Latest / The Dr. Randi Show / Breaking Barriers in Aesthetics: A Conversation with the First Female President of The Aesthetic Society — Dr. Jennifer Walden

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Breaking Barriers in Aesthetics: A Conversation with the First Female President of The Aesthetic Society — Dr. Jennifer Walden · The Dr. Randi Show

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  The views expressed in this podcast are for informational
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  purposes only and do not constitute medical advice.
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  This episode of the Doctor Randy Show is proudly sponsored by New
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  Beauty, the ultimate authority in beauty and aesthetics.
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  Whether you're looking for the latest innovations, expert
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  insights or trusted recommendations, New Beauty is
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  your go to source. Visit newbeauty.com to stay
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  ahead of the trends and discover what's next in beauty.
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  Now let's get into the episode. Hello everyone, and welcome to
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  the Doctor Randy Show real conversations about the people
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  and ideas driving aesthetics today.
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  I'm your host, Doctor Randy Boyett.
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  She's one of the most respected plastic surgeons in the country.
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  She's broken barriers as the first woman to become president
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  of the Aesthetic Society, And she's at the forefront of where
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  aesthetic surgery is heading next.
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  Please welcome Doctor Jennifer Walden.
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  Thank you so much for having me, Randy.
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  I appreciate being on. Absolutely.
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  All right, we are going to go ahead and jump in.
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  Doctor Walden, so excited to have you on the show today.
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  You are known for your surgical excellence, leadership, as well
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  as influence in the industry. When you look at what is
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  unfolding right now, what part of aesthetics has your attention
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  most? I think that there's been a
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  broad growth in aesthetics providers.
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  So I think one of the biggest things that's happened, say in
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  the past three years is kind of a massive growth and not only
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  physicians and plastic surgeons, but other people that provide
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  aesthetic services. So I think we've had the feel
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  over the past few years like it's the Wild West.
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  And I actually think that's beginning to calm down and self
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  regulate and regulate from a standpoint of legislation
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  oversight and people just, you know, understanding how
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  important it is to become educated to before performing
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  aesthetic treatment. So just as kind of a leader in
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  the field of plastic surgery, which kind of sits up at the top
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  of the heap with facial plastic surgery, dermatology, we want
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  people to be safe. Patient safety is the number one
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  thing. And so I think that we're really
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  seeing a coming of age and we're really focusing on training and
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  education of injectors, providers of services.
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  And I think that's very important that that happened.
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  You have a front row seat to what is happening across
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  aesthetics, both with other clinicians as well as patients.
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  What conversations are coming up most often right now?
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  Well, most often I would say these tie together that post GLP
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  one agonist use where we have younger patients that are losing
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  weight and they tend to have saggier skin of the face and
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  neck. So younger patients seeking
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  aesthetic surgery is something a plastic surgeon would see in an
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  IC, facelifting, for example, tummy tuck, breast lift.
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  So those things are happening in larger numbers just because
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  America is shrinking in size, right?
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  You'll hear on the news that airlines are going to play less
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  in jet fuel next year just because of the weight of the
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  American public is going down because of these medicines.
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  So I think that ties into the fact that we're seeing
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  resurgence and something called the facelift.
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  And we didn't see that over the past five years.
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  We just saw people pumping fillers into faces and is what
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  things that were FDA cleared regenerative medicine.
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  I think that we're seeing the bell curve go up on the
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  resurgence of whether it's high smash or deep plane face
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  lifting, the gold standard and facial aging, which is the
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  facelift and it took celebrities to get those procedures done.
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  I think for the American public to acknowledge that, but there
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  is only so much that we can do with facial fillers and that
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  sort of thing. And I'm seeing a big resurgence
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  of that, right? I feel like there was a time
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  where we're seeing everything non surgical.
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  Yeah, now it seems to be going back to surgical.
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  I've lived through it all. I mean, I think just being in
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  the medical spa industry and having owned Med spas in the
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  past and run them and directed them, it's interesting to see
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  the iterations we go through, you know, every three to four
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  years. And I think we're coming in out
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  of like a real non invasive kick and injecting, you know,
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  substances in the face that we don't really know and that sort
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  of thing. And we're getting into kind of
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  the more of the gold standard, which is facelifting because
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  there is no other way to lift the underlying foundation.
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  And we've been having conversations about that with
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  clinics that focus on non invasive.
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  And it's like when do they say to the patient it's time for
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  surgery, right? And how far do we try?
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  Yeah. I think that's one of the most
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  important things that injectors or say if it's an RN or a nurse
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  practitioner own medical spot, I think it's one of the smartest
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  and most important things for them to understand.
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  And usually I believe from what I've seen, it's those that have
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  worked for a plastic surgeon before that know when to say
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  when or they're going to make the patient unhappy.
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  Their skin is going to be all modeled and, you know,
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  disappeared prior to surgery. That's a smart thing to do is to
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  know when to refer to the plastic surgeon for a Bluff
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  roplasty or facelift neck lift, that sort of thing.
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  For our listeners who may be getting to know you for the
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  first time, can you share you know what procedures your clinic
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  is most focused on today and what really defines your
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  practice? So what my practice focuses on
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  right now is really probably 50% facial aesthetics and in that is
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  facial aesthetic surgery, eyelid lift, facelift, rhinoplasty and
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  even minimally invasive procedures you may hit on later.
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  And then the other half I do breast and body and female
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  genitalia as well as male enhancement procedures.
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  So being aesthetic surgery trained and having kind of that
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  whole energy based device Med spa experience for the past 15
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  years and my practice has kind of given me the ability to have
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  a broad portfolio in the industry and I'm able to do a
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  lot. Now there's some things I don't
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  do. I don't do the non invasive
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  devices. I refer them to my laser
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  technicians, my estheticians, but I do a wide variety of
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  procedures here. So we'll dive in a little deeper
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  to the topic of surgical versus non surgical and the evolution
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  that we're seeing right now. Are patients still coming in
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  asking for non surgical techniques?
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  And is it those that are maybe afraid of surgery?
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  And then once they understand what you're capable of, they're
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  like, oh, maybe I need to switch in that other direction.
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  What are patients really asking for right now?
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  Well. Any patient, I mean even
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  patients I see for face lifting, they would love to be able to
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  get away with something less invasive than a surgery because
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  I mean, it's more expensive, there's more downtime
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  associated, but the results last longer and they know that.
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  But anytime they can get away with something more minimally
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  invasive, we will put them into that category.
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  Noninvasive patients are very smart.
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  By the time they reach my chair and my treatment room, they know
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  that they're not just here for noninvasive services.
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  They know they need something beyond that, but sure, people
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  want to do as least invasive as possible.
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  And then there's the occasional patient that comes in like I had
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  last week and I'm doing a facelift on her soon that had
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  gotten fillers for so long. I mean, the amount of the filler
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  she got, the cost of it added up to the cost of a facelift.
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  And she still was saggy and heavy.
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  And she kind of had come to me a little frustrated saying, gosh,
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  I wish they would have told me, you know, that I needed surgery.
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  I spent XX thousands on filler and I probably should have done
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  this a long time ago. And she was, I mean, she was 67,
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  like platysmal bands, jowling, definitely just facelift
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  candidate filler wasn't going to cut it anymore.
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  And so we'll see people like that that come in, they're like,
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  I know I need a facelift that as well.
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  I'm here. I figured this out on my own or
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  my provider told me. Are patients coming in for
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  surgical techniques they weren't even asking for just a couple of
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  years ago? I see a lot more patient
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  education on the surgical side. Yeah.
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  I mean, I think that celebrities and Instagram and social media
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  has really brought facelifting and some of our aesthetic
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  surgery procedures to the forefront where patients and
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  just to lay public is more educated on terminology that say
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  maybe 10 years ago a patient might never bring up the smash
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  layer, the superficial muscular upper neurotic system of the
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  face, which is the muscular connective tissue layer under
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  the skin. Nowadays they will come in and
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  ask what type of facelift we do, whether it's deep plane or a
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  high smash facelift. It really has to do with the
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  technique of the surgeon rather than the smash technique.
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  And I think that's an educational process because a
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  patient might look at Instagram and we don't know exactly what
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  facelift was performed, but they might get just read the caption
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  and get hooked. And they're mine on an idea of
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  like, I need a deep plane facelift.
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  And they actually might not need the risk of that.
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  High smash face looks amazingly well like you see on Kris
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  Jenner. So I think for plastic surgeons,
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  we kind of smile, we kind of chuckle because these terms have
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  been around a long time. A deep plane facelift has been
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  around for decades, since Sam Hamara.
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  And so we see resurgence on social media as if it's new.
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  But what's old is always new again, I think in plastic
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  surgery. Let's talk for a minute about
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  innovation and what's moving the needle.
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  The show is really focused on innovation and what's coming
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  next. So I'm curious, Doctor Walden,
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  how do you distinguish between innovation that genuinely
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  advances aesthetics and then ideas that simply don't even
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  translate into meaningful results?
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  Because I'm sure techniques and different devices and whatnot
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  are presented to you on a daily basis, and how do you make that
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  decision? I make it on a case by case
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  basis. And I have an example right here
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  of the fact I get emails and phone calls and texts from
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  representatives of companies all the time, right?
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  And they want to show me the next and the best.
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  But if I review it and I look at some of the science and the
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  predicate devices that will give me some information.
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  And for example, I've been presented and now I'm using a
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  dual hybrid subdermal interstitial laser, which is
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  new. It's new to the US market, and
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  I'm the chief medical officer for the company.
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  It's called Junera. But when that CEO brought that
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  technology to me and he showed it to me and he showed me the
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  evidence behind it and the before and after photos, by the
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  way, of the people that have been performing it longer than I
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  have, it's like, you can tell it from the doorway, right?
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  I could tell it from the doorway.
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  And I said, I want to do that, want to be associated with that.
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  We can tell what's works, right? I've been doing this long
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  enough, I can tell what's going to make or break something.
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  And so this one I think really works well because it actually
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  can help melt the fat, but it also tightens the skin and
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  there's no stitches, there's no incisions.
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  And it's something I do, I don't delegate it.
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  And I think it bridges that gap. There's that big gap between say
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  some type of great non invasive technology and then a surgery, a
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  facelift. And we needed something to
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  bridge that gap that doesn't cause a tremendous amount of
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  scarring and that sort of thing. I do think we need something
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  that's in the middle because there's only so far that the
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  skin tightening treatments, the art can take us.
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  And if that's the middle ground, then that's a great option.
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  And what kind of results have you seen with that?
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  I've seen very nice results. Obviously, it's not surgical,
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  meaning we're not lifting or removing skin like I'm going to
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  get a facelift soon. So you guys, you can tell I
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  always do this, it's not lifting or moving, but we're getting me
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  as close to surgical results and I have seen with the minimally
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  invasive device. So that's an important term.
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  I think it's close to OR terms and I've kind of talked about
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  that when I went to MCAS in Paris is I've kind of been
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  watching this evolve and I think we're getting better and better.
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  Actually, I think device technology is getting better and
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  better and more nuanced. And this is just a precise, it's
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  like the diameter of a hair that we insert under the skin and
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  it'll tight neckline. And you can see that immediately
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  results get better over the next three to six months.
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  So with the public knowing I do that procedure, I have seen so
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  many new patients. It's interesting that because
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  that doorway opened in my practice, so many new patients
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  have come in and I'm like, do I know you?
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  And they're like, no, but I knew you were, but I knew I didn't
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  want to facelift yet, but here I am.
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  I hear you can do this now. Once you have it, they come.
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  And so I've kind of seen that is an unmet need because of the
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  flow of patients that that's brought in that otherwise
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  wouldn't have come in. That's remarkable.
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  That's remarkable. And what's the downtime for
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  something like that? Usually it's about 3:00 to five
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  days, a little bit of swelling, a little bit of bruising.
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  We put you in a compression garment and you wear that in the
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  first couple days and then every 30 days at night.
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  And it helps kind of retrain the skin as the skin is healing
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  down. But we're also seeing just
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  improvement in the quality of the skin because it is a 980 and
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  1470 diode. Do a wavelength laser so it can
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  target hemoglobin like vasculature teleinjectation or
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  age lots of the skin and then it can also target fat and
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  neocalogenesis. The 1470 targets the water
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  molecule. That's its criminal.
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  For it sounds like you're excited about that trend.
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  Are there any trends that you're seeing right now in aesthetics
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  that you think are getting far too much attention than they
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  really should that maybe we should be phasing out?
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  I think the word regenerative aesthetics is interesting.
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  I think it's a vague term. And recently there was a paper
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  that came out in our plastic surgery journal that about 25
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  plastic surgeons signed saying that it's kind of a dangerous
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  word we used is just regenerative aesthetics.
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  Because if we're getting exosomes or PDGF growth factors
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  or PLA and we're injecting it under the skin, you can do that
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  year in and out, but we don't really know the long term
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  effects yet on the skin. And so I think the big wave of
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  regenerative aesthetics, I think there is a place for that, but
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  it needs to be evidence based and backed by scientific
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  literature and we need to study these things before we just
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  start serendipitously injecting into the face.
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  So caution with regenerative aesthetic.
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  Yeah. And as you look back to the
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  innovation maybe that you've seen over the last 10 years, is
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  there something that was new at the time that you're glad that
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  you didn't rush into? There's always a device or two
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  that might collect dust after a couple years.
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  I tend to have done research on them and so I don't have any
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  device that I'm like, man, I wish I'd never gotten that.
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  I'm pretty happy with the devices I got and I've since
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  told the meds was I don't deal with that as much as I used to.
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  But yeah, I mean, there are definitely devices out there
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  that I'm glad I didn't buy, let's just put it that way.
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  So let's talk more about the patient perspective of what are
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  the treatments that are worth doing right now and what isn't.
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  Some people may be on a different budget than others.
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  How do they prioritize with so many options on the table?
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  It's frankly overwhelming, I would think for the average
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  layperson and all the terminology, you know, if you're
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  starting at a place that only does injectables are
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  noninvasive, you want it to be run by physicians, right?
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  And preferably core physicians either run or directed or going
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  to your local plastic surgeon or facial plastic surgeon and you
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  get a treatment plan. So if someone comes to me and
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  they say I'm interested and minimally invasive right now and
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  facelift in five years when my son graduates college or
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  whatever that is, we come up with a treatment plan.
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  And that's really what it's all about is sorting through the
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  fluff and writing down what they want at this point in time,
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  their aging process, what they afford, what kind of downtime do
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  they have. And then we come up with her
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  treatment plan and we can stack treat.
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  You know, we don't want to do 6 different procedures on the face
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  on the same day. We may stack them and see how
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  each one will do. For example, we may do the dual
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  wavelength laser like I mentioned in six months, see if
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  maybe add some filler in, maybe do a chemical peel for texture,
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  those kind of things. Just I think the focus now is on
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  natural results. You've probably seen in the news
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  that sort of thing. There's less of a push for heavy
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  filler in the face and it's more of a natural aesthetic, which
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  is, I think, my goodness, you know?
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  We see a wide range on social media, people talking about the
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  treatments they've had, when patients are happiest with their
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  results. Are there certain behaviors or
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  patterns that you think contribute to that success?
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  Sure. I think the patients that do the
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  best usually have kind of the most realistic expectations on
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  the front end. When we talk to them, they've
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  done research ahead of time. It's not like a blank slate.
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  Like doctor, you tell me everything about that.
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  I know nothing. That is a hard console.
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  You don't almost have time for that.
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  Meaning you might not have blocked an hour to just start
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  from a blank slate on something. So someone who's educated
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  themselves prior to coming in on the various options and then
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  they want to hone in and have the plastic surgeon tell them
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  what's best for me. Me at this point in time with my
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  signs of aging. One of the other things I think
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  always contributes to the success.
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  And I tell patients this when I see them in the office and
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  they're not swollen and their smile on their faces.
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  The patients that have followed the post operative instructions
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  tend to do the best. And when you heal the best,
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  you're happiest the quickest. So compliance is really the key,
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  making sure that you're following the instructions that
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  you have provided. The question I wanted to ask
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  you, because this is so intriguing, you did make history
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  as the first female president of the Aesthetic Society, which is
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  such an important role in our industry.
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  What responsibility comes with that kind of leadership today, I
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  think. It provides female plastic
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  surgeons with just a role model or someone to manifest after.
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  I think you have to see it kind of to be it.
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  And So what I've liked is being inspiring to young women.
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  And I hope I will as I age more. But I like to be an
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  international speaker. So I like to speak around the
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  world, get invited, and that's fun for me.
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  And I get to take my sons. And so these are roles that
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  never would have occurred had I not been the president of the
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  Ascetic Society, which was an amazing, amazing experience.
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  I will never forget it went by like that, you know, in 5
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  minutes it was over, it feels like.
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  But it was one year. But I've enjoyed doing it.
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  I think there are more female plastic surgery in residents
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  than men now. So I mean, you can see the tides
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  have changed a little. Bit yeah, it's definitely
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  changed. It was so rare just a few years
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  ago. Talking about the future of our
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  industry, from your vantage point, where do you think
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  aesthetic still needs to raise the bar a little bit and where
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  do you think we're doing really well?
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  I think we're doing really well with the evolution of techniques
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  in surgery. But say, for example,
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  facelifting, I think we are using techniques and we're
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  getting better at it. I think we see better results
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  because we're able to challenge each other with knowledge and
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  meetings and podcasts and webinars.
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  And so surgeons are able to teach other surgeons quicker,
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  younger surgeons. I almost think you're seeing
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  better results than you saw 50 years ago in Faceless Thing.
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  I think everybody would probably agree with that.
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  But on the flip side of that, you know, we're seeing more
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  overdone next from carving them out, you know, removing things
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  that might not need to be removed at that time.
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  And so I think there's a plea for caution there.
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  That's really kind of where we are with surgery is that our
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  techniques evolve as we learn from each other and as we've
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  been doing it longer. What do you believe will clearly
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  define the next phase of aesthetics?
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  I think the next phase of aesthetics will be defined by
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  better minimally invasive devices.
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  I think it will be defined by improved techniques in surgery.
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  I think it really is looking to me like we're defining an anti
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  aging process that incorporates peptides and incorporates
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  longevity medicine and GLP ones. And I think that helps the inner
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  rejuvenation as well as the external, so more holistic
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  approach. And then finally think just
• 19:24
  natural. I think we're going back to a
• 19:26
  more natural aesthetic and seeing people look 10 years
• 19:29
  younger, but it really looks like they're pictured 10 years
• 19:31
  younger. That's really what the whole
• 19:33
  point is supposed to be. As we begin to wrap up the show
• 19:36
  before our speed round, as someone so deeply invested in
• 19:40
  this field, what are you personally most excited to keep
• 19:44
  building or contributing to aesthetics next?
• 19:47
  I'm excited just to keep contributing on an international
• 19:50
  level like I'm doing now. I'm living my dream, you know,
• 19:53
  I'm living for the day. And I think that's very
• 19:56
  important for surgeons to learn to do.
• 19:58
  I think I'm excited about the minimal invasive technology that
• 20:01
  I'm using with the dual wavelength laser.
• 20:03
  I think it's important. I think it's new to market.
• 20:07
  I don't think we've seen it before in the United States.
• 20:09
  And so I think that's something that has legs.
• 20:12
  All right, so we're going to dive right into our speed round
• 20:15
  and ask you about some hot topics and hot treatments in the
• 20:19
  industry and just get your take on them kind of a in or out, yes
• 20:23
  or no answer. OK, Right.
• 20:26
  Gotcha. All right, full face injectable
• 20:29
  planning. Yes or no?
• 20:31
  No fat grafting to the face. Yes.
• 20:34
  Energy based skin tightening. Yes.
• 20:37
  Ultrasound based skin tightening?
• 20:39
  Yes. Laser resurfacing, yes.
• 20:43
  Combination laser and injectable plans.
• 20:47
  Yes. Sweet spot for the first
• 20:49
  facelift. The age range there. 45 to 55.
• 20:54
  Roughly what percentage of your surgical cases are revision
• 20:58
  surgeries from other clinicians? 35%.
• 21:02
  OK. So that's a large percentage.
• 21:05
  How do you feel about chemical peels?
• 21:07
  Yes. Prescription retinoids versus
• 21:10
  retail retinoids. Prescription.
• 21:13
  Topical peptides for the skin in or out.
• 21:17
  Yes. In topical hyaluronic acid
• 21:21
  always. In topical exosomes.
• 21:24
  Yes. At home.
• 21:25
  Micro needling trends. No.
• 21:29
  Red light therapy both the at home and in the clinic options.
• 21:33
  Yes and yes. Hormone therapy for Wellness and
• 21:37
  skin quality. Absolutely.
• 21:39
  Oral supplements for skin health.
• 21:42
  No exfoliating acids in your daily skin care routine.
• 21:47
  Not necessary. Skin cycling routines.
• 21:51
  Yes. That's how I do mine.
• 21:53
  Chemical exfoliants or physical exfoliants?
• 21:57
  Either one depends on the patient's examination.
• 22:00
  PN and PDRN. Don't know yet.
• 22:03
  The jury's still out. Yeah, jury's still out.
• 22:06
  OK the best non surgical treatment for the neck and chest
• 22:10
  area. Humera best treatment for acne
• 22:14
  and pigmentation. Broadband light best.
• 22:18
  Treatment for melasma. Hard problem.
• 22:21
  Multifactorial topical compounded skin care with
• 22:24
  bleaching agents. Hair restoration treatments in
• 22:27
  or out in Best treatment for redness and rosacea.
• 22:32
  So some skin care agents, dermatologists consult and
• 22:36
  broadband light. Best treatment for sun damage?
• 22:39
  SPF over 30, sun avoidance and laser resurfacing when out of
• 22:46
  the sun. And to switch gears, a couple
• 22:48
  questions about body here. What is the best body contouring
• 22:52
  device that's non surgical that you've used?
• 22:55
  What type of tech? High frequency electromagnetic
• 22:58
  stimulation hyphen. What are your thoughts on non
• 23:02
  surgical Cellulite treatments in or out?
• 23:04
  Out. Body skin tightening after
• 23:07
  weight loss. Does it work non surgically?
• 23:10
  It can work minimally, invasively with the device we
• 23:13
  talked about. Well, Doctor Walden, thank you
• 23:16
  so much for being here today and thank you to everyone listening.
• 23:20
  The conversation continues next week on the Doctor Randy Show.
• 23:25
  Doctor Randy Boyett holds a PhD and is a recognized leader in
• 23:28
  the aesthetics and medical industry.
• 23:31
  She is not a licensed medical doctor.
• 23:33
  All commentary and product recommendations are based on
• 23:36
  industry expertise and are provided for informational
• 23:39
  purposes only.