Sculptra, Radiesse & All About Biostimulators - KNOWFACE Episode 3

[00:00:00]Welcome beauties to the next episode of No Face. It's your two favorite aesthetic insiders, Olivia Tree Beauty and my favorite Dr. L, >> my number one sidekick. And we really need to I'm the more we do this virtually, the more I just want to see you and do it in person. But >> Oh, it's coming.

[00:00:23]>> It's coming. It's coming. But I don't know if you guys know this, but you're based in the US in Arizona and I'm in Europe. So, we wanted to make this happen even that we're across the pond from one another. So, but >> I'd rather be on your side.

[00:00:40]>> It's It's pretty nice this time of year, but soon. So, we're going to we're going to make that happen. We'll record a we'll rent a podcast studio for the day and we can do this face to face, my love. So on today's episode we are going to be talking about drum roll bio stimulators.

[00:01:00]Big topic right now. Um pretty big debates around bio stimulators. Um I work with a lot of plastic surgeons and hear varying things from plastic surgeons and you perform a lot of bio stimulator treatments, a lot of sculpture. So really what there is to know about sculpture if you don't know it isn't worth knowing. Would I be correct?

[00:01:22]>> Yes.

[00:01:24]>> Good. Glad to hear it. So let's get let's let's start on the positive. So tell me about bio stimulators in your practice. Why do you love them? And who do you use them on? Who's the ideal patient for a bio stimulator?

[00:01:40]>> Let's talk about the categories of bio stimulators. So there is sculptra which is PLA polyactic acid. There is rad which is calcium hydroxy appatite that's kaha what we call there's also bellophil bellophil is pmama suspended in hing bovine collagen um and then there's PRP okay I consider those to be bio stimulators um they're all very different some of these very different sculptra for example works through an inflammatory cascade meaning it causes inflammation and that's how it leads to collagen stimulation so it's an inflammatory process process. Um but that's okay because aging is an inflammatory process. um calcium hydroxy appetite.

[00:02:23]>> That's why we eat anti-inflammatory foods to slow the aging process.

[00:02:28]>> Eat stress, >> exercise, get, you know, do things like hiking, get a little bit of sun exposure, health in a healthy way, good skin care. It's really like a lifestyle thing. Like when you think about inflammaging is the word. Inflammaging, right?

[00:02:43]>> Oh my god, I love that. It's patentive.

[00:02:46]>> I heard it from somebody else. So I can't wait >> but and we will get to why that is important in bio stimulators. Kaha is rad which is calcium hydroxy appatite.

[00:02:55]Then you have bellophil which is FDA approved for acne scarring for the most part. And then there's PRP. Now these all have different abilities to produce volume. They have different planes of injection. They work in different people. They work in different ways.

[00:03:09]Sculptra is using polyactic acid to stimulate our macrofasages and our fiberblasts. Um, so the sculpture gets eaten up by our cells. The cells then react by stimulating collagen and it's building a protein. Collagen is a protein. Okay. Now, if you are, and this is my opinion, if you are on a GLP, if you eat a protein deficient diet, I don't think sculpture is going to do well for you because you need to eat protein to build protein. If you're not taking the amino acids, even though I'm injecting what I call it as a fertilizer, that's what sculpture is in my opinion, as fertilizer. If you don't have the building blocks, you're not going to build anything. That's why Sculptra is such a high dissatisfaction rate because people get Sculptra and nothing happens because they didn't ask the right questions. Are you eating? Are you exercising? How much are you eating?

[00:03:55]Are you eating protein? That's Sculptra.

[00:03:58]Sculptra is my favorite bio stimulator of choice. RADS is calcium hydroxy appetite. This works in a non-inflammatory pathway. So, there's no inflammation. You inject um and this stimulates collagen just as is. um it is a very good collagen stimulator. Um calcium hydroxy appetite is the same material that's found in bone. So that's why with radius there's a very high risk of nodules and thickened skin. I had a patient the other day I was injecting hyaluronic acid filler in and this patient had radius before and as I'm injecting it even though you couldn't see it on top in the skin. It was almost like there were calcifications that I had to break through.

[00:04:35]>> I don't like that. Okay. Now, >> if you get an occlusion, >> you're screwed. You are >> be screwed.

[00:04:42]>> You are screwed. It's over. Um, so Radius is not my favorite, but Radius is a very robust bony filler. So, people like it for >> I know people who used to use it on jaw in the lower face. So, jaw, chin, areas.

[00:04:56]>> But, let me tell you something. I just We talked about this in one of our earlier episodes. Filler really should be injected in the subcutaneous plane.

[00:05:04]So why are we using a bony filler in the subcutaneous >> plane >> plane?

[00:05:10]I think where radius shines in the right hands is on the decolletage on the >> decage.

[00:05:17]>> That's where it shines. So we'll talk >> injected as is or >> no blended blended. So dilute uh uh diluted or reconstituted uh kaha works very well in the decolletage.

[00:05:29]>> Interesting. Can't wait to get into that.

[00:05:30]>> Okay, so the next one is Bellafhil.

[00:05:33]Bellafil um is really good for acne scars. Not a lot of people do it anymore because it does require a skin test because it has bovine collagen in it.

[00:05:40]So, we have to test to make sure you're not allergic. Um I will tell you that Bellafhil is one of the best bio stimulators. However, it lasts in your skin for 5 years.

[00:05:51]Five years.

[00:05:52]>> How does it how does it work exactly?

[00:05:55]>> So, it has PMA which is polymethylthacrylate beads. So, kind of works in many different mechanisms.

[00:06:01]there's an inflammatory mechanism, but these beads are suspended and so they stimulate collagen. They cause, you know, a little of fibrosis. So, it's kind of both inflammatory and non-inflammatory. The crazy thing is it's one of the best bio stimulators and people don't know about it, but it freaking lasts five years and I see so many nodules in people that have had it many years ago. So, something that lasts that long is not something you want in your face.

[00:06:23]>> Yeah.

[00:06:24]>> That's what I've heard about um Bellafhil is that there's nodules.

[00:06:28]There's a lot of complications with it and it's really not used frequently.

[00:06:33]Certainly not.

[00:06:34]>> Right.

[00:06:36]>> I think so. I don't know any clinic that does it. I I don't think I know one single um clinical plastic surgeon that uses it in their practice.

[00:06:44]>> Same in the US. It's kind of like one of those dying fruits. It's a sad thing because like I said, it's a great product. I just don't think it's used in the right way and that's what happens.

[00:06:52]>> Okay. And then both of us love PRP.

[00:06:56]>> Love PRP. and a PRF as well. So maybe >> gel or no gel?

[00:07:03]>> No gel.

[00:07:04]>> Okay. Yeah. Um so PRF PRP and PRF are very different. Um PRF is more of a sustained release. Think of it like as a extended release um uh reservoir of your growth factors. Okay. That's PRF.

[00:07:19]>> Slow. Um it's a slow and steady.

[00:07:23]Exactly. PRP is more immediate release of growth factors because the platelets have just released those growth factors.

[00:07:29]Um PRP and PRF both will give you results that are not noticeable. So you're not going to walk away being like, "Oh my gosh, I look amazing."

[00:07:36]You'll be swollen and you're going to look amazing, but when it goes down, you're going to be like, "Damn it, it's gone." But guess what? It's working on the inside. So you don't necessarily have to see everything that's happening on the surface. Okay? You know what? I'm so glad that you bring this up because there's a category of treatments and I that I call the consistency treatments and there are whole group that you are not going to notice today that anything spectacular has happened to your skin.

[00:08:03]And I hear people say all the time, "Oh, I tried PRF. I tried PRP. It didn't do anything." It's like, that's not the point. You're not going to notice that it does something. but your 60-year-old self is going to thank you for doing these treatments now. So, that's how I categorize things like micro needling, PRP, PRF. It's a it's a kind it's a kind of um it's your retirement plan. It's your face's retirement plan. Not going to notice the difference today. You're going to notice a difference. If you had a twin sister and one of you had it regularly throughout your life and the other didn't, you're going to notice a difference when you're 60 years old. For sure.

[00:08:39]>> Oh, yeah.

[00:08:42]I 100% agree.

[00:08:43]>> We're both fans of PRP PRF. So the difference is for those who don't know, it's first of all the speed at which they're spun in the centrifuge to separate those platelets. So PRP is spun quicker. Correct me if I'm incorrect here. PRP is spun faster. So all those platelets come to the top and gets injected with all those growth factors in. But it's it's a quicker release of those. P RF it's spun more slowly.

[00:09:12]They're it's weighted slightly differently and then it can be heated and cooled to create a thicker consistency. And then it is either injected or micro needled. And because it's a bit weightier, the release of those growth factors is slower and steadier.

[00:09:31]>> Yeah.

[00:09:32]>> Did I pass the test?

[00:09:34]>> Yeah, you passed. You're ready. come on into work.

[00:09:37]>> Thank goodness. Few of that's reassuring. Um, so do you prefer do you have a preference or which do you prefer in which patients?

[00:09:47]>> I love Sculptra. I will tell you I probably have this is just me being honest. I have Sculptra in my face. I have Sculptra in my flanks. I have Sculptra in my butt. I love Sculptra. I think Sculptra when done right can do the right thing. However, I'm also someone that eats a good diet rich in protein. I exercise. I massage. I do all the right things. Um, I think Sculptra is everyone is talking about GLPS, Ozmpic, Mangjaro, um, and the GLP associated facial fat loss and are telling people to get Sculptra. I think if you're losing fat, >> I mean, sculpture was initially designed for patients who were who had AIDS and were losing so much volume rapidly in their face and were looking so gorgeous and skeletal and sculpture first used on these patients >> and same thing for rads both were get do you know were approved for lipo atrophy.

[00:10:39]So the difference is there's a difference between hyper metabolic lipo atrophy and acquired lipo atrophy from people that are not eating. So I'm just not see and the difference is I'm just not seeing the same results. I think it can work. I just think it requires more work on the patient. So I'm very cautious in those people. I think if someone has GLP associated facial fat loss, then their best bet is HA because HA what you see is what you're going to get. In fact, I don't even think doing fat transfer is worth it until you're done with your weight loss journey because if you're going to be injecting a GLP and you get fat transfer to your face, your fat's going to die.

[00:11:13]>> Exactly. You're just going to money. Go the HA route. Sculpture is really good, I think, for people that are trying to what I call collagen bank. They're in their 40s. They're noticing laxity in their skin, poor skin quality, poor radiance. Sculpture kind of works in a global way. It improves skin radiance.

[00:11:31]We actually have data now to show that in the right people, it can stimulate fat cell growth. So, you can see atyposytes or fat cells that are growing in the tissue that it's suspended in.

[00:11:40]Okay.

[00:11:40]>> Interesting.

[00:11:41]>> Yeah. And that's new cellular data. Um, that's why it works very well in the buttock. We're not talking about GLP, just regular people. So when sculptor is injected and we're injecting it in multiple planes with different dilutions, it's going to give us different outcomes. Sculpture you can use on the face and on the body. I like doing sculpture in the lateral face. So if we dropped this line down by the eye all the way down, sculpture out here, filler in this area. Okay, sculpture can be good for the temples. I've done sculpture especially in the forehead in this area to kind of help give people some augmentation and a little bit of um non-invasive tightening and collagen thickening here especially for those people that have had very who have very thin foreheads, very thin skin. Um I like doing sculpture in the neck. It works very well. Sculptra works great around the elbows, around the knees.

[00:12:29]>> Hands. What about hands?

[00:12:31]>> I hands are too mobile in the hands. I think pure HA um or in this area I will be honest dilute hyperdilute rads is probably very good um because it will probably give you the most amount of thickening even in people. The thing with um rads is you can blend it down to where you can you know it's an area where there's a lot of movement and you can easily massage. So I think in this area I prefer fat.

[00:12:56]>> Okay, >> ha dilute radius. I don't like doing sculpture on the hands because I'm worried about nodules and the nodules even if you can't feel them. I've seen people get little tiny beads here and people I wouldn't like that. So, I don't want to do that. With rads, you don't get tiny beads like that. If you're going to get a nodule, you'll get a big nodule and that's an easier thing to fix than the tiny beads. Let's talk about nodules with sculpture because, as we mentioned at the beginning, sculpture is pretty divisive. I hear people who love it and loathe it. Um, one of the risks with sculpture are granulomaas.

[00:13:29]And I work with many plastic surgeons who really do not like they will but they don't like treating patients with facelifts who have had sculpture and one of the reasons that they site is because of granuloma formations.

[00:13:47]Let's talk about this. Why are some patients getting granulomaas?

[00:13:53]>> We don't know. But I will tell you a lot of things play a role into this. It's how you in in disinfect the skin. So using a good antiseptic is really important. Um massage is really important. Dilution is really important.

[00:14:06]>> So do you think it could be because of bacteria and an inflammatory?

[00:14:10]>> I mean always you can have bofilms and you can have bacteria in the skin that gets leeched in that could lead to that type of inflammation and once bacteria is seeding into a substance like sculpt or filler it can cause reactions. Yeah, I don't want to digress, but when we talk about breast, I've had these conversations with plastic surgeons as well about >> I don't think people realize having operating rooms that are not as sanitary as they can be >> and having bacteria around. If that gets into you, that can cause a cascade of issues that then later on that don't appear till much later on. you know, really high per capsule formation response and inflammation. And I was even talking to one plastic surgeon about, you know, all these patients that um have the the symptoms associated with breast implant illness. Could this potentially be because there's bacteria in the O? And they were like, it could be. We'll never know the answer because no one's going around, you know, swabbing every O of every patient that had BI, but it's things that you don't even think about. So having going somewhere that's super clean and so sanitary is fundamental. And you know I'm a germaphobe. I'm like major contamination OCD. And I know people think that I'm maybe sometimes a bit crazy cuz I won't touch a door handle with my bare hand. But I'm like if you saw what I've seen, you'd be the same.

[00:15:32]Well, it's like I will tell you that's why there's no there it makes sense or why we're not surprised when I have a lot of patients that go to and this is nothing against the countries because everyone has different microbiomes, right? So, I have a lot of patients that go to the Dominican Republic. I have a lot of patients that go to Mexico. I have a lot of patients that go to South America, a lot of patients that go to Turkey and they come back with all these issues. And the reality is in the US we have and in Europe every country has their own set of standards. Okay. The US is extremely strict. You can get into big big big trouble. We have >> it's veryious um >> very ligious. We have to keep logs of every single thing. Temperature uh temperatures in the refrigerator, the filtration, all of these things. And the O is such a sterile environment that when I was a student, if you even sneeze under a mask, the whole world go shuts down.

[00:16:26]You know, I was once in an O and the door was a touch door and I was shocked to my core. People were just walking out opening this door. I was horrified like get me out of here.

[00:16:38]>> Well, that's what I tell people when you're paying for something, what you're paying for is the whole experience. So, there's no, you know, there's no surprise that when I see patients that come in from, you know, I manage a lot of kloids from breasts, they're coming from other countries. very few people that I have that have had breast implants here in the US get those types of outcomes. Um, so those are the things that you think about. Same thing with injectables, right? Everyone in their own country has their own microbiome. So if someone is for example in Dominican Republic and you know they've grown their their whole life, they're used to that microbiome in the environment, in the air, in the water. So when you're having surgery done, their body's used to those organisms. We're not used to those organisms. So we are going to react in many different ways to those organisms. Now as we come back sculptra sculptra nodules I told you. So sculptra are like little crystals. They get taken up by macrofasages. When a macroofage which is an inflammatory cell takes up something it becomes a granuloma. A collection of macrofasages with granuloma. So it makes sense that in sculpture we get granulomaas. Sometimes you feel them, sometimes you don't. You should never see them. Um I think we used to see more nodules when people were getting larger um they were getting more concentrated solutions of sculpture. I was g going to ask does the dosage and the dilution have an impact on >> so you see people used to get five cc's of a dilution before um that was pretty standard five to six cc's which is very concentrated um and still sometimes I know some really good dermatologists that will do even 3 cc concentrations but they're doing it injecting on bone to stimulate bone and you are going to get a nodule there because you're injecting a nodule there you're you're trying to stimulate bone so you're trying to generate that type of same tissue response. So that makes sense.

[00:18:26]Nowadays, we're using hyperdilute sculptra 8 cc's, 10 cc's. My dilution is 10 cc's. Um, and I do less. I think volume, concentration, all of those things matter. Patient education, making sure that they massage, I think, is really important. Showing them how to do the massage is really important. I've only had one patient that had a nodule, and it was a male, and I should have known because you can't trust a man through anything. So, he had one nodule.

[00:18:49]It wasn't even many. One nodule.

[00:18:51]>> Converted right now. I've had a I had a a disaster with a personal thing. Um and it's like you know what? I'm can't trust a man with things at all.

[00:18:59]>> You cannot trust a man. Okay. You just cannot trust a man and let alone a straight man. So the straight man in my office will not get sculpture. They're getting filler. Okay. Um so yes, exactly. Um that's sculpture nodules for you.

[00:19:14]>> How long do you need to massage sculpture for? What's the other >> is five times a day for five minutes a day for five days. I tell people, >> yeah, I tell people instead of focusing on the 555, I would rather have you do really thorough. I mean, I just tell people go buy a cheap massager from the store like, you know, the handheld ones that are like 10 bucks because I also don't know how your hand pressure is.

[00:19:37]Put some lotion on and let the massage just work the massager or a gouacha tool all the way out. That's going to give you probably the best outcome and the more homogeneous result.

[00:19:45]>> But the five minutes is quite a long time and doing that multiple times a day.

[00:19:49]>> Yes. So, I just tell people when you're sitting down watching TV, you're eating lunch, grab the massager and just, you know, go at it.

[00:19:56]>> Got you. And with Sculpture, when can a patient expect to see kind of their final results? Because, as we know, it's not an immediate result. It takes some time.

[00:20:05]>> Well, it depends how many vials that you do it over what period of time. The recommendation is for one vial for one for every decade of life you've lived, you do one vial. So, for if you're 40 years old, you're supposed to do four vials. Um, and most people will do two and two. So they'll do two vials the first visit, wait six weeks, do another two vials. Um, and after that you typically will start seeing results at 3 months, start to develop. Sculpture develops over time. So you'll start to see results at 3 months and they will continue to improve over two years. And so they improve over two years, but let's talk about what if you don't like your sculptural results, like how long do they last? It's a permanent is there anything you can do to um kind of resolve that? because I've had people messaging me going, "I had sculpture. I didn't like it. What can I do to get rid of it?" I'm like, "Girl, not much."

[00:20:54]>> So, unfortunately, unless you have a nodule, there's nothing that you can do.

[00:20:58]I've never heard people not be happy with the result because the way it looks. I get more people that are unhappy because the way it doesn't look, meaning they didn't expect, they didn't see a difference.

[00:21:06]>> Okay?

[00:21:07]>> So, Sculptra, in my opinion, is for people that want something subtle. And this is what I tell people with Sculptra. The best test to do is the skin stretch. So say for example, we're putting sculpt in the neck. You stretch the skin out. Okay. And in three months after the treat, >> everyone's gonna do this.

[00:21:24]>> Yep. After 3 months, >> the goal is to go instead of being like this being like this. So your skin should be less stretchy 3 months after your shot. That's how you know the sculpture is working.

[00:21:35]>> Okay. Well, I have had people say that they had more volume than they wanted to. So they felt a bit fatter in the face, a bit chubbier faced after sculpture and and they didn't like it.

[00:21:48]>> So I have seen this as well. I've seen it in people that like it, but usually these are people that have thinner faces that wanted that volume. However, I don't think it is consistent to say to say that that's going to happen to everybody. And that's the thing with sculpture with bio stimulators. It's not what you see is what you get. Anything could happen. So you have to choose wisely. So often people will use this in people that are super volume deficient.

[00:22:14]Okay? And the other issue is a lot of people follow the rules. I will tell you the best experts do not follow the rules. Okay? I'm not putting four vials in a 40-year-old.

[00:22:25]>> Okay? So again, it goes back to expertise. I always say, you know, aesthetics is it's like, you know, having a a car. You know, we all know Ferrari is better than I don't know a Scoda. Sorry, SCOD drivers. That was the first one that came to my mind. But it's better. A Ferrari in the wrong hands in someone who doesn't have a driving license is going to be a disaster. You'd rather be in the SC Scoda with Lewis Hamilton than in the Ferrari with someone who's never driven before. So who you have treating you is fundamental. It's almost I think it's more important than the treatment itself.

[00:23:04]>> 100%. That's what you're paying for.

[00:23:06]Otherwise, why why do we have different pricing? Why is my pricing more expensive than somebody else's? And why is, you know, it's all >> Yeah, I'm always It's because everyone has different expertise. Yes. And that's another thing. People get turned away by price. But listen, if I'm telling you I charge, say, $1,000 a vial for Sculptra, and I think you need two. However, you're going to go to somebody else that charges $800 and they're telling you they need four. In the end, you're paying less with me because I'm giving you the better outcome. Four vials in a 40-year-old. I'm almost 40. There's no way I'm going to be putting four vows of sculpture in my face.

[00:23:41]>> Well, let's talk about this because like we're going to talk about the good, bad, and the ugly. So, obviously, you know, I have a bit of a bias because I work with so many plastic surgeons and I hear what they have to say and I have seen facelifts. So I have seen people midface lift who have had bio stimulators and I you know saw one patient and you could literally see the layers of sculpture radi she'd had several different bio stimulators.

[00:24:09]What is going on there? Is that the going to be the case with every single person who's had these treatments or is this someone who was injected poorly with maybe an old technique or what is causing that? What can someone who has sculpture today with an expert injector expect their plastic surgeon to find if they choose to have a facelift down the line?

[00:24:34]>> Sculpture is like surgery.

[00:24:37]>> Sculpture is like glue or if in the sandwich do you like mayo or no?

[00:24:42]>> Uh yeah, why not?

[00:24:44]>> So in a sandwich, right, we have our condiments. I think of sculptra as the condiment that holds a sandwich together. Okay. So you have your fascia, your muscle, >> and you have your skin. And in between the two, you have your fat. Sculptor is injected somewhere between your skin and your fat and your fascia. So we're not injecting it into the fascia, but it's kind of like glue. So when it goes in, it's interwoven like this. And it's like this. Okay? So it's like this. So when they are when when they go in with a facelift, okay, this is your skin. This is your fascia. Okay? And in between is everything else. when they're doing a facelift, what they're doing is they're dissecting your tissue, right? In order to move that tissue, they have to dissect through this area. So, in a normal person, you have saggy skin.

[00:25:28]Imagine your skin being like this. Okay?

[00:25:31]Easy to go through, easy to pull, easy to stretch, do the job. You have sculpture, your skin is like this. Okay?

[00:25:38]Scissoring through that is going to be much harder. Their dissection is going to be harder. There's more adhesion to the tissues because that's what sculpture does. So, it's as if they've had already another facelift and they're doing a secondary revision. So, there's a level of fibrosis or scarring. So, yes, it doesn't make you getting a facelift harder. However, a good plastic surgeon and most of them, like my friend is a great one in California who I refer to, she has no problem doing a a facelift in someone's sculpture because she knows it's no different than if they had a a facelift 10 years ago, you have the same level of scarring. For example, I had lipos suction and stuff years ago and I just did it again. It's the same thing. you have scarring and scarring is going to impede wound healing your outcomes, but you go to somebody good that knows how to do that and it's not going to be a problem. Now, I think that if someone tells you that they cannot do a facelift because you have sculpture in your face or radius in your face, take it as a god sign because that means they don't do complicated cases and they don't know what's going on. Okay.

[00:26:36]>> Well, I was working with a real expert plastic surgeon. He actually I give shout out to Dominic Bray. He prides himself on being the most expensive facial plastic surgeon in the UK. He works with a ton like um Mike Nyak in the US actually performed his facelift and I was at a meeting and he was doing live surgery and he he gave a talk and I'll never forget the expression that he used. He a couple of things. He said now in modern surgery the unexpected is the expected because pretty much everyone has had some treatment before they end up in the O.

[00:27:15]People's very very rarely is someone's first treatment a facelift. So they've they've done non-surgical treatments ahead of that. To which degree and which treatments does vary and there's they prefer some things over others and there's many that they recommend that you have. Um, but we have a whole episode on energy based devices. We'll get into that cuz that's that's a minefield. Um, but when it comes to sculpture is he said and it's it's an analogy that Mike Knight uses as well is just as you said he when you open a book imagine this tissue as you said it's like pages of a book and they all open and it's really easy to flip between the pages just like it's very easy to dissect that tissue and I've seen it.

[00:27:58]It's if you're not squeamish, I'll show you one day. Um, not you. I know you're not squeamish. I'm talking about the viewers. Um, Instagram put like a a sensitive content over anytime I post one of these things. So, it's like a bit of a jump scare. Um, but it's beautiful.

[00:28:12]It opens, you know, like a harmonica or something. Is that the instrument? No, not a harmonica. Uh, what's what's the >> Yeah, it's a it's a it is a harmonica.

[00:28:22]>> Is it a harmonica? This one?

[00:28:23]>> Well, there Well, there's two. There's a harmonica and then there's like the I know what you're talking about. It is a harmonic. It is a harmonic. It's a different type.

[00:28:29]>> Okay. Well, that one >> accordion.

[00:28:32]>> An accordion. Thank you. Oh my god. My granddad called it a meloan. I don't know if that's an Irish name, but anyway. Um, yeah, that one.

[00:28:42]And whereas when you have something like sculpture, it is like those pages of a book have basically been glued together.

[00:28:50]And while you can dissect it, and these surgeons dissect it all the time, it is more complicated. it's more laborious.

[00:28:57]You spend more time in the O and you know there's always that even if it's a really great surgeon when the tissue has been altered, there's always, you know, a risk that the outcome is not going to be as predictable as if it hadn't been altered. I mean, and that just makes sense to a 5-year-old. So, there's there's these things. So, what would you say to someone who's sitting at home and they've heard all these different things about sculpture and they've heard people say, "Oh my god, it's amazing. Have it my favorite treatment." And then they had a plastic surgeon say, "It's terrible. Don't have it." And they're like, "What do I do?"

[00:29:39]What would you say to this person? A, figure out what your goals are. Okay, you want a facelift in 10 year? You have to know all of these things. A, are you ever going to get get want a facelift?

[00:29:50]Okay, if so, how long are you away from a facelift? Okay, what are your primary concerns? Okay, make sure no one is guilting you into doing anything. That's the most important thing. No one should ever force you or guilt you into doing anything. Always do your research, okay?

[00:30:05]And ask the right questions. I don't think that if you're if you're getting a face in 10 years, there's so much time in between 10 years. There's so many things you can do. I think the most important thing is be conservative and don't expect one thing to do everything for you. Okay? Sculpture is not going to do the job of multiple different treatments.

[00:30:21]>> That is a really good point. Then so if someone is thinking okay in the future I may want a facelift. Is there a time what timeline would you recommend to them? Like have it now and don't have it x years before your facelift. What would you what would at least three years before your facelift you should avoid?

[00:30:42]I really think three years before your facelift short of lasers I would do no injectables.

[00:30:47]I would do no botox, no filler.

[00:30:50]>> No botox. forget it.

[00:30:53]>> Because the reason is when they're going in there, if they're going to be doing some adhesion, you know, lis of muscles, um, or they're going to be moving muscles around, you don't want muscles to be compensated, you kind of want a little bit of strength back. So, because if you're relaxing all your muscles and they go in there and they're going to be repositioning things, there's a lot of disynchrony that happens. So, you have to let those muscles kind of regrow back so that when they do their treatment, things are not wonky. Okay, a lot of people won't tell you that, but the reality is for my people that are expecting a facelift in three years.

[00:31:27]We're not doing anything other than we're doing BBLs, we're doing lasers, we're getting that skin nice, thick, and healthy, micro needling, hydroacial.

[00:31:34]Those are the things we're going to focus on. Good skin care.

[00:31:37]>> PRP or PRF three years before a facelift.

[00:31:40]>> I would have no problem doing PRP or PRF. Yes, I would have no problem doing that.

[00:31:45]>> Yeah, I agree.

[00:31:46]>> I think polyucleotides, no.

[00:31:50]PDRN.

[00:31:51]>> Yeah.

[00:31:52]>> Or poly. Um, injectable or topical.

[00:31:55]>> Injectable.

[00:31:58]>> I don't think I can say that it's harmful, but I don't know. I think it's much higher risk. Okay, let me give you an example. I know somebody recently who had PDRN done, injectable into their face, um, and actually had no so they had no problem eating seafood before, had PDRN three months later, went to a restaurant, had seafood, and went into anaphylactic shock.

[00:32:20]So >> that they don't tell you.

[00:32:24]>> Yes. So I I'm not a big PDR PDR and injectable fan at the moment. So I would not say >> I'm not either. I'm really not. I just I think it's overhyped, but that we have that for another episode. Yes.

[00:32:38]>> I think uh yeah, I think the initial swelling that you get, people think it's filled out their lines and their wrinkles, but when it goes, I'm I don't know. I'm not ask me again in a few years time about that treatment but okay so for the most part hyaluronic acid uh filler sculpture rad all these bio stimulators apart from the more natural ones like PRP and PRF just avoid three years for three years I know that's a long time but believe me we have a lot of good devices a lot of lasers that can keep your skin in check because the most important factor for your outcomes are going to be your skin health okay So reducing sun damage, reducing brown spots, stimulating that collagen and then also having your musculature back so when they go inside they know what they need to do because things are compensated otherwise.

[00:33:29]>> Yeah. And what are the benefits then of there's a lot of conversations around you know you were talking about the dilution of sculpture. um what are the just general benefits of the reduction in the risk of granulomaas and getting you know more subtle outcomes. What are the benefits of hyperdiluting sculpture? And I want to talk to you about micro needling sculpture. So this is something that's quite popular and is sounds pretty new and people say that they're loving their results of having sculpture placed topically with a micro needling procedure. So are you doing that and what are your thoughts?

[00:34:08]>> So I have done uh okay so first question dilution matters. The more dilute something is the less likely it is to cause nodules in theory. However it could also make more nodules because things are not going to be as homogeneous. So I think being hyper dilute and then also mixing a lot before you inject is important immediately.

[00:34:28]The other thing is >> really making sure that it's well blended.

[00:34:32]>> Correct. and making sure that you're focusing in areas where there's not a lot of movement. If you're putting sculpture in area, for example, we do not put sculpture anywhere in this area right here because here there's a lot of movement and so those little balls are going to, you know, bunch up and form little granulomaas in this area.

[00:34:52]Sculptra really is meant for the lateral face. So, >> I love that. So, any from the corner of your eye out?

[00:35:00]>> Yeah. like I will put a corner of the eye down essentially and I will focus on sculpture in that area. That's where we want that effect. Now, if you want to do depot on bone to stimulate bone, you can do that. Um, that's different because that's less likely to cause nodules that you can see because they're going deep.

[00:35:17]But if you're injecting things in the superficial plane and you're in all these areas when you're moving all this animation, you're going to get those bumps.

[00:35:24]>> Okay? And sculpture does spread throughout all the planes. So it doesn't exactly >> spread throughout all the planes.

[00:35:31]Exactly. For the most part. So you know and Sculptra by the way is not just for skin for volume but they have data for skin radiance, skin quality. So it does do a lot of things outside of so it's truly something that's working on all aspects of the skin. That's the first thing. Second thing micro needling. Yes, I have done it on patients. I like it for micro needling because it kind of takes the place of for example exoomes.

[00:35:57]I think it helps reduce wound healing and again helps with skin radiance, but with micro needling, you get so much swelling. I can't say that the sculptor always goes down all the way into all of the channels. I think a lot of it probably sits on top. It doesn't make it all the way down. With lasers though, when you're doing a fractional laser and you're ablating and coagulating a channel of skin out, even non-ablative lasers where you're coagulating the skin and you put sculptra, you're able to get this. They've shown histologically the sculpture crystals going into those channels.

[00:36:27]>> So you would prefer kind of a sculpture with a laser treatment as opposed to micro needling.

[00:36:33]>> Yes. I would I would prefer to do a nice deep fractional blade of treatment and then adding sculpture on top.

[00:36:40]>> And what should a patient expect their results to be like having sculpture like this with a laser treatment applied topically and it makes its way down as opposed to injected?

[00:36:52]It's not going to go into your deeper plane. So, you don't have to worry about nodules. You don't have to worry about uh you know it causing swelling or you know you know chubbiness of your face.

[00:37:00]It's really working on improving skin quality stimulating collagen in that superficial dermis. So, it's in a different plane you know it's going to it's going it's like you're directly depositing it.

[00:37:11]>> Yes. So, I think it helps reduce wound healing. I think it helps stimulate collagen long over time. Reduces the risk of nodules. doesn't add volume, but definitely gets that collagen banking process going.

[00:37:23]>> It kind of sounds like a bit of a tippy toe into sculpture, like a bit of a if you're on the fence and you're not sure which way to go. It seems like this could be a good solution. Maybe not great for someone who has who wants to actually get some volume back in their face, but who wants to get some plumpness or fullness.

[00:37:40]>> For example, they did a study looking at fractional blade of resurfacing on the for the upper lip lines, you know, the smoker's lines >> and putting sculpture on top and they found that it actually helped reduce the amount of lines on in that area. So, I think if people have superficial wrinkling and you're doing it laser and you're putting sculpture on top, you may get a better outcome with than with just laser alone.

[00:38:01]>> Interesting. because I love it's kind of making me think of so one of the treatments that I've seen has outstanding results is nanofat which is um obviously taken from your own fat but the adiposites so the fat cells are removed so it doesn't give you any volume nanofat they remove all the adiposites so all of the fat cells are removed so it does not give any volume but everything else that's left in there is just full of all of those stem cells and have this amazing amazing regenerative result on patients and it takes like 8 to 10 months to see these results but I have seen before and after pictures of patients who've had this and it's like oh my you know what it reminds me of you know that um movie I'm sure you love it as much as I do becomes her with Meryill Streep Goldie Hill >> Bruce Willis um you know when uh they take the elixir and they just have this transformation and Merryill Streep like her boobs go like this and her face goes like that That's what nanofat looks like. And you can micro needle it. So I've seen everything from it being injected to I saw one surgeon when he was giving a facelift, he sprayed it under her skin with like a a spray can. Um I'm sure it was much more sterile than that. And also um I've seen it micro needles. So someone that you know they're still under general anesthesia. They've had their facelift and then at the end of the surgery the surgeon just puts all the nanofat it's bright yellow and just micro needles it all into the skin. So what you're saying about sculpture kind of sounds reminiscent to the results that you can achieve with nanop fat.

[00:39:41]Maybe same but different.

[00:39:43]>> Correct. Exactly. Well yes. Yes, in some ways or no because I think again when you're injecting something you're probably going to get a better outcome and nanopat works in a very different way because there's stem cells and fat and growth factors. Sculptra I think more is like filling in the spaces and reduce reducing the fine lines if that makes sense.

[00:40:01]>> You mean when you when you micro needle it or use it with a laser?

[00:40:03]>> Micro needle or when you're applying it after a laser. I think if you're going to do it, do it after a laser.

[00:40:09]>> Okay. That's the first time I've heard anyone talk about that. So we talked briefly earlier about using sculpture on the body and you mentioned you've used it on the body. There was a lot of talk you know several years ago about sculpture on the ass to give bigger booty. What are your feelings on this?

[00:40:25]You mentioned about having radas on the decollete on the chest. So let's get into other areas of the body because you know people neglect they focus a lot on the face but we have four faces one two three four and they all give our age away so if you're treating one we need to think about treating them all right cuz people see my butt quite often on Instagram so I >> no that's only reserved for a very special few in my case but okay so so you mentioned you live Radius on the decollete and you like it in you say it's better on the hands than sculptra.

[00:41:05]>> I do think rads shines chest and back of the hands for sure.

[00:41:10]Now caveat remember if you get if you're a woman and you're getting rads here and ship migrates down to your boobs and you get a mamogram and they find calcifications.

[00:41:22]>> Yeah, that's a problem. They're going to assume it's something else.

[00:41:25]>> Exactly. So be careful and be mindful of that. That's why I like sculpture because it avoids the knee. You can do sculpture in the decolletage too. I like sculpture for there too. I just think that radius I think gives more of a robust noticeable difference in this area. My opinion >> to thicken and plump the skin. If someone has, you know, um kind of a lot of sun damage, if they have those lines, you know, when you're lying on on your side and you wake up in the morning and you wake up with with all of these lines down the center of your chest, who is the ideal user? I mean it's really for people that have I would say super laxity like when they lean forward you can see rippling okay so if you have rippling sun damage but again not in isolation laser first >> bladed laser to blast >> I would do a nice BBL fractional bladed laser BBL moxy or BBL profarion on the chest um uh and then see what we get and then do maybe one one you know session of rads on the chest or sculpture I think rads is good um I always warn women though if you're going to be getting mammos and the person that's injecting gets too close and they do a mammo there, girl, you might be in trouble. That's why I I prefer to do sculpture everywhere. That's my opinion.

[00:42:35]I don't like >> you have to tell them that you've had sculpture and it could be oh radius and it could be >> you could tell them if they could have rads, but it still wouldn't for example if I was a breast surgeon and I saw that and my license and my liability dependent if I had to make a decision is that potentially breast cancer or not, it's getting a biopsy.

[00:42:52]>> Yeah. Yeah.

[00:42:54]So now it's one thing if you have a bunch of them everywhere, you know what I mean? And then maybe you could make an argument, but guess what? Then you're probably going to need an MRI. So now more advanced imaging, more potential testing, things to think about unnecessarily as a woman.

[00:43:07]Okay. But it does become >> I know. So I think on the chest again, radius does perform the best. I like sculptra. Um again, caveat with laser.

[00:43:19]Sculptra in the butt is amazing. Again, I don't want calcium bumps in the butt.

[00:43:22]I've seen them many times. Rads, when you're injecting, this is the difference. Here's the difference. When you're diluting rads, right, you have to mix it a lot and it's not homogeneous in solution. So, you may get an area that's hyperconentrated and an area that's not.

[00:43:37]That is a problem. Sculptra is a suspended molecule that is meant for homogeneous distribution after you mix it.

[00:43:44]>> Okay, >> does that make sense?

[00:43:46]>> Yeah. So, it it blends much more. It it it blends much better. Basically, >> you're suspending it in solution, which RADS off label, you're blending something that is a thick product and when you inject it, areas may get more or less. So, that's why when things bunch up, you get calcium.

[00:44:03]Now, I will say again for volume on the buttock area, you see a lot of people do good things with RDS. Rads helps with volume and skin quality.

[00:44:12]>> But how how much product would you need for that?

[00:44:16]>> So, if you I'm going to tell you the truth. I'm going to I love sharing my story. I have probably 20 vials of Sculpture in my butt and I will tell you my butt is at the time cuz I'm competing for a show is mostly muscle. I have no fat. So what did Sculptor do for me? It helped with skin quality. So it helped with skin quality, thickened up the skin, less dimpling.

[00:44:40]Definitely for sure with a good booty workout and Sculptra you can get less wrinkles, less dimples, better contours.

[00:44:48]It's not going to make your butt look like a BBL. You're gonna >> if you because obviously you had sculpture because you know you're very you have very little body fat. You work out a lot. So you weren't a good candidate for a fat transfer to your butt. But imagine that you it's today and now we have alo clay. We're going to talk we've got a whole other episode on fat um which is offtheshelf fat.

[00:45:11]Would you have chosen alo clay or sculpture? Um, I would have probably done both. I would have done alo clay for volume first and then sculptor for skin quality after. Cuz that's the thing, as men age, men have the worst butts. I refuse to be that man that has a butt that looks like >> Wait, wait. You reminded me of, you know, that episode of Sex in the City.

[00:45:34]>> Yeah, that's that. Listen, listen, listen.

[00:45:38]>> It was all good until she saw his the like 75year-old ass and then she was out of there. It looked like a degraded leather handbag. I said, "This will not be me ever." Okay.

[00:45:50]>> Okay. So, with all of his money, he needed Sculptra and >> at least >> 20 vials or 20 syringes of alo clay. So, six I mean, yes.

[00:46:04]>> I will tell you, no one likes a pancake butt in men or women.

[00:46:08]>> No one likes a pancake butt. That's for sure. Okay. So, good to know. Good to know we have a solution for all of these things. No one's ugly. They're just broke. Right >> now, I will tell you if I had to choose, I'm not going to lie, I would love to have a BBL, but there are complications of BBLs. It's a very high-risisk procedure. Okay? 1% mortality rate. My friend was like, I'm not doing a BBL in you. Plus, guess what? My plastic surgeon, I told him, take the fat that you find and put in your butt. He goes, Curran, shame on you. He goes, first off, I don't know what what [ __ ] you have in your ass. You have so much sculpture in there. I'm not going to add fat in there. add a layer of complication. He goes, "I'm not even entering that danger zone because I don't know what's in there." So, he knew and I told him, God forbid I didn't tell him who, you know, it's going to be it's complicated when you go in there, right?

[00:46:55]It changes your anatomy. So, that's another thing. The second thing is BBLs over time, there's a lot of these things that people don't talk about, which is the fat starts to sag and droop.

[00:47:05]Okay?

[00:47:06]>> Right?

[00:47:07]>> That can lead to a heavy looking butt.

[00:47:08]People also get what they call the BBL smell where the fat starts to degrade and change a lot. Yeah. So BBLs are actually on their way out. Injectable BBLs are the way to go and work out. Girl, you got to work out.

[00:47:23]>> A good workout. Yeah. But for for me, for example, I'm the most European person genetically on planet Earth and I work out a lot and I'm I'm muscular, but I just I don't have fat in those areas.

[00:47:37]So, I have muscle, but I just I'm and you know what? I'm I own my European booty, so I'm good with it. It's high and she's tight, but she's she's small, but it's all good. Um yeah, let's bring let's bring all different sizes and shapes back into this world, right?

[00:47:55]>> Yep. Exactly.

[00:47:56]>> Um no, I was going to say something very interesting um about a product I know is coming out. Future future future. It's still in R&D. Um, but I actually can't say anything. So, I'm going to keep my mouth shut about that. But there are more technologies coming out when it comes to the butt. Let's just let's just leave it at that in the future. That was so insightful. So now, I mean, I was kind of like, I'm definitely never having sculpture. And now I'm like, is it something I want to think about with a little laser treatment?

[00:48:27]>> When I come, I'll do it for you.

[00:48:30]>> I already told you you're the only man who's allowed to do anything to me. So, I feel very safe in your loving arms, my love. Um, we hope that you found that very helpful. And if you were undecided or considering having a bio stimulator like Sculpture, like Readers, like anything else, we hope that this episode helped to clear all your doubts and really help you with your decision-m journey. So, thank you so much and we will see you on the next episode where we're going to dig into my personal favorite topic, energy based devices.

[00:49:07]This is a juicy one. So, we will see you in that episode.

[00:49:12]Chop ice.