Beauty Essentials Present and Future w/ Dr. Joel Cohen

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Welcome to Park Avenue
Plastic Surgery Class,

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a podcast where we explore controversies
and breaking issues in plastic surgery.

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I'm your co-host Doreen Wu,

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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.

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The title of today's episode is
"Beauty Essentials Present and Future."

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Dr. Bass,

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we've discussed various aspects of
aesthetic treatment and beauty care in our

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podcast. What's the idea
behind this episode?

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There are some treatments
that are beauty essentials,

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components of maintenance and
rejuvenation that almost everyone needs

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sooner or later, and that will have
a major impact on your appearance.

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Then there are new entries
to the marketplace,

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things that are really innovative
and not just a new and slightly

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improved version of something
that's already on the market.

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My guest and I are going to
touch on a few of these. Finally,

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there are research projects that are
working on the next big breakthroughs.

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So let me introduce our guest.

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Joining us again on the
podcast is Dr. Joel Cohen,

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who's a dermatologist in the Denver area.

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He is an international authority on

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new technologies in aesthetic medicine,

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being very active in clinical
research and lecturing and

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teaching on what's coming
next. Dr. Cohen, welcome.

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Thank you very much, Larry.

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We both agree that resurfacing
is one of those beauty

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essentials. Tell our listeners why.

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If people really want to see improvement
in lines and wrinkles that are etched

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in the skin, resurfacing is
really key to that success.

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And we do have multiple
modalities that we can use from

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chemical peels to injectable agents to

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microneedling, to
radiofrequency microneedling.

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But really resurfacing is
the key to seeing success

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for etched lines and wrinkles that
are small and thin versus that are

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large and deep. That whole
spectrum is going to improve.

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And as I said, I completely
agree with this notion.

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My view is that if you're
doing work on rejuvenation,

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you're trying to restore your appearance
and you leave behind the lines and

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wrinkles, you are never going
to have your best appearance.

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You're always going to look
significantly more aged.

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It's a major component of
what makes you look older.

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So it's essential to chase that
as part of any beauty plan.

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Separate from that, I think what's
appealing about resurfacing,

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as you alluded to,

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is this ability with
modern technologies to

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really range up and down
the scale from very light

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to very heavy and predictably
everywhere in between,

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depending on how much aging
change you're showing.

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In other words,

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what you need and depending
on how much recovery time and

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what kind of treatment is
going to fit your lifestyle.

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So that's essential given that
we have to squeeze this into

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everybody's busy work and social schedule.

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Okay,

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so I see why resurfacing is a beauty
essential with the broad scope of

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things, concerns, issues
that can be treated.

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But what else is so powerful
about this approach?

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You know,

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I think that resurfacing is a
complement to the many different

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technologies and different procedures
that we can do for our patients.

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But if we break things down
to really early concepts,

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wearing sunscreen, trying to prevent
sun damage in the form of pigmentation,

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trying to prevent the changes
that happen with losses,

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some of the support networks of the
skin from sun damage that really causes

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those lines and wrinkles
is really key to an overall

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plan that is comprehensive for patients
to think about over the course of many

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years.

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And you know, as we said,
there are light options,

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but sometimes bigger
treatment is more worthwhile.

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I've done a significant amount
of full field resurfacing

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that's a laser treatment where
the surface of the skin is

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vaporized off leaving a raw
surface over a hundred percent

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of the surface area that needs treatment.

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This is in distinction to
fractionated treatments,

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which we also use commonly
where only a percentage

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of the surface area is stripped
off that provides faster

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healing but also predictably
less improvements.

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So for folks with
well-established lines a very

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durable and very substantial
degree of wrinkle clearance

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can be obtained with full field
resurfacing and that's become

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faster, easier,

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more reliable with some of
the newer technologies that

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really let us be very
precise on tissue depth

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and and degree of thermal effect

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in the tissues.

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One of the devices that I'm most
excited about is actually the

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UltraClear laser.

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It's a new laser that was
FDA cleared in December of

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2021, and the company
really has been innovative.

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This is a laser that really allows

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multiple different modes to be
used. So as Dr. Bass is describing,

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having patients with more downtime,

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there's also the ability to have
patients with very, very little downtime.

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So one of the early modes is
called the 3D miracle mode,

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where there is almost no discomfort.

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So you don't actually even need topical
anesthesia unless you want to use it.

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The treatment takes 10 or 15 minutes,

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there's some burning and sting for a
few hours and patients are just dry and

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pink for a couple days.

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So it's really a weekend recover and
it's meant to be done in a series

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of treatments.

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So for people who it's not reasonable
for them to take any time off of work or

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any time off social engagements,

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they can do these over the
course of many weekends. And then

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for people who have more downtime,
we can use this particular laser,

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the UltraClear on different modes to treat

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with more settings and more density

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and different parameters to actually
treat in a face some of the lines that are

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etched in the skin.

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And you can take it all the way up to a
point where traditional fractional blade

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of lasers, fractional erbium,
or fractional CO2 are done.

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And then for people who really have a
major event coming up and they really want

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to have major improvement
with just one treatment,

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usually just one treatment and they
have the flexibility for a week plus

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downtime in terms of the skin healing,

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that's when I moved to another type
of laser like the Sciton JOULE X

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for full field heavy resurfacing.

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And I think that raises
another interesting point.

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If you have a lot of
established aging changes,

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then it may be worthwhile

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proceeding with a little bit
more aggressive treatment
that involves a little

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bit of downtime. However,
if you're not there yet,

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this is a wake up call to
think about some lighter

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treatments on a periodic basis

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to really for stall and delay the
the time that you're going to get

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to showing heavy aging changes.

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So if you do some light treatments
with little or no downtime now

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and keep things cleaned up,

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it will be a good while before you
have to contemplate going ahead

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with a more aggressive treatment.

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Agree. I think that this is
really just preventative.

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We all go to the dentist a few times
a year. We get our teeth cleaned,

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we try to floss all the time and
be really conscious of really good

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overall hygiene when it comes to the
oral area. And when it comes to the skin,

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we have to think about
using sun protection,

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using skincare with the right ingredients
and thinking about procedures that

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really fit our schedule. And then I
always talk to patients about goals.

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Is their goal to see improvement in
pigment improvement in redness or lines

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and wrinkles?

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And then we tailor these types of laser
therapies to those specific parameters.

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In the episode title, we
alluded to the future.

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What are a few of the new innovations
that our listeners should know about?

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I'm excited about multiple new devices
that we have on our office that we

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actually participated in the clinical
trial for over the past couple years.

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So I mentioned the UltraClear laser
is really exciting and the reason

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it's different is because it
allows a shorter pulse duration.

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So for example,

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a laser may have a pulse duration of 50
milliseconds and even though that's a

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really short period of time,

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you start to feel the energy
and the heat build up.

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So what the UltraClear does is it
really divides that 50 milliseconds into

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micro pulses.

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So there's four micro
pulses of 12.5 milliseconds.

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So just when your body's
about to feel that,

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it kind of goes away and goes down and
then it comes back and it goes down.

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So that ability to cause
these small micro pulses

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makes the discomfort much less
and allows patients to tolerate

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these procedures,

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especially on lower settings
like that 3D miracle. We've also

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participated in the number of
energy-based device studies.

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So Emsculpt NEO is a
technology that came out

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in 2020 and even despite coming
out in the year of the pandemic,

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it quickly became one of the most
popular body treatments and it combines

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what's called high femme,
which is high intensity focus,

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electrical muscle stimulation,

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much more so than you can get in any
way shape or form by going to the gym.

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The number of muscle contractions
for areas of Emsculpt NEO treatment

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such as the abdomen would
be, it's super physiologic.

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You could never do that from a workout.

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It's like 20,000
abdominal crunches in a 30

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minute session.

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So Emsculpt NEO we've been using
on the center part of the abdomen,

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we've been using on the buttock,
the inner thigh, the outer thigh,

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even the calves and the arms.

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And we just finished the study
for the flank applicator.

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And what Emsculpt NEO allows
is combination of that

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high intensity focused electrical
muscle stimulation to tighten

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musculature and to see more
definition for musculature,

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but at the same time combines a
radiofrequency type of parameter

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to allow decrease in fat in these areas.
So for the center

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part of the abdomen and the flanks,

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having that ability to see
25% more muscle definition

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decrease fat by 30%.

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And then for people who may have
had pregnancies and have some

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separation of the muscle in the
abdomen called diastasis recti,

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there's a 19% improvement in that as well.

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So very exciting technology.
And the edge applicator,

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which is the flank applicator,

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has quickly become the second most common
area for NEO to be used, Emsculpt NEO,

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in our office next to the central abdomen.

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And now there's a new system
that they've just developed that

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focuses on facial treatment.

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So I understand you have some
experience with that as well.

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So at our office,

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AboutSkin Dermatology and AboutSkin
Research in metropolitan Denver,

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I have enjoyed being a part of
clinical trials for a very long time.

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And in addition to doing the
clinical trials for the Emsculpt NEO,

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I also did the clinical
trial for the EMFACE.

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So we were one of six sites that
did the EMFACE clinical trial.

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So EMFACE uses technology
similar to Emsculpt NEO where it

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uses high intensity focused electrical
stimulation of muscle but it's more

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superficial.

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And then it also uses radiofrequency
and applicator starts placed over

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very specific areas. So in the cheek,

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the applicator is going directly from
the cheekbone to the corner of the

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mouth.

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So in that area is a series of
muscles called the Zygomaticus minor

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and major in the risorius muscle.

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And these are not muscles that we
would typically treat at all with Botox

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unless somebody had a
facial asymmetry or bell's

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palsy. So this particular
type of approach allows us to

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focus on muscles,

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to take muscles that are elongated
with aging and understand that

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these muscles interconnect with
ligaments and the ligaments become

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lax over time. It's similar
to the fact that, you know,

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if you use a hammock
over a period of time,

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the weave on that is going
to become much more lax.

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So being able to tighten the
laxity and the weave of these

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ligamentous structures at the same
time being able to tighten some of the

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elongated muscles leads to a lift
in the center part of the face.

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And that lift actually
translates to a much more defined

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jawline and in many patients dramatic
improvement in the jowling that they

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have as well.

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So this is a brand new
technology as we record this.

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And an example of how the
ability to do do things that

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previously we either had no way of
addressing or had to be addressed with a

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significant surgery gives an option,

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especially when I suspect applied early.

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This is not going to take
the 80 year old and magically

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make them look like a 40 year old,

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but in people who are relatively
early in the aging game

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or mid in the aging game,

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this can really be a
big inroad in terms of

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restoring appearance.

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So for younger patients and that whole
concept that Ken Arndt describes as

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rejuvenation, you know,

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sometimes patients feel like
they're starting to see changes,

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whether it's in person or on a
video call where EMFACE may come

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into play because you'll see more
jawline definition and reduction in some

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of the jowling.

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And really that tightening can help
lift up what some people are starting to

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call tech neck. In addition,

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having EMFACE as a
technology is a complement to

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other treatments that we
certainly do on our office,

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such as injectables like fillers
or neuromodulators like Dysport

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and Botox.

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And being able to use these in
complement to one another is really key.

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And you can still do other devices that
we've spoken about such as lasers to

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treat pigment or redness or lines and
wrinkles that are etched in the skin.

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Most recently a new laser was just cleared
by the FDA for the treatment of acne.

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Can you tell us how it works
and why it's an innovation?

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So I was part of the clinical trial
for the FDA study on what's called

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the Accure laser,

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and Rox Anderson who
is a dermatologist and

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a investigator and a really
inventor who practices out of

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Harvard and MIT, it's called the
Wellman Institute of Photo Medicine.

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Rox Anderson invented many of
the technologies that we use.

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He's really done fractional
ablative resurfacing

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fractional technology. He's done
pulsed dye laser, laser hair removal,

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laser tattoo removal, CoolSculpting,
and technologies like that.

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And when he was asked at one
point what he wanted to do next in

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his career, he said he wanted
to find a cure for acne.

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And by coming up with a
laser wavelength and really

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developing this wavelength
that's 1726 nanometers,

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he really, with his team,

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has been able to focus
on destroying or at least

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minimizing and attenuating the
sebaceous gland that causes acne.

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So now there are two FDA clear devices for

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1726.

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One is the ACCURE laser and
the other is the AviClear.

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And they're two different technologies
using the same wavelength and

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it's exciting to have something to
add to the armamentarium for kiddos

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and even adults that have acne.

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It's definitely exciting to hear
about all the new innovations that are

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currently on the market. So earlier
you promised a glimpse into the future,

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Dr. Cohen, what's coming down the
pipeline that you were excited about?

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I think in the world of
energy-based devices,

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we're seeing a lot of new treatments
such as combination treatments.

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So I mentioned Emsculpt NEO and
using the high intensity focused

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electrical stimulation of
muscle plus radiofrequency.

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And I think being able to treat different
body areas and now the flank with that

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type of technology is really leading
to great results for our patients.

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Being able to use similar technology
for the face combination technology

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like EMFACE similarly is
giving our patients really nice

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results where we can stimulate the
muscle and the elongated muscle

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and the lax ligaments.

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But we can also use this in complement
with other types of treatments such

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as injectables,

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such as neuromodulators like Botox
and Dysport as well as fillers.

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And now we have new
neuromodulators and new fillers

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that offer us different things that
we didn't necessarily have before.

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and some of those things in the
pipeline are the ability to really

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tailor the injection to what
the patient's looking for.

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So the company that makes Botox
called Allergan has been developing

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a short-acting
neuromodulator called Bonti,

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which is a botulinum type E.
So it's very short acting.

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And the thought process behind this is
that if patients aren't sure they're

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going to like the way that they
look, they can essentially try it on.

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So many of us wouldn't buy a car
unless we took it for a test drive.

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So this is kind of like a test drive
where it's like going to a Nordstrom

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dressing room and and trying
it on. And then similarly,

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there are companies that are developing
neuromodulators that the goal is to

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actually have a longer overall efficacy.

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It won't have a longer
efficacy for everybody,

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but for some people it may actually
last longer. And that's little tweaks in

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the technologies.

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So the one that got FDA approved
recently is called DAXXIFY by Revance

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Aesthetics. And similar
to Botox and Dysport,

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it is a botulinum agent type A.

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So the mechanism of action
isn't any different,

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but it has a special peptide
where it may potentially lead

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to longer efficacy in some patients
because of the charge on that

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peptide,

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as well as the fact that the peptide
prevents the neuromodulator molecules from

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aggregating to each other.

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So it's exciting to have new agents
that for some people may be able to

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alter their dosing regimens so that it
fits in their schedule more conveniently.

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And I think we all have patients that may
come from far to join us and see us at

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the office and being able to cut down
from perhaps three treatments a year to

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two treatments a year may actually work
better for them. And then there are

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new studies looking at products that we've
had for a long time, such as Dysport,

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I was in the DREAM study,

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which is the Dysport Real World Experience
trial that showed that some people

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are happy with their treatment
of Dysport in the glabella at a

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six month interval. Anyway. So
for those patients, you know,

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I think that having that new data to
show them that they may actually have

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satisfaction in that particular study,

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it was 95% satisfaction
with 60% satisfied and

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35% very satisfied. And then Galderma,

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the company that makes Dysport and
the Restylane family products has

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been innovating their own
neuromodulator called QM.

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And I presented the phase two FDA data
at the World Congress of Dermatology

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in Milan.

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And the phase three data is
being looked at right now and

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has been made public for
some parameters of it.

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And what they're seeing is that this
is a neuromodulator that also probably

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has a longer amount of duration.

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So I think there's a lot of exciting
things going on in the world of aesthetics

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from the devices and energy-based devices
we have in our offices to some of the

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injectables that are going to
be coming out or are out now.

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Finally, before we conclude Dr. Bass,

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what should our listeners take
away from today's episode?

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Well, Dr. Cohen was talking about
participating in clinical trials,

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and I also participate in clinical trials.

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And I love doing that for exactly
the reasons he was describing.

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You are working with new technologies,

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you're seeing the latest and greatest,

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and you also get an in-depth
understanding of the performance of those

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technologies because you're not
just treating people who leave,

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00:23:13,980 --> 00:23:18,940
but you're treating people
studying the effects in

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depth in conjunction with multiple
collaborators around the country.

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And that gives you a level of insight
that it's hard to get any other way.

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I think listening to this
fabulous update from Dr. Cohen

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about some of the newest and
most interesting additions

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in aesthetic medicine teaches
us a couple of things.

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We can see that there are
a range of options for

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early and late changes.

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00:23:51,650 --> 00:23:56,400
There's a degree of predictability
to those options and

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gradability from light to heavy,
even within a given option.

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The parameter range
allows a lot of adjustment

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for individual needs. And finally,

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I think we see that

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these new technologies are much more data

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driven than a lot of what
happened in past decades.

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So there's a lot of study and
identification of the performance

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characteristics of these new
technologies that gives us the assurance

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00:24:32,970 --> 00:24:37,960
as they hit the market of what they're
going to do for us and how they're going

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to perform.

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Dr. Cohen, would you like
to add any takeaways?

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I think it's really important for
people to think about the fact that many

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different treatments have been really
commoditized, and it's not the paint,

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it's the painter.

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And when you're having a treatment
done such as resurfacing,

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you really want to see somebody who has
a lot of experience and you want to see

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00:25:01,920 --> 00:25:06,560
their results because it
really varies. And again,

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00:25:06,900 --> 00:25:07,440
you know,

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00:25:07,440 --> 00:25:12,240
you could give me some paint and I'm
not going to be able to make a beautiful

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painting. Whereas some
world class artist will,

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there is artistry in medicine and
it's important to really realize that.

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Thank you,

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00:25:21,130 --> 00:25:25,050
Dr. Cohen and Dr. Bass for sharing your
insight and expertise on the status of

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00:25:25,050 --> 00:25:28,770
innovation and various cutting edge
developments in the world of aesthetics.

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And I'd like to add my thank
you to Dr. Cohen for again,

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sharing a fabulous perspective
and I think very well

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00:25:37,990 --> 00:25:41,670
said point of view about how to
approach your aesthetic care.

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00:25:42,110 --> 00:25:44,630
Thank you very much, Dr.
Bass. I appreciate it.

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00:25:46,030 --> 00:25:49,870
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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00:25:50,300 --> 00:25:52,790
Follow us on Apple
Podcasts, write a review,

390
00:25:52,790 --> 00:25:54,070
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391
00:25:54,520 --> 00:25:57,830
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00:25:57,830 --> 00:26:01,150
coming your way. If you want to
contact us with commons or questions,

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00:26:01,150 --> 00:26:02,150
we'd love to hear from you,

394
00:26:02,380 --> 00:26:06,270
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00:26:06,270 --> 00:26:08,390
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