Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / SkinVive, Non-Surgical Rhinoplasty & More - Get Off My Lawn Part 2
Transcript
- Announcer (00:02): You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis. Kirstin (00:11): We're back with more hot takes from Dr. Koehler. Alright, so how about fillers? Now, Allergan, they maker of Botox has recently, within the past, what, 12 to 24 months come out with SkinVive. What do we think about that? Any benefit to it? Is it just a plot to sell more filler? Dr. Koehler (00:37): Sometimes you wonder. Kirstin (00:41): To my knowledge, we have not had a single person come in here and say, you know what, I really think I need an injectable to make my skin glow. Can you give me some SkinVive? Dr. Koehler (00:49): Yeah. Well, I mean, the theory behind it is to kind of get your skin more hydrated and to give it that little bit of glow. But alright, I will get on my, I will get a little old grumpy old man on this. So back when, okay, so before the hyaluronic acid fillers, we were using collagen and then the hyaluronic acid fillers came out and that was the big thing. But really there was one filler or two fillers. I mean, there was a handful of fillers, there wasn't a lot. Now they've got a filler for every application. There's one for your lip, there's one for your big toe, there's one for your this fold, there's one for this fold. I mean, I'm joking, but they have filler for almost every area, like the cheek, the lips, the nasal labial folds. They all have their own special filler. And I'll just tell you from a practical standpoint, carrying that inventory of all these different fillers in the office, and by the way, it's not just, there's multiple companies and they all do it. So then it's like to try to keep all these options available for people. It's like, okay, well you come in and you're like, okay, I want something to treat my nasal labial folds. And they're like, okay, well, which company do you like this company, or do you like that company? Oh, you like this company? Kirstin (02:05): Oh, which one's going to give you the most points and the most coupons? Dr. Koehler (02:08): Yeah. So really, and the negative side of it is it does, from our perspective in a practice, it's carrying a lot of different inventory. And that's a little frustrating. But if it really does better with one type of filler, then hey, you accept it, you move on, you do it. But I sometimes, I guess question if we need all those different types of fillers, but then to say, okay, well we need filler to get our skin to glow a little bit more. I don't know. So I'm going to go ahead and say that I just don't have a ton of experience using the SkinVive, so I will reserve my opinion, but stay posted. But I will say that I feel like we've kind as a, I don't know, society, we were really, we used filler a little bit, but it just seems like there was, we're almost on filler overload here the past few years. Dr. Koehler (03:02): You've seen some of these people in Hollywood and everything else, and you kind of wonder how did they get to that point? They've got so much filler in their face. And as I've mentioned before, I mean, it's the gradual change. You get some filler and then you get used to how you look, and then you think it's going away and you get some more. And over a period of time you don't realize until you look back at a picture of yourself from a couple years ago. But anyhow, yes, too much filler. I like filler, but I like to use it with a moderation. Everything in moderation is okay. Kirstin (03:39): Agreed. Dr. Koehler (03:39): I'm not anti SkinVive, I honestly can't speak about it. I've not really used it. I haven't had any patients request it. But yeah, stay posted. Kirstin (03:49): Okay. All right. Next thing. Non-surgical rhinoplasty using fillers and such. Dr. Koehler (03:57): Yeah, not a huge fan. The complications, if they occur, can be devastating. So the whole, first of all you can really do is just if there's areas of the nose, you can't do it for. Not every patient is a candidate for a nonsurgical rhinoplasty. With filler, you have to have certain features, and if you do, yes, you can camouflage certain appearances by adding filler. So for instance, maybe you have a deep, we call it a radix, like the deep part where your nose meets your forehead. If that's really deep there and maybe you have a little bit of a hump, well, we could put some filler in that deep area and maybe a little filler up in here. And we can kind of smooth that appearance of that hump to where it makes it look like your nose has got more of a straight profile, but we're building your nose up. Dr. Koehler (04:47): The whole process is to make your nose look more aesthetic by adding to your nose. And a lot of people when they come in, that's the opposite of what they want. They're like, I want my nose smaller. And so they're trying to reduce the hump and other things. So yes, it's an option for somebody who wants to, maybe they're not ready for surgery or maybe they just have an event that's coming up and they're just like, could you do something to make this look a little softer, a little more appealing, so I don't have this distracted hump? The shorter answer is yes, you can do it, but the long answer is it can be dangerous, especially when injecting to try to give more tip projection or things like that, because the face is very vascular and there's certain parts of the body that are more prone to issues with circulation. When we were in medical school, they had this little saying like the ears, nose, fingers, toes, and well, and hoes, but we won't get into that. But anyhow, those are end organ areas where that's the blood supply stops. And if you do something to cut off that circulation, the skin is not going to have oxygen and it's going to die. Dr. Koehler (05:59): And so if you inject somewhere in the nose near the tip, and if you obstruct the blood flow with that filler by injecting into it, and people say, oh, well, you just have to have to aspirate. Well, let me tell you, it may be not that simple. And it's not necessarily like you can aspirate, not get anything back, and you can occlude a vessel. So anyhow, the point is, if that vessel becomes occluded, then the skin to the tip of the nose could die. It's just not a, we always assume that nonsurgical things are safe, but sometimes they can be just as actually sometimes in this case, more dangerous than a rhinoplasty. The likelihood of ending up with the skin and the tip of your nose dying from a rhinoplasty for a first time rhinoplasty is not very likely. Now, if you've had multiple rhinoplasties, a different story, Michael Jackson, different story. But anyhow, nonsurgical rhinoplasties, I'd say maybe in select circumstances, but really if you really are bothered by your nose, you really ought to consider doing something that is long-term safe and by somebody who's reputable that can do that for you. Kirstin (07:13): Okay, I like that answer. All right. What about Kybella? What does Kybella do? Dr. Koehler (07:22): It makes rock hard tissues is what it does. There's been many years prior to even Kybella, people were doing mesotherapy, and it's the whole concept of injecting different substances to hopefully metabolize and burn or get rid of the fat in that area. And Kybella is this deoxycholic acid that is, again, it's supposed to try to non-surgically dissolved fat, and it's indicated for subcutaneous fat. So this is important, it's just fat that sits underneath the skin, that's between the skin and your platysma muscle to dissolve that fat. Now, you can't inject it deeper because deeper to that muscle is arteries, veins, nerves, vital structures that would be very dangerous to inject it or could be dangerous to inject in those areas. And so you can only treat the subcutaneous fat. So it would be the nonsurgical competitor to liposuction, because when you liposuction, you can only treat subcutaneous fat. Dr. Koehler (08:30): You also cannot suction that deeper fat because again, all the vital structures are there. So if a person just has subcutaneous fat, then I guess you could try that non-surgically, I'll share my experience with that, but really a lot of times, and I guess just now many years of experience and myself, personal experiences, I've realized that I think there's very few patients that are really good candidates for just neck liposuction. A lot of times people that need improvements in the contour of their neck, it's a combination of yes, maybe removing some superficial fat, but a lot of times it's doing stuff to the deeper structures. Sometimes shaving down part of the sub mandibular glands. Sometimes we're removing the deeper fat in the neck. So there's all these things and tightening up the muscles of the neck. But anyhow, if it's about dissolving this fat, the long answer is I've never really seen it really do much. Dr. Koehler (09:29): However, I have gone in surgically on people to do a neck lift, and I did, I don't know, a year or two ago on a gentleman, and I didn't know that he'd had Kybella several times. And I went in to do the surgery. And during the whole surgery, I said a lot of bad words. I was in timeout for a little while, but it was awful. I was like, I cannot, the tissue planes were not easily identifiable. It was very scarred down, matted down, trying to lift things up. It was really just a very, it was not a pleasant surgical experience. And I can just tell you from doing lots of necks that have not had that done typically. And if they've not had surgery or anything done to their neck, just a virgin neck, you can get in there, and it's not a problem to do the things that you need to do to improve the contours. Dr. Koehler (10:30): It's generally pretty straightforward. The anatomy's pretty straightforward, but once you add these other things, like previous treatments that create a lot of scarring, it can just kind of make it a very difficult procedure for the doctor. So I'm not anti non-surgical stuff. I think the thing is, if you're a surgeon and you've seen the kind of transformations that you can get with surgery, and you understand that people don't really want surgery, but then they pay a lot of money for nonsurgical stuff, and then they change their mind. It's like they took something that could have been just a straightforward procedure and they made it 10 times more difficult. Kirstin (11:12): Get off my lawn. Dr. Koehler (11:13): Yeah, get off. Well, I don't actually, if somebody asked me to inject that now, I would just say no. And I guess I understand the whole nonsurgical thing, I mean, I really do understand. I mean, I have plenty of patients in my practice, they know I'm a surgeon and they know that, if they come in and say I don't want surgery, and we're not here to talk people into surgery, but so I get it, and we want to offer those non-surgical things. But what we really try to do is to offer those things that are going to give them meaningful results. And I can tell you, I personally, because I have injected Kybella and I have done it for a while, and sometimes you don't realize these things until you have done a number of your own patients. I've done thread lifts and other things too, and I want to meet those patient desires. And so the only thing is sometimes you look back and you go, gosh, I wished I wouldn't have done X or Y. But when people are seeking it out, you oftentimes, you can't wait three years to be the guy to say, okay, yeah, it looks like it's good. I think if they've passed their FDA studies and it's out there, you a lot of times think well, and you hear people lecturing at meetings and all that kind of stuff, so some stuff just doesn't pan out the way you expect it to. Kirstin (12:31): All right. Well, you mentioned threads. Dr. Koehler (12:35): Yeah. Kirstin (12:35): Let's talk about threads. Dr. Koehler (12:37): Get off my lawn. Kirstin (12:39): We already know. We already know. We hate the threads. Dr. Koehler (12:41): Yeah, I've talked about it before. I don't have much new to say here. It's just they came out early two thousands. The first iteration FDA approved, it was a permanent thread. Now they've just, similar thing, it's just dissolvable or resorbable now. But yeah, the basic crux of this is as a surgeon, if you realize what it takes to lift a face, you you'll understand that there's not a suture that can hold things in place for any specific length of time. I guess maybe you could get a result for several months or so. But looking, I would love to see a long list of before and after that patient's done in succession, and you look at a year later and see where they're at. I mean, probably a lot of them, by six months, their results gone. Kirstin (13:36): Interesting. Dr. Koehler (13:38): And they're not, again, without complications. The threads can be visible when you smile, you sometimes you can see animation deformities where you can kind of see lines where the threads are sitting and stuff. So yeah, I'm just not a huge fan, and I tell people all the time, that's something that I wouldn't waste my money on. I think those can get pretty pricey pretty quick too. I'd rather see people either just save that up and when they're ready to do a proper procedure or, yeah, just not do it. Kirstin (14:12): Okay. Get off my lawn thread lifts. All right. Okay. Next thing is IV therapy. We've been seeing little clinics pop up and people driving around to bachelorette parties and to your house and whatever. And we actually just got a new IV clinic right up the road, probably about two miles. What is your feeling on these little pop-up clinics? Dr. Koehler (14:39): So as a surgeon, we were always told when the gut is available, use the gut, drink water, H2O, you can do it. Kirstin (14:52): Water. Dr. Koehler (14:54): Yes, you can get electrolytes too. You can actually put some electrolytes if you want into your water and do that. But no, truthfully, I mean, your gut will absorb the fluids that you need and your kidneys regulate whether or not if you've got too much, you're peeing it off and you're not enough, it's holding on. So our bodies are pretty fascinating, and they're able to do what they can do. We use IVs in hospitals and in surgery because when patient's asleep, we can't be having them drink water. And when we're giving 'em medications, we need to have something to flush that through their system. But I guess if a person's dehydrated, I mean, it's certainly acceptable to give them fluids. There's a difference between, oh, I was out partying last night and I've been out lost in the woods and haven't had water in three days or something like that. There's a dehydration and there's really clinical, oh my gosh, this person, it needs more than just fluids, but it's not necessary. And if you need an IV, you probably need to be in the hospital. That's what I think. Kirstin (16:08): There we go. Dr. Koehler (16:08): You can get the fluids that way too, but I just don't think it works any quicker or does anything more. Your body can do it on its own. Kirstin (16:17): Okay. Human body is phenomenal. There you have, it will be back with more hot takes from Dr. Koehler. Announcer (16:26): Got a question for Dr. Koehler? Leave us a voicemail at alabamathebeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.