The Difference Between a Bad Result and a Bad Attitude

Dr. Chang (00:04):
You are listening to Secret Services where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang. So we're back. I'm Dr. Chang.

Jackie (00:19):
I'm Jackie.

Dr. Chang (00:20):
All right. Great to be back with you. So last time on one of our first episodes, you had told me a little bit about the Mormon wives.

Jackie (00:31):
Oh yes, Jessi.

Dr. Chang (00:31):
And you were educating me about that. And I think there's some updates with how she's been doing. But first, I think we were going to actually shift gears. We had planned to talk a little bit about what's trending right now. And one of the celebrities I had heard about was Megan Fox.

Jackie (00:48):
Oh yeah. Did you see those photos?

Dr. Chang (00:51):
I saw them. I saw them. They're getting a lot of play online.

Jackie (00:57):
I mean, she looks great.

Dr. Chang (00:59):
Yeah. She had some photo shoot. For those of you who haven't seen it, she had a photo shoot and they're very provocative photos. And everybody's always judging her appearance, right?

Jackie (01:12):
Oh yeah.

Dr. Chang (01:13):
And the number one comment I saw was, did she get a BBL?

Jackie (01:18):
Yep. Yep. I had some friends send it to me to ask your opinion as a professional. Do we think she got a BBL?

Dr. Chang (01:28):
So for those of you who've been living under a rock, a BBL stands for ...

Jackie (01:33):
Brazilian butt lift.

Dr. Chang (01:34):
Brazilian butt lift. So that's been a very popular procedure in the cosmetic world for a long time.

Jackie (01:42):
Oh yeah. The Kardashians made it big. And then it was kind of trending out.

Dr. Chang (01:48):
Only recently, I think.

Jackie (01:49):
Only recently.

Dr. Chang (01:51):
Right.

Jackie (01:51):
So now is it going to come back? What do we think?

Dr. Chang (01:55):
I don't know. I don't know. She definitely has sort of rekindled the discussion a little bit. But yeah, so BBLs are extremely popular or were very popular. I mean, they're still quite a common cosmetic procedure.

Jackie (02:12):
Yeah.

Dr. Chang (02:13):
And what really is involved with taking fat out of one part of the body. So usually it's liposuction around the abdomen, waist, the back, the thighs, and then putting it into an area where you want, right?

Jackie (02:29):
I was thinking about this with Megan Fox because I was like, where did they get the fat from?

Dr. Chang (02:34):
Right. She's super thin.

Jackie (02:36):
She's so thin. But we haven't seen her in a while. So I was like, maybe she was hibernating, putting some weight on.

Dr. Chang (02:42):
So you think she had one?

Jackie (02:44):
I do. Do you not?

Dr. Chang (02:48):
I don't know. I don't know. She's pretty thin.

Jackie (02:51):
Right. Yeah. That was my only holdup. Where did this fat come from?

Dr. Chang (02:56):
Yeah. And the way that she's posing in the photographs kind of accentuates her hips and butt waist kind of ratio, right?

Jackie (03:06):
Yeah. Well, that was the other thing I was thinking. I don't ever really remember her butt from before. She wasn't really showing it off.

Dr. Chang (03:14):
Right.

Jackie (03:15):
Right?

Dr. Chang (03:15):
Sure. So that is a big thing too. How does positioning and young people know this certainly, like how you pose in a photograph can accentuate certain things or hide other things.

Jackie (03:27):
Yeah, that's true.

Dr. Chang (03:28):
It used to be that the young ladies would pose with one foot forward and hand on a hip, right? And now there's other different poses that are trendy.

Jackie (03:36):
Yeah. Well, sometimes when I look on my For You page on Instagram, it'll show girls like the same girl posing one way and then another way, and they look completely different.

Dr. Chang (03:46):
Oh, right. I've seen those. Like tutorials and how to pose.

Jackie (03:48):
Yeah. One shot they'll have, it looks like six pack abs and the next one they're just kind of hanging out over their leggings. So is it just a matter of posing?

Dr. Chang (03:59):
Maybe. It certainly helped her look. But you've been in the operating room. You've seen many BBLs, right?

Jackie (04:06):
Oh yeah. We still do a decent amount.

Dr. Chang (04:08):
Right. Right. And so tell me in your mind from what you've seen, because you've seen it across number of surgeons, what do you think are the volumes that would be needed to do like a BBL?

Jackie (04:21):
Right. I think you need a couple liters of fat to make a big difference, right? And then you have to assume that not all of it will take. It'll be a little less voluptuous after you heal up and everything. So I feel like you need a substantial amount of fat to do something like that.

Dr. Chang (04:43):
That's what I've seen in the past, for sure.

Jackie (04:45):
So then I'm like, do they do many BBLs? Is that an option?

Dr. Chang (04:49):
Well, if you don't have enough, I mean, you are limited by what your body has to take from. I mean, so a thinner person, you don't have a couple liters or you have to be very, very aggressive as the surgeon to get all that fat out if there were enough.

Jackie (05:06):
Right. So what if someone came into the office and they were interested in a BBL and you just look at them and you're like, "There's no way we could get all of that fat off of you".

Dr. Chang (05:16):
Right. So then if you don't have enough supply to fill the area you want to fill, you have to be creative. You have to sort of think, "Well, can I improve the contour in where you need it the most?" There are some alternative ways to augment areas such as the buttocks, but they're not as good as your own fat. So the number, one thing that was popular for skinny people who didn't have any fat was to use off the shelf fillers such as sculptra.

Jackie (05:51):
Oh, yes. I've seen that. Yep.

Dr. Chang (05:53):
So sculptra is an injectable product, which is a poly L lactic acid, which is a synthetic product that stimulates collagen and is also a dissolving product. Your body can break it down. But the idea is that you would inject this off the shelf synthetic product so that you could provide volume where you didn't have any. And obviously you wouldn't take it from a skinny person who doesn't know fat.

Jackie (06:26):
Right.

Dr. Chang (06:28):
So that was popular for a little while or at least disgust. I think in reality it was expensive to do because you needed such large volumes. I mean, these kinds of things come in vials that you would reconstitute in maybe five ccs to 10 ccs. And if what you're saying is you need liters of volume, you're talking about amplifying that by a hundred, right? So five ccs times 100 for 500 Cs for one side of my butt and for the other.

Jackie (06:57):
That's a lot of money. Well, now that you mentioned the sculptra, Megan Fox has the means to do something like that. I wonder if, what if that's something?

Dr. Chang (07:06):
Well, then that gets me to the second option would be to get a buttock implant.

Jackie (07:14):
Oh yeah.

Dr. Chang (07:15):
She could have gotten butt implants and that's not ... I mean, she's definitely said that she's comfortable with plastic surgery before.

Jackie (07:23):
Oh yeah.

Dr. Chang (07:25):
So buttock implants are silicone implants, but they're not like breast implants where they're soft and squishy. They're a little bit firmer, form stable, and they're designed to create shape. Did I ever tell you how they put those in?

Jackie (07:43):
No, I was going to say I've actually never seen butt implants put in.

Dr. Chang (07:47):
Yeah. So obviously when you want to show off, you're enhanced, but you don't want to have incisions or scars on the butt.

Jackie (07:58):
So?

Dr. Chang (07:58):
So the incision is usually in the cleft or between the cheeks.

Jackie (08:02):
Oh, no.

Dr. Chang (08:03):
Yeah. Yeah.

Jackie (08:05):
That's interesting.

Dr. Chang (08:06):
That's not exactly the place where you want it. I mean, I don't know. I don't do that surgery, but it has had its niche popularity in certain groups, in certain areas of the country, in the world. So there are people that'll do it, but I think that it's a little freaky.

Jackie (08:26):
Yeah. It seems a little risky.

Dr. Chang (08:28):
Yeah.

Jackie (08:28):
Is that why you don't do that?

Dr. Chang (08:31):
There's a couple reasons. I think that whenever we place an implant, anything, a hip implant, a heart valve, a breast implant, sterility is the number one thing.

Jackie (08:50):
Yep.

Dr. Chang (08:50):
It's got to be clean. And we really are emphatic about that because the implant is not alive. It doesn't have circulation and it never will have circulation. Your body's going to heal around the implant. So if there is a small amount of bacteria or it seeds that implant, as much as you can try to treat an infection with antibiotics, medication, even rinsing it off and washing any kind of infection that comes in there, you will have to remove the implant ultimately in almost every case because you will not be able to get rid of every ounce of bacteria. It will just hide on that prosthetic. I'll look at you. You making a yucky face.

Jackie (09:37):
It doesn't sound pleasant.

Dr. Chang (09:39):
You've seen it before, I'm sure.

Jackie (09:41):
I've seen infections with implants and I can't imagine having-

Dr. Chang (09:45):
Different kinds of implants, I'm sure.

Jackie (09:47):
Yeah. Oh yeah. All kinds. Hips, knees, all that stuff.

Dr. Chang (09:50):
Yeah.

Jackie (09:51):
so having one in your butt seems not ideal.

Dr. Chang (09:54):
Well, exactly, exactly. The buttock is a dirty area. It's kind of, you can clean it and sterilize it in the moment. So there is the potential for success, but at the same time, it is a riskier spot.

Jackie (10:08):
Yeah.

Dr. Chang (10:09):
Similar reason why I am not a fan and most US surgeons are not a fan or well-trained in nose implants because the nose isn't as dirty in the same way we think about it as the buttocks, but you have a lot of bacteria and things in your nasal passages.

Jackie (10:26):
Right? Yeah, that makes sense.

Dr. Chang (10:29):
So

Jackie (10:29):
Then you have people that leave the country to get stuff like this done.

Dr. Chang (10:33):
Right, Right, right. Because it's not really well done or commonly done in the US. So I mean, you know people travel for BBLs, right?

Jackie (10:46):
Oh yeah. Down to South America. Oh yeah.

Dr. Chang (10:51):
South America, it's very popular. Dominican, it's very popular. And in the US, the number one destination for BBLs is?

Jackie (11:02):
Miami.

Dr. Chang (11:03):
Miami, yeah. Miami is great, but culturally is so influenced by South America and the Latin American population. I think that the aesthetic obviously gets influenced by the culture and some of the physicians, of course, also are either Latin American or they've trained in South America and they have close ties or family, and they also have a lot of skills that are developed in South America or Latin America. Take a guess as to what percentage of BBLs in the United States are done in South Florida.

Jackie (11:41):
Oh, wow.

Dr. Chang (11:42):
And the whole US.

Jackie (11:43):
Of BBLs. 40%?

Dr. Chang (11:47):
Oh my. Did I tell you this beforehand?

Jackie (11:49):
Did I guess?

Dr. Chang (11:50):
45%.

Jackie (11:51):
No way. I swear you didn't tell me.

Dr. Chang (11:54):
I must have told you.

Jackie (11:55):
No, I swear. I swear.

Dr. Chang (11:57):
You took my thunder. But isn't that crazy? One city or essentially county, maybe Dade County or Miami and Broward, it's like you have 45% of the whole country.

Jackie (12:12):
Well, I was recently in Miami and it feels like literally every corner was a plastic surgery office. There are so many people down there, so I guess they have the ...

Dr. Chang (12:23):
The numbers.

Jackie (12:24):
Yeah.

Dr. Chang (12:24):
Yeah. And they do a lot of volume. There's a lot of places that only do liposuction and fat transfer.

Jackie (12:37):
Yeah. And there's some new technology now to help with the safety of BBLs, right? Like the ultrasounds.

Dr. Chang (12:44):
Right, right. So do you remember why or have you been thinking about why that was controversial? Were you involved at all at that time or did you hear that? I don't think so. So maybe about five years ago or so, it sort of came to a head. Every year we would hear about some stories out of practices that had BBL patients that had bad outcomes. Bad outcomes, meaning things that sent them to the ICU or even ended up with death. And really the trouble was that these large volumes of liposuction, fat transfer, and then injection were putting the patients at risk for blood clots or fat embolism, which is essentially, instead of blood clot going to your lungs, fat.

Jackie (13:37):
So fat, yeah.

Dr. Chang (13:38):
Clogging up your blood vessels, then blocking your lungs so that you couldn't essentially ventilate the patient.

Jackie (13:45):
Yeah, that's terrifying.

Dr. Chang (13:46):
Yeah. Yeah. It was really scary. So fast forward, a lot of people sort of said, "Well, okay, let's slow down and figure out how to make this a safer procedure. What are the risk factors?" And a lot of people started to sort of say that if you could be more observant of where the fat is being placed and more careful and avoid large blood vessels, then that would improve the safety. And so in the past, the technique was often to inject the fat into the gluteus muscle because muscle has a lot of blood flow. And as you know, for blood flow and cells that are being transferred, the blood flow helps the cells live, and then you have more survival, like you were saying, some of the fat resorbs before.

(14:37):
So once you have that blood flow, then your graft is going to take better and hopefully will live better. However, once you're inflating with ... I mean, again, think of a two liter bottle of soda once you're inflating with these large volumes of fat, if you tear the blood vessels or have any kind of thing that kind of comes in and puts pressure in that system, then the blood vessels can get seeded with a little bit of fat and that was the problem. So now it's more in vogue and really the standard of care to try to inject in the subcutaneous and the fat layer of the butt. And that's being done generally with ultrasound has been recommended as a very popular and proficient way to observe the depth of the injections and things like that.

Jackie (15:25):
Nice.

Dr. Chang (15:26):
So that's kind of the trend of where we are now in terms of improving safety. I think a lot of people who do high volume buttock injection are on the forefront of that. They do this stuff a lot, but it is something that did get a lot of attention. But I think that, like you were saying, it seems that it's trending down. Do you have any thoughts about why?

Jackie (15:57):
Well, I just think with the, as we've discussed, the Ozempic craze, everyone's thinner now, and then people were saying, like I said, the Kardashians kind of started the whole BBL trend, and then now it seems like they're on the leaner side and there was rumors that they were getting their BBLs dissolved, and then you kind of see that trickle through Hollywood. Everyone's thinner. They're not really talking about their butt as much. So that's why I thought it was pretty interesting to see Megan Fox come out and be like, "Boom." I still got a nice butt.

Dr. Chang (16:29):
That's funny. I think that ... Well, because she was always skinny. She didn't have to prove. Everybody always wants what they don't have. If you're skinny, you want to be curvy. Yes. If you're curvy, you want to be skinnier.

Jackie (16:41):
Definitely.

Dr. Chang (16:42):
So that's not surprising. But I forgot to say, there is a third option, at least something that's becoming popular now, and that is cadaveric fat transfer.

Jackie (16:55):
Yeah.

Dr. Chang (16:56):
So cadaveric meaning ...

Jackie (16:58):
From a cadaver, a dead person.

Dr. Chang (17:01):
Yeah.

Jackie (17:02):
Correct.

Dr. Chang (17:03):
Yeah.

Jackie (17:03):
Yeah. So I did think about that too. It could have been that, that Megan Fox got a little ...

Dr. Chang (17:11):
I mean, if that happened, the interest in cadaveric fat transfer would have been-

Jackie (17:17):
Would go through the roof. That's true.

Dr. Chang (17:19):
Yeah. So yeah, they take donated tissue, much like they donate skin for burn victims, or they donate tendons or ligaments for orthopedic reconstruction.

Jackie (17:34):
Cartilage.

Dr. Chang (17:35):
Yeah, all sorts of stuff. And basically use it for tissue banking instead of live organs like, okay, a beating heart or kidneys or liver or something like that, some of these other tissues can be processed and cleaned and decellularized for a transfer. So that's becoming a newer technology, a newer trending thing in cosmetic medicine. So that's a good solution for patients who don't have enough fat and really ... And if you're skinny, you might not need that much volume really to make a difference.

Jackie (18:11):
Yeah, That's true. Yeah.

Dr. Chang (18:14):
But yeah, that's certainly a popular trend there.

Jackie (18:18):
I feel like she's pretty open. Maybe in the next couple months, she'll come out and say what it was, or maybe it was just posing.

Dr. Chang (18:26):
Yeah. I do think Megan Fox is a little bit of a sad story in the sense that she's so beautiful and she always is talking about pushing the envelope of doing more things. So I don't know how you feel about that.

Jackie (18:47):
I agree. I mean, when she came out in Transformers, she was stunning, beautiful, like the it girl. So it is kind of crazy to see someone where you're the standard for hot, be so insecure and want to get more surgeries because you're like, whoa, everyone else is getting surgery to look like you. So it is kind of weird, but at this point, I mean, she's aging, she has kids, but I think she did get a lot done pretty early on.

Dr. Chang (19:17):
Right. When she was young. Yeah. I think that we saw this during the pandemic too. I think the more you're on screen, the more you look in the mirror, the more you see yourself, you kind of say, "Well, could I do this and that? " And I think there are people and doctors and practices who will do a good job of sort of guiding you to not get too far off the line there. But sometimes people will just, especially if you're a celebrity, they'll just be so starstruck, they'll say yes to whatever you want.

Jackie (19:50):
Right. Well, and I was going to say someone like that, it's like you can be like, "Oh, you won't do it. Someone else will."

Dr. Chang (19:56):
Right. Or be like, "Oh yeah, I'm Megan Fox's BBL doctor." And then that brings you a whole nother level of prestige or cachet. But anyway, but yeah, BBLs I think are a part of plastic surgery. I think stylistically there's a trend as you discussed. Dr. Jenny was out in LA and she really loves the skinny BBL. Maybe we'll get her back to talk about that sometime because I think it's a more subtle change.

Jackie (20:33):
It's kind of like people now, they want the ballerina implants. Is that what they're calling them?

Dr. Chang (20:38):
Yeah. Ballerina boobs.

Jackie (20:39):
Yeah, just small implants. So maybe their small BBLs are on the rise.

Dr. Chang (20:45):
Yeah. Yeah. I mean, the breast implants is another topic that we should talk about in terms of sizing because I think people are really ... Always seem to have a little difficulty deciding and then there's always this what if and what if it was bigger, what if it was smaller kind of a thing. But as promised, we said that we would talk a little bit about this lady from the Mormon Wives, Jessi. So-

Jackie (21:16):
Season four just came out.

Dr. Chang (21:18):
Okay. Okay. So let's recap a little bit. So tell us what her journey was with the original surgery or something.

Jackie (21:26):
Well, she's had several surgeries, but a few months ago she came out, she got another surgery and we were all like ... Yeah, she spent $25,000 on a new surgery. And we kind of were all like, "Well, what did she even get done now?" Because it seemed as though there was nothing else to get done. So it looks like she got, I think she had her alert base, the edges of her nose maybe touched up, and then she did fat grafting. So with fat grafting, you're a little swollen, bruised, it takes a little while. So everyone was commenting on her face and maybe now that she's in the limelight again with the premiere, she's coming out again saying that it ruined her life, this most recent procedure.

Dr. Chang (22:10):
But didn't she get something around her eyes? Or I feel like-

Jackie (22:12):
She's had blephs.

Dr. Chang (22:13):
I feel like everybody's commenting about her eyes for some reason.

Jackie (22:16):
They were comments. She had a brow lift or something? She didn't admit to a brow lift and I thought she had already had a bleph before. I don't know. To me, she just looked a little swollen.

Dr. Chang (22:25):
And she's pretty young, right?

Jackie (22:27):
She's like 30 something. I think she's like 31, 32. Yeah. But-

Dr. Chang (22:32):
To me, that's young.

Jackie (22:33):
Well, yeah. Yes, she is young. She is young, but not like some of them on the show are very young. But I'm going to be honest with you, lately, I think she looks pretty good.

Dr. Chang (22:44):
It started to settle?

Jackie (22:45):
I think it's settling and I think she looks pretty good, but now I'm wondering, is she just hating it because of the feedback she was getting from the comments?

Dr. Chang (22:58):
I think we used the term for her, she could be an evil genius on the other podcast. Maybe she's just stoking this and milking this experience for as much kind of commentary and discussion as possible because the new season's coming out.

Jackie (23:18):
That is true.

Dr. Chang (23:18):
And maybe it's really something that she's already had to deal with. So she said, "Oh, why don't we make it a little more interesting?"

Jackie (23:30):
Well, one of the things, I mean, she does pose and talk about her surgeon, pose with and talk about her surgeon a lot, but now she's saying, "Oh, well, when we discussed fat transfer, I didn't know I was going to be going in my lips." So then she's kind of dropping hints as if, "Oh, not everything I wanted was done correctly by the surgeon." So it kind of creates this weirdness because she's kind of throwing the doctor under the bus instead of being like, "No, I wanted this. "

Dr. Chang (23:59):
Love that.

Jackie (24:00):
Right, right. So it kind of creates this PR nightmare for her surgeon.

Dr. Chang (24:06):
Yeah. Well, either way, we do deal with that sometimes where patients feel that they didn't fully understand even though we spend time in consultation and discuss things with them about what to expect and what we're going to do. They may not always fully understand, but-

Jackie (24:26):
I think she looks pretty good.

Dr. Chang (24:28):
Yeah, I think she looks good. At least in some of those photos, she looks good. And I think things settle with time. They look kind of bizarre right after, but with everything, it settles generally.

Jackie (24:42):
I think like you mentioned being on camera more, her job is, she's just on camera twenty four seven, filming her day-to-day life.

Dr. Chang (24:52):
Oh, she does the TikTok mom thing, right?

Jackie (24:54):
Yeah. Yeah. So she does the vlogging and she's constantly on camera. So I think during that healing process, you know it's a weird time. You don't look immediately how you're going to look. So I think that could have also distorted how she feels about her results.

Dr. Chang (25:11):
Yeah. That and the social media and the commentary on her, everybody's talking about her appearance probably all the time. That's a pretty exposed position to be in for anybody. Even the celebrities like Megan Fox, she's limited exposure to the public when she has a photo shoot or she's on the red carpet or whatever she does or in her movie she has sort of scheduled appearances. But if you're on there every day with your phone and vlogging, you're going to get a lot of exposure.

Jackie (25:45):
Oh yeah. Well, we hope the best for Jessi. I think she looks good. I think it'll be interesting to see a year out when everything's settled, what does your face look like?

Dr. Chang (25:57):
Yeah. I think things always settle and I think it's a journey. It's a journey for everybody. And you do run that risk as the surgeon working with an influencer like that. You know what I mean?

Jackie (26:08):
Oh yeah.

Dr. Chang (26:09):
Yeah. Somebody asked me would I ever work with an influencer? And I have had people approach me. Early in the practice, we'd have people who would just send messages about opening for a collab. And I was like, "What does that even mean? Are you open to collab?"

Jackie (26:26):
Yeah.

Dr. Chang (26:30):
But yeah, no, I think recently we had a pretty big influencer through the practice who was sharing her journey and stuff like that. So it always makes you a little bit nervous. You don't really have control over how they're going to present the message and that kind of thing and what they say. So you definitely do expose yourself on social media.

Jackie (26:52):
Totally.

Dr. Chang (26:54):
But anyway, so sort of to wrap it up, I guess the thing to think about is really what separates people from those who really love the results versus those who-

Jackie (27:07):
Have a little regret.

Dr. Chang (27:09):
Or chance for, yeah, chance for regret. What do you think?

Jackie (27:14):
I think you have to have a level of confidence within yourself already going in. You can't look to these procedures to solve everything. And I think you have to have a realistic mindset going in. And I think also it's a very personal choice to get plastic surgery. And so I think you have to be prepared to hear other people's comments and just be ready to take it on like, "Hey, well, I wanted this done, not you. So if you don't like the way my new lips look, then so what? "

Dr. Chang (27:47):
I mean, that's great advice. I think you have to be strong. You have to know what you want and those patients that are very confident about that and don't let the outside noise kind of shake them, feel good about it. I think that's true. I think the other thing that does help, of course, is communication with the provider, doctor, injector. Definitely. Certainly make sure you're on the same plane as like, I understand just like what she was saying, like she didn't understand what the doctor had planned or feels like her questions weren't addressed. That's not the right plan, but you want to make sure you feel that way before you start.

Jackie (28:28):
Right. That's why it's important to pick someone that you feel like you can have open, clear communication with too.

Dr. Chang (28:35):
Right, exactly. So I think that's important, being able to hear both sides, make sure you guys are aligned, but I certainly think a lot of it is internal, like what you're saying. It's sort of, you got to do this for you and be sure about it and don't let outside influences, most importantly, your family members really get down on you and make you feel bad about yourself when you're trying to do the opposite.

Jackie (29:01):
Yeah, exactly. I think that's pretty good advice.

Dr. Chang (29:04):
All right. Well, patients are here. We got to go.

Jackie (29:07):
All right.

Dr. Chang (29:08):
See you next time.

Jackie (29:09):
See you. Bye.

Dr. Chang (29:12):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @CongressionalPsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.