Episode 1
Auto-generated Transcript
Arash AkhavanHost
00:04
This is the Dr A Explains it All podcast. A podcast about cosmetic procedures, skincare, dermatology and everything in between. I'm board-certified dermatologist, dr Arash Akhavan. Let's get started, but first a quick disclaimer.
AnnouncerAnnouncement
00:19
Medical disclaimer. The information provided on this podcast is for general information and educational purposes only. It is not intended as medical advice, diagnosis or treatment and should not be relied upon as such. Listening to this podcast does not establish a physician-patient relationship between you and the host or any contributors. If you have specific medical concerns or questions, we encourage you consult directly with a licensed healthcare provider or physician in your area. The views expressed in this podcast are solely those of the individuals and do not necessarily represent the views of any affiliated institutions or organizations. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast.
Arash AkhavanHost
01:22
Hello and welcome to the Dr A Explains it All podcast. I'm Dr Arash Akhavan. I'm a board-certified dermatologist in Manhattan, new York, owner of the Dermatology and Laser Group. As this is our first podcast, I just wanted to introduce the concept to you. We're basically going to be discussing cosmetic procedures, skin care, dermatology all with myself and a special guest. On each episode I'll be joined by members of the practice, by patients, by other colleagues that are experts, and we hope to bring you sort of honest, no fluff, no BS input on all these different topics.
02:02
And for this first episode I'll be joined by Ashley Greenstein, who is our office manager and one of the cosmetic coordinators at the Dermatology and Laser Group. She fields a lot of the questions from people like you, whether online or by telephone or email, and I think it'll be great. She'll bring in her perspective, patient perspective and hopefully I can add my input and kind of round out the topics. We decided to start with Botox Cosmetic as our first topic of discussion, just because it's the most asked about procedure. It's the most completed procedure in practices like ours and we thought that that would be a great thing to kick us off with. And we thought that that would be a great thing to kick us off with. We'll also discuss different TikTok and Instagram trends, as well as skincare tips and product reviews.
02:53
So, without further ado, let's get started.
Ashley Guest
02:59
So let's get down to it Botox. What is it?
Arash AkhavanHost
Very simply, botox is an injectable medication. It's derived from botulinum toxin. It's a medication. It's injected into the muscle. It's injected into the muscle and it actually gets absorbed into the nerve that's feeding that muscle, and when the nerve tries to send a signal to the muscle telling it to squeeze, some of that signal gets blocked. So the muscle can't squeeze as much as it's used to squeezing. So it's basically getting the muscle not to flex as much and that's the way it works.
03:32
So we're using it in dynamic wrinkles like the 11s over here in this glabella area. You're squeezing that area, but when you have the Botox there, some of that signal to squeeze is blocked and, like any muscle, that's not working out. Like, let's say, every day you're using a 20 pound dumbbell to do curls for your biceps and now you go down to a five pound dumbbell. You're still doing the movement ideally, and still here. You want to have movement in places. You're getting Botox to have a natural result, but you're not squeezing it as much. So this muscle, for that time that the Botox is active, is not developing and we don't want these muscles to develop. These muscles are causing these wrinkles, these furrows between the eyebrows, the lines on the forehead, the lines by the eyes, and we want to relax them. So that's the way Botox works it's a medication injected into the muscle, preventing the muscles from contracting as much.
Ashley Guest
04:27
As much, ideally, ideally, ideally. All right, I guess we touched on this a little bit, but in terms of Botox, botox is essentially now this overarching word that we use for neurotoxins, right? So are there other brands of Botox? What's the deal with that? If you're going into a doctor and you're saying I want Botox, are you getting branded Botox every time, or are there some options to choose from and you know what kind of sets these different products apart from one another?
Arash AkhavanHost
05:01
Yeah.
Ashley Guest
05:18
So there are multiple brands.
Arash AkhavanHost
05:19
Yeah, so there are multiple brands. We use Botox to kind of justysport there's Xeomin, there's Jevo, um there's Daxify, there's Botox. So there there are different brands and they're they all have the same active um part of the molecule that does what I just explained the relaxing of the muscle. But they have slight little adjustments, um, in what are called accessory molecules, little extra pieces that are slightly different between them. For the most part it doesn't really make that much of a difference.
05:53
Most people could get Botox, xeomin, dysport, have exactly the same response. There are some slight differences, just like any medication. Like if you take a cholesterol medication, you take cholesterol medication A and you do okay with it and you get switched by your insurance company to B and it's not as good, even though it's in the same class. You know when you're talking about medications, human bodies react differently to things. So you'll have somebody come in and they'll say nothing else works, just ZMN works. And you'll have somebody that'll say nothing, but Botox works.
06:27
So there may be some truth to that. Maybe it was their injector did something different, or it was a different injector, maybe they got more units, maybe they got less units, or maybe it's real. Maybe the medication has some different reaction for that particular person. The only one that stands out is there's a newer one called Daxify that came out where that accessory compound and they added a peptide where it was designed to last longer and it has FDA approval to last longer and before it came out I was a little skeptical. You know, is this just marketing? We have found that our patient cells it does last a little bit longer, you know, probably like 25% longer than Botox.
Ashley Guest
07:09
And we've been hearing that it kicks in a lot faster as well.
Arash AkhavanHost
07:12
Yes. So, um, you know, typical for this class of medications you start to see some activity a few days. Four or five days full activity by two weeks. This is slightly faster. So even at two days, we've started to see some of the muscles reacting to Daxify. For our patients, that's what they've been telling us- it is cool.
Ashley Guest
07:33
People are loving it In terms of Daxify lasting 25% longer. What is the typical sort of timeframe that we can expect for Botox to last?
Arash AkhavanHost
07:46
I think reasonable is somewhere in that three to four month range, um. So if you want to have the same um level of muscle relaxation throughout the year, most people have to do it about three times a year. I don't think that's necessary. I think you definitely can just do it twice a year and let it, let your muscle come back a little bit. You don't need to be that obsessive about it. With Daxify I think it's closer to around five months, maybe, plus some people it's been six months. Um, so just a little bit longer.
Ashley Guest
08:19
Amazing, um, in terms of when you should get started on this. Um, you know you, you hear young people in college saying I'm going to start getting Botox at 19 because it's going to be preventative and I'm never going to get those lines.
Arash AkhavanHost
08:39
What's the truth here? And we do get patients coming in and they say my friend got it. They're just like 20 years old, they're on break from college and they want to start on Botox because they've heard about preventative Botox. I think that's excessive. I don't think there's one answer. I think the you know your lines, your face, your genetics, your sun exposure, your expressiveness, all that should dictate it. Um, I think if I were to, if you were to force me to pick an age where, for most patients, it's time to get started to prevent the wrinkles from really setting in, it's probably somewhere around 25, 26. Um, but it could be more, it could be less. Um, the, but it could be more, it could be less. Um, the. The signs to look for are when you're starting to see the lines, even a hint of the line at rest. That's a good time to get started. That's not too early. If you're not seeing that at all, I think you're wasting time and money.
Ashley Guest
09:39
I would agree. And what about? Like you know, we're getting ready to go out and halfway through the night we go to the bathroom and our makeup is creasing on our forehead, but you don't necessarily realize that you have lines at rest. Is that a decent time to start?
Arash AkhavanHost
09:52
Yeah, absolutely, I think that makes sense, I get that question often.
Ashley Guest
09:56
Yeah, that makes sense, like I don't see the lines when I'm not wearing makeup. But I put makeup on and two hours and I've got creases. So if you're thinking about it, that that might be a good time to start. Um, baby Botox yeah, if I hear this term one more time, what the hell are people referring to when they say they only want baby Botox? And if we won't offer baby Botox, they won't even have a conversation? What is baby Botox?
Arash AkhavanHost
10:26
Yeah, I mean, in the end it's marketing. So you have so many doctors, non-doctors injecting and having little injection clinics and med spots and this and that, and unfortunately, with all these things, everybody is looking for a little marketing angle, so they'll. And with social media, things sort of explode. Unfortunately, with all these things, everybody's looking for a little marketing angle, so they'll, and and with social media, things sort of explode. So you start talking baby Botox and you make a couple of videos saying you should not get Botox. It's bad. When you're young you should get baby Botox. And everybody starts talking about baby. There. There's obviously no such thing as baby Botox. That's just random, not a different molecule.
Ashley Guest
11:04
It is not such thing as baby Botox, that's just random.
Arash AkhavanHost
11:06
If you had, to define it, you'd say baby amounts of Botox, um, which also there's no such thing. So you know you, you have to put in enough Botox for it to have an effect, otherwise you're wasting time and money. Um, you should ideally put in enough units so that somebody doesn't have to come in every three weeks to get it. Um, you should ideally put in enough units so that somebody doesn't have to come in every three weeks to get it. Um, you know, if I put in one little unit of Botox over there and you think you are relaxing that muscle, maybe you are, but not for very long, maybe just a couple of weeks. Um, so it's kind of a waste of money in the end. You don't want to be thinking in terms of a set number of units.
11:47
Everybody's face is different. Everybody's muscles are different. You could have a 25-year-old with thick, thick muscles that require a certain number of units, right for their baby Botox. And you could have a 40 year old and they have a delicate face with delicate little muscles and we actually use less for that person, even though their lines are a little bit thicker. So it does need. It does come down to doing a tailor-made sort of approach for each patient, making sure that you're going to someone who knows what they're doing and isn't just following some sort of formula or something they learned in some weekend course, telling them to inject five units here, seven units there. There is no such thing. Everybody's muscles are so different. Even just the way they're shaped the muscles are different. In the end, somebody who wants baby Botox is probably what they're talking about is they're looking for natural Botox and, yes, all Botox should be natural looking Botox.
Ashley Guest
12:42
Yeah, but it isn't. So what's the difference between this Botox treatment that we would do here versus that real shiny, very frozen forehead that doesn't seem to move at all, which is really the only people that people really notice have Botox. So they see that shiny forehead. They say that is what I don't want, I will never get Botox. However, the contrary still moving um is also true, and it's way less detectable. So what would be the difference between? Is it the injector? What's going on here? Why do some people have those crazy shiny foreheads and other people? It's virtually, you know, undetectable.
Arash AkhavanHost
13:25
I mean, it does come down to the injector and what it is exactly. It's probably a combination of things. So just putting in lots of Botox is a bad idea in general. So overdoing it, if you're paralyzing someone completely so that they're frozen, um, they are going to have that sort of classy, thin look, um atrophied. Look to the muscles, um. The other thing is more important than probably the number of units is the placement of the Botox. So, like I said, there's no cookie cutter approach. I remember when I first graduated I was working in a practice where there was a older doctor who had just started, had no training in Botox, had just wanted to get into it, and every time he was about to go do Botox he wasn't doing much of it He'd do a couple here or there.
14:20
Every time he was about to go do Botox, he wasn't doing much of it. He'd do a couple here or there. Every time he was going to go, he'd come and ask me to draw on a piece of paper how many units to put for the patient who was about to go see. I kept explaining to him like there's no such thing. You can't, I can't just tell you without seeing the patient examining the patient put this many number of units. Every single person's so different, but it's the placement.
14:40
So somebody's frontalis muscle, this muscle over here that makes up our forehead, may go straight up, somebody else's may go at an angle. And if we're doing, if we're not taking that into account, and we're paralyzing different parts of that muscle that shouldn't necessarily be weakened, they're going to have a weird look. Their eyebrows are going to move weird their, their expression's going to look weird, um, and not only that. We can. Actually the weirdest thing is we could actually be aging them instead of being a preventative treatment and anti-aging treatment. With poor placement it can look very unnatural that that sucks, um, but we can actually, in the long term, be causing more harm than good. So we could be paralyzing muscles. That would be, you know, over time leading to a more aged appearance, um, and that's that's something that I mean. Like I said'm an, I'm an injection trainer for Allergan. I would say the majority of people who haven't had good formal training don't know that that they could actually be harming the patients in the longterm.
Ashley Guest
15:51
It's definitely good to know. So if you need training, you should call it.
Arash AkhavanHost
15:56
There's so many amazing trainers throughout the country.
Ashley Guest
15:59
And well, I have a father that flies here on a plane every four months because he will not let anybody touch his face except you.
Arash AkhavanHost
16:06
Well, that's nice, but yeah, like I said, there are there's so many great injectors out there.
Ashley Guest
16:13
Very humble of you. Um, uh, another one interesting one that we get is you know, we see these Botox bars and these med spas kind of popping up everywhere, of concept behind them. Um, a lot of these places do. However, you know, personally at least, I have friends that go to these places. Maybe they don't want to pay what they think is a premium to come to somebody like you. Uh, likely they're saving saving $100 in the end but it feels like they're going to get somewhere, something that they're going somewhere a little bit cheaper. However, all of my friends that do those also say that it lasts only about a month or two months. So what is the difference between getting injected by a board certified dermatologist and going to somewhere like a med spa or a Botox bar where you feel like it's great for a month and then it's kind of gone? Is that the baby Botox? What's happening?
Arash AkhavanHost
17:17
No, I mean there's multiple things happening there. First of all, I mean I don't think you know you could have a great experience at a med spa or a Botox bar. You could have a great experience with a physician. You could have a horrible experience with a Botox bar. You could have a horrible experience with a physician. Um, with most things, the more training the person has in that procedure, the more education they have and everything surrounding that procedure, chances are they're going to do it better. I, I'd rather. The person flying my next flight to Florida is a trained pilot, ex-air Force pilot who's had the maximum amount of training. Could somebody from flight school land it? Most likely, I'd rather it was that pilot.
18:16
Certified dermatologist. Most modern dermatologists, plastic surgeons, have had formal training on all the anatomy of the area that you're treating. They've had very formal education on the toxins. They've had years of courses, years of experience, years of procedures. There was a vetting process that occurs. Just that's inherent to those fields. You know they were at the top of their medical school class. They went through a very rigorous training period and were at the top of that and now you're going in and you're seeing them for the Botox the, the average injector at a med spa or Botox clinic has not had that. Maybe they were trained by the owner of that med spa. Maybe they went to a few weekend courses here or there. Maybe they did 20 weekend courses. They probably didn't, they probably did three. But if they did a hundred, it's still nothing compared to the training that somebody who's board certified in those fields has gone through.
19:35
So is there a place for that? Yes, I mean if, if, when I was first graduated and I was practicing in upstate New York, there were so few dermatologists that by my, you know, by my first week out of training, I had like a three month wait for patients to see me because there's nobody to see. So if you're in a place like that and you're desperate for Botox, you know there's a place for non-physicians to be doing it. Hopefully they're trained, hopefully as trained as they can be, hopefully they have lots of experience, hopefully they have a good reputation that you can check and that's the best you could do. Um, typically a med spa will charge less if there's economic um considerations.
20:17
Um, you know you have to do what you've got to do If you want to get your Botox fix. You gotta, you gotta get it. You know you have to do what you've got to do If you want to get your Botox fix. You got to, you got to get it, you know. So I understand it. You know, but you know I think there is something to be said for expertise, you know I, you know, as a physician trained in everything, I can deliver a baby. I have been part of heart surgeries and colonoscopies. You don't want me delivering your baby, you don't want me to your ex colonoscopy. Could I do it? Will you probably be fine? Yes, could you go to a med spa and get great Botox? Yes, um, but it's not your best choice. So you know, if you've got the alternative, you have the means choice. So you know, if you've got the alternative, you have the means. Then then yes, you can't go wrong with going to a board certified dermatologist, board certified plastic surgeon.
Ashley Guest
21:08
Obviously I'm biased yeah, me too, but I would say in new york the real truth of it is you're really not saving much when you're going to a men's barbers. The prices, have gotten.
Arash AkhavanHost
21:19
actually, over time they're more in line with each other. You know it's it's not like, uh, we don't charge that much more for Botox, we didn't charge that much more for laser hair removal. In some cases we're right in line with the other, with the other people. So you know, to each their own. You know, I honestly don't want to knock anybody, and there are horrible. There's dermatologists that are horrible at Botox and horrible at what they do. And there's med spa people that are amazing. Um, I mean, I, I go out there and train at the med spa. I've I've seen it all. I've seen people I'm like, ooh, you know, that's not the best. You know, I hope my friends see this person.
Ashley Guest
22:00
And then I've seen people I'm like, okay, yeah, they're fine, yeah it makes sense, um, in terms of getting Botox and being worried that you're going to look so different or women don't want their husbands to know things like that is Botox going to really change the way that you look? Is it going to change the shape of your face? What's the truth there?
Arash AkhavanHost
22:24
It shouldn't. If it's done correctly it shouldn't. That's more of a concern. Obviously, with fillers, sometimes you're trying to change the shape of a person's face. You're trying to make their lips bigger, trying to give them more of a cheekbone or more of a chin. Make their lips bigger, trying to give them more of a cheekbone or more of a chin, um. So you know, with fillers it can be a lot more obvious. Plus, there's a swelling period. Um, so we we do get that quite a bit, with people saying I don't want my significant other to know. And with filler we say good luck, yeah, um, but with Botox you know you wait 15 minutes. But with Botox you wait 15 minutes. The little bumps from the Botox go down. You should be good to go.
23:07
The two sort of exceptions that one is master Botox, which is a lot of people get it in this muscle over here that's involved in chewing. People will get it because they clench in that area and it causes tension, headaches, teeth grinding, tmj. Some people do it because they want to slim their masseter. It's a big muscle. If we weaken that muscle you are going to get a little bit of slimming in that area. I think that's one of the things that, even if it's done perfectly, it is going to cause an element of not anti-aging but pro-aging. So it, uh, it does age you a little bit. By just softening that jaw line a little bit, of that, um sort of the volume is holding up your jawline and the skin in this area. It's one of the reasons we can get into it in a later episode. I hate that buckle, fat removal, um, but yeah, you just do need to realize that it is aging in that area and does change the shape of your face.
24:06
So it'll soften your jawline a little bit Softens it, so the skin isn't going to be held up by as much. And there's ethnic preferences preferences, um, so we'll have patients that, um, maybe Korean or Chinese, and they actually, in their culture, typically, um, prefer a slimmed jawline. Um, so those are the people that you know. That's an acceptable trade off. The fact that maybe it is a little aging in the skin in the jowl area, um, they'd like that sort of slimmed jawline.
Ashley Guest
24:41
Look, yeah speaking of the jowls here, botox just got fda approved for the neck. That's not to say that people were not treating the neck for many years prior, but it is now officially fda cleared. We're big rule followers, so we're happy about this. What does? Does it mean? What kind of patients are going to get Botox injected into their neck?
Arash AkhavanHost
25:07
I mean, we've been doing it for the last decade. So the primary reason is there are these vertical bands they're called platysmal bands, and doing injections along the platysmal band so it's basically you'll see people where the skin kind of sticks out over here, and injecting that relaxes this muscle, that's like a sheet across the neck and it just kind of has it settled down so you don't see those bands and just doing it along the jawline also can define the jawline a little bit and give you a little upturn in that area. Good side benefit but yeah, with Botox we've been using it off label for years. Even what I just mentioned, that uh, tmj, not not FDA approved, but something we commonly do. Um, I think if, if you're doing it when you've been well-trained on it, you understand the risks and consequences of all of that, that a lot of that stuff we can use off-label safely. Nice, all right. Yeah, that is actually hot off the presses.
Ashley Guest
26:07
I mean, I think it's like a week or a week ago. It's just hitting TikTok. Oh, okay, there you go, so I see it everywhere. Okay, I feel like we, you know we pretty much got to the basis, basics of Botox.
Arash AkhavanHost
26:27
Yeah, there's so much to discuss with both. I mean, we could literally talk about it for hours and I'm sure we'll do other episodes. I do.
Ashley Guest
26:34
I have so many questions, lip flips, these people who are taping their face at night instead of getting Botox, isn't working. He's Botox in a bottle, like we'll get to all of that at some point. But pivoting here a little bit, I want to talk about something else that I'm seeing on social media. Can you tell I'm addicted to TikTok, the salmon sperm facial. Yeah, what's going on?
Arash AkhavanHost
27:00
Yeah, we've been getting lots of again just social media. Like you said, we do get lots of patients asking about that, I think over the last month. You know that I don't really have mixed feelings with. I'd say if this were a take it or leave it question, I'd say leave it. This, you know, it's a, it's a, it's, that's all it is. It's really just a social media trend.
27:28
So there's claims that the salmon sperm has nucleotides like little RNA and DNA fragments, that when they're injected, all sorts of things, great things happen. You know, you, you generates collagen and tightens pores. There's no such thing as tightening board tightens pores and all these things. You know. There I have a couple of issues with it. Primarily, who got the salmon sperm? You know, know, where's it coming from. There's no FDA clearance for it. There's no U S companies, you know, unless you're, you know, collecting that sperm yourself, which you know I, I, you know, you don't know what the source is. It's not something that's regulated, so that's, and it's being injected into the, the, into your skin, not only your skin, your face skin like. No, thanks, I would rather not. The other thing is you know what are all the other ingredients that they've mixed in with that salmon sperm. You know, I saw like one of the leading brands. One of its main ingredients is hyaluronic acid and then patients are saying it's hydrating, giving them a glow and plumping them up. Are you just doing some sort of weird hyaluronic acid, unregulated not to be injected into the face and now you're injecting into your face Just just? If you want to do that, just get a little filler, get a little skin beaver, something like that. You know, something that's FDA cleared for that purpose and is sterile and clean and made for that purpose.
29:05
There's a lot of trends and hopefully we'll discuss them in coming episodes that are harmless, you know, and if it's fun, do it and no big deal. Then there's some that are potentially not safe. This would be one that I would say don't even do it and no big deal. Then there's some that are potentially not safe. This would this would be one that I would say don't even do it for fun. There are better things that can generate collagen. There are better things that can hydrate you. There's better things for rejuvenation that are also FDA cleared and made in our country and safe. Um, leave it, leave it. Leave it. It's a leave it. So that is, our social media sort of discussion of the day.
Ashley Guest
29:45
I think those things are good to discuss. Yeah, for sure. I mean a lot of stuff that you you'll hear on tech talk is just positives about it. Nobody's really getting down into the nitty gritty of what this stuff is.
Arash AkhavanHost
29:55
Yeah, I mean, I've been seeing now this interesting thing where something will come up in Tik, tok, everybody's positive on it. Then I'm like, just wait. And then, like six months later, everybody's negative. It ruined my face, it melted my fat. Oh, I don't want to discuss the specifics of what devices I'm talking about, but there was this device that was all the rage because the Kardashians did this, that and everybody was doing it, and my patients would ask and I'd be like Nope, and maybe we'll get into another episode, but I don't know, I don't know about the legality of it, let's hold on, we'll get into it, we just maybe won't.
Ashley Guest
30:32
Won't say the name.
Arash AkhavanHost
30:40
But and then they? You know, now everybody's talking all the posts about this thing all. Whenever you see this hashtag or mention of this one device, it's always melted my face, melted my fat.
Ashley Guest
30:46
I was like see, ya, see, I told you yeah yeah, especially for younger patients who really you want to keep that healthy facial fat as we age, and introducing something like that to kill it, it's not great, um. Next topic would be our at-home hero product of the week. This is a new one, um. It was just dropped off to us a few weeks ago and I've been using it ever since. It is the CeraVe oil control moisturizing face gel.
Arash AkhavanHost
31:24
Yes, you, you were kind enough to drop one off for me. I used it for a couple of weeks and what do you think? You can go first.
Ashley Guest
31:33
Obsessed. Yeah, for someone who, at the end of the day, is just like feeling so oily. We're running around a lot here, you know we're, we're touching our face, we're explaining things to people, um, and by the end of the day, every day, I am so oily. There's just no if and or buts around it. Um, um, with this moisturizer, I kid you, not no oil, like I and, but I'm not dry, not dry whatsoever. I'm moisturized, I'm smooth, I feel hydrated, but I'm not shiny and I'm not slick to the forehead and it's amazing and when I say I've now started using this as my makeup prep, this is now my skin prep.
32:19
Your makeup doesn't get that shiny, crazy hue after wearing it for a few hours. It actually stays on so nicely. It's got like a little bit of a grip and I'm pretty much obsessed with it. I know it just came out. I'm not sure if it's on shelves yet, but it should be relatively soon. If it isn't yet, I didn't realize it was that new.
Arash AkhavanHost
32:45
I think it is brand new and it's amazing. So I just full disclosure. I mean, we want to be honest about everything we talk about. I. I like it, not obsessed. Um, I thought it was okay. The you know. It just kind of shows different things work for different people and different skin types. Uh, I think I'm probably just too oily. I'm like an oil slick and I found it helped for an hour or two and then I just want to wash it off because it was my oil, was mixing with the moisturizer. So you know it's everybody's always looking for that miracle oil control. I haven't found it yet there's. I'm so bad.
33:16
There's a La Roche-Posayay like matt. I don't know the name, um, but something matt. Somebody dropped off for me that I do use um. I'll get the name for that and maybe we'll discuss it on another episode. But as far as the survey product you mentioned, it was good, it was, uh, it was a. It was fine it was. It was a moisturizer. I could definitely see myself using. Um did not give me the amount of oil control. You'd kind of really hyped it up. I was so excited to use it sorry, I'm gonna do better next time.
Ashley Guest
33:47
No, no, this is good. This is good we should.
33:49
We should love this product yeah, but yeah, definitely just goes to show like what works for your best friend is not going to work for you. This is a huge thing on all social media is you know the perfect skincare routine and influencers saying you need to use these three products and your skin is going to be amazing. And guess what? For 90% of other people, that just doesn't happen. And so it really is. It's so subjective and it so comes down to your skin and what your skin likes. My skin likes CeraVe oil control.
34:19
Okay, there you go, but maybe yours won't. You should try it. Leave it at that. Yeah, yeah, um, and I feel like that's it.
34:26
Yeah, it's sort of everything that we wanted to talk about today. Yeah, um, oh. I do have one last thing. Yeah, barbie Botox. Just to kind of bring it back real quick, because that was huge Barbie movie came out and, I kid you, not beginning the next day, we had 30 reach outs a day to our office wanting to come in for Barbie Botox. So can you just quickly explain what it is?
Arash AkhavanHost
34:50
Yeah, I mean that was just sort of like clever rebranding of something we'd been doing for a while trapezius Botox. So there are these muscles over here on top of your shoulder towards the back, and they can get overdeveloped in some people, especially people with, like, desk jobs and things like that, because we're holding that area under tension. Some people overuse them in their gym, like misuse them almost, and it can be a source of neck tension for a lot of people. And that's a reason why people relax the muscle for the with the trap Botox. But the, the Barbie Botox angle of it is, if you can get this muscle to shrink down a little bit, it creates more of an angle between your neck and your shoulder, so it gives you the illusion of elongating your neck. It makes sense, it works, it's effective both cosmetically and for symptom relief, and a lot of people love both of those benefits. It's just another use. It requires more units than we use in the facial muscles. These are much bigger muscles but it works and people like it.
Ashley Guest
36:00
Love it. Yeah, it's been huge. I think that's good, right I think that's it.
Arash AkhavanHost
36:05
So the one thing I wanted to kind of reach out and ask is if you have any questions or anything. Our email address and ways to contact us will be listed at the end of the podcast. Please reach out with things you'd like us to discuss and we'll definitely incorporate those into future episodes as well. Absolutely.
Ashley Guest
36:26
Looking forward to next week.
Arash AkhavanHost
36:28
Sounds good.
Ashley Guest
36:29
I'll get a better product Okay.
AnnouncerAnnouncement
36:33
Thank you so much for tuning in today. If you enjoyed this episode, please make sure to subscribe to Dr A Explains it All on your favorite podcast platform. By subscribing, you'll never miss an episode and you'll be the first to hear about our latest discussions on skin care, cosmetic procedures and more. And if you found this content helpful, we'd love for you to leave a rating or review. It really helps us reach more listeners like you To learn more about our podcast or to send us questions you would like answered on here. Please visit our website at drapodcast.com. That's d-r-a- podcast.com. To see us as a patient at our New York clinic. Visit us at dermatologyandlasergroup.com.
We hope you enjoyed this episode of our podcast! Visit our clinic website if you would like to see us for a Botox treatment in our NYC office.
Episode 2
Auto-generated Transcript
Arash Akhavan, M.D.Host
00:04
This is the Dr A Explains it All podcast. A podcast about cosmetic procedures, skincare, dermatology and everything in between. I'm board-certified dermatologist, Dr. Arash Akhavan. Let's get started, but first a quick disclaimer.
Speaker 2Announcement
00:19
Medical disclaimer. The information provided on this podcast is for general information and educational purposes only. It is not intended as medical advice, diagnosis or treatment and should not be relied upon as such. Listening to this podcast does not establish a physician-patient relationship between you and the host or any contributors. If you have specific medical concerns or questions, we encourage you consult directly with a licensed healthcare provider or physician in your area. The views expressed in this podcast are solely those of the individuals and do not necessarily represent the views of any affiliated institutions or organizations. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast.
Arash Akhavan, M.D.Host
01:22
Hey everyone, welcome to the second episode of our podcast. Today I'm joined by Alyssa DiVenedetto, who visitors to our office know very, very well. She's my first ever hire at the Dermatology and Laser Group, been with me since day one. She's the Director of Operations here at the Dermatology and Laser Group and her Cosmetic Coordinator here at the Dermatology and Laser Group and our cosmetic coordinator. A lot of our patients and people who email and call the practice know Alyssa very well and Alyssa was saying that one of the things that she thought we should talk about and she wanted to cover in today's episode was something that's been in the sort of social media world and even in magazines and things like that quite a bit over the last couple of years, and that's RF microneedling, kind of made most popular by um uh, as you were saying, Morpheus eight um, which kind of got a lot of buzz going uh, with posts with, like Kim Kardashian and other Instagram and TikTok celebrities and, yes, I feel like it did come out very strong.
Alyssa DiBenedettoGuest
02:32
Everyone wanted to do it, everyone was doing it. And then I have noticed recently which is kind of showing on Instagram that people are feeling a little bit more negative. They're seeing bad effects from it, which I know. You've always had a very strong feeling about that from the beginning, so I think we should definitely review that.
Arash Akhavan, M.D.Host
02:57
Sounds good.
Alyssa DiBenedettoGuest
02:58
So should people be getting RF microneedling on their face?
Arash Akhavan, M.D.Host
03:03
It wouldn't be at the top of my Christmas list. So I think there's for multiple reasons, there's better devices for facial and neck rejuvenation than RF microneedling, no matter what brand RF microneedling you're talking about. And we do have a couple, and we'll kind of go over the fact that we do have a couple of RF microneedling devices in the office. So before we get started, let me just get that out of the way, any conflicts of interest. We do. I am a paid consultant for a few companies that produce RF microneedling devices but despite that, like I've said from the beginning, the goal with this podcast is the truth on everything and kind of being upfront and honest and very simple with our discussion. So, yeah, I'm not a huge fan of RF microneedling for the face and neck. We do, we, we can do it and we do do it every now and then and we'll get into why.
03:54
But, um, you know the the social media trend began and everybody was very excited about what they were reading on TikTok and Instagram and also magazines and websites about the skin tightening effects and lifting effects of these devices. We had patients coming in even before it was a trend asking about it, because we have pretty knowledgeable patients and you know I've always kind of said stay away from it when recommended I was seeing bad things in people who were getting it. I had sort of extra access to the clinical studies from the manufacturers of some of these devices and saw long-term results and I was concerned that the patients looked better three months after the procedure when their skin was tighter, but they actually looked like they'd aged a bit. When you looked at pictures a year down the road or even six months down the road, I start to get a little concerned. Road, or even six months down the road, I start to get a little concerned. So, yeah, I was.
05:10
I was kind of fighting the trend a couple of years ago when everybody was talking about it and it all kind of started when, um, I think Kim Kardashian was linked on Instagram getting a Morpheus eight procedure. It wasn't clear where, but it was sort of assumed that it was the face. That wasn't clear. And then you know the sort of the social media influencers then started posting it as a life-changing procedure and I look 10 years younger and blah, blah, blah and I was like, oh, this is going to be bad.
05:46
I'm glad we didn't succumb to it. I'm glad we didn't do it, those sort of treatments for our patients and, like I said, we have done RF microneedling. We will continue to do RF microneedling when appropriate and for the appropriate things, and we can get into that. But, um, now, as you mentioned, what you keep seeing on social media is people talking about how it ruined my face and it melted my fat and my skin texture is ruined and I have more wrinkles and all this stuff, which is kind of what I was expecting to see, and it's finally caught on.
Alyssa DiBenedetto
06:22
Yeah, caught on, yeah, so, like you mentioned, we do have two of these devices and I know that you do not have devices in the offices that you don't truly believe in. So if we can talk about kind of what we use those for, yeah, so body treatments, as you know.
Arash Akhavan, M.D.Host
06:42
So I think you say, wouldn't you say that's kind of mostly what we use it for? Um, a lot of people after pregnancy, people with like laxity in their arms or above the knees, but abdomen is probably our number one place after pregnancy, so I'm fine with it on the body. So the main problem I have with RF microneedling is if it's used incorrectly, which I think it is honestly the majority of the time unfortunately and by that I mean if it's used at too high of a setting, you're introducing too much of a too high of a temperature at the tip of these RF microneedles and potentially you are damaging the fat right at the tip of these RF microneedles and Potentially you are damaging the fat right at the tip there. So with With radiofrequency, radiofrequency is a great technology if it's used correctly. If you use the appropriate temperature, which is in the low 40 degrees, like 40 degrees, 41, 42 On the skin, you can get collagen on elastin generation, um, you could get smoothing of wrinkles, the skin gets a glow, it actually gets hydrated, it produce uh, they can cause an increase in hyaluronic acid production, so the skin looks hydrated, looks and feels firmer.
08:02
I love traditional radio frequency. When you're doing it with microneedling, the way it works is the tip is very, very hot and then as you get away from the tip it's a little less hot. If you get above 45 degrees Celsius you can actually permanently damage fat cells and that's not something you see right away. So the fat cell first dies and then it sort of slowly empties and dies off over the course of a few months and it's absorbed. So you know that worries me with the way most people are using RF microneedling.
08:36
We will use it on the body, if on somebody's abdomen, because if we lose a little bit of fat, if we're using it, the strong settings, that's still okay, um, and we'll use it anywhere, as long as the temperature is really turned down, um. The one thing that patients that need to be like aware of is then don't expect, like a skin tightening, a profound skin tightening, or certainly not a lifting effect or anything like that. So you know, that's why I say it's not my favorite device for face and neck rejuvenation, because we have better things. We can use it if it's a convenient thing to use or very rare cases, like if you want to eliminate a little bit of fat under someone's, like under under their lower eyelid, we can actually use this side effect to our benefit.
Alyssa DiBenedettoGuest
09:26
But um, yeah, yeah, we use it judiciously in the right places, right time yeah for the right person yeah, um, and then just to kind of get into some cool things that we have on the device um that we currently use, um, one like the patenza that has the infusion tip, um, if you wanted to.
Arash Akhavan, M.D.Host
09:50
Yeah, so that's one that we um. So there's two that we have in the office out of all, uh I don't know, like dozens and dozens of rf microneedling devices out there. The patenza, like you mentioned, has the infusion tip. So that's a cool technology where it, uh, it has like a spring that it kind of pushes in the serum that you have on the face, whether it's prp or growth factor serums or things like that. We can push it in with force with that, which I find really cool. So we turn the energy way down. We are basically using it like a microneedling device and we're getting a little bit of benefit from very gentle heating as well. And then another one is Exxon, which is made by BTL, which is again sort of really gentle, not super painful, the way that RF microneedling devices can be quick and easy, minimal downtime. The way that RF microneedling devices can be quick and easy, minimal downtime.
10:47
And that company is a very sort of concerned with getting it right with um. I know they're science people pretty well with making sure that their technology is producing collagen and elastin, not getting too hot, being gentle. They've shown the hyaluronic acid increase in the skin. So there's a, there's a couple of products and that's why we pick those, um, because you know they were safer. Um, but yeah, if I still wouldn't use those, if, like somebody said, they wanted a lift in their face, you know I may then use something like all therapy which I can use safely because I could see exactly where the heat's going. I could use M face, which does it in a completely different way, by building muscle tone. So you know, they're not the device effects or issues other than the fat loss that.
11:58
So what we have seen sometimes is, if, again, high energy is used and the needle depth isn't appropriate, you could get weird texture in the skin too. So, instead of forming collagen and elastin, the way our body normally has in the skin, you form these collagen tracks that are essentially scar tissue. So the skin gets like a textured feel and I feel like you almost see the pores more clearly. Not quite a orange peel, peau d''orange as they call it um, fancy, um, not not that kind of uh, skin texture, not that severe, but uh, the pores seem a little bit more prominent. The skin looks a little woody, a little bit more texture that you're seeing. Yeah, um, that used to be a bigger problem, like five years ago, when the first devices had come out.
Alyssa DiBenedettoGuest
12:36
The needles weren't insulated correctly, so a lot of heat was going to the surface of the skin.
Arash Akhavan, M.D.Host
12:39
That used to be a bigger problem, like five years ago when the first devices had come out. The needles weren't insulated correctly, so a lot of heat was going to the surface of the skin. With the more modern devices, that isn't as big of an issue. It still is, though, a lot of sort of user-dependent. So you don't want to have super high settings and you want the needle to be at the correct depth.
Alyssa DiBenedettoGuest
13:02
Yeah, so why do you think people are still using this device incorrectly and people are still going to get it?
Arash Akhavan, M.D.Host
13:13
Well, the social media trends. You know they take a while to die out and then you know. More important than that is the fact that when these trends started, you know we had a lot of pressure on us as providers to provide this for our patients. Supply and demand. Patients were demanding and we need to supply it and a lot of doctors, med spas and other sorts of clinics ended up buying these and some it's their only rejuvenation device. For some clinics and they've spent $100,000 or something like that on these devices and that's a big investment and you need to use it to make your money back. And you unfortunately have a lot of people just using it for crazy things, like inappropriate things that it makes zero sense for, like acne scars or things like that, where there's so many better devices, like microneedling alone or lasers, and it's kind of that. When all you have is a hammer, everything looks like a nail, sort of expression. So people have bought these devices.
Alyssa DiBenedettoGuest
14:21
They want to use them Sometimes, oftentimes- in a lot of med spas, it may be the only rejuvenation device that they have. Do you think there's one better than the other in terms of devices for RF microneedling?
Arash Akhavan, M.D.Host
14:46
No, I mean, I think it really comes down to the person using it. So all of them can be used correctly and safely as long as the person who's doing it knows what they're doing and is conscious of it and isn't pushed to produce results that are unsafe. So, you know, isn't pushed to try and overt over, tighten or lift or do anything crazy like that.
Alyssa DiBenedettoGuest
15:04
Yeah, and we've mentioned that we have tons of other equipment here that we use. So what is kind of the alternative to doing RF micro-needling?
Arash Akhavan, M.D.Host
15:19
Yeah. So that's one thing I think it's important to note Any practice you're going to get facial rejuvenation or neck or body or anything like that, you want to make sure they have options. They're not using a one-size-fits-all and they can kind of tailor make their approach to what your individual needs are. So it really depends on what you're looking for. Like I said, if you're trying to get a little bit more of a lift, something I call therapy M-FACE would be my go-to of a lift, something I call therapy m face, um would be my go-to all therapy actually being even fda cleared as a non-surgical lift, the um.
15:55
If you're doing just general face rejuvenation, lasers are great. Rf alone, strangely enough, is great and microneedling alone, strangely enough, is great. So if you take those two components and separate them and we do this for some patients who really have their friends got rf microneedling and they really want it we say we can do it really light with our rf microneedling device or, even better, we can separate out the two and the reason it's better. So rf devices like um, temperature thermy, things like that they're wands that are like massaged on the skin and they are very precise. Within milliseconds they can measure the temperature. So whatever energy they're putting in, they can measure exactly what temperature your skin's at, so it can never get overheated and you maintain the temperature and get collagen elastin generation throughout the whole skin. So it's not just in certain areas where the needle's going in or this or that, it's massaging the entire surface of the skin. You get great deep collagen and elastin with these in the dermis, and a very pleasant procedure too.
16:58
Yeah, not super painful, no downtime. If you want more textural issues, things on the surface, and you don't want to do a laser, the microneedling alone is great. And why microneedling is better than RF microneedling? A traditional RF microneedling device uses a stamping technique, so you're getting just where the device stamps. You had that series of needles go in. Then you go to the next spot and the same thing happens With a microneedling device. You're getting thousands of little pokes, so much more collagen and elastin generation, much more damage being created healthy damage being created by these needles on the surface of skin, again covering more surface area and having a safer treatment because that heat's not being used so weirdly. The rf microneedling, separating out the two components, is a great option. Lasers are great. There's ultrasound devices, there's muscle building devices, there's injectables, there's lots of things. It really depends on the need.
Alyssa DiBenedettoGuest
17:53
So if somebody is very set on getting RF microneedling, that's what they have in their mind. What do you suggest that they do to get the best treatment?
Arash Akhavan, M.D.Host
18:06
I think go to a provider that is very experienced that's one thing A well-educated. Look at their education background, look at their experience. Go to a place that has lots of options to offer you. They're not just like you come in there and no matter what you say, they say this rf microneedling device will cure all your needs. You know that's. That's a red flag. And then don't push them for amazing before and after results. A good rf microneedling you should barely see anything or nothing at all on your before and after results. A good rf microneedling you should barely see anything or nothing at all on your before and afters. So you want your skin to look a little smoother, a little more hydrated, a little bit more glowy and not tighter, not lifted, none of that stuff. If that happens, you've potentially permanently damaged your skin, yeah, and long term you've aged yourself. So bad decision. So you want to go super light.
Alyssa DiBenedettoGuest
19:08
Yeah, I feel like that's one thing that I've learned working for you for all these years that you know, just going slow into a treatment, doing lighter treatments, in the long run you're going to get the better results, you know, and sometimes you may need something stronger, but for most just cosmetic concerns or aging, we, you know, we'll do the lighter options.
Arash Akhavan, M.D.Host
19:34
Yeah, I mean, I think that's probably best with almost everything, even like surgical procedures that plastic surgeons do you know. Taking a less is more approach is definitely our way, but I think it's the right way.
Alyssa DiBenedettoGuest
19:47
Yeah, all right, so switching gears now. Um, for this week's review of tiktok and instagram trends, I wanted to talk about collagen supplements, something that patients will ask a lot if they should take them to maintain their results, and I find it's mixed reviews everywhere on how people feel about them.
Arash Akhavan, M.D.Host
20:18
So what are your thoughts? Yeah, I have no problem with them. I think they're a good source of protein. So collagen is a protein. It's found in our skin, cartilage, connective tissue, veins, hair, nails. It's found in animals. It's a big component of our body. It's basically a series of three long peptides made of amino acids glyine, proline, hydroxyproline, different amino acid combos and different types of collagen. Oh, there's lots of types of collagen, by the way, and they're these. The collagen in our skin gives it its structure and we talked about it all day long. With all of our procedures, we're trying to maintain and generate new collagen.
21:08
The collagen that you consume in the supplements is a healthy way to get protein. The one thing you know I think it's a little bit of marketing, but they make you think that you're consuming the collagen. They make you think that you're consuming the collagen and somehow it's going into your bloodstream and popping into your skin as collagen, or popping into your nails as collagen or hair. That's definitely not happening. It's just breaking down like any other protein. You eat the protein in your steak, the protein in your almonds, you know, or whatever food you're eating. So it's breaking down into amino acids and small little peptides getting absorbed in your blood and your body decides what to do with it. Maybe it's going to repair muscle, maybe it's going to use it to burn as calories, as energy. Maybe it's going to make collagen, um. So there's nothing magical necessarily about collagen.
22:03
You're you're primarily you're talking about two types of collagen. There's marine collagen, they call it, which is fish, um, fish skin, and there's, they call it it's again marketing term, but they call it grass fed collagen. They never say so, that's cow, um. So those are the two types of collagen you're consuming the, the, that fish skin isn't like going into your blood and becoming collagen for you. You're not getting rid of wrinkles that way.
22:30
There are some studies that have actually shown that consuming collagen peptides and collagen supplements could potentially improve skin texture, skin hydration, things like that. But there's nothing particularly special about those studies, because the same thing has been shown with consuming whey protein. So that protein shake that you eat that's dairy derived, has the same studies behind it. And the same thing has been shown with soy protein. So edamame and soy protein shakes and all tofu have also been shown to have the same sort of skin benefits. So there's similar studies for all of them. I'm not convinced that there's anything special about collagen, but it is another good, healthy source of protein and I know a lot of people like it. I know you like it.
Alyssa DiBenedettoGuest
23:19
Yeah, I mean I've been highly influenced to try it. One specifically that Jennifer Aniston really likes and I'll do anything to what she likes Um, and what's nice about it is? It just dissolves in anything you want to put it in. Yeah, that's what I found about it actually.
Arash Akhavan, M.D.Host
23:39
Um, with collagen, as opposed to like when you have like a whey protein shake. It's so filling, you know it's like a meal. The collagen you don't even you could literally have it in the collagen water and it's just hydrating water, so it's not a big deal. I actually have read on I've never tried this on Instagram that you can actually bake with collagen. It's really heat resistant. I don't know how well that works, but I've heard of like baking it into cookies and stuff like that too, just to add a little protein.
Alyssa DiBenedettoGuest
24:09
Yeah, I've seen the putting it oatmeal and yeah, I think it dissolves easily and it's heat resistant, so why not?
Arash Akhavan, M.D.Host
24:16
Yeah, no, I have no problems with collagen. I don't think it's magical, um, but so I don't think it's necessarily any better or worse than having other sources of protein. That hasn't been proven. But it's a healthy source of protein and protein is good.
Alyssa DiBenedettoGuest
24:31
Yeah, anything to make you feel good about it? Yeah, and then every week we're going to talk about a skincare product. So one of my favorites and an office favorite that I really love is Elta MD UV clear. Um, I use that every day for years. Um, it's super light, easy to put on. I can wear makeup over it. Um, they have a tinted shade, which is nice, uh, for summer, and then they also came out with a deep shade as well.
Arash Akhavan, M.D.Host
25:06
Um, so, yeah, yeah, I love that you picked that one. That's kind of um, when we're when we have a new patient come into the office and we ask them about their uh, skincare. That's like 90% of the time the one they mentioned, um, you know, since the beginning of my career I feel like we've been mentioning it as a recommendation. With the niacinamide that it has as an ingredient, it's helpful for acne prone skin, rosacea prone skin, anti-inflammatory effects. It's broad spectrum protects well against skin cancer and aging. It's lightweight. People like it. Like you said, the three different tinted and two different tints and one untinted, so three different varieties of it. It's a super popular product. I think a great pick. That's like out of that sort of class of sort of physician recommended skincare products, I think that's number one. It's got to be the number one recommended dermatologist product. I don't know if that's true or not, but it feels like it's got to be because all my friends who are dermatologists use it and recommend it as well. It's like in everybody's house.
Alyssa DiBenedettoGuest
26:13
Yeah, I've never heard anybody have any issues with it. I have super sensitive skin and cannot use anything, and that's always been an easy product for me.
Arash Akhavan, M.D.Host
26:23
Yeah, yeah, no Good pick. Easy product for me yeah, yeah, no good pick.
Alyssa DiBenedettoGuest
26:25
Okay, All right. Well, that does it for this week and we hope you all enjoyed. Make sure to follow and review our podcasts. Reach out with any suggestions. We loved hearing from all of you last week.
Arash Akhavan, M.D.Host
26:40
And yeah, we've been getting a lot of people um DMing and filling out our contact form. It's been it's been really cool.
Speaker 2Announcement
26:48
Thank you so much for tuning in today. If you enjoyed this episode, please make sure to subscribe to. Dr a explains it all on your favorite podcast platform. By subscribing, you'll never miss an episode and you'll be the first to hear about our latest discussions on skincare, cosmetic procedures and more. And if you found this content helpful, we'd love for you to leave a rating or review. It really helps us reach more listeners like you To learn more about our podcast or to send us questions you would like answered on here. Please visit our website at drapodcast.com. That's drapodcast.com. To see us as a patient at our New York clinic. Visit us at dermatologyandlasergroup.com.
We hope you enjoyed this episode of our podcast! Visit our clinic website if you would like to see us for an RF Microneedling treatment of the body.
Episode 3
Auto-generated Transcript
Arash Akhavan:
This is the Dr A Explains it All podcast. A podcast about cosmetic procedures, skincare, dermatology and everything in between. I'm board-certified dermatologist, dr Arash Akhavan.
Announcement:
Let's get started, but first a quick disclaimer Medical disclaimer the information provided on this podcast is for general information and educational purposes only. It is not intended as medical advice, diagnosis or treatment and should not be relied upon as such. Listening to this podcast does not establish a physician-patient relationship between you and the host or any contributors. If you have specific medical concerns or questions, we encourage you consult directly with a licensed healthcare provider or physician in your area. The views expressed in this podcast are solely those of the individuals and do not necessarily represent the views of any affiliated institutions or organizations. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast.
Ashley:
We're back, episode three. I don't think we realized how popular this was going to be.
Arash Akhavan:
Yeah, our patients like it and lots of people we don't know, so it's been nice. Yeah, positive reception.
Ashley:
So episode three I really want to talk about cellulite. I think that it is something that patients reach out about a ton and it's something that 95% of women have. I might be off on that stat. You know better than I, but it's something that you know almost everybody has and we get a ton of questions about it. We do have some really great procedures that help to improve it, and I kind of like the way that you sort of break it down. So let's talk about cellulite today.
Arash Akhavan:
Yeah, so it's. Yeah, the stats probably a little less than 95%. But that is the main thing to know about cellulite is that it is very, very, very common. So you know, some studies say 70%, some say 90, I've seen as high as 90%, 95%, certainly with possible. But yeah, so it's the norm. That's the most important thing to know about cellulite. It's not like it's a disease state, has nothing to do with health, has nothing to do with even skin health. It's just a normal thing for most adult women and it can actually start even before you're an adult. It can start in adolescence.
Ashley:
Right, there's a genetic component to it, isn't there?
Arash Akhavan:
Yep, genetics definitely plays a role, much, much more common in women than men. We have seen it in men very rarely. It's much more common in women. And that kind of gets to your question. What is cellulite? So it's a, it's a condition primarily occurs on the buttock and the back of the thighs. Those are the most common places. You'll see it on the side of the thighs, sometimes on the front of the thighs, but primarily on the buttock, back of the thighs, and it can kind of present in two different ways either dimples so picture like the little puckered dimples on a golf ball, so little circles that are pulled in. Or it can look kind of like rippled skin, so just skin that isn't smooth. And they're both conditions that are caused by collagen issues and they're very different causes.
Arash Akhavan:
So with the difference between men and women, as far as we understand, is for the attachment of the skin to the underlying muscle. So you have the skin, then you have fat, then you have muscle. You have these collagen bands that are running from the muscle layers to the skin layer, holding everything intact together. In men these collagen bundles go in every direction, haphazard, left, right, diagonal, straight, parallel. In women they're organized much more neatly in parallel bands.
Arash Akhavan:
I don't know why. And if those collagen bundles as you age get shortened and condensed and hardened, it'll pull down on the skin, causing dimples. And then also, if we lose a little bit of collagen which we all do and you lose that attachment between the muscle layer and the skin layer, the skin will get rippled. So you'll see it's not smooth. So one other way you can kind of tell them apart is that rippled cellulite. If you pull the skin really tight upwards, like towards your head, it gets smooth. The dimple ones, they don't go away, they're there. And the treatments are different. Which one do you feel like we get asked about the most? I mean, I know we have patients that have both.
Arash Akhavan:
I definitely have both, I would say for a patient it's hard to just discern between rippling and um so they just, when they call you, they just say I have cellulite, I have cellulite.
Ashley:
Um, I would say I would say, more often than not it is more of that laxity, horizontally running cellulite, that is bothersome to the point where someone wants to do something about it.
Ashley:
But most of the younger patients I feel like who reach out about cellulite are dealing with those dimples and are generally great candidates for um, a valley which we'll get into a little bit later but we definitely get a ton of reach outs about both, and laxity seems to be kind of what you diagnose a lot of the time yeah, that sort of um rippling one, I think gets more common the older you get.
Arash Akhavan:
That dimpling you can get you know when you're 16, yeah, yeah, and you again just stressing that it's a um, not something that needs to be treated in any way. But it does seem, and studies have also shown this, that the majority of women who have cellulite, um, if there's an effective treatment for it, would want it. Um, so it does bother people, um, for whatever reason and the you know it's. It's nice that we're now able to provide really effective treatment for it. It's not like the old days where nothing would work. Now we have amazing things that work it. It's interesting the cellulite treatment ones and we've discussed this before together is the patients will literally cry tears of joy in the room, and that's not that common in the cosmetic dermatology world, but with cellulite treatment it is, and you can tell how much it's been bothering the person for a decade, two decades, and to just see the final results. It's really satisfying from our viewpoint also, just to get to experience that with the patients.
Ashley:
I would say that our cellulite treatments are my one of my favorite things that we do in the office, just because of the, the response, the response and the result that patients get and how happy that they are and, you know, almost unexpectedly better than what they thought that it would be. And the fact that these things last for a while is also amazing and some of the treatments and we can discuss them.
Arash Akhavan:
You know, the results seem, when you look at the pictures, too good to be true, but they're true and that's why I think the patients you know know with every cosmetic procedure, I think every patient comes into any office being like those results are probably too good to be true and then when they see that, nope, that's what I got, I'm perfectly smooth now in the area that was bothering me and they just get so happy yeah, it's a really happy yeah thing, um, what are your favorite treatments for cellulite?
Ashley:
And if we could break down the treatments that are great for the dimpling and the treatments that are great for more of the horizontal laxity and stuff like that? We'll start with dimples.
Arash Akhavan:
But yeah, they're very different again because the cause is different. So for the dimples, again, that's because the collagen band is constricting, it's pulling from below, it's gotten shortened and hardened and it's pulling on the skin. So our treatments, the most effective treatment, would eliminate that collagen band that's pulling down and release it, and then the skin would pop back to the surface. Those are really satisfying treatments because our sort of results thus far have been when you treat it, it's permanent. Um, our current favorite treatment for that is a belly, um, the one you mentioned it's. I love that device, it's. It's really simple procedure. You, um, you can visualize the collagen band that's causing the problem. You can double check is this the collagen band that's causing the dimple? You eliminate that band and you see the results right there, um, and you know they have some minor bruising for a couple of weeks and they can. They can be on the beach a couple weeks, weeks later, um, in a bathing suit and they're fine. So it's pretty cool and the results are amazing and nobody's dimples have come back, so that's good too.
Arash Akhavan:
Uh, before a belly was out, we used to do a lot of this procedure called self FINA, which was also amazing, um, not as sophisticated. Obviously it's an older device as a valley so we don't do it anymore, even though we have the device just kind of sitting there collecting dust. In between those two an injection came out called quo, which we did a couple of patients with and had great results, and then just saw physicians in in use were just reporting such horrible bruising with it and then we decided to just not do anymore, not press our luck. We had a couple of amazing results and I'm glad we stopped, because one thing that then happened was a lot of patients the bruising was just so bad they got skin staining from the bruises. And then there's really old devices like cellulase and stuff like that that weren't that effective. I don't think anybody's really doing them anymore. So that's for dimples, for for ripples it's not as satisfying. So we have some results where it's just spectacular, but we have to do a lot to get there.
Arash Akhavan:
So probably the most popular device right now is one called Emtone. It's a device that uses heat, radiofrequency, to thicken the collagen layer, build up the collagen layer in the skin, and it uses another technology called acoustic sound waves, which are basically shockwave sound waves going in. They say it improves circulation in the area and things like that. I think it's just basically just pounding down on the fat. Um, it's really the radio frequency that's working on it. The cool thing about the shock waves is they make you feel the radio frequency less, because it's a pretty intense device sounds like a distraction yeah, almost like that, but I mean that's not what it was made for.
Arash Akhavan:
The two together were shown to work better than either one of them separate. I just don't completely know why. Yeah, the problem with Emtone is the results are great, there's no downtime, all that, but they're just very short lived. So some patients need to just keep doing it, like once a month. Some patients can get away with doing it once every few months, but it's not a. You do it and you're cured. Your cellulite's gone. You just have to keep doing it.
Arash Akhavan:
A longer lasting thing that's not FDA cleared that we do is there's a filler called radius and we mix it with saline so we dilute it. It's called hyper dilute radius. We really dilute it with saline and then we inject it under the skin and it doesn't add volume that way, because it's mostly just saline that's being injected. So they look puffy right after the procedure, but that goes away in a few hours. It's just saline. What's left behind is this coating, really finely dispersed everywhere of this radius, and the radius causes itself causes new collagen generation in the patient. It's cool because it lasts a lot longer than the M-tone.
Arash Akhavan:
Downside is bruising and it's very expensive, depending on how much area you're doing, but results may last a year or even 18 months in some patients and the best results we've had which you know, these are sort of really exciting. Where we've seen really amazing results for this ripple type of cellulite is where we combine the two, actually, and there are studies showing that hyperdilute radius followed by radio frequency it's almost like the radio frequency activates that collagen production pathway and just kind of augments your results, and that's what we found as well. So we'll do the radius together with that and the combination's been great as well. Just gets so pricey and it's it's not permanent. You know. Best case we're talking 18 months, maybe just a year yeah, so a bit of upkeep needed what's that?
Ashley:
so a bit of upkeep needed.
Arash Akhavan:
Yes, upkeep needed, yep.
Ashley:
And just quickly to go back to the abeli selfina. When we're talking about that first quo, I think it's a really, really cool procedure. So just to kind of break it down a little bit further, the abeli and the selfina work very similarly in that it is almost like a tiny it's minimally invasive, which is something that we should definitely mention, right?
Arash Akhavan:
Neither one's non invasive, you're right.
Ashley:
That it does have a little bit of um downtime with it. Um, the aveli and the selfina um are usually kind of inserted right underneath the skin, a tiny little needle-like um device, and it actually cuts that band that you've been talking about that's pulling the skin through the fat into the muscle, and it's really, really great. That is not the same as quo, and quo, being an injectable device, was actually meant to dissolve those bands.
Arash Akhavan:
Is is how I kind of understand it correct so just to kind of um further explain let me see for those of our listeners watching on youtube. So this is actually the Aveli device. It's a really fine little, tiny probe that's inserted under the skin. This they probably won't be able to see on camera, but then we push out a little hook and then that hook catches the cellulite band. We tug on it to see if it's actually causing the dimple. We eliminate the band with another button, we check to make sure that we can no longer tug and cause the cellulite band and then we pull it up. And that's as simple as that.
Ashley:
That's amazing. Yeah yeah, I just wanted to get a little bit deeper into that because it is the coolest device and procedure.
Arash Akhavan:
Cool, but so simple yeah.
Ashley:
And it's like such a huge difference for such a tiny little quick in-office procedure that you're awake and chit-chatting through. It's not something you need to be put out for, it's not something you need your friend to come pick you up from the office with. It is really easy and really comfortable.
Arash Akhavan:
Yeah, I mean, it's simply like you just come in, we mark the cellulite dimples, we're going after, we numb it with local injections of lidocaine, just like any skin procedure we do. Or like when you go to the dentist's office and you have a cavity same Novocaine, um, so that's injected right where we're treating. That's the only part. You feel a little needle from that. Then we do the procedure. You don't feel any of that. Patients are talking, they're watching shows on their phone, um, they're doing work on their laptop, um. And then you, we do have you wear like exercise type, um, compression, so not special surgical garments or anything, just like regular, uh, yoga pants and leggings and you wear that for the first few days to help with the bruising and you can exercise as soon as you feel comfortable. We've had patients exercise the next day.
Ashley:
We've had patients wait like two, three days, um, nobody takes off work or anything like that and actually exercising I I feel like I've heard you say can help improve the bruising and the discomfort, because you're kind of getting blood flow to the area, kind of moving it around. Is there any truth in that?
Arash Akhavan:
Yeah, I mean, you may be mixing that up with another thing. Um, I do like that with, um, blood vessel, uh, veins, leg veins, um no, this is just really. It doesn't help or hurt, it's just, whenever you feel comfortable you can go get to it. Yeah.
Ashley:
And it hasn't.
Arash Akhavan:
it hasn't been long and according to our patients no, no, yeah, Most patients like a day or two, um, you know, and, and it's like I said, the coolest thing about it is how happy patients are after the treatment. It's such a pleasure, the like the day they come in for their after photos. I love it. I look forward to the Aveli after photo day and the. You know, there there's this whole thing. With every good thing, I feel like sometimes people ruin it. So, all about body positivity and you know, having people just feel comfortable with in their own skin and not feeling like they need to do something against cellulite is completely normal. But you'll have like a perversion of the body positivity sort of movement and you'll have people just confused and saying it's wrong to treat cellulite. You'll hear the same thing about stretch marks, like, why would you treat cellulite? Why would you treat stretch marks? You can say that about anything.
Arash Akhavan:
I mean, people are doing it for two reasons. They're doing it for themselves, or maybe they're doing it for society, um, just because there are societal norms. And it just like brushing your hair. You know, nobody needs to brush their hair. You can all just walk around with messy hair. Certainly nobody needs to color their hair. We could all have white, gray hair, we could. Nobody needs to do their. You know, get a manicure, you don't need to paint your nails. It's just things people decide to do and there's some societal norms.
Arash Akhavan:
People mostly do it for themselves, I think, and it's kind of crazy for people to pick on people who want to do these things and it even gets the point of like confusion on things like social media platforms and things like that, where they'll censor cellulite treatment because it goes against body positivity values. That's just such confusion and such garbage. Um, from you know these social media companies and just their algorithms and not you know picking and choosing what you know is okay and what's not okay. So you know Botox okay. Treating cellulite not okay. Uh, lip filler Okay. Treat treating stretch marks from pregnancy not okay. Who decided that? Some algorithmic thing at you know meta, yeah, um, so that's unfortunate and that's that's kind of going against the whole.
Ashley:
You know the idea behind the by positivity movement like you should support people and doing things that make them happy yeah and I I love providing things that make people confident and happy yeah, I think, like a lot of the stuff that we do and the way the office runs in general too, is, um, that a lot of the time it feels like we're helping people. We're not we're not, you know, trying to make a perfect human. It is things that really bother people, that they really want to improve, and how we can help them do that. And the reason why I love this procedure so much is because of the confidence that we give patients when they see their overall result, and it's something that maybe they've never worn a bathing suit on the beach because they don't feel comfortable with their butt or their legs out. And then, to you know, have them, show us pictures on vacation and their bikini on the beach and how happy they are with it.
Ashley:
Um, it is. It's interesting that the internet kind of decides that improving specific things on your body is vain and abnormal when other things are totally normal and perfect. Um, so I think it's it's good to kind of talk about um in terms. I think we we've gotten kind of the, the dimpling and the procedures for the dimpling under under wraps here. But in terms of the rippled, I know we kind of touched on it and it's a little bit harder to manage and a little bit tougher to keep results in place.
Arash Akhavan:
Um, for that rippling, do you feel like m tone or the radius is the better move, or ideally the combination is better, and then if the combination, because of monetary reasons, is not something that's feasible, it comes down to do you want something that has absolutely no downtime, no bruising, no swelling, actually leaves you looking better right after the visit. Yep.
Ashley:
It's all.
Arash Akhavan:
No, yeah, no swelling actually leaves you looking better right after the visit. Um, then natural, yep, it's all. No, yeah, no external products being injected. Then you pick Emptone, um, understanding that you'll have to come frequently for visits, but people are really happy with it and people do come frequently to our office for it. Um, people have loved it and have been doing it for years.
Ashley:
Like a hot stone massage meets a lymphatic drainage massage.
Arash Akhavan:
Like it is it's not I mean, I've never had a hot stone massage. I would say an intense hot stone massage. Yeah, really hot. Yeah, I mean again, patients love it and keep coming back for it. But the couple of times I've like tested it out on my own, like abdomen or something, I'm like whoa that is hot, yeah, yeah. But then, for some reason, a lot of our patients are like it's fine.
Ashley:
Well, they do say men have a lower pain tolerance. Yeah, yeah.
Arash Akhavan:
And I've never had a hot stone massage. I don't know, but that sounds miserable. Report back when it does. Yeah, and then the radius would be for somebody who doesn't want to keep coming back in is okay with the downtime Maybe it's the winter or something like that. If they had to pick one or the other and it does cost more, so they'd be willing to put up with that as well. Even if you split the cost of M-Tone over all that time, it's still less expensive than radius. Just because radius is an expensive material, you know, it's a filler.
Ashley:
Yeah, absolutely. And it's, it's, you know, a lot bigger than a cheek.
Arash Akhavan:
Yeah, yeah, you're not like filling a chin or a cheek here. It's, you know, maybe the entire back of somebody's thighs or back and sides, but you know it's, it's. It's a lot of injections, it's a lot of bruising, it's a lot of swelling.
Ashley:
And do you feel like diet and exercise can help to eliminate cellulite?
Arash Akhavan:
No, I mean so that second type, the rippling type of cellulite. When you have more body fat, the fat you'll see pushing out a little bit more. So people will say, you know, if their body fat percentage goes down, some people will actually improve that type of cellulite. Um, it doesn't go away, though, or anything cause. That's not really the root cause of it and, yeah, it's not really anything you're eating or doing and you can't exercise cellulite away really. Except for that, except for maybe a little bit of improvement by decreasing your body fat percentage.
Ashley:
Right Interesting. And then I see all over creams, Cellulite reducing creams they're kind of all over the place and they pop up every now and then and then they kind of go away and then a new one comes out and people swear by it.
Arash Akhavan:
Um, I bet, uh, you know, with all the good targeting they do now on social media, you probably see a lot more of those and I see all the baldness things.
Ashley:
Yeah, I'm like, yeah, I'm on cellulite, talk I guess, talk I guess. Um. Well, like, what are in these creams?
Arash Akhavan:
are. I mean they're. They vary, but a lot of them contain like caffeine. Some of them contain like pepper extracts, so they're temporarily irritating your skin, which makes your skin swollen. So you don't see imperfections under it. Um, that's basically all it is, you know I know like long-term effects no, zero, yeah, zero chance of improving your cellulite with the cream. Um, and if it is really going to be effective, it it needs to be pretty damn irritating, yeah, yeah, um, cause a lot of swelling so you don't see the cellulite temporarily.
Ashley:
Yeah, maybe just a few hours, honestly I've definitely tried them and uh, no, they do not work, yeah, not even in the short term. Um, I don't know. I don't know why they, why they're so buzzy and why it won't just go away, because it seems like they keep popping up.
Arash Akhavan:
But I had a friend try one. Um, she kind of got fooled by the ad and it was like these neon attractive bottles and they looked very harmless and her skin was, like she said, it felt like she's been burned alive. Um, but her skin was smooth for a few hours, all right.
Ashley:
Okay.
Arash Akhavan:
So not no, but not yes for sure.
Ashley:
Anything else you want to talk about regarding cellulite?
Arash Akhavan:
No, I think. I mean, I think we covered it and I've got patients in, so let's wrap it up, okay.
Ashley:
So switching gears, our trending Tik TOK or social media, yeah, procedure of the week would be something we saw as an an alert article actually, and it was called the labial puff procedure. Have you heard about it? What does it do?
Arash Akhavan:
Yeah, I mean we've actually used that term, even in our office, I think, for more than a decade probably. The first time I heard about it was when I did it with one of my professors at when I was a resident at Mount Sinai in the cosmetic clinic, and that was the first I heard about it. So I mean, that was probably like 17 years ago or something, so it's nothing new.
Ashley:
It has the title of, it is new.
Arash Akhavan:
Yeah, maybe a late veal puff.
Arash Akhavan:
Yeah, I don't think we like call it that to patients. When we we do it, it's not something we do like every day. We're talking about you know, handful here and there per year, but definitely increasing. We've done a lot more this year. The procedure is basically filler in the labia majora. T-dure is basically filler in the labia majora.
Arash Akhavan:
So as we age we lose volume everywhere and it causes some of the signs of aging. So on your cheeks you'll lose a little bit of the fat there and the muscle and the bone and things start to sag down. That's one of the big causes of aging. And combine that with collagen loss and elastin loss, which ruins the structural integrity of your skin, so you start to get aging on the face. The labia, the vulva is really no different, obviously for the great, great, great great majority of people, less sun exposure there, um. So collagen, elastin loss not as severe. Some of that just happens with age and stress and unhealthy lifestyle and things like that, and some of it just happens naturally. But that's not the major issue. The major issue is the labia majora, which is the part that's on the outside, versus the labia minora, which is on the inside. The labia majora loses a little bit of the fat under it and we see the little bit of crinkling on the skin there. It looks deflated a little bit and the only solution when you lose volume is to fill the volume one way or another, same thing as we do for the lips and the face and the butt and all the other areas. In this area we're injecting fillers um to smooth it out again, so to add the volume back that's been lost with time. That's it's one of the areas that actually shows I think you know age relatively early, um, and that's in the labia majora, the inner part. You don't really see that. What you actually see is from loss of collagen, elast in the labia majora, the inner part. You don't really see that. What you actually see is from loss of collagen and elastin. The labia minora can actually hang a little bit lower so it becomes elongated, but in the labia majora it's really that loss of volume.
Arash Akhavan:
And you can use any filler. I think the majority of the time we use either Sculptra, which is polylactic acid. That's a powder we inject and slowly you build volume over time. I like that one because it lasts a long time. The patients sometimes have results that last two, two and a half years. We also do juvederm, voluma, a hyaluronic acid one. You can use really any of the fillers. And the one thing to kind of be aware of in that area it's it's not like the lips, um, on on your face, on your mouth, where one syringe does a lot. So you are going to need a few syringes so it can get a little bit more pricey. That's one of the other reasons I like sculpture in that area, because it lasts a long time, so, um, you're getting your money's worth. It's another one of those things that I feel like.
Arash Akhavan:
Again, just getting back to that sort of body positivity arguments, again you'll hear it is weird. It's always like the female specific conditions. I feel like people get sort of hyper sensitive about them and we'll say nobody needs to treat that, it's a normal part of aging. One thousand percent, it's a normal part of aging and nobody needs to treat it. It would be hard to make a medical argument for why that should be done. For medical reasons. It's a cosmetic thing. People are doing it for themselves, maybe they're doing it for their partner. Why it's getting a little bit more um buzz to it is the labia majora. A lot of people have done things like laser hair removal and things like that, or regularly get wax there more than they used to, so it's more visible than it used to be. That's probably one of the main reasons and sort of you know, the adult movie industry and stuff like that and exposure to that creates societal norms around that as well.
Arash Akhavan:
So, whatever the cause is, if someone wants to do that, there is an available treatment for that. It's safe. It's a vascular area. So we always do it with a cannula as opposed to needles and I suggest if anybody is having it done, they don't have it injected with a needle, just because it decreases the risk of accidentally injecting the filler into a blood vessel. Do it with someone who's experienced and does a lot of injections of fillers. Yeah, it's a safe and easy thing. It's. It's uh, you know, I, I think I. I saw the allure um article and then all of a sudden everybody started posting about it again, cause it's interesting. Anything that I feel like has to do with the genitals or this or that, everybody's like Ooh, that's, that's going to be a hot topic, let me, let me post about that, so you'll hear people talking about that. So like, oh, that's, that's gonna be a hot topic, let me. Let me post about that, so you'll hear people talking about that.
Ashley:
So I think that's why we saw it trending yeah, plus the nice little buzzy name, yeah it's got a name, maybe a little puff, yeah it's really anything that they want to kind of rebrand an old, an old treatment or procedure on and give it a new name.
Arash Akhavan:
Kind of tends to pop off and it isn't I I feel like two years ago with the Botox and the scrotal skin. Everybody was talking about scrotox, scrotox. I mean, yeah, I mean it's now nobody talks about that anymore. Yeah, yeah, it's, it's, it's yeah social media for you, things just um yep, um Yep.
Ashley:
All right, do you know, like how many is it patient to patient? Or like how many syringes?
Arash Akhavan:
What's the average? I mean I think we average anywhere. So if we're doing like either of those two fillers I mentioned, like the Sculptra or the Juvenile Voluma, it's probably somewhere around like two to four, something in that range. Yeah, I think one would be kind of pointless almost.
Ashley:
Yeah, um, all right, and I think that leads us to our last topic of the week, which is this week's product of the week. Um, I'm ready for you to to roast me on it, oh, no but I enjoy. I've fallen into a deep, dark, dark hole on eye creams. Um, I have tried caffeine eye creams. I've tried growth factor and peptide eye creams. I've tried. I've tried everything um one that I have tried and really, really liked is the chaos by isden our patients like that too.
Ashley:
Yeah, I have no idea why I like it. Um, I obviously don't suffer from much under eye issue, but that one I like the way that it goes on and the way that it drives and how concealer lays on top of it. But what do you think about eye creams? Is there one type that works best? Is it the one with the caffeine in it? Is it the one with growth factors in it? Or are they all kind of made the same? And how do they differ, honestly, from just your regular face facial moisturizer that's also being put on your under eyes?
Arash Akhavan:
probably not much. And if you love your facial moisturizer and it's doing what you want in the under eye area and you try an under eye area and it's not really looking like it's any better than your moisturizer, then you probably could skip the um under eye cream and just stick with your facial moisturizer. Everywhere you know they'll, they'll always be filled with things like, like you said, the caffeine or peptides a big buzzword where peptides supposedly can penetrate into your skin and do things like getting you to generate collagen and elastin your skin and do things like getting you to generate collagen and elastin. All of that without any sort of enough definitive proof scientifically to actually like prove that they do that. Um, you know we're not seeing major double blind, placebo, controlled studies. We're not seeing any fda approval for any of these things, um, so some of it's a trial and error. Maybe your under eye cream is just suited better for the thin skin there and you like it and you think it is doing something compared to your moisturizer. Put it on. I don't think it's probably making any sort of long-term changes. Um, but if you're using it every day, on the days that you're using it, it may be improving the fine lines and wrinkles. Some of them have like titanium, which masks. It's like a block, so it doesn't allow the darkness to show through, kind of like makeup. So that's another benefit it can help with, like the darkness and the hollows under the eyes, you know. But then they all have other ingredients. You know, the one ingredient that does have FDA clearance for treating fine lines and wrinkles and improving discoloration and things like that is retinoids. So retinol over the counter, tretinoin as a prescription. It's tough to use it.
Arash Akhavan:
There are some retinoids, retinol products, that are under eye creams, like there's one. Let me just look it up, hold on, there's one. So the La Roche-Posay Redermic R Eyes Retinol Eye Cream. That's a mouthful. Yeah, it's a lot. That's one that I had tried and could tolerate. I don't use one. I don't use it regularly. I think I tried it like a while ago and gave up after a few days.
Arash Akhavan:
Um, but using a retinoid under your eyes could build collagen and be anti-aging. I use um, a prescription one and just put it over my moisturizer. Um for anti-aging. I use a prescription one and just put it over my moisturizer for anti-aging and nothing's going to be better than that in terms of a cream. But a lot of people you know the problem with retinoids is they're irritating for a lot of people and eventually you'll get used to it. Most people on, especially on like the thicker, like forehead, nose areas like that but in the under eye people, some people just never get used to it. So I'm not suggesting everybody jumps to using retinoids there. Just test it out and see if your skin can handle it.
Ashley:
Yeah, I would say like the meatier parts of the face in terms of retinol first, and then, as your skin gets used to it, you can kind of kind of kind of scooch it up to the under eye area and your face should be okay with that. But always, um, if you, if you have an under eye cream, you may want to put it on top just so that you don't have, um, any like discomfort in in terms of redness and dryness in the under eye area. Um, but I mean, I guess overall it works for some things. Um, I mean, sometimes there are there are things in people that just need intervention if they really want to improve that area. No wonder I was going to fix some things, but it could.
Arash Akhavan:
Yeah, what I'm hearing is it could help yeah, no, I mean, and patients really like some of them and everybody has their favorites, and I I think that, yeah, our skin on different parts of our face is different, like your under eyes very different than the skin on your nose which is right there next to it.
Arash Akhavan:
You know just, different oil gland, different makeup, um, and you know if you find a particular cream that's best suited for that area and it's not too much of a hassle, then go for it. Yeah, use an eye cream and then use a moisturizer on the rest of it, and you know, you can, you, you can figure it out, maybe like a particular neck cream or this. You know everybody's got their things, um, and you just a lot of it's trial and error, so it'd be ridiculous for me to be like these are the four steps that everyone must do. There's, that's just. You know that's not true. Everybody has to kind of do trial and error and work with your dermatologist or esthetician or figure it out on your own, and you know trial yeah, figure it out, yeah, uh, yeah, I agree I think, um, it's just like makeup, it's just like anything else, it's like your face wash and your moisturizer.
Ashley:
No one is going to be great for everyone. And if it is something you want to try and it's really not an integral part of your, your nighttime routine, right Like at the basis of what you should be doing every morning and every night, and eye cream is an add on.
Ashley:
It's a nice add on if you want to. But, um, you know I, I know what you kind of tell our patients in terms of, like you know bare minimum what you want to do for your skincare routine and eye cream is something you can work into when you kind of get bored, yeah.
Arash Akhavan:
They do get pricey. Some of them, you know some of the like $50.
Ashley:
Yeah, yeah, and that sucks If you try yeah.
Arash Akhavan:
And if it's doing nothing for you, then skip it and just use whatever you're using on the rest of your face.
Ashley:
Yeah, case closed. Cool, we did it.
Arash Akhavan:
Let's go see patients. Let's do it All right.
Ashley:
See you next week. Bye.
Announcement:
Bye. Thank you so much for tuning in today. If you enjoyed this episode, please make sure to subscribe to Dr A Explains it All on your favorite podcast platform. By subscribing, you'll never miss an episode and you'll be the first to hear about our latest discussions on skin care, cosmetic procedures and more. And if you found this content helpful, we'd love for you to leave a rating or review. It really helps us reach more listeners like you To learn more about our podcast or to send us questions you would like answered on here. Please visit our website at drapodcastcom. That's drappodcastcom. That's drapodcastcom. To see us as a patient at our New York clinic, visit us at dermatologyandlasergroupcom.
We hope you enjoyed this episode of our podcast! To book a consultation for cellulite evaluation at our office visit our cellulite treatment procedure page on our main website.
Episode 4
Auto-generated Transcript
Announcer: Let's get started, but first a quick disclaimer Medical disclaimer the information provided on this podcast is for general information and educational purposes only. It is not intended as medical advice, diagnosis or treatment and should not be relied upon as such. Listening to this podcast does not establish a physician patient relationship between you and the host or any contributors. If you have specific medical concerns or questions, we encourage you consult directly with a licensed healthcare provider or physician in your area. The views expressed in this podcast are solely those of the individuals and do not necessarily represent the views of any affiliated institutions or organizations. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast.
Arash Akhavan: Hi, for today's episode I'm flying solo. We're essentially sticking to one topic today, so I thought, for the purposes of efficiency and getting the information to you in the most simple way, I would just go alone. And the topic for today is something that keeps coming up, and it's been a new thing where a lot of patients who are calling to make appointments at our office new patients over the last year and a half have been calling and asking about getting their filler dissolved, and a lot of our patients have uh, that have been calling have also been asking what we can do. That's like a filler, but not quite a filler, some of them with sort of wrong ideas about what we could do. So that's been an interesting thing and I think a lot of it's social media driven.
Arash Akhavan: We've been seeing lots of people sort of talking about getting their filler dissolved on social media influencers on Instagram and TikTok, and so just kind of thinking about why are we getting this question? Our filler is really bad. Should everybody be getting their filler dissolved? Um, basically, some people are complaining the filler is making them look puffy. Some people are complaining that the filler has migrated and it's not the way it used to look six months ago or three months ago or two years ago, um, and both of these are reasons why people and then and then some people have just been coming in and we're meeting them and they say they just want to dissolve their filler. And we asked why? And they said they don't know. Um, they just feel like filler should be dissolved now, um, and and so what? What are the bad aspects of facial filler that people are sort of upset about? Why? Why is this a thing over the last year and a half? Why is it getting traction on social media? And I think there's three reasons. One of it is the fillers themselves have changed. So there's a few different competing filler companies in the United States and a few everywhere around the world, and they're competing against each other and they need to come up with reasons why you should buy brand X and not brand Z, or check out the new type of subtype of filler brand z just put out, and then they put out another one six months, another one a year later, and one of the big things is they want them to last a very long time. And then the other big thing is they want them to accomplish a lot with just a syringe. So one syringe or two syringes transforms this person's lips or their under eyes or their jawline or their cheekbones, and one way that they can accomplish a lot with filler is to have some.
Arash Akhavan: When I'm talking about fillers right now, I'm talking about hyaluronic acid fillers. That's the majority of fillers out there. There's other ones too, um, so the mean hyaluronic acid filler brands in the U? S or Juvederm, rha, restylane, and they each have subtypes, and there's other ones Bolotero, and then the non-HA, non-hyaluronic acid fillers Radiesse and Sculpture are the two main ones. And so right now I'm talking about hyaluronic acid fillers. Those are the only ones that you can dissolve, so that's the trend of dissolving those fillers. Those are the only ones that you can dissolve, so that's the trend of dissolving those fillers.
Arash Akhavan: And one thing about hyaluronic acid that you may know from your serums and moisturizers and things like that, is that it's known for its ability to attract water. It loves water, it absorbs water, and these newer fillers can absorb a lot of water and that sounds great. But when you kind of think about a little bit more, is that makes the results very variable. So some days your body retains more water that does on other days. So is your filler gonna swell in those days? It could, so that one syringe of filler, which is one fifth of a teaspoon maybe in your cheek, has actually swollen on certain days to five syringes of filler volume, five ml one teaspoon, or maybe three. Maybe one cheekbone three, one cheekbone five. So that that's one thing. And you wouldn't notice that if you were injecting one syringe of filler or two syringes of filler, but if you're injecting 10 syringes of filler and 10 has become the equivalent of three syringes, 30 syringes worth of volume, then that could make you look puffy and that could be a bad thing.
Arash Akhavan: And another thing is that these filler companies are sort of competing on is how long they last, the longevity of the filler. And one way they can make them last longer is by getting them cross-linked. That means the hyaluronic acid molecules are really bound to each other. Um, so they stick around longer, which again sounds great. But life happens. And that filler that you put under your eyes, maybe you slept on it for four nights in a row, maybe you rub your eyes a lot, maybe you swim for exercise and you wear goggles for hours a week on it. That can't be good. This is a gel under your skin and it's under continuous pressure, chances are it can move a little bit if it's sticking around for a really long time. And when I was training, you know two decades ago that um wasn't an issue because the fillers would last like five, six months, so they didn't have a chance to move anywhere. They'd be gone Um, so we wouldn't see migration. But now that they stick around they migrate. So you know that's two of the bad things that people complain about. And you know the fillers themselves have some characteristic changes that have occurred over the last couple of decades that make these things more likely. Another thing is the people that are injecting them. There's just too many people injecting filler now. But I mean I mean providers.
Arash Akhavan: Again, when I graduated two decades ago, it was after residency at Mount Sinai here in New York City. We all, all of us residents had something called a cosmetic clinic. It met twice a week. We would bring in our own patients there. They knew that we were going to be the ones injecting them. They were getting a discounted rate because we were training for the years that we were there in our residency and we were training with the most accomplished cosmetic dermatologists in New York City, and it wasn't just hands-on training, it was also didactic lectures and books and journals and tests, exams, correction of technique on people seeing the patients back month after month at these clinics and seeing our results. And that was with fillers, it was with Botox, it was with lasers, it was with liposuction, it was with hair transplants, and that was part of our training. It was part of the plastic surgeon's training and we were the only ones, when I got out of residency, that were doing these procedures.
Arash Akhavan: And then you start to see some physicians that weren't trained doing it, and then you started seeing nurses and PAs and estheticians and and uh, not to knock anybody but you know, there there's a difference between that sort of training and training that you get on a job or at a certification course. You know, and then you call yourself a certified injector. I'm not sure what that means. Um, you know. So. So the more people you have with less training injecting, I think it makes sense that you will see some results that are less than ideal. Leave it at that.
Arash Akhavan: And then the other thing is the third thing I think that's sort of driving bad cosmetic results with injectables, with fillers in particular, is social media. So everybody trying to compete for clicks. How do you do that with injectables? By having amazing before and after results. You really should not have amazing before and after results with filler. They should be subtle. They should be hard to see.
Arash Akhavan: If they're amazing in a two dimensional picture, you probably put a lot of filler in. If you're, if you're saying you gave somebody a lift or if people are saying, wow, that person looks like they had a lift, you probably put a lot of filler in. If you're, if you're saying you gave somebody a lift or if people are saying, wow, that person looks like they had a lift, you probably put a lot of filler in. You probably put it in very exaggerated, with an exaggerated sort of projection, weird injection techniques to get that result and that's not going to look good in real life. It may look good in a two-dimensional picture where they're looking straight at the camera, but the second that person's talking, interacting, bending their head down or up or eating. It's going to look weird to everybody else and that gives you weird, weird contours and puffiness and lack of lines in the proper places.
Arash Akhavan: And a facelift should give you a facelift results and and you know there are non-surgical things that can give you results, that approach, a facelift, when you combine things. A little bit of judicious filler, a little bit of this, a little bit of that, we can get into those alternatives to fillers. But filler on its own giving you a facelift probably bad news. So what would be good filler results? Because I love filler, I love doing filler and I think we have great results with filler One. I mean I'm biased, but go to a trained person, go to a board-certified dermatologist or plastic surgeon. If you can Not saying every board-certified dermatologist is better than every certified injector, um, just, chances are. But again, I'm biased, but chances are. The person with years of rigorous training probably is more trained to do that procedure.
Arash Akhavan: Don't dry and do too much um with filler. No, it's limitations. It should be injected very sparingly. It should ideally be injected pretty deep um over bone, in certain areas. Um, another big thing is combine it with other procedures. Don't try and do everything with filler. Um, combine a little bit of filler, a little bit of skin tightening and other procedures that rejuvenate. So combination procedures are always going to look more natural and if a lot of time has passed, don't be afraid to dissolve and redo it.
Arash Akhavan: If we've injected your lips and two and a half years have gone by. It makes sense that maybe your right upper lip is a little fuller than your left upper lip, maybe it's traveled a little bit this way or that way. You've kissed, you've chewed food, you've played your trombone. I don't know what you've done, but you know it's not going to stay right where we injected it for two and a half years. Um, dissolve it, take a break for a week or two, do it again. That's the way to have ideal results.
Arash Akhavan: And then, uh, the question of alternatives. So my favorite one it's actually a company I've worked with in the past, a company, btl, which everybody mostly knows from M Sculpt, but they have an amazing face rejuvenation device that I think is a great alternative to fillers called Emface Combines two technologies radiofrequency and the real thing. That is the important thing high fes. So radiofrequency, not not important, it um heats the proper level of skin depth to the proper temperature to get collagen and elastin generation to help with fine lines and skin texture and skin firmness. Um. And then the high fes, which stands for high intensity, focused electrical stimulation.
Arash Akhavan: There's lots of contractions of the key muscles in the face, so in the cheeks, midface, this muscle called the risorius, the zygomaticus, major and minor on the forehead, the frontalis down here, the digastric under the chin, and you're building muscle tone in these which gives a lifting effect to the mid face, to the uh jawline, to the forehead and brow area, to this under chin area, and the under chin does other things that don't really pertain to here, to help with double chin, but that's a different technology. But yeah, the M phase is a really cool device. There's zero chance that you're going to have funny looking results because it's your own muscle going back in tone. So we don't have to worry about weird puffiness, unnatural results, migration, things like that Looks great and if you want more, you can add a little bit of filler to it. But people really do love the Emface on its own.
Arash Akhavan: But it can be combined and, like I said, that's the most important thing I think honestly is combining procedures. So you could Emfacec the , you could add a little under eye filler, a little lip filler, a little tweak here, tweak there, without doing too much, and everybody's going to look natural. And the other thing you can combine it with is skin tightening. So that could be accomplished with ultrasound, like all therapy device, fda cleared for lifting, can treat the face, the neck, the decollete, the brow, and it uses ultrasound to target deeper layers of collagen to get a sort of a profound tightening effect, and that that can give you a really great lift, um. So I really love um that and I love that in combination, actually, with the Emface, um, and all three of these things we mentioned can be combined the Emface, the ultrasound and the a little bit of judicious filler here or there. Um.
Arash Akhavan: And then the last thing I was going to mention is as an alternative to fillers. It's funny, but when I talk about alternative to fillers, I'm talking about alternative to hyaluronic acid fillers. There's this other type of filler called biosimulatory fillers. One of them I mentioned Radiesse calcium hydroxyapatite. We take this and we dilute it with saline.
Arash Akhavan: This technology, this technique, sorry, is well documented in medical literature. Lots of doctors doing it with great success. We've had great results on the face, neck and body with it. We inject it and what we're injecting most of the volume, is just saline. It's water, salt water, and that water makes you puffy at the time of injection. A couple hours later it's been absorbed in and what's left is this fine sort of mesh of this radius material that was suspended in water, this calcium hydroxyapatite, and your body forms collagen and elastin around it over the course of months and you get this really nice sort of smoothing of skin, tightening of skin, without volume, and it doesn't have water affinity, so it's not going to puff, doesn't migrate, last a long time, excuse me. So that's another sort of procedure that you can do where you wouldn't have to worry about some of the things we're worried about with hyaluronic acid, fillers and then facelifts.
Arash Akhavan: And again, that shouldn't be overdone either. We've been unfortunately that's been the opposite trend People getting facelifts a little too early, in my opinion, before they need it, and that also can look very odd in real life. Looks great in the before and after in a two-dimensional picture on social media, but we've been seeing some very weird results around New York City, unfortunately, with the sort of sudden increase in the number of facelifts that's been occurring since the pandemic. So everything has its place. Things should be done in conjunction. That's sort of the lesson from today's podcast, I think.
Arash Akhavan: Um and filler still has its place as well. Just do little amounts, do it slowly, don't do too much, know its limitations. Combine it with other procedures and you'll be happy with your results. Um, check out Emface like . That can be a good substitute for it If you really don't want to do it, or combine the two, um. But yeah, we can have great results without surgery with little to no downtime. That you see quickly, um, but you just have to know. The person who's treating you and yourself should be educated on the sort of benefits of these procedures and their limitations. As usual. If you have any questions about this episode or any other episodes or suggestions for future episodes, please reach out to us either by email or at drapodcastcom.
Announcer: Thanks, Talk to you soon. Thank you so much for tuning in today. If you enjoyed this episode, please make sure to subscribe to Dr A Explains it All on your favorite podcast platform. By subscribing, you'll never miss an episode and you'll be the first to hear about our latest discussions on skin care, cosmetic procedures and more. And if you found this content helpful, we'd love for you to leave a rating or review. It really helps us reach more listeners like you To learn more about our podcast or to send us questions you would like answered on here. Please visit our website at drapodcastcom. That's drapodcastcom. To see us as a patient at our New York clinic, visit us at dermatologyandlasergroupcom. Bye.
We hope you enjoyed this episode of our podcast! To book a consultation for any of our procedures including Emface, biostimulatory fillers, or dermal fillers please visit their corresponding paged on our clinic website!