Future of Devices w/ Dr. Vic Ross

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your cohost, Doreen
Wu, here with Dr. Lawrence Bass,

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Park Avenue plastic surgeon,
educator, and technology innovator.

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Today we are joined by Dr. Vic Ross
to talk about the future of devices in

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aesthetic medicine and the role of
the partnership between professional

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societies and industry in
producing these devices.

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Delighted that Dr. Ross has agreed
to join us again on the podcast.

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Dr. Ross is a board
certified dermatologist

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who works at the Scripps Clinic
in San Diego, California. He is,

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had a long career in
laser and device based

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research.

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He has served as the past president
of the American Society for Laser

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Medicine in surgery,

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as well as on the board of
directors of the American Society of

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Dermatologic Surgery.

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He completed the laser clinical
and research fellowship at the

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Wellman Labs at Massachusetts General
Hospital that launched him on his career

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in lasers and devices.

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But he's contributed tremendously in the,

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if I can say it, decades
since then to this field.

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So welcome Dr. Ross.

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I'm glad to be here. Good to be back.

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Dr. Bass, we've talked about the role
of devices in aesthetic medicine before.

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In a capsule summary,

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what were the main breakthroughs that
gave rise to this revolutionary role of

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devices?

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The big sentinel breakthrough

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was the recognition that by
delivering very short pulses

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of laser light,

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and by selecting the
amount of energy and the

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wavelength or color of light,

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that you could confine the
effects of laser treatments to

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the target within the skin,

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to the abnormal part of the skin that
you were trying to damage or change

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instead of just damaging
the skin globally.

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And that went by the term
selective photothermalisis.

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That was something that was first
published in the early 1980s from the

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Wellman Labs by Dr. Rox
Anderson and the then

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director of the laboratory, John Parrish.

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And that really revolutionized
the use of these devices for

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skin disorders and
cosmetic skin treatments.

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Okay. So devices are here to
stay. What is happening now?

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I'm wondering what are the
main developmental avenues
in technology taking place

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currently?

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Yeah, I think they're twofold. Well,

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one is incremental improvements in
some of the devices we already have.

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So from an engineering perspective,
efficiency perspective, cost,

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and size devices are certainly more
reliable than they were 25, 30 years ago.

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More powerful.

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And they tend to do a better job
and cover larger areas faster.

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So let's take laser hair
removal, for example.

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The early device may have had a 10
millimeter spot size the size of a penny,

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and you have to go maybe
at one pulse per second.

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So imagine doing a whole back that
way for laser hair reduction or leg,

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that would take quite a while. Now,

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devices typically have spots that
are three or four times larger.

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They can fire at two pulses per second.

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So you're talking about covering a
back and maybe eight minutes or less

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whereas that might have taken
45 minutes to an hour before.

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So some of the technology
involves better reliability,

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speed, comfort, safety,
those types of things. Also,

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we've seen what I call navigational aids
added to several devices. For example,

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there's one device that measures the
skin pigment with a little meter,

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and then that provides settings
for the provider based on say,

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if you're tanned or untanned.
So that's one thing.

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The other thing is the
devices oftentimes have

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application driven menus on
like a tablet type of thing.

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So you push a button and let's say you
want to treat a leg vein, for example,

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the laser may have settings.

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If you push leg vein and you push the
size of the vein and where it is on the

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face versus a leg,

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it'll provide you some
recommended settings from the
manufacturer that are built

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in. So those are some incremental
things that have been done.

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They're not necessarily revolutionary,
but on a daily practical level,

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they mean a lot to the
practitioner and to the patient.

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And the other side of the picture,

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we have just brand new
things that are happening.

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In other words things that have
involved different types of

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technologies altogether. For
example, using cold to destroy fat,

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the advent of fractional lasers
over the last 15 to 20 years,

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we've put little holes in the skin and
that's really allowed us to do lots of

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new things. I think in the future,

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we'll see as Dr. Bass has
talked about in the past,

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maybe optical diagnosis. In
other words, you use a scanner,

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some type of tool to
tell what is in the skin.

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So you might not have to get a biopsy,

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you would just be able to go over the
skin and find out whether somebody has a

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tumor or not. So these are some things,
and there are a lot more things,

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but just very briefly, these are some
things that are happening and will happen.

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Robotics that'll happen
even probably later. But,

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so there's a lot of new
things on the horizon.

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Let's move into application.

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What clinical problems are being chased
or might be addressed more effectively

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by these technologies?

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Yeah, probably the hottest
thing right now is is acne.

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There are two devices now that have,
one is already FDA cleared for acne.

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The other hopefully will be cleared soon.

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And these are using devices that
target sebum directly, directly.

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So all of us have these glands that
reduce grease on our skin called sebaceous

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glands. And if you don't have
sebaceous glands, you won't have acne.

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That's largely why little kids don't
get acne. Their skin always looks nice,

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even if they're going to have
bad acne when they're 12 or 14,

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if you see a six year old kid,
they look pretty darn good.

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So if you can destroy those
glands or make them smaller,

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the acne should diminish quite a bit.

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And so we have new lasers that
target those glands specifically.

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But it's a challenge
because the targets are

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hard to treat without
damaging the normal skin.

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It involves a lot of complex
interactions between cold and heat.

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So that's one of the
biggest frontiers, I think,

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as far as something entirely new
that we haven't done in the past.

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So I'm curious to hear
your thoughts about how

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industry decides what technologies
to work on and how they

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choose clinical problems.

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Yeah,

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I think the first thing that industry
looks at is how common the problem is.

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I mean, if it's a common problem,
it's more worth pursuing,

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like body contouring with Coolsculpting,
for example, or cryolipolysis.

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Everybody has some fat somewhere they
probably would like to remove or move

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around to a different
position. And likewise, acne,

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97% of people have acne at
some point in their lives.

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So I think if things are common,

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that motivates the laser
industry to pursue that problem.

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Cellulite, another, I mean, these
are things that are very common.

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Skin looseness and the alternative
means skin tightening. Again,

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everybody has some loose
skin somewhere after age 50.

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So I think common things happen commonly,

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and that's the greatest motivator
for device industry to move toward

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solutions.

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And you know,

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I think aesthetic medicine is
such a mainstream concern of the

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public nowadays,

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that the companies really
put a big effort into market

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research,

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trying to understand what things
really bother people bother them enough

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that they want to get some treatment
for it, as well as, as you said,

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looking at what's most
common. And in that sense,

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I think they've gotten much more
on the job in recent decades

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compared to 30,

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40 years ago where it
was more happenstance.

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Whatever they thought they could
chase, they might try to do it.

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Now they're really drilling down
on what bothers most of us most

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often.

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No, that's right.

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And sometimes there are common problems
that you would think a device would work

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well for and in fact would work well for.

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But it hasn't been quite as successful
as you would predict. An example,

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there's a microwave device for
sweating underarm sweating.

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It works remarkably well when
my daughters had it done,

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and we've had patients who've lauded
as maybe the best thing they've done in

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their life, but yet the device, I don't,
I mean, it's been somewhat successful,

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but market research said like 30 million
Americans or 40 million Americans have

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excessive under arm sweating.

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But there's a very small percentage of
those patients who will pay money to have

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their sweating treated, even if it's
something that interferes their lifestyle.

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So oftentimes market research,
I think, although it's

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helpful and I'm always amazed when
I see some companies say, Well,

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we actually queried all these patients,

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and all of them said they would do
this or this if they had this problem.

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But I look at it and I say
no, I don't think they would.

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I think when people fill
out these questionnaires,

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I don't know who they're talking to.

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I think sometimes the
companies are too optimistic.

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And I'll use an example as my brother.
My brother has severe underarm sweating,

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and he would never do a microwave
laser procedure. He just,

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because he wouldn't want
to pay for it, you know,

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he's just not something he would
do. Although on a questionnaire,

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he'd probably say, "Oh,

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underarm sweating impacts my life."
And so the company would say, "Well,

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this would be a guy who would do it."
So there's a little disconnect, I think.

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And same thing with acne. Even
though all these people have acne,

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I'm a little bit concerned, you know,

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how many people would actually undergo
a somewhat painful procedure to treat

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their acne that wouldn't
be covered by insurance.

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So there's a lot of I think,

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and you don't necessarily
know until you do it.

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I think the companies aren't at fault
sometimes for pursuing these things

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because I'm not a businessman and I
might think this is great and it's fun to

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pursue these different projects
from a scientific perspective.

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But in the end, the procedures cost money

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and some procedures people are willing
to pay for and some they're not.

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And it's odd. You can't always predict
what those procedures are going to be.

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Yeah, I mean,

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there's some testing bias in asking
people in the abstract or even

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asking them if they're participating
for free in a clinical trial.

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And we see this all the time where
patients are very satisfied with the free

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treatment they got in a clinical
trial, but in real world application

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where they have to pay to come in the
office instead of get paid to come in the

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office, it's not quite as pleasing.

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Absolutely. Absolutely. Yeah. Yeah. So
sometimes the companies miss the mark,

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I think, and they, I
think are a little bit,

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probably not skeptical enough about the
number of people who walk in the door.

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I mean, tattoo removal's another issue
where we would've thought 25 years ago,

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we'd have lines of people coming in
for a tattoo removal, and in fact,

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we're better at tattoo removal
than we were 25 years ago.

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But we still have lots of patients
out there with tattoos. And frankly,

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a lot of people now since
tattoos are so acceptable,

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they don't necessarily want their tattoos
off like they might have 25 years ago.

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So some things changed, perceptions
changed to certain things too.

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And so these things that
people would say, "Well,

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so many millions of Americans have
tattoos." And the the problem is

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the acceptance of tattoos is in flux.
So maybe those denominators are large,

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but the number of people would
have or want their tattoo off,

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particularly with 8, 10, 20
treatments would be relatively small.

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Dr. Bass, Dr. Ross,

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you are both members of professional
societies and leaders in what they're

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doing.

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I'm wondering how do the
societies contribute to the
advancements of all these

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wonderful new treatments and really
understand where and how they work?

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Well, I think the societies,

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I think they establish
some balance in some,

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I think they ground, I think

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some of the procedures in
the sense that people are,

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I think looking at more peer
reviewed publications and studies.

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If you go to industry sponsored workshops,

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and I've participated in those, they're
always a little biased. You know,

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if you watch a Chevrolet commercial
for their Chevrolet truck,

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they're going to say the truck is the
best and it's better than the F-150 and

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the Ram and all that sort
of thing, which is fine.

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And if you go to those types
of events, you expect that.

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But the societies at
least are supposed to.

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And I think largely they're
pretty successfully doing
it better than we have in

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the past.

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Having sort of a
nonbiased venue to look at

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different procedures and
different technologies and
how they're evolving and how

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they might help people.

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And looking at also some negative
features of some technologies.

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So I think the societies provide that
type of venue for professionals and also

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they provide education in hopefully
a relatively unbiased fashion.

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00:13:34,090 --> 00:13:38,480
So I think the societies are helpful
for providers and in the long run that's

232
00:13:38,481 --> 00:13:42,560
helpful for the consumer
because those providers receive

233
00:13:43,520 --> 00:13:48,440
better education and better
skills and hopefully take that

234
00:13:48,441 --> 00:13:49,274
back to their clinic.

235
00:13:49,950 --> 00:13:54,520
I think that's exactly right. I
mean, when new technologies come out

236
00:13:56,020 --> 00:13:59,800
and so many new technologies
are coming out these days or,

237
00:13:59,890 --> 00:14:04,880
or improvements or iterations of
existing technologies that it's hard to

238
00:14:04,881 --> 00:14:05,714
keep up.

239
00:14:05,780 --> 00:14:10,720
And so the society give a forum to hear
about the totality of what's out there,

240
00:14:11,810 --> 00:14:16,160
to see some of the data
presented and to have a critical

241
00:14:16,161 --> 00:14:18,960
discussion amongst a
broad range of colleagues.

242
00:14:19,140 --> 00:14:23,720
And we've all been present
when there are really diverse,

243
00:14:23,721 --> 00:14:25,480
contentious points of view,

244
00:14:25,780 --> 00:14:29,960
and that's really constructive
in helping each provider

245
00:14:30,310 --> 00:14:35,080
stay up to date and make sure that
they're really delivering everything they

246
00:14:35,081 --> 00:14:37,400
can to do their best for the patient.

247
00:14:37,630 --> 00:14:41,040
Absolutely. I mean, sometimes we call
out our colleagues and say, you know,

248
00:14:41,041 --> 00:14:43,360
I think that's a bunch of booey, you know,

249
00:14:43,470 --> 00:14:45,320
what you just said doesn't make any sense.

250
00:14:45,321 --> 00:14:49,040
So we were just at a controversy
meeting in Santa Barbara a month ago,

251
00:14:49,041 --> 00:14:51,040
and there's always good banter.
It's friendly, friendly,

252
00:14:51,041 --> 00:14:55,280
but it's good because I think it helps
everybody to stay a little honest and

253
00:14:55,520 --> 00:14:56,353
critical.

254
00:14:56,630 --> 00:15:00,940
So what do you think are the main themes
going forward in terms of modern energy

255
00:15:00,941 --> 00:15:01,900
tissue interactions?

256
00:15:02,640 --> 00:15:03,473
You know,

257
00:15:03,830 --> 00:15:08,260
there's a continued role
for short pulse treatments.

258
00:15:08,261 --> 00:15:11,900
These are picosecond pulsed

259
00:15:12,730 --> 00:15:14,620
lasers or even shorter.

260
00:15:15,240 --> 00:15:18,980
And some of the effects that take
place with these lasers are not totally

261
00:15:19,320 --> 00:15:22,780
photothermal light being
converted into heat,

262
00:15:22,781 --> 00:15:26,620
but photo acoustic or even biostimulatory.

263
00:15:26,960 --> 00:15:31,180
And so I think we're going to
see more of that. And there's,

264
00:15:31,181 --> 00:15:36,140
even though we went to
pulse treatments to confine

265
00:15:36,360 --> 00:15:41,220
the thermal effect and
injury and not damage skin,

266
00:15:41,221 --> 00:15:46,140
there's been really a renaissance of bulk
heating treatments for skin remodeling

267
00:15:46,141 --> 00:15:50,820
on the body and face and for tightening
and lifting effects as well as for

268
00:15:50,821 --> 00:15:51,860
targeting fat.

269
00:15:54,310 --> 00:15:57,380
We will see continued refinement in

270
00:15:59,060 --> 00:16:01,740
pulse treatments,
selective photothermalisis,

271
00:16:02,340 --> 00:16:06,740
there are still refinements and
iterations coming along with hardware

272
00:16:06,770 --> 00:16:07,603
advances.

273
00:16:08,610 --> 00:16:09,301
Yeah, I agree.

274
00:16:09,301 --> 00:16:13,900
I think another thing that's going to
happen is we're going to see more a true

275
00:16:14,340 --> 00:16:16,740
robotic type of treatments
where the device, for example,

276
00:16:17,140 --> 00:16:21,460
might find a blood vessel on the face
and target that almost like a drone over

277
00:16:21,660 --> 00:16:26,100
the face. And you would have a tool
that would do your spectroscopy,

278
00:16:26,460 --> 00:16:28,260
which is a tool to find
maybe red or brown,

279
00:16:28,540 --> 00:16:29,900
and then it would target those spots.

280
00:16:30,180 --> 00:16:34,540
So you would have the advantage of
not even having to do the procedure.

281
00:16:34,820 --> 00:16:38,620
You could have a person turn on a
machine and it would find the spots.

282
00:16:38,940 --> 00:16:43,420
You could go through a conveyor belt like
a TSA like baggage going through TSA.

283
00:16:43,620 --> 00:16:47,100
You would have your body go through there
and it would find the spots and target

284
00:16:47,340 --> 00:16:51,380
the spots. You come out the other side
and red and brown spots, for example,

285
00:16:51,660 --> 00:16:53,620
or hair follicles might
be selectively targeted.

286
00:16:54,300 --> 00:16:58,260
And then you would come out the other
side and be done which would be a faster

287
00:16:58,580 --> 00:17:00,660
way to do it. So that
technology's evolving quickly.

288
00:17:01,220 --> 00:17:05,100
And some companies are already,
I think starting to look at that.

289
00:17:06,110 --> 00:17:10,620
So we're going to see a lot more
integration between diagnostics and

290
00:17:10,621 --> 00:17:14,140
therapeutics and the same
tools that, although, you know,

291
00:17:14,141 --> 00:17:16,740
it always amazes me how long things take.

292
00:17:16,741 --> 00:17:21,620
So when I was in the lab starting
in 1994 with optical diagnostics,

293
00:17:21,621 --> 00:17:23,780
there's a device called
confocal microscopy.

294
00:17:23,781 --> 00:17:26,460
And one of my colleagues
was working hard on that,

295
00:17:26,461 --> 00:17:30,020
and I would've thought 28 years later
we'd have that at the bedside. You know,

296
00:17:30,021 --> 00:17:32,820
I would take a little tool,
I would run it over the skin,

297
00:17:32,821 --> 00:17:35,660
but there are a lot of
complexities and challenges there.

298
00:17:35,661 --> 00:17:40,220
So although I think some of
these things are going to happen,

299
00:17:40,221 --> 00:17:41,660
maybe not as fast as we thought.

300
00:17:41,660 --> 00:17:45,220
One of my other colleagues was working
for a company called General Scanning,

301
00:17:45,560 --> 00:17:49,880
and they were looking at a way to target
blood vessels. We had had rabbit ears,

302
00:17:49,881 --> 00:17:51,680
they would find the rabbit
ear, find the vessel,

303
00:17:51,681 --> 00:17:55,720
and target the blood vessel in the
rabbit ear. But now, 28 years later,

304
00:17:55,890 --> 00:17:58,720
we still don't have a tool
that does that in real life.

305
00:17:59,090 --> 00:18:03,840
So things take a long time
and I would've said in 1994,

306
00:18:03,840 --> 00:18:06,760
we're going to see, well, we probably
throw away our punch biopsies.

307
00:18:06,761 --> 00:18:09,160
We don't need to be cutting people
to find out what's going on.

308
00:18:09,161 --> 00:18:10,160
But we're not there yet.

309
00:18:10,161 --> 00:18:13,720
So maybe it's going to take longer
than I think to get to the next step.

310
00:18:14,500 --> 00:18:19,080
But, you know, you raised that
issue of diagnostic modalities,

311
00:18:19,081 --> 00:18:24,000
either standing alone or mated
to search out the pathology

312
00:18:24,001 --> 00:18:26,680
for therapeutic intervention.

313
00:18:29,000 --> 00:18:32,440
There is this big push
to use optical devices,

314
00:18:33,520 --> 00:18:38,320
harnessing them to help evaluate skin
lesions, sort of an optical biopsy.

315
00:18:39,050 --> 00:18:43,960
So how do you think that's going to
play into the future of skin cancer

316
00:18:44,000 --> 00:18:46,880
diagnosis and treatment
over the next decade?

317
00:18:48,510 --> 00:18:52,840
I know you just said, you know, it
may not go there as fast as we think,

318
00:18:52,841 --> 00:18:56,440
and people have been looking at
these things for decades now. But,

319
00:18:56,700 --> 00:19:01,080
but on another level, I feel like
we may be at a watershed point.

320
00:19:01,720 --> 00:19:02,600
What do you think?

321
00:19:02,990 --> 00:19:06,440
Yeah, I mean, again, I would've said
earlier we'd be there, but you know,

322
00:19:06,441 --> 00:19:09,360
I think our training, for
example, in dermatology,

323
00:19:09,440 --> 00:19:12,240
we do a lot of dermatopathology
is a big part of our training,

324
00:19:12,600 --> 00:19:13,440
probably more than any other,

325
00:19:13,441 --> 00:19:18,000
especially we do a lot of pathology
and we look at slides and we do typical

326
00:19:18,790 --> 00:19:20,800
biopsies and that's how we're trained.

327
00:19:20,801 --> 00:19:25,320
So it would be transformative
to go through a training
program where your first

328
00:19:25,321 --> 00:19:27,080
day of residency, somebody
would say, "Well, look,

329
00:19:27,081 --> 00:19:31,320
we're going to have this bedside tool
where we just scan the scan and you look

330
00:19:31,321 --> 00:19:33,000
at it. And that's another tool we have.

331
00:19:33,001 --> 00:19:36,960
And maybe that patient doesn't need
a biopsy. That's just not happening.

332
00:19:36,961 --> 00:19:40,360
I don't know when that's going to
happen. You have a lot of challenges.

333
00:19:40,361 --> 00:19:43,480
Who's going to interpret
these optical biopsies?

334
00:19:43,970 --> 00:19:47,160
Do you send it to the pathologist?
The scan like ultrasound,

335
00:19:47,161 --> 00:19:50,520
You can do ultrasound, for
example, at the bedside for veins.

336
00:19:50,521 --> 00:19:53,080
A lot of people do that
when they treat leg veins.

337
00:19:53,081 --> 00:19:55,120
They don't send it to the
radiologist to look at.

338
00:19:55,121 --> 00:19:57,880
They just look at it themselves
and make a call right there.

339
00:19:57,881 --> 00:20:02,600
So who's going to be responsible for the
final interpretation of these types of

340
00:20:02,800 --> 00:20:06,040
scans? And who's going to
get reimbursed? I mean,

341
00:20:06,280 --> 00:20:10,480
reimbursement's a big issue if you're
taking the time to do a procedure,

342
00:20:10,790 --> 00:20:13,520
a diagnostic procedure, and
there's no reimbursement.

343
00:20:13,521 --> 00:20:18,400
That's been a big issue with
these non biopsy tools or

344
00:20:18,540 --> 00:20:20,040
nontraditional biopsy tools.

345
00:20:20,050 --> 00:20:24,280
So these are things that are happening
very slowly and it's hard to know how

346
00:20:24,281 --> 00:20:27,160
it's all going to kind
of cull out over the next

347
00:20:28,680 --> 00:20:31,560
10 or 15 years, but I think
it's going to be years many,

348
00:20:31,561 --> 00:20:36,000
many years before we replaced
our traditional biopsies.
And the other thing is,

349
00:20:36,001 --> 00:20:38,160
traditional biopsies
are the gold standard,

350
00:20:38,260 --> 00:20:42,120
and the other noninvasive biopsy
tools typically are helpful,

351
00:20:42,121 --> 00:20:45,800
but they don't provide the
same amount of detail or depth.

352
00:20:46,330 --> 00:20:49,000
So I think we have a long way to go.

353
00:20:49,710 --> 00:20:53,080
It's tantalizing because
you can see the potential,

354
00:20:53,081 --> 00:20:57,640
but you've very clearly pointed
out a lot of the obstacles as well.

355
00:20:58,100 --> 00:20:58,690
You know,

356
00:20:58,690 --> 00:21:03,240
devices are an important
modality in modern skincare,

357
00:21:03,241 --> 00:21:08,160
but there's also been explosive growth
in our understanding of the biology

358
00:21:08,850 --> 00:21:13,760
of communication among cells in
the skin and elsewhere in the body.

359
00:21:14,980 --> 00:21:19,600
And just like many medications
have been overtaken for

360
00:21:19,710 --> 00:21:24,600
conditions by biologicals
the same thing is

361
00:21:24,601 --> 00:21:26,560
really happening in skin.

362
00:21:27,330 --> 00:21:31,440
Do you think this will eclipse energy
options or will there be some kind of

363
00:21:32,010 --> 00:21:33,800
synergy between these options?

364
00:21:34,430 --> 00:21:38,400
Yeah, that's a great point. I mean, I'll
use psoriasis as an example. You know,

365
00:21:38,401 --> 00:21:39,920
we use an excimer laser,

366
00:21:39,921 --> 00:21:44,200
which is a ultraviolet laser for
psoriasis in vitiligo. At the same time,

367
00:21:44,201 --> 00:21:46,520
we have these great biological tools.

368
00:21:47,040 --> 00:21:51,000
One of the creams just got approved
for vitiligo recently with these new

369
00:21:51,400 --> 00:21:52,880
so-called jak inhibitors.

370
00:21:53,210 --> 00:21:57,760
So we kind of are having two
roads that we have this biological

371
00:21:57,761 --> 00:21:59,640
road and this energy based road.

372
00:21:59,641 --> 00:22:01,600
And I think there is some
synergy between the two.

373
00:22:02,150 --> 00:22:06,960
I think eventually for systemic
skin diseases like psoriasis

374
00:22:07,920 --> 00:22:10,120
the biological tools will win out. I mean,

375
00:22:10,121 --> 00:22:14,960
I say if I was building
UV lasers for the future,

376
00:22:15,200 --> 00:22:19,240
I would think you might be going the
way of the elevator operator. You know,

377
00:22:19,241 --> 00:22:20,800
I don't know if you'd
have great job security,

378
00:22:20,801 --> 00:22:22,240
because I think with the advances,

379
00:22:22,790 --> 00:22:27,480
like you pointed out about cell
to cell connections and cytokines

380
00:22:27,600 --> 00:22:32,040
and the better understanding of the
biology of these different diseases,

381
00:22:32,041 --> 00:22:36,560
that it could be that these types of
drugs are going to take over and devices

382
00:22:36,561 --> 00:22:40,560
would be displaced completely.
Other things, so like blood vessels,

383
00:22:40,561 --> 00:22:42,440
broken blood vessels, brown lesions,

384
00:22:43,080 --> 00:22:47,000
I don't think that's going to be an area
where these types of biological tools

385
00:22:47,001 --> 00:22:47,960
are going to be as helpful.

386
00:22:48,810 --> 00:22:51,160
On the more technical side
of things, I'm curious,

387
00:22:51,630 --> 00:22:56,560
what engineering details
could manufacturers develop
to make devices more user

388
00:22:56,720 --> 00:22:57,450
friendly?

389
00:22:57,450 --> 00:22:57,450
Devices,

390
00:22:57,450 --> 00:23:02,160
I think that's a tough question because
there's a lot of simultaneous things

391
00:23:02,161 --> 00:23:04,520
going on. We say user
friendly for the provider.

392
00:23:05,680 --> 00:23:09,200
I think it's going to be
cooler, quieter, smaller lasers,

393
00:23:10,000 --> 00:23:14,920
more application driven menus where the
provider has more input from the device.

394
00:23:14,921 --> 00:23:18,440
The device interrogates the skin, maybe
provides some input to the provider.

395
00:23:18,930 --> 00:23:20,480
As I was talking about before,

396
00:23:20,481 --> 00:23:23,560
navigation aids you have a
backup camera in your car.

397
00:23:24,440 --> 00:23:26,920
You could have tools to example,

398
00:23:26,921 --> 00:23:31,280
maybe measure the redness of the skin or
the pigment of the skin built into the

399
00:23:31,281 --> 00:23:33,520
system. From a consumer standpoint,

400
00:23:34,190 --> 00:23:38,880
I think all these device improvements
are going to make treatments more

401
00:23:38,881 --> 00:23:43,360
comfortable, safer, and faster.
And that's critical. I mean,

402
00:23:43,361 --> 00:23:48,360
one of the things that's improved
the lasers is I think the

403
00:23:48,800 --> 00:23:50,680
calibrations are tighter.
Everything's tighter.

404
00:23:50,850 --> 00:23:53,960
So I can remember 25 years ago,

405
00:23:53,961 --> 00:23:57,880
we had lasers where the energy would
vary from pulse to pulse by 10 or 20%.

406
00:23:57,881 --> 00:24:01,480
That's largely like 2 to 3% now.
So every pulse is kind of the same.

407
00:24:02,060 --> 00:24:04,480
And these are engineering
improvements and they're largely

408
00:24:06,390 --> 00:24:09,560
driven by more computer control,

409
00:24:10,070 --> 00:24:11,400
more efficient lasers.

410
00:24:11,401 --> 00:24:14,040
We have fiber lasers now that
are inherently more efficient.

411
00:24:14,041 --> 00:24:16,360
So you're going to see a lot of
progress on the engineering front,

412
00:24:16,520 --> 00:24:21,080
which will I think make lasers, like I
said, safer, faster, more comfortable.

413
00:24:21,910 --> 00:24:22,420
Next,

414
00:24:22,420 --> 00:24:25,880
I'm going to ask you to pull out your
crystal ball and make some predictions

415
00:24:25,881 --> 00:24:27,880
about the future. So, Dr. Ross,

416
00:24:28,240 --> 00:24:30,560
what would the realistic
treatment of the future look like?

417
00:24:31,160 --> 00:24:36,120
And do we have reasonable research
options to get there or is industry just

418
00:24:36,440 --> 00:24:39,640
likely to keep developing minor
variations for the next decade?

419
00:24:40,610 --> 00:24:42,820
I think minor variations are
going to drive most of it.

420
00:24:42,821 --> 00:24:45,740
I think the biggest advance might be in

421
00:24:47,620 --> 00:24:52,580
trying to use again tools to
interrogate the skin where you have

422
00:24:52,581 --> 00:24:56,340
a scanner, we go over the skin,
find different pathologies,

423
00:24:56,620 --> 00:25:00,780
and then target those pathologies
accordingly without the provider having to

424
00:25:01,260 --> 00:25:02,420
kind of target them themselves.

425
00:25:02,740 --> 00:25:06,700
So I think that's going to be the
biggest change. These true robotics.

426
00:25:07,020 --> 00:25:09,380
They already have it
with hair restoration.

427
00:25:09,381 --> 00:25:14,260
There's a device that actually finds
the hair follicle and kind of targets it

428
00:25:14,261 --> 00:25:17,260
and drives it out the little
biopsy, these little plugs.

429
00:25:17,261 --> 00:25:21,780
And so I think that's going
to also be seen in the skin

430
00:25:22,640 --> 00:25:25,380
rejuvenation kind of future.

431
00:25:26,420 --> 00:25:29,700
More feedback between
imaging and treatment.

432
00:25:29,701 --> 00:25:34,620
So I think that is going to be the future
or part of the future and that's more

433
00:25:34,621 --> 00:25:35,620
than an incremental change.

434
00:25:35,620 --> 00:25:39,580
But these are expensive changes
for companies to integrate and

435
00:25:40,610 --> 00:25:44,660
it's like this self-driving
car and there's always
going to be some resistance.

436
00:25:44,661 --> 00:25:47,500
But I think that's kind of where
the future might be with lasers,

437
00:25:47,501 --> 00:25:52,140
that you would just press a button and
voila everything happens and I might be

438
00:25:52,141 --> 00:25:56,500
out of business. I don't think I'll
be alive to see that final change,

439
00:25:56,501 --> 00:26:00,220
which is probably good , because
then I'd have to be an Uber driver.

440
00:26:00,221 --> 00:26:02,500
Well, we won't have Uber drivers
because everything will be self-driving,

441
00:26:02,600 --> 00:26:04,900
but that's sort of the future I think.

442
00:26:04,900 --> 00:26:08,260
Well, Dr. Ross, it has been a
pleasure having you on here.

443
00:26:08,261 --> 00:26:11,420
Thank you for coming on and sharing
your insight and expertise with us.

444
00:26:11,560 --> 00:26:14,860
And thank you to all of our listeners
for joining us today to hear about the

445
00:26:14,861 --> 00:26:18,180
future of high technology devices
like lasers and aesthetic medicine.

446
00:26:18,180 --> 00:26:20,730
You're welcome. I enjoyed the opportunity.

447
00:26:20,950 --> 00:26:25,650
And I'll add my thank you to Dr.
Ross for joining us today and sharing

448
00:26:25,651 --> 00:26:26,690
his expertise.

449
00:26:26,691 --> 00:26:31,610
It's really been wonderful hearing
your viewpoints on what's happening in

450
00:26:31,611 --> 00:26:33,170
this fascinating industry.

451
00:26:33,690 --> 00:26:37,290
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

452
00:26:37,580 --> 00:26:40,330
If you enjoyed this episode, be
sure to share it with your friends.

453
00:26:40,331 --> 00:26:43,400
Follow us on Apple Podcasts
and Spotify and leave a review.

454
00:26:43,401 --> 00:26:44,400
We'll see you next time.

455
00:26:45,280 --> 00:26:49,520
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

456
00:26:49,521 --> 00:26:54,160
Class podcast with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

457
00:26:54,960 --> 00:26:56,800
educator, and technology innovator.

458
00:26:56,900 --> 00:26:59,560
The commentary in this
podcast represents opinion.

459
00:26:59,561 --> 00:27:02,320
This podcast does not
present medical advice,

460
00:27:02,460 --> 00:27:06,640
but rather general information about
plastic surgery that does not necessarily

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relate to the specific conditions
of any individual patient.

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No doctor patient relationship
is established by listening
to or participating

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00:27:14,881 --> 00:27:15,714
in this podcast.

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Consult your physician to advise you
about your individual healthcare.

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please share it with your friends and
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