History 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 co-host Doreen Wu,

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and I'm here with Dr.
Lawrence Bass Park Avenue,

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plastic surgeon educator
and technology innovator.

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Today we are talking with Dr. Vic Ross
about the history of laser devices and an

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overview of laser tissue interaction.

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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.

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He's really been a leader
in the arena of laser

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and energy based medicine,

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conducting a lot of research
on these technologies.

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He completed the laser fellowship
at the Wellman Labs in Massachusetts

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General Hospital.

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He's been a past president of the
American Society for Laser Medicine And

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Surgery and has served on the board
of directors of the American Society

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of Dermatologic Surgery.

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He has also won two of the most
prestigious awards from the

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American Society for Laser Medicine
and Surgery for his career long

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contributions in this field.

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So I'm very happy that he's
able to join us today to discuss

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what's happening in laser medicine.

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Awesome. So let's jump right in and
start with some history. Dr. Ross,

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what do you see as the key
historical points of laser devices?

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I think the key historical
point was Rox Anderson,

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who's sort of the founder of a lot of
what we do today and my personal mentor.

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His

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quest to truly try to
treat target selectively.

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So, and that goes back to 1979.

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So if you look at the
mid 1970s and before,

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lasers were used sort of as a tool,

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but there was no design of a laser to
treat something specifically on the skin.

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In other words,

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people took devices that were already
made and tried to fit them for an

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application like taking a shoe
that's too big or a shoe that's too

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small, as you try to
put the foot in there.

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So Rox Anderson came up
with the theory that, look,

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what if we designed a laser
to try to target, for example,

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red birth marks, which is
really how all of this started.

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And so that goes back to 1979. I
have a copy of a letter he wrote,

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and it was returned to him about
how we could design, for example,

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a light source from an engineer's and
a physician's perspective to treat

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red things selectively. And that
really goes back again like 43 years.

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And what insights or eureka
moments, so to speak,

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occurred that produced these advances?

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Yeah, I mean, I think that the
real eureka moment was, again,

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going back to Dr. Anderson because
he knew that based on physics,

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you could target say blood vessels
or pigmented lesions selectively.

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And instead of just trying to target
everything with a laser and heating it

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up, which is really what
was done in the 1970s,

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people tried to just heat
things up in general,

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almost like napalm in the forest. They
just went in and took out everything.

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And the only thing that guided you was
your hand guiding the laser like a pin to

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the right target. But what if you could
have a laser that was a large spot,

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like the size of a quarter,

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which you're only treating something like
a hair follicle or a blood vessel or a

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small pigment lesion
within that large spot.

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That would be something
that'd be very novel.

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And he really was the one who came
up with that theory that would work.

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And it was called selective
photothermal. In other words,

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rather than having everything
get hot on the skin,

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it was extreme localized heating. So
this way only the bad guy is targeted,

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which would be whatever that
lesion might be on the skin,

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A broken blood vessel,

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so like a broken blood vessel on
the nose or a port wine stain,

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which is a red birth mark
in kids or say a brown

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spot on the skin and just had that
heated and spare the good guy,

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which is the background skin.

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So that was really the eureka moment that
Dr. Anderson probably had in the late

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seventies,

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and that was transformed into real
technology in the early eighties.

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And, you know, then from there,

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there was this increasing investigation,

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both on a theoretical or
mathematical modeling basis and on an

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empirical or testing basis,

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but experimental testing
at the university,

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looking at a very broad
range of laser parameters to

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try to decide what devices we
might want to try to build.

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And this was done with
free electron lasers.

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So these are huge research devices, again,

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at a university that are
made to a linear accelerator,

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but they allow a wide range
of laser parameters so you

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can test what you're theoretically
projecting might work,

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and then you have to translate that
into a clinical laser that can sit in a

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doctor's office and
treat real live patients.

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So that was kind of a
decade of investigation that

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followed some of the early
introduction of these devices.

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But, you know, these are
all short pulsed treatments.

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So this transition in the eighties and
early nineties was to doing short pulse

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treatments with lasers and
things have evolved from there,

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which will get into in a bit.

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Yeah, that's exactly right.

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And Rox Anderson and
Fernanda Sakamoto used a free

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electron laser roughly
about 10 to 12 years ago,

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and we were able to determine certain
wavelengths that were otherwise would be

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unavailable. And that was very helpful
to try to find new targets, for example,

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like fat or sebum, which has allowed us
to start to look at acne, for example,

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as another application for lasers.

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Now shifting the focus to
what these devices can do,

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you mentioned the sebum and the acne.

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What are the main aesthetic applications
where devices are the primary modality?

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Yeah, I think that the
number one application,

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and it's something I would
tell people all the time,

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is if I look at my 32 patients,

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I'm gonna see today probably
15 of those patients,

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we're gonna target red and
brown spots on the skin.

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So if you look at just sheer
numbers broken blood vessels,

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redness of the face, and pigment lesions,

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like the one I have on my cheek here
these are the types of things that we see

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mostly. And those are two applications
where devices I think are the primary

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go to tool.

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Which wouldn't have been true necessarily
40 or 50 years ago. For example,

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you might've used a chemical peel over
the entire face in the 1970s and for

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vessels you would've taken electric
tool and traced out the vessels.

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And looking back in time,
chemical peels still have a role,

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but using electric needle to treat
blood vessels and particularly diffuse

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redness, it really would be a little bit
kind of flintstone ish Now to do that.

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You wouldn't think that anybody
would try something that that old.

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So we made great advances and those
are actually two applications where

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I think devices are
clearly on a report card,

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we get an A and other technologies
might get a C or less.

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And I think there's a huge
impact to those kind of visible

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features in terms of how clear
our skin looks, how young we look.

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People always think about
loose skin and wrinkles,

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but really red and brown pigment has

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a huge impact on appearance
and cleaning that up has

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a huge improvement to appearance.

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Yeah, that's right. I mean,
a lot of people, I had a
patient yesterday who says,

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"I don't want laser.

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I think I need plastic surgery now." But
she had a fundamental misunderstanding

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of really what the
difference was between the

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things she wanted treated. I think her
main problem was she had thought, well,

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plastic surgery was a permanent
solution to facial texture issues.

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And I said, Well, they're
synergistic. They're complimentary,

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the surgery would do
contouring and changing

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the foundation of the house, so to
speak. But for the paint of the house,

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you need something
that's more superficial,

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whether that's a peeling laser or
laser that treats red and brown.

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So I think a lot of people, there's
kind of a misunderstanding that that,

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that you can use surgery for certain
things and, and lasers for certain things,

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but sometimes they're the same thing, and
oftentimes they're not the same thing.

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And they're indeed complimentary.

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And I think that's something
that people need to understand.

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So it's not one or the other.

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Oftentimes it's something like
breakfast and lunch and dinner,

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you want all three and it's not
always gonna work out with one tool.

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Yeah. And to follow that analogy
a little further, you know,

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when you have dinner, you,
you want your protein,

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your starch and your vegetable and eating,

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just a lot of one of them doesn't give
you a satisfying a meal as if you have a

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little bit of all three.

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That's a really great comparison.

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So it sounds like these devices can
have a lot of benefits and achieve many

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different goals. Now, can you break
it down for the average layperson,

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what are the main types of
devices for each application?

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Okay, yeah. We'll start with redness.
For example, redness, the initial laser,

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Rox Anderson came up with 40 years
ago was called a pulsed dye laser.

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And it's still available. You
can still buy a pulsed dye laser.

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So that's the number
one laser for redness,

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although there are a lot of other
competitors. Now. We also have a,

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a 5 32 nano laser called
an LBO laser or KTP

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laser,

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which is really a frequency double
neodymium-YAG laser that puts out green

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light. The pulsed laser
puts out yellow light,

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and there's another device
called intense pulse light,

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which a lot of people hear about. It's
called IPL. So a lot of people say, "Oh,

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I want an IPL," or "I have an
IPL." And that's the device. Again,

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it can target red and brown spots.

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So this is all based really
on green and yellow light or

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combinations thereof
treating red and brown spots.

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But that's just sort of the way
those devices work. So that's,

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that's an idea of three types of
devices that are used for redness,

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and to some degree, brown spots.

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And then there are other devices, for
example, hair removal, hair removals,

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probably the most popular laser procedure
that is done in the United States.

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They probably more laser hair reduction
procedures will be done any other single

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type of procedure. And there are
lots of lasers available for that.

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The first laser really was well the
first device was really IPL for hair

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removal,

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and then people went into the
ruby laser and then Alexandrite

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lasers, diode lasers and
neodymium-YAG lasers.

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There's a whole host of lasers
for laser hair reduction.

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And they all work pretty well.

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Different devices work better
for darker skin and lighter skin,

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but overall the concept is the same.

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You're selectively targeting the
hair follicle and sparing the

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normal skin.

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And typically these devices all are
equipped with a cooling technology that

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cools the surface. And that's another
revolution over the last 20 years.

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We used to just use ice in the late
eighties and mid eighties and ice is okay,

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but ice is very unpredictable because it
depends on how long you put the ice on

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the skin all sorts of other nuances
where these integrated cooling devices

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very specific and controlled
and work better. I think.

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Based on our discussion so far,

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the general sense I'm getting is that
some things are lasers and some are other

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types of devices.

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Can you talk a little about
the significance of laser
versus non laser energy

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based devices?

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Yeah, I mean, there's a lot of
devices outside of lasers or light.

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One of those is ultrasound, for example.
There's a device that uses ultrasound,

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a few devices now that use ultrasound,

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which penetrates somewhat
deeper to tighten the skin.

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It's more of a skin
tightening type of technology.

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And there are a whole host of non laser
devices that use energy such as radio

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frequency devices. And these devices
heat the skin in one way or another,

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again, achieved some sort of tightening.

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So there's a whole host
of non laser devices,

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which have really become more
popular in the last 10 to 15 years.

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And they're well equipped
to do certain things.

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They don't do a great job for the most
part of treating pigment and red spots

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on the surface of the skin.

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These technologies typically go a little
bit deeper and the idea is to heat the

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skin,

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generally speaking from inside out and
they can do reasonably good things for

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skin tighten. This whole concept of
skin tightening came up years ago,

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but they're not gonna
replace surgery in general.

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And I think there's a number
of devices that try to

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follow the same strategies.

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A lot of what we've been talking about
are really devices that function in a

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photothermal fashion

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by having light or energy
introduced into the skin and then

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being converted to heat.

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And it's the heat that creates the
therapeutic effect that we're trying

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to achieve.

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There are other kinds of laser devices
that work somewhat differently and,

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and in some cases non laser devices.

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But that's the basic focus of
how we're accomplishing things

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with these technologies.

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One of our main goals on this podcast
is to empower listeners and provide them

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with the knowledge and tools as
they embark on their beauty journey.

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We are really just trying to help our
listeners think about how to make their

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own beauty plan. With that being said,

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can you elaborate on what the role of
device treatments is in this beauty plan?

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00:14:01,240 --> 00:14:05,260
And I'll just jump in here because in
some ways that's not a totally fair

235
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question because it's really going to
differ to some extent by age or where you

236
00:14:10,461 --> 00:14:13,540
are in the aging process. You know,

237
00:14:13,541 --> 00:14:18,420
younger folks are maybe trying to
perfect their skin, clear up acne,

238
00:14:18,421 --> 00:14:19,460
things like that.

239
00:14:20,220 --> 00:14:23,660
There are folks that are
starting to see aging changes,

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00:14:23,661 --> 00:14:26,180
folks who are well into middle age,

241
00:14:26,240 --> 00:14:29,740
and then folks who are really
in a postsurgical age group

242
00:14:31,320 --> 00:14:35,700
but still want to look their
best. And so it might be fruitful.

243
00:14:35,701 --> 00:14:40,300
Dr. Ross, if you could to sort of break
it down into those groups briefly.

244
00:14:40,300 --> 00:14:43,540
No, that's great. Yeah. The
younger people will come in,

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00:14:43,541 --> 00:14:48,060
if we just start people maybe 25 to
40, the most common thing we see with,

246
00:14:48,061 --> 00:14:50,660
with that group of people
is pigment problems.

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00:14:50,661 --> 00:14:53,560
The first pigment problems
typically melasma, for example,

248
00:14:53,561 --> 00:14:56,160
where women get this sort
of mask of pregnancy,

249
00:14:56,161 --> 00:14:57,840
which certainly you can
have without being pregnant.

250
00:14:58,520 --> 00:14:59,800
The other thing is acne scarring.

251
00:14:59,801 --> 00:15:02,000
So in that group we see a lot
of acne scarring. Those are,

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00:15:02,001 --> 00:15:05,600
those are two common applications
in that young age group.

253
00:15:05,601 --> 00:15:10,480
And generally speaking devices
can play a role in those types of

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00:15:11,510 --> 00:15:14,560
concerns. Generally speaking
with melasma for example,

255
00:15:14,561 --> 00:15:16,080
you're trying to gently peel the skin.

256
00:15:16,081 --> 00:15:20,440
Oftentimes we use complementary creams
to brighten the skin, acne scarring.

257
00:15:20,690 --> 00:15:24,880
We oftentimes use what we call fractional
lasers to try to break up the acne

258
00:15:24,881 --> 00:15:28,280
scars. These are lasers that create
little microscopic dots on the skin,

259
00:15:28,281 --> 00:15:30,560
little wounds and that can be popular.

260
00:15:31,600 --> 00:15:35,000
So those are the two main
devices we use for young people.

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00:15:35,460 --> 00:15:40,360
And as we move into the group
of 40 to 60 we see a lot

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00:15:40,361 --> 00:15:43,040
more sun damage because there's
more time to accumulate sun damage.

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00:15:43,041 --> 00:15:47,600
And then we typically are treating
again, still red and brown, dyschromnia.

264
00:15:47,800 --> 00:15:50,360
That's probably the most common thing
we see here in Southern California.

265
00:15:51,600 --> 00:15:53,880
Yesterday I had a beach volleyball player.

266
00:15:53,881 --> 00:15:58,120
She's 37 and she's been playing
that sport for a long time.

267
00:15:58,121 --> 00:16:00,840
And so her body's in great shape,

268
00:16:00,841 --> 00:16:04,880
but her skins just had a lot of sun damage
even trying to do her best to prevent

269
00:16:04,881 --> 00:16:06,560
it. And so that's a patient,

270
00:16:06,561 --> 00:16:11,400
you take the red and brown
lesions and try to improve that by

271
00:16:11,401 --> 00:16:13,800
brighten the skin with
different lasers or IPL.

272
00:16:14,880 --> 00:16:17,800
And oftentimes those patients may
need a little bit of filler and a

273
00:16:17,801 --> 00:16:20,240
neuromodulator like Botox to assist.

274
00:16:20,250 --> 00:16:23,960
So oftentimes it's a combination of
things we do in that group of patients.

275
00:16:24,240 --> 00:16:27,680
Those patients do get wrinkles
occasionally, especially above the lip.

276
00:16:28,120 --> 00:16:32,120
Usually in that group we
might do a resurfacing laser
to peel some of the skin.

277
00:16:33,000 --> 00:16:38,000
So those are the sort of
typical devices we use for

278
00:16:38,001 --> 00:16:38,834
that day.

279
00:16:39,540 --> 00:16:42,240
And you know, when I
think of the older folks,

280
00:16:43,760 --> 00:16:48,720
certainly wrinkles and pigment
changes and redness are

281
00:16:49,810 --> 00:16:51,360
central problems,

282
00:16:51,900 --> 00:16:54,840
but skin laxity becomes a big issue.

283
00:16:55,500 --> 00:17:00,480
And I often have people in their
seventies walk into my office and

284
00:17:00,590 --> 00:17:05,520
they might have had a facelift at some
time in the past or maybe never had

285
00:17:05,521 --> 00:17:08,680
a face or neck lift, but
they don't want surgery.

286
00:17:08,870 --> 00:17:12,600
They might not be healthy enough
for surgery at this point in time,

287
00:17:13,260 --> 00:17:17,440
and they'd really like to do something
energy based to just take away all the

288
00:17:17,441 --> 00:17:19,160
loose skin.

289
00:17:19,860 --> 00:17:24,800
And I always have a concern in
that group because noninvasive

290
00:17:25,270 --> 00:17:30,240
skin smoothing and skin tightening
with energy based devices

291
00:17:30,290 --> 00:17:34,400
is really pushing the skin
and asking the skin to respond

292
00:17:35,290 --> 00:17:40,240
in surgery, I go in and I tailor
out a couple of inches of skin and I

293
00:17:40,241 --> 00:17:44,400
reposition the skin and I know it's going
to be sitting in a different position.

294
00:17:45,440 --> 00:17:47,920
I know I'm going to get
some degree of improvement,

295
00:17:47,921 --> 00:17:52,680
but I'm concerned when I see
the older patient come in

296
00:17:53,310 --> 00:17:58,280
asking for a lot of skin
laxity to be tailored out

297
00:17:58,281 --> 00:18:03,240
with devices because I feel like their
skin may have retired by now and I can

298
00:18:03,241 --> 00:18:07,240
push the skin, but it may not respond.
What are your thoughts on that?

299
00:18:07,350 --> 00:18:09,120
Yeah, that's something I see every day.

300
00:18:09,320 --> 00:18:12,240
So I see a lot of patients every
day who have had a facelift.

301
00:18:13,470 --> 00:18:16,720
A lot of these patients are
70 to 75, sometimes younger,

302
00:18:16,960 --> 00:18:20,960
but they had a facelift when they were
55 or 65 or sometimes even younger.

303
00:18:21,320 --> 00:18:25,200
And they don't want surgery. They have
a lot of loose skin on their neck.

304
00:18:25,480 --> 00:18:26,680
They have jowling,

305
00:18:27,560 --> 00:18:31,320
the lower face is descended a bit and
they want to do something nonsurgical.

306
00:18:31,760 --> 00:18:34,640
And that's a tough task. I
always tell people, again,

307
00:18:34,840 --> 00:18:36,160
going back to the report card analogy,

308
00:18:36,600 --> 00:18:39,680
when you give out grades for
nonsurgical skin tightening,

309
00:18:39,681 --> 00:18:43,920
I say the best devices might get a c plus
and it's not a failure of the device,

310
00:18:44,160 --> 00:18:48,680
to be honest. And there are a whole
host of devices, greater than 50 or so,

311
00:18:49,560 --> 00:18:53,040
skin tightening devices that
use various sources of energy,

312
00:18:53,480 --> 00:18:56,560
light ultrasound, radio
frequency, electrical energy,

313
00:18:57,320 --> 00:19:01,440
and they don't suffer from lack
of the design of the engineers.

314
00:19:02,280 --> 00:19:03,600
It's the skin's response.

315
00:19:04,640 --> 00:19:09,320
To ask a device to tighten
the skin for somebody who's

316
00:19:10,000 --> 00:19:13,480
75 who has very loose
skin it's asking too much.

317
00:19:14,200 --> 00:19:18,120
So I tell those patients that if
I'd seen you when you were 50,

318
00:19:18,480 --> 00:19:20,440
maybe these devices would
work reasonably well,

319
00:19:21,200 --> 00:19:25,040
but now that you're 75 we might have
missed a window, but on the other hand,

320
00:19:25,400 --> 00:19:28,800
we'll give it a try if you're willing
to accept very modest improvement.

321
00:19:29,000 --> 00:19:31,080
So that's the critical, I think,

322
00:19:31,840 --> 00:19:36,120
issue is that if somebody's willing
to accept modest improvement and the

323
00:19:36,480 --> 00:19:38,040
procedure is sort of sold as that,

324
00:19:38,760 --> 00:19:42,560
then I think it's reasonable in some
cases to provide that sort of service.

325
00:19:43,020 --> 00:19:47,400
But to expect somebody to have
an energy based intervention

326
00:19:48,130 --> 00:19:52,800
to reposition a scan, as Dr. Bass
said, is asking too much. It's just,

327
00:19:53,230 --> 00:19:57,680
it's like a tablecloth is too big
for the table. At a certain point,

328
00:19:57,681 --> 00:20:02,240
you have to just kind of lop off the
excess tablecloth and these devices can't

329
00:20:02,241 --> 00:20:02,561
do that.

330
00:20:02,561 --> 00:20:07,160
So if I can take the skin and really take
a big swath of it and take it between

331
00:20:07,161 --> 00:20:12,160
my thumb and fore finger and you can't
ask the device to tighten the skin

332
00:20:12,161 --> 00:20:12,994
up that much.

333
00:20:13,270 --> 00:20:16,560
Most of our discussion up until
now has centered around the face.

334
00:20:16,670 --> 00:20:19,040
What about the body? Is
that still all surgical?

335
00:20:20,100 --> 00:20:23,950
Yeah, so body contouring and of course
a lot of things you can do off the face,

336
00:20:23,951 --> 00:20:25,390
right? Red and brown spots. So any

337
00:20:28,110 --> 00:20:30,350
application that we use on the face,

338
00:20:30,370 --> 00:20:33,710
for example brown spots on the hands,

339
00:20:34,610 --> 00:20:38,150
leg veins, all that is
fair game for lasers.

340
00:20:38,151 --> 00:20:39,550
And just like you would use on the face,

341
00:20:39,551 --> 00:20:43,630
you might use various lasers to target
specifically red or brown spots.

342
00:20:43,631 --> 00:20:46,030
We do a lot of that. We have
a lot of people, for example,

343
00:20:46,031 --> 00:20:49,520
the whole arm is kind of littered
with freckles and lentigines,

344
00:20:49,521 --> 00:20:50,760
which are these brown spots.

345
00:20:51,140 --> 00:20:54,720
And we'll use something like an intense
pulse light device that can cover

346
00:20:54,721 --> 00:20:56,680
relatively large areas relatively quickly.

347
00:20:57,320 --> 00:21:02,240
Again taking advantage of that
selective photothermal to treat only the

348
00:21:02,241 --> 00:21:06,760
bad guy and in those brown spots will
peel off oftentimes within a month or so.

349
00:21:06,760 --> 00:21:10,600
So that's helpful. Little angiomas,
little cherry spots that people get,

350
00:21:10,601 --> 00:21:14,720
we can treat those fairly
easily. Body contouring is,

351
00:21:14,721 --> 00:21:19,680
is the other kind of part of energy
based devices and that's more

352
00:21:19,920 --> 00:21:20,880
challenging. So in other words,

353
00:21:20,881 --> 00:21:25,320
rather than surgery like a
tummy tuck or liposuction

354
00:21:26,530 --> 00:21:31,040
do these devices have a role in
contouring the body? And they do,

355
00:21:31,041 --> 00:21:31,601
but again,

356
00:21:31,601 --> 00:21:36,320
the improvement's gonna be more modest
than it would be with a more invasive

357
00:21:37,520 --> 00:21:38,960
procedure. So for example,

358
00:21:39,390 --> 00:21:44,320
cool sculpting where we use cold
to try to reshape the abdomen or

359
00:21:44,321 --> 00:21:49,200
love handles is not going to be as
predictably effective as some sort

360
00:21:49,201 --> 00:21:52,320
of liposuction procedure. So,

361
00:21:52,321 --> 00:21:56,120
so there are different concessions you
make when you move into noninvasive

362
00:21:56,121 --> 00:21:59,760
procedures, whether they're
on the body or the face.

363
00:22:00,380 --> 00:22:02,400
And if you take that into account,

364
00:22:02,401 --> 00:22:07,280
you can get some modest skin tightening
and some improvement in the contour.

365
00:22:07,570 --> 00:22:10,920
There's some things we don't do a
good job of that are common problems.

366
00:22:10,921 --> 00:22:14,480
A lot of women come in and they say
their stomach is loose. In other words,

367
00:22:14,481 --> 00:22:18,880
it's not that they're overweight,
they're working out every day,

368
00:22:18,881 --> 00:22:22,280
but they've had children and
they have loose skin, men too.

369
00:22:23,080 --> 00:22:24,360
The little wrinkles over the knees.

370
00:22:24,361 --> 00:22:27,520
A lot of women and men are unhappy
with their wrinkles over their knees.

371
00:22:27,600 --> 00:22:30,360
They go work out and they see themselves
in the mirror and they see these little

372
00:22:30,361 --> 00:22:33,120
venetian blind lines
running across their knee.

373
00:22:33,460 --> 00:22:36,640
And that's another thing I don't
think we have a great way to treat.

374
00:22:36,650 --> 00:22:41,400
So we can do some very simple
procedures off the face.

375
00:22:42,700 --> 00:22:45,800
But a lot of them don't work very
well. Cellulite, another frontier.

376
00:22:45,801 --> 00:22:47,960
People have tried lots
of things for cellulite.

377
00:22:48,080 --> 00:22:51,840
There's probably 20 or 30 different
devices that have been used for cellulite,

378
00:22:51,841 --> 00:22:53,920
including a new injectable product.

379
00:22:53,921 --> 00:22:57,400
All of which can work okay
for selected patients,

380
00:22:57,401 --> 00:23:01,600
but we're not really gonna get an A or
B on our report card yet for those types

381
00:23:01,601 --> 00:23:02,720
of applications.

382
00:23:03,390 --> 00:23:07,080
Yeah, I've actually written about
this in a number of book chapters.

383
00:23:07,750 --> 00:23:12,320
Body skin smoothing, just to
put it in a general category,

384
00:23:12,810 --> 00:23:17,200
is an immensely challenging problem
because the areas are very large

385
00:23:17,760 --> 00:23:21,320
compared to face and neck. There's
a lot of weight on those areas,

386
00:23:22,260 --> 00:23:27,120
and there are other factors besides
what's happening in the skin itself that

387
00:23:27,121 --> 00:23:29,680
feed into the appearance deficit,

388
00:23:29,860 --> 00:23:32,440
the thing we're trying to fix up.

389
00:23:33,050 --> 00:23:37,960
So it's something we can
make modest progress with,

390
00:23:37,961 --> 00:23:38,561
but it's,

391
00:23:38,561 --> 00:23:43,400
it is a frustrating area that in some
ways is an unsolved problem in aesthetic

392
00:23:43,720 --> 00:23:44,110
medicine.

393
00:23:44,110 --> 00:23:47,200
Absolutely. Absolutely. It's a
common problem and like you said,

394
00:23:47,200 --> 00:23:50,560
it's very complex and the areas are large.

395
00:23:51,010 --> 00:23:54,680
So if somebody says they want their whole
thigh to be tighter or they're behind

396
00:23:54,681 --> 00:23:55,514
to be tighter, it's

397
00:23:57,280 --> 00:24:02,200
a big task and the areas are large
and the procedures would take a long

398
00:24:02,201 --> 00:24:04,120
time. And even when you
do those procedures,

399
00:24:04,270 --> 00:24:07,280
oftentimes they work only a little bit.

400
00:24:07,330 --> 00:24:12,120
So we have a long way to go if we're
gonna try to do something non-surgical or

401
00:24:12,360 --> 00:24:12,801
surgical, I mean,

402
00:24:12,801 --> 00:24:16,520
I see people who get thigh lifts and
butt lifts and then the scars look bad,

403
00:24:16,521 --> 00:24:19,800
and so they, kind of have to wear a
lot of clothes to cover the scars,

404
00:24:19,801 --> 00:24:23,360
and I don't know if that defeats the
purpose to some degree, the procedure. So

405
00:24:25,370 --> 00:24:29,360
we just have a lot of opportunities
to get better for some of these pretty

406
00:24:29,361 --> 00:24:30,520
common presentations.

407
00:24:31,170 --> 00:24:33,880
We usually focus on beauty and aesthetics,

408
00:24:33,881 --> 00:24:37,480
But can you tell us a little about
how devices have impacted medical

409
00:24:37,481 --> 00:24:40,440
applications for skin in
both adults and children?

410
00:24:40,510 --> 00:24:42,040
Yeah, that's a great question.

411
00:24:42,041 --> 00:24:45,760
We do a lot of what I call
medical laser dermatology.

412
00:24:46,400 --> 00:24:48,080
It's kind of a noble thing,

413
00:24:48,081 --> 00:24:51,280
maybe more noble in some ways than
some of the more pure cosmetic things.

414
00:24:51,281 --> 00:24:56,200
And a lot of that involves pigmented
birthmarks and red birthmarks

415
00:24:56,201 --> 00:24:58,280
in kids, that can be a port wine stain,

416
00:24:58,920 --> 00:25:01,640
that can be what we call nevus of ota,

417
00:25:01,641 --> 00:25:05,520
where some patients get this brownish
discoloration or gray discoloration of

418
00:25:05,521 --> 00:25:07,360
their skin. We have lots
of opportunities there.

419
00:25:07,620 --> 00:25:11,560
And then that's an area where lasers
work quite well and there is no other

420
00:25:11,780 --> 00:25:15,640
intervention that's reasonable
to use. So that's very helpful.

421
00:25:16,600 --> 00:25:21,000
We have lasers that work
reasonably well for, like I said,

422
00:25:21,001 --> 00:25:24,400
for acne scarring for rosacea,

423
00:25:24,401 --> 00:25:27,360
which is a common thing
that we use lasers for,

424
00:25:27,361 --> 00:25:31,800
where people get sort of
redness and acneform like bumps,

425
00:25:31,801 --> 00:25:35,520
pustules, pimples, that
can be very helpful.

426
00:25:35,520 --> 00:25:40,320
Poikiloderma, which is this red dyschromia
that people get kind of cosmetic,

427
00:25:40,321 --> 00:25:43,600
but it's also from the sun
and genetics, and that's very,

428
00:25:43,601 --> 00:25:44,920
very well treated by laser.

429
00:25:44,921 --> 00:25:49,160
So we have a lot of medical
things and the list can go on.

430
00:25:49,161 --> 00:25:51,440
We treat lupus lesions
sometimes with laser,

431
00:25:51,441 --> 00:25:55,520
which are sometimes red or brown,

432
00:25:55,600 --> 00:25:57,400
there's a host of things. If it's red,

433
00:25:57,401 --> 00:26:01,560
we generally have a laser that
we use a red laser for, you know,

434
00:26:01,561 --> 00:26:04,680
a laser that puts out yellow green
light. But it's a laser that's designed,

435
00:26:04,681 --> 00:26:07,160
you treat red things,
so anything that's red,

436
00:26:07,161 --> 00:26:09,760
even psoriasis we can treat with laser.

437
00:26:09,970 --> 00:26:14,880
So there are a lot of non purely
cosmetic conditions that we can

438
00:26:14,881 --> 00:26:15,720
use lasers for.

439
00:26:16,160 --> 00:26:19,680
Thank you so much Dr. Ross for taking
the time to share your insight and

440
00:26:19,681 --> 00:26:20,560
expertise with us.

441
00:26:20,561 --> 00:26:23,960
And thank you to our listeners for joining
us today to hear about the history of

442
00:26:23,961 --> 00:26:27,200
high technology devices like
lasers in aesthetic medicine.

443
00:26:27,780 --> 00:26:29,760
And I'll add my thank yous,

444
00:26:29,761 --> 00:26:32,960
Dr. Ross for joining us this morning.

445
00:26:33,590 --> 00:26:38,400
It's tremendous to have your
great wealth of expertise and

446
00:26:38,590 --> 00:26:42,920
your ability to explain this in
such a clear way for people to

447
00:26:43,080 --> 00:26:43,640
understand.

448
00:26:43,640 --> 00:26:46,920
Well, you're welcome. I'm glad to
be here. Appreciate the opportunity.

449
00:26:47,160 --> 00:26:50,760
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

450
00:26:51,050 --> 00:26:53,880
If you enjoyed this episode, be
sure to share it with your friends.

451
00:26:53,881 --> 00:26:56,880
Follow us on Apple Podcast or
Spotify and leave a review.

452
00:26:57,040 --> 00:26:58,160
We'll see you next time.

453
00:26:58,720 --> 00:27:03,120
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

454
00:27:03,121 --> 00:27:07,800
Class podcast with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

455
00:27:08,600 --> 00:27:10,480
educator, and technology innovator.

456
00:27:10,620 --> 00:27:13,280
The commentary in this
podcast represents opinion.

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This podcast does not
present medical advice,

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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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in this podcast.

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Consult your physician to advise you
about your individual healthcare.

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If you enjoyed this episode,

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please share it with your friends and
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