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Fillers: Past, Present, and Future with a Global Expert · The Science of Skin

• 0:09
  SPEAKER_02: Hello and welcome to Skincare Confidential, a podcast supporting the Science of Skincare Summit, an annual educational conference occurring in Austin September 5th through the 7th, 2025.
• 0:20
  SPEAKER_02: My name is Dr.
• 0:21
  SPEAKER_02: Ted Lane.
• 0:21
  SPEAKER_02: I am your host for today, and I am so pleased to introduce my guest, uh Dr.
• 0:27
  SPEAKER_02: Michael Gold.
• 0:28
  SPEAKER_02: Dr.
• 0:28
  SPEAKER_02: Gold is owner of the Gold Skin Care Center and the Tennessee Clinical Research Center in Nashville, Tennessee.
• 0:36
  SPEAKER_02: He is also the co-founder and co-director of a wonderful aesthetic and medical conference called Scale that occurs in Nashville every year.
• 0:44
  SPEAKER_02: In fact, this will be your 20th year.
• 0:45
  SPEAKER_02: So congratulations on 20 amazing years.
• 0:48
  SPEAKER_00: Thanks.
• 0:49
  SPEAKER_00: It's uh it's a pleasure to be with you on this.
• 0:51
  SPEAKER_00: Um, yeah, um, Scale is scale started with 20 people, right?
• 0:57
  SPEAKER_00: You you know, 20 years ago, and we'll be over 1,500, 1800, something like that this year.
• 1:04
  SPEAKER_00: So amazing.
• 1:05
  SPEAKER_00: It's it's sort of had taken on a life of its own, which is always nice.
• 1:09
  SPEAKER_00: And again, I get a lot of the credit with Dr.
• 1:12
  SPEAKER_00: Brian Bisman, who's an oculoplastic surgeon here, but we got a great team, as you know, the teams.
• 1:17
  SPEAKER_00: You do um who now oversee your great science of skincare summit.
• 1:22
  SPEAKER_00: Yeah, and um they're the they're great, um, compass management um for all you listening.
• 1:28
  SPEAKER_00: Um, they do a great job and they make our lives easy, which is really nice and um and seamless is all that you can ever want.
• 1:37
  SPEAKER_00: So um, yeah, so we we run a really big educational event, and the nice part like of ours as is with yours, Austin is a great place to hang out, yeah.
• 1:48
  SPEAKER_00: And and Nashville is also a great place to hang out.
• 1:52
  SPEAKER_02: I mean, but that's just one of many meetings that you direct, right?
• 1:55
  SPEAKER_02: Because you direct so many internationally as well.
• 1:57
  SPEAKER_00: Um we run we run something called the Five Continents Meeting.
• 2:01
  SPEAKER_00: The concept was we were going to take that to a different continent every year.
• 2:05
  SPEAKER_00: Somehow we never left Europe.
• 2:06
  SPEAKER_00: So we've done a couple in Asia because one of our partners is from Hong Kong, but that'll be um May 27th to the 29th, or I think that's it, in Lisbon, Portugal.
• 2:18
  SPEAKER_00: So it's called the Five C C meeting, um, and that's in its 17th year.
• 2:23
  SPEAKER_00: And um, then I run an international nonprofit group called Dazzle.
• 2:29
  SPEAKER_00: It's the Dermatology Aesthetics Surgical International League.
• 2:34
  SPEAKER_00: Um, and we take that meeting everywhere around the world.
• 2:37
  SPEAKER_00: So we just finished in November in Hanoi, um, and this is like year 15 or 16 for that.
• 2:43
  SPEAKER_00: And then in October, we're gonna be going to Cape Town.
• 2:47
  SPEAKER_01: Yeah.
• 2:48
  SPEAKER_00: Um and we'll have some fun there too.
• 2:51
  SPEAKER_02: Oh, yeah, I'm excited to go to Cape Town.
• 2:52
  SPEAKER_02: That's gonna be an amazing meeting as well.
• 2:54
  SPEAKER_02: So, so as you can tell, Dr.
• 2:56
  SPEAKER_02: Gold is a man of many talents and and not much sleep uh because he does so much.
• 3:02
  SPEAKER_02: He shows me his calendar at meetings and it raises my blood pressure.
• 3:05
  SPEAKER_02: I have no idea how he keeps up with it.
• 3:09
  SPEAKER_00: It's all on paper.
• 3:10
  SPEAKER_00: It's not on it's not on the phone or anything like that.
• 3:12
  SPEAKER_00: You gotta keep it all on paper.
• 3:15
  SPEAKER_02: Well, we are gonna talk today about one of Dr.
• 3:17
  SPEAKER_02: Gold's interests, and that is dermal fillers.
• 3:20
  SPEAKER_02: He is a true international expert.
• 3:22
  SPEAKER_02: He's an expert in many things, but we decided today to really focus on dermal fillers because not only does he know all about them and lecture on them, he does all the clinical trials, he lectures internationally, he knows what's coming from other countries and what's happening in other countries.
• 3:37
  SPEAKER_02: So I just thought there's no one more perfect than than Dr.
• 3:41
  SPEAKER_02: Gold to really talk about this for our audience.
• 3:43
  SPEAKER_02: So thank you again for being on.
• 3:44
  SPEAKER_02: Thank you for having me.
• 3:46
  SPEAKER_02: Let's let's jump in.
• 3:47
  SPEAKER_02: I mean, I think if you look at what's happening in the United States, our most recent filler that that was new was dermavive, right?
• 3:55
  SPEAKER_02: The the the booster or skin vee, I should say.
• 3:57
  SPEAKER_02: The booster.
• 3:58
  SPEAKER_00: Skin beave, right.
• 3:59
  SPEAKER_00: And and that's an interesting thing.
• 4:01
  SPEAKER_00: Um, interesting filler, because that was the first of the fillers in the U.S.
• 4:05
  SPEAKER_00: that looked at what we call skin quality, right?
• 4:08
  SPEAKER_00: Small, you know, injections that contain the these that's a hyaluron acid, and we know hyaluron acid benefits the skin quality, and their their clinical trials prove that point.
• 4:20
  SPEAKER_00: And I think that's uh that's interesting.
• 4:22
  SPEAKER_00: And if you look at the history of these skin boosters, um, there are lots of them, right?
• 4:29
  SPEAKER_00: And and um the first one was actually a Goutderma product, which was called Skin Booster.
• 4:35
  SPEAKER_00: Um, and it just it never came to the U.S.
• 4:38
  SPEAKER_00: Um for whatever reason.
• 4:40
  SPEAKER_00: It was just not the right time to bring that product to the U.S.
• 4:45
  SPEAKER_00: FDA had a hard time at that when it first came out 10 or 15 years ago now, trying to figure out how to develop scales and so forth.
• 4:56
  SPEAKER_00: Um, so yeah, I mean we are, I always tell people, and you understand this, we have lots of fillers in the United States, whether they're HA fillers, hyaluron acid fillers, whether they're the biostimulatory fillers, which we have too.
• 5:13
  SPEAKER_00: Um, and and you know, we'll maybe talk about an adipose-derived filler product as well.
• 5:19
  SPEAKER_00: Um, we have a lot of fillers, but compared to the rest of the world, we have very few fillers.
• 5:26
  SPEAKER_00: And so depending on where where you live and you know what the regulatory authorities have allowed.
• 5:34
  SPEAKER_00: Um, you know, I used to show a slide when I lectured at one point, I think we had like 10 fillers in the US, and there were 300 fillers available in Europe.
• 5:43
  SPEAKER_00: Yeah, right.
• 5:44
  SPEAKER_00: If you go to the Asian market, triple that, right?
• 5:48
  SPEAKER_00: As far as the number of available fillers.
• 5:51
  SPEAKER_00: That all sounds good, um, but coming to the US is a lot harder.
• 5:57
  SPEAKER_00: We are we are we are so much more stringent in allowing filler products to get through the FDA.
• 6:03
  SPEAKER_00: The actually in Europe now, it's almost becoming as hard.
• 6:08
  SPEAKER_00: So for years and years and years, we used to say in the US, it's safety first, efficacy second.
• 6:15
  SPEAKER_00: And in Europe, it was get the products out and worry about safety later.
• 6:20
  SPEAKER_00: And a lot of those products went away because adverse events, ingredients that weren't appropriate, whatever it was.
• 6:27
  SPEAKER_00: Um, and then the European Union regulatory bodies changed all the rules.
• 6:32
  SPEAKER_00: So it forced all the filler companies to go actually, if they didn't have clinical work behind them, to they had to prove to the European Union that they were not only efficacious, but they were safe.
• 6:44
  SPEAKER_00: And so that was actually a good thing.
• 6:46
  SPEAKER_00: Um, many, many docs, you know, boohoo the FDA and all that what they do, and you do clinical trials and I do clinical trials.
• 6:55
  SPEAKER_00: FDA is there for a reason, right?
• 6:57
  SPEAKER_00: It's to protect the patient and to do safety.
• 7:00
  SPEAKER_00: So again, it may be harder and it may be more expensive to get a filler developed in the US, but for the you know, 99.9% of the time, we know it's going to be a safe product.
• 7:11
  SPEAKER_00: Yeah.
• 7:11
  SPEAKER_00: And I think that's really important.
• 7:13
  SPEAKER_02: You mentioned the the adipose-derived filler, which is a really interesting product, RENUVA, right?
• 7:19
  SPEAKER_02: And so can you just talk to us about that, Michael, and and you you were involved, and it's just so different than anything we've got.
• 7:26
  SPEAKER_00: Yeah, so RANUVA is a is from is a is they don't actually call it a dermal filler.
• 7:31
  SPEAKER_00: It's an it's an acellular adipose derived matrix.
• 7:34
  SPEAKER_00: Um, it comes from a company, and I will use the name here because it's a little bit of a story, the musculoskeletal transplant foundation, which is the world's largest tissue bank, and they're based in New Jersey.
• 7:46
  SPEAKER_00: And about almost 10, 12 years ago, they I got a phone call when I come visit them because they have the donor, the donor that is donating their body, their whatever.
• 7:59
  SPEAKER_00: And it's all about the the maintaining the integrity and the sanctity and everything.
• 8:05
  SPEAKER_00: So less than 2% of the tissue that they actually get actually goes out into the uh marketplace.
• 8:12
  SPEAKER_00: Uh, my wife is a beneficiary of an MTF graft in her ankle, and so it becomes a little more personal.
• 8:18
  SPEAKER_00: Um, but they had all these things, and the fat component that were donated were not being utilized.
• 8:27
  SPEAKER_00: And somebody said we might as well think about that.
• 8:30
  SPEAKER_00: And so, over the course of a tremendous amount of clinical work that they did in-house, and then through what we've done with them through our clinical studies, they've shown that we can take this adipose matrix, inject it in places that have volume loss, and it over time it turns from a acellular matrix, it has all the growth factors for fat and for blood to turn into fat.
• 8:58
  SPEAKER_00: And it's not overgrowing and all that.
• 9:01
  SPEAKER_00: And I now have patients eight years out, nine years out, um, that have done really well with scars and with depressions that we've taken care of.
• 9:10
  SPEAKER_00: But it can be used on the face, it can be used on the hands, it can be used on the buttocks.
• 9:16
  SPEAKER_00: I stick to the face and hands.
• 9:18
  SPEAKER_00: Um, people, you know, will do other things with it, but it's it's a remarkable product if you haven't ever tried it or used it.
• 9:26
  SPEAKER_00: And I think, you know, more power to the company that they have created a whole germ and plastic surgical weight unit now that actually goes around and we teach this um product.
• 9:38
  SPEAKER_00: It's only available in the US and in the UAE, which is also interesting.
• 9:45
  SPEAKER_01: Interesting.
• 9:46
  SPEAKER_00: And and um, and I've given courses on this all over the place.
• 9:49
  SPEAKER_00: And I think again, once you get your hands on it and realize what the benefits are, it becomes something you want to use and you see the benefits in your patients.
• 9:58
  SPEAKER_02: Yeah, you introduced me to this product, and it's it's really it fits right in with the idea of regenerative medicine, which is kind of where Durham is going, and especially aesthetic derm, because it really impels the body to produce more fat.
• 10:10
  SPEAKER_02: And so it's regenerative in that way.
• 10:12
  SPEAKER_02: And as you said, growth factors, and and just to remind remind people, it is acellular.
• 10:16
  SPEAKER_02: This is not, you know, you're not taking tissue for someone with their DNA uh and and and their signature cells, none of that.
• 10:24
  SPEAKER_02: It's purely acellular.
• 10:26
  SPEAKER_02: So it's so interesting because that is is kind of biostimulatory regenerative, and then we also have sculpture, for example, and and PMMA products.
• 10:36
  SPEAKER_02: And and what do you think about those, Dr.
• 10:38
  SPEAKER_00: Well we've got a lot.
• 10:39
  SPEAKER_00: So in the U.S., obviously, we have sculpture poly P L L A.
• 10:43
  SPEAKER_00: Um, outside of the U.S., there are a lot of these, PMLA, PRNA, uh or L A, and there are a bunch of these that are sculpture-like, if you will.
• 10:55
  SPEAKER_00: Um, I've heard rumors that there's going to be another one trying to enter the U.S., so we'll see what that is all about in the PLLA world.
• 11:05
  SPEAKER_00: Um, these are biostimulatory products.
• 11:08
  SPEAKER_00: I think the biggest uh hurdle that sculpture had to overcome at the beginning, it was easier to come to the U.S.
• 11:16
  SPEAKER_00: as an HIV lipoatrophy filler or biostimulatory product.
• 11:22
  SPEAKER_00: And those of us that did the trials and then did the took care of these patients, we we saw this amazing benefit, right?
• 11:30
  SPEAKER_00: And then a couple years later that the cosmetic indication was approved.
• 11:35
  SPEAKER_00: I think what we've learned about sculpture over the years is the way we can change the dilutions, right?
• 11:42
  SPEAKER_00: We used to have to put a certain amount of this, say, you know, and then we had to wait, keep it overnight.
• 11:47
  SPEAKER_00: Yeah.
• 11:48
  SPEAKER_00: Um, we now dilute it a lot more.
• 11:50
  SPEAKER_00: We can use the it immediately after we reconstitute it.
• 11:55
  SPEAKER_00: Um, and again, I think what the strengths of these companies have been is the science behind them now, right?
• 12:03
  SPEAKER_00: So again, we were just going, okay, well, here it is.
• 12:06
  SPEAKER_00: And we have so much data um on how PLLA and the other biostimulatory fillers work, um, producing not only collagen and elasting and improving the skin quality, um, but how well they last.
• 12:23
  SPEAKER_00: And I think that's really helpful for our patients and for us as clinicians to know that yes, it's not a new product, but there's so much new about it.
• 12:33
  SPEAKER_00: Um, and again, changing the label was important for them.
• 12:38
  SPEAKER_00: And so we have all that stuff.
• 12:40
  SPEAKER_00: The other biostimulatory product, obviously, we have is radius or or you know, or calcium hydroxylapetite.
• 12:46
  SPEAKER_00: And it is also gone undergone a whole transformation, right?
• 12:51
  SPEAKER_00: When it first came out, and you're too young for this, but everybody said this, we're injecting bone, right?
• 12:57
  SPEAKER_00: And and and and then you know, David Goldberg actually did the first study looking at the transformation of calcium hydroxylate into collagen one and type type one and three.
• 13:09
  SPEAKER_00: But since then, I mean, again, this the stimulatory benefits of this and how it can work.
• 13:16
  SPEAKER_00: So it's a great product.
• 13:17
  SPEAKER_00: Again, we use diluted Radius a lot and and in different concentrations to treat outside the face, it with the face.
• 13:26
  SPEAKER_00: And again, I think the kudos to the companies that have done the work um to show us the best ways to best injection techniques for this, and our patients are much happier now with how we use these products.
• 13:40
  SPEAKER_00: So, what's out there, so you know what's coming, right?
• 13:44
  SPEAKER_00: So there are several European Middle Eastern companies that are now owned by us in the US, not me, but companies in the US, I wish it was me, um, who have who have decided, okay, let's take the calcium hydroxylapetite and mix it with hyaluronic acid, right?
• 14:06
  SPEAKER_00: And so we get the initial benefit of an HA, that'll go away over time, and then we get the long-term effects of what the calcium hydroxyl appetite can be.
• 14:20
  SPEAKER_00: That it it's they're available around the world, right?
• 14:24
  SPEAKER_00: They're not available in the US, and we're just waiting for clinical trials to start.
• 14:29
  SPEAKER_00: I think some of the companies are are dealing with, you know, how do we determine what's, you know, I to me personally, I don't know why they haven't started yet.
• 14:38
  SPEAKER_00: It's frustrating.
• 14:38
  SPEAKER_00: Um I if as as somebody who does this work like you, if something goes wrong in a clinical trial, is it the hydro is it the calcium hydroxylapatite or is it the HA or is it the combination?
• 14:51
  SPEAKER_00: And I think in my brain, that's sort of what we're we're trying to figure out with the FBA is so we can move ahead with these trials.
• 14:59
  SPEAKER_00: But there are several companies that are really good companies that are trying to bring these products to the US.
• 15:05
  SPEAKER_01: Yeah.
• 15:06
  SPEAKER_00: Um, and again, if you it that's the Euro world, in the Asian world, they already also exist.
• 15:12
  SPEAKER_00: Um, and so that's good.
• 15:13
  SPEAKER_00: There's another product um coming from Europe that has um I'm just drawing a blank on its name, but it's Alance is the brand name.
• 15:23
  SPEAKER_01: Okay.
• 15:23
  SPEAKER_00: And it's it's a fascinating biostimulatory product because in Europe they have one they they call them one, two, three, four, and five, right?
• 15:34
  SPEAKER_00: And they're spheres that basically turn into biostimulatory agents that create new collagen.
• 15:41
  SPEAKER_00: Wow.
• 15:41
  SPEAKER_00: But at two, if it's a two, at two years it turns off.
• 15:45
  unknown: Okay.
• 15:45
  SPEAKER_00: At three years, they turn off.
• 15:47
  SPEAKER_02: So the number corresponds to when it turns off.
• 15:50
  SPEAKER_02: Right.
• 15:51
  SPEAKER_00: So you know if you want something to last two years, you're gonna pick number two, right?
• 15:54
  SPEAKER_00: That's incredible.
• 15:55
  SPEAKER_00: And so there was always this thing of coming to the U.S.
• 15:59
  SPEAKER_00: And again, I think the that we finally have the green light that at some point in maybe 2025 or 2026, we're gonna be able to start testing this product in the United States.
• 16:09
  SPEAKER_00: But again, globally, it's already out there.
• 16:12
  SPEAKER_01: Okay.
• 16:12
  SPEAKER_00: Um, and you know, so those are really good.
• 16:15
  SPEAKER_00: We do have a permanent filler in the US called Bellafill.
• 16:18
  SPEAKER_00: Um, it is um, you know, it it it's good, and it's got an FDA approval for where we want it, but also for acne scars.
• 16:29
  SPEAKER_00: Um, you got to be very careful, it's permanent, right?
• 16:32
  SPEAKER_00: So, but in the right hands and the right indications, it works really well.
• 16:37
  SPEAKER_00: In the wrong hands, I've had people come to me that had injections under the eyes and tear troughs.
• 16:43
  SPEAKER_00: It's not where it there's certain places you don't go, right?
• 16:47
  SPEAKER_00: And if you know the do-not-go places, it's perfectly safe as well.
• 16:52
  SPEAKER_00: Um, so that's really good.
• 16:53
  SPEAKER_00: I think the other thing that I really want to stress, there are a lot of fillers in Asia.
• 17:00
  SPEAKER_00: Um, China has a whole bunch, South Korea has a ton.
• 17:05
  SPEAKER_00: Um, a lot of them are going to be, especially from Korea, will be coming to the United States at some point.
• 17:12
  SPEAKER_00: Um, again, they have HAs, they have the PLLAs and PLR and you know, all those different initials coming with it for biostimulatory props purposes and the calcium hydroxyapatites.
• 17:26
  SPEAKER_00: In order for a company to come here to the US, they have to do, they have to have what's called GMP, good manufacturing process or that's approved in the US.
• 17:38
  SPEAKER_00: Right?
• 17:38
  SPEAKER_00: And so a lot of these companies, in all the Korean companies, for instance, they all have Korean GMP.
• 17:46
  SPEAKER_00: Getting US GMP, again, is an FDA mandate in order to come here.
• 17:51
  SPEAKER_00: So we've had companies come up to us and say, you know, hey, Dr.
• 17:55
  SPEAKER_00: Gold, we want to bring our products to the United States and we want to start the trials in a month.
• 18:00
  SPEAKER_00: Well, the first question I would ask them is, well, tell me about your GMP.
• 18:04
  SPEAKER_00: Not tell me if your product works or not.
• 18:06
  SPEAKER_00: I want to know about GMP.
• 18:08
  SPEAKER_00: And again, they go, Well, we have Korean GMP, and I have to explain to them that's not US GMP.
• 18:16
  SPEAKER_00: Yeah.
• 18:16
  SPEAKER_00: And that can put people back a year or two.
• 18:19
  SPEAKER_02: Oh, I can imagine.
• 18:20
  SPEAKER_02: I mean, especially to get the FDA just to inspect what they're doing over there could take care of.
• 18:24
  SPEAKER_02: Correct.
• 18:24
  SPEAKER_00: And then the time that it takes to make it the facilities.
• 18:28
  SPEAKER_00: And most of these companies have to build new facilities, right?
• 18:31
  SPEAKER_00: That are that best meet the standards of the US FDA.
• 18:34
  SPEAKER_00: Yeah.
• 18:34
  SPEAKER_00: Um, but again, that's all exciting because uh, you know, they're all not all, but a bunch of them are actually doing that now.
• 18:41
  SPEAKER_00: Uh, and so that's good.
• 18:43
  SPEAKER_00: I I think that that will only enhance the market over time.
• 18:48
  SPEAKER_00: I hope it'll enhance the market over time.
• 18:50
  SPEAKER_00: Um, I think that again, going back to what's coming, there's um European products that are coming here from very sound companies that have been around for years and years and years.
• 19:04
  SPEAKER_00: They have to go through the same hurdles, though, of getting with the FDA and registering the products, going through the clinical trials here um in the US.
• 19:15
  SPEAKER_00: Um, and if you're a if you're a skin quality filler, um getting the scales appropriate that the FDA will allow.
• 19:25
  SPEAKER_00: So there are skin quality scales, like we talked about skin vive at the beginning, that have made it through the FDA.
• 19:33
  SPEAKER_00: And there are some others that are pending at the FDA based on scales because they're different than Skin Viv.
• 19:40
  SPEAKER_00: They are injected differently.
• 19:42
  SPEAKER_00: We're skin vive, we put little injections.
• 19:44
  SPEAKER_00: Yes.
• 19:44
  SPEAKER_00: This this is more of there are products that you sort of just put into the skin a lot more that hydrate really well and give an amazing effect on the skin quality.
• 19:56
  SPEAKER_00: And you know, they're in Europe and around the world, but we're just we're just waiting, right?
• 20:00
  SPEAKER_00: And it's just gonna take a little bit of time.
• 20:03
  SPEAKER_00: Um, but once we have all this, again, the world of fillers is shh.
• 20:08
  SPEAKER_02: Yeah, it's just about to blow up, isn't it?
• 20:10
  SPEAKER_02: I mean, it's it's interesting to think about the dichotomy of the skin veave, which is injected so superficially it's and it's unit's not crosslinked HA that just gives you an immediate hydration effect, because that's what HA is, right?
• 20:24
  SPEAKER_02: It's a humectin, it absorbs a ton of water, so you get this great dewy complexion for three to six months and then it slowly wanes.
• 20:32
  SPEAKER_02: And then you've got sculptra, which is uh PLLA polyolactic acid.
• 20:36
  SPEAKER_02: It's a sugar essentially, it's what absorbable sutures are made out of this product, so we know it's safe in the body.
• 20:42
  SPEAKER_02: It's injected much deeper, and yet we still get skin quality improvement even with sculptor.
• 20:47
  SPEAKER_02: And so whether you inject very superficially with HA or much deeper with a biostimulatory, it can affect the the thickness of the epidermis, the thinness of the stratum corneum, how much collagen you make.
• 21:00
  SPEAKER_02: It's really impressive.
• 21:01
  SPEAKER_00: Yeah, and I think again, I think over when we started the journey, um, skin quality wasn't on the table.
• 21:09
  SPEAKER_00: Not at all.
• 21:10
  SPEAKER_00: Yeah.
• 21:10
  SPEAKER_00: And and I think our patients told us, right?
• 21:14
  SPEAKER_00: And the company started to hear from the patients as well, you know, yes, my mid-face hollows are better, you know, the my nasolabial folds are better, um, my jawline looks better, but darn my skin just looks better.
• 21:31
  SPEAKER_00: I don't have to put you know all this moisturizer on every second of the day, or you know, I don't have to cover the skin as much as I used to.
• 21:40
  SPEAKER_00: And I mean, that's what we that was the feedback.
• 21:43
  SPEAKER_00: And so once we had the feedback, you know, the companies are are are understanding that.
• 21:48
  SPEAKER_00: And again, lots of little injections uh that with Skin Viv, some of the other um um hydrating fillers really are just gonna be a couple injections.
• 21:59
  SPEAKER_00: That's amazing.
• 22:00
  SPEAKER_00: that are coming.
• 22:01
  SPEAKER_00: And that's that's you know exciting.
• 22:03
  SPEAKER_00: If it if and again, they're available outside the US, we're just, you know, we just have to wait our turn.
• 22:10
  SPEAKER_02: I know.
• 22:10
  SPEAKER_02: We just got back from a a a meeting in Paris.
• 22:13
  SPEAKER_02: It was a huge international aesthetic meeting called MCAS.
• 22:16
  SPEAKER_02: And if you walk the exhibitor hall, as you said, Michael, it's just full of it's either exosome companies or filler companies.
• 22:24
  SPEAKER_02: Right.
• 22:24
  SPEAKER_00: Those are the two things.
• 22:25
  SPEAKER_00: Right.
• 22:26
  SPEAKER_00: And at least on the filler companies, for the most part, if it's if it says it's an HA filler, hopefully it is an HA filler.
• 22:33
  SPEAKER_00: Some of the exosome companies that are not, again, they're not here in the US, so um the ones in the US, we know what they are because that's the way it has to be.
• 22:42
  SPEAKER_00: They're all US GMP.
• 22:44
  SPEAKER_00: Some of them, there's another meeting called Derma Dubai that I that have you been to that one?
• 22:50
  SPEAKER_02: I have not.
• 22:51
  SPEAKER_00: So last year I went and I can't go this year, but I've been like five years in a row and there must be 250 different exosome companies there.
• 22:58
  SPEAKER_00: And somebody actually bought a whole bunch of them right because they sell them on the spot.
• 23:03
  SPEAKER_00: And you know some of them had water some of them were saline.
• 23:08
  SPEAKER_00: And so you it it's sort of the you know what I tell people buyer beware.
• 23:13
  SPEAKER_00: If it if it's too good to be true, it's too good to be true.
• 23:18
  SPEAKER_02: So we don't have a lot of time left but I wanted to cover PDRN and what your thoughts were on you know Rajuran for example which has in the United States they've got a topical it's okay to apply.
• 23:29
  SPEAKER_02: Right.
• 23:30
  SPEAKER_02: But overseas it's it's something that can be injected.
• 23:34
  SPEAKER_00: PDRN contains a lot of um you know um growth factors and other things that are actually really beneficial for the skin.
• 23:45
  SPEAKER_00: The problem is they're better injected as are exosomes for the most part yeah but once they do that they can't do that here.
• 23:57
  SPEAKER_00: You can't inject these products because then then they become drugs.
• 24:00
  SPEAKER_00: Yes.
• 24:01
  SPEAKER_00: The pathway has to you think fillers are complicated that pathway is even more complicated.
• 24:06
  SPEAKER_00: So we have to apply them topically so that you have to have a delivery system really so like a micro needling or a non-ablative fractional laser system to be able to use beforehand which again it just complicates the the situation a little bit because it's a procedure and a topical so is the procedure doing what we want or is it the topical outside of the US again especially in Asia we know these things work um incredibly well then you said Rajuran and there's Tuscany Tuscani there's a couple of these companies out there that have amazing data right and so for the US docs you to me you just have to take the data and realize okay show me the topical data.
• 24:51
  SPEAKER_00: Yeah right um I work with I work with a company in India that's called QR678 um and they have probably one of the best hair growth injectables I've ever seen but it's again you we it's not here in the US because again it's injected and it's kind of it's it's it's delivering the stem cells that we need to grow hair as are these PDRNs they have amazing capabilities.
• 25:19
  SPEAKER_00: So I think if again the when I tell people there there need with exosomes with pdrns and all this that we apply topically we need data.
• 25:32
  SPEAKER_00: We need the companies to understand what our limitations are here in the US which is we can't inject that period end of story.
• 25:40
  SPEAKER_00: So show me what they do topically show me what they do topically alone show me what they do topically with microneedling and then go from there.
• 25:52
  SPEAKER_00: But that's a that's that's a hard thing because these companies again they have the data injectable stuff that that that data exists but you can't extrapolate that to topical.
• 26:03
  SPEAKER_02: Yeah and so for our listeners pdrn is essentially fragments of DNA that is derived from salmon sperm so every time I say that I chuckle a little bit because it just it's just so odd.
• 26:16
  SPEAKER_02: And so when you see you'll see online and on social media people getting salmon sperm facials for example and what they're getting is they're using this PDRN.
• 26:24
  SPEAKER_02: And as Dr.
• 26:25
  SPEAKER_02: Gold said it is it's incredibly regenerative especially when injected it's got tons of nucleotides which make up our DNA along with growth factors and stem cell factors.
• 26:37
  SPEAKER_00: And it's been shown XUS outside the US to have incredible effects especially around the eyes from what I've heard from from those who inject it quite a bit but in the US it can't be used that way it has to be applied topically and there is one company that we're that I work with or in discussions with of again they have to file with the FDA after they get a US GMP so so again we're looking at we're looking at a long time but I do think that again we have two companies here that I know of in the U.S.
• 27:08
  SPEAKER_00: And again if people are out there listening worth trying um because people like this salmon concept and um you know it's all part of what we can do.
• 27:20
  SPEAKER_00: So I think that's helpful.
• 27:21
  SPEAKER_02: But again it's acellular there's no there's no cells it's fragments of the DNA so you're really getting just the nucleotides and growth factors and so it's you're not worried about you know growing gills later after you apply yeah you're not going to grow anything yeah that's that that that's not going to happen but it will make your skin look a whole lot better.
• 27:38
  SPEAKER_02: There's lots of data to support that too.
• 27:40
  SPEAKER_02: Well Dr.
• 27:41
  SPEAKER_02: Gold thank you so much it's it's we're already butting up to half an hour.
• 27:46
  SPEAKER_02: And when I told you he was an expert guys he just spent 30 minutes telling you everything that's happening in fillers from around the world so thank you again Dr.
• 27:55
  SPEAKER_02: Gold uh again uh he runs an amazing meeting called scale he also has 5cc and dazzle so he is everywhere all the time uh my name is Dr.
• 28:05
  SPEAKER_02: Ted Lang thank you so much for listening please subscribe and and and please uh tell your friends about skincare confidential we so appreciate your support and thank you