Can you tell us a little bit about what goes what is going on right now in your field, in your office, and you are offering patients that come in to see you. > Well the revolution is FAT. FAT is really turned out to be a great reservoir of regenerative tissue. We’ve used it for the breasts with their sections about that how we can restore breasts with fire only fat injection and we’re going to talk today about what we do for the hands and it’s a tremendous soup from treating arthritis, to contractures, to age-related diseases, to rejuvenating and treating wounds. > That’s right Kathy. See the key is understanding the anatomy, understanding what’s missing and what parts of the function are affected once you can understand the disease process you can target and fix it. > So let’s get to the fun part because you break it down to three things that we lose, correct? — That’s right, — So break … So what happens to our hands, what are we losing? > So in terms of hand rejuvenation there’s three things that are happening that basically give away your age. One is with age what happens is you’re fat the skin everything sort of diminishes, atrophies, it becomes smaller. So what that does is now it allows you to see the tendons in your hands, it allows you to see the valleys, and the peaks between the bones of your fingers, it allows you to see the veins more clearly. There’s another element which is the elastin, the collagen, the fibrous tissues within the the dermal elements and also in that that skin as you can see in this photograph becomes very thin and you can start to see your skin becomes very thin and it’s aged looking and then lastly with time what happens is you get these age spots this hyperpigmentation of the skin. So the three elements the anatomy that needs to be fixed.