Latest / Skin Anarchy / Lori Robertson, MSN, FNP-CNurse Practitioner

Transcript

Lori Robertson, MSN, FNP-CNurse Practitioner · Skin Anarchy

• 0:01
  SPEAKER_01: Hi guys, welcome back to Skincare Anarchy.
• 0:03
  SPEAKER_01: This is your host, Ekta, and I am super excited because this is a very different kind of episode that I have for you guys today.
• 0:10
  SPEAKER_01: Um, I am going to be interviewing a few people that are really leaders in their field, and I'm super excited to introduce everybody to you.
• 0:19
  SPEAKER_01: So, first, I have um Lori Robertson, um, who is a very, very nationally acclaimed um nurse practitioner.
• 0:27
  SPEAKER_01: Lori has over 39 years of experience in medicine.
• 0:31
  SPEAKER_01: She has also been the medical consult and actress for the ABC TV show General Hospital for 19 years.
• 0:37
  SPEAKER_01: So, welcome to the show, Lori.
• 0:38
  SPEAKER_01: Thank you so much for your time.
• 0:40
  SPEAKER_00: Thank you so much, Ekta, for having me.
• 0:42
  SPEAKER_00: I appreciate it.
• 0:45
  SPEAKER_01: It's truly my honor.
• 0:47
  SPEAKER_01: I would love to um ask you a little bit about um your background.
• 0:51
  SPEAKER_01: I want, I want the uh listeners to know, you know, just what you've done and how your background has been in the industry.
• 0:57
  SPEAKER_00: Oh my gosh, I don't know where to start, girl.
• 1:00
  SPEAKER_00: I um I started my career in intensive care as an RN and then went to emergency rooms.
• 1:05
  SPEAKER_00: So I did those combined, I did those for about 24 years and then became a nurse practitioner and educated myself right out of a job because uh my hospital at that time didn't use nurse practitioners or PAs.
• 1:16
  SPEAKER_00: So I ended up working in family practice for a few years.
• 1:19
  SPEAKER_00: And uh during that time, um, the whole time, I was the medical consultant for General Hospital and quite a few movies and stuff.
• 1:26
  SPEAKER_00: So I said I did a lot of medical consulting on the set, wrote wrote dialogue, just all kinds of fun stuff for TV land and learned a lot about that fantasy world of a kid.
• 1:36
  SPEAKER_01: Yeah, that's so cool because I love all the I love all the medical shows, and this is so surreal to be talking to you.
• 1:41
  SPEAKER_00: Yeah, it was neat because because General Hospital, I had my I'm a I'm union too, so I would be on the show and play a nurse whenever I was there.
• 1:48
  SPEAKER_00: But I did that for about 19 years and I was able to bring a lot of uh diagnoses into the scripts like HIV and breast cancer and pediatric heart transplant and things that really educated the audience uh regarding a lot of medical conditions.
• 2:03
  SPEAKER_00: And we gave them a lot of good medical information, but then whenever the writers would kind of stray off into uh oblivion and fake stuff, I would just say, okay, let's just make a fake drug.
• 2:13
  SPEAKER_00: You're not gonna use a real drug, make a fake drug.
• 2:15
  SPEAKER_00: So people don't think it's real, but it was it was it was fun, it was very, very fun.
• 2:20
  SPEAKER_00: But um anyway, after I yeah, so after I um after I did that, I became a nurse practitioner and then um ended up going and getting Botox once with a friend and said, Wow, look at this clinic.
• 2:33
  SPEAKER_00: You know, the doctor has time to stay with me and and spend time and talk with me and educate me.
• 2:37
  SPEAKER_00: And I've never had that opportunity in all of the specialties I've worked in to really spend time with my patients and and get to know them and really find out what they need.
• 2:48
  SPEAKER_00: So I kind of transitioned into aesthetics and it became my absolute passion.
• 2:54
  SPEAKER_00: And I feel like Cinderella.
• 2:55
  SPEAKER_00: I've I've just I've loved to learn and share what I know.
• 2:59
  SPEAKER_00: And it's just kind of, I think people appreciate that I love to share what I know and uh what I've learned along the way.
• 3:04
  SPEAKER_00: And it's been, it's been amazing.
• 3:06
  SPEAKER_00: It's been an amazing, amazing ride.
• 3:08
  SPEAKER_00: I feel I pinch myself because I'm meeting so many amazing people and being able to help people and be help practitioners be better and safer practitioners with their patients.
• 3:17
  SPEAKER_01: I love that.
• 3:18
  SPEAKER_01: I love how much passion and enthusiasm you have for what you do.
• 3:21
  SPEAKER_01: I mean, it really shines.
• 3:23
  SPEAKER_01: And I think the people in this world who really make a difference are like that.
• 3:26
  SPEAKER_01: So it's it's such an honor to meet you.
• 3:28
  SPEAKER_01: Seriously.
• 3:29
  SPEAKER_01: Thank you so much.
• 3:30
  SPEAKER_01: I have a impression for you, Lori, because I know you have a uh uh background in injectables and you're an expert in that field.
• 3:37
  SPEAKER_01: And I want to ask for all the listeners out there, um, can you tell us one of the biggest facts about injectables that all consumers need to be mindful of before they go to a dermatologist or a clinic or anywhere?
• 3:50
  SPEAKER_00: Yeah, the I think number one, pick your practitioner carefully.
• 3:53
  SPEAKER_00: Don't pick them by degree.
• 3:54
  SPEAKER_00: Don't go to a plastic surgeon because it's a plastic surgeon.
• 3:57
  SPEAKER_00: Don't go to a dermatologist because they're a dermatologist because they generally aren't the ones who inject full time.
• 4:02
  SPEAKER_00: You need to pick a practitioner who injects full time.
• 4:05
  SPEAKER_00: And generally, those are gonna be PAs, nurse practitioners, or RNs, most likely.
• 4:09
  SPEAKER_00: Um, and besides that, you need to make sure that your practitioner has not only done this for a while and that they're not brand new.
• 4:17
  SPEAKER_00: So I mean, somebody's gotta learn, people have to learn everywhere.
• 4:20
  SPEAKER_00: I mean, yeah, but you want to make sure that you vet your practitioner because I have taught so many practitioners over the years who tell me I've done this for 10 years, and they are just as basic and just as dangerous as a brand new injector.
• 4:35
  SPEAKER_00: So they have not they have not sought any continuing education in this specialty.
• 4:41
  SPEAKER_00: And it's paramount that when you pick an injector, it could be a doctor, nurse, I don't care who it is, to make sure they do it full time, and you make sure that they go to conferences, they read articles, maybe even they teach in this specialty.
• 4:53
  SPEAKER_00: Because when you teach, you have to keep up on the latest research and safety measures, and it's paramount.
• 5:01
  SPEAKER_00: So I I tell you, people think when they're their doctor or nurse says, Oh, I've done this for five years, you think you're safe, you're not.
• 5:07
  SPEAKER_00: So you have to ask more questions.
• 5:09
  SPEAKER_01: That is such good advice because I know um with like, you know, for example, a surgical consult, you would want to do your research, make sure your your surgeon is up to par and you know, and is up to date with all the academic um, you know, research out there.
• 5:22
  SPEAKER_01: So that makes complete sense what you're saying.
• 5:24
  SPEAKER_00: Absolutely, absolutely.
• 5:26
  SPEAKER_00: So I I get a lot of patients in that come to me to me, say off of Instagram, and they I can tell that these they've gone from Instagram famous to Instagram famous to Instagram famous.
• 5:34
  SPEAKER_00: And some of the people on Instagram aren't safe.
• 5:38
  SPEAKER_00: And I tell them, please, please be careful who you're going to.
• 5:42
  SPEAKER_00: I say, I'm really glad you came to me because I am I'm very conservative, I'm extremely careful, and I love anatomy.
• 5:49
  SPEAKER_00: So I know I'm as safe as possible.
• 5:51
  SPEAKER_00: But I say, please be very careful, vet your practitioner, don't just go to an insta famous person because you need to make sure someone really knows what they're doing and really is safe and really is cautious.
• 6:02
  SPEAKER_00: Um, so it's very it's it they need to be careful.
• 6:06
  SPEAKER_01: Well, I think we need to make you more insta-famous because honestly, you're the experts, and I would like everyone to know that there if you need, you know, if you're thinking about injectables, really, you know, find someone like Lori.
• 6:18
  SPEAKER_01: Probably not gonna find as extensive of a background, but as close as possible, if not hard.
• 6:24
  SPEAKER_01: But I thank you, Lori, for that.
• 6:25
  SPEAKER_01: That was that's exactly what I wanted um our listeners to understand.
• 6:29
  SPEAKER_01: I actually want to ask you a little bit um about Botox as well.
• 6:32
  SPEAKER_01: Can you give us a little bit of a understanding of any new technologies out right now?
• 6:36
  SPEAKER_01: I know Botox is a very old, um, you know, it's kind of old in the sense of like, you know, a technique, but have you noticed anything that's you know up and coming breakthrough that you could tell us about?
• 6:46
  SPEAKER_00: Um I can I back up one quick second and talk about injectables.
• 6:50
  SPEAKER_00: Just real quick.
• 6:51
  SPEAKER_00: Yes, please.
• 6:52
  SPEAKER_00: Number two on injectables, make sure you do not get any permanent fillers put in your face, nothing permanent.
• 6:57
  SPEAKER_00: So, like some of these, some of these fillers are actually grounded plastic.
• 7:01
  SPEAKER_00: So be and and if you put a filler in that's not dissolvable, um, you can get into problems and you can't get out of the problems.
• 7:09
  SPEAKER_00: So be very careful and use only dissolvable fillers.
• 7:12
  SPEAKER_00: I highly recommend that um because you can dissolve them and at least prevent a lot of skin death or tissue death that can occur with things, something you can't dissolve.
• 7:21
  SPEAKER_00: So that's one other thing I wanted to.
• 7:25
  SPEAKER_00: There are, well, if you look at the restulin or juvenile products, those are dissolvable.
• 7:30
  SPEAKER_00: If you look at a clear gel, those are called hyalonic acid fillers, and those are dissolvable.
• 7:35
  SPEAKER_00: If you look at fillers like Bellafil, P is called PMMA, polymethyl methacrylate, that is that is pretty much ground-up plastic, that's not dissolvable.
• 7:43
  SPEAKER_00: If you look at RADS, that is calcium particles, that is not dissolvable.
• 7:48
  SPEAKER_00: So I I many people use it, and many people have been safe for years, but I would say be cautious and know what is getting injected in your face.
• 7:58
  SPEAKER_00: Just be aware and do your research.
• 8:01
  SPEAKER_00: Absolutely.
• 8:01
  SPEAKER_00: So that's like my two cents on being careful.
• 8:04
  SPEAKER_01: Yeah.
• 8:04
  SPEAKER_01: Thank you.
• 8:05
  SPEAKER_01: Thank you for that.
• 8:05
  SPEAKER_01: Yeah, no, that's very interesting.
• 8:07
  SPEAKER_01: And I'm actually wondering, um, what is some of the uh most recent research you've uh read in in the area of injectables?
• 8:13
  SPEAKER_01: If you could share that with us, something interesting you found.
• 8:17
  SPEAKER_00: Um, well, lately we have we've had a product come out um by Allargan called uh Voluma Vobella and Valura.
• 8:23
  SPEAKER_00: Those are Vicross products, and they are they are molecularly structured differently, they're very tightly cross-linked, it's a different weight molecular uh hyalonic acid.
• 8:32
  SPEAKER_00: And the problem is the body, sometimes bodies, people's systems are recognizing that as a horn body and it's becoming very inflammatory and they're getting nodules.
• 8:42
  SPEAKER_00: So you need to be like that's one of the newer things that are coming out where we're realizing, okay, there's certain people.
• 8:47
  SPEAKER_00: I mean, the product, I can't say it's a bad product, it's just different.
• 8:50
  SPEAKER_00: It's different.
• 8:52
  SPEAKER_00: So we need to choose that we don't put it in somebody with autoimmune disease or somebody with a lot of allergies or somebody that has an illness because the bacteria will go right to the implant.
• 9:01
  SPEAKER_00: So we need to know our products, and we need to know, okay, this product has a propensity towards having inflammation and nodules, kind of like BBs that form.
• 9:09
  SPEAKER_00: So we need to be really careful in who we put it in, and we need to be careful where we inject it.
• 9:14
  SPEAKER_00: So practitioners and patients need to know kind of like if I have an autoimmune disease, I probably shouldn't be using that certain product.
• 9:20
  SPEAKER_00: Or if I don't want something I can't dissolve, don't use this certain product.
• 9:24
  SPEAKER_00: So patients need to do research.
• 9:26
  SPEAKER_00: I want, I love patients to be knowledgeable and do their research.
• 9:29
  SPEAKER_00: They I love questions.
• 9:31
  SPEAKER_00: As a practitioner, I want as many questions as they can give me.
• 9:34
  SPEAKER_00: Yeah, I love that.
• 9:35
  SPEAKER_01: I really love that you're open to that.
• 9:37
  SPEAKER_01: And I think any good practitioner is, you know, someone who really knows what they're doing, they're going to be open to questions.
• 9:42
  SPEAKER_01: So I absolutely love that you said that.
• 9:44
  SPEAKER_01: Now, one question I have as a follow-up to what you just explained is how do we deal with something that has gone bad?
• 9:50
  SPEAKER_01: So somebody goes in, they get a filler done, it just looks terrible, something you know, a bad reaction.
• 9:55
  SPEAKER_01: How is that usually dealt with from the medical school?
• 9:57
  SPEAKER_00: Well, well, number one, when you go to a good practitioner, practitioner who's knowledgeable, they should also know how to deal with adverse events, be it early adverse event or a late onset adverse event.
• 10:07
  SPEAKER_00: So you can have early ones like a lumps and bumps, or you can have a late one that's one of those inflant inflammations, nodules, infections, and abscesses.
• 10:15
  SPEAKER_00: So you need to have a practitioner who's well versed in this.
• 10:17
  SPEAKER_00: That's what I'm saying, it's somebody who does it all the time.
• 10:20
  SPEAKER_00: If there is a problem, say a vascular occlusion where an artery gets blocked off, you pray that they have used a dissolvable filler.
• 10:29
  SPEAKER_00: Because if they haven't used something that does that's dissolvable, there is nothing you can do.
• 10:34
  SPEAKER_00: Nothing.
• 10:35
  SPEAKER_00: You get dead tissue, you get a hole in your face, you get loss of part of a lip, it it could be you could be blind, whatever.
• 10:42
  SPEAKER_00: So you just pray that it was dissolvable.
• 10:44
  SPEAKER_00: Now, if you've used a dissolvable filler, most of us in our offices, I hope everybody have a I have a whole truckload of what's called hieralonidase.
• 10:52
  SPEAKER_00: It's an enzyme that dissolves the clear gel fillers.
• 10:55
  SPEAKER_00: So we can inject and we can dissolve it and get circulation back to an area that had lost circulation.
• 11:01
  SPEAKER_00: And it can happen to anybody, no matter how good an injector is, an artery can get blocked off if they're using needles and we can't see underneath there.
• 11:09
  SPEAKER_00: We don't have X-ray vision.
• 11:10
  SPEAKER_00: We know anatomy, but everybody's anatomy is so very different.
• 11:15
  SPEAKER_00: So we just be as careful as we can.
• 11:17
  SPEAKER_00: And if there's a problem, we know how to deal with it.
• 11:19
  SPEAKER_00: So if you use the products that are like that are clear gels, then we have a medication that can dissolve them and get out of trouble.
• 11:27
  SPEAKER_00: But we have to do it within a couple days.
• 11:30
  SPEAKER_00: We can't, we can't let the patient go home and develop blisters that look like herpes, um, which is actually a vascular occlusion.
• 11:37
  SPEAKER_00: So it's up to us as a practitioner to educate our patients in what to look for when they leave our office.
• 11:43
  SPEAKER_00: So hence, I don't just I don't inject anyone that isn't going to be in my area for two days.
• 11:48
  SPEAKER_00: They have to be in with, you know, in my in Southern California with it for two days.
• 11:53
  SPEAKER_01: So you can monitor them.
• 11:54
  SPEAKER_01: So you can monitor them.
• 11:55
  SPEAKER_01: Yeah.
• 11:55
  unknown: Absolutely.
• 11:56
  SPEAKER_01: No, I have a question.
• 11:57
  SPEAKER_01: So when you when we uh deal with injectables, is there any research out there pertaining to giving some sort of anti-inflammatory, such as a steroid or something afterwards?
• 12:06
  SPEAKER_01: Is that even needed?
• 12:07
  SPEAKER_01: Or have you seen anything like that?
• 12:09
  SPEAKER_01: Okay.
• 12:09
  SPEAKER_00: Not at all.
• 12:10
  SPEAKER_00: No, it's not needed.
• 12:10
  SPEAKER_00: And it's not needed unless there's an inflammatory reaction.
• 12:13
  SPEAKER_00: So sometimes they'll do that.
• 12:14
  SPEAKER_00: Like I said, with the with that certain one that allergan makes, and there's more inflammatory reactions sometimes with people.
• 12:19
  SPEAKER_00: So they might give, you know, steroids or antihistamines.
• 12:22
  SPEAKER_00: We have noticed with research that there is a little bit of a connection between the vaccine, the COVID vaccine, and dermal fillers.
• 12:29
  SPEAKER_00: So it's about a less than it's less than 4% that it's happening, and it happens 9% normally.
• 12:35
  SPEAKER_00: So it's really not a big deal.
• 12:37
  SPEAKER_00: But if it, if somebody does get an inflammation from having their immune system being on high alert after the vaccine, then um usually antihistamines and maybe a little bit of steroids take care of it and it's not a big deal at all.
• 12:49
  SPEAKER_00: So most of us are saying don't do dermal fillers three weeks before or three weeks after they get the COVID vaccine, just so the immune system can kind of be a little bit more calmed down and um maybe not have any kind of a reaction.
• 13:00
  SPEAKER_00: But it's not, it's very easily treatable and it's not common at all.
• 13:04
  SPEAKER_01: Wow.
• 13:04
  SPEAKER_01: Okay, that's that makes me feel better because I know steroids can also thin the skin.
• 13:08
  SPEAKER_01: So I was wondering about that.
• 13:09
  SPEAKER_01: If there's like some sort of reason to use them and then it causes skin thinning, and then we have other problems.
• 13:14
  SPEAKER_01: So that's that's good.
• 13:16
  SPEAKER_01: So I actually want to thank you.
• 13:18
  SPEAKER_01: That was my those are my main questions.
• 13:19
  SPEAKER_01: I I just want to ask for some general advice from you for everybody listening about injectables, you know, um, in terms of age, like is there an age range that you can start?
• 13:28
  SPEAKER_01: Or, you know, do you recommend like a time period when we should start thinking about getting injectables?
• 13:34
  SPEAKER_00: You know, it's it's it it really, really varies.
• 13:37
  SPEAKER_00: I see a lot of younger millennials coming in because they look at Instagram and they want that chin or that jawline.
• 13:42
  SPEAKER_00: And I really am very conservative and I I caution against it unless they really have an anatomical issue where they're really not balanced well.
• 13:50
  SPEAKER_00: Um, I you really don't want to do a lot to a young person because they will look older.
• 13:54
  SPEAKER_00: They will look older and done.
• 13:56
  SPEAKER_00: So we have to be very conservative in younger people.
• 13:59
  SPEAKER_00: And our goal, our goal as aesthetic providers, is only to replace what people have lost, not to put stuff in where they never had it.
• 14:06
  SPEAKER_00: So we want to, as people age, we just want to replace that volume so they continue to look like they did a few years ago.
• 14:13
  SPEAKER_00: So the majority of the people that come in for fillers are in their 30s and beyond.
• 14:17
  SPEAKER_00: If they come in younger, it might be just for like a little bit of a chin or lips or something very small that they kind of want.
• 14:24
  SPEAKER_00: But younger people generally don't need as much.
• 14:26
  SPEAKER_00: They really, really don't.
• 14:27
  SPEAKER_00: We're really looking at replacing volume.
• 14:29
  SPEAKER_00: And when you see cabbage patch dolls walking around that have that are overfilled, that's simply that's simply either lack of education with a provider or greed.
• 14:39
  SPEAKER_00: They're making money out of putting stuff in people's faces and they're gonna keep putting it in.
• 14:43
  SPEAKER_00: So you've got to find a provider who will tell you no.
• 14:46
  SPEAKER_01: If you if you have a provider practice, Lori, like if you do that, like isn't that no?
• 14:50
  SPEAKER_00: No, no, it's unethical, it's absolutely unethical on every every every level.
• 14:56
  SPEAKER_00: But if you have a provider that tells you that makes money off of doing fillers and they tell you no, you don't need it, stay with that provider.
• 15:03
  SPEAKER_00: Yeah, because they're being honest with you.
• 15:05
  SPEAKER_00: And I tell people no all the time.
• 15:08
  SPEAKER_00: I say, please wait, let's wait six months and re-evaluate you.
• 15:10
  SPEAKER_00: You don't want to look like anything's been done.
• 15:13
  SPEAKER_00: You don't want to, you don't want people to see your cheeks.
• 15:15
  SPEAKER_00: You don't want to be able to do that.
• 15:16
  SPEAKER_01: Well, the goal is to, you know, the goal is like I want to just say, you know, we use the buzzwords anti-aging and whatnot.
• 15:22
  SPEAKER_01: And this is what we're talking about.
• 15:23
  SPEAKER_01: Do you want to look like yourself again, or do you want to look like that?
• 15:27
  SPEAKER_01: Or do you want your cheeks?
• 15:28
  SPEAKER_00: Yes.
• 15:28
  SPEAKER_00: Or do you want your cheeks or your lips to to get in the room before you do?
• 15:32
  SPEAKER_01: Oh, you know, I'm gonna ask you, I'm gonna ask you one question though, and I uh you don't have to answer, but what has been your least favorite like trend that people have hopped on?
• 15:40
  SPEAKER_01: You know how everybody was like, oh, I want Kylie Jenner lips now, or I want this now.
• 15:45
  SPEAKER_01: What's your what's been your like least favorite trend?
• 15:48
  SPEAKER_00: Oh god, I have a I have a few.
• 15:50
  SPEAKER_00: Um the jawlines, beautiful when done right.
• 15:53
  SPEAKER_00: I see so many jawlines that look masculine.
• 15:55
  SPEAKER_00: People are overdoing the jawlines and they're looking like they're looking like avatars.
• 16:01
  SPEAKER_00: They're looking the the women are looking like men.
• 16:04
  SPEAKER_00: So you know, there's a point where you can accentuate something, and there's a point where you can go overboard and not look normal.
• 16:10
  SPEAKER_00: We have to, we as providers, we have to know balance.
• 16:14
  SPEAKER_00: We have to know when someone starts looking abnormal and they might make a few bucks off of it, but they need to stop.
• 16:19
  SPEAKER_00: Yeah, they need to stop.
• 16:21
  SPEAKER_00: You were asking me about toxins earlier.
• 16:23
  SPEAKER_00: Yes, so you were asking me about Botox and you know those toxins.
• 16:26
  SPEAKER_00: I want to tell you something that was that was an eye-opener for me.
• 16:29
  SPEAKER_00: I um love Dysport.
• 16:30
  SPEAKER_00: I've loved Disport since 11 years ago when it was FDA approved.
• 16:33
  SPEAKER_00: And I used Botox before that, and I didn't know why it kicked in earlier and lasted longer.
• 16:37
  SPEAKER_00: I never knew why.
• 16:39
  SPEAKER_00: It wasn't until um 2018 a study came out that that that looked at the FDA approved dose of Botox, Zealman, and Dysport.
• 16:49
  SPEAKER_00: Okay, looked at how much active toxin is in each dose.
• 16:52
  SPEAKER_00: And it came out that Dysport had quite a bit more active toxin in each dose than then it came to Botox than Dysport was the lowest.
• 16:59
  SPEAKER_00: I mean, I'm sorry, I'm sorry, Zealman was a lotus.
• 17:02
  SPEAKER_00: So Dysport had the highest amount of toxin in each active toxin in each dose.
• 17:06
  SPEAKER_00: So with this drug, with this this class of drug, the amount of toxin you get equals duration.
• 17:12
  SPEAKER_00: Yeah.
• 17:13
  SPEAKER_00: So this so I wonder why it lasted so long over all these years.
• 17:16
  SPEAKER_00: I'm like, why did it last long?
• 17:18
  SPEAKER_00: And people would ask me, I'm like, I don't know, they'd have to kill me if if I found out, I don't know.
• 17:22
  SPEAKER_00: But um, it ends up that so it ends up that it that's why it lasts longer.
• 17:26
  SPEAKER_00: It's a stronger medication.
• 17:28
  SPEAKER_00: So it that's you ask if there's differences, and yeah, the disport has more active toxin in each dose, so that's why it lasts longer.
• 17:34
  SPEAKER_00: So I am probably one of the only clinics in the country.
• 17:37
  SPEAKER_00: I don't even order Botox.
• 17:38
  SPEAKER_00: Is that crazy?
• 17:39
  SPEAKER_00: Really?
• 17:39
  SPEAKER_00: Wow, I don't even order it because it's been patient.
• 17:44
  SPEAKER_00: It's been patient-driven.
• 17:45
  SPEAKER_00: Patients have wanted to go back to the disport, they haven't wanted to go back to the Botox, they wanted to.
• 17:49
  SPEAKER_01: So no, is there any is there any like adverse effects with more toxin per dose?
• 17:53
  SPEAKER_01: Or is that no?
• 17:54
  SPEAKER_01: There's no longer duration.
• 17:56
  SPEAKER_01: That's it.
• 17:56
  SPEAKER_01: Wow.
• 17:57
  SPEAKER_00: You can go to a point where you you have an adverse event when people have you know hundreds of units, you know, more than what they should be given, but that doesn't that doesn't happen.
• 18:05
  SPEAKER_00: That's only happening in research.
• 18:06
  SPEAKER_01: Yeah, and of course that goes back to a good practitioner versus you know somebody who doesn't know what they're doing.
• 18:12
  SPEAKER_00: And and and you it's you have to think of the medication of the the dose.
• 18:15
  SPEAKER_00: I mean, the the medicine is when you give a a a little a unit of Botox or disport, it's there isn't a dimmer switch on it.
• 18:23
  SPEAKER_00: The muscle's either paralyzed or it's not.
• 18:25
  SPEAKER_00: There is no dimmer switch on it.
• 18:27
  SPEAKER_00: So if you give a little bit, it'll only last a little bit of time.
• 18:31
  SPEAKER_00: If you give more, it will just last longer, but it's still going to be paralyzed or frozen.
• 18:36
  SPEAKER_00: Does that make sense?
• 18:37
  SPEAKER_00: Yeah, all or nothing effect.
• 18:39
  SPEAKER_00: Yeah.
• 18:39
  SPEAKER_00: It's it's either one unit will last a little a little bit of time, and five units will last a lot longer.
• 18:44
  SPEAKER_00: So the amount of toxin per dose means a lot.
• 18:47
  SPEAKER_01: So now how much dosing would you recommend for like fine lines?
• 18:50
  SPEAKER_01: You know, something like very minor, like maybe crows, feeds or fine lines?
• 18:54
  SPEAKER_01: Like, is there uh usually like a like a table with you know recommended doses or units?
• 19:00
  SPEAKER_00: The doses, well, you know what?
• 19:01
  SPEAKER_00: If I give one unit, it will be paralyzed the same as five units.
• 19:05
  SPEAKER_00: Five units will just last longer, that's all.
• 19:08
  SPEAKER_00: Interesting.
• 19:08
  SPEAKER_00: So when people come in and say, when people come in and say, Oh, like Botox, give me 20 units to my whole face.
• 19:14
  SPEAKER_00: Okay, well, 20 units is FDA approved just for the globella, just for the frown lines.
• 19:18
  SPEAKER_00: So if you spread that out over the whole face, you're gonna be under-treated everywhere and it's not gonna last very long, and the people will be unhappy.
• 19:26
  SPEAKER_00: You want someone to get at least three months out of this stuff.
• 19:29
  SPEAKER_01: Yeah.
• 19:30
  SPEAKER_00: So if you spread it out, if these patients come in and ask for a little tiny dose and give me half of or a third of whatever's recommended, it's gonna last a third as long.
• 19:38
  SPEAKER_00: Right, right.
• 19:40
  SPEAKER_00: Makes sense.
• 19:41
  SPEAKER_01: Well, Lori, I want to thank you so much for your time.
• 19:43
  SPEAKER_01: This has been so educational, and I would love it if you would come back to the show.
• 19:47
  SPEAKER_01: I know you're super busy, but I would love to do a whole episode with just us talking.
• 19:51
  SPEAKER_00: Absolutely, absolutely.
• 19:53
  SPEAKER_00: Thank you.
• 19:54
  SPEAKER_00: Thank you for having me.
• 19:54
  SPEAKER_00: I appreciate it.
• 19:55
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