Latest / Scalpel and Skin / Are Non-Surgical Facelifts Worth It? Ultherapy, RF Microneedling & More | EP 12

Transcript

Are Non-Surgical Facelifts Worth It? Ultherapy, RF Microneedling & More | EP 12 · Scalpel and Skin

0:00
SPEAKER_04: You can pull somebody's skin as tight as you want.
0:02
SPEAKER_04: And if they have paper mache shit skin, they're still gonna have paper mache shit skin hold really tight.
0:08
SPEAKER_02: I like you already.
0:09
SPEAKER_02: Okay, well, this is it.
0:10
SPEAKER_02: Thanks, guys.
0:11
SPEAKER_02: That was a really good short podcast.
0:14
SPEAKER_05: This podcast is all about asking, is it worth it?
0:17
SPEAKER_05: Right now we're talking about does it work?
0:20
SPEAKER_05: And is it worth it?
0:21
SPEAKER_05: Those are two different questions.
0:23
SPEAKER_04: And we were like, this doesn't make sense.
0:25
SPEAKER_01: That's hurting people.
0:27
SPEAKER_01: Stop hurting people.
0:28
SPEAKER_01: That's ridiculous.
0:30
SPEAKER_01: Triggered.
0:31
SPEAKER_01: He's triggered.
0:32
SPEAKER_01: That's insane.
0:34
SPEAKER_01: It's insane.
0:48
SPEAKER_02: Welcome everybody to Scalpel and Skin.
0:50
SPEAKER_02: I'm Dr.
0:50
SPEAKER_02: Algy Labrasca here with my baby sister, Mystica Labrasca.
0:54
SPEAKER_02: She is a dermatology PA of 16, almost 17 years.
0:58
SPEAKER_02: She is the master of the skin, and I am a plastic surgeon for almost 17 years.
1:03
SPEAKER_02: I'm the master of the scalpel.
1:04
SPEAKER_02: Together we are scalpel and skin.
1:06
SPEAKER_02: Let's go.
1:07
SPEAKER_02: Today with us, we have Andrew Lysio.
1:09
SPEAKER_02: He is an aesthetic medical professional, clinical educator, consultant, and host of the Aesthetically Speaking podcast.
1:16
SPEAKER_02: Andrew, welcome.
1:17
SPEAKER_04: Thank you so much for having me, you guys.
1:19
SPEAKER_04: It's a good one.
1:20
SPEAKER_05: You know, you're you're our first official guest.
1:23
SPEAKER_05: Am I really?
1:24
SPEAKER_05: That's crazy.
1:25
SPEAKER_05: Yeah.
1:26
SPEAKER_05: Melissa co-hosted with me, but you're like our first official guest.
1:30
SPEAKER_04: Oh, I love it.
1:30
SPEAKER_04: That's awesome.
1:31
SPEAKER_05: Yes.
1:32
SPEAKER_04: So excited.
1:32
SPEAKER_04: Thank you guys for having me.
1:33
SPEAKER_02: Yeah, you're welcome.
1:34
SPEAKER_02: Tell us a little bit about yourself.
1:36
SPEAKER_04: So, I mean, I actually started out in this business 11 years ago, almost 12.
1:42
SPEAKER_04: And uh I was I started in PR and advertising.
1:46
SPEAKER_04: I was helping people kind of um like change from insurance pay to cash pay um models in their practice.
1:53
SPEAKER_04: And then I just happened to be in all these trainings and I was really good at everything.
1:57
SPEAKER_04: So I just decided I think it's time I go back to nursing school.
2:00
SPEAKER_04: So then became a nurse and here we are.
2:02
SPEAKER_04: And now I'm in my NP program too, which I mean doesn't help, but I mean it's just there's things always going, but I've been progressively going for the past 11 years and doing more and more.
2:13
SPEAKER_04: So I've seen my fair share of stuff and love the hospital.
2:17
SPEAKER_02: Love it.
2:18
SPEAKER_05: So Andrew and I met.
2:20
SPEAKER_05: He was my uh we bought we bought three devices from Sinush or Eleutronic.
2:26
SPEAKER_05: Um, and that's a company that he used to train for.
2:29
SPEAKER_05: So he did all three of our trainings at Skin Lab for the three devices that we have.
2:36
SPEAKER_05: And he is the best.
2:38
SPEAKER_04: So why they get such good results is because of this guy.
2:41
SPEAKER_05: That's right.
2:42
SPEAKER_05: It's because of this guy.
2:44
SPEAKER_02: So Nebraska Plastic Surgery also bought a device, and we like waited like an extra month for training just to try to get you.
2:53
SPEAKER_02: Um, but we couldn't make it happen.
2:56
SPEAKER_02: Uh, the the trainer that we got was apparently very good.
3:00
SPEAKER_02: She just wasn't Andrew.
3:02
SPEAKER_02: So this is the first time Andrew and I have uh actually met, uh either virtually or in person.
3:08
SPEAKER_02: And I just want to tell you, I'm super disappointed.
3:10
SPEAKER_02: No, I don't kiss fine.
3:11
SPEAKER_02: Uh so today we are going to talk about um basically, we're gonna talk about different devices, different technology.
3:21
SPEAKER_02: And, you know, we're gonna basically we're gonna ask with can a device really lift your face?
3:27
SPEAKER_02: Can any non-surgical devices actually give you the equivalent of a facelift?
3:32
SPEAKER_02: Jump right in.
3:32
SPEAKER_04: So, from my standpoint, I hate the term skin tightening, skin lift, especially when it's a non-invasive.
3:38
SPEAKER_04: So I don't like to use that, whether it's with patients or whether I'm doing a training.
3:43
SPEAKER_04: So companies that I've worked with, whether in the past or now, don't love that I say that, but it kind of is what it is.
3:50
SPEAKER_04: I don't think that you're tightening the skin.
3:52
SPEAKER_04: I think that it's great for collagen remodeling and adding new collagen and elastin to the face and the skin.
4:00
SPEAKER_04: You are giving the appearance of smoother, tighter, firmer looking skin.
4:04
SPEAKER_04: So I usually focus on saying firmer, tighter, smoother looking skin versus actually tightening the skin.
4:10
SPEAKER_04: There are very few that I think actually truly lift or tighten.
4:14
SPEAKER_02: I like you already.
4:15
SPEAKER_02: Uh this okay.
4:17
SPEAKER_02: Well, this is it.
4:17
SPEAKER_02: Thanks, guys.
4:18
SPEAKER_02: That was a really good.
4:20
SPEAKER_02: I'll see you guys later.
4:21
SPEAKER_02: Yeah, guys.
4:22
SPEAKER_02: Uh, that was that was great.
4:23
SPEAKER_02: I'm gonna go back.
4:23
SPEAKER_02: Uh I got some uh chips from Chipotle here.
4:26
SPEAKER_02: Let me just say that, didn't you say that?
4:28
SPEAKER_02: I was like, he nailed it.
4:31
SPEAKER_02: This is great.
4:32
SPEAKER_02: He nailed it.
4:33
SPEAKER_04: Yeah, see you guys later.
4:35
SPEAKER_02: That was great.
4:36
SPEAKER_02: Thanks.
4:36
SPEAKER_02: Apparently, Andrew's got some place to go.
4:38
SPEAKER_02: He came in here, dropped a truth bomb, and out.
4:41
SPEAKER_02: Um, okay.
4:42
SPEAKER_02: So um, yeah, this is great.
4:44
SPEAKER_02: So devices work.
4:45
SPEAKER_02: So you know now I will drop a truth bomb on you.
4:49
SPEAKER_02: Devices work, they they do what they are to do.
4:53
SPEAKER_02: The problem, the problem in the aesthetics industry in general, and specifically with some of the devices we're gonna talk about today, is that they overpromise and underdeliver.
5:03
SPEAKER_02: A hundred percent.
5:04
SPEAKER_02: Okay.
5:05
SPEAKER_02: Um the the issue is that they do they work, okay, but right to say that they are going to do the same as I can do with a four-hour procedure under general anesthesia, where I peel your skin back and I tighten the deepened layers and I do all that other stuff.
5:24
SPEAKER_02: This is not the same, no matter how much we pay for a device, and they are expensive.
5:28
SPEAKER_02: And and we we as classic surgeons and dermatologists and PAs and MPs, and we want them to do for all the money that we spend on, we want them to do all these great things and and they work, they just don't do that, right?
5:44
SPEAKER_04: Now, I do think though, where some of and I don't know if this is more of like a company marketing or just like a sleazy sales rep type of thing.
5:53
SPEAKER_04: I think that they go in selling you an expectation of a device, which is not always the best thing.
6:01
SPEAKER_04: Um, but I think too, from your point of view, what you can't do, and Mystica, I think, is going to agree with me now, is that you don't do anything for skin quality.
6:11
SPEAKER_04: You can pull somebody's skin as tight as you want.
6:14
SPEAKER_04: Yep.
6:14
SPEAKER_04: And if they have paper mache shit skin, they're still gonna have paper mache shit skin pulled really tight.
6:21
SPEAKER_04: So I mean, I think that's kind of where a lot of these devices have value is improving the quality of the skin.
6:30
SPEAKER_04: And again, you are going to get, I mean, certain there's a few that are actually cleared for lifting, and they wouldn't get the clearance if they didn't do that, right?
6:41
SPEAKER_04: To an extent.
6:41
SPEAKER_04: Like you said, are they gonna do it like surgery?
6:44
SPEAKER_04: Absolutely not.
6:45
SPEAKER_04: But that's why I think as we get into like device by device or technology by technology rather, I think we'll kind of all understand a little bit more about like why expectations play a part, but then also like who our patient's gonna be.
6:59
SPEAKER_04: And I think that's truly who like what we have to talk about is who the patient is at the end.
7:04
SPEAKER_02: So let's talk about it then.
7:05
SPEAKER_02: Uh let's talk about microfocus ultrasound uh with visualization, MFU dash v.
7:13
SPEAKER_02: Or you're talking about all therapy?
7:14
SPEAKER_02: All therapy.
7:15
SPEAKER_02: Yep.
7:15
SPEAKER_02: All therapy, all therapy prime.
7:17
SPEAKER_02: All therapy prime is what the new one?
7:18
SPEAKER_02: Is that like all therapy 2.0?
7:20
SPEAKER_02: So are they basically?
7:21
SPEAKER_05: I mean, I remember all therapy from my very early derm years.
7:28
SPEAKER_05: So are they still are they they're still making new all therapy devices?
7:32
SPEAKER_05: Is that really?
7:33
SPEAKER_04: That's a thing.
7:34
SPEAKER_04: Yeah, it's a new thing.
7:35
SPEAKER_05: And people still are people still asking for all therapy?
7:38
SPEAKER_02: No, I don't mean I mean I doubt it.
7:40
SPEAKER_02: I I think people come in and they say, Hey, I want uh, you know, I I want a facelift, but I don't want surgery.
7:47
SPEAKER_05: And you know, they want if you have come in and they go like this.
7:50
SPEAKER_05: I want, I want this.
7:52
SPEAKER_02: Yeah, yeah.
7:53
SPEAKER_05: Right.
7:53
SPEAKER_04: Yeah, go ahead, Andrew.
7:55
SPEAKER_04: No, I think I mean, and I don't want the all therapy people to hate me, but I just it is creating coagulation in the tissue, as all of the ultrasounds are.
8:05
SPEAKER_04: The ultrasounds are great, whether it's gonna be superb technology, hyfu, um, anything like that, you are getting coagulation, which essentially, I mean, the way that I describe it to people and when I do a training, I mean, you think about think about chicken on a hot grill.
8:23
SPEAKER_04: You put chicken on a hot grill, it contracts.
8:26
SPEAKER_04: That's kind of what we're doing.
8:28
SPEAKER_04: So you are getting that like slight bit of contraction immediately.
8:32
SPEAKER_04: Obviously, we're not trying to cook the skin, but I mean, they do work.
8:36
SPEAKER_04: Ultrasound does work.
8:38
SPEAKER_02: Uh all therapy, basically, um, it it creates little uh coagulation points at a certain depth, and you can watch it under under ultrasound.
8:47
SPEAKER_02: So you know, basically you can look at the tissue.
8:50
SPEAKER_02: It basically is what it is.
8:51
SPEAKER_02: So it's it heats up the tissue, it coagulates the tissue, and so the skin, you know, basically it it does tighten.
8:58
SPEAKER_02: Who who is the best, like who's the best patient for all therapy?
9:03
SPEAKER_04: Like in general, all of the like anything like all therapy is I feel like mild to moderate laxity.
9:10
SPEAKER_04: And that's that's generally what you're looking at with with most of them.
9:14
SPEAKER_04: But the problem that I find with most all therapy is that it hurts, whether it's the prime or not.
9:21
SPEAKER_04: Yeah, um, and so people don't like you just have to have a very five millimeters of depth.
9:26
SPEAKER_02: That's like half a centimeter.
9:28
SPEAKER_02: That's way the heck in there.
9:30
SPEAKER_02: That's crazy.
9:30
SPEAKER_02: That's crazy.
9:31
SPEAKER_04: Yeah, that's gonna be more for body laxity, but so 4.5 for body.
9:36
SPEAKER_05: What so like how I I don't remember any?
9:39
SPEAKER_05: Three for the face or neck, is that what it's like?
9:41
SPEAKER_02: It's 1.5, 3, and 4.5 so millimeters.
9:45
SPEAKER_04: Yeah, all therapy.
9:46
SPEAKER_04: I mean, I believe they train you like you can do the 1.5 and 3 on the face.
9:52
SPEAKER_04: Um, but even so, like that's personally, I mean, we'll talk about I'm sure a little bit later too, but like softwave, softwave is fixed, fixed at 1.5 millimeters.
10:03
SPEAKER_04: So out of out of the two, I prefer softwave to an all therapy for sure.
10:08
SPEAKER_04: Because I think part of the problem is people don't always know and they're just like, yeah, I'm just gonna crank it up.
10:13
SPEAKER_04: Yeah, crank it up and do whatever tissue that I can.
10:16
SPEAKER_04: You know, and so I think too, it like with all therapy, it's it's you really have to know what you're doing.
10:22
SPEAKER_04: Like I actually saw an office and I did a training at her office.
10:28
SPEAKER_04: Um very nice.
10:30
SPEAKER_04: However, she had she had three devices in her office.
10:35
SPEAKER_04: Two of them were monopolar radio frequency, and one of them was all therapy prime.
10:40
SPEAKER_02: And I was like, girl, I think you I think I think you were sold over goods, like she's got it covered, she's got that covered, yeah.
10:49
SPEAKER_02: Yeah, okay.
10:50
SPEAKER_04: So I mean that covered.
10:51
SPEAKER_02: They have 25 devices or no, she only had those three.
10:55
SPEAKER_05: She only had three, and they all kind of did they all do the same thing.
10:58
SPEAKER_04: Yeah, they all do the same thing.
10:59
SPEAKER_04: Well, similar things.
11:01
SPEAKER_05: Yeah, yeah, yeah, yeah.
11:02
SPEAKER_02: So, you know, the thing about the about all therapy that I wrote down here is four three millimeters, okay, three to four point five millimeters, it, you know, it can almost reach the smash layer, which is um the the layer that we tighten uh in a facelift.
11:19
SPEAKER_02: So if it can reach the smash layer, why why can't it lift like a facelift?
11:23
SPEAKER_02: And the answer is simple, because just tickling something is not the same as going in and releasing it and repositioning and and tightening it down.
11:33
SPEAKER_02: And so those are two totally different things.
11:36
SPEAKER_02: And that's why something like Altherapy is just not gonna ever hit, you know, do anything significant to that smash layer.
11:43
SPEAKER_05: Other than that, I think that's I think that, you know, for the purposes of this conversation, we for me, I think there's a difference between lifting and tightening.
11:54
SPEAKER_05: Lifting to me is going against gravity, and nothing is going to do that except for surgery.
12:02
SPEAKER_05: Tightening, when I, and this is gonna, this is subjective to some extent, right?
12:07
SPEAKER_05: I mean, tightening to me is a collagen contraction to the point where you're going to see changes in skin quality.
12:17
SPEAKER_05: And when you tighten tissue enough, sometimes you can visualize some repositioning of tissue, like temporarily and the jowls, right?
12:29
SPEAKER_05: Temporarily.
12:30
SPEAKER_05: But I also think, you know, like this podcast is all about asking, is it worth it?
12:37
SPEAKER_05: So we're asking, but we're asking two different things here.
12:40
SPEAKER_05: Right now we're talking about does it work and is it worth it?
12:44
SPEAKER_05: Those are two different questions.
12:47
SPEAKER_04: But so I love that you said that because that actually brings up truly, like you said, it's very subjective.
12:53
SPEAKER_04: And it actually and it is, because you said that skin tightening is like collagen contraction and um like basically improving the quality of the skin.
13:02
SPEAKER_04: I don't see it that way.
13:04
SPEAKER_04: And so I feel like some like that's where that conversation with the patients is so huge.
13:09
SPEAKER_04: Because when to me, if somebody says skin tightening, to me, that means that the skin takes up less surface area, so there's less of it.
13:17
SPEAKER_04: So for me, tightening is more of a surgical thing because I'm pulling it, cutting, and now there's less of it.
13:23
SPEAKER_04: So it takes up less surface area.
13:26
SPEAKER_04: So, yes, the contraction, but I mean, I think that having that conversation with your patients and understanding the difference between the two is huge.
13:36
SPEAKER_04: And that's why I don't love saying skin tightening or lifting in any consultation.
13:41
SPEAKER_04: Like when somebody says that, I'm like, look, what we're gonna do is improve the quality of the skin.
13:46
SPEAKER_04: We're going to stimulate collagen elastin, lead to firmer, tighter, smoother looking skin.
13:51
SPEAKER_04: We can like give you a more contoured looking jawline.
13:56
SPEAKER_04: We can do all of those things, but am I tightening your skin?
13:59
SPEAKER_04: No.
14:00
SPEAKER_02: So it just we're gonna get along a whole lot more on this conversation on this podcast than I expected.
14:08
SPEAKER_02: So uh yeah, so that that's great.
14:10
SPEAKER_02: Um anything else we we want to say about uh all therapy?
14:15
SPEAKER_02: Do we want to ask if it's worth it or do we want to save that for later?
14:20
SPEAKER_05: I think we save that for later.
14:21
SPEAKER_05: I mean, I kind of think that's a good idea.
14:23
SPEAKER_02: We'll go over a bunch of them together.
14:24
SPEAKER_04: We could do like a quick fire thing.
14:26
SPEAKER_02: Yeah, yeah.
14:27
SPEAKER_02: Well, yeah, we'll do that at the end.
14:28
SPEAKER_02: Okay, that sounds good.
14:29
SPEAKER_02: So we uh we uh Andrew, you touched on soft wave a little bit.
14:33
SPEAKER_02: What is it?
14:34
SPEAKER_02: Um basically it's also ultrasound, but it's a little bit different.
14:38
SPEAKER_02: Uh as you mentioned, 1.5 millimeter depth kind of uh uh kind of and and that's it.
14:44
SPEAKER_04: Um, but so instead of those points that you the ultrasound points, think of them almost like um grains of rice in this way instead of that, it's flipped.
14:55
SPEAKER_04: So you have a longer range, like so more coverage size essentially.
14:59
SPEAKER_04: Yeah, you have more coverage.
15:01
SPEAKER_04: Um, and then there's like seven beams laid down at the same time.
15:05
SPEAKER_04: So instead of doing that like one little spot, you're getting seven grains of rice essentially.
15:11
SPEAKER_04: So can you do multiple passes to get deeper?
15:15
SPEAKER_04: Not deeper because they're fixed at 1.5.
15:18
SPEAKER_04: Well, if you take the 1.5 and then you do it again, can you get to I mean, not three, but you know, something less than no, but no, but you can get more coagulation in that area.
15:28
SPEAKER_04: So um Mystica has genius at her uh office, which is an RF microneedling.
15:36
SPEAKER_04: Um so it's gonna be similar the way that they uh want you to actually treat is treat the total energy, which is something that I kind of went over with them when they we did their training.
15:48
SPEAKER_04: So soft wave kind of works the same way.
15:50
SPEAKER_04: It's how much energy am I putting in one area um to give proper coverage?
15:56
SPEAKER_04: So if I do the proper coverage, I'm injuring X percent of those those cells and saying, hey, one, we need to build new collagen elastin.
16:05
SPEAKER_04: Um, but two, I'm injuring this tissue to get enough contraction in an area um to tighten the skin.
16:14
SPEAKER_02: So, you know, I I do think at this point in time, it's fair to ask if if we're comparing these two devices together, and I and I think we should, uh, if we were to pick a favorite, let's pick a favorite.
16:26
SPEAKER_02: Go ahead.
16:26
SPEAKER_02: Soft wave for sure.
16:28
SPEAKER_05: I I would pick soft wave.
16:29
SPEAKER_02: I mean, just over even the the generation 2.0 all therapy prime?
16:34
SPEAKER_02: Absolutely.
16:35
SPEAKER_02: Okay.
16:35
SPEAKER_05: Just by the mechanism.
16:37
SPEAKER_05: I mean, all therapy it hurts like a bitch.
16:41
SPEAKER_05: And I just don't, I I've never understood the purpose of treating so deep, you know, because collagen only lives in in one layer.
16:52
SPEAKER_05: So why are we going all the way down to the SMAS?
16:56
SPEAKER_05: What are what are we trying to achieve there?
16:58
SPEAKER_05: So I think you just stay where you know the collagen lives rather than increase risk of hitting neurovasculature.
17:06
SPEAKER_05: I just threw that term out there.
17:08
SPEAKER_05: What do you think of that?
17:09
SPEAKER_05: What do you think of my netter's anatomy?
17:12
SPEAKER_02: And fat, yeah.
17:12
SPEAKER_02: You're, I mean, if you're getting to the muscle layer, you're going through the fat layer.
17:17
SPEAKER_02: And you know, and that's an issue too.
17:19
SPEAKER_02: That that I don't love that plan.
17:21
SPEAKER_04: Now I'm gonna doc, I'm gonna ask you a question.
17:23
SPEAKER_04: Yeah, go.
17:24
SPEAKER_04: Everybody's always focused so much on like, we're lifting the smaz, we're lifting the smas.
17:28
SPEAKER_04: How many areas on the face really is there the smaz?
17:31
SPEAKER_02: Well, the smash it it's contiguous.
17:33
SPEAKER_02: It goes all the way up from the deep temporal fascia through the the smash and down to the platisma.
17:38
SPEAKER_02: So the the whole thing, the smas layer is continuous uh all the way throughout.
17:43
SPEAKER_02: Yeah, so the the mobile smash, the the fixed mass is is a little higher, the mobile smas is a little bit lower.
17:49
SPEAKER_02: So we're not really lifting this part of the smash so much uh where it's fixed because you release where it's mobile, and then that's gonna give you that that's where the majority of the of the heavy, heavy, heavy lifting is done.
18:02
SPEAKER_02: Right.
18:03
SPEAKER_04: So well, that being said, so people will tend to say, like, I want this and this, because my back, my uh my cheeks are so low.
18:12
SPEAKER_04: This, like with any of these devices, I mean, even if I'm getting down to this mas, like I'm not lifting this at all.
18:19
SPEAKER_02: There's not a lot of lifting that happens right here specifically.
18:22
SPEAKER_02: No, there's not a lot of lifting that happens right here.
18:26
SPEAKER_02: Okay.
18:26
SPEAKER_02: Yeah.
18:26
SPEAKER_02: There we're we're moving skin, we're you know, we're we're tightening skin, but there's not a lot of lifting here.
18:32
SPEAKER_02: Now there's lifting up here in the temple when you release the uh the do a lateral, like do a brow lift here, there's lifting there.
18:40
SPEAKER_02: We used to do this.
18:40
SPEAKER_02: That's that we uh thankfully we don't do that anymore.
18:43
SPEAKER_02: And then the like this lifts great.
18:46
SPEAKER_02: Like you can really take you know several centimeters of of lift here, and it's just it comes out gorgeous.
18:52
SPEAKER_02: But this area specifically, no.
18:53
SPEAKER_02: And and and for those of you listening, it's it's the amber herd area again.
18:58
SPEAKER_02: Okay.
18:58
SPEAKER_02: The zygoma.
19:00
SPEAKER_02: Yeah, it's called uh zygoma, uh, the zygomatic bone here.
19:05
SPEAKER_02: Um, it's the like the part of your cheek that kind of sticks out on the side again.
19:09
SPEAKER_02: A couple episodes ago, for those of you that are OG scalpel and skin podcast people, the it's the uh the maleficent cheeks area, or if you know your bones, it's the zygomatic bone.
19:20
SPEAKER_02: Nerdy.
19:21
SPEAKER_02: Okay, moving on.
19:22
SPEAKER_02: Uh uh okay.
19:25
SPEAKER_02: So now we're gonna talk non-invasive monopolar RF.
19:29
SPEAKER_02: Uh and that is Thermage.
19:32
SPEAKER_02: Thermage.
19:32
SPEAKER_02: Thermage F L X.
19:34
SPEAKER_02: It's a it's a really pretty name.
19:35
SPEAKER_02: It it sounds French.
19:37
SPEAKER_02: Thermage.
19:38
SPEAKER_02: It's it kind of it rolls off the lips.
19:41
SPEAKER_02: Uh tell me about it, and um, you know, what do we think?
19:45
SPEAKER_04: Are we gonna talk about other monopolar RF too, or just this one for now?
19:49
SPEAKER_02: Well, we're gonna talk about uh RF microneedling, we're gonna talk about genius, we're gonna talk about Morpheus.
19:56
SPEAKER_02: You know, we're gonna talk about um Okay, why don't we do we want to group them?
20:00
SPEAKER_05: Why don't we just have to?
20:02
SPEAKER_05: Yeah, let's talk about RF.
20:03
SPEAKER_04: Well, so we could do like our monopolar RF, bipolar RF, and like uh RF microneedling because let's do that.
20:11
SPEAKER_02: That's your let's talk about monopolar RF.
20:14
SPEAKER_02: Uh Andrew.
20:16
SPEAKER_05: I'm I'm dying for a little lesson from Andrew.
20:18
SPEAKER_05: I haven't got a Andrew lesson in over a year.
20:21
SPEAKER_05: Yeah, let's go.
20:22
SPEAKER_05: Let's hear about it.
20:22
SPEAKER_05: I'm ready.
20:23
SPEAKER_04: I can relax now.
20:24
SPEAKER_04: All right, so monopolar RF.
20:27
SPEAKER_04: Everybody is like very into it right now.
20:30
SPEAKER_04: There's multiple devices, whether that is Thermage, Legio X, Zerf, Density.
20:37
SPEAKER_04: Oh, there's a bunch, right?
20:39
SPEAKER_04: Everyone's gonna hate me.
20:41
SPEAKER_04: No, I love it.
20:42
SPEAKER_04: We won't so yeah, no, I know you guys won't.
20:45
SPEAKER_04: Here we go.
20:45
SPEAKER_04: No, so ther Thermage hurts.
20:47
SPEAKER_04: It is what it is.
20:48
SPEAKER_04: Nobody buys Thermage anymore.
20:50
SPEAKER_04: Um, does it work?
20:51
SPEAKER_04: Sure, it works.
20:52
SPEAKER_04: It is going to again stimulate collagen elastin and provide smoother, tighter, firmer looking skin, whether or not that's a lift.
21:02
SPEAKER_04: The other ones, the biggest thing between all of them, there's like slight minute differences, right?
21:09
SPEAKER_04: Out of all of them, I do like Legio X the best.
21:13
SPEAKER_04: And I will say, like, I am slightly biased because I do train for them now at Wantec.
21:19
SPEAKER_04: However, I train for them because they actually have like research and stuff behind it.
21:24
SPEAKER_04: Um, so I do like that device the best now that I've worked with multiple of them.
21:29
SPEAKER_04: Most of the monopolar RFs are um one frequency, which is 6.78 megahertz.
21:36
SPEAKER_04: That's been like the traditional what we use, right?
21:40
SPEAKER_04: Um there's one out here now that is two frequencies.
21:46
SPEAKER_04: So that's 6.78 followed by two.
21:49
SPEAKER_04: That two megahertz is what again has traditionally been then used for fat disruption.
21:55
SPEAKER_04: For whatever reason, that company says that they ignore the fat.
22:00
SPEAKER_04: Cells and that's physically impossible to do.
22:03
SPEAKER_04: So that that to me doesn't quite make sense.
22:06
SPEAKER_04: I mean, I also know somebody that does not work there anymore, and they said that they kind of stopped with their RD, but that's a whole other story.
22:13
SPEAKER_04: So uh we'll cut that.
22:16
SPEAKER_02: Yeah, sometimes when I go on a diet, um it also ignores the fat cells, but yeah, that's a whole other story, right?
22:22
SPEAKER_04: Exactly.
22:22
SPEAKER_04: But so in general, I mean, you it's a lot of these devices are more about um like provider technique and how to do it.
22:34
SPEAKER_04: So for example, the device that is that that 6.78 followed by two megahertz is only available in one mode, which is meant for the jaw.
22:43
SPEAKER_04: So fine.
22:44
SPEAKER_04: If that's kind of what you want to do, maybe it is um maybe you're trying to like disrupt a little fat or something like that, or you truly want to quote unquote get down to the SMAS with it, fine.
22:55
SPEAKER_04: My my problem with some of the devices is that again, a lot of it is marketing and they're claiming results that are usually combined with other things.
23:06
SPEAKER_04: I do think personally that monopolar RF works.
23:10
SPEAKER_04: It's I I think that it's a great technology as far as firming the skin, stimulating collagen, and improving the quality of the skin.
23:19
SPEAKER_04: So I definitely think that there's a need for it.
23:22
SPEAKER_04: And I think it works well with other things, even a facelift, because you're not getting so much coagulation to the point of like scar tissue.
23:31
SPEAKER_04: So I think it works well with what you do as well overall.
23:34
SPEAKER_04: There's another device or a couple devices, I think, that are bipolar and monopolar radio frequency in the same device.
23:42
SPEAKER_04: Um, I think that is pure gimmick because why would I need bipolar if the monopolar is going through the superficial tissue anyway and heating the superficial tissue?
23:52
SPEAKER_04: And their plane is, oh, well, it focuses on the superficial tissue.
23:56
SPEAKER_04: I mean, who cares?
23:57
SPEAKER_02: And and then why would you need bipolar if the monopolar's working?
24:00
SPEAKER_02: Why would you need monopolar if the bipolar's working?
24:03
SPEAKER_04: So uh okay.
24:04
SPEAKER_04: So that's kind of where I'm at on those.
24:06
SPEAKER_04: I think that each each of them have a or I guess I should say the technology itself has a purpose.
24:13
SPEAKER_04: I think it's more how it's delivered and who's doing it is really the what it comes down to.
24:19
SPEAKER_02: I I think anybody worth their weight in this industry will tell you that someone who's really good can get better results with a 10-year-old technology than someone who sucks with brand new technology.
24:31
SPEAKER_02: I I and and if anybody tells you any different, that they're the ones that suck.
24:35
SPEAKER_04: I mean, that's that's absolutely true.
24:37
SPEAKER_04: I think there are newer technologies that like maybe have a better safety profile.
24:42
SPEAKER_04: Maybe there are things that do things more efficaciously, but at the end of the day, you're absolutely right because I mean it's just it's just how things have always been.
24:53
SPEAKER_04: Technology doesn't change that much to the point of like anything else.
24:57
SPEAKER_02: It's when to do it and and when not to do it.
25:00
SPEAKER_02: Mystica just gave a lecture on complications of energy-based devices at a conference in Dallas.
25:07
SPEAKER_02: It was uh fantastic.
25:09
SPEAKER_02: And and so knowing when to do something and when not to do something is uh is the most important thing, right?
25:17
SPEAKER_02: Uh oh uh the the thing that that I tell uh my patients and I tell my staff is do the right thing for the right patient at the right time.
25:26
SPEAKER_02: And if you do that, you're gonna stay out of trouble most of the time.
25:31
SPEAKER_02: They have the right energy.
25:33
SPEAKER_02: Right, yeah.
25:34
SPEAKER_02: Well, right.
25:34
SPEAKER_02: That's that's doing the right thing.
25:36
SPEAKER_02: Yeah.
25:36
SPEAKER_02: You know, in my in my house, we only have two rules.
25:39
SPEAKER_02: Miss, do you know what my rules are?
25:41
SPEAKER_02: Do you remember what they are?
25:42
SPEAKER_02: In my house for my kids.
25:44
SPEAKER_02: Anyone, you can take this.
25:46
SPEAKER_02: Um, it is get good grades, get good grades, and don't be an asshole.
25:51
SPEAKER_02: That's it.
25:51
SPEAKER_02: Those are the two rules in my house.
25:53
SPEAKER_02: There's nothing else.
25:54
SPEAKER_05: I thought you were gonna say with with uh great power becomes great responsibility.
26:00
SPEAKER_02: No, that's in Spider-Man's house.
26:03
SPEAKER_02: I wish you would invite that too.
26:06
SPEAKER_02: But you know, no, I live, I don't have great power.
26:08
SPEAKER_02: I have moderate power.
26:10
SPEAKER_02: Um get good grades, don't be an asshole.
26:14
SPEAKER_02: That covers everything for your kids.
26:16
SPEAKER_02: Okay.
26:17
SPEAKER_02: Do well in school, don't be a dickhead.
26:20
SPEAKER_02: Um, and and my uh I've got multiple people now who follow that, um, but their kids are younger.
26:27
SPEAKER_02: Like Tosh, uh Tosh says, you know, get good grades and don't be a jerk.
26:33
SPEAKER_02: Her kids are like five and nine, so it's yeah.
26:36
SPEAKER_05: So in like six to seven years, she can say asshole.
26:39
SPEAKER_05: Or if you live in my house and my kids are nine and seven, I'd probably just say asshole now.
26:46
SPEAKER_05: I mean, let's be real.
26:49
SPEAKER_02: I get it.
26:50
SPEAKER_05: Don't judge me.
26:51
SPEAKER_05: Don't judge me, people.
26:52
SPEAKER_05: I have a potty mouth.
26:54
SPEAKER_05: It's fine.
26:55
SPEAKER_05: Fine.
26:56
SPEAKER_05: There are worse things for kids to learn.
26:58
SPEAKER_05: There are worse things for them to learn.
27:00
SPEAKER_02: There are.
27:02
SPEAKER_02: There absolutely are.
27:03
SPEAKER_02: Okay, so like what else?
27:04
SPEAKER_02: Uh what else do you want to talk about with um with this topic here?
27:08
SPEAKER_02: What do you want to talk about uh RF?
27:10
SPEAKER_02: I mean, there's a lot, there's a ton of RD.
27:13
SPEAKER_04: Yeah, there's a ton of things.
27:14
SPEAKER_05: How about RF microneedling?
27:16
SPEAKER_04: I mean absolutely.
27:17
SPEAKER_04: Yeah, let's do that.
27:17
SPEAKER_05: And I definitely I wouldn't be, it wouldn't be a conversation about RF microneedling without talking about the FDA warning from last year that scared the shit out of a lot of people that I have to address almost weekly.
27:30
SPEAKER_05: Why don't we do that?
27:31
SPEAKER_05: Let's talk about it.
27:32
SPEAKER_02: Yeah, get it, let's get it out there.
27:33
SPEAKER_04: Miss, why don't you tell us what that FDA warning was?
27:36
SPEAKER_04: Because I mean, we all know.
27:37
SPEAKER_05: I think it was it was um October, I want to say October of last year, where they they issued a warning about RF microneedling devices causing fat loss, burns, tissue damage.
27:55
SPEAKER_05: They didn't elaborate really on why they all of a sudden decided to issue this warning.
28:01
SPEAKER_05: And and my question at the time was you know, we know that lasers and IPL and devices for decades have been burning patients and and causing issues.
28:14
SPEAKER_05: So, why all of a sudden did the FDA decide to issue this warning now?
28:18
SPEAKER_05: Clearly it's because they were getting more reports than made them comfortable keeping quiet on about patients having issues.
28:26
SPEAKER_05: So they they issued this warning about just taking care with using these devices and and warning patients to be diligent in in the choices that they make.
28:39
SPEAKER_05: Um what I think most of us would agree upon is that RF microneedling is very safe in the right hands, and it's extremely operator dependent, as is any device, any any laser device or any energy-based device or microneedling device is is going to be.
29:03
SPEAKER_04: I think that's that's the biggest thing that people don't understand, plus the people that make laws, lawmakers, uh they don't understand a lot and they make laws kind of or but even warnings just kind of haphazardly.
29:19
SPEAKER_04: But I think that like you said, it's it's the right age at the right time, the right provider, all of those things, because that especially truly comes down to like who did it, you know.
29:32
SPEAKER_04: Absolutely.
29:33
SPEAKER_04: It's not that it's not that the device is I don't want to say dangerous, could but like I mean a laser, you can cause necrosis and like a hundred percent, literally from the skin.
29:45
SPEAKER_04: Yeah.
29:45
SPEAKER_04: So like it's it's it's all the same.
29:48
SPEAKER_04: Like when we're talking about high amounts of energy, um, I think where um a lot of it became um negative was initially in mode um with Morpheus 8.
30:03
SPEAKER_04: Morpheus.
30:03
SPEAKER_04: And and that was because um, and I will tell you flat, like one of the the first training that I had on Morpheus 8, because the office that I have or office that I work at has a Morpheus 8 as well.
30:17
SPEAKER_04: Um they were we wanted to do like under eyes, and they're like, oh well, you can you caness the under-eyes and you can go four millimeters with high energy if you really want to like like tighten up and improve who said that I swear in mode said that yeah, and and so I think granted that was that was when it first came out because we got that device when it first came out, and we were like that doesn't make sense, and uh we did it on the doctor's wife, um, because that was who was at training, and never did it again because she was she was four millimeters, she was so used for like a like two weeks, and like her eyelids.
31:06
SPEAKER_05: The skin isn't four millimeters, the skin of the lower eyelids is about as the fat like is you did you did like the fat under her eyes fry?
31:15
SPEAKER_05: Like, does she have any fat left?
31:17
SPEAKER_05: Irregularly for sure.
31:20
SPEAKER_04: Well, it I mean, I will say they finally look better a couple years later, but we've done a thousand other treatments on it.
31:27
SPEAKER_05: Oh my god, but he's so glad that was his wife.
31:30
SPEAKER_04: Oh, a hundred percent.
31:31
SPEAKER_02: And also he knows she knows where he sleeps, so maybe not so much.
31:37
SPEAKER_02: Maybe, maybe not so much.
31:39
SPEAKER_02: Holy shit.
31:40
SPEAKER_04: But I feel like back in the day, their reasoning for doing that was because they were like, Oh, well, you can tomess the eye because you're now making space essentially for that needle to go.
31:53
SPEAKER_04: And we were like, Well, this just this doesn't make sense.
31:55
SPEAKER_04: This doesn't make sense.
31:57
SPEAKER_01: Um, you're putting the needle in the way.
31:59
SPEAKER_01: I hate so much in the aesthetics industry because that's insane.
32:04
SPEAKER_01: It's insane.
32:05
SPEAKER_04: Absolutely.
32:05
SPEAKER_04: It's insane.
32:06
SPEAKER_01: That is insane.
32:07
SPEAKER_01: Triggered.
32:07
SPEAKER_01: He's triggered.
32:08
SPEAKER_01: Oh, absolutely.
32:09
SPEAKER_01: I knew you were gonna get triggered at least once during this episode.
32:13
SPEAKER_01: That's hurting people.
32:14
SPEAKER_01: Stop hurting people.
32:16
SPEAKER_04: But so that's ridiculous.
32:18
SPEAKER_04: That's hate.
32:19
SPEAKER_04: That device that's why they got they had so many lawsuits against them at one point.
32:26
SPEAKER_04: But I think that that's kind of where that came from.
32:29
SPEAKER_04: And then we have other devices like Genius, which I think is probably one of the better RF microneedlings on the market.
32:37
SPEAKER_04: Um, and there's no doubt.
32:39
SPEAKER_04: Yeah, and yeah, we love our genius.
32:42
SPEAKER_04: Yeah, part of it is because you can go by it, it's great.
32:44
SPEAKER_04: Yeah, by a tenth of a millimeter.
32:47
SPEAKER_04: Me personally, I hate it for myself, but that's because I'm it hurts.
32:52
SPEAKER_05: It hurts, no, it hurts.
32:54
SPEAKER_04: I was like flying off the table.
32:55
SPEAKER_04: Yeah, it hurts.
32:57
SPEAKER_04: I will say there is a newer device on the market right now that they released uh just a couple months ago from Boston Aesthetics, and that's called Zen Tite.
33:07
SPEAKER_04: And that is RF microneedling.
33:09
SPEAKER_04: And I haven't had it done to myself yet, but um I've I've seen it done, and I've I've seen people have it done.
33:17
SPEAKER_04: And um the cool thing with that one, it works very similarly in that it goes by a tenth of a millimeter.
33:23
SPEAKER_04: You can adjust your pulse duration and your uh uh wattage.
33:28
SPEAKER_04: But the way that they do it, they deploy the needles and then instead of like kind of just blast and heat, it will go, it will pulse two needles, two needles, two needles, two needles until it gets to all of the needles.
33:42
SPEAKER_04: So it's a sequential pulse, um, so it's not as uncomfortable.
33:48
SPEAKER_04: And then it retracts them.
33:49
SPEAKER_04: Obviously, it doesn't matter.
33:50
SPEAKER_04: Does it take longer?
33:52
SPEAKER_04: No, it's just it's just done so quickly.
33:54
SPEAKER_04: So like it deploys and it's a fraction of a second, obviously.
33:58
SPEAKER_04: So it deploys, pulses, retracts, and people are really liking it from what I've seen so far.
34:04
SPEAKER_04: So I mean, they all hurt, it's all hot needles in the face.
34:09
SPEAKER_04: Let's just be real.
34:10
SPEAKER_05: I mean, like everything hurts, everything we do hurts.
34:13
SPEAKER_05: Everything.
34:16
SPEAKER_04: Yeah, yeah.
34:18
SPEAKER_02: I know, but but yeah, same kind of thing.
34:21
SPEAKER_02: I just stabbed a lady thousands of times today with a blunt cannula in the in the hips.
34:27
SPEAKER_02: She looks awesome though.
34:28
SPEAKER_02: Yeah, lipo?
34:30
SPEAKER_02: Yeah, yeah, yeah.
34:31
SPEAKER_02: With with everything.
34:32
SPEAKER_02: I did a full mommy makeover today.
34:34
SPEAKER_02: She looks amazing, but uh I need a daddy do-over.
34:39
SPEAKER_05: You need a mommy makeover, yeah.
34:41
SPEAKER_02: Getting there.
34:42
SPEAKER_02: Daddy do over.
34:42
SPEAKER_02: There you go.
34:43
SPEAKER_02: All right.
34:43
SPEAKER_04: But so like like a RF microneedling, I do kind of compare a little bit to ultrasound because you are still getting those like little coagulation zones.
34:53
SPEAKER_04: Um but obviously you're you're potentially getting like a little blood and a little bit more erythema where um ultrasound, there's like truly no downtime.
35:05
SPEAKER_04: So of the two, I feel like me personally, and not to say that they like that RF microneedling doesn't work because it absolutely does.
35:13
SPEAKER_04: Um, if it was me, I would prefer probably the ultrasound at a specific step, just because one, I can probably get through the treatment a little faster.
35:27
SPEAKER_04: Um and then do yeah, as a patient, well, and a provider, and I can do other things easier on top.
35:36
SPEAKER_05: So meaning like I can I can uh you want to do laser that yeah, I don't want like the word stacking, but like combination therapies, um you can do it a lot easier with something like a software because they're like truly like barely even I think I think the the the microneedling component though, there's something something to be said about skin quality, maybe more skin quality improvement when you have the microneedling component.
36:06
SPEAKER_05: But yeah, I mean I think I think generally speaking, they're all kind of gonna be pretty comparable in terms of results.
36:14
SPEAKER_04: Very good.
36:14
SPEAKER_04: I like I like that we agree.
36:16
SPEAKER_02: So uh yeah, so um what uh uh let's wrap up RF.
36:21
SPEAKER_02: Go ahead and um what are we what are any final things you want to say about it?
36:26
SPEAKER_04: Yeah, the only other thing like RF technology we haven't really talked about is bipolar RF by itself, which I think is a joke.
36:34
SPEAKER_05: Is that Zurf?
36:36
SPEAKER_04: No, no, that's monopolar RF too.
36:39
SPEAKER_04: Oh, is it Zerf is monopolar, but it's it's the dual frequency.
36:41
SPEAKER_04: It's 6.78 followed by two.
36:44
SPEAKER_04: Bipolar RF is gonna be like forma.
36:47
SPEAKER_05: I'm I don't I'm never even I don't know what that is.
36:49
SPEAKER_05: I don't think I could name it a bipolar RF.
36:51
SPEAKER_04: Uh um, it's basically just like a wand that you do this with and you heat up the tissue.
36:57
SPEAKER_04: I think it's nice for like more of an immediate kind of like a Cinderella effect type thing.
37:04
SPEAKER_04: Um but like it's it's more labor-intensive because you're like really just going back and forth.
37:10
SPEAKER_04: It's like it's like laser toning.
37:12
SPEAKER_04: Um okay, got it.
37:14
SPEAKER_04: But I love like you know I love laser toning.
37:16
SPEAKER_05: Yes.
37:17
SPEAKER_04: But laser toning to me is more about overall skin quality because it's a laser and you can actually improve skin quality by the chromophores, obviously.
37:26
SPEAKER_04: This is purely just heat.
37:27
SPEAKER_04: So if it's just heat, all you're getting is some collagen production.
37:31
SPEAKER_04: But I mean, yeah, right.
37:33
SPEAKER_04: Like cool, right, yeah.
37:35
SPEAKER_04: I don't think it's like anything impressive.
37:38
SPEAKER_02: Nothing to write home about.
37:39
SPEAKER_02: Yeah.
37:39
SPEAKER_02: So let's now kind of go into more um minimally or less invasive devices like face tight, acutite, renovion J Plasma.
37:51
SPEAKER_02: Um, these are similar but different uh uh modalities.
37:56
SPEAKER_02: Uh face tight, I believe, is bipolar uh facial lipolysis, um neck lipolysis.
38:03
SPEAKER_02: So removing fat uh and Renewion J Plasma is it's monopolar, it's helium-based.
38:10
SPEAKER_02: Uh they've both been around for a few years.
38:12
SPEAKER_02: Let's uh, Andrew, let's go ahead and let's get your thoughts on that.
38:16
SPEAKER_04: So obviously, from like a provider standpoint, that is something that I'm I'm not quite cal qualified to do.
38:24
SPEAKER_04: Um but from what I've seen and other like people's results and patient satisfaction and stuff like that, I do think that like a Renewion works great when done properly.
38:37
SPEAKER_04: Um I think that absolutely if you are looking to um I don't want to say shrink wrap the skin, but shrink wrap the skin.
38:44
SPEAKER_04: Right.
38:44
SPEAKER_04: Because that's essentially kind of what you're doing.
38:46
SPEAKER_04: Like you're going in and sizzling and and causing some some contraction that way.
38:51
SPEAKER_04: Um it absolutely works.
38:53
SPEAKER_04: I've seen great results with it.
38:54
SPEAKER_04: I know people that are very happy with it.
38:56
SPEAKER_04: I think that with like the face tights, acu-tites, um, they are a little bit more um subtle.
39:06
SPEAKER_04: Yes, there you go.
39:09
SPEAKER_04: That was a perfect word.
39:11
SPEAKER_04: A little bit more subtle.
39:13
SPEAKER_04: Look at us agreeing on things.
39:15
SPEAKER_04: I normally disagree with a plastic surgeon so often.
39:18
SPEAKER_05: But did you guys just become best friends?
39:20
SPEAKER_05: We just became best friends for some.
39:22
SPEAKER_04: I think that was it.
39:25
SPEAKER_04: Um, but yeah, no, definitely a little bit more subtle.
39:28
SPEAKER_04: Again, I've seen some nice results with them, more so on the face and neck, though.
39:32
SPEAKER_04: Um, but again, that's a more subtle area.
39:35
SPEAKER_02: So I mean, if you're getting a so let's let me let me talk about it from my perspective.
39:41
SPEAKER_02: We use these uh devices in in a combination as as part of a typically as like a liposuction procedure um or uh or liposuction and like tightening to the neck.
39:55
SPEAKER_02: We use it uh on the body a lot.
39:57
SPEAKER_02: And uh J Plasma was the original name, and then uh Renewion J Plasma.
40:02
SPEAKER_02: It's basically the it's the same thing, helium-based device.
40:06
SPEAKER_02: Basically, you go in and traditional liposuction is you make a little cut, you put some fluid in there uh with some different medications, and then uh and then you suck that some of that fluid out in addition to some of the fat out.
40:20
SPEAKER_02: And that's that's uh the most basic definition or description of liposuction you can get.
40:26
SPEAKER_02: Uh, there is uh an additional device that can be used in between those two steps called vasor, and that is uh ultrasound technology, which if you think uh I like to describe it, if you think of fat as like a bunch of grapes or a clump of grapes, the vaser will go in and break break those clumps of grapes down into individual grapes for a easier removal by uh in in what was step two is now step three.
40:55
SPEAKER_02: Uh, you can also do Renevion with that.
40:58
SPEAKER_02: So uh that goes in uh as well to then once the fat is removed, to then tighten the skin uh from the inside.
41:07
SPEAKER_02: So you you tighten the skin from the deeper surface uh with this helium energy.
41:13
SPEAKER_02: Um and it works really, really nice.
41:15
SPEAKER_02: Um I think it's I think it's great for the uh great for the neck.
41:20
SPEAKER_02: It's nice for other areas.
41:22
SPEAKER_02: Um I you know the the thing about it is is in my uh patient load, it's less necessary now than it was two or three or four years ago um because we were doing liposuction in basically skinnier patients before.
41:38
SPEAKER_02: Um and now everybody's in my patient population, patients have lost so much weight that they have a ton of loose skin.
41:47
SPEAKER_02: And it that's just not enough anymore.
41:51
SPEAKER_02: Uh, so we're going in and we're doing liposuction and we're doing a lot more skin removal than than we were a few years ago.
41:57
SPEAKER_05: Because of GLP1s.
41:59
SPEAKER_02: Because of GLP one, right, because of uh the the different uh weight loss uh medications, which are which have basically they're transforming America as we speak.
42:09
SPEAKER_02: Um and and it's uh very interesting to see, and it's just getting bigger, and uh, you know, I'm here for it.
42:15
SPEAKER_02: I um I I've said that uh I think we had to put that stuff in the water.
42:20
SPEAKER_02: I'm joking, people.
42:22
SPEAKER_02: Don't take it seriously.
42:25
SPEAKER_02: I say we should put Lexapro and Ozempic in the water supply.
42:29
SPEAKER_02: Be carefully mean it.
42:32
SPEAKER_02: Okay, I don't know.
42:32
SPEAKER_05: In a few years, Claude is gonna do that.
42:36
SPEAKER_05: You're Claude.
42:37
SPEAKER_02: Absolutely.
42:38
SPEAKER_05: My chat, they're gonna do it.
42:40
SPEAKER_05: Give it a couple years.
42:41
SPEAKER_05: They're gonna be able to do that.
42:42
SPEAKER_05: I have them closed.
42:43
SPEAKER_02: No, I actually don't.
42:44
SPEAKER_02: They're both actually still oh, they're running in the background on my laptop.
42:47
SPEAKER_02: I'm just kidding.
42:48
SPEAKER_05: Um, I know.
42:54
SPEAKER_02: Uh yeah, so I think it's a great, I think J Plasma Vernuvian is a great device.
42:59
SPEAKER_02: Again, in the right patient, I think face tight.
43:02
SPEAKER_02: Um uh uh the results are typically not enough in most patients, my opinion.
43:10
SPEAKER_02: Andrew, disagree or agree?
43:13
SPEAKER_04: No, I agree with you in in that I do think Vernuvian is definitely better um than the other option, um, like like your whatever tights, you know.
43:22
SPEAKER_04: But I I think that again, it's it's who is that patient?
43:27
SPEAKER_04: Because I've seen, I mean, you're used to making scars on people.
43:31
SPEAKER_04: I'm used to getting rid of scars on people or trying to get rid of scars on people.
43:35
SPEAKER_04: And especially when you're going in here, like you get that little like nodule kind of ledge, little ledge, right?
43:43
SPEAKER_00: Exactly.
43:44
SPEAKER_04: And then I mean, all I hear is people being like, I had this done and now I have this.
43:49
SPEAKER_04: I'm like, okay, well, what'd you think was gonna happen?
43:51
SPEAKER_02: But then we just cut it out and and and smooth it out and and do it again.
43:56
SPEAKER_02: Make another scar.
43:58
SPEAKER_04: Totally.
43:58
SPEAKER_04: Um, but I feel like That's that's why so many more people are opting for these more non-invasive options is because they do that in downtime, not in downtime, yeah.
44:09
SPEAKER_04: No, absolutely.
44:09
SPEAKER_04: But I mean, even with that, I mean I feel like with with Renuvion, there's really not that much downtime.
44:14
SPEAKER_02: Not that much.
44:15
SPEAKER_02: I mean a week probably for yeah, yeah.
44:18
SPEAKER_02: I mean it's it's it's uh liposuction, you know, plus uh an additional step.
44:23
SPEAKER_02: So, you know, it's not that much different.
44:26
SPEAKER_05: Did it my old my the the dermatologist that I used to work for, Dr.
44:31
SPEAKER_05: Obaji, does Renuvion.
44:32
SPEAKER_05: I don't know if she's still doing it, but she was doing it when I was there.
44:35
SPEAKER_04: I totally agree that it's it's it's definitely great, but like you said, in in the right hands.
44:40
SPEAKER_04: I mean, obviously there's way more complications that can happen with that.
44:44
SPEAKER_04: I don't want to, I don't want somebody perforating somebody's vowel.
44:48
SPEAKER_02: Right.
44:49
SPEAKER_01: Yeah, that's a bad idea.
44:50
SPEAKER_02: Right um generally frowned upon.
44:53
SPEAKER_02: Uh Endolift.
44:54
SPEAKER_02: What what is Endolift?
44:56
SPEAKER_02: Um, huge on social media, particularly outside the US.
45:00
SPEAKER_02: Let's tell me about it.
45:02
SPEAKER_02: What do you know?
45:02
SPEAKER_04: So so I I have not had too much firsthand experience with it, but I've been hearing amazing things, and I actually think I'm gonna get it done so I can like follow up later.
45:15
SPEAKER_04: I think so, because I know somebody close by that does one.
45:18
SPEAKER_04: Um, and I I'm gonna kill myself over all of this.
45:22
SPEAKER_04: Not actually editing.
45:24
SPEAKER_04: We know, we know, yeah, yeah.
45:26
SPEAKER_04: It this is crazy that we have to keep saying that over and over again.
45:30
SPEAKER_04: This has been really bad though.
45:31
SPEAKER_04: So I I do think that I'm gonna do it there.
45:34
SPEAKER_04: But so that's basically like a laser-assisted type fat melting and skin tightening.
45:40
SPEAKER_02: Is it by the same company that did Smart Lipo?
45:42
SPEAKER_02: Because that was something that was around for a long time and you know it it is different, yeah.
45:47
SPEAKER_02: And this is uh Smart Lipo was laser lipo.
45:51
SPEAKER_02: It it never really worked out as well as we had hoped for it.
45:54
SPEAKER_02: It came out a few times.
45:56
SPEAKER_04: But this, so this goes, this is such it's almost like a little tiny, thin, like a little tiny, like almost like hair-like probe that is flexible.
46:06
SPEAKER_04: Okay, and you kind of go in that way and inside.
46:10
SPEAKER_04: Um, inside, yeah.
46:11
SPEAKER_04: So you literally and then you deliver the energy of the laser inside, right?
46:16
SPEAKER_05: It's a is it a diode?
46:18
SPEAKER_05: It's a diode laser.
46:19
SPEAKER_05: Yeah, okay, very cool.
46:21
SPEAKER_05: I believe so.
46:21
SPEAKER_05: If you like it, I'm next in line.
46:23
SPEAKER_02: It says it is a 1470 diode laser.
46:27
SPEAKER_04: 1470, yeah.
46:28
SPEAKER_02: 1470 diode laser.
46:30
SPEAKER_02: I just it says it may ultimately prove to be excellent pop, but popularity is ahead of the quality of the evidence.
46:38
SPEAKER_02: So it's pending.
46:41
SPEAKER_02: Yes.
46:41
SPEAKER_02: So that tells me that's something that I want that I wouldn't get for two or three more years because I I I apologize.
46:48
SPEAKER_02: I would rather be late to the party than apologize for hurting a bunch of people.
46:53
SPEAKER_02: And that is that's the that's the approach that I typically always take.
46:57
SPEAKER_02: A hundred percent.
46:58
SPEAKER_04: So I generally don't like suggest people purchase it.
47:03
SPEAKER_02: But you're willing to do it to your own face, that's cool.
47:06
SPEAKER_04: I mean, you gotta you gotta try things for uh the sake of research.
47:12
SPEAKER_02: Uh why the heck not?
47:13
SPEAKER_02: I love it.
47:14
SPEAKER_02: Okay, we have a couple other things here.
47:17
SPEAKER_02: Oh my god, there's actually a bunch of things.
47:19
SPEAKER_02: Okay, you if you can uh we can go smash or we could do some like rapid fire ones, yeah.
47:24
SPEAKER_02: M face m face is synchronized RF and high fest.
47:28
SPEAKER_02: Is that what it is?
47:29
SPEAKER_02: High intensity, huh?
47:30
SPEAKER_02: Pass elicore, micro coring.
47:33
SPEAKER_04: Why that's literally like a sewing machine.
47:36
SPEAKER_02: Pass.
47:37
SPEAKER_02: Pass.
47:38
SPEAKER_02: Okay.
47:38
SPEAKER_02: Um elixis Ultra 360, RF Ultra, non-invasive RF ultrasound.
47:44
SPEAKER_02: Great.
47:45
SPEAKER_03: Um yeah, pass.
47:47
SPEAKER_02: Uh okay.
47:47
SPEAKER_02: What about lasers?
47:48
SPEAKER_02: Let's let's you know, so let me let's talk a little bit about lasers.
47:52
SPEAKER_02: Are are are they actually skin tightening device?
47:56
SPEAKER_04: No, and I'm never gonna tell somebody that.
47:58
SPEAKER_04: No, so I think definitely not.
48:00
SPEAKER_04: Yeah, no, okay, good question.
48:02
SPEAKER_05: No, no, I would never call lasers.
48:04
SPEAKER_05: No, so you're telling me there's something that lasers can't do?
48:08
SPEAKER_05: What lasers are lasers quality treatment?
48:12
SPEAKER_04: There's God and I will say in her defense of lasers can do everything, is that if you are truly stimulating collagen, you will get smoother, tighter, firmer looking skin, looking skin.
48:30
SPEAKER_04: So again, we're not removing anything unless we're CO2, then we're removing.
48:34
SPEAKER_04: And a CO2 is the only device, only laser that I will tell people truly tighten skin because you're physically removing the skin.
48:42
SPEAKER_04: So you're literally taking like a little piece out, and the skin has to pull itself shut.
48:47
SPEAKER_04: Granted, are you getting that much?
48:49
SPEAKER_04: No, but you are tightening it because you're removing the skin.
48:52
SPEAKER_02: You know what works amazingly well?
48:54
SPEAKER_02: A facelift and a CO2.
48:57
SPEAKER_02: No, a facelift and a CO2 combined together.
49:00
SPEAKER_02: 100%.
49:02
SPEAKER_02: 100%.
49:03
SPEAKER_02: You were like, oh, here it comes.
49:04
SPEAKER_02: No, I got you right there.
49:07
SPEAKER_02: That is true.
49:08
SPEAKER_02: Combination CO2 facelift.
49:10
SPEAKER_04: And if you really want to be able to coming soon.
49:14
SPEAKER_02: Coming soon to Skinlab.
49:17
SPEAKER_02: Oh, really?
49:17
SPEAKER_02: Did I just do that?
49:20
SPEAKER_04: Oh, you did?
49:21
SPEAKER_04: Did you pull the trigger?
49:22
SPEAKER_02: Yeah, we pulled the trigger.
49:23
SPEAKER_02: We're getting to CO2.
49:24
SPEAKER_02: Nice.
49:25
SPEAKER_02: Yeah, yeah.
49:25
SPEAKER_02: I can't wait.
49:26
SPEAKER_02: I picked his brain.
49:30
SPEAKER_02: And so is actually my face.
49:31
SPEAKER_02: So is she.
49:33
SPEAKER_02: She called me earlier or text me earlier this week.
49:36
SPEAKER_05: Yeah, we I picked his brain about it.
49:38
SPEAKER_02: Um, I'm excited.
49:39
SPEAKER_05: I'm gonna get I don't make devices.
49:41
SPEAKER_05: Am I gonna get fried next Sunday?
49:42
SPEAKER_05: Um I'm not gonna have to I'm not gonna be ready for it.
49:45
SPEAKER_04: Are we allowed to say which one or no?
49:47
SPEAKER_05: Yeah, we got um the Tetra.
49:49
SPEAKER_02: Why would you invite me to come if you're not gonna be ready to fry my neck?
49:52
SPEAKER_05: Uh Cortessa.
49:53
SPEAKER_02: Okay.
49:53
SPEAKER_02: All right, we're gonna go, Andrew.
49:55
SPEAKER_02: Yeah, all right.
49:57
SPEAKER_02: This is possibly the most important segment.
50:00
SPEAKER_02: Who should buy and who should not buy one?
50:02
SPEAKER_02: Okay, so um I'm gonna give you patient A, but you mean like patient C.
50:07
SPEAKER_02: Yeah.
50:07
SPEAKER_02: 42-year-old, good volume, mild neck, jawline looseness.
50:12
SPEAKER_02: What what what what should she get?
50:15
SPEAKER_04: My um, I would say either device.
50:17
SPEAKER_02: So device or combination or surgery.
50:21
SPEAKER_04: Totally.
50:21
SPEAKER_04: I mean, so all of them in general are going to have some sort of laser at some point, but obviously we're not talking about that today.
50:29
SPEAKER_04: But um, so you said 42.
50:32
SPEAKER_04: Okay, cool.
50:33
SPEAKER_04: Welcome back.
50:34
SPEAKER_04: You're just super loud now, but that's cool.
50:36
SPEAKER_02: Oh, good.
50:38
SPEAKER_04: No, so we're we're gonna do some like almost like case studies.
50:41
SPEAKER_02: Yeah, so case study 42-year-old, uh, good volume, mild neck, jawline looseness, uh, once once some improvement.
50:49
SPEAKER_02: Um, and we're gonna say that's me.
50:52
SPEAKER_05: That's literally me.
50:54
SPEAKER_02: That is literally you in like a couple of weeks.
50:57
SPEAKER_02: A week or two, yeah, in a couple of weeks.
50:59
SPEAKER_02: I I I got your uh your your present today.
51:03
SPEAKER_02: I put it together for you.
51:04
SPEAKER_05: Was it a a vial of sculpture and a syringe of PDGF under my eyes?
51:10
SPEAKER_02: No, that's just that's just a regular Thursday gift.
51:14
SPEAKER_02: It's a birthday gift.
51:16
SPEAKER_02: I actually put some thought into it.
51:18
SPEAKER_05: All right.
51:19
SPEAKER_02: Exciting.
51:20
SPEAKER_02: You got your device.
51:21
SPEAKER_02: Okay, good job.
51:22
SPEAKER_05: I did you did.
51:24
SPEAKER_05: You co-signed a device for me.
51:27
SPEAKER_02: I signed for the I signed for a device for you.
51:29
SPEAKER_02: Uh okay.
51:30
SPEAKER_02: No, um, so that patient, I feel so we're basically we're talking uh non-invasive, uh minimally invasive, surgical candidate.
51:39
SPEAKER_02: You don't have to name the specific device you'd give, but bonus points, I guess if you do.
51:45
SPEAKER_04: So I would say dependent on her actual like skin like thickness, I would go either soft wave or like Elegio X.
51:56
SPEAKER_04: Okay.
51:56
SPEAKER_04: So monopolar RF or my ultrasound.
52:00
SPEAKER_04: Mystica.
52:00
SPEAKER_05: Because I like it.
52:03
SPEAKER_05: I mean, I I am gonna always be partial to genius.
52:09
SPEAKER_05: I I like genius for lower face, but I never do anything alone.
52:16
SPEAKER_05: So you're gonna get the best results by doing something like that with some lower face uh talks and and some sculpture in the jawline.
52:26
SPEAKER_02: Excellent.
52:27
SPEAKER_02: 54-year-old thin skin, early laxity, crepey neck.
52:33
SPEAKER_02: Held 54.
52:36
SPEAKER_02: Crapey neck, crepey neck, thin skin, early laxity.
52:43
SPEAKER_02: So loose crepey neck and thin skin, 54.
52:47
SPEAKER_05: And she doesn't want a facelift?
52:49
SPEAKER_02: You in 10 years, 12 years.
52:51
SPEAKER_05: No, my skin's never gonna be thin, bro.
52:56
SPEAKER_05: My skin is gonna be thick, thick forever.
53:00
SPEAKER_04: Uh-huh.
53:00
SPEAKER_04: Yeah, so we're not talking like injectables or anything, but obviously she could.
53:06
SPEAKER_04: Well, she could throw in some of that.
53:08
SPEAKER_04: So, I mean, realistically, if we were gonna do that, that I would do like a um a monopolar RF with sculptura, and then probably when they come back later, that as their skin quality gets a little thicker, then I would do a genius or like a or a RF micro because at that point we've built it, we've built a little skin quality up.
53:30
SPEAKER_04: I like and that's again if they don't want a facelift, but I also think that obviously we need to improve the skin quality before they get their facelift because it'll just heal nicer.
53:39
SPEAKER_02: Yes.
53:40
SPEAKER_02: Okay, okay, 62-year-old, significant jowls, platismal laxity, true skin excess.
53:49
SPEAKER_04: What is she and she doesn't want surgery, or we have to say, like, no, she's not a candidate?
53:54
SPEAKER_04: Because go ahead.
53:55
SPEAKER_04: What do you want to do?
53:56
SPEAKER_04: Like, so I mean, I would it would be a a conversation.
54:00
SPEAKER_04: Are you willing to do a facelift?
54:02
SPEAKER_04: And if you're not willing to do a facelift, what are we expecting at that point?
54:07
SPEAKER_04: I love it.
54:08
SPEAKER_02: Right here, yeah, right here, baby.
54:11
SPEAKER_04: Yeah, let's go.
54:13
SPEAKER_04: Hey, let's go.
54:14
SPEAKER_04: But so ideally, yes, it's gonna be that's gonna be your your perfect facelift candidate.
54:21
SPEAKER_04: Um, but if they're like, I don't know, I mean, I literally have 80-year-old patients, it's like, I don't know if I'm ready for Botox yet.
54:30
SPEAKER_04: I'm like, okay, you're a little late, but uh late to the party.
54:36
SPEAKER_04: But so yeah, like if she's not willing to do a facelift, I would that's a conversation to really sit down and be like, so what are you expecting from these treatments?
54:46
SPEAKER_02: You know, like I can make you sit down in this chair and let my anesthesiologist put a tube in your throat.
54:53
SPEAKER_02: Absolutely, absolutely that's where you go for that.
54:57
SPEAKER_02: Sit right here, let's put a tube in your throat.
55:01
SPEAKER_02: I agree to it.
55:03
SPEAKER_05: I love how you you put on a full costume, um, and Andrew didn't break once.
55:12
SPEAKER_05: That is I feel like we all do that.
55:17
SPEAKER_05: No, he didn't he didn't break.
55:19
SPEAKER_05: I love it.
55:20
SPEAKER_05: He just he kept talking, you know, about about his clinical case.
55:24
SPEAKER_04: You must have worn it.
55:25
SPEAKER_05: I love it.
55:26
SPEAKER_05: No, I'm pretty sure.
55:27
SPEAKER_04: No, I've I've done my research.
55:29
SPEAKER_04: I mean, yeah, I've done my research.
55:31
SPEAKER_05: You're you're uh you're you you have a little bit of a social media following.
55:37
SPEAKER_05: I'm not I'm not sure.
55:38
SPEAKER_02: Yeah.
55:40
SPEAKER_02: So are we ready?
55:43
SPEAKER_02: Is it worth it?
55:44
SPEAKER_02: Final round, okay?
55:46
SPEAKER_02: You can only answer yes or no.
55:49
SPEAKER_02: Uh oh, yeah.
55:52
SPEAKER_02: You can only answer yes or no in the right patient.
55:58
SPEAKER_02: Okay, all therapy.
56:01
SPEAKER_02: Is it worth it?
56:03
SPEAKER_02: Soft wave, is it worth it?
56:05
SPEAKER_05: Yes, I guess.
56:07
SPEAKER_04: Soft without a T.
56:09
SPEAKER_05: Yeah.
56:10
SPEAKER_05: Right.
56:11
SPEAKER_02: Soft without a T.
56:12
SPEAKER_02: Soft, soft Thermage.
56:15
SPEAKER_02: No, the beautiful French name.
56:17
SPEAKER_02: Genius.
56:19
SPEAKER_02: Yes.
56:19
SPEAKER_02: Yes.
56:20
SPEAKER_02: Hell yeah.
56:21
SPEAKER_02: Morpheus 8 with the to mess under the eyes and and no.
56:28
SPEAKER_02: Again, why I hate the aesthetics industry.
56:31
SPEAKER_02: It's insane.
56:32
SPEAKER_02: Stop hurting people.
56:34
SPEAKER_02: Okay.
56:35
SPEAKER_04: Can I give you one quick reason why?
56:36
SPEAKER_02: Listen, why I think it's probably, I don't know if it like I it has, I think it has a place.
56:42
SPEAKER_02: Okay.
56:42
SPEAKER_02: I, you know, that said, now I just bash it forever.
56:46
SPEAKER_02: It probably has a place.
56:48
SPEAKER_02: Does it work?
56:49
SPEAKER_02: Yes, it's painful.
56:50
SPEAKER_02: Is there better options?
56:51
SPEAKER_02: Definitely.
56:53
SPEAKER_02: But I think so.
56:55
SPEAKER_02: No, I guess that's it.
56:56
SPEAKER_02: I guess my answer is that well, because there are other better options.
57:00
SPEAKER_04: Well, because because it well, the original Morpheus only goes in one millimeter increments.
57:06
SPEAKER_04: Um, the new one millimeters.
57:08
SPEAKER_04: Correct, not 0.1 millimeters.
57:10
SPEAKER_04: So that is my main reason why I know.
57:12
SPEAKER_04: And even with the new one with the cold plate, um, I think that goes by 0.5, which still, like, why not just make it go by 0.1 since all the good devices go by 0.1.
57:22
SPEAKER_04: That's my that's my biggest reason, is because you can't customize it as much.
57:27
SPEAKER_02: That's fair.
57:28
SPEAKER_02: Uh M face?
57:31
SPEAKER_02: No.
57:31
SPEAKER_02: Not worth the money, no.
57:33
SPEAKER_02: Face tight, accute.
57:36
SPEAKER_02: No.
57:36
SPEAKER_02: No.
57:37
SPEAKER_02: Renuvion.
57:39
SPEAKER_02: I think yes.
57:40
SPEAKER_02: Yes.
57:40
SPEAKER_02: I think yes, definitely.
57:42
SPEAKER_02: Uh Endolift?
57:44
SPEAKER_02: Well, I guess we're gonna find out.
57:46
SPEAKER_02: Yeah, we're gonna find out.
57:48
SPEAKER_02: Yeah, Elecor.
57:51
SPEAKER_02: No, no, CO2 for tightening.
57:54
SPEAKER_02: Yes.
57:54
SPEAKER_02: Yeah, yeah, I think so, right?
57:56
SPEAKER_02: Yeah.
57:57
SPEAKER_02: So, one final question.
57:59
SPEAKER_02: You're 50 years old with mild to moderate facial and neck laxity.
58:03
SPEAKER_02: You can choose one device and you have to pay for it yourself.
58:06
SPEAKER_02: What are you choosing?
58:08
SPEAKER_02: Wait, what was me.
58:10
SPEAKER_02: 50 mild to moderate facial and neck laxity, one device.
58:16
SPEAKER_02: One treatment, one device.
58:18
SPEAKER_02: You can do it more than once.
58:20
SPEAKER_05: I I would go with I would go with RF microneedling because you can give a little bit of a tightening effect.
58:28
SPEAKER_05: I'll say tightening, not lifting, tightening, but skin quality improvement too.
58:34
SPEAKER_05: However, I'd rather just do CO2.
58:37
SPEAKER_05: I mean, but we're not, we're, but that's a laser.
58:39
SPEAKER_05: I mean, that's not technically a lifting device.
58:41
SPEAKER_05: So Right.
58:42
SPEAKER_02: It's we talked about it though.
58:44
SPEAKER_05: Yeah.
58:44
SPEAKER_02: So you say CO2?
58:46
SPEAKER_02: Is that your answer?
58:47
SPEAKER_02: Or do you want to use RF?
58:48
SPEAKER_02: You gotta pick one.
58:50
SPEAKER_05: There's no there, there's no, there's no substitute for CO2.
58:54
SPEAKER_05: So I'm gonna say CO2 since it's on the table since we brought it up.
58:57
SPEAKER_04: Andrew?
58:58
SPEAKER_04: I mean, if it's if it's on the table, I'm always gonna pick a laser over anything because that's me.
59:03
SPEAKER_04: Right.
59:04
SPEAKER_04: Same.
59:04
SPEAKER_04: Um, but so you said you were the patient though?
59:07
SPEAKER_02: Well, essentially me, yeah.
59:08
SPEAKER_02: Well, yeah, that's me.
59:09
SPEAKER_02: So like 50 years old, my moderate facial and neck laxity.
59:14
SPEAKER_04: So if it's mild to moderate, I would say for the most part, and then I mean, this is where we're probably gonna disagree, is I would probably say at that point, either monopolar RF or soft wave.
59:26
SPEAKER_04: And this is the reason, this is the reason why.
59:29
SPEAKER_04: I'm ready, let's go.
59:30
SPEAKER_04: Because I can have you come back multiple times and you're gonna be happy with like the immediate of a monopolar RF and then the progression of how it goes, um, with no downtime to prevent and improve over time.
59:45
SPEAKER_04: So, I mean, realistically, I could have you back in the chair every three months if I wanted to.
59:51
SPEAKER_04: Um that's a reasonable approach, you know.
59:54
SPEAKER_04: Um, and then your skin's just gonna look better and better every time.
59:58
SPEAKER_04: Um, kind of the same thing with soft wave, but I would wait like at least six months.
1:00:03
SPEAKER_04: Um I'm only talking about one singular treatment, CO2.
1:00:08
SPEAKER_02: So um, because I'm asking the questions, I'm gonna um not do what I said to you guys.
1:00:14
SPEAKER_02: I'm gonna pick uh Renewion and then I'm gonna pick CO2 um on top of that.
1:00:19
SPEAKER_02: So there you go.
1:00:20
SPEAKER_05: That's I knew you were gonna pick Renewion.
1:00:23
SPEAKER_02: Yeah, right, because I'm a I'm the master of the scalp, and you're the master of the scalp.
1:00:27
SPEAKER_02: You want to cut, yeah, always.
1:00:29
SPEAKER_02: They always want to cut, Messica.
1:00:31
SPEAKER_05: Yeah, always want to cut, but but you have and I always want a laser.
1:00:36
SPEAKER_04: So yeah, I always want a laser.
1:00:40
SPEAKER_04: Always.
1:00:41
SPEAKER_02: So, Andrew, thank you so much for being here.
1:00:43
SPEAKER_02: I appreciate it.
1:00:44
SPEAKER_02: You are wonderful.
1:00:45
SPEAKER_02: You are a uh a master, you have a ton of knowledge, and thank you.
1:00:50
SPEAKER_02: Um I and now that we became best friends, we will uh we'll talk more and uh and we'll you know.
1:00:57
SPEAKER_05: Everyone follow him, follow him on social media.
1:01:00
SPEAKER_05: Andrew, how can we find you his podcast?
1:01:02
SPEAKER_04: Absolutely.
1:01:03
SPEAKER_04: So um my Instagram is just my name, Andrew Lycio, and D R A W L I S C I O.
1:01:10
SPEAKER_04: Um, and then obviously you can listen to the aesthetically speaking podcast, where actually we have uh Mystica as a guest schedule coming soon.
1:01:18
SPEAKER_04: So that's something to look forward to as well.
1:01:21
SPEAKER_04: Um now I might have to have my bestie now too come on.
1:01:26
SPEAKER_05: I love that.
1:01:27
SPEAKER_05: I love that.
1:01:28
SPEAKER_05: We'll put your we'll put your Instagram and your podcast in the show notes too.
1:01:32
SPEAKER_04: Oh, awesome.
1:01:33
SPEAKER_04: Sounds good.
1:01:33
SPEAKER_04: Thank you guys so much.
1:01:34
SPEAKER_04: And I mean, I know we didn't mention it, but I just really want to quickly mention about the monopolar RFs, um, that I feel like many of them are overpriced.
1:01:48
SPEAKER_04: And that's why a lot of the times it's a no for a lot of patients.
1:01:52
SPEAKER_04: Yeah.
1:01:53
SPEAKER_04: Because the amount that you're spending per treatment.
1:01:56
SPEAKER_04: How much do they cost per treatment?
1:01:58
SPEAKER_02: Uh how much uh as a ballpark compared to some of the other ones?
1:02:01
SPEAKER_02: Is it 20% more, 50% more?
1:02:04
SPEAKER_02: Is it 100% more?
1:02:05
SPEAKER_02: Is it ridiculous?
1:02:06
SPEAKER_04: I mean, so some of them.
1:02:07
SPEAKER_02: I'm sure you know, goes Manhattan's gonna be different than Pittsburgh, but right.
1:02:11
SPEAKER_04: Obviously, areas are gonna be different, but I mean, I've seen it as high as like 2700 for one treatment.
1:02:20
SPEAKER_04: And I think that that's insane.
1:02:23
SPEAKER_04: And just the expectation of your patient is now all the way up here where you better deliver.
1:02:30
SPEAKER_04: Yeah, you better deliver, and and you're not gonna be able to deliver at that price point, right?
1:02:34
SPEAKER_04: Um, so for me, I think that it those are good devices, but the price point per treatment needs to come down a little bit um to something a little bit more realistic for a lot of people.
1:02:46
SPEAKER_04: But that's my my main reason why.
1:02:48
SPEAKER_04: But I know that was a tangent, but that was something.
1:02:50
SPEAKER_04: No, that sounds good.
1:02:51
SPEAKER_02: Totally fair, yeah, because um it it's it's worth it for the money too, right?
1:02:57
SPEAKER_02: Right.
1:02:58
SPEAKER_02: Well, that's what I mean.
1:02:58
SPEAKER_02: Like it's that's the that's the that's the thing, is you know, is it worth it for twenty dollars or worth it for twenty seven hundred dollars?
1:03:08
SPEAKER_02: So, you know, almost anything is worth it for twenty dollars too.
1:03:12
SPEAKER_02: But you know, if you're spending$2,700 and you have significant town time, you really have to make the decision if it's worth it or not.
1:03:18
SPEAKER_02: So thank you, Andrew.
1:03:21
SPEAKER_02: Thank you for coming.
1:03:22
SPEAKER_02: Of course, thank you for having me.
1:03:24
SPEAKER_02: Thank you for coming.
1:03:25
SPEAKER_02: I am Dr.
1:03:26
SPEAKER_02: Alja Labraska, board certified plastic surgeon, Pittsburgh, Pennsylvania, and New York City.
1:03:32
SPEAKER_02: Mystica Labraska is my baby sister.
1:03:35
SPEAKER_02: She is a dermatology PA of 16 plus years.
1:03:39
SPEAKER_02: She's located north of Pittsburgh in Cranbury Township at Skin Lab by Dr.
1:03:42
SPEAKER_02: Labraska.
1:03:43
SPEAKER_02: Together, we are scalpel and skin.
1:03:46
SPEAKER_02: Let's go.
1:03:46
SPEAKER_02: That's it for today's episode of Scalpel and Skin.
1:03:49
SPEAKER_02: Follow the show wherever you listen and come find us on social media.
1:03:52
SPEAKER_02: Send us the treatments, trends, or questions you want us to break down next.
1:03:56
SPEAKER_02: This is Scalpel and Skin.
1:03:58
SPEAKER_02: Let's go.