Latest / The Science of Skin / Defining Skin Quality: Dr Shannon Humphrey Discusses Her Groundbreaking Work

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Defining Skin Quality: Dr Shannon Humphrey Discusses Her Groundbreaking Work · The Science of Skin

• 0:08
  SPEAKER_00: Hello and welcome to Skin Care Confidential, the podcast supporting the Science of Skin Care Summit, occurring September 21st to the 23rd in Austin, Texas this year.
• 0:18
  SPEAKER_00: I am so happy to have Dr.
• 0:20
  SPEAKER_00: Shannon Humphrey with me.
• 0:22
  SPEAKER_00: My name is Dr.
• 0:22
  SPEAKER_00: Ted Lane.
• 0:23
  SPEAKER_00: I'm a board certified dermatologist in Austin, but Dr.
• 0:25
  SPEAKER_00: Humphrey, who's way more important than I am, is a dermatologist in Vancouver in our neighbors to the north.
• 0:32
  SPEAKER_00: Dr.
• 0:32
  SPEAKER_00: Humphrey, thank you so much for being here.
• 0:34
  SPEAKER_01: Yeah, Ted, thanks for inviting me.
• 0:36
  SPEAKER_01: It's my pleasure.
• 0:37
  SPEAKER_00: Well, let me just do a quick introduction.
• 0:39
  SPEAKER_00: So Dr.
• 0:39
  SPEAKER_00: Humphrey is a researcher and innovator in cosmetic dermatology.
• 0:44
  SPEAKER_00: Hailing, almost said hauling, hailing from Vancouver, British Columbia in Canada.
• 0:50
  SPEAKER_00: She is regarded as an expert in the use of cosmetic injectables, multimodal treatment planning as well.
• 0:56
  SPEAKER_00: She's also a lecturer, an educator, and particularly in the topic of integrated and holistic skin care and care for the entire 360-degree approach to the aesthetic patient.
• 1:07
  SPEAKER_00: She pushes beyond historically transactional cosmetic care to achieve more desirable and natural-looking treatment outcomes.
• 1:14
  SPEAKER_00: She's also a regular expert voice in popular media.
• 1:18
  SPEAKER_00: She somehow has time to be an active clinical trialist with uh more than 40 pivotal cosmetic clinical trials under her belt.
• 1:25
  SPEAKER_00: She is the medical director at Humphrey and Belesny Cosmetic Dermatology.
• 1:30
  SPEAKER_00: She's also a mother of four.
• 1:32
  SPEAKER_00: And why I really, really like Dr.
• 1:35
  SPEAKER_00: Humphrey is because she's a mother of two Portuguese water dogs as well.
• 1:40
  SPEAKER_00: So it's so nice to have you.
• 1:42
  SPEAKER_00: So let's just jump in.
• 1:44
  SPEAKER_00: I mean, your career really has been incredible, uh, Dr.
• 1:47
  SPEAKER_00: Humphrey.
• 1:48
  SPEAKER_00: I was looking at your CV, and my goodness, you were a resident until 2009.
• 1:53
  SPEAKER_00: And since then, you've been on the international stage.
• 1:56
  SPEAKER_00: Give us an idea of how it all started for you and really kind of walk us through how you got to the point that you are in your amazing career.
• 2:03
  SPEAKER_01: Thanks so much.
• 2:04
  SPEAKER_01: That's a big question.
• 2:05
  SPEAKER_01: Um just like everybody else, one foot in front of the other, one step at a time, but it did go way back starting when I was uh eight years old.
• 2:14
  SPEAKER_01: I had an awesome woman dermatologist who helped me with uh, you know, very unglamorous um eczema, warts, acne.
• 2:21
  SPEAKER_01: And I remember thinking, she is so smart, and she has helped me so much.
• 2:25
  SPEAKER_01: I think I could do that.
• 2:26
  SPEAKER_01: And then, you know, the deal was sealed on the day I went to see her, and she opened her sample cupboard.
• 2:32
  SPEAKER_01: And in my memory, light shines out, and the hallelujah chorus plays.
• 2:37
  SPEAKER_01: Like I've always loved skincare, anything, creams, gels, lotions, potions.
• 2:42
  SPEAKER_01: And so, you know, my mom remembers that day, and I got in the car and I was eight, and I said, I think I'm gonna do that.
• 2:48
  SPEAKER_01: And really, there's been no looking back.
• 2:50
  SPEAKER_01: Like Team Shannon has always been uh laser focused on dermatology, and and I'm sure grateful that it was such a good fit.
• 2:58
  SPEAKER_01: Um, you know, fast forward 20-ish years when I'm coming out of residency, I really thought that I would do uh melanoma research or immunoderm.
• 3:08
  SPEAKER_01: I was focused on something kind of more research-based, um, academic, and you know, through a series of events and opportunities that you just see.
• 3:17
  SPEAKER_01: I had this opportunity to train in aesthetic dermatology.
• 3:20
  SPEAKER_01: Gene and Alistair Carruthers took me on as a fellow, and all the pieces kind of fell into place.
• 3:26
  SPEAKER_01: You know, I felt like I'd have a really great opportunity to have patients who arrive happy and leave happier, but also weave in my passion for evidence-based medicine and clinical research.
• 3:38
  SPEAKER_01: Um, there's definitely even still an opportunity in aesthetic derm to close the gap on the science piece and the evidence-based medicine.
• 3:46
  SPEAKER_01: So the fact that I could do something I loved and bring the science along along the way made it a perfect fit for me.
• 3:54
  SPEAKER_01: And so this takes us to kind of 2011-2012.
• 3:58
  SPEAKER_01: I've been growing my practice, I've been growing my clinical research unit and really taking opportunities as they come for thought leadership, teaching.
• 4:07
  SPEAKER_00: Um, you know, and here we are.
• 4:10
  SPEAKER_00: Gosh, amazing.
• 4:11
  SPEAKER_00: So when you look back, it sounds like kind of that that fellowship with Drs.
• 4:16
  SPEAKER_00: Carruthers was pivotal for you.
• 4:18
  SPEAKER_00: I mean, and and for those listening, Gene and Alistair Carruthers really were seminal in development of Botox Cosmetic, for example, uh, and and other uh toxins along the way, as well as fillers.
• 4:29
  SPEAKER_00: I mean, truly foundational um KOLs in aesthetic dermatology.
• 4:35
  SPEAKER_01: And even further than that, I think they created this specialty of medicine.
• 4:39
  SPEAKER_01: You know, if if Botox hadn't been pioneered for cosmetic purposes, you know, all of the downstream developments wouldn't have happened.
• 4:49
  SPEAKER_01: And so I think they opened the door for all of us to this new area of medicine and they really led in a way that was science-based and also sharing, you know, they shared their knowledge with anyone who wanted to learn.
• 5:02
  SPEAKER_01: So I've always been very inspired by that and and trying to do the same.
• 5:07
  SPEAKER_00: When I was a medical student in uh Houston, I remember Alistair Cruthers coming down and giving a lecture to the dermatology department.
• 5:15
  SPEAKER_00: And this was right when, you know, it seemed like Botox Cosmetic was gaining a ton of steam in our specialty.
• 5:22
  SPEAKER_00: And then uh beyond that, as you said, kind of corollary to that, more of aesthetic medicine was as well.
• 5:28
  SPEAKER_00: Um and I just thought, just what an amazing, amazing couple they were.
• 5:32
  SPEAKER_00: I mean, he he put all he gave he gave his wife all of the accolades, really.
• 5:37
  SPEAKER_00: He was he was so wonderful.
• 5:38
  SPEAKER_00: Um, I learned a lot from that lecture, and actually that was seminal and me really wanting to become a dermatologist as well.
• 5:44
  SPEAKER_00: So I completely understand.
• 5:45
  SPEAKER_00: I I had 30 minutes with the man, and you had much longer than that.
• 5:48
  SPEAKER_00: So I'm sure it was incredible.
• 5:50
  SPEAKER_00: Absolutely.
• 5:51
  SPEAKER_00: Um so and since then, so you finished your your aesthetic fellowship, you've gone out in private practice, you're you're working, you're going.
• 5:57
  SPEAKER_00: How did you decide to do research?
• 5:58
  SPEAKER_00: And and what what kind of made you decide to move in that, you know, way in your career?
• 6:04
  SPEAKER_01: So I think, you know, I've always been driven by science, and research was always going to be part of what I practiced.
• 6:11
  SPEAKER_01: And when I saw, you know, I looked to different mentors who did research in the aesthetic space, and it kind of all clicked, I'd had a little bit of uncertainty, you know, can I pursue aesthetic dermatology with the same rigor and passion and ethics and transparency that I would, for example, melanoma, cancer care.
• 6:29
  SPEAKER_01: And when I saw a model that it was possible, again, not only possible, but necessary, because I still do see gaps in the aesthetic space for science.
• 6:40
  SPEAKER_01: But when I saw I could do both together, I think it just all clicked for me.
• 6:45
  SPEAKER_01: And your question is a good one because clinical research isn't easy and it's not glamorous and it's administratively heavy, but um it makes me feel good about what I do.
• 6:58
  SPEAKER_01: You know, I feel good about practicing aesthetic medicine, knowing I'm doing it with science on my side.
• 7:04
  SPEAKER_00: Yeah, yeah.
• 7:06
  SPEAKER_00: You're so right about that.
• 7:07
  SPEAKER_00: I I'm sure you get asked this as well.
• 7:09
  SPEAKER_00: I I run a clinical trials unit, and so many young Durhams ask me, how did you get into it?
• 7:13
  SPEAKER_00: And there's it's a high hurdle to get into research.
• 7:16
  SPEAKER_00: You have to persuade industry that that you are serious about it, that you have the space, the time, the people, the equipment.
• 7:23
  SPEAKER_00: All of it is difficult.
• 7:25
  SPEAKER_00: So to get started young in your career like you have and just continue even as busy as you are, because I know you're international lecturer and you are so busy with your patient load, um, really, you have to make it a priority uh in order for it to flourish.
• 7:40
  SPEAKER_00: And so I get it.
• 7:42
  SPEAKER_00: And for those listening, you know, you just can't dip your toe in the water of research.
• 7:47
  SPEAKER_00: You kind of have to dive in head first, and it's just one of those things.
• 7:50
  SPEAKER_00: If you are interested in the science, and I'd love to hear what you say here, Dr.
• 7:54
  SPEAKER_00: Humphrey, if you're if you're interested in the science and that really drives you, and you don't think you'll be happy unless you are at the tip of the spear in terms of what you offer your patients, research is the way to go, and you'll be happy in your career.
• 8:06
  SPEAKER_01: Yeah, I agree.
• 8:07
  SPEAKER_01: I get a lot of professional fulfillment.
• 8:10
  SPEAKER_01: I learned so much from the research, you know, to be forced to observe in a rigorous and controlled way that you never could with your own patients has helped me so much as a practitioner.
• 8:21
  SPEAKER_01: Um, but yes, it takes definitely commitment and hard work.
• 8:26
  SPEAKER_01: You know, it requires a whole team, a whole infrastructure to keep that flowing.
• 8:30
  SPEAKER_01: And then, as you say, there's a critical mass required.
• 8:33
  SPEAKER_01: You can't just do one study here or there.
• 8:35
  SPEAKER_01: You can't cherry pick.
• 8:36
  SPEAKER_01: You need to do enough to support a whole unit, to support a team of people working full-time.
• 8:41
  SPEAKER_01: You have to have the space.
• 8:43
  SPEAKER_01: Um, the overheads are significant, but I think it's worth it.
• 8:47
  SPEAKER_01: You know, it balances out, it keeps my days diverse, and it opens the door to so many opportunities in terms of teaching, training, thought leadership, connecting with peers from around the globe.
• 8:57
  SPEAKER_01: So, you know, I'm a big proponent, but be ready for the uphill uh battle.
• 9:03
  SPEAKER_00: You're you're it puts you on an even step with some of the KOLs, um, the true luminaries in our specialty, because you're all going, for example, I went to an investigator meeting this past weekend for a trial, and there were some people that I'd never met, but but people that had really developed our specialty over the last 20 years.
• 9:19
  SPEAKER_00: And so I just sat at lunch when we had a break and just picked their brain and was just so excited to have time with them.
• 9:27
  SPEAKER_00: And and that's what research can do, really.
• 9:30
  SPEAKER_00: It it allows you to develop relationships with other like-minded, various, very curious professionals in our space that otherwise you may not have access to or even think that you could meet.
• 9:41
  SPEAKER_00: So anyway, I'm glad that we think alike in that respect.
• 9:45
  SPEAKER_00: Um, so listen, I I one of the things that I really wanted to talk to you about was um from the paper that you wrote, uh, defining skin quality, um, which I found incredibly interesting just because of my work in skincare, which I know you do quite a bit as well.
• 10:00
  SPEAKER_00: Um, where, and and quite frankly, not just skincare, but also in what I call injectable skincare, where we're talking about intradermal Botox, and now we have these boosters that you have in Canada, and we're trying to get here in the United States at some point.
• 10:13
  SPEAKER_00: Um, and and so can you just walk me through the genesis of of this paper and and and what you were thinking in terms of what the gap was that you needed to fill um with the with the publication?
• 10:26
  SPEAKER_01: Yeah, and I mean this is a publication that um came from a clinical observation.
• 10:34
  SPEAKER_01: We all know beautiful skin, healthy skin when we see it.
• 10:38
  SPEAKER_01: Like close your eyes, picture the person with the best skin you can possibly imagine.
• 10:42
  SPEAKER_01: It's probably a child or a teenager, but um, you know, it's you know it when you see it, but it's very difficult to put clear and precise words around.
• 10:52
  SPEAKER_01: And this is for a lay person.
• 10:53
  SPEAKER_01: You know, it's hard to describe why that skin is so healthy and beautiful.
• 10:57
  SPEAKER_01: And it's even harder as clinician scientists to be precise when we're defining um a variety of attributes that are effectively composite when we're looking for a single measure of skin quality.
• 11:11
  SPEAKER_01: You know, it doesn't exist.
• 11:12
  SPEAKER_01: And if you turn to the literature, whether it's cosmosceuticals or energy-based treatments, even the definitions for the attributes are very diverse.
• 11:22
  SPEAKER_01: They're inconsistent, sometimes contradictory, poorly defined.
• 11:27
  SPEAKER_01: And so, you know, we acknowledge there's a gap in science around aesthetic procedures and skin quality, but we don't even, we're not even starting at the same place.
• 11:36
  SPEAKER_01: There's not a consistent vocabulary from which, as scientists, we can start to do our research to understand better how treatments work, how to define skin quality, and let alone, you know, defining it, how to measure it, you know, how to consistently measure these attributes.
• 11:51
  SPEAKER_01: So basically, I saw an opportunity to a bit of a call to action.
• 11:56
  SPEAKER_01: So this paper for me, you know, we knew it would be controversial.
• 11:59
  SPEAKER_01: We knew everyone wouldn't agree exactly with how we came together and proposed a framework and a definition, but at least it's a springboard for discussion, and at least it acknowledges that there are inconsistencies.
• 12:12
  SPEAKER_01: And so, upfront in any of these papers, the the very least we need to do is define the terms that we're using so that we can understand if there's any comparisons with existing literature.
• 12:23
  SPEAKER_01: Um but basically that's what it is.
• 12:24
  SPEAKER_01: It's a springboard for discussion, it's a call to action amongst clinician researchers.
• 12:28
  SPEAKER_01: Let's come together and try and use the same words.
• 12:31
  SPEAKER_01: Let's try and get more consistent in how we measure skin quality.
• 12:34
  SPEAKER_01: We know it when we see it, but let's uh let's hold ourselves to a higher standard in how we measure and describe.
• 12:40
  SPEAKER_00: I think it's brilliant.
• 12:41
  SPEAKER_00: I really do.
• 12:42
  SPEAKER_00: I think um historically what we've done in skincare and in other um aesthetic trials is we've used the the global aesthetic improvement scale, the G A I S, which is improved somewhat better.
• 12:54
  SPEAKER_00: You know, it's just an overarching, you know, does it look better to you?
• 12:58
  SPEAKER_00: Yeah, it looks better to me.
• 12:59
  SPEAKER_00: Okay, that's a one-point improvement.
• 13:00
  SPEAKER_00: That's great.
• 13:01
  SPEAKER_00: But you know, we we have the technology now to to really drill down into a lot of the metrics that you have talked about in your paper.
• 13:10
  SPEAKER_00: Yeah.
• 13:11
  SPEAKER_00: You know, redness, for example, um, radiance, uneven pigmentation.
• 13:16
  SPEAKER_00: I'm just looking at one of the figure figure one from your paper.
• 13:18
  SPEAKER_00: And by the way, folks, the paper is uh defining skin quality, clinical relevance, terminology, and assessment.
• 13:25
  SPEAKER_00: And uh Dr.
• 13:26
  SPEAKER_00: Humphrey is a primary author on that, with it's in dermatologic surgery, July 2021.
• 13:32
  SPEAKER_00: So uh, you know, it's just absolutely we have these metrics that we need to that we can measure, not only with our own aesthetic eye, but with technology now, AI, for example, different imaging, that I think this is such an important paper to push the industry forward into objective measurement of skin quality and beauty.
• 13:55
  SPEAKER_00: And so I I kudos to you for for publishing this.
• 13:58
  SPEAKER_00: It's so important.
• 14:00
  SPEAKER_00: Can you just go through the three primary or major kind of categories that you put the different metrics in?
• 14:08
  SPEAKER_01: Absolutely.
• 14:08
  SPEAKER_01: And I think um as a teacher and a researcher, I'm I'm a lumper, not a splitter.
• 14:14
  SPEAKER_01: So I do like to categorize things.
• 14:17
  SPEAKER_01: And so we we took all of the attributes and tried to clump them into three categories.
• 14:21
  SPEAKER_01: One is visible, that's easy, it's things that you can see.
• 14:24
  SPEAKER_01: One is topographical, so it's surface changes that you could measure.
• 14:28
  SPEAKER_01: Sometimes you can feel them, but not always, but variations in in the topography of skin.
• 14:33
  SPEAKER_01: And the last is mechanical, so these are kind of biomechanical properties in how skin moves when a force is applied to it.
• 14:40
  SPEAKER_01: And of course, it's a Venn diagram because some of the attributes exist in more than one of those categories.
• 14:46
  SPEAKER_01: Um but yeah, I think it's a good starting point.
• 14:49
  SPEAKER_00: When you look at these metrics, are there any that to you are the more important when you think about, you know, you see aesthetic patients all day long.
• 14:56
  SPEAKER_00: And are there any that really you thought, you know what, this is really to many patients, these are kind of the top three that these patients really think is important for their own uh perception of beauty?
• 15:08
  SPEAKER_01: You know, I think skin that is perceived to be beautiful and youthful and healthy is smooth in texture, it's even in color, and it has a very specific light reflection property that we refer to as radiance.
• 15:21
  SPEAKER_01: So, you know, when I'm talking to patients, that's what I'll say.
• 15:24
  SPEAKER_01: We want it to be smooth, even in color, and have some glow or radiance.
• 15:28
  SPEAKER_01: And so I think those oversimplified are ones we can hold as a North Star from a perception of beauty.
• 15:35
  SPEAKER_01: Um, from a science perspective, I really think hydration is like pivotal.
• 15:41
  SPEAKER_01: You know, it's an anchor and it is one of the attributes that exists in all three of those categories.
• 15:46
  SPEAKER_01: And I think that's why hydrated skin looks so much better than dehydrated skin.
• 15:52
  SPEAKER_01: You know, it looks better, it feels better, it acts like younger skin.
• 15:56
  SPEAKER_01: So that one has a special place for me as well.
• 16:00
  SPEAKER_00: In addition to hydration, I'm just looking at where the three Venn diagrams overlap.
• 16:04
  SPEAKER_00: We've included crepiness and laxity.
• 16:08
  SPEAKER_00: You know, crepiness is a word I hear all day, every day.
• 16:11
  SPEAKER_00: Whether it's their people are referring to their under-eye area, their their dorsal hands, they refer to as crepiness.
• 16:19
  SPEAKER_00: Yes.
• 16:20
  SPEAKER_00: And that I feel like just over the last five years or so, that that term has really crept into the common lexicon of beauty.
• 16:28
  SPEAKER_00: Um, and and so I think it really does, and that's reflected in your paper.
• 16:32
  SPEAKER_01: You know what's interesting though, I was at an ad board recently with global thought leaders in um skin quality specifically, and maybe 20% didn't know what crepe paper was.
• 16:43
  SPEAKER_01: And that's the genesis of this word.
• 16:44
  SPEAKER_01: It it's like crepe paper, right?
• 16:46
  SPEAKER_01: Like tissue paper.
• 16:47
  SPEAKER_01: So anyone who's kind of crafty would know, but it was fascinating for me that again, assumptions I made that everyone knows what crepiness is.
• 16:56
  SPEAKER_01: Apparently, we don't have a standard definition, but again, it's those very fine surface wrinkles that are like crepe paper.
• 17:04
  SPEAKER_00: Okay, great.
• 17:04
  SPEAKER_00: And then and then laxity as well, which is kind of skin sagging, is how I think of laxity, or um the inability of the skin to recoil once pulled.
• 17:13
  SPEAKER_00: You tell me, how do you how do you define laxity?
• 17:16
  SPEAKER_01: Yeah, no, I think that laxity and sagging um are relatively synonymous.
• 17:23
  SPEAKER_01: Um, we are currently lacking a validated scale for skin laxity, and it's quite a tricky pursuit, um, one that I'm very interested in, but tricky because um so many factors related to aging, including volumetric changes, can be perceived to impact laxity.
• 17:41
  SPEAKER_01: Um, so you know, difficult.
• 17:42
  SPEAKER_01: Again, it's one of those kind of composite attributes that likely have multiple contributors.
• 17:48
  SPEAKER_00: Yeah.
• 17:48
  SPEAKER_00: I think most patients would say skin sagging.
• 17:51
  SPEAKER_00: My skin is sagging.
• 17:52
  SPEAKER_00: Yeah.
• 17:52
  SPEAKER_00: Agreed.
• 17:53
  SPEAKER_00: Which which you know sounds like a deflated balloon or something like that.
• 17:57
  SPEAKER_01: But you and I know sometimes it's skin and sometimes it's bony remodeling and fat redistribution.
• 18:03
  SPEAKER_00: So much below the surface of what skin sagging is actually due to.
• 18:08
  SPEAKER_00: When you think about um, you know, as as I mentioned before, there's this the this injectable skincare idea, and and how much of that, as we look in the next two to three years, I'm I'm excited in the United States to get Skin Viv, which is this new skin booster from AB slash Allergan that's meant to be injected incredibly superficially.
• 18:27
  SPEAKER_00: How how much of that do you think that's going to change our our method of treating and improving skin quality in the States as that kind of comes into our into our into our um you know armamentarium of of of how we can treat this?
• 18:41
  SPEAKER_01: Um like I am a conservative practitioner.
• 18:45
  SPEAKER_01: I credibility is important to me.
• 18:47
  SPEAKER_01: I don't often speak in superlatives, but um, HA microdroplet for skin quality has completely revolutionized my practice.
• 18:55
  SPEAKER_01: It has improved my ability to improve patient outcomes, patient satisfaction.
• 19:00
  SPEAKER_01: It's I've doubled the amount of HA that I use by just incorporating HA microdroplet in all of my existing patients.
• 19:08
  SPEAKER_01: So I think it'll have a huge impact in your ability in the US to improve skin quality, specifically through the primary mechanism of hydration.
• 19:17
  SPEAKER_00: Okay.
• 19:17
  SPEAKER_01: Um, and again, we kind of touched on hydration, but you know, it's a it's a one-time treatment.
• 19:22
  SPEAKER_01: It's performed at the bedside, it's well tolerated, it's very predictable in terms of its outcomes, and all patients could potentially benefit.
• 19:31
  SPEAKER_01: You know, it's very rare that every patient could have some improvement from a particular treatment, but this one, this one can, and Juvederm um skin vee is the one that um I use most often in my own practice.
• 19:44
  SPEAKER_01: We have several in Canada.
• 19:45
  SPEAKER_00: Yeah, yeah.
• 19:46
  SPEAKER_00: Can could you just explain to us HA microdoplet what you're referring to with that, just so that everybody understands?
• 19:52
  SPEAKER_01: Yeah, so the injection technique is a microdroplet technique, intradermal or immediate subdermal.
• 19:57
  SPEAKER_01: So um we're talking about 0.01 to 0.05 mils, which is lots of little pokes.
• 20:03
  SPEAKER_01: You know, the patient feels a bit like a pin cushion, but technically it's pretty straightforward.
• 20:08
  SPEAKER_01: With a little bit of icing and topical anesthetic, it's pretty comfortable.
• 20:11
  SPEAKER_01: But totally unlike an HA filler injection, which is going deeper and designed to change the shape of the face or smooth a line.
• 20:19
  SPEAKER_01: This is not going to have any impact on the shape of the face.
• 20:22
  SPEAKER_01: It's strictly for hydration and improvement in skin quality.
• 20:26
  SPEAKER_00: Okay.
• 20:26
  SPEAKER_00: So when we think about those very, very fine lines, maybe that crepiness that some people talk about, uh, it I see it as improving that.
• 20:35
  SPEAKER_00: Um anything else that where you would say, you know, you really get an improvement in?
• 20:39
  SPEAKER_01: So, you know, those to me, fine lines and crepiness, that's secondary.
• 20:43
  SPEAKER_01: Like the primary is hydration, which is going to make skin um feel firmer.
• 20:49
  SPEAKER_01: It's going to feel more hydrated, it's going to look more radiant.
• 20:52
  SPEAKER_01: So light reflection property improves, but only half of it is visual.
• 20:56
  SPEAKER_01: The other half is tactile.
• 20:57
  SPEAKER_01: And one of the most consistent pieces of feedback, patients say, my skin just feels better.
• 21:03
  SPEAKER_01: Whether younger, firmer, the skin feels better.
• 21:07
  SPEAKER_01: And so there's this dual benefit for patients.
• 21:10
  SPEAKER_01: Not only does it look better, it feels better.
• 21:12
  SPEAKER_01: And that really has a strong kind of positive psychological benefit.
• 21:16
  SPEAKER_01: The emotion they communicate is different than I've seen with toxin and filler.
• 21:20
  SPEAKER_01: They really, really love it.
• 21:21
  SPEAKER_00: Gosh, that's so interesting.
• 21:22
  SPEAKER_00: That's something that we haven't even really talked about, how the patient feels when they touch their own skin.
• 21:27
  SPEAKER_00: Yeah.
• 21:28
  SPEAKER_00: Because I would imagine, as you've experienced, you've got much more experience than I do with this, that what they're feeling is that kind of bounce back, that rebound elasticity that they've been losing because of the hydration is is uh it's not elasticity, obviously, it's hydration.
• 21:43
  SPEAKER_00: Yeah, but that's kind of what they're feeling.
• 21:45
  SPEAKER_00: Am I am I right about that?
• 21:46
  SPEAKER_01: Or I think you're absolutely right.
• 21:49
  SPEAKER_00: Okay.
• 21:50
  SPEAKER_00: Yeah.
• 21:50
  SPEAKER_00: So interesting.
• 21:51
  SPEAKER_00: I I didn't haven't really thought about it that way.
• 21:53
  SPEAKER_00: And then besides skin v Shannon, in in Canada, what else, what other skin booster are you excited about or do Do you find you use quite often in your practice?
• 22:03
  SPEAKER_01: So Skin Viv would be the number one.
• 22:05
  SPEAKER_01: We've done almost 7,000 milliliters, and why I like it is because it's been studied as a one-time treatment.
• 22:11
  SPEAKER_01: You know, then it would be repeated at six to nine months.
• 22:13
  SPEAKER_01: Some of the competitors do require a series.
• 22:16
  SPEAKER_01: So we have um the Galderma product skin boosters in Canada.
• 22:20
  SPEAKER_00: Okay.
• 22:21
  SPEAKER_01: Um MERS has a product called Revive, not in Canada, but in the world.
• 22:26
  SPEAKER_01: It also has some glycerol in it, so a humectant.
• 22:28
  SPEAKER_01: Um, I'm I'm keen to try that, but for now, Skin Viva, uh, which is which is currently marketed in Canada under the name Volite, is is doing the trick for my patients.
• 22:38
  SPEAKER_01: Yeah.
• 22:39
  SPEAKER_00: Can't wait to get our hands on that.
• 22:40
  SPEAKER_00: Do you use um quite a bit of intradermal Botox as well to improve pore size and redness, sebum production?
• 22:48
  SPEAKER_00: Is that part of your practice pattern?
• 22:50
  SPEAKER_01: I have um moderate experience with it, but with the introduction of volite, I haven't needed it because pore size and redness are both improved quite predictably uh with HA micro droplet.
• 23:05
  SPEAKER_00: Okay.
• 23:05
  SPEAKER_00: Um adjunctive skincare or complementary skincare is something that is a huge uh subject within the skincare community as we think about how we uh add on skincare products to procedures that we do in the office.
• 23:19
  SPEAKER_00: And I could see you know, something like a skin booster where we're immediately increasing hydration may change the skincare um regimen that you would otherwise suggest because you may not need as much hydration with that the skin V, for example, in place.
• 23:34
  SPEAKER_00: Is that is that true?
• 23:35
  SPEAKER_01: I think that's true in general.
• 23:38
  SPEAKER_01: Like uh when I see our patients, I think many of them are underhydrated, and more is generally better, except for patients who are very oily or acne prone.
• 23:48
  SPEAKER_01: Um, but you know, in a different way, I see an opportunity for synergy.
• 23:52
  SPEAKER_01: So like a topical HA and an injected HA is a home run for someone who has creepy skin or dullness or is perimenopausal, postmenopausal.
• 24:01
  SPEAKER_01: Like those patients just get better results if you add a topical HA with their injected HA.
• 24:07
  SPEAKER_00: Okay, great.
• 24:07
  SPEAKER_00: And we've seen some of that data has come out with HA5, for example.
• 24:11
  SPEAKER_00: We've seen that with hyaluronic acid filler.
• 24:13
  SPEAKER_00: Wonderful.
• 24:14
  SPEAKER_00: Listen, we're almost out of time, but I just wanted to touch on another publication that I found where you you talk about the terminology of dermal filler and how it's really time for us to move beyond that because I think this is even in the title of the paper, Words Matter, or the How We Describe Things Matter, which I completely agree with as well.
• 24:32
  SPEAKER_00: Just talk to me about what the point is of that and why we need to get away from the term dermal filler.
• 24:40
  SPEAKER_00: Sure.
• 24:40
  SPEAKER_01: I mean, obviously I have a passion for being precise with language, uh, what we're talking about today.
• 24:46
  SPEAKER_01: And I just think the term filler is deeply ingrained in our vernacular, but it actually doesn't reflect what we're doing with HA Gels today, right?
• 24:55
  SPEAKER_01: We have evolved our use of HA Gels to be refined and nuanced and anatomically precise and more evidence-based.
• 25:02
  SPEAKER_01: And this concept of filling is it's antiquated.
• 25:05
  SPEAKER_01: It minimizes the skill, it sets false expectations for new providers and for our patients.
• 25:12
  SPEAKER_01: And I know there's a resistance to change.
• 25:14
  SPEAKER_01: Everyone's not going to want to call it something else because that's how it's always been.
• 25:18
  SPEAKER_01: But it creates an expectation that's false on many levels.
• 25:22
  SPEAKER_01: And I think we probably need to start being more precise, you know, an injectable HA gel for volumizing, for skin quality improvement, for contouring, for lifting, for smoothing.
• 25:33
  SPEAKER_01: You know, we can just be precise and accurate with our language, and I think it will take leaders in the space to drive that change, but I think it's probably time.
• 25:43
  SPEAKER_00: Yeah, it's the terminology that's used on podium.
• 25:46
  SPEAKER_00: It's the terminology that's used in publications and in popular press.
• 25:49
  SPEAKER_00: All of that needs to change.
• 25:50
  SPEAKER_00: It's a it's a heavy lift, but I agree with you.
• 25:53
  SPEAKER_00: First of all, that makes no sense in in in and of itself.
• 25:56
  SPEAKER_00: Dermal filler.
• 25:57
  SPEAKER_00: I mean, you can't really fill the dermism.
• 25:59
  SPEAKER_00: So uh it doesn't make any sense.
• 26:01
  SPEAKER_00: And and I totally agree in terms of what we have available now from the biostimulatory fillers that we have currently and that are that are soon to be hitting the market, plus this the skin boosters that are hydrating.
• 26:12
  SPEAKER_00: It just we we absolutely need to move beyond.
• 26:15
  SPEAKER_00: So I just wanted thank you for explaining that.
• 26:17
  SPEAKER_00: And I was excited to read that um because I think you're really pushing our specialty in into a much better position to to kind of um reflect the science uh of what we're doing, because there's so much science behind these fillers, um, as well as our common practice and what we can do is beyond filling the dermis, which we don't even do anyway.
• 26:38
  SPEAKER_00: Exactly.
• 26:39
  SPEAKER_00: Okay.
• 26:40
  SPEAKER_00: All right.
• 26:40
  SPEAKER_00: Well, listen, guys, it's been uh a wonderful, wonderful podcast.
• 26:44
  SPEAKER_00: Thank you so much, Dr.
• 26:45
  SPEAKER_00: Humphrey, for your time and your expertise and your passion.
• 26:47
  SPEAKER_00: I so appreciate it.
• 26:49
  SPEAKER_00: And um, this will do.
• 26:50
  SPEAKER_00: This is uh Skin Care Confidential.
• 26:52
  SPEAKER_00: Thanks so much for listening.