The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person, because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome to Meet the Doctor. My guest today is Dr. Gary Horndeski. He's plastic surgeon in Sugar Land, Texas, a place that I love very much. Welcome to the show, Dr. Horndeski. Nice to meet you.

Well, thank you for inviting me.

Can you just give us a little bit of information about yourself first? Seems like a good place to start.

Yeah. I'm a plastic surgeon. I, practice in Sugar Land, Texas. I've been, uh, in Texas for, well since 1986, so it's been a long time. I've been here practicing plastic surgery. My plastic surgery training was at UT Houston, and then a fellowship at MD Anderson and Microvascular Reconstructive Surgery. So now I'm practicing here since then. And I, I mostly do breast surgery, particularly breast lifts and breast reductions. And the technique I use is a no vertical scar technique. And I've developed that. And, uh, I've trained other doctors in this technique and I've spoken about it many times. I've actually gave a lecture about two weeks ago in Miami at the, uh, aesthetic meeting. I was scheduled to present in about two months in the Athens, Greece at international meeting about my technique. Um, the value of my technique is it's no vertical scars, the way the breast is transferred to the muscle. And this helps people relieve natural or back pain without excessive breast reduction. So that's kind of what I'm focused on now in my career.

So I assume patients find you because of this technique. Is that something they come to you specifically for?

Yes, we've done people from like six continents, even Antarctica, China, Australia, the Congo, Nigeria, Mexico, Canada, 49 of the 50 states. I haven't had anybody from Alaska yet. But other than that, all the states and, uh, France, England, Israel, Constantinople, and the Middle East, uh, Saudi Arabia, Qatar. So I've been busy with people throughout the world. They find me online, which is, uh, which is what's really good because it's impossible to advertise all these locations, but people go online and look for something new and, and, um, international patients all have always looked to America for innovation. And that's, that's what America is great for innovation and that's why they come. That's what we're trying to do, promote the concept of innovation with, with breast surgery, the, the traditional techniques of breast surgery have been developed in the 1950s and, uh, that's been kind of standard. But, um, I stopped doing those techniques about 25 years ago and developed my own technique, uh, of no scar. So, uh, it's fun for me. It's fun to see people from all over the world.

Many of these innovations in plastic surgery happen because you're trying to solve a specific problem and sometimes they're even a happy accident. Is there a story behind what led you to try doing this a different way?

Sure. You know, I trained at UT Houston, and then I trained at MD Anderson, and then I'm gonna get down with my training. The traditional technique of breast lifting, particularly on darker skin, women, leaves a vertical scar. And that vertical scar is just plain ugly. I mean, no one, no woman wants a vertical scar down the middle of their breast. Why wouldn't anybody want that if it could be eliminated? Uh, so that's the cosmetic reason. There's no vertical scar. Also, this technique shapes your breast mode like an implant. Okay. So this cosmetic reasons then functional, I use what's called mild integrion. The, the breast and muscle become one unit. So I tell women, if you take your hands and holds up your breast, that's how you'll feel the rest of your life. It cures neck, shoulder, back pain, and many people, or uses it or diminishes it. And the third thing that's really good is psychological. The people appear taller, thinner, can go braless by different clothing, never were before. So it's, it's very liberating for the patients to have this procedure done. Um, they're very happy with and I very appreciative. And, uh, like I say, they come from all over because they want that alternative available to them.

I think you said Antarctica. How did that happen?

It's interesting. She was a, a person working Antarctica, and in Antarctica you have a lot of time on your hands, I guess <laugh>, you know, you can't go outside and play, I guess. So they're on the internet all the time. So she found me in Antarctica, then came to Houston, have it done. And, uh, so she found me from the Antarctica. So that's kind of unusual. Uh, <laugh> that only one's Antarctica.

I'm pretty sure you're the only person who's ever told me they got a patient from Antarctica. <laugh>.

Yeah, I've, I've never heard one either, but that's, that's kinda cool.

<laugh>

Kinda fun.

And so you teach this technique all over the, the country and all over the world now?

I've taught several people. One in Canada, one in Dominican Republic. I'm working with a guy in Morocco. I've taught several people in the States. Yes.

Is it something that you think is catching on that more people wanna learn?

People are very reluctant to change. And particularly in America, I think there's more appeal internationally than in US because there's so much potential, uh, problems with new techniques in America. Uh, litigation is the big fear, of course. You know, there's a thing called standard of care, and you know, people talk about standard of care. Well, if something is new, then it's certainly not standard of care because they're new. So you, it kind of works against you in some ways, but, but people are accepting it. It's, I've been doing so long, other peoples doing things like it. So I think it's, it's gonna, it's become established. And I president the paper on it was published in, in PRS Global Open. I've spoken about five occasions to international. So it's, it's becoming established, but it takes a long time for something to be discovered to be incorporated in mainstream medicine. It takes years. It's not a quick, quick change.

How many times now you say you've done this particular procedure in your career?

Close to 1000. Probably close to a thousand.

A thousand. Yeah. Now I often say this is gonna come outta left field, but I often say, if I could go back in time to anywhere in the world, I would go back to Houston in the 1980s during the oil boom, like the urban cowboy days. Because I imagine that Houston was a pretty cool place during that time, and you were there. And that, that also during this time, there are some of the greats of plastic surgery were around town and it, so did you train with some of those folks?

Yeah, there's, um, of course there was, uh, Frank Drew and, and, um,

Thomas, um,

Thomas Cronan and Thomas Bigs. I did train with both of them. The gentleman who was at, uh, St. John's, or I'm sorry, St. Joe's downtown. And then the other gentleman was, uh, uh, instructor at Baylor College of Medicine. So I heard him speak many times. Frank Drew spoke many times. They both died around 94, I believe. They were both, both died close to the same time. Uh, they were both, you know, pillars of the past, um, history.

And then you also went through the period of time where implants were taken off the market.

Yeah, yeah. Well, I tell you, the problem with implants is they're not lifetime devices. And what you're doing, you're making a hole in the patient. I mean, there's no space there. You're making a hole and shoving something in there and seeing the people bigger is better to, in many thoughts. And, and the bigger the hole, the more the weight and the more problems it presents, it's, it goes on to have problems because, you know, you're, you're putting in dead weight and like a 450 cc implant was a pound. Now a pound doesn't sound like much, but after 10 or 20 years, that pound is stretched to skin envelope. And the only holding up breast implant is the skin envelope. So that's the, that's what's important about what I'm doing. I see a lot of women who present to plastic surgeons who really needed a breast lift.

(07:58)
They see a plastic surgeon. Plastic surgeons don't do good, very good breast lifts, but they do better implants. So, you know, to redirect them towards an implant rather than breast lift, then they'll come back seven years later. But a large droopy breast as opposed to just a droopy breast, so it makes it even more difficult. Plus he's also injured the blood supply. And that's, that's an issue too. So, or even the nerves. So a lot of times I, I'm hoping that with my technique, uh, both of my methods I use for a no scar technique become more available. More patients will avoid the implant and go right to the breast lift to get the resulting one, the whole whole point of what I'm doing. Women want an attractive breast. A vertically scard breast is not attractive. That's why they're shifting to implants. And as we all know, implants have a series of complications. They are not lifetime devices.

So do you still use them sometimes?

Very rarely. Very rarely. Like once or twice a year. I use them for exchanges. Uh, sometimes a patient just wants it back. Being a woman who has very little breast tissue and very little fat, there's really no alternative other than being flat. So small implants of the order of two or 300 ccs. I don't use big implants because they won't last. So I'll probably do one or two sets of implants per year. And I don't do huge. I, I do like a hun over a hundred lifts and reductions, but I only do one or two implants because I know they won't last. And I try to redirect people away from them.

I'm starting to see a clear picture of the patient who would probably love to know what you're doing. And it's somebody who really needs better looking breasts. Maybe they've fallen, maybe they breastfed some kids and got destroyed by them or lost weight or something like that. And may still have enough volume, but still doesn't wanna have implants. And I think the number of people who don't want implants is growing now.

Yes.

And then may also be combined or independent of the person who doesn't want ugly scars either. They just kind of wanna go back to what they used to look like without putting anything in.

Right. Patients just wanna be back the way they were, the mommy maker, they're not asking for anything other than what they used to be. Now sometimes people will try to do more than that by putting big implants or something like that, but, but that doesn't really work. So, you know, my goal is to get them back to age 18. Again. Look like when they were 18, their breasts were high and brown and the chest fall, breasts move down from gravity. And, and people don't like that. It just doesn't look good. And the breastfeeding like that and weight changes, uh, weight loss surgery will cause breast to hang too. So the whole big demand for breast lifts and reductions, um, actually if you look at the numbers, lifts and reductions probably right now will be exceeding implants in terms of demand because, uh, there's so many more people need that. And, and the problems with implants become a well known there. It's, it's just getting out more and more.

The other thing I think is important here is that these may be women who don't want to buy themselves a second surgery if they get breast implant and are looking for a way to only do this one time.

Right. The key to what I'm doing is kind of one and done.

Yeah.

What's nice about this is you do it once and you're done. Now, oftentimes I'll do a little revision, I'll touch it up a little bit, a little scar, but I do that in the local, it's not a big deal. It's, you know, it's like going to dentist filling or something's comparable, that local anesthesia and you drive yourself there, drive home type thing. So, uh, we'll do some touchups, but, but the whole idea is implants are non lifetime device. This procedure should be a lifetime device. It it pretty much last lifetime. I have never had to redo one for mechanical failure despite doing this for about 20 years. Because what I do, I use the excess skin of the breast instead of throwing it away the skin to make a cup and on, on the base of the cup of straps and, you know, bra straps go over your shoulder, around your back.

(11:46)
But with my technique, the bra straps go directly into the muscle below, looping out the muscle. So the muscle and breasts become one unit. And with them functioning as one unit, it's, it's permanent. Uh, and um, I recently presented my work in Miami and I have a five year follow-up of a woman who had an MRI scan with confidence showing the straps are alive. Unfortunately, she underwent mastectomy cuz she was a BRCA positive and her sister had breast cancer. But, so I did my great operation and then take it apart from me. They, they had to do mastectomy, but uh, for, for good reasons and the pathology showed good news for her. No cancer of course, but also showed that my straps were attached and revascularized and functional. So the whole idea is I have radiographed proof as well as histological proof that the straps and the operation lasts. And that's, you know, that the last five years, it lasted a lifetime. It's not gonna change after five years.

Right.

Living is living. Yeah. So that's the real, real good thing about this procedure. You just one and done. That's our goal.

So can you describe where the incisions are in this procedure?

Yeah. The typical breast lift incision is what was called anchor incision, which is goes around the areola and vertical and then horizontally. Now my incision only goes it an almond shape pattern. The almond pattern, the tip of the almonds near the sternum and the wide part of the almond is lateral because see, breast fall down went out. So nice thing about this almond pattern, it takes advantage of the do out tissue by getting all that, all that skin and making a, a cone out. So you, you take all that skin in this form into a cone, and then from the base of that cone elevate the straps so it's all one piece and just loop it in and out of the p major muscle back to the base of the cone. So that's what's what's really unique about it. It, it's really specific for the pathology, but the breath fall down went off. And that's, that's what the album's all about.

Many times when we hear about, uh, an innovation in plastic surgery, it's followed by a statement like, and when I presented this, everybody yelled at me or people got really angry or they told me I was crazy. Has that ever happened to you? <laugh>?

All the time. <laugh>,

(13:53)
Yeah, absolutely. So I'm going battle, you know, when, when something new comes up, first thing that can't work, and then after a while I'll say, well, that mights work. And then saying, well, I guess it can work. But then people say, well, everybody knows that. So it goes through a phase of denial to acceptance, you know, so it goes through that phase. And uh, you know, when I first presented this, said, oh, I was tax viciously, my website was torn apart and everything. I had all sorts of things happened. People attacked my website and uh, of course they attacked me too, you know, and, uh, but that's given it. But as time's gone on through various things like real self, I've got the word out there and, and people have come to accept what we're, what we're doing.

Yeah, I was just wondering where you got these drawings of me for your website?

<laugh>

<laugh>? No. Uh, I will link in the show notes for anybody who's listening to illustrations and I think they're really helpful to visualize how this is in what you're doing. And, uh, I'm sure that you probably tell people to go to this page 50 times a day because it's really useful to actually see it in action. Were those drawings something that you developed yourself?

Yeah, we developed these drawings and so computer animation, we have a variety of things available for people to understand it, to distinguish ourself from the traditional techniques that, that whole idea, we want to give people an alternative. Many women are sitting on the sidelines, they'll do nothing before they do the vertical scar technique. So looking for something. And when they finally find me, then they'll say, oh my gosh, this is, this is what I've been looking for for 10 years. I've, I've had people actually following me for 10 years because they couldn't believe it's real. And uh, I remember I had a doctor, I think she was out in New York who was, uh, contacted me eight years ago. She contacted me again. I said, well listen, you know, if you're still not sure, call me eight years from now. You know, it's like gonna be <laugh> 16 years now.

(15:43)
So it's like, yeah, I mean I'm around and you know, she, if she's still around, I'm still around engineer from now, then we can do it, you know, but people, a lot of disbelief and, which is understandable because a lot of times people say, well if that technique really works, everybody will be doing it that way. Well, everybody can't do that maybe cuz they don't understand how I'm doing it. My background is in math and physics and engineering. So what I do is I scan the breast, I determine the critical surface dimensions from that, I derive a mathematical solution for each breast to make a hemisphere, and then that generates a blueprint. And from that blueprint, then I can do the surgery, no blueprint, no surgery. So that's, that's how it works. You got a computer solution. So it's all math-based.

And did you develop software to do that yourself too?

Yeah, yeah. Well we have a software company, but I, I gave the input to software company. I don't, I don't write code, but I write the algorithms, the algorithm. No one's gonna do it.

Right. The math behind the code.

Right,

Right. That makes sense. Yeah, I mean the cases are beautiful and I'll make sure that we put a link to these that is easily found in the description of this podcast, so that if anyone wants to look at what you're doing, those pictures will be there. This is very exciting.

Yeah, it's, it's really a, the whole idea now is instead of the word of mouth, it's the word of mouth. And the whole world can see things now, you know? And, um, you don't have to just ask your neighbor, you know, who do you go to? You know, you go out, people find me, they go online, they look a breath lift or minimal scar or whatever, and they are able to find me sometimes quickly, sometimes longer time to find me. But, uh, it's a, it's a different world and it also allows you to communicate without high cost. You know, you don't have to, I can't advertise in London. I mean, how am I gonna know? You can't advertise the world. I mean, cost is prohibitive, but the internet is basically free. I mean mm-hmm. <affirmative>

Platforms like RealSelf are great for getting information out that's different.

Yes. That's the whole idea. Give people an opportunity to find something that they can, uh, really, uh, use for their life and also give 'em a chance to interact. The, the good thing about RealSelf, um, they can contact patients and say, Hey, you know, you did had it done. Uh, what do you think? Really? You know, that kind of thing. You, it's kind of back and forth. It's not just, you know, it's just as me saying I'm, I'm great or something like that. Wanna hear from the patients. And, and when patients make negative comments, that's also helpful too, in the sense that if everybody says something positive, that's good, but you kind of learn from mistakes or from people who say, when I first started doing this, I used to use three points of attachment. Then one patient said, well, the breast is kind of triangular because there's only three points. So now I have nine points of attachment with my straps. So the feedback from patients helps advance the, the technology and um, and that's what you want. You learn from your mistakes more than your successes. And that's kind of a general rule of surgery across the board.

One of my favorite questions to ask is always, uh, what have you learned from listening to your patients? And you just answered it as one of the things, and I'm sure there's many more, but sometimes people look at me like, what could I have possibly learned from them?

Right? Oh yeah, <laugh>. Yeah. Sometimes some depends on the patients. Sometimes that's true. <laugh>

Sometimes, yes.

What I like about what I'm doing is it a selects for more intelligent patients. They've done their homework, they've looked online, they come and ask good questions, they wanna know how it's done. Not someone, us just like, eh, I was walking by your office. I thought I'd stop in. Those people, they're clueless to what I'm doing. They think it's like what everone else does. But no, the people do their research and then they ask good questions. And those are the ones that are, are most likely to do the procedure because they've been looking and looking and looking and dissatisfied. I mean, when people come from Australia, that's, that's a long fight. That's a long way to go.

Sure. So when people come from out of town, do you and your staff kind of help them figure out where to stay and make sure they're comfortable? Yeah,

Yeah. We have, we have a whole protocol. The hotel arranged with the hotel, they have free shuttle service, things like that. So we're probably 25% of my people are within Houston, another 25% is in the state, another 25% out of state, and then probably another 25% out of the country. So it's a variety now. Those ratios have gone down, out of he country has gone down markedly since Covid, but it's starting to come back up. I have a lady coming from Portugal and I have another lady coming from France in the next, uh, month or two. But we were shut down for a while with Covid, of course.

Yeah. This must keep your days incredibly interesting. Meeting all these people from all over the place.

That's the fun part about it. You know, they, it's not boring, you know, you see different people and also training people, like I said, I'm, I'm going to, um, Athens, Greece and about two months or so. And it's nice to talk to the international doctors too, um, get their perspective on things. It's a totally different world. Uh, America we think we're the greatest in all and maybe we rare, but in some ways it's good to see some input from other countries. And, and a lot of times they can do stuff that we can't get away with here. You know, there's certain things they do that we just can't do here. The, they do all sorts of stuff that's very innovative. But look, for instance, like implants, they can use polyurethane implants in Europe we cannot use in America. There's a variety of things that they can do there that we can't do there. And a lot of things there I've done first in Europe and then brought to America because it's easier to get established there. Like if you wanna have clinical studies, if, you know, you try to do 'em in America, it's a big cost to do the clinical study, but in Europe it's less expensive. They do it there, then you can kind of transfer the results and, and look at it here. So it's, it's a lot more open there.

Have you ever done any studies through your office?

Oh yeah, yeah. Well my papers have been, um, uh, like the last paper I published was a, was a seven year review of my patients. I did seven, seven patients in 2015 with lift in reduction. I followed them for seven years and I got my results. Uh, 91% of my people at seven years gonna go while abroad. And that's something that people don't even discuss in other techniques. They go bras even at seven years. Cuz the whole technology is so much better. They don't need to wear a bra. It's unbelievable. Again, the other techniques don't even discuss it because it can't be done, you know, just, it doesn't work for the other technique. But this internal bra that I make, it's all your own tissue and it's living. See bras as you know, a is a passive device. It's elastic, it's rubber, it stretches the word that you throw away.

(21:47)
Bras do not last lifetime. What I'm making is your own skin, as long as you're living as skin's living. And the muscle, the muscle provides elastic recoil, the muscle provides active lift. It's not dependent on stretch. So you have tongues. So within your muscle, I would call neuromuscular spindles that senses length and loss acceleration. So when a woman's laying down, the breasts are fine, but when woman stands with a breast amount drop, once a breast drop, they're pulling on the muscle. And that senses with the muscle, you, you're lengthening. So the muscle responds by transfer. So just like when you stand up, you don't fall over, you don't lean this way or that way. You stand straight. But because you have these neuromuscular spindles, it's sensing your position. And the same thing is true with a pec muscle. Then the muscle use APEC major muscle.

(22:30)
When you do a pull up or pushup, it lifts your whole body's weight. So if your, if your, let's say you weigh 200 pounds and you have two breasts, okay, well if your muscle can lift a hundred pounds each side and it hold up one pound breast, I mean if the muscle has a capable to hold a hundred pounds, it hold one pound. Right? I mean that, that makes sense. So the muscle has so much reserve that it could care less about one pound. And that's a decent side breast. And even if you have a two pound breast, still the muscle capable a hundred pound lift. So the whole idea is what we're doing, you know, does not depend on the external skin <inaudible>. You external skin rope wraps around your neck. That's why you have neck pain and goes through your, should you have shoulder pain and <inaudible> and all that stuff, all that stuff is gone because you're attaching to the muscle directly behind there. And the muscle does not have pain sensory cells like the skin does. There's no skin being compressed. So the muscle itself is, is providing an active lift. So it's the difference between an airplane, the glider airplane, you can fly anywhere you want. You go up and down or whatever glider, you only go down, you know, it's all passive. That's the analogy.

What is the recovery like after this procedure?

Same as the other procedure, I, I have people about after one month do anything you want, you know? I tell one month you, you don't wanna go higher than about nine degrees because you're stretching your muscle and your muscle hurt. So we give people muscle relaxes after surgery. We give 'em pain pills, but also muscle relaxants. So that's the distinguishing fact between the two. Probably more muscle pain than the other procedure because we're using the muscle put into work. But, uh, other than that, people are back normal. And, uh, within the month of backwards, uh, you know, a lot of people I work with, of course, they're not doing manual labor. They're, they have internet jobs, they're at a desk or whatever all day. They go back to work within a week or so. Once they go back home, they go to work. If you had a demanding job, like some nurses will have to like lift patients. I tell 'em, yeah, you gotta be off a month. Can't lift anybody for a month. But most jobs are, you know, most jobs are more sedentary now.

So you're innovating, you're teaching, you're taking care of patients, you're probably writing, you definitely are spending time thinking. And I'm curious what else you like to do, especially away from work.

Well away from work. Okay. <laugh>. I have a hobby. Alright. Number one, hobby electronics. If I like to restore and rebuild electronic equipment, like, uh, audio equipment particularly. So, um, two weeks from today I'll be in Xenia, Ohio, where it has the world's largest ham radio show in the world. Uh, so it's, uh, every year around this time it developed there from Dayton, Ohio. Dayton has a big military base there and a lot of military surplus was there. So this became an area where people go for, um, ham radio stuff. It's, uh, two-way radio things. So I go to that show, uh, every year if I can. Um, that's one hobby.

Do you have a ham radio at home?

No, I, I just do audio. My, my friends of mine do a ham but I just do the audio stuff. I, I like audio, tape decks, uh, record players, you know, I like playing with those. And, uh, restoring old rigs, old tube braids, they're, they're really fun, you know, they're really very primitive and compared to what's available now. See the stuff available now when it breaks, you throw it away, but the old stuff you can actually fix.

Mm-hmm. <affirmative>

Tube radios glow and they're kind of, well, kind of magical. They're kind of really neat. It's kind of old school, so that's one hobby. My other hobby is model railroading trains, toy trains. So like that. So collect toy train. I've been doing that since I, a kid, in fact.

What size?

H o. H o.

H o.

Yeah. When I was about 10 years old, I got a train and then when you played with toy trains, you have to learn a lot. Electricity. So that's how I get into the electronics. So the trains went to the electronics and, and then, uh, so I do that. But, uh, that's kind of the fun stuff to do out outside the, uh, outside or, but uh, when you have spare time, which is nice, it is nice. You have spare time.

Is there anything you're looking forward to on the horizon? Either work or otherwise? Uh, a trip or an event? You, you talked about Greece a little.

Yeah. Let, lemme tell you what I'm looking forward to. There's something called obesity week every year, the first week in November, it is usually obesity week. Okay. And I went last year, this is true. This really, it's called obesity week. And last year I went, uh, obesity week and I gave copies of a book. I wrote, I wrote a book on weight regulation. And I'm trying to promote some contests on wave reg. It's just like you did on breast. So the whole idea is, uh, you can approach weight regulation mathematically and help people understand how their weight's controlled, help 'em lose weight. So I wrote a book on it, I published it, and um, I submitted three papers for the meeting in the, it's gonna be in dialysis here. It's gonna be in Dallas in about mid-October. So hopefully I can go there and present on obesity too, because a lot of people who come for breast have weight problems too. And as we know, weight issue, two thirds of Americans are either overweight or obese now. And that's a real problem. Healthcare wise, about 10% of our healthcare costs goes for obesity. And if you can eliminate obesity, that'll change heart disease, cancer, a whole variety of things. So I, I like to see, I'm a scientist first, a doctor second, a plastic surgeon third. So there's, there's other issues here involved, not just breast.

A lot of people say stuff like that, but you, I think are actually living it. <laugh>.

Yeah, I'm, I'm trying, I'm trying to live it. I, I like science, technology and math. It's, it's fun. Yeah.

So what's the elevator pitch version of the book that you wrote about weight regulation?

Yeah. Okay. People are looking for the magic pill. Okay. There isn't the magic pill. I mean, it's not, you're not gonna cure obesity until you understand how weight is regulated and you will not understand how weight is. I regulated until you understand control system theory. And, uh, my background in math and physical engineering, I did study control systems theory cog my sophomore year. And it comes down to this. It's like, what does the body actually sense? How, how do you feel sa sat? How is sati generated? Sati is generated mechanically, okay? It's a mechanical phenomena. And within the wall of stomach are gonna call inter gang laminate endings. It senses pressure or tension. And when you eat a meal, you know, you think, you think the meal is going in your stomach, but it's not just not just going in your stomach. When you eat a meal, it's going in your stomach, but your stomach decide your abdominal cavity.

(28:27)
And the cause of obesity is mechanical failure of the abdominal wall. Children are obese because they don't develop their abdominal wall, they don't play baseball, they don't do sit-ups. They can't do anything like that. So they have a, a loose, weak abdominal wall. Now, this typical story over here all the time as a, as a doctor, doctor, before I was married, I weigh 120 pounds. And then I had a pregnancy, went to 130 pounds, another pregnancy, 150 pounds, and the third pregnancy 200 pounds. And now I can't lose weight on 200 pounds, I be 120. What happened, doctor? And you say, well, your hormones change or this or that. Well, that's not what changed. What happened? Each pregnancy expanded your abdominal cavity and damaged your abdominal wall, the achieving satiety because you have a bigger container now. So when we do the mommy makeover, one of the things I I do is I make the container smaller by using mesh to reinforce the container and create satiety.

(29:15)
So that's what it comes down to. You have a stomach and fat, see fat is distributed throughout the body. By fixed ratio, there's a certain percent of fat interabdominal. Okay? In women it's only 20% and men is 25. Men have more interabdominal fat. And what that does is it allows men to sense fat increases quicker or, or less, less change of environment. So they have more interabdominal fat um, so the whole key is when you, you eat a meal, you havedo fat is accumulated versus meal size. If you have a lot of fat inter abdominally you won't eat a bunch of meal. If you have little fat, you'll eat a bigger meal. And so the whole idea is if we can compress abdominal cavity and create satiety sooner helps to reduce weight, that's what it comes down to. It's, it's all biomechanical know. So I've been trying to promote this concept, wrote this book a few years back.

(30:06)
I've been trying to talk to key people about it, but as you know, everybody's going crazy. GLP one agonist, the, the, the,

That was my next question? Mm-hmm.

Ozempic. Okay. What does Ozempic do? Well, decreases bond GM motility and slows the absorption. So the food stays in the, in the abdomen longer. No one has hypothesized Ozempic deficiencies, causes obesity. It's not gonna cure obesity. It's gonna help with things. But the whole idea is you must understand the physiology of weight regulation but fails and how you correct the actual cause of obesity. So the actual cause of obesity is by, again, everybody keeps saying the same thing. It's diet and exercise. Why diet? Okay, the fat content, the food varies widely. Every fruit and vegetable, except for corn is less than 1% fat. You can eat all the fruit and vegetables you want. You, you can't gain weight.

(30:53)
There's no fat on them. All the fat, your body is fat. You ate, you don't make fat. Fat is is what you have from your diet. Okay? So that's one thing. And people don't realize fast, exponential, like all fruit and vegetables are less than 1%. Like corn's only vegetables is higher than 1%. It's 4% corn, Turkey, chickens about four, 5%. And then cheese and nuts and chalk 50% up, you know? So there's 0.5%, 5%, 50%, there's a whole big scale of fat content varies widely. And unfortunately, or fortunately, we're programmed to like fat and that's why we survived. When, when the famine hit, you know, thousands of years ago, the fat ones survived was the ones that are skinny they didn't make it, so to be a little bit overweight was, was bad, was in, in your best interest. But, uh, now of course we have a sedentary lifestyle, so we don't have to be physically fit anymore.

(31:40)
We sit at a desk or we, or women get pregnancies. Children don't, aren't active anymore. Show me a fat person who's not round. Okay, you ha show me a fat person grew a hundred sit-ups, no fat people can't do sit ups. Fat people are round. You become round. And it's not the roundest cause of obesity. It's, it's the fact that your abdominal wall became weak and you fill the cavity, you're filling the container. So you tell people, well, we're abdominal binder. Well that can help a certain degree, but control is abdominal binder. A lot of the pressure gel by bind binder is dissipated by the fat. Cause you've got this much thick fat before it gets to the force, gets to abdominal cavity. So what can help people liposuction? Now liposuction actually a treatment that can be used for obesity and it's frowned upon because you know, you're only taking about 10 pounds at a time.

(32:26)
But if you take 10 pounds off the abdomen, give 'em in a binder, then 10 pounds and 10 you can repeat it and get them down to the weight and then do a tummy tuck on it. So there's other techniques other than just the intestinal bypass and, and the sleeve. And again, those techniques, uh, have problems too. Like until some bypass. Now the nutrition problems with that and you know, it's irreversible gastric sleeve, irreversible, you know, you have problems with those things too. So the whole idea is if, if we can understand the physiology of weight regulation, then we can cure obesity. But until we understand the regulation, so you just go on Amazon or, or Google rather, just Google how weight is controlled. They give you this complex run around story that all these hormones are interacting with.

It can't be that complicated.

It can't be that complic. No, it can't be. No. Here's the, here's the key thing. It's like this is one thing really makes sense at all. Okay? When you eat a meal, you,achieve satiety in about five or 10 minutes. I mean, you can gobble on a meal in five or 10 minutes and feel full. Once you reach satiety, you've not absorbed the meal, the meal, still. You don't know what you ate. You could have eaten sand for all you know. No, this doesn't know what, doesn't know how, how much proteins there, how much carbohydrates. You don't know what you eaten.

Once you're not hungry anymore, you don't even remember what you ate. And I've told myself this for years.

Right.

I could eat a giant salad or a pizza once I'm full. It's irrelevant.

Right? Satiety is achieved bio mechanically not bio chemically. And so the whole idea is if you can understand that it's um, it's a mechanical situation and it's a very simple, you have a container, you have accumulative fat on one side and a stomach on the other. And what really proved this whole thing, the rat study was done on this in 1985. A guy named Cupin up in Calgary did an experiment called, um, about one way intestinal cross intestines. Anyway, I talked to the man and he, he did all the analysis on these rats and everything. And we came down to the conclusion there's an inverse relationship between Meal V and fat weight. And, and they proved it in the rats. So the, the rats that had more four fat ate smaller meals and the rats that had small volume, ate bigger meals. And see what he did, he took rats and put them, he sewed the two rats together.

(34:32)
Now this kind of not kosher anymore. I don't think he can do things like that anymore. But what he did was by sewing the two rats together, he exchanged the circulation. So the, so any blood factor controlling eating was between the two of them was identical. The blood, no. So the only thing that was separate was the neurological system. And he had crossed the intestines. So one rat would get the food before the other rat would get by bypassing intestine. Now it was a brilliant study, brilliant guy talked to him twice and um, he came to the conclusion to see their stomach or small bowel. He spent a whole career looking for a small bowel. I talked to him about a month or two before he died. And he said, this isn't a small bowel. I said, yeah, I know it's stomach. So what it is is the inter ganga lemon innings within the wall of stomach that senses pressure generated by the combination of food and accumulated fat. And it's, it's that simple. And the, I wrote a whole book on it. Again, it's a mathematical book and people don't like math in generally <laugh>. So it's, it's hard to understand. So, but what I'm doing now is writing a, a lay people's book right in front of my desk. Right now I'm working on that.

If you had little kids right now and you didn't, and you wanted them to grow up and not ever become overweight, what would you do with them?

<laugh>. Tell 'em do a hundred sit-ups a day.

Sit ups.

Sit ups. The core exercises, sit ups, planks pilates. You gotta do cores. Burning calories won't do it cuz you burn calories, you'll absorb the fat. But then when you go down, eat either meal, there's less ol fat and they'll eat more the compensate. So you're gonna keep that thing balanced. So burning calories is essential to lose weight, you must learn, lose 3,500 calories to lose one pound, one pound of fat, 3,500 calories. It's about a day's supply of food. So if I had children today, you know, my kids are grown up by the way, but uh, and they're both thin and they're both are very active. Yeah. And they're, they're like, BMI is like 22. But, uh, the whole idea is be physically active, have core strength, and that's what I emphasize the most. Well, and I also tell'em not play football either. I won't play football <laugh>. Yeah. I wasn't hitting their heads. Yeah, no football. No football for them. Yeah. Other sports. Nope.

I have girls, but one of them did just ask me, mom, can girls play football? I said, well, technically.

Yeah. You don't wanna hit your head though.

You can do whatever you want to, honey.

Yeah.

I hope it's not football.

Yeah, right. Do it. Do somebody else run track?

Mm-hmm. <affirmative> lacrosse.

Yeah. Yeah.

I am so just captured by everything that you've told me today. It, and I, uh, I love what I do because I never know what to expect and I'm always surprised and I'm, I'm so grateful that you took the time to tell us all of your incredible stories and the work that you're doing and I hope that we can come back and talk to you again about some of these things. Like maybe we'll do an obesity week special <laugh>.

Yeah, yeah. If you do something that'd be great. I'd love to talk about obesity because it's like, you gotta get the ideas out here. You've, you've got all these charlatans trying to capitalize on things, um, you know, special diet and it's not, it's not that way at all. It's jumping biomechanical. You show me a fat person that can do a hundred sit ups. They don't exist.

I feel like I was always on the right track because the volumetrics is the one that made the most sense to me. And so my husband would always say this dumb thing and he'd be like, eating breakfast and he'd say, no, I need more calories than that. And I'd be like, no, you don't. You just need to feel full.

Right? Yeah.

Like the trick is to feel as full as you can with the least amount of calories.

Right. Yeah. And again, fat content you can fill up with, with fruit and vegetables. You eat yourself sick, you explode, you can't get enough fat and, and you fat. See, fat is nine calories per gram. Okay? The fat density of food varies widely. Fat is the highest calories per, per unit volume. You know, it's really, really pack in there. So eat low fat density foods and you can sit, you know, get, sit, tighten now. Like fiber, fiber is good for you. All the high fiber, uh, foods are, fruits and vegetable except for nuts, nuts have high fiber, but you know what? Nuts not. They're about fish fat. Mm-hmm. <affirmative>, that's their, that's their kinda, they're good and bad. Nuts are good and bad. But, but all the fruit and vegetable except for corn. Now, you know, they corn feed cattle making them fat. See corn's got almost 5% fat, but every other fruit and vegetable, about 0.5% fat.

This is why riced cauliflower is the best thing ever invented.

I've never had it.

Riced cauliflower? Oh, you can fool yourself into thinking, rice, cauliflower. You can replace spaghetti with it. You can use it instead of rice you can eat and it has like no calories at all. So. My lunch every day is a bag of riced cauliflower with ground Turkey and

Yeah, that's very, that's low fat. That's very low fat. Yeah. But the thing you're gonna have to do, I tell people low fat diet, core exercises, abdominal binder, you can go so far with that, okay? If you want something surgical liposuction, you can do liposuction. Anybody take off 10 pounds, do it on your abdomin and then wear a compressive garment and that will help help you compact your abdominal wall. And eventually, uh, keep doing that and you can lose the weight. So it's, it's, it can be done. It's less invasive and less dangerous than, than the, um, bypasses and the

For sure.

Much less. Cuz you're extra abdominal, you know, <inaudible> and the pathology, the pathology is your abdominal wall. The problems, your abdominal wall, there's two parts of the abdominal wall. One is muscle, which you can build up in time. Unfortunately, women who have pregnancy, they've torn the fascia. The fascia is a strength layer. Now a hernia is a complete tear in fascia. Obesity is a partial tear in fascia. That's the only difference between a hernia and obesity, if you look at, you know, and in my book, I show a picture of it, but, but the fascia should be like a nice white, sheet, it's all spread out. Like this is all, it's all torn and, uh, stretched off. But when you have a complete of 100% tear, that's a hernia. And the treatment for hernia is not going to the gym. You know, you have a hernia, you do surgery.

No.

And the treats,

That's right.

You've gotta rebuild the strength of the abdominal wall. And you cannot repair fascia directly unless you do suture. I mean, you can't, you can't heal your fascia. It's been stretched out from pregnancy. You're, it's a done deal. It's like a spring. You take a spring and overstretch it never goes back. It's still a spring, but

Really, there's no muscle that can be torn and repaired any other way than surgery, right?

Well, the muscle muscle just stretches. See what happens with muscle as the muscle stretches it loses mechanical strength, loses mechanical stretch, it stretches more. It's, it's a positive, it's a runaway train, you know, just keeps worse, worse, worse, worse. You know, the whole idea, you've gotta get control of it. That's where the abdominal binder and core exercises come in, get an abdominal binder, get core exercises, low fat diet, planks, pilates. And that's what I tell people to do to help them, uh, lose weight. I don't read in green tea or any of other magic potions, you know, and it just doesn't work, you know? But every study instead of the same thing, your diet and exercise diet is diet, but there'll be people who will do some of these surgical procedures, but you still eat through that. You still overeat it, you, you can outstretch that stomach you drink milkshakes.

(41:18)
That's what people prove. They can undo it. So it requires the cooperation of patient and understanding of, of what, what you want to change. Uh, it's all abdominal wall. So like I said, my background is mass physical engineering and you can apply that to, to obesity, apply to breast surgery. That whole idea. A lot of things are apply science to it. Where the way you solve a complex problem as a scientist, you make a model, a simple model. You write the equations for the model, solve equations, solve a model, solve the problem. So that's what I do with breast surgery and with, with obesity, it's all series of equations that determine the, I figured all that out and, uh, trying to pro promote that. So like I said, I submitted three articles for the, uh, for the, uh, obesity week and we'll see what, let's see if they published, uh, let me present. And I, I talked to some of the big wigs there. I talked to a lot of the big shots there at the meeting. I gave copies of my book, you know, I didn't hear one word back. Anyway, I gave 'em like five copies to all these big shots of guys. One guy's from mass general other guys from the Institute of Louisiana, another guy from Colorado, all these big shot guys. And they didn't even send me a thank you card. I guess I, I shouldn't expect that. I guess.

There's still time.

Yeah. We'll see. Well, well, like I said, I'm looking forward. I'll, I'll find out in June, whether I'm gonna present or not. But, uh, submit the three papers and we'll see if they'll allow me to present paper. But if I'm in the eyes, I'm gonna ask 'em some tough questions.

I expect you to, if you had a podcast, you could just tell everyone everything all the time. <laugh>.

Yeah. Yeah. Well I'm not a tech guy in that regard. I'm just a, I'm just a plastic surgeon and, uh, I like that. I, I'm good at what I do. I'm not technically oriented. You're more technically oriented with that, so I'll let you know.

I just do it every day.

Yeah, you do it every day. I, I do surgery every day. So you guys can run with that.

Before we wrap it up, I'm curious, when did you know that you were gonna be a doctor? Was there a moment or an event?

Yeah, <laugh> kind of a called Vietnam War. Okay. Oh, the war was going on. And one of my friends was a pre-med student and they said, well, you know, medicine's deferred, you know, and I said, I understand that, you know, and I see it was interesting, biomedical engineering. And, um, they had the lottery back then. I don't know if you're familiar with that. There used to be a lottery for the draft, and I was, I think number 13. And that year they went to 330, like, like 90% of people in my class were drafted. Yeah. And, um, I used to get a call from recruiter every day, you know, like every weekend you wanted me to join up wanted me first lieutenant. Well, at the time, the first lieutenants were all killed by their own men because they were incompetent, you know? So now I've been want to go into the military and, um, these are alternatives for me. So I applied to medical school and I got in, I was fortunate and, um, I thought I was gonna be a pediatrician. Uh, I'd like to psychiatry a lot and I thought I'd be a pediatrician. I did not like the sight of blood. I dunno why here I'm a

<laugh>,

Figure that out. I, I still have figured out. I think, I think what I don't like is sight of my blood. I think that's what it, I don't like my blood, but other people doesn't bother me, I guess. But, um, however I became, I don't know, I, it's, it's just because, um, I like mechanical stuff too, like the cut and sew and stuff. So it's, it's a, it's a fun job being a plastic surgeon. It's really nice.

Mm-hmm. <affirmative>, If someone's listening today and they want to find out more about you or reach out, where would you suggest that they go to learn more about.

Probably my website, just by www.horndeski.com where I'm listed. Yeah.

I'll make sure we link that in the show notes. Thank you again for, for being, uh, on the show today. We really appreciate it.

Well, I hope it was entertaining to some degree as well.

Definitely, yes.

Different type of approach. Well, it, it's nice, uh, you know, not all doctors are the same, but a whole variety of people, which is good. And, uh, I only think I'm different than most of them. And, uh, I have a different approach to it. You know, I have a different background, which is good. And then that's what we need, a variety of people.

That's how we get better. If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet The Doctor podcast. Check the show notes for links, including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.