Latest / Scalpel and Skin / Is Filler Actually Worth It? Hyaluronic Acid Filler, Overfilling, and What Patients Should Know | EP 03

Transcript

Is Filler Actually Worth It? Hyaluronic Acid Filler, Overfilling, and What Patients Should Know | EP 03 · Scalpel and Skin

• 0:00
  SPEAKER_01: Sometimes it was medical grade silicone, sometimes it was industrial grade silicone.
• 0:04
  SPEAKER_01: It was criminal.
• 0:04
  SPEAKER_01: Now filler has a little bit of a bad rotation.
• 0:07
  SPEAKER_01: Let's talk about it.
• 0:08
  SPEAKER_02: But yeah, I remember watching the trial and she was a bit overfilled.
• 0:12
  SPEAKER_02: I generally don't like talking about celebrity faces, but she pooped the bed.
• 0:18
  SPEAKER_01: She deserves a little bit of bad puff.
• 0:21
  SPEAKER_02: I mean, you are wrong.
• 0:22
  SPEAKER_01: I'm no hyaluronic acid filler.
• 0:24
  SPEAKER_01: Is it worth it?
• 0:38
  SPEAKER_01: Welcome to Scalpel and Skin.
• 0:40
  SPEAKER_01: This is Dr.
• 0:40
  SPEAKER_01: Algie Labrasca.
• 0:41
  SPEAKER_01: I'm here with my sister, Mystica Labrasca.
• 0:44
  SPEAKER_01: I'm a board certified plastic surgeon of 16 years.
• 0:46
  SPEAKER_01: She is a 16-year veteran of cosmetic dermatology, lasers, injectables, and everything skin in general.
• 0:54
  SPEAKER_01: She is the master of skin.
• 0:55
  SPEAKER_01: Today we're here to begin our very first episode that is the kind of the crux of why we started scalpel and skin.
• 1:04
  SPEAKER_01: And that is, is it worth it?
• 1:06
  SPEAKER_01: Today we're going to be talking about dermal filler.
• 1:10
  SPEAKER_01: We're going to go on the history of dermal filler or where filler started, where it is, where it's been, and where it's going.
• 1:17
  SPEAKER_01: So Missica, say hello.
• 1:19
  SPEAKER_02: Hi everyone.
• 1:19
  SPEAKER_02: I'm excited to be back.
• 1:21
  SPEAKER_02: New shirt on.
• 1:22
  SPEAKER_01: Oh, thanks.
• 1:23
  SPEAKER_01: God, she dropped it.
• 1:25
  SPEAKER_01: So the first two episodes, she did a peace sign.
• 1:28
  SPEAKER_02: Oh, crap.
• 1:30
  SPEAKER_02: It's the the millennial urge to hold up.
• 1:35
  SPEAKER_02: Most of the people listening are probably millennials.
• 1:37
  SPEAKER_01: Yeah, but you don't have to peace sign everything.
• 1:40
  SPEAKER_02: We love it.
• 1:41
  SPEAKER_02: We love the peace sign.
• 1:42
  SPEAKER_01: It's the I would feel better if you peace sign the end, not the.
• 1:45
  SPEAKER_02: What if I was?
• 1:46
  SPEAKER_02: Aren't you glad I'm like not doing this?
• 1:48
  SPEAKER_02: What's this?
• 1:48
  SPEAKER_02: This is a thing, right?
• 1:50
  SPEAKER_01: Is it Pac-Man?
• 1:51
  SPEAKER_01: Like there's Miss Pac-Man up here.
• 1:53
  SPEAKER_02: This is what the Gen Alpha are doing.
• 1:55
  SPEAKER_02: They like put their thumb and index and middle finger together and they like do this like little mini pat thing.
• 2:01
  SPEAKER_02: I will never do it.
• 2:02
  SPEAKER_02: Don't worry.
• 2:04
  SPEAKER_01: I guess I'll have to learn about that.
• 2:07
  SPEAKER_01: Okay, I guess we're stuck with the peace sign.
• 2:09
  SPEAKER_01: So probably isn't a treatment that's generated more opinions over the last 20, 25 years or whatever, than filler.
• 2:18
  SPEAKER_01: So we're talking about the brand names are going to be your Restalin, your Juvederms, your other RHA and others, but it didn't start there.
• 2:26
  SPEAKER_01: Mystic, will you kind of tell us a little bit about the history of filler and uh going back before anybody else listening to this knows?
• 2:35
  SPEAKER_01: Because most people who've even been in aesthetics don't know.
• 2:39
  SPEAKER_02: So I looked into this a little bit before the episode, and what I learned is that actually the first filler on the market was in 1981.
• 2:50
  SPEAKER_02: That predates me.
• 2:51
  SPEAKER_02: That's that that's older than me.
• 2:52
  SPEAKER_02: That's older than me.
• 2:53
  SPEAKER_01: That is older than you.
• 2:55
  SPEAKER_02: But I so but I think the idea of filling tissue to replace lost volume and make things look a little bit more full started to pick up more in the 90s with silicone injections.
• 3:09
  SPEAKER_01: Let's do a quick pause because this is interesting.
• 3:11
  SPEAKER_01: I did a rotation in in medicine.
• 3:15
  SPEAKER_01: We do undergrad, regular college, we do four years of medical school.
• 3:21
  SPEAKER_01: The last two years are rotations where we rotate for a month or six weeks or whatever in different things.
• 3:27
  SPEAKER_01: And then that continues to degree during residency as well.
• 3:31
  SPEAKER_01: So I did four years of undergrad, four years of medical school, five years of general surgery residency where I did gallbladders and colons and thyroids and spleens and trauma and vascular and all the other stuff, and plastic surgery.
• 3:45
  SPEAKER_01: And I did a rotation in Philadelphia in 2007.
• 3:49
  SPEAKER_01: It was kind of a good part of Philadelphia, but the particular surgeon that I was working with was very early on in the transgender surge at that point in time.
• 4:00
  SPEAKER_02: Gender affirmation surgery.
• 4:01
  SPEAKER_01: Yes, but it wasn't just that.
• 4:04
  SPEAKER_01: Part of it was he would have a lot of transgender folks who were sex workers.
• 4:10
  SPEAKER_01: Okay.
• 4:10
  SPEAKER_01: It was a different time where you couldn't get health insurance.
• 4:14
  SPEAKER_01: You couldn't really get jobs.
• 4:16
  SPEAKER_01: There was a lot of discrimination.
• 4:17
  SPEAKER_01: And again, you couldn't get health insurance if you were transgender at the time.
• 4:21
  SPEAKER_01: And they would be terrible.
• 4:23
  SPEAKER_01: Right.
• 4:23
  SPEAKER_01: Right.
• 4:23
  SPEAKER_01: Right.
• 4:24
  SPEAKER_01: Yeah.
• 4:24
  SPEAKER_01: They would go to pumping parties.
• 4:26
  SPEAKER_01: And so what did that mean?
• 4:28
  SPEAKER_01: So a a maybe a nurse, maybe not a nurse, would go to a hotel room or a back room of some facility or whatever, and would bring a container of silicone and inject them wherever they wanted in the hips, in the butt, in the face, anywhere, in the breasts to add volume, big giant BBLs, big uh hips, breasts, face, all of that.
• 4:53
  SPEAKER_01: And sometimes it was medical grade silicone, sometimes it was industrial grade silicone.
• 4:57
  SPEAKER_01: Oh, yeah, industrial grade silicone.
• 5:00
  SPEAKER_01: And so we would see these, and these people would be the only thing that I can think it was criminal what was done to these people.
• 5:08
  SPEAKER_01: And so yeah, so that happened.
• 5:10
  SPEAKER_01: And we would see these people and we would have to treat them.
• 5:13
  SPEAKER_01: And it was it was cut it out?
• 5:15
  SPEAKER_01: You cut out the we would often cut it out.
• 5:17
  SPEAKER_01: Sometimes we would cut out part of it.
• 5:19
  SPEAKER_02: And did they have to, they they didn't have health insurance, so they had to pay for the correct surgery.
• 5:26
  SPEAKER_01: Oh, that's so sad.
• 5:27
  SPEAKER_01: Correct.
• 5:27
  SPEAKER_01: Yeah, it was uh it was, it was, it was terrible.
• 5:30
  SPEAKER_01: And I'm sure it's still going on.
• 5:32
  SPEAKER_01: Every now and then I see like a post on uh uh on social media from uh from you know somebody who's like showing the the silicone that's removed and it's it's just it's awful what what that looked like.
• 5:44
  SPEAKER_01: And so yeah, we had to treat that.
• 5:45
  SPEAKER_01: And and thankfully I don't have that in my practice now because it is uh it's highly not satisfying.
• 5:51
  SPEAKER_02: The results are just you know, it's way too permanent.
• 5:54
  SPEAKER_01: I mean, the the Oh, it's forever.
• 5:57
  SPEAKER_02: Yeah.
• 5:58
  SPEAKER_01: So it's forever.
• 5:59
  SPEAKER_02: I think the one of the biggest draws of hyaluronic acid filler is that they are not permanent and they are totally reversible.
• 6:09
  SPEAKER_02: So that to me, as as a consumer and someone who has plenty of filler in my face, but also someone who performs the procedure, I think it's it's a huge draw.
• 6:22
  SPEAKER_02: So I would never, even if, even if a permanent filler came out, I would not perform it.
• 6:27
  SPEAKER_01: Yeah, there were even in my last in the last 10 years or so, there was there's a five-year filler that's out, right?
• 6:34
  SPEAKER_01: And uh starts with a B.
• 6:35
  SPEAKER_01: Which one is that?
• 6:36
  SPEAKER_01: I can't remember.
• 6:36
  SPEAKER_02: Bellafil.
• 6:37
  SPEAKER_01: Talking about Bella, probably probably Bellafil.
• 6:39
  SPEAKER_01: And it was like five years.
• 6:40
  SPEAKER_01: And so I was in the OR with a nurse who she went to somebody else.
• 6:44
  SPEAKER_01: She started asking about it.
• 6:46
  SPEAKER_01: And I said, Yeah, I would never do that because five years, it it'll stay fine for five years, but you will age around it, right?
• 6:52
  SPEAKER_01: Right.
• 6:53
  SPEAKER_01: You will you age around the filler, and so your body, your face is not going to be the same at that point in time.
• 6:59
  SPEAKER_01: And he told her, Yeah, and you know, and that's why I wouldn't ever do it.
• 7:02
  SPEAKER_01: And she said, Well, I just got it.
• 7:04
  SPEAKER_01: I was like, Oh, it'll probably be fine for you.
• 7:07
  SPEAKER_02: Like, oh shit.
• 7:09
  SPEAKER_01: Oh, crap.
• 7:10
  SPEAKER_01: You know, you should have asked me before, but you know, it's whatever.
• 7:13
  SPEAKER_01: She's a lovely, uh, lovely woman, and I'm sure it's fine by now.
• 7:16
  SPEAKER_02: She she knows you.
• 7:18
  SPEAKER_02: So if she has problems, she can call you out.
• 7:20
  SPEAKER_01: Well, it's more than five years now.
• 7:21
  SPEAKER_01: So she's either it's either not there or you know, she's dealt with it everybody.
• 7:25
  SPEAKER_01: Yeah, yeah, it's fine.
• 7:26
  SPEAKER_01: So you talked about hyaluronic acid filler.
• 7:29
  SPEAKER_01: Let's let's give me a little history of hyaluronic, let's touch on hyaluronic acid filler.
• 7:33
  SPEAKER_01: What is it?
• 7:34
  SPEAKER_01: When was it approved in the United States?
• 7:36
  SPEAKER_02: The first approved hyaluronic acid filler in the US was Restalin in 2003.
• 7:44
  SPEAKER_02: So that was a long time ago.
• 7:45
  SPEAKER_02: That's when I graduated high school.
• 7:47
  SPEAKER_02: Restlin is still one of the most popular fillers out there.
• 7:51
  SPEAKER_02: They I use a ton of Restalin products, but now they have a lot more products in their portfolio.
• 7:57
  SPEAKER_02: So it was, it was just one filler and you would just put it wherever the person needed it.
• 8:03
  SPEAKER_02: But now we have a whole bunch of different types of hyaluronic acid fillers that are that are created differently depending on where you want to put it.
• 8:13
  SPEAKER_02: So there are softer fillers for the lips, there are firmer fillers for the cheeks, and and they've really honed in on the technology and put a lot of research into creating these hyaluronic acid molecules that will behave how we want them to behave in a given area in the face.
• 8:33
  SPEAKER_01: So whenever I first got into plastic surgery in officially in 2008, and when you got into dermatology in 2010, there was um there was Juvederm at that point in time, and there was uh wrestling, and but it was only approved for the nasal labial folds, and yeah, and and that was yeah, and lips.
• 8:54
  SPEAKER_02: I mean, well, I don't even know.
• 8:55
  SPEAKER_02: I don't think it's not even lips yet, but we would put it in lips.
• 8:58
  SPEAKER_02: We would put it in lipstick.
• 8:59
  SPEAKER_01: We started putting it in lips, kind of, you know, off label.
• 9:04
  SPEAKER_01: I those of you that don't know, I don't think lips were approved 15 years ago.
• 9:10
  SPEAKER_01: Like it was off label, and and then we just decided, and then we were able to put it in the cheeks, and then we were able to put it in the chin, and then you know, the next thing you know, people are putting it freaking everywhere.
• 9:20
  SPEAKER_02: Yeah.
• 9:20
  SPEAKER_02: And I mean, just to clarify too, off label doesn't mean unsafe.
• 9:26
  SPEAKER_01: Correct.
• 9:26
  SPEAKER_01: Correct.
• 9:27
  SPEAKER_02: It just means that they didn't go through the the rigmarole of all of the testing and to show the FDA safety and efficacy, but that does not mean that it's not safe.
• 9:37
  SPEAKER_02: And we do a ton of off-label stuff in aesthetics.
• 9:41
  SPEAKER_01: Fun thing.
• 9:41
  SPEAKER_01: So now we use filler kind of everywhere, but you know, let's talk about things that we used to do that we don't do today.
• 9:49
  SPEAKER_01: That's kind of a big one.
• 9:50
  SPEAKER_01: There have been trends in our your 16 years, I guess my 18 years that we did that we don't do now.
• 9:57
  SPEAKER_01: Let's kind of go over that a little bit.
• 9:59
  SPEAKER_01: In general, and maybe you in particular.
• 10:01
  SPEAKER_02: Well, when I started, it was just filling nasolabial folds right here, right, right above, kind of outside it for people who aren't watching and are just listening.
• 10:11
  SPEAKER_02: It's the everyone knows where their nasolabial folds is.
• 10:14
  SPEAKER_02: It's the little fold kind of parentheses.
• 10:17
  SPEAKER_02: The parentheses around the mouth, exactly.
• 10:20
  SPEAKER_02: And I remember that's all, that's all we did.
• 10:23
  SPEAKER_02: We just filled nasolabia folds, and now that's like the last place I will fill, honestly, because it was kind of just treat the treat the symptom, treat where there's a little deficiency in the in the anatomy of the face, but not why.
• 10:39
  SPEAKER_02: So what we've we've learned over the past decade plus by studying cadavers and studying the aging face is that the reason the nasolabial fold happens is actually typically from volume loss in the cheek.
• 10:54
  SPEAKER_02: And the nasal labial fat pad itself actually is one of the few fat pads in the face that actually gets bigger with age.
• 11:00
  SPEAKER_02: So we were putting more volume in an area that was already getting bigger.
• 11:06
  SPEAKER_02: So that is why initially, you know, the looking sort of monkey kind of lip look, mouth around the mouth look was a big thing when filler starts started coming out because you were adding more volume where there already was more volume occurring with AIDS.
• 11:23
  SPEAKER_01: Do you do any nasal abial folds now?
• 11:26
  SPEAKER_02: I I will, if the person truly needs it.
• 11:29
  SPEAKER_02: And that is the case sometimes.
• 11:31
  SPEAKER_02: But I will definitely address the cheek deficit first before I would fill the fold.
• 11:37
  SPEAKER_02: Another area that's that really gives a lot of beautiful improvement is treating what's called the piriform, which is this area right here, sort of above where the fold would be and deeper.
• 11:50
  SPEAKER_01: So for those of you that are listening, the the piriform area, what she's talking about is kind of like the bottom on like just outside your nostril there, where maybe when you were a teenager, that was like a really good place to get a zit, right?
• 12:03
  SPEAKER_01: At the bottom of your nose on the side.
• 12:05
  SPEAKER_02: It would hurt too.
• 12:06
  SPEAKER_01: And it hurt like it would make you cry when you squeezed it.
• 12:09
  SPEAKER_02: Adding some volume there with filler is is a great way to improve the fold without making it look fuller.
• 12:16
  SPEAKER_01: I absolutely agree.
• 12:17
  SPEAKER_01: That is that's a that's a strong point.
• 12:19
  SPEAKER_01: And there are people that don't do that anymore.
• 12:22
  SPEAKER_01: And I think it's a mistake because if they're like, no, I never do nasal labial fold filler, you're screwing up.
• 12:29
  SPEAKER_01: You're you're screwing up again.
• 12:30
  SPEAKER_01: Absolutely.
• 12:31
  SPEAKER_01: Inexperienced injector.
• 12:32
  SPEAKER_02: Some people still need it.
• 12:34
  SPEAKER_01: I I've been kind of waiting, I've been saving this one, right?
• 12:37
  SPEAKER_01: Mystica and I, we rarely disagree in uh the way that we treat patients and stuff like that.
• 12:43
  SPEAKER_01: But there was, I remember more than 10 years or so ago, we disagree.
• 12:47
  SPEAKER_01: I don't know what's coming.
• 12:48
  SPEAKER_00: Oh, I know.
• 12:48
  SPEAKER_00: I'm so excited.
• 12:49
  SPEAKER_01: It's not like a big giant thing, but like it's a thing.
• 12:52
  SPEAKER_01: I want to see maybe if you have evolved or changed, you would tell me that fillers lift.
• 12:59
  SPEAKER_01: Fillers don't lift.
• 13:00
  SPEAKER_01: Fillers fill.
• 13:01
  SPEAKER_01: This is I'm this is my version.
• 13:03
  SPEAKER_01: Fillers fill.
• 13:04
  SPEAKER_01: There was a study, and it said that injection of like a CC of filler would lift the equivalent of the thickness of a credit card.
• 13:14
  SPEAKER_01: So I don't even have a credit card here.
• 13:16
  SPEAKER_01: So like I mean, like a little, oh here.
• 13:18
  SPEAKER_01: This is the thickness of a credit card.
• 13:20
  SPEAKER_01: It's that much of a fill.
• 13:22
  SPEAKER_01: It's like a millimeter.
• 13:23
  SPEAKER_01: So go ahead.
• 13:24
  SPEAKER_01: Tell me how I'm wrong.
• 13:25
  SPEAKER_01: Tell me how you've changed.
• 13:26
  SPEAKER_02: I mean, you are wrong.
• 13:32
  unknown: I'm not wrong.
• 13:33
  SPEAKER_02: I mean, I listen, I I do this all day.
• 13:36
  SPEAKER_02: I see it with my own eyes.
• 13:37
  SPEAKER_02: I see it with my patient before and after photos.
• 13:40
  SPEAKER_02: Now, I am not saying that fillers are going to give a facelift like result.
• 13:45
  SPEAKER_02: I am talking millimeters.
• 13:47
  SPEAKER_01: A millimeter, yeah, that sounds right.
• 13:49
  SPEAKER_02: Millimeters.
• 13:50
  SPEAKER_01: But you're also giving sculpture, you're giving microneedling, you're giving laser, all of those things together.
• 13:57
  SPEAKER_01: But filler by itself, you if you put a CC of filler in someone's cheek and a CC in someone's someone, the other cheek, or even a half in each one, whatever, how much you do, it's not gonna raise, it's not gonna do jack shit to the jowls.
• 14:10
  SPEAKER_02: No, it's not.
• 14:11
  SPEAKER_02: But listen.
• 14:12
  SPEAKER_01: Number one, right here.
• 14:14
  SPEAKER_02: There, there are actual studies on filling you the the same plane of tissue, the temples down to the down to the jowl.
• 14:24
  SPEAKER_02: That if you so there are studies that if you fill certain areas in the same plane of tissue, it does give a lift.
• 14:31
  SPEAKER_02: And I have and I have trained with the best in the industry that will also agree with that.
• 14:38
  SPEAKER_01: That doesn't mean they're right.
• 14:40
  SPEAKER_01: So, so it's but so that that there is a tissue plane, the platisma, which is this muscle in the neck that gets loose that we all hate in our neck.
• 14:51
  SPEAKER_01: It continues superior, it continues up into the face, and we call that the SMAS, the superficial musculo-apineurotic system, and it continues up into the temple as well.
• 15:00
  SPEAKER_01: So that is the tissue plane that she is speaking of.
• 15:03
  SPEAKER_01: And she is exactly right about that part of it of the argument.
• 15:08
  SPEAKER_02: So, but I'm I'm very realistic with patients.
• 15:11
  SPEAKER_02: I I will not sit in front of them and tell them, we're gonna lift all of we're gonna totally lift your jaws, it's gonna be a whole new jawline.
• 15:20
  SPEAKER_02: Absolutely not.
• 15:20
  SPEAKER_02: That's the I literally say to them if we do all of these things, if we address the volume loss, meaning the fat loss in the face with filler, if we address the pool on the muscle with Botox in the lower face, if we address the collagen loss with skin quality treatment, skin tightening like RF microneedling, you will see improvement, but we're still talking millimeters of improvement.
• 15:49
  SPEAKER_02: But that's enough that I mean that's enough for two, three millimeters.
• 15:53
  SPEAKER_01: It makes it, you can see a difference with a few millimeters, right?
• 15:57
  SPEAKER_01: There's no question about it.
• 15:58
  SPEAKER_01: A couple of millimeters in a 30-something, 40-something.
• 16:03
  SPEAKER_01: That ain't bad.
• 16:04
  SPEAKER_01: That ain't bad.
• 16:04
  SPEAKER_01: But you know, it's multiple treatments, it's not just uh, you know, a little bit of filler.
• 16:07
  SPEAKER_02: It's multiple treatments, yeah.
• 16:09
  SPEAKER_02: And then and I will also the the actually the first question that I ask those patients in the consult is is a facelift off the table for you?
• 16:18
  SPEAKER_02: And if they say a facelift is not off the table, I will say you have a consult first to decide if you because if you're if you if you are if you say to me, I'm never gonna do surgery, I'm never gonna have a facelift, then I will do all the things to get you improvement.
• 16:35
  SPEAKER_02: But if they are, you know, late 40s, 50s, 60s, and they really want to lift the lower face and the jowls and they would consider surgery, it's worth having that conversation before they dump a whole bunch of money into fillers and such.
• 16:50
  SPEAKER_01: And then what do you do at that time?
• 16:52
  SPEAKER_02: I send them to you.
• 16:53
  SPEAKER_01: There we go.
• 16:53
  SPEAKER_01: DrLebraska.com, 814-849-6591.
• 16:57
  SPEAKER_01: I'm drlabraska, dr.labrasca on Instagram and TikTok and Lebraska Plastic Surgery on Facebook.
• 17:06
  SPEAKER_01: Come see me.
• 17:07
  SPEAKER_02: Shameless.
• 17:09
  SPEAKER_02: Shameless.
• 17:11
  SPEAKER_01: Absolutely, right?
• 17:14
  SPEAKER_01: That's the first time I did that in three episodes.
• 17:16
  SPEAKER_01: So, you know, I feel like we're doing pretty good.
• 17:18
  SPEAKER_01: That's pretty good.
• 17:19
  SPEAKER_01: Pretty good.
• 17:20
  SPEAKER_01: What are the things that I see?
• 17:22
  SPEAKER_01: I don't really regret it, but the things that I don't do anymore are big, overfill.
• 17:27
  SPEAKER_01: I hate big, overfilled anything.
• 17:29
  SPEAKER_01: I hate big overfilled butts.
• 17:31
  SPEAKER_01: I hate big overfilled hips.
• 17:33
  SPEAKER_01: I hate big overfilled breasts.
• 17:35
  SPEAKER_01: I hate big overfilled lips.
• 17:37
  SPEAKER_01: Now, I never done, I've never done the big Miami butts.
• 17:42
  SPEAKER_01: And the trend is away from that.
• 17:44
  SPEAKER_02: Honestly, I don't get the trend.
• 17:46
  SPEAKER_01: I I I'd but there are people that that like there are subsets of people who that that's okay, right?
• 17:53
  SPEAKER_01: That it's it's okay.
• 17:55
  SPEAKER_01: It's not my thing.
• 17:56
  SPEAKER_01: I'm not an a master of BBLs.
• 17:59
  SPEAKER_01: I'm just not.
• 18:00
  SPEAKER_01: I've done dozens, 250s, maybe a hundred, maybe a hundred, but not thousands.
• 18:07
  SPEAKER_02: The recovery from that's terrible too, right?
• 18:09
  SPEAKER_01: I mean it's it's not great.
• 18:11
  SPEAKER_01: When you add in a tummy tuck with it, it makes it super not great.
• 18:14
  SPEAKER_02: Yeah, I mean they can't they can't they can't sit on their yeah, it sucks.
• 18:19
  SPEAKER_01: Yeah, it's like we're right.
• 18:21
  SPEAKER_01: You know, as long as you know it's coming, that's fine.
• 18:23
  SPEAKER_01: And and if you just quote unquote, just get a BBL, it's better than a BBL with a tummy tuck, because that's tough because then you can only with a tummy tuck, you need to be bent, and with a BBL, you need to be off your butt.
• 18:35
  SPEAKER_01: And so, you know, it's tough.
• 18:37
  SPEAKER_01: It's tough.
• 18:37
  SPEAKER_01: Yeah, yeah, it's tough.
• 18:38
  SPEAKER_01: Only the fittest patients who are also good candidates for that.
• 18:41
  SPEAKER_01: But specifically in this case for for filler, overfilled lips.
• 18:46
  SPEAKER_01: I uh for a long time, I would not overfill lips.
• 18:50
  SPEAKER_01: And then I have a friend who was like, come on, just put some more in here, put some, you know.
• 18:54
  SPEAKER_01: And uh the next thing I know, about three years in, she's got overfilled lips.
• 18:57
  SPEAKER_01: And I'm like, Yeah, they're overfilled, but they actually look pretty good.
• 19:00
  SPEAKER_01: She's had so I so I did some of it, but I haven't seen her for I don't know, a long time now.
• 19:04
  SPEAKER_01: You got married.
• 19:05
  SPEAKER_02: I I overfill nothing.
• 19:06
  SPEAKER_02: I I just Right, right, right.
• 19:08
  SPEAKER_01: Yeah, I haven't overfilled in in years.
• 19:10
  SPEAKER_02: The big lip trend was a few years ago.
• 19:12
  SPEAKER_02: Yeah, yeah.
• 19:13
  SPEAKER_01: Her lips are actually still on my wall.
• 19:15
  SPEAKER_01: They're a little overfilled uh on my wall here.
• 19:17
  SPEAKER_01: But you know, it it I'm I'm glad it's not that.
• 19:20
  SPEAKER_01: Yeah, yeah, right.
• 19:21
  SPEAKER_02: You know, but there's you know, I always say there's a there's a there's an East Coast aesthetic and there's a West Coast aesthetic.
• 19:27
  SPEAKER_01: And there's a South aesthetic.
• 19:28
  SPEAKER_02: And there's a yes, there's a Miami aesthetic.
• 19:31
  SPEAKER_02: There's the there's a Miami aesthetic.
• 19:33
  SPEAKER_02: The East Coast aesthetic is very is is much more subdued, not overly enhanced.
• 19:39
  SPEAKER_02: Yeah.
• 19:39
  SPEAKER_02: Miami tends to, they tend to like a more enhanced look.
• 19:44
  SPEAKER_02: And on the West Coast, although I feel like things are trending more East Coast, even on the West Coast.
• 19:48
  SPEAKER_01: So Yeah, that's fair.
• 19:49
  SPEAKER_01: That's fair.
• 19:50
  SPEAKER_01: You know, one of the things, so one of the things that not, again, you and I, uh, other than the fillers lift thing, we have mostly agreed on everything.
• 19:58
  SPEAKER_01: But there are there are good injectors who who would say, you know, I have eight syringes of filler in my face, you know, I get eight syringes every six to twelve months.
• 20:08
  SPEAKER_01: And so the thought for a while in some circles was more syringes, better results.
• 20:14
  SPEAKER_01: Well, let's talk about that a little bit and and let's disprove that because we both disagree with that, with that.
• 20:19
  SPEAKER_02: Yeah, yeah, totally.
• 20:20
  SPEAKER_02: I mean, if you are some people, depending on their age, may need eight syringes, but we're not doing eight syringes in one setting.
• 20:30
  SPEAKER_02: We are doing this over 12 to 18 months, potentially.
• 20:34
  SPEAKER_02: And we are also incorporating skin quality treatments.
• 20:38
  SPEAKER_02: We're doing laser to build collagen.
• 20:40
  SPEAKER_02: We're doing sculptra to build collagen.
• 20:43
  SPEAKER_02: It would be extremely rare.
• 20:45
  SPEAKER_02: In fact, I can't think of a person I put eight syringes in, come to think of it.
• 20:49
  SPEAKER_02: I never did.
• 20:49
  SPEAKER_02: I know.
• 20:50
  SPEAKER_02: I never did.
• 20:51
  SPEAKER_01: I never put eight in, I mean, maybe over five years, but not in not in 12 to 18 months.
• 20:57
  SPEAKER_01: I never did.
• 20:58
  SPEAKER_02: I I know there was uh there was a training there that I did with uh an injectable company several years ago, and I wasn't, it wasn't hands-on for me.
• 21:08
  SPEAKER_02: I was just watching to get a few little new techniques.
• 21:11
  SPEAKER_02: And the trainer from the company actually had the person that was doing the hands-on do eight syringes on the patient.
• 21:19
  SPEAKER_02: In one setting.
• 21:20
  SPEAKER_02: In one setting.
• 21:21
  SPEAKER_02: I mean, it was it, you know.
• 21:23
  SPEAKER_01: So yeah, you know, it's a I think there's multiple points there.
• 21:26
  SPEAKER_01: One is that's an industry shill doing that to somebody.
• 21:31
  SPEAKER_01: And two, that's the companies.
• 21:32
  SPEAKER_01: The listen, we we love our companies to a degree, but they'll always do what's best for them.
• 21:40
  SPEAKER_01: And what's best for them is sell more syringes of filler, sell more tox, like whatever, even if it's not the right thing for the patient.
• 21:48
  SPEAKER_01: We are treating individual patients one at a time, trying to do our best.
• 21:53
  SPEAKER_01: And if you are an inexperienced injector and you are following what the company says, terrible.
• 22:01
  SPEAKER_01: You're setting yourself up for bad results.
• 22:04
  SPEAKER_01: I'm going to tell you something.
• 22:05
  SPEAKER_01: I've been thinking about that Philadelphia rotation that I did, and I'm going to knock your socks off now.
• 22:10
  SPEAKER_01: Okay.
• 22:11
  SPEAKER_01: So at that rotation, again, I am in general surgery.
• 22:15
  SPEAKER_01: I'm not in plastic surgery yet.
• 22:17
  SPEAKER_01: I was near the end.
• 22:18
  SPEAKER_01: I finished in 2008.
• 22:19
  SPEAKER_01: I was trying to get a plastic surgery residency.
• 22:21
  SPEAKER_01: I did get offered this spot in Philadelphia, but uh, but that was in, I ended up going to Detroit.
• 22:28
  SPEAKER_01: And one of the reasons I did was there are certain things that I that I didn't like about that rotation.
• 22:33
  SPEAKER_01: That particular rotation, so I I have a I now have a syringe with me.
• 22:37
  SPEAKER_01: This is just an empty syringe.
• 22:38
  SPEAKER_01: There's, there's, it's full of air.
• 22:40
  SPEAKER_01: This is a one CC syringe.
• 22:42
  SPEAKER_01: So this doctor would, you'd come in as a patient and be like, yeah, you need like a little bit of filler.
• 22:47
  SPEAKER_01: So very early filler.
• 22:49
  SPEAKER_01: And I we sell it for$50 per tenth of a CC.
• 22:54
  SPEAKER_01: So he would have a syringe.
• 22:55
  SPEAKER_01: I'm holding a syringe in my hand with 10 tenths of a CC.
• 22:58
  SPEAKER_01: So he would charge$100 for two tenths of a CC.
• 23:02
  SPEAKER_01: He would go one tenth in the pure form here, one tenth in the pure form here, take the needle off, put a new needle on for the next patient.
• 23:10
  SPEAKER_01: Oh yes.
• 23:12
  SPEAKER_01: I saw it.
• 23:13
  SPEAKER_02: No.
• 23:14
  SPEAKER_01: Yes.
• 23:15
  SPEAKER_01: So different patients, same syringe.
• 23:20
  SPEAKER_01: I saw that.
• 23:21
  SPEAKER_02: Disgusting.
• 23:22
  SPEAKER_02: It's right.
• 23:23
  SPEAKER_02: But I was young.
• 23:24
  SPEAKER_02: I had young.
• 23:26
  SPEAKER_02: I had no idea.
• 23:26
  SPEAKER_01: I didn't do it.
• 23:28
  SPEAKER_01: And it didn't, you know, I like I thought, uh okay.
• 23:32
  SPEAKER_01: A little weird.
• 23:32
  SPEAKER_02: That is so freaking gross.
• 23:34
  SPEAKER_01: Right, right, right.
• 23:35
  SPEAKER_01: I don't even think that surgeon's alive anymore, but that but that happened.
• 23:39
  SPEAKER_02: Um like transmissible disease.
• 23:42
  SPEAKER_01: Right.
• 23:42
  SPEAKER_01: Everything.
• 23:43
  SPEAKER_01: And again, same rotation.
• 23:45
  SPEAKER_01: We're dealing with sex workers.
• 23:46
  SPEAKER_02: Oh, was the silicone rotation?
• 23:48
  SPEAKER_02: Dude, what was that guy doing?
• 23:50
  SPEAKER_02: Someone is like that.
• 23:52
  SPEAKER_01: So he taught me a lot.
• 23:54
  SPEAKER_01: He was a very good plastic surgeon.
• 23:56
  SPEAKER_02: He was he was a plastic surgeon.
• 23:58
  SPEAKER_01: He was a plastic surgeon.
• 23:58
  SPEAKER_01: Yeah, I'm not even sure he's alive anymore.
• 24:01
  SPEAKER_01: Uh, and I won't share his name just because I'm sharing stories that were that were bad.
• 24:05
  SPEAKER_01: But, you know, a very good plastic surgeon did a lot of really good work and probably was very early on treating transgender, was doing it very early on and was, you know, cutting edge for the time.
• 24:18
  SPEAKER_02: I mean, to give to his credit, he was trying to help a population of people that no one wanted to help.
• 24:24
  SPEAKER_02: At the time, nobody wanted, right?
• 24:26
  SPEAKER_02: Right, right, right.
• 24:27
  SPEAKER_02: Give him a lot of credit and props for that, even though the sharing the filler syringe is absolutely disgusting.
• 24:34
  SPEAKER_01: Disgusting.
• 24:35
  SPEAKER_01: Totally, yes.
• 24:36
  SPEAKER_01: Totally, yes.
• 24:36
  SPEAKER_01: I agree.
• 24:37
  SPEAKER_01: And I never saw that again.
• 24:38
  SPEAKER_01: And I brought it up it sometime during my my fellowship, and they were like, What?
• 24:42
  SPEAKER_01: He did what?
• 24:43
  SPEAKER_01: And I was like, Yeah, you know, and uh yeah, so so that happened.
• 24:48
  SPEAKER_01: Yeah, so that's why so that's something that I would never do.
• 24:51
  unknown: Um yeah, right.
• 24:53
  SPEAKER_01: So, so let's talk a little bit about uh why filler.
• 24:56
  SPEAKER_01: So filler was great, it was used for everything, it was amazing, and now it's not.
• 25:01
  SPEAKER_01: So now filler has a little bit of a bad rotation on social media.
• 25:05
  SPEAKER_02: Let's talk about it, you know, the bad, the bad reputation is mostly because of social media because the people are posting really bad before and afters that they think are good.
• 25:19
  SPEAKER_02: And the the whole the the big thing now that really drives me nuts on social media is the maleficent cheeks.
• 25:27
  SPEAKER_02: So you you know, maleficent from um Sleeping Beauty.
• 25:31
  SPEAKER_01: Yeah.
• 25:32
  SPEAKER_02: She has like the really pointy cheeks.
• 25:34
  SPEAKER_02: Think about when Angelina Julie played her.
• 25:36
  SPEAKER_01: Yeah.
• 25:37
  SPEAKER_01: The lady that pooped on uh that that pooped on um Jack Sparrow's bed.
• 25:44
  SPEAKER_01: You remember what was her name?
• 25:46
  SPEAKER_01: She pooped on uh Jack Sparrow is Johnny Depp, his ex-wife, his ex-wife.
• 25:53
  SPEAKER_00: What was her name?
• 25:57
  SPEAKER_00: She said it was the the dogs, the little four-pound dogs, and those are like four sterns.
• 26:12
  SPEAKER_02: You said you said Jack Sparrow, and I thought, wait, what did it did that happen in Pirates of the Caribbean?
• 26:19
  SPEAKER_02: Did that happen?
• 26:19
  SPEAKER_02: I'm trying to think of the scene when I realized you meant Johnny Depp.
• 26:26
  SPEAKER_02: Yeah, yeah.
• 26:27
  SPEAKER_01: Johnny Depp's wife, what was her name?
• 26:29
  SPEAKER_02: Amber Heard.
• 26:30
  SPEAKER_02: Amber Heard, yes, Amber, yeah.
• 26:33
  SPEAKER_02: Yes, and we're not listening we're not spreading rumors.
• 26:35
  SPEAKER_02: This is was in a court of law.
• 26:37
  SPEAKER_02: This was proven in a court of law.
• 26:39
  SPEAKER_02: She did that.
• 26:40
  SPEAKER_02: Did she did?
• 26:41
  SPEAKER_01: She pooped on his bed.
• 26:43
  SPEAKER_01: She pooped his bed.
• 26:44
  SPEAKER_02: She did.
• 26:45
  SPEAKER_01: She had those those weird cheeks.
• 26:48
  SPEAKER_02: She had the she did because she was they they aired the trial.
• 26:52
  SPEAKER_02: Yeah.
• 26:52
  SPEAKER_02: So I remember looking at her every day during the trial because obviously I was watching the trial.
• 26:58
  SPEAKER_02: Who wasn't?
• 26:59
  SPEAKER_02: I couldn't look away.
• 27:01
  SPEAKER_02: And and I probably I think I started the day that the I had to I knew I had to start watching when I heard about her pooping his belly.
• 27:10
  SPEAKER_02: That's when everyone tuned in.
• 27:12
  SPEAKER_02: Everyone started tuning in then.
• 27:14
  SPEAKER_02: But yeah, I remember watching the trial, and she she really did have she was a bit overfilled.
• 27:20
  SPEAKER_02: I I I I I generally don't like talking about celebrity faces, but but she pooped the bed.
• 27:27
  SPEAKER_02: Yeah.
• 27:28
  SPEAKER_02: Yeah.
• 27:29
  SPEAKER_01: She deserves a little bit of bad pub for pooping the bed.
• 27:36
  SPEAKER_02: So maleficent cheeks, terrible.
• 27:38
  SPEAKER_02: I mean, I I see them all the time.
• 27:40
  SPEAKER_02: I see them in person.
• 27:43
  SPEAKER_02: Now I will, you know, in passing, not my not my patients.
• 27:46
  SPEAKER_01: Yeah.
• 27:47
  SPEAKER_01: Right.
• 27:47
  SPEAKER_02: But I but I see it, yeah.
• 27:48
  SPEAKER_01: And just repeat a little touch.
• 27:50
  SPEAKER_01: Yeah.
• 27:50
  SPEAKER_01: So let's say that a 40-year-old woman comes in for a treatment.
• 27:56
  SPEAKER_01: Okay.
• 27:56
  SPEAKER_01: It's the first time you've met her.
• 27:58
  SPEAKER_02: I'm so thinking about it.
• 27:59
  SPEAKER_02: I'm sorry.
• 28:02
  SPEAKER_02: All right, go ahead.
• 28:03
  SPEAKER_02: Okay.
• 28:03
  SPEAKER_01: So 40, 40-year-old woman comes in, first time for you.
• 28:07
  SPEAKER_01: She wants, I don't know, let's say a laser.
• 28:09
  SPEAKER_01: Okay.
• 28:09
  SPEAKER_01: And you can see that that she's got the the amber herd poop in the bed uh cheeks.
• 28:16
  SPEAKER_01: And uh, and so like, how are you going?
• 28:20
  SPEAKER_01: Like, and and you can't look away.
• 28:21
  SPEAKER_01: Like there, it's obvious.
• 28:23
  SPEAKER_01: Are you going to talk about it, even though it's the first time you've met her?
• 28:27
  SPEAKER_01: Or will, you know, how are you, how will you handle that?
• 28:29
  SPEAKER_01: This is this is very nuanced.
• 28:32
  SPEAKER_01: Go ahead.
• 28:32
  SPEAKER_01: What will you do?
• 28:33
  SPEAKER_01: Let's say you decide to do laser on her.
• 28:35
  SPEAKER_01: When will will you bring it up?
• 28:37
  SPEAKER_01: When will you bring it up?
• 28:38
  SPEAKER_01: Whatever.
• 28:38
  SPEAKER_01: And then I'll tell you what I think I might do.
• 28:40
  SPEAKER_02: It's sensitive, obviously.
• 28:41
  SPEAKER_02: It it's it's very sensitive.
• 28:43
  SPEAKER_02: You have to approach it in a very tactful way.
• 28:46
  SPEAKER_02: But at the end of the day, I think that we as healthcare providers, we have an obligation to tell people if we think that something needs to be addressed.
• 28:58
  SPEAKER_02: And and I also, if I'm going to start treating you as a patient, you're going to become my cosmetic patient.
• 29:06
  SPEAKER_02: I don't want them, they're a billboard.
• 29:09
  SPEAKER_02: I mean, they're a billboard for the work that I do.
• 29:11
  SPEAKER_02: And so if they have poorly placed filler and they're no longer seeing that injector and they're gonna be walking, you know, telling people I go to Skin Lab and I see Mystica, I do not want them walking around looking inappropriately filled.
• 29:29
  SPEAKER_02: So yes, I yes, I will bring it up.
• 29:31
  SPEAKER_02: I will.
• 29:32
  SPEAKER_02: You know, what I might never had anyone get upset.
• 29:34
  SPEAKER_01: Right, because you're trustworthy and you're honest and you don't come off like you're yelling at them.
• 29:39
  SPEAKER_01: No, that's super important.
• 29:40
  SPEAKER_01: You know, what I might do is I might agree to do the the laser.
• 29:43
  SPEAKER_01: When I do the laser, maybe mention, hey, you're you know, your cheeks are kind of hard.
• 29:48
  SPEAKER_01: When was the last time you got filler?
• 29:50
  SPEAKER_01: Are you still getting filler?
• 29:51
  SPEAKER_01: And then give options, say, hey, you know what?
• 29:54
  SPEAKER_01: We could dissolve this and and give you sculpture, which will give you not only volume, but ABCD.
• 30:01
  SPEAKER_01: And that might be a good thing.
• 30:03
  SPEAKER_01: And I think you'll really love the results, you know.
• 30:05
  SPEAKER_01: But I would also carefully say, hey, you know, if you're coming to me for laser, are you still going to that other person for filler?
• 30:12
  SPEAKER_01: Because, you know, we we may not, that person's goals and and out and my goals may not meet and be the same goals for you.
• 30:20
  SPEAKER_01: You know, those are it's very nuanced, very sensitive topic.
• 30:26
  SPEAKER_01: You know, you risk losing the patient, but not just losing the patient, which you know, that kind of sucks, uh, but but you also lose the patient and they end up looking worse.
• 30:35
  SPEAKER_01: You know, I try to save people.
• 30:37
  SPEAKER_01: My my staff, they they call me Oprah sometimes because I try to save people from, you know, from other people.
• 30:45
  SPEAKER_02: I think if if someone is going to, and I've had this conversation, I had someone recently come in and she was going to one person for her Botox in her forehead, and then she was having another provider in a different practice do her lips, and she came to me for sculpture.
• 31:03
  SPEAKER_02: I said to her, and I think it might have been the second visit when it was when it was clear that she wanted more advice.
• 31:11
  SPEAKER_02: I said, Listen, I don't care if it's me.
• 31:14
  SPEAKER_02: I don't care if you pick me, but I think that you need to go to one provider because I need to know what's in your face.
• 31:23
  SPEAKER_02: I need to know what the last treatment you had was, I need to know where you were injected.
• 31:27
  SPEAKER_02: I can't treat you in and give you the best care possible if I don't know these things.
• 31:34
  SPEAKER_02: So whoever you decide to stick with, and it doesn't have to be me, it should be one person because it's like it's like going to your annual exam as a as a woman, your annual gynecologic exam, and having your pap smear done by one doctor and then going to another doctor for your breast exam.
• 31:54
  SPEAKER_02: It's it stick with one provider, you will get better care.
• 31:58
  SPEAKER_01: Absolutely agree.
• 31:59
  SPEAKER_02: And for the record, she did pick me.
• 32:01
  SPEAKER_02: And I still see her.
• 32:03
  SPEAKER_01: Of course she did.
• 32:04
  SPEAKER_01: So uh let's talk about who is an ideal filler candidate.
• 32:08
  SPEAKER_01: I know it's very, very broad, but just pick one ideal candidate.
• 32:12
  SPEAKER_01: Not the only one, but pick one.
• 32:14
  SPEAKER_02: I think that the vast majority of people who are 40 and up are going to be filler candidates.
• 32:20
  SPEAKER_02: I mean, they just to some degree.
• 32:22
  SPEAKER_01: To some degree, yes.
• 32:23
  SPEAKER_02: Right.
• 32:23
  SPEAKER_02: In varying amounts, right?
• 32:25
  SPEAKER_02: You know, but but anatomically, what happens is we age, we lose fat in our face.
• 32:31
  SPEAKER_02: The fat bike, fat beds get smaller and smaller, they shift, we get bone resorption, the bones getting smaller, the bones changing shape.
• 32:38
  SPEAKER_02: So if you want to have a more youthful appearance, you have to, you have to address that that component of aging.
• 32:47
  SPEAKER_02: So, and anyone over 40 is going to have that.
• 32:50
  SPEAKER_02: So that would be the answer to my question.
• 32:52
  SPEAKER_02: Now, what someone needs is going to vary widely from person to person and the amount that they need.
• 32:58
  SPEAKER_01: Great.
• 32:59
  SPEAKER_01: You know, and they're there that just because they need it doesn't mean we'll do it.
• 33:03
  SPEAKER_01: And that's that's important too.
• 33:05
  SPEAKER_01: If someone has other medical problems, if they're still actively going into a tanning bed and destroying their face, if they're uh if they're doing a lot of other smoking, smoking thing.
• 33:18
  SPEAKER_01: I mean, if someone smokes a little bit, like every all these kids vape now, uh, you know, while I do filler on someone who vapes, I mean, I guess, like, you know, but I don't want someone who comes in at 35 looking like a looking like they're 70.
• 33:32
  SPEAKER_02: Who's going to the tanning bed every day and I wouldn't have to do that?
• 33:35
  SPEAKER_02: Yeah, they're throwing their money away.
• 33:36
  SPEAKER_02: Right.
• 33:36
  SPEAKER_02: Yeah.
• 33:37
  SPEAKER_02: They're throwing their money away.
• 33:38
  SPEAKER_01: Throwing their money away.
• 33:39
  unknown: Yeah.
• 33:40
  SPEAKER_02: But I literally will say that.
• 33:42
  SPEAKER_02: I'll say, Yeah, if you you're coming in for Botox, you're coming in for filler, and you're as tan as you are, and you are actively tanning as much as you are, you might as well flush your money down the toilet.
• 33:55
  SPEAKER_02: Absolutely.
• 33:55
  SPEAKER_02: I say that I say those words.
• 33:56
  SPEAKER_02: Maybe sometimes I'm probably too blunt, but it gets the point across.
• 34:01
  SPEAKER_01: It sure does.
• 34:01
  SPEAKER_01: Whenever I do certain, like uh, whenever I do a certain breast surgery, if someone's smoking, like I do a breast lift or a breast reduction or whatever, you know, we test them for nicotine.
• 34:10
  SPEAKER_01: But we didn't, 10 years ago, we didn't really do that because it wasn't nicotine testing wasn't as simple to get 10 years ago.
• 34:16
  SPEAKER_01: But what I would tell patients is if you're smoking and I do a breast reduction, your nipples could turn black and fall off.
• 34:22
  SPEAKER_02: Yeah, yeah.
• 34:23
  SPEAKER_02: As blunt as you can.
• 34:24
  SPEAKER_01: As blunt as you can.
• 34:26
  SPEAKER_01: You have to sometimes be as blunt as you can.
• 34:28
  SPEAKER_01: So when do you think filler is the wrong tool and lasers or surgery is more indicated?
• 34:36
  SPEAKER_02: I definitely take a skin first approach to all of my patients.
• 34:40
  SPEAKER_02: Yeah, you do.
• 34:40
  SPEAKER_02: I think that skin health treatments like laser, microneedling, skincare, getting the skin and the canvas of the face to look healthier is one of the best ways to anti-age someone.
• 34:54
  SPEAKER_02: So that is always going to be in at the very least, skincare is always going to be the number one thing in my patient's treatment plan.
• 35:03
  SPEAKER_01: And you are absolutely exceptional with that.
• 35:06
  SPEAKER_01: The results that I see you get with lasers, with energy devices, with lasers and and and skincare and microneedling and stuff.
• 35:15
  SPEAKER_01: And our aesthetician Melissa, you guys knock my socks off, if I'm being honest.
• 35:20
  SPEAKER_01: And that's really, I mean, that's before I think I've made you a believer in laser.
• 35:24
  SPEAKER_01: Regardless of filler, regardless of talks.
• 35:27
  SPEAKER_01: Yeah, because I see it.
• 35:28
  SPEAKER_01: There, the results you get.
• 35:29
  SPEAKER_01: I like I don't see other providers, other PAs, injectors, aestheticians, et cetera.
• 35:35
  SPEAKER_01: I, Skinlab gets the best results.
• 35:37
  SPEAKER_01: I'm partial, obviously, but I'm also realistic.
• 35:40
  SPEAKER_01: If I thought you did a shitty job, I would tell you.
• 35:42
  SPEAKER_01: Probably not here, you know, but in person, I would tell you.
• 35:45
  SPEAKER_02: Of course.
• 35:46
  SPEAKER_02: So yeah, I think that skin health should always come first.
• 35:49
  SPEAKER_02: And just as a side note, I think this is worth everyone knowing.
• 35:53
  SPEAKER_02: Certain lasers will actually decrease your your risk of precancerous growth on the face.
• 35:58
  SPEAKER_02: And then therefore, possibly certain types of skin cancers.
• 36:02
  SPEAKER_02: So you're you're making your skin healthier.
• 36:05
  SPEAKER_02: It is well worth the investment.
• 36:07
  SPEAKER_02: So that is often the first thing in the treatment plan.
• 36:11
  SPEAKER_02: And then and then filler would probably come after that if it's indicated.
• 36:16
  SPEAKER_02: And and most of the time, depending on their age, it probably is.
• 36:19
  SPEAKER_02: What was the wait, what did you ask me originally though?
• 36:22
  SPEAKER_01: When is filler the wrong tool?
• 36:24
  SPEAKER_01: And maybe laser or you know, or skincare or surgery is the right tool.
• 36:27
  SPEAKER_01: And you you answered the question.
• 36:29
  SPEAKER_01: I mean, the answer is if they're too if if filler's not gonna get them anywhere and they want to consider surgical treatment.
• 36:38
  SPEAKER_01: Yeah.
• 36:38
  SPEAKER_02: And if you draska.com.
• 36:42
  SPEAKER_02: At the end of the day, if their skin is not healthy, filler is just not going to look as good.
• 36:47
  SPEAKER_02: So I will try to steer them in the direction of focusing on their skin health first.
• 36:52
  SPEAKER_01: Let's bust a couple of myths.
• 36:53
  SPEAKER_01: Let's be simple with it.
• 36:54
  SPEAKER_01: All right.
• 36:54
  SPEAKER_01: Filler stretches your skin.
• 36:56
  SPEAKER_01: No, I never even heard that before, but I guess it's a myth.
• 36:58
  SPEAKER_02: People ask me, like, like if I get filler in my lips, is it gonna stretch out my lips?
• 37:03
  SPEAKER_02: And then the filler goes away and my lips look wrinkly or something like that.
• 37:07
  SPEAKER_01: You're right.
• 37:07
  SPEAKER_01: Yep, yep, yep.
• 37:08
  SPEAKER_01: I've heard that.
• 37:09
  SPEAKER_01: Yeah.
• 37:09
  SPEAKER_01: Not true.
• 37:10
  SPEAKER_01: Dissolving filler is always harmless.
• 37:12
  SPEAKER_02: There's very little that there's very little.
• 37:17
  SPEAKER_01: So long-term, pretty much harmless, but you know, like it's it's not without discomfort.
• 37:23
  SPEAKER_02: Yeah, it hurts.
• 37:24
  SPEAKER_02: It hurts like hell, honestly.
• 37:25
  SPEAKER_02: But it's it's a very safe procedure.
• 37:28
  SPEAKER_02: There's very, very small chance of an allergic reaction, but your your skin regenerates hyaluronic acid very, very quickly.
• 37:37
  SPEAKER_02: So it's it's not an issue.
• 37:39
  SPEAKER_01: Once you start, you have to keep doing it.
• 37:40
  SPEAKER_01: False.
• 37:41
  SPEAKER_01: Straight up false.
• 37:42
  SPEAKER_01: You know, absolutely false.
• 37:43
  SPEAKER_01: What what happens if you what happens if you stop doing it?
• 37:46
  SPEAKER_02: Just back to how you you're back to your baseline.
• 37:48
  SPEAKER_02: You just look older.
• 37:48
  SPEAKER_02: Yeah.
• 37:49
  SPEAKER_02: I mean, it's five years later.
• 37:51
  SPEAKER_02: Ratchet.
• 37:52
  SPEAKER_02: But but if it's a year later, you're you're just back to your baseline.
• 37:55
  SPEAKER_02: Yeah.
• 37:56
  SPEAKER_02: Maybe even a little better, really.
• 37:57
  SPEAKER_02: Oh, sure.
• 37:58
  SPEAKER_02: There's depending on what's still a little filler.
• 38:00
  SPEAKER_01: There's still a little filler left at a year.
• 38:02
  SPEAKER_01: It's not all of it.
• 38:03
  SPEAKER_02: The hyaluronic acid fillers maybe biostimulate a little bit too.
• 38:09
  SPEAKER_02: So they maybe build a little bit of collagen in elastic.
• 38:12
  SPEAKER_02: So potentially your skin could look better in a year.
• 38:14
  SPEAKER_01: New to me.
• 38:15
  SPEAKER_02: You've not heard that.
• 38:16
  SPEAKER_02: Yeah.
• 38:16
  SPEAKER_01: No.
• 38:17
  SPEAKER_01: Well, I have now.
• 38:18
  SPEAKER_01: I heard it now.
• 38:18
  SPEAKER_02: That was that was a study from Sabrina Fobbie, who is a dermatologist in California, and she's incredible.
• 38:25
  SPEAKER_01: Very good.
• 38:26
  SPEAKER_01: Shout out Sabrina Fobbie.
• 38:28
  SPEAKER_01: Hi.
• 38:28
  SPEAKER_02: She's not watching.
• 38:29
  SPEAKER_01: She's not listening.
• 38:30
  SPEAKER_01: But maybe someday.
• 38:31
  SPEAKER_02: She's too busy.
• 38:32
  SPEAKER_01: She's she'll catch it on episode six.
• 38:34
  SPEAKER_02: Yeah.
• 38:35
  SPEAKER_01: So, okay.
• 38:36
  SPEAKER_01: The crux of scalpel and skin, hyaluronic acid filler.
• 38:40
  SPEAKER_01: Is it worth it?
• 38:41
  SPEAKER_02: Yes.
• 38:42
  SPEAKER_01: Out of 10.
• 38:42
  SPEAKER_02: Well, how would I rate it?
• 38:43
  SPEAKER_02: Out of 10?
• 38:44
  SPEAKER_02: 8 out of 10.
• 38:45
  SPEAKER_01: I was gonna say 10 out of 10, absolutely worth it in almost all patients.
• 38:49
  SPEAKER_01: You know, like in all patients that we do it, that we choose to do it on, I was gonna say 10 out of 10.
• 38:54
  SPEAKER_01: I can't wait to do that.
• 38:55
  SPEAKER_01: So okay, that's true.
• 38:56
  SPEAKER_01: So you're strict.
• 38:57
  SPEAKER_01: No, no, no.
• 38:58
  SPEAKER_01: Let's do it like that.
• 38:58
  SPEAKER_01: Let's do it like Dave Portnoy does that does the pizza reviews.
• 39:02
  SPEAKER_01: Okay.
• 39:03
  SPEAKER_01: So you choose eight out of 10.
• 39:04
  SPEAKER_01: 10.
• 39:05
  SPEAKER_01: So there it leaves room for growth for for like what's 10 out of 10.
• 39:09
  SPEAKER_01: I guess we'll have to.
• 39:10
  SPEAKER_01: I guess we're just gonna have to wait and listen to the next episode to see if whatever we talk about next is more or less than eight out of 10.
• 39:20
  SPEAKER_01: Uh, and and let's let's kind of wrap it up on that.
• 39:24
  SPEAKER_01: Listeners, um, dad, hi.
• 39:26
  SPEAKER_01: Maybe even Ryland, your son.
• 39:28
  SPEAKER_01: Listeners, I want you to suggest what uh he's nine, by the way.
• 39:34
  SPEAKER_01: What do you suggest for our next couple of episodes of scalpel and skin?
• 39:38
  SPEAKER_01: We're we're into it.
• 39:39
  SPEAKER_01: We we don't have a topic.
• 39:40
  SPEAKER_01: This is it.
• 39:41
  SPEAKER_01: We're we're cooked.
• 39:42
  SPEAKER_01: We'll come up with another topic for next week or whatever.
• 39:45
  SPEAKER_01: We don't have one scheduled right now.
• 39:47
  SPEAKER_01: So what is our next topic to be?
• 39:48
  SPEAKER_01: What are our next couple of topics to be?
• 39:50
  SPEAKER_01: Let's go.
• 39:50
  SPEAKER_01: Let's hear about it.
• 39:51
  SPEAKER_01: Send it to us, tell us what you want to hear.
• 39:53
  SPEAKER_01: And that's it.
• 39:54
  SPEAKER_01: Mystica, this was our first worth it, is it worth it scalpel and skin episode.
• 39:59
  SPEAKER_01: What do you think?
• 40:00
  SPEAKER_01: How are we doing so far?
• 40:01
  SPEAKER_02: Well, you know, I think that the fact that we talked about Jack Sparrow's girlfriend pooping the bed is definitely how things are gonna go in future episodes.
• 40:13
  SPEAKER_02: We we love what we do, we love talking about it, but we have fun doing it too.
• 40:19
  SPEAKER_01: Yes, we absolutely do.
• 40:20
  SPEAKER_01: That's what that's what I always say.
• 40:22
  SPEAKER_01: We we do great work and we have a lot of fun doing it.
• 40:25
  SPEAKER_01: Listen, thank you all for listening to Scalpel and Skin episode three.
• 40:29
  SPEAKER_01: Stay tuned for episode four coming up next week.
• 40:31
  SPEAKER_01: Let's go.
• 40:32
  SPEAKER_01: That's it for today's episode of Scalpel and Skin.
• 40:35
  SPEAKER_01: Follow the show wherever you listen and come find us on social media.
• 40:38
  SPEAKER_01: Send us the treatments, trends, or questions you want us to break down next.
• 40:42
  SPEAKER_01: This is Scalpel and Skin.
• 40:44
  SPEAKER_01: Let's go.