the concept 0:03:48.761 --> 0:03:52.681 of restriction of sugar, restriction of processed food, go on 0:03:52.761 --> 0:03:55.401 a healthy diet, and maybe the entire family has a 0:03:55.401 --> 0:03:58.681 clean up diet. Right. Or if you're doing an exercise 0:03:59.361 --> 0:04:01.521 regime with your daughter, try and make it like it's 0:04:01.561 --> 0:04:04.361 a mom daughter yoga challenge, right, so you go with 0:04:04.481 --> 0:04:06.681 her to a yoga class or a pilates class, so 0:04:06.681 --> 0:04:09.241 as opposed to making it like sound like a chore. Right, 0:04:09.561 --> 0:04:11.881 So then you have buying from them, which will be 0:04:11.881 --> 0:04:14.241 a much more sustainable practice without having to go through 0:04:14.281 --> 0:04:17.601 the process of embarrassing them or shaming them. Yeah. Absolutely, Okay, 0:04:17.601 --> 0:04:19.241 it's a very delicate one. I've seen a lot of 0:04:19.281 --> 0:04:22.400 patients of mind who have gone through disordered eating phases, 0:04:22.440 --> 0:04:25.841 and we usually tell them that and look, it's natural. 0:04:25.880 --> 0:04:29.200 It's normal because you've been told diet, diet, diet, and 0:04:29.241 --> 0:04:31.161 you don't see no change, and you believe that you're 0:04:31.161 --> 0:04:35.361 not doing enough, and at one point when you draw 0:04:35.401 --> 0:04:36.401 the line is enough is enough? 0:04:36.561 --> 0:04:39.041 Well, that's right, you know, and at the end of 0:04:39.081 --> 0:04:41.401 the day you've got to have happy kids. Say why 0:04:41.440 --> 0:04:44.601 does it hurt to press the skin with lipaedema? 0:04:44.681 --> 0:04:48.440 Okay, this is nobody knows why. But there is a 0:04:48.561 --> 0:04:53.241 condition called in fat growth. Like we all know about lipomas, 0:04:53.241 --> 0:04:55.401 which is abnormal fat growth, there's a condition called angio 0:04:55.481 --> 0:04:58.001 lipomas where's a bit more clustered blood vessels. And these 0:04:58.001 --> 0:05:00.400 are small p shaped fat lumps in the body that 0:05:00.841 --> 0:05:04.880 are exquisitely tender. So there's some internal signaling that can 0:05:05.081 --> 0:05:09.521 trigger off either nerve increasing nerve sensitivity due to the 0:05:09.561 --> 0:05:13.321 pattern of signaling. That's what we don't know, right, So 0:05:13.401 --> 0:05:18.201 there is, and these fat pockets can be tender and 0:05:18.241 --> 0:05:20.241 can be painful to the point that if a cat 0:05:20.281 --> 0:05:22.520 sits on your lap, you don't like it. If a 0:05:22.601 --> 0:05:24.721 dog runs into your legs, you hate it. And if 0:05:24.761 --> 0:05:27.721 you actually have someone tap your shoulder and say come 0:05:27.721 --> 0:05:30.281 beg let's go and have a drink ouch, it hurts you. 0:05:30.320 --> 0:05:32.001 So these are really tender spots. 0:05:32.401 --> 0:05:39.721 So this condition really impacts women's lives significantly. 0:05:39.081 --> 0:05:39.840 Yes it does. 0:05:40.320 --> 0:05:43.121 So is there research happening in this area. 0:05:43.201 --> 0:05:45.201 There's a lot of research happening in this area, and 0:05:45.681 --> 0:05:50.241 Australia is actually one of the pioneering research places. And 0:05:50.641 --> 0:05:53.801 Dr Romin Scheine, who's a plastic surgeon in Melbourne, is 0:05:53.880 --> 0:05:57.320 pioneering a lot of original genetic research because Romen along 0:05:57.320 --> 0:06:00.681 with this wife Tartt, is run an adipose biology laboratory 0:06:00.721 --> 0:06:03.321 and you can't get more specific for lipitma than having 0:06:03.361 --> 0:06:07.001 an adipose lab. And they have got a global research 0:06:07.440 --> 0:06:10.640 group of people who know multiple countries in Europe and 0:06:10.841 --> 0:06:13.121 US of course. And there's an American organization called the 0:06:13.201 --> 0:06:19.521 Lepidiema Foundation LF and they fund lepadema focused research in 0:06:19.681 --> 0:06:23.280 across the world. So I think there is lipidima research happening, 0:06:23.361 --> 0:06:26.080 but is it happening quick enough? The answer is we 0:06:26.081 --> 0:06:29.401 don't know, but it is surely showing evidence that this 0:06:29.481 --> 0:06:32.361 is a genetic based disease because they're isolating genes now 0:06:32.361 --> 0:06:34.601 little by little, so hopefully there will be some sort 0:06:34.641 --> 0:06:37.640 of groundbreaking treatment in the future. But even what we're 0:06:37.681 --> 0:06:40.721 practicing today compared to what was being practiced twenty years 0:06:40.721 --> 0:06:44.041 ago is significantly different. So research of today will defind 0:06:44.041 --> 0:06:44.921 the medicine of tomorrow. 0:06:45.201 --> 0:06:47.841 Yeah, gotta love that, don't you. Why are gps not 0:06:47.921 --> 0:06:50.321 informed about lipaedema? 0:06:51.880 --> 0:06:56.121 It's I think back to the education and in medical school, 0:06:56.201 --> 0:06:59.440 this is not even recognized as a condition. And because 0:06:59.481 --> 0:07:04.201 it the appearance of lipedema fits into our understanding of 0:07:04.320 --> 0:07:09.280 fat and we're very easily kind of or very quick 0:07:09.361 --> 0:07:12.161 to say, oh that's only fat, God out an exercise. 0:07:12.201 --> 0:07:15.121 So every single passion of mind, we ask what's been 0:07:15.161 --> 0:07:17.441 your experience with a GP. Does a GPE noble epidema? 0:07:17.481 --> 0:07:21.121 Because what is very important is if you have a 0:07:21.121 --> 0:07:25.641 GP who understands slipidema and will be willing to look 0:07:25.641 --> 0:07:28.041 after you and you care for you. If your GP 0:07:28.681 --> 0:07:31.481 does not understand lipidima, does not make any attempt to 0:07:31.561 --> 0:07:36.641 learn about lipidema, then you run the risk of being gaslighter, 0:07:37.761 --> 0:07:41.481 which is not a good therapeutic place to be. Okay, 0:07:41.601 --> 0:07:44.321 So my recommendation I tell patients like, if you've you, 0:07:44.401 --> 0:07:47.521 it is very critical for your success that every single 0:07:47.561 --> 0:07:51.241 practitioner is treating you has to be not only lepedema aware, 0:07:51.721 --> 0:07:55.001 but it has to be lipidma empathetic. It starts from 0:07:55.041 --> 0:07:57.561 your personal trainer as well. You can't have your personal 0:07:57.561 --> 0:08:00.361 trainer say why are you not losing weight? Everyone else 0:08:00.401 --> 0:08:02.041 is losing weight, And that's not a nice thing to 0:08:02.081 --> 0:08:07.121 say because that shows a fundamental lack of understanding of 0:08:07.121 --> 0:08:08.840 the fundamental pathology of your patient. 0:08:10.121 --> 0:08:14.481 I would imagine women that have suffered this condition have 0:08:14.561 --> 0:08:15.521 been gas a little lot. 0:08:15.641 --> 0:08:20.681 Absolutely, Absolutely, I've suffer in silence. There's silence, silence terrible. 0:08:20.761 --> 0:08:22.481 It makes me feel sick. 0:08:22.641 --> 0:08:26.641 Actually, at least now in twenty twenty four, twenty five, 0:08:27.041 --> 0:08:31.041 you have information and thanks to social media and Instagram, 0:08:31.081 --> 0:08:33.441 when people start posting pictures, people look at the legs 0:08:33.481 --> 0:08:35.521 and say like, oh, this looks like my friend's legs, 0:08:35.681 --> 0:08:37.281 or they themselves look at the legs and say like, 0:08:37.321 --> 0:08:39.481 oh my god, they looks like mine, and then they 0:08:39.481 --> 0:08:41.961 start and Instagram is such a wonderful platform that we 0:08:42.001 --> 0:08:44.721 spend more than two seconds on one post, it'll start 0:08:44.921 --> 0:08:48.241 feeding you relative stuff. So in some ways that has 0:08:48.281 --> 0:08:50.721 been very helpful to patients who could bypass the traditional 0:08:50.801 --> 0:08:54.161 channels of seeking knowledge and advice. 0:08:54.321 --> 0:08:59.201 And what does the procedure usually do on patients? 0:08:59.721 --> 0:09:03.561 Okay with lida, so Lepidima has got technically three stages, 0:09:03.601 --> 0:09:05.441 stage one, two, and three, and we never see a 0:09:05.441 --> 0:09:07.441 stage one at the age of fifty, and we never 0:09:07.481 --> 0:09:09.481 see a stage three at the age of twenty, implying 0:09:09.481 --> 0:09:11.721 that the longer you leave it, the worse it becomes. 0:09:12.081 --> 0:09:13.641 And if you look at the internet and look at 0:09:13.681 --> 0:09:16.041 stage one, two, and three, it's a progression in the 0:09:16.161 --> 0:09:19.921 size at a macroscopic photographic level, but at a microscopic 0:09:20.001 --> 0:09:23.281 level underneath the tissues, what happens is the fat cells 0:09:23.321 --> 0:09:25.601 become bigger. Like if you say the fat cell is 0:09:25.601 --> 0:09:27.361 one by one in stage one, it'll be two by 0:09:27.361 --> 0:09:29.281 two in stage two, and three by three instat three. Right, 0:09:29.321 --> 0:09:32.881 I'm just picking numbers to illustrate the point. But in 0:09:32.921 --> 0:09:36.441 addition to that, there's additional College information as you incrementally 0:09:36.481 --> 0:09:39.081 go open the stages and as a consequence that you've 0:09:39.121 --> 0:09:42.681 got fibrosis. Right, so your outcomes are going to be 0:09:42.761 --> 0:09:45.241 proportional to the tissues you're going to handle. Okay, So 0:09:46.641 --> 0:09:51.561 the targeted procedure to treat lip patients is accommodation of 0:09:52.081 --> 0:09:55.921 non surgical conservative treatment first followed by liposuction to get 0:09:56.001 --> 0:10:00.921 rid of the fat, followed by maintenance conservative treatment for life. Right, 0:10:01.041 --> 0:10:04.281 So if you haven't optimized your conservative treatment before the surgery, 0:10:04.361 --> 0:10:07.121 you will fail, and that operation will fail because the 0:10:07.121 --> 0:10:08.481 outcomes are not going to be as good as you 0:10:08.521 --> 0:10:11.761 expect it to be. So I am a very strong 0:10:11.801 --> 0:10:14.841 believer in preparing, and I sometimes I use an actet 0:10:14.881 --> 0:10:16.881 of you know, if you want to run an Olympic marathon, 0:10:16.961 --> 0:10:18.961 you're not going to run the marathon the first day. 0:10:18.961 --> 0:10:20.881 If you have to prepare for a year. This is 0:10:20.921 --> 0:10:24.321 not different, right, so you but you can. It is 0:10:24.361 --> 0:10:26.641 complex when you look at it, but when you incorporate 0:10:26.681 --> 0:10:29.041 them one way one, it becomes almost a seamless process 0:10:29.041 --> 0:10:31.001 in your day to day life and lifestyle. And and 0:10:31.041 --> 0:10:32.841 people are done it very well and managed to keep 0:10:32.881 --> 0:10:34.961 it at bay. Right. It's a combination of many things 0:10:34.961 --> 0:10:37.081 that will go through that in a second. And the 0:10:37.121 --> 0:10:39.281 aim of lip persuction is to take out as much 0:10:39.321 --> 0:10:42.761 pathological fat as possible, as much as possible. 0:10:42.801 --> 0:10:45.321 How do you tell the difference between. 0:10:46.161 --> 0:10:48.641 Normal and leipadima fat? Yes, look, that's that's a good 0:10:48.721 --> 0:10:51.201 question because that's commonly get asked. There is no way 0:10:51.201 --> 0:10:55.161 of finding out right, Okay, So what we what I 0:10:55.201 --> 0:10:58.241 believe is based on my experience, is the fat you 0:10:58.281 --> 0:11:00.921 see in a lipid patient between your knee and your 0:11:00.961 --> 0:11:05.321 ankle is all lepidima fat. Okay, okay, The fat in 0:11:05.361 --> 0:11:09.321 your thigh between your knee and your hip is sixty forty, right, 0:11:09.801 --> 0:11:12.601 but you want to debulk it as much as possible. Now, 0:11:12.641 --> 0:11:14.401 the reason you want to get rid of your normal 0:11:14.401 --> 0:11:17.121 adipose tissue or a normal fat in a lipiduma patient 0:11:17.481 --> 0:11:22.041 is what triggers lipodema growth formation. Nobody knows it is 0:11:22.081 --> 0:11:25.681 a genetic process that gets amplified bass something. But both 0:11:25.721 --> 0:11:30.161 your normal adipos tissue and your lipidima fat cell secrete 0:11:31.041 --> 0:11:34.601 hormones and mediators in the same level of which a 0:11:34.681 --> 0:11:38.281 higher concentration comes out of lipidma cells. Right, So if 0:11:38.321 --> 0:11:42.160 you have more adipose tissue, you'll have a worse of lipoedema. 0:11:42.441 --> 0:11:45.441 So it is not in your interest to have lots 0:11:45.441 --> 0:11:49.481 of adipose tissue, normal adipos tissue or lipidima tissue, so 0:11:49.521 --> 0:11:51.961 you need to debulk all of them. So diet exercises 0:11:52.001 --> 0:11:57.001 an essential part of controlling lepidema, not directly, but indirectly. 0:11:58.001 --> 0:12:00.681 Liposuction is the only way you can get rid of 0:12:01.241 --> 0:12:04.281 lipedema tissue. Say, for example, if a patient goes and 0:12:04.681 --> 0:12:08.481 has surgical weight loss procedures and loses eighty kilos. Right, 0:12:08.881 --> 0:12:12.601 they will lose fat everywhere except your leg. Just need 0:12:12.601 --> 0:12:14.041 to ankle. It will not change. 0:12:14.281 --> 0:12:14.801 Is that right? 0:12:16.081 --> 0:12:17.961 It will not change. I've never seen that change. Right, 0:12:18.481 --> 0:12:22.161 And your thigh will come down in size, but you'll 0:12:22.201 --> 0:12:23.961 still have residual epidema. 0:12:23.601 --> 0:12:26.481 Facts YEP, which then has potential. 0:12:27.441 --> 0:12:30.561 To beget more epidema fat. Yes, so it's a positive reinforcement, 0:12:30.601 --> 0:12:34.601 so I think. So the best best outcomes in summary 0:12:34.721 --> 0:12:38.081 is if you can get early. In other words, when 0:12:38.441 --> 0:12:41.761 patients on early stage one is early twenties because you've 0:12:41.761 --> 0:12:45.241 had a fat deposit for three, four, five, six, seven, 0:12:45.281 --> 0:12:49.281 eight years, because you haven't been heavy at that point, 0:12:49.481 --> 0:12:52.721 your tendency to put on normal atipost issues low, so 0:12:52.841 --> 0:12:57.081 your amplification of your lipidema fat cells is less. So 0:12:57.161 --> 0:12:59.921 you can be quite aggressive and aggressive in the sense 0:13:00.001 --> 0:13:01.761 like it's a you know, take out as much lipidoma 0:13:01.801 --> 0:13:05.001 fat as possible, set them back on a healthy die, 0:13:05.161 --> 0:13:08.241 to exercise other non surgical modalities, which is plenty of them, 0:13:08.481 --> 0:13:13.081 and then they can lead a very very good, comfortable 0:13:13.561 --> 0:13:16.561 life for quite some time. The fat production of lipedima 0:13:16.601 --> 0:13:19.801 does not stop, never stops. It'll come back, but you 0:13:19.841 --> 0:13:24.481 can slow down the rate of production. It's a bit 0:13:24.561 --> 0:13:26.841 like if you had a leaking tap, your aim is 0:13:26.881 --> 0:13:31.001 to control the rate of dripping or leaking, as opposed 0:13:31.001 --> 0:13:32.801 to shutting off the tap. Shutting off the tap is 0:13:32.801 --> 0:13:35.121 currently not an option because shutting implies cure. 0:13:35.721 --> 0:13:39.881 It's a it's a really profound disorder for someone to have. Yes, 0:13:39.921 --> 0:13:45.241 it is because they must feel heavy and boggy and exhausted. 0:13:45.681 --> 0:13:49.121 This I'm kind of blun away with particularly these questions, 0:13:49.121 --> 0:13:52.441 but your answers, how is it that someone who is 0:13:52.521 --> 0:13:55.761 not a surgeon can perform live per suction in Australia? 0:13:55.961 --> 0:14:00.921 Now, this is this is a very important question and 0:14:00.961 --> 0:14:04.281 according to the national law, if you're a registered medical 0:14:04.281 --> 0:14:09.841 practitioner can pretty much do whatever you think you're capable 0:14:09.881 --> 0:14:15.641 of doing, provided you are appropriately and adequately trained. So 0:14:15.761 --> 0:14:18.361 that is exactly the words that has been used. It's 0:14:18.401 --> 0:14:21.641 not been defined. It's not been defined. So what the 0:14:21.681 --> 0:14:24.761 government has done is says they do not regulate scope 0:14:24.761 --> 0:14:27.241 of practice. In other words, if a newer surgeon tomorrow 0:14:27.241 --> 0:14:29.761 wants to do like persuction, the government can't say you 0:14:29.801 --> 0:14:32.761 can't do this, okay, right, If a cartithorised exigeon wants 0:14:32.761 --> 0:14:35.041 to lip persuction tomorrow. If a CRTI ex surgeon wants 0:14:35.041 --> 0:14:37.441 to brest augmentation tomorrow, the government is not going to 0:14:37.441 --> 0:14:41.241 say you can't do it, provided he's had adequate training. Right, So, 0:14:41.521 --> 0:14:45.281 every single medical practitioner is, according to the law, is 0:14:45.321 --> 0:14:49.161 capable of performing any procedure as long as they feel 0:14:49.161 --> 0:14:52.321 they adequately trained and support it. Okay, So that's why 0:14:52.361 --> 0:14:57.401 we saw this with the cosmetic surgery regulations and the 0:14:57.441 --> 0:14:59.801 Four Corners episode and Cosmetic Cowboys. A lot of this 0:14:59.961 --> 0:15:05.361 page doctors were basic medical practitioners who are doing performing 0:15:05.401 --> 0:15:09.721 cosmetic surgery. So that has not been taken away. They 0:15:09.721 --> 0:15:12.521 can still perform cosmetic surgery, but now they cannot use 0:15:12.521 --> 0:15:14.121 the title cosmetic surgeon. 0:15:15.361 --> 0:15:18.761 What about visitation rights? So what if something goes wrong 0:15:19.201 --> 0:15:24.161 at one of the practices that you are having bypersuction 0:15:25.041 --> 0:15:29.641 done that's by someone who isn't a surgeon or a 0:15:29.641 --> 0:15:34.921 plastic surgeon, and they don't have visitation rights and something 0:15:34.961 --> 0:15:38.521 goes significantly wrong, what happens? Who takes over the care 0:15:38.561 --> 0:15:39.841 of that patient and what happens? Then? 0:15:40.081 --> 0:15:42.801 Okay, let's answer the question two points. Now. The first 0:15:42.801 --> 0:15:45.841 thing is all Professional Plastic Surgery Society is the Solution. 0:15:45.921 --> 0:15:48.761 Society of Esthetic Plastic Surgeons and ASPS Society of Plastic 0:15:48.841 --> 0:15:53.001 Surgeons believe that they are five pillars of safety surgery 0:15:53.001 --> 0:15:55.481 by surgeons and its theasy binis that is surgery to 0:15:55.521 --> 0:15:58.721 be performed in accredited, licensed facility, the surgeon to be 0:15:58.721 --> 0:16:01.801 available to provide after k in the post operative phase, 0:16:01.841 --> 0:16:05.601 and the surgeon to have the expertise to esclate care 0:16:05.641 --> 0:16:08.161 should they need a rise. In other words, if you 0:16:08.361 --> 0:16:10.921 need to be admitted to a hospital to provide care 0:16:11.041 --> 0:16:13.561 due to excessive bleeding or excessive infection, you should have 0:16:13.561 --> 0:16:16.441 the ability not rely on the emergency department. So what 0:16:16.521 --> 0:16:20.841 happens is no hospital will give you admitting rights in 0:16:20.881 --> 0:16:24.721 surgery if you're not a registered surgeon. So in some 0:16:24.761 --> 0:16:28.761 ways this patients should choose a non surgeon for a 0:16:28.801 --> 0:16:34.721 surgical procedure have an inherent disadvantage because in the event 0:16:34.881 --> 0:16:38.401 of an emergency, you'll be at the mercy of the 0:16:38.401 --> 0:16:41.281 emergency department and the personal provides care in the hospital 0:16:41.401 --> 0:16:44.161 someone totally different. And this is what used to happen 0:16:44.161 --> 0:16:46.201 when I work in a public hospital in city and 0:16:47.041 --> 0:16:49.601 pre cosmic surgery reviews. We used to see a lot 0:16:49.601 --> 0:16:53.721 of patients being sent to emergency department following complications of 0:16:53.761 --> 0:16:57.321 cosmetic surgery because the primary proceduralists or the doctor who 0:16:57.321 --> 0:17:00.161 performed the cosmetic surgery did not have admitting rights in 0:17:00.161 --> 0:17:04.321 a hospital. Okay, then you come into the emergency department, 0:17:04.441 --> 0:17:08.521 then the department of plastic Surgery will look after you, 0:17:09.001 --> 0:17:11.041 but it is not the kind of care that you'd 0:17:11.080 --> 0:17:14.761 expect because you've gone through a surgeon or a person 0:17:15.001 --> 0:17:15.840 cosmetic surgery. 0:17:16.481 --> 0:17:20.720 So that is something I think is important to stress 0:17:22.360 --> 0:17:26.281 for the people that are listening to this that that 0:17:26.441 --> 0:17:31.080 is a really important question to whoever it is that 0:17:31.120 --> 0:17:34.281 you're going to have your treatment with, is that you 0:17:34.481 --> 0:17:37.441 need to ask them if they're a plastic surgeon, if 0:17:37.441 --> 0:17:41.481 they have visitation rights at a hospital, what happens if 0:17:41.640 --> 0:17:45.201 there is an emergency? What procedures do they have in place? 0:17:46.160 --> 0:17:48.321 But I think by asking the first two questions, you'll 0:17:48.321 --> 0:17:49.920 answer all the others. 0:17:49.721 --> 0:17:51.720 That's correct. You can ask a question, are you a 0:17:51.761 --> 0:17:52.521 registered surgeon? 0:17:52.921 --> 0:17:53.321 Yeah? 0:17:53.400 --> 0:17:55.600 Then and if the answer is no, then you have 0:17:55.640 --> 0:17:57.921 to ask the next question to yourself, why am I 0:17:58.041 --> 0:18:01.120 going for a surgical operation by a person who's not 0:18:01.120 --> 0:18:05.640 a registered surgeon. It's a passion choice, but I think 0:18:05.921 --> 0:18:09.121 it has to be informed choice, and I think the honest, 0:18:09.241 --> 0:18:12.681 unfortunately is on the patient to know that information before 0:18:12.721 --> 0:18:13.961 the patient makes a choice. 0:18:14.241 --> 0:18:17.081 Just having done some research and that sort of thing, 0:18:17.921 --> 0:18:26.120 what I have noticed is the disparity of cost as well, 0:18:26.521 --> 0:18:31.600 between what these people are are charging compared to what 0:18:31.600 --> 0:18:33.600 a plastic surgeon charges. And I just want to say 0:18:33.721 --> 0:18:37.600 that plastic surgeons are far more realistic with their pricing 0:18:37.801 --> 0:18:40.881 than what these other clinics are that are offering life 0:18:40.921 --> 0:18:44.041 a suction. It sometimes makes me feel like they're really 0:18:44.360 --> 0:18:48.401 targeting a very vulnerable group without you saying the wrong thing. 0:18:49.600 --> 0:18:50.681 Is that a fair assumption. 0:18:51.481 --> 0:18:54.600 Look, we don't know, we're not prival to what people 0:18:54.681 --> 0:18:58.400 charge and how people charge, and individual businesses can choose 0:18:58.441 --> 0:19:05.001 to price things accordingly. But for someone to see value 0:19:05.321 --> 0:19:09.680 in a service provided a potentially consumable see value at 0:19:09.761 --> 0:19:14.680 multiple levels, value of the expertise, value of the cost, 0:19:14.880 --> 0:19:18.880 value of what information has been provided, sometimes unrealistic. And 0:19:18.961 --> 0:19:23.801 most of the time people get told a very very 0:19:23.880 --> 0:19:26.961 rosy picture of the post operative recovery so that they 0:19:27.001 --> 0:19:32.680 can kind of be convinced to have search. I'm not 0:19:32.721 --> 0:19:35.920 saying that happens everywhere, but being accurate, especially when you 0:19:36.001 --> 0:19:39.600 understand something as complex as to our procedure three opposition 0:19:39.640 --> 0:19:42.121 and your downtime is going to be quite significant. How 0:19:42.120 --> 0:19:45.401 does that material impact? Your school can drop off? You're 0:19:45.400 --> 0:19:48.001 ability to drive the car, you're getting out of a car, 0:19:48.321 --> 0:19:52.161 how fast can you prepare lunches for your two kids 0:19:52.160 --> 0:19:54.360 at home? All those things make a huge difference that 0:19:54.360 --> 0:19:55.961 they will materially impact you on These things have to 0:19:56.001 --> 0:19:59.240 be explicitly mentioned to patients before the operation, so that 0:19:59.241 --> 0:20:01.241 that's when we talk about informed choice. So I think 0:20:01.801 --> 0:20:04.641 to as plastic surgeons, we spend a lot of time 0:20:04.640 --> 0:20:06.761 trying to tell patients the right information so that they 0:20:06.761 --> 0:20:09.041 can make the right choice. It is not my job 0:20:09.120 --> 0:20:12.240 for them to go through the procedure, but it is 0:20:12.281 --> 0:20:14.921 my job an obligation to provide you the right information 0:20:14.961 --> 0:20:15.960 for you to make the choice. 0:20:16.160 --> 0:20:25.001 Yeah, that's very well said. Okay, what are the common 0:20:25.561 --> 0:20:28.521 comorbidities associated with lipidema? 0:20:28.840 --> 0:20:33.801 This is a difficult question. There's no set answer, but 0:20:33.880 --> 0:20:36.681 let me let me start off by saying that there's 0:20:36.681 --> 0:20:40.481 a concept called metabolic health, and metabolic health is your 0:20:40.681 --> 0:20:45.120 basic cellular health, and the metabolic health markers are things 0:20:45.241 --> 0:20:48.521 like your blood pressure, your heart rate, your cholesterol, your 0:20:48.521 --> 0:20:50.561 tritless rights, your blood sugar and HP and AC and 0:20:50.561 --> 0:20:52.561 all those things. And these are the things that ultimately 0:20:52.600 --> 0:20:55.681 impact your cellular health and ultimately decide if you are 0:20:55.721 --> 0:20:57.761 going to have a healthy life or not a healthy life. 0:20:58.041 --> 0:21:02.600 There are multiple drivers for metabolic health the abnormalities, and 0:21:02.640 --> 0:21:05.041 some of them are endocrine and the words hormonal health. 0:21:05.281 --> 0:21:08.761 Sometimes it's weight which is kind of a excessive weight, 0:21:08.801 --> 0:21:11.041 and obesity and so on and so forth, And unfortunately 0:21:11.041 --> 0:21:14.241 with labandin patients, a lot of these things go exist 0:21:14.961 --> 0:21:18.000 and it is important to peel them. And we have 0:21:18.041 --> 0:21:21.321 a bias that if you've got the ideal body weight, 0:21:21.640 --> 0:21:24.201 you should be healthy. But research has shown that even 0:21:24.241 --> 0:21:26.481 people who are the perfect body weight for their height 0:21:26.561 --> 0:21:30.600 and the age, thirty percent of people are metabolically unwell right, 0:21:30.880 --> 0:21:34.120 and that number goes up when you are at the 0:21:34.241 --> 0:21:38.721 OH weight category on BMI, obesity Cat one, obesity category two, 0:21:38.721 --> 0:21:41.521 and morbid obs. So if you're heavier, your metabolic health 0:21:41.600 --> 0:21:46.241 is kind of not suboptimal. Other issues like thirore issues, 0:21:46.281 --> 0:21:49.961 hormone issues, some people may have type of diabetes, no 0:21:50.080 --> 0:21:53.120 different other population, but migraines are sent to be more 0:21:53.160 --> 0:21:58.840 common in laban in patients and some patients may have 0:21:59.201 --> 0:22:05.321 disordered eating sleep apnea based on urbesity and joints would 0:22:05.360 --> 0:22:09.600 be yeah, join pain, joint pain, and because the knee 0:22:09.640 --> 0:22:13.721 joint in particular is the most vulnerable joint in my opinion, 0:22:13.761 --> 0:22:16.880 because knee joint relies on collagen ligaments, a good quality 0:22:16.921 --> 0:22:19.801 collagen in your ligaments to be strong, and lipid human 0:22:19.840 --> 0:22:22.561