Latest / Scalpel and Skin / Is Sculptra Worth It? Sculptra vs. Filler, Collagen, Risks & Results | EP 08

Transcript

Is Sculptra Worth It? Sculptra vs. Filler, Collagen, Risks & Results | EP 08 · Scalpel and Skin

0:00
SPEAKER_01: I wish that I could say people won't do that nowadays, but now it's worse than ever.
0:05
SPEAKER_01: You mean Capricorn?
0:06
SPEAKER_00: No, a unicorn.
0:07
SPEAKER_00: It doesn't exist like all the other ones.
0:09
SPEAKER_00: None of them exist, all right?
0:12
SPEAKER_01: I am in a deep dive on a podcast right now, going every single day of the trial.
0:18
SPEAKER_01: I have changed my mind.
0:19
SPEAKER_01: No one has ever gone from talking about sculptra to talking about a triple homicide.
0:26
SPEAKER_00: We're siblings, we're business partners, and do 180 pivots in the middle of an episode.
0:31
SPEAKER_00: So, sculptra in general, is it worth it?
0:47
SPEAKER_00: Hello, everybody.
0:48
SPEAKER_00: Welcome to Scalpel and Skin.
0:49
SPEAKER_00: This is like our 85th or 8th episode here.
0:53
SPEAKER_00: Dr.
0:54
SPEAKER_00: Labraska, Board Certified Plastic Surgeon, North Pittsburgh, Pennsylvania, in New York City with my beautiful baby sister, Mystica Labraska.
1:00
SPEAKER_00: She is a dermatology PA of 16 plus years, and she is the master of the skin.
1:06
SPEAKER_00: I'm the master of scalpel.
1:07
SPEAKER_00: Together we are scalpel and skin.
1:09
SPEAKER_00: Let's go.
1:10
SPEAKER_00: Today we're talking about sculpture.
1:14
SPEAKER_00: What the heck is sculpture?
1:16
SPEAKER_01: Love sculpture, one of my favorites.
1:18
SPEAKER_01: Let's talk about it.
1:19
SPEAKER_00: Give us a little rundown of what sculpture is, what is it not?
1:24
SPEAKER_00: Just give me, you know, a couple of seconds and tell us a little bit about that.
1:28
SPEAKER_01: So sculpture is what what we call a biostimulator.
1:33
SPEAKER_01: So it's going to be injected.
1:36
SPEAKER_01: And because it's injected into the face, a lot of people think of it as a traditional filler.
1:43
SPEAKER_01: I don't consider it a traditional filler.
1:45
SPEAKER_01: Traditional filler is made up of hyaluronic acid and it's used precisely in certain areas to mimic fat in areas where there's maybe a deficit.
1:57
SPEAKER_01: Whereas sculptra is going to be injected and it's going to stimulate your skin to build more collagen and elastin very gradually over time.
2:08
SPEAKER_01: And when you when you do that and you thicken up your skin, you thicken up your dermis, that's the middle layer of skin.
2:16
SPEAKER_01: It can also improve global sort of volume in the face.
2:21
SPEAKER_01: But I would consider it more of a skin treatment than I would a volume replacement type treatment.
2:30
SPEAKER_01: But how it came to be is actually really cool.
2:33
SPEAKER_01: When I'm talking about sculpture, I tell all of my patients this story.
2:37
SPEAKER_01: So the original FDA approval for sculptra was like 25 plus years ago.
2:45
SPEAKER_01: And the original FDA approval was for patients with AIDS and HIV-related, what we call lipoatrophy in the in the face.
2:55
SPEAKER_01: So patients with that chronic disease, some of them would lose a lot of weight because of the illness.
3:03
SPEAKER_01: And they would become very sort of gaunt in the face.
3:07
SPEAKER_01: And it would really contribute to the stigma of the disease process.
3:11
SPEAKER_01: So sculpture was a people would look like AIDS, right?
3:15
SPEAKER_00: You would look sick.
3:17
SPEAKER_01: You look sick.
3:18
SPEAKER_00: You look sickly like AIDS.
3:20
SPEAKER_00: And I actually remember, so it's now known as sculpture aesthetic.
3:24
SPEAKER_00: I remember when it was just sculpture because why?
3:28
SPEAKER_00: Because I'm I've been doing it for that long.
3:31
SPEAKER_00: I brought a little prop with us today here.
3:34
SPEAKER_00: So I'm holding up a sign that says, I was certified in sculpture in 2010.
3:41
SPEAKER_00: That's not the first time I used it.
3:42
SPEAKER_00: The first time I used it was 2008.
3:44
SPEAKER_00: It was just sculpture then.
3:46
SPEAKER_00: I think it became sculpture aesthetic in like 09 or even 2010.
3:51
SPEAKER_00: My first few patients were AIDS patients.
3:57
SPEAKER_00: Um that I did.
3:58
SPEAKER_00: Yeah.
3:59
SPEAKER_00: Yeah.
3:59
SPEAKER_00: I actually did.
4:01
SPEAKER_01: No one can say that anymore.
4:03
SPEAKER_01: And it I did it's to be clear, it's not cool that they had AIDS.
4:08
SPEAKER_01: It's cool that you've been doing it that long that you can say that you treated it for the original FDA indication.
4:16
SPEAKER_01: Literally nobody can say that.
4:19
SPEAKER_01: Not even me.
4:21
SPEAKER_00: What does that mean?
4:22
SPEAKER_00: That just means I've been I've been around a long time.
4:25
SPEAKER_00: And uh and it worked and it did really well.
4:28
SPEAKER_01: And it's covered by insurance still to this day for those patients.
4:32
SPEAKER_00: Yeah, for that it is.
4:34
SPEAKER_00: And so we used to call it a facial volumizer.
4:37
SPEAKER_00: Now it's kind of been rebranded as a biostimulator.
4:41
SPEAKER_00: What it is, it's a product called poly L-lactic acid or P-L-L-A.
4:45
SPEAKER_00: It is very much the same product as a type of suture that we use.
4:50
SPEAKER_00: And what it does is again, it's injected and it causes collagen to grow.
4:55
SPEAKER_00: It's it's like the only thing that caused collagen to grow for the longest time.
4:59
SPEAKER_00: Now there are a few other different things that do that, but but nothing else did for the longest, longest time.
5:06
SPEAKER_01: And think of it like fertilizer.
5:08
SPEAKER_01: You know, you sort of you inject it into the skin and it sort of fertilizes the skin.
5:13
SPEAKER_01: Like you, when you fertilize your lawn, you're making it healthier and helping it to grow over time.
5:19
SPEAKER_01: So it's kind of sculpture's kind of like a skin fertilizer.
5:23
SPEAKER_00: So the most one of the most important things to to know is that sculpture results are not immediate like a like a filler, like a HA filler is hyaluronic acid filler, is it is gradual.
5:36
SPEAKER_00: It's used best in a series, uh, a couple of uh about six weeks or so apart.
5:42
SPEAKER_00: Do you still do six weeks apart usually?
5:44
SPEAKER_01: I do.
5:44
SPEAKER_01: So you can definitely do four to six weeks, and I know plenty of people who do it.
5:49
SPEAKER_01: I personally find that I don't start to see an appreciable change until about three months.
5:58
SPEAKER_01: So I wait.
5:59
SPEAKER_01: I I wait longer.
6:00
SPEAKER_00: So you do it three, three months apart.
6:02
SPEAKER_01: Three months.
6:02
SPEAKER_01: I do.
6:03
SPEAKER_01: I mean, for a while I was doing six, but it for me, it wasn't quite enough.
6:08
SPEAKER_01: And honest, and quite honestly, it wasn't quite enough for the patients either.
6:11
SPEAKER_01: Because at six weeks, you have to be a really trained eye to be able to tell.
6:15
SPEAKER_01: You can't usually tell in photos.
6:17
SPEAKER_01: So they're kind of like, oh, I don't know if I see anything.
6:20
SPEAKER_01: And then it's sort of a bigger ask to say, you know, ask them to make another investment when when they're not seeing really an appreciable change yet.
6:29
SPEAKER_01: And I will say they will see it, but it just takes time.
6:33
SPEAKER_01: It just takes time.
6:35
SPEAKER_00: You know, what what we what we what I've been doing for uh the longest time is I like math.
6:41
SPEAKER_00: So I would draw like a graph.
6:44
SPEAKER_00: And so at six weeks, you see a little bit, and then you do a second injection, and then at 12 weeks, you have double the work going in.
6:53
SPEAKER_00: So you have your original injection at day zero, and then your second injection coming in at six weeks.
7:02
SPEAKER_00: That starts to kick in by the time you get to 12 weeks.
7:05
SPEAKER_00: So then your improved your improvement is double when you get beyond 12 weeks.
7:09
SPEAKER_00: And so that's what I tell people.
7:11
SPEAKER_00: And you just have to, again, there's a trust factor because in six weeks, there's really not much.
7:17
SPEAKER_01: Yeah.
7:17
SPEAKER_00: You don't you don't start to see anything, anything until six weeks.
7:23
SPEAKER_01: And and for me, I'll tell you, the sweet spot, I think, for for for me and my patients is closer to six to eight months.
7:34
SPEAKER_01: And that's after I've probably done two, a series of two, which is usually around four-ish vials.
7:41
SPEAKER_01: Um and and around six months, they come back in and we do their photos, and that's when it's like, wow.
7:49
SPEAKER_01: And inevitably, I I swear it could be every single time they won't see it until I show them their photos because it's so gradual.
8:00
SPEAKER_00: So gradual.
8:01
SPEAKER_00: Yep.
8:02
SPEAKER_00: So gradual.
8:02
SPEAKER_01: And when you're looking in the mirror every day, you don't perceive those changes as as easily as I can when I haven't seen you in several months.
8:11
SPEAKER_01: So then I show them, we do their photos and I show them their photos, and then they're like, wow, that is insane.
8:18
SPEAKER_01: And you know, the one thing I always say about sculpture that I can almost always guarantee is you will look better in a year.
8:24
SPEAKER_01: You'll you'll look better in a year.
8:26
SPEAKER_01: Oh, for sure.
8:27
SPEAKER_00: Yep, 100%.
8:28
SPEAKER_01: But it's it is definitely a a slow process.
8:32
SPEAKER_00: So how long do we say it lasts now?
8:35
SPEAKER_01: So what we say is we say two years because that's when they stopped the study.
8:41
SPEAKER_01: They stopped the study at two years.
8:43
SPEAKER_01: However, I think that we see results well beyond two years, but we can only really say two years because that's when they stopped doing the clinical studies.
8:54
SPEAKER_01: But I think when we are when we're building collagen and making the skin healthier and the and the support and the framework of the skin is stronger, you're going to see those results for years to come.
9:07
SPEAKER_01: I think it's a it is such an incredible investment for for the future of your face.
9:16
SPEAKER_00: Absolutely is.
9:17
SPEAKER_00: It absolutely is.
9:18
SPEAKER_00: So where does it work well?
9:22
SPEAKER_00: Where does it work?
9:22
SPEAKER_00: Where do you like to put it?
9:24
SPEAKER_01: Put it in the cheeks, mid-cheek, like kind of in the center.
9:29
SPEAKER_01: It also works really well in in what we call the pre-auricular area.
9:34
SPEAKER_01: So it's kind of the cheek that's in front of the front of the ear.
9:37
SPEAKER_01: I also love to put it in the jawline for some support there.
9:41
SPEAKER_01: It's beautiful in the jawline.
9:43
SPEAKER_01: The temple in the temples are very powerful in the right patient.
9:47
SPEAKER_01: Yep.
9:48
SPEAKER_01: In the right patient.
9:49
SPEAKER_00: We get what's called the peanut face.
9:51
SPEAKER_00: And so you get a little bigger on top of your head, and then in that temporal area, it kind of goes in uh and then it goes back out again for the the the rest of your cheeks and face.
10:02
SPEAKER_00: So in very thin patients in their 50s, 60s, uh 40s, I guess.
10:08
SPEAKER_00: Very powerful there.
10:09
SPEAKER_00: Go ahead.
10:09
SPEAKER_01: Uh that's an area that people don't really think about.
10:11
SPEAKER_01: You know, nobody, nobody comes in and says, I want my temples to look better.
10:16
SPEAKER_00: Right.
10:16
SPEAKER_00: I look like a peanut.
10:17
SPEAKER_00: Right.
10:17
SPEAKER_00: Yeah.
10:17
SPEAKER_00: Nobody says that.
10:18
SPEAKER_01: Nobody says that.
10:20
SPEAKER_01: But what they might see is they might feel like maybe their brow is sitting a little lower.
10:27
SPEAKER_01: Sometimes when you lose volume in the temple, it can change the brow position and the brow support.
10:31
SPEAKER_01: It can just make them look a little bit more tired.
10:34
SPEAKER_01: And it really just contributes to sort of overall holistically how youthful the face looks when the temple is concave.
10:43
SPEAKER_01: And you do sort of want a little bit of a concavity in the temple.
10:48
SPEAKER_01: That's normal and natural and what you're supposed to have, but you don't want sort of a big divot.
10:53
SPEAKER_01: So if we soften that a little bit, it can it can just make globally the face appear more youthful.
11:00
SPEAKER_01: And it's it can be really powerful.
11:02
SPEAKER_00: So sculpture in general, is it worth it?
11:05
SPEAKER_01: Yes.
11:06
SPEAKER_00: So let's talk a little bit about what it is not good for.
11:09
SPEAKER_00: So what do most folks come in for where filler is the answer these days?
11:14
SPEAKER_00: I think lips are probably still the biggest one, but some other areas as well.
11:21
SPEAKER_00: So is sculpture good for the lips?
11:24
SPEAKER_01: We're not putting sculpture in the lips.
11:26
SPEAKER_01: We're not putting sculpture under the eyes.
11:29
SPEAKER_01: Skin is just too thin.
11:31
SPEAKER_01: And I think we should probably talk about what someone's inevitably going to Google after they listen to this episode and find is what people, if you Google it, you might get worried about is lumps, right?
11:46
SPEAKER_01: So, you know, back in the days of you doing sculpture, it was done very different.
11:51
SPEAKER_01: Yeah.
11:52
SPEAKER_00: And um I haven't had lumps for a long time.
11:55
SPEAKER_00: Any reasonable lumps.
11:57
SPEAKER_01: Yes.
11:58
SPEAKER_00: Yeah.
11:58
SPEAKER_00: It's so much it's so much easier to do sculpture now than it was 15 years ago.
12:06
SPEAKER_00: I would get a so it gets mixed up into a volume, let's say about six or eight CC syringes.
12:12
SPEAKER_00: I would have to have like a an extra handful of needles because they would all they would get clogged over and over again all the time.
12:20
SPEAKER_00: And they they changed up the formulation.
12:22
SPEAKER_00: It is so easy and smooth now, and it just works really, really well.
12:28
SPEAKER_00: Uh, I haven't had those little granulomas in a long time.
12:31
SPEAKER_00: Do you have have you had any?
12:34
SPEAKER_01: None.
12:35
SPEAKER_01: Not a single one.
12:36
SPEAKER_01: Not a single one.
12:37
SPEAKER_01: And you do a ton of sculpture.
12:39
SPEAKER_01: And I do a ton of sculpture.
12:40
SPEAKER_00: Yeah, yeah, you do.
12:41
SPEAKER_01: I think I'm I'm top 25 sculpture provider in the in the region.
12:46
SPEAKER_01: So our our region of Galderma, that's the company that makes sculpture and disport and wrestling, I'm in the top 25.
12:54
SPEAKER_01: And I think the region's considered like most of the Northeast.
12:57
SPEAKER_01: I do a ton of sculpture.
12:59
SPEAKER_01: Yeah.
12:59
SPEAKER_01: So knock on wood, no lumps, literally ever.
13:02
SPEAKER_01: And and I I hope that it stays that way.
13:04
SPEAKER_01: But so if a patient were to get a little bump under the skin, most of the time it's it can be a little basically nodule of collagen that can happen.
13:14
SPEAKER_01: It works too well.
13:16
SPEAKER_01: It sits under the skin and just and forms a little bump of collagen, which a lot of times we can just massage out or we can inject it with a little bit of steroid and it'll go away.
13:26
SPEAKER_01: Sometimes they could get a lump that is what's called a granuloma, which is more of an immunoresponse to the collagen.
13:37
SPEAKER_01: So your immune system sort of forms this encapsulated bump under the skin where your immune system was a little hyperactive.
13:46
SPEAKER_01: That can happen too.
13:46
SPEAKER_01: And that same thing, we can often inject it.
13:49
SPEAKER_01: Worst case scenario, we have them see a plastic surgeon like you, and you can make a little incision, cut it out, right?
13:56
SPEAKER_01: Have you ever had to do that?
13:57
SPEAKER_00: I I I know you don't know this story or you forgot it, but I had a patient uh more than 10 years or so ago, because it was in my very first office here, and uh she came in and she said she had sculptra done by some somewhere else.
14:15
SPEAKER_00: And then with some digging, she went and she found some like black market sculpture on the internet, thought it was sculptra, wasn't, you know, wasn't sure, and injected it on herself.
14:29
SPEAKER_01: She injected herself.
14:30
SPEAKER_00: Yeah, yeah.
14:31
SPEAKER_00: She and she was not a nurse or uh or uh anything at all.
14:36
SPEAKER_00: Yeah, and she had all of these huge lumps and I did I did a bunch of steroids to shrink them down over a period of like six months or more.
14:47
SPEAKER_00: And when it when they got small enough Could you see them or see them, you could feel the yeah, both.
14:53
SPEAKER_00: Yep, you could see them and feel them.
14:55
SPEAKER_00: And so when they got small enough that I could only make a uh you know, a small incision, then I would cut them out one at a time.
15:05
SPEAKER_00: I think I eventually lost her to follow up.
15:08
SPEAKER_00: She was um not the most dependable, sane patient I've ever had, but those are some of the ones that you learn the most from.
15:16
SPEAKER_00: And so I uh I learned a lot from her.
15:19
SPEAKER_00: I mean one of the things that I learned is patients will do crazy shit to save a buck.
15:25
SPEAKER_00: Right.
15:26
SPEAKER_01: I w I wish that I could say people won't do that nowadays, but now it's worse than ever.
15:31
SPEAKER_00: Yeah, I just told people that you could get black market sculpture and and you know, have that talked about all these terrible complications, but somebody's gonna go and look for it.
15:41
SPEAKER_01: Oh, somebody, somebody just heard you say that and their ears pain and they're like immediately on the dark web trying to find it.
15:48
SPEAKER_00: Please please don't do that.
15:51
SPEAKER_01: Do it, just don't do it.
15:52
SPEAKER_01: Please do it.
15:53
SPEAKER_00: Please don't do it.
15:54
SPEAKER_00: Yeah.
15:54
SPEAKER_01: Please don't do it.
15:56
SPEAKER_01: It is not worth it.
15:57
SPEAKER_01: It is not worth it.
15:58
SPEAKER_00: So someone wants a quick fix.
16:00
SPEAKER_00: Should they get sculptra?
16:02
SPEAKER_01: No.
16:02
SPEAKER_00: No.
16:03
SPEAKER_01: No.
16:03
SPEAKER_01: You gotta play the long game with sculptra.
16:05
SPEAKER_00: Yeah, that's right.
16:07
SPEAKER_00: So what if someone has an event tomorrow?
16:12
SPEAKER_01: They have an event tomorrow and they want to get sculptra.
16:14
SPEAKER_01: I know what you're going for.
16:15
SPEAKER_01: I mean, you're going for they're gonna be a little bit swollen and they're probably gonna like that little bit of swelling.
16:22
SPEAKER_01: Yeah.
16:22
SPEAKER_01: So yeah, I mean, I I still I still wouldn't do it.
16:25
SPEAKER_01: I mean, that's they're gonna unpredictable.
16:29
SPEAKER_00: Yeah, I had a patient who was a uh she's a doctor, and uh a few years ago, her son was getting married, and she came to me about three months before the the wedding, and she, you know, she wanted a bunch of stuff done.
16:43
SPEAKER_00: And so we decided on sculpture.
16:46
SPEAKER_00: We did some sculpture and we lined it up so that her, I think it was her second, possibly her third treatment was like the day before the the day before the rehearsal dinner.
16:57
SPEAKER_01: She wanted to do that.
16:59
SPEAKER_01: That's what choice.
17:00
SPEAKER_00: Right, right.
17:01
SPEAKER_00: And and I said, look, if you bruise, I'm sorry, you're gonna have to cover it up.
17:06
SPEAKER_00: And and we did it.
17:08
SPEAKER_00: And so what happens is you you put a lot of uh uh saline in uh with the sculpture.
17:15
SPEAKER_00: And so she used to- Yeah, I'm sorry, yeah, yeah, sorry, water.
17:19
SPEAKER_00: Um, and we put it in and uh she looked volumized and she looked amazing and she looked great.
17:25
SPEAKER_00: And then, you know, two days after the wedding, it was gone because it takes a few days for that volume to disappear.
17:31
SPEAKER_00: But for a day or two, it's people love that sculpt preview.
17:35
SPEAKER_00: It's an option, right?
17:37
SPEAKER_00: It it is an option.
17:39
SPEAKER_01: It is a very, it is a very unpredictable, uncontrollable option that I would probably not have done.
17:48
SPEAKER_01: But I mean, also, you know, she's she's a doctor, you're giving her informed consent.
17:53
SPEAKER_01: She really wants to do it.
17:55
SPEAKER_00: Yeah, okay.
17:56
SPEAKER_00: It wasn't her first treatment either.
17:58
SPEAKER_01: Did she bruise?
17:59
SPEAKER_00: No, she rocked it.
18:00
SPEAKER_00: She crushed it.
18:02
SPEAKER_01: She was bruised.
18:02
SPEAKER_00: She didn't crush it.
18:03
SPEAKER_00: I did it.
18:04
SPEAKER_00: Are you kidding me?
18:04
SPEAKER_01: My baby was.
18:10
SPEAKER_00: Right.
18:11
SPEAKER_00: No one was water.
18:13
SPEAKER_00: She rocked it.
18:16
SPEAKER_00: Okay, so let's talk about sculpture versus filler again.
18:21
SPEAKER_00: Let's let's go over it.
18:22
SPEAKER_00: Let's give it, let's give it five minutes of information.
18:26
SPEAKER_00: You know, what are the differences?
18:28
SPEAKER_00: What are the like three things you want we want people to leave this podcast with information that they can kind of tuck in their pocket?
18:37
SPEAKER_01: Gotta play the long game with sculpture.
18:39
SPEAKER_01: Don't do it if you want instant gratification or wait for the right time.
18:43
SPEAKER_01: However, when it's feasible, I would typically tell someone to do sculpture before they start investing in filler, because a lot of times you do sculpture first, you need less filler down the road.
18:58
SPEAKER_01: You will need less filler down the road.
19:01
SPEAKER_01: Um, but on the reverse side, you know, if you're maybe new to aesthetics and you haven't really done anything to your face and you kind of just want to get your feet wet, and maybe you don't want to do something as long-lasting, then something like filler that is not going to last as long as sculptra.
19:21
SPEAKER_01: And in a worst case scenario, if you don't like it, which is has literally never happened for me at least.
19:30
SPEAKER_00: Right.
19:30
SPEAKER_00: Right.
19:31
SPEAKER_01: Um, but in a worst case scenario, you don't like it, we can we can get rid of it, we can take it out very easily.
19:36
SPEAKER_01: So that's that's kind of how I would work through it with the patient.
19:40
SPEAKER_01: And and we would look at it from those angles.
19:43
SPEAKER_01: The other thing to consider too is I I don't treat patients with sculptra if they have some type of uncontrolled autoimmune disease.
19:54
SPEAKER_00: Why?
19:55
SPEAKER_01: Because they can if they have an autoimmune condition, they in theory they could get some type of autoimmune reaction and maybe they're more likely to form those those bumps under the skin.
20:06
SPEAKER_00: All right, so let's talk about this.
20:08
SPEAKER_00: You're a patient and you're trying to figure out where to go.
20:12
SPEAKER_00: You can't come to Skin Lab, you can't come to Lebraska Plastic Surgery.
20:17
SPEAKER_00: You're trying to find a place to go and you look at a options that that people have and you pick a med spa and they don't offer sculpture.
20:27
SPEAKER_00: Is that a red flag?
20:28
SPEAKER_01: No, I'm I'm not gonna say that's a red flag.
20:31
SPEAKER_01: No, because I I do know a couple of really good providers, not here in Pittsburgh, but in other in other cities who just choose not to do sculpture.
20:42
SPEAKER_00: Why wouldn't they do sculpture?
20:44
SPEAKER_01: Because they they they don't like that it's not quite as predictable as filler.
20:52
SPEAKER_00: It takes too long, maybe.
20:54
SPEAKER_00: If some people, you know, it it's a it's an immediate instant gratification world and some people just can't play the long game.
21:02
SPEAKER_00: I I would say that's probably reasonable.
21:05
SPEAKER_01: And it's is a little bit more unpredictable.
21:08
SPEAKER_01: I mean, you know, you you can't say exactly how someone is going to stimulate.
21:15
SPEAKER_01: Some people who are say you have someone who's very, very healthy and they take care of their bodies and maybe they're a little younger.
21:24
SPEAKER_01: Compare that to someone who's maybe a little bit older and they smoke and they don't eat right and you know, don't eat a ton of protein, things like that.
21:32
SPEAKER_01: They don't take care of themselves as well.
21:34
SPEAKER_01: Are they going to have as good a sculptural result?
21:37
SPEAKER_01: I would say no, they're not.
21:39
SPEAKER_01: So everyone's gonna stimulate a little bit differently.
21:41
SPEAKER_01: So that's how it's a little bit more unpredictable.
21:44
SPEAKER_01: Whereas filler, you can give someone virtually almost the exact same result, maybe using different quantities of filler.
21:52
SPEAKER_00: So, what about folks who burn through Botox quickly, burn through uh HA filler quickly?
21:58
SPEAKER_00: Are they gonna burn There are they gonna not do as well with sculpture as well?
22:03
SPEAKER_00: Is that a predictive factor or not necessarily?
22:07
SPEAKER_01: I would say that's not necessarily a predictive factor because it's it's an entirely different process.
22:13
SPEAKER_01: It's just an entirely different process.
22:16
SPEAKER_01: But I would say in general, there is some degree of unpredictability to sculpture.
22:23
SPEAKER_01: But you know, it's it's also one of the longest, it's been on the injectable market longer than almost every filler.
22:30
SPEAKER_00: It sure has.
22:31
SPEAKER_00: It has it has other than maybe the the the OG Juvederm, which isn't around anymore, and the OG Restalin, which it still is, but that's it.
22:41
SPEAKER_00: So okay.
22:45
SPEAKER_01: Let's be clear.
22:46
SPEAKER_01: There's I'm very comfortable doing sculpture.
22:49
SPEAKER_01: We have decades of research and safety.
22:52
SPEAKER_01: It's used on HIV patients and AIDS patients safely for decades.
22:57
SPEAKER_01: So, you know, I I think I think sculpture potentially could be even better, a bet even better option for those patients.
23:03
SPEAKER_00: So you have to answer, you have to choose.
23:06
SPEAKER_00: You can only pick one product, and you listen, you can only pick one product.
23:11
SPEAKER_00: All right.
23:11
SPEAKER_00: You have to answer sculpture or ha filler.
23:15
SPEAKER_00: Cheeks.
23:18
SPEAKER_01: This is you're made, you're asking me to choose like between two children.
23:23
SPEAKER_00: I could pick.
23:24
SPEAKER_00: It's different by the day, but you know, you have to pick one.
23:27
SPEAKER_01: I won't do it.
23:29
SPEAKER_00: I can't.
23:30
SPEAKER_00: That's you're exhausting.
23:32
SPEAKER_00: Listen, we're here.
23:33
SPEAKER_00: We're here to entertain and educate.
23:35
SPEAKER_00: You have to pick.
23:36
SPEAKER_00: Let's make it easy.
23:38
SPEAKER_00: It's me.
23:38
SPEAKER_00: You've already made it over.
23:41
SPEAKER_01: All right.
23:42
SPEAKER_01: I'm gonna pick sculpture.
23:43
SPEAKER_00: You're a dork.
23:44
SPEAKER_00: Temples.
23:46
SPEAKER_01: Filler.
23:47
SPEAKER_00: Filler for temples?
23:48
SPEAKER_01: Yes.
23:50
SPEAKER_00: Lips.
23:50
SPEAKER_01: Filler.
23:51
SPEAKER_00: Jawline.
23:52
SPEAKER_01: Can I say sculpture then filler?
23:54
SPEAKER_00: Yes.
23:55
unknown: Okay.
23:56
SPEAKER_00: Thin face.
23:57
SPEAKER_01: Sculpture.
23:59
SPEAKER_00: Heavy face.
24:01
SPEAKER_01: Nothing.
24:02
SPEAKER_00: Patient terrified of looking overfilled.
24:05
SPEAKER_00: Sculpture.
24:06
SPEAKER_00: Just say sculpture.
24:07
SPEAKER_01: Sculptra.
24:08
SPEAKER_00: Thank you.
24:08
SPEAKER_00: So global deflation.
24:10
SPEAKER_00: H a filler or sculpture?
24:12
SPEAKER_00: Does it tighten the skin?
24:14
SPEAKER_01: Do you mean lift?
24:15
SPEAKER_01: Are you trying to say does it lift the skin?
24:17
SPEAKER_01: Or are you saying does it tighten the skin?
24:19
SPEAKER_00: Tighten the skin.
24:20
SPEAKER_01: Yes.
24:22
SPEAKER_00: Does it lift the skin?
24:23
SPEAKER_01: No.
24:24
SPEAKER_00: Right.
24:24
SPEAKER_00: What lifts the skin?
24:26
SPEAKER_00: Me.
24:27
SPEAKER_00: Me.
24:28
SPEAKER_00: I do.
24:29
SPEAKER_00: I lift the skin.
24:30
SPEAKER_01: Tighten and lift are two different things to me.
24:33
SPEAKER_00: Correct.
24:33
SPEAKER_00: Right.
24:34
SPEAKER_00: Yeah, and you're right.
24:35
SPEAKER_00: If the main problem is gravity and you add collagen, what happens?
24:39
SPEAKER_00: Right.
24:40
SPEAKER_01: Yeah.
24:40
SPEAKER_01: I mean you can't reverse gravity.
24:42
SPEAKER_00: Yeah.
24:43
SPEAKER_00: So sculpture when when we when it first when I started using it for the first time, we called it the liquid facelift.
24:50
SPEAKER_00: It's not exactly a liquid facelift, but it's really nice.
24:54
SPEAKER_00: It is really nice.
24:56
SPEAKER_00: Although, if you get sculpture, I would ask you to not get a facelift for a couple of years.
25:01
SPEAKER_00: I've got that.
25:03
SPEAKER_01: People ask that all the time.
25:05
SPEAKER_01: Yeah.
25:05
SPEAKER_01: I I mean, you can correct me, but I think the issue is poorly placed sculpture could really be a problem.
25:12
SPEAKER_00: I mean, it migrates a little bit.
25:14
SPEAKER_00: There's the uh even someone who does it as well as you do, it migrates a little bit.
25:19
SPEAKER_00: It's just gonna migrate.
25:20
SPEAKER_00: It is what it is.
25:21
SPEAKER_00: A lot of it doesn't, but some of it does.
25:23
SPEAKER_00: And it just makes it a little bit more difficult for me.
25:26
SPEAKER_00: That very same patient whose uh son got married also got a facelift in the last three months or so.
25:33
SPEAKER_00: By you.
25:34
SPEAKER_00: Yeah, right, by me.
25:36
SPEAKER_00: And the the uh the sculpture was not an issue except on one cheek in one area, and it took me uh, you know, an extra 15 minutes of of work.
25:47
SPEAKER_00: And uh, you know.
25:49
SPEAKER_01: That's what I say.
25:50
SPEAKER_01: I mean, if it's a good surgeon, it it really shouldn't be that big of an issue.
25:55
SPEAKER_00: Well, it was also a good surgeon to put in the sculpture, if I do say so myself.
26:00
SPEAKER_00: Of course it was.
26:02
SPEAKER_01: It's just so it's just kind of like there's more scar tissue there, right?
26:05
SPEAKER_00: Yeah, yeah, yeah.
26:06
SPEAKER_01: Yeah.
26:06
SPEAKER_00: So, okay, how much sculptra do you need?
26:09
SPEAKER_00: So, what's what's your your plan?
26:12
SPEAKER_00: I can tell you what we started doing back again uh when I got this uh in 2010.
26:19
SPEAKER_00: We would try to do six syringes of sculptra, two, two, and two, six weeks apart.
26:25
SPEAKER_00: And then we would do one a year after that.
26:29
SPEAKER_00: So what's your protocol now?
26:31
SPEAKER_01: Yeah, I think I think that it really depends on the person's age and the the health of their skin and how much volume loss they have.
26:41
SPEAKER_01: I will tell you that the general rule from Galderma, the company that makes sculptura, is one vial of sculpture per decade of life.
26:52
SPEAKER_01: So if you're in your 30s, that's three vials, 40s, that's four vials, fifties, that's five.
26:57
SPEAKER_01: I find that's probably a little more than what most people need, but as a general rule, that's that's kind of like that.
27:07
SPEAKER_00: We do think these companies, you know, they try to oversell their products and you know, they they do that.
27:13
SPEAKER_00: So uh I think you're right, maybe every decade minus one.
27:19
SPEAKER_00: So two, two in your 30s, three in your 40s, four, yeah, as a ballpark.
27:23
SPEAKER_00: But you know, more, you know, you get you need you might need more at at 49 than you do at 40.
27:29
SPEAKER_00: So, you know, right.
27:31
SPEAKER_00: It's a ballpark.
27:32
SPEAKER_01: And then I do I do maintain it.
27:33
SPEAKER_01: So I usually say once a year, once every 18 months, come in and and we'll do a maintenance treatment with one vial.
27:43
SPEAKER_01: But also, you know, if they're doing other things for their skin, if they're doing quarterly microneedling or quarterly laser like like we want them to be, their skin's gonna be healthier.
27:53
SPEAKER_01: Maybe they don't need that.
27:54
SPEAKER_01: We just we just play it by air.
27:55
SPEAKER_00: So let's talk about hype versus social media hype versus reality.
28:00
SPEAKER_00: You ready?
28:01
SPEAKER_00: Okay, sculpture.
28:02
SPEAKER_01: Is this rapid fire?
28:04
SPEAKER_00: Yeah, close enough.
28:05
SPEAKER_00: Okay.
28:05
SPEAKER_00: Yeah, we already tried that and you already wouldn't answer cheat, you know, an answer for cheats.
28:10
SPEAKER_01: I'm a chronic overthinker.
28:12
SPEAKER_01: Oh I'm a zebra.
28:14
SPEAKER_01: You can't do something like that to a Libra.
28:17
SPEAKER_00: You're a zebra?
28:18
SPEAKER_01: Libra.
28:18
SPEAKER_01: I'm a Libra.
28:20
SPEAKER_00: Oh, I th I thought you were a zebra.
28:22
SPEAKER_01: You don't even know what you are.
28:24
SPEAKER_00: Fun fact.
28:24
SPEAKER_00: I'm a unicorn.
28:26
SPEAKER_01: No.
28:27
SPEAKER_01: Do you know what I mean?
28:29
SPEAKER_01: What's your what's your horoscope?
28:31
SPEAKER_00: Uh a zebra.
28:32
SPEAKER_00: Uh uh, a unicorn.
28:34
SPEAKER_01: No.
28:35
SPEAKER_01: You mean Capricorn?
28:36
SPEAKER_00: No, a unicorn.
28:38
SPEAKER_00: It doesn't exist like all the other ones.
28:39
SPEAKER_00: None of them exist, all right?
28:41
SPEAKER_00: I'm a unicorn, same as you.
28:43
SPEAKER_00: They don't exist.
28:44
SPEAKER_00: You can just pick whatever the hell you want because it's all bullshit.
28:47
SPEAKER_00: Sorry, you know, my my my mercury is in retrograde.
28:52
SPEAKER_00: No, it just means you're being an asshole.
28:56
SPEAKER_00: I'm gonna put that on one of the uh on one of the uh the hype, the pre-hype videos.
29:02
SPEAKER_01: I happen to like saying that merch mercury is in retrograde, and that's why I'm acting insane.
29:08
SPEAKER_01: I happen to like saying that.
29:10
SPEAKER_00: You're acting insane because you're a little bit insane.
29:13
SPEAKER_00: You probably think that guy, that Clancy guy uh killed his kids.
29:18
SPEAKER_01: No, no, no.
29:19
SPEAKER_01: I listen, I am in a deep dive on a podcast right now, going, it goes through every single day of the trial.
29:26
SPEAKER_01: I have, I do, I have changed my mind.
29:29
SPEAKER_00: Good, yes.
29:30
SPEAKER_01: I retract what I said a few weeks ago.
29:32
SPEAKER_00: There was a the the absolute complete timeline.
29:35
SPEAKER_00: She was walking up the steps at 5 34 and he was in Bright Aid or the CVS or whatever.
29:41
SPEAKER_01: She well, she's she's already admitted guilt, I'm pretty sure.
29:44
SPEAKER_01: Sure, right.
29:45
SPEAKER_01: Yeah.
29:45
SPEAKER_01: Right.
29:45
SPEAKER_01: I and I don't I don't know by reason of insanity.
29:48
SPEAKER_00: You know, there they're people who think he did it, they'll they'll jump through any hoop to blame the guy.
29:55
SPEAKER_01: What I will say though is that, and we are totally it's super sad and terrible off topic.
30:02
SPEAKER_01: That as someone who has been through two children and and postpartum, it's it's a really horrible thing what she went through.
30:12
SPEAKER_01: If I if it truly, right?
30:15
SPEAKER_01: I I mean if it was truly postpartum psychosis or or whatever it was, she clearly needed help and wasn't getting it.
30:24
SPEAKER_00: She was screaming for help.
30:26
SPEAKER_01: Screaming for help, screaming for help.
30:28
SPEAKER_01: She was she did not want to do that.
30:32
SPEAKER_01: She needed help and she she didn't get help, and it's super, super freaking sad.
30:37
SPEAKER_01: It's terrible, super freaking sad.
30:39
SPEAKER_00: It's it's an absolutely horrific, horrible story, and I hope other people learn from it, right?
30:47
SPEAKER_00: I hope other people learn from it.
30:50
SPEAKER_01: Literally, no one has ever gone from talking about sculptura to talking about a triple homicide trial ever in the history of podcasting.
31:03
SPEAKER_01: That was the biggest 180 pivot that has ever happened.
31:06
SPEAKER_01: Ever.
31:07
SPEAKER_00: Thank you.
31:10
SPEAKER_00: Thank you so much.
31:11
SPEAKER_00: I did that.
31:12
SPEAKER_00: Yeah, I did that.
31:13
SPEAKER_00: Yeah, I wanted to see what you were gonna say about it because the other day you were like, I don't know.
31:17
SPEAKER_01: I'm not sure.
31:19
SPEAKER_01: It's just that nobody wants to believe that a mom could do that.
31:24
SPEAKER_01: That's that's that's what it that's in that moment.
31:26
SPEAKER_00: She wasn't a mom.
31:27
SPEAKER_00: She wasn't she wasn't herself, she wasn't who she was.
31:31
SPEAKER_00: And it's right, it's soul crushing.
31:34
SPEAKER_00: Yep.
31:35
SPEAKER_00: Soul crushing for for so many people.
31:38
SPEAKER_00: Uh okay.
31:39
SPEAKER_00: So sculpture.
31:40
SPEAKER_00: More natural than filler.
31:42
SPEAKER_01: Yes.
31:43
SPEAKER_00: Tightens the face.
31:44
SPEAKER_00: We already said that.
31:45
SPEAKER_01: Yes.
31:46
SPEAKER_00: Everyone should start it in their 30s.
31:48
SPEAKER_01: No.
31:48
SPEAKER_00: Correct.
31:49
SPEAKER_00: Right.
31:49
SPEAKER_00: Because it's your own collagen, there's no risk.
31:52
SPEAKER_00: That is absolutely your own.
31:54
SPEAKER_00: Oh, yeah, yeah, yeah.
31:55
SPEAKER_00: Sorry.
31:55
SPEAKER_00: I read it wrong.
31:56
SPEAKER_00: Because it's your own, because it's your own collagen, there's basically no risk.
32:00
SPEAKER_01: Oh, there's risk.
32:02
SPEAKER_00: There is absolutely risk with everything.
32:04
SPEAKER_00: Yeah, right.
32:04
SPEAKER_00: Can it replace a facelift?
32:06
SPEAKER_00: And I'm gonna tell you the answer is absolutely no.
32:08
SPEAKER_00: In some people, it can make it take a little longer before you need one, but uh, but it absolutely cannot.
32:16
SPEAKER_00: Uh men, yes.
32:18
SPEAKER_01: Yes.
32:18
SPEAKER_00: Lips, no, no, can it create lumps?
32:21
SPEAKER_00: Yes, yes.
32:22
SPEAKER_00: Does it hurt?
32:24
SPEAKER_00: Not really.
32:25
SPEAKER_01: Barely.
32:25
SPEAKER_00: Barely.
32:26
SPEAKER_01: Barely.
32:27
SPEAKER_00: I mean, it'd probably hurt you.
32:29
SPEAKER_01: It's it yeah, I think Botox hurts more because we put numbing in there too.
32:34
SPEAKER_01: There's numbing in the sculpture.
32:36
SPEAKER_00: You get really numb.
32:37
SPEAKER_00: Yeah.
32:38
SPEAKER_00: So am I due for more sculpture?
32:41
SPEAKER_01: Yes.
32:42
SPEAKER_01: Please.
32:43
SPEAKER_01: Yes.
32:43
SPEAKER_01: I'm dying to put some sculpture in you.
32:45
SPEAKER_00: I'm dying for you to put anything in me.
32:47
SPEAKER_00: You've been abandoning me for over a year now.
32:50
SPEAKER_00: Like, this is basically all natural at this point.
32:53
SPEAKER_00: I don't even have any Botox in my face.
32:56
unknown: God.
32:57
SPEAKER_01: We never, it's like the shoe cobblers' kids never have shoes.
33:02
SPEAKER_01: I was just saying, I was saying just to Melissa, our aesthetician, yesterday.
33:09
SPEAKER_01: I get the least amount of treatments of anyone who works at Skinlab.
33:13
SPEAKER_01: Everyone's so well taken care of, and there's little old me aging, like, help me, I'm poor.
33:24
unknown: Please.
33:25
SPEAKER_00: That was so funny.
33:26
SPEAKER_01: Somebody anti-age me for once.
33:30
SPEAKER_00: Yeah, I know.
33:31
SPEAKER_00: My my whole staff, they all look good.
33:34
SPEAKER_00: They're all in good shape.
33:35
SPEAKER_00: They're they're thin, they're fit, they're all toxed and filled up, and and here I am.
33:40
SPEAKER_01: They've all got boobs and tummy tucks and and filler in their lips, and and there's little you poor me.
33:48
SPEAKER_00: No boobs.
33:50
SPEAKER_00: No, no boobs.
33:54
SPEAKER_01: You you did get you did get a bluff though.
33:56
SPEAKER_00: I did six years or so ago.
33:58
SPEAKER_00: Yeah.
34:00
SPEAKER_00: Yeah, we sure did.
34:01
SPEAKER_00: Okay.
34:02
SPEAKER_00: Final answer.
34:03
SPEAKER_00: A sculpture.
34:04
SPEAKER_00: Is it worth it?
34:05
SPEAKER_01: Yes.
34:06
SPEAKER_00: I'm Dr.
34:07
SPEAKER_00: Labraska, board certified plastic surgeon, north of Pittsburgh, Pennsylvania, and New York City.
34:12
SPEAKER_00: I'm here with my wonderful baby sister, Mystica Labraska.
34:15
SPEAKER_00: She's the dermatology PA of 16, going on 17 years.
34:19
SPEAKER_00: Together, we are scalpel and skin.
34:22
SPEAKER_00: We're siblings, we're business partners, and somehow we still get along and have a blast.
34:27
SPEAKER_00: And do 180 pivots in the middle of an episode.
34:30
SPEAKER_00: Everybody, let's go.
34:32
SPEAKER_00: That's it for today's episode of Scalpel and Skin.
34:35
SPEAKER_00: Follow the show wherever you listen and come find us on social media.
34:38
SPEAKER_00: Send us the treatments, trends, or questions you want us to break down next.
34:42
SPEAKER_00: This is Scalpel and Skin.
34:44
SPEAKER_00: Let's go.