Dec. 28, 2021
Before the Facelift: How a Multi-Faceted Program of Non-Surgical Treatments Can Postpone The Facelift
How a multifaceted program of non-surgical treatments rejuvenation can postpone the facelift for a decade
Most people focus of the facelift when they think of plastic surgery, and rightly so as it is still the main reset for facial aging. Still, there are several decades of facial aging before a facelift is indicated. During this time, a plan of treatment is needed to correct the earlier aging changes taking place, as well as to maintain appearance and prevent or slow the onset of facial aging. In fact, non-surgical treatments of the face have become by far the predominate treatments being provided these days.
There are non-surgical modalities that are used in concert to create the desired anti-aging and rejuvenation appearance goals. Medicated skin products, laser and energy based treatments and injectables like neuromodulators (Botox, Dysport, Xeomin and Jeuveau) and fillers (e.g. Restylane, Juvederm and a growing list of others) are mixed and matched based on what features are aging and the preferences and lifestyle limitations of the individual to prevent and restore early facial aging. Given all the options and the range of aging changes encountered in people aged 30, 40 and beyond, Dr. Bass explains how a plan should be constructed in partnership with an experienced plastic surgeon who has a full range of options, surgical and non-surgical, available to patients.
Links
- Read more about facelifts
- Read more about injectable fillers
- Read more at Dr. Bass’s blog
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome back to Park Avenue
Plastic Surgery Class.
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My name is Doreen Wu and I co-host this
podcast where we explore controversies
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and breaking issues in plastic surgery.
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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 "before the facelift:
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how a multifaceted program
of nonsurgical treatments can
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postpone the facelift for a decade
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as someone who is young enough to be in
the pre facelift group." I'm excited to
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hear about the ways that a facelift can
be postponed with all of these cutting
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edge nonsurgical aesthetic treatments.
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Exactly. Doreen. This is really a
critical part of plastic surgery.
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It's great to fix an aging
change in someone's face,
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but the ideal is to help people just
stay the same and keep looking young,
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modern plastic surgery actually
spends much more time on prevention,
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support and maintenance
than on restoration.
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In this episode, we'll discuss
how a variety of treatments,
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support appearance without downtime
and have modulated the average age
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for the facelift.
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In years past,
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it seems like facial rejuvenation options
were largely limited to a facelift,
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but now we have so much
more at a disposal.
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Can you describe some of the
components of nonsurgical,
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facial maintenance and rejuvenation?
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Sure. Uh,
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this relies heavily on
treating changes in the skin,
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as well as treating laxity
and volume loss in the face.
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So skin surface changes
are things like redness,
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either broken blood
vessels or little red dots,
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or just a general red
or plethora look often
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that's rosacea brown changes.
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Our pigmentation gets
less even as we age. Uh,
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but we also sometimes get brown spots
that people call sun spots or age spots or
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liver spots. Uh,
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those are really from sun
and wrinkles loss of the
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smoothness of the skin and
the turker of the skin.
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And this is really all about
chemical peels, laser peels,
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and all of the no recovery lasers
and energy devices that have
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evolved out of the laser peels.
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That's one big category. It
changes then there's skin laxity,
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um, very early in the game.
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And this means in your
late thirties in your
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forties, various energy options
can give you a little drop of skin,
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tighten up, not so much
to take away a big,
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a big degree of skin laxity,
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but to keep the amount of
skin laxity at a minimum.
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Um, there are also some minimally invasive
options where energy is introduced
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through needle punctures in the skin.
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These procedures have a little bit of
recovery time or where there's sutures
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suspension under the skin, again,
a little bit of recovery time,
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but local anesthesia and no need for the
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anesthesiologist.
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And what about, I think most
people consider Botox and fillers,
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a little bit of the bread and butter of
plastic surgery. What do those types of,
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um, treatments do?
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Yeah,
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they've really become the
mainstay of what happens
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in medical treatments to prevent
and reverse aging changes.
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So volume loss in the face,
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which starts in our twenties starts
to become evident as contour,
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depressions and emptiness in
our late thirties and forties
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and fillers, or if we're
in the operating room,
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fat grafting can restore
some of that shape,
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fill in those hollow or sunken contours.
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These are things like the nasal
labial fold, the marionette lines,
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loss of volume and curviness in
the lips, flattening of the cheeks,
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hollowing of the temples and hollowing
of the tear trough the transition
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zone between the eyelid skin and
the cheek skin in the lower eyelid,
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Botox and other neuromodulators.
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The official name for these medicines
is neuromodulators, Botox, Dysport,
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Xeomin, and Jeuveau. I
like the word relaxers.
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These are for dynamic wrinkles.
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So wrinkles that are not fixed
into the fabric of the skin,
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but are there because of
resting muscle tension,
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bending our now somewhat
less elastic skin.
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And so most of the upper facial lines,
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the frown lines between the eyebrows,
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which are sometimes called the elevens
bunny lines on the side of the nose,
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when you smile or laugh far headlines,
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crows feet that are not fixed but
happen when you smile or animate,
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these are all
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routinely and best treated with
neuromodulators or relaxer medicines.
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Other changes in lip
wrinkles, marionette line,
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neck banding are also well
treated with the neuromodulators.
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It makes sense that patients are finding
that they can delay surgery for a few
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years or even extend the results
from an older facelift by utilizing
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all of those maintenance and rejuvenation
treatments that you just described.
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I didn't realize there's so many
different options available,
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which makes me wonder
what I should be doing.
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And this is what everybody wants
to know, what, what should they do?
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But there's no single answer.
It's a product of your skin type,
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where you are in aging changes,
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what features you're seeing and how much
those features happen to bother you.
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You know,
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one person will look at crows feet
and be very upset that they're there.
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And other folks say, I don't mind
those so much. I earned them,
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but I hate some other feature.
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They hate the deepening of marionette
lines or they hate hanging skin or gel.
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So what you need to do depends on
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what you're seeing and what
bothers you. And it, it also
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really revolves around how much
work you want to do in maintenance.
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There are people who spend two hours a
day playing with their skin with skin
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products, medicated skin,
lotions, and so forth.
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And other folks, you know, want
a quick medicated moisturizer.
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They can put on in the morning and
a different product for nighttime.
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That's not going to invest more
than 10 or 15 minutes a day.
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So everybody does what suits them.
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Let's say that I'm a new Yorker
who has a busy schedule and is
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starting to see some fine
lines and wrinkles that
weren't there a few years ago.
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I like looking like me and I don't
really wanna change my looks or my age,
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if I don't have to, what can I
do? What are some of my options?
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So for starters, home skin care products,
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and there are thousands of products,
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some of them have really
useful medications in them and
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enough of the medication in
there to have an effective dose.
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Um, others do not,
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but there's no single answer for that
because everyone's skin is different.
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So the skin is like a puzzle and you
have to tinker with skin medicines to
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figure out if they're doing
something meaningful for you,
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but on the early end of aging,
certainly things like that,
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microdermabrasion,
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which is an exfoliation of the
skin that's done mechanically,
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but is very gentle to the
skin is a good option.
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And some of the light or epidermal
chemical peels that that are no recovery
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peels that keep the skin
bright, fresh, even.
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I think microdermabrasion like
the dental cleaning of the skin,
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whatever your skin is doing,
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it's probably going to benefit you
and your skin will be healthier. It,
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it picks up the things you're not
getting with your home skincare process.
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Just like you brush your teeth at
home, you get most of what's there,
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but you get your dental cleaning
once or twice a year to really deep
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clean the things that you're not
successfully removing on your own.
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So that's the start. Um,
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eventually you're really gonna have to
coordinate with a skillful provider and I
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believe a collaborative back and forth
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works incredibly much
better than just doing
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something single treatment by single
treatment with someone who's really
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providing a technical function and
not a consultative function with you.
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Um,
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so someone who has a lot of options
who understands the whole range of
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aging changes, Botox and
fillers, as you said,
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are really the mainstay
once you're actually seeing
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established aging changes. Uh,
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and there's a whole level of activity.
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That's now picking up momentum where
in addition to energy treatments to
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stimulate collagen in the
skin or skin medicines,
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medicated skin products
to stimulate collagen,
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we also put energy or
dilute filler under the skin
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to further stimulate from below.
In addition to from above.
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There's a really fine line between what
is too much and what is too little.
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I have friends who are approaching
their mid twenties and are considering
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whether to start getting
preventative Botox. At the same time.
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I also see influencers on social media
post about going in for maintenance,
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Botox and filler a few times a year,
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and possibly even getting some laser
treatments and chemical peels on top of
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that to really keep their
skin in optimal shape.
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So there's definitely
a trend towards this.
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What's been term rejuvenation.
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You don't look older yet, but you
never want to get to that point.
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And I think it really is a, a gen X
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kind of, of behavior or a
millennial kind of behavior.
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Those patients come in and say,
I never want to look older.
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You are gonna keep me from looking older.
We're gonna start working on that now.
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And obviously you can overdo that,
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but it's not a bad idea to think about
problems before they develop and take
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limited steps to maintain and
prevent and neuromodulators
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Botox like medicines are
a perfect example of that.
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The thought is if you keep
the muscles relaxed in places,
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we know, tend to wrinkle as we age,
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instead of ironing in a
line for the next 20 years.
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And now it becomes visible
all day. Every day,
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we prevent that by putting
small amounts of Botox,
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there is also a trend towards,
you know, micro Botox.
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Uhlin toxin medicines,
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neuromodulators have multiple effects on
the skin besides just relaxing muscle.
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It controls sebum production
and other things in the skin.
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So we're just starting to understand
that there may be a much broader role
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for these medicines, separate from
what the label indications are.
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So this is off-label use,
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but it's being studied and examined
more and more as we realize
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there's so much more there than
we appreciated at the beginning.
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I've also heard of Botox being used
to control sweat production and
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reduce the amount of sweat when it's
injected and to say your underarms,
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or maybe even your hands.
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Yes. The use for hyperhydrosis
or just to reduce sweating.
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That's an on-label use of Botox, um,
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and has been known for many years,
the effects on other things,
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the skin does oil
production and other things
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is very analogous to the
effect on sweating but
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has not been as completely exploited.
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And we're just starting
to learn more about it.
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I wanna go back to the generational
divide that you pointed out.
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It reminds me of an article
I read recently that was
talking about how plastic
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surgeons are seeing a huge uptake
in the number of millennial aged
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patients that are coming into their
offices. And interestingly enough,
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the article mentioned how in the past
patients would bring in a picture
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of a celebrity or a model from a magazine
and say to their plastic surgeon,
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this is who I want to look
like. Whereas nowadays,
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millennials being the tech
savvy consumers, that they are,
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will show their plastic
surgeon a filtered,
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or touched up photo of themselves
and say, I want to look like this.
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Yeah, I've seen that in
my practice as well. I,
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I think there were iconic
images of beauty in the past
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that various forms of media had
promoted or that were trendy at
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the time.
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And I think the view of beauty currently
is much broader and more diverse.
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People want to look like
themselves rather than, uh,
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on balance or most of the time there
are individual exceptions rather than
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emulating a celebrity appearance
or a trendy appearance. Um,
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it's not entirely true.
There are trends in,
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in appearance that people are
pursuing in terms of body, shape,
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lips, other things, but, uh,
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but more and more people want to
be their optimized self or their
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beautiful self rather than somebody else.
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Um, to kind of steer us back on track.
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Can you describe some of
the common problems that you
see in your patients when
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it comes to rejuvenation
and maintenance treatments?
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00:14:45,370 --> 00:14:49,350
So again, it goes back to those
basic problems we, we talked about,
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00:14:49,790 --> 00:14:52,960
the skin surface changes,
dynamic wrinkling, skin quality
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and laxity. Um,
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and that's what we're
trying to address. Um,
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a younger patient might mostly be working
with medicated skin products at home
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and only doing a couple of in-office
treatments a year just to boost the,
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the effectiveness, uh,
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if they're not seeing quite as much as
they hope from the home skin products,
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once there are some
established aging changes,
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it really becomes a wrinkling
contour, depression, correction,
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along with skin brightness, skin evenness.
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So there's some energy treatments
a couple of times a year for that,
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or light chemical peels
along with some, some,
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uh, neuromodulators like Botox,
Dysport, Xeomin, Jeuveau,
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and, uh, and fillers, um,
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as laxity becomes a little more
of the focus energy treatments
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above and below the skin and diluted, uh,
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stimulatory fillers below the
skin, uh, has a role early,
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early in the laxity process.
So those are examples of,
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of what different
patients are focusing on,
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00:16:10,321 --> 00:16:13,800
mostly working at home with an
occasional boost in the office,
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00:16:15,280 --> 00:16:20,200
a schedule of typical
fill and neuromodulator
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muscle relaxation versus a
more intensive program of
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00:16:25,351 --> 00:16:28,830
really trying to stave off the
need for surgical intervention,
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00:16:30,390 --> 00:16:33,710
separate from that, you
know, patients, hunger for
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00:16:35,730 --> 00:16:40,400
perfecting or maximizing their beauty
outcomes varies all over the map.
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As I mentioned earlier,
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some people come in and just a
particular aging change, bugs them.
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And some of the other changes don't
really show up on their radar.
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00:16:52,190 --> 00:16:56,350
Um, they come in and say, I really
hate my lipstick bleed lines,
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and I don't care too much about the other
stuff. Other patients come in and say,
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just fix everything. You
know, I'm getting older,
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whatever you see, take
aim and fire. Um, and,
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and there's another group of patients
that say, look, life is good.
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00:17:13,500 --> 00:17:15,380
I see these things. I
wish they weren't there,
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but I'm too busy doing things
that are important to me.
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So that's an okay answer as well.
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00:17:22,390 --> 00:17:27,050
But basically if you see something that
bothers you and we have a reliable way
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00:17:27,110 --> 00:17:31,800
to improve it, then that's
the thing you should pursue.
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00:17:32,860 --> 00:17:35,000
If I see something, but
you don't care about it,
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00:17:35,100 --> 00:17:37,840
or you see something and I
don't have a good way to fix it,
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00:17:37,910 --> 00:17:40,510
then we probably should
leave well enough alone.
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00:17:40,511 --> 00:17:45,270
It's not important that I see something
it's only important if it bothers
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00:17:45,370 --> 00:17:49,200
you, uh, when something
bothers you enough,
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00:17:49,201 --> 00:17:54,200
that it's worth undergoing
the inconveniences of whatever
treatment is involved,
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that's when it's time to schedule it.
You know, we all see a dozen things.
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00:17:58,300 --> 00:18:02,040
If we had the magic wand,
we'd change our appearance,
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00:18:02,340 --> 00:18:05,160
but since we can only do
it the real world way,
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it has to bug you enough to be worth what,
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00:18:08,230 --> 00:18:10,030
whatever the treatment
is going to involve.
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00:18:10,930 --> 00:18:14,030
If only there was this
magic cure solution,
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00:18:14,190 --> 00:18:17,710
I think a lot of people
would be much happier. Um,
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but many would still
prefer to avoid surgery.
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00:18:21,130 --> 00:18:25,750
If nonsurgical alternatives might
provide comparable results or at least
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00:18:26,070 --> 00:18:31,020
a noticeable improvement for someone who
wishes to maintain a youthful natural
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00:18:31,030 --> 00:18:35,460
appearance and would like to
stave off various signs of aging,
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00:18:35,810 --> 00:18:38,180
what should they take away
from this episode? Dr. Bass.
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00:18:39,630 --> 00:18:43,970
The takeaways are, are pretty
simple and common sense. Um,
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it's really worthwhile to have a plan
of preventative and maintenance care
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00:18:49,470 --> 00:18:53,800
that will always help you look
your best versus just, you know,
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00:18:54,110 --> 00:18:57,960
sitting back and waiting till
you need to take some big step.
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00:18:59,480 --> 00:19:03,000
Um, when you're 20, I like
to say you're wash and wear.
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00:19:03,180 --> 00:19:06,390
You don't need very much to look
your best, but as we get older,
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00:19:06,450 --> 00:19:09,030
we need a little more
maintenance. And that goes,
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00:19:09,270 --> 00:19:11,030
a little maintenance goes a long way.
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00:19:12,370 --> 00:19:14,670
The beauty of this is
you're in the driver's seat.
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You can do a lot or a little
at home or in the office,
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00:19:18,591 --> 00:19:22,220
depending on what suits you. And if
you're happy with your appearance,
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00:19:22,221 --> 00:19:23,100
you've done enough.
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00:19:23,101 --> 00:19:27,740
We have seen a transition
to looking better for longer
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00:19:28,050 --> 00:19:30,140
because of nonsurgical treatments.
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00:19:30,810 --> 00:19:35,540
It's very clear from the data
that nonsurgical treatments
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00:19:35,860 --> 00:19:40,170
are raising the average age of
facelift over the past two decades.
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00:19:41,230 --> 00:19:44,930
And lifestyle changes have helped
with that as well, less sun,
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00:19:45,000 --> 00:19:48,330
less smoking and so forth. Um,
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00:19:48,550 --> 00:19:50,970
people age in certain typical patterns.
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And that lets us predict
what likely will be useful,
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but everyone is aging as an individual.
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00:19:57,270 --> 00:20:01,760
So it's really looking at what
you have a level of concern about
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00:20:02,460 --> 00:20:04,720
rather than copying what
your friends are doing.
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00:20:04,740 --> 00:20:09,320
And I call this beauty thermostat
and beauty lens. So, you know,
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00:20:09,560 --> 00:20:14,560
a thermostat could click back on if
the temperature drops by a degree
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00:20:14,700 --> 00:20:18,070
or it could wait till it drops
three degrees before it clicks on.
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00:20:18,650 --> 00:20:22,310
It just depends how sensitive you
are to small changes in appearance.
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00:20:22,570 --> 00:20:24,750
And then the beauty
lens is, you know, what,
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00:20:25,050 --> 00:20:29,310
in your eyes is important to
your appearance. And again,
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00:20:29,311 --> 00:20:32,750
doesn't matter what your friends are
doing or a celebrity is doing. It's,
305
00:20:32,751 --> 00:20:33,790
what's important to you.
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00:20:35,570 --> 00:20:39,700
Any care plan should be
customized and not cookie cutter.
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00:20:40,970 --> 00:20:45,940
That way you can partner
with an experienced provider
and find a plan that fits
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00:20:45,941 --> 00:20:46,860
your needs and budget.
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00:20:47,630 --> 00:20:50,840
That was a really
interesting metaphor. And I,
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00:20:51,000 --> 00:20:53,960
I think that's an important distinction
that you just made between that beauty
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00:20:53,970 --> 00:20:58,320
thermostat and beauty lens. Well, thank
you for joining us today, Dr. Bass,
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00:20:58,470 --> 00:21:00,400
this was an eye-opening episode,
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00:21:00,540 --> 00:21:04,440
and I know I learned a lot about the
different non-surgical treatments and
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00:21:04,441 --> 00:21:08,990
technologies that can be used to target
aging and delay the need for surgery.
315
00:21:10,520 --> 00:21:11,650
This is Doreen Wu,
316
00:21:11,770 --> 00:21:15,770
thanking you for joining Dr. Bass and
me for this discussion of treatment
317
00:21:15,771 --> 00:21:19,450
programs for facial aging,
designed to postpone the facelift.
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00:21:20,160 --> 00:21:24,130
What non-surgical treatments would you
like to hear more about email us to let
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00:21:24,131 --> 00:21:24,860
us know,
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00:21:24,860 --> 00:21:29,360
and we will discuss it in a future
episode as always be sure to join us next
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time for our episode on after
the facelift prevention,
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00:21:33,241 --> 00:21:35,480
maintenance and restoration. Continue.
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00:21:36,690 --> 00:21:40,640
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:21:40,730 --> 00:21:45,390
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:21:46,230 --> 00:21:48,070
educator, and technology innovator.
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00:21:48,410 --> 00:21:50,870
The commentary in this
podcast represents opinion.
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00:21:51,100 --> 00:21:53,510
This podcast does not
present medical advice,
328
00:21:53,850 --> 00:21:57,790
but rather general information about
plastic surgery that does not necessarily
329
00:21:57,850 --> 00:22:00,870
relate to the specific conditions
of any individual patient.
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00:22:01,290 --> 00:22:06,140
No doctor-patient relationship
is established by listening
to or participating
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00:22:06,280 --> 00:22:07,113
in this podcast,
332
00:22:07,370 --> 00:22:11,420
consult your physician to advise you
about your individual healthcare.
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00:22:11,680 --> 00:22:13,100
If you enjoyed this episode,
334
00:22:13,280 --> 00:22:17,300
please share it with your friends and
be sure to subscribe to our podcast on
335
00:22:17,301 --> 00:22:21,330
Apple Podcasts, Google, Spotify, Stitcher,
336
00:22:21,630 --> 00:22:23,930
or wherever you listen to podcasts.
00:00:00,850 --> 00:00:03,620
Welcome back to Park Avenue
Plastic Surgery Class.
2
00:00:04,000 --> 00:00:08,700
My name is Doreen Wu and I co-host this
podcast where we explore controversies
3
00:00:08,760 --> 00:00:10,500
and breaking issues in plastic surgery.
4
00:00:11,200 --> 00:00:15,220
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
5
00:00:15,860 --> 00:00:17,340
educator, and technology innovator.
6
00:00:18,080 --> 00:00:20,730
The title of today's episode
is "before the facelift:
7
00:00:20,731 --> 00:00:25,530
how a multifaceted program
of nonsurgical treatments can
8
00:00:25,531 --> 00:00:27,250
postpone the facelift for a decade
9
00:00:29,070 --> 00:00:33,130
as someone who is young enough to be in
the pre facelift group." I'm excited to
10
00:00:33,131 --> 00:00:37,130
hear about the ways that a facelift can
be postponed with all of these cutting
11
00:00:37,570 --> 00:00:39,560
edge nonsurgical aesthetic treatments.
12
00:00:40,310 --> 00:00:44,320
Exactly. Doreen. This is really a
critical part of plastic surgery.
13
00:00:45,480 --> 00:00:48,320
It's great to fix an aging
change in someone's face,
14
00:00:48,920 --> 00:00:53,360
but the ideal is to help people just
stay the same and keep looking young,
15
00:00:55,200 --> 00:00:58,990
modern plastic surgery actually
spends much more time on prevention,
16
00:00:59,910 --> 00:01:03,070
support and maintenance
than on restoration.
17
00:01:04,410 --> 00:01:08,550
In this episode, we'll discuss
how a variety of treatments,
18
00:01:08,620 --> 00:01:13,430
support appearance without downtime
and have modulated the average age
19
00:01:13,530 --> 00:01:14,510
for the facelift.
20
00:01:15,370 --> 00:01:16,300
In years past,
21
00:01:16,560 --> 00:01:21,100
it seems like facial rejuvenation options
were largely limited to a facelift,
22
00:01:21,720 --> 00:01:23,580
but now we have so much
more at a disposal.
23
00:01:24,360 --> 00:01:27,140
Can you describe some of the
components of nonsurgical,
24
00:01:27,440 --> 00:01:29,460
facial maintenance and rejuvenation?
25
00:01:30,330 --> 00:01:31,180
Sure. Uh,
26
00:01:31,210 --> 00:01:35,770
this relies heavily on
treating changes in the skin,
27
00:01:36,670 --> 00:01:41,410
as well as treating laxity
and volume loss in the face.
28
00:01:42,430 --> 00:01:45,530
So skin surface changes
are things like redness,
29
00:01:45,531 --> 00:01:48,570
either broken blood
vessels or little red dots,
30
00:01:48,590 --> 00:01:53,320
or just a general red
or plethora look often
31
00:01:53,321 --> 00:01:57,340
that's rosacea brown changes.
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00:01:58,240 --> 00:02:02,180
Our pigmentation gets
less even as we age. Uh,
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00:02:02,181 --> 00:02:06,900
but we also sometimes get brown spots
that people call sun spots or age spots or
34
00:02:06,901 --> 00:02:08,500
liver spots. Uh,
35
00:02:08,501 --> 00:02:13,450
those are really from sun
and wrinkles loss of the
36
00:02:13,660 --> 00:02:16,530
smoothness of the skin and
the turker of the skin.
37
00:02:16,531 --> 00:02:20,730
And this is really all about
chemical peels, laser peels,
38
00:02:21,190 --> 00:02:25,730
and all of the no recovery lasers
and energy devices that have
39
00:02:25,880 --> 00:02:27,930
evolved out of the laser peels.
40
00:02:29,860 --> 00:02:33,840
That's one big category. It
changes then there's skin laxity,
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00:02:35,240 --> 00:02:37,680
um, very early in the game.
42
00:02:37,681 --> 00:02:41,680
And this means in your
late thirties in your
43
00:02:42,550 --> 00:02:47,520
forties, various energy options
can give you a little drop of skin,
44
00:02:47,620 --> 00:02:51,030
tighten up, not so much
to take away a big,
45
00:02:51,031 --> 00:02:53,990
a big degree of skin laxity,
46
00:02:54,090 --> 00:02:58,670
but to keep the amount of
skin laxity at a minimum.
47
00:02:59,280 --> 00:03:04,120
Um, there are also some minimally invasive
options where energy is introduced
48
00:03:04,121 --> 00:03:07,000
through needle punctures in the skin.
49
00:03:07,001 --> 00:03:11,680
These procedures have a little bit of
recovery time or where there's sutures
50
00:03:11,770 --> 00:03:15,640
suspension under the skin, again,
a little bit of recovery time,
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00:03:16,090 --> 00:03:20,990
but local anesthesia and no need for the
52
00:03:21,250 --> 00:03:22,110
anesthesiologist.
53
00:03:23,220 --> 00:03:27,720
And what about, I think most
people consider Botox and fillers,
54
00:03:28,360 --> 00:03:32,160
a little bit of the bread and butter of
plastic surgery. What do those types of,
55
00:03:32,680 --> 00:03:33,560
um, treatments do?
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00:03:34,150 --> 00:03:34,830
Yeah,
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00:03:34,830 --> 00:03:39,590
they've really become the
mainstay of what happens
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00:03:39,850 --> 00:03:44,670
in medical treatments to prevent
and reverse aging changes.
59
00:03:45,170 --> 00:03:46,910
So volume loss in the face,
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00:03:47,350 --> 00:03:51,190
which starts in our twenties starts
to become evident as contour,
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00:03:51,910 --> 00:03:55,980
depressions and emptiness in
our late thirties and forties
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00:03:57,620 --> 00:04:00,260
and fillers, or if we're
in the operating room,
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00:04:00,660 --> 00:04:03,900
fat grafting can restore
some of that shape,
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00:04:04,580 --> 00:04:06,780
fill in those hollow or sunken contours.
65
00:04:07,020 --> 00:04:10,580
These are things like the nasal
labial fold, the marionette lines,
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00:04:11,780 --> 00:04:16,210
loss of volume and curviness in
the lips, flattening of the cheeks,
67
00:04:17,330 --> 00:04:22,170
hollowing of the temples and hollowing
of the tear trough the transition
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00:04:22,530 --> 00:04:26,370
zone between the eyelid skin and
the cheek skin in the lower eyelid,
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00:04:30,070 --> 00:04:32,860
Botox and other neuromodulators.
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00:04:33,380 --> 00:04:37,980
The official name for these medicines
is neuromodulators, Botox, Dysport,
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00:04:38,740 --> 00:04:42,940
Xeomin, and Jeuveau. I
like the word relaxers.
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00:04:44,220 --> 00:04:46,340
These are for dynamic wrinkles.
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00:04:46,620 --> 00:04:49,460
So wrinkles that are not fixed
into the fabric of the skin,
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00:04:50,220 --> 00:04:53,090
but are there because of
resting muscle tension,
75
00:04:54,130 --> 00:04:57,250
bending our now somewhat
less elastic skin.
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00:04:58,810 --> 00:05:01,170
And so most of the upper facial lines,
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00:05:02,490 --> 00:05:04,530
the frown lines between the eyebrows,
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00:05:04,810 --> 00:05:08,970
which are sometimes called the elevens
bunny lines on the side of the nose,
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00:05:09,480 --> 00:05:12,120
when you smile or laugh far headlines,
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00:05:13,040 --> 00:05:17,320
crows feet that are not fixed but
happen when you smile or animate,
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00:05:18,200 --> 00:05:19,033
these are all
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00:05:20,440 --> 00:05:25,080
routinely and best treated with
neuromodulators or relaxer medicines.
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00:05:26,440 --> 00:05:30,830
Other changes in lip
wrinkles, marionette line,
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00:05:31,590 --> 00:05:36,510
neck banding are also well
treated with the neuromodulators.
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00:05:37,650 --> 00:05:42,030
It makes sense that patients are finding
that they can delay surgery for a few
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00:05:42,031 --> 00:05:46,670
years or even extend the results
from an older facelift by utilizing
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00:05:47,000 --> 00:05:51,020
all of those maintenance and rejuvenation
treatments that you just described.
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00:05:51,740 --> 00:05:54,260
I didn't realize there's so many
different options available,
89
00:05:54,710 --> 00:05:56,900
which makes me wonder
what I should be doing.
90
00:05:57,980 --> 00:06:02,600
And this is what everybody wants
to know, what, what should they do?
91
00:06:02,940 --> 00:06:07,360
But there's no single answer.
It's a product of your skin type,
92
00:06:07,930 --> 00:06:10,080
where you are in aging changes,
93
00:06:10,270 --> 00:06:14,720
what features you're seeing and how much
those features happen to bother you.
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00:06:15,460 --> 00:06:15,911
You know,
95
00:06:15,911 --> 00:06:19,750
one person will look at crows feet
and be very upset that they're there.
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00:06:19,890 --> 00:06:23,230
And other folks say, I don't mind
those so much. I earned them,
97
00:06:23,690 --> 00:06:26,110
but I hate some other feature.
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00:06:26,111 --> 00:06:30,790
They hate the deepening of marionette
lines or they hate hanging skin or gel.
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00:06:30,791 --> 00:06:35,340
So what you need to do depends on
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00:06:35,930 --> 00:06:40,300
what you're seeing and what
bothers you. And it, it also
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00:06:42,340 --> 00:06:47,200
really revolves around how much
work you want to do in maintenance.
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00:06:47,250 --> 00:06:51,360
There are people who spend two hours a
day playing with their skin with skin
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00:06:51,361 --> 00:06:54,990
products, medicated skin,
lotions, and so forth.
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00:06:55,610 --> 00:06:59,990
And other folks, you know, want
a quick medicated moisturizer.
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00:07:00,060 --> 00:07:03,230
They can put on in the morning and
a different product for nighttime.
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00:07:03,850 --> 00:07:07,310
That's not going to invest more
than 10 or 15 minutes a day.
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00:07:08,090 --> 00:07:09,830
So everybody does what suits them.
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00:07:10,650 --> 00:07:15,510
Let's say that I'm a new Yorker
who has a busy schedule and is
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00:07:15,511 --> 00:07:19,390
starting to see some fine
lines and wrinkles that
weren't there a few years ago.
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I like looking like me and I don't
really wanna change my looks or my age,
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if I don't have to, what can I
do? What are some of my options?
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So for starters, home skin care products,
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and there are thousands of products,
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some of them have really
useful medications in them and
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enough of the medication in
there to have an effective dose.
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Um, others do not,
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but there's no single answer for that
because everyone's skin is different.
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So the skin is like a puzzle and you
have to tinker with skin medicines to
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figure out if they're doing
something meaningful for you,
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but on the early end of aging,
certainly things like that,
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microdermabrasion,
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which is an exfoliation of the
skin that's done mechanically,
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but is very gentle to the
skin is a good option.
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And some of the light or epidermal
chemical peels that that are no recovery
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peels that keep the skin
bright, fresh, even.
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I think microdermabrasion like
the dental cleaning of the skin,
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whatever your skin is doing,
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it's probably going to benefit you
and your skin will be healthier. It,
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it picks up the things you're not
getting with your home skincare process.
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Just like you brush your teeth at
home, you get most of what's there,
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but you get your dental cleaning
once or twice a year to really deep
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clean the things that you're not
successfully removing on your own.
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So that's the start. Um,
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eventually you're really gonna have to
coordinate with a skillful provider and I
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believe a collaborative back and forth
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works incredibly much
better than just doing
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something single treatment by single
treatment with someone who's really
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providing a technical function and
not a consultative function with you.
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Um,
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so someone who has a lot of options
who understands the whole range of
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aging changes, Botox and
fillers, as you said,
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are really the mainstay
once you're actually seeing
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established aging changes. Uh,
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and there's a whole level of activity.
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That's now picking up momentum where
in addition to energy treatments to
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stimulate collagen in the
skin or skin medicines,
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medicated skin products
to stimulate collagen,
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we also put energy or
dilute filler under the skin
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to further stimulate from below.
In addition to from above.
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There's a really fine line between what
is too much and what is too little.
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I have friends who are approaching
their mid twenties and are considering
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whether to start getting
preventative Botox. At the same time.
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I also see influencers on social media
post about going in for maintenance,
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Botox and filler a few times a year,
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and possibly even getting some laser
treatments and chemical peels on top of
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that to really keep their
skin in optimal shape.
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So there's definitely
a trend towards this.
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What's been term rejuvenation.
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You don't look older yet, but you
never want to get to that point.
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And I think it really is a, a gen X
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kind of, of behavior or a
millennial kind of behavior.
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Those patients come in and say,
I never want to look older.
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You are gonna keep me from looking older.
We're gonna start working on that now.
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And obviously you can overdo that,
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but it's not a bad idea to think about
problems before they develop and take
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limited steps to maintain and
prevent and neuromodulators
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Botox like medicines are
a perfect example of that.
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The thought is if you keep
the muscles relaxed in places,
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we know, tend to wrinkle as we age,
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instead of ironing in a
line for the next 20 years.
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And now it becomes visible
all day. Every day,
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we prevent that by putting
small amounts of Botox,
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there is also a trend towards,
you know, micro Botox.
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Uhlin toxin medicines,
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neuromodulators have multiple effects on
the skin besides just relaxing muscle.
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It controls sebum production
and other things in the skin.
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So we're just starting to understand
that there may be a much broader role
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for these medicines, separate from
what the label indications are.
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So this is off-label use,
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but it's being studied and examined
more and more as we realize
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there's so much more there than
we appreciated at the beginning.
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I've also heard of Botox being used
to control sweat production and
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reduce the amount of sweat when it's
injected and to say your underarms,
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or maybe even your hands.
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Yes. The use for hyperhydrosis
or just to reduce sweating.
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That's an on-label use of Botox, um,
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and has been known for many years,
the effects on other things,
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the skin does oil
production and other things
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is very analogous to the
effect on sweating but
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has not been as completely exploited.
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And we're just starting
to learn more about it.
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I wanna go back to the generational
divide that you pointed out.
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It reminds me of an article
I read recently that was
talking about how plastic
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surgeons are seeing a huge uptake
in the number of millennial aged
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patients that are coming into their
offices. And interestingly enough,
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the article mentioned how in the past
patients would bring in a picture
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of a celebrity or a model from a magazine
and say to their plastic surgeon,
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this is who I want to look
like. Whereas nowadays,
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millennials being the tech
savvy consumers, that they are,
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will show their plastic
surgeon a filtered,
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or touched up photo of themselves
and say, I want to look like this.
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Yeah, I've seen that in
my practice as well. I,
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I think there were iconic
images of beauty in the past
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that various forms of media had
promoted or that were trendy at
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the time.
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00:13:56,160 --> 00:14:00,320
And I think the view of beauty currently
is much broader and more diverse.
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00:14:01,400 --> 00:14:05,550
People want to look like
themselves rather than, uh,
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00:14:05,830 --> 00:14:09,990
on balance or most of the time there
are individual exceptions rather than
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00:14:10,590 --> 00:14:14,630
emulating a celebrity appearance
or a trendy appearance. Um,
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00:14:15,270 --> 00:14:17,310
it's not entirely true.
There are trends in,
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00:14:17,750 --> 00:14:22,340
in appearance that people are
pursuing in terms of body, shape,
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00:14:22,860 --> 00:14:24,700
lips, other things, but, uh,
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00:14:24,940 --> 00:14:29,780
but more and more people want to
be their optimized self or their
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00:14:30,340 --> 00:14:32,540
beautiful self rather than somebody else.
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00:14:33,920 --> 00:14:36,320
Um, to kind of steer us back on track.
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00:14:36,900 --> 00:14:41,550
Can you describe some of
the common problems that you
see in your patients when
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it comes to rejuvenation
and maintenance treatments?
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00:14:45,370 --> 00:14:49,350
So again, it goes back to those
basic problems we, we talked about,
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00:14:49,790 --> 00:14:52,960
the skin surface changes,
dynamic wrinkling, skin quality
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and laxity. Um,
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and that's what we're
trying to address. Um,
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a younger patient might mostly be working
with medicated skin products at home
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and only doing a couple of in-office
treatments a year just to boost the,
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00:15:12,790 --> 00:15:14,470
the effectiveness, uh,
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00:15:14,670 --> 00:15:18,270
if they're not seeing quite as much as
they hope from the home skin products,
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00:15:19,150 --> 00:15:21,550
once there are some
established aging changes,
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00:15:21,950 --> 00:15:25,710
it really becomes a wrinkling
contour, depression, correction,
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along with skin brightness, skin evenness.
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So there's some energy treatments
a couple of times a year for that,
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or light chemical peels
along with some, some,
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00:15:38,580 --> 00:15:43,180
uh, neuromodulators like Botox,
Dysport, Xeomin, Jeuveau,
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and, uh, and fillers, um,
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as laxity becomes a little more
of the focus energy treatments
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00:15:53,770 --> 00:15:57,210
above and below the skin and diluted, uh,
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00:15:58,210 --> 00:16:02,570
stimulatory fillers below the
skin, uh, has a role early,
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00:16:02,970 --> 00:16:07,600
early in the laxity process.
So those are examples of,
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00:16:08,020 --> 00:16:10,320
of what different
patients are focusing on,
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00:16:10,321 --> 00:16:13,800
mostly working at home with an
occasional boost in the office,
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00:16:15,280 --> 00:16:20,200
a schedule of typical
fill and neuromodulator
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00:16:20,380 --> 00:16:25,350
muscle relaxation versus a
more intensive program of
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00:16:25,351 --> 00:16:28,830
really trying to stave off the
need for surgical intervention,
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00:16:30,390 --> 00:16:33,710
separate from that, you
know, patients, hunger for
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00:16:35,730 --> 00:16:40,400
perfecting or maximizing their beauty
outcomes varies all over the map.
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00:16:40,460 --> 00:16:41,400
As I mentioned earlier,
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00:16:42,030 --> 00:16:46,310
some people come in and just a
particular aging change, bugs them.
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00:16:46,370 --> 00:16:50,710
And some of the other changes don't
really show up on their radar.
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00:16:52,190 --> 00:16:56,350
Um, they come in and say, I really
hate my lipstick bleed lines,
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00:16:56,570 --> 00:17:00,710
and I don't care too much about the other
stuff. Other patients come in and say,
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00:17:00,900 --> 00:17:04,980
just fix everything. You
know, I'm getting older,
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00:17:05,420 --> 00:17:09,660
whatever you see, take
aim and fire. Um, and,
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and there's another group of patients
that say, look, life is good.
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00:17:13,500 --> 00:17:15,380
I see these things. I
wish they weren't there,
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00:17:15,381 --> 00:17:18,500
but I'm too busy doing things
that are important to me.
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00:17:18,680 --> 00:17:21,650
So that's an okay answer as well.
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00:17:22,390 --> 00:17:27,050
But basically if you see something that
bothers you and we have a reliable way
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00:17:27,110 --> 00:17:31,800
to improve it, then that's
the thing you should pursue.
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00:17:32,860 --> 00:17:35,000
If I see something, but
you don't care about it,
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00:17:35,100 --> 00:17:37,840
or you see something and I
don't have a good way to fix it,
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00:17:37,910 --> 00:17:40,510
then we probably should
leave well enough alone.
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00:17:40,511 --> 00:17:45,270
It's not important that I see something
it's only important if it bothers
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00:17:45,370 --> 00:17:49,200
you, uh, when something
bothers you enough,
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00:17:49,201 --> 00:17:54,200
that it's worth undergoing
the inconveniences of whatever
treatment is involved,
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00:17:54,420 --> 00:17:58,200
that's when it's time to schedule it.
You know, we all see a dozen things.
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00:17:58,300 --> 00:18:02,040
If we had the magic wand,
we'd change our appearance,
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00:18:02,340 --> 00:18:05,160
but since we can only do
it the real world way,
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00:18:05,620 --> 00:18:07,950
it has to bug you enough to be worth what,
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00:18:08,230 --> 00:18:10,030
whatever the treatment
is going to involve.
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00:18:10,930 --> 00:18:14,030
If only there was this
magic cure solution,
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00:18:14,190 --> 00:18:17,710
I think a lot of people
would be much happier. Um,
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00:18:17,890 --> 00:18:20,870
but many would still
prefer to avoid surgery.
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00:18:21,130 --> 00:18:25,750
If nonsurgical alternatives might
provide comparable results or at least
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00:18:26,070 --> 00:18:31,020
a noticeable improvement for someone who
wishes to maintain a youthful natural
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00:18:31,030 --> 00:18:35,460
appearance and would like to
stave off various signs of aging,
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00:18:35,810 --> 00:18:38,180
what should they take away
from this episode? Dr. Bass.
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00:18:39,630 --> 00:18:43,970
The takeaways are, are pretty
simple and common sense. Um,
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00:18:44,560 --> 00:18:49,000
it's really worthwhile to have a plan
of preventative and maintenance care
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00:18:49,470 --> 00:18:53,800
that will always help you look
your best versus just, you know,
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sitting back and waiting till
you need to take some big step.
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00:18:59,480 --> 00:19:03,000
Um, when you're 20, I like
to say you're wash and wear.
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You don't need very much to look
your best, but as we get older,
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00:19:06,450 --> 00:19:09,030
we need a little more
maintenance. And that goes,
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00:19:09,270 --> 00:19:11,030
a little maintenance goes a long way.
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00:19:12,370 --> 00:19:14,670
The beauty of this is
you're in the driver's seat.
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00:19:15,090 --> 00:19:18,590
You can do a lot or a little
at home or in the office,
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00:19:18,591 --> 00:19:22,220
depending on what suits you. And if
you're happy with your appearance,
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00:19:22,221 --> 00:19:23,100
you've done enough.
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00:19:23,101 --> 00:19:27,740
We have seen a transition
to looking better for longer
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00:19:28,050 --> 00:19:30,140
because of nonsurgical treatments.
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00:19:30,810 --> 00:19:35,540
It's very clear from the data
that nonsurgical treatments
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00:19:35,860 --> 00:19:40,170
are raising the average age of
facelift over the past two decades.
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00:19:41,230 --> 00:19:44,930
And lifestyle changes have helped
with that as well, less sun,
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00:19:45,000 --> 00:19:48,330
less smoking and so forth. Um,
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people age in certain typical patterns.
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And that lets us predict
what likely will be useful,
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00:19:54,910 --> 00:19:56,970
but everyone is aging as an individual.
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So it's really looking at what
you have a level of concern about
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00:20:02,460 --> 00:20:04,720
rather than copying what
your friends are doing.
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00:20:04,740 --> 00:20:09,320
And I call this beauty thermostat
and beauty lens. So, you know,
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a thermostat could click back on if
the temperature drops by a degree
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00:20:14,700 --> 00:20:18,070
or it could wait till it drops
three degrees before it clicks on.
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It just depends how sensitive you
are to small changes in appearance.
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00:20:22,570 --> 00:20:24,750
And then the beauty
lens is, you know, what,
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00:20:25,050 --> 00:20:29,310
in your eyes is important to
your appearance. And again,
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00:20:29,311 --> 00:20:32,750
doesn't matter what your friends are
doing or a celebrity is doing. It's,
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00:20:32,751 --> 00:20:33,790
what's important to you.
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00:20:35,570 --> 00:20:39,700
Any care plan should be
customized and not cookie cutter.
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00:20:40,970 --> 00:20:45,940
That way you can partner
with an experienced provider
and find a plan that fits
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00:20:45,941 --> 00:20:46,860
your needs and budget.
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00:20:47,630 --> 00:20:50,840
That was a really
interesting metaphor. And I,
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I think that's an important distinction
that you just made between that beauty
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00:20:53,970 --> 00:20:58,320
thermostat and beauty lens. Well, thank
you for joining us today, Dr. Bass,
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00:20:58,470 --> 00:21:00,400
this was an eye-opening episode,
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00:21:00,540 --> 00:21:04,440
and I know I learned a lot about the
different non-surgical treatments and
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00:21:04,441 --> 00:21:08,990
technologies that can be used to target
aging and delay the need for surgery.
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00:21:10,520 --> 00:21:11,650
This is Doreen Wu,
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00:21:11,770 --> 00:21:15,770
thanking you for joining Dr. Bass and
me for this discussion of treatment
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00:21:15,771 --> 00:21:19,450
programs for facial aging,
designed to postpone the facelift.
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00:21:20,160 --> 00:21:24,130
What non-surgical treatments would you
like to hear more about email us to let
319
00:21:24,131 --> 00:21:24,860
us know,
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00:21:24,860 --> 00:21:29,360
and we will discuss it in a future
episode as always be sure to join us next
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00:21:29,361 --> 00:21:33,240
time for our episode on after
the facelift prevention,
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00:21:33,241 --> 00:21:35,480
maintenance and restoration. Continue.
323
00:21:36,690 --> 00:21:40,640
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:21:40,730 --> 00:21:45,390
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:21:46,230 --> 00:21:48,070
educator, and technology innovator.
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00:21:48,410 --> 00:21:50,870
The commentary in this
podcast represents opinion.
327
00:21:51,100 --> 00:21:53,510
This podcast does not
present medical advice,
328
00:21:53,850 --> 00:21:57,790
but rather general information about
plastic surgery that does not necessarily
329
00:21:57,850 --> 00:22:00,870
relate to the specific conditions
of any individual patient.
330
00:22:01,290 --> 00:22:06,140
No doctor-patient relationship
is established by listening
to or participating
331
00:22:06,280 --> 00:22:07,113
in this podcast,
332
00:22:07,370 --> 00:22:11,420
consult your physician to advise you
about your individual healthcare.
333
00:22:11,680 --> 00:22:13,100
If you enjoyed this episode,
334
00:22:13,280 --> 00:22:17,300
please share it with your friends and
be sure to subscribe to our podcast on
335
00:22:17,301 --> 00:22:21,330
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336
00:22:21,630 --> 00:22:23,930
or wherever you listen to podcasts.