Skin care and new Skin Care Technology
Dr. Salvatore Pacella: [00:00:00] Good morning everybody. Dr. Pacella from San Diego, California, and I'm joined by my two good friends and colleagues. Dr. Sam Jejurikar from Dallas, Texas, and Dr. Sam Rhee from Paramus New Jersey. you can see on our screen, our Instagram handles that's @samjejurikar @SanDiegoplasticsurgeon and @Bergencosmetic.
How are you guys today?
Dr. Sam Jejurikar: [00:00:23] We're doing wonderful. How are you doing
Dr. Salvatore Pacella: [00:00:26] fantastic. Got a nice morning here in lovely San Diego. How's the weather for you guys? Starting to cool. Down a little bit.
Dr. Sam Jejurikar: [00:00:36] Not too bad.
Dr. Salvatore Pacella: [00:00:38] Yeah. Alright. if you don't get outside, it's still important to take care of your skin. Even though these guys are living in a coffin, okay.
Today's episode will be about skincare and new skincare technologies. We have a very special guest which we'll introduce in a few minutes, but first I'd like to do a little distance.
This show is not a substitute for professional medical advice, diagnosis or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation and medical judgment after appropriate discussion.
Always seek the advice of your surgeon or other qualified health provider with any questions that you may have regarding medical care, never disregard professional medical advice, or delay seeking advice because of something in the show.
Now with that I'd like to hand it over to Dr. Sam Jejurikar in Dallas?
Here we go.
Dr. Sam Jejurikar: [00:01:31] Thanks. Thanks Dr. Pacella. today we are, very fortunate to have a special guest. And what else before I even introduce Nina, I'm gonna basically just let you know that as surgeons. I think we know a lot about cutting on people, but we tend not to know a lot about other aspects of beauty regimens of anti-aging regimens, unless we really seek out additional training. And, there's a bias sometimes that we have towards surgery. And it's really over, only the last few years that I've really gained an appreciation for the huge benefits that both preventative care and nonsurgical technologies can have for helping patients with both anti-aging and reversing some of the signs of aging.
And most of what I have learned has come from our guest who is Nina Owen. So we're the last five years, more than five years, I've had the great pleasure of working with Nina. She's actually the regional director of epicenter skincare and laser center, which I will admit is affiliated with our practice of Dallas plastic surgery Institute.
But really is one of Dallas's premier skincare and laser centers. She has more than 20 years in the business. She's a graduate of Temple University. she has actually served as the past president of the Society of Plastic Surgical Skincare Specialists. So she really has an expertise in this and is my go to person.
If I have questions, which is frequent about what and what would be a good noninvasive technology for my patient or the right skincare regimen, she'll either herself or with one of her excellent staff at epicenter will get us. We'll get us hooked up. And so with that, I'd love to bring up Nina. to start picking her brain.
Okay. Thank you again so much for joining us.
Nina Owen: [00:03:04] Yeah. Thank you for having me. It's great to be here.
Dr. Sam Jejurikar: [00:03:07] one of the things that, I find myself having conversations with patients with, a lot is just how to formulate a skincare regimen. It seems like a lot of patients will go to an expensive department store or spend several hundred dollars on skincare products, have whatever the person at the counter has them buy.
And every month they change what they're doing without any rhyme or reason when you're seeing a new patient particularly in a place like Dallas or San Diego where Dr. Pacella is. And they're in a, an environment where they're in the sun all the time. What are the sort of basic steps that you'll have a patient think about when they're starting their skincare?
Nina Owen: [00:03:41] I always believe to have, there's a course core products to have, so I always love to tell patients to get on, at least the antioxidant, a great retinol and a sunscreen. Those are your basics for me. when I'm speaking with a patient, cleansers, toners, growth factors are great, but the core is to get on a great antioxidant, a retinol retin-A, retinol, or, and a sunscreen.
Dr. Sam Jejurikar: [00:04:11] Okay. so let's say. Let's say you're talking to a 40 something year old plastic surgeon who is out in the sun a lot and surfs all the time. I'm like Dr. Pacella. Yeah. I think you surf what? Five times a week? Probably. Yeah, three times a week. And he's okay. You just, you've just said all of these things to me. I still have no idea how to buy my, how to start my register.
Dr. Salvatore Pacella: [00:04:35] this is how much, I don't know.
Dr. Sam Jejurikar: [00:04:41] So antioxidants, what does that mean? Because antioxidants, the thing I learned in chemistry. And so how does that, how do I get a skincare product? That's going to be a great antioxidant. What does that mean?
Nina Owen: [00:04:52] Really? It's a vitamin C product. that's what I highly recommend vitamin C. And what that does is helps this skin protects you from free radicals, protects you from the sun, it helps stop cell damage. So the, of course we know environment going out in the sun surfing five days a week, you could possibly get a lot of sun exposure. So using that antioxidant, the vitamin C is giving you added protection along with that sunscreen. So if you use a vitamin, just say a vitamin C product consistently for four to six weeks.
It's giving you that added protection with your sunscreen. You still need a sunscreen, but it's just, it's almost starts building every day that you use it to give you that extra protection.
Dr. Sam Jejurikar: [00:05:41] Okay. And The thing that I've always cause I'll and full disclosure, Nina, largely through my wife, I'll see products going to show up in my house.
And, and I don't know when to use it. I don't know how to work it into that. I basically am a guy who might wash my face with a cleanser at night. Maybe put some moisturizer on there, but then. Somewhere in that regimen. I have to figure out when to use a great vitamin C products when to use a retinol.
when do you use one of these growth factors, serum products, it's confusing sometimes, and I'm a plastic surgeon. like if you're trying to guide a patient. How do they pick the right cleanser? is there one cleanser that fits all patients for instance?
Nina Owen: [00:06:20] there's all different skin types. You have dry, normal combination oily. it just depends on the patients. A lot of times, somebody that is a little bit more dehydrated, maybe a little bit more mature skin, they're going to go with a cream cleanser. That's where I would take my patient.
Oh, let's go to the cream cleansers. a lot of patients that have a little bit more oil in their skin, you may want to put them on a gel cleanser or somebody that has a little bit of acne, maybe in an exfoliating cleanser. It has a little bit of salycilic acid in it. So there's so many different kinds of cleansers.
you really just have to get with your patient, find out what their skincare needs are, figure out what their skin type is. And then you can really pick the correct cleanser for them.
and that is incredibly elucidating, actually, that I just learned a lot more about cleansers. I had always been taught, that maybe the next step in the regimen might be a toner, but to me, toner conjured up these images of these products that dry out your skin that are, when a stringent, is that true?
Is there, do patients need a toner?
they say that toners help, With the pH balance of the skin. I'm not a huge toner person, but there are patients that you can put them on like a calming tone or, they now have the little wipes that come as a toner instead of the traditional toner.
You put on a cotton ball. So the wipes now have a little bit of glycolic acid, so it helps to we, the skin a little bit of cellular turnover. so it just, it, that also depends on the patient. I personally do not use a toner every now and again, if it's sitting there, I'll slap it on, but, it really depends on the patient.
If they have a little bit more oil in their skin, I tend to go towards some of the toners that have the pads. That they could just wipe on their skin am and PM. somebody that has oily skin, they like that. They feel like they're really getting that excess oil off, off their skin.
Dr. Sam Jejurikar: [00:08:23] would this be the point of the, of a skincare regimen where you might add a serum or you might add a vitamin C product. Like when and when an order would a patient do that,
Nina Owen: [00:08:33] typically you would go cleanser, toner, then it. This is all in the AM. I will put them on the antioxidant. Next. That is, I always tell patients, vitamin C is in the morning sunshine. So that would be the next product I would put them on.
and then, you could be as simple as a moisturizer and a sunscreen at that point. It depends on what your patient is willing to use am and PM there's patients that love just the whole complete skincare line of using, six to seven products am and PM. And then some patients just want it simple.
So you have to work with what they're actually going to do at home. When you're not with them.
Dr. Salvatore Pacella: [00:09:17] Can I ask, do you, you've seen a huge difference between male skin and female skin and sort of the tolerance for regimens that, men and women may like to use. So for example, I want my forehead to look like. Dr. Jejurikar's forehead. he's got that kind of
but, obviously with men, we're. We're just jumping in the shower, wash our face, in the shower type of guys, I just, a lot of my male patients just don't have the tolerance for a lot of product, unless they're very fancy,
Nina Owen: [00:09:53] I would say, you know what, tell them, what, with our male patients, with my husband put that cleanser in the shower with you.
So you're washing your face with a cleanser in the shower. it could be a gel cleanser. You usually would. a lot of male skin types, you have thicker skin. you have a little bit more oil to your skin. So put that cleanser in the shower. you're going to wash your face in there anyway, hopefully.
use the cleanser and you can even put a Polish. In there for them to use. that's what my husband has in his shower. He has a cleanser and a Polish. So every now and again, I'm like, are you using that Polish?
Dr. Sam Jejurikar: [00:10:28] what is a Polish? I don't even know what a Polish is.
Nina Owen: [00:10:30] Something that I tell patients use after you cleanse, there's all kinds of different polishes you can use.
There are so many out there, but it's tiny little beads, right? Almost like the old crystals from the microdermabrasion back in the day. you just put it on your face. You massage it in for about 30 to 60 seconds. It's great exfoliation. You rinse. You're nice and fresh. Okay.
Dr. Sam Jejurikar: [00:10:57] so then my, my next question has to do with retinols.
Cause you had mentioned that sort of earlier on, in addition to antioxidants, who do you think should be using a retinol? Is there a right age to retinol? Are there things patients should be wary of if they're going to be taking a
Nina Owen: [00:11:12] retinol? one of the first thing comes to mind with retinols is sun exposure.
So it makes you a little bit more photosensitive. So if you have a tennis player, you might not want to put them on a stronger retina, like a retin-A. they've come a long way. Way. I think we all right. Nice. Where, with the retinols now. Okay. It's a blend. So patients seem to tolerate it a little bit better than they did before.
there's different strengths, but I tell patients that, let's start you out with a lower strength. You want to use that product. If you feel like you're getting irritation and you're using it twice a week, and then you stop using it because of the redness, a little bit, your rotation, you're not getting a benefit of the retinol.
I'd rather start them out at a lower percentage. Use it more often, and you're getting more of a benefit. Higher strength doesn't necessarily mean you're getting a better end result.
Dr. Sam Jejurikar: [00:12:08] And
Dr. Salvatore Pacella: [00:12:08] what's a low percentage
Nina Owen: [00:12:10] 0.2, 5% of a retinol. with that being said, that's not, that's a blend, so it's a little bit more gentle on the skin.
So patients can use it. usually I tell patients, try using it every other day, every other evening, before you go to bed. Don't use it in the am. not that you can't, but just so you have a regimen, any oxygen in the morning, retinol at night. So if you using it every other day, I think that's great and you don't necessarily have to bump that percentage up.
Let's see how your skin tolerated. That's what we gave you to start. And of course, thicker oily skin can take a little bit more. So you might want to start them at a 0.5%.
Dr. Sam Jejurikar: [00:12:55] Do you, and we, and I will try to make you, avoid trying to pick sort of one company over another. But, you have a wealth of knowledge and I have an advantage in my practice because I can send my patients to see you or your staff.
And it's amazing, but let's say you're a patient listening to this podcast and you've gotten all this information thrown at you. You're like, okay, now I need to find the right cleanser depending on my skin type. I may or may not need a toner. I definitely need an antioxidant and I definitely need a retinol.
Sunscreen's got to fall in there somewhere and we haven't even talked about moisturizer. Like, how do I do all this? is there's a variety of companies that have a complete line that's out there. is there, do you have sort of faith in a few companies lines that they just you're a patient.
You go out there, you buy this line and. You're going to be, you're going to be taken care of, or how does a patient maneuver through this jungle
Nina Owen: [00:13:43] of course, definitely big on prescription retinols. I'm not that over the counter products. aren't okay, but you're not getting what you need.
You're going to spend the same amount of money you might as well come in, to a medical spa professionals that deal with this every day, to help with. with the retinols, with your product line, some of the stores, what they spend in a store and what they spend with us, it's very similar, if not at the store, it's a little bit more expensive.
Dr. Sam Jejurikar: [00:14:12] Yeah.
Nina Owen: [00:14:13] so it just, it really just depends on the patient. skincare lines, I have my favorite for sure. and each line they do have the retinols. So some are a little bit more aggressive than others, even though they're the same percentage, that we have a lot of great ones and I have my two favorites.
Dr. Sam Jejurikar: [00:14:31] I think you can tell us what they are. yeah, that's fine.
Nina Owen: [00:14:35] I love, XEO skin health. I love their, their retinol. They have a 0.5 that, it's called wrinkle plus texture repair. And I tell you, patients can really tolerate it and they get great results with it. I have patients that come in all the time saying, Hey, I love that retinol.
It's the first retinol. I was able to tolerate naturally you use on a regular basis. another great one is skin Medica really has some great retinols. and they have a variety that 0.2, five to five, and then the 1.0, they've been in a game a long time, so I just feel like. Patients who get on the retinols from those companies.
there's other companies, of course, that are great. but personally, the feedback I get from patients, I steer them towards those, retinols.
Dr. Sam Jejurikar: [00:15:24] that is super helpful. Before we switch topics to technologies, do you guys have any other questions about skincare or specific things you want Nina to answer?
Dr. Sam Rhee: [00:15:33] Yeah, I was going to ask about, sunscreen. So there are a lot of different types of
Nina Owen: [00:15:40] sunscreens
Dr. Sam Rhee: [00:15:40] with different chemicals and so forth. So what do you recommend for patients and also, patients with kids? So they're always like, should I use this type of sunscreen? It has this in it.
Nina Owen: [00:15:51] I think the body broad spectrum sunscreens and for kids, I always like using the physical sunscreens for kids.
It's not a chemical. if they have sensitive skin, we're not causing any kind of irritation, you want to be careful with kids also. Cause they're going to be running around. if they're at the beach, you want to make sure that sunscreen doesn't burn their eyes. you're not getting that, where they're sweating and it's running into their eyes.
Dr. Sam Rhee: [00:16:18] So physical meaning like zinc or titanium oxide which I think a lot of adults don't like, because it leaves your face kind of chalky you've come
Nina Owen: [00:16:28] such a long way with sunscreens. Now, they have a light tint. The big thing right now is there's light tents and most every skincare line with their sunscreens.
you can put it on and you're not getting that white effect that we used to get. my husband's a perfect example. He's a big fishermen and we've tried every sunscreen, because of that reason, cause he has lighter skin type and you put it on and he could see them a mile away, That white face. So I got him on a lighter tint, sunscreen, nothing that's going to stay in his fishing shirt. it really works for him. So the tents have taken over that, white look to the skin that we all know very well.
Dr. Salvatore Pacella: [00:17:14] Just a couple of comments on sunscreen. So I have two little ones ages seven and nine, and it's a fight every single day to go out anywhere surfing or mountain biking and go wherever.
And. one of the best things I use is a roll on stick or a application stick. and what's really frightening to me is I'm a, I do a tremendous amount of facial skin cancer, and one of the most common places I see skin cancer is on the eyelid. And you never think as a person applying sunblock that you need to put it on your eyelids.
You say, I'm going to have sunglasses on right. And what a lot of us don't understood stand or don't realize is, sunglasses. Sometimes if the ambient sun gets into the lens, that's a concave effect and that can focus. So the UV radiation right on the lower lid and. Right here on the medial campus.
And so what's your take on applying sunblock to the eyelids? Do you, is there a specific product you recommend or how do patients do it and how do you balance that burning sensation with sun protection?
Nina Owen: [00:18:24] Yeah, that's, it's a tough one. I definitely recommend putting it all over the skin on the legs also.
that's why I like the physical sunscreen. So it's, I feel like they don't burn as much if they do get into the eye area. for kids, I would rec I definitely recommend just all over the skin, eyelids, but also they came out with a powder brush. For a lot of patients when you're at the beach, it's like a makeup brush and the powder comes out and it's used, uses a sunscreen.
And that seemed to help with the IRA because you can go over your eyelids. You can even, I'm sure you can put it on kids. Also. It has a little bit of tents on their eyes maybe, but, It's going to help with that burning sensation, but those toddlers are really great too, because when you're on the beach, you know how you're supposed to reapply.
if you're wearing a little bit of makeup out there and you have that brush, you're just applying some powder on it. Given that extra little bit of sunscreen you're getting,
Dr. Salvatore Pacella: [00:19:22] and two other followup questions on sunscreen. we hear a lot about, avabenzone. which is a very popular product and in sunscreens.
And my understanding is there's some data that shows that, it can be absorbed into the bloodstream. We don't quite know whether or not it's a carcinogen and the difference between the zinc titanium and avabenzone.
Nina Owen: [00:19:47] Difference between the two.
Dr. Salvatore Pacella: [00:19:49] So like the, so then some products are a lot of in the less expensive sunblocks, you get at CVS or whatever, the more expensive ones are the mineral type of sunblocks, your thoughts on those types and what, what you may tell patients.
Nina Owen: [00:20:04] I just feel like a lot of the store back, Brett. Bought products. They're the ones that run they're the runs are well, just with my experience. They seem to run a little bit more. don't last as long on the skin, they're not going to tolerate the water as well. You're sweating if you're, doing sporting activities.
So a lot of them are physician grade skincare products. I feel lasts a little longer on the skin. and they take into account, the eye area, and just longevity on the skin throughout the day.
Dr. Salvatore Pacella: [00:20:39] And how about the aerosols blocks or sunscreens that, again, I, a lot of, if you walk into CVS or writing or any drug store, there's, volumes of and products that have a application and for the moms out there that are taking care of young ones, the fight, hang on sunblock.
they may say, I'm just going to spray it on, and we're done, what are your thoughts
Nina Owen: [00:21:03] on that? I think if you're going to spray it on, that's great, but I think you should rub it into because everything is you're going to miss. So when you're spraying, I think you should maybe do a little rub on if you can.
I feel like
Dr. Salvatore Pacella: [00:21:15] if we talk, we use one of those I had to get in front of somewhere,
Nina Owen: [00:21:18] Yeah. You get that griping. that's why, a lot of the aerosols they're pretty big right now, too. I just say sprayed on it's great. It's quick, but rub that on too. So you're know that you're getting full coverage.
I can't tell you how many people on the beach and you can see it when they're laying there. There's that Stripe up their back. I just want to go over and spray them.
Dr. Sam Jejurikar: [00:21:41] in the last few minutes in our program, I want to switch gears just a little bit and talk about technology because, as surgeons, we are oftentimes somewhat skeptical about some of the.
The results that we can see with newer technologies that are out there. But I will say that in the last year or two, some of the things that we've been seeing with radio frequency and some of the other technologies we're going to talk about are going to be, are pretty impressive. So Nina, I want to switch gears first and talk to you about radio frequency and specifically your experience with it over the years and what you're seeing in the newer products that are out there
Nina Owen: [00:22:13] Radio-frequency, we are getting terrific results with it. we have the Morpheus eight, in particular that we have, at our medical spa. So we're getting tightening, we're getting toning with the Morpheus eight product radio-frequency and then there's also the Thermage FLX is radio frequency.
So I'm going to throw up a few pictures while you're talking here. can you guys see this? Okay. Is this a, is this coming up? Sam Sal. Hello. Okay, great. so you're talking about Morpheus eight. What is Morpheus? All? I, what I have known about is microneedling, and then all of a sudden Morpheus eight came about.
And, these are, and these are from, ultimate skin sores, which is affiliated with, dr. Rod work and it's David who, is a nurse injector. So we've taken these from his Instagram accounts.
Dr. Salvatore Pacella: [00:23:06] And you asked what is Morpheus? I thought you were going to say, what is the matrix
Dr. Sam Jejurikar: [00:23:09] exactly what is I always feel cheesy telling patients, Hey, you need Morpheus eight.
I don't know Morpheus one through seven are. what is this exactly
Nina Owen: [00:23:17] microneedling with radio frequency. So what it is, it's a fractional technology. And it has a micro pins that actually get inserted into the skin going down to the dermis, tiny little pin holes in the skin, which causes collagen production, tightening, toning, and it does have heat involved with it.
you definitely need a numbing cream, so I wouldn't do the treatment without a topical numbing cream for about 45 minutes to an hour. patients tolerate it well. you do feel it, it's not something that. it's not relaxing, but patients get amazing results with it.
Dr. Sam Jejurikar: [00:23:56] and the, I'm just, these are some body shots it's commonly used in the face jowls neck area as well.
Is there anything that people need to be aware of? It let's say they get Botox and fillers on a regular basis. Is there, is there any contraindication to doing radiofrequency treatments?
Nina Owen: [00:24:11] I think that with, I would always go with the injections a few days after because you can have some swelling if you're doing facial areas.
I always recommend, what, just wait three to five days before you get your Botox injections or Dysport, they're really, with injectable fillers, I would wait a little bit longer, because it will tend to just, Your filler won't last as long. If you're getting the treatments and you have your filler, so you might want to go through your series and Morpheus eight first and then go with your filler product after your series.
Dr. Sam Jejurikar: [00:24:46] Okay. And I've also heard, conversations about, Radio frequency, heat relative to have to cooling. So CoolSculpting is something that I think most of our viewers will be familiar with and it's been around for awhile. Yeah. And now all of a sudden we're using heat to dissolve fat and there's this nutrient evolve, which maybe you could tell us a little bit about which we don't even have as such new technology, but.
The pictures are pretty remarkable.
Nina Owen: [00:25:12] there's the system itself is called evolve and then there's three different hand pieces for the system. So there's one for tightening, one for toning. the toning one is the muscle stimulation. and then there's a tightening, toning and fat loss. Okay. The heat with that handpiece with the fat loss, it helps with the fat loss.
I'm a little bit more familiar with the toning, with a muscle stimulation, because we actually did a study with one of the tightening devices, for the muscle stimulation. Okay. and I think it's just for the toning end of it. I think it's just like exercise. You have to keep up with it.
Dr. Sam Jejurikar: [00:25:55] So is this so the tree, so I'm going to show a couple of pictures here that are off of Instagram from a variety of different, Med spa is a, we are not affiliated with, here's here is a four treatments of evolves type.
You can see that the patient clearly has lost some fat and has gotten some substantial skin tightening, pretty impressive for a nonsurgical treatment. Here's a patient that got four treatments of trim and tight. So what is trim? I'm confused by what these things are,
Nina Owen: [00:26:21] is the fat loss. Okay. So that's going to help with the fat loss.
And like I said, the device has evolved that it has three different. A hand pieces that treat the fat, the tightening, and then the muscle stimulation.
Dr. Sam Jejurikar: [00:26:34] I'm just curious what the other two plastic surgeons think about this as a nonsurgical result, four treatments of a noninvasive treatment. I want their feedback.
Dr. Sam Rhee: [00:26:44] it looks pretty impressive. but I have seen so many before and afters with so many devices in the past and then actually used them and it's always a, you can always get an amazing result with almost anything, but it's about consistency and degree of efficacy across a broad range of patients.
I think that's always the proof.
Dr. Sam Jejurikar: [00:27:07] Sure. For sure.
Nina Owen: [00:27:11] Go ahead. No, I just think that, you have to pick the, the right candidate for this type of procedure, because if they're a liposuction candidate, they're not going to get the results. That they're looking for through this type of device liposuction, you're always gonna get, my opinion, a better result with the liposuction.
Dr. Salvatore Pacella: [00:27:31] I think these are fantastic results. They look really good. I think, a lot of companies that, market these products, they have a little disclaimer at the bottom that says when, coupled with diet and exercise. I think, it's hard.
I think, honestly, to attribute what. What with patient lifestyle modification and what the device actually does just to echo what dr. Ray was talking about. And, I think for a lot of patients out there that are young busy professionals, they don't have a downtime. the average mom who's taking care of young ones, doesn't have the downtime to go do a full tummy tuck.
And so these sort of products are very nice because they can add a little bit of extra cost body contour, and without a major amount of downside.
Dr. Sam Jejurikar: [00:28:14] Yeah, I w I would echo what everyone is saying. I think it's echo what Nina is saying. I think patients need to know that technology is getting better, but surgical liposuction is still the most effective way to remove fat.
That being said to echo what Dr. Pacella was saying. There's no downtime with the majority of these procedures and you can even work while they're being done. Dr. Robert Woodfield, he's an Austin. Three treatments of, of evolve where this was, I guess all three, the trim, the tone and the tights are those the three.
Yeah. And, what I was particularly struck by this was not only the fat loss, but the skin tightening that came along with it as well. So it makes me really encouraged about what's. Possible, with noninvasive technology and it's never a substitute for diet and exercise, but in conjunction, there are some really exciting treatments that are out there
Nina Owen: [00:29:03] and you can also use them in combination with lipo. So after liposuction, you can use, B evolve or any kind of tightening toning. Post surgery.
Dr. Sam Jejurikar: [00:29:17] Yeah, exactly. I think that the potentials for actually synergy between surgery and noninvasive just allows us to get better and better results. The other thing I wanted to touch on really quickly in the last two minutes, we have some of the newer treatments that are out there for sun damage.
And I'll admit that I've always known about broadband light and, As a treatment, but some of the newer stuff is a little bit confusing to me. So you mind talking about some of the newer technology for sun damage and for broadband light that's out there?
Sure. the new, the new Moxy and BBL by Sciton, the Moxy, what that is a 1927 laser.
And, what makes us a little bit different that you can treat all skin. Yeah. Which is pretty amazing, all skin types throughout the year. So a lot of times in the summertime or laser treatments, back off a little bit, cause patients are getting a little bit more sun exposure with the Moxy. There's little to no downtime.
it's a fractionated laser. 1927 and it just, patients get great results it's for all skin types at all ages. So when you
say 1927, I think our viewers aren't gonna necessarily know what that means, but no, but is that, are you, what are you using it for? Are you using it to reverse aging or using it to treat sun damage?
Are you using it to treat pigment? who's a good candidate for a Moxy.
Nina Owen: [00:30:37] It's all of the above. So a pigmentation, it's amazing. If you have sun damage. The Moxy is great. It works with, fine lines and wrinkles, definitely texture of the skin. it's for all ages and it's little to no downtime. So for the patients that want to refresher or want to target some of that pigment, it's a really great treatment for that.
You have about two to four days of maybe a little bit of pepper into the skin, which means just a little bit of, it looks like you have a little bit of sand on your skin. There's not a lot of downtime, a little bit of redness after, but that's about it.
Dr. Sam Jejurikar: [00:31:14] and then in, and, Oh, sorry, I didn't mean to cut you off.
I'm sorry.
Nina Owen: [00:31:18] No, and just with a BBL, the new BBL broadband light, a lot of patients know it as, IPL, right? so they have the new it's called the hero, but basically it is the BBL or IPL on steroids. So it's four times faster, three times the energy, the power, and the cooling is two times higher than the normal BBL or their normal IPL.
Dr. Sam Jejurikar: [00:31:47] so it's more, is there a more comfortable as a result of that too, then?
Nina Owen: [00:31:50] It's definitely more comfortable. I was actually treated on my legs with the hero and it was definitely very comfortable. it's nice. It's quick. It's fast. And they use a gliding motion. Instead of just pulsing it, during the treatment.
So anyone that's had a BBL or IPL, it's a pulse and they use a, of coal crystal to treat. This is just gliding on this, like you're painting.
Dr. Sam Jejurikar: [00:32:18] And I understand that you can do the Moxy all year long, the broadband light treatment. Is that something you can also do all year round?
Nina Owen: [00:32:25] Yeah, I'd be a little bit more cautious with, the BBL. if somebody has a little bit more pigment to the skin, if they've had some recent sun exposure that hasn't changed, so you want to be a little bit more cautious with that. Okay.
Dr. Sam Jejurikar: [00:32:39] that's a lot of information. We just threw it everybody. So I appreciate you, spending a few minutes plus on Sunday morning to help with that.
do you guys have any questions about follow up about this new technology before we sign off?
Dr. Sam Rhee: [00:32:52] No, that was fantastic. I learned a lot and I am very interested to see as these new technologies continue to grow and evolve. It's very impressive. I think if you look at. The technology of these products from say 10 years ago to now, you can definitely see just how much more impactful they are.
And again, this is not something that most plastic surgeons that we, we have to keep up with this stuff because it's not stuff that we got very much of in training and whatever we learned back then was fairly outdated. And I'm very glad we have specialists like Nina to help guide us with this, with this technology.
Dr. Sam Jejurikar: [00:33:27] All right, Nina, thank you again so much. And,
Nina Owen: [00:33:29] it was great being here. Thank you very much.
Dr. Sam Jejurikar: [00:33:33] And with that, I guess we'll call it a show. Gentlemen, see you guys next week. Yes.
Dr. Salvatore Pacella: [00:00:00] Good morning everybody. Dr. Pacella from San Diego, California, and I'm joined by my two good friends and colleagues. Dr. Sam Jejurikar from Dallas, Texas, and Dr. Sam Rhee from Paramus New Jersey. you can see on our screen, our Instagram handles that's @samjejurikar @SanDiegoplasticsurgeon and @Bergencosmetic.
How are you guys today?
Dr. Sam Jejurikar: [00:00:23] We're doing wonderful. How are you doing
Dr. Salvatore Pacella: [00:00:26] fantastic. Got a nice morning here in lovely San Diego. How's the weather for you guys? Starting to cool. Down a little bit.
Dr. Sam Jejurikar: [00:00:36] Not too bad.
Dr. Salvatore Pacella: [00:00:38] Yeah. Alright. if you don't get outside, it's still important to take care of your skin. Even though these guys are living in a coffin, okay.
Today's episode will be about skincare and new skincare technologies. We have a very special guest which we'll introduce in a few minutes, but first I'd like to do a little distance.
This show is not a substitute for professional medical advice, diagnosis or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation and medical judgment after appropriate discussion.
Always seek the advice of your surgeon or other qualified health provider with any questions that you may have regarding medical care, never disregard professional medical advice, or delay seeking advice because of something in the show.
Now with that I'd like to hand it over to Dr. Sam Jejurikar in Dallas?
Here we go.
Dr. Sam Jejurikar: [00:01:31] Thanks. Thanks Dr. Pacella. today we are, very fortunate to have a special guest. And what else before I even introduce Nina, I'm gonna basically just let you know that as surgeons. I think we know a lot about cutting on people, but we tend not to know a lot about other aspects of beauty regimens of anti-aging regimens, unless we really seek out additional training. And, there's a bias sometimes that we have towards surgery. And it's really over, only the last few years that I've really gained an appreciation for the huge benefits that both preventative care and nonsurgical technologies can have for helping patients with both anti-aging and reversing some of the signs of aging.
And most of what I have learned has come from our guest who is Nina Owen. So we're the last five years, more than five years, I've had the great pleasure of working with Nina. She's actually the regional director of epicenter skincare and laser center, which I will admit is affiliated with our practice of Dallas plastic surgery Institute.
But really is one of Dallas's premier skincare and laser centers. She has more than 20 years in the business. She's a graduate of Temple University. she has actually served as the past president of the Society of Plastic Surgical Skincare Specialists. So she really has an expertise in this and is my go to person.
If I have questions, which is frequent about what and what would be a good noninvasive technology for my patient or the right skincare regimen, she'll either herself or with one of her excellent staff at epicenter will get us. We'll get us hooked up. And so with that, I'd love to bring up Nina. to start picking her brain.
Okay. Thank you again so much for joining us.
Nina Owen: [00:03:04] Yeah. Thank you for having me. It's great to be here.
Dr. Sam Jejurikar: [00:03:07] one of the things that, I find myself having conversations with patients with, a lot is just how to formulate a skincare regimen. It seems like a lot of patients will go to an expensive department store or spend several hundred dollars on skincare products, have whatever the person at the counter has them buy.
And every month they change what they're doing without any rhyme or reason when you're seeing a new patient particularly in a place like Dallas or San Diego where Dr. Pacella is. And they're in a, an environment where they're in the sun all the time. What are the sort of basic steps that you'll have a patient think about when they're starting their skincare?
Nina Owen: [00:03:41] I always believe to have, there's a course core products to have, so I always love to tell patients to get on, at least the antioxidant, a great retinol and a sunscreen. Those are your basics for me. when I'm speaking with a patient, cleansers, toners, growth factors are great, but the core is to get on a great antioxidant, a retinol retin-A, retinol, or, and a sunscreen.
Dr. Sam Jejurikar: [00:04:11] Okay. so let's say. Let's say you're talking to a 40 something year old plastic surgeon who is out in the sun a lot and surfs all the time. I'm like Dr. Pacella. Yeah. I think you surf what? Five times a week? Probably. Yeah, three times a week. And he's okay. You just, you've just said all of these things to me. I still have no idea how to buy my, how to start my register.
Dr. Salvatore Pacella: [00:04:35] this is how much, I don't know.
Dr. Sam Jejurikar: [00:04:41] So antioxidants, what does that mean? Because antioxidants, the thing I learned in chemistry. And so how does that, how do I get a skincare product? That's going to be a great antioxidant. What does that mean?
Nina Owen: [00:04:52] Really? It's a vitamin C product. that's what I highly recommend vitamin C. And what that does is helps this skin protects you from free radicals, protects you from the sun, it helps stop cell damage. So the, of course we know environment going out in the sun surfing five days a week, you could possibly get a lot of sun exposure. So using that antioxidant, the vitamin C is giving you added protection along with that sunscreen. So if you use a vitamin, just say a vitamin C product consistently for four to six weeks.
It's giving you that added protection with your sunscreen. You still need a sunscreen, but it's just, it's almost starts building every day that you use it to give you that extra protection.
Dr. Sam Jejurikar: [00:05:41] Okay. And The thing that I've always cause I'll and full disclosure, Nina, largely through my wife, I'll see products going to show up in my house.
And, and I don't know when to use it. I don't know how to work it into that. I basically am a guy who might wash my face with a cleanser at night. Maybe put some moisturizer on there, but then. Somewhere in that regimen. I have to figure out when to use a great vitamin C products when to use a retinol.
when do you use one of these growth factors, serum products, it's confusing sometimes, and I'm a plastic surgeon. like if you're trying to guide a patient. How do they pick the right cleanser? is there one cleanser that fits all patients for instance?
Nina Owen: [00:06:20] there's all different skin types. You have dry, normal combination oily. it just depends on the patients. A lot of times, somebody that is a little bit more dehydrated, maybe a little bit more mature skin, they're going to go with a cream cleanser. That's where I would take my patient.
Oh, let's go to the cream cleansers. a lot of patients that have a little bit more oil in their skin, you may want to put them on a gel cleanser or somebody that has a little bit of acne, maybe in an exfoliating cleanser. It has a little bit of salycilic acid in it. So there's so many different kinds of cleansers.
you really just have to get with your patient, find out what their skincare needs are, figure out what their skin type is. And then you can really pick the correct cleanser for them.
and that is incredibly elucidating, actually, that I just learned a lot more about cleansers. I had always been taught, that maybe the next step in the regimen might be a toner, but to me, toner conjured up these images of these products that dry out your skin that are, when a stringent, is that true?
Is there, do patients need a toner?
they say that toners help, With the pH balance of the skin. I'm not a huge toner person, but there are patients that you can put them on like a calming tone or, they now have the little wipes that come as a toner instead of the traditional toner.
You put on a cotton ball. So the wipes now have a little bit of glycolic acid, so it helps to we, the skin a little bit of cellular turnover. so it just, it, that also depends on the patient. I personally do not use a toner every now and again, if it's sitting there, I'll slap it on, but, it really depends on the patient.
If they have a little bit more oil in their skin, I tend to go towards some of the toners that have the pads. That they could just wipe on their skin am and PM. somebody that has oily skin, they like that. They feel like they're really getting that excess oil off, off their skin.
Dr. Sam Jejurikar: [00:08:23] would this be the point of the, of a skincare regimen where you might add a serum or you might add a vitamin C product. Like when and when an order would a patient do that,
Nina Owen: [00:08:33] typically you would go cleanser, toner, then it. This is all in the AM. I will put them on the antioxidant. Next. That is, I always tell patients, vitamin C is in the morning sunshine. So that would be the next product I would put them on.
and then, you could be as simple as a moisturizer and a sunscreen at that point. It depends on what your patient is willing to use am and PM there's patients that love just the whole complete skincare line of using, six to seven products am and PM. And then some patients just want it simple.
So you have to work with what they're actually going to do at home. When you're not with them.
Dr. Salvatore Pacella: [00:09:17] Can I ask, do you, you've seen a huge difference between male skin and female skin and sort of the tolerance for regimens that, men and women may like to use. So for example, I want my forehead to look like. Dr. Jejurikar's forehead. he's got that kind of
but, obviously with men, we're. We're just jumping in the shower, wash our face, in the shower type of guys, I just, a lot of my male patients just don't have the tolerance for a lot of product, unless they're very fancy,
Nina Owen: [00:09:53] I would say, you know what, tell them, what, with our male patients, with my husband put that cleanser in the shower with you.
So you're washing your face with a cleanser in the shower. it could be a gel cleanser. You usually would. a lot of male skin types, you have thicker skin. you have a little bit more oil to your skin. So put that cleanser in the shower. you're going to wash your face in there anyway, hopefully.
use the cleanser and you can even put a Polish. In there for them to use. that's what my husband has in his shower. He has a cleanser and a Polish. So every now and again, I'm like, are you using that Polish?
Dr. Sam Jejurikar: [00:10:28] what is a Polish? I don't even know what a Polish is.
Nina Owen: [00:10:30] Something that I tell patients use after you cleanse, there's all kinds of different polishes you can use.
There are so many out there, but it's tiny little beads, right? Almost like the old crystals from the microdermabrasion back in the day. you just put it on your face. You massage it in for about 30 to 60 seconds. It's great exfoliation. You rinse. You're nice and fresh. Okay.
Dr. Sam Jejurikar: [00:10:57] so then my, my next question has to do with retinols.
Cause you had mentioned that sort of earlier on, in addition to antioxidants, who do you think should be using a retinol? Is there a right age to retinol? Are there things patients should be wary of if they're going to be taking a
Nina Owen: [00:11:12] retinol? one of the first thing comes to mind with retinols is sun exposure.
So it makes you a little bit more photosensitive. So if you have a tennis player, you might not want to put them on a stronger retina, like a retin-A. they've come a long way. Way. I think we all right. Nice. Where, with the retinols now. Okay. It's a blend. So patients seem to tolerate it a little bit better than they did before.
there's different strengths, but I tell patients that, let's start you out with a lower strength. You want to use that product. If you feel like you're getting irritation and you're using it twice a week, and then you stop using it because of the redness, a little bit, your rotation, you're not getting a benefit of the retinol.
I'd rather start them out at a lower percentage. Use it more often, and you're getting more of a benefit. Higher strength doesn't necessarily mean you're getting a better end result.
Dr. Sam Jejurikar: [00:12:08] And
Dr. Salvatore Pacella: [00:12:08] what's a low percentage
Nina Owen: [00:12:10] 0.2, 5% of a retinol. with that being said, that's not, that's a blend, so it's a little bit more gentle on the skin.
So patients can use it. usually I tell patients, try using it every other day, every other evening, before you go to bed. Don't use it in the am. not that you can't, but just so you have a regimen, any oxygen in the morning, retinol at night. So if you using it every other day, I think that's great and you don't necessarily have to bump that percentage up.
Let's see how your skin tolerated. That's what we gave you to start. And of course, thicker oily skin can take a little bit more. So you might want to start them at a 0.5%.
Dr. Sam Jejurikar: [00:12:55] Do you, and we, and I will try to make you, avoid trying to pick sort of one company over another. But, you have a wealth of knowledge and I have an advantage in my practice because I can send my patients to see you or your staff.
And it's amazing, but let's say you're a patient listening to this podcast and you've gotten all this information thrown at you. You're like, okay, now I need to find the right cleanser depending on my skin type. I may or may not need a toner. I definitely need an antioxidant and I definitely need a retinol.
Sunscreen's got to fall in there somewhere and we haven't even talked about moisturizer. Like, how do I do all this? is there's a variety of companies that have a complete line that's out there. is there, do you have sort of faith in a few companies lines that they just you're a patient.
You go out there, you buy this line and. You're going to be, you're going to be taken care of, or how does a patient maneuver through this jungle
Nina Owen: [00:13:43] of course, definitely big on prescription retinols. I'm not that over the counter products. aren't okay, but you're not getting what you need.
You're going to spend the same amount of money you might as well come in, to a medical spa professionals that deal with this every day, to help with. with the retinols, with your product line, some of the stores, what they spend in a store and what they spend with us, it's very similar, if not at the store, it's a little bit more expensive.
Dr. Sam Jejurikar: [00:14:12] Yeah.
Nina Owen: [00:14:13] so it just, it really just depends on the patient. skincare lines, I have my favorite for sure. and each line they do have the retinols. So some are a little bit more aggressive than others, even though they're the same percentage, that we have a lot of great ones and I have my two favorites.
Dr. Sam Jejurikar: [00:14:31] I think you can tell us what they are. yeah, that's fine.
Nina Owen: [00:14:35] I love, XEO skin health. I love their, their retinol. They have a 0.5 that, it's called wrinkle plus texture repair. And I tell you, patients can really tolerate it and they get great results with it. I have patients that come in all the time saying, Hey, I love that retinol.
It's the first retinol. I was able to tolerate naturally you use on a regular basis. another great one is skin Medica really has some great retinols. and they have a variety that 0.2, five to five, and then the 1.0, they've been in a game a long time, so I just feel like. Patients who get on the retinols from those companies.
there's other companies, of course, that are great. but personally, the feedback I get from patients, I steer them towards those, retinols.
Dr. Sam Jejurikar: [00:15:24] that is super helpful. Before we switch topics to technologies, do you guys have any other questions about skincare or specific things you want Nina to answer?
Dr. Sam Rhee: [00:15:33] Yeah, I was going to ask about, sunscreen. So there are a lot of different types of
Nina Owen: [00:15:40] sunscreens
Dr. Sam Rhee: [00:15:40] with different chemicals and so forth. So what do you recommend for patients and also, patients with kids? So they're always like, should I use this type of sunscreen? It has this in it.
Nina Owen: [00:15:51] I think the body broad spectrum sunscreens and for kids, I always like using the physical sunscreens for kids.
It's not a chemical. if they have sensitive skin, we're not causing any kind of irritation, you want to be careful with kids also. Cause they're going to be running around. if they're at the beach, you want to make sure that sunscreen doesn't burn their eyes. you're not getting that, where they're sweating and it's running into their eyes.
Dr. Sam Rhee: [00:16:18] So physical meaning like zinc or titanium oxide which I think a lot of adults don't like, because it leaves your face kind of chalky you've come
Nina Owen: [00:16:28] such a long way with sunscreens. Now, they have a light tint. The big thing right now is there's light tents and most every skincare line with their sunscreens.
you can put it on and you're not getting that white effect that we used to get. my husband's a perfect example. He's a big fishermen and we've tried every sunscreen, because of that reason, cause he has lighter skin type and you put it on and he could see them a mile away, That white face. So I got him on a lighter tint, sunscreen, nothing that's going to stay in his fishing shirt. it really works for him. So the tents have taken over that, white look to the skin that we all know very well.
Dr. Salvatore Pacella: [00:17:14] Just a couple of comments on sunscreen. So I have two little ones ages seven and nine, and it's a fight every single day to go out anywhere surfing or mountain biking and go wherever.
And. one of the best things I use is a roll on stick or a application stick. and what's really frightening to me is I'm a, I do a tremendous amount of facial skin cancer, and one of the most common places I see skin cancer is on the eyelid. And you never think as a person applying sunblock that you need to put it on your eyelids.
You say, I'm going to have sunglasses on right. And what a lot of us don't understood stand or don't realize is, sunglasses. Sometimes if the ambient sun gets into the lens, that's a concave effect and that can focus. So the UV radiation right on the lower lid and. Right here on the medial campus.
And so what's your take on applying sunblock to the eyelids? Do you, is there a specific product you recommend or how do patients do it and how do you balance that burning sensation with sun protection?
Nina Owen: [00:18:24] Yeah, that's, it's a tough one. I definitely recommend putting it all over the skin on the legs also.
that's why I like the physical sunscreen. So it's, I feel like they don't burn as much if they do get into the eye area. for kids, I would rec I definitely recommend just all over the skin, eyelids, but also they came out with a powder brush. For a lot of patients when you're at the beach, it's like a makeup brush and the powder comes out and it's used, uses a sunscreen.
And that seemed to help with the IRA because you can go over your eyelids. You can even, I'm sure you can put it on kids. Also. It has a little bit of tents on their eyes maybe, but, It's going to help with that burning sensation, but those toddlers are really great too, because when you're on the beach, you know how you're supposed to reapply.
if you're wearing a little bit of makeup out there and you have that brush, you're just applying some powder on it. Given that extra little bit of sunscreen you're getting,
Dr. Salvatore Pacella: [00:19:22] and two other followup questions on sunscreen. we hear a lot about, avabenzone. which is a very popular product and in sunscreens.
And my understanding is there's some data that shows that, it can be absorbed into the bloodstream. We don't quite know whether or not it's a carcinogen and the difference between the zinc titanium and avabenzone.
Nina Owen: [00:19:47] Difference between the two.
Dr. Salvatore Pacella: [00:19:49] So like the, so then some products are a lot of in the less expensive sunblocks, you get at CVS or whatever, the more expensive ones are the mineral type of sunblocks, your thoughts on those types and what, what you may tell patients.
Nina Owen: [00:20:04] I just feel like a lot of the store back, Brett. Bought products. They're the ones that run they're the runs are well, just with my experience. They seem to run a little bit more. don't last as long on the skin, they're not going to tolerate the water as well. You're sweating if you're, doing sporting activities.
So a lot of them are physician grade skincare products. I feel lasts a little longer on the skin. and they take into account, the eye area, and just longevity on the skin throughout the day.
Dr. Salvatore Pacella: [00:20:39] And how about the aerosols blocks or sunscreens that, again, I, a lot of, if you walk into CVS or writing or any drug store, there's, volumes of and products that have a application and for the moms out there that are taking care of young ones, the fight, hang on sunblock.
they may say, I'm just going to spray it on, and we're done, what are your thoughts
Nina Owen: [00:21:03] on that? I think if you're going to spray it on, that's great, but I think you should rub it into because everything is you're going to miss. So when you're spraying, I think you should maybe do a little rub on if you can.
I feel like
Dr. Salvatore Pacella: [00:21:15] if we talk, we use one of those I had to get in front of somewhere,
Nina Owen: [00:21:18] Yeah. You get that griping. that's why, a lot of the aerosols they're pretty big right now, too. I just say sprayed on it's great. It's quick, but rub that on too. So you're know that you're getting full coverage.
I can't tell you how many people on the beach and you can see it when they're laying there. There's that Stripe up their back. I just want to go over and spray them.
Dr. Sam Jejurikar: [00:21:41] in the last few minutes in our program, I want to switch gears just a little bit and talk about technology because, as surgeons, we are oftentimes somewhat skeptical about some of the.
The results that we can see with newer technologies that are out there. But I will say that in the last year or two, some of the things that we've been seeing with radio frequency and some of the other technologies we're going to talk about are going to be, are pretty impressive. So Nina, I want to switch gears first and talk to you about radio frequency and specifically your experience with it over the years and what you're seeing in the newer products that are out there
Nina Owen: [00:22:13] Radio-frequency, we are getting terrific results with it. we have the Morpheus eight, in particular that we have, at our medical spa. So we're getting tightening, we're getting toning with the Morpheus eight product radio-frequency and then there's also the Thermage FLX is radio frequency.
So I'm going to throw up a few pictures while you're talking here. can you guys see this? Okay. Is this a, is this coming up? Sam Sal. Hello. Okay, great. so you're talking about Morpheus eight. What is Morpheus? All? I, what I have known about is microneedling, and then all of a sudden Morpheus eight came about.
And, these are, and these are from, ultimate skin sores, which is affiliated with, dr. Rod work and it's David who, is a nurse injector. So we've taken these from his Instagram accounts.
Dr. Salvatore Pacella: [00:23:06] And you asked what is Morpheus? I thought you were going to say, what is the matrix
Dr. Sam Jejurikar: [00:23:09] exactly what is I always feel cheesy telling patients, Hey, you need Morpheus eight.
I don't know Morpheus one through seven are. what is this exactly
Nina Owen: [00:23:17] microneedling with radio frequency. So what it is, it's a fractional technology. And it has a micro pins that actually get inserted into the skin going down to the dermis, tiny little pin holes in the skin, which causes collagen production, tightening, toning, and it does have heat involved with it.
you definitely need a numbing cream, so I wouldn't do the treatment without a topical numbing cream for about 45 minutes to an hour. patients tolerate it well. you do feel it, it's not something that. it's not relaxing, but patients get amazing results with it.
Dr. Sam Jejurikar: [00:23:56] and the, I'm just, these are some body shots it's commonly used in the face jowls neck area as well.
Is there anything that people need to be aware of? It let's say they get Botox and fillers on a regular basis. Is there, is there any contraindication to doing radiofrequency treatments?
Nina Owen: [00:24:11] I think that with, I would always go with the injections a few days after because you can have some swelling if you're doing facial areas.
I always recommend, what, just wait three to five days before you get your Botox injections or Dysport, they're really, with injectable fillers, I would wait a little bit longer, because it will tend to just, Your filler won't last as long. If you're getting the treatments and you have your filler, so you might want to go through your series and Morpheus eight first and then go with your filler product after your series.
Dr. Sam Jejurikar: [00:24:46] Okay. And I've also heard, conversations about, Radio frequency, heat relative to have to cooling. So CoolSculpting is something that I think most of our viewers will be familiar with and it's been around for awhile. Yeah. And now all of a sudden we're using heat to dissolve fat and there's this nutrient evolve, which maybe you could tell us a little bit about which we don't even have as such new technology, but.
The pictures are pretty remarkable.
Nina Owen: [00:25:12] there's the system itself is called evolve and then there's three different hand pieces for the system. So there's one for tightening, one for toning. the toning one is the muscle stimulation. and then there's a tightening, toning and fat loss. Okay. The heat with that handpiece with the fat loss, it helps with the fat loss.
I'm a little bit more familiar with the toning, with a muscle stimulation, because we actually did a study with one of the tightening devices, for the muscle stimulation. Okay. and I think it's just for the toning end of it. I think it's just like exercise. You have to keep up with it.
Dr. Sam Jejurikar: [00:25:55] So is this so the tree, so I'm going to show a couple of pictures here that are off of Instagram from a variety of different, Med spa is a, we are not affiliated with, here's here is a four treatments of evolves type.
You can see that the patient clearly has lost some fat and has gotten some substantial skin tightening, pretty impressive for a nonsurgical treatment. Here's a patient that got four treatments of trim and tight. So what is trim? I'm confused by what these things are,
Nina Owen: [00:26:21] is the fat loss. Okay. So that's going to help with the fat loss.
And like I said, the device has evolved that it has three different. A hand pieces that treat the fat, the tightening, and then the muscle stimulation.
Dr. Sam Jejurikar: [00:26:34] I'm just curious what the other two plastic surgeons think about this as a nonsurgical result, four treatments of a noninvasive treatment. I want their feedback.
Dr. Sam Rhee: [00:26:44] it looks pretty impressive. but I have seen so many before and afters with so many devices in the past and then actually used them and it's always a, you can always get an amazing result with almost anything, but it's about consistency and degree of efficacy across a broad range of patients.
I think that's always the proof.
Dr. Sam Jejurikar: [00:27:07] Sure. For sure.
Nina Owen: [00:27:11] Go ahead. No, I just think that, you have to pick the, the right candidate for this type of procedure, because if they're a liposuction candidate, they're not going to get the results. That they're looking for through this type of device liposuction, you're always gonna get, my opinion, a better result with the liposuction.
Dr. Salvatore Pacella: [00:27:31] I think these are fantastic results. They look really good. I think, a lot of companies that, market these products, they have a little disclaimer at the bottom that says when, coupled with diet and exercise. I think, it's hard.
I think, honestly, to attribute what. What with patient lifestyle modification and what the device actually does just to echo what dr. Ray was talking about. And, I think for a lot of patients out there that are young busy professionals, they don't have a downtime. the average mom who's taking care of young ones, doesn't have the downtime to go do a full tummy tuck.
And so these sort of products are very nice because they can add a little bit of extra cost body contour, and without a major amount of downside.
Dr. Sam Jejurikar: [00:28:14] Yeah, I w I would echo what everyone is saying. I think it's echo what Nina is saying. I think patients need to know that technology is getting better, but surgical liposuction is still the most effective way to remove fat.
That being said to echo what Dr. Pacella was saying. There's no downtime with the majority of these procedures and you can even work while they're being done. Dr. Robert Woodfield, he's an Austin. Three treatments of, of evolve where this was, I guess all three, the trim, the tone and the tights are those the three.
Yeah. And, what I was particularly struck by this was not only the fat loss, but the skin tightening that came along with it as well. So it makes me really encouraged about what's. Possible, with noninvasive technology and it's never a substitute for diet and exercise, but in conjunction, there are some really exciting treatments that are out there
Nina Owen: [00:29:03] and you can also use them in combination with lipo. So after liposuction, you can use, B evolve or any kind of tightening toning. Post surgery.
Dr. Sam Jejurikar: [00:29:17] Yeah, exactly. I think that the potentials for actually synergy between surgery and noninvasive just allows us to get better and better results. The other thing I wanted to touch on really quickly in the last two minutes, we have some of the newer treatments that are out there for sun damage.
And I'll admit that I've always known about broadband light and, As a treatment, but some of the newer stuff is a little bit confusing to me. So you mind talking about some of the newer technology for sun damage and for broadband light that's out there?
Sure. the new, the new Moxy and BBL by Sciton, the Moxy, what that is a 1927 laser.
And, what makes us a little bit different that you can treat all skin. Yeah. Which is pretty amazing, all skin types throughout the year. So a lot of times in the summertime or laser treatments, back off a little bit, cause patients are getting a little bit more sun exposure with the Moxy. There's little to no downtime.
it's a fractionated laser. 1927 and it just, patients get great results it's for all skin types at all ages. So when you
say 1927, I think our viewers aren't gonna necessarily know what that means, but no, but is that, are you, what are you using it for? Are you using it to reverse aging or using it to treat sun damage?
Are you using it to treat pigment? who's a good candidate for a Moxy.
Nina Owen: [00:30:37] It's all of the above. So a pigmentation, it's amazing. If you have sun damage. The Moxy is great. It works with, fine lines and wrinkles, definitely texture of the skin. it's for all ages and it's little to no downtime. So for the patients that want to refresher or want to target some of that pigment, it's a really great treatment for that.
You have about two to four days of maybe a little bit of pepper into the skin, which means just a little bit of, it looks like you have a little bit of sand on your skin. There's not a lot of downtime, a little bit of redness after, but that's about it.
Dr. Sam Jejurikar: [00:31:14] and then in, and, Oh, sorry, I didn't mean to cut you off.
I'm sorry.
Nina Owen: [00:31:18] No, and just with a BBL, the new BBL broadband light, a lot of patients know it as, IPL, right? so they have the new it's called the hero, but basically it is the BBL or IPL on steroids. So it's four times faster, three times the energy, the power, and the cooling is two times higher than the normal BBL or their normal IPL.
Dr. Sam Jejurikar: [00:31:47] so it's more, is there a more comfortable as a result of that too, then?
Nina Owen: [00:31:50] It's definitely more comfortable. I was actually treated on my legs with the hero and it was definitely very comfortable. it's nice. It's quick. It's fast. And they use a gliding motion. Instead of just pulsing it, during the treatment.
So anyone that's had a BBL or IPL, it's a pulse and they use a, of coal crystal to treat. This is just gliding on this, like you're painting.
Dr. Sam Jejurikar: [00:32:18] And I understand that you can do the Moxy all year long, the broadband light treatment. Is that something you can also do all year round?
Nina Owen: [00:32:25] Yeah, I'd be a little bit more cautious with, the BBL. if somebody has a little bit more pigment to the skin, if they've had some recent sun exposure that hasn't changed, so you want to be a little bit more cautious with that. Okay.
Dr. Sam Jejurikar: [00:32:39] that's a lot of information. We just threw it everybody. So I appreciate you, spending a few minutes plus on Sunday morning to help with that.
do you guys have any questions about follow up about this new technology before we sign off?
Dr. Sam Rhee: [00:32:52] No, that was fantastic. I learned a lot and I am very interested to see as these new technologies continue to grow and evolve. It's very impressive. I think if you look at. The technology of these products from say 10 years ago to now, you can definitely see just how much more impactful they are.
And again, this is not something that most plastic surgeons that we, we have to keep up with this stuff because it's not stuff that we got very much of in training and whatever we learned back then was fairly outdated. And I'm very glad we have specialists like Nina to help guide us with this, with this technology.
Dr. Sam Jejurikar: [00:33:27] All right, Nina, thank you again so much. And,
Nina Owen: [00:33:29] it was great being here. Thank you very much.
Dr. Sam Jejurikar: [00:33:33] And with that, I guess we'll call it a show. Gentlemen, see you guys next week. Yes.
