Aesthetics Unscripted

Revision Breast Surgery, Natural Results & Biohacking Longevity with Dr. Richard Baxter

Kim Laudati

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Revision Breast Surgery, Natural Results & Biohacking Longevity with Dr. Richard Baxter | Aesthetics Unscripted

Host Kim welcomes Dr. Richard Baxter of Phase Plastic Surgery & Longevity (Seattle area) to discuss his background in art, innovative revision aesthetic surgery, and his focus on evidence-based longevity medicine. Baxter explains breast implant complications like animation deformity and “double bubble,” and how implant plane choices such as subfascial placement and split muscle techniques can reduce these issues. They compare implants with fat transfer, including limits, variability, and best uses like asymmetry correction. Baxter addresses viral social media trends, ethical marketing, body dysmorphia concerns, and the importance of saying no to unrealistic patients. The conversation then shifts to longevity: biological age testing (TruDiagnostic and GlycanAge), tiers of interventions from lifestyle to high-tech therapies, risks of self-dosing peptides, and his downloadable, frequently updated book “Biohacking Longevity,” including cautions about NAD infusions.

SPEAKER_01

Welcome to Aesthetics Unscripted. I'm your host, Kim, and your regenerative aesthetic obsessed host here with Dr. Richard Baxter of Phase Plastic Surgery and Longevity Clinic. I'm so honored and pleased and excited to have him here with us because there's a lot to unpack. There's so many layers to Dr. Richard that I think you, the viewer, are going to have a great time with us. So thank you, Dr. Richard, for joining us today.

SPEAKER_00

I am so excited to be here. We do have a lot to talk about, and uh so it's gonna be a great, a great day.

SPEAKER_01

Thank you. I'm going to, well, I know a lot about you, but please, can you uh take a moment to let your self shine? Tell the viewers who are you? And I know, like I said, you're a plastic surgeon, but you're so much more than that between tango dancing and your uh early career in art. So if you could just let us know all about that and all about you, please.

SPEAKER_00

Oh, thank you. So the yeah, the tango dancing is something that kind of takes over in a lot of ways if you're not careful. But I did just get back from Buenos Aires where I was dancing and going to a plastic surgery conference. So that was a win-win. Uh, I've been in uh practice here in the Seattle area for many years. Um, and having this background uh in art, I actually started college as an art major. Um, I think that really informed my approach to things in terms of creative problem solving, seeing things different. Uh, and and that that I think got me involved very early on in some kind of innovative approaches that just needed uh they needed a different solution. And um so over the years I became uh more involved in doing um re-revision surgeries, you know, just things that were kind of needed these solutions, and um, and so now I do entirely aesthetics, but a lot of it is still revision uh surgery. And then over the past uh several years I've gotten really pretty obsessed in longevity medicine. Uh it's it's something that is kind of coming into its own. The science is starting to catch up to the hype, but there, you know, just like with anti-aging, which is what we used to call longevity medicine, the hype tends to kind of get ahead of the real science. And so uh my real focus is looking for the evidence and trying to trying to follow evidence-based uh treatments. And there's some exciting things there.

SPEAKER_01

Absolutely. Uh there, like you said, there is so much to talk about. Um, one of my passions and my ultimate respect goes to the most evolved in my mind, the most evolved plastic surgeons that can do revision repair. So for our viewers, that's your classic botched job. And uh you can't just or you shouldn't just go to just anyone. Uh, for example, here on your phase plastic surgery, you have this pendant. I find this a spectacular and beautiful revision here. And I'm so impressed because this wasn't just a double bubble, but as it points out, there was uh severe transformation issues with this. Can you explain this case?

SPEAKER_00

So animation deformity is what happens when implants are placed under the muscle, and the muscle, when it contracts, it distorts the breast. And that can contribute to what we call a double bubble. Um, but still a lot of surgeons just have a blind spot about that. They were trained to do it a certain way, and when it when this happens, they just don't see it. And so a lot of the patients get very frustrated because they're not getting an answer from their own plastic surgeon, and and they consult around. And when I first got involved in this particular type of surgery many years ago, it was a patient who she was actually a fitness model. Uh, and so this was a real significant um problem for her. Uh, she had seen 10 plastic surgeons already, and uh and and we came up with this solution, and so she's been one of my biggest advocates uh for all these years. Um, but it's just a matter of kind of seeing a problem in a way and saying, well, what's really going on here? And um I still to this day I think a lot of plastic surgeons just don't want to deal with it. So the patients come from all over.

SPEAKER_01

When it comes to breast implants, what with a new patient? What is your advice? And I know you have a multiple surgeon and a large staff practice there at phase. Uh, again, very admirable, and uh the reviews are excellent. Uh, how do you approach that when you have a new patient coming in uh seeking implants? Because I know as the years have gone by, breast implants themselves have evolved for the better. There's still controversy. Do you really want to do it? We'll talk about uh fat transfer and alternatives like L clay afterwards, but when it comes to the the actual breast implant, where do you stand on that right now?

SPEAKER_00

Well, I think implants are safe. I think um there are a lot of controversies and um kind of conflicting evidence. Um I don't know how much of that I want to get into, but I assume if a patient is here asking about breast augmentation with implants, they're already willing to kind of uh accept that. Um and so we talk about what are their goals. Um particularly for like athletic women, this is where these animation deformity issues come into play, and you want to design the operation in the first place to minimize that. And um so that's kind of been another special interest of mine. We are able now to do probably the majority of our implants in what's called the subfascial plane, so it's above the muscle, but with that extra little layer uh what's called the fascia, and that gives the implant a little bit more support. Um we used to be hesitant to do that because without the muscle coverage, you could see the implant more, it would look fake, it could do uh have issues with rippling. But now we have better implants that can do really well in the subfascial plane, and then we just minimize that whole uh we just eliminate that whole question of animation deformity and and uh minimize the rippling. So we go to that a lot. Um and if they do need a little coverage, then I do what's called a split muscle, which uh also prevents the animation deformities and maintains muscle function, which is also important.

SPEAKER_01

Very impressive. Uh thank you for that. I'm learning with every word that comes out of your mouth. Uh so let's talk about fat transfer. I have some aesthetic patients that over the years have had fat transfer for breast enhancement, um, for balancing asymmetry, and also just for volumization. And it's been very positive for me to see and for them to experience that over the years. Uh one patient in particular I can think of did this about 10 years ago, and she still retains about 80% of that volumization. So I think that's great. Uh, what are what are the things that make you a candidate for fat transfer, and what would you be cautious about when it comes to that and offer an alternative?

SPEAKER_00

Yeah, so the main um thing has to do with volume. I think you know, there are limits to how much fat you can put in and expect it to take. Once it takes, it is living tissue just in a new part of your body. You know, it's your own fat, it's just moved to a different location. Um but you can only put so much in. Each little particle of fat that you inject has to be surrounded by healthy tissue in order to survive. And if you overwhelm the recipient site, the breast tissue, with too much fat, then you're gonna get more of it die. Um so uh you know, there are just practical limits to how much you can put in and expect it to be a good long-term result. Now, sometimes patients are willing to stage it and do multiple sessions to get to where they want to be. Um, and you know, that's that's multiple operations when you could do with one. Um the other trade-off is that an implant you have a known volume, uh, and that volume is what you get permanently. Whereas with fat grafting, there's always variability. You know, that 80% take you got is a really good number. Uh I think we can get reasonably close to that more often now. Um, but um not everybody's gonna get that. And so then you're gonna have to deal with you know how much how much you can really um accomplish. I think you mentioned cases of asymmetry or just kind of balancing things out or fine-tuning shape, things like that. It works really, really well.

SPEAKER_01

So, Dr. Baxter, the bane of everyone's existence from your chair and my chair as providers seems to be these viral TikTok trends or social media trends. So, how do you have your staff and yourself, how do you deal with that? And when it comes to genuine surgical options versus all this hype and all this craziness and these filtered pictures that patients will bring in, uh how do you deal with it?

SPEAKER_00

It's a problem both for the surgeons and for the public at large considering doing these things because they, you know, there's a great temptation as a surgeon to kind of keep up with that and to kind of put content out that is going to draw patients in. Um, but if you get into, you know, things that are just unrealistic, uh, there are ethical issues there. Um and for the public, they're looking at these things and they're thinking, this is this is just crazy. Why don't I do this? So we just try to, you know, fortunately for me, I'm I'm established enough in my practice that I don't get a lot of people of kind of superficial interest that way. Uh they may see something and then they'll come, and then we we have to spend some time with them and really show them what is realistic and and what to expect. Um, you know, our injectables practice is more feeded, more fed by that. Um but um, you know, fortunately I don't see it as much in my facelift um practice. I think those patients are um just a little more skeptical about all of that and not sort of on the trend of the moment kind of thing.

SPEAKER_01

Oh, that's fantastic. It's good to hear. Uh you've uh earned the right to be shielded from a lot of that craziness. But I'm sure in your med spa, and as you said, in your injectable side of the practice, they're probably getting bombarded every day. So it's like, please, everyone out there, get a grip. A lot of these pictures are filtered, they're not real, it's not realistic. You might not even have the same facial structure, your bone structure, your muscles. You can talk to someone like Dr. Richard Baxter and his very educated staff, and they can help explain to you why these things are not good for you, or how you might be able to achieve a little bit, right? And keep it natural without looking crazy.

SPEAKER_00

That's kind of an important point right there. In this corner of the country, people are more interested in natural looking results. I think in a lot of areas it's um uh you know status symbol to look done. And and so people see these extreme results, and that's actually what they want. Um, so if that's what they're really looking for, they're probably not gonna come to me anyway.

SPEAKER_01

Right. I understand that. And that again, you've earned those stripes. So uh very, very commendable and uh admirable for sure. When it comes to the patient that is like a new patient, um how for the for the practitioners out there that are watching, can you give a little bit of advice? Because I know this is a big subject. Um if it's possible to give uh a quick advice when it comes to a patient that is maybe obsessed with a particular viral trend versus body morphic disorder or body dysmorphic.

SPEAKER_00

Yeah, I mean, that's always been here and um probably more of an issue now. And I think we just have to, you know, you develop a sense for who's who's gonna be just obsessed. And you're not doing them a favor by operating on them or doing a procedure that you know is not gonna meet that standard that they have that they're expecting. You're not doing yourself a favor because you know you're gonna end up having to do all that hand holding afterwards and all that talking, and and you really do just have to be willing to say no sometimes. And it's hard in a very competitive industry to do that. Um you know, maybe you just kind of hang on to them in the injectables and aesthetic services uh for a while uh and until you can be convinced that they're ready. But um I think bottom line is you just have to be willing to say no sometimes.

SPEAKER_01

Absolutely, I agree with that, and thank you for that. Uh you mentioned a very deep passion for longevity. Uh I got actually got into aesthetics for a selfish reason first, that are not 18 anymore. And as you have said, the the longevity industry is leaping forward, and I'm also excited about it. We've gone from PRP to PRP and PRF, and now we're we're all the way accelerated into masenchymal stem cells, or depending on what the FDA tells us, we can call them acellular matrix or what have you, and peptides, and all these alternatives to a healthier lifestyle. Um, for me in particular, I'm always a little shocked to see how much of the general public doesn't understand your aesthetic, how you look, has everything to do with what you're putting in, what you're putting on, uh your lifestyle, your sleep patterns, your hydration. They don't understand this full picture. So I would love to hear how you feel about longevity and where do you see it going with things in particular like peptides?

SPEAKER_00

Yeah, so you know, the you kind of hit on a key point there, which is that your your skin appearance, uh, your skin health informs your systemic health and vice versa. So you can't have healthy, beautiful skin unless you have good overall health. And so all those things that fit into health uh contribute to that. Um, you know, just on a practical basis, I do all these procedures on a day-to-day basis to make people look younger. But you know, after a while you start to wonder, well, how can I really address the aging process itself? Because this facelift that I'm doing or whatever it is is not permanent. I've set back the clock, uh, but you know, the clock will keep ticking unless we find some other ways to do it. And um, you know, I had this interest in kind of wine and health and got down this long road with resveratrol, and uh everybody thought that was the final answer, which it was not, but it did kind of open the door to a lot of research that um about aging itself and the aging biology and the genes involved in it and how we could start to impact those directly. And as that science progressed, then I thought, okay, I'm just gonna put all this together and see what's what's there. So um it's a fascinating field. It's really based on AI and not generative AI that we're all familiar with, but just AI to identify to analyze massive data sets. So the fundamental principle behind longevity medicine is to measure biological age. And you do that by analyzing banked data sets. So they're they're called biobanks, and they're all these kind of massive anonymized banks of health data and samples. And so um you can run analyses on those from you know 10, 15, 20 years ago, and say, okay, now find train the AI program to find what was in those samples that predicted the health outcomes of those people, how long they lived, what diseases they got, and that's what determines biological age. Um and it's a process that's called epigenetics, it's measuring gene expression, and so there are a number of those biological age clocks, and that's that's the fundamental idea. So we use that information to then develop interventions for longevity that are testable. You can test them because you can measure the effect on biological age. And the regenerative medicine part fits into that because if we're keeping people healthier longer, um you still have to address all that damage that's accumulated to your tissues over your lifetime, and and that's where the regenerative medicine part of it comes in.

SPEAKER_01

Absolutely. I've been obsessed with the blue zones and uh as you've said, epigenetics, to me, it's all like and and I love it. I mean, every step we move forward with is uh treating, getting closer to treating the cause, not just the symptom. And I do seem to find that is more prevalent in other countries, not bashing our country here in the US. Uh, you know, proud and happy to be born and raised here and have freedom of speech. However, we do what we seem to be behind the eight-ball when it comes to things like this, like stem cell therapies and peptide therapies, and um, as you said, using AI to do more extensive studies. And I'm so happy to see that we're moving forward finally on our front as well. Um, when it comes to patients self-dosing with peptides, I feel like this has already become a rampant thing and it scares me. So, how do you feel about that?

SPEAKER_00

I'm just um pretty dismayed because um peptides are essentially drugs, and even though there are ways that you can acquire them without going through a physician, um, you're not doing any testing to kind of see whether it worked or not. Um, somebody's just kind of, oh, this TikToker said, you know, this glow peptide is great, try that. Well, you don't really have any idea what it is and what you're doing, and maybe there's a better formulation or something that'll work better for you. Um, I do think peptides have have a role to play, and I I use them a lot in in my practice. It's it is in a tricky area in terms of the regulations because so many of them are just naturally occurring molecules, they exist in your body already anyway, or they're slightly modified from that. But they're not approved as drugs, and they probably many of them never will be, um, because the process of drug approval and the testing and clinical trial work you have to do is so costly. You know, it costs millions and millions of dollars. Uh, like a total new drug development is like like a half a billion dollars to get a new drug. Um, and if somebody's investing that kind of money in a peptide that we can already buy, um, there that's not going to happen. So the onus is on us as longevity medicine providers to really track what we're doing and and provide high quality care and and be honest about it. Um so uh it's it's an interesting area. I think they're powerful things, but they really have to be used right and they have to be used uh intelligently.

SPEAKER_01

There you go, intelligently, absolutely. Um, when it comes to a new patient coming to you, let's say I'm a new patient and I've got a decent budget and I'm very interested in longevity. I want to live as long as I can and thrive while I'm doing it. So I'm going to walk into phase plastic surgery and um, correct me, phase plastic surgery and or would you just call it phase plastic surgery?

SPEAKER_00

Well, we call it phase plastic surgery and longevity. I'm trying to, you know, at some point spin the longevity part of it out as a completely separate entity. Uh, but right now it's kind of all in one because a lot of the longevity patients have come from the plastic surgery practice. Yeah, so we first do, you know, basically in intake history and physical, because the practice of longevity medicine has all these tiers at the and the foundation of it is the lifestyle stuff. And a lot of people just think that's the whole thing, you know, that's sleep hygiene and exercise and diet and uh stress management and socialization. Those are all really important things, but that's just the foundation. Um, and then above that you have more medical type interventions, and uh some of these things that's where peptides fit in, for example. Um, a lot of patients use metformin, uh, rapamycin. There are things in that category that really do have to be managed medically and more carefully, I think. And then there's an upper tier, uh, which is the kind of really high-tech biomedical stuff, and that's like uh plasma exchange, hyperbaric oxygen. Um, again, hyperbaric has to be done in a really specific way if it's going to benefit longevity. It's not just kind of go to a wellness clinic and get your your uh hyperbaric. But so it has all those tiers. But the starting point then is we kind of figure out where you are in terms of lifestyle and what you're doing now, and then we want to do a biological age test. Um, and the the two best ones are ones called True Diagnostic, which is an epigenetic test, and it's kind of the gold standard across the industry because it's so comprehensive. They're literally measuring a million different sites on your DNA. And uh so that's that's where we start, and it gives a really detailed uh picture of how you're aging and what specific things we can we can start doing in your case. And the other one that's really interesting is called glycan age. And this is one that's kind of hard to explain, but it's your immunoglobulin G molecule and the different sugar molecules that attach to it. And it turns out that that is highly sensitive to how you're aging and and the different patterns of it. And one of the things that came out of that, for example, is um the the fact that menopause accelerates aging and hormone replacement then offsets that. So hormone replacement therapy has been so controversial for so many years, and I think. Women have been so poorly served by that that misinformation because you know we've been forcing them to age faster. So this is one of the tests that really is um sensitive to that in particular, uh, but it's also one that kind of responds better. So you have you have good feedback on whether what you're doing is actually helping or not.

SPEAKER_01

So that's an incredible journey. And uh I would love to see you expand your clinics all across the country and beyond. I actually wish you were here in New York City because we do we have touched on the beginning of longevity services, um, but it's it infantile and very small compared to what you've already established at phase. And if you were here, I would be like begging you to have a sit-down five-minute meeting. And do you think there's a way we can partner up or what can we do? How can we collaborate?

SPEAKER_00

So it would be awesome.

SPEAKER_01

Yeah, absolutely. So I wish you the best with that because it's obvious that phase plastic surgery and longevity, you know what you're doing, you've earned your stripes, you research everything that you're providing on your menu. And I think to age well and to age naturally and to age beautifully and to do enhancements that work for each individual, uh, what a spectacular place to go.

SPEAKER_00

Well, thank you. Yeah, I I uh I agree. It all it all fits together. Um, and even having having a procedure to help you look younger might actually help you live longer. And that's that's kind of a fascinating thing. There's it's part of it is psychological, but it resets what's called your time horizon. And uh there's some fascinating work being done around that. So uh that all fits in as well.

SPEAKER_01

Can you expand on that a little bit? Time horizon. It sounds like um Harry Potter with the time turner or jumping into a spaceship.

SPEAKER_00

Well, it's basically the the idea that how long you believe you will live informs how long you live. And so when you do proactive things that have that make you look younger, and it often marks a kind of uh effort to do other things that are healthy, um, then there's evidence that you do actually live longer. Um, it's a hard thing to test specifically, uh, but there's a a center at Stanford that's doing a lot of work on that, and it's just to me absolutely fascinating.

SPEAKER_01

That is fascinating because we've all heard, uh, whether you are a practitioner or you're part of the general public, we've heard for many, many years now that the power of positive thinking when it comes to health, when you're battling uh diseases such as cancer, that it's actually a real thing. It is a real thing, yeah. And we're taking that further. And in my experience, in my lifetime, I've met uh three different gentlemen, each one of them 100 years old, randomly, because I moved around a lot for work and they were like a next-door neighbor, they did not know each other, they were not from the same parts of the country, and randomly each one of them popped into a conversation, uninvited, and said, you know, I get asked often, what's my secret? Because these gentlemen were not in wheelchairs, they were not drooling out of the corner of their mouth, they were not like mentally lost, they were very sharp and they were still mobile, and they all said the same thing. I've never fixated on my age as a chronological number. I've always thought young and my body followed. And I always found that profound that the three different people told me that same exact thing, and I didn't even ask them.

SPEAKER_00

Yeah, so they knew their biological age was younger. It didn't matter to them what the number was, they just felt biologically younger. And some people do just age more slowly. You know, there's one of the studies um that they did with the true diagnostic data and another big data set um uh called the Dunedin Pace from New Zealand. But what they did was they selected um a group of people uh who were all the same chronicological age. They were all 35 years old, but they they put picked the ones whose number said they were aging slowly, the ones who were aging kind of on par with their their calendar age, and the ones who were aging more quickly, and then they took their images of them, the men and the women, and made a composite. And you can just look at the ones who were aging slowly and they looked young. You know, their that number just kind of randomly selected showed that they were actually they looked younger. And uh and you know, so that reflects through every tissue in your body. If you uh are aging slowly in terms of appearance, then you're also healthier and better muscle mass and so forth. So I I think that's absolutely fascinating how all that works.

SPEAKER_01

Okay, Dr. Richard, I would like to bring up your latest book. And I know that ties directly into longevity, and it's gonna be super exciting. So please share with us.

SPEAKER_00

Well, thank you. I I wrote this book called Biohacking Longevity, and it was just kind of the notes I was taking as I was studying this over uh the first few years I was taking this deep dive into it, and I realized that patients needed to sort of guide to all this stuff because there's so much out there they're being bombarded with. And the idea of it is um here's what works, here's what might work, here's what doesn't work. And and I update it constantly so the book is not published in print form, it's on my website, just download it. It's called biohacking longevity. Yeah, every couple of months I update it because it's happening so quickly. So um you can go in there and say, Oh, I heard about uh you know methylene blue, everybody's you know, there's a big thing everybody's talking about with that. Well, does that work? Probably doesn't do very much uh and not a hundred percent safe. So I'll just put that in there and talk about what the data is. Uh another one that I have a little bit of a peeve about right now is uh people are doing what are called NAD infusions. And these wellness clinics and IV uh drip clinics and and um and a big deal. And the first time I heard about it, I thought, what the heck are you doing? That doesn't work. And um and it doesn't. So the idea is that NAD is this molecule that your cells need for metabolism, and it's really important in aging. It has to be in your cells, in the mitochondria in your cells. When you infuse the NAD molecule, it doesn't get there. It has to get broken down into precursors, then go through the cell membrane and get in there. And so people are spending uh hundreds of dollars per session to do this, and it's really not doing them any good. And in fact, when it's circulating in your bloodstream, it's a marker of inflammation and probably doing more harm than good. So there are better ways to get NAD into your cells, but if you're going to an IV clinic, you're just wasting your money and probably doing more harm than good. So I talked a little bit about that as well as some better options.

SPEAKER_01

So wow, that's really huge news. I mean, that should be on the front of every media outlet going right now. Um, so I'm I'm astounded by it. I'm gonna have a talk with my doctor about that too. Like, like, hey, because we don't here at IT intelligence treatment, we don't do IV drips. Um, but on the super, super slow push, depend she does do a health intake and the whole uh blood testing and everything first. But you know, that NAD is um available depending on the patient. And I'm going to definitely be reading your book, and I'm gonna make sure she reads your book as well, and we'll move forward based on you know clinical evidence that just what you're sharing right now to me sounds like it absolutely makes sense, and it's not something that we should be doing. So let's you know pump the brakes on that for the moment.

SPEAKER_00

Yeah, I mean there are better alternatives.

SPEAKER_01

Well, it has been spectacular sitting with you. I legitimately could listen to you all day long. Um hopefully in the future, I'd love to have you back. I'd love to talk to you more in the future about things like um things with having to do with longevity. And um uh one of my peeves right now is how our beloved industry calls everything having to do with machines um except CO2 laser not invasive. And we all know a lot of what we're doing actually is invasive. And then there's there's my Soma cell that's actually truly not invasive, but that's all for another day. I would love to have you back and discuss that and and follow along with your book because I'm I'm just shocked that you have a digital book that you are updating all the time. I mean, what an incredible resource, and thank you for that. I really appreciate that.

SPEAKER_00

My pleasure. It's my own kind of passion.

SPEAKER_01

Absolutely, along with the tango dancing and art.

SPEAKER_00

Yes.

SPEAKER_01

And plastic surgery, of course. So let's not leave that. Okay, so for us, please drop your comments. We want to hear your questions, we want to hear your comments. If you haven't subscribed yet, please subscribe and check out phase plastic surgery and longevity. If you're in the Seattle area, I'm gonna say this is definitely the place to go. But Dr. Richard Baxter, you're a rock star, you're a superstar, and an icon. Can you please let everyone know how they can find you on your social, on your website, uh, where are you located in Seattle?

SPEAKER_00

Yeah, so we're just north of Seattle. Um, the website is uh drbaxter.com, easy to remember, or phasebs.com. And it's been an absolute joy on my end. Uh, next time we'll talk about um uh microplastics toxicity and how to get microplastics out of your body and plasma exchange to make you biologically younger.

SPEAKER_01

Well, Dr. Baxter, please have a wonderful day and keep tangoing. And I would love to have you on again. Like you said, we'll talk about microplastics and and just um, you know, we'll get after that entire part of how we're poisoning ourselves and how to get rid of it.