Latest / The Science of Skin / History of Injectables...and a bit about skincare

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History of Injectables...and a bit about skincare · The Science of Skin

• 0:09
  SPEAKER_00: Hello and welcome to Skincare Confidential, the podcast dedicated to giving you a 360-degree view, an insider's view of the industry of skincare.
• 0:21
  SPEAKER_00: And I am Dr.
• 0:22
  SPEAKER_00: Ted Lane.
• 0:23
  SPEAKER_00: I am your host today, and it is my great pleasure to introduce Dr.
• 0:27
  SPEAKER_00: Mary Lupo.
• 0:28
  SPEAKER_00: Thank you, Mary, for being here.
• 0:30
  SPEAKER_01: Thank you, Ted, for the invitation.
• 0:33
  SPEAKER_00: Absolutely.
• 0:33
  SPEAKER_00: Dr.
• 0:34
  SPEAKER_00: Lupo is the owner, founder, and director of the Lupo Center for Aesthetic and General Dermatology.
• 0:40
  SPEAKER_00: She opened that in 1984.
• 0:43
  SPEAKER_00: She also is the director and founder of the Cosmetic Boot Camp meeting starting in 2005 and held annually in Aspen, Colorado.
• 0:51
  SPEAKER_00: I went this year.
• 0:52
  SPEAKER_00: It was an amazing meeting.
• 0:54
  SPEAKER_00: She's a former president of the Women's Derm Society.
• 0:56
  SPEAKER_00: She was on the board of directors for the ASDS and overall an absolute key opinion leader and go-to person for anything regarding cosmetics and in the aesthetic industry of dermatology.
• 1:09
  SPEAKER_00: So Dr.
• 1:09
  SPEAKER_00: Lupo is a wonderful person for us to discuss the history of aesthetics in dermatology.
• 1:15
  SPEAKER_00: So again, Mary, this is just, I'm so excited about this because I started my practice in 2006 and it was really kind of at the I thought it was the heyday of fillers and toxins and everything from there.
• 1:28
  SPEAKER_00: But we're going to be able to go back in time and you're going to tell me what it was like to practice, you know, really, I think that Botox in terms of the the um you know the Caruthers doing their uh studies on the the aesthetic use of Botox was in the what late 80s, maybe?
• 1:47
  SPEAKER_01: Yeah, they really started to talk to other doctors about it in about 1992.
• 1:52
  SPEAKER_01: I went to the very first ad board, it was at an AAD meeting in Dallas, and it was somewhere between 90 and 92 that they had that meeting.
• 2:00
  SPEAKER_01: And uh we all kind of looked at them, we weren't sure.
• 2:04
  SPEAKER_01: We thought it was a good idea to be injecting people with toxins, but I actually injected myself as my first patient, it was in 1996, and I injected myself with Botox, I spoke my eyebrows, uh, but you know, it was uh it's it was a learning curve, and very rapidly, you know, I I think Al Kligman, who, as you know, was the inventor, the patent holder at Penn for uh uh uh tretnoin, which became Retin A and Renova, and he said that it takes years for scientists to validate and prove the observations of practicing physicians.
• 2:50
  SPEAKER_01: So that's sort of like a a hash of the of a quote.
• 2:54
  SPEAKER_01: But his point was that when you're in the trenches and you're treating patients, you sometimes realize things and then bring it to pharmaceutical companies or tell pharmaceutical companies about it.
• 3:07
  SPEAKER_01: And that's what happened with the Carruthers.
• 3:09
  SPEAKER_01: They were doing a blef spasm treatment and noticed that the crow's feet on that side improved.
• 3:18
  SPEAKER_01: So they extrapolated that observation and brought their receptionist in and they injected her corrugators to get rid of her frown lines.
• 3:27
  SPEAKER_01: And as they say, the rest is history.
• 3:30
  SPEAKER_00: I mean, especially for Allergan, right, which really was an eye company at that time, had botulinum toxin, used, I mean, it was approved in 1989 for strabismus and bleferospasm.
• 3:40
  SPEAKER_00: And as you said, that's when you know Cruthers and others started realizing that that, hey, this has some cosmetic aspect to it as well.
• 3:47
  SPEAKER_00: And it really changed that company altogether.
• 3:49
  SPEAKER_01: Completely.
• 3:50
  SPEAKER_01: And um, they became and and arguably still remain the leader in what I call non-surgical rejuvenation because they have so many.
• 4:00
  SPEAKER_01: Um I was also uh one of the principal investigators in 2004 for Juvederm.
• 4:09
  SPEAKER_01: Um before 2004, we only had uh Restalin as the HA.
• 4:15
  SPEAKER_01: And I so Inamed was the company that had Juvederm.
• 4:20
  SPEAKER_01: And I was one of the principal investigators with Leslie Baumann and on that original study in 2005, and yesterday was National Juvederm Day, which was interesting.
• 4:33
  SPEAKER_01: Um, and then when um it was FDA well approved, I don't know what they call it, in Australia, when it got approval in Australia, I actually was the physician from the United States that went to Australia to introduce it in a big symposium that Allargan had for their lead uh injectors of Botox to teach them about the Juvidarm.
• 4:55
  SPEAKER_00: So just uh going back to Botox for a second, and now as we've, you know, Botox, of course, then Disport, now we've had multiple other toxins that have been approved.
• 5:05
  SPEAKER_00: Most recently Daxybotulinum toxin, which is of course Daxify.
• 5:09
  SPEAKER_00: Um, what what are you excited about right now in terms of, you know, are you are you excited about Daxify?
• 5:14
  SPEAKER_00: Have you has it reached your um expectations in terms of its longevity?
• 5:18
  SPEAKER_00: And what are you thinking about in the future?
• 5:21
  SPEAKER_01: So um, you know, uh I was on the study for uh revance for the uh the Sakura.
• 5:28
  SPEAKER_01: I think I was on Sakura 2, uh which was there was Sakura 1 and there was Sakura 2.
• 5:34
  SPEAKER_01: And it clearly in the globella area at that double dose uh does give improved longevity.
• 5:42
  SPEAKER_01: Uh the problem we're seeing is we're all now extrapolating that information to the forehead, the crow's feet, and other areas.
• 5:50
  SPEAKER_01: And what I'm not seeing is a similar duration in those areas.
• 5:57
  SPEAKER_01: So I'm sort of in a quandary right now at this moment in time as to exactly how I'm going to add the the AxiFi into the system because you know people want to have all of it done all at the same time.
• 6:14
  SPEAKER_01: And I can tell you, I personally uh typically do uh 50 units of Java is my personal favorite, works the longest and the best on me.
• 6:26
  SPEAKER_01: And uh so I typically do 50 units to Glabella, uh Crow's feet, and my frontalis.
• 6:34
  SPEAKER_01: That's my usual routine.
• 6:36
  SPEAKER_01: It will typically last me five months.
• 6:40
  SPEAKER_00: Okay.
• 6:41
  SPEAKER_01: And um the Daxy with a hundred units is uh is not gonna give me that because I'm already getting movement at about three months.
• 6:51
  SPEAKER_01: Because I did it in May, June, July, August.
• 6:54
  SPEAKER_01: And I'm already getting, you see a little bit of movement there?
• 6:57
  SPEAKER_00: Yeah.
• 6:57
  SPEAKER_01: And I, you know, I don't get that at three months with Java.
• 7:02
  SPEAKER_00: Interesting.
• 7:03
  SPEAKER_01: So um it's been it's been difficult for me to incorporate it because of the increased cost to my patient.
• 7:10
  SPEAKER_01: You know, my goal is always to do the least that makes a patient look and feel better uh about themselves.
• 7:18
  SPEAKER_01: And I don't want to, I'm I'm not a terribly aggressive physician in dosaging, and I certainly am not that way with fillers.
• 7:27
  SPEAKER_01: I am an incremental mover of the needle.
• 7:30
  SPEAKER_01: You know, I tell people I turn the clock back, but I do it incrementally, and and it keeps ticking forward, so it's a constant battle and forth.
• 7:40
  SPEAKER_01: But you know, I use myself as an example because I'm gonna be 69 next month and I haven't had a facelift.
• 7:46
  SPEAKER_01: And I've done this all with toxin laser and uh, to be honest, a lot of sculpture.
• 7:53
  SPEAKER_01: Uh, sculpture's been my personal main um filler, but I don't think it's a fit, I don't consider sculpture a filler, I call it a biostimulatory device, and because it works completely differently.
• 8:06
  SPEAKER_01: And I've always had pretty high cheekbones, so I don't need volume there, but I need not to look gaunt.
• 8:13
  SPEAKER_01: And I as we get older, we start, if you have strong bone structure, you tend to start looking a little gaunt.
• 8:22
  SPEAKER_01: And I told one of my friends once she came in and I looked at her and I said, You're looking a little gaunt.
• 8:27
  SPEAKER_01: And she joked, because we're children of the of the 60s, she says, Gaunt, isn't that what we're going for?
• 8:32
  SPEAKER_01: And I said, Not anymore.
• 8:34
  SPEAKER_01: You know, so so so sculpture, so but really the art of all of these tools is the hands of the person who's doing them.
• 8:44
  SPEAKER_01: Because I know people who get great results with Daxify, great results with Disport, great results with Xeom and Botox, Java, you name it.
• 8:53
  SPEAKER_01: So you really have to trust that the physician is going to do for you what they believe that you need, and that's going to give you your best results in their hands.
• 9:05
  SPEAKER_01: And then it's your job to just go to someone who's trained, board certified, and has your aesthetic eye.
• 9:12
  SPEAKER_01: Um, I don't like excessively done fillers.
• 9:16
  SPEAKER_01: So women who want that tend to find a physician who'll give them that.
• 9:21
  SPEAKER_01: It's like, it's like a different style of art, you know, it's impressionistic or cubist.
• 9:27
  SPEAKER_01: And I always say, I want to have the person give the impression of youth and vitality.
• 9:32
  SPEAKER_01: I don't want them like a cubist where they concentrate on the mouth or they have the eyes, you know, like a Picasso.
• 9:38
  SPEAKER_00: Yeah, there's no balance.
• 9:39
  SPEAKER_01: Yes, you want balance and you don't want to over-emphasize any one particular feature excessively.
• 9:45
  SPEAKER_01: So, you know, you find people find the people who will give them the result that they want.
• 9:51
  SPEAKER_00: And to your credit, Mary, I know you have been talking about balance well before balance became even kind of popular in terms of cosmetic.
• 9:59
  SPEAKER_00: I feel like we were so focused on either the cheeks, first the nasalabial folds, then the cheeks, now the lips.
• 10:05
  SPEAKER_00: But you have forever been saying, no, we need to be balanced, we need to be balanced in the way we we inject.
• 10:10
  SPEAKER_00: So that's and now people are starting to listen, and we are trying to get to that.
• 10:14
  SPEAKER_00: And I feel, you know, in Europe, I've been to a couple of meetings recently, uh cosmetic meetings in in Europe, and that's all that they talk about is balance, don't overfill.
• 10:22
  SPEAKER_00: This these are great techniques.
• 10:24
  SPEAKER_00: Let's use the filler, let's use the different needles to get to that very natural look.
• 10:29
  SPEAKER_00: And and thankfully, in the United States, we're we're getting to that aesthetic point, I feel like.
• 10:33
  SPEAKER_01: I I I feel like it's getting better.
• 10:36
  SPEAKER_01: You know, social media has done a lot of good, but done a lot of harm.
• 10:42
  SPEAKER_01: Because everyone wants to, it's almost like the ultimate watch me, watch me.
• 10:48
  SPEAKER_01: And it's almost some of these people are like, I I make the analogy, is they're like train wrecks.
• 10:53
  SPEAKER_01: You can't turn away because they look so ridiculous, but it's their currency, if you will, to look ridiculous because that's why people look at them in the first place.
• 11:04
  SPEAKER_00: Oh, right.
• 11:04
  SPEAKER_00: It's a good point.
• 11:05
  SPEAKER_00: It's a way to gain to gain to gather attention.
• 11:07
  SPEAKER_01: Yeah.
• 11:08
  SPEAKER_00: Yeah.
• 11:09
  SPEAKER_00: Well, you know, it's interesting.
• 11:10
  SPEAKER_00: Uh right now with the toxin world, you're exactly right.
• 11:12
  SPEAKER_00: It seems like some people, you know, respond very well to Botox, others respond much better to Disport.
• 11:17
  SPEAKER_00: There's there's Java as well.
• 11:19
  SPEAKER_00: It's nice to have all the different tools in our toolbox so that we can personalize to the patient.
• 11:24
  SPEAKER_00: Um, I think what's really interesting now is there's some companies using AI and apps so that patients can take photos of themselves.
• 11:31
  SPEAKER_00: And over time, you can see what when your toxin is really wearing off, and then you might go in and have a different product, and then you can really compare because you'll have standardized photos done at certain endpoints so that you can really learn individualized about yourself which toxin lasts the longest.
• 11:47
  SPEAKER_00: And one of them that I know about is called Love My Delta, which is a really interesting app.
• 11:52
  SPEAKER_00: And I I encourage people to look at that.
• 11:55
  SPEAKER_00: Uh, it encourages you to take photos of yourself after a toxin treatment, and it's called Toxon Tox Off.
• 12:01
  SPEAKER_00: And so it'll show you when your toxin is wearing off, and that's an indicator for you to think about okay, now it's time for me to make an appointment.
• 12:07
  SPEAKER_00: So we're really getting to the point now where patients can kind of use their phones and technology to determine when it's time for them to come back in and then decide which product works better for them individually.
• 12:18
  SPEAKER_00: Um, sculpture, we you mentioned, Mary, I think that was 2004 for uh HIV lipoatrophy initially, right?
• 12:26
  SPEAKER_01: And we immediately began to use it off-label in aging in 2004.
• 12:31
  SPEAKER_01: We were demonstrating sculpture techniques at that 2005 boot camp.
• 12:36
  SPEAKER_00: Oh my gosh.
• 12:37
  SPEAKER_01: Yeah.
• 12:38
  SPEAKER_01: And we were also doing um hyper blended radius in the hands with a cannula in 2007.
• 12:47
  SPEAKER_01: We did that at boot camp.
• 12:49
  SPEAKER_00: This is incredible because really hyper blended radius for the neck and other areas.
• 12:54
  SPEAKER_00: Obviously, in South America, it's been in the literature there for quite a while, but really last four or five years here is when we've been thinking about it mainly.
• 13:01
  SPEAKER_00: And you were doing it in 2007.
• 13:04
  SPEAKER_01: We did it, I did it on the stage in 2007 using a cannula.
• 13:09
  SPEAKER_01: I was so annoyed with MERTS when they did their protocol for the FDA.
• 13:14
  SPEAKER_01: I go, why didn't you why don't you ask the doctors who've been using your product off label, how do you use it in the hands?
• 13:20
  SPEAKER_01: And because it was a horrible idea to get it approved with a needle.
• 13:24
  SPEAKER_01: And it was four CCs in a hand.
• 13:26
  SPEAKER_01: That's way too much.
• 13:28
  SPEAKER_01: You don't need to do it.
• 13:29
  SPEAKER_01: Because they were using it as a space-occupying filler, and they weren't realizing at that time it's biostimulatory properties, and so we were kind of nagging them about that at at boot camp since 2007, but you know, no one was listening to us.
• 13:47
  SPEAKER_01: It's it's amazing that sometimes these companies don't, like I said, it's the doctors who are in the trenches, really, really doing it.
• 13:57
  SPEAKER_01: And you know, Ted, sometimes those aren't the KOLs.
• 14:01
  SPEAKER_00: Yeah.
• 14:01
  SPEAKER_01: Sometimes the KOL's expertise is from being a KOL.
• 14:06
  SPEAKER_00: Well, that's you hope that the KOLs are get to that point because of their experience and not just because they were handpicked to someone that that the industry likes.
• 14:15
  SPEAKER_01: It's political, Ted.
• 14:17
  SPEAKER_01: It's who who is in the mix and stuff like that.
• 14:21
  SPEAKER_01: It's very political.
• 14:23
  SPEAKER_01: And uh to the detriment, I think, of some of the clinical trials, because you don't have the uh now, listen, you got some great injectors out there doing great things, but you know, we know inside who in their practice is really injecting and who's really not injecting quite that much.
• 14:42
  SPEAKER_01: And the the concept of hyperblending, now it started because originally Radius did not have any anesthetic in it.
• 14:50
  SPEAKER_00: Right, we believe it.
• 14:51
  SPEAKER_01: And so what I was doing was I was um uh Mario Busso was the one who taught me this.
• 14:57
  SPEAKER_01: It was his idea to add lidocaine to it.
• 15:01
  SPEAKER_01: And this and that was right at about 2007.
• 15:04
  SPEAKER_01: And what what I did was want it to be more thinned out for the hands so I wouldn't get any lumps.
• 15:11
  SPEAKER_01: And that's when I started hyperblending it one-to-one in the hands.
• 15:15
  SPEAKER_00: There you go.
• 15:16
  SPEAKER_00: And now we're seeing hyperblended in the face to to increase collagen production, increase thickness of the of the epidermis, which we're seeing as well with sculpture, right?
• 15:25
  SPEAKER_01: Oh, big time.
• 15:26
  SPEAKER_00: That's and I think that you you really hit the nail on the head when you said, look, all I've been doing is sculpture and some lasers and toxins and village, but sculpture really it helps multiple layers of the skin.
• 15:36
  SPEAKER_00: And so that's why it's such a fantastic product.
• 15:39
  SPEAKER_01: Well, you know, and so do the neuromodulators.
• 15:43
  SPEAKER_01: They improve skin texture too.
• 15:45
  SPEAKER_01: And so I think what we're seeing now, uh, because it's been an evolution.
• 15:51
  SPEAKER_01: In 84, when I opened my practice, the reason I opened it was because I in 1983, when I was a chief resident, I decided that I wanted to be focused on aesthetics.
• 16:03
  SPEAKER_01: And in 1983, we were doing full-face wire brush dermabrasion resurfacing, a bloody mess.
• 16:11
  SPEAKER_01: But it was John Yarborough, who was the king of dermabrasion.
• 16:15
  SPEAKER_01: He taught Patty, he taught me, and that's how we resurfaced until the CO2 laser came out in about 1994-95.
• 16:24
  SPEAKER_01: I started doing CO2.
• 16:26
  SPEAKER_01: And the pendulum swung almost too much to the aggressiveness, and then it swung too much to the non-ablative that it was not only non-ablative, it was non-effective.
• 16:36
  SPEAKER_01: So, because it was so subtle of a result.
• 16:39
  SPEAKER_01: Where are the results?
• 16:40
  SPEAKER_01: So now we're in this really sweet spot where you can titrate the treatment by aggressiveness and number of sessions to the sensibility of the patient.
• 16:52
  SPEAKER_01: So I have patients that want to be one and done, and I do aggressive resurfacing.
• 16:58
  SPEAKER_01: But I have a lot of people who don't want to have as bad of downtime, and maybe they'll do one or two reasonably aggressive fraxals, and then I have patients who don't want any downtime, and they'll do the Aclaro 3D miracle, or they'll do clear and brilliant, or they'll do something along those lines.
• 17:16
  SPEAKER_01: So we really can cherry pick.
• 17:19
  SPEAKER_01: And from the beginning in 1984, I wanted to be able to do that.
• 17:24
  SPEAKER_01: So I was doing wirebrush, I was doing xyderm and zyplast, and I was doing 35% TCA peels.
• 17:32
  SPEAKER_01: And I was taught phenol peels, but I didn't want to get into, in an office setting, the need for cardiac monitoring, et cetera, that you need with the phenol peels.
• 17:43
  SPEAKER_01: But phenol peels are amazing results.
• 17:48
  SPEAKER_01: Marina Landau in Israel is the goddess of phenol peels.
• 17:54
  SPEAKER_01: And I don't think I know anyone who's living who does more phenol peels and gets as outstanding results as Marina does.
• 18:03
  SPEAKER_01: She's amazing.
• 18:04
  SPEAKER_00: You know, I have I've watched a phenol peel.
• 18:07
  SPEAKER_00: I've never done one, primarily for the exact reasons you said.
• 18:10
  SPEAKER_00: I know the results are amazing, but I have to agree with you.
• 18:12
  SPEAKER_00: I think TCA peels also, if you do them consistently, can give you incredible results.
• 18:18
  SPEAKER_00: So if you're out there listening and you're thinking, gosh, these lasers are so expensive, which they are, um, think about peels, but but not just your glycolic or salicylic acid.
• 18:27
  SPEAKER_00: These TCA peels, 30%, 35% TCA peels, give you an incredible result.
• 18:32
  SPEAKER_00: Uh you just have to do them the right time of year with the right skin care around them, with the right person doing it for you.
• 18:38
  SPEAKER_00: Uh, but they really are incredibly rejuvenating.
• 18:42
  SPEAKER_01: You know, for young physicians, young dermatologists who are out there, what because I teach a lot of residents, and what I to build a cosmetic practice from a business standpoint, you want to have a good ROI, which means you don't want to have a high investment.
• 18:59
  SPEAKER_01: So I tell them get good with peels, because peels aren't as expensive to the physician.
• 19:05
  SPEAKER_00: Not at all.
• 19:06
  SPEAKER_01: Uh get very good with the injections because you could you pay as you go with the injections.
• 19:11
  SPEAKER_01: When you get a buy a bit, expensive laser, it's a year before you make that money back.
• 19:17
  SPEAKER_01: And you know, you you want to avoid the syndrome of the hammer and the nail, is what I call it.
• 19:24
  SPEAKER_01: And what I mean by that is when a doctor buys a very expensive hammer, which is a laser, everything starts to look like a nail.
• 19:34
  SPEAKER_02: So true.
• 19:35
  SPEAKER_01: So, you know, you you want to be able to always put the needs of the patient first, what's in their best interest.
• 19:43
  SPEAKER_01: Don't go for the quick buck.
• 19:45
  SPEAKER_01: I tell people, look, if money is your focus, go to Wall Street, go into finance, be a baron on Wall Street, don't be a physician.
• 19:57
  SPEAKER_01: Physicians will make a good living, but they'll never make the money that the people do who are moving other people's money around and and doing those kinds of I don't I don't even know how they make money.
• 20:08
  SPEAKER_01: They make money just when they're sleeping, these people.
• 20:11
  SPEAKER_00: That's right.
• 20:12
  SPEAKER_00: No, I I think you're exactly right.
• 20:14
  SPEAKER_00: I've got two children who both want to be doctors, and I think it has to be a calling.
• 20:18
  SPEAKER_00: Otherwise, if you do it for the money, you'll be sorely disappointed.
• 20:21
  SPEAKER_00: You have to do it because you can't think about doing anything else.
• 20:24
  SPEAKER_01: Right.
• 20:25
  SPEAKER_01: And unfortunately, to a certain extent, we're not scalable because there's only us.
• 20:31
  SPEAKER_02: Right.
• 20:31
  SPEAKER_01: And there's only two hands and only so many slots in the day that I can treat people, and only so many years that I'm gonna practice.
• 20:40
  SPEAKER_01: So, you know, I have to uh you you have to realize that.
• 20:43
  SPEAKER_01: But it's a wonderful calling, and it is a calling because Ted, you know, I like I said, I'm gonna be 69.
• 20:49
  SPEAKER_01: I have no plans to retire.
• 20:50
  SPEAKER_01: None, because I still enjoy doing what I'm doing.
• 20:54
  SPEAKER_00: Yeah.
• 20:54
  SPEAKER_00: Well, you know, somebody told me you have to tire in order to retire.
• 20:58
  SPEAKER_00: And so if you're not tired, if you enjoy what you do every day, there's no reason to, right?
• 21:02
  SPEAKER_00: Yeah.
• 21:02
  SPEAKER_00: You you mentioned just going back, you mentioned Zyderm and Zyplast, which I remember that those were the first fillers I was trained on in residency, and those were bovine fillers, right?
• 21:12
  SPEAKER_00: That's bovine collagen.
• 21:13
  SPEAKER_00: You needed to do skin tests for those.
• 21:15
  SPEAKER_01: Correct, correct.
• 21:17
  SPEAKER_01: So, and we it we were skin testing once for years, and then they had some people have delayed reaction on like their third exposure.
• 21:25
  SPEAKER_01: So then they uh sort of mandated that you needed two skin tests.
• 21:30
  SPEAKER_01: So we started doing two skin tests, so it completely eliminated the um impulse by, if you will, because I'll tell you, Ted, in my practice, when I have a new patient consult, I would say it's about 90% of them get treatment the same day.
• 21:47
  SPEAKER_01: And you they couldn't do that with zyderm and zyplast.
• 21:50
  SPEAKER_00: Yeah, it delayed that that gratification, didn't it?
• 21:54
  SPEAKER_00: And sometimes you wouldn't have patients come back because of that, right?
• 21:57
  SPEAKER_01: Correct.
• 21:57
  SPEAKER_01: Correct.
• 21:58
  SPEAKER_01: So from a uh So the HAs were a big deal.
• 22:02
  SPEAKER_01: And you know, the biostimulatory fillers I think are extremely important.
• 22:09
  SPEAKER_01: And the combination of a what I call a biostimulate, because I have done several lectures on biostimulation, and I explained to patients and to to when I lecture is, you know, we all think biostimulatory fillers, i.e.
• 22:24
  SPEAKER_01: radius and sculpture, but biostimulation is anything.
• 22:28
  SPEAKER_01: Lasers are biostimulatory, uh, peels are biostimulatory.
• 22:33
  SPEAKER_01: There are peptides and exosomes and growth factors that are biostimulatory.
• 22:37
  SPEAKER_01: Uh retinoids are biostimulatory.
• 22:40
  SPEAKER_01: I mean, it's about upregulating those uh components of our dermis, specifically, usually the fibroblast, to produce more collagen, elastin, fibronectin, uh uh chondroitin, hyaluronic acid.
• 22:56
  SPEAKER_01: Because remember, the skin has hyaluronic acid in it, and we you you need that produced.
• 23:02
  SPEAKER_01: So it's there's so many things we do now.
• 23:05
  SPEAKER_01: I mean, I think when you get a good night's sleep, it's biostimulatory.
• 23:09
  SPEAKER_00: Yeah.
• 23:10
  SPEAKER_00: No, I think you're exactly right.
• 23:11
  SPEAKER_00: I mean, you make a really good point that that even juvenile, I mean, any hyaluronic acid as you inject it into the skin can be biostimulatory.
• 23:18
  SPEAKER_00: We can produce collagen.
• 23:19
  SPEAKER_00: You know, that's why I think we have patients who, for example, get their nasal labial folds done and and it just lasts for two to three years in some cases.
• 23:27
  SPEAKER_00: And I just think they are great responders to that expansion of the tissue, which causes collagen production for them.
• 23:33
  SPEAKER_00: And they've kind of won the lottery because they they without them knowing their body is really responding to that filler in a beautiful way and and producing the collagen that they have lost.
• 23:43
  SPEAKER_00: So I think that's that's great.
• 23:45
  SPEAKER_00: You know, another thing that we talk about in in I don't do it, I don't know if you do it as is autologous fat transfer.
• 23:51
  SPEAKER_00: Do you do that in your practice?
• 23:53
  SPEAKER_01: No, I don't because I don't do any liposuction.
• 23:56
  SPEAKER_01: I don't I inject, you know, typically four to five patients an hour.
• 24:02
  SPEAKER_02: Okay.
• 24:02
  SPEAKER_01: I don't have time to do that, but I am using the RENUVA, which is the fat matrix.
• 24:10
  SPEAKER_01: Now, I've started using it, so I'm very I've been using it on the buttocks because what I'm finding is it works a little bit better than sculpture and radius to give a little bit more enhancement of the buttock.
• 24:23
  SPEAKER_01: And that's an obvious place to use it because that's where you definitely want more fat, for sure.
• 24:30
  SPEAKER_01: Because what's interesting about biostimulation of sculpture and radius on the face, even though we're using it to replace lost fat pads and shifting fat pads, they don't make fat.
• 24:45
  SPEAKER_01: They have a stimulatory effect of the dermis that gives the illusion that deeper levels are being affected.
• 24:52
  SPEAKER_01: So it so I'm very excited about RENUVA, but if right now I'm using it mainly above the knees for that crepiness and on the buttocks.
• 25:04
  SPEAKER_01: But I want to mention, you mentioned about how there's biostimulation from hyaluronic acid.
• 25:10
  SPEAKER_01: Did you know it was Voorhees at the University of Michigan who actually published the study and it was the stretch theory of aging, and it was taking older fibroblasts and putting it in younger medium and vice versa.
• 25:24
  SPEAKER_01: And when you take older fibroblasts and you stretch them in a medium with more youthful components of the skin, they sort of woke up.
• 25:34
  SPEAKER_01: And if you took young fibroblasts and you put them with old, you know, deteriorating matrix of the dermis, they went senescent.
• 25:43
  SPEAKER_01: So the theory was that anytime you stretch the fibroblasts mechanically with the hyaluronic acid, some people will respond with biostimulation.
• 25:56
  SPEAKER_01: So you're absolutely right.
• 25:57
  SPEAKER_01: And I have people who have a phobia against sculpture because they've read bad things on it on the internet, because goodness knows, between 2005 and 2007, there were charlatans out there training anyone who had a pulse on how to do sculpture, and they didn't train them well, and nodules and stuff were reported, and they weren't they weren't diluting it product properly and mixing it properly.
• 26:20
  SPEAKER_01: So a lot of people won't try it.
• 26:22
  SPEAKER_01: Well, you can take and you can hyper blend HA and inject it panfacial.
• 26:30
  SPEAKER_01: And I've done that, I did that on the Versa rep because I use Versa also, which is a filler from Canada.
• 26:37
  SPEAKER_01: And naturally, she she used to be a sculpture patient.
• 26:40
  SPEAKER_01: And she said, Well, I want you to use here's my product, um, you know, so I don't have to pay for the product.
• 26:46
  SPEAKER_01: And I said, Sure, but you know, I can't use it the same.
• 26:48
  SPEAKER_01: And she had a very thin gaunt face, so I hyper blended it and I fanned it with a cannula, panfacial, and it was exquisite results.
• 26:57
  SPEAKER_01: I put I posted it on uh on my lupo dermatology Instagram page.
• 27:01
  SPEAKER_01: There was some people said, Oh, that that looks painful, but you know, the cannula in and of itself is causing biostimulation because of that.
• 27:11
  SPEAKER_01: It's like a subsion.
• 27:12
  SPEAKER_00: Right, right.
• 27:13
  SPEAKER_00: Yeah, you it's amazing how many things we do that that lead to improvement in collagen that we don't even really, you know, it's just in order to inject, we have to use the cannula, which in and of itself could be super very beneficial.
• 27:24
  SPEAKER_00: Um, you mentioned RNUVA, which I actually have some on my desk right here.
• 27:28
  SPEAKER_00: Reneva is a cell-free uh adipose matrix.
• 27:32
  SPEAKER_00: So it's it's uh adipose tissue that's derived from surgical specimen, and then it's processed in a way that is cell-free.
• 27:40
  SPEAKER_00: And it is the idea behind it is once it's injected, it causes the person's own fat cells to be produced and collagen as well.
• 27:49
  SPEAKER_00: Uh Dr.
• 27:49
  SPEAKER_00: Lupo is saying she uses it in the buttocks.
• 27:51
  SPEAKER_00: I've used it quite a bit in the face, and I enjoy it in kind of in the medial cheeks and to lateral cheeks in the face to replenish those fat pads as well.
• 28:00
  SPEAKER_00: The issue can be longevity of results, that's the only thing that I've done.
• 28:04
  SPEAKER_01: Well, I think because we don't know.
• 28:06
  SPEAKER_01: We don't know yet.
• 28:07
  SPEAKER_00: We're still learning.
• 28:08
  SPEAKER_01: We're learning more and more about it, but it's an interesting concept.
• 28:12
  SPEAKER_01: And now, you know, you've I don't know if you know someone taught me this little trick at uh boot camp.
• 28:21
  SPEAKER_01: And you were at boot camp, so I don't know if you picked this up if you were there the whole time.
• 28:25
  SPEAKER_01: Steve Fagan, who's an oculoplastic surgeon, who's an excellent injector, and he's a frequent speaker, he gave me the magic secret because he hyperblends the RENUVA and he adds a little bit of HA to it.
• 28:42
  SPEAKER_01: He adds a little bit of Juvederm to it because he says it improves the glide.
• 28:47
  SPEAKER_01: Because you know it can be hard to inject.
• 28:49
  SPEAKER_00: It can be, yeah.
• 28:50
  SPEAKER_01: So uh, and you know, I don't have super big hands, and these are the hands of uh, you know, not a young woman, so I you know I don't want to get arthritis, uh, so I have to be careful.
• 29:01
  SPEAKER_01: So I'm gonna try it next time with a little bit of HA in the mix just for a glide.
• 29:07
  SPEAKER_01: And think about it, HA is a lubricant, right?
• 29:09
  SPEAKER_00: Sure.
• 29:10
  SPEAKER_00: So that's what it's meant to do.
• 29:12
  SPEAKER_01: So you should try that too, and we'll we'll we'll compare notes next time we talk.
• 29:16
  SPEAKER_00: That sounds great.
• 29:17
  SPEAKER_00: Well, we're actually out of time.
• 29:19
  SPEAKER_00: Mary, I've enjoyed this so much.
• 29:21
  SPEAKER_00: Thank you so much for for being on and and giving us your your knowledge and your experience.
• 29:26
  SPEAKER_00: And I thought it was amazing.
• 29:27
  SPEAKER_00: We didn't even really talk about skincare, but I enjoyed learning about all of your uh everything that you talked about regarding toxins and fillers and the latest, from the latest to the most historic.
• 29:39
  SPEAKER_00: It's been amazing.
• 29:40
  SPEAKER_00: Thank you so much.
• 29:41
  SPEAKER_01: It was my pleasure.
• 29:42
  SPEAKER_01: Well, we like we did it at your skincare summit, the science of skincare summit, you had me discuss how I pair skincare with my injections.
• 29:53
  SPEAKER_01: I thought that was a great idea.
• 29:54
  SPEAKER_01: So I really enjoyed giving that talk.
• 29:57
  SPEAKER_00: There you go.
• 29:57
  SPEAKER_00: We'll have you back.
• 29:58
  SPEAKER_00: Well, thank you everybody for listening.
• 30:00
  SPEAKER_00: This is Skincare Confidential.
• 30:02
  SPEAKER_00: I'm Dr.
• 30:02
  SPEAKER_00: Ted Lane.
• 30:03
  SPEAKER_00: I am the uh co founder of Skincare Confidential.
• 30:06
  SPEAKER_00: My co host is Dr.
• 30:07
  SPEAKER_00: Patty Ferris.
• 30:08
  SPEAKER_00: We also are the co founder and co directors of the Science of Skin Care Summit happening this year, 2023, September 21st to the 23rd in Austin.
• 30:16
  SPEAKER_00: Um, thank you for listening and goodbye.