Full Audio Transcript:

I have really been focused a lot on skin and in the past few years I’ve been evolving my thinking over and over. I would encourage you to listen to my recent podcast, two podcasts I released a couple weeks ago on total Botox. I’m not gonna try to repeat everything that I’ve mentioned in there, but just talk about sort of developments and philosophy about skin.

What prompted this podcast was I got a message sent to me from a relative who lives in France, who sent me an article in French. I read French, I speak French, and I briefly scanned over it and the article was arguing how this new injection with HA fillers into the skin would be comparable and safer and better than phenol peeling. I think the article is a gross overstatement in terms of how it’s delivered this and sometimes marketing can be way too forceful in my opinion, but I think it’s good to understand sort of a measured thought process of what’s going on.

I have migrated away from peels and lasers for the most part, my practice, I use the analogy of ironing a shirt and wearing it. So, in other words, ironing a shirt is like a laser. You get a temporary benefit off of the laser, but then every time you smile, you frown, constantly the collagens being fragmented very quickly and there’s not long-term durable results. Now that being said, the phenol peel or deep CO2 laser, when you’re looking at a leather bound skin that’s like a farmer’s face that’s been outside in the sun, there’s nothing like what that can do. If you can do a deeper skin therapy, that will be probably a very important core to the solution.

Unfortunately, or fortunately, that kind of peel or laser really is only necessary in less than a fraction of 1% of people. Because today people use sunscreen. They don’t go and bake in the sun for 20 hours. Even my patients that have had pretty significant sun damage don’t look like that leathery bound skin that requires a deep laser therapy. So, I wind up not doing as many lasers as I have in the past for that reason. What I’ve migrated to is to understand a molecular regeneration of the skin. And no matter what you do, if you do a facelift, and I’m a big fan of facelift, facelifting because there’s only so much you can do with skin therapies, but it’s a separate category. So if you think about sagging, I sort of divide aging into three categories, volume loss, sagging, and skin.
And so volume loss, I do fat grafting and or fillers depending on the context of where I do what and I’ve done podcasts on that and a lot of virtual consultations describing that and then facelifting or blepharoplasty, eye bag removals, surgical excisions of things that are just, you just cannot do non-surgery on. I would encourage you to listen to my podcast from last week called surgery-I think it’s called surgery or not. It’s basically defining when I do surgery or not. But the last category that is the magic category, is skin therapy. It’s a way that we perceive the face that gives us an understanding. I talked a lot about that in my podcast from two weeks ago called Total Botox. I really encourage you to sort of listen to the last two podcasts. This is almost like a trilogy or a three part series that has you understand a lot to do with how I approach the face and you’ll hear it during consultation.

With total Botox, the summary of it is that we do so much Botox of the upper face that the lower face just doesn’t look right. There’s too many wrinkles,there’s a collapse with the collagen, there’s fragmentation of wrinkles. It doesn’t look correct. I do a lot of Meso Botox or Micro Botox where I’m putting Botox into the midface neck, chest, et cetera and what that’s doing is doing so much more than just wrinkle reduction. It’s managing rosacea discolorations and I don’t wanna overstate that because I always say women are very left brain. In other words, they’re always looking for micro flaws. I’m looking for the right brain, I’m an artist, I look at a face and say, does it look better?

So, when you’re trying to look at micro flaws correction, of course it’s doing that but there’s this profound difference of how to train you to read your face. I wanna make you look better in a social professional engagement not just when you’re standing in the mirror with an eight x mirror trying to figure out, did I knock out this one pore?

A great example is a guy that I did a deep neck facelift on a year ago and he said, Hey, you know, um, I don’t like these pores. I had a Mohs surgery done on my nose. Can you fix that? I said, yeah, Botox will do it. So I did it in one round. I got his pores better. I said, to be honest with you, your midface just looks, doesn’t look so healthy, there’s a lot of deep pores, things like that. I said, I recommend Botox. So I started doing Botox within two to three rounds of that with the micro Botox on his nose, People are saying, Hey, have you got a laser? What have you been doing?

So there’s this deep molecular restructuring that Botox does. Where the Botox fails though is the area right near the mouth and that area near the mouth where you smile, it’s hard to get Botox in the area. I’ve done it. I I don’t do that often. I do it, but there’s more of a compromise in the way you smile for six weeks, which people don’t like. Again, listen to my total Botox discussion.

So what I’ve been doing is a fern technique. Essentially what that is is a, it’s a technique developed by an Amsterdam doctor where you go back and forth across a dynamic fold or wrinkle and that actually changes the way that that fold looks. So wrinkles that when you, when you look at a person that smiles, they have those creases near their mouth that are pretty deep and they look bad on dynamic shaping. What I do is I have you smile as I inject that wrinkle and I’m actually starting to reshape that wrinkle in a way that looks really good.

So this is very interesting because in the past I always had the mantra, if you listen to my old podcast or listen to my old discussions of fillers, I always say, I don’t, I can’t treat something that’s moving. I treat a static issue. I usually say fillers are great for volume and not great for folds but I’ve had a really 180 on this and I’ve really started to understand that for dynamic wrinkles and creases there’s a technique now that you can place it intradermally and a cross hatching method that really, really, really changes the way that these infolding of the skin looks and it changes and I can, you can see it. I do one side for the patient and then have the patient look and they’re blown away. They’re like, oh my God, I can see this look so much younger than the other side.

I’ve only been doing this for a little while now, so I don’t have years of experience on this. But the colleague that I learned this from said, look, just like everything else you do, because I taught him micro Botox, he didn’t even understand it and he taught me this technique. What’s interesting, what he says is that if you do this every three to four to six months, initially, you start to build it and that filler in the skin starts to become six months, nine months, one year, two years, three years. It provides a deep collagen restructuring that’s there. So that’s the power of these dynamic fills is that they start to change the molecular structure of the unfolding of the collagen, which is great.

Now there’s another technique which you can also place micro aliquot of the HA into the skin. I can also deliver that. However, when I’m always looking at budget allocations for patients and sort of discerning what would be the best way to spend money with me, I find that the healing agency of what Botox does at a molecular level from regenerating rosacea, not a hundred percent remember, discolorations, pores, texture, tone, quality of skin far surpasses what a micro pass of fillers can do.

That’s why I think that article in French was a bit of an overstatement because they may not know that the Micro Botox is powerful in terms of these cellular regenerations. So these are like, you know, two parts of the puzzle in terms of skin rejuvenation of the midface. I guess that’s what I’m really focusing on right now. I’m not talking about a facelift. I don’t believe fillers can lift something. I think that’s absolute garbage. You place fillers deep, they’re just gonna provide volume. I’ve never seen it. I’ve heard people come and train me to do this, and its total nonsense. Placing two or three C syringes deep is not gonna pull up your sides and make wrinkles go away. You need to get close to the problem. So, the problem is at the superficial level of the skin and so if I can manage those superficial areas, I can truly knock those areas out.

A sort of a composite understanding of how I see the mid facial area that I think is being undertreated from a skin level is that if you’re dealing with deep, horrible looking skin, you’ve gotta do a deep peel or laser to manage it but for the vast majority, I would say 99% of people out there, they can usually be managed with a combination of Botox and fillers to get the great results. Now, even if the person did get a laser appeal and took care of that leathery bad skin, they still need the filler and the Botox because you cannot get durable laser results just by knocking out that surface damage.

What Botox and the fillers do is that they work together to restructure the collagen. So, the way that I liken it is that the outer, the outer third, the outer half of the face, so from outside of the, the smile line out to all the way to the ear is usually what I manage with Botox in general micro Botox, and then the area of the corrugations and the deep folds and the wrinkles that are happening near the mouth, I’m usually addressing that more with this dynamic micro resilience treatment across the fold and now is that always exactly the case? No, sometimes there’s deep corrugations on the outer face.

There’s a couple of deep lines and Botox just has a hard time knocking out. I’ll go in there and just do a little bit of resilience to accelerate that healing process. So it’s not a hundred percent non overlap situation, they oftentimes overlap. As I said, sometimes those corrugations and some wrinkles that go down to the face and to near the chin area or even some mild scarring. I know it’s hard to believe that, but I put Botox all the way across there. So there’s definitely an overlap in this approach but in general, the easiest way to understand it is the dynamic fillers are done closer toward the mouth. Again, I’m not just talking about a non-filing static fold, I’m talking about an actual creasing that occurs. Go look at your friends when they smile on Facebook, you’ll start to see that these corrugations that are occurring near the mouth, these creases are actually a sign of aging. When you’re younger, they don’t infold as sharply, there’s a softness to it. So my goal is to soften those roles and eventually knock those out. So hopefully this gives you some understanding and when you come in, I will work with you in your consultation to see what works for you.