WEBVTT
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Language: en
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Welcome to the Aesthetic Angle presented
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by Monarch Plastic Surgery, Kansas
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City's number one resource for all
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things cosmetic, wellness, skincare,
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injectables, and of course, plastic
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surgery. Today's topic is weight loss,
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especially after using GLP1s. I'm joined
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today by our nurse practitioner, Laura,
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and our nurse injector, Kirsten. So,
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we're going to talk about weight loss
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management medically. We're going to
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talk about how we help patients with
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fillers and injectables during their
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journey, as well as after they've
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maintained their weight. And of course,
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surgical options help them look their
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best after they've lost their weight.
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So, let's start with Laura. Hi, Laura.
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>> Hi.
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>> Before we jump into the surgical aspect
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of things, can you kind of briefly tell
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us how we do things at Monarch as far as
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starting with the consult process and
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how you help people along their journey?
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>> Yeah, I'd love to. So, when uh clients
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come to me looking for medical weight
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loss options, of course, we do have GLP1
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medications that we use that are very
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effective. I like to start by talking
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with the patients about their goals and
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typically we dive into nutrition. We
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want to ensure kind of what their diet
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modifications have been. Are they
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following any type of specific diet at
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this point? Obviously, we talk about
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exercise. Um, it's very important to get
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baseline metrics. We'll look at their
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lean muscle mass, their skeletal mass,
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uh, visceral fat as well as body fat.
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Putting that all together, we want to
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make a plan of dosing which medications
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appropriate from them and again focusing
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on healthy weight loss. Um not wanting
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them to lose weight too quickly,
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establishing I would say um just
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realistic expectations.
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Education is very important so they
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understand how the GLP-1 medications
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work as well as
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looking at protein goals um and diet
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because all of the studies were done
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with weight loss based on nutrition and
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exercise in combination with the
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medication. Um so we start there. We
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follow closely visits each month to get
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their weight, look at their body fat
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percentage again, adjust medication
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dosing, and talk about diet um and
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exercise.
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>> I love that. So, I like how you said
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it's healthy weight loss. So, other than
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medications, you're starting with the
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baseline labs, you're looking at the
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nutrition. Do do you recommend a
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specific diet or just tailor what
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they're already doing?
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>> That's a great question. Typically,
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we'll look at protein goals. So, 1.2 two
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to 1.5 grams per kilogram. So we do
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estab establish that for the patients
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and that gives them a good guide. We do
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talk about and give them a list of
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protein uh rich foods and the serving
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size. So we'll come up with ideas that
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they would like. Um I do recommend
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different protein shakes, which is a
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really easy way when you don't have a
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great appetite to ensure you're getting
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protein. So that can be 25 to 30 gram
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just from the shake alone. Um, we talk
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about high fiber foods. So, you still
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want to focus on whole foods. Um, that
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combination's a really good baseline and
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they can switch out foods that they
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like. Um, so that's where we start with
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the nutrition.
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>> Does anybody come in with their protein
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goals already met or do you have to
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>> I was just ask that like do people come
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in with their diet and exercise plans
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already in place or
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>> Yeah, you know, a lot of uh clients have
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maybe they're exercising two or three
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times a week. I typically recommend
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strength training. So, we're gonna avoid
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the muscle mass loss. Um, continue to
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keep lean muscle mass is really
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important when you are losing weight. We
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want to lose body fat verse muscle. Um,
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so we do focus on the strength training
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aspect um when it comes to the exercise
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and yeah, diet. Um, a lot of people are
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not getting the protein that they should
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anyway. When we talk about 100 grams of
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protein a day or maybe 120, they think
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that's a lot. But when we break it down
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to 25 to 30 3 to four times a day and
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spreading that out, it's actually doable
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and you'll work up to that. So I always
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tell clients, u let's work up to that.
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Maybe you're getting 60 65 g instead of
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some of those higher carbohydrate foods.
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We're going to switch it out for
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something and and I always tell the
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patients to um consume the protein first
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on the plate. That way they ensure
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they're getting it right instead of that
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full.
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>> Yeah, exactly. Because you're not going
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to have as as much of an appetite. So,
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yeah. So, we work through that.
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>> Okay. And with exercise, do you is it is
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obviously resistance, but is like do you
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have a plan for them? Do they see a
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trainer? Is there option?
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>> Yeah, that's a great question, too. Um,
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some are working out at gyms, so they go
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to classes doing Pilates. So, they're
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already doing something that's active.
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we may just adjust it a little bit, add
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in two days of like free weights. Um, we
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do kind of talk through that, but I like
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that clients can figure out what works
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for them. And, you know, with exercise,
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you want to be motivated. You want to do
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something that you're going to stick to.
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And so, that's really up to them to
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figure out what's right for me, where do
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I want to do I want to join a class,
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join a new gym, get a trainer is always
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a great option. So, it's more tailored
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to them. Um, yeah. and and depending on
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kind of their limitations or health in
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general, we may kind of adjust things as
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needed, more like yoga, more Pilates, if
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there's joint issues. Um, so we focus on
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that.
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>> Mhm.
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>> Yeah.
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>> You know, prior to GOP ones, we see the
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massive weight loss patients after
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surgery. They've lost 100 150 pounds.
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But I assume we're seeing everything
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across the board now from I mean, I'm
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seeing more like I lost 30 pounds, I
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lost 60 pounds. So in in your
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experience, where are your patients
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usually? Are they do they need to lose
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do they need to lose 30 50 100 I mean
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I'm sure it's all but I mean what do you
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see most commonly?
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>> Yeah the studies with GLP-1 medications
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um which is uh simaglletide or
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tzimpetide were done over a year and so
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20% on average weight loss. So again
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that's going to mean um depending on
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where you start you can you can
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hopefully get to that 20% with the diet
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and exercise. Again that's really
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important to stress it's not just
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medication. you're really wanting to
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make some changes and even coming off
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the medication. I get that question a
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lot. Can I come off of a GLP1 or take a
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lower dose and still maintain the weight
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loss? That's highly dependent to have
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you changed some of your habits. Um, you
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know, can we spread out the medication
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where you're not taking such a high
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dose?
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>> Um, yeah, it's really all over the
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board. GLP1s are very um powerful
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medications. They work really well. So,
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again, kind of getting patients to that
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goal. if it's 40 pounds, you know, where
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they want to feel better, improve their
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health outcomes, we may have to again
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make some diet changes, increase protein
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as we're going, um, and play around with
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the dose. So, it's really all over the
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board.
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>> Okay.
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>> Yeah.
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>> Well, it could be very rewarding because
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not only are people looking better,
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they're feeling better, but they're all
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they're also making them healthier. I
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mean, you see patient, I'm I'm no longer
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diabetic. Yes.
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>> I'm no longer on insulin. And they're
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have a longer life. I mean, you're
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really changing their entire life from
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every aspect from inside to outside. So,
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it's got to be very rewarding.
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>> It is. Yeah. And I think especially as
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you said, they feel better, more
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confident, um more energy, they're
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sleeping better. So, they have all these
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subjective um you know, improvements,
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but objectively their lipid panel
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improves, inflammation goes down
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metabolically, their A1C, which is your
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average glucose over 3 months is better.
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Um everything improves. their immune
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function is secondary to that when you
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drop inflammation, better metabolic
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flexibility. Um they have less joint
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pain. I've had patients who have um
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postponed a hip replacement or a knee
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replacement, which is great, too. Um
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just by losing 20 or 30 pounds. So yeah,
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all around it it's um if it's done the
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right way, it can improve your health um
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in so many different outcomes.
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>> Well, think about also just the way
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everything in your life improves. you
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know, it's not just your health, but
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even like your relationships and like I
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don't know, just when you when you feel
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better,
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>> everything outwardly is better. You
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know, you're truly changing the wellness
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of the entire person.
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>> Yes.
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>> It's amazing.
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>> Just a positive outlook about
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everything.
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>> Yes. Absolutely.
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>> Yeah.
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>> When you talk about inflammation, that's
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really diet primarily, right? I mean,
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you're cutting out the sugar and the
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ultrarocessed foods. That really is
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what's decreasing the inflammation
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you're speaking of. Correct.
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>> Yeah. And when we have more visceral
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fat, we have more, you know, higher uh
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body fat percentage,
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>> typically you're going to have higher
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systemic inflammation. And so when we're
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improving that glucose control, we're
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losing that um that body fat. Yeah.
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You're overall decreasing in
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inflammation in the joints um and the
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organs, the tissues. Um so yeah,
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>> that's great.
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>> Yeah.
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>> So Kirsten,
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>> you're obviously seeing some weight loss
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patients and some that aren't. Yes.
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>> So, can you uh elaborate for us how you
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treat someone differently whether
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they're in the process in the journey of
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weight loss or if they reach their goal?
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>> Yes.
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>> Can you talk about how you consult with
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those patients?
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>> Yeah, I mean I definitely see a wide
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variety of patients. Um,
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I think my ideal situation is seeing a
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patient that is just starting up on
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their weight loss journey and we can
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kind of get on top of any weight loss
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that they are seeing that they would be
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seeing in their face because um I think
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it it's really patient dependent. Um,
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but people do see some sort of weight
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loss in their face. Um, whether that's
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you know fat loss or skin laxity, skin
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quality. um just decreasing. Um not all
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patients are going to have that, but
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it's good to get on top of that. So, one
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of the things that I like to do is start
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those patients on a plan for Sculptra,
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which is a collagen stimulator. So, if
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we can start stimulating that collagen
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at that beginning of their weight loss
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journey, it's just going to bode better
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for them in the future because we're
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going to be stimulating collagen as
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they're losing weight. we're I like to
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call it investing in their collagen
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bank, you know, so we can we can start
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that collagen ball rolling. Um we can
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target areas that we typically would see
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volume loss. Um and sculpture is a great
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treatment because you do treat the whole
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entire face. So you're stimulating
00:10:23.920 --> 00:10:26.630
collagen growth. Um sculpture is a
00:10:26.640 --> 00:10:30.389
longer duration to see your results. So,
00:10:30.399 --> 00:10:33.030
um, I would say, you know, up to 6
00:10:33.040 --> 00:10:35.190
months after their final treatment,
00:10:35.200 --> 00:10:37.269
we're still seeing collagen production.
00:10:37.279 --> 00:10:39.670
Um, so that's why it's good to get on
00:10:39.680 --> 00:10:41.910
the ball of let's start this as you're
00:10:41.920 --> 00:10:44.550
starting your weight loss and we'll just
00:10:44.560 --> 00:10:46.550
see the benefits as you're seeing the
00:10:46.560 --> 00:10:48.790
benefits from the weight loss. Um,
00:10:48.800 --> 00:10:50.389
>> so sculpture is different from a typical
00:10:50.399 --> 00:10:51.590
HA filler.
00:10:51.600 --> 00:10:52.150
>> Definitely.
00:10:52.160 --> 00:10:54.310
>> So, can you describe for us kind of how
00:10:54.320 --> 00:10:56.150
you use sculpture? like you have to mix
00:10:56.160 --> 00:10:58.150
it and do some things then you see some
00:10:58.160 --> 00:11:00.069
swag initially then it kind of goes
00:11:00.079 --> 00:11:01.910
away. Can you kind of dive into that for
00:11:01.920 --> 00:11:02.069
me?
00:11:02.079 --> 00:11:05.670
>> Yeah, you said it all. Um so I would say
00:11:05.680 --> 00:11:09.269
so Sculptra comes as a powder. We mix it
00:11:09.279 --> 00:11:11.750
with sterile water. We inject it
00:11:11.760 --> 00:11:14.710
throughout the face. Um you can hit lots
00:11:14.720 --> 00:11:16.790
of different areas like I said temples,
00:11:16.800 --> 00:11:19.350
cheeks, jawline, kind of the front part
00:11:19.360 --> 00:11:22.389
of those cheeks. um the the smile lines
00:11:22.399 --> 00:11:25.030
down in that the chin chin shadows. So
00:11:25.040 --> 00:11:26.230
you can hit all these different areas
00:11:26.240 --> 00:11:29.350
with sculpture. Um initially you are
00:11:29.360 --> 00:11:31.670
going to see that sculpture kind of
00:11:31.680 --> 00:11:33.509
filling in areas but a lot of what
00:11:33.519 --> 00:11:35.990
you're seeing is the fluid that sterile
00:11:36.000 --> 00:11:38.389
water um with the sculpture suspended
00:11:38.399 --> 00:11:41.110
into it. Your body will then absorb all
00:11:41.120 --> 00:11:43.590
that water. Um so a couple days later it
00:11:43.600 --> 00:11:46.150
feels like nothing happened. Um but then
00:11:46.160 --> 00:11:48.710
over time your body will be stimulating
00:11:48.720 --> 00:11:51.110
collagen growth and that's when you
00:11:51.120 --> 00:11:54.150
start to see the real benefits of the um
00:11:54.160 --> 00:11:57.670
improved skin texture and quality um
00:11:57.680 --> 00:12:01.670
volume um loss gets better or you're
00:12:01.680 --> 00:12:03.350
just building collagen in those areas
00:12:03.360 --> 00:12:05.509
where you're seeing um volume loss.
00:12:05.519 --> 00:12:06.710
>> And that's typically a series of
00:12:06.720 --> 00:12:08.629
treatments. series of treatments at
00:12:08.639 --> 00:12:11.910
least two um sometimes three depending
00:12:11.920 --> 00:12:14.870
on the the level of volume loss that
00:12:14.880 --> 00:12:15.750
we're trying to correct.
00:12:15.760 --> 00:12:17.590
>> And then what's the maintenance after?
00:12:17.600 --> 00:12:19.269
>> Um typically just one maintenance
00:12:19.279 --> 00:12:23.430
treatment per year. A standard treatment
00:12:23.440 --> 00:12:25.750
is going to be multiple vials, usually
00:12:25.760 --> 00:12:28.310
one per side of the face of Sculptra. Um
00:12:28.320 --> 00:12:30.069
and then a maintenance treatment
00:12:30.079 --> 00:12:32.550
annually is going to be just one vial
00:12:32.560 --> 00:12:35.110
annually to maintain those results.
00:12:35.120 --> 00:12:37.509
>> Okay. Well, for me, you know, my
00:12:37.519 --> 00:12:40.150
favorite filler is fat. So,
00:12:40.160 --> 00:12:40.629
>> yeah,
00:12:40.639 --> 00:12:42.629
>> in spite of all their weight loss, if
00:12:42.639 --> 00:12:44.230
I'm doing a facial procedure,
00:12:44.240 --> 00:12:46.230
rejuvenation procedure after weight loss
00:12:46.240 --> 00:12:47.829
or just from aging, you know, I
00:12:47.839 --> 00:12:49.190
typically use fat
00:12:49.200 --> 00:12:50.870
>> because it's the best. It has the stem
00:12:50.880 --> 00:12:53.430
cells. It's your tissue, you know.
00:12:53.440 --> 00:12:53.750
>> Yeah.
00:12:53.760 --> 00:12:56.629
>> But you do have to um have a donor site.
00:12:56.639 --> 00:12:57.829
You have to harvest the fat from
00:12:57.839 --> 00:12:59.110
somewhere. You got to do lipo suction.
00:12:59.120 --> 00:13:00.470
You got to collect it sterily, wash it,
00:13:00.480 --> 00:13:02.550
then reinject it. And so, if I'm doing a
00:13:02.560 --> 00:13:04.550
face lip procedure, it does uh tend to
00:13:04.560 --> 00:13:06.150
make patient a little more swollen. Mhm.
00:13:06.160 --> 00:13:08.230
>> And you do overfill because you're only
00:13:08.240 --> 00:13:10.389
going to get 50 to 70% take.
00:13:10.399 --> 00:13:12.629
>> So, it does prolong the uh downtime a
00:13:12.639 --> 00:13:14.150
little bit, but it's still my favorite
00:13:14.160 --> 00:13:15.350
filler. But, of course, you know,
00:13:15.360 --> 00:13:17.750
there's there's, you know, good things
00:13:17.760 --> 00:13:18.949
and bad things about everything we do,
00:13:18.959 --> 00:13:20.150
right? There's always options.
00:13:20.160 --> 00:13:21.590
>> How long would you say it takes to get
00:13:21.600 --> 00:13:24.389
to your final result after doing a fat
00:13:24.399 --> 00:13:25.350
transfer?
00:13:25.360 --> 00:13:28.710
>> Uh, I would say 6 weeks it's it's done.
00:13:28.720 --> 00:13:29.990
You're going to keep the rest of that.
00:13:30.000 --> 00:13:30.310
>> Yeah,
00:13:30.320 --> 00:13:32.069
>> I would say six weeks on average. And
00:13:32.079 --> 00:13:34.550
are you typically doing those with in
00:13:34.560 --> 00:13:36.230
combination with a facelift?
00:13:36.240 --> 00:13:36.949
>> Yes.
00:13:36.959 --> 00:13:38.150
>> Yeah. It'd be very rare to do that in
00:13:38.160 --> 00:13:38.790
isolation.
00:13:38.800 --> 00:13:39.350
>> Yeah.
00:13:39.360 --> 00:13:42.949
>> So, but for me, you know, I see patients
00:13:42.959 --> 00:13:44.629
sometimes during their journey and
00:13:44.639 --> 00:13:47.110
sometimes uh they're already stable. So,
00:13:47.120 --> 00:13:48.949
I want them to be at a stable weight for
00:13:48.959 --> 00:13:51.030
6 months before we do anything.
00:13:51.040 --> 00:13:52.550
>> And then it really just depends on where
00:13:52.560 --> 00:13:54.710
they want to start. You know, of course,
00:13:54.720 --> 00:13:56.949
most commonly we're doing tummy tucks.
00:13:56.959 --> 00:13:58.389
There are different types of tummy tucks
00:13:58.399 --> 00:13:59.750
available to people depending on their
00:13:59.760 --> 00:14:01.829
needs. There are many tummy tucks where
00:14:01.839 --> 00:14:03.670
we don't tighten the muscle. We're just
00:14:03.680 --> 00:14:04.710
working on the lower half of the
00:14:04.720 --> 00:14:06.389
abdomen. There are full tummy tucks
00:14:06.399 --> 00:14:08.389
where we are doing lipo suction with
00:14:08.399 --> 00:14:10.310
skin removal and muscle tightening.
00:14:10.320 --> 00:14:12.470
There are fluid delete tummy tucks where
00:14:12.480 --> 00:14:15.110
if someone's lost, you know, 150 pounds.
00:14:15.120 --> 00:14:16.629
We not only the typical bikini line
00:14:16.639 --> 00:14:19.030
incision, we add a vertical component to
00:14:19.040 --> 00:14:21.110
bring in the tissues and ver both the
00:14:21.120 --> 00:14:23.350
horizontal and vertical planes.
00:14:23.360 --> 00:14:25.430
Um, if someone's really lost a ton of
00:14:25.440 --> 00:14:28.230
weight, say 150, 200 lb, then I will
00:14:28.240 --> 00:14:29.829
usually come back and do reverse tummy
00:14:29.839 --> 00:14:31.750
tuck after that, which means I'm pulling
00:14:31.760 --> 00:14:35.110
from the bottom up because you can't if
00:14:35.120 --> 00:14:36.949
they some people have multiple folds on
00:14:36.959 --> 00:14:38.230
their abdomen if they've really been
00:14:38.240 --> 00:14:40.389
heavy. And so the tummy tuck would treat
00:14:40.399 --> 00:14:42.629
the lower half, but there's this upper
00:14:42.639 --> 00:14:46.230
laxity. You can't just lift the entire
00:14:46.240 --> 00:14:48.550
abdominal skin off the off the uh
00:14:48.560 --> 00:14:50.629
abdominal wall. It needs a blood supply.
00:14:50.639 --> 00:14:52.470
So, we come back and pull from the top
00:14:52.480 --> 00:14:54.870
to get that upper uh tightness we didn't
00:14:54.880 --> 00:14:57.110
quite get from the first time. So, um
00:14:57.120 --> 00:14:59.030
it's it's a process, but you know, we
00:14:59.040 --> 00:15:00.470
can still end up with a flat tummy
00:15:00.480 --> 00:15:01.189
usually.
00:15:01.199 --> 00:15:04.550
>> Yeah. Do you feel like you see more
00:15:04.560 --> 00:15:06.710
weight loss patients coming into you
00:15:06.720 --> 00:15:08.710
with concerns about body or would you
00:15:08.720 --> 00:15:09.990
say it's face?
00:15:10.000 --> 00:15:10.870
>> More about body.
00:15:10.880 --> 00:15:11.350
>> Body.
00:15:11.360 --> 00:15:12.949
>> Our most our most common procedures
00:15:12.959 --> 00:15:15.670
would be a tummy tuck of some sort and
00:15:15.680 --> 00:15:17.670
arm lifts and then thirdly would be
00:15:17.680 --> 00:15:18.550
thigh lifts.
00:15:18.560 --> 00:15:20.790
>> Okay. But of course, facelifts, you
00:15:20.800 --> 00:15:22.310
know, too. So,
00:15:22.320 --> 00:15:25.509
>> yeah. Yeah. So, I've had a couple um a
00:15:25.519 --> 00:15:27.110
handful of patients either before or
00:15:27.120 --> 00:15:29.910
after that are looking for um
00:15:29.920 --> 00:15:32.389
liposuction or, you know, and they need
00:15:32.399 --> 00:15:34.230
to lose weight as you mentioned and be
00:15:34.240 --> 00:15:36.710
stable um so that that procedure,
00:15:36.720 --> 00:15:38.470
whatever they're aiming for and their
00:15:38.480 --> 00:15:41.189
goals are going to be better outcomes
00:15:41.199 --> 00:15:42.230
for them. Right.
00:15:42.240 --> 00:15:44.550
>> So, I've had and I also had um a client
00:15:44.560 --> 00:15:46.629
who had had lipos suction on her abdomen
00:15:46.639 --> 00:15:49.430
and thighs, had been on a GLP1,
00:15:49.440 --> 00:15:51.189
unfortunately went off and g started
00:15:51.199 --> 00:15:53.509
gaining weight. And so, she came back to
00:15:53.519 --> 00:15:55.670
see me. We put her back on a lowd dose
00:15:55.680 --> 00:15:58.710
GLP-1, really worked on nutrition to get
00:15:58.720 --> 00:16:00.150
some of that weight she had started
00:16:00.160 --> 00:16:03.269
gaining off as well as um just maintain
00:16:03.279 --> 00:16:06.629
her so that her results were um could
00:16:06.639 --> 00:16:09.269
last and she you know felt good and
00:16:09.279 --> 00:16:11.990
didn't have to um go back and do surgery
00:16:12.000 --> 00:16:14.470
again of course and repair anything. So
00:16:14.480 --> 00:16:16.389
there's yeah lots of different patients,
00:16:16.399 --> 00:16:17.749
lots of different, you know, treatments
00:16:17.759 --> 00:16:19.350
they've had and how we can all work
00:16:19.360 --> 00:16:22.389
together. Um, again with the Sculptra or
00:16:22.399 --> 00:16:25.030
Filler and all the the cosmetic
00:16:25.040 --> 00:16:27.430
procedures they can do. So it's really a
00:16:27.440 --> 00:16:29.990
one-stop shop here. You can, you know,
00:16:30.000 --> 00:16:31.590
see any of the providers that you need
00:16:31.600 --> 00:16:32.710
are here. So
00:16:32.720 --> 00:16:34.470
>> yeah, and for me, it really depends on
00:16:34.480 --> 00:16:36.230
their age and and the amount of weight
00:16:36.240 --> 00:16:37.910
loss. You know, someone's young in their
00:16:37.920 --> 00:16:39.189
20s or 30s losing weight, they're not
00:16:39.199 --> 00:16:40.870
going to need a facelift. This will be
00:16:40.880 --> 00:16:42.949
more the body, right? you know, again,
00:16:42.959 --> 00:16:45.430
typically tummy, then arms and thighs.
00:16:45.440 --> 00:16:47.030
But if someone's older,
00:16:47.040 --> 00:16:48.470
>> you know, we age, we all could use some
00:16:48.480 --> 00:16:50.150
facial tuneups anyway, but you add the
00:16:50.160 --> 00:16:51.269
weight loss to it, they can be more
00:16:51.279 --> 00:16:52.870
dramatic. So then we're doing upper
00:16:52.880 --> 00:16:55.829
eyelids, you know, lower eyelids, face
00:16:55.839 --> 00:16:58.550
and neck is a big one with weight loss,
00:16:58.560 --> 00:17:01.189
>> skin laxing the neck, extra fat deposits
00:17:01.199 --> 00:17:02.870
that just are resistant to the weight
00:17:02.880 --> 00:17:04.870
loss. And at Monarch, you know, we offer
00:17:04.880 --> 00:17:06.710
the deep plane facelift in the office of
00:17:06.720 --> 00:17:08.150
local anesthesia if they want that or we
00:17:08.160 --> 00:17:09.350
can go to the surgery center. It's their
00:17:09.360 --> 00:17:11.510
preference. We also offer the deep neck
00:17:11.520 --> 00:17:14.710
lift so we can really contour the necks
00:17:14.720 --> 00:17:16.710
and faces, those jaw lines, get that get
00:17:16.720 --> 00:17:19.189
that angle back and give them a a
00:17:19.199 --> 00:17:20.949
natural faceelift, but something that's
00:17:20.959 --> 00:17:23.590
significant. Um, so it really depends
00:17:23.600 --> 00:17:25.590
on, you know, what they want and the
00:17:25.600 --> 00:17:27.029
order they want to do it in and, you
00:17:27.039 --> 00:17:28.950
know, whether it's a local or general
00:17:28.960 --> 00:17:30.870
anesthesia.
00:17:30.880 --> 00:17:32.870
>> Laura, I do have a question for you. I
00:17:32.880 --> 00:17:35.110
see um
00:17:35.120 --> 00:17:37.750
I don't see as many patients coming from
00:17:37.760 --> 00:17:41.430
you that have a lot of volume loss in
00:17:41.440 --> 00:17:45.110
their face, but I see it so often um
00:17:45.120 --> 00:17:46.710
they've come from a different company or
00:17:46.720 --> 00:17:48.390
different office and they've had a lot
00:17:48.400 --> 00:17:50.630
of volume loss in their face. Is there
00:17:50.640 --> 00:17:53.029
anything in particular that you do with
00:17:53.039 --> 00:17:54.789
your weight loss patients to prevent
00:17:54.799 --> 00:17:56.710
something like that from happening? And
00:17:56.720 --> 00:17:58.150
do patients come to you with those
00:17:58.160 --> 00:17:59.350
concerns?
00:17:59.360 --> 00:18:00.710
>> That's a great question. And you know,
00:18:00.720 --> 00:18:02.390
I've had patients that are just starting
00:18:02.400 --> 00:18:04.789
out. So, we really again want to focus
00:18:04.799 --> 00:18:06.470
on the nutrition aspect with the
00:18:06.480 --> 00:18:09.669
protein, um, with the exercise, um, and
00:18:09.679 --> 00:18:11.909
weight loss, doing it steady and not
00:18:11.919 --> 00:18:14.150
quick. And of course, patients want a
00:18:14.160 --> 00:18:16.630
fast result. So, they get worried
00:18:16.640 --> 00:18:19.430
sometimes. I only lost 5 lbs this month.
00:18:19.440 --> 00:18:20.630
Well, that's still a lot of weight. It's
00:18:20.640 --> 00:18:22.789
one pound a week, a little bit more. And
00:18:22.799 --> 00:18:25.750
so, we will sometimes just titrate the
00:18:25.760 --> 00:18:28.630
medication more slowly. And as you're
00:18:28.640 --> 00:18:30.470
asking, I do have patients that have
00:18:30.480 --> 00:18:32.310
come from other weight loss clinics.
00:18:32.320 --> 00:18:34.630
Maybe it was an online um source where
00:18:34.640 --> 00:18:36.470
they were getting it. They've told me
00:18:36.480 --> 00:18:38.630
they didn't have a lot of direction with
00:18:38.640 --> 00:18:42.150
nutrition um with, you know, a steady um
00:18:42.160 --> 00:18:44.310
just the monitoring and adjustments of
00:18:44.320 --> 00:18:47.029
the medications so that they had um
00:18:47.039 --> 00:18:50.789
steady weight loss. Um, so that probably
00:18:50.799 --> 00:18:52.230
would be the one thing would be
00:18:52.240 --> 00:18:53.750
different that we're able to do is
00:18:53.760 --> 00:18:56.150
provide a tighter management and control
00:18:56.160 --> 00:18:58.549
um, for these patients. Um, yeah, and
00:18:58.559 --> 00:19:00.230
you know, I was also going to say I
00:19:00.240 --> 00:19:02.870
typically don't see as much volume loss
00:19:02.880 --> 00:19:05.430
with um, the younger clients cuz I have
00:19:05.440 --> 00:19:07.510
patients of all age. They have better
00:19:07.520 --> 00:19:09.029
quality collagen to begin with and
00:19:09.039 --> 00:19:11.190
elastin. And so they're losing weight
00:19:11.200 --> 00:19:12.710
and you typically don't lose weight and
00:19:12.720 --> 00:19:14.630
just like it's not a spot treatment. And
00:19:14.640 --> 00:19:16.470
I've had clients say, "Well, can I just
00:19:16.480 --> 00:19:18.070
lose weight off my abdomen or my
00:19:18.080 --> 00:19:19.909
thighs?" So, it doesn't Unfortunately,
00:19:19.919 --> 00:19:21.029
it doesn't work like that.
00:19:21.039 --> 00:19:22.310
>> No, you never lose it where you want to
00:19:22.320 --> 00:19:22.710
lose it.
00:19:22.720 --> 00:19:25.830
>> Exactly. Right. You're los
00:19:25.840 --> 00:19:28.549
volume in my face. So, um you can't
00:19:28.559 --> 00:19:30.789
always tell, especially everyone's, um
00:19:30.799 --> 00:19:33.350
body composition is different. And so,
00:19:33.360 --> 00:19:36.070
yeah, but my the older patients um the
00:19:36.080 --> 00:19:38.630
clients are where you typically do see
00:19:38.640 --> 00:19:40.789
more volume loss in the face, especially
00:19:40.799 --> 00:19:42.390
if they have a lot of weight to lose.
00:19:42.400 --> 00:19:44.470
And so that's when it's appropriate and
00:19:44.480 --> 00:19:45.909
perfect to send them to one of our
00:19:45.919 --> 00:19:48.390
injectors um to get a consult and see if
00:19:48.400 --> 00:19:50.310
there's anything that could help um
00:19:50.320 --> 00:19:52.710
prevent that or replace some of that
00:19:52.720 --> 00:19:53.190
volume.
00:19:53.200 --> 00:19:54.150
>> Right.
00:19:54.160 --> 00:19:56.150
>> Okay. Well, I hope if you're considering
00:19:56.160 --> 00:19:57.669
a weight loss journey or you've already
00:19:57.679 --> 00:19:59.590
started and you need some help, you can
00:19:59.600 --> 00:20:01.430
tell that Laura is very passionate about
00:20:01.440 --> 00:20:04.230
this and that is that just gives her so
00:20:04.240 --> 00:20:06.950
much satisfaction in life helping people
00:20:06.960 --> 00:20:09.190
achieve their goals. Kersonen obviously
00:20:09.200 --> 00:20:13.029
is uh excellent at facial rejuvenation,
00:20:13.039 --> 00:20:15.270
giving uh appropriate contours, looks
00:20:15.280 --> 00:20:17.430
very natural, it's not overdone, and so
00:20:17.440 --> 00:20:18.630
we're just here for you at Monarch. We
00:20:18.640 --> 00:20:19.750
want to help you with this weight loss
00:20:19.760 --> 00:20:21.990
journey. We're here for the nutrition,
00:20:22.000 --> 00:20:24.470
the medication, the counseling, the
00:20:24.480 --> 00:20:27.110
injectors, and if needed, surgery. And I
00:20:27.120 --> 00:20:28.310
love helping people look better and feel
00:20:28.320 --> 00:20:29.669
better about themselves. It's been my
00:20:29.679 --> 00:20:31.590
passion for the past 23 years. So, if
00:20:31.600 --> 00:20:33.350
you're considering this, contact us at
00:20:33.360 --> 00:20:37.240
Monarch. Thank you.
Kind: captions
Language: en
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Welcome to the Aesthetic Angle presented
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by Monarch Plastic Surgery, Kansas
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City's number one resource for all
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things cosmetic, wellness, skincare,
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injectables, and of course, plastic
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surgery. Today's topic is weight loss,
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especially after using GLP1s. I'm joined
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today by our nurse practitioner, Laura,
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and our nurse injector, Kirsten. So,
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we're going to talk about weight loss
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management medically. We're going to
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talk about how we help patients with
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fillers and injectables during their
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journey, as well as after they've
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maintained their weight. And of course,
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surgical options help them look their
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best after they've lost their weight.
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So, let's start with Laura. Hi, Laura.
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>> Hi.
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>> Before we jump into the surgical aspect
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of things, can you kind of briefly tell
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us how we do things at Monarch as far as
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starting with the consult process and
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how you help people along their journey?
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>> Yeah, I'd love to. So, when uh clients
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come to me looking for medical weight
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loss options, of course, we do have GLP1
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medications that we use that are very
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effective. I like to start by talking
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with the patients about their goals and
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typically we dive into nutrition. We
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want to ensure kind of what their diet
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modifications have been. Are they
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following any type of specific diet at
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this point? Obviously, we talk about
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exercise. Um, it's very important to get
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baseline metrics. We'll look at their
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lean muscle mass, their skeletal mass,
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uh, visceral fat as well as body fat.
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Putting that all together, we want to
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make a plan of dosing which medications
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appropriate from them and again focusing
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on healthy weight loss. Um not wanting
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them to lose weight too quickly,
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establishing I would say um just
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realistic expectations.
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Education is very important so they
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understand how the GLP-1 medications
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work as well as
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looking at protein goals um and diet
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because all of the studies were done
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with weight loss based on nutrition and
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exercise in combination with the
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medication. Um so we start there. We
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follow closely visits each month to get
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their weight, look at their body fat
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percentage again, adjust medication
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dosing, and talk about diet um and
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exercise.
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>> I love that. So, I like how you said
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it's healthy weight loss. So, other than
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medications, you're starting with the
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baseline labs, you're looking at the
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nutrition. Do do you recommend a
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specific diet or just tailor what
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they're already doing?
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>> That's a great question. Typically,
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we'll look at protein goals. So, 1.2 two
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to 1.5 grams per kilogram. So we do
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estab establish that for the patients
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and that gives them a good guide. We do
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talk about and give them a list of
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protein uh rich foods and the serving
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size. So we'll come up with ideas that
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they would like. Um I do recommend
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different protein shakes, which is a
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really easy way when you don't have a
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great appetite to ensure you're getting
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protein. So that can be 25 to 30 gram
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just from the shake alone. Um, we talk
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about high fiber foods. So, you still
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want to focus on whole foods. Um, that
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combination's a really good baseline and
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they can switch out foods that they
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like. Um, so that's where we start with
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the nutrition.
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>> Does anybody come in with their protein
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goals already met or do you have to
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>> I was just ask that like do people come
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in with their diet and exercise plans
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already in place or
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>> Yeah, you know, a lot of uh clients have
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maybe they're exercising two or three
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times a week. I typically recommend
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strength training. So, we're gonna avoid
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the muscle mass loss. Um, continue to
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keep lean muscle mass is really
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important when you are losing weight. We
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want to lose body fat verse muscle. Um,
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so we do focus on the strength training
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aspect um when it comes to the exercise
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and yeah, diet. Um, a lot of people are
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not getting the protein that they should
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anyway. When we talk about 100 grams of
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protein a day or maybe 120, they think
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that's a lot. But when we break it down
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to 25 to 30 3 to four times a day and
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spreading that out, it's actually doable
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and you'll work up to that. So I always
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tell clients, u let's work up to that.
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Maybe you're getting 60 65 g instead of
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some of those higher carbohydrate foods.
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We're going to switch it out for
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something and and I always tell the
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patients to um consume the protein first
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on the plate. That way they ensure
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they're getting it right instead of that
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full.
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>> Yeah, exactly. Because you're not going
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to have as as much of an appetite. So,
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yeah. So, we work through that.
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>> Okay. And with exercise, do you is it is
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obviously resistance, but is like do you
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have a plan for them? Do they see a
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trainer? Is there option?
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>> Yeah, that's a great question, too. Um,
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some are working out at gyms, so they go
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to classes doing Pilates. So, they're
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already doing something that's active.
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we may just adjust it a little bit, add
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in two days of like free weights. Um, we
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do kind of talk through that, but I like
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that clients can figure out what works
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for them. And, you know, with exercise,
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you want to be motivated. You want to do
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something that you're going to stick to.
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And so, that's really up to them to
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figure out what's right for me, where do
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I want to do I want to join a class,
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join a new gym, get a trainer is always
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a great option. So, it's more tailored
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to them. Um, yeah. and and depending on
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kind of their limitations or health in
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general, we may kind of adjust things as
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needed, more like yoga, more Pilates, if
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there's joint issues. Um, so we focus on
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that.
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>> Mhm.
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>> Yeah.
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>> You know, prior to GOP ones, we see the
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massive weight loss patients after
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surgery. They've lost 100 150 pounds.
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But I assume we're seeing everything
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across the board now from I mean, I'm
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seeing more like I lost 30 pounds, I
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lost 60 pounds. So in in your
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experience, where are your patients
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usually? Are they do they need to lose
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do they need to lose 30 50 100 I mean
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I'm sure it's all but I mean what do you
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see most commonly?
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>> Yeah the studies with GLP-1 medications
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um which is uh simaglletide or
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tzimpetide were done over a year and so
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20% on average weight loss. So again
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that's going to mean um depending on
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where you start you can you can
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hopefully get to that 20% with the diet
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and exercise. Again that's really
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important to stress it's not just
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medication. you're really wanting to
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make some changes and even coming off
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the medication. I get that question a
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lot. Can I come off of a GLP1 or take a
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lower dose and still maintain the weight
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loss? That's highly dependent to have
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you changed some of your habits. Um, you
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know, can we spread out the medication
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where you're not taking such a high
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dose?
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>> Um, yeah, it's really all over the
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board. GLP1s are very um powerful
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medications. They work really well. So,
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again, kind of getting patients to that
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goal. if it's 40 pounds, you know, where
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they want to feel better, improve their
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health outcomes, we may have to again
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make some diet changes, increase protein
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as we're going, um, and play around with
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the dose. So, it's really all over the
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board.
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>> Okay.
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>> Yeah.
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>> Well, it could be very rewarding because
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not only are people looking better,
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they're feeling better, but they're all
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they're also making them healthier. I
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mean, you see patient, I'm I'm no longer
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diabetic. Yes.
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>> I'm no longer on insulin. And they're
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have a longer life. I mean, you're
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really changing their entire life from
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every aspect from inside to outside. So,
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it's got to be very rewarding.
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>> It is. Yeah. And I think especially as
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you said, they feel better, more
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confident, um more energy, they're
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sleeping better. So, they have all these
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subjective um you know, improvements,
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but objectively their lipid panel
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improves, inflammation goes down
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metabolically, their A1C, which is your
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average glucose over 3 months is better.
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Um everything improves. their immune
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function is secondary to that when you
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drop inflammation, better metabolic
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flexibility. Um they have less joint
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pain. I've had patients who have um
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postponed a hip replacement or a knee
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replacement, which is great, too. Um
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just by losing 20 or 30 pounds. So yeah,
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all around it it's um if it's done the
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right way, it can improve your health um
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in so many different outcomes.
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>> Well, think about also just the way
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everything in your life improves. you
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know, it's not just your health, but
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even like your relationships and like I
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don't know, just when you when you feel
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better,
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>> everything outwardly is better. You
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know, you're truly changing the wellness
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of the entire person.
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>> Yes.
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>> It's amazing.
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>> Just a positive outlook about
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everything.
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>> Yes. Absolutely.
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>> Yeah.
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>> When you talk about inflammation, that's
00:08:16.000 --> 00:08:17.909
really diet primarily, right? I mean,
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you're cutting out the sugar and the
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ultrarocessed foods. That really is
00:08:20.560 --> 00:08:21.909
what's decreasing the inflammation
00:08:21.919 --> 00:08:23.029
you're speaking of. Correct.
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>> Yeah. And when we have more visceral
00:08:24.960 --> 00:08:27.830
fat, we have more, you know, higher uh
00:08:27.840 --> 00:08:29.670
body fat percentage,
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>> typically you're going to have higher
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systemic inflammation. And so when we're
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improving that glucose control, we're
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losing that um that body fat. Yeah.
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You're overall decreasing in
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inflammation in the joints um and the
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organs, the tissues. Um so yeah,
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>> that's great.
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>> Yeah.
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>> So Kirsten,
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>> you're obviously seeing some weight loss
00:08:51.279 --> 00:08:53.190
patients and some that aren't. Yes.
00:08:53.200 --> 00:08:56.630
>> So, can you uh elaborate for us how you
00:08:56.640 --> 00:08:58.070
treat someone differently whether
00:08:58.080 --> 00:09:00.070
they're in the process in the journey of
00:09:00.080 --> 00:09:01.670
weight loss or if they reach their goal?
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>> Yes.
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>> Can you talk about how you consult with
00:09:04.000 --> 00:09:04.790
those patients?
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>> Yeah, I mean I definitely see a wide
00:09:07.040 --> 00:09:09.829
variety of patients. Um,
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I think my ideal situation is seeing a
00:09:13.360 --> 00:09:16.230
patient that is just starting up on
00:09:16.240 --> 00:09:18.710
their weight loss journey and we can
00:09:18.720 --> 00:09:21.350
kind of get on top of any weight loss
00:09:21.360 --> 00:09:22.790
that they are seeing that they would be
00:09:22.800 --> 00:09:26.070
seeing in their face because um I think
00:09:26.080 --> 00:09:29.509
it it's really patient dependent. Um,
00:09:29.519 --> 00:09:31.590
but people do see some sort of weight
00:09:31.600 --> 00:09:33.910
loss in their face. Um, whether that's
00:09:33.920 --> 00:09:37.110
you know fat loss or skin laxity, skin
00:09:37.120 --> 00:09:40.070
quality. um just decreasing. Um not all
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patients are going to have that, but
00:09:42.000 --> 00:09:44.310
it's good to get on top of that. So, one
00:09:44.320 --> 00:09:47.269
of the things that I like to do is start
00:09:47.279 --> 00:09:50.070
those patients on a plan for Sculptra,
00:09:50.080 --> 00:09:52.550
which is a collagen stimulator. So, if
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we can start stimulating that collagen
00:09:55.600 --> 00:09:57.670
at that beginning of their weight loss
00:09:57.680 --> 00:10:00.870
journey, it's just going to bode better
00:10:00.880 --> 00:10:02.870
for them in the future because we're
00:10:02.880 --> 00:10:04.870
going to be stimulating collagen as
00:10:04.880 --> 00:10:07.350
they're losing weight. we're I like to
00:10:07.360 --> 00:10:08.790
call it investing in their collagen
00:10:08.800 --> 00:10:11.350
bank, you know, so we can we can start
00:10:11.360 --> 00:10:15.590
that collagen ball rolling. Um we can
00:10:15.600 --> 00:10:17.829
target areas that we typically would see
00:10:17.839 --> 00:10:20.230
volume loss. Um and sculpture is a great
00:10:20.240 --> 00:10:21.910
treatment because you do treat the whole
00:10:21.920 --> 00:10:23.910
entire face. So you're stimulating
00:10:23.920 --> 00:10:26.630
collagen growth. Um sculpture is a
00:10:26.640 --> 00:10:30.389
longer duration to see your results. So,
00:10:30.399 --> 00:10:33.030
um, I would say, you know, up to 6
00:10:33.040 --> 00:10:35.190
months after their final treatment,
00:10:35.200 --> 00:10:37.269
we're still seeing collagen production.
00:10:37.279 --> 00:10:39.670
Um, so that's why it's good to get on
00:10:39.680 --> 00:10:41.910
the ball of let's start this as you're
00:10:41.920 --> 00:10:44.550
starting your weight loss and we'll just
00:10:44.560 --> 00:10:46.550
see the benefits as you're seeing the
00:10:46.560 --> 00:10:48.790
benefits from the weight loss. Um,
00:10:48.800 --> 00:10:50.389
>> so sculpture is different from a typical
00:10:50.399 --> 00:10:51.590
HA filler.
00:10:51.600 --> 00:10:52.150
>> Definitely.
00:10:52.160 --> 00:10:54.310
>> So, can you describe for us kind of how
00:10:54.320 --> 00:10:56.150
you use sculpture? like you have to mix
00:10:56.160 --> 00:10:58.150
it and do some things then you see some
00:10:58.160 --> 00:11:00.069
swag initially then it kind of goes
00:11:00.079 --> 00:11:01.910
away. Can you kind of dive into that for
00:11:01.920 --> 00:11:02.069
me?
00:11:02.079 --> 00:11:05.670
>> Yeah, you said it all. Um so I would say
00:11:05.680 --> 00:11:09.269
so Sculptra comes as a powder. We mix it
00:11:09.279 --> 00:11:11.750
with sterile water. We inject it
00:11:11.760 --> 00:11:14.710
throughout the face. Um you can hit lots
00:11:14.720 --> 00:11:16.790
of different areas like I said temples,
00:11:16.800 --> 00:11:19.350
cheeks, jawline, kind of the front part
00:11:19.360 --> 00:11:22.389
of those cheeks. um the the smile lines
00:11:22.399 --> 00:11:25.030
down in that the chin chin shadows. So
00:11:25.040 --> 00:11:26.230
you can hit all these different areas
00:11:26.240 --> 00:11:29.350
with sculpture. Um initially you are
00:11:29.360 --> 00:11:31.670
going to see that sculpture kind of
00:11:31.680 --> 00:11:33.509
filling in areas but a lot of what
00:11:33.519 --> 00:11:35.990
you're seeing is the fluid that sterile
00:11:36.000 --> 00:11:38.389
water um with the sculpture suspended
00:11:38.399 --> 00:11:41.110
into it. Your body will then absorb all
00:11:41.120 --> 00:11:43.590
that water. Um so a couple days later it
00:11:43.600 --> 00:11:46.150
feels like nothing happened. Um but then
00:11:46.160 --> 00:11:48.710
over time your body will be stimulating
00:11:48.720 --> 00:11:51.110
collagen growth and that's when you
00:11:51.120 --> 00:11:54.150
start to see the real benefits of the um
00:11:54.160 --> 00:11:57.670
improved skin texture and quality um
00:11:57.680 --> 00:12:01.670
volume um loss gets better or you're
00:12:01.680 --> 00:12:03.350
just building collagen in those areas
00:12:03.360 --> 00:12:05.509
where you're seeing um volume loss.
00:12:05.519 --> 00:12:06.710
>> And that's typically a series of
00:12:06.720 --> 00:12:08.629
treatments. series of treatments at
00:12:08.639 --> 00:12:11.910
least two um sometimes three depending
00:12:11.920 --> 00:12:14.870
on the the level of volume loss that
00:12:14.880 --> 00:12:15.750
we're trying to correct.
00:12:15.760 --> 00:12:17.590
>> And then what's the maintenance after?
00:12:17.600 --> 00:12:19.269
>> Um typically just one maintenance
00:12:19.279 --> 00:12:23.430
treatment per year. A standard treatment
00:12:23.440 --> 00:12:25.750
is going to be multiple vials, usually
00:12:25.760 --> 00:12:28.310
one per side of the face of Sculptra. Um
00:12:28.320 --> 00:12:30.069
and then a maintenance treatment
00:12:30.079 --> 00:12:32.550
annually is going to be just one vial
00:12:32.560 --> 00:12:35.110
annually to maintain those results.
00:12:35.120 --> 00:12:37.509
>> Okay. Well, for me, you know, my
00:12:37.519 --> 00:12:40.150
favorite filler is fat. So,
00:12:40.160 --> 00:12:40.629
>> yeah,
00:12:40.639 --> 00:12:42.629
>> in spite of all their weight loss, if
00:12:42.639 --> 00:12:44.230
I'm doing a facial procedure,
00:12:44.240 --> 00:12:46.230
rejuvenation procedure after weight loss
00:12:46.240 --> 00:12:47.829
or just from aging, you know, I
00:12:47.839 --> 00:12:49.190
typically use fat
00:12:49.200 --> 00:12:50.870
>> because it's the best. It has the stem
00:12:50.880 --> 00:12:53.430
cells. It's your tissue, you know.
00:12:53.440 --> 00:12:53.750
>> Yeah.
00:12:53.760 --> 00:12:56.629
>> But you do have to um have a donor site.
00:12:56.639 --> 00:12:57.829
You have to harvest the fat from
00:12:57.839 --> 00:12:59.110
somewhere. You got to do lipo suction.
00:12:59.120 --> 00:13:00.470
You got to collect it sterily, wash it,
00:13:00.480 --> 00:13:02.550
then reinject it. And so, if I'm doing a
00:13:02.560 --> 00:13:04.550
face lip procedure, it does uh tend to
00:13:04.560 --> 00:13:06.150
make patient a little more swollen. Mhm.
00:13:06.160 --> 00:13:08.230
>> And you do overfill because you're only
00:13:08.240 --> 00:13:10.389
going to get 50 to 70% take.
00:13:10.399 --> 00:13:12.629
>> So, it does prolong the uh downtime a
00:13:12.639 --> 00:13:14.150
little bit, but it's still my favorite
00:13:14.160 --> 00:13:15.350
filler. But, of course, you know,
00:13:15.360 --> 00:13:17.750
there's there's, you know, good things
00:13:17.760 --> 00:13:18.949
and bad things about everything we do,
00:13:18.959 --> 00:13:20.150
right? There's always options.
00:13:20.160 --> 00:13:21.590
>> How long would you say it takes to get
00:13:21.600 --> 00:13:24.389
to your final result after doing a fat
00:13:24.399 --> 00:13:25.350
transfer?
00:13:25.360 --> 00:13:28.710
>> Uh, I would say 6 weeks it's it's done.
00:13:28.720 --> 00:13:29.990
You're going to keep the rest of that.
00:13:30.000 --> 00:13:30.310
>> Yeah,
00:13:30.320 --> 00:13:32.069
>> I would say six weeks on average. And
00:13:32.079 --> 00:13:34.550
are you typically doing those with in
00:13:34.560 --> 00:13:36.230
combination with a facelift?
00:13:36.240 --> 00:13:36.949
>> Yes.
00:13:36.959 --> 00:13:38.150
>> Yeah. It'd be very rare to do that in
00:13:38.160 --> 00:13:38.790
isolation.
00:13:38.800 --> 00:13:39.350
>> Yeah.
00:13:39.360 --> 00:13:42.949
>> So, but for me, you know, I see patients
00:13:42.959 --> 00:13:44.629
sometimes during their journey and
00:13:44.639 --> 00:13:47.110
sometimes uh they're already stable. So,
00:13:47.120 --> 00:13:48.949
I want them to be at a stable weight for
00:13:48.959 --> 00:13:51.030
6 months before we do anything.
00:13:51.040 --> 00:13:52.550
>> And then it really just depends on where
00:13:52.560 --> 00:13:54.710
they want to start. You know, of course,
00:13:54.720 --> 00:13:56.949
most commonly we're doing tummy tucks.
00:13:56.959 --> 00:13:58.389
There are different types of tummy tucks
00:13:58.399 --> 00:13:59.750
available to people depending on their
00:13:59.760 --> 00:14:01.829
needs. There are many tummy tucks where
00:14:01.839 --> 00:14:03.670
we don't tighten the muscle. We're just
00:14:03.680 --> 00:14:04.710
working on the lower half of the
00:14:04.720 --> 00:14:06.389
abdomen. There are full tummy tucks
00:14:06.399 --> 00:14:08.389
where we are doing lipo suction with
00:14:08.399 --> 00:14:10.310
skin removal and muscle tightening.
00:14:10.320 --> 00:14:12.470
There are fluid delete tummy tucks where
00:14:12.480 --> 00:14:15.110
if someone's lost, you know, 150 pounds.
00:14:15.120 --> 00:14:16.629
We not only the typical bikini line
00:14:16.639 --> 00:14:19.030
incision, we add a vertical component to
00:14:19.040 --> 00:14:21.110
bring in the tissues and ver both the
00:14:21.120 --> 00:14:23.350
horizontal and vertical planes.
00:14:23.360 --> 00:14:25.430
Um, if someone's really lost a ton of
00:14:25.440 --> 00:14:28.230
weight, say 150, 200 lb, then I will
00:14:28.240 --> 00:14:29.829
usually come back and do reverse tummy
00:14:29.839 --> 00:14:31.750
tuck after that, which means I'm pulling
00:14:31.760 --> 00:14:35.110
from the bottom up because you can't if
00:14:35.120 --> 00:14:36.949
they some people have multiple folds on
00:14:36.959 --> 00:14:38.230
their abdomen if they've really been
00:14:38.240 --> 00:14:40.389
heavy. And so the tummy tuck would treat
00:14:40.399 --> 00:14:42.629
the lower half, but there's this upper
00:14:42.639 --> 00:14:46.230
laxity. You can't just lift the entire
00:14:46.240 --> 00:14:48.550
abdominal skin off the off the uh
00:14:48.560 --> 00:14:50.629
abdominal wall. It needs a blood supply.
00:14:50.639 --> 00:14:52.470
So, we come back and pull from the top
00:14:52.480 --> 00:14:54.870
to get that upper uh tightness we didn't
00:14:54.880 --> 00:14:57.110
quite get from the first time. So, um
00:14:57.120 --> 00:14:59.030
it's it's a process, but you know, we
00:14:59.040 --> 00:15:00.470
can still end up with a flat tummy
00:15:00.480 --> 00:15:01.189
usually.
00:15:01.199 --> 00:15:04.550
>> Yeah. Do you feel like you see more
00:15:04.560 --> 00:15:06.710
weight loss patients coming into you
00:15:06.720 --> 00:15:08.710
with concerns about body or would you
00:15:08.720 --> 00:15:09.990
say it's face?
00:15:10.000 --> 00:15:10.870
>> More about body.
00:15:10.880 --> 00:15:11.350
>> Body.
00:15:11.360 --> 00:15:12.949
>> Our most our most common procedures
00:15:12.959 --> 00:15:15.670
would be a tummy tuck of some sort and
00:15:15.680 --> 00:15:17.670
arm lifts and then thirdly would be
00:15:17.680 --> 00:15:18.550
thigh lifts.
00:15:18.560 --> 00:15:20.790
>> Okay. But of course, facelifts, you
00:15:20.800 --> 00:15:22.310
know, too. So,
00:15:22.320 --> 00:15:25.509
>> yeah. Yeah. So, I've had a couple um a
00:15:25.519 --> 00:15:27.110
handful of patients either before or
00:15:27.120 --> 00:15:29.910
after that are looking for um
00:15:29.920 --> 00:15:32.389
liposuction or, you know, and they need
00:15:32.399 --> 00:15:34.230
to lose weight as you mentioned and be
00:15:34.240 --> 00:15:36.710
stable um so that that procedure,
00:15:36.720 --> 00:15:38.470
whatever they're aiming for and their
00:15:38.480 --> 00:15:41.189
goals are going to be better outcomes
00:15:41.199 --> 00:15:42.230
for them. Right.
00:15:42.240 --> 00:15:44.550
>> So, I've had and I also had um a client
00:15:44.560 --> 00:15:46.629
who had had lipos suction on her abdomen
00:15:46.639 --> 00:15:49.430
and thighs, had been on a GLP1,
00:15:49.440 --> 00:15:51.189
unfortunately went off and g started
00:15:51.199 --> 00:15:53.509
gaining weight. And so, she came back to
00:15:53.519 --> 00:15:55.670
see me. We put her back on a lowd dose
00:15:55.680 --> 00:15:58.710
GLP-1, really worked on nutrition to get
00:15:58.720 --> 00:16:00.150
some of that weight she had started
00:16:00.160 --> 00:16:03.269
gaining off as well as um just maintain
00:16:03.279 --> 00:16:06.629
her so that her results were um could
00:16:06.639 --> 00:16:09.269
last and she you know felt good and
00:16:09.279 --> 00:16:11.990
didn't have to um go back and do surgery
00:16:12.000 --> 00:16:14.470
again of course and repair anything. So
00:16:14.480 --> 00:16:16.389
there's yeah lots of different patients,
00:16:16.399 --> 00:16:17.749
lots of different, you know, treatments
00:16:17.759 --> 00:16:19.350
they've had and how we can all work
00:16:19.360 --> 00:16:22.389
together. Um, again with the Sculptra or
00:16:22.399 --> 00:16:25.030
Filler and all the the cosmetic
00:16:25.040 --> 00:16:27.430
procedures they can do. So it's really a
00:16:27.440 --> 00:16:29.990
one-stop shop here. You can, you know,
00:16:30.000 --> 00:16:31.590
see any of the providers that you need
00:16:31.600 --> 00:16:32.710
are here. So
00:16:32.720 --> 00:16:34.470
>> yeah, and for me, it really depends on
00:16:34.480 --> 00:16:36.230
their age and and the amount of weight
00:16:36.240 --> 00:16:37.910
loss. You know, someone's young in their
00:16:37.920 --> 00:16:39.189
20s or 30s losing weight, they're not
00:16:39.199 --> 00:16:40.870
going to need a facelift. This will be
00:16:40.880 --> 00:16:42.949
more the body, right? you know, again,
00:16:42.959 --> 00:16:45.430
typically tummy, then arms and thighs.
00:16:45.440 --> 00:16:47.030
But if someone's older,
00:16:47.040 --> 00:16:48.470
>> you know, we age, we all could use some
00:16:48.480 --> 00:16:50.150
facial tuneups anyway, but you add the
00:16:50.160 --> 00:16:51.269
weight loss to it, they can be more
00:16:51.279 --> 00:16:52.870
dramatic. So then we're doing upper
00:16:52.880 --> 00:16:55.829
eyelids, you know, lower eyelids, face
00:16:55.839 --> 00:16:58.550
and neck is a big one with weight loss,
00:16:58.560 --> 00:17:01.189
>> skin laxing the neck, extra fat deposits
00:17:01.199 --> 00:17:02.870
that just are resistant to the weight
00:17:02.880 --> 00:17:04.870
loss. And at Monarch, you know, we offer
00:17:04.880 --> 00:17:06.710
the deep plane facelift in the office of
00:17:06.720 --> 00:17:08.150
local anesthesia if they want that or we
00:17:08.160 --> 00:17:09.350
can go to the surgery center. It's their
00:17:09.360 --> 00:17:11.510
preference. We also offer the deep neck
00:17:11.520 --> 00:17:14.710
lift so we can really contour the necks
00:17:14.720 --> 00:17:16.710
and faces, those jaw lines, get that get
00:17:16.720 --> 00:17:19.189
that angle back and give them a a
00:17:19.199 --> 00:17:20.949
natural faceelift, but something that's
00:17:20.959 --> 00:17:23.590
significant. Um, so it really depends
00:17:23.600 --> 00:17:25.590
on, you know, what they want and the
00:17:25.600 --> 00:17:27.029
order they want to do it in and, you
00:17:27.039 --> 00:17:28.950
know, whether it's a local or general
00:17:28.960 --> 00:17:30.870
anesthesia.
00:17:30.880 --> 00:17:32.870
>> Laura, I do have a question for you. I
00:17:32.880 --> 00:17:35.110
see um
00:17:35.120 --> 00:17:37.750
I don't see as many patients coming from
00:17:37.760 --> 00:17:41.430
you that have a lot of volume loss in
00:17:41.440 --> 00:17:45.110
their face, but I see it so often um
00:17:45.120 --> 00:17:46.710
they've come from a different company or
00:17:46.720 --> 00:17:48.390
different office and they've had a lot
00:17:48.400 --> 00:17:50.630
of volume loss in their face. Is there
00:17:50.640 --> 00:17:53.029
anything in particular that you do with
00:17:53.039 --> 00:17:54.789
your weight loss patients to prevent
00:17:54.799 --> 00:17:56.710
something like that from happening? And
00:17:56.720 --> 00:17:58.150
do patients come to you with those
00:17:58.160 --> 00:17:59.350
concerns?
00:17:59.360 --> 00:18:00.710
>> That's a great question. And you know,
00:18:00.720 --> 00:18:02.390
I've had patients that are just starting
00:18:02.400 --> 00:18:04.789
out. So, we really again want to focus
00:18:04.799 --> 00:18:06.470
on the nutrition aspect with the
00:18:06.480 --> 00:18:09.669
protein, um, with the exercise, um, and
00:18:09.679 --> 00:18:11.909
weight loss, doing it steady and not
00:18:11.919 --> 00:18:14.150
quick. And of course, patients want a
00:18:14.160 --> 00:18:16.630
fast result. So, they get worried
00:18:16.640 --> 00:18:19.430
sometimes. I only lost 5 lbs this month.
00:18:19.440 --> 00:18:20.630
Well, that's still a lot of weight. It's
00:18:20.640 --> 00:18:22.789
one pound a week, a little bit more. And
00:18:22.799 --> 00:18:25.750
so, we will sometimes just titrate the
00:18:25.760 --> 00:18:28.630
medication more slowly. And as you're
00:18:28.640 --> 00:18:30.470
asking, I do have patients that have
00:18:30.480 --> 00:18:32.310
come from other weight loss clinics.
00:18:32.320 --> 00:18:34.630
Maybe it was an online um source where
00:18:34.640 --> 00:18:36.470
they were getting it. They've told me
00:18:36.480 --> 00:18:38.630
they didn't have a lot of direction with
00:18:38.640 --> 00:18:42.150
nutrition um with, you know, a steady um
00:18:42.160 --> 00:18:44.310
just the monitoring and adjustments of
00:18:44.320 --> 00:18:47.029
the medications so that they had um
00:18:47.039 --> 00:18:50.789
steady weight loss. Um, so that probably
00:18:50.799 --> 00:18:52.230
would be the one thing would be
00:18:52.240 --> 00:18:53.750
different that we're able to do is
00:18:53.760 --> 00:18:56.150
provide a tighter management and control
00:18:56.160 --> 00:18:58.549
um, for these patients. Um, yeah, and
00:18:58.559 --> 00:19:00.230
you know, I was also going to say I
00:19:00.240 --> 00:19:02.870
typically don't see as much volume loss
00:19:02.880 --> 00:19:05.430
with um, the younger clients cuz I have
00:19:05.440 --> 00:19:07.510
patients of all age. They have better
00:19:07.520 --> 00:19:09.029
quality collagen to begin with and
00:19:09.039 --> 00:19:11.190
elastin. And so they're losing weight
00:19:11.200 --> 00:19:12.710
and you typically don't lose weight and
00:19:12.720 --> 00:19:14.630
just like it's not a spot treatment. And
00:19:14.640 --> 00:19:16.470
I've had clients say, "Well, can I just
00:19:16.480 --> 00:19:18.070
lose weight off my abdomen or my
00:19:18.080 --> 00:19:19.909
thighs?" So, it doesn't Unfortunately,
00:19:19.919 --> 00:19:21.029
it doesn't work like that.
00:19:21.039 --> 00:19:22.310
>> No, you never lose it where you want to
00:19:22.320 --> 00:19:22.710
lose it.
00:19:22.720 --> 00:19:25.830
>> Exactly. Right. You're los
00:19:25.840 --> 00:19:28.549
volume in my face. So, um you can't
00:19:28.559 --> 00:19:30.789
always tell, especially everyone's, um
00:19:30.799 --> 00:19:33.350
body composition is different. And so,
00:19:33.360 --> 00:19:36.070
yeah, but my the older patients um the
00:19:36.080 --> 00:19:38.630
clients are where you typically do see
00:19:38.640 --> 00:19:40.789
more volume loss in the face, especially
00:19:40.799 --> 00:19:42.390
if they have a lot of weight to lose.
00:19:42.400 --> 00:19:44.470
And so that's when it's appropriate and
00:19:44.480 --> 00:19:45.909
perfect to send them to one of our
00:19:45.919 --> 00:19:48.390
injectors um to get a consult and see if
00:19:48.400 --> 00:19:50.310
there's anything that could help um
00:19:50.320 --> 00:19:52.710
prevent that or replace some of that
00:19:52.720 --> 00:19:53.190
volume.
00:19:53.200 --> 00:19:54.150
>> Right.
00:19:54.160 --> 00:19:56.150
>> Okay. Well, I hope if you're considering
00:19:56.160 --> 00:19:57.669
a weight loss journey or you've already
00:19:57.679 --> 00:19:59.590
started and you need some help, you can
00:19:59.600 --> 00:20:01.430
tell that Laura is very passionate about
00:20:01.440 --> 00:20:04.230
this and that is that just gives her so
00:20:04.240 --> 00:20:06.950
much satisfaction in life helping people
00:20:06.960 --> 00:20:09.190
achieve their goals. Kersonen obviously
00:20:09.200 --> 00:20:13.029
is uh excellent at facial rejuvenation,
00:20:13.039 --> 00:20:15.270
giving uh appropriate contours, looks
00:20:15.280 --> 00:20:17.430
very natural, it's not overdone, and so
00:20:17.440 --> 00:20:18.630
we're just here for you at Monarch. We
00:20:18.640 --> 00:20:19.750
want to help you with this weight loss
00:20:19.760 --> 00:20:21.990
journey. We're here for the nutrition,
00:20:22.000 --> 00:20:24.470
the medication, the counseling, the
00:20:24.480 --> 00:20:27.110
injectors, and if needed, surgery. And I
00:20:27.120 --> 00:20:28.310
love helping people look better and feel
00:20:28.320 --> 00:20:29.669
better about themselves. It's been my
00:20:29.679 --> 00:20:31.590
passion for the past 23 years. So, if
00:20:31.600 --> 00:20:33.350
you're considering this, contact us at
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Monarch. Thank you.
