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Best practices for pairing skincare with procedures · The Science of Skin

• 0:09
  SPEAKER_01: Hi, I'm Dr.
• 0:10
  SPEAKER_01: Patty Ferris.
• 0:11
  SPEAKER_01: I'm a board certified dermatologist, and I'm your host of this episode of Skin Care Confidential.
• 0:16
  SPEAKER_01: If you've not listened to Skin Care Confidential, this is a podcast that was started by Dr.
• 0:20
  SPEAKER_01: Ted Lane and I, and it's an extension of our medical meeting, the Science of Skin Care Summit.
• 0:25
  SPEAKER_01: Our meeting is going to be held November 8th through the 10th in Austin, Texas this year.
• 0:29
  SPEAKER_01: So if you want to take a deeper dive into topical skin care and how to use it in practice, check us out at Science of Skincare Summit.com.
• 0:37
  SPEAKER_01: I am very excited tonight to have a very good friend and a colleague who I have tons of respect for with me, Dr.
• 0:43
  SPEAKER_01: Roy Geronimus.
• 0:45
  SPEAKER_01: Roy's a board-certified dermatologist, and he's the director of the Laser and Skin Surgery Center of New York.
• 0:50
  SPEAKER_01: He graduated from Harvard University, got his medical degree at the University of Miami, and then trained in dermatology as well as most surgery and cutaneous oncology at NYU.
• 1:00
  SPEAKER_01: He continues to hold a clinical professorship at NYU, and he founded the laser program there and served nine years as chief of dermatologic and laser surgery.
• 1:10
  SPEAKER_01: He's a past president of the ASDS and also of Aslums.
• 1:15
  SPEAKER_01: He's well known for everything laser.
• 1:17
  SPEAKER_01: I say Roy Geronimus, you probably first think laser.
• 1:20
  SPEAKER_01: But Roy has really a wide variation of interests.
• 1:24
  SPEAKER_01: He's also chairman of the board of the New York Stem Cell Foundation.
• 1:28
  SPEAKER_01: And he also has received numerous awards, no surprise.
• 1:32
  SPEAKER_01: He's received awards from Aslums for his contributions to laser medicine and laser research.
• 1:37
  SPEAKER_01: He received the prestigious Sam Stegman Award from the ASDS.
• 1:41
  SPEAKER_01: And he was a physician of the year honored from the Vascular Birthmark Foundation.
• 1:46
  SPEAKER_01: He's been one of New York magazine's best doctors 23 times.
• 1:50
  SPEAKER_01: Are we old enough for you to have gotten that 23 times?
• 1:54
  SPEAKER_01: We're not now we're dating ourselves.
• 1:56
  SPEAKER_01: We're now the same age.
• 1:58
  SPEAKER_01: And he's 16 times one of the best doctors in America.
• 2:02
  SPEAKER_01: He's obviously well published.
• 2:04
  SPEAKER_01: He's a sought-after speaker, and he really has been involved in the development of multiple new laser systems, therapeutic techniques that are now used commonly throughout the whole world.
• 2:14
  SPEAKER_01: He also has expertise in vascular birthmarks and sits as the medical director for the Vascular Birthmark Foundation, where he makes possible laser therapy for numerous children with vascular birthmarks.
• 2:27
  SPEAKER_01: So, Roy, welcome.
• 2:28
  SPEAKER_01: That's quite a bio impress.
• 2:31
  SPEAKER_00: Pleasure to be here.
• 2:32
  SPEAKER_01: It's super pleasure to be able to do it.
• 2:35
  SPEAKER_00: Thanks.
• 2:36
  SPEAKER_01: We're having fun with it.
• 2:37
  SPEAKER_01: And today I'm going to kind of go into some different subjects because Roy has so much expertise in different areas.
• 2:44
  SPEAKER_01: We're going to get into skincare a little bit later, but I really want to start with something that I think he pioneered, and that is laser-assisted delivery of drugs.
• 2:53
  SPEAKER_01: And I remember, Roy, I was visiting your office, and it was forever ago, and you were telling me that you were working with these, you know, the new lasers, it was the fractional lasers at the time, and looking at what happens when we do fractionated laser resurfacing on the skin, and then apply something afterwards.
• 3:10
  SPEAKER_01: So kind of walk us through those early studies and what they showed that was of interest.
• 3:17
  SPEAKER_00: Yeah, it was really interesting, Patty.
• 3:20
  SPEAKER_00: I began working with fractional lasers going back to 2004.
• 3:24
  SPEAKER_00: We actually had the very first fraxal laser in the world in our office at that point in time.
• 3:30
  SPEAKER_00: Really didn't appreciate or understand the potential of what was going to transpire for the subsequent 20 years.
• 3:36
  SPEAKER_00: So we started off with the fraxal at 15, 50 nanometers, just looking at rejuvenation of the skin, acne scarring, making the skin look fresher, cleaner, more of a glow, more of a luster.
• 3:48
  SPEAKER_00: And that was the first fractional product that was out there, pretty much developed in response to all the issues that we were seeing with non-fractional laser resurfacing, that caused a lot of problems back in the 90s.
• 4:02
  SPEAKER_00: So that fell by the wayside, and there was this great opportunity developed by Rox Anderson and Dieter Manstein with this whole concept of fractional treatments.
• 4:13
  SPEAKER_00: So subsequent to the 1550 nanometer fraxal, uh, the fractional CO2 laser came out in 2008, and shortly thereafter, another wavelength of nonoblader fractional resurfacing came out around 2009-2010.
• 4:29
  SPEAKER_00: Uh that was the thulium laser at 1927 nanometers.
• 4:34
  SPEAKER_00: So throughout my career, I've worked very closely with industry, and around the time that the 1927 came out, I was visiting uh Salta, uh laser company, which previously was reliant, and there was a young scientist there, uh uh guy named Kin Chan, just a very brilliant scientist, who casually mentioned to me that uh he did some drug uptake studies looking at the uptake of various different topical drugs following the non-oblative fractional, particularly at 1927 nanometers, I was seeing some really interesting things.
• 5:15
  SPEAKER_00: He was seeing increased permeability, increased penetration, increased absorption.
• 5:21
  SPEAKER_00: So I thought this was interesting.
• 5:23
  SPEAKER_00: And you know, I went to a variety of different uh companies, and including our buddies over at Medicys back in the day in Arizona, and said, hey, you uh you must have some products sitting on your shelf that you can't get into the skin.
• 5:37
  SPEAKER_00: What if we had a way where we could actually deliver those products into the skin?
• 5:42
  SPEAKER_00: Or what if we can increase uh the penetration or permeation of products to the point where you had increased efficacy?
• 5:50
  SPEAKER_00: And there wasn't a lot of interest.
• 5:52
  SPEAKER_00: Uh but there was one company that showed interest at that point in time, and that was skin seuticals.
• 5:57
  SPEAKER_00: So we did a down and dirty study with skin suiticals, I think, in 2011, uh, looking at their CE ferulic.
• 6:05
  SPEAKER_00: This is the ferrulic acid and combination of vitamin C and vitamin E.
• 6:10
  SPEAKER_00: And lo and behold, there was real increased absorption of this product into the skin.
• 6:17
  SPEAKER_00: So, you know, we started using this in our practice on a routine basis, not only for the CE ferulic at that time, but other products as well.
• 6:27
  SPEAKER_00: What surprised me is that this concept really didn't take off.
• 6:31
  SPEAKER_00: You know, I was pumped up about it.
• 6:33
  SPEAKER_00: I thought we had something really interesting.
• 6:35
  SPEAKER_00: Uh, and it wasn't until years later that we began to see more interest in the in our space in dermatology and cosmetic medicine uh of this concept of laser-assisted drug delivery.
• 6:49
  SPEAKER_00: So actually, Solta sat on this data, and it wasn't until 2022 that we published a series of papers.
• 6:58
  SPEAKER_00: Uh, my colleague Jordan Wag and I, along with Paul Friedman out of Houston, uh, published a few papers in Dobrologic Surgery looking at a variety of different products and showed a dramatic increase in absorption and penetration, looking at their eye serum that they had with uh uh skin suiticals, looking at salicylic acid, vitamin C, hydrokinones, 5FU, and even monoxidyl with dramatic increase uh in absorption.
• 7:28
  SPEAKER_00: So uh I think over the years there's been increased interest and more acceptance of this concept.
• 7:36
  SPEAKER_00: And I think the potential is just beginning.
• 7:39
  SPEAKER_00: And I think there still is a ton of interest.
• 7:41
  SPEAKER_00: It's just unfortunate it's taken this long to get there.
• 7:44
  SPEAKER_00: But hopefully our publications and the the widespread acceptance, at least in the dermatologic community, will allow for increased uh interest in this area.
• 7:54
  SPEAKER_00: So I know in our practice we're using it routinely for a question.
• 7:59
  SPEAKER_01: What are you using it for?
• 8:00
  SPEAKER_01: That's exactly my next question.
• 8:01
  SPEAKER_00: I think the the most common thing we use it for right now is pigmentation.
• 8:05
  SPEAKER_00: Uh from elasma.
• 8:06
  SPEAKER_00: You know, we're applying topical tranxemic acid after uh a low energy, low density, not ablative fractional treatment.
• 8:15
  SPEAKER_00: I don't use the regular fractional for this purpose, but I use the uh LAES MD made by electron or the clear and brilliant made by Salta.
• 8:24
  SPEAKER_00: These are lower energy devices that don't stimulate pigmentation, but do just enough that you can get uh reduction of pigmentation, but you're also opening up these channels.
• 8:35
  SPEAKER_01: Right.
• 8:36
  SPEAKER_00: And these channels are really cool.
• 8:37
  SPEAKER_00: So we're using it a lot for pigmentation.
• 8:41
  SPEAKER_00: The other area where I'm using it a lot uh is for the treatment of wrinkles and acne scars and other types of scars, atrophic scars, where I do an ablative procedure.
• 8:52
  SPEAKER_00: So I'm doing an ablate of CO2 or an ablate of erbium where there are open channels that actually stay open for quite some time.
• 9:00
  SPEAKER_00: Uh, we put the PLA topically into the skin.
• 9:05
  SPEAKER_00: Uh I was initially uh wary of this.
• 9:08
  SPEAKER_00: This is there was a paper published by Jill Weibel out of Miami and David Ozog out of Detroit, where they looked at topical PLLA after fractional CO2 laser, and they did this uh immunofluorescent staining, and you could see the PLLA deep into the dermis.
• 9:26
  SPEAKER_00: So I let them be the leaders in this and uh because I was concerned about um inflammatory reactions with putting this uh uh PLLA in into the skin because it was going deep into the dermis, and uh they weren't seeing problems.
• 9:43
  SPEAKER_00: And you know, we adopted it maybe you know in 2015 or so, and recently published a data, our data looking at about 100 and so patients or more, and I forget the exact number, where we saw no reactions, no inflammatory reactions.
• 10:00
  SPEAKER_00: So we're using that now routinely for uh following our ablative treatments, and we think it does help uh our patients with aridities, you know, these so-called wrinkles, uh, and patients with deeper scars.
• 10:13
  SPEAKER_00: It also allows us to use lower energy laser so we can get people by with less uh prolonged healing, faster healing, uh, by adding this to the skin surface as well.
• 10:26
  SPEAKER_01: Aaron Ross Powell So interesting.
• 10:27
  SPEAKER_01: Um one of the things that I was gonna ask you about was one of the articles you published in Durham Surgery, you really looked at different devices and the channels.
• 10:36
  SPEAKER_01: And with things like microneedling and microneedling RF, there really weren't channels, which I think is like dermatologists would be surprised by that.
• 10:44
  SPEAKER_00: Yeah, that's a little bit controversial.
• 10:46
  SPEAKER_00: What we did in the study.
• 10:47
  SPEAKER_00: This was actually uh an in vivo study on the arm of uh Dr.
• 10:51
  SPEAKER_00: Jordan Wang.
• 10:54
  SPEAKER_00: So Jordan uh took all these different devices and we did uh treatments on his arm, and then we did uh OCT, optical coherence tomography, right?
• 11:02
  SPEAKER_00: And looked at the channels and followed them over time.
• 11:05
  SPEAKER_00: So this is not ex-vivo, this is real-time, real stuff.
• 11:09
  SPEAKER_01: Right.
• 11:10
  SPEAKER_00: And uh we found really interesting findings that I think are real.
• 11:15
  SPEAKER_00: Uh we didn't find really much on microneedling.
• 11:19
  SPEAKER_00: Uh there were there were really no discernible channels.
• 11:22
  SPEAKER_00: Uh radio frequency with microneedling, no discernible channels.
• 11:26
  SPEAKER_00: But I must say others have found some mild channels.
• 11:30
  SPEAKER_00: Uh, but what they found with these mild channels is that you need a uh a very small or small molecule liquid to get into this into the channels that they found.
• 11:40
  SPEAKER_00: So a larger molecule like PLLA would not go through uh in that area.
• 11:46
  SPEAKER_00: But I think the most exciting part is that it confirmed what we were seeing with these studies that from the data from Salta and our own work, uh, we found that non-ablative treatments, you know, do provide channels for drug absorption.
• 12:00
  SPEAKER_00: Initially it was thought by others, and the and the great work done by Jill Weibel and Marette Hurdestall out of Denmark, who've done amazing work on uh laser-assisted drug delivery, uh, their early work was just with ablative technologies, but we did the push and and have proven, have proved uh that not ablative approaches do leave demonstrable channels that do allow for drug delivery.
• 12:28
  SPEAKER_00: Now, the greatest uh uh uh the most significant channels that we saw that actually stayed open for over 24 hours was with the fractional CO2.
• 12:38
  SPEAKER_00: Right.
• 12:38
  SPEAKER_00: But people don't generally want to have an ablative procedure.
• 12:42
  SPEAKER_00: Granted, you could do it very conservatively, so there's not much healing time.
• 12:46
  SPEAKER_00: Uh but if you could do it non-ablatively, why not?
• 12:49
  SPEAKER_00: Because uh, you know, it's just much easier for the patient for sure.
• 12:53
  SPEAKER_01: So interesting, really totally fascinating.
• 12:57
  SPEAKER_01: Um I want to switch subjects a little bit and talk to you because of your interest in stem cells about exosomes.
• 13:04
  SPEAKER_01: Um you know, they're they seem to be the new it girl in skincare and it girl in the post-procedure world.
• 13:11
  SPEAKER_01: So, you know, are you using exos?
• 13:13
  SPEAKER_01: What do you well maybe what do you think about them based on your uh knowledge of stem cells?
• 13:19
  SPEAKER_01: Is this the new thing?
• 13:21
  SPEAKER_00: Stem cells have a lot of potential to be of value, uh, but I don't think we've realized that potential as of yet.
• 13:28
  SPEAKER_00: I think it's more hype than fact.
• 13:31
  SPEAKER_00: So, you know, one of the the great things about our field is it's moving quickly, and and one of the bad things about our field is it's moving.
• 13:40
  SPEAKER_00: So sometimes it gets ahead of itself.
• 13:43
  SPEAKER_00: So I'd like to have uh databased decisions, you know, in terms of deciding whether to incorporate something into my practice.
• 13:53
  SPEAKER_00: And while exosomes have a lot of potential, uh I don't think we know exactly what exosomes really are and what they really do.
• 14:04
  SPEAKER_00: And they may be great and they they may be harmful.
• 14:07
  SPEAKER_00: You know, I I just don't know.
• 14:08
  SPEAKER_00: I'm waiting to see.
• 14:09
  SPEAKER_00: And I think this exosome is a catchphrase.
• 14:12
  SPEAKER_00: You know, there are lots of different types of exosomes.
• 14:16
  SPEAKER_00: They carry different products, they are they're made of different things.
• 14:20
  SPEAKER_00: So I think until we drill down a little bit further, uh, you know, I'm holding back personally, uh, but I'm open to the idea that once we have something that's reproducible and proven, uh, it can play a role.
• 14:33
  SPEAKER_00: And I think this whole idea of laser-assisted drug delivery might be very, very good for exosomes once we realize which one to use and which ones work best.
• 14:44
  SPEAKER_01: Yeah.
• 14:44
  SPEAKER_01: I I call it the exosome wars now because you've got you know the mazenchymals versus the platelets versus you know, we've plant exos, there's exos from everything, and so who knows what's the best.
• 14:54
  SPEAKER_00: Aaron Powell I think all that's true.
• 14:56
  SPEAKER_00: And you know, I I think it might be a while before we really know which ones are best.
• 14:59
  SPEAKER_00: Maybe they all work.
• 15:00
  SPEAKER_00: You know, I don't know.
• 15:02
  SPEAKER_00: Perhaps you do.
• 15:03
  SPEAKER_01: I really don't know.
• 15:04
  SPEAKER_01: But I mean, I you know, I think a lot of them have been characterized, but I don't think that a lot of it's been published, and we don't know enough about it, I think, at this point.
• 15:12
  SPEAKER_01: So I agree with you, although I think we all know we do have colleagues who are using them, particularly in the hair arena for, you know, patients with uh androgenetic alopecia and also for treating scars.
• 15:23
  SPEAKER_01: I've seen people on podium showing some, you know, fairly impressive before and after pictures again.
• 15:28
  SPEAKER_01: They're not big studies.
• 15:30
  SPEAKER_01: Uh there was actually one double-blind uh vehicle-controlled study of a patient, uh group of patients who had acne scars they were treating with one of the XO products.
• 15:41
  SPEAKER_01: I can't remember which one it is now, but it's one study.
• 15:43
  SPEAKER_01: I think we do need more studies.
• 15:45
  SPEAKER_00: Yeah, I'm open to it.
• 15:47
  SPEAKER_00: And I I would like to see more.
• 15:50
  SPEAKER_00: But look, you and I have been around long enough to see things come and go.
• 15:54
  SPEAKER_00: So I want to make sure it's not a fad and there's real science behind it.
• 15:59
  SPEAKER_00: And reproducible results and safe results.
• 16:02
  SPEAKER_01: Yeah.
• 16:02
  SPEAKER_01: I think that's the thing.
• 16:03
  SPEAKER_00: You know, like we did with the laser-assisted drug delivery, where you know you got to make sure that you know if you're increasing absorption, uh, you're not doing it something bad.
• 16:12
  SPEAKER_00: Yeah, nothing bad's gonna happen.
• 16:14
  SPEAKER_01: So I I was gonna say, I know you guys recently, a whole group of you, including Joe Weiball and Dover, published some guidelines around laser-assisted drug delivery.
• 16:23
  SPEAKER_01: I ran across that somewhere, which I thought was very timely and very wise.
• 16:29
  SPEAKER_01: Because again, it's relatively new.
• 16:32
  SPEAKER_01: And you know, it's we need some guidelines like that.
• 16:35
  SPEAKER_01: It'd be lovely to see something like that coming out on exosomes.
• 16:40
  SPEAKER_00: It will at some point.
• 16:41
  SPEAKER_01: Yeah, of course it will.
• 16:42
  SPEAKER_01: Of course.
• 16:43
  SPEAKER_01: And there's so much money in all of this, as you know.
• 16:45
  SPEAKER_01: You know, cosmetic companies are very interested in this technology and and how they can customize these exosomes and put the things they want to put in them.
• 16:55
  SPEAKER_00: Yeah, but uh the downside of that is there are also very few controls over what can be Absolutely.
• 17:01
  SPEAKER_00: Uh what can be produced uh and what could be promoted.
• 17:05
  SPEAKER_01: Yeah, yeah, yeah, absolutely.
• 17:07
  SPEAKER_01: Well, they're they're in the cosmetic market, so I think that's totally fascinating in and of itself.
• 17:12
  SPEAKER_01: Let's kind of talk for a few minutes more in the skincare arena, because this is sort of an area that you I know have expertise in, and I think you spoke at our meeting a couple years ago about it.
• 17:23
  SPEAKER_01: But one of the things that cosmetic companies are so interested in, Roy, and it always amazes me, is everybody wants to be in the pre and post procedure space.
• 17:31
  SPEAKER_01: It is I can't every company that I consult with is like, well, what about pre- and post-procedure?
• 17:36
  SPEAKER_01: And I'm like, you know, there's a lot of companies that have, I think, done a good job in this area.
• 17:41
  SPEAKER_01: And kind of this niche is is, I don't know, it's just of great interest to the cosmetic company.
• 17:48
  SPEAKER_01: So, and I know you work with tons of these companies too.
• 17:50
  SPEAKER_01: So, you know, talk about what do you see the pre and post procedure cosmetic uh products?
• 17:58
  SPEAKER_01: How how do you use them?
• 17:59
  SPEAKER_01: How do you decide what you're gonna use for a patient?
• 18:02
  SPEAKER_01: Because you do probably more laser resurfacing or at least as much as anybody in the country.
• 18:07
  SPEAKER_01: And that's always a question that's asked on the podium is from people in the audience is what do you what do you use?
• 18:13
  SPEAKER_00: Well, you have first of all, just uh by bit of background, uh there are several goals you have to keep in mind when you're choosing uh what you're gonna use on the skin uh before, during, and after your procedure.
• 18:26
  SPEAKER_00: Uh first of all, you want something that's gonna be helpful, that's gonna facilitate the healing.
• 18:32
  SPEAKER_00: Uh you want something that's non-cometogenic, for sure.
• 18:36
  SPEAKER_00: Uh you want something that that could potentially improve your outcome.
• 18:40
  SPEAKER_00: Uh these are all things that are you know part of the goals and establishing what you're going to use in skincare.
• 18:47
  SPEAKER_00: Now I got I I particul wasn't particularly interested early on uh in skincare.
• 18:52
  SPEAKER_00: I didn't think wasn't necessarily sure that it made a difference, but as we began to do more and more ablative resurfacing, you know, we would develop pro patients would develop problems that would delay healing.
• 19:03
  SPEAKER_00: You know, for example, you know, putting aquive on a re ablative skin, a skin that's been ablated, uh, patients would come back and it would be cometogenic.
• 19:14
  SPEAKER_01: Of course.
• 19:15
  SPEAKER_00: So they would break out and you know, all of a sudden I've got a secondary problem I have to deal with.
• 19:20
  SPEAKER_00: Right.
• 19:20
  SPEAKER_00: So I wasn't just worrying about them re-epithelializing, I was worried about managing these breakouts.
• 19:27
  SPEAKER_00: And, you know, uh it wasn't good for the patient, and it certainly wasn't good for me, and it was it was a hindrance.
• 19:34
  SPEAKER_00: So uh we began to look uh for products uh early on uh that would be helpful, that would be non-comedogenic, but I a great believer in moist wound healing.
• 19:45
  SPEAKER_00: You know, before I got into laser field, I was a wound healing guy at down at the University of Miami working with Bill Eaglestein in his lab.
• 19:52
  SPEAKER_00: You know, and my first paper ever published was on topical skin care and wound healing, you know, where we try different vehicles and different products on on pigs and and man uh evaluated the rate area put the lealization.
• 20:07
  SPEAKER_00: So I became a believer in moist wound healing, but again, you don't want to end up with anything communogenic or anything problematic.
• 20:15
  SPEAKER_00: So um back in the day, Skin Medica, you know, had a great product that uh was working well for us in the healing phase, they phased that out.
• 20:25
  SPEAKER_00: Uh so then we began to use the uh soothe and protect from elastin uh for our ablative procedure.
• 20:32
  SPEAKER_00: And then along the lines of what we're doing with laser-resisted drug delivery, uh we began to look at various different things uh to facilitate healing and to enhance outcomes in the non-oblative arena.
• 20:44
  SPEAKER_00: So uh again, finding something in the ablative for the ablative procedures that uh would not be cometogenic and would enhance healing by being moist uh was particularly important to us.
• 20:55
  SPEAKER_00: And then in the non-oblative area, uh we have f found that there are different uh products, and I don't have objective criteria to to prove this, but just having a ton of experience can say uh that some of these products do facilitate healing.
• 21:12
  SPEAKER_00: Uh they do allow for uh an enhanced outcome with uh pre-treatment.
• 21:18
  SPEAKER_00: Uh, for example, we use the elastin nectar product uh for a couple of weeks prior to a procedure.
• 21:24
  SPEAKER_00: We find this very helpful.
• 21:26
  SPEAKER_00: And in the in the post-treatment phase, uh depending upon the procedure we do, let's say we're using a 1927 folium laser, the skin gets dry.
• 21:35
  SPEAKER_00: They get microscopic epidermal necrotic debris, these little pepper spots on the skin.
• 21:40
  SPEAKER_00: And you know, you want to facilitate that removal.
• 21:43
  SPEAKER_00: So uh there are various things that you can do there uh that I think are particularly helpful.
• 21:49
  SPEAKER_00: Uh so we'll use like a hyaluronic acid topically, we'll use the nectar post treatment, and we'll use a moisturizer that's not going to be cometogenic.
• 21:58
  SPEAKER_00: And these are all very, very helpful.
• 22:00
  SPEAKER_00: Things and this leads to you know long-term skincare that we advise for patients that will help maintain the results that we've achieved from uh the the laser treatments that we performed.
• 22:13
  SPEAKER_00: So from somebody who was basically ignorant on skincare uh and not necessarily appreciating what it can do, uh I think it's become a very, very important part of our treatment process, allowing for uh faster healing and better outcomes.
• 22:32
  SPEAKER_01: What about things like growth factors?
• 22:34
  SPEAKER_01: Do you use any growth factor products?
• 22:37
  SPEAKER_00: Uh not necessarily.
• 22:39
  SPEAKER_00: Um, unless you consider you know a nectar, uh a growth factor product.
• 22:44
  SPEAKER_01: I'm thinking of something like TNS or, you know.
• 22:47
  SPEAKER_00: Yeah, we've used the TNS in the past.
• 22:49
  SPEAKER_00: And I think that could be helpful as well.
• 22:51
  SPEAKER_01: Yeah, I thought that you had.
• 22:53
  SPEAKER_01: Um what about things for mitigating any complications, for example, hyperpigmentation?
• 23:00
  SPEAKER_01: Like maybe where when in the sequence might you start something like that?
• 23:05
  SPEAKER_00: So um I'm not a big hydrokinone fan.
• 23:08
  SPEAKER_00: Um, I find it in the healing phase that it can be very irritating.
• 23:12
  SPEAKER_01: Irritating, sure.
• 23:13
  SPEAKER_00: And the more irritation one gets in the healing phase, the more likely they are to get post-inflammatory hyperpigmentation.
• 23:21
  SPEAKER_00: Uh, but I do use uh some trendzemic acid, or at least products that contain trend eczemic acid uh topically.
• 23:29
  SPEAKER_00: So uh again, uh I'm not a last in salesman, but uh they do have a product, uh luminate, uh, which is containing some trenoxemic acid and non-irritating uh that we will sometimes use if we see PIH starting to develop.
• 23:47
  SPEAKER_01: Gotcha.
• 23:48
  SPEAKER_01: Yeah, that's a good one.
• 23:49
  SPEAKER_01: I mean, we have so many good non-hydroquinone options now.
• 23:52
  SPEAKER_01: That's one place I think we've got to do that.
• 23:53
  SPEAKER_00: Yeah, and some of the vitamin Cs can be helpful for that too.
• 23:56
  SPEAKER_01: We've got some nice vitamin C's that you can use, and you know, there's um lots of they are all these combo products with various uh ingredients that can lighten the skin, niacinamide and all of that together with the phone.
• 24:08
  SPEAKER_00: Yeah, but one of the things we found, Patty, in the in the healing phase, the skin barrier is different.
• 24:12
  SPEAKER_01: Absolutely.
• 24:14
  SPEAKER_00: So uh, you know, there are some products that where patients tell us, well, I was great, I could use this before the procedure, but now I can't use it.
• 24:22
  SPEAKER_00: Well, you know, stratum corneum is different, you know, the penetration's different, you know, your skin's going through a healing phase.
• 24:29
  SPEAKER_00: I mean, you'll get back to it, you'll be able to use it in the future, but you can't use it in the healing phase.
• 24:33
  SPEAKER_01: Right.
• 24:34
  SPEAKER_00: So we've got to find something that's uh tolerable, not harmful, and potentially beneficial.
• 24:41
  SPEAKER_01: Yeah.
• 24:41
  SPEAKER_01: No, there's no doubt about it.
• 24:43
  SPEAKER_01: And as you said, it it can be your best friend or it can be your worst enemy if you use the wrong way.
• 24:48
  SPEAKER_01: Absolutely true.
• 24:49
  SPEAKER_01: That's that's so true.
• 24:51
  SPEAKER_01: Uh I've had somebody tell me once if a patient comes back after a laser procedure with some weird thing you can't figure out, they put something on there they shouldn't have put on there, and that is so true.
• 25:02
  SPEAKER_00: And that's one of the reasons why I try to control what patients use afterwards.
• 25:06
  SPEAKER_00: Good advice.
• 25:07
  SPEAKER_00: You know, they some patients complain, they say, well, why do I have to you know spend this money on these products?
• 25:12
  unknown: Right.
• 25:13
  SPEAKER_00: And basically my answer is I want to know what you're using.
• 25:16
  SPEAKER_00: Exactly.
• 25:16
  SPEAKER_00: I want to have some control because if you're having a problem, you know, we'll know what we can stop.
• 25:21
  SPEAKER_00: But we we're recommending what's been tried and true, which works for most people.
• 25:26
  SPEAKER_00: Things don't work for everybody.
• 25:27
  SPEAKER_00: Every now and then somebody's gonna have a reaction.
• 25:30
  SPEAKER_00: Uh but we've have found that we've limited uh the problems that people see, and we we do enhance recovery uh by using a regimen that we're comfortable with that works.
• 25:41
  SPEAKER_00: And different regimens for different procedures that we do.
• 25:44
  SPEAKER_01: Do you use antioxidants, Roy?
• 25:47
  SPEAKER_00: Oh, yeah, I use vitamin C.
• 25:50
  SPEAKER_00: I found that helpful.
• 25:51
  SPEAKER_01: So interesting.
• 25:51
  SPEAKER_01: I know Joe Weibel's done some good work on that as well, looking at post-procedure and helping with the healing process.
• 25:59
  SPEAKER_01: Very interesting.
• 26:00
  SPEAKER_01: Let's finish by talking for a second about injectables, because I know you do tons of lasers, but you also do a lot of injectables.
• 26:08
  SPEAKER_01: And how do you deal with the injectable patients in terms of skin care?
• 26:12
  SPEAKER_01: Do you are you an Arnica person?
• 26:14
  SPEAKER_01: Are you uh do you have some special things that you like to give them?
• 26:18
  SPEAKER_01: I mean, I guess you've got your lasers.
• 26:20
  SPEAKER_00: If they bruise, you can always Yeah, if they bruise, you know, we developed a technique a while back, uh, you know, using the pulse style laser, the VP for bruising, which uh is is is good and bad.
• 26:31
  SPEAKER_00: It's great for the patient, but you know, all of a sudden we've got people calling us up, they want their bruises treated, so you've got to add the patient into your schedule.
• 26:38
  SPEAKER_01: So it's great to have that option.
• 26:41
  SPEAKER_01: Be careful with the habitat.
• 26:43
  SPEAKER_01: Yeah, absolutely.
• 26:44
  SPEAKER_00: Yeah, I think you know Arnica can be helpful.
• 26:48
  SPEAKER_00: Uh there are some topical products, uh, again, the elastin uh enhancer.
• 26:53
  SPEAKER_01: They're enhance, yeah.
• 26:54
  SPEAKER_00: I like that product a lot.
• 26:56
  SPEAKER_00: Can minimum ice and bruising as well.
• 26:58
  SPEAKER_00: Uh the other thing we we use are are these uh Arnica patches.
• 27:04
  SPEAKER_00: Uh they really work.
• 27:06
  SPEAKER_00: Uh, you know, Alleghen bought this company and then sat on the product and it's no longer distributing it.
• 27:13
  SPEAKER_00: But we saw some great results.
• 27:14
  SPEAKER_00: We have patients who uh are very disappointed that it's no longer available because we I felt it made a big, big difference.
• 27:21
  SPEAKER_00: And I hope somebody out there resurrects the product and uh will allow for uh this to be distributed again.
• 27:29
  SPEAKER_00: Uh because we would use this routinely, uh our patients post-fillers, and found it very, very helpful.
• 27:35
  SPEAKER_00: More helpful than the topical or the oral arnica.
• 27:39
  SPEAKER_01: That's so interesting.
• 27:40
  SPEAKER_01: I I don't know that I knew about that Arnica patch.
• 27:43
  SPEAKER_01: Oh, I do remember that.
• 27:44
  SPEAKER_01: That was a long time ago, though.
• 27:46
  SPEAKER_00: Uh that's just in the past year that uh Allocant stopped distributing it.
• 27:50
  SPEAKER_01: That they stopped distributing it, yeah.
• 27:51
  SPEAKER_01: I mean, but we haven't had that for a while.
• 27:53
  SPEAKER_00: So if anybody out there is listening, is looking for an opportunity, there it is.
• 27:57
  SPEAKER_01: Somebody, yeah, somebody please buy it and get it back out in.
• 28:01
  SPEAKER_01: Um just one last question, because we're almost out of time.
• 28:04
  SPEAKER_01: What do you do with your post-surgical patients?
• 28:06
  SPEAKER_01: Um, in terms of skin care.
• 28:08
  SPEAKER_01: I know.
• 28:09
  SPEAKER_01: Well, first, what do you treat the post-surgical wounds with?
• 28:11
  SPEAKER_00: And then as they start healing and the sutures come out, do you let them start their skin care, their retinoids, their hydroxyacids, their So somebody coming in for like excisional surgery, whether it be a BOES procedure or other type of surgery, uh, you know, I'm a big believer in voice wound care, as I mentioned earlier.
• 28:28
  SPEAKER_00: So uh I I simply use aquaphor healing ointment, you know, for them.
• 28:32
  SPEAKER_00: Uh I'm a big believer in silicone, uh topical silicone gels.
• 28:38
  SPEAKER_00: I I really do think that makes a difference.
• 28:41
  SPEAKER_01: They do.
• 28:41
  SPEAKER_00: Uh there's a a surgeon up at Mass General, uh, Matthew Donlin, uh, who has uh done some great work with topical silicone and um made a believer out of me.
• 28:52
  SPEAKER_00: So every patient who's having a surgical procedure and you know will will be given silicone to use once the stereotyps come off.
• 29:01
  SPEAKER_00: I think that makes a big difference.
• 29:03
  SPEAKER_00: And of course, we do a lot of laser work on the scars uh to make them better as well.
• 29:08
  SPEAKER_00: So but scarring is a is a big problem.
• 29:11
  SPEAKER_00: I know and uh topical silicone is part of our regimen.
• 29:16
  SPEAKER_00: Patients coming with hypertrophic scars, you know, they'll get their laser treatment, they'll get the well ask them to massage the scar, uh, and you know, we'll give the silicone as well, as well as uh intralesionals, uh mostly 5FU under the scars as well.
• 29:32
  SPEAKER_01: Right.
• 29:33
  SPEAKER_01: So interesting.
• 29:34
  SPEAKER_01: Everybody has their favorites, but it's great to hear from somebody who has a lot of experience and has done a lot.
• 29:41
  SPEAKER_01: All right, so we're wrapping at 30 minutes.
• 29:43
  SPEAKER_01: I told you we would.
• 29:44
  SPEAKER_01: I'm so appreciative of getting on.
• 29:46
  SPEAKER_01: Well, I knew it would be, and I love to interview people like you because I just asked a question and I don't have to say anything.
• 29:51
  SPEAKER_01: It's such a wealth of information.
• 29:54
  SPEAKER_01: I so appreciate it, though.
• 29:56
  SPEAKER_01: You know, I really do.
• 29:57
  SPEAKER_01: I know how busy you are, but I'm sure everybody's gonna love this episode and learn a lot like I did.
• 30:03
  SPEAKER_00: I've really enjoyed listening to the other episodes.
• 30:05
  SPEAKER_01: Thanks.
• 30:05
  SPEAKER_01: We've had a good time doing it.
• 30:07
  SPEAKER_01: We really have.
• 30:07
  SPEAKER_01: We've interviewed some great people.
• 30:09
  SPEAKER_01: We've tried to give people sort of a 360 view of skincare.
• 30:12
  SPEAKER_01: We talk to people in industry and talk about their end of it, and then people like you who are experts, like everybody wants to know what Roy Geronimous uses.
• 30:20
  SPEAKER_01: So thank you for sharing all of your knowledge with our listeners and everybody.
• 30:24
  SPEAKER_01: Have a great day.
• 30:25
  SPEAKER_01: Check us out again at Science of Skincare Summit.com if you're interested in our meeting.
• 30:30
  SPEAKER_01: Thanks again, Roy.
• 30:31
  SPEAKER_00: My pleasure, Patty.
• 30:33
  SPEAKER_00: Thank you.