What's your experience been with our board at Marguerite Casey Foundation?

Sure.

Well, first, they certainly haven't been a hindrance to a lot of the incredible work we've done the last few years, and our most recent announcement around $500 million in grant-making over the next decade.

And that was a decision that didn't happen overnight.

We've actually been building towards that decision over the last few years, probably since really in 2024 in, in earnest.

Our board and our staff, we began to prepare for a new political reality kind of in the middle of 2024.

We knew the organizations and communities that we support and serve would be targeted and harmed if there was a change at the federal level.

I wonder for you, Dan, what are the inputs to getting the kinds of returns that put us in the position that we're in right now?

The

anatomy is the best way to look at these problems because if I can understand the data, the anatomy of what's happening, then I can help to explain what you're seeing.

There's a deeper fat compartment and then there's a superficial fat compartment and then there's this fat right below the skin and then the skin.

And then there's below the deep fat compartment, there's muscle and then there's bone.

And these are the things that contribute to the volume in your face.

But the deeper fat compartment is like the buckle fat, right? Or the fat that's like within the actual cheek and the superficial is the superficial fat pads.

And then above those is a little thin layer of fat underneath the skin.

How do you determine whether a patient needs filler, fat transfer, energy-based treatments, a face or neck lift, or simply more time for the face to adjust to the weight loss?

Yeah, you can

see the, so for me, what I do that's different compared to other deep plane surgeons, most deep plane surgeons make an incision, go below the fascia to the deep layer, lift until they think it looks good and that's where they put things.

And preoperatively they're measuring, they're marking where they want it to go, but they're not really thinking about the internal anatomy because they're looking at the outside of the face when they mark for the surgery.

And you can see through the skin, you can see a lot of what we normally see.

So I'm not going to argue because you can see things like filler, you can see the gonial angle, zygomatic arch, and you can kind of identify where it's going to go.

But when I'm inside, I see the zygomatic retaining ligaments and I mark them.

So you can see where it's stretched and where it's dropped and imagine a string between my two fingertips.

Can you talk about that? That was a fascinating talk.