What Low-Cost Surgeons Hide From You (The Brutal Truth of Facial Aging)

Dr. Timothy Rankin: My mission statement is to improve people's quality of life. I have a surgical bias on that, but at the end of the day, it doesn't always need surgery to get there. The fun part about what we do is the fact that it's a concert of people and preparedness and all these other things that go into action to be able to ensure that, at the end of the day, somebody wakes up nice and quickly and comfortably. That notion of going to that level of specificity to be that detail-oriented is pretty powerful. One of my favorite things to hear, and I get to hear luckily all the time, is "I'm back." And that literally gives me chills. A holistic approach to health and wellness is the only way that we ultimately get to maximizing quality of life.

Interviewer: Dr. Timothy Rankin, plastic surgeon extraordinaire. Welcome to the Pathway to Peak Performance. So great to have you in. Thank you for coming.

Dr. Timothy Rankin: Thanks for having me. I've been really amped to do this. It's been a couple of years that we've been sort of chatting about it, so I'm just pumped to finally get it started.

Interviewer: Yeah, so great to have you here and we have so much to cover. Well, first we have to talk about the charity. As you know at this show, all of the proceeds from the views go to the charity of your choice for the episode. And yours is...

Dr. Timothy Rankin: I think most of the work that my wife Kenneique and I have done over the years is with the Boys and Girls Club of America. So that would be the one of choice.

Interviewer: Outstanding group. That's a super charity. That's amazing work that they do for people all over, so that's terrific. All right. Now the next piece is the show is sponsored by KetoneAid, and this particular product—I've had you try the K2 before. This one is a step up. This is the longer ride, if you will. And so what I'd like you to do is go ahead and read the dosage, and you can go ahead and put that in as we start to talk about things.

Dr. Timothy Rankin: So I will say the last time I did this, I didn't realize there were different versions of it as far as how strong you can make it. But yeah, I think I'm going to start us off with a couple of caps here. Yeah, because the last time we did this, I think I felt pretty good, but I feel like this time I want to give it the chance that it's owed. So, there you go. There's a couple.

Interviewer: You might want to do one more if you want to give it the chance that it's owed. Actually, the third one's the charm for me.

Dr. Timothy Rankin: Okay.

Interviewer: All right. So, see how the show is going to go. This is... here's the good news. If somebody has a problem, there's a doctor. There's one person in the room that can save that one person. That's you.

Dr. Timothy Rankin: Okay. So, hopefully I don't have the problem.

Interviewer: That's right. That's right. Okay. There we go.

Dr. Timothy Rankin: Well, I'm glad that we diluted it this time.

Interviewer: Mhm. Tastes a little bit different, doesn't it?

Dr. Timothy Rankin: It's... yeah, I'm glad that you didn't make me drink that straight, but anyway, you know, there's a lot of things that are very, very effective that you don't take for flavor, so that's okay.

Interviewer: Very true. Well, we have so much to cover today. Holy smokes. You know what's interesting? Two Marin County guys. Um, you are a Drake graduate.

Dr. Timothy Rankin: True.

Interviewer: So is my wife.

Dr. Timothy Rankin: Okay.

Interviewer: Which is really amazing. And I think that's really cool because, you know, I think of all the kids that go to Drake. You have kids all the way out from Point Reyes all the way through Ross and Kentfield and San Anselmo and all the way, I guess, somewhere down into Larkspur, right?

Dr. Timothy Rankin: Totally. And then there's like the cutoff that goes to Redwood and all that.

Interviewer: And then our kids from here, you know, all in the Reed School District—which you support the Reed School Foundation, you did that event just the other day. So in Belvedere and Tiburon, and then we've got Sausalito, Mill Valley, Corte Madera... we talked about Larkspur.

Dr. Timothy Rankin: Mhm.

Interviewer: So, we've kind of got that whole area and that's kind of interesting because that's sort of the area that you tend to see most of your patients probably from, although you draw from further away.

Dr. Timothy Rankin: We do. Yeah, we've got a pretty good catchment area. So, I think that while we get plenty of people that are from the local community, we've got a catchment area because there's not a lot of offerings sort of north of the bay. And so we see people all the way from like Ukiah—pretty much Ukiah to San Jose to Modesto is pretty much the catchment area that we have right now. So, I do appreciate the people that come all the way out from the Central Valley there. But otherwise, we get people in from surrounding states. You know, we pick up Oregon, Utah, Nevada, Southern California. Southern California always cracks me up a little bit because, you know, you pass like two dozen plastic surgeons just getting to LAX. But again, I appreciate that. I think we have a special offering and I think people appreciate that.

Interviewer: Well, I think this goes to a point—after, gosh, I hate to even admit this, but after three decades in healthcare, there's a reason why that happens. And that's typically because that sort of work that you do is so personal and people really want to feel that... they want to feel comfortable with a person. You do such a phenomenal job. People always say that about you, that it's so easy to kind of interact with you, and I think that's a real testament. I think that's something that's not always easy for everybody. They could be great surgeons, but they don't have that other part, and I think that's one of the parts that is so critical to what you do.

Dr. Timothy Rankin: And so, you know, we've talked about this a number of times. I feel like while my technique and the surgery itself can evolve and improve and things like that, my understanding of how it actually impacts people continues to evolve. And so I think that for somebody, being technically sound kind of misses the boat a little bit. If you could literally just stick somebody in a back room and let them just operate because they were technically gifted, but they didn't understand what the goal of the patient was... as much as my wife says I love the sound of my own voice, ultimately the ability to just sit and be quiet and listen to what the patient is saying is key. Because they will tell you everything that they want to achieve and what their goals are. Their goals don't always necessarily align with what part of their face is aging. There may be a part of their face they don't want to address, and so why would you expose them to additional risk if it's not necessary?

Interviewer: Yeah, that's such a great point. You know, we're going to kind of jump around in this and come back and forth, but I think you're on to something here that's really interesting. A question I have for you is, in working with a patient, how do you set the right expectation? Because I would imagine at certain points in time, people come to you and they expect that they're going to be able to get a result that maybe is not possible. You can get them close, yeah, but how do you work with somebody to really help them understand how things will turn out?

Dr. Timothy Rankin: Brutal honesty. Yeah. So, I mean, ultimately, I think that my staff is amazing. We've been there long enough now that the staff understands how I think and what I like and don't like. And so, you know, the worst-case scenario is you don't want to have somebody who has unreasonable expectations and/or may not be a surgical candidate, and they make a long trip out to come see us. It's a waste of their time, and then they feel frustrated and everything like that.

So, I think from that standpoint, they do a great job of setting expectations about what types of procedures we do and things that are frequently asked questions that are answered in a common way. From that standpoint, being able to make sure that the patient is already educated helps. Something that I'm very excited about is a new series of videos that we're going to be putting together that I think will help to do just that. It's going to help to better educate our patients about whether or not they even want to see me, right? Which ultimately is going to set them up for success.

Furthermore, how do you best prepare for that conversation? Because I think like any conversation you go into, you want to be fully aware of the things that you're going to talk about. There are lots of very basic questions that are good questions, but it's not like my answer is unique to that. And so I think that the better that we can prepare them for those conversations, the better and more personal that consultation becomes. I think that that's the heart of the matter, right? Is that we want to be able to customize every single surgery to ensure that we're actually getting to why... what brought them there? Why did somebody take time out of their busy schedule to come see some blonde guy in an office? Right? So, the better we do that, I think the happier people are and the better we are at our outcomes.

Interviewer: Yeah, for sure. You know, it's interesting to think as you kind of go all the way back to that moment in time when you decided, hey, I actually want to be a doctor. Did you know at that point in time that you wanted to be a plastic surgeon?

Dr. Timothy Rankin: No. No, absolutely not. I think I was a late bloomer. I come from a long line of bankers and lawyers and had no idea I was going to be going into healthcare. I went to college as a business major, took Business 101, and hated it—which of course is funny since I have my own practice now. But, you know, I enjoyed having... I guess maybe it's more of like my Type A, control-freak kind of thing that I like having control over my little environment.

But ultimately, I figured out I did not like that. I realized that I really enjoyed people and the human body. Part of that early on, even in high school, I thought I was going to go into computer animation, which was like a very cool time—sort of the late '90s, and there were tons of new software packages coming out. All of that stuff they were doing was really cool, but I realized sitting in a dark room for 12 hours a day was probably not the best thing for me.

So ultimately, it was an evolution and sort of self-discovery of what brought me joy and how I liked to interact with people. I played football my first year of college and quickly realized that as I was gaining weight, I was getting slow and was therefore not going to be a terribly successful football player. So I took a break from that and then thought training was very interesting and engaging, maybe physical therapy. I had a good friend that I grew up with who also graduated from Drake, and his mom had been a physical therapist, so I talked to her about it. Through this whole process, what I realized that I liked was the journey. I just like information, acquiring new information, and figuring out how do you tweak things? How do you make something better?

Very quickly it became apparent that I was looking more towards sort of a research versus medicine route. In either case, it was probably going to be a doctorate of something like that. This whole process took time, and I was off-cycle. So essentially, having graduated with a bachelor's in biology, I worked on an ambulance and then got a job at UCSF in their dynamic neuroimaging lab.

Interviewer: Was it?

Dr. Timothy Rankin: Yeah. I mean, they were doing some really cool functional MRI stuff at the time.

Interviewer: Oh, yeah.

Dr. Timothy Rankin: But again, I kind of realized, based on where things were going, that as interesting as it was and as much as the research stuff really gets you to the absolute bleeding edge of technology and where that meets humanity, I like people. And so I think that medicine became the obvious route, so I went that route.

Interviewer: Yeah. And Vanderbilt, interesting. Yeah. I mean, for people who haven't been there, it's a totally different world. It's amazing.

Dr. Timothy Rankin: The cool part is that it is like its own little world, its own little ecosystem. I did my plastic surgery training at Vanderbilt and the cool part was when I got there, R. Bruce Shack was the chairman. He had been the chairman for 32 years at that point, and so I got to be part of the end of his legacy, which was pretty cool. But it was an interesting time and transition for the university and university medicine because they had been able to create this epicenter that literally drew people from the surrounding five states. People would drive five, six, seven hours to get to Vandy. So it was a very cool place to be, and we got to take care of all sorts of weird pathologies, which was, of course, an incredible training opportunity for me. It obviously feels good to be able to take care of people, but yeah, it was a very cool place, a very cool time to be there, and I'm very grateful that Dr. Shack chose me.

Interviewer: Not an easy program to get into. I mean, you've got to be pretty darn good. It is highly regarded. I mean, it is what it is, and you hit it at the right time. That's so cool to do that. I want to ask you, what do you love the most about what it is that you do? Because on this show, you know, we talk about peak performance. Hitting the peak of something is a never-ending journey. We hit a peak and then we've got to try to sustain that for a period of time, and sometimes, through homeostasis, we return back down to something else. But we're always trying, as Type A personalities, to hit the next level. We're never satisfied with where we've been before. The next peak I want to climb has got to be higher. The next thing I jump off of, I want it to be higher than that.

Dr. Timothy Rankin: Yeah.

Interviewer: So, what do you love the most about the opportunity in plastic surgery to continue? The other day I was having a conversation about closures and how closures have really evolved over the last 30 years. Can you give me an idea? I mean, there's all sorts of technology, but what are the things driving peak performance for you today?

Dr. Timothy Rankin: There's always a number of different facets where we're trying to push things. I'll answer the question in a second, but one of the things that I found interesting and introspective for myself when it comes to constantly trying to push the field forward and push the business forward was exactly that. I was talking to an employee a couple of years ago and we were talking about how best to make sure that patients were essentially getting the information and the answers they needed in an appropriate amount of time, or as fast as possible, right? Particularly for a lot of really busy people, the idea of engaging them between the hours of 9 and 5 is pretty unlikely. They're busy doing their own thing.

I walked away from that conversation saying something to the effect of, "Well, you know, we'll just keep pushing because I'm never going to be happy." And it sat poorly with me because it didn't come out the way that I wanted it to. What I realized was that there is a difference between dissatisfaction and enjoyment in tinkering, or the journey, or the process. I literally went back a few days later, got the employee, and said, "Hey, I just want to apologize. One, I think you're doing a killer job. Two, I'm not unhappy about what we're doing, but it's simply the fact that the way my brain works, it doesn't matter how good the solution is that you came up with today, the question of 'how do we make this better?' is always the next step. It's always the follow-up question."

As far as what we are doing today that pushes this forward, I think in the last few years, the things that I wanted to get to were really some very, very simple, seemingly mundane things—well, not so mundane. One is bruising, because essentially, if we're doing surgery or injections or anything like that, we want to do everything we can to minimize it. Particularly when it comes to the face, if you have a bruise on your face, that is something that is absolutely obvious and hard to hide. In the worst-case scenario, it can sort of bring into question whether there's some sort of domestic unrest or issue. Then there is incisional healing, and lastly, a big topic that's luckily not super common in plastic surgery and simply not common in facial surgery, is deep vein thrombosis, or DVTs.

There are a few things we're doing. I think for the first one, as far as bruising, even though it's not this super sexy topic and it's not a device we can market, there's a way in which we can essentially administer certain medications, the way in which we inject them, and things like that. A lot of times, it's just being patient enough to make sure that it's not fast and aggressive when we're administering a local anesthetic or administering some sort of product. We want to be thoughtful about that because it's something that can seem as mundane as bruising, but the absence or presence of a bruise has a very positive or negative impact on somebody's quality of life.

If you look at my website, my mission statement is to improve people's quality of life. I have a surgical bias on that, but at the end of the day, it doesn't always need surgery to get there. The things that allow people to get back to life are making sure that we do the very best possible job that we can in whatever we're doing, and then just allow them to get back to life and look like themselves. Obviously, people tend to want to look younger, but ultimately that's one way to do that. The process of doing that has been looking at research, talking to people, being patient enough, and pre-treating people. It's not that any one step of those was some major, life-altering discovery, but I think putting together a system allows us to walk people through even very invasive procedures in a way that is comfortable and doesn't elicit a ton of downtime.

Two, you talked about incisions. Again, this is one of those things where there are very few new data sets out there looking at the management of incisions. It obviously should be a given that plastic surgery equals a nice closure. That being said, within your own realm, you can still be very, very particular and nitty-gritty, and I think that's where I should always live. Those are the little details that I would hope everybody who sees me wants me to be obsessing over. It's one of those things that is very straightforward, but ultimately, as my practice has evolved, the way that I close certain incisions has continued to evolve in order to get to the absolute best closure. I think that particularly for facial rejuvenation—things like eyelids, facelifts, stuff like that—we've got a pretty awesome way in which we do it that allows us to really minimize downtime.

Interviewer: Yeah. I mean, you just mentioned something, and when we're talking about the face... the body stuff, there are plenty of opportunities for people to hide the scarring associated with some of those procedures, but on the face, it's really difficult to avoid that. Even like in an eyelid lift where those fibroblasts can start to bunch up and create these bumpy scars, it's such an art to get that right, to hide it in the seam and have it look completely natural—something that you're an absolute master at. But you have to take every single case and really dig into that individual patient. It's one of the things I love about the way that you approach it, which is why I wanted to ask you how you address that with an individual patient. All right, let's come to the third thing.

Dr. Timothy Rankin: The third thing is that we're actually doing a quality improvement project right now. We've got a Quad A-approved surgery center, which is a big feather in our cap, and obviously, I think the absolute foundation is to maximize and ensure people's safety. Ultimately, the project we're working on right now is because a deep vein thrombus, or DVT, is basically a clot in the legs. The reason that it's scary is that it can cause pain and discomfort, but the scarier part is that it can travel to your lungs and cause all sorts of issues, inclusive of death, for obvious reasons.

I think healthcare, and certainly surgery in general, has taken a very proactive approach to trying to mitigate that risk. You can use various ways of interviewing people to make sure that you've got an organized system. In this case, it would be like the Caprini risk score or risk calculator, which has been developed over the course of the last 30 years or so in order to make sure that people are essentially being appropriately categorized in terms of how you're supposed to address them.

Interviewer: Yeah, like people of our heritage where Factor V Leiden may be an issue that could cause a DVT. Making sure that you're screening appropriately for that is so critical.

Dr. Timothy Rankin: Yeah. And so the one area that I have found interesting, particularly if you pair that with trying to mitigate bruising, is that you could probably capture more people or take care of more people if you were to do what they call chemical prophylaxis—giving them an injectable shot of Heparin or Lovenox or something like that. There are lots of studies to say that in certain surgeries those are safe, but if we're sort of at that bleeding edge of trying to take care of people physiologically and certainly psychologically, in terms of their ability to return to life and work and all the usual things they want to do, the one part that I thought was very interesting is that there are now a number of companies that make a battery-powered sequential compression device.

They're like the leg squeezers, right? If you go to a hospital, they've got a machine that sits there and you plug in these cuffs that sometimes are reusable. From that standpoint, it sort of brings into question how adequately these are being cleaned when we're putting them on other people. If they're just disposable, that's kind of a lot of waste to just have something that represents a pretty significant amount of plastic and waste that you're just going to put on and then throw away. The hospital units are too expensive for the patient to take home, and certainly, if you have people that are traveling from out of town like some of our patients—they're going to come in, be in town for seven to 10 days, and then fly home somewhere—that travel is also an additional risk.

Interviewer: Yeah, that's where you can get into trouble.

Dr. Timothy Rankin: And so that's where this conversation arose as we were building out the surgery center. The question came to mind: do we want to go down the pathway of the hospital-based model where we have a piece of durable medical equipment and plug in these potentially wasteful cuffs, or do we essentially create an offering where we're not getting the primary wall unit, but instead you've got a battery-powered unit within each cuff that the patient is able to use with them as they recover? Whether they're traveling or not, I think just the act of having those on if they're just hanging out watching TV for a couple of hours could theoretically cover a time early in recovery that could put them at risk for getting a DVT.

Now, instead of telling them they have to walk or otherwise they're at risk, or looking at the possibility of giving them a Lovenox injection they have to put in every day—though some people certainly need that—we're hoping to essentially further mitigate the risk of DVT by giving people a tool that they can continue using at home as opposed to just there at the surgery center.

Interviewer: So cool. You know, the interesting thing is, in Marin County, the only Quad A-certified facility other than yours is an ambulatory surgical center in Novato that I'm aware of. So that shows the level of commitment. I hope for the viewers they understand, because oftentimes they don't think people really do understand what that actually means. Back in the early days, what we used to call JCAHO, or Joint Commission for Accreditation... you typically found that in hospitals, and then AAAHC. Quad A is like... you had zero deficiencies on your first pass. That's almost unheard of.

Dr. Timothy Rankin: Really hard. I don't know what the percentage is exactly, but it's really rare.

Interviewer: So to prepare for that means that you knew going in that you wanted to do it absolutely the right way. How much stress did that put on you? I'm curious because when we're talking now about opening this new practice, there's a lot riding on it. You've got to be making sure that you're doing all of these things. Not only do you have to take care of patients, but you also have to make sure that they're safe, and you've got to provide the highest level of care and a great experience. How stressful was all of that for you to put together?

Dr. Timothy Rankin: Stressful. Yeah, I mean, it was like that, no doubt. I think that it was a whole lot on my plate, and I was very grateful for the people that I had around me that helped to offload some of that. Not everything could be offloaded, and I think that as much as I don't want to be essentially the rate-limiting step in any particular process, when it came to the actual facility itself, the infrastructure, and the safety elements, that was not something that I was willing to pass off. So I think from that standpoint, I was very lucky that we had the people that we had in order to be able to make sure that happened.

Certainly, one of the groups that was a huge help and operating at the top of their game is a group called Universal Healthcare Consulting. Essentially, they had done a wonderful job of making sure that we were absolutely up to date on every possible step of the way or demand of Quad A. One of the other things that made us even more bragworthy was that other than during COVID when there had been some virtual inspections, Universal Healthcare Consulting has reached such a status and has such a good working relationship with Quad A that we ended up being the very first Quad A-approved facility in the country to actually undergo a fully virtual review using one of the UHC consultants there on-site.

We still had somebody there to be able to guide the inspection, and ultimately our Quad A surveyor was there via FaceTime. They still have to look and see every single document, every policy and procedure, and every element of the system that has to be in place to ensure patient safety. It was historic and, like I said, bragworthy to just be part of that process. I think the very cool part there is that it further enhances Quad A's ability to essentially ensure safety across many more surgical facilities as they are built out across the country, because it allows them to broaden their scope without having to compromise on the quality of their inspector.

Interviewer: That says a lot about you. I mean, it's always difficult to be the first one to do anything because you're going to be under much higher scrutiny, which ups the ante—all ships rise with a rising tide.

Dr. Timothy Rankin: Yeah, totally.

Interviewer: I mean, you contributed a lot in that, and that's a huge thing. For those of us who want to see patients every day get the best possible care and the best possible outcome, that's a big deal. You have a family and you have to balance all of that. How do you turn it off at the end of the day? How do you think about just like, okay, now I've got to go home and I'm going to be a dad, I'm going to be a husband, I'm going to spend some time, I'm going to go on vacation, I'm going to do those things? It must be tough. I know it's hard for me.

Dr. Timothy Rankin: Yep.

Interviewer: So, how do you do it?

Dr. Timothy Rankin: I built in set times during the day that were sort of compatible with when my wife's schedule also set up for her to just kind of be off, because I think both of us have the tendency to go, go, go all the time. Eventually, I got to the point where I realized that as much as I don't even know how much I believe in work-life balance—and I'll get to that in a second—for me, it had to do with basically just a timeline. I just knew that between the hours of, let's say, 5:00 and 7:00 when we're trying to feed the kids and trying to get everybody ready for bed, that was a time where I focused.

I don't believe that multitasking truly exists. I think that neurologically, if you read about the way in which the human brain works, some people are better at task-switching than others, and people will call that multitasking. But I think at the end of the day, it's one of those things that's really, really exhausting if you're constantly trying to switch back and forth between multiple things.

A clinical practice doesn't really set you up for success most of the time, particularly if you're going to be a clinician, business owner, surgeon, etc. With all these different things, there are many, many people that are trying to get your attention all at the same time. I have really tried to set up my schedule in a way that is more conducive to reducing the number of task-switching events that I have to engage in at any given time. I just find that on the days where you feel like you're just putting out fires and you're constantly back and forth, I am exhausted and, frankly, probably didn't put my best foot forward.

Ultimately, while I will certainly have days where I operate and then see patients afterward, I try not to do surgery, clinic, surgery, clinic. I try to have a surgical day when that is my full-time focus. It allows me to get into a flow state. By surrounding myself with people where it's not just a rotating technician of the day, I know that the same guy or girl is going to be there all the time so that we can talk about higher-level things as opposed to, "Hand me this instrument right now." They already know the process, they know what the procedure is, and so therefore, unless there's some unexpected change, we don't even have to address that. It allows me to stay in that flow.

Interviewer: I love the fact that you brought that up because that flow state in surgery—even though I'm not a surgeon, I'm well aware of how that actually works. If you have to look up out of the surgical area, it breaks it. You need to work with people who know exactly what you need in that moment, and you've assembled a team that does that with you. A great friend of mine, surgeon Russ Leeck, was in just the other day, and Dr. Leeck said, "In that moment, I need that tool that's being handed to me. They know exactly what I want, I don't even have to say anything." It allows you to all get into a unified flow state, which is really interesting to see in an OR environment when it really clicks in.

Dr. Timothy Rankin: Mhm. It's pretty powerful. It's incredible. I started my practice six years ago after being with another employer, but starting out initially, I had that sort of technician-of-the-day setup. There was nothing wrong with most of them, but ultimately, until you get that team mentality—which extends even beyond the sterile field to the anesthesiologist and the nurse—and when that group of people has worked together, it feels certainly not stressful. It's downright enjoyable, and I very much enjoy what I do.

The funny part is a lot of the times, the cases where you're sort of in this group flow state and things are just working well almost across the board are usually the faster operative times. Not always—you can still encounter a case that's a revision, revision, revision, and there are certain challenges there where you've got to make sure that you're keeping people safe. But a lot of the times, when you're sort of in that flow state, before you know it the case is over and we finish 30 minutes before you expected to. It's almost like that drive where you get home and you go, "How did I get here?"

Interviewer: Totally. It's when you're super proficient at what you do and you've got the right people around you. I had the opportunity to meet some of your staff. Judy is your OR nurse manager, and she has like 30 years plus, I think, and she came out of retirement.

Dr. Timothy Rankin: I pulled her out of retirement, actually.

Interviewer: If you've been around healthcare, you know when people retire they generally are like, "I'm done." To get somebody to come back means that they really wanted to work with you, which is a kind of interesting thing. And she was super enthusiastic, which was really cool to see. You must have had some great surgeries together.

Dr. Timothy Rankin: I think we had worked together before she retired for maybe like four years. When she was done, she was just kind of frustrated with the way things were going. The way that particular surgery center was being managed she found very frustrating, and she kind of got to the point like, "What am I doing? This is time to move on." We ran into each other, I guess this is probably like six months ago, and just started talking about stuff. It just became so obvious that she was kind of missing some of the elements, even if not the administrative frustrations, but just missing that environment. I told her the people that we're going to be working with in the new setup, and she was like, "Well, do you need any help?" I was like, "Judy, I am drowning. I absolutely need help."

So she was incredibly helpful. I think the cool thing for her was that even though she has been doing this for a very, very long time, she had never had a project de novo, meaning she usually walked into something already built. She was like, "So what do you want me to do?" and I was like, "Okay, we basically built a nursing station here and a recovery station here, but there are no labels." I told her, "I want you to essentially take these Post-its and create your perfect workflow. Where do the things go that make sense so that as you're going through preparing somebody for surgery, recovering them after surgery, and taking care of them in the OR, everything will just be where it's supposed to be?" This was opposed to being kind of limped along with little patch fixes for somebody who didn't necessarily look at the soup-to-nuts flow that the patient experiences as they go from pre-op to intra-op to post-op. And so, of course, I think she actually really enjoyed that. It was awesome, you know. Suddenly we end up with something that is built for performance. Everything is where it's supposed to be to ensure that flow state can be achieved.

Interviewer: A couple of questions I want to ask you about procedures, and one last one with regards to staffing. I met your anesthesiologist, Dr. Townsend. That's a unique relationship that happens between a surgeon and an anesthesiologist. From a surgical perspective, after talking to many surgeons over the years, there is that notion of comfort knowing that, hey, the airway is being managed, they're looking at everything that they need to be paying attention to. It's pretty intense with what's going on. You really need to be super proficient there. It gives you a lot of freedom to not have to worry about that portion of what's happening, and having that right relationship is just so, so important. I'm sure you've worked with many anesthesiologists, right?

Dr. Timothy Rankin: Yeah. But that relationship is so, so special. Totally. I mean, I tell everybody at the consultation because many times people are very stressed out about the idea of having anesthesia at all, or any sort of general or sedation. What I tell everybody is that anesthesia is not a one or a zero. It's not like they turn on the switch and then you go to sleep, and then they turn the switch off and you wake up. I mean, that could not be further from the truth. It is truly weird in the sense that I really don't know how well we understand human consciousness.

Whether it's Dr. Townsend or Dr. Jacobson, they are masters, but at the same time, it is an art. They have absolutely perfected the way in which they do it. The interesting part is that if you head-to-head compare what they do, it's very different—the way that they approach it and the types of medications they use is not the same. It's not like there's just this perfect recipe that nails it every time. But both of them do a wonderful job where, through our communication, we can time things appropriately. As soon as somebody is no longer aware that they're receiving some sort of painful stimulus, I can put enough local anesthetic into an area so that essentially the brain is not even aware that there's some sort of painful stimuli going on. That then sets them up to actually have a reduced amount of post-operative pain and reduced swelling, because the brain is not aware and is not essentially sending out signals saying, "We're under attack, help!" That's not there.

Furthermore, I think the other interesting part is that a lot of this happens before you even start the anesthetic. If you look at it, there's a way in which you can treat people's pain around surgery called multimodal therapy. It's not an invention of mine by any means, mostly piloted by colorectal surgeons that were looking for ways to essentially get people's gut functioning faster, get them ambulating sooner, and get them out of the hospital with fewer blood clots. All this stuff starts way ahead of time.

I think that the fun part about what we do is the fact that it is a concert of people and preparedness and all these other things that go into action to be able to ensure that at the end of the day, somebody wakes up nice and quickly and comfortably. They're not nauseous, they're not groggy, they're not constipated, and all the things that typically go along with what people find to be terrifying about anesthesia just don't happen. Without having somebody who was looking at how do we make this better in the same way you and I are, if it weren't for them asking that question over the last 20 or 30 years, you'd sort of end up with the opposite—people that take a long time to wake up and are groggy, nauseous, and constipated. So, yeah. It's amazing actually when you talk about the different drugs they use because they're able to use what they feel comfortable with, and what gives them certain signals. The way that they see it is kind of interesting to me.

Interviewer: When we go past that and we get into the actual procedures—face procedures—this is where you have to be really good at this. You see the people who maybe just went for the... flew to the moon on the cheaper rocket, if you will, and it doesn't always turn out so great. One of the things that I think is interesting about you is that you really like face procedures. That means you have to be really skilled, you have to really want to produce an outstanding result, and you have to know what you've got going into that. So, why is it that you like the face so much?

Dr. Timothy Rankin: Again, not that everything starts with a story, but the reason that I got into plastic surgery had to do with essentially coming from a general surgery background. I trained as a general surgeon before I trained in plastic surgery, and essentially had a background taking care of really sick people and doing palliative surgery on people that don't have a lot of time left. Ultimately, I was looking for something where I could focus on that interest in people and quality of life, which is kind of how I took that medicine route.

I think it wasn't until I was doing palliative surgery that I realized how significant an impact you can have on somebody's life even if it doesn't extend their life. Essentially, you can have somebody have a procedure that is not a life-saving procedure—they know it's not going to extend the time that they have here—but at the same time, you can still make the time that they have so much more high quality and valuable. It allows them to either get home or spend more time with their family members, and that was something that really stuck with me out of general surgery.

At some point during my training, I had met a plastic surgeon and was really, really impressed by microsurgery, and that's sort of how I ended up taking that route. I realized that the quality-of-life thing was a big focus for me. If you fast-forward to why facial rejuvenation and why face procedures, it had a lot more to do with maybe the demographic or the type of people that I get to meet. They're not necessarily young anymore, but these people know exactly who they are, they know what they like, and they certainly know what they're good at. Most of the people I get to meet are Type A, successful, driven individuals that are incredibly energetic and health-conscious. How do they continue to tinker and fine-tune their own life? I'm just loving longevity medicine and all the other things that go along with that because I don't think that you can deal with any one of these things in a silo. I think that a holistic approach to health and wellness is the only way that we ultimately get to maximizing quality of life.

Interviewer: 100% agree, and it's really an interesting time for us in that the whole longevity cellular medicine world is just exploding.

Dr. Timothy Rankin: So essentially, the point that I was making was that as much as I love the anatomy, the design of the procedures, and all those things, at the end of the day, what makes it so interesting is the impact that it has on the individuals that I get to meet in this practice. That's it. Let's say that we extrapolate and get to some point where everyone's just like, "Well, obviously what you do is so good you're going to take care of me. I don't even need you to talk to the guy. I understand that he basically just lives in the back in his OR and he never sees the light of day and he just cranks stuff out, right?" Even if that was a theoretical possibility, you kind of just go back to what motivates me. Why did I not go sit in a dark room for 12 hours and do computer animation for my entire life? It was the people.

If somebody's asleep and I don't have a chance to know how that impacts somebody, that misses the part that fills my cup. Without having the feedback and talking to somebody... like talking to a patient I think you guys will be meeting soon. She's a young mother of five, but has triplets. The triplets are graduating from high school. Through a quality-of-life perspective, she's going through a big transition in her life with the kids going to college, all this other stuff, and she is really feeling like age is sort of weighing her down. She told me, "I'm super energetic, I run a business, I'm driven, I've got the kids, everybody's doing awesome, but man, I really do not recognize the person I see in the mirror and in pictures. There's some sort of discordance that has developed there."

Having the chance to take care of somebody like that, who is certainly very anxious about the whole process but ultimately looks at what's the alternative... being able to take somebody like that where there are a lot of people relying on her—she still needs to be productive, she's got to be Mom, she's got to be CEO, she's got to be all those things—to be able to walk somebody like that through the process is great. On the other side, for them to then send a text message with a picture of them at an event... she had an image where she felt, "I need this image to look different," and for that to make me feel like, okay, we did it, she made it, and it was her. One of my favorite things to hear, and I get to hear luckily all the time, is "I'm back." That literally gives me chills anytime it happens. We're not making somebody that never was. I'm not the guy that makes people look like Brad Pitt—I'm sure there's probably somebody out there that does that, there's probably that guy—but ultimately, the goal is we're trying to get people back to where they used to be. We're not making something that never was.

Interviewer: Yeah. No, it's so cool. And you know what's so interesting now is that the whole thing has shifted. There was a period of time it was like, well, no one would admit that they ever had work done. Now everybody... now it's just like, ah, no one cares. Nobody cares about that. It's like, hey, this is what we do when we get to this age. What's really fascinating for me is the amount of guys that are really stepping into that and saying, "Hey, I want to be my best version of my best self. I'm going to do the things that look natural." I think this is another thing that you're really good at. I would love to just talk to you about this and how you figured this out. What I've seen in plastic surgery with regards to men is there are a lot of these surgeons who do procedures on men, but they kind of tend to feminize men because they're used to doing those procedures geared towards women. They're not as attuned to the face of a man. How do you go about that? Some of it seems like it must be obvious, but there is some sort of art to this, isn't there?

Dr. Timothy Rankin: 100%. I think that's what I always found so incredibly interesting about even just plastic surgery training. For most cases, if plastic surgery is born out of wartime injury, you don't know... not everybody's going to have the same pattern of injury, right? And so you have these really complex cases. Literally, the framework within which I trained was you get to the OR and by the time you finally get there, you're like, "Oh thank God we're operating," after being up all night or something. And you'd be faced with, "Give me six different ways you're going to fix this," and you're like, "One, two, three, four, five... uh, uh..." and they're like, "Get out of the OR, you blew it." So, one, you had to make sure you were really well-read. Two, you were very prepared. It didn't matter whether you slept at all; you were just on. It didn't matter how you got there, you just had to make sure that you got there and that you took care of that person.

I think from that standpoint, that is maybe the biggest difference between general surgery and plastic surgery: plastic surgery is based more upon principles as opposed to procedures. When it comes to making somebody look more masculine or feminine, that's sort of where you get to the level of detail where if you're looking at an individual and you take a second to talk to them specifically about what are your goals and what's bothering you, you can say, "Hey, let's take a look at a picture of you from 20 years ago. What did that look like?" If I just say I'm going to make somebody look younger, I'll make all sorts of assumptions about how to get there. But if you show me a picture from then, well, now I have the blueprint. Now I know where you started. There may be certain things like somebody saying, "Well, you probably need a brow lift," and you look at their photo and you're like, "No, you don't. It's exactly where it's always been. That wasn't the issue."

Interviewer: That would make you look weird if you did it.

Dr. Timothy Rankin: Correct. And so, I think from that standpoint, that's where, again, you just start with talking to the person. It's not just like patient 864 showed up, okay, we did the facelift, done. We need to be thoughtful about what we're doing. More importantly, as we start getting into the Bay Area, there's a big melting pot, right? There are a lot of different cultures that are represented, certainly in the San Francisco area, and the priorities of those different cultures are also different. So, even just saying that for women from the age of 45 to 50, "this is how I do it"—that still isn't correct. Because essentially, I haven't even asked: well, one, what was their goal? Two, what's their ethnicity? Does a scar equal better? Not always, but that's always the trade-off for plastic surgery. Unless you're talking about liposuction or something like that, if you are contouring something and there's some excision—you're removing some part of the skin—the idea is that somebody gets a scar but hopefully gets better contour. Theoretically, that should be the exchange. That should be the trade-off.

That's not always the case, though. Until you talk to that person or understand what's their ethnic background, what's their priority, and what's their tolerance for potentially having that permanent change, you may do a technically perfect job and still blow it because you just didn't ask the right questions.

Interviewer: I'm really intrigued by what you just said. I will think about that a lot. You always hear the blessing of growing up in the Bay Area is the exposure to all the different cultures and having friends from all over. To break it down to the basics, it's like different food, right? You have all these different friends who have different backgrounds, and it's so powerful. But that notion of going to that level of specificity down to really understand, okay, culturally, and also in the aesthetics portion of it, to be that detail-oriented is pretty powerful. You operate in an area where it requires just an intense amount of... I mean, you kind of just blew me away with that. I've always been blown away by plastic surgeons because of that level of detail and wanting to be really, really great at what they do. But what you just said is like that's on a whole other level. It's not unique to San Francisco. I mean, we have it in New York, and when I lived in New York it's all about that, and Los Angeles, sure. It's all over, but what you just said is really powerful and it actually says quite a bit about how you care. That's one thing I wanted to kind of talk about. Let's just imagine you have somebody, they come from, I don't know, Mill Valley, and they say, "Hey, I want to have a facelift." What's the process that you take somebody through? Don't give away your trade secrets, but kind of give us the macros of how you sort of approach that. A facelift is not something that's super easy to do. Really, at the end of the day, it's the biggest of them all, right?

Dr. Timothy Rankin: When you're talking about the face, it is certainly the most anxiety-provoking because there are other things from a reconstruction standpoint that are a little bit different. But I think that's the one that people tend to feel the gravity of aging on. I think by the time they actually get there, just the thought that, "Man, I might need a facelift," ultimately, in and of itself, is already a little bit of a struggle for people. If you've gotten all the way down that pathway of, "I really don't like whatever this is, there's some change in my face that I am not digging, what is it? What do I do? Do I just let it ride?"—essentially, by the time you get to that point, you've now done your superficial research on what's happening with my face, maybe it's this, maybe I need that. You've then gone to the next layer of actually looking up who do I even talk to about this? Who should I go see? You've probably talked to some family, friends, whatever it is, to figure out if anyone has experience with these people.

Finally getting in... I tell everybody that the ask to walk into a plastic surgery office for a consultation frankly faces people with their own mortality a little bit. You're like, "Wow, this is different than it was." This is not like turning 40 and saying, "Man, my elbow is really getting me." This is some other level of introspection that I think tends to shake people pretty deeply. Not everybody, you know, some people kind of walk in and they've had this in their mind. Sometimes the massive weight loss crowd can be like that—somebody loses 150 pounds...

Interviewer: Yeah. And you know what? Here's the thing. I just have to interrupt you, forgive me, because this is one thing I wanted to make sure I didn't forget. Can we come back to this and talk about the GLP-1 effect on the face and what we're seeing with patients today, and how you're addressing this? Because I think the GLP-1 face thing is really big.

Dr. Timothy Rankin: Yeah, yeah, yeah. So, I mean, as far as the GLP-1 crowd and its impact on surgery for facial rejuvenation, I think the cool part is that it's effective, and effective in a way that's safe. If you look at it, they got FDA approval for weight loss, and an additional FDA approval for reduction of cardiac risk factors—which again is probably just a spillover from the fact that if you weigh less, you've got less burden on your system, you're not eating as much, you're not stressing out your liver, and all these other things. You're reducing your blood pressure, so now it's less stressful on your kidneys. All these things are incredibly positive. The fact that it has that effect and is increasing longevity is not surprising. The cool part is that weight loss is now successful, unlike sort of drugs like Fen-Phen and things like that where it basically forced people to choose, "I can be skinny, but I might die." That's not a good trade-off; that sucks.

The cool part is, one, it's actually been a safe drug that has helped people be effective in maximizing their health, and certainly very much on brand with how we take care of the whole person.

Interviewer: Yeah, 100%. The neurocognitive benefits now... I mean, I think when you start to take a look at regulating glucose and increasing insulin sensitivity, the cascade of benefits are immense. It'll be interesting to see what happens as this progresses. There is something coming we all know about that has the potential to be pretty amazing and is going to have incredible effects. I wonder, in your practice, do you provide those services to people?

Dr. Timothy Rankin: We do, yeah.

Interviewer: And then when they get to the point in time where they've lost... I mean, obviously, the beautiful thing about being a plastic surgeon and providing that is that you're able to sort of take a look at the overall progression and do it in a way where you're going to have the least negative effect on that. You see these... I'm sure there are tons of great primary care providers that are offering this. There's another show that I do with a bunch of other providers, and they talk about this all the time—the big scares. It's like just prescribing a statin; next thing you know, you've got people just pushing out GLP-1s without really thinking about what you've been talking about, which is the holistic wellness of a patient. Taking a look at them from that perspective of the whole, what do they need to really be healthy? You have this ability to actually provide that treatment, but also look at them and say, "Okay, at what point in time is it going to be necessary to actually maybe take a little bit of that face and change it a little bit so that it's not as noticeable?" Where someone goes all the way out, they have these results where you look at them and go, "Whoa, what happened to you?"

Dr. Timothy Rankin: Well, I mean, I think just like anything, you can overdo anything, right? You can drink too much water and essentially screw up your electrolytes and put yourself into cardiac arrest or something like that. Whether it's medications or devices or otherwise, I don't think there's anything that is inherently good or bad. I think things can be used inappropriately. You can use the wrong dose, you can use them in the wrong diagnosis, the wrong situation—all those things. Essentially, if the goal is to improve people's quality of life, there are lots of different levers that we can pull to be able to do that.

Ultimately, as far as the GLP-1s are concerned, the way that it's certainly benefited my patients is, one, that they're successful with their weight loss. Two, unless you're talking about diabetes or something like that, there's certainly a goal trajectory. And essentially, that comes from my background and passion in weightlifting and some amateur bodybuilding when I was younger. There are all these things that you can glean from your experience, and so when it came to incorporating GLP-1s in the practice, one thing that I always thought was interesting was: what group of people is really, really good at losing body fat but is absolutely not willing to tolerate losing lean muscle? Bodybuilders, right? These people do it every year; they're cycling on and off.

I think even that crowd, for the most part, if you look at natural bodybuilders, has gotten a whole lot better at doing it in a health-conscious way. When I was in college, I knew a couple of guys that had gone pro, and they had these massive weight swings—off-season they're 250 and on stage they're 190. I mean, there's no way that that's healthy. So I think that you see people are getting, even in that community, to a place that's a little bit more health-conscious. From that standpoint, the rate with which we tailor people's weight loss, I think, should be around four pounds a month.

The reason being is that, one, we're dealing with human beings, and if you're anything like me, as long as you're getting some sort of feedback when you're working really hard towards some end goal—as long as you're seeing some kind of feedback that you're moving the needle—that's really encouraging. I think for somebody if they're on a GLP-1, in general, just losing weight is not sufficient. Right now, the cool part is that living in an area like this, people are very health-conscious. People all over the area are tuned in, and we tend to be pretty lucky to live in an area where people are not just happy with, "I go in and I get my labs drawn once a year and that's it." It moves far beyond that. At the end of the day, to be able to work with a group of people that are already motivated and interested, and then to be able to kind of push the needle in that regard so that essentially we are maximizing their fat loss but not digging into their muscular gains, is key because that doesn't benefit them.

Interviewer: I mean, you know what's crazy about that is you see these people who are starting to use GLP-1s and they don't understand that in order to really use that effectively, you've got to put pressure on the bones and you have to actually use resistance training as part of it. You've got to keep your protein up. GLP-1s kill your thirst signal, so you've got to hydrate at a whole another level. I mean, and that's the big concern—are people actually going to tell these people everything that they need to know? A lot of people were just using them and not doing the things that you would prescribe. Totally. You know what I mean? I know because I ran into you in the gym. So, you know, yeah, it's an exciting time. One of the things, when I'm always excited for my friends, is when you can gain the perspective where you can sit back and see when someone in their career is about to have something truly magical happen. Now, who knows, the world is what it is, but it seems like what I'm witnessing with you is an incredible beginning of just a really phenomenal time. And it comes after a tremendous amount of work. People think that, oh, you know, plastic surgery must be easy. Oh, I mean, come on, man. This is like a huge commitment. The amount of time and starting off where you started to get to where you are today, that's pretty amazing. At times, do you ever sort of look back and say to yourself, "Wow, that was a lot of work?"

Dr. Timothy Rankin: Yes. At the same time, I think the only thing I would say is like, what else would I do with that time, right? I mean, essentially, from one tinkerer to another, if you're constantly trying to figure out what to do, at no point am I like... I wouldn't be happier if I just sat by. I've got a good friend who loves podcasts and loves listening to cutting-edge thought leaders, certainly in the efficiency space—how do you maximize the time that we have? From that standpoint, he was even part of launching a tech company years ago, and so he's always the one that tells me, "I know lots of billionaires. I've met a lot of people that have been incredibly financially successful, and they are very unhappy." Not all of them; there are plenty of people out there that are very happy with what they're doing, tinkering and on to the next project. But he said he's met plenty of them that are just unhappy. Just because you're financially successful doesn't mean that you've got everything dialed together.

I think it boils down to what you are doing on a daily basis. Sometimes, like you said, you do sort of get to feel like you achieve a milestone or get some sort of quantum step in the right direction. As far as the practice is concerned, things have felt really great lately. It's not that I think we've necessarily changed the way that we're doing things, but I think that we've had a unique time in the community here between other business owners, other doctors, and certainly the patient experience, that have allowed us to be able to reach people in a way that we haven't done before. I think that we're starting to see more and more connectivity within a very multidisciplinary community of people in the area that is allowing all of us to teach each other and, in turn, better take care of all of our patients.

Interviewer: Yeah, super exciting time. Hey, so we've been a few minutes in on the ketones here. How'd they go for you?

Dr. Timothy Rankin: I feel pretty rad. I don't use that term lightly—I probably use it more often than most—but yeah, I think the third capful was probably the answer. I think a couple of days ago I did the K2. Today was the K4, certainly more potent on the flavor. So I'm glad that we went a little dilute, but three capfuls is banging.

Interviewer: It's going to keep you going for a while. That's an amazing product. It's truly the Ferrari of... or, you know, whatever. I don't know what the super exotic cars are these days, but we're M guys.

Dr. Timothy Rankin: No, I mean, I feel sharp. I feel dialed. It may have just been the artifact of also just hanging out and chatting with you. I always find the work you're doing to be inspiring, so so far, I'm enjoying it.

Interviewer: That's great, I always love to hear that because I use them every day, and I've found over time as I've done that it's just been better and better for me.

Dr. Timothy Rankin: What's your dosing frequency? What's the cadence throughout a day, or do you just pick a point where you're like, "I know that for the next four hours, it is go time?"

Interviewer: Yeah, so there are those moments. I'll be in these blocks where it's kind of like a surgical day for you, where I'm going to start and I'm going to go with no breaks all the way through. So, I use some essential amino acids in the morning when I first wake up. Then I use this along with those, and they have sort of a synergistic effect that amplifies.

Dr. Timothy Rankin: Break it down for me timewise.

Interviewer: Okay, so I'm going to wake up usually about 5:30. I'm going to do some stuff, and admittedly, I like to play chess, so I'm going to play a little chess just to kind of get the brain going.

Dr. Timothy Rankin: How many games do you play simultaneously? Is it one at a time or are you playing multiple?

Interviewer: Usually one at a time. I like to win, so I found playing one at a time really works.

Dr. Timothy Rankin: Why am I not surprised? Yeah.

Interviewer: So I'll get that going with a bunch of water, and depending on what I'm going to be doing athletically, I'm going to get some salt in there as well. Then I'm waiting about 45 minutes before I leave and go straight to the gym. I better get a little caffeine on board probably. And then I'm into an Isel water, which is a product by a company called New BioAge, and that's just got some osolytes in it along with a capful of daily minerals called LyteShow from KetoChow. And then some AKG+, so alpha-ketoglutarate in that water. That's about 64 ounces of water that I'm going to drink while I'm working out.

Post-workout, I'm going to hit 50 grams of Isopure whey protein isolate with some MyoDrops along with some really high-quality cocoa to get that in, as I'm trying to suppress my statin. From there, I'm going to get to my first meal of the day after I spend 15 minutes in the sauna. I try to do that about four or five times per week. From there, I'm going to have my first meal of the day, which is usually going to be six eggs, some sort of sautéed mushrooms or Swiss chard in that. Then I'm going to continue to drink lots of water.

Then on to lunch, which is usually going to be a pretty significant amount of protein, some white rice, and some vegetables. And then at the 3:00 mark, okay, this comes back out along with those essential aminos. Then I'm going to dinner. Before I go to bed, I take the essential aminos and this again, but in a much smaller dose, just to kind of make sure that I'm not getting any kind of wake-up in the middle of the night with a drop in glucose, which is going to trigger some cortisol and adrenaline that's going to make it hard for me to sleep. So, I'm trying to get my sleep into this mode where I can get into that deep sleep and get that repair. We both know that muscle isn't made in the gym; it's made in sleep, right?

Dr. Timothy Rankin: Totally, yeah. Absolutely. I was always a big fan of a couple of different products like nocturnal protein. Of course, America is obsessed with getting rid of fat, so there are so many different strategies that are aimed at essentially not consuming any calories too close to bedtime. It's always interesting trying to find that true north for whatever your goals are. It's almost like... I remember with our first baby, we were trying to figure out how to essentially not induce juvenile diabetes but at the same time not end up with a bubble kid because they're allergic to everything, trying to find this optimal time point.

I think that's very interesting. I will say the other thing that I've added in the last year that was, at least for me, an absolute game-changer was Eight Sleep. I don't know if you're familiar with this product, but it's essentially a temperature-controlled mattress. You can do a mattress or a topper.

Interviewer: Yes, I've got to get one of those. I mean, that is an absolute game-changer.

Dr. Timothy Rankin: It is an absolute game-changer. The thing that I love about it is, of course, if you're a gearhead like myself, there is data—just all the data. You actually get to see what's happening and what's going on. They've got an autopilot mode so that the first week that you're on this thing, it's learning you. It's actually exposing your body to different temperatures based upon the fact that it can sense your heart rate and little cardiac variations, and it can also figure out whether or not you're in deep, REM, or awake sleep. Essentially, it puts you into this cold cruise control mode, and then, of course, it will assign you whatever their sleep score is. It was certainly very, very helpful for me, and an absolute game-changer for my wife, who was smack-dab in the middle of trying to sort out perimenopausal symptoms and stuff like that. It has just been night and day.

Interviewer: You know, it's so funny too. I remember for my wife, the same thing—these crazy hot-cold, hot-cold cycles. I get hot in the middle of the night and I wind up with the covers off, and I think that is such a smart play. I'm definitely looking into that. Highly recommend?

Dr. Timothy Rankin: Highly recommend.

Interviewer: Maybe you can shoot me the link on that.

Dr. Timothy Rankin: Yeah, yeah.

Interviewer: Hey, I'm curious while we're talking about this, since we kind of like the same stuff... how much creatine per day do you do?

Dr. Timothy Rankin: You know, it depends on what I'm doing. I always found it to be a great addition when I'm really on. From my standpoint, while I think that there are some basic vitamins and things like that that everybody should be taking to ensure that they're going to have good health, wellness, bone density, etc.—you don't want to get anemic depending on how that's going for you—for me, the exercise supplements were something that if I fall off consistency, if I'm not putting in the consistency that I feel like I should be, the supplements were actually the first thing that I would sort of take off the list. Not the vitamins, but the supplements would go just because most of the stuff that we consume tends to be water-soluble.

From my standpoint, it was sort of my own little internal algorithm of: is the muscle missing something? Is there some way that by essentially having that additional creatine or having a little bit more water volume in the muscle, that it fixes something missing for recovery? Otherwise, if essentially I've fallen off—whether we got super busy with the build-out or something like that—and I'm just not getting there with the consistency I need, it sort of felt to me like, okay, I'm probably just peeing this stuff out. Whereas, if you've got a hungry muscle and you are stressing this thing out and it needs to recover, that's where I think those can be incredibly valuable. So, it just depends, but essentially trying to think of the formula that I had... I don't even know what the specific milligrams were, but what do you typically do?

Interviewer: I usually, well, I'm getting five grams in the morning and I'm going to up it. I'm going to go through a nine-week training cycle of just a lean bulk to put a little more mass on. I just feel like I wanted to add some on, so I'm going to go up to 10 and see how that does. The big challenge there is obviously making sure that you get enough fiber and water to keep it all working, as otherwise, it can be not so great. But, yeah, no, it's really interesting. I'm glad you like the ketones; we'll get you some of those.

Dr. Timothy Rankin: Awesome.

Interviewer: Yeah, they're a great sponsor, and yeah, I'll be curious to see what you think as time goes on.

Dr. Timothy Rankin: Very cool.

Interviewer: Well, I hope you'll come back and share with us in the future sort of where things have gone, how they've gone for you, and what the new updates are. Bring us up to speed with... I mean, there's always new lasers, there's always new this, always new that. We'd love to hear about these things, so there's always a seat for you here and hope you'll come back and see us.

Dr. Timothy Rankin: Appreciate it. Yeah, happy to. It was great. Thank you very much.

Interviewer: Absolutely.