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Transcript

VIVACE Conference Extended Cut · Skin Anarchy

• 0:01
  SPEAKER_11: Hi guys, welcome back to Sculpture Anarchy.
• 0:03
  SPEAKER_11: 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.
• 0:11
  SPEAKER_11: 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_11: So, first, I have um Lori Robertson, um, who is a very, very nationally acclaimed um nurse practitioner.
• 0:27
  SPEAKER_11: Lori has over 39 years of experience in medicine.
• 0:31
  SPEAKER_11: She has also been the medical consult and actress for the ABC TV show General Hospital for 19 years.
• 0:37
  SPEAKER_11: So welcome to the show, Lori.
• 0:38
  SPEAKER_11: Thank you so much for your time.
• 0:40
  SPEAKER_03: Thank you so much, Ecta, for having me.
• 0:42
  SPEAKER_03: I appreciate it.
• 0:43
  SPEAKER_11: It's truly my honor.
• 0:47
  SPEAKER_11: I would love to um ask you a little bit about um your background.
• 0:51
  SPEAKER_11: 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_03: Oh my gosh, I don't know where to start, girl.
• 1:00
  SPEAKER_03: I um I started my career in intensive care as an RN and then went to emergency rooms.
• 1:05
  SPEAKER_03: 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_03: So I ended up working in family practice for a few years.
• 1:19
  SPEAKER_03: 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_03: 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 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_03: 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_03: 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_03: 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_03: You're not gonna use a real drug, make a fake drug.
• 2:16
  SPEAKER_03: So people don't think it's real, but it was it was it was fun, it was very, very fun.
• 2:20
  SPEAKER_03: 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_03: You know, the doctor has time to stay with me and and spend time and talk with me and educate me.
• 2:37
  SPEAKER_03: 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_03: So I kind of transitioned into aesthetics and it became my absolute passion.
• 2:54
  SPEAKER_03: And I feel like Cinderella, I've I've just I've loved to learn and share what I know.
• 2:59
  SPEAKER_03: 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_03: And it's been, it's been amazing.
• 3:06
  SPEAKER_03: It's been an amazing, amazing ride.
• 3:08
  SPEAKER_03: 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_11: I love that.
• 3:18
  SPEAKER_11: I love how much passion and enthusiasm you have for what you do.
• 3:21
  SPEAKER_11: I mean, it really shines.
• 3:23
  SPEAKER_11: And I think the people in this world who really make a difference are like that.
• 3:26
  SPEAKER_11: So it's it's such an honor to meet you.
• 3:28
  SPEAKER_11: Seriously.
• 3:29
  SPEAKER_11: Thank you so much.
• 3:30
  SPEAKER_11: I have a question 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_11: 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_03: Yeah, the I think number one, pick your practitioner carefully.
• 3:53
  SPEAKER_03: Don't pick them by degree.
• 3:54
  SPEAKER_03: Don't go to a plastic surgeon because it's a plastic surgeon.
• 3:57
  SPEAKER_03: 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_03: You need to pick a practitioner who injects full time.
• 4:05
  SPEAKER_03: And generally, those are gonna be PAs, nurse practitioners, or RNs, most likely.
• 4:09
  SPEAKER_03: 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_03: So I mean, somebody's gotta learn, people have to learn everywhere.
• 4:20
  SPEAKER_03: 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_03: So they have not, they have not sought any continuing education in this specialty.
• 4:41
  SPEAKER_03: 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_03: Because when you teach, you have to keep up on the latest research and safety measures.
• 4:59
  SPEAKER_03: And it's paramount.
• 5:01
  SPEAKER_03: 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_03: So you have to ask more questions.
• 5:09
  SPEAKER_11: That is such good advice because I know um with like, you know, for example, a surgical consultant 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_11: So that makes complete sense what you're saying.
• 5:24
  SPEAKER_03: Absolutely, absolutely.
• 5:26
  SPEAKER_03: 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_03: And some of the people on Instagram aren't safe.
• 5:38
  SPEAKER_03: And I tell them, please, please be careful who you're going to.
• 5:42
  SPEAKER_03: 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_03: So I know I'm as safe as possible.
• 5:51
  SPEAKER_03: 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_03: Um, so it's very it's it they need to be careful.
• 6:06
  SPEAKER_11: 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_11: Probably not gonna find as extensive of a background, but as close as possible, if not hard.
• 6:24
  SPEAKER_11: But I thank you, Lori, for that.
• 6:25
  SPEAKER_11: That was that's exactly what I wanted um our listeners to understand.
• 6:29
  SPEAKER_11: I actually want to ask you a little bit um about Botox as well.
• 6:32
  SPEAKER_11: Can you give us a little bit of an understanding of any new technologies out right now?
• 6:36
  SPEAKER_11: 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_03: Um I can I back up one quick second and talk about injectables.
• 6:50
  SPEAKER_03: Just real quick.
• 6:51
  SPEAKER_03: Yes, please.
• 6:52
  SPEAKER_03: Number two on injectables, make sure you do not get any permanent fillers put in your face, nothing permanent.
• 6:57
  SPEAKER_03: So, like some of these, some of these fillers are actually ground-up plastic.
• 7:01
  SPEAKER_03: 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_03: So be very careful and use only dissolvable fillers.
• 7:12
  SPEAKER_03: 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_03: So that's one other thing I wanted to be.
• 7:23
  SPEAKER_11: How do we add for protection?
• 7:25
  SPEAKER_03: There are, well, if you look at the restulin or juvenile products, those are dissolvable.
• 7:30
  SPEAKER_03: If you look at a clear gel, those are called hyalonic acid fillers, and those are dissolvable.
• 7:35
  SPEAKER_03: 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_03: If you look at RADS, that is calcium particles, that is not dissolvable.
• 7:48
  SPEAKER_03: 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_03: Just be aware and do your research.
• 8:01
  SPEAKER_03: Absolutely.
• 8:01
  SPEAKER_03: So that's like my two cents on being careful.
• 8:04
  SPEAKER_11: Yeah.
• 8:04
  SPEAKER_11: Thank you.
• 8:05
  SPEAKER_11: Thank you for that.
• 8:05
  SPEAKER_11: Yeah, no, that's very interesting.
• 8:07
  SPEAKER_11: 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_11: If you could share that with us, something interesting you found.
• 8:17
  SPEAKER_03: Um, well, lately we have we've had a product come out um by Allargan called uh Voluma Vobella and Valura.
• 8:23
  SPEAKER_03: 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_03: 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_03: 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_03: I mean, the product, I can't say it's a bad product, it's just different.
• 8:50
  SPEAKER_03: It's different.
• 8:52
  SPEAKER_03: 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_03: 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_03: 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_03: 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_03: Or if I don't want something I can't dissolve, don't use this certain product.
• 9:24
  SPEAKER_03: So patients need to do research.
• 9:26
  SPEAKER_03: I want, I love patients to be knowledgeable and do their research.
• 9:29
  SPEAKER_03: They I love questions.
• 9:31
  SPEAKER_03: As a practitioner, I want as many questions as they can give me.
• 9:34
  SPEAKER_03: Yeah, I love that.
• 9:35
  SPEAKER_11: I really love that you're open to that.
• 9:37
  SPEAKER_11: 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_11: So I absolutely love that you said that.
• 9:44
  SPEAKER_11: 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_11: So somebody goes in, they get a filler done, it just looks terrible, something, you know, a bad reaction.
• 9:55
  SPEAKER_11: How is that usually dealt with from the medical school?
• 9:57
  SPEAKER_03: 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_03: 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_03: So you need to have a practitioner who's well versed in this.
• 10:17
  SPEAKER_03: That's what I'm saying, it's somebody who does it all the time.
• 10:20
  SPEAKER_03: 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_03: Because if they haven't used something that does that's dissolvable, there is nothing you can do.
• 10:34
  SPEAKER_03: Nothing.
• 10:35
  SPEAKER_03: 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_03: So you just pray that it was dissolvable.
• 10:44
  SPEAKER_03: 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 hyalonidase.
• 10:52
  SPEAKER_03: It's an enzyme that dissolves the clear gel fillers.
• 10:55
  SPEAKER_03: So we can inject and we can dissolve it and get circulation back to an area that had lost circulation.
• 11:01
  SPEAKER_03: 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_03: We don't have X-ray vision.
• 11:10
  SPEAKER_03: We know anatomy, but everybody's anatomy is so very different.
• 11:15
  SPEAKER_03: So we just be as careful as we can.
• 11:17
  SPEAKER_03: And if there's a problem, we know how to deal with it.
• 11:19
  SPEAKER_03: 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_03: But we have to do it within a couple days.
• 11:30
  SPEAKER_03: 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_03: 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_03: 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_03: They have to be in with, you know, in my in Southern California with it for two days because you can monitor them.
• 11:54
  SPEAKER_11: So you can monitor them.
• 11:55
  SPEAKER_11: Yeah.
• 11:55
  unknown: Absolutely.
• 11:56
  SPEAKER_11: No, I have a question.
• 11:57
  SPEAKER_11: 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_11: Is that even needed?
• 12:07
  SPEAKER_11: Or have you seen anything like that?
• 12:09
  SPEAKER_03: Okay, not at all.
• 12:10
  SPEAKER_03: No, it's not needed, and it's not needed unless there's an inflammatory reaction.
• 12:13
  SPEAKER_03: So sometimes they'll do that, like I said, with the with that certain one that allergan makes, and there's more inflammatory reactions sometimes with people.
• 12:19
  SPEAKER_03: So they might give, you know, steroids or antihistamines.
• 12:22
  SPEAKER_03: 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_03: So it's about a less than it's less than four percent that it's happening, and it happens nine percent normally.
• 12:35
  SPEAKER_03: So it's really not a big deal.
• 12:37
  SPEAKER_03: 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_03: 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_03: But it's not, it's very easily treatable and it's not common at all.
• 13:04
  SPEAKER_11: Wow.
• 13:04
  SPEAKER_11: Okay, that's that makes me feel better because I know steroids can also thin the skin.
• 13:08
  SPEAKER_11: So I was wondering about that.
• 13:09
  SPEAKER_11: 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_11: So that's that's good.
• 13:16
  SPEAKER_11: So I actually want to thank you.
• 13:18
  SPEAKER_11: That was my those are my main questions.
• 13:19
  SPEAKER_11: 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_11: Or, you know, do you recommend like a time period when we should start thinking about getting injectables?
• 13:34
  SPEAKER_03: You know, it's it's it it really, really varies.
• 13:37
  SPEAKER_03: 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_03: 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_03: Um, I you really don't want to do a lot to a young person because they will look older.
• 13:54
  SPEAKER_03: They will look older and done.
• 13:56
  SPEAKER_03: So we have to be very conservative in younger people.
• 13:59
  SPEAKER_03: 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_03: 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_03: So the majority of the people that come in for fillers are in their 30s and beyond.
• 14:17
  SPEAKER_03: 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_03: But younger people generally don't need as much.
• 14:26
  SPEAKER_03: They really, really don't.
• 14:27
  SPEAKER_03: We're really looking at replacing volume.
• 14:29
  SPEAKER_03: 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_03: They're making money out of putting stuff in people's faces and they're gonna keep putting it in.
• 14:43
  SPEAKER_03: So you've got to find a provider who will tell you no.
• 14:46
  SPEAKER_10: If you if you have a provider practice, Lori, like if you do that, like isn't that no?
• 14:50
  SPEAKER_03: No, no, it's unethical, it's absolutely unethical on every every every level.
• 14:56
  SPEAKER_03: 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_03: Yeah, because they're being honest with you.
• 15:05
  SPEAKER_03: And I tell people no all the time.
• 15:08
  SPEAKER_03: I say, please wait, let's wait six months and re-evaluate you.
• 15:10
  SPEAKER_03: You don't want to look like anything's been done.
• 15:13
  SPEAKER_03: You don't want to you don't want people to see your cheeks.
• 15:15
  SPEAKER_03: You don't want to be able to do that.
• 15:16
  SPEAKER_11: 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_11: And this is what we're talking about.
• 15:23
  SPEAKER_11: Do you want to look like yourself again, or do you want to look like your cheeks or your lips to to get in the room before you do?
• 15:32
  SPEAKER_11: 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_11: You know how everybody was like, oh, I want Kylie Jenner lips now, or I want this now.
• 15:45
  SPEAKER_11: What's your what's been your like least favorite trend?
• 15:48
  SPEAKER_03: Oh god, I have a I have a few.
• 15:50
  SPEAKER_03: Um the jawlines, beautiful when done right.
• 15:53
  SPEAKER_03: I see so many jawlines that look masculine.
• 15:55
  SPEAKER_03: People are overdoing the jawlines and they're looking like they're looking like avatars.
• 16:01
  SPEAKER_03: They're looking the the women are looking like men.
• 16:04
  SPEAKER_03: 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_03: We have to, we as providers, we have to know balance.
• 16:14
  SPEAKER_03: We have to know when someone starts looking abnormal.
• 16:16
  SPEAKER_03: And they might make a few bucks off of it, but they need to stop.
• 16:19
  SPEAKER_03: Yeah, they need to stop.
• 16:21
  SPEAKER_03: You were asking me about toxins earlier.
• 16:23
  SPEAKER_03: Yes, so you were asking me about Botox and you know those toxins.
• 16:26
  SPEAKER_03: I want to tell you something that was that was an eye-opener for me.
• 16:29
  SPEAKER_03: I um love Dysport.
• 16:30
  SPEAKER_03: I've loved Disport since 11 years ago when it was FDA approved.
• 16:33
  SPEAKER_03: And I used Botox before that, and I didn't know why it kicked in earlier and lasted longer.
• 16:37
  SPEAKER_03: I never knew why.
• 16:39
  SPEAKER_03: 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_03: Okay, looked at how much active toxin is in each dose.
• 16:52
  SPEAKER_03: And it came out that Dysport had quite a bit more active toxin in each dose.
• 16:57
  SPEAKER_03: Then it came to Botox, and then Dysport was the lowest.
• 16:59
  SPEAKER_03: I mean, I'm sorry, I'm sorry, Zealman was a lotus.
• 17:02
  SPEAKER_03: So Dysport had the highest amount of toxin in each active toxin in each dose.
• 17:06
  SPEAKER_03: So with this drug, with this this class of drug, the amount of toxin you get equals duration.
• 17:12
  SPEAKER_03: Yeah.
• 17:13
  SPEAKER_03: So this so I wonder why it lasted so long over all these years.
• 17:16
  SPEAKER_03: I'm like, why did it last long?
• 17:18
  SPEAKER_03: 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_03: But um, it ends up that so it ends up that it that's why it lasts longer.
• 17:26
  SPEAKER_03: It's a stronger medication.
• 17:28
  SPEAKER_03: 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_03: So I am probably one of the only clinics in the country.
• 17:37
  SPEAKER_03: I don't even order Botox.
• 17:38
  SPEAKER_03: Is that crazy?
• 17:39
  SPEAKER_03: Really?
• 17:39
  SPEAKER_03: Wow, I don't even order it because it's been patient-up, you've upgraded.
• 17:44
  SPEAKER_03: It's been patient-driven.
• 17:45
  SPEAKER_03: Patients have wanted to go back to the disport, they haven't wanted to go back to the Botox.
• 17:48
  SPEAKER_11: They wanted to know is there any is there any like adverse effects with more toxin per dose, or is that no?
• 17:54
  SPEAKER_11: There's no longer duration.
• 17:56
  SPEAKER_11: That's it.
• 17:56
  SPEAKER_11: Wow.
• 17:57
  SPEAKER_03: 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_03: That's only happening in research.
• 18:06
  SPEAKER_11: 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_03: And and and you it's you have to think of the medication of the the dose.
• 18:15
  SPEAKER_03: 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_03: The muscle's either paralyzed or it's not.
• 18:25
  SPEAKER_03: There is no dimmer switch on it.
• 18:27
  SPEAKER_03: So if you give a little bit, it'll only last a little bit of time.
• 18:31
  SPEAKER_03: If you give more, it will just last longer, but it's still going to be paralyzed or frozen.
• 18:36
  SPEAKER_03: Does that make sense?
• 18:37
  SPEAKER_03: Yeah, all or nothing effect.
• 18:39
  SPEAKER_03: Yeah.
• 18:39
  SPEAKER_03: 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_03: So the amount of toxin per dose means a lot.
• 18:47
  SPEAKER_11: So now how much dosing would you recommend for like fine lines?
• 18:50
  SPEAKER_11: You know, something like very minor, like maybe crows' feeds or fine lines?
• 18:54
  SPEAKER_11: Like, is there uh usually like a like a table with you know recommended doses or units?
• 19:00
  SPEAKER_03: The doses, well, you know what?
• 19:01
  SPEAKER_03: If I give one unit, it will be paralyzed the same as five units.
• 19:05
  SPEAKER_03: Five units will just last longer, that's all.
• 19:08
  SPEAKER_03: Interesting.
• 19:08
  SPEAKER_03: 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_03: Okay, well, 20 units is FDA approved just for the globella, just for the frown lines.
• 19:18
  SPEAKER_03: 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_03: You want someone to get at least three months out of this stuff.
• 19:29
  SPEAKER_12: Yeah.
• 19:30
  SPEAKER_03: 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_03: Right, right.
• 19:40
  SPEAKER_03: Makes sense.
• 19:41
  SPEAKER_11: Well, Lori, I want to thank you so much for your time.
• 19:43
  SPEAKER_11: This has been so educational, and I would love it if you would come back to the show.
• 19:47
  SPEAKER_11: I know you're super busy, but I would love to do a whole episode with just us talking.
• 19:51
  SPEAKER_03: Absolutely, absolutely.
• 19:53
  SPEAKER_03: Thank you.
• 19:54
  SPEAKER_03: Thank you for having me.
• 19:54
  SPEAKER_03: I appreciate it.
• 19:55
  SPEAKER_11: It has Cristino Bay Aguilera.
• 19:57
  SPEAKER_11: Um, he is a board-certified dermatologist and dermatologic surgeon.
• 20:01
  SPEAKER_11: Um, Dr.
• 20:02
  SPEAKER_11: Aguilera has uh a lot of experience in not only dermatology, but he is also an international keynote speaker on the newest laser advances in cosmetic techniques and also has tons of experience in running uh FDA clinical trial studies for a leading laser manufacturer.
• 20:19
  SPEAKER_11: So, welcome to the show, Dr.
• 20:20
  SPEAKER_11: Aguilera.
• 20:21
  SPEAKER_11: I'm so excited you're here.
• 20:23
  SPEAKER_00: Thank you for having me here.
• 20:24
  SPEAKER_00: It's always exciting to talk about skincare.
• 20:27
  SPEAKER_11: Absolutely.
• 20:27
  SPEAKER_11: I would love it if you could tell us a little bit about your background.
• 20:31
  SPEAKER_11: I know I covered it very, very um, I skimmed over it, but I would love to tell our listeners a little bit more about you.
• 20:37
  SPEAKER_00: So um I started my career as a laser expert, actually, even before I got into dermatology, I just had such a great passion for laser technology and laser medicine.
• 20:48
  SPEAKER_00: And uh, and that caused me to want to be a dermatologist because at the time only dermatologists and plastic surgeons were doing aesthetics, or at least lasers, and uh that was my venture on on um uh on the world of aesthetics, but I always love uh skincare and always been fascinated with skin.
• 21:10
  SPEAKER_00: Um reason why, because I think um the skin basically is a good way to measure health and other things, just never never gonna people are never gonna stop caring about what the skin looks like because it's on our primitive brain, where we know that when people are looking at us, the the primitive brain is sorrowing in the skin to see if you are of good reproductive age, like you have 40 eggs or one egg or no eggs.
• 21:43
  SPEAKER_00: Or also what kind of healthy status you are, you know.
• 21:47
  SPEAKER_11: Yeah, yeah.
• 21:48
  SPEAKER_11: Absolutely.
• 21:49
  SPEAKER_11: No, I completely agree with you.
• 21:50
  SPEAKER_11: And I think the skin is such a reflection of, you know, like you said, like the rest of our body and the rest of our health, especially something like gut health.
• 21:57
  SPEAKER_11: You know, I know there's a huge um movement right now where people Talking about using probiotics more and whatnot.
• 22:02
  SPEAKER_11: But I actually want to ask you about lasers because I don't know anything about laser treatments.
• 22:07
  SPEAKER_11: And I would love it if you could tell our listeners some, you know, some tips and some advice for people who are beginners when it comes to laser uh you know techniques and what to do and how to approach that.
• 22:19
  SPEAKER_00: Yeah, so lasers are great, and they've been around for a long time.
• 22:23
  SPEAKER_00: Thanks to the to the great work of Albrecht Einstein.
• 22:27
  SPEAKER_00: And basically, it's a light that has a preference for a target on your skin.
• 22:35
  SPEAKER_00: So that's why different wavelengths.
• 22:37
  SPEAKER_00: So the way I like to explain lasers, like imagine you have a rainbow, and out of that rainbow you get a yellow light.
• 22:44
  SPEAKER_00: Well, that yellow light is closed in wavelength of um the light of the post-type laser that lights things that are red.
• 22:54
  SPEAKER_00: And then let's say you get the green light, and you see that this green light has preference for things that are brown.
• 23:00
  SPEAKER_00: So you can get a target that is going to be matched with a particular color of the visible light spectrum.
• 23:07
  SPEAKER_00: So, really, in order for us to get a laser to work, the laser light, that green light needs to have affinity for the target.
• 23:16
  SPEAKER_00: Let's see, pigment on skin, like freckles, and the freckles also have to have affinity for that light.
• 23:22
  SPEAKER_00: So it's like a marriage made in heaven.
• 23:24
  SPEAKER_00: Yeah, the light gets attracted to the target, the light turns into heat above 40 degrees Celsius and destroy.
• 23:31
  SPEAKER_00: We nook things with the laser.
• 23:33
  SPEAKER_11: Interesting.
• 23:34
  SPEAKER_11: That's very interesting.
• 23:35
  SPEAKER_11: So you the way you're describing it though, it sounds like a ligand receptor relationship, but um, yeah, you know, that's interesting.
• 23:42
  SPEAKER_00: Unfortunately, in relationships, somebody dies.
• 23:45
  SPEAKER_11: Yeah, I know.
• 23:47
  SPEAKER_11: Well, I want to know.
• 23:48
  SPEAKER_11: Um, actually, uh one quite follow-up question is um, what are some of the differences uh that you've noticed in patients with more melanated skin versus not?
• 23:56
  SPEAKER_11: I mean, I know that's a very um buzzworthy topic these days in skincare.
• 24:00
  SPEAKER_11: So are can you tell us about some differences you've noticed or some differences in laser treatments um between the two?
• 24:07
  SPEAKER_00: That's a great, great question because you know, uh, and I and I'm very happy that I mean I'm Latino, but I'm very mixed.
• 24:14
  SPEAKER_00: Uh my mom's Chinese and Costa Rica, my father Spanish, Portuguese, uh Native, Indian, and Black.
• 24:20
  SPEAKER_00: So I have everything.
• 24:21
  SPEAKER_00: Wow, you are quite ethnic.
• 24:25
  SPEAKER_00: Yeah, and I have a uh a dark olive skin tone.
• 24:28
  SPEAKER_00: And uh yeah, you know, that's a very important question because usually we use Fitzpatrick skin types, which is uh different, uh scale that we use to kind of predict who should use more sunblock to prevent skin cancer, but we also use it to use lasers.
• 24:45
  SPEAKER_00: So you have to be very careful with the darker skin types, not to use a laser that's more too aggressive because it can lead to pigmentation.
• 24:54
  SPEAKER_00: That's why I really love uh for darker skin types, things like the Vivaci and things like that, that's radio frequency with micro-needling, where we don't depend on light because it is safer to do devices like that, like microneedling radio frequencies on the darker skin type.
• 25:11
  SPEAKER_00: Because the problem with dark skin type, yeah, if for example, whenever there's inflammation, it may lead to pigment.
• 25:17
  SPEAKER_00: Let me use myself as an example.
• 25:19
  SPEAKER_00: When I get if I get a pimple, the pimple goes away, but I can get a brown spot that can last me six months.
• 25:26
  SPEAKER_00: So it's very, very important to when you are looking to do an energy device, you need to understand the the what type of skin do you have, what color skin you have, and what devices are safe for skins you own natural skin tone, because not every laser will work on all skin types.
• 25:49
  SPEAKER_11: Right.
• 25:49
  SPEAKER_11: So, what are some of the techniques that you love for hyperpigmentation?
• 25:53
  SPEAKER_00: Well, there's so many things, depending on the hyperpigmentation.
• 25:57
  SPEAKER_00: Uh, we can do chemical pills, those are great.
• 26:01
  SPEAKER_00: Um, uh, if the pigmentation is not something like terrible, like melasma.
• 26:07
  SPEAKER_00: You can use lasers that have affinity for melanin, and you can also have things like uh microneedling with radio frequency in combination with agents that you add immediately after you do your little microneedling opening.
• 26:26
  SPEAKER_00: So the product sips into the dermis deeper, and it helps by bleaching out the skin and the areas where you need to.
• 26:34
  SPEAKER_00: There's so many ways to treat hyperpigmentation from um um topical creams, yeah, that things natural like cogic acid and licorice and to more um aggressive things like hydroquinone and climate semic acid, you know, there's a lot of different chemicals that bleach out the skin cysteamine, and then a lot of energy devices that will do so as well.
• 27:02
  SPEAKER_11: So I have a question about um, you know, like in terms of hyperpigmentation, when you treat it, does it cause like a lightning effect in that area?
• 27:10
  SPEAKER_11: Where, you know, because you know in vitiligo, for example, is very extreme.
• 27:14
  SPEAKER_11: You have the light and the dark patches um because of the disease.
• 27:17
  SPEAKER_11: Now, when you get rid of hyperpigmentation, what's left behind?
• 27:21
  SPEAKER_00: Your normal skin tone.
• 27:22
  SPEAKER_00: So you should imagine think about hyperpigmentation that is caused from sun damage or from a scar, you know, like or a pimple.
• 27:32
  SPEAKER_00: These are things that are secondary, it's not your natural pigment.
• 27:36
  SPEAKER_00: So when you use these bleaching agents or energy devices, you just remove the pigment that is there.
• 27:42
  SPEAKER_00: Imagine that you just got a natural tattoo with brown in the area where you have the injury or the area where you have sun damage or the area where you have the melasma.
• 27:52
  SPEAKER_00: So you only bleach out the extra exogenous or the extra uh pigment that is not your natural skin tone.
• 28:01
  SPEAKER_11: That's very interesting.
• 28:02
  SPEAKER_11: Now, I actually want to um ask you, you had mentioned radio frequency earlier for darker skin types.
• 28:06
  SPEAKER_11: What is the difference between radio frequency and light therapy?
• 28:10
  SPEAKER_11: I mean, is uh in terms of is it just the wavelength that you're using or the it the amount of damage you're inducing?
• 28:15
  SPEAKER_11: What is the real difference?
• 28:16
  SPEAKER_00: So, in in terms of physical terms, when you're talking about lasers, it's just a light that turns into heat.
• 28:24
  SPEAKER_00: Radio frequency, it also has a certain type of wavelength, but again, it's radio frequency.
• 28:31
  SPEAKER_00: So it works more on those levels of things that you want to think maybe like sound, and then you have things like like ultrasound, like ult therapy, right?
• 28:40
  SPEAKER_00: It's ultrasound.
• 28:41
  SPEAKER_00: At the end of the day, whether it's light that turns into heat or sound that turns into heat, um it is uh it is a mechanical force, yeah.
• 28:54
  SPEAKER_00: That is an energy that turns into something else.
• 28:58
  SPEAKER_00: So remember uh another of the things that our wonderful uh Albert Einstein's uh led us um to play with is that energy is never created or destroyed, it's always something else.
• 29:14
  SPEAKER_00: So in laser you have light that turns into heat, and then you have other devices that are sound that turns into heat.
• 29:21
  SPEAKER_11: So it's really the amount of heat that is released in the reaction, right?
• 29:25
  SPEAKER_11: That's that's the difference.
• 29:26
  SPEAKER_00: Like, is that well it's it's the no, it's the me, the me that for example, in lasers, there's different lasers, right?
• 29:32
  SPEAKER_00: That create different wavelengths.
• 29:34
  SPEAKER_00: If I use a post-dy laser, which is a dye, that will create a yellow light that lies oxychemoclobin, that's why it's good for blood vessels, right?
• 29:44
  SPEAKER_00: So you can you can use a gas, CO2, the CO2 laser is a gas that will emit a wavelength that goes after the water under the skin.
• 29:56
  SPEAKER_00: So it's the medium that generates uh uh a wavelength, and that wavelength will turn into heat.
• 30:04
  SPEAKER_00: When you talk about like acoustic wave sounds, radio frequency, things like that.
• 30:09
  SPEAKER_00: It's a different mechanical force that will turn into heat.
• 30:14
  SPEAKER_11: Wow, that is so fascinating! I'm sorry, I I I kind of picked your brain there for a minute, but uh, this is so fascinating to me.
• 30:21
  SPEAKER_11: I don't know anything about lasers, but um, I want to ask you um some advice for people who you know they're just getting into treatments.
• 30:29
  SPEAKER_11: Um, you know, like I know in our 30s we often do that.
• 30:32
  SPEAKER_11: So, you know, what are some of the most common procedures that you see um or that people opt for with with laser treatments?
• 30:40
  SPEAKER_00: Well, most people always um worry about the tone and texture of the skin, tone being one because blemished skin is unsightly for most people.
• 30:51
  SPEAKER_00: That's why there's makeup and concealer.
• 30:54
  SPEAKER_00: Uh uh, a skin that is flawless with with a good tone and no blemishes, it's a very desired skin because it's a skin that advertised I'm healthy, I'm young, I'm attractive.
• 31:09
  SPEAKER_00: It's sending all those messages.
• 31:11
  SPEAKER_00: Um, so people are always gonna try to do uh a laser treatment according to what they see.
• 31:19
  SPEAKER_00: Um, a lot of red in your skin, then you're gonna look for a laser that addresses redness.
• 31:25
  SPEAKER_00: If you have a lot of brown, you look for a laser that treats brown.
• 31:29
  SPEAKER_00: If you have melasma, you're gonna find a laser that treats melasma without making it worse because that can truly happen.
• 31:36
  SPEAKER_00: Um so you're really trying to match what you see.
• 31:39
  SPEAKER_00: But on the early tourists, most people are starting to see that the pores are getting bigger, the fine wrinkles are starting to happen, and there's a lot of blemishes from some damage that you didn't have on your younger years.
• 31:52
  SPEAKER_00: So nothing too aggressive.
• 31:55
  SPEAKER_00: There are so many devices out there that are gentle lasers that can address your issues without having a lot of downtime.
• 32:03
  SPEAKER_00: Because when you pick a laser, your lifestyle is very important.
• 32:06
  SPEAKER_00: Meaning you want to take off from work for a week or two or a month, or you want to do a laser that you're just gonna hide over the weekend.
• 32:14
  SPEAKER_00: So you just don't do anything aggressive.
• 32:17
  SPEAKER_00: It's very important the lifestyle of the patient.
• 32:20
  SPEAKER_00: If you're very outdoorsy, most likely you don't want to do a laser, you may want to do microneedling or radio frequency combined with microneedling, because the laser it'd be a big no-no if you're a person that cannot get out of the cell.
• 32:33
  SPEAKER_11: Now, after you have a laser treatment, are you supposed to like even if it's like a month or two down the line, should you be using higher levels of SPF to protect your um skin as you would normally before you had the treatment?
• 32:46
  SPEAKER_00: Yeah, especially the first two to three weeks of the treatment.
• 32:50
  SPEAKER_00: Those are the first two weeks are very crucial that you do not get some because imagine you're red, you inflamed because you the skin got injured, and now you're adding UV rays to that nature because we know UV rates are not only can be detrimental for the collagen on your skin because it will break it down, causing a solar scar or wrinkles, but also it can stimulate pigment.
• 33:16
  SPEAKER_00: So you have a skin that's inflamed, and now you're having a wavelength, the UV wavelength, that adds pigment, so you get stain and very, very dark uh blemish and is your own doing because you should not go on the sun when you do a laser.
• 33:33
  SPEAKER_11: Now, I have a question about the science behind um lasers and especially UV light.
• 33:37
  SPEAKER_11: I mean, I know that there are there's this thing called you know uh formation of dimers, um, DNA damage that can occur by UV light.
• 33:45
  SPEAKER_11: Now, is there any risk of such DNA damage with laser therapy for cosmetic reasons?
• 33:51
  SPEAKER_00: No.
• 33:52
  SPEAKER_00: Okay.
• 33:52
  SPEAKER_00: Great question.
• 33:53
  SPEAKER_00: And the reason why is that laser, the the laser wavelength that we use in aesthetics and in medicine, there are non-ionizing wavelengths.
• 34:05
  SPEAKER_00: They're not your UV wavelengths or your uh X-rays wavelengths or your gamma X-rays that are ionizing, therefore, they will change your DNA and can be detrimental in terms of changing the configuration.
• 34:24
  SPEAKER_00: That can lead to um problems with your health, like cancers and things like that.
• 34:30
  SPEAKER_11: Right, right.
• 34:32
  SPEAKER_11: That's why I asked you, but that that's really good to know.
• 34:34
  SPEAKER_11: I'm glad that there's no um adverse effects like that.
• 34:37
  SPEAKER_11: Um, my last question for you, um, doctor, is about the FDA clinical trials.
• 34:41
  SPEAKER_11: I'm very curious because I know that um right now in the skincare industry, there are a lot of companies who are conducting their own uh version of clinical trials, but then I also know that when you're doing it with from the academia aspect, there's this huge list, right?
• 34:54
  SPEAKER_11: That you have to go through, you have to get approvals and all this stuff.
• 34:57
  SPEAKER_11: So, what are some of the differences or or key points that um everyone should keep in mind for clinical trials?
• 35:03
  SPEAKER_11: Can you share that with us?
• 35:04
  SPEAKER_00: Yeah, I mean, definitely when we do clinical clinical trials, we're trying to find just two things.
• 35:10
  SPEAKER_00: It's efficacious and it's safe.
• 35:12
  SPEAKER_00: They're all doing the same way and they're presented to the FDA because they want to know that their results are reproducible, but also that the patients are gonna be safe.
• 35:23
  SPEAKER_00: And if there's anything negative happening during the trial, well, though that's those are premises for the product not get approved by the FDA.
• 35:33
  SPEAKER_00: Having uh the CO of approval of the FDA is important because we know how finicky and sometimes fastidious the FDA can be in approve things, but you know, safety first.
• 35:48
  SPEAKER_00: So I uh I kind of like the the FDA's put a lot of rigorous rules in order to approve things in the United States.
• 35:57
  SPEAKER_00: Sometimes it's like a little too much, but it is done with with good intentions.
• 36:03
  SPEAKER_11: Now, is there more like options in Europe, Doctor, because they don't have the FDA thing, like the the hurdle of FDA?
• 36:09
  SPEAKER_11: Do you know if there's like a huge difference in treatments?
• 36:12
  SPEAKER_00: Yes, yes.
• 36:13
  SPEAKER_00: A good example is like heliocare, which was uh an when uh when heliocare came into the aesthetic market, which is a song block.
• 36:25
  SPEAKER_00: Um in Europe, it took almost 10 years to get here to the United States.
• 36:30
  SPEAKER_00: It's like 10 years for a song block.
• 36:32
  SPEAKER_00: Are you kidding me?
• 36:33
  SPEAKER_00: Wow, yeah, that's what they call it.
• 36:35
  SPEAKER_00: They were trying to to make sure that the product was safe.
• 36:39
  SPEAKER_00: You know, there's always also uh uh agendas, you know.
• 36:43
  SPEAKER_00: Like I sometimes I feel that there's money to be made when things get approved, and that also can kind of yeah, there's a huge, there's always politics involved.
• 36:54
  SPEAKER_11: There's always, yeah, you know, somehow because you know it's interesting you say that because I wonder about all those skincare lines right now in the US that are just there's no you know regulation at all, and they're unsafe, you know, for consumers, but then you have something like this sunblock, it takes 10 years to get into the states that makes no sense.
• 37:11
  SPEAKER_00: Well, I tell you how that works.
• 37:12
  SPEAKER_00: It's like so you have cosmos cyclicals, which are still it's common, it's kind of like neutra-ceuticals, commosceuricles, they're not readily regulated by the FDA unless you make claims.
• 37:25
  SPEAKER_00: Okay, if you make a claim, then the FDA says, uh-uh, I need to.
• 37:30
  SPEAKER_00: So you cannot create a for example, I'll tell you an example because I created a shampoo long time ago because I I suffered with dandruff and I found this amazing shampoo, yeah.
• 37:42
  SPEAKER_00: Um, and uh and then went off the market.
• 37:45
  SPEAKER_00: But I have other uh bottles because when I find something I like, I buy a lot of it.
• 37:50
  SPEAKER_00: Yeah, yeah.
• 37:51
  SPEAKER_00: But you never know, and it happens to me all the time.
• 37:53
  SPEAKER_00: So they took it out of the market.
• 37:55
  SPEAKER_00: Well, I just like okay, I have the bottles, the bottle, I'm gonna go and tell people to replicate the shampoo for me because I need the shampoo.
• 38:03
  SPEAKER_12: I love that.
• 38:05
  SPEAKER_12: That is brilliant.
• 38:06
  SPEAKER_00: I was the guinea pig, like it made my dandruff worse, and it was itchy, couldn't sleep, but finally they got it right the way it was, and uh so I wanted to sell it in my practice.
• 38:18
  SPEAKER_00: I'm a dermatologist, but you know, I could not say that was um anti-itch or anti-dandruf because once I say it's anti-dandruff, it becomes a claim and a medical claim.
• 38:30
  SPEAKER_00: So FDA wanna regulate it, and it costs lots of money, yeah, yeah, and trouble and all the time.
• 38:41
  SPEAKER_00: And one horror after all because you could do everything right, and you pay thousands, if not millions, and and the FDA says, Well, we don't like it, we don't like this word, and then you have to reapply again, and then you have to pay the same amount of money.
• 38:53
  SPEAKER_00: Wow, so they don't even they don't even refund you, yeah.
• 38:56
  SPEAKER_00: They're just like, nope.
• 38:57
  SPEAKER_00: So you know what I did, I didn't call anti-itch or anti-dandrups, I just call it soothing.
• 39:03
  SPEAKER_00: Yes, brilliant, yeah, soothing shampoo, you know.
• 39:08
  SPEAKER_11: Yes, I mean it is though, you know, you're soothing the itch of the dandruff.
• 39:11
  SPEAKER_11: That makes sense.
• 39:12
  SPEAKER_11: It's I love that.
• 39:13
  SPEAKER_11: Nice, nice score.
• 39:18
  SPEAKER_00: My practice without claims, of course.
• 39:20
  SPEAKER_00: Behind doors, I would tell my petrol I use this and I would tell the story.
• 39:24
  SPEAKER_00: I told you I did it because of the continued shampoo is the best thing, but then you know, it got so like I just stopped making it.
• 39:31
  SPEAKER_11: Yeah, but I mean, you had a you had a nice little run there for a while with it.
• 39:35
  SPEAKER_11: I like that.
• 39:36
  SPEAKER_11: I like how you went about it.
• 39:37
  SPEAKER_11: But thank you so much, Doctor.
• 39:39
  SPEAKER_11: This has been amazing.
• 39:40
  SPEAKER_11: I would love to have you back anytime.
• 39:42
  SPEAKER_11: Um, if you have any room in your schedule to talk more and really dive into the science.
• 39:46
  SPEAKER_00: Oh, it's my pleasure.
• 39:48
  SPEAKER_00: It's great to talk to people about cosmosuticles, lasers is my um my part.
• 39:54
  SPEAKER_00: So always happy to do it.
• 39:55
  SPEAKER_00: Thank you so much, Doctor.
• 39:57
  SPEAKER_00: Have a blessed day.
• 39:58
  SPEAKER_00: You too.
• 39:59
  SPEAKER_00: Ciao.
• 40:10
  SPEAKER_11: Okay, that was good.
• 40:11
  SPEAKER_11: And now the next guest, I'll be ready.
• 40:18
  SPEAKER_11: Hi guys, so our next guest is Dr.
• 40:20
  SPEAKER_11: Michael Salmonek.
• 40:22
  SPEAKER_11: Dr.
• 40:22
  SPEAKER_11: Salmanek is a double board certified facial plastic surgeon.
• 40:25
  SPEAKER_11: He is uh currently practices in Washington, DC, and he's also the owner of his own practice, Somek plus Pittman MD.
• 40:33
  SPEAKER_11: He is also considered one of the leading experts in rhinoplasty and facial rejuvenation.
• 40:37
  SPEAKER_11: Additionally, Dr.
• 40:38
  SPEAKER_11: Salnenek has published numerous articles um in peer-reviewed medical journals, and he's often quoted for things involving cosmetic surgery issues.
• 40:47
  SPEAKER_11: So, welcome to the show, Dr.
• 40:48
  SPEAKER_11: Somnnik.
• 40:48
  SPEAKER_11: I'm so excited that you've joined us.
• 40:50
  SPEAKER_06: Thank you for having me, Ekta.
• 40:52
  SPEAKER_11: I would love for you to tell us um a little bit more about your background.
• 40:55
  SPEAKER_11: I know I kind of skimmed over it, but um tell all of our listeners everything um that led you here.
• 41:01
  SPEAKER_06: Sure.
• 41:01
  SPEAKER_06: So I'm a facial plastic surgeon that trained in head and neck surgery, and I've been in the Washington, DC area for about 10 years now and started my own practice.
• 41:12
  SPEAKER_06: It's been almost five years, and um we really focus on regenerative medicine in addition to my surgical practice.
• 41:21
  SPEAKER_06: And I'm such a big fan of medical grade cosmeceuticals, PRP, a lot of the regenerative regenerative things that are are coming out and developing on a daily basis.
• 41:31
  SPEAKER_06: So I kind of focus on the bigger picture with my patients, and not everyone is a surgical candidate, and I think that's a good thing.
• 41:39
  SPEAKER_11: I love that.
• 41:39
  SPEAKER_11: I love that you said that because I know there are a lot of people who are just they go straight to cutting.
• 41:44
  SPEAKER_11: So I'm glad that you said that.
• 41:46
  SPEAKER_11: Um, I I wanted to ask you, um, especially with your immense background in medical research, um, one of the things that I'm very curious about is um how can we incorporate true academic medical research into this um skincare, skin health industry, you know, like do you have any thoughts around that topic?
• 42:07
  SPEAKER_06: So I think the skincare industry obviously is a multi-billion dollar industry for a reason.
• 42:12
  SPEAKER_06: People have such an interest in taking care of their skin.
• 42:15
  SPEAKER_06: Yeah, and I do think that's where the quality research is going to come into play.
• 42:21
  SPEAKER_06: And I was just talking to somebody last night about doing a split face study on one of these new skincare topicals that they're developing with PRP within the serum versus some other competitor thing.
• 42:34
  SPEAKER_06: And that's that's really how we start to develop innovation in the skincare realm and figure out what works and what doesn't.
• 42:42
  SPEAKER_06: Because how many of us have an entire cosmetic cabinet full of 200 products that we've and we leave them on the side and we're kind of like, okay, I did try that.
• 42:53
  SPEAKER_06: And then you're putting on 12 things on your face a day and don't know what any of it is doing.
• 42:57
  SPEAKER_12: Right.
• 42:58
  SPEAKER_12: Right.
• 42:59
  SPEAKER_06: And and that's what brings me a lot of times.
• 43:01
  SPEAKER_06: I have such a passion for skin care with and with my patients, I like to keep it as concise as possible.
• 43:06
  SPEAKER_06: I hate to throw 10 products on you and have you look at it, get so overwhelmed, and just be non-compliant, you know?
• 43:12
  SPEAKER_11: Right, right, absolutely.
• 43:14
  SPEAKER_11: I mean, I would love for you to really clarify the role of skincare in um overall skin health, especially when as it pertains to dermatology, because I think there's a huge gray area there, you know, um, in terms of is it uh is it like a replacement for going to a dermatologist or is it something that you can use to augment the care you're receiving?
• 43:32
  SPEAKER_11: So if you could tell us a little bit about that.
• 43:34
  SPEAKER_06: Yeah, when I first meet a patient, even if it's for a surgical facelift or something, I start off with asking them what their skincare is.
• 43:42
  SPEAKER_06: Because without a foundation of a quality skincare regimen, what I do to you is kind of going to be useless.
• 43:49
  SPEAKER_06: And I could really optimize what I'm able to do if your skin is conditioned.
• 43:55
  SPEAKER_06: And, you know, I talk to people about treatments all the time, such as like laser treatments.
• 44:00
  SPEAKER_06: Treatments, et cetera.
• 44:01
  SPEAKER_06: And if your skin isn't conditioned, your healing is going to be less and your results aren't going to be suboptimal.
• 44:06
  SPEAKER_06: So I put such a stress on what is your skincare and how can we get it optimized for you?
• 44:14
  SPEAKER_06: And obviously, not everyone has the same skincare regimen, but it really is the foundation.
• 44:20
  SPEAKER_06: And it doesn't, it doesn't supplement uh or I'm sorry, replace a dermatologist.
• 44:25
  SPEAKER_06: It's going to complement everything you're going to do in your daily life, but it's going to make your skin better just because of being being compliant with it.
• 44:34
  SPEAKER_11: So, what do you think is something that's essential in um in most people's regimen for skincare before they see their dermatologist?
• 44:41
  SPEAKER_11: So just so their skin is primed, like you mentioned, you know, and in the best state it can be.
• 44:47
  SPEAKER_06: I am such a big fan of having every single one of my patients on a retinol.
• 44:52
  SPEAKER_06: And I think that is such an underrated product that truly is one of the pinnacles of anti-aging for a topical cosmeceutical.
• 45:02
  SPEAKER_06: I mean, when you look at the mechanism of action of a retinol, it thins out the epidermis, which is the superficial skin layer, but it thickens that dermal layer right below, which is the collagen-producing layer.
• 45:14
  SPEAKER_06: So if you think about what that's doing translationally on your skin, it's it's reducing the fine lines and wrinkles, it's increasing the tone and potentially improving the texture.
• 45:25
  SPEAKER_06: I can always tell when someone is on a stable retinol regimen because their skin just looks smoother because it's naturally exfoliating.
• 45:32
  SPEAKER_11: That's so interesting that you mentioned the changes in the dermal layer.
• 45:36
  SPEAKER_11: Um, you know, because I know that, you know, so much in skincare and especially on social media, um, you know, there's so much talk about exfoliation and there's so much talk about sloughing off that top layer of dead skin cells.
• 45:49
  SPEAKER_11: But um I'm curious what you think about exfoliation um versus retinol, you know, um, should people go for one or the other, or can we combine them into a good routine?
• 45:59
  SPEAKER_06: I think they go hand in hand.
• 46:00
  SPEAKER_06: However, I always do caution people when they are on a retinol that you have to cautiously exfoliate, or else you're gonna get a very raw face because that retinol is inherently creating a thinner superficial layer at baseline.
• 46:16
  SPEAKER_06: So when you put it exfoliate, you're just trying to gently clean it off.
• 46:20
  SPEAKER_06: And the way I liken it is if you're going to, in order for your cosmosceuticals that you're going to be applying to effectively penetrate into your skin, you do need to regularly exfoliate and be on a retinol because otherwise, you're putting these products on a layer of dead skin cells and it's kind of just sitting there not doing what it's supposed to be doing.
• 46:41
  SPEAKER_11: Yeah, no, that makes total sense.
• 46:43
  SPEAKER_11: But I'm curious from your um, you know, professional opinion, what is the best uh way of exfoliating?
• 46:49
  SPEAKER_11: Is it chemical or physical, or is there really a difference?
• 46:52
  SPEAKER_11: I mean, I I don't know if there's a difference.
• 46:54
  SPEAKER_06: So I think for like at-home purposes, which is what most people are going to want to do, there are some great kind of exfoliating polishes out there, which have very, very tiny like silicone beads and even um environment-friendly beads uh in there to kind of gently exfoliate while you're in the shower.
• 47:14
  SPEAKER_06: There's the Clarisonic brush, which many have used over the years, which Oh, I did.
• 47:20
  SPEAKER_06: I loved it.
• 47:21
  SPEAKER_06: Yeah, I kind of think it's like a sonicare for your face, you know, like it's it's nice, it's it's gentle, it's predictable.
• 47:29
  SPEAKER_06: It it you're able to control the pressure with it where you're not going to do something too aggressive.
• 47:34
  SPEAKER_06: And really the cheap way of doing it, say you don't have an exfoliating polish or a clairsonic, is a good old washcloth, but you have to be really gentle with the washcloth, or else you can create really raw areas.
• 47:45
  SPEAKER_06: I've been a victim of that myself.
• 47:47
  SPEAKER_11: Yeah, yeah.
• 47:48
  SPEAKER_11: No, I mean that's a great point.
• 47:49
  SPEAKER_11: But I and I'm wondering because I know there's so much hype around this idea of micro-tears due to physical exfoliance, you know, for a while.
• 47:57
  SPEAKER_11: And I I was, you know, thinking about it and I'm like, yeah, I wonder what a doctor thinks about this.
• 48:01
  SPEAKER_11: I mean, how relevant are micro-tears?
• 48:03
  SPEAKER_11: Is it something that can make or break your skin?
• 48:06
  SPEAKER_11: Or, you know, what are your thoughts on that?
• 48:08
  SPEAKER_06: Well, I mean, it can cause like a kind of almost like a superficial abrasion to your skin.
• 48:14
  SPEAKER_06: Yeah.
• 48:14
  SPEAKER_06: And I've absolutely done that to my skin because I am such a regular, regular retinol user.
• 48:20
  SPEAKER_06: And there's times when I've been a little too aggressive with the washcloth or the polish.
• 48:25
  SPEAKER_06: And you do see kind of like little areas of redness on your face that kind of need to heal, almost like a very, very superficial scab.
• 48:33
  SPEAKER_06: So I really do stress to people to just be gentle because you really don't want to cause micro-tears into your skin, because that's a little more damage than the skin is asking for.
• 48:42
  SPEAKER_11: That's interesting.
• 48:42
  SPEAKER_11: Yeah.
• 48:43
  SPEAKER_11: And I'm glad you clarified that because, you know, on social media it was everywhere.
• 48:46
  SPEAKER_11: It was like people were posting slides, you know, like one step away from histology slides.
• 48:52
  SPEAKER_11: I was like, what is going on?
• 48:54
  SPEAKER_11: It was pretty extreme.
• 48:55
  SPEAKER_11: But um, I actually want to ask you, um, you know, in terms of combining therapies, I'm very confused about this because I know that there's so many therapeutic options out there.
• 49:05
  SPEAKER_11: There's lasers and, you know, um obviously surgical, you know, techniques.
• 49:09
  SPEAKER_11: But what are some things that, you know, the average consumer should be looking at in terms of therapy?
• 49:14
  SPEAKER_11: You know, going when you go to a dermatologist or a surgeon, you know, what are some things that everybody can really kind of think about and it would benefit their skin?
• 49:22
  SPEAKER_06: Yeah, I think when you're looking at truly achieving anti-aging levels and really making positive improvements to your skin, combination therapies is where it's at.
• 49:33
  SPEAKER_06: And there is because there is not just one single treatment that is a cure all, right?
• 49:40
  SPEAKER_06: And so, you know, if you're going in and you want to improve like texture and tone, there's microneedling with radio frequency.
• 49:47
  SPEAKER_06: But what I also use for my like semi-older population that is getting like deeper wrinkles and sun damage is I combine a little very superficial CO2 treatment with them to target some of those things.
• 49:59
  SPEAKER_06: And that is a beautiful combination treatment that works quite nicely, but even more than that, it matters on what they're putting on their skin after.
• 50:08
  SPEAKER_06: That's part of the combination.
• 50:10
  SPEAKER_06: And if you're just giving them like cetophil moisturizer, no offense against cetophil, I'm not paid for them or anything, but you know, that is a very, very weak kind of topical that has nothing in it.
• 50:23
  SPEAKER_06: And versus if you're gonna give them something that has like growth factors and peptides that's gonna penetrate into their skin and really help their skin heal, you're gonna see such a difference in that combination treatment.
• 50:36
  SPEAKER_11: So, you know, I have a question, a follow-up question to what you just said, because for me, you know, um, I also have a science background.
• 50:42
  SPEAKER_11: And I when I think of growth, like, you know, growth peptides, and I'm gonna think of these like molecular level, like, you know, you're altering the um, you know, molecular cascade of events that's happening.
• 50:52
  SPEAKER_11: How does that really work with skincare?
• 50:54
  SPEAKER_11: I mean, is it is it is there some merit in that?
• 50:57
  SPEAKER_11: Or I mean, I I've I just have a hard time understanding it.
• 51:00
  SPEAKER_06: Yeah, well, I did for a long time as well, and I potentially still do, but you know, there it it really matters with the product.
• 51:09
  SPEAKER_06: Does the product carry with it a delivery mechanism, a carrier to bring that growth factor into the level of the skin that is needed?
• 51:18
  SPEAKER_06: And not all skincare products, as you know, are created equal.
• 51:21
  SPEAKER_06: So there are some really quality skincare products out there that have true science behind them.
• 51:27
  SPEAKER_06: And they have shown that yes, we have a carrier molecule that is able to deliver your retinal, your growth factor, or whatnot.
• 51:34
  SPEAKER_06: And they've derived certain molecular sizes for this.
• 51:38
  SPEAKER_06: So it's not as easy as just throwing growth factors in a moy shea butter and putting it in a jar and giving it to someone.
• 51:45
  SPEAKER_06: That's just gonna sit on their surface, you know?
• 51:48
  SPEAKER_11: Right, right.
• 51:49
  SPEAKER_11: No, that makes sense.
• 51:50
  SPEAKER_11: And the delivery component really makes sense because you always need that for almost any medical um therapeutic, you know, like when you're delivering it.
• 51:57
  SPEAKER_11: So you you need to work on that.
• 51:59
  SPEAKER_11: It makes sense to me.
• 52:00
  SPEAKER_11: So thank you for that.
• 52:01
  SPEAKER_11: I I actually want to ask you, um, when it comes to like, you know, just patients, seeing patients every day, what are some of the hardest, like the challenges you have with patient care and like, you know, in terms of people having a misunderstanding about something when it comes to skin health or something that you find yourself explaining to a lot of people?
• 52:20
  SPEAKER_06: Yeah, I think the era of social media has caused an exponential amount of confusion.
• 52:27
  SPEAKER_06: Yeah.
• 52:27
  SPEAKER_06: And similarly, um, misplaced expectations.
• 52:32
  SPEAKER_06: And I think most of my day is establishing expectations and educating patients to get them on the same page and help them understand what they may want is potentially not realistic and or may require many treatments to get there.
• 52:49
  SPEAKER_06: So um it really comes down to, I mean, I consider myself as an educator in the office on a daily basis, trying to educate people on the foundation of their skincare, what potential surgeries are appropriate for them, what non-surgical interventions can meet their expectations.
• 53:05
  SPEAKER_06: I have a constant, you know, back and forth with people who come in saying, like, oh my God, you offer, I saw on your website you offer this non-surgical facelift.
• 53:13
  SPEAKER_06: And I look at them, their skin is hanging down to their collarbones.
• 53:16
  SPEAKER_06: And, you know, what that's like and you know, you look at them and say, I'm sorry, it's not a magic wand, it's a non-surgical treatment.
• 53:26
  SPEAKER_06: So I'm always very transparent with them that this non-surgical intervention isn't for you, and I don't want you to spend money or put forth money on something that you're gonna look in the mirror three or four months later and say, I don't see a damn bit of difference because you probably don't.
• 53:40
  SPEAKER_11: Right, because it's not meant for you, right?
• 53:42
  SPEAKER_11: That makes total sense.
• 53:43
  SPEAKER_11: I mean, you know, for me, I've never gotten anything um done surgically.
• 53:47
  SPEAKER_11: And when I for me, it was always scary, you know.
• 53:49
  SPEAKER_11: So, do you have people come in that are like really afraid?
• 53:52
  SPEAKER_11: Maybe it's their first time, and they're like, What's your advice to all of us out there that have never gotten um anything done uh surgical for our face or anything for our you know, aesthetically?
• 54:02
  SPEAKER_06: Yeah, so I mean I'm a facial plastic surgeon, so I only deal with the face, which is like I think exponentially more scary to deal with than say like body surgery that you can conceal very early on with clothing, right?
• 54:14
  SPEAKER_06: While you're healing.
• 54:15
  SPEAKER_06: Yeah, yeah.
• 54:16
  SPEAKER_06: Every single one of my patients, I would say, probably 90% or greater, have some reservations about having a surgical treatment.
• 54:25
  SPEAKER_06: And it really is about walking them through the process, explaining the explaining the procedure to them.
• 54:32
  SPEAKER_06: And what I found in the past couple of years has worked as uh has worked equally as well is um really showing them my patients before and afters and going over them to show them, you know what, you're still gonna look like yourself.
• 54:47
  SPEAKER_06: That's a huge, huge concern with most people, and it's a reasonable concern.
• 54:51
  SPEAKER_06: And they they're worried that they're gonna lose their identity.
• 54:54
  SPEAKER_12: Yes, exactly.
• 54:56
  SPEAKER_12: Exactly.
• 54:59
  SPEAKER_06: And they're they have a huge hump, and that's been part of their family ethnicity for generations, but they they don't want it, but they they still want to look like their family.
• 55:08
  SPEAKER_06: I explained to them that these are it's small subtleties that we're changing on your face, and we're really just refining and improving your overall appearance.
• 55:17
  SPEAKER_06: That's it, but you still absolutely look like yourself.
• 55:20
  SPEAKER_06: And I use an imaging program in the office, a 3D imaging program.
• 55:23
  SPEAKER_06: Oh, okay.
• 55:24
  SPEAKER_06: I went over it with them, where I'm able to simulate what I can give you as a surgical result.
• 55:31
  SPEAKER_06: And I think that puts their fears at ease because it allows them to visually see what my what my image is or what my surgical uh thought is of what they can get.
• 55:43
  SPEAKER_06: And I think that it puts us on the same page as well, you know?
• 55:46
  SPEAKER_11: Absolutely.
• 55:47
  SPEAKER_11: I mean, I would feel a lot more comfortable if you were able to show me, you know what I mean?
• 55:50
  SPEAKER_11: Like, oh, well, this is where I'm going, this is my vision.
• 55:53
  SPEAKER_11: Like that would make a huge difference as a consumer.
• 55:57
  SPEAKER_11: So um, you know, I wanna I wanna ask because you know, it's interesting to me that you know, people are still so reluctant.
• 56:04
  SPEAKER_11: And I and I made a comment on one of my earlier episodes about how whenever you hear about a bad nose job, it's you always in America.
• 56:12
  SPEAKER_11: It's rarely in Europe.
• 56:13
  SPEAKER_11: Now, I know you've been trained by some of the best.
• 56:15
  SPEAKER_11: So I, you know, obviously your work is very different than what I'm referring to, but what are what are some of the common mistakes that you notice in rhinoplasty by other, you know, maybe other people that you've seen do it, or you know, some common mistakes that are made?
• 56:31
  SPEAKER_06: Yeah, I think, well, about 40% of my rhinoplasty practice right now is a re is revisionary.
• 56:37
  SPEAKER_06: So um it's it's quite a lot.
• 56:40
  SPEAKER_06: And these are people who have had two and three rhinoplasties coming in to see me.
• 56:44
  SPEAKER_06: I think one of the biggest things that you see that is sort of a dead ringer for a nose job and just doesn't fit someone's face is an overreduced nose.
• 56:56
  SPEAKER_06: It's that super sloped, um, I call it a sliver tip.
• 57:00
  SPEAKER_06: It's like that tiny pointy nasal tip that exists in nature.
• 57:07
  SPEAKER_11: Yeah, it does not look right.
• 57:09
  SPEAKER_11: It's like a berry.
• 57:11
  SPEAKER_06: Exactly.
• 57:11
  SPEAKER_06: It looks like someone dropped a berry on your nose and it's just like this tiny little thing.
• 57:16
  SPEAKER_06: And it's it's about maintaining facial proportions.
• 57:19
  SPEAKER_06: And it's rare that there's only a few faces out there that that nose can fit on, and so it's not a one size fits all.
• 57:25
  SPEAKER_06: So I deal with people that uh that have overreduced noses and subsequently have developed nasal obstruction because the cartilages that used to be in their nose, providing that lord, that sort of larger nasal tip, have been removed or decreased so much that they no longer have the support.
• 57:43
  SPEAKER_06: So when they're breathing, even just like sleeping, they feel nasal obstruction.
• 57:48
  SPEAKER_06: And so it's about restoring the support and structure to the nose.
• 57:52
  SPEAKER_11: Wow.
• 57:52
  SPEAKER_11: Yeah, I mean, I can imagine like because you know I've always wondered about like if you if you restructure bone, right?
• 57:58
  SPEAKER_11: It's it's gonna cause problems in some way if it's not done right.
• 58:02
  SPEAKER_11: So that's why I was asking.
• 58:03
  SPEAKER_11: Um, but that's interesting, that's very interesting.
• 58:06
  SPEAKER_11: But I want to thank you so much for your time, Dr.
• 58:08
  SPEAKER_11: Salmonek.
• 58:09
  SPEAKER_11: This has been amazing, and I've learned so much.
• 58:11
  SPEAKER_11: And I would love it if you would come back and tell us more science stuff.
• 58:16
  SPEAKER_06: Oh, I would love to chat with you again.
• 58:18
  SPEAKER_06: It's so great talking to you.
• 58:19
  SPEAKER_06: Thanks for having me.
• 58:20
  SPEAKER_11: Thank you.
• 58:22
  SPEAKER_11: This is Dr.
• 58:23
  SPEAKER_11: Vivian Bukai, who is a dermatologist and was trained at the University of Miami and the Baylor College of Medicine.
• 58:30
  SPEAKER_11: She is a clinical assistant professor in the Department of Physician Assistant Studies at the University of Texas Health Science Center.
• 58:37
  SPEAKER_11: In addition, um, Dr.
• 58:38
  SPEAKER_11: Bukai is a nationally and internationally, you know, lecturing member of the medical community.
• 58:45
  SPEAKER_11: And she is also in the process of writing book chapters for dermatology textbooks.
• 58:49
  SPEAKER_11: So um without further ado, welcome to the show, Dr.
• 58:52
  SPEAKER_11: Bukai.
• 58:53
  SPEAKER_11: I'm so excited that you are here with us.
• 58:55
  SPEAKER_08: Thank you so much.
• 58:56
  SPEAKER_08: I'm really honored to be here.
• 58:57
  SPEAKER_08: How much fun.
• 58:58
  SPEAKER_08: This is all new.
• 58:59
  SPEAKER_08: You know, I'm I'm a dinosaur in medicine.
• 59:01
  SPEAKER_08: And so all these technologies, technologies are uh sometimes, you know, they still manage to put a little fear in me, you know.
• 59:09
  SPEAKER_08: I've I feel much I feel much more comfortable talking about what I do than getting my message out there.
• 59:15
  SPEAKER_11: That's what I want to ask you, actually.
• 59:17
  SPEAKER_11: I want to I want to get started though first by you telling us a little bit about your um your journey in medicine and you know, just just the whole the whole, I guess, journey and and adventure of becoming a dermatologist.
• 59:29
  SPEAKER_08: So I'm I'm one of these people that I've always loved art and I've always loved detective, being a detective, very visually oriented.
• 59:37
  SPEAKER_08: I originally thought I was I was like the little girl that had a Barbie doll with her dream house, but I also had a chemistry set.
• 59:44
  SPEAKER_11: Oh my gosh, me too.
• 59:46
  SPEAKER_08: So that was yeah, so this is this was like I was, you know, there was always this duality.
• 59:50
  SPEAKER_08: And I think I originally wanted to be an architect.
• 59:52
  SPEAKER_08: And then once I figured out that there wasn't that much autonomy in it, and it wasn't just about letting your creative energies flow, you know, unrestricted, that I thought I read the fountain head and I said, Oh no, I'm not gonna be an architect.
• 1:00:03
  SPEAKER_08: And the chemistry got the best of me.
• 1:00:05
  SPEAKER_08: And I thought I was gonna become a chemist, but I love people and science and biology, and so medicine was like a perfect fit.
• 1:00:13
  SPEAKER_08: I originally wanted to be a reconstructive plastic surgeon and you know, treat children with cleft lip, cleft palate, that type of thing.
• 1:00:20
  SPEAKER_08: But I was really hooked on dermatology at my first lecture in medical school.
• 1:00:26
  SPEAKER_08: And I and it was this was way before before aesthetics was even on the radar, to be quite honest.
• 1:00:33
  SPEAKER_08: I mean, it was to me, it was interesting enough that acne, psoriasis, all the things that are so visible on the skin and can have such an impact on quality of life that that there was actually a whole specialty dedicated to to skin diseases and skin wellness.
• 1:00:48
  SPEAKER_08: Well, and hair and nails too, right?
• 1:00:50
  SPEAKER_08: Right, right.
• 1:00:51
  SPEAKER_08: Yeah.
• 1:00:51
  SPEAKER_08: So that's what that's what got me really interested.
• 1:00:54
  SPEAKER_08: I started my private practice in 1991.
• 1:00:57
  SPEAKER_08: My husband and I went to Mexico City, that's where he was born and raised, and that's where my parents come from originally.
• 1:01:03
  SPEAKER_08: Although my mom, when she got married, moved to the States and, you know, and stayed here.
• 1:01:07
  SPEAKER_08: So we had um so from 91 to 99, uh, I practiced there.
• 1:01:14
  SPEAKER_08: And you know, I'm luckily I'm completely fluent in Spanish.
• 1:01:18
  SPEAKER_08: And although I didn't attend medical school there, thankfully my studies were recognized and I was able to, you know, have my medical license and and practice.
• 1:01:26
  SPEAKER_08: Wow, that's so cool.
• 1:01:27
  SPEAKER_08: So it was really fun.
• 1:01:28
  SPEAKER_08: And you know, the first thing to me that was very exciting was just skin care in the sense of like, you know, it wasn't too many years after uh Dr.
• 1:01:35
  SPEAKER_08: Klingman had pop, you know, published on uh the use of tretinoin to treat photoaging, right?
• 1:01:42
  SPEAKER_08: And uh and then glycolic acid and the alpha hydroxy acids came on the scene, and then patients would kind of push me.
• 1:01:49
  SPEAKER_08: They would drive, they would drive questions like, well, what else can I do?
• 1:01:52
  SPEAKER_08: What else can I do to make my skin look better?
• 1:01:55
  SPEAKER_08: And I was very much focused on how the skin could look better.
• 1:01:58
  SPEAKER_08: And in fact, I brought the CO2, the first CO2 resurfacing laser into Mexico.
• 1:02:03
  SPEAKER_08: I brought it in 1995, wow, and started doing treatments, you know, of all different skin types so that I wouldn't necessarily, you know, hyper pigment somebody or do that.
• 1:02:14
  SPEAKER_08: But you know, a year after I started doing that, people's wrinkles were starting to come back, and so and and it they look tighter and smoother, but not necessarily more youthful.
• 1:02:24
  SPEAKER_08: Yeah, so very organically grew into that combination treatments with um with fillers, botulinum toxin, um, or neuromodulators.
• 1:02:32
  SPEAKER_08: And then we came back to the States in '99 because of all the kidnappings, and my husband just really felt like with three little girls that that we would be.
• 1:02:42
  SPEAKER_08: So we really to San Antonio, which is where I was born, but didn't really have any family there.
• 1:02:46
  SPEAKER_08: And I started private practice all over again.
• 1:02:50
  SPEAKER_08: And it was a personal experience with melanoma that I had.
• 1:02:53
  SPEAKER_08: I had a stage four melanoma.
• 1:02:54
  SPEAKER_08: I've been very public about it.
• 1:02:56
  SPEAKER_08: Uh, this was in 2006 and 2007, but it really made me think about what I was putting on my skin.
• 1:03:04
  SPEAKER_08: And even though my skin looked good and I didn't have wrinkles and so on, my skin clearly wasn't healthy.
• 1:03:10
  SPEAKER_08: So that's how I got really interested in skincare, DNA repair, started thinking about growth factors, about a lot of different things, and also realized that skincare can achieve things that devices cannot.
• 1:03:23
  SPEAKER_08: So, devices, if you remember what I said, how to make things look better.
• 1:03:27
  SPEAKER_08: Yeah.
• 1:03:27
  SPEAKER_08: Devices, and we do need them, we definitely do need that in-office technology, they can really help with wrinkles and scars and textural changes and discoloration and redness and broken capillaries and all of those things, right?
• 1:03:47
  SPEAKER_08: Of oxidative stress.
• 1:03:48
  SPEAKER_08: Can they do DNA repair?
• 1:03:50
  SPEAKER_08: And they actually do not for the most part.
• 1:03:53
  SPEAKER_08: Wow.
• 1:03:54
  SPEAKER_08: Yeah.
• 1:03:54
  SPEAKER_08: Skincare is really what becomes the most interesting, you know, to me now, as a way to enhance what we do and also protect what it is that we're doing.
• 1:04:03
  SPEAKER_08: Or for somebody who doesn't want to have an in-office treatment, and a lot of that, you know, during the pandemic, people were staying home more.
• 1:04:10
  SPEAKER_08: That's where skincare, I think, really, really, really had a chance to shine.
• 1:04:15
  SPEAKER_08: And so that's really interesting.
• 1:04:17
  SPEAKER_08: So I've been really interested right now in using autologous, you know, using platelet-rich plasma for skincare.
• 1:04:24
  SPEAKER_08: And so there is a method, you know, there is a way to do that.
• 1:04:28
  SPEAKER_08: And so that's just kind of next level in terms of.
• 1:04:30
  SPEAKER_11: What does that provide?
• 1:04:31
  SPEAKER_11: What like what does that do for us?
• 1:04:33
  SPEAKER_08: Like, can you can you tell us about the technology and the and the science behind that?
• 1:04:36
  SPEAKER_08: Yeah.
• 1:04:36
  SPEAKER_08: Yeah.
• 1:04:37
  SPEAKER_08: So the science, and this has been studied.
• 1:04:38
  SPEAKER_08: Dr.
• 1:04:39
  SPEAKER_08: Zoe Dreilos has actually done uh blinded studies and and vehicle controlled studies.
• 1:04:44
  SPEAKER_08: So it's basically it's a serum that is that that creates an environment to protect and preserve the activity of the platelets, which are loaded with growth factors.
• 1:04:55
  SPEAKER_08: So, in very much the same way if when anybody's had a platelet-rich plasma done, whether for hair loss or for uh after a laser resurfacing, you know, for wound healing or injected, this is now done where it's the platelet-rich plasma.
• 1:05:09
  SPEAKER_08: And then it's it's it's you know, it's so it's the patient's own platelets.
• 1:05:15
  SPEAKER_08: And then those are actually produced those are added to a serum that it's actually refrigerated, so you have like a one-month supply of each.
• 1:05:22
  SPEAKER_08: So every three months, yes, the downside is every three months you have to go in and get your PRP done.
• 1:05:27
  SPEAKER_08: But the real upside is that you're using your own growth factors, it's not derived from anybody else.
• 1:05:33
  SPEAKER_08: Yeah, it's and the serum does not allow the growth of any viruses, any bacteria.
• 1:05:39
  SPEAKER_08: That's also been studied.
• 1:05:41
  SPEAKER_08: There is no, God forbid, there was a mistake, and somebody, you know, was the accidentally had transmitted an infected plasma, you know.
• 1:05:48
  SPEAKER_08: I don't know, it won't grow in that.
• 1:05:52
  SPEAKER_08: It will not.
• 1:05:52
  SPEAKER_08: So it's another level safety, but at the same time, the growth factors can then target our own cells to do.
• 1:06:00
  SPEAKER_08: They normally do, but do it better.
• 1:06:02
  SPEAKER_08: And you know, everything slows down as we get older.
• 1:06:04
  SPEAKER_08: So I think it's kind of like I always say it's like you know, charging your battery or using both bump uh jumper cables, you know, to kind of boost that charge.
• 1:06:12
  SPEAKER_08: It's so it's really great for evening out skin tone, uh, decreasing the appearance of pores, the uh you know, treating kind of fine lines and wrinkles.
• 1:06:22
  SPEAKER_08: But the great thing is that you can use it right after a treatment, or you can use it as a standalone.
• 1:06:27
  SPEAKER_08: So I really like it.
• 1:06:28
  SPEAKER_08: And so again, there's peer-reviewed uh journal studies that show that it does improve the appearance of skin and reduces the appearance of photo damage, it improves collagen and plastin.
• 1:06:41
  SPEAKER_08: So that that's what I really like about it.
• 1:06:43
  SPEAKER_08: And there isn't another thing on the market like it.
• 1:06:46
  SPEAKER_08: It's called so me.
• 1:06:47
  SPEAKER_08: I know I used to thought it was called some, but no, it's so me.
• 1:06:51
  SPEAKER_08: Yeah, and so it's it's neat.
• 1:06:54
  SPEAKER_08: And so what's great about it is that, you know, most most of the in terms of offices that are already doing platelet rich plasma, whatever device they have that that generate, you know, that's used to do that, it doesn't have to be a special device that only goes with that serum.
• 1:07:09
  SPEAKER_08: So as long as people already are successfully using PRP, it's a very easy, easy add-on to a practice.
• 1:07:17
  SPEAKER_08: And again, it's it's a product that from you know, as a physician, um, it really I think provides like the ultimate like safety in skincare for the patient who's worried about putting on things that are you know animal derived or or from a human donor, let's say, or you know, if they have how do you feel about that though, as a scientist?
• 1:07:36
  SPEAKER_11: Like, and be and I'm asking honestly, because I am so split on that.
• 1:07:40
  SPEAKER_11: Like, in terms of like, you know, like I know that we want things to be cruelty-free, and obviously we don't want human testing on a lot of things, but when it comes to skin health, and especially everything you just described, I'm thinking of this, you know, from a research standpoint.
• 1:07:53
  SPEAKER_11: I'm thinking of a petri dish, right?
• 1:07:54
  SPEAKER_11: And you have the right medium that you put on top of it so that it can the cells can grow optimally, you know, right?
• 1:08:00
  SPEAKER_11: So, like, that's what I'm thinking when you're describing this.
• 1:08:02
  SPEAKER_11: But then at the same time, I'm wondering how will we ever know if this works for skin health if we're not using human testing, right?
• 1:08:09
  SPEAKER_11: If we're not doing that.
• 1:08:10
  SPEAKER_11: So, what are your thoughts around that?
• 1:08:12
  SPEAKER_08: So, if we're talking about this particular system, the PRP, yeah, uh, you know, of course there's variation, right?
• 1:08:19
  SPEAKER_08: Because my thoughts have always been okay, with platelet-rich plasma, you're you're using the person's own growth factors to target their own cells, right?
• 1:08:27
  SPEAKER_08: And if their own cells already got them to where they are, what's the guarantee that, you know, putting more of the same thing on the same cells, that the same is responding, how is that really gonna work?
• 1:08:38
  SPEAKER_08: But these are concentrated amounts, these now become more than physiologic amounts, these become almost pharmacologic amounts.
• 1:08:44
  SPEAKER_08: So you're putting on more, just like it might just take more to get to the same, you know.
• 1:08:49
  SPEAKER_08: Maybe it takes, maybe it's like like let's say a car that gets older, it's mileage, it's not as efficient as when it was a younger car, right?
• 1:08:55
  SPEAKER_08: It's still gonna go distance, it's just gonna take a little more fuel to get there.
• 1:08:59
  SPEAKER_08: And so that's how I see that.
• 1:09:01
  SPEAKER_08: The reason that I know that SOME works is because there's the biopsy-controlled study.
• 1:09:06
  SPEAKER_08: There's a biopsies using the serum compared to the serum with the PRP to show that there really is improvement.
• 1:09:14
  SPEAKER_08: So there's actually histology studies to show that the benefit is not just visually, it's not just dependent on our eyes or a patient telling us, you know, this looks better, but actually proving through biopsies and special stains that there has been actually an improvement in skin wellness.
• 1:09:31
  SPEAKER_08: Now, if people don't change their habits and they're they're bent on getting sun and smoking and and ingesting, you know, not not having a good diet.
• 1:09:40
  SPEAKER_08: I mean, well, what is the best?
• 1:09:41
  SPEAKER_11: That's like countering the effects of the good, you know, that really is.
• 1:09:44
  SPEAKER_11: And especially, you know, going back to your point about free radical formation.
• 1:09:48
  SPEAKER_11: I mean, I think that's a very hot topic in skincare right now.
• 1:09:51
  SPEAKER_11: And I remember when I first um really got into it.
• 1:09:54
  SPEAKER_11: I I'm so glad, by the way, that you validated my um my understanding of using skincare for combating free radical damage because when I discovered this brand, uh Neode, they had this mist called um superoxide dismutase mist.
• 1:10:08
  SPEAKER_11: And as soon as I saw that, I was like, this is brilliant.
• 1:10:11
  SPEAKER_11: Like this is brilliant.
• 1:10:12
  SPEAKER_08: They really are.
• 1:10:13
  SPEAKER_08: And right now, you know, hot topic also being uh, you know, you blue light, high energy, um, you know, the high energy blue violet uh light, things that are emitted from devices, also, you know, being able to wreak havoc on the skin.
• 1:10:27
  SPEAKER_08: And, you know, people are so focused in it.
• 1:10:29
  SPEAKER_08: And it does take a long time to educate the public, the consumer, our patients about skincare and why we really should be very good about using it.
• 1:10:38
  SPEAKER_08: It doesn't have to be a 12-step regimen, but we know that you know, people are so used to UVA and UVB, and they think of UV radiation in total as just the the sunburner, the tanning, and they kind of forget that the whole spectrum also encompasses visible light and infrared light.
• 1:10:56
  SPEAKER_08: And as the wavelength gets longer, the penetration goes deeper.
• 1:11:02
  SPEAKER_08: The shorter the wavelength, the more it reacts with the parts that are more superficial, which shorter wavelengths include UVB and UVA, but UVB is still shorter and it targets that DNA in the upper skin cells, and it does, you know, lead to sunburn and mutations and skin cancers and all of that.
• 1:11:21
  SPEAKER_08: But the ones that penetrate more deeply, like UVA, blue light, and infrared, can age the skin in different ways because they cause breakdown of collagen.
• 1:11:31
  SPEAKER_08: They do cause thinning in deeper layers, leading to more wrinkles and sagging.
• 1:11:36
  SPEAKER_08: So all of it together, and actually, blue light can all visible light can also trigger discoloration.
• 1:11:41
  SPEAKER_08: And you know, we're kind of a global, we're a global society now, and and skin of color and diversity being a hot topic as well.
• 1:11:49
  SPEAKER_08: Yeah, it's but it's also realistic.
• 1:11:51
  SPEAKER_08: It's not that it's just a trending topic, it's just something we've we have overlooked for so many years.
• 1:11:56
  SPEAKER_08: It's really important to educate our patients that do have um that do have darker skin types, that they might actually be more susceptible to some of the the damage from infrared and visible light through different pathways.
• 1:12:11
  SPEAKER_08: Maybe they won't sunburn as much because melanin is a natural sunscreen, right?
• 1:12:16
  SPEAKER_08: But at the same time, there's still going to be it, it's not gonna stop the penetration of infrared and uh blue and blue light, visible light.
• 1:12:25
  SPEAKER_08: So to me, these are just really interesting things.
• 1:12:27
  SPEAKER_08: And as you said, back to antioxidants, being able to neutralize some of those free radicals to then decrease the body's inflammatory response.
• 1:12:37
  SPEAKER_08: That's where it all plays together.
• 1:12:38
  SPEAKER_08: And that's what skincare can do so well for us.
• 1:12:42
  SPEAKER_08: I love that.
• 1:12:43
  SPEAKER_11: I love that you explained the role of skincare and skin health because this has been such a great topic or area for me, especially, because you know, on one side you have hardcore, you know, medical practitioners saying you don't like, you know, forget the big skincare industry, you know, come go straight to a dermatologist, but then you also have them selling skincare in the offices.
• 1:13:03
  SPEAKER_11: You know what I mean?
• 1:13:04
  SPEAKER_11: So, like you explaining this is very interesting and it makes so much more sense.
• 1:13:08
  SPEAKER_11: I love that.
• 1:13:09
  SPEAKER_11: Thank you for explaining that.
• 1:13:10
  SPEAKER_11: Now, one question I have um you mentioned that everyone is susceptible to different types of damage depending on the wavelengths of light.
• 1:13:17
  SPEAKER_11: Now, how do you feel about all of these LED masks that are coming out that are over the counter?
• 1:13:22
  SPEAKER_11: Like, do you think that they're doing more harm than good, or is this something that consumers should get behind when it comes to skincare?
• 1:13:29
  SPEAKER_08: I think it depends on the light and how it's used, and are people capable of following directions?
• 1:13:34
  SPEAKER_08: Because you know how how we are as human beings.
• 1:13:37
  SPEAKER_08: It's like if a little bit is good, more is better.
• 1:13:40
  SPEAKER_08: So it also depends on the wavelength.
• 1:13:42
  SPEAKER_08: And we know that certain wavelengths from LED, if we're talking kind of like the orange, red, more anti-inflammatory.
• 1:13:49
  SPEAKER_08: So if you can suppress that inflammation, that can be beneficial.
• 1:13:52
  SPEAKER_08: I mean, blue light, yes, it can be good for some things for you know, for fighting bacteria, for acne, but we know some of the over-the-counter devices were were, you know, withdrawn from the market because of the possibility.
• 1:14:03
  SPEAKER_08: Theoretical didn't happen, but theoretical concern that if people use them for too long, could it damage the eyes?
• 1:14:10
  SPEAKER_08: Right.
• 1:14:11
  SPEAKER_08: Right.
• 1:14:11
  SPEAKER_08: So again, I I think that used as they were designed to be used, we can use like orange light, red light as a call for a calming effect.
• 1:14:21
  SPEAKER_08: Many years ago, I remember there was a device in LED panels.
• 1:14:25
  SPEAKER_08: I think it was called, I can't remember if it was called like gentle waves or gentle something, but it wasn't the hair removal.
• 1:14:31
  SPEAKER_08: It was one that you was in office where you sat in front of these light bulbs, you know, the LED lights.
• 1:14:36
  SPEAKER_08: And they had they showed that used after three months, the effects you know on wrinkled on fine lines around the eyes was very similar to um having used a retinoic acid, a tretinoin cream, a prescription retinoid.
• 1:14:49
  SPEAKER_08: So I think that it can help and all of that, but again, if it's just being used as a solo, you know, as a monotherapy and not with everything else, yeah, uh, it's just not going to um, you know, it's not gonna have the maximum effect.
• 1:15:04
  SPEAKER_08: So I circle back to skincare, I circle back to photo protection and um all of that because very much like you wouldn't send like one soldier out to fight a battle.
• 1:15:17
  SPEAKER_08: Yeah, you send a whole bunch of them.
• 1:15:19
  SPEAKER_08: You may have a star warrior in the group or a star basketball player, but it really takes a team to really get things under control.
• 1:15:27
  SPEAKER_08: And skincare is part of that, is one of the essentials of the team, just like you know, there are other essentials as well.
• 1:15:35
  SPEAKER_08: So sleeping, exercising, eating well, and there's just certain things that we know will benefit.
• 1:15:42
  SPEAKER_08: So that's that's how I see skincare.
• 1:15:44
  SPEAKER_08: I love that in control.
• 1:15:46
  SPEAKER_11: I love that.
• 1:15:47
  SPEAKER_11: Thank you so much for for clarifying that.
• 1:15:49
  SPEAKER_11: Now, one um one more question I have is about SPF, because you know, obviously we want to protect our skin.
• 1:15:55
  SPEAKER_11: And um, you know, when it comes to SPF, how do you feel about, you know, I know you spoke of growth factors earlier and and certain other you know components that really help with um reducing some of the damage or really actually repairing.
• 1:16:08
  SPEAKER_11: So, how do you feel about the hybrid um of sunscreen with something that is more rich in, like, for example, growth factors or peptides or whatever it is that you think um could really benefit um our skin?
• 1:16:22
  SPEAKER_08: I'm all for a multitasking, you know, as long as it's multitasking uh photo protection or environmental protection, as I like to call it.
• 1:16:29
  SPEAKER_08: Yeah, because people should still wear it if they're sitting in front of their screens all day or sitting by windows, even if they're not outside on, you know, on vacation or something, right?
• 1:16:37
  SPEAKER_08: Or or doing outdoor activities.
• 1:16:39
  SPEAKER_08: So the idea of using, and there's several commercially available products right now, you know, that have, for example, uh a sunscreen, you know, sun filter, a UV filter paired with DNA repair or paired with antioxidant.
• 1:16:53
  SPEAKER_08: Like anything else, I'm not a formulator, but I will talk to formulators and talk to skin, you know, cosmetic chemists and say, okay, it's great you have this combo, but are the ingredients individually available, right?
• 1:17:06
  SPEAKER_08: What's the bioavailable?
• 1:17:07
  SPEAKER_08: Because they're mixed in together, does that mean that it's really getting to the skin?
• 1:17:11
  SPEAKER_08: Or are they in amounts that are effective that can actually do something, right?
• 1:17:16
  SPEAKER_08: So one of our favorite sunscreens has been one that also has 5% niacinamide in it.
• 1:17:23
  SPEAKER_08: And niacinamide being such a great antioxidant, great for the immune system and the skin, pigment regulator, anti-acne.
• 1:17:31
  SPEAKER_08: I mean, it does a whole multitude of things.
• 1:17:34
  SPEAKER_08: And so having that in a sunscreen, for example, if I like if I have a young acne patient and they're they're put on a medication, and I'm telling them, don't even think of this as a sunscreen, think of this as additional treatment for your breakouts to help with the marks that are left behind, to help you have a better skin barrier so that you're not as prone to sensitivity from the medication.
• 1:17:54
  SPEAKER_08: So I think the combination ones are great as long as they've been shown to be effective.
• 1:18:02
  SPEAKER_11: That's I mean, I that makes total sense to me.
• 1:18:04
  SPEAKER_11: And I actually have a question because you brought up acne about acne scarring, because I know for me as a woman of color, I one of my biggest problems with skin has been um, you know, I had acne as a teenager and I had gone to a dermatologist who's on antibiotics, whole nine yards.
• 1:18:20
  SPEAKER_11: But um, one thing I suffered with was these indentation like scars for my acne.
• 1:18:25
  SPEAKER_11: Now, if you have that kind of scarring versus just hyperpigmentation, like how can we deal with that kind of um damage to our skin post, you know, acne flare-ups and whatnot?
• 1:18:36
  SPEAKER_08: Sure.
• 1:18:36
  SPEAKER_08: So if you have, there's there's several things that you can do, right?
• 1:18:40
  SPEAKER_08: Any type of scar, and there's different kinds of scars in acne, right?
• 1:18:43
  SPEAKER_08: Because there is just post-inflammatory hyperpigmentation.
• 1:18:46
  SPEAKER_08: There are also what are called ice pick scars that look just like what it sounds like, right?
• 1:18:52
  SPEAKER_08: There's also what are called rolling scars, which are the ones more like what you're describing, where you have an indentation.
• 1:18:57
  SPEAKER_08: Yeah, and if you actually pull on the skin tight, it makes it look like the scar goes away.
• 1:19:02
  SPEAKER_12: Yeah.
• 1:19:03
  SPEAKER_08: Rolling scars are some of my favorite because those you can really treat nicely with devices.
• 1:19:10
  SPEAKER_08: Oh, really?
• 1:19:10
  SPEAKER_08: You know, you can do it with devices, or but you can also do it with skincare because anything that's done to stimulate collagen production, to help build more collagen, because a scar is basically a loss, a focal loss of collagen in a specific area.
• 1:19:26
  SPEAKER_08: So if you can help build that collagen by stimulating production, you know, production of that protein, but also minimizing free radical damage, then a good skincare regimen is gonna help.
• 1:19:36
  SPEAKER_08: At least it's not gonna allow it to progress.
• 1:19:39
  SPEAKER_08: But things that also work are, for example, I like what are called biostimulatory fillers, something like polyel lactic acid.
• 1:19:47
  SPEAKER_08: Um, for example, also known as sculptor aesthetic, or um that can be used to help thicken the skin underneath and improve the appearance of the scars.
• 1:19:56
  SPEAKER_08: Right.
• 1:19:56
  SPEAKER_08: Um really well.
• 1:19:58
  SPEAKER_08: But another favorite treatment is microneedling with radio frequency, because with microneedling, you're creating very controlled wounds, which of course now the body has to clot, right?
• 1:20:08
  SPEAKER_08: So it has those little platelets that are rich in growth factors.
• 1:20:11
  SPEAKER_08: So that's one way, it's like doing like little micro PRP, you know, with microneedling, but then radio frequency, which helps tissue with tissue tightening and making that skin more taut, that also helps a lot.
• 1:20:23
  SPEAKER_08: So doing devices, and we also know that, for example, microneedling, there are you can, for example, apply apply a serum afterwards, whether it be like one's own PRP, you know, where you have extra absorption of those growth factors, or whether you want more antioxidants like vitamin C, vitamin E that can.
• 1:20:44
  SPEAKER_08: So you can then start doing those combinations where you have what's called basically a device-assisted uh skincare delivery.
• 1:20:52
  SPEAKER_11: That's that's very interesting.
• 1:20:53
  SPEAKER_11: Now, if when it comes to like creating um channels in our skin, I know there are a lot of at-home rolling devices that have like small needles, you know, and and I know that a lot of people use them.
• 1:21:05
  SPEAKER_11: Unfortunately, a lot of people also hurt themselves using them.
• 1:21:08
  SPEAKER_11: But um, does that really work in terms of doing that and then putting on your serums afterwards?
• 1:21:13
  SPEAKER_11: Because I know a lot of companies, you know, they claim like, well, if you use this device first, then you do your skincare, the efficacy of your skincare is gonna go up.
• 1:21:21
  SPEAKER_11: And I'm just like, I don't understand that.
• 1:21:24
  SPEAKER_08: I don't know if that makes sense.
• 1:21:25
  SPEAKER_08: I mean, I'm very confused about it.
• 1:21:27
  SPEAKER_08: I know such companies and I've consulted for companies that have this, but here's the thing if you've got a skincare, if you have a home microneedling device, it's usually a roller.
• 1:21:36
  SPEAKER_08: Yeah, not getting into all the physics.
• 1:21:38
  SPEAKER_08: When you roll a device on the skin, think of like a rolling pin, like you use for like, you know, rolling out dough if you're you know if you're baking or something.
• 1:21:46
  SPEAKER_08: Yeah, yeah.
• 1:21:47
  SPEAKER_08: The angle at which the needle inserts, it definitely has more potential for damage because it's not going in at a perfect perpendicular, it's not going in perfectly perpendicular, 90-degree angle.
• 1:21:57
  SPEAKER_08: And it can be more trauma by kind of tearing at the skin.
• 1:22:00
  SPEAKER_08: Also, needle sharpness is not necessarily guaranteed.
• 1:22:04
  SPEAKER_08: So, all of that are things that we you know we have to think about when we're doing these treatments at home.
• 1:22:11
  SPEAKER_08: The other thing is the depth of penetration.
• 1:22:13
  SPEAKER_08: If if it's all you know, like if we're talking about for scarring, for example, the needle isn't getting deep enough to even impact the collagen.
• 1:22:20
  SPEAKER_08: So, really, it just becomes about making the epidermis, just the outer layer, the stratum of corneum, slightly more permeable.
• 1:22:26
  SPEAKER_08: So I'm not sure that I'm completely convinced.
• 1:22:30
  SPEAKER_08: Right, right.
• 1:22:31
  SPEAKER_08: You and me both.
• 1:22:32
  SPEAKER_08: Yeah, but so I really would like to see some biopsy, you know, some studies with some controls, skincare versus the device plus skincare.
• 1:22:40
  SPEAKER_08: And uh, and of course, these studies can get expensive, they need to go on for at least three months, they need to be blinded, you know, blinded evaluator.
• 1:22:48
  SPEAKER_08: Uh, the person having the treatment done can't be blinded because you can't blind a microneedling device unless you have like just a very smooth thing, just because it's gonna be different.
• 1:22:57
  SPEAKER_08: So I think science still has to really drive our decisions in skincare.
• 1:23:03
  SPEAKER_08: But we also know that it's not, you know, not everything can be a rigorous trial that way.
• 1:23:10
  SPEAKER_08: So, and then we go back to the whole fact that cosmetics, all of what we're talking about, skincare, with the exception of sunscreens, which are regulated as over-the-counter drugs by the Food and Drug Administration, skincare does not have the oversight of the FDA.
• 1:23:25
  SPEAKER_08: So, other than certain substances that have, you know, been banned from skincare, you know, worldwide, it's just really wildly unregulated.
• 1:23:33
  SPEAKER_08: So there's there's a lot.
• 1:23:35
  SPEAKER_08: There's more, you know, the more you you delve into it, as you know, I'm the same thing happens to you, as I'm sure as happens to me, is like the more the more you read and the more you you delve into it, the more questions you have.
• 1:23:45
  SPEAKER_08: Yes, exactly.
• 1:23:45
  SPEAKER_11: And the more you realize that there are huge white spaces in the understanding in dermatology, you know, in dermatology.
• 1:23:51
  SPEAKER_11: I mean, that's something I think I've been trying to put that message out there is that you know, you've got for from the consumer standpoint, you can't simply say, well, this doesn't work for me and it's a bad product.
• 1:24:02
  SPEAKER_11: No, because we can't formulate something that we have no data about, you know.
• 1:24:08
  SPEAKER_08: And it isn't one size fits all.
• 1:24:09
  SPEAKER_08: And we do have unique, you know, you know, people somebody who lives at uh in Denver is not going to have the same needs as somebody who lives in Miami, right?
• 1:24:17
  SPEAKER_08: And we talk about if we even talk about altitude, right?
• 1:24:20
  SPEAKER_08: For every kilometer we go up uh in altitude, we go up and it's 1.6 kilometers is a mile, but we go we get 10 to 25 percent more UV radiation.
• 1:24:30
  SPEAKER_08: So the role of photo protection or sunscreens becomes that much more vital at higher altitudes.
• 1:24:36
  SPEAKER_11: Wow, I had no idea about that.
• 1:24:37
  SPEAKER_11: That's very interesting.
• 1:24:38
  SPEAKER_08: Well, yeah, one time, whenever you want, we'll do it just to talk on just sunscreens and photos.
• 1:24:42
  SPEAKER_08: Yes, please.
• 1:24:43
  SPEAKER_08: Oh my gosh, please come back if you have the time.
• 1:24:46
  SPEAKER_08: I would love to have you back.
• 1:24:48
  SPEAKER_08: Sure.
• 1:24:48
  SPEAKER_08: Well, I really appreciate the opportunity to have this discussion with you.
• 1:24:52
  SPEAKER_08: I think it's a lot of fun, and I love when they're whenever there's a chance to try to clear up some of those, you know, skincare myths that are out there.
• 1:24:59
  SPEAKER_11: Absolutely.
• 1:25:00
  SPEAKER_11: And it's been such an honor hosting you, Dr.
• 1:25:02
  SPEAKER_11: Bucai.
• 1:25:03
  SPEAKER_11: Thank you so much for your time.
• 1:25:04
  SPEAKER_11: And everyone out there, if you have any questions for Dr.
• 1:25:06
  SPEAKER_11: Bukai, please leave them in the concept art for this um this segment of the episode.
• 1:25:11
  SPEAKER_11: Thank you so much, Doc.
• 1:25:12
  SPEAKER_11: Thank you.
• 1:25:16
  SPEAKER_11: Next guest is Dr.
• 1:25:17
  SPEAKER_11: Ava Shambin.
• 1:25:18
  SPEAKER_11: Um, she is a cosmetic dermatologist and owner of Ava MD and Skin 5.
• 1:25:23
  SPEAKER_11: Um, she is a renowned board-certified dermatologist and truly a visionary.
• 1:25:28
  SPEAKER_11: Um, Dr.
• 1:25:28
  SPEAKER_11: Shambin has been on the editorial board um for New Beauty magazine.
• 1:25:33
  SPEAKER_11: She's always featured in big publications like Allure, Bazaar, um, Wall Street Journal.
• 1:25:38
  SPEAKER_11: She's been on L, um, MSN, Yahoo Many.
• 1:25:42
  SPEAKER_11: So um, without further ado, I I want to introduce you guys to Dr.
• 1:25:45
  SPEAKER_11: Shambin.
• 1:25:45
  SPEAKER_11: Dr.
• 1:25:46
  SPEAKER_11: Shannon, thank you so much for making the time for our show.
• 1:25:48
  SPEAKER_11: Oh, I'm so happy to be here.
• 1:25:51
  SPEAKER_11: It's such a pleasure to host you.
• 1:25:52
  SPEAKER_11: I would I would love to um to learn more about your background because I know I covered very little.
• 1:25:57
  SPEAKER_11: So well, I've had a spotty background.
• 1:26:01
  SPEAKER_05: Um, a very impressive background, I would say.
• 1:26:05
  SPEAKER_05: Well, I actually did I actually did a lot of I started out in bench research, like in a laboratory looking at the expression of the collagen and elastin gene.
• 1:26:15
  SPEAKER_05: So a lot of my background really begins from a very science-oriented perspective.
• 1:26:20
  SPEAKER_05: Then I um I went undergrad to Harvard and then I went to medical school at Case Western in Cleveland.
• 1:26:25
  SPEAKER_11: Oh my gosh, I'm an alum of Case Western!
• 1:26:28
  SPEAKER_05: You are?
• 1:26:28
  SPEAKER_05: It's the best one.
• 1:26:29
  SPEAKER_11: Yes, I got my master's in medical physiology there.
• 1:26:32
  SPEAKER_10: Oh my gosh.
• 1:26:34
  SPEAKER_10: The best school ever.
• 1:26:35
  SPEAKER_10: It's the best school ever, absolutely.
• 1:26:38
  SPEAKER_10: Go ahead, I interrupted you though.
• 1:26:40
  SPEAKER_05: Yeah, no, not at all.
• 1:26:41
  SPEAKER_05: And so then I so then I um let's see, I worked for actually Howard Murad, who came up really, he was one of the big creators of glycolic acid and its use in skincare.
• 1:26:52
  SPEAKER_05: And then I opened my own practice, and then shortly after I opened my own practice, I started to do, and I it was so I was there at the very beginning of I would say aesthetic medicine, where we just started, like when I first bought my practice, we had three lasers, and that's like all that there were.
• 1:27:11
  SPEAKER_05: Um, and there was just injectable collagen, there was no Botox, there was no all these hyaluronic acid fillers, and so I was privileged to be at the very beginning of all of this work.
• 1:27:21
  SPEAKER_05: And then over the years, I so I did all the dermatology for the show Extreme Makeover, which was the most profound experience of my career because I just saw how transformative it was to people's lives when they felt better about how they looked.
• 1:27:37
  SPEAKER_02: Right, right.
• 1:27:38
  SPEAKER_05: That was one part, and then the other the other big part of my career now, too, is I do a lot of clinical trials.
• 1:27:44
  SPEAKER_05: So basically, everything that you have injected into you, I've been a clinical investigator for.
• 1:27:50
  SPEAKER_05: And so these, of course, are for companies and we prepare them.
• 1:27:53
  SPEAKER_05: We do the data for FDA approval of their use, and I've done that for lasers too.
• 1:27:59
  SPEAKER_05: So And then I also in recent years I opened up the Skin Fives because I felt that it was really important for people to have the opportunity to do prejuvenation procedures.
• 1:28:11
  SPEAKER_02: Yeah.
• 1:28:12
  SPEAKER_05: Distilled it down to five treatments for a face and five treatments for body.
• 1:28:16
  SPEAKER_05: And then finally, most recently, I just started a subscription box because there's no dermatologist curated subscription box for skincare called Oh my gosh, I'm totally getting it.
• 1:28:26
  SPEAKER_05: First of all, that's amazing.
• 1:28:29
  SPEAKER_05: It's really good.
• 1:28:30
  SPEAKER_05: We just are having our second box come out for the spring.
• 1:28:33
  SPEAKER_05: Wow.
• 1:28:34
  SPEAKER_05: Yeah.
• 1:28:34
  SPEAKER_05: So those are, you know, that's kind of like that's the highlights.
• 1:28:38
  SPEAKER_05: Oh, yeah.
• 1:28:38
  SPEAKER_05: And I wrote a book called Heal Your Skin.
• 1:28:40
  SPEAKER_05: Yes, I saw that.
• 1:28:42
  SPEAKER_11: I I'm I'm so impressed.
• 1:28:43
  SPEAKER_11: You have done so much, Dr.
• 1:28:44
  SPEAKER_11: Shan.
• 1:28:45
  SPEAKER_11: But how do you how did you do that, first of all?
• 1:28:48
  SPEAKER_05: Well, I think in order to be able, in order to have a wide range in your career, you have to be able to delegate.
• 1:28:56
  unknown: Yeah.
• 1:28:56
  SPEAKER_05: You have to figure out what you need to supervise and make happen.
• 1:29:00
  SPEAKER_05: And then what other people can help you.
• 1:29:02
  SPEAKER_05: And you have to be able to share the credit and to share, you know, share responsibility.
• 1:29:09
  SPEAKER_05: And so and share and share your money.
• 1:29:12
  SPEAKER_05: So I just feel really grateful.
• 1:29:14
  SPEAKER_05: And actually, one of my one of the things I'm most proud of is that I have I've I employ 50 women, um, most of whom are the primary wage earners in their family.
• 1:29:24
  SPEAKER_05: And so I'm just so excited.
• 1:29:25
  SPEAKER_11: Wow.
• 1:29:25
  SPEAKER_11: Yeah.
• 1:29:26
  SPEAKER_11: Wow, that is truly, truly, truly impressive.
• 1:29:29
  SPEAKER_11: I'm I'm in shock.
• 1:29:30
  SPEAKER_11: That's amazing.
• 1:29:32
  SPEAKER_11: I love that.
• 1:29:33
  SPEAKER_11: So I I actually have some questions for you because obviously um you are the expert.
• 1:29:38
  SPEAKER_11: And I and I want to know about you know how much skincare is enough.
• 1:29:43
  SPEAKER_11: I mean, do we need skincare?
• 1:29:45
  SPEAKER_11: How beneficial is it?
• 1:29:47
  SPEAKER_11: You know, what have you noticed with with your background and your your experience um in the field?
• 1:29:53
  SPEAKER_05: Skin care.
• 1:29:54
  SPEAKER_05: So um, skincare, I would say the best analogy is like dentistry.
• 1:29:59
  SPEAKER_05: So if you go to the dentist and you have your teeth cleaned once a year, twice a year, three times a year, and then you never brush your teeth, do you think that your teeth are gonna still look good?
• 1:30:08
  SPEAKER_05: And the answer is, you know, if you wash your hair like once a month or something and then you never brush it, is it gonna look good?
• 1:30:15
  SPEAKER_05: The answer is no.
• 1:30:17
  SPEAKER_05: And so I think people they tend to discount the value of skincare, but in fact, it's just as essential as having an in-office procedure because you're just never gonna see the full result of the procedure and you're never gonna maintain the result.
• 1:30:31
  SPEAKER_05: So skincare is is just it's a cornerstone of all beauty treatments for sure.
• 1:30:37
  SPEAKER_11: No, I I want to know um what your opinion is about just you know a normal skincare routine.
• 1:30:43
  SPEAKER_11: I know that everyone's looking for their ideal skincare routine.
• 1:30:46
  SPEAKER_11: What are some things that you think are absolutely important for almost everybody?
• 1:30:51
  SPEAKER_11: Um, other than SPF, obviously, I think everyone wants to say SPF.
• 1:30:55
  SPEAKER_05: Well, you know, it's really interesting because the Korean community they love doing like multiple steps, and so I don't know, they get up a half hour earlier or more like an hour or an hour, so they can do like nine different things to their skin, and honestly, when they do it, skin looks really good.
• 1:31:12
  SPEAKER_05: But you know, us Americans, we don't really have time for all of that, we're multi-tacking away.
• 1:31:17
  SPEAKER_05: So, what do I think is important?
• 1:31:18
  SPEAKER_05: Well, obviously, sunscreen, sun protection, because that is the number one um you know um preventable cause of skin aging.
• 1:31:30
  SPEAKER_05: And then uh the other thing I really like is I do like something at retinoid, and I know everybody's like, oh, the dermatologist, all she says is sun screen, you know, her retinoids, you know.
• 1:31:41
  SPEAKER_05: Well, but the truth is that retinoids can do so much for your skin, yeah.
• 1:31:46
  SPEAKER_05: Evening out the pigment from evening out the pigment layer from helping reverse precancerous changes to increasing collagen production, eliminating fine lines and wrinkles, giving you an even texture, you know, it goes on and on and on.
• 1:31:57
  SPEAKER_05: Um, the trick with the retin the retinoids is pairing it with something to reduce the irritation because in Southern California, obviously it's very dry.
• 1:32:05
  SPEAKER_05: So I like to pair it with a hyaluronic acid and a vitamin C.
• 1:32:08
  SPEAKER_05: So, what do I think is essential?
• 1:32:10
  SPEAKER_05: I think that in the morning, if you can put on some kind of an antioxidant under your sunscreen, yeah, I think that's really important.
• 1:32:17
  SPEAKER_05: In the morning, it shouldn't be that much of an effort to cleanse your face unless you have oily skin and are and are prone to acne.
• 1:32:24
  SPEAKER_05: I think that in the afternoon now, I think for people who are prone to getting maskne, which is just about everybody, or even mask rosacea, that when you take your mask off and you obviously want to treat your mask like your underwear and wash it every day, that then you can put on something soothing, even if it's like an aloe gel or a toner that has antioxidants and anti-inflammatories in it.
• 1:32:47
  SPEAKER_05: And then at night, that's your opportunity to put a peptide on.
• 1:32:51
  SPEAKER_05: So one of the growth factor um products, you could put another antioxidant, never hurts.
• 1:32:58
  SPEAKER_05: Um, and then sometimes an emollient uh moisturizer.
• 1:33:02
  SPEAKER_05: So, how many steps is that?
• 1:33:04
  SPEAKER_05: I mean, you know, three steps maybe.
• 1:33:07
  SPEAKER_05: Yeah, it's about three.
• 1:33:08
  SPEAKER_12: You're right.
• 1:33:09
  SPEAKER_05: Yeah, and so it shouldn't take that long.
• 1:33:10
  SPEAKER_05: So yeah, do it.
• 1:33:11
  SPEAKER_11: So, I mean, I want to ask you about peptides because what is exactly like in from a skincare standpoint, I get so confused because when I think of peptides, I think of um stability of things like this, right?
• 1:33:24
  SPEAKER_11: And then when you're putting it in skincare and it's like mass marketed, like I mean, how effective are they?
• 1:33:30
  SPEAKER_11: How do they work?
• 1:33:31
  SPEAKER_11: What are some of your recommendations for people who want to go out there and and buy a product that is uh you know a peptide product?
• 1:33:38
  SPEAKER_05: So excellent questions.
• 1:33:39
  SPEAKER_05: So peptides are little short chains of proteins and they act like what are called cytokines, where they they message from cell to cell.
• 1:33:49
  SPEAKER_05: And so the message may be to the cell, you know, reproduce yourself turnover.
• 1:33:54
  SPEAKER_05: Um, or the message may be to the cell, ideally, you know, make some collagen, or the message may be to this to the cell, all right, relax, like for muscle, relaxing peptides.
• 1:34:04
  SPEAKER_05: You know, with cosmoceuticals, it's a it's a uh tricky road that the companies walk because if they show a real biological effect, then it becomes a pharmaceutical.
• 1:34:16
  SPEAKER_05: And so they usually, so with the claims, it usually reduces the appearance, you know, as opposed to reduces fine lines and wrinkles, it's always reduces the appearance of fine lines and wrinkles.
• 1:34:26
  SPEAKER_05: So you have to, but there has to be some data out there, and so I think that when you look to buy a peptide, you or a peptide-containing cream, you want to find something that actually has done some kind of a clinical trial to at least show that it reduces the appearance of fine lines and wrinkles or improves laxity because those and I have done some of those studies and they're real, so I think that's what you have to look for.
• 1:34:51
  SPEAKER_05: But which one is right for you?
• 1:34:53
  SPEAKER_05: That's a you know, that's a big question.
• 1:34:56
  SPEAKER_05: Yeah, that's a big question.
• 1:34:57
  SPEAKER_05: That's a big question.
• 1:34:58
  SPEAKER_05: I mean, I do like the the um TNS growth factor.
• 1:35:04
  SPEAKER_05: I do like that one, but I kind of mix and match my skincare, you know.
• 1:35:08
  SPEAKER_11: Well, I'm I'm curious also because when when I think about you know things like peptides or growth factors, I often wonder, um, well, how does it work in a formulation?
• 1:35:16
  SPEAKER_11: Because I'm I'm guessing, you know, things obviously molecules interact, you know, everyone knows that.
• 1:35:20
  SPEAKER_11: And I I'm curious, like from that standpoint of a product that is, you know, like a multi-use product, like or purpose product, I mean, how logical is that?
• 1:35:31
  SPEAKER_11: Because these molecules, are they stable enough to be in a formulation together for the most part, or are they are are there things that you want in isolation, like a serum that only has one specific type of peptide?
• 1:35:43
  SPEAKER_11: You know, if it if you're trying to go for collagen production, you know, boost that, you have that only in there.
• 1:35:49
  SPEAKER_11: So, like, can you explain that a little bit more if that makes sense?
• 1:35:52
  SPEAKER_05: Yeah, well, formulation is all about the quality of the chemist.
• 1:35:55
  SPEAKER_05: And there are certainly chemists who are known in the field to to produce really good formulations, because of course you don't want two ingredients in the in the formula to cancel each other out.
• 1:36:05
  SPEAKER_05: Yeah.
• 1:36:06
  SPEAKER_05: And in general, that's why you do see an antioxidant formula that may have, you know, more than one antioxidant in it, may have, you know, 10 antioxidants in it because they play well together.
• 1:36:16
  SPEAKER_05: With growth factors, they do tend to be, or with peptides, they do tend to be all by themselves.
• 1:36:22
  SPEAKER_05: And it and to your point, probably because they're unstable.
• 1:36:25
  SPEAKER_05: But something like TNS, what they've what they've how they've solved that problem is they have a dual chamber so that when you press on the top, like some cream comes out from each you know, from separate chambers, and they just mix right there in your hand, and then you can put them on, and so they're not going to destroy each other.
• 1:36:42
  SPEAKER_05: But yeah, that's interesting.
• 1:36:45
  SPEAKER_11: That's very interesting.
• 1:36:46
  SPEAKER_11: I I actually want to ask you because I know that you mentioned you did um bench research with collagen and being your the focus.
• 1:36:53
  SPEAKER_11: So, can you tell us something, um, a basic understanding of how collagen works in our skin layers and just for everybody listening out there to really understand the role of collagen in our skin health?
• 1:37:04
  SPEAKER_05: Okay, so collagen makes up 70% of the dry weight of skin.
• 1:37:09
  SPEAKER_05: So when I say dry weight, you know, you're taking out all the water, you're taking out the hyaluronic acid.
• 1:37:14
  SPEAKER_05: So it's it's most of the, you know, it's the it's the protein, they're they're triple helixes, they look like ropes in your skin, like tiny little ropes.
• 1:37:23
  SPEAKER_05: Um, that's number one.
• 1:37:24
  SPEAKER_05: The number two is that there are actually 13 types of collagen in your skin.
• 1:37:29
  SPEAKER_05: There's different types of collagen around the blood vessels, there's different types of collagen at the at the junction between the epidermis, which is the cellular part of the skin, and to the dermis, and on.
• 1:37:40
  SPEAKER_05: Most of the collagen, that being said, though, most of the collagen in our skin is type one and type three, with type one being having the biggest presence.
• 1:37:48
  SPEAKER_05: And that's what's really in our dermis.
• 1:37:50
  SPEAKER_05: What does collagen do?
• 1:37:51
  SPEAKER_05: Collagen gives the firmness to the skin.
• 1:37:55
  SPEAKER_05: And I'm trying to think about the analogy.
• 1:37:58
  SPEAKER_05: Well, I mean, you know, it's the meat below the skin.
• 1:38:01
  SPEAKER_12: Yeah.
• 1:38:01
  SPEAKER_05: Yeah.
• 1:38:02
  SPEAKER_05: Chicken thigh or something.
• 1:38:04
  SPEAKER_05: Right.
• 1:38:05
  SPEAKER_05: So it really, although it's not muscle fibers, but it's it's in muscle fibers, but it's it's yeah, it's gives you the firmness to the skin.
• 1:38:14
  SPEAKER_05: It gives the firmness.
• 1:38:15
  SPEAKER_11: Whereas No, what about another, you know, if with collagen products, I know that the synthesis of collagen is a very like, you know, it it's very, very complex.
• 1:38:23
  SPEAKER_11: So, you know, thinking about it from that research standpoint, how important would it be to add factors such as copper or you know, um, like some of the things that are used in the actual physiological synthesis of collagen?
• 1:38:35
  SPEAKER_11: Does that make sense?
• 1:38:36
  SPEAKER_11: Or do formulations do that?
• 1:38:38
  SPEAKER_11: Or have you seen that in your practice in some products?
• 1:38:41
  SPEAKER_05: The cofactors, yeah.
• 1:38:42
  SPEAKER_05: So copper-containing products, actually, copper has been shown to increase um or to improve wound healing.
• 1:38:48
  SPEAKER_05: And it was all that research with copper was done on wounded, you know, like cut like uh cuts and um ulcers in skin.
• 1:38:57
  SPEAKER_05: Yeah.
• 1:38:58
  SPEAKER_05: So, but adding um, well, vitamin C is one of the cofactors, and so that's why so many of these creams, the vitamin C turns out that it stimulates collagen production.
• 1:39:07
  SPEAKER_05: The other thing is, you know, when you cut yourself, or if it, you know, if you have surgery or something, then why does the skin, how does it know to heal?
• 1:39:15
  SPEAKER_05: Yeah, well, there's a whole bunch of different signals, but one of them is disrupted or like collagen like just shreds.
• 1:39:23
  SPEAKER_05: They tell the body, like, oh my god, there's damaged collagen in here.
• 1:39:26
  SPEAKER_05: Okay, we have to make new, we have to get rid of the old.
• 1:39:28
  SPEAKER_05: Because obviously there's enzymes to digest the damaged collagen and old collagen.
• 1:39:33
  SPEAKER_11: Yeah, yeah.
• 1:39:34
  SPEAKER_11: And and you know, I'm curious about how you would regulate the production of type one versus type three collagen.
• 1:39:41
  SPEAKER_11: Like, that's where I get confused.
• 1:39:43
  SPEAKER_11: You know what I mean?
• 1:39:44
  SPEAKER_11: Because obviously, like one is more for like you know, fibrous changes, right?
• 1:39:48
  SPEAKER_11: It's it's more of like a it's a harder, I don't know how to describe it.
• 1:39:52
  SPEAKER_05: The big fibers, yeah.
• 1:39:54
  SPEAKER_11: Yeah, so like how do you how do you regulate that?
• 1:39:57
  SPEAKER_05: Yeah, you can't, you can't really actually what happens is type three is laid down first and then it's replaced by type one.
• 1:40:02
  SPEAKER_05: It's just part of they can lay down type three first, but you can't, we can't, we don't have any way of controlling.
• 1:40:08
  SPEAKER_11: Yeah, we have no way of controlling it makes sense.
• 1:40:10
  SPEAKER_11: Um, so I I actually want to ask you a general question.
• 1:40:13
  SPEAKER_11: Do you have any advice for all of the budding dermatologists out there?
• 1:40:17
  SPEAKER_11: Because I know that it's a very competitive field, and I know they're you know, the medical school classes are expanding like crazy these days, and everybody wants to go into medicine.
• 1:40:26
  SPEAKER_11: So, any uh career advice you have for our listeners?
• 1:40:29
  SPEAKER_05: Oh, for well, I think that it's really important to pursue your heart's desire and don't listen to anyone that says you can't do it, you will not be able to do it.
• 1:40:38
  SPEAKER_05: If that's what's in your heart and your head, and that's what you want to do, you should go for it.
• 1:40:43
  SPEAKER_05: You shouldn't go for it if you say, Oh, well, that's specialty, oh, I don't think I have to do that much call, or I'm gonna, you know, be able to do this or that.
• 1:40:51
  SPEAKER_05: You can certainly do a lot of these cosmetic procedures if you are in another specialty.
• 1:40:56
  SPEAKER_05: But if you really want to be a dermatologist, then you should be a dermatologist.
• 1:40:59
  SPEAKER_05: And what advice?
• 1:41:00
  SPEAKER_05: Well, I think that it's always good to, I mean, it's one of my my middle son who's actually in is residency right now, he did some work looking at leprosy in Nepal and so and also the Beruli ulcer in Africa.
• 1:41:17
  SPEAKER_05: And so if you have an an interest in going internationally when things open up again, that's always cool to kind of learn about some of these conditions.
• 1:41:25
  SPEAKER_05: And then the other part is working in a lab.
• 1:41:28
  SPEAKER_05: I think that um as long as you like it, you know, you wanna every moment we have on this planet, it's precious.
• 1:41:34
  SPEAKER_05: So you want to be sure that it's something you want to do.
• 1:41:36
  SPEAKER_05: But having sort of a more general background behind that is helpful in doing a in getting okay.
• 1:41:45
  SPEAKER_11: Hey guys, so our next guest is Mary Ann Guerra.
• 1:41:48
  SPEAKER_11: She is the CEO and president of Aesthetics Biomedical and has an immense and very impressive background in in really helping brands come up with FDA clear technology and treatment serums.
• 1:42:02
  SPEAKER_11: And um, Ms.
• 1:42:03
  SPEAKER_11: Guerra has also had a very impressive career at the NIH, and she has held senior level positions such as executive officer and also at the National Heart and Lung, Heart, Lung and Blood Institute, and Deputy Director of Management and Executive Officer at the National Cancer Institute.
• 1:42:20
  SPEAKER_11: So that's you know, just a little glimpse of her background.
• 1:42:23
  SPEAKER_11: But welcome to the show, uh, Marianne.
• 1:42:25
  SPEAKER_11: I'm so excited you had the time.
• 1:42:27
  SPEAKER_09: Well, it's a pleasure to be here and talking to you and uh being able to uh share some information with your uh your uh viewers and the the folks listening to this.
• 1:42:37
  SPEAKER_09: So um thank you very much.
• 1:42:39
  SPEAKER_09: Yeah, it's my pleasure.
• 1:42:40
  SPEAKER_11: I would love it if you could tell us more about your your career and um you know just dive deeper because I know I just skimmed the surface.
• 1:42:48
  SPEAKER_09: Well, thanks for giving me an opportunity to do that because I think um my my career has really fashioned where we are today with the company.
• 1:42:57
  SPEAKER_09: Um and you know, every time you have a job, whether it's a good job or a bad job, an experience, it's a good experience or a bad experience, you learn from it, right?
• 1:43:05
  SPEAKER_09: And you take it and you say, Oh, I'm gonna do that again and build on it, or I'll never do that again.
• 1:43:09
  SPEAKER_09: And this is how how I will avoid that.
• 1:43:12
  SPEAKER_09: And so um I was really lucky when I got started to work with the the National the NIH um really early on in my career.
• 1:43:20
  SPEAKER_09: Um and um I I started with the Cancer Institute.
• 1:43:24
  SPEAKER_09: Um, and uh when I was there, um I worked with the medical oncology branch and just really got a feel for you know treating patients and the importance of science and you know the impact on families when they don't um whether a loved one is faced with these horrible diseases.
• 1:43:41
  SPEAKER_09: And then um I got a chance to um, I was recruited then to the National Institute of Allergy and Infectious Diseases, and that was probably um a really extraordinary time in my career because I worked with uh Dr.
• 1:43:56
  SPEAKER_09: Anthony Fauci.
• 1:43:58
  SPEAKER_09: Um and Tony at that time was uh both a lab chief, um the chief of the laboratory of immune regulation as well as the director of the NIAID, and as most of us know, he still is.
• 1:44:08
  SPEAKER_09: Um he's great, but when I was there, it was um AIDS.
• 1:44:13
  SPEAKER_09: We were just faced with the AIDS dilemma, and what are we gonna do about that?
• 1:44:17
  SPEAKER_09: And people didn't know about the virus, they didn't know how it was transmitted, and you know, the panic that is facing us with COVID was the exact same thing, and there were no drugs, and there were, you know, so um it was so interesting to be there, but allergy to infectious diseases also is an institute that is developing vaccines for all kinds of things.
• 1:44:39
  SPEAKER_09: So hepatitis B, dengue virus, um uh chlamydia.
• 1:44:44
  SPEAKER_09: So when I was there, um I really got into technology transfer because it became really important if you if you have new knowledge, which we're doing at NIH or NIH funded programs, and you create this new information, but you don't transfer that to pharma companies or to entrepreneurs who create businesses and then create products, then it's a waste of taxpayers' money and and research, right?
• 1:45:11
  SPEAKER_09: So yeah, yeah.
• 1:45:12
  SPEAKER_09: And I got into this how do we have those better connections?
• 1:45:15
  SPEAKER_09: How do we forge these partnerships with industry to make that happen?
• 1:45:19
  SPEAKER_09: And so um I have to say, while I was at um NIAID, we forged uh quite a few relationships with industry and we got the chlamydia vaccine out, the respiratory system of the virus vaccine out, hepatitis B, all kinds of things.
• 1:45:34
  SPEAKER_09: So it was really rewarding to see that you know, great science leads to incredibly important products.
• 1:45:41
  SPEAKER_09: And, you know, of course, we had major um, you know, uh accomplishments in the AIDS field as well.
• 1:45:47
  SPEAKER_09: And then, you know, then I went on to Heart, Lung and Blood, which was doing amazing things in the cardiovascular area.
• 1:45:52
  SPEAKER_09: You know, that was the number one uh killer in the United States at that point in time, probably still is, um, you know, and then went back to the NCI.
• 1:46:02
  SPEAKER_09: And um when I was at NCI, I again took this tech transfer um mentality with me.
• 1:46:09
  SPEAKER_09: Um, and we really uh started again forge the relationships that we needed with industry.
• 1:46:15
  SPEAKER_09: And once I left NIH, um, you know, I kept that and went and worked with an organization in in Phoenix.
• 1:46:23
  SPEAKER_09: That's how I ended up in Phoenix called the Translational Genomics Research Institute.
• 1:46:27
  SPEAKER_09: And that was and that's personalized medicine.
• 1:46:30
  SPEAKER_09: What we had just mapped the human genome at NIH, right?
• 1:46:33
  SPEAKER_09: You know, so all this genetic information you and you know, they were getting the point where everybody could, you know, back their own human genome, their own genome.
• 1:46:42
  SPEAKER_09: And so personalized medicine really came into play.
• 1:46:45
  SPEAKER_09: It's like, okay, you know, what's your what's your genomic uh profile?
• 1:46:50
  SPEAKER_09: How do we get a drug that goes against that profile?
• 1:46:53
  SPEAKER_09: You know, how do we, you know, and and interestingly enough, if you have a profile, you know, you'll hear patients say, well, this drug worked on this cancer patient, but you know, this drug didn't work on this cancer patient.
• 1:47:05
  SPEAKER_09: You know, why?
• 1:47:06
  SPEAKER_09: Well, they had different genomic profiles, you know.
• 1:47:09
  SPEAKER_09: And so the the exciting thing is how do you match those?
• 1:47:12
  SPEAKER_09: How do you get the right drug with the right profile?
• 1:47:14
  SPEAKER_09: And it's a it's a whole new field.
• 1:47:16
  SPEAKER_09: And I think that's it leads me to like, you know, where we are now with the company I formed.
• 1:47:20
  SPEAKER_09: I worked um with a bunch of startup companies, um, ran a nonprofit, founded a nonprofit called BioEccel.
• 1:47:27
  SPEAKER_09: Um, and the whole idea was how do we accelerate that transfer of information from universities, um, from research and start companies.
• 1:47:36
  SPEAKER_09: And yeah, yeah, I love that.
• 1:47:38
  SPEAKER_11: By the way, can I just say like, you're the person I've been looking for since I started this podcast?
• 1:47:44
  SPEAKER_11: Because what you're addressing is exactly the questions I've had is that how do we get academia involved with the corporate world?
• 1:47:53
  SPEAKER_11: You know what I mean?
• 1:47:54
  SPEAKER_11: And it's like, like, because there's so much data that's being generated, or there's so much knowledge and just, you know, that's that's out there in the medical community.
• 1:48:02
  SPEAKER_11: But it when it comes to um just you know, consumers and and brands that are coming out that don't have a medical background, it's almost as if it's like they're, you know, people are living in this age where they think that medical discovery isn't there, but it is, you know what I mean?
• 1:48:16
  SPEAKER_11: And so to get that translated over to where it's being applied on a mass, you know, like mass market level, like that's been always my one of my biggest questions.
• 1:48:26
  SPEAKER_09: Yeah, you know, it's a it's a complicated situation, right?
• 1:48:30
  SPEAKER_09: Because um, when we work with startup companies, it's so hard, right?
• 1:48:36
  SPEAKER_09: So you um if you talk to scientists, every discovery that they have is the next best thing, right?
• 1:48:42
  SPEAKER_09: It's gonna be, you know, it's what everybody wants, the market wants it, you know, and you know, and it's actually not that way.
• 1:48:49
  SPEAKER_09: It's you know, it's very few great discoveries that are great science, but there aren't great products, right?
• 1:48:55
  SPEAKER_09: And so first you have to narrow down, you know, what is what is a great product, what is a great discovery, but which is a great discovery that's actually important in terms of developing a product that's going to benefit society or benefit an industry, et cetera.
• 1:49:10
  SPEAKER_09: So you got to have that betting process.
• 1:49:12
  SPEAKER_09: And that's hard because a lot of you know the wrong things get funded and the and the right things don't.
• 1:49:18
  SPEAKER_09: Um, you know, and then there's so many risks.
• 1:49:21
  SPEAKER_09: So if you're in the biomedical community, you know, now you've got this great product, and then you have you, you know, you look up at your horizon and you got regulatory obstacles, and you have intellectual property obstacles, and you have all of these things that you know are could be crushing to a startup company.
• 1:49:37
  SPEAKER_09: Um line is I I think that um science is really important, you know, and so you know, you have to look at you know what supports these new products, what supports um like in the aesthetic industry, you know, what I tried to bring to the company is a more rigorous approach to when we promote something, let's do it it either has To have the science, or we need to do more science behind it.
• 1:50:03
  SPEAKER_09: Um, we need to share that with the public.
• 1:50:05
  SPEAKER_09: Um, and so we've tried um very hard um to do more science and then to have that science published because again, you we're living in a world where you know there are people questioning whether they should get the COVID vaccine, you know.
• 1:50:19
  SPEAKER_09: Yeah, yeah, questioning science, and you know, um it you you have to say, okay, I question, you know, but um when you see data and you see enough data, then you should feel comfortable that that data supports um what is tried to be done.
• 1:50:36
  SPEAKER_09: And I think that um, you know, that's something we have to move into the aesthetics industry and we have to build back that trust of, you know, um, you know, science, here's data, we have to believe data, and then we have to act on that data.
• 1:50:51
  SPEAKER_11: Well, I think it's a very, very interesting uh that you brought this up because you know, from my standpoint, I I, you know, I also have a medical background and a research background.
• 1:51:00
  SPEAKER_11: And one of the biggest things I think um that I notice in the skincare industry, for example, is that you know, people don't it's like you can give them numbers and you can tell them that this was found in such and such clinical trial to be effective, but then they have a hard time understanding the overall picture, right?
• 1:51:19
  SPEAKER_11: Like, if you know what I mean.
• 1:51:20
  SPEAKER_11: Like that it's like they don't understand, I think, where everything is fitting in.
• 1:51:23
  SPEAKER_11: Like, for example, you know, you have something like hyaluronic acid, and you know, you have all this data around it, all this these publications, but for some reason the consumers are still very confused about hyaluronic acid.
• 1:51:36
  SPEAKER_11: You know, there's still questions like, well, what's the best molecular weight?
• 1:51:39
  SPEAKER_11: What's you know, how does it penetrate?
• 1:51:41
  SPEAKER_11: All these kind of questions, but it's like if you go to the research, it's answered already.
• 1:51:45
  SPEAKER_11: So there is this giant disconnect between, you know, like consumers and the biomedical industry.
• 1:51:52
  SPEAKER_09: Yeah, and I think, you know, unfortunately, you know, we're in a competitive world and you have different companies that are competing against each other.
• 1:51:59
  SPEAKER_09: And, you know, so you have this war that's out there of saying, you know, this is the information you need to have.
• 1:52:06
  SPEAKER_09: Um, and it, but it's only part of the information, right?
• 1:52:09
  SPEAKER_09: So, you know, you I I think sometimes you need independent uh parties to say, okay, so on the HA question, you look at them and compare, and you say, okay, I'm gonna, you know, get this data that's out there and I'm gonna analyze it and I'm gonna compare it.
• 1:52:22
  SPEAKER_09: And I and what we're gonna say is, you know, here are the answers.
• 1:52:26
  SPEAKER_09: And this is why, you know, this this product is better, because you know, when we analyzed it, um, you know, this is what we've discovered.
• 1:52:33
  SPEAKER_09: Um, and you know, companies aren't gonna do that, you know, against themselves, right?
• 1:52:39
  SPEAKER_09: So somebody else has to be that independent third party that does it, or you know, um, you know, and I think that's um when you advertise, you know, you obviously you want to focus on the positive things, right?
• 1:52:50
  SPEAKER_09: You know, yes.
• 1:52:53
  SPEAKER_09: Um, and you know, so uh that that's a tough one because as long as you have companies that are supporting their own products, they're going to um, you know, promote what science they've learned or what their products does.
• 1:53:09
  SPEAKER_09: And um, you know, probably in most instances stay away from you know other information that's out there that might not support what their product does.
• 1:53:21
  SPEAKER_09: Right, right.
• 1:53:22
  SPEAKER_11: Exactly, or only like certain ingredients that are like, you know, beneficial that are in their formulation, you know, they'll they'll highlight those, but then they'll ignore like all other ones that everyone's questioning, you know.
• 1:53:33
  SPEAKER_09: Well, yes, and here's an interesting thing, you know.
• 1:53:35
  SPEAKER_09: I mean, uh, and I'm a business person, not a scientist, but you know, the the one thing that my my colleagues at NIH used to love about me, they said you're not a scientist, but you asked some darn good questions.
• 1:53:45
  SPEAKER_09: And so, you know, we're looking at um, you know, you're looking at products, right?
• 1:53:49
  SPEAKER_09: And uh, I look at the the beauty magazines, and you know, it's great they have, you know, this, you know, physician or um somebody talking about, well, in the morning, you know, I put on these, you know, four products, and then at night I put on these, you know, five products.
• 1:54:02
  SPEAKER_09: And you know, you look at that, and I said, you know, well, they're not even the same brands, right?
• 1:54:07
  SPEAKER_09: You know, but one's H A, one's uh retinol, one's uh vitamin C, you know, blah, blah, blah, whatever they are.
• 1:54:14
  SPEAKER_09: And then, you know, I said, Well, how do they know that they don't counteract each other?
• 1:54:20
  SPEAKER_11: Yes, thank you so much for saying that.
• 1:54:22
  SPEAKER_09: Yes, yes, there's an ingredient in there that doesn't, you know, you know, obviate the good that the other product you just put on did, you know, and so um and so more isn't always better.
• 1:54:34
  SPEAKER_09: And that is one of the things that we're, you know, at Aesthetics by Medical, we're trying to get to is a more simple simple approach to things.
• 1:54:40
  SPEAKER_09: So, like our product, um, so me, um, which is so me, skincare, that's all you.
• 1:54:47
  SPEAKER_09: Um, now this is some new knowledge.
• 1:54:49
  SPEAKER_09: We um platelet rich plasma, which is well known and is, you know, out there in the market um in terms of um its benefit.
• 1:54:56
  SPEAKER_09: You know, there's a lot of science behind platelet rich plasma, especially in the orthopedic world, about why it benefits, you know, collagen, elastin, repair, etc.
• 1:55:05
  SPEAKER_09: Um, it started to be used in the aesthetics field.
• 1:55:07
  SPEAKER_09: Um, but the it was um it would only be stable for four to six hours, and then the platelets degranulate.
• 1:55:13
  SPEAKER_09: Well, we found a way of stabilizing those platelets so that they stay in their natural state for up to 120 days.
• 1:55:21
  SPEAKER_09: Now, when we got this product, it's got 22 ingredients.
• 1:55:25
  SPEAKER_09: That's it.
• 1:55:26
  SPEAKER_09: They're all natural, right?
• 1:55:28
  SPEAKER_09: Wow.
• 1:55:29
  SPEAKER_09: There's nothing um in it that's not, it's you know, and no animal cruelty, all of the things that are you know trendy right now, but we didn't do it to be trendy, we did it to be simple.
• 1:55:40
  SPEAKER_09: Um and so, and then you know, we believe that you don't need anything else.
• 1:55:45
  SPEAKER_09: Wash your face, use some me, and go to bed.
• 1:55:52
  SPEAKER_09: But it's really hard to convince people that you don't need to put all the other products on top of it, you know.
• 1:55:58
  SPEAKER_09: So it's it's just something that I think um, you know, we'll continue to try to keep a simple approach.
• 1:56:03
  SPEAKER_09: Um, and then we'll hopefully do more studies that show this simple approach works.
• 1:56:08
  SPEAKER_09: Um and that um, you know, we have enough complications in our life.
• 1:56:12
  SPEAKER_09: I don't need to figure out 25 skincare products that I have to put on my face daily.
• 1:56:16
  SPEAKER_11: Exactly.
• 1:56:16
  SPEAKER_11: Thank you for saying that once again.
• 1:56:18
  SPEAKER_11: Yes, exactly.
• 1:56:19
  SPEAKER_11: And you know, I know that minimalism right now is becoming another trend.
• 1:56:23
  SPEAKER_11: And, you know, I like to see that because it's like at the end of the day, I mean, the some of the dermatologists that I've interviewed, a lot of them will tell you, you know, all you really need is a moisturizer.
• 1:56:32
  SPEAKER_11: Use Vaseline, you know, and like I'm sitting here like, wait a minute, like I can't believe that Vaseline is all you need.
• 1:56:39
  SPEAKER_11: And you know, it's it's just such a it's so many different like opinions, and it's never like in the skincare industry and never like a decisive answer.
• 1:56:47
  SPEAKER_11: Like, this is what you should be going for in terms of bettering your skin health.
• 1:56:52
  SPEAKER_11: So I like that you said that you know, it's it's just a quick step and that's all you need because I I don't I don't believe in the 25-step ritual either.
• 1:56:59
  SPEAKER_09: Well, the reason I I mean I say that, and and there are probably people that are listening to this would totally disagree and say, no, you need to do this.
• 1:57:07
  SPEAKER_09: But what we approached on this is when you are able to use your own platelets, platelet-rich plasma, you know, you um the the platelets have a number of biomolecules, hundreds of biomolecules that are contained in those platelets.
• 1:57:22
  SPEAKER_09: And when you are able to activate them on your face, the biomolecules are able to um be of a Dalton weight that will be absorbed into the skin.
• 1:57:31
  SPEAKER_09: Um, you know, and it then it's your body doing what it naturally does, right?
• 1:57:37
  SPEAKER_09: So we're not trying to say that, you know, so me is like the be all end all.
• 1:57:42
  SPEAKER_09: What we're saying is that you know, we've created the ability for you to use your platelets to let your body do what your body does really well.
• 1:57:50
  SPEAKER_09: And so for me, you know, if you can do that, how you know, and maybe technology can, you know, will you know find things to, you know, I mean, you do have different skin conditions like you know, rosacea or um acne and things that um you know you need to have treated with with different um topicals, and that's important.
• 1:58:09
  SPEAKER_09: You need to do the research behind it.
• 1:58:11
  SPEAKER_09: But I think for your day-to-day skincare, I think if you can keep it simple, keep it natural, you know, just like with um other treatments, you know, you know, we have the Vivaci, it's RF microneedling, you know, basically it's stimulating, you know, it's it's using radio frequency and needles to create purposeful injury so that your body kicks into gear and repairs it and that stimulates your collagen and elastic.
• 1:58:35
  SPEAKER_09: It's natural, you know.
• 1:58:37
  SPEAKER_11: Yeah, it is.
• 1:58:38
  SPEAKER_11: And you know, I think the the for me when I think about it, you know, it makes sense medically, it all makes sense.
• 1:58:45
  SPEAKER_11: But I am just curious for everyone listening out there, you know, I think this is a good point to mention that, you know, um what Ms.
• 1:58:52
  SPEAKER_11: Guerra is saying is that you know, you would really as consumers have to do our research because you know, these kind of everything you've described so far, I mean, there's no reason why anybody in the skincare industry, consumer, you know, sector, why you wouldn't gravitate towards this.
• 1:59:07
  SPEAKER_11: You know what I mean?
• 1:59:08
  SPEAKER_11: And and it's like because you can't sell products based on is it clean beauty or is it you know vegan beauty?
• 1:59:14
  SPEAKER_11: It can be everything, but still scientifically relevant.
• 1:59:17
  SPEAKER_11: And I think that's something that a lot of people are having a hard time grasping right now in this industry because there's this division, you know, there's this that either you're clean or you're scientific or medical grade, you know, uh skincare or or therapy or you're you know something else.
• 1:59:32
  SPEAKER_11: And I just I don't I've never understood that because I think you can definitely combine them all.
• 1:59:36
  SPEAKER_09: Well, and I mean I guess it's you've got to get away from the trends, you know, just because it's vegan doesn't mean it's good.
• 1:59:42
  SPEAKER_09: I mean, I mean well let me say it doesn't mean it's gonna do what you want it to do, right?
• 1:59:47
  SPEAKER_09: It's you know, so you know, you you have to say, and you know, again, animal cruelty.
• 1:59:51
  SPEAKER_09: I mean, I you know, I I just picked up a stray cat, and you know, I mean, I'm so like such an animal lover.
• 1:59:58
  SPEAKER_09: And um, but on the other side of it, you know, how do you advance research sometimes if you don't do testing with animals, right?
• 2:00:06
  SPEAKER_11: I actually asked another panelist this earlier, the same question you just addressed.
• 2:00:10
  SPEAKER_11: I said, how can we possibly make improvements and innovations in medicine if you don't let people test on something?
• 2:00:18
  SPEAKER_11: You know what I mean?
• 2:00:18
  SPEAKER_11: We can't have everything be in a petri dish.
• 2:00:21
  SPEAKER_11: You know what I mean?
• 2:00:22
  SPEAKER_11: Petri dishes don't translate into live human skin that's being, you know what I mean, like you're applying this on to and it's going through its own molecular cascade of events.
• 2:00:31
  SPEAKER_11: Like there's a whole, you know, it's it's a totally different world in vitro and in vivo.
• 2:00:35
  SPEAKER_09: Yes, it is.
• 2:00:36
  SPEAKER_09: I mean, and you want to do um as much as you can, you know, um without going into animals.
• 2:00:43
  SPEAKER_09: But then, you know, I when I used to work at NIH because we had uh PETA that was always out there, because if you did any research um, you know, in chimpanzees or you know, in that, you we had them lined up.
• 2:00:53
  SPEAKER_09: And, you know, again, it's this dilemma, you know, if you if where are you gonna test?
• 2:00:58
  SPEAKER_09: You're gonna test it on humans, um, you know, and what if it doesn't work?
• 2:01:01
  SPEAKER_09: And then, you know, you're gonna have, unfortunately, then the whole legal systems on you because you've put in a human and it didn't work.
• 2:01:08
  SPEAKER_09: And, you know, so it's yeah, we struggle with a lot of things when you're when you look at science and um, you know, and and what's the right thing to do.
• 2:01:15
  SPEAKER_09: But I think you start out, you know, you try to do as much as you can, you know, in in the test tube or in the petri dish.
• 2:01:22
  SPEAKER_09: Um, you get information and there's a point in time if you need to move it on to um, you know, other studies um, you know, in animals, you do it with um, you know, in a humane way, um, you know, and then you bring it to people.
• 2:01:36
  SPEAKER_09: Um, so that's a double benefit.
• 2:01:38
  SPEAKER_09: Um, so I I mean it's not an easy, it's a it's not an easy situation, but I think you can do things the right way, you know.
• 2:01:46
  SPEAKER_09: I mean aside, but you know, when we were, you know, at NIH, we used to um, you know, if we did studies, we had this whole thing, we had to look at the labs that we used for any of our animal studies.
• 2:01:59
  SPEAKER_09: And I was doing a tour of it and we were listening to it, and I found out, realized that like the in uh and this probably makes sense because it's animals, but the HVAC system was like eight times better than we had in the hospital, you know, for our patients.
• 2:02:14
  SPEAKER_09: Yeah.
• 2:02:15
  SPEAKER_09: Because we were trying so hard to make sure that we we had the right environment and all of that.
• 2:02:20
  SPEAKER_09: And uh, you know, and and it all our chips had to be in their own individual rooms.
• 2:02:25
  SPEAKER_09: And I'm looking at patients and they're stuffed in two rooms or four.
• 2:02:29
  SPEAKER_11: We have better care for animals, yeah.
• 2:02:32
  SPEAKER_11: Yeah.
• 2:02:32
  SPEAKER_11: I mean, well, we have health care now for animals, you know what I mean?
• 2:02:36
  SPEAKER_11: So like health insurance.
• 2:02:39
  SPEAKER_09: I mean, I tell people I said, you know, I mean, I I wish I had a farm and I could just any stray animal or you know, whether dog, cat, you know, bird, turtle, whatever, I'd have them in my house.
• 2:02:49
  SPEAKER_09: But, you know, I guess everything's a balance, and you know, and and at some point in time you have to say, you know, what's the problem?
• 2:02:55
  SPEAKER_09: You know, so like COVID, I mean, it's killing the world.
• 2:02:57
  SPEAKER_09: So what do we have to do, you know, um, you know, to solve the problem.
• 2:03:02
  SPEAKER_09: And, you know, and I I think that's it's just use some intelligence and you know, um, to bring to science as well as to, you know, bring to the consumer.
• 2:03:10
  SPEAKER_09: Um, but if you can do it without, you know, um animal studies, if if you can do it, then that's great.
• 2:03:17
  SPEAKER_11: Yeah, yeah, I totally agree with that.
• 2:03:19
  SPEAKER_11: And I I'm so glad that you elaborated on that, on that whole topic, because I think there's definitely a lot more that needs to be learned, you know, in this area.
• 2:03:27
  SPEAKER_11: And I think a lot more understanding needs to go into it, you know.
• 2:03:31
  SPEAKER_11: Like we all want skin, we we all want discovery in in the area of skin health, but it's you know, it's more of a question of how bad do you really want it, you know, and and how do you want it?
• 2:03:41
  SPEAKER_11: Do you want it to be done scientifically and follow the scientific method, which I still think a lot of people don't understand.
• 2:03:47
  SPEAKER_11: That's really what goes on behind the scenes on the medical side, is that there's a very strict protocol in place and there's a lot of approvals, and you know, and I I don't think that translates very well, you know, very well to like the layman understanding of you know medical discovery.
• 2:04:03
  SPEAKER_11: So I think that's something that a lot of people, most people, including myself, I think we need to do a lot more research into that.
• 2:04:09
  SPEAKER_09: Well, it's it's a complicated, you know, it's complicated, and you can't expect people to do it.
• 2:04:13
  SPEAKER_09: I think what we have to, you know, make sure is that um there are either like the good-to-hous keeping, you know, seal of approval or you know, these these things where there's trusted sources and you know, these trusted sources the consumer can rely on, you know, again like NIH, it's uh we are so blessed in and you know to have the NIH here um, you know, and doing the research that we're doing in so many different areas.
• 2:04:40
  SPEAKER_09: I mean, and um, you know, it it truly is an amazing organization that supports our country and supports advancements.
• 2:04:48
  SPEAKER_09: Um, you know, and they do, they have a, you know, the institute of um, what's the uh I don't know if they've changed it, but one with skin, you know, um they're looking at dermatology and they're looking at that.
• 2:04:59
  SPEAKER_09: And, you know, um they may be looking at it for cancer and skin, but you know, there's information that's that they're gonna glean that can be applied to, you know, um, you know, our industry, you know, the industry, you know, and I mean, so um, so I I think we in the United States are really, really blessed um with the research and you know, the universities that do the research they do.
• 2:05:21
  SPEAKER_09: And um, you know, I think what we miss is how do we make that connection between trusted sources and the products that are out there on the market.
• 2:05:30
  SPEAKER_09: And the more we can do for that, the the better.
• 2:05:32
  SPEAKER_09: Um I agree.
• 2:05:33
  SPEAKER_09: I can't fix it all, but I at least in my little world of aesthetics biomedical, I will do my best to do that.
• 2:05:40
  SPEAKER_11: Well, you're definitely doing a lot more than 99% of people.
• 2:05:43
  SPEAKER_11: I can say that for sure, you know.
• 2:05:44
  SPEAKER_11: So I really hats off to you.
• 2:05:46
  SPEAKER_11: I love everything that you've explained and what you're doing.
• 2:05:49
  SPEAKER_11: I, you know, one one thing I brought up, and I don't know, um, I would love to get your opinion on this, is the idea of, you know, the skincare industry is a multi-billion dollar industry at this point.
• 2:05:59
  SPEAKER_11: And, you know, you have all these brands.
• 2:06:02
  SPEAKER_11: And I and I remember I was talking to a founder a while ago, and I brought up the idea that why don't companies contribute to this like fund, you know, that is very much structured, like how the NIH distributes, you know, grant grant money and grant funding, where the research is done in trusted laboratories and and trusted facilities that are going to give an unbiased, you know, report, which is going to be more, I think, in sync with peer-reviewed articles that get published rather than just companies coming out with data, which nobody really knows much about because you know they don't disclose any of their protocols or how they went about it or where the participants came from.
• 2:06:38
  SPEAKER_11: You know what I mean?
• 2:06:39
  SPEAKER_11: So like I've always wondered that, like, why there can't be this more collaborative effort where we have a fund and we have the money to do real research that can then be published and then also benefit brands.
• 2:06:50
  SPEAKER_11: So I would love to see hear your opinion on that.
• 2:06:53
  SPEAKER_09: Yeah, I I think that's uh an interesting question.
• 2:06:56
  SPEAKER_09: So um when I look at like how we spend our research money, um, you know, it we have very specific questions, like, you know, um if we're looking at um our product compared to nothing or our product in combination with something, and so it gets very specific.
• 2:07:16
  SPEAKER_09: And um, you know, if you had a a central organization, you know, like other than an NIH, you um the questions that are asked are very specific to your product.
• 2:07:28
  SPEAKER_09: And so it would, I think it would be very difficult to manage that, you know, because you'd have all of these commercial enterprises that would be want to be asking specific questions about their product.
• 2:07:38
  SPEAKER_09: Um and and sometimes um, you know, I used to again say at NIH that we should have the the um publication of failed research, right?
• 2:07:49
  SPEAKER_09: I mean, you publish everything that works, but you don't publish what didn't work, right?
• 2:07:53
  SPEAKER_09: Doesn't work, yes, oh my gosh, yes.
• 2:07:56
  SPEAKER_09: So many times you you learn from what doesn't work, right?
• 2:08:01
  SPEAKER_09: Um you know how if you're in the business world, you know, you if you've just spent a lot of money learning what doesn't work, um, you know, sometimes you want to keep that to yourself.
• 2:08:10
  SPEAKER_09: So if somebody else has to spend that money, that's you know, because it's competitive.
• 2:08:15
  SPEAKER_09: I mean, unfortunately, you know, you you know, businesses, you know, you've got investors and they want to make money and they want to do this.
• 2:08:22
  SPEAKER_09: And so, you know, it uh well, I, you know, would love to have an organization you could go to that would do these studies.
• 2:08:28
  SPEAKER_09: I think it would be really hard to have that happen.
• 2:08:31
  SPEAKER_09: Um, and I think the closest you you can get to a lot of that is by having, you know, institutions like NIH that actually do a lot of research that are, you know, basic, you know, uh the biology and you know, of mechanisms of action, why things work.
• 2:08:47
  SPEAKER_09: And you know, that you look at, you know, what are those mechanisms of action, you know, and how do you apply it to your particular industry or your disease problem or your um, you know, the therapy that you're trying to create.
• 2:09:00
  SPEAKER_09: Um, but I I like where you're going, but I think it would be really hard to do it just because of the competitive nature of industry and you know information is is really important and you want to keep it um good stuff and bad stuff sometimes.
• 2:09:14
  SPEAKER_09: Um, you know, sometimes the best way to protect intellectual property is like you know, Coca-Cola.
• 2:09:20
  SPEAKER_09: You just never patent it, you just keep Coca-Cola, you know, and so um I think industry always faces that, you know, is you know, we have to think about great science and we have to think about great products, but we you also have to think about business because somebody won't invest in you if you're not you know showing you know good bottom lines.
• 2:09:39
  SPEAKER_09: It's tough.
• 2:09:40
  SPEAKER_09: I mean, I've uh this has been a whole new world um when I founded this company and have been tried to you know juggle all of these things and regulatory and all of the stuff.
• 2:09:49
  SPEAKER_11: I bet.
• 2:09:50
  SPEAKER_11: I bet it's uh it's it's an immense task.
• 2:09:53
  SPEAKER_11: Yeah, I I can imagine.
• 2:09:54
  SPEAKER_11: And you know, I really hats off to you because you're you know you're doing a wonderful job and you've taken on something very big.
• 2:10:00
  SPEAKER_11: So, you know, I have um much admiration for your work.
• 2:10:04
  SPEAKER_09: So this is why I said the aesthetic industry, you know, you you start a new business and you age 10 years to one.
• 2:10:09
  SPEAKER_09: So we need to have product.
• 2:10:13
  SPEAKER_11: We need you're absolutely right.
• 2:10:15
  SPEAKER_11: We need a skincare line dedicated to all of the business professionals out there that are aging because of all of the we age 10 years and one like a dog, seven years to one.
• 2:10:28
  SPEAKER_11: Oh, I love that.
• 2:10:29
  SPEAKER_11: I love that analogy.
• 2:10:30
  SPEAKER_11: Well, thank you so much, Marianne.
• 2:10:32
  SPEAKER_11: This has been such a pleasure speaking with you, and I would love to have you back anytime if you have the the room in your schedule to just cover one topic if you want and just dive deeper.
• 2:10:41
  SPEAKER_09: Oh, I I I would love to do that.
• 2:10:43
  SPEAKER_09: This has been a joy too, because it's uh you've touched on so many things that are obviously near and dear to my heart.
• 2:10:48
  SPEAKER_09: Um, and I don't need to live and breathe it every day anymore.
• 2:10:50
  SPEAKER_09: So thank you very much.
• 2:10:52
  SPEAKER_09: It's my pleasure.
• 2:10:53
  SPEAKER_11: Um so that's the end of the recording, but I wanted to ask you, because I'm I'm just promoting myself.
• 2:10:58
  SPEAKER_11: I actually am applying next year for match in plastic surgery and dermatology.
• 2:11:03
  SPEAKER_11: And I am trying to make as many connections as I can.
• 2:11:05
  SPEAKER_11: Um, I've actually done a lot of research.
• 2:11:08
  SPEAKER_11: So um I would love it if you have any advice for me or any contacts I can connect with, um, you know, at all.
• 2:11:16
  SPEAKER_11: Yeah, I mean, in terms of um where you would do um a residency or where you would do Yeah, I'm applying for a residency, but I also like I'm really interested in uh, you know, research in dermatology and and skin health.
• 2:11:28
  SPEAKER_11: And I, you know, I I have done a lot of research in the in the past, but I would love to, you know, even a research opportunity or a mentor of some kind.
• 2:11:35
  SPEAKER_09: Well, you know, I'm we'd be happy to um I'd have be really happy to have you talk to our uh chief science officer.
• 2:11:42
  SPEAKER_09: He's also uh helped do a couple startup companies and has been through this whole thing, and he's um spent time at um J and J and then um Yeah, I mean, so what's it not J and J, it's um oh Proctron Gamble, P and G um in Cincinnati.
• 2:11:57
  SPEAKER_09: So he came out of the city.
• 2:11:58
  SPEAKER_12: Oh, I'm from Cincinnati.
• 2:12:00
  SPEAKER_12: I'm from Cincinnati, actually.
• 2:12:01
  SPEAKER_09: Yeah.
• 2:12:02
  SPEAKER_09: I'm a buckeye too.
• 2:12:03
  SPEAKER_09: I'm a I'm from um, I actually graduated from Ohio State, so I'm a huge buckeye.
• 2:12:07
  SPEAKER_09: I grew up in northeastern Ohio.
• 2:12:09
  SPEAKER_11: Um such a small world.
• 2:12:12
  SPEAKER_11: Yeah, I went to the University of Cincinnati for my bachelor's and my MBA.
• 2:12:16
  SPEAKER_11: And I am I'm a bear cat all the way, but I love Ohio.
• 2:12:20
  SPEAKER_09: Larry, I think Larry graduated from the University of Cincinnati because that's where he was um from, I believe.
• 2:12:26
  SPEAKER_09: So but Larry is his name, and I'd love to hook you up with him.
• 2:12:30
  SPEAKER_09: And you know, maybe you can even work with us on some of the things that oh my God, yes, please, yes, please.
• 2:12:35
  SPEAKER_11: I am down.
• 2:12:36
  SPEAKER_11: Anything you can uh hop, anything I can hop into, I'm down.
• 2:12:39
  SPEAKER_11: Seriously, I love science.
• 2:12:41
  SPEAKER_11: It is my passion and any any opportunity, I welcome.
• 2:12:44
  SPEAKER_11: So, yes, please.
• 2:12:46
  SPEAKER_09: Well, um, do you you've got my contact, or Sheldon can give you, or Kaylee, whoever you're talking to, to give you my contact.
• 2:12:52
  SPEAKER_09: And let's hook up uh email and then I'll I'll get you set up with Larry to talk to and and we'll do whatever we can to make any connections.
• 2:12:59
  SPEAKER_09: Thank you so much, Marianne.
• 2:13:00
  SPEAKER_09: You're amazing.
• 2:13:01
  SPEAKER_09: Thank you so much.
• 2:13:02
  SPEAKER_09: Well, my pleasure.
• 2:13:03
  SPEAKER_09: You know, I I have to say, um, when the our company, when we got started, it you know, you're small, you don't have much money.
• 2:13:10
  SPEAKER_09: And um we had um, I I believe in the universe, we had Chino Beyon, and we're talking about the universe and positive energy and all of that.
• 2:13:18
  SPEAKER_09: And uh we had this young intern walk in, right?
• 2:13:22
  SPEAKER_09: He's out of the AASU and um he um came into my office and we started talking.
• 2:13:27
  SPEAKER_09: So, you know, I said, Oh, sure, I'll give you an internship, you know, we'll just try this.
• 2:13:31
  SPEAKER_09: And you know, ended up, he's our director of RD now.
• 2:13:34
  SPEAKER_09: He's the one who came up with the invention for and he's like 25 years old now, right?
• 2:13:41
  SPEAKER_09: I mean, oh my gosh, that's amazing! And Sheldon, our marketing officer, is very young too.
• 2:13:47
  SPEAKER_09: And he came to me and just dropped in my lap.
• 2:13:50
  SPEAKER_09: And I was like, oh my god, this guy's brilliant.
• 2:13:52
  SPEAKER_09: Um, and so we have, you know, I really love to see, you know, people that are young and energetic and have potential, maybe not experience, but have potential, and it hasn't done me wrong.
• 2:14:02
  SPEAKER_09: So we've got an amazing young group of incredible that sounds amazing.
• 2:14:06
  SPEAKER_11: I would love it if you could take your, you know, put some trust in me.
• 2:14:10
  SPEAKER_11: I would love to work with you.
• 2:14:11
  SPEAKER_11: Seriously.
• 2:14:12
  SPEAKER_11: I it's it would be so amazing.
• 2:14:14
  SPEAKER_09: Well, where are you located now?
• 2:14:15
  SPEAKER_09: I'm in New York.
• 2:14:16
  SPEAKER_09: So I'm yep.
• 2:14:19
  SPEAKER_09: Well, I will definitely um hook you up.
• 2:14:22
  SPEAKER_09: So I'll talk to Sheldon about it.
• 2:14:23
  SPEAKER_09: We'll get hooked up after this and you know, we'll be in touch because I would love to do it.
• 2:14:27
  SPEAKER_09: I love to see energetic young folks uh getting ahead and doing what they're passionate about.
• 2:14:32
  SPEAKER_09: Thank you so much.
• 2:14:33
  SPEAKER_09: Can I have your personal email actually just to have it?
• 2:14:36
  SPEAKER_09: Sorry.
• 2:14:37
  SPEAKER_09: You know, I I use um the work one all the time because I'm you know, so just it's Marianne at aesthetics biomed.
• 2:14:46
  SPEAKER_09: Okay, okay, got it.
• 2:14:47
  SPEAKER_09: Yeah, dot com because I end up forgetting to look at the other ones.
• 2:14:52
  SPEAKER_11: I know I should be better than that and didn't have a maths like no worries, though I got it down and I'm gonna definitely check up on it.
• 2:14:59
  SPEAKER_09: Yeah, simplicity in life, you know, is kind of like you strive for it wherever you can get it.
• 2:15:04
  SPEAKER_09: True minimalism.
• 2:15:05
  SPEAKER_09: Yes, there you go.
• 2:15:07
  SPEAKER_11: Well, thank you so much, Marianne.
• 2:15:09
  SPEAKER_11: You're amazing, and I am so, so blessed and honored to have met you and to talk to you.
• 2:15:13
  SPEAKER_12: Thank you so much.
• 2:15:14
  SPEAKER_12: Okay, you take care, have a good rest of your day.
• 2:15:19
  SPEAKER_12: So, our next guest is Dr.
• 2:15:22
  SPEAKER_12: W.
• 2:15:22
  SPEAKER_12: Grant Stevens.
• 2:15:23
  SPEAKER_11: He is the CEO, uh, CMO and co-founder for um for Orange, the Orange Twist Institute, a medical spa in California.
• 2:15:32
  SPEAKER_11: He is also a clinical professor of plastic surgery at the University of Southern California.
• 2:15:37
  SPEAKER_11: Uh, Dr.
• 2:15:38
  SPEAKER_11: Stevens is on the board of directors of the American Society of Aesthetic Plastic Surgery, serving as the president-elect, and he is also the third vice president on the board of directors of the International Society of Aesthetic Plastic Surgery.
• 2:15:51
  SPEAKER_11: So, without further ado, welcome to the show, Dr.
• 2:15:53
  SPEAKER_11: Stevens.
• 2:15:54
  SPEAKER_11: I'm so excited that you had the time for this.
• 2:15:56
  SPEAKER_11: Thank you very much.
• 2:15:57
  SPEAKER_01: Thank you for having me on the show.
• 2:15:59
  SPEAKER_11: It's my pleasure.
• 2:16:00
  SPEAKER_11: Um, I would love if you could uh dive a little bit more into your career background, because I know you have so many um accolades uh in your in your CB.
• 2:16:09
  SPEAKER_01: Well, you're very kind.
• 2:16:10
  SPEAKER_01: I'm a board-certified plastic surgeon.
• 2:16:13
  SPEAKER_01: My office is there in the Los Angeles area, actually, right by LAX in Marina Del Rey.
• 2:16:17
  SPEAKER_01: I have marina plastic surgery for 35 years and the marina med spa.
• 2:16:22
  SPEAKER_01: Uh, you mentioned Orange Twist.
• 2:16:24
  SPEAKER_01: Uh I was the co-founder there with Clint Clint Carnell.
• 2:16:28
  SPEAKER_01: We now have 17 Orange Twist stores throughout the primarily Southern California, but also Texas, Washington, Nevada, New Jersey, a few other places.
• 2:16:38
  SPEAKER_01: And those are um sort of med spas, Dr.
• 2:16:41
  SPEAKER_01: Light med spas.
• 2:16:43
  SPEAKER_01: And then in my uh Marina med spa in Marina Del Rey, we have a number of aestheticians and uh PAs and so forth, and we do all sorts of non-surgical and minimally invasive aesthetic procedures.
• 2:16:57
  SPEAKER_11: Wow, that's really, really impressive.
• 2:16:59
  SPEAKER_11: And I and I know that you've um you've authored more than 90 articles and chapters on aesthetic plastic surgery.
• 2:17:05
  SPEAKER_11: So I would love it if you could uh tell us a little bit about what you think about the current scene around skin health and skin care.
• 2:17:12
  SPEAKER_11: I mean, what are some things that that maybe pop out to you that as either you know misinformation or something that's being done right?
• 2:17:21
  SPEAKER_01: Well, these are very exciting times because um a lot of this is now being driven by science and not marketing.
• 2:17:29
  SPEAKER_01: Historically, uh people had lotions and potions to make their skin look uh moist or or or uh uh glowy, but they didn't have active ingredients.
• 2:17:41
  SPEAKER_01: We now have scientifically validated studies, uh prospective, sham control, double-blind studies that have shown the effectiveness of various peptides that actually are penetrating the skin and changing the environment in the skin and deep to the skin, uh and uh increasing uh uh collagen and uh elastin, and also the damaged collagen and elastin, believe it or not.
• 2:18:08
  SPEAKER_01: And we have biopsies to prove this.
• 2:18:10
  SPEAKER_01: In addition to topicals, though, we also have technologies that weren't available even 10 years ago, such as Bibacci with micro-needling and radio frequency that clearly um stimulate the fibroblasts and the cells in the skin and beneath the skin to make more collagen elastin and thereby tighten the skin and smooth the skin and even help with pigmentation.
• 2:18:33
  SPEAKER_01: So the um yes, there's a lot of disinformation out there, but thankfully less so than there was.
• 2:18:40
  SPEAKER_01: And we have a lot of money being put into prejuvenation as well as rejuvenation uh with the use of topicals as well as energy-based devices.
• 2:18:50
  SPEAKER_11: That's very interesting that you mentioned prejuvenation.
• 2:18:53
  SPEAKER_11: Can you tell us a little bit about that concept?
• 2:18:55
  SPEAKER_01: Well, sure.
• 2:18:56
  SPEAKER_01: Historically, you know, people uh would wait until they were kind of old and had wrinkles, and then they'd say, I want to look young again.
• 2:19:03
  SPEAKER_01: And people were always looking for the fountain of youth.
• 2:19:06
  SPEAKER_01: But basically, with the new technologies uh and the millennials coming through, the the shift has been to I don't want to get old and look old.
• 2:19:16
  SPEAKER_01: And I'm gonna take some steps right now in my 20s, in my 30s, to uh avoid some of the wrinkles, avoid some of the sun damage, the sunspots, and the various uh things that are associated with the look of a of an older face.
• 2:19:31
  SPEAKER_01: And so I'm seeing a lot of 20 and 30 year olds coming in for what is generically called prejuvenation, including both neuromodulators, of which there are four on the market now, though.
• 2:19:43
  SPEAKER_01: Of course, the 800-pound gorilla is Botox.
• 2:19:45
  SPEAKER_01: But there's ZM, there's Desport, and there's Jouveau.
• 2:19:49
  SPEAKER_01: So there's four neuromodulators.
• 2:19:51
  SPEAKER_01: Soon there's going to be a fifth taxi.
• 2:19:53
  SPEAKER_01: So um the 20 and 30-year-olds are starting are using that as well as fillers for various things like skeletal augmentation, lip augmentation, cheek augmentation, chin augmentation, and all sorts of things with fillers uh and also energy-based devices, as I mentioned earlier.
• 2:20:11
  SPEAKER_01: And there's lighter lasers like Clear and Brilliant, and I mentioned Bivaci a moment ago.
• 2:20:16
  SPEAKER_01: So they're they're very approachable uh devices, even for the younger millennials.
• 2:20:21
  SPEAKER_11: Absolutely.
• 2:20:22
  SPEAKER_11: And you know, that's very interesting that you went through that.
• 2:20:24
  SPEAKER_11: And I'm wondering because, you know, in terms of, you know, you've been in this in this field for so long, and I and I wonder with the education aspect of new dermatologists and you know, new people coming into this field of medicine, do you feel like there's maybe a disconnect or maybe there's a piece of information missing in the training?
• 2:20:43
  SPEAKER_11: Um, but like how do you feel about the training of dermatologists and and medical practitioners?
• 2:20:48
  SPEAKER_01: And first of all, I'm not a plastic surgeon.
• 2:20:50
  SPEAKER_01: Um but I certainly work with a lot of very qualified dermatologists and facial plastics and so forth, and we consider ourselves what's called the core.
• 2:20:59
  SPEAKER_01: And and um I think the training has never been better.
• 2:21:04
  SPEAKER_01: Uh I I chair my fellowship for the last 20 years, and I'm training two plastic surgeons a year for the last 20 years.
• 2:21:13
  SPEAKER_01: Um, and we now have the American Society for Aesthetic Plastic Surgery has 30 such fellowships.
• 2:21:18
  SPEAKER_01: This is all after residency.
• 2:21:20
  SPEAKER_01: So a doctor goes to uh med school for four years, and a plastic surgeon does six more years minimum of plastics, that's 10 years, and one year of fellowship, that's 11 years to come out and start practice in this.
• 2:21:33
  SPEAKER_01: And so I I actually think the training is exceptional, much better than it was 20, 30 years ago.
• 2:21:40
  SPEAKER_11: Right.
• 2:21:40
  SPEAKER_11: That's I I love that.
• 2:21:41
  SPEAKER_11: I'm glad that, you know, in terms of the medical side of things, we are progressing.
• 2:21:45
  SPEAKER_11: And I often wonder how that translates into the consumer um end of everything because there's so much misinformation out there um with skin health.
• 2:21:53
  SPEAKER_11: And you know, it it's it's interesting to see that the doctors, you know, the doctor and the medical side of it knows so much, but the consumer side, there's still this missing gap of information.
• 2:22:02
  SPEAKER_11: So, do you have any insight onto like how we can fill that gap and really educate, you know, in layman terms, um, everybody out there?
• 2:22:10
  SPEAKER_01: Well, I think the most important thing is to have a trusted provider, either a derm or plastics or facial plastics or oculoplastics, that a person can go to and ask the questions.
• 2:22:24
  SPEAKER_01: Now, of course, I'm not discouraging active research.
• 2:22:28
  SPEAKER_01: Going to real self, for instance, is a pretty uh good sour source of information.
• 2:22:33
  SPEAKER_01: Um, the various societies have information.
• 2:22:36
  SPEAKER_01: I know the American Board of Plastic Surgery has a uh site within their uh within their site.
• 2:22:42
  SPEAKER_01: You go to surgery.org and there's something called the Smart Beauty Guide, or you can go to smartbeautyguide.com and that information has been vetted by board certified, uh highly qualified plastic surgeons who who participate in the surgical as well as medical field of aesthetics, and it's just for aesthetics.
• 2:23:02
  SPEAKER_01: So again, smartbeautyguide.com or surgery.org.
• 2:23:06
  SPEAKER_01: Wow, I love that.
• 2:23:08
  SPEAKER_01: I have no idea.
• 2:23:08
  SPEAKER_01: I'm gonna check that out.
• 2:23:10
  SPEAKER_01: Please do, or you can go to my podcast, the technology of beauty.
• 2:23:14
  SPEAKER_01: You can go to the technology of beauty.com and subscribe, and you can meet the movers and the shakers of the aesthetic business and also learn a lot about the what you're asking me.
• 2:23:24
  SPEAKER_11: That's awesome.
• 2:23:25
  SPEAKER_11: I will definitely check it out.
• 2:23:26
  SPEAKER_11: One podcast host to another.
• 2:23:28
  SPEAKER_01: There you go.
• 2:23:28
  SPEAKER_01: That's technology of beauty.
• 2:23:31
  SPEAKER_11: Yes.
• 2:23:32
  SPEAKER_11: Thank you so much, Dr.
• 2:23:33
  SPEAKER_11: Stevens.
• 2:23:33
  SPEAKER_11: It was so lovely talking to you.
• 2:23:35
  SPEAKER_11: And I would love to actually invite you on for like an hour-long session about something that you feel really strongly about in the in the field.
• 2:23:41
  SPEAKER_12: Um in your special okay, guys, our next guests are well, the first guest is Sheldon Larson.
• 2:23:50
  SPEAKER_11: He is the CMO for aesthetics aesthetics biomedical.
• 2:23:54
  SPEAKER_11: So welcome, Sheldon.
• 2:23:55
  SPEAKER_11: Thank you so much for the time.
• 2:23:57
  SPEAKER_07: Thank you so much for having me.
• 2:23:58
  SPEAKER_07: I appreciate it.
• 2:23:59
  SPEAKER_11: Uh, it's my pleasure.
• 2:24:00
  SPEAKER_11: And our second guest is, I'm sure a lot of you know her from the amazing show The Bachelor, um, Ashley Ikonetti.
• 2:24:09
  SPEAKER_11: Hello.
• 2:24:09
  SPEAKER_11: Yes, nice to meet you.
• 2:24:12
  SPEAKER_11: Um, I'm so excited to have you on.
• 2:24:14
  SPEAKER_11: I mean, I'm this is such a starstruck moment for me.
• 2:24:17
  SPEAKER_11: So thank you so much for your time as well.
• 2:24:21
  SPEAKER_04: Well, thank you.
• 2:24:23
  SPEAKER_11: Um, I would love to get started.
• 2:24:24
  SPEAKER_11: Um, Sheldon, can you tell us a little bit more about your background um in marketing and and just the whole company?
• 2:24:30
  SPEAKER_11: Because um I would love to give our listeners an idea of what goes into being a marketing officer.
• 2:24:36
  SPEAKER_07: Yeah, definitely.
• 2:24:38
  SPEAKER_07: So I think uh really aesthetics has been great in my DNA, I think, since I was a little kid.
• 2:24:43
  SPEAKER_07: Um my mom and both my sister are in the the industry and um in the in the uh private practice side.
• 2:24:51
  SPEAKER_07: Um and uh so it's just been something that's come natural to me.
• 2:24:55
  SPEAKER_07: Um it's not I actually went to school for hospitality and tourism management and kind of fell into it.
• 2:25:00
  SPEAKER_07: Um, you know, but I I think it's interesting because it's constantly changing, the technology technology is evolving.
• 2:25:07
  SPEAKER_07: Um something that uh, you know, it's an exciting industry that that is growing.
• 2:25:12
  SPEAKER_07: Um, and especially, you know, right after the pandemic, uh, or so kind of in the pandemic, but towards the end of December, you know, we saw a huge spike with aesthetic treatments.
• 2:25:20
  SPEAKER_07: And so um it's something we're we're really excited about.
• 2:25:23
  SPEAKER_07: But yeah, so I I grew up um with aesthetics kind of uh a part of um you know my family and and whatnot, my lot.
• 2:25:30
  SPEAKER_07: And then um I shifted and and ran a couple uh marketing departments for um pretty large um physician practices um and helped them transition through um different uh physicians coming in and out.
• 2:25:43
  SPEAKER_07: And so uh there was an opportunity with um an industry brand.
• 2:25:49
  SPEAKER_07: Um, and uh one of those physicians introduced me to uh Marianne, our CEO and founder, and uh I had no idea that I was coming in for an interview.
• 2:25:59
  SPEAKER_07: Um I just said, hey, you know, do you want to come in and chat with Marianne?
• 2:26:02
  SPEAKER_07: And I was like, sure.
• 2:26:03
  SPEAKER_07: Um, and um lo and behold, I walk in, she goes, Where's your resume?
• 2:26:07
  SPEAKER_07: And I said, uh it's not an interview.
• 2:26:09
  SPEAKER_07: What's the ready?
• 2:26:12
  SPEAKER_11: She was ready to analyze you.
• 2:26:14
  SPEAKER_07: Yeah, and um, you know, and then the rest is history, but uh you know that's how I got to Aesthetics Biomedical about five years ago, and uh we've built it from a very small startup in uh basically an office the size of probably like a typical New York apartment.
• 2:26:30
  SPEAKER_07: Um, and uh now we're in uh you know our entire third floor of our building and I'm about to do a second build out um in there as well.
• 2:26:38
  SPEAKER_07: So everything's going really well and uh really excited.
• 2:26:42
  SPEAKER_11: That's amazing.
• 2:26:42
  SPEAKER_11: That's really amazing, and it's so interesting.
• 2:26:45
  SPEAKER_11: It must have been great to watch um a company grow from the ground up.
• 2:26:49
  SPEAKER_07: Yeah, it's fantastic.
• 2:26:50
  SPEAKER_07: You know, I think the one thing about startups is you're really able to put your kind of um own spin on things and create it from the ground up.
• 2:26:57
  SPEAKER_07: And and I enjoy that because then it's like it's just I feel like it's it's mine.
• 2:27:03
  SPEAKER_11: Absolutely, absolutely.
• 2:27:04
  SPEAKER_11: And I and I love what you're doing, by the way.
• 2:27:06
  SPEAKER_11: So really hats off to you for for the great work.
• 2:27:09
  SPEAKER_11: And I know you put this whole event together from what I heard.
• 2:27:12
  SPEAKER_11: So really, I mean, this is a phenomenal job.
• 2:27:15
  SPEAKER_11: So hats off.
• 2:27:17
  SPEAKER_07: Thank you.
• 2:27:18
  SPEAKER_11: Um, Ashley, I would love if you could share your background with us as well.
• 2:27:22
  SPEAKER_04: Well, um, I I got my master's in broadcasting at Syracuse University, and right after that, I went on The Bachelor.
• 2:27:33
  SPEAKER_04: And it was kind of a weird, it was like a weird season for that, uh, luckily, um, where social media became a big thing with people coming off the show.
• 2:27:43
  SPEAKER_04: So I got kind of like ingrained in um social media marketing, and I was also just kind of able, I was able to kind of build a career with my background based on the platform that the show gave me.
• 2:27:55
  SPEAKER_04: So I ended up kind of being like the bachelor beat reporter, um, and I grew a good following.
• 2:28:00
  SPEAKER_04: And after all the four seasons of the franchise that I appeared on, um ended up getting married to a guy on the show, Jared.
• 2:28:09
  SPEAKER_04: And then um how exciting! That's awesome! It's been very good, it's been a very good thing for me in my personal life and in my career.
• 2:28:19
  SPEAKER_04: Um, but I've always like going into college even, I was like, I do I want to be a dermatologist or do I want to go into broadcasting?
• 2:28:26
  SPEAKER_04: And I went the broadcasting way, and um now given my platform, I've kind of able to like use my use my social media as like um a medium for talking about skincare.
• 2:28:41
  SPEAKER_04: So I'm like melting them together.
• 2:28:43
  SPEAKER_04: And my my dad's an anesthesiologist, so I do feel like the the science of medicine is kind of like in my blood.
• 2:28:49
  SPEAKER_11: Yeah, it's ingrained.
• 2:28:50
  SPEAKER_11: Once you have a doctor in the family, it's over.
• 2:28:53
  SPEAKER_04: Totally.
• 2:28:54
  SPEAKER_04: I'm I feel like I'm like I'm definitely not a doctor point, but like I'm able to speak about medicine and health a little bit more advanced than your average person.
• 2:29:02
  SPEAKER_11: Yeah, yeah.
• 2:29:03
  SPEAKER_11: I grow up hearing all the terms.
• 2:29:05
  SPEAKER_11: My dad is also um in medicine, so I I know what you mean.
• 2:29:09
  SPEAKER_11: So I I want to ask you, Sheldon, um, when you were putting the event together, um, what made you actually invite Ashley on?
• 2:29:16
  SPEAKER_07: Um well, I think it's just that.
• 2:29:19
  SPEAKER_07: I think she speaks about our space in a really unique way.
• 2:29:23
  SPEAKER_07: Um she's knowledgeable about the treatment she's doing, her skin, and and um really pays attention.
• 2:29:28
  SPEAKER_07: I think she's I I hate the term authentic, but I'm going to use it.
• 2:29:31
  SPEAKER_07: Um she's very authentic, you know.
• 2:29:33
  SPEAKER_07: I think that she she just uh in a really unique way is able to talk to her her loyal kind of fan base and they listen to her and and um you know I just thought she'd be a perfect fit for what we were trying to do for perspectives.
• 2:29:48
  SPEAKER_04: I'm so flattered to hear that.
• 2:29:50
  SPEAKER_11: That's awesome.
• 2:29:51
  SPEAKER_11: I love that.
• 2:29:51
  SPEAKER_11: And I, you know, honestly, Ashley, with somebody with your background, I always wonder um, you know, how you like approach skincare and the products that you love, you know, because you obviously have such an immense platform.
• 2:30:03
  SPEAKER_11: I mean, you have over a million followers, and I'm sure that when you recommend something or if you highlight something, your followers really, you know, they trust you, right?
• 2:30:11
  SPEAKER_11: So like they they obviously will go and try it.
• 2:30:13
  SPEAKER_11: So when you're approaching your own skin health, what are some of the fundamental things that you like to keep in mind and to you know really kind of hone in on when you purchase your products?
• 2:30:23
  SPEAKER_04: Well, as somebody who has is acne prone and melasma hyperpigmentation prone, I um I obviously am a little bit more gravitated towards those types of products, and luckily a lot of my audience is interested in that, but also I I'm very pro medical grade formulations.
• 2:30:46
  SPEAKER_04: I basically it's it takes a lot for me to promote something that is not medical grade, so I try to stay loyal to a few brands, and you know, I'm always down to experiment, but I'll do research on stuff, and if it just doesn't sound like the type of thing that I would personally use, then I'm probably not gonna recommend it.
• 2:31:06
  SPEAKER_04: And like given the platform, it is kind of funny because I have brands sending me stuff all the time.
• 2:31:13
  SPEAKER_04: I have like an entire like I call it my glam room.
• 2:31:15
  SPEAKER_04: I have like a whole, like it looks like an esthetician's office.
• 2:31:19
  SPEAKER_04: Like, I look like I have stuff up for sale, and it actually gets like first world problem here, but like a little bit annoying because I'm like, I'm not gonna use this product or recommend it.
• 2:31:29
  SPEAKER_04: Like, I know it's like it may like it may be fine, like it may wash my face, but it's not going to like do anything to help improve my skin.
• 2:31:37
  SPEAKER_04: So that you know, so I just you know, I'm just like, no, thank you, thank you.
• 2:31:41
  SPEAKER_04: Please don't send me things I don't need when in the skincare department.
• 2:31:45
  SPEAKER_11: Right, right, of course.
• 2:31:46
  SPEAKER_11: And there's so many cleansers you can have, there's only so many.
• 2:31:50
  SPEAKER_04: Yeah, there was like I was reading, I think it was New Beauty or something, and or maybe it was um um Alore, and there there was like an editor who went in for a facial and the esthetician was like, What do you do for a living?
• 2:32:03
  SPEAKER_04: And she was like, I'm um a beauty editor at Allure, and she's like, Oh, your skin looks like a beauty editor, and then she goes, What does that mean?
• 2:32:11
  SPEAKER_04: It looks good, and she goes, No, it looks like you use a whole bunch of different products and you're constantly experimenting and you're not keeping it consistent.
• 2:32:16
  SPEAKER_04: So I'm always trying to keep it consistent.
• 2:32:18
  SPEAKER_04: Wow, what a reality story that story stuck with me.
• 2:32:23
  SPEAKER_04: I don't I want to experiment, but only to a certain degree.
• 2:32:26
  SPEAKER_11: It's hard.
• 2:32:28
  SPEAKER_11: Of course.
• 2:32:28
  SPEAKER_11: No, especially now with you know, I know in the in the industry there's a lot of talk, and I think this goes you know hand in hand with the with the conference today, is that you know, there's a lot of in inflammation, and inflammation is becoming the central, you know, talking point in the in the industry because you know, people are starting to realize there is such a thing as too much skincare.
• 2:32:48
  SPEAKER_11: So, you know, I I love that you said that because you know you're that tells me that you're telling your your followers the right information rather than just taking a picture, which I've seen so many, you know, micro influencers do, right?
• 2:33:00
  SPEAKER_11: Like they'll just take a picture of a product and it's like, do you even know if this works?
• 2:33:04
  SPEAKER_11: Like, do you even know like what the science is or if this works or anything?
• 2:33:08
  SPEAKER_11: So I I love that what you said about you know how you approach school care.
• 2:33:12
  unknown: Thank you.
• 2:33:13
  SPEAKER_07: I think that's the the key point here is that um Ashley just is ed, you know, it's educational content.
• 2:33:18
  SPEAKER_07: And I think it's there's a desperate need for informative educational content that can sift through this all the content that's like a bunch of misinformation and very hard and these TikTok challenges that are out there and things of that.
• 2:33:32
  SPEAKER_11: It's anarchy.
• 2:33:33
  SPEAKER_11: It's anarchy.
• 2:33:34
  SPEAKER_11: That's why I named my podcast Can Care Anarchy.
• 2:33:37
  SPEAKER_07: You know, so I think I was on a panel um today with um three uh beauty directors um from some of the major media outlets.
• 2:33:45
  SPEAKER_07: And it was funny because I asked them that same question.
• 2:33:48
  SPEAKER_07: I've been dying to ask me, you know, beauty directors questions versus them asking me.
• 2:33:52
  SPEAKER_07: Yeah.
• 2:33:52
  SPEAKER_07: I said, So can you tell me like how's your beauty closet?
• 2:33:56
  SPEAKER_07: You know, like and they're like, Well, I'm surprised, like, I haven't got divorced because I had to take over my my husband's man cave and because it's filled with all these products, I'm like, oh my goodness, like I just don't understand.
• 2:34:07
  SPEAKER_07: I mean, that's insane.
• 2:34:08
  SPEAKER_11: Well, it's a lot, and it's also, you know, in terms of sustainability, it's just I wonder, you know, that's why I said to Ashley, that I was like, how many cleansers can we really have?
• 2:34:17
  SPEAKER_11: You know, I would rather have one line that's dedicated to making cleansers, and then you just buy the cleanser, and then you have other brands that are doing something new and innovative, you know.
• 2:34:26
  SPEAKER_11: So I I completely, completely hear what you're saying.
• 2:34:29
  SPEAKER_11: And also, Sheldon, I want to ask you because from a marketing perspective, I'm very curious how we can really influence people to not buy all the BS marketing and really buy into the real stuff.
• 2:34:41
  SPEAKER_11: So can you tell us about that?
• 2:34:43
  SPEAKER_11: What your experience has been, or if you've seen colleagues, you know, promoting something that you might not, you know, think is the best thing, you know, in the market.
• 2:34:51
  SPEAKER_11: Can you tell us a little bit about that experience?
• 2:34:53
  SPEAKER_07: Yeah, a lot of our talking points, I think, when we look at this is the difference, and I'll talk specifically about microneedling, is between the at-home rollers um and the microneedling pens, and then the microneedles radio frequency.
• 2:35:06
  SPEAKER_07: And I think there's just again, there's some misinformation out there.
• 2:35:09
  SPEAKER_07: Um, not to say, you know, I'm not here to say anything.
• 2:35:12
  SPEAKER_04: I'm just I say don't roll at home.
• 2:35:14
  SPEAKER_04: Yeah, me too, Ashley.
• 2:35:16
  SPEAKER_04: No, me too.
• 2:35:17
  SPEAKER_04: Right, all right, yeah.
• 2:35:17
  SPEAKER_04: So my institution was like those rollers are BS.
• 2:35:21
  SPEAKER_04: The way that they go into your skin is at an angle, and that angle is only going to create little tears in your skin.
• 2:35:26
  SPEAKER_04: It's not doing anything that you would have.
• 2:35:28
  SPEAKER_11: That's exactly what one of the doctors said in this conference.
• 2:35:31
  SPEAKER_11: They explained that, yep, exactly.
• 2:35:33
  SPEAKER_07: Yeah, I think that that's uh you know a must-know for consumers out there looking, you know, for this is just hundreds and thousands of consumers looking each day on real self for microneedling.
• 2:35:44
  SPEAKER_07: And um, you know, then they come back after they've done these in in-home rollers and they have infections and they have problems with their skin.
• 2:35:52
  SPEAKER_07: And it's just it's really awful to see it's something that you don't want, obviously, in the category of microneedling.
• 2:35:57
  SPEAKER_07: So I think education is a key component when we look at um our brand strategy, our positioning, um, how we look at different campaigns, especially direct-to-consumer uh campaigns.
• 2:36:07
  SPEAKER_07: Uh, it's all about education and making sure that the consumers on their journey make the right decision.
• 2:36:12
  SPEAKER_07: Um some of that's different for for each individual, but ultimately I think if you provide them the right material and education to make the most uh informed decision, we're doing our right thing.
• 2:36:23
  SPEAKER_11: No, I have a I have a question, and this applies, I think, to both of you is you know, in terms of giving knowledge and information to, you know, the masses, right?
• 2:36:33
  SPEAKER_11: Like how how has that been for both of you in terms of using layman terms and really translating science into everyday talk that people can understand?
• 2:36:42
  SPEAKER_11: Because I, you know, I and I ask this because I think that there's a huge disconnect between consumers understanding the science and then you know, really making informed decisions versus just another brand, you know, or some random brand that's founded in someone's kitchen who just says, Hey, listen, my product is gonna make your skin brighter, so you should buy it.
• 2:37:01
  SPEAKER_11: You know what I mean?
• 2:37:02
  SPEAKER_11: Like, so how do you how do you deal with that?
• 2:37:05
  SPEAKER_11: Like with relaying real medical information to everyday people?
• 2:37:10
  SPEAKER_07: Well, I think that the consumer now more than ever is the most educated, right?
• 2:37:15
  SPEAKER_07: Because of um some of these doctors and and physicians and providers who are coming out with content that is helpful.
• 2:37:21
  SPEAKER_07: Um but I think that's why you see um you know different sites having the success they do like real self and being able to get those um reviews that are actual uh reviews and and all the information that um you know are qualified by physicians.
• 2:37:36
  SPEAKER_07: So I mean, to me, I lean on those resources.
• 2:37:39
  SPEAKER_04: I I also use real self.
• 2:37:41
  SPEAKER_04: I love scrolling on real self.
• 2:37:42
  SPEAKER_04: As soon as I see a new technology, I'm like, oh, what are the examples?
• 2:37:46
  SPEAKER_04: What are the before and afters that real stuff has?
• 2:37:48
  SPEAKER_04: What are the doctors?
• 2:37:49
  SPEAKER_04: What are they saying?
• 2:37:50
  SPEAKER_04: Yeah, but I I don't know if I'm a typical uh audience member.
• 2:37:55
  SPEAKER_04: I do feel like when I try to relay information to my audience, like if I'm with my dermatologists or um my aestheticians, and I only trust a solid few, I will take their information and kind of like it just put it in bullet points, you know.
• 2:38:11
  SPEAKER_04: Whatever I walk away from that conversation remembering in my head, like that's what I'll relay to the audience.
• 2:38:16
  SPEAKER_11: I love that.
• 2:38:17
  SPEAKER_11: I really I like that because I think that that's how people, you know, we need more effort like that because that's what I keep running into is that people are like, well, what do you mean, tyrosinase inhibitors?
• 2:38:27
  SPEAKER_11: Well, what do you mean, you know, uh peptides or you know, growth factors?
• 2:38:31
  SPEAKER_11: And and it's just like the understanding um doesn't seem to to register, you know, on this other side of things.
• 2:38:37
  SPEAKER_11: But um moving on, I want to talk about social media and I want to talk about how both of you um feel that social media fits in um as far as you know just promoting really good skin health devices or skin health treatments.
• 2:38:52
  SPEAKER_04: Well, um I do feel like Instagram is a huge beauty platform.
• 2:38:57
  SPEAKER_04: I mean, wow.
• 2:38:59
  SPEAKER_04: Um, it's just all you see are faces, right?
• 2:39:02
  SPEAKER_04: And it's hard to tell which faces are real and which ones are manipulated.
• 2:39:06
  SPEAKER_04: I mean, look at what Khloe Kardashian went through this week or or what we experienced her going through.
• 2:39:11
  SPEAKER_04: I don't know.
• 2:39:13
  SPEAKER_04: I'm like, I'm like that first picture that you posted made me feel like really great and normal.
• 2:39:17
  SPEAKER_04: Like you still look insanely in shape.
• 2:39:20
  SPEAKER_04: I wish that she would have, you know, just stuck with that first picture and not make such much hoopla about it.
• 2:39:25
  SPEAKER_04: Cause now I'm like, oh, you didn't feel like you looked great then because like now that makes me feel like I'm maybe not as looking great as I thought I could be.
• 2:39:33
  SPEAKER_04: Anyway, um yeah, yeah, I hear you though.
• 2:39:35
  SPEAKER_11: I hear you.
• 2:39:36
  SPEAKER_04: Come on.
• 2:39:36
  SPEAKER_04: What a tangent, but I guess um I mean, I just all you're seeing is like aesthetics, right?
• 2:39:45
  SPEAKER_04: Because everybody on Instagram wants to look their most beautiful, or even it's not if it's not their face, it's like the scenery or something.
• 2:39:52
  SPEAKER_04: Like all Instagram is all about beauty.
• 2:39:54
  SPEAKER_04: So I I just feel like it's just a natural place to promote different procedures and skincare.
• 2:40:01
  SPEAKER_07: Yeah, for us, you know, Instagram has been a fantastic platform for us to showcase our treatments, right?
• 2:40:08
  SPEAKER_07: The good, the bad, and the ugly.
• 2:40:09
  SPEAKER_07: Um if you look at you know our social media accounts and handles, it's 100% user-generated content.
• 2:40:15
  SPEAKER_07: We don't post promotional um material, we don't uh we leave it to where it's just kind of a raw, it's almost you know, like just if they were to walk into a derm or a plastic, you know, surgeon's office and see someone getting the treatment.
• 2:40:29
  SPEAKER_07: And we've seen success from that, you know, we get hundreds of DMs a day that we're connecting consumers to physicians, and I think because uh user-generated content is just king right now.
• 2:40:39
  SPEAKER_04: Yeah, and we talked about this on the panel earlier, but like I will determine the kind of doctor that I go to for a certain procedure because of what they show on their Instagram.
• 2:40:48
  SPEAKER_04: Like, how many times have they done this?
• 2:40:50
  SPEAKER_04: How does it look every time they do it?
• 2:40:52
  SPEAKER_04: And then I utilize hashtags a lot.
• 2:40:55
  SPEAKER_04: Like, I will I will like hashtag Vivachi and see what the before and afters on Vivaci are.
• 2:41:01
  SPEAKER_11: Oh, that's I love that.
• 2:41:02
  SPEAKER_11: I love hashtags, and I I think if you utilize them well, they can be a great source of learning for a lot of people.
• 2:41:08
  SPEAKER_11: And you know, unfortunately, I don't I don't see a lot of people doing that, so it's interesting about that.
• 2:41:13
  SPEAKER_04: I mean, from an influencer's perspective, yeah, they really lower engagement.
• 2:41:18
  SPEAKER_04: Once people see that, it feels like sponsored content, it feels like you're trying to promote something.
• 2:41:24
  SPEAKER_04: Yeah, um, but from somebody who's like researching, hashtags are great.
• 2:41:29
  SPEAKER_11: Yeah, yeah.
• 2:41:30
  SPEAKER_11: No, I mean I I struggle with them as well.
• 2:41:32
  SPEAKER_11: So, you know, I understand where you're coming from.
• 2:41:34
  SPEAKER_11: I'm actually curious, Ashley, for all the micro influencers out there, I want you to give some advice because you know, I see a lot of people trying to become, you know, or create a platform that is going to be, you know, it valid, right?
• 2:41:49
  SPEAKER_11: Where people can take the advice they're giving, but it just doesn't seem to come through or they don't gain followers.
• 2:41:54
  SPEAKER_11: So, do you have any advice for um all of the aspiring micro influencers out there?
• 2:42:01
  SPEAKER_04: Find your peak engagement day and limit your content to just good content that you really like sharing because okay, so my best engagement day is Sunday by far, Sunday night at nine Eastern.
• 2:42:12
  SPEAKER_04: It differs for each person.
• 2:42:14
  SPEAKER_04: I don't know, Sheldon's nodding.
• 2:42:15
  SPEAKER_04: Do you feel the same?
• 2:42:16
  SPEAKER_07: Sunday is is the best, I in my opinion.
• 2:42:19
  SPEAKER_07: Uh a lot of people we worked with Sunday is is is great, and it's in that average night.
• 2:42:24
  SPEAKER_07: You know, I feel like people scroll, right?
• 2:42:26
  SPEAKER_07: People scroll before they're going back to work.
• 2:42:28
  SPEAKER_07: Exactly.
• 2:42:28
  SPEAKER_04: Before I think definitely it's that like relaxation before the work week.
• 2:42:32
  SPEAKER_04: Um, but even just nighttime in general works best for me.
• 2:42:36
  SPEAKER_04: So I always post at nine Eastern, whether that's story or main feed.
• 2:42:40
  SPEAKER_04: I think you just have to figure out what time you're gonna get seen the most because the Instagram algorithm is wacky.
• 2:42:47
  SPEAKER_04: And then I think that you need to um, I mean, a lot of people just think, oh, we'll just keep putting content out there like over and over again.
• 2:42:56
  SPEAKER_04: I actually find if you space it out throughout the week and you only post a certain number of days, that actually helps you.
• 2:43:02
  SPEAKER_11: I love that.
• 2:43:03
  SPEAKER_11: Thank you for providing that.
• 2:43:05
  SPEAKER_11: I had no idea, by the way, about Sunday.
• 2:43:08
  SPEAKER_11: You both just told me something new, and I'm going to try it.
• 2:43:13
  SPEAKER_07: Right.
• 2:43:14
  SPEAKER_07: I think that I think less is more.
• 2:43:16
  SPEAKER_07: Yeah, you know, I just I've never been a fan of let's blanket people with content because there's there's just an overwhelming amount of content out there right now.
• 2:43:25
  SPEAKER_07: It's hard for people to to you know view it all.
• 2:43:29
  SPEAKER_07: And and I just think that less is more.
• 2:43:31
  SPEAKER_07: And and yeah, I mean Sundays has always been great.
• 2:43:33
  SPEAKER_07: Wednesdays, I have heard, is a good thing too.
• 2:43:35
  SPEAKER_04: I say Sunday through Wednesday.
• 2:43:37
  SPEAKER_04: Once you hit Thursday and like it brings you back to college, like Thursday Thursday, I think people are starting to like to relax a little bit, get a little bit more social.
• 2:43:45
  SPEAKER_04: Get drunk.
• 2:43:48
  SPEAKER_04: Yeah.
• 2:43:49
  SPEAKER_11: Yeah, no, it makes sense.
• 2:43:51
  SPEAKER_11: I I've never understood the full algorithm of Instagram.
• 2:43:53
  SPEAKER_11: I know I played around with it, but it was always something that was like, you know what, screw it.
• 2:43:57
  SPEAKER_11: I'm gonna put what I put up, and hopefully somebody likes it.
• 2:44:01
  SPEAKER_11: But um, I you know, I I want to thank both of you.
• 2:44:04
  SPEAKER_11: This has been awesome.
• 2:44:04
  SPEAKER_11: I uh you know, I don't get to talk to um you know people with your background a lot.
• 2:44:09
  SPEAKER_11: So I really appreciate your time and all all the great work that you guys have put into this amazing conference.
• 2:44:15
  SPEAKER_04: Oh, thank you.
• 2:44:16
  SPEAKER_04: Well, it's all Sheldon.
• 2:44:17
  SPEAKER_04: He's he's rocked this.
• 2:44:19
  SPEAKER_04: This has been amazing.
• 2:44:21
  SPEAKER_11: Great work, Sheldon.
• 2:44:22
  SPEAKER_07: I mean, I think we've had fun and uh, you know, thanks for having us on.
• 2:44:25
  SPEAKER_07: I appreciate it.
• 2:44:26
  SPEAKER_07: And uh, you know, hopefully next time um, you know, we'll be taking this uh symposium out to uh um you know city near you.
• 2:44:34
  SPEAKER_07: You guys can come out and and be on and uh it'll be great.
• 2:44:38
  SPEAKER_11: Would love to.
• 2:44:38
  SPEAKER_11: Thank you so much for the offer.
• 2:44:40
  SPEAKER_11: Um okay, so that's the end of the episode, but I want to thank both of you so hey guys, so I hope you love that episode.
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