Aesthetic Titans #2: Dr. Jean Carruthers, Botox Pioneer

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.
This is the start of a new series,

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Aesthetic Titans. What is
the idea behind this series,

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Dr. Bass?

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There are certain individuals who've
made game-changing contributions to

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plastic surgery and aesthetic
medicine. Beyond that,

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they've continued to
actively research, lecture,

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and teach over a span of
decades really changing

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the way these fields are practiced.

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This gives these individuals
an unparalleled breadth and

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depth of experience and
perspective about plastic surgery.

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Listening to the accumulated
wisdom of these individuals is a

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very worthwhile undertaking
because their accomplishments make

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them proven thought leaders.

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Mostly these are physicians,

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but there are some business people
and engineers in this group as well,

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along with some people
in journalism and media.

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That all sounds very exciting and
worthwhile. I can't wait to get started.

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Who are we talking to today, Dr. Bass?

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I'd like to introduce
Dr. Dr. Jean Carruthers.

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Dr. Carruthers is an oculoplastic
surgeon who practices in

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Vancouver, British Columbia.

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She pioneered the development of
treatments using Botox for aesthetic

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purposes. Since then,

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she's lectured thousands of times
worldwide and written hundreds

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of scientific publications on
these techniques and many others

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in aesthetics.

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She's a clinical professor of
ophthalmology at the University of British

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Columbia in Vancouver.

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I'm delighted that she has
agreed to join us for an

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episode of the podcast to
discuss the history of Botox

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as well as cutting edge advances
and her vision of future trends.

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Welcome Dr. Carruthers.

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How did you get involved with aesthetics?

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Was it Botox or did it
precede your work with Botox?

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I knew about aesthetics
because my husband is a

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dermatologist,

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but I didn't realize that I would
ever get involved with aesthetics,

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and it was really the fact that
I had done a fellowship with

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Dr. Allen Scott in San Francisco
at the Smith-Kettlewell Institute

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of Visual Sciences on the use
of botulinum toxin A to treat

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misaligned eyes,

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and also to treat blepharospasm
where the eyelids really spasm shut

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a person can't safely cross
the street for drive a car.

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So when it was one of those
patients who got angry at

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me, she said, you didn't treat me here.

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And I apologized to her
and said, I'm so sorry,

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but I didn't think you had been
spasming there. And she said, oh,

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I know I'm not spasming there,

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but every time you treat me there
I get this beautiful untroubled

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expression.

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And that was when the penny dropped
because my husband had explained to me

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that it was very difficult to get a
natural result with the face at rest

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and the face moving with
the currently available

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treatments for glabellar
frown lines, collagen, fiber,

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fat.

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So that was when the penny dropped
that we should maybe do a study.

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So that's how I got involved.

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I was definitely a therapeutic
doctor before that.

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Okay. Thank you for sharing.
You touched on it a little bit,

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but could you tell us about the early
days with Botox and when you really

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realized that the aesthetic
potential was there?

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It was a long time to get
that realization because wow,

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we started the study and it took us

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several years to get
enough patients to publish.

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It took us until 1992 to get 18

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patients from 1987.

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So that's a lot of
patients would say, well,

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I don't know. It's poison, isn't it? I
don't think I want to be in your study.

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And so we realized what we
had to do was to walk a walk.

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So I got Alastair to inject my glabella,

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and then they would say the poison
thing, and then I would say, well,

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what do you think? And I'd pull out
my picture of my big frown lines,

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which I had lovely ones before.

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And what do you think and moved my bangs
back and show that there's not a single

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frown line. And they'd say, oh, do it.

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That would be great.

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And so that's the story is you
have to walk the walk if you want

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and show that you believe in it if
you want other people to follow you.

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And now I say probably I
haven't frowned since 1987.

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That's really interesting. Where has
Botox gone from this focus start then?

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It's really gone so far.

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It is now the commonist cosmetic
procedure performed worldwide.

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It is accepted by early generations,

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perhaps more by the millennials
than any other generation.

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It has gone from the glabella where
we started it all over the face

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now the neck and into
our other neck muscles,

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the bladder, the back, shrinking the taf,

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treating scars, preventing scars,

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treating other things that people
had never thought of before,

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such as emotional states
such as depression and social

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anxiety, and also

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doing self-esteem. It
improves self-esteem as well.

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So it's a huge thing that
it's gone from being a more

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obvious treatment,

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treating cosmetic things that you
can actually photograph to now you

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need to use a different
measuring device such as a scale

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of how somebody is feeling.

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There are a lot of validated
scales for the emotional states.

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So it's really just
galloping on into a whole new

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arena from the aesthetic world.

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But it also has kept its place
in the aesthetic world because

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as surgeons, we all like to give
our patients the very best result.

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And it works perfectly
with surgery to enhance.

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It's like the icing on the cake.

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And I think sticking again with
the aesthetic applications for a

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moment. That's a good point
that you started with that

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really Botox has turned out to be
something that's part of the beauty

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plan along with all kinds
of other modalities,

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but part of the beauty plan for
almost everyone at every stage of

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aging.

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So it really plays a central
role across the board.

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And that can't be said for many
other things in aesthetic medicine.

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There are some things that are right at
the right time and do a tremendous job,

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but there are very few things
that are as broadly applied as

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Botox,

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and that's part of what's made it the
most popular treatment amongst all the

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aesthetic treatments.

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But one of the other things I think
we've learned and that you've been very

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central, Dr. Carruthers
in teaching people is

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amongst modalities or
even amongst medications,

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pharmaceutical agents,

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there are a few that have
the precision that Botox

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does, the selectivity that Botox does,

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and for people who really understand
the anatomy and the dynamics of how

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facial muscles were,

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that rewards you with tremendous
benefits and tremendous

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precision in treatment.

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Yeah, I totally agree.

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In the days when I was
doing endoscopic brow lifts,

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six months later I would
sometimes see a regrowth of the

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corrugated muscles and you would
see these strange movements here,

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and rather than have to
go in again surgically,

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the little Botox would solve the problem.

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I think that it's been,

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I totally agree with you that
it's the young people who start

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with the Botox, but as the
aging process comes along,

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they add in the surgical
procedures because Botox wonderful

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as it is, can't do everything.

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So changing gears a bit, this has
been a really interesting discussion,

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but I'm curious, what is the mix of
surfaces in your practices today?

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I used to do a lot of surgery,
blepharoplasty, facelifts, liposuction,

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but now I have confined myself to

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neuromodulators,

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fillers and energy-based
devices such as intense pulsed

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light and the various
devices that are used to

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resurface such as microneedling
and also ultrasound

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devices that tighten skin.

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There are a lot of combinations
that I do of those things.

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And so we also have added in devices that

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electrically stimulate muscles,

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so that one treatment of the
abdominal muscles will be

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the equivalent of

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inches and also will change your
shape and improve your waist line.

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So the other thing that we're
doing now is treating more people

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who have a lot of laxity in their
skin because they've finally

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lost all that weight they wanted
to lose using one of the GLP

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drugs such as ozempic.

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And I think that that has made
liposuction perhaps less important,

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but skin tightening way more important,
skin lifting way more important.

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That's really interesting and it's a
perfect illustration of how the aesthetic

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marketplace never stands still because

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laser liposuction was a big
thing five or 10 years ago,

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10 years before that,

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there were big surgical treatments for

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post-bariatric surgery patients
who had a loss of a hundred

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pounds or 200 pounds in some cases.

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But the advent of the
GLP one medications like

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Ozempic has created yet another
pivot in the body contouring

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marketplace that really creates a lot of

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opportunity for patients
that didn't exist before,

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that were having a lot of
frustration with body contouring,

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but now have a good option.

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But there are still related
issues that the aesthetic

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medicine physician needs to jump in on

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to help those patients as well.

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So you answered about your practice
in particular that at this point

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you're essentially non-surgical,

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but I'm curious to hear
your perspective on the role

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of let's say in facial
rejuvenation surgery versus

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non-surgical treatment.

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I think that there's a change in where the

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transition is between surgery and

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non-surgery.

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So supposing you have a person who's 45

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say, then her brows have come down,

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probably you're going to start
treating that person these days with

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Botox in her brow depressor
muscles in order to lift

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her brows. And that may obviate the need
for a blepharoplasty an upper bleph,

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for some time, she may
buy two or three years,

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but eventually the dermatochalasis,

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the saing will require a
little work with surgery.

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And I think in the lower
face is a great place to,

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you can lift the jawline nicely
using Botox in the platysma muscle

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because the platysma now goes,

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we know goes from the
collarbone up and in the lower

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third of the facial muscles. So
it's really a facial muscle as well,

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but you can,

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it's one of these bi-directional
muscles when it contracts,

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it can pull the lower face down,

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but if you actually weaken
its action along the jawline,

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the upper facial muscles,

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pull the upper face up and
you can actually also improve

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can for orbital hollows. So that's
the thing I think is so exciting about

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doing the face these days.
And you mentioned Larry,

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the anatomy being so uber
important that what we can do now

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is to change the,

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we can shape the face
using neuromodulators,

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not just treat wrinkles.
So we can lift the brows,

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we can actually make the
lower face more heart shaped.

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We can lift the jawline
all using neuromodulators.

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Things that we could only do
before this sort of change in

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a way of thinking about
neuromodulators of and binding.

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That thinking into the real anatomy
has allowed us this whole new

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play.

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And that surgery that
used to be done to try to

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contour the jawline, that was
big surgery with big recovery,

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taking off the angle of the
mandible to get a narrower shape

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that now is so easily
done in a non-invasive

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way.

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And that's really a big change
as a big trend right now

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in the facial surgery
side of neck lift is a lot

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of very aggressive treatment
of glands as well as

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muscles deep in the neck.

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And some of us are not as sanguine
about proceeding with those kinds of

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procedures,

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and I'd much rather be
treating with botulinum

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toxin to try to shrink
the glands than risk,

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the bleeding,

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the nerve injury or just the
recovery time associated with

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going deep in the neck.

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I think that you couldn't say it better
because it is safe, it's effective,

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okay, it's not permanent, but then
complications can be permanent,

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whereas just having a few injections
again in four to six months,

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that's really up. Most people
would much rather do that.

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00:16:05,240 --> 00:16:10,160
Yeah, I mean it's never a happy
thought that you have maintenance,

241
00:16:10,160 --> 00:16:14,180
but I think it's a universal
thought that life is maintenance.

242
00:16:15,020 --> 00:16:17,990
I tell my patients, how
many teeth would you have?

243
00:16:18,110 --> 00:16:20,330
It doesn't matter how
good a cleaning you got,

244
00:16:20,630 --> 00:16:24,440
how many teeth would you have left if
you didn't do some daily maintenance on

245
00:16:24,440 --> 00:16:25,273
your teeth?

246
00:16:26,180 --> 00:16:31,130
Maintenance is just part of life
and if the maintenance steps

247
00:16:31,130 --> 00:16:34,280
are quick and you to be very reliable,

248
00:16:35,180 --> 00:16:37,850
then we can be pretty happy about that.

249
00:16:39,830 --> 00:16:40,663
Yeah, definitely.

250
00:16:40,790 --> 00:16:44,300
So then just to move on to the future,

251
00:16:44,300 --> 00:16:49,100
I'm wondering where are neuromodulators
and botulinum toxins going in terms

252
00:16:49,100 --> 00:16:53,090
of role capabilities and types of
new products that we might see?

253
00:16:53,660 --> 00:16:58,430
I think that's a great question
because it's a question that is,

254
00:16:59,030 --> 00:17:03,890
the answer is going to
change because the growth is

255
00:17:03,890 --> 00:17:08,360
so phenomenal on an annual
basis. But right at the moment,

256
00:17:08,750 --> 00:17:12,590
what we've seen now is recently
in the last couple of years,

257
00:17:13,370 --> 00:17:18,050
a profusion of new neuromodulators
that are very similar to Botox,

258
00:17:18,410 --> 00:17:22,250
but we've also seen some new
derivatives like botulinum toxin E,

259
00:17:22,790 --> 00:17:27,620
which is very short acting or
come on right away and last

260
00:17:27,620 --> 00:17:29,720
for as long as two weeks.

261
00:17:30,260 --> 00:17:35,180
So it could be used as a rehearsal or
it could be used because you forgot to

262
00:17:35,180 --> 00:17:38,360
get your Botox treatment and your
daughter's getting married in three days.

263
00:17:39,290 --> 00:17:43,730
It's a rescue. And there are other
things that could be used for as well,

264
00:17:43,730 --> 00:17:47,960
such as you had surgery
with a knee replacement

265
00:17:48,530 --> 00:17:52,260
and of taking those nasty drugs,

266
00:17:53,070 --> 00:17:54,150
the opiates,

267
00:17:54,480 --> 00:17:59,340
you could have your pain released
by botulinum toxin E so that you can

268
00:17:59,400 --> 00:18:04,350
painlessly do the physiotherapy
that's required. I think also

269
00:18:04,350 --> 00:18:09,240
we've seen long acting where initially
we felt that this was a longer

270
00:18:09,240 --> 00:18:14,100
acting product with Daxxify
botulinum toxin and some of the

271
00:18:14,100 --> 00:18:15,510
more recent studies have shown,

272
00:18:15,510 --> 00:18:19,260
maybe it's not lasting as quite
as long as initially thought,

273
00:18:19,740 --> 00:18:24,150
but I think that what we're seeing
is a profusion of neuromodulators,

274
00:18:26,130 --> 00:18:30,360
that there's enormous competition
out there in the marketplace.

275
00:18:30,840 --> 00:18:35,700
But I think we're seeing
some changes in what's

276
00:18:35,700 --> 00:18:39,930
in the bottle as well between
products that have only the

277
00:18:39,930 --> 00:18:40,763
150 kDa

278
00:18:42,300 --> 00:18:46,830
like Xeomin for Revance that have the 150

279
00:18:48,720 --> 00:18:53,550
kDa with a small peptide chain
rather than the big overcoats,

280
00:18:53,550 --> 00:18:55,590
if you will, of complexing proteins.

281
00:18:56,700 --> 00:19:00,150
So there's an interesting too,

282
00:19:00,150 --> 00:19:05,070
what's happening is that it's
not just plastic surgeons

283
00:19:05,070 --> 00:19:05,903
and dermatologists,

284
00:19:06,240 --> 00:19:11,040
oculoplastic surgeons and ENT
people that are using botulinum

285
00:19:11,040 --> 00:19:14,370
toxin now. It's a whole lot of people.

286
00:19:14,370 --> 00:19:17,460
And so when we see our patients,

287
00:19:17,460 --> 00:19:22,200
we must be sure that we know what
else is going on in their treatments

288
00:19:22,230 --> 00:19:24,570
from other physicians. For example,

289
00:19:24,990 --> 00:19:29,970
somebody gets 400 units into their neck

290
00:19:30,270 --> 00:19:34,710
for cervical dystonia and
500 units into their bladder,

291
00:19:35,400 --> 00:19:39,120
and now they come in and want to have
cosmetic treatments on their face,

292
00:19:39,540 --> 00:19:41,220
another 50 or 60 units.

293
00:19:41,730 --> 00:19:46,710
We know that immunogenicity
is much more common in higher

294
00:19:46,710 --> 00:19:47,543
doses.

295
00:19:48,180 --> 00:19:52,500
So it's very important if you know
that people are getting these big doses

296
00:19:52,500 --> 00:19:57,060
elsewhere to adjust your timing so that
you don't do treatments too quickly,

297
00:19:57,570 --> 00:19:59,100
that you're not immunizing somebody.

298
00:19:59,550 --> 00:20:03,540
Yeah, these are really important
points and it points up why,

299
00:20:03,540 --> 00:20:06,570
and this is something we talk
about a lot on the podcast,

300
00:20:07,350 --> 00:20:11,850
why it's important to
have a relationship with a

301
00:20:11,850 --> 00:20:14,460
physician who's treating you,

302
00:20:14,850 --> 00:20:18,090
who understands your
entire aesthetic plan,

303
00:20:18,120 --> 00:20:22,860
not just that you're getting
20 units of Botox today in your

304
00:20:22,860 --> 00:20:23,730
elevens,

305
00:20:25,170 --> 00:20:29,550
that's coordinating what happens
to you watching how things

306
00:20:29,550 --> 00:20:31,440
change as you age.

307
00:20:31,950 --> 00:20:35,040
And separate from that,

308
00:20:35,070 --> 00:20:38,070
I think in addition to the new products,

309
00:20:38,070 --> 00:20:42,660
we're seeing a lot of
tinkering by the physicians,

310
00:20:43,110 --> 00:20:47,220
which we can term customization

311
00:20:47,650 --> 00:20:51,100
with how much dilution is being used,

312
00:20:51,100 --> 00:20:53,260
what kind of injection patterns,

313
00:20:53,650 --> 00:20:58,030
and that customization
is letting us again,

314
00:20:58,570 --> 00:21:02,950
target the results we're
aiming for more precisely,

315
00:21:02,950 --> 00:21:07,780
more effectively and perhaps
more durably because there's some

316
00:21:07,780 --> 00:21:12,130
argument about whether it's
concentration effect in the

317
00:21:12,130 --> 00:21:16,600
injection or other things that's
contributing to some of the durability

318
00:21:16,600 --> 00:21:20,740
seen in some of the recent studies.

319
00:21:21,430 --> 00:21:22,263
So

320
00:21:23,320 --> 00:21:27,100
physician input as well as medical

321
00:21:27,100 --> 00:21:31,960
marketplace pharmaceutical input is

322
00:21:31,960 --> 00:21:36,910
going to probably continue to
evolve what we're doing with

323
00:21:37,390 --> 00:21:38,920
the neuromodulators.

324
00:21:40,720 --> 00:21:41,680
I totally agree.

325
00:21:42,190 --> 00:21:47,140
The high dose studies that you are
referring to were really remarkable in how

326
00:21:47,530 --> 00:21:52,270
it increased the length of time
that people had a response.

327
00:21:53,020 --> 00:21:56,260
So I think that's something that
a lot of people are interested in,

328
00:21:57,220 --> 00:22:00,280
and I think too that

329
00:22:02,470 --> 00:22:07,360
you need to be really aware of
which neuromodulator using and

330
00:22:07,360 --> 00:22:12,070
get really familiar with one
or maybe two rather than having

331
00:22:13,000 --> 00:22:17,800
a real panorama of neuromodulators
and also having them

332
00:22:18,250 --> 00:22:21,160
indifferent syringes so that
you can tell what's what.

333
00:22:22,330 --> 00:22:22,960
Yeah, I mean,

334
00:22:22,960 --> 00:22:27,640
that's interesting because you
travel the world and you talk to

335
00:22:27,640 --> 00:22:28,300
everyone.

336
00:22:28,300 --> 00:22:32,980
And I talked to some of my
European colleagues and they

337
00:22:32,980 --> 00:22:37,420
have dozens of products between injectable

338
00:22:37,420 --> 00:22:41,770
fillers and neuromodulators,
dozens in their office,

339
00:22:42,250 --> 00:22:46,210
and I think we're not quite as

340
00:22:46,930 --> 00:22:51,580
overwhelmed with product
spread the way Europeans

341
00:22:51,580 --> 00:22:56,380
are and probably some of our
Asian colleagues in North

342
00:22:56,380 --> 00:22:59,380
America. We have a lot of products,

343
00:22:59,380 --> 00:23:04,240
but much more confined number
that's much more thoroughly studied.

344
00:23:04,570 --> 00:23:05,140
And again,

345
00:23:05,140 --> 00:23:10,060
from a safety point of
view and a consistency

346
00:23:11,230 --> 00:23:13,690
in terms of producing
results for patients,

347
00:23:13,690 --> 00:23:15,550
I think that helps us in a lot of ways.

348
00:23:16,770 --> 00:23:18,010
I agree with you.

349
00:23:18,820 --> 00:23:22,060
This has been a really interesting
discussion to listen to.

350
00:23:22,150 --> 00:23:25,750
I'm curious in the broader sense now
what your vision for the future of

351
00:23:25,750 --> 00:23:27,850
aesthetic medicine and surgery is.

352
00:23:28,630 --> 00:23:30,070
I think it's not going away.

353
00:23:30,790 --> 00:23:34,510
I think it's going to carry
on very exponentially.

354
00:23:35,290 --> 00:23:38,550
When you look at the millennials,

355
00:23:40,690 --> 00:23:45,320
boomers are initially very hesitant

356
00:23:45,320 --> 00:23:49,850
because they were the
product of a generation four

357
00:23:50,180 --> 00:23:54,170
that went through World Wars, very frugal,

358
00:23:54,830 --> 00:23:56,570
and then boomers were rebels,

359
00:23:56,600 --> 00:24:01,460
and they actually decided that
this would be a good thing.

360
00:24:01,850 --> 00:24:05,540
And luckily as boomers became
luckily for the products,

361
00:24:05,810 --> 00:24:09,620
as boomers became the predominant
members of the population,

362
00:24:10,580 --> 00:24:15,530
it became very happy for them to
have treatments that were symbol and

363
00:24:16,190 --> 00:24:19,790
to apply because they're looking after
their aging parents and after their

364
00:24:19,790 --> 00:24:22,280
children. Well, along come generation X

365
00:24:25,520 --> 00:24:30,410
and then the millennials a little bit
different because millennials actually are

366
00:24:30,410 --> 00:24:35,120
quite into prevention when they've
seen how the boomers look and they

367
00:24:36,070 --> 00:24:38,630
would like to look better
than their parents,

368
00:24:39,650 --> 00:24:42,470
and they're quite willing to do that.

369
00:24:42,470 --> 00:24:45,890
And it's interesting that even though
they don't have nearly as much money as

370
00:24:45,890 --> 00:24:47,360
their parents already,

371
00:24:47,360 --> 00:24:51,680
they're spending twice as much
on self-care as their parents.

372
00:24:52,040 --> 00:24:56,810
Plus they are sharing the inflammation
about their treatments on the

373
00:24:56,810 --> 00:24:59,270
internet, which most
boomers don't want to do.

374
00:25:00,020 --> 00:25:04,190
And then generation Z come
along. It's always been there.

375
00:25:04,220 --> 00:25:08,510
There's always been, it's like
Kleenex, Botox, it's always been there,

376
00:25:08,960 --> 00:25:11,180
and there's no stigma whatsoever.

377
00:25:11,480 --> 00:25:16,280
So people are sharing even before
they've left the office and

378
00:25:16,640 --> 00:25:17,690
what they've just done.

379
00:25:18,110 --> 00:25:23,060
So I think that the power
of that change of attitude

380
00:25:23,870 --> 00:25:26,510
in the millennials in particular,

381
00:25:27,140 --> 00:25:32,090
plus the power of magnification
given by the internet are

382
00:25:32,090 --> 00:25:36,320
just going to and the lack of stigma
is just going to make sure that

383
00:25:37,280 --> 00:25:41,120
new developments carry on. People
are going to be excited to try them,

384
00:25:41,540 --> 00:25:46,340
share the results. So I think that's
one big thing for the aesthetic part,

385
00:25:46,760 --> 00:25:51,530
but I think that the emotional
part is going to really grow as

386
00:25:51,530 --> 00:25:51,890
well,

387
00:25:51,890 --> 00:25:56,540
because if you could have a
treatment which is just treating for

388
00:25:57,020 --> 00:26:01,910
the frown lines for your depression
in nine out of 10 patients in one

389
00:26:01,910 --> 00:26:06,230
study and 52% in another study,
and there's many other studies,

390
00:26:06,740 --> 00:26:11,480
get these lovely results of no
depression lasting for four to six

391
00:26:11,480 --> 00:26:16,220
months without the side
effects of the SSRI group where

392
00:26:16,220 --> 00:26:20,720
people gain weight and lose libido.
I mean, it makes so much sense.

393
00:26:21,170 --> 00:26:24,710
So I think look good, feel good,

394
00:26:25,040 --> 00:26:26,210
and do even better.

395
00:26:27,080 --> 00:26:28,130
Absolutely.

396
00:26:29,000 --> 00:26:33,740
I'm curious to hear your
thoughts about microneedling with

397
00:26:33,740 --> 00:26:37,910
Botox and effects of
Botox on sebum production.

398
00:26:38,570 --> 00:26:40,730
Yeah, I think it works really nicely.

399
00:26:42,440 --> 00:26:46,890
Most of work on the sebum I
think has been by injection

400
00:26:47,250 --> 00:26:49,950
and people trying to get
as intradermal as possible.

401
00:26:50,370 --> 00:26:54,330
So I think the microneedling
is a good idea.

402
00:26:54,720 --> 00:26:58,230
As long as you get the
neuromodulator on there quickly,

403
00:26:58,710 --> 00:27:03,030
it's just very difficult to get
that huge molecule through the

404
00:27:03,360 --> 00:27:07,680
stratum cornium and into the lower dermis.

405
00:27:08,100 --> 00:27:12,900
So maybe the microneedling with
instant botulinum toxin is the better.

406
00:27:13,140 --> 00:27:14,910
I haven't seen a comparison study,

407
00:27:16,050 --> 00:27:20,280
but certainly if you look at complexion,

408
00:27:20,280 --> 00:27:25,050
that's one of the side effects
of I think probably people

409
00:27:25,050 --> 00:27:29,520
looking at rosacea as well as acne.

410
00:27:30,270 --> 00:27:32,940
Terrific. Dr Woffles Wu,

411
00:27:33,720 --> 00:27:37,770
who's a plastic surgeon
of renowned in Singapore,

412
00:27:38,070 --> 00:27:39,630
has really explored this area.

413
00:27:40,080 --> 00:27:44,880
And I think that it's really
worthwhile reading his work because

414
00:27:45,990 --> 00:27:50,280
he has done amazing work in improving
the complexion of all his patients,

415
00:27:50,550 --> 00:27:54,900
but he's also done amazing work with
scars. And for those of us who are

416
00:27:54,900 --> 00:27:56,580
surgeons, well,

417
00:27:56,580 --> 00:27:59,970
we'll wait until six weeks and then
we'll see if we treat your scar. No.

418
00:28:00,450 --> 00:28:03,870
Now you get in there with
your Botox at say, two weeks,

419
00:28:05,040 --> 00:28:10,020
and you inject the Botox
into the skin next to

420
00:28:10,020 --> 00:28:10,853
the scar,

421
00:28:11,400 --> 00:28:15,030
and it works on TGF beta and some other

422
00:28:16,770 --> 00:28:17,603
cytokines.

423
00:28:18,150 --> 00:28:22,800
And so then you just stop from
fibroblasts from making too much

424
00:28:22,800 --> 00:28:27,720
collagen so you can really treat
not only the anatomy of the scar

425
00:28:27,720 --> 00:28:32,550
and stop it becoming a hypertrophic
scar about there's a hundred million new

426
00:28:32,550 --> 00:28:36,690
scars a year, and about 10%
of those become hypertrophy.

427
00:28:37,230 --> 00:28:39,900
So I think it's a great
treatment for that.

428
00:28:40,200 --> 00:28:43,470
Plus when a scar is going
to become hypertrophy,

429
00:28:43,890 --> 00:28:47,490
it often is quite itchy and uncomfortable,

430
00:28:47,730 --> 00:28:49,560
so that gets rid of that as well.

431
00:28:50,010 --> 00:28:54,360
So I think it's a whole new
world and scar treatment.

432
00:28:55,200 --> 00:28:57,210
Wow. Yes.

433
00:28:57,210 --> 00:29:01,710
So that's really a fascinating
look back at the history and

434
00:29:01,710 --> 00:29:06,090
forward at future trends using botulinum

435
00:29:06,090 --> 00:29:09,120
toxins and Dr. Carruthers,

436
00:29:09,600 --> 00:29:14,580
tremendous for you to join us
today and share your deep insight

437
00:29:14,580 --> 00:29:17,100
into these trends in aesthetic medicine.

438
00:29:17,610 --> 00:29:21,480
Thank you so much for franking
on me and your brilliant podcast.

439
00:29:21,690 --> 00:29:25,740
I really appreciated it, and
it's an honor to work with you.

440
00:29:26,460 --> 00:29:28,470
Thank you for joining us, Dr. Carruthers.

441
00:29:28,650 --> 00:29:31,710
It was a pleasure to meet you and
hear your fascinating perspectives.

442
00:29:32,160 --> 00:29:33,930
Thank you so much. Thank you Summer.

443
00:29:34,860 --> 00:29:38,940
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.

444
00:29:39,000 --> 00:29:40,890
Follow us on Apple Podcasts,

445
00:29:40,960 --> 00:29:43,210
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the show with your friends.

446
00:29:43,360 --> 00:29:46,870
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447
00:29:46,870 --> 00:29:50,440
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448
00:29:50,440 --> 00:29:51,640
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449
00:29:51,730 --> 00:29:56,410
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450
00:29:56,410 --> 00:29:58,300
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